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Volume 23, Issue 4
Displaying 1-37 of 37 articles from this issue
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Yukimitsu Kawaura, Masatoshi Sasaki, Kenji Omura, Eiji Kanehira, Yoshi ...1990 Volume 23 Issue 4 Pages 821-826
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTwo reconstructive methods of operating on the pharynx and/or cervical esophagus were compared. The patients were divided into a reconstructive group of 7 cases (Gastric group) and a group of 14 cases with a free jejunal autograft without dissection of the mediastinal lymph nodes (FJA group). In the FJA group, complication in the respiratory system and anastomotic leakage did not occur, in contrast with the Gastric group in which there were 2 cases of respiratory disorders and 2 cases of anastomotic leakage. Mediastinal lymph node metastases was not seen in the Gastric group, but cervical paraesophageal lymph node metastases were found in 57.1% of the Gastric group and in 42.9% of the FJA group. These findings indicate that we should placed great importance on the dissection of the neck lymph nodes. In the patients with distant metastases, mediastinal lymph node metastases were found. Anastomotic stenosis and/or thrombus formation in a nutrient artery of FJA were not revealed by common carotid arteriography after the operation. The patient who survived the longest in the Gastric group survived 62 months and died of recurrence in the lung. In the FJA group, two patients have survived 5 years more. A significant difference in survival tme was not seen between the two groups. We emphasize that reconstruction with FJA is safe and benefical, especially in high-risk cases.View full abstractDownload PDF (10155K) -
Treatment of sm Esophageal CancerKazuo Tenma, Shichisaburo Abo, Michihiko Kitamura, Masaji Hashimoto, K ...1990 Volume 23 Issue 4 Pages 827-833
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIn order to determine a therapeutic policy, we conducted a retrospective study on 20 cases of early esophageal cancer (mm 4, sm 16) concerning histopathological findings, treatment and prognosis. Of the 20 patients, 18 were male, and 2 were female. There were no differences in clinical fetures between mm and sm cancers. Twelve patients (7.5%) with sm cancers complained of some kind of symptom, while only one (25%) with mm cancer did. mm cancers were classified macroscopically as 0-II type, and most of the sm cancers as 0-I type. The mean longitudinal diameter of the lesions in sm cancers was 2.1 cm and that in mm cancer was smaller (0.9 cm). In the 8 patients with lymphatic invasion, 7 of the cancers were in sm and only 1 was mm histopathologically. We observed no recurrence of mm cancers, while there was recurrence in 2 patients wth sm cancers. The 5 year survival rate for our early esophageal cancers (75%) was the same as that reported in Japan as a whole. We concluded that the grea t histopathological difference between mm cancer and sm cancers reflected their own prognoss. It is essential that we adopt the same surgical approach and multidisciplinary treatment for sm cancers as we do for advanced cancers.View full abstractDownload PDF (11758K) -
Hiroo Oshita, Sengai Tanaka, Takao Ito1990 Volume 23 Issue 4 Pages 834-840
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe clinicaly and pathologically investigated, by degree of depth of invasion, 231 cases of early gastric cancer undergoing curative resection. The details of which are as follows. 1) There were 128 cases (55.4%) of mucosal cancer and 103 cases (44.6%) of submucosal cancer. 2) Metastasis to lympn nodes was found in 9.5% of the total cases (1.6% of m cancer cases and 19.4% of sm cancer cases). 3) The larger the tumor diameter, the more frequent was the occurrence of lymph node metastasis. However, in patients with tumor less than 1.0 cm in diameter, no lymph node metastasis was seen. 4) For patients with sm cancer positive for lymph node metastasis, the 5-and 10-year survival rate was 87.6%, which compared unfavorably with the rates of 97.0% and 92.7% for negative cases. 5) At this time, we consider that dissection of lymph nodes in the second group for even an early gastric cancer should be conducted.View full abstractDownload PDF (12122K) -
