We studied the cases operated on during the 16 years from the beginning of 1970 to the end of 1985 in our hospital. There were 100 patients older than 75 years (group A) and 150 from 65 to 74 years (group B). The following results were obtained. (1) Postoperative complications were found in 9% of group A and in 5.3% of group B. (2) Preoperative tests revealed anemia, nutritional disorder and respiratory disorder more frequently in group A than in group B. Reflecting these data, postoperative suture insufficiency and respiratory complications were more frequently found in group A than in group B. (3) Neither severe renal failure requiring hemodialysis nor severe liver cirrhosis was seen in group A, whereas the former was seen in 1.3% and the latter in 4.7% in group B. (4) The operative mortality was 3% in group A, whereas 4.7% in group B, so there was no significant difference of the mortality between 2 groups. The principal cause of this result came from the fact that neither severe renal failure nor severe liver cirrhosis was found in group A.
In 4% of group A, dementia was from before the operation. We discussed the operative indications for the older patients complicated by dementia.

View full abstract

Effect of nutritional treatment against inflammatory bowel diseases was examined.
1) We examined the effect of elemental diet against active Crohn's disease in 29 cases, and elemental diet seemed to be effective against active Crohn's disease.
2) Low residual diet was administered in 5 cases of Crohn's disease in remission, but recurrence could not be prevented in 2 cases.
3) We examined the effect of home elemental enteral hyperalimentation (HEEH) against 5 cases of Crohn's disease in remission and HEEH seemed to be useful for management of patients with Crohn's disease in remission.
4) We administered elemental diet in four cases of severe ulcerative colitis, but ED was not effective in all cases. Therefore, ED is not indicated for severe ulcerative colitis.

View full abstract

Endoscopic injection sclerotherapy (EIS) has become popular in the treatment of emergency cases of hematemesis. We report here the results of our study, mainly those of the emergency cases.
Of 75 patients subjected to EIS, emergency EIS (E-EIS) was performed on 23 cases in which EIS was done within 24 hours after the onset of bleeding. EIS was performed by intravenous injection of 5% ethanolamine oleate according to the procedure of Takase et al.
Of 23 cases subjected to E-EIS, successful hemostasis for more than one week was obtained in 22 cases (96%). Re-bleeding was seen in 5 cases (22%). No aggravation was seen just after the first E-EIS. Form factor (F) was highly improved in 63%. Location (L), F and red-color sign (RC sign) maintained the improved variceal conditions in 100%, 93%, and 85%, respectively. Eight patients died and death was not directly caused by bleeding from esophagel varices in any cases: the cause of death was hepatic insuffciency in 4 cases, hepatic insufficiency from hematemesis in 3 and intraperitoneal bleeding of hepatocellular carcinoma in one.
Thus, it is suggested that E-EIS is a very important method in treating the emergency cases of esophageal varices.

View full abstract

Between January 1971 and December 1986, 51 patients (29 male, 22 female) with esophageal varices underwent surgical intervention.
Twenty-one patients had liver cirrhosis, fourteen had idiopathic portal hypertension and five had extrahepatic portal obstruction.
As for surgical methods, esophageal transection including paraesophagogastric devascularization was applied in 25 patients, proximal gastrectomy in 4, splenectomy alone in 6 and so forth.
Results were assessed comparatively between patients undergoing emergent operation (emergency group) and those recieving elective or prophylactic operation (elective group). The preoperative condition in the emergency group was 9 cases of Child C and 7 of B, while only 1 case out of 35 was judged Child C in the elective group.
Follow-up results were evaluated by the 5-year survival rate: 74.3% in the elective group and 12.5% in the emergency group.
The postoperative course of esophageal varices was observed by means of barium meal and esophagoscopy. After esophageal transection 9 cases were rated as “disappearing”, 9 cases as “improved” and 1 case as “unchanged”. However, after ligation of varices without esophageal transection, or splenectomy alone many cases remained unchanged.
In conclusion, surgical treatment of esophageal varices should involve esophageal transection including paraesophagogastric devascularization. Furthermore, for better results it may be important that emergency operations should be avoided and elective operations should be replaced for these as much as possible.

