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Volume 45 (1994)
- Issue 6 Pages 419-
- Issue 5 Pages 353-
- Issue 4 Pages 303-
- Issue 3 Pages 211-
- Issue 2 Pages 73-
- Issue 1 Pages 1-
Volume 45, Issue 2
Displaying 1-23 of 23 articles from this issue
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Y. Gyoten1994 Volume 45 Issue 2 Pages 73-80
Published: April 10, 1994
Released on J-STAGE: February 22, 2010
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T. Matsunaga1994 Volume 45 Issue 2 Pages 81-82
Published: April 10, 1994
Released on J-STAGE: February 22, 2010
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Toshio Kaneko1994 Volume 45 Issue 2 Pages 83-86
Published: April 10, 1994
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSI report on the present status of the scientific and clinical significance of tracheo-broncho-esophagology viewed from the standpoint of a member of the Oto-Rhino-Laryngolocial Society of Japan and the Japan Society of Head and Neck Cancer in terms of the following characteristics. (1) The number of diseases and their associated entities covered in the classification codes of tracheo-broncho-esophagology. (2) The number of diseases which appear in the guidelines for the National Board Examination for medical doctors. (3) The incidence of malignant tumors in the tracheo-broncho-esophageal regions listed in the TNM classification of head and neck cancers in Japan. (4) The number of papers concerning tracheo-broncho-esophagology which were presented at the annual convention of the Japan Society of Head and Neck Cancer in the past 16 years.
According to this research, I have confirmed that among a wide variety of diseases observed in the field of oto-rhino-laryngology and head and neck surgery, the diseases associated with tracheo-broncho-esophagology are extremely limited. I believe that it is time for us to reevaluate the future planning of this society from the viewpoint of the entire framework of medical science and medical practice.View full abstractDownload PDF (482K) -
Ken Okamoto1994 Volume 45 Issue 2 Pages 87-89
Published: April 10, 1994
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSRecently, in terms of its medical content, bronchoesophagology as a lawful medical title has been hardly understood by patients. Although the future progress of bronchoesophagology as a science is indispensable and promising, the main question is whether it can maintain its identity as a clinical field. It seems to be more appropriate that bronchoesophagology remain the title of subspecialty of a medical field than a title of a clinical field.View full abstractDownload PDF (415K) -
Tadashi Hinohara1994 Volume 45 Issue 2 Pages 90-92
Published: April 10, 1994
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSPrefaced by a brief history of clinical bronchoesophagology and its treatment in Japan from 1949 to the present, current concerns in the field of clinical bronchoesophagology are addressed as follows:
1) The regions to be treated by bronchoesophagologists were delimited as the larynx, the tracheo-bronchus, the lungs, the esophagus, the mediastinum and the head and neck diseases.
2) The advantages of cooperative medical teams composed of members of differing medical specialities, including surgeons, internists, radiologists, anesthesiologists, pediatricians, otolaryngologists and head and neck surgeons was stressed.
3) The introduction (in 1988) and implementation of a new system was recommended for specialists which retains and provides up-to-date information concerning advances and discoveries in this changing medical speciality, this assuring patients better quality medical care.
4) The recommendation that the flexible fiberoptic scope be more frequently used in cases of tracheo-bronchial and esophageal diseases, instead of the rigid scope, was made.View full abstractDownload PDF (422K) -
Shigenori Nakajima1994 Volume 45 Issue 2 Pages 93-97
Published: April 10, 1994
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSIn the Japan Broncho-esophagological Society, only 173 (4.7%) of the 3, 647 total members are internists, and most of these are pulmonologists. Of the certified specialists of this society, 3.8% are internists. Of the total number of scientific presentations at the annual meeting of the society in the past six years, 5.8% were presented by internists. As for the scientific articles published in the Journal of the Japan Broncho-Esophagological Society, 9.9% are by the internists, and many of these are studies of the lower airway or the lung.
