For 25 years ago, we have been performing to the several multidisciplinary treatment for patients with esophageal cancer.
15 years ago, we had stopped the preoperative radiotherapy for patients with operable esophageal cancer because the postoperative radiotherapy had shown a higher survival rate than pre-and postoperative radiotherapy reported in prospective randomized trial by Japanese Esophageal Oncology Group (JEOG).
Thereafter, we had performed the study of a comparison chemotherapy and radiotherapy as an adjuvant treatment to surgery for esophageal cancer by JEOG'S trial. However, there was no significant difference between chemotherapy and radiotherapy in survival up to 5 years.
On the other hand, the area of lymph node dissection in surgical treatment for esophageal cancer have been changed that the dissected area became wide. specially it was important to dissect the lymph nodes around the right and left recurrent laryngeal nerve.
According to perfomed the extensive lymph node dissection, the postoperative 5-years survival of esophageal cancer was improved to 50%, To prove the improvement of postoperative survival rate by extensive lymph node dissection, we performed the examination of micrometastasis in esophageal cancer. The examination for micrometastasis had two methods, one was examining the extranodal lymphatic vessel permiation (Exn-LV-Pm) in fibrofatty tissue around dissected lymph nodes, and the other performed study of the tumorgenecity of cancer cells in lymph fluid gathered from thoracic duct by cannulation during the operation.
We investigated that positive rate of Exn-LV-Pm was 31.2%, and implantable rate into nude mice of cancer cells was 61.8%.
We have to receganize that the micrometastasis is important target to treat patients with esophageal cancer. In conclusion, the development of anticancer agent targetting to cancer cells in lymph fluid is needed to improve the postoperative survival for patients with esophageal cancer.

View full abstract

Among 171 patients who were undergone renal transplantation at Sakura National Hospital between March 1974 and December 1995, we have experienced various degrees and types of respiratory infection 45 times in 38 cases after renal transplantation and have lost 3 patients. We deviled those cases into three groups according to the degree of severity of disease for further analysis. The respiratory infections after renal transplantation were seen in any period after transplantation and there were no difference between pre-(1974-1981) and post-cyclosporine (1982-1995) era in frequency, origin and the severity of the infection. All cases were started to treat with antibiotics without definitive diagnosis. Although little was seen the deterioration of the graft function, transient liver dysfunction was seen 4 times in 14 cases who received multi-drug therapy to infection. Among 4 severe cases, 2 patients died due to a lack of proper treatment with antibiotics and one died of liver failure after multi-drug therapy. One severe case with pneumocystis carinii has recovered because of early cytological diagnosis by TBLB (transbronchial lung biopsy) for the treatment.
Despite of recent advance in post-transplant management, respiratory infection after renal transplantation remains one of the major causes of death. Our experience indicates that the early diagnosis for precise treatment should be most important to avoid unnecessary adverse effects.

View full abstract

We analized the anti-HCV core (C 22-3) antibody response to interferon (IFN)-αtherapy in patients with chronic hepatitis C. Basal values of serum anti-C 22-3 antibody correlated significantly with basal values of serum ALT, suggesting that anti-HCV might reflect the activity of hepatic inflammation. The responses to IFN therapy were decided by the serum HCV-RAN values 6 months after IFN therapy as a complete response, transient response and non-response groups. As the values of serum anti-C 22-3 showed to decrease in either groups, it was impossible to differenciate the complete response group from the other groups according to values of serum anti-C 22-3 during IFN therapy. However, the values of serum anti-C 22-3 had a tendency to decrease still more after IFN therapy in complete response group, although the other groups showed the increasement of values of anti-C 22-3 antibody immediately after IFN therapy. The cut off values of 79% ratio to basal values of anti-C 22-3 antibody 6 months after IFN therapy had a significant differenciable capacity of complete response group from the other groups.