View full abstract

Sixty samples of gastric juice collected from 50 patients with HBsAg positive sera wereexamined by the method of radioimmunoassay. Eight samples (13.3%) from 7 patients (14.0%) were found to be positive for HBsAg. All of these 7 patients were persistent carriers of HBsAg including those with asymptomatic carriers, chronic hepatitis, cirrhosis, and hepatocellular carcinoma. To evaluate the reliability of these results, several tests were performed and it was confirmed that the reaction was related to pH in the sample solutions.
The sensitivity of the reaction for HBsAg was maximum when pH in the sample solution reached to 7.0 and vice versa. These positive reactions were blocked by anti-HBs.

View full abstract

The general aspects on the chronological modification of colorectal cancer treatment at Osaka National Hospital have been reviewed with 783 cases during these 20 years from January 1965 to December 1984. In view of the statistical significance, the number of the cases in the latter decade increased 2.4 times as many as those reported in the former half and it should be emphasized that the operations were performed more successfully in all respects such as manipulation, etc. during the last ten years. On the other hand, with regard to frequency of the sigmoid and the colorectal cancer in the aged, there was no significant difference, and this result was against our expectation.
As to the perspective of coloproctology, the early detection is important for improvement of the postoperative results. Based on these observations described above, the following suggestions have been substantiated and well reflected on the good results of our own; 1) Demonstration and explanation of this disease for the potentially symptomatic patients with colorectal cancer. 2) Establishment of the medical check system for more careful and detailed examination for the outpatients. 3) Mass screening for the asymptomatic, apparently healthy persons.

View full abstract

In four cases of hepatolithiasis, we performed cholangiotomy, lithotomy, and bile drainage attachment (hepaticojejunostomy and choledochojejunostomy) from both proximal (porta hepatis) and distal sites by pincer operation and obtained excellent results.
A rapid increase in frequency of hepatectomy was found in recent cases out of 56 hepatolithiasis operations in our hospital. The reason was that the diagnosis of the disease became possible at younger ages prior to the onset of the disease by a progress of diagnostic instruments. In some cases however, the hepatectomy should be avoided because of stones in both lobes and poor reserve function of the liver. This implys difficulty of surgical treatments. Cholangiography, a main traditional intraoperative examination, dose not give informations of the duct distal to the occlusion site or sufficient image and cholangioscopy misses local sites beyond expected frequency. On the other hand, ultrasonography is a useful assistant tool for a complete removal of stones and an improvement of cholestasis and thus should become the base of the surgical treatment for hepatolithiasis.

View full abstract

We described our experience with a revascularized isolated jejunal segment for the immediate reconstruction of cervical esophagus.
The first patient was a 62-year-old man who was admitted with the chief complaint of dysphagia. Esophagograms revealed cervical esophageal cancer associated with laryngeal involvement.
The second patient was a 60-year-old woman with a previous history of disseminated breast cancer. She was admitted to our hospital suffering from severe dysphagia and weight loss. Esophagograms and CT-scan revealed marked constriction and displacement of the cervical esophagus at C_5-7 levels.
These two patients were treated by laryngoesophagectomy combined with bilateral neck dissections. The deficient portion of esophagus was reconstructed with revasculized isolated jejunal segment, and a permanent tracheostoma was formed. In these cases, jejunal vessels were anastomosed to the superior thyroid/lingual artery, and internal jugular vein, respectively. Other technical details were essentially the same as described by other authors.
No serious postoperative complications were associated with this operative procedure, and postoperative digestive functions of these patients were satisfactory.
We confirmed that a revasculized isolated jejunal segment was a reliable and effective method of reconstructing the cervical esophagus with a high success rate and low mortality.

View full abstract

We evaluated clinically the effect of surgical treatment in 4 cases of intractable intestinal obstruction caused by metastatic cancer. Surgical strategies was loop ileostomy in 2 cases, catheter jejunostomy in one case and resection of the ileum with jejunostomy in one case. Three of the 4 cases improyed and one case enjoyed home life for 74 days until readmission. This study suggests that surgical decompression procedure is sometimes useful for cases of intractable intestinal obstruction caused by metastatic cancer.

View full abstract

We report a case of intestinal amebiasis treated successfully with metronidazole. A 72-year-old male who had traveled two times to Southeast Asia was admitted to our hospital because of chronic constipation. A barium enema showed polyps from the descending colon to the rectum and a slight irregularitiy of contour in the cecum. On the first colonoscopic examination, nine polyps and a “collar stud” ulcer were observed. All these polyps were removed out endoscopically and they were adenoma (group III). Many trophozoites of Entameba histolytica were discovered in the biopsied specimens from the ulcer margin. After treatment with 500mg/d of metronidazole for 14 days, the ulcer in the cecum was cured completely, and the constipation subsided spontaneously.
In our country, the incidence of amebic colitis has been gradually increasing since 1979, so amebiasis should be remembered in the differential diagnosis of inflammatory bowel diseases.

