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Lauren D. Holinger
1992 Volume 43 Issue 2 Pages
65-71
Published: April 10, 1992
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Ingo F. Herrmann
1992 Volume 43 Issue 2 Pages
72-79
Published: April 10, 1992
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[in Japanese]
1992 Volume 43 Issue 2 Pages
80
Published: April 10, 1992
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A. Treatment of Carcinoma of the Hypopharynx
Kunitoshi Yoshino, Takeo Sato, Katsunori Umatani, Takashi Fujii, Satos ...
1992 Volume 43 Issue 2 Pages
81-87
Published: April 10, 1992
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A total of 256 previously untreated patients with hypopharyngeal carcinoma from 1978 to 1990 were enrolled at our clinic, resulting in 194 piriform sinus type (PSC), 39 postcricoid type and 23 posterior wall type; 14 stage I, 33 stage II, 96 stage III and 113 stage IV. Therapeutic methods for them were radical in 211, palliative in 32 and no treatment in 13 mainly because of high age. Modalities of curative treatment were surgery in 178 (90 of them combined with radiation and/or chemotherapy), radiation in 30 and chemotherapy in 3. The crude 5-year-survival rates were 34.6% for the overall (
n=253) and 40.2% (cause specific 49.9%) for curative treatment group (
n=211). The surgery alone group and the postoperative radiation group had better prognosis than the preoperative radiation or chemotherapy group. From these results, we have performed surgery first when the combined therapy has been applied if necessary. At the resection of the lesion, we make efforts to preserve pharyngeal mucosa as much as possible with the margin of about 2 cm. Primary closure of the pharynx is performed, when the width of the mucosa is more than 2-3 cm, and the reconstruction by a forearm free skin flap, when less than it. In the case of circumferential mucosal defect, a free jejunum is used. Out of 138 PSC, 94 (68.1%) was possible to close the pharynx primarily. The second primary malignancies were found in 47 patients (18.4%) and the strict follow up is important especially for carcinoma of the esophagus, the mesopharynx or the lung, which have common risk factors of drinking or smoking.
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B. Treatment of Hypopharyngeal Carcinoma
Shinzo Tanaka, Minoru Hirano, Hidetaka Matsuoka, Kiminori Sato, Tomoak ...
1992 Volume 43 Issue 2 Pages
88-95
Published: April 10, 1992
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One hundred and thirty eight out of 173 cases of hypopharyngeal carcinoma visiting to our clinic during 1971 to 1990 were radically operated, and resulted in 41% of accumulated 5 year survival rate. Local recurrence occurred in 20 cases, indicating that 20 mm and 25 mm of safety margin are necessary for oral and anal sides, respectively. For NO, the rate of occult lymph-node metastasis in the affected neck was high in T2, T3 and T4 cases. The half of NO cases with metastasis in the affected neck indicated the metastasis in the unaffected one. For N2, the metastasis rate in the unaffected neck was high in any T category. The larynx was conserved in some of the T1 or T2 cases of piriform sinus and posterior wall carcinoma. Deltopectral flap and pectoralis major myocutaneous flap were useful. Among the reconstractive methods after pharyngolaryngectomy, the free jejunum graft was the most reliable although the time of food intake was long.
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C. The Treatment of Esophageal Cancer
Hiroyasu Makuuchi, Takao Machimura, Kyoichi Mizutani, Takashi Sugihara ...
1992 Volume 43 Issue 2 Pages
96-100
Published: April 10, 1992
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We had been treated 596 cases of esophageal cancers and would take measures to cope with the problem concerning about the treatment of esophageal cancer with the analysis for them.
The rate of resected cases was 71.3%. The direct operative death was 3.4% and post operative hospital death was 4.0%, althogh they were decreased to 1.7% and 1.1% respectively in recent 6 years. As for the postoperative complications, pneumonia was gradually decreased in number but recurrent nerve pulsy and aspiration pneumonia were increased recently for the reason that we had been spreading the area of lymphnode dissection. The 5 year survival rate of all cases was poor as 34.5%, that of resected cases was 47.5%, and that of unresected was 3.5%. Superficial esophageal cancers were account for 24% of total cases that is very high incidence compared to other institution. Mucosal cancers had rarely lymphnode metastasis or vessels invasion, and also they had a good prognosis (100% of 5 year survival rate).
The best procedure to manage the esophageal cancer is as follow : The first, detecting the mucosal cancers with applying chromoendoscopy in high risk groups and the second, the endoscopic mucosal resection should be applied for these cases.
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D. The Treatment of Thorasic Esophageal Cancer
Kazuaki Okuyama, Teruo Kouzu, Noriyuki Tohnosu, Yoshio Koide, Tomotaka ...
1992 Volume 43 Issue 2 Pages
101-106
Published: April 10, 1992
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A total of 1373 thorasic esophageal cancer patients (847 resected and 526 non-resected or nonsurgical) during 1961-1990 were devided into the three decade groups to chronologically analyze therapeutic result, i. e. Group I (1961-70), Group II (1971-80) and Group III (1981-90). Resection rate has increased gradually in the chronological order, reaching 70.4% in group III. Direct operative mortality rate in group III (1.5%), was significantly lower than those in Group I (7.5%) and group II (5.0%), respectively. On postoperative complications, pulmonary complication, pyothorax and anastomotic leacage has been less frequently seen in Group III. However, recurrent nerve paralysis increased to replace significantly more frequent than Group I and Group II . Cumulative 5-year survival rate in Group III was 29.1%, showing significant difference between Group I (16.7%) and Group II (18.5%) (p<0.001). Stage III patients who underwent curative resection revealed significantly favorable in prognosis among the three group. Whereas, in Group III patients with a
3 and n
(-) , n
1, 2 or n
3, the extended lymph node dissection (neck, mediastinum and abdomen) was significantly superior in survival to the conventional dissection (mediastinum and abdomen).
