Background: The frequency of gastric tube cancershas increased with advances in surgical techniques and improvement of survival rates in patients with esophageal cancer. However, a standard surgical treatment has not yet been established. Total resection of the gastric tube with lymphadenectomy has been considered a radical treatment, while repeat surgery with both laparotomy and thoracotomy has been associated with severe complications, including anastomotic leakage, recurrent nerve paralysis, bronchotracheal injury, and damage to other organs.Case presentation: We present a successful case of a gastric tube cancer that was treated with surgical resection in combination with sentinel node biopsy. The tumor was diagnosed as a type 0-IIc lesion with ulceration, and was located proximal to the pyloric ring. Endoscopic submucosal dissection was not indicated because the primary lesion was submucosally invasive, and undifferentiated. By the dye-guided method, sentinel nodes were detected along the right gastroepiploic artery and vein. Intraoperative pathological examination revealed no metastasis of the sentinel nodes. Resection of the distal gastric tube was safely performed with a Roux-en-Y reconstruction, preserving the right gastroepiploic artery and vein and the perfusion of the proximal gastric tube.Conclusion: We suggest distal resection of the gastric tube with sentinel node biopsy as a novel surgical method for a cT1N0 gastric tube cancer located in the abdomen.

The purpose of the current study was to investigate the concurrent validity of the stages of exercise behavior change based on body composition by using dual energy x-ray absorptiometry (DXA). Numerous studies have investigated the validity of the stages of exercise behavior change. However, the evidence available regarding the validity of these stages based on body composition is inadequate. DXA can reliably estimate the body composition, and its use is minimally stressful for most individuals. Participants were 193 female Japanese university students in various stages of change regarding exercise; their body compositions were estimated. The participants classified as being in the action and maintenance stages exhibited the lowest percent body fat and the highest bone-free lean mass, as measured by DXA. These results offer additional partially support for the validity of the stages of exercise behavior change based on body composition by using DXA.

BACKGROUND:Measured physical activity and percent body fat obtained by bioelectrical impedance analysis have been used as indicators of cardiorespiratory fitness in middle-aged women and children. However, the relationship between subcutaneous fat thickness in various regions of the thigh determined by ultrasonography and cardiorespiratory fitness has not been previously reported.METHODS:We measured subcutaneous fat thickness in the frontal, lateral, and medial regions of both thighs using ultrasonography, and also determined peak VO2 and percent body fat in 13 healthy and generally well female college students.RESULTS:There were significant negative correlations found between peak VO2 and the 3 frontal portions of the thigh, as well as the vastus lateralis (both sides), while correlations were not seen with the right and left medial regions 15 cm above the medial epicondyle.CONCLUSIONS:Our results suggest that increases in peak VO2 are reflected by decreases in subcutaneous fat thickness in the frontal and lateral regions of the thigh, but not in decreases in that in both sides of the medial region of the thigh. In addition, subcutaneous fat thickness may indicate partial or segmental activation of the frontal and lateral regions of the legs, such as that obtained by cycling. We concluded that measurement of subcutaneous fat thickness in the region above the muscle mass of the thigh such as the rectus femoris or lateral vastus using ultrasonography may reasonably represent physical activity. Further study is needed to be done with larger groups of subjects and to evaluate the effects of training on activation of regions of the thigh.

A 66-year-old male with chronic hepatitis C was treated with interferon therapy and achieved a sustained viral response. Two years and two months later, a liver tumor was detected in liver segment 8. Upon closer ex-amination, the tumor was found to be atypical for hepatocellular carcinoma, we therefore performed a hepatic resection of S8. Both histopathologically and immunohistochemically, the tumor was diagnosed to be cholangiocellular carcinoma. Hepatocellular carcinoma after the elimination of HCV-RNA due to interferon therapy has sometimes been reported, but cholangiocellular carcinoma is rare. Previous findings suggest that the hepatitis C virus affects the carcinogenesis of cholangiocellular carcinoma, and therefore both close and long term obser-vations are required for patients who have achieved a sustained viral response of the hepatitis C virus.

1247 Maintaining balance is important to prevent falling with advancing age. However, the effect of balance pad exercise in frail elderly population is not well known. PURPOSE: To determine the effect of a 10 weeks of balance pad exercise on reducing falling risks in geriatric health services facility residents. METHODS: This study was an exercise intervention trial with participants assigned either to an exercise group or to a control group. Participants were four male and twenty female volunteers aged 76–95 years, living dependently in long-term care facility. Four male and twelve female performed balance pad exercise for 45 minute, 3 days a week, for 10 weeks. The exercise included single leg standing, walking on a balance pad, strength, locomotion/agility, and motor processing. Outcome variables included functional reach, one leg balance with eyes open, semi-tandem, timed up & go, stepping, 10 m walking time, Tinetti balance scale, falls efficacy scale, geriatric depression scale, daily steps, exercise energy expenditure, total daily energy expenditure and body balance obtained by stabilometer. RESULTS: The percentage of attendance in an exercise group was 94.2 ± 6.8%. No subjects became ill or had any injury related to the exercise program. At the beginning of the study, both exercise and control groups performed similarly in all tests. After the 10-wk training program, the exercise group showed significantly greater functional reach, semi-tandem, timed up & go, stepping and Tinetti balance subscale (p<0.05–0.001). In contrast, there were no significant improvements in any of the test measures in the control group. CONCLUSION: These findings suggest that 10 weeks of a balance pad exercise adopted in this study may improve balance, lower limb muscle function and locomotion/agility, thereby attenuating falling risks in frail elderly individuals.