Tsunehide Boku, Yasushi Nakane, Tokio Okusa, Masashi Okamoto, Shigeo O ...1990 Volume 23 Issue 4 Pages 841-850
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe present study examined whether survival after curative gastrectomy is related to the total number, frequency and rate of lymph node metastasis in 433 patients. Of these patients, 45.3% had lymph node metastasis. Of a total of 10, 130 dissected lymph nodes, 13.0% were positive for metastasis. The average number of positive nodes was 3.0. The rate, frequency and number of metastasized nodes increased as cancer progressed. In addition, the five-year survival rate correlated with nodal staging, depth of invasion, and the number and frequency of metastatic lymph nodes. The present findings suggest that the extent of lymph node disection is closely related to the number of metastatic node, and metastatic rate, and that extended lymph node dissection is efficacious in the treatment of gastric cancer.View full abstractDownload PDF (18263K) -
Nobuhiro Tsukuda, Kiyoshi Sawai, Toshio Takahashi, Kousuke Seiki, Take ...1990 Volume 23 Issue 4 Pages 851-856
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSRecently, in accordance with the increasing ratio of older people in the total pupulation, operations on the aged patients have been increasing. Records were reviewed for 78 patients aged 75 years or older who underwent gastrectomy for gastric cancer at the Frst Department of Surgery, Kyoto Prefectural University of Medicine, between 1973 and 1987. Seventeen cases were in the 1st period (1973-1977), 23 were in the 2nd period (1978-1982), and 38 were in the 3rd period (1983-1987). The results were as follows: 1) The number of aged patients has doubled in these 15 years. 2) The incidence of early gastric cancer has increased significantly from 5.9% to 39.5% (p<0.01), whereas the incidence of advanced gastric cancer decreased remarkably. 3) There was only one operative death in the 15 years. 4) In all three periods, R2 lymphnode dissection was performed in about 60% of all cases. 5) The rateof absolute curative resection was improved from 29.4% to 63.2%. 6) The 5-year survival rate improved significantly from 9.3% to 50.5%.(p<0.01) In conclusion, it seems that improvement in detection of early gastric cancer has contributed to these reults.View full abstractDownload PDF (11400K) -
A Solvent Mixture of Methyl Tert-butyl ether with Fluorocarbon for Cholesterol Gallstone DissolutionShigeaki Inoue, Masaaki Endoh, Shoichi Shida, Hiromichi Nakachi, Mustu ...1990 Volume 23 Issue 4 Pages 857-860
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSSince methyl tert-butyl ether (MTBE), which has recently received a lot of interest as a directly cholelitholytic agent for its rapid effect, cannot dissolve in bile and floats on it (specific gravity, 0.747), stone-solvent contact which is the rate-limiting factor in gallstone dissolution is unexpectedly insufficient. If excessive amounts of MTBE escape from the biliary tract and are absorbed systemically, such local and systemic toxicities as vomiting dyspnea, somnolence, duodenitis and so on are often produced. We used fluorocarbon, which was developed as an excellent substitute for red blood cells (oxygen carrier), to obtain a solvent mixture with MTBE, and found that MTBE dissolved completely in fluorocarbon. A mixed stone initially weighing 137 mg decreased in weight to 91 mg (66.4%) after 3 hr exposure to the solvent mixture of MTBE (0.5 ml) and fluorocarbon (1.5 ml), whereas another stone (initially 403 mg) weighed 327 mg (81.1%) after exposure to a mixture of MTBE (2 ml) and bile (1 ml). Fluorocarbon and MTBE, therefore, will be able to constitute a solvent mixture to fill in the space for gallstone dissolution (for example, gallbladder) safely for much greater stone-solvent contact.View full abstractDownload PDF (8440K) -
Yoshinobu Sato, Minoru Fukuda, Masaki Hirota, Yoshihiro Baba, Akio Iga ...1990 Volume 23 Issue 4 Pages 861-866