As is suggested by the above facts, internists have played a small role in this society. However, internists have a lot of things to learn from the society. For example, the relation of the upper and lower airways, the sleep apnea syndrome and airway allergies should be investigated from both sides of the airway, i. e. from the upper and the lower side. In the future, internists should co-operate with the otolaryngologists and other members of this society in learning about advances in internal medicine. This co-operation will lead the members of this society forward further advances in both fields of medicine.View full abstractDownload PDF (518K) -
Mitsuo Endo1994 Volume 45 Issue 2 Pages 98-102
Published: April 10, 1994
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSThe Japanese Society of Bronchoesophagology was established and developed by Dr. J. Ono and some otorhynolaryngologists. Surgeons studied the technique of Esophagoscopic examination from otorhynolaryngologists untill 1960. A flexible esophagoscope was first applied in an ordinary clinic in 1970, and then esophagoscopy using a flexible endoscope became widely used by gastroenterologists and surgeons. Nowadays, diagnosis and treatment using the flexible endoscope have become remarkably developed. Endoscopic mucosal resection (EMR) for mucosal cancer of the esophagus is a routine procedure at present.
General surgeons and otorhynolaryngologists work together in the surgical treatment of pharyngoesophageal cancer. As a reconstructive surgery, free jejunal esophagoplasty is the usual method after pharyngo-laryngo-esophagectomy for Ph cancer. In CeIu cancer, pharyngogastrostomy or pharyngocolostomy through the posterior mediastinum is common. Composite reconstruction using stomach and jejunum is carried out in cases with anastomosis in a high position. Double esophageal and pharyngeal cancer has increased recently. Previously, pharyngolaryngectomy and total esophagectomy were definite operative methods. At present, EMR for esophageal cancer is performed in addition to free jejunal reconstruction, when mucosal cancer is suspected. So “team surgery, ” with surgeons and otorhynolaryngologists co-operating, important for improving the prognosis of pharyngoesophageal cancer.View full abstractDownload PDF (591K) -
Minoru Hirano1994 Volume 45 Issue 2 Pages 103-105
Published: April 10, 1994
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSBronchoesophagology (BE) has been an officially recognized clinical specialty in Japan. Over the past several years, the Japan Broncho-esophagological Society has qualified specialists in BE. There are five major areas which qualified BE specialists should cover: larynx-hypopharynx, trachea-bronchus-lung, esophagus, mediastinum and neck including the thyroid and parathyroid glands. However, no specialist can cover all five of these areas. Among the 148 hospitals which are affiliated with the Kurume University Hospital, only two have a department of BE. In the United States, I have never come across any hospital which has an independent department for BE. BE as a field of medical science is an interdisciplinary area. Clinical practices in BE often call for team work involving a variety of specialists.View full abstractDownload PDF (408K) -
Patrick A. Coyne1994 Volume 45 Issue 2 Pages 106-107
Published: April 10, 1994
Released on J-STAGE: February 22, 2010
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T. Kakegawa1994 Volume 45 Issue 2 Pages 108-109
Published: April 10, 1994
Released on J-STAGE: February 22, 2010
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Nobutoshi Ando, Soji Ozawa, Yuko Kitagawa, Yoshifumi Ikeda, Masakuzu U ...1994 Volume 45 Issue 2 Pages 110-115
Published: April 10, 1994
