Background. We investigated clinicopathologic features of esophageal small cell carcinoma

Background: This study was designed to examine the efficacy and compliance of S-1 for the patients with peritoneal metastasis of gastric cancer. Methods: Sixteen consecutive patients with peritoneal metastasis of gastric cancer were treated with S-1. Their survival was compared with that of the historical control group (25 patients). Thymidylate synthase, dihydropyrimidine dehydrogenase, thymidine phosphorylase and orotate phosphoribosyl transferase mRNA expression in the tumor were evaluated. Results: The median survival time of S-1-treated patients was 550 days, which was significantly longer than that of the historical control group (215 days). We elucidated some factors to prolong the survival of the patients treated with S-1 for peritoneal metastasis: peritoneal metastasis without other distant metastases, the combination of S-1 treatment and gastrectomy, and low expression of thymidine phosphorylase mRNA in primary tumors. Conclusions: S-1 showed a surprisingly long-term survival with minimum toxicity in patients with peritoneal metastasis of gastric cancer.

A Killian-Jamieson (K-J) diverticulum is an uncommon hypopharyngeal diverticulum related to the betterrecognized Zenker's diverticulum. Cervical cellulitis due to K-J diverticulitis is also highly exceptional. We report the case of a 53-year-old woman with cervical cellulitis caused by K-J diverticulitis. The cellulitis was cured by the administration of an antibiotic agent. The patient underwent a resection of the K-J diverticulum 2 months after the cellulitis was cured. The cervical diverticulum was judged to be a K-J diverticulum because the diverticulum prolapsed laterally just below the cricopharyngeus muscle on the esophagogram. The left recurrent laryngeal nerve adhered to the proximity of the orifi ce of the diverticulum. The recurrent laryngeal nerve was carefully preserved before the resection of the diverticulum. Accurate differential diagnosis between K-J and Zenker's diverticula is necessary before surgery to preserve the recurrent laryngeal nerve.

We herein report a case of gastric small cell carcinoma (GSCC), which was successfully treated by surgery and postoperative chemotherapy consisting of cisplatin (CDDP) and the fluoropyrimidine S-1. The patient was a 63-year-old man in whom a gastric tumor had been endoscopically detected. The type 1 tumor was located in the gastric body. An abdominal computed tomogram showed many metastasized nodes around the stomach. A total gastrectomy with regional node dissection was performed. The removed tumor was histologically and histochemically diagnosed to be a GSCC with node metastases. Furthermore, washing peritoneal cytology histologically revealed the presence of carcinoma cells. Metastasis was histologically observed in 17 of 24 dissected nodes. After surgery, CDDP was intravenously administered and S-1 was orally administered for 1 year. Consequently, the patient is now well without any recurrence 45 months after surgery. We reviewed 52 Japanese patients with GSCC/endocrine cell carcinoma (EC) reported between 2001 and 2005 with reference to chemotherapy. Chemotherapy using S-1 was performed for 11 of the 52 patients. Four of the 11 patients, including the present case, who were treated with S-1 survived for over 2 years after surgery, although the GSCC/EC of the four patients were staged as III or IV. Therefore, chemotherapy consisting of CDDP and S-1 may provide a survival benefit for patients with GSCC/EC.

Background and Aims: The roles of the virD4 and the cagG genes in the cag pathogenicity island of Helicobacter pylori for gastroduodenal pathogenesis are unclear and their roles in vivo have not been examined. Methods: Seven week old male Mongolian gerbils were inoculated with the wild type H pylori TN2GF4, its isogenic virD4, or cagG mutants. Animals were sacrificed at 4, 12, and 24 weeks after inoculation. Gastric inflammation and H pylori density were evaluated by histology, inflammatory response (as measured by interleukin (IL)-1b mRNA levels), proliferative activity (as assessed by 59-bromo29deoxyuridine labelling indices), and host systemic reaction (as measured by anti-H pylori IgG antibody). Results: Degree of gastric inflammation, proliferative activity, and mucosal IL-1b mRNA levels remained low throughout the first 12 weeks in gerbils infected with the virD4 mutants. Degree of gastric inflammation and proliferative activity increased at 24 weeks with the virD4 mutants reaching levels comparative with those seen at four weeks with the wild-type strains. Mucosal IL-1b mRNA levels were also increased at 24 weeks with the virD4 mutants and levels at 24 weeks were similar between the wild-type and virD4 mutants. In contrast, gerbils infected with the cagG mutants had reduced ability to colonise gerbils, and no or little gastric inflammation or proliferative activity was observed. Conclusions: Loss of the virD4 gene temporally retarded but did not abrogate gastric inflammation. Loss of the cagG gene abolished gastric inflammation partially via reduced ability to colonise gerbils. Unknown factors related to the type IV secretion system other than CagA may influence gastric inflammation.