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSDiagnosis and operative results in 33 patients with carcinoma of the gallbladder (GBC) were reviewed in order to improve the prognosis of this disease, which is difficult to cure. The high incidence of gallstone positive GBC among patients with cholelithiasis (5.5%) showed that the Shrone district is a zone of very high risk for GBC. The rate of preoperative correct diagnosis improved significantly after the interoduction of endoscopic ultrasonography (21% to 83% in resectable cases). However, intraoperative diagnosis by macro-scopical observation of the specimen was still important for detecting superficial type early carciomas. Four out of 5 patients who were checked through the health examination by ultrasonography were treated succussfully. Therefore, mass screening by ultrasonography was considereduseful. GBC was resected in 25 patients (76%). However, curative resection was performed in only 18 patients (54.5%). Cumulative 3-and 5-year suvival rates for the resected cases excluding operative death (one case) and death by coexisting gastric cancer (2 cases) were 53.7% and 43.0%, respectively. The outcome instage I was excellent including those patients who underwent simple cholecystectomy only. However the rate of recurrence was high in stage II or more advanced stages. A more radical procedure including excision of the extrahepatic bile duct and systemic dissection of the hepato-duodenal ligament must be used in patient with advanced GBC.View full abstractDownload PDF (10170K) -
Morihiko Toda, Iwao Sasaki, Hiroo Naito, Yuji Funayama, Yasuhiko Kamiy ...1990 Volume 23 Issue 4 Pages 867-874
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSExperimental studies were carried out to investigate the effect of ileo-jejunal transposition (IJT) upon the plasma lipids and gastrointestinal hormones after the oral administration of butter (2g/kg). Dogs undergoing either IJT (n=6) or sham operation (n=5) were compared and the following results were obtained. 1) In both the IJT and the sham groups the plasma triglyceride levels at 0 to 30 minutes after the ingestion of butter significantly increased after the operation. The plasma free fatty acid and cholesterol levels showed no differences afte surgery. 2) Five weeks after IJT, a significant increase in the fasting plasma total glucagon-like immunoreactivity (total-GLI) level was observed, but the postprandial plasma total-GLI level showed no difference after IJT. 3) The plasma gastric inhibitory polypeptde response to butter ingestion was lower after IJT. The plasma gastrin and insulin levels showed no differences after IJT. The present studies suggest that the absorption of fat is not found to be affected by IJT. Digestion of intraluminal fats may play an important role in the release of enteroglucagon.View full abstractDownload PDF (15798K) -
Masato Ihara1990 Volume 23 Issue 4 Pages 875-883
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSMagnetic resonance imaging (MRI) was performed to evaluate the preoperative staging of rectal cancer and to diagnose its postoperative local recurrence, and the MRI was compared with computed tomography (CT). MRI was significantly better than CT in its specificity for preoperative diagnosis of invasion into local organs (98.4% and 72.3%, p<0.05). Assessing the diagnosis of local recurrence of rectal cancer by the MRI relaxation times, the T1 value of local recurrence of post-anterior resection was 648±71.4 msec, and the T2 value was 84±27.8 msec. The T1 value of the local recurrence of post-rectal amputation was 705±94.4 msec, and the T2 value was 103±24.3 msec. The T1 value of scar tissue was 475±156.5 msec and the T2 value was 49±4.5 msec. The T1 and T2 relaxation times of local recurrence of post-anterior resection, and those of post-rectal amputation were significantly greater than those of scar tissue (p<0.05, p<0.01).View full abstractDownload PDF (18414K) -
Hisaki Mio, Ryuunosuke Kumashiro, Hidethune Ikenaga, Takahiko Yamanaka ...1990 Volume 23 Issue 4 Pages 884-888
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA very rare case of pedunculated polypoid carcinoma of Yamada IV type in the esophagus is reported which was effectively treated by irradiation and chemotherapy. A 54-year-old man complained of the horseness. The polypoid tumor, of which size is 2 cm in diameter, developed in upper intra-thoracic esophagus and shown squamous cell carcinoma with a short stalk. The lymph node involvement could not deny though the tumor controlled effectively by irradiation and chemotherapy, so the surgical resection was performed. This polypoid carcinoma of Yamada IV type would be