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSDuring the period from 1980 to 1991, sixteen cases of carcinoma involving the cervicothoracic esophagus were resected in our institute. Among these, nine cases died of a recurrence in the superior mediastinal lymph nodes or in the lungs. Suggesting that prophylactic strategies against these two patterns of recurrence should be considered. As an approach to carcinoma in the cervicothoracic esophagus, we designed an exclusive right thoracic approach: a right anterolateral incision through the fourth intercostal space with an upper median sternotomy, namely an “door open method.” By opening the incised anterior chest wall laterally, optimal access to the cervicothoracic esophagus and the lymph nodes along the recurrent laryngeal nerve is obtained. We have become able to identify preoperatively esophageal cancer patients with high malignancy by factors such as the tendency to relapse in distant organs after surgery, and by an examination of the amplification of some oncogenes (namely int-2/hst-1) in endoscopically biopsied specimens. For this kind of patient, limited field surgery, namely transhiatal esophagectomy, is desirable in order to conserve the patient's immunity, which then makes possible an effective adjuvant chemotherapy following surgery.View full abstractDownload PDF (1892K) -
Masahiko Tsurumaru, Harushi Udagawa, Yoshiaki Kajiyama, Kenji Tsutsumi ...1994 Volume 45 Issue 2 Pages 116-119
Published: April 10, 1994
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSThe proper extent of lymph node dissection for esophageal carcinoma at the junctional portion of the cervical and the upper thoracic esophagus was discussed. Thirty-six resected cases were analyzed concerning the extent and the incidence of lymph node metastasis. The most frequent site of positive nodes was found to be the junctional area between the neck and the upper mediastinum at a rate of 77.8%. Most of these were detected along the recurrent laryngeal nerves. Carcinoma whose main portion was located in the cervical esophagus (CeIu) showed no lymph node metastasis in the middle or the lower mediastinum. However, cervical node metastasis was found in the upper region of the neck, where thoracic esophageal carcinomas hardly metastasized. On the other hand, when the main portion was located in the upper thoracic esophagus (IuCe), cervical node metastasis was confined within the lower part of the neck. The involvement of the lymph nodes was recognized not only in the middle mediastinum but also in the abdomen. Based on these clinical data, we conclude as follows. 1) CeIu carcinoma requires wide node clearance in the neck, as in the case of hypopharyngeal or cervical esophageal carcinoma. Upper mediastinal dissection through median sternotomy is neccessary, while middle or lower mediastinal dissection through right thoracotomy is not mandatory. 2) In the case of IuCe carcinoma, limited neck dissection so far as the lower part of the neck, mainly below the level of the omohyoid muscle, may be sufficient. However, right thoracotomy is needed to eliminate possible metastasis in the middle and lower mediastinum. Abdominal node dissection is also essential considering the possible incidence of metastatic nodes in the left gastric area.View full abstractDownload PDF (376K) -
Hiromasa Fujita, Teruo Kakegawa, Hideaki Yamana, Ichiro Shima, Toshio ...1994 Volume 45 Issue 2 Pages 120-125
Published: April 10, 1994
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSWe have investigated the extent and efficacy of reasonable esophagectomy and lymphadenectomy for a carcinoma at the cervicothoracic junction in 28 patients who underwent surgery between 1980 and 1992 at Kurume University Hospital. Lymph node metastasis and/or the recurrence of these cancers was found only in the neck and/or the upper mediastinum. These findings suggest that thoracotomy for the dissection of lower mediastinal nodes is not always needed. A total laryngoesophagectomy with mediastinal tracheostomy, occasionally developed tracheal necrosis and a subsequent rupture in the great cervical vessels. However, such complications do not occur after subtotal esophagectomy preserving the larynx, or after upper esophagectomy preserving the lower esophagus. Therefore, a subtotal esophagectomy or upper esophagectomy should be adopted for esophageal cancer at the cervicothoracic junction as far as practicable-not only in order to avoid the dismal complications, but also to maintain a better quality of life for the patients.View full abstractDownload PDF (1367K) -
Satoshi Ebihara, Hiroshi Tachimori1994 Volume 45 Issue 2 Pages 126-129
Published: April 10, 1994
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSWe studied lymph node involvement in upper esophageal carcinoma and compared it to nodal involvement in hypopharyngeal carcinoma.