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[in Japanese]
1992 Volume 43 Issue 2 Pages
107-108
Published: April 10, 1992
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[in Japanese]
1992 Volume 43 Issue 2 Pages
109-110
Published: April 10, 1992
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A. Foreign Body in the Tracheo-bronchial Tree and Esophagus
Osamu Tanaka
1992 Volume 43 Issue 2 Pages
111-117
Published: April 10, 1992
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A domestic questionnaire survey was done to collect information on the use of the endoscopy for the removal of foreign bodies in the tracheo-bronchial tree or the esophagus. Based on the survey and the author's own experiences, this paper discusses the advantages and disadvantages of the rigid endoscopes as well as flexible ones. An appropriate choice for removal of the foreign body is also discussed.
The flexible endoscope provides a better view, while the rigid endoscope is convenient for the removal of the foreign body. In addition, the flexible endoscope can access to the foreign body caught in distal bronchi or stomach that can't be reached by the rigid apparatus. Considering these advantages and disadvantages of each type of endoscope, the best choice should be made to remove foreign bodies safely and quickly.
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B. Flexible Endoscopic Surgery-Larynx and Airway (LASER) -
Manabu Nakanoboh
1992 Volume 43 Issue 2 Pages
118-123
Published: April 10, 1992
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Many diseases in otorhinolaryngology develop in the lumen of the head and neck. Introduction of the flexible endoscope has brought about a remarkable progress in the diagnostic technique for these diseases. Recently, it has been used as one of the treatment techniques and the concept of flexible endoscopic surgery is being established in the domain of otorhinolaryngology. This paper deals with flexible endoscopic laser surgery which uses various kinds of lasers mainly in the treatment of neoplastic lesions and stenotic lesions. Flexible endoscopic laser surgery is minimally invasive and advantages of endoscopes are combined with those of lasers. It may serve as a very useful tool, if indications are selected properly.
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dications and Techniques C. An Air-way Stent Made from Shape-memory Alloy and Its Application for the Treatment of Tracheobronchial Stenosis
Tatsuo Nakamura
1992 Volume 43 Issue 2 Pages
124-128
Published: April 10, 1992
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An innovative thermal shape-memory alloy stent was formulated for use in the treatment of tracheobronchial stenosis and airway collapse. The stent is designed to sustain the cartilagenous part of the airway with a cross-sectional profile of a horseshoe. The stent is made of a Ti-Ni alloy wire with a diameter of 0.5 mm with a transition temperature of 20°C and covered with silicone. The stents cooled in ice-water were placed through an endotracheal tube into the targeted site using a flexible bronchial fiberscope. Experimental study using tracheomalasial model dogs revealed that the stent was effective in overcoming airway stenosis. Encouraged by these promising results in experimental study, we have begun to study clinical applications of the thermal shape-memory alloy stent.
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D. Flexible Endoscopic Surgery-For Esophageal Diseases-
Teruo Kouzu, Kaichi Isono
1992 Volume 43 Issue 2 Pages
129-132
Published: April 10, 1992
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Endoscopic treatment for esophageal diseases has been developed with the progress of the diagnostic techniques in recent years. It can be assumed that no doctor uses a rigid type of endoscope any more concerning to gastrointestinal diseases. Removal of a foreign body or a benign tumor and treatment of stenosis or esophageal varices, have become routine works for endoscopists. Although, the numbers of cases of early esophageal cancer have been increasing recently, improvement of diagnosis of the lymphnode metastasis and accurate detection of depth of cancer invasion make it possible to clarify which cancer can be treated endoscopically. In an endoscopic treatment for cancer, there are several techniques, such as laser or heat-probe. Among these techniques, an endoscopic mucosal resection is the most prevailing.
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
1992 Volume 43 Issue 2 Pages
133
Published: April 10, 1992
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[in Japanese]
1992 Volume 43 Issue 2 Pages
134
Published: April 10, 1992
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[in Japanese]
1992 Volume 43 Issue 2 Pages
135
Published: April 10, 1992
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[in Japanese]
1992 Volume 43 Issue 2 Pages
136
Published: April 10, 1992
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[in Japanese]
1992 Volume 43 Issue 2 Pages
137
Published: April 10, 1992
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[in Japanese]
1992 Volume 43 Issue 2 Pages
138
Published: April 10, 1992
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[in Japanese], [in Japanese], [in Japanese]
1992 Volume 43 Issue 2 Pages
139
Published: April 10, 1992
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
1992 Volume 43 Issue 2 Pages
140
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1992 Volume 43 Issue 2 Pages
141-149
Published: April 10, 1992
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1992 Volume 43 Issue 2 Pages
150-158
Published: April 10, 1992
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1992 Volume 43 Issue 2 Pages
158-166
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1992 Volume 43 Issue 2 Pages
166-174
Published: April 10, 1992
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1992 Volume 43 Issue 2 Pages
174-182
Published: April 10, 1992
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1992 Volume 43 Issue 2 Pages
183-191
Published: April 10, 1992
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1992 Volume 43 Issue 2 Pages
191-199
Published: April 10, 1992
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1992 Volume 43 Issue 2 Pages
199-207
Published: April 10, 1992
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1992 Volume 43 Issue 2 Pages
207-214
Published: April 10, 1992
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1992 Volume 43 Issue 2 Pages
214-221
Published: April 10, 1992
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