0441 Near-infrared spectroscopy (NIRS) is a noninvasive method of measuring muscle oxygenation. Several studies have examined relationship between the kinetics of local muscle oxygenation and systemic oxygen intake during incremental and constant work-rate exercise. However, none has reported about muscle oxygenation during prolonged exercise. PURPOSE: To examine the relationship between the kinetics of local muscle oxygenation and systemic oxygen intake during prolonged exercise below anaerobic threshold. METHODS: Ten healthy males completed an orientation trial, a maximal exercise test, and a 30-min submaximal exercise bout. During the exercise test, expiratory gas analysis was performed using an expiratory gas analyzer, and the kinetics of vastus lateralis muscle were determined by NIRS. RESULTS: Oxygenated hemoglobin, deoxygenated hemoglobin, and total hemoglobin decreased immediately after the onset of exercise and gradually increased from 5 to 30 min with an increase in VO2. The increase in deoxygenated hemoglobin may indicate that oxygen transported by arterial blood during exercise test is taken up by the vastus lateralis muscle for contraction, and oxygenated hemoglobin changes into deoxygenated hemoglobin. On the other hand, the increase in both oxygenated hemoglobin and total hemoglobin, an index of muscle blood volume, may represent a redistribution of blood to the exercising muscles. There was a positive correlation between oxygenated hemoglobin and VO2 (r = 0.38, p < 0.01), between deoxygenated hemoglobin and VO2 (r = 0.46, p < 0.01), and between total hemoglobin and VO2 (r = 0.52, p < 0.01) after the 5th min of prolonged exercise. CONCLUSIONS: These results indicate that the increase in VO2 during prolonged exercise is attributed to the increase in both O2 dissociation (deoxygenated hemoglobin) and blood flow (total hemoglobin, total hemoglobin) in the capillary bed of the muscles to meet aerobic energy demand.

Near-infrared spectroscopy (NIRS) is a noninvasine method of measuring muscle oxygenation. The purpose of this study was to examine the relationship between muscle oxygenation and lactate accumulation during prolonged a 60-min steady-state exercise below AT. Tenth healthy subjects (3 males and 7 female) completed an orientation trial a maximal exercise test, and a 60-min submaximal exercise bout. Muscle oxygenation was recorded continuously throughout the test using a NIRS probe located on the vastus lateralis muscle. At 30 min after exercise, calibration was performed by cuff occlusion at 260mmHg for 10 min. VO2, VCO2, VE, respiratory exchange ratio (RER), lactate (La) were measured at rest and during exercise. Muscle oxygenation decreased immediately after the onset of exercise, with a maximal decrease (−22.9 ± 12%) at 5 min, and returned gradually close to pre-exercise levels by 60min. From 5 to 60 min, muscle oxygenation significantly increased with significant changes in VO2. It appeared that the gradual increase over time in muscle oxygenation indicated an increase in muscle blood volume. From 10 to 60 min, La and RER significantly decreased with a significant increase in muscle oxygenation. These results suggested that energy demand was met almost entirely by aerobic metabllism. There was a significant negative correlation between Δ La (60–10) and Δ muscle oxygenation (60–10) (R = 0.75, P < 0.05). Based on the present results, a slight decrease in La during prolonged light- moderate exercise may be induced by increasing muscle oxygenation (muscle blood volume) in working muscles.

Background. Tumors of the so-called intrathyroidal epithelial thymoma type are a rare group of thyroid neoplasm tumors. Of this type of tumor, spindle epithelial tumor with thymuslike differentiation (SETTLE) has been reported only 17 times in English literature.Methods. An 18-year-old woman was initially seen with a 6-cm left thyroid mass that was resected with a left thyroidectomy. Histopathologic features of the excised left thyroid tumor together with an immunohistochemistry and electron microscopy led us to a diagnosis of SETTLE.Results. Most of the specimen was composed of highly cellular spindle cells that formed intersecting and streaming fascicles. The spindle cells showed both vimentin immunoreactivity and cytokeratin immunoreactivity but no immunoreactivity for thyroglobulin or calcitonin. Electron microscopic examination of the spindle cells demonstrated prominent cytoplasmic tonofilaments, desmosomes, and basal lamina consistent with epithelial cell origin. DNA content analysis by flow cytometry revealed DNA diploidy.Conclusions. SETTLE of thyroid gland is an extremely rare entity. A review of the literature reveals that SETTLE has distinctive morphologic features and an immunohistochemical profile. (C) 2002 Wiley Periodicals, Inc.