In carcinoma of pyriform sinus, lymph node metastases were most frequently observed in the jugular chain, especially in its upper portion. Involvement of the jugular nodes was also very frequent in carcinoma of the postcricoid area and the posterior wall of the hypopharynx, although the lymph node involvement of these cases not infrequently included the accessory, paratracheal and/or paraesophageal nodes. In cervical esophageal carcinoma, metastases to the supraclavicular, paratracheal and paraesophageal nodes were more common.
When the main portion of upper esophageal carcinoma was situated above the thoracic inlet, the involvement of the middle and lower mediastinal and abdominal lymph nodes was very rare, which suggests that a dissection of these areas is not necessary in this type of carcinoma. However, a dissection of all cervical, mediastinal and abdominal lymph nodes is strongly recommended if the main portion of an upper esophageal carcinoma is located below the thoracic inlet.View full abstractDownload PDF (411K) -
Kunihiko Nagahara, Tetsushi Otani, Masaharu Sudo, Tetsuya Tsukamoto, K ...1994 Volume 45 Issue 2 Pages 130-134
Published: April 10, 1994
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSProblems in performing curative resection and immediate reconstruction for esophageal carcinoma of the cervico-thoracic segment are discussed with special reference to lymph node metastasis by analyzing 34 esophageal carcinomas of this region operated on in the past 10 years. The results of 69 mediastinal dissections and 50 nerve repairs of the recurrent laryngeal nerve (RLN) are also discussed. A modified sternotomy, which enables an optimal operative field for both the upper mediastinal dissection and reconstruction, is also presented. Metastasis to the uppermost part of the upper thoracic paraesophageal lymph nodes (No. 105) was most frequent, indicating the importance of performing a thorough dissection around the RLN, the trachea and the innominate artery. A clear tendency toward wide spreading cervical metastasis was noticed in Ce and Ce/Iu esophageal carcinoma. On the other hand, metastasis was limited to the lower cervical lymph nodes in case of Iu and Iu/Im. Furthermore, reconstruction of RLN, together with laryngeal framework surgery, was shown to be effective in laryngeal preservation.View full abstractDownload PDF (597K) -
Yasushi Murakami1994 Volume 45 Issue 2 Pages 135-140
Published: April 10, 1994
Released on J-STAGE: February 22, 2010
JOURNAL FREE ACCESSBiopsy materials were studied immunohistologically in terms of factors responsible for neck metastasis. These materials were obtained from patients with hypopharyngeal or laryngeal carcinomas. A continuous expression of type IV collagen in the basement membrane that surrounds cancer nests may indicate that neck metastasis is negative and prophylactic neck dissection is not mandatory. Negative expression of type IV collagen, on the contrary, does indicate a positive neck metastasis and is a definite indication of neck dissection for any N classifications.
Some metalloproteinases that may effect the expression of type IV collagen were also evaluated immunohistologically using monospecific monoclonal antibodies. These include type IV collagenase and cathepsin B, D and G. Their expression was observed in some cases, but a mutual relation between them and type IV collagen was not clearly demonstrated.View full abstractDownload PDF (8426K) -
T. Umezaki1994 Volume 45 Issue 2 Pages 141
Published: April 10, 1994
Released on J-STAGE: February 22, 2010
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Y. Tomita, [in Japanese]1994 Volume 45 Issue 2 Pages 142
Published: April 10, 1994
Released on J-STAGE: February 22, 2010
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H. Terasaki1994 Volume 45 Issue 2 Pages 143
Published: April 10, 1994
Released on J-STAGE: February 22, 2010
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C. Kijimoto1994 Volume 45 Issue 2 Pages 144
Published: April 10, 1994
Released on J-STAGE: February 22, 2010
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N. Inamura1994 Volume 45 Issue 2 Pages 145-146
Published: April 10, 1994
Released on J-STAGE: February 22, 2010
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1994 Volume 45 Issue 2 Pages 147-172
Published: April 10, 1994
Released on J-STAGE: February 22, 2010
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1994 Volume 45 Issue 2 Pages 173-205
Published: April 10, 1994
Released on J-STAGE: February 22, 2010
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