Abstract:Background. The frequency of tumors in the upper one-third of the stomach has been increasing. The standard operation for proximal gastric cancer has been total or proximal gastrectomy. The aim of this study was to present the pathologic and surgical results of 30 patients with early-stage proximal gastric cancer managed by proximal gastrectomy. Methods. A consecutive series of 30 patients who underwent proximal gastrectomy for early-stage proximal gastric cancer was studied. Sixteen patients underwent jejunal interposition, while 14 underwent gastric tube reconstruction, which consisted of a direct anastomosis between the esophagus and the remnant of the tube-like stomach. Results. Twenty patients (67%) had no abdominal symptoms and the lesions were detected by screening gastric fiberscopy. The tumors were mostly located along the lesser curvature (73%), were grossly depressed type (IIc) (70%), and histologically well differentiated type (63%). The depth of wall invasion was the mucosa in 12 patients, submucosa in 15, and muscularis propria in 3; lymph node metastasis was absent in 28 patients (93%). When compared with patients with jejunal interposition, patients with gastric tube reconstruction had a shorter operation time (327 vs 165 min), less blood loss (508 vs 151 g), and shorter hospital stay after operation (31 vs 17 days). Endoscopy and 24-h pH monitoring showed no evidence of reflux esophagitis, except in 1 patient with gastric tube reconstruction, and no patient died of recurrence. Conclusions. Early-stage proximal gastric cancer can be successfully treated by proximal gastrectomy. Since gastric tube reconstruction is a simple, easy, and safe procedure, proximal gastrectomy followed by gastric tube reconstruction is recommended for patients with early-stage proximal gastric cancer. Offprint requests to: Y. Adachi

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Bile leakage after hepatic resection often results in the formation of a biliary-cutaneous fistula. Such a fistula, when caused by an isolated bile duct in the remnant liver, can be intractable. We report a successful case of ethanol injection therapy of an isolated bile duct. A 73-year-old man underwent right hepatic resection for hepatocellular carcinoma. Bile leakage occurred after surgery, and the patient developed a biliary-cutaneous fistula. Fistulography revealed an isolated bile duct in the remnant portion of the caudate lobe without communication to the main biliary system. As conservative management with simple drainage was ineffective, injection therapy with ethanol was performed with a balloon occlusion catheter. After 11 therapy sessions, the bile duct was eradicated, and the biliary- cutaneous fistula was completely healed. The post-treatment course was uneventful. Ethanol injection therapy can be a choice for management of patients with a biliary fistula caused by an isolated bile duct.

Human breast cancer MCF‐7 cells containing estrogen receptor are killed by transforming growth factor‐beta (TGF‐β). We isolated variants of MCF‐7 highly resistant to TGF‐β. Variants ES‐1 and ES‐4 were cloned, and the growth of ES‐1 and ES‐4 was found to be inhibited by estradiol, whereas estradiol stimulated the growth of the parental MCF‐7 cells. ES‐1 cells contained about 2‐fold higher level of estradiol receptor than MCF‐7 cells. Addition of estradiol to the culture medium for MCF‐7 and the variant changed the expression of several secreted proteins. The repertoire of secreted proteins was markedly altered in the variant. Polypeptides of molecular weight 52,000 (52 K), 65 K and 160 K were increased about 10‐ to 50‐fold in both estradiol‐treated MCF‐7 and ES‐1 cells. Polypeptide of 130 K was decreased in estradiol‐treated ES‐1 cells while this polypeptide was increased about 4‐fold in estradiol‐treated MCF‐7, as compared with untreated MCF‐7. Polypeptide of 100 K was specifically secreted in ES‐1 whether or not estradiol was present, but there appeared to be no significant amount of the 100 K protein in MCF‐7. The estradiol‐hypersensitive phenotype is discussed in relation to its aberrant expression of secreting proteins.

Whereas TES is useful for patients with small rectal carcinoid tumor of typical histology within the submucosal layer in the upper and middle rectum, TAR is effective for accessing the lower rectum.