View full abstract

During the past 14 years from 1982, 72 patients with renal cell carcinoma were treated surgically in our hospital; 35 had incidental renal cell carcinoma and 37 had symptomatic carcinoma. The clinicopathological features of incidental carcinoma were compaired to those of symptomatic carcinoma. The results obtained are as follows:
The size of incidental carcinoma was significantly smaller than that of symptomatic carcinoma. Both the pathological stage and the grade of incidental carcinoma were significantly lower than those of symptomatic carcinoma. The incidence of venous invasion in incidental carcinoma was significantly lower than that in symptomatic carcinoma. The survival time of patients with incidental carcinoma was significantly longer than that of patients with symptomatic carcinoma.

View full abstract

Concerning the management of National Hospital, two crises are pointed out, namely, a financial and a low level of medical care. This group aims the improvement of management of National Hospital, mainly focusing on making proper claims for medical fee reimbursement. Studies under six items are done. They consist of 1) doctors, 2) Division of Medical Affairs, 3) general considerations on omission of claim, 4) slips of accounting, 5) computer and 6) consignment of business.
Important points to be solved are as follows: Guidance to doctors on the system of medical care insurance is most important. Due to their indifference to the work, it is very difficult to educate doctors how to make proper claim. Capacity of Division of Medical Affairs has an impotant influence on management, particularly on income of the hospital.
The factors and occations of omission of claim are various. For avoidance of omissions, much devices are required. Slips of accounting are various in form and content. New ideas to improve slips is necessary. Computer is indispensable for claim works. It is important to equip the suitable systems for each hospital. Consignment of business has many ploblems to be debated in the near future. Prudent considerations will be required.
After solving financial problems, each hospital should be required to improve the level of medical treatment, that is, to provide a medical care of high grade in quality.

View full abstract

We report a case of B cell lymphoma associated with rectal cancer and acute renal failure due to tumor lysis syndrome. An 83-year-old woman was admitted to our hospital because of abdominal distension and hematochezia. Enlarged inguinal lymph nodes, intra-abdominal masses involving the subcutaneous tissue, and abundant ascites were present. She was diagnosed as having B cell lymphoma from the results of cytology, surface marker studies and DNA analysis of abnormal cells from the ascites. Colonoscopy also revealed adenocarcinoma with a villous adenoma in Ra region. lmmediately after the admission, she rapidly developed acute renal failure due to the tumor lysis syndrome. Her renal function was improved by hemodialysis and steroid pulse therapy. However, chemotherapy was ineffective and she died of multiple organ failure three months after admission. At autopsy, the lymphoma involved various organs, macroscopically looking like carcinornatous pleuritis and peritonitis. Histological examination showed non-Hodgkin's lymphoma of the diffuse large cell type and there was no metastasis from her rectal cancer.

View full abstract

A case of a 58-year-old woman with multiple retroperitoneal pheochromocytoma is reported. She complained hot flush for 3 years, had been medicated for hypertention after toxemia of pregnancy and was incidentally pointed out a retroperitoneal tumor by abdominal ultrasonography at health examination before admission. The blood pressure at admission was 190/120mmHg and the value of noradrenalin in serum and urine was extreamly high. CT and MRI showed two tumors within the retroperitoneal cavity around the abdominal aorta. So the tumors were diagnosed as multiple pheochromocytomas. During operation, soon after resection of the tumors, blood pressure was immediately down, but it was recovered by blood transfusion. After operation blood pressure has been good control and 10 days after serum noradrenalin level was within normal limit.

View full abstract

The use of autologus transfusion in National Hospital Group was 59 out of 88 (67%) and the rate in small sized hospitals seemed lower than those in middle and large sized hospitals. Five hospitals out of 59 (8%) had the whole autologus transfusion system. Most of other hospitals had one department where autologus transfusion was used, especially in the department of orthopedics. Blood transfusion service was carried out consistently in 12 hospitals out of 88 (14%). Sixteen hospitals out of 88 (18%) had the transfusion committee.

View full abstract