Clinicopathological Aspects of Gastric Carcinoma in the Remnant Stomach

The clinicopathological differences between remnant gastric carcinoma (RGC) after partial gastrectomy for benign disease (RGC-BD) and RGC after partial gastrectomy for gastric carcinoma (RGC-GC) were evaluated. The incidences of developing gastric carcinomas in patients more than 10 years after partial gastrectomy for benign disease or for gastric carcinoma were compared with those of developing gastric carcinomas in patients with colorectal carcinoma who were determined to have no malignant disease in the stomach preoperatively. Next, we analyzed the clinicopathological differences among RGC-BD, RGC-GC and primary gastric carcinoma (PGC) in the upper third of the stomach. RGC-BD was detected in 8 of 1,187 (0.7%) patients and RGC-GC was detected in 19 of 764 (2.5%) patients. Among the controls, 7 of 226 (3.1%) patients developed gastric carcinoma. The estimated risk of developing of RGC-BD and RGC-GC were 0.12 and 0.798. No difference was found among 18 patients with RGC-BD, 16 patients with RGC-GC and 229 patients with PGC in terms of patient age, histologic type, tumor size and distribution of tumor stage. The 5-year survival rate for patients with PGC (55%) was not different from that for patients with RGC-BD (43%) or that for patients with RGC-GC (65%). However, the interval between initial operation and detection of RGCs was longer in RGC-BD than in RGC-GC (P = 0.004), and RGCs were more frequently detected at the site of anastomosis in patients with RGC-BD (50%) than in patients with RGC-GC (19%, P= 0.057). The incidence of developing RGCs after partial gastrectomy for benign and malignant diseases was low. The histologic type of tumors and tumor stages of RGC-GC were not different from those of RGC-BD; however, RGC-GC developed within a short time and most lesions were at sites remote from the anastomosis. These findings indicate that carcinogenesis of RGC-GC appears to be different from that of RGC-BD

Guided Discussion and Activities in English for Future Health Professionals: Relationships between Nursing and Community Design

Recent interest in community design has become evident in medical circles. Relationships between a community’s design, its function, and citizens’ health are an increasing concern for people who care about the quality of human life. Among these people, an influential group is health professionals. They can play a great part in how a community can be constructed or (re)designed to afford better living conditions in society. To develop a sense of the importance of involvement in community planning and clarify the health needs of citizens, and to rethink ideas about responsibilities of health professionals, medical education should provide classes, seminars, lectures and activities to give students chances to explore possibilities of direct involvement for creating a healthy community. At the Tottori University Faculty of Medicine, a seminar was held for 3rd-year nursing students and faculty members on community development and design as related to health. The main lecturer explained how trends in various diseases and increases in obesity in the United States are directly related to how communities are designed. Although the lecture was in English, translation into Japanese was provided with a question-and-answer period at the end. In preparation for the lecture, students were given two questions on the relationship between nursing and community design. As this lecture occurred at the end of the year, further study could not be done. This paper presents ideas for giving future health professionals opportunities to explore a new direction. Class activities are outlined with an emphasis on English language teaching and learning techniques

Plasma Leptin Level, the Adipocyte-Specific Product of the Obese Gene, Is Associated with Tumor Progression and Is a Marker of the Nutritional Status of Patients with Gastric Cancer

Leptin, a product of the obese gene, is synthesized and released into the circulation in response to increased energy storage in adipose tissue. Leptin plays an important role in the regulation of body weight and energy balance. However, leptin levels in patients with malignant tumor have not been fully examined. The purpose of the present study is to clarify the clinical implications of leptin levels in the circulation in patients with gastric cancer. The subjects were 103 patients with gastric cancer at various stages. Levels of leptin in the plasma were determined with a commercially available human leptin-selective quantitative enzyme immunoassay kit. There were clear decreasing trends in leptin levels along with tumor progression in both males and females, and statistically significant differences were observed in males between stages II and IV, and in females between stages I and IV. Plasma leptin levels of females were consistently higher than those of males when we compared them with patients in the same stages. Moreover, statistically significant decreases in leptin levels were observed postoperatively. However, there were no statistically significant relationships between leptin levels and clinicopathological findings. There was a positive correlation between levels of plasma leptin and values of the body mass index. These findings may indicate that plasma leptin levels do not involve factors relevant to specific tumor growth but involve some tumor-related nutritional status due to tumor progression. We conclude that leptin levels are reflected during tumor-bearing status, and these are also useful markers for both indicating tumor progression and discovering the nutritional status of patients with gastric cancer

Immunohistochemical Detection of Occult Serosal Microinvasion in Primary Lesions of Gastric Cancer with Subserosal Invasion

In gastric cancer, the presence or absence of serosal invasion by cancer in the primary lesion is an important prognostic factor. Pathological findings are routinely determined by hematoxylin-eosin (H&E) staining, but it is well known that micrometastasis or microinvasion are easily overlooked by H&E staining. Cytokeratin (CK) proteins serve as reliable markers for cells from epithelial origins. The purpose of this study was to clarify the usefulness of CK immunohistochemical staining in the detection of serosal microinvasion in gastric cancer with subserosal invasion. We examined 50 primary lesions from 50 gastric cancer patients with subserosal invasion. Two consecutive sections were prepared for simultaneous staining with ordinary H&E and CK immunostaining with anticytokeratin antibody (CAM 5.2), respectively. Although there were no differences in the postoperative survival rates between patients with or without microinvasion, serosal microinvasion was 0detected in 8 (16%) of 50 patients by CK staining, including 1 patient whose invasion was detected by both H&E and CK stainings. CK immunostaining enabled us to make an accurate and detailed diagnosis which we believe to be useful for detecting serosal microinvasion in the primary lesion in gastric cancer with subserosal invasion

Cytokeratin-Positive Cells in Lymph Nodes in Which Metastases Are Undetectable by Conventional Histological Staining in Advanced Gastric Cancer

Detection of occult metastases in lymph nodes by immunostaining is becoming of increasing interest as a way to improve the accuracy of predicting the prognosis for patients with gastric cancer. Immunohistochemical detection of cytokeratin (CK) is recognized as the most sensitive method for identification of cancerous epithelial cells. In this study, lymph nodes were stained for CK in an effort to detect micrometastases and the clinical implications of the results were examined. We immunostained sections from a total of 1,198 lymph nodes from 25 totally gastrectomized patients with T3 or T4 gastric cancer who had been diagnosed as having no nodal involvement by conventional hematoxylin-eosin (HE) staining. Eighty (6.7%) of 1,198 lymph nodes from 15 (60%) of the 25 patients were immunostained with a CK-specific monoclonal antibody. CK-positive cells were more frequent in patients with macroscopic types of 3,4 and 5 gastric cancer. Patients with nodes that were both HE-negative and CK-negative had the best postoperative survival, followed by patients with HE-negative and CK-positive nodes and, finally, by patiof micrometastases in lymph nodes is a reliable indicator of the prognosis of patients with advanced gastric cancer