Reported in this paper are two cases of peptic ulcer which developed in the gastric tube used for esophageal replacement following esophagectomy for esophageal tumors in adults. The results of our cases suggest that acid secretion from the mucosa of the gastric tube, in spite of truncal vagotomy and the state of the tube, seems to play important roles in the pathogenesis of peptic ulcer of the gastric tube after esophageal replacement, even though circulatory disturbances, due to postoperative irradiation and gastric tube formation, have been suspected as the cause. Therefore, in those cases of gastric tube stasis, surgical drainage of the gastric tube should be performed.
In a series of 378 patients with esophageal carcinoma, 43 patients with head and neck carcinoma were divided into two groups: 30 patients without symptoms whose esophageal or head and neck second primary carcinomas were incidentally detected by an endoscopic examination for the second carcinoma (group 1) and 13 patients with symptoms whose esophageal or head and neck second primary carcinomas were detected by routine examinations (group 2). Regarding the second primary carcinomas, the incidence of stage 0-I and curability were significantly higher in group 1 than in group 2 (p < 0.001 and p < 0.05 respectively). The 5-year overall survival rates of patients with the second primary carcinomas were significantly higher in group 1 (60.4%) than in group 2 (0%) (p < 0.01). We suggest that a routine endoscopic screening of the upper aerodigestive tract in patients with esophageal carcinoma or head and neck carcinoma contributes to the improvement of the prognosis and the patient's quality of life.
The fine structural alteration in the gastric nerve fibers containing gastrin-releasing peptide (GRP) was studied in relation to the dynamics of gastrin-producing cells (G-cells) after truncal vagotomy in a rat model. The circulating gastrin levels were markedly elevated from the 1st day after vagotomy and the number of G-cells with positive immunoreaction for G17 and G34(1-15) was significantly increased in the vagotomized group. On the 3rd day after vagotomy, the G-cells showed conspicuous ultrastructural changes characterized by hypertrophy of the Golgi complexes and increased numbers of secretory granules. The GRP-positive nerve fibers formed a fine network in the gastric wall and were densely distributed in the oxyntic mucosa close to the blood vessels and showing varicosities composed of either small clear or GRP-positive large vesicles containing an electron-dense core. In the oxyntic mucosa of the vagotomized rats, axonal swelling of the nerves occurred on the 3rd day, and a depletion of GRP immunoreactivity was evidenced by a markedly decreased number of large-cored vesicles on the 7th day, when the serum GRP levels were also found to be markedly elevated. These findings indicate that the alteration in gastric nerve fibers containing GRP after truncal vagotomy may be related to hypergastrinemia and antral G-cell hyperplasia in the rat gastric mucosa.
We examined the immunohistochemical expression of proliferating-cell nuclear antigen (PCNA) and p53 proteins in dysplasia and intramucosal carcinoma of the esophagus. Immunohistochemistry was performed with monoclonal antibodies directed against PCNA and p53. We used surgically resected specimens from 29 patients who had a total of 55 lesions of severe dysplasia (n = 16), intraepithelial carcinoma (n = 21), and mucosal carcinoma (n = 18). The mean PCNA index with immunoreactivity for p53 was 48.9 +/- 6.5 in areas of severe dysplasia (n = 7), 58.2 +/- 7.3 in areas of intraepithelial carcinoma (n = 10), and 71.4 +/- 9.3 in the invasive areas of mucosal carcinoma (n = 10). The mean PCNA index without immunoreactivity for p53 was 41.2 +/- 5.5 in areas of severe dysplasia (n = 9), 48.0 +/- 7.4 in areas of intraepithelial carcinoma (n = 11), and 63.7 +/- 9.1 in invasive areas of mucosal carcinoma (n = 8). The PCNA indices of the areas of severe dysplasia with immunoreactivity for p53 were significantly lower than those of intraepithelial carcinoma and mucosal carcinoma with immunoreactivity for p53. Similarly, the PCNA indices of severe dysplasia without immunoreactivity for p53 were significantly lower than those of intraepithelial carcinoma and mucosal carcinoma without immunoreactivity for p53. These results thus suggest that severe dysplasia has a lower proliferative potential than carcinoma and may therefore represent a precancerous lesion.
Gastrin‐producing cells (G cells) were studied in the rat antral mucosa after truncal vagotomy. Significant elevation of circulating gastrin levels was observed from 12 hours after the operation and this was sustained throughout the entire experimental period. Upon light microscopic observation, G cells showing positive immunostaining for G17 were significantly increased in number at 2 days, 1, 2 and 3 weeks after the operation and were a more prominent cell type than G cells containing positive reaction product for G34 throughout the entire experimental period. Ultrastructural changes occurred predominantly in G cells, which showed hypertrophy of Golgi complexes and noticeable increases in the amounts of rough endoplasmic reticulum between 2 days and 3 months after the operation. During these periods, secretory granules apparently increased in number and displayed various degrees of electron density. Immature, highly electron‐dense granules appearing in or near the Golgi stacks mainly showed localization of immuno‐gold particles for G34, whereas mature granules with low electron‐density predominantly demonstrated a positive reaction product for G17. The Golgi apparatus and rough endoplasmic reticulum were free of any immunoreaction for either G34 or G17. ACTA PATHOL JPN 38: 841 ‐852, 1988.
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