View full abstract

A 58-year-old man was admitted to our hospital complaining of discomfort in the right hypochondrial region. Under the diagnosis of cholelithiasis, cholecystectomy was performed. During the operation, a small mass (1.7×1.2×0.5cm) attached to the serosal surface of the gallbladder was incidentally found. It was oval, red-brown in color with a smooth surface and elasticity was firm. A short mesentery-like tissue connection with the right lobe of the liver was observed. The gallbladder was swollen and contained three mixed stones.
Microscopically, the small mass proved to be the hepatic tissue showing an almost normal liver architecture of the lobule, enclosed in a thin fibrous capsule, thus diagnosed as an accessory liver. There were no particular pathologic changes except for slightly irregular arrangement of central veins and liver cell cords. The portal area had one or two arteries, a single vein and bile ducts with infiltration of small round cells. The mesentery-like tissue consisted of blood vessels, nerve bundles in addition to fibrous connective and adipose tissues, but no bile ducts. Thus, the accessory diver in this case appeared to be supplied by a branch of the hepatic artery and vein. We could not ascertain further connections of extra-hepatic bile duct with this small mass. The gallbladder showed histological features of chronic cholecystitis.

View full abstract

A 73-year-old woman was admitted to our hospital on May 22, 1986 because of jaundice and hepatomegaly.
A CT-scan and abdominal ultrasound examination revealed a gallbladder cancer with massive direct invasion and multiple metastases to the liver.
She was treated with U1'TM chemotherapy. Improvement of subjective symptoms was obtained and hepatomegaly and jaundice reduced remarkably. The serum levels of tumor markers also decreased in parallel with the reduction of hepatic metastasis. However, after two months of remission period the disease recurred, and the patient died about 4 months after the initiation of therapy.
Further trials will be required to determine the efficacy of UFTM therapy for gallbladder cancer.

View full abstract

Galmiche and Krejs and their co-workers individually reported a case of pancreatic somatostatinoma associated with calcitonin secretion. Ooi and his collaborators also reported 3 cases of WDHA with the same disease. We had the opportunity to operate on a case of sole secretion of calcitonin by pancreatic tumor. The patient was a 58-year-old woman complaining of upper abdominal pain and weight loss. A diagnosis of endocrine pancreatic tumor was not made preoperatively on the basis of the following clinical examinations. Ultrasonography and a CT-scan provided signs of a mass (5cm in diameter) located in the head of the pancreas. A celiac arteriography revealed a large round tumor with demonstrable vascularity of branches of the gastroduodenal artery in the arterial phase. A remarkable acinar filling in the tumor was visualized by ERCP examinations, and some areas of necrosis within the tumor communicating with the pancreatic ductules showed the appearance of “a lake” of contrast medium.
A pancreaticoduodenectomy was performed on January 18, 1983. Pathological examinations by both light and electron microscopy of resected specimen revealed cell proliferations with both duct and endocrine characteristics of a so-called ductulo-insular tumor, and secretory granules in the cytoplasm of the tumor cells. Many tumor cells were well stained by peroxidase-antiperoxidase (PAP) method using specific antibodies against calcitonin, whereas no other polypeptides were negative including ACTH, gastrin, glucagon insulin motilin, secretin, somatostatin and VIP.
This case might be called a pancreatic calcitoninoma, which to our knowledge has not been previously deseribed. The clinical signs and symptoms of this case did not suggest the secretion of calcitonin, because of a very low biological activity of calcitonin. By January of 1987, 4 years after the operation, the patient had been quite well.

View full abstract

A 50-year-old male patient with cancer of the body and tail of the pancreas, underwent distal pancreatectomy on May 18th, 1981.
This was the second case in Japan who survived more than 5 years after the operation of cancer of the body and tail of the pancreas.
We discussed about the reason why the prognosis of the cancer of the body and tail of the pancreas was bad, with special reference to the high grade of the biological malignancy of pancreatic cancer.
We would like to emphasize the importance of early diagnosis to obtain better operative results about the pancreatic cancer, especially in the region of body and tail.
Wc also presented our operative results of the cancer of the peri-ampullary region.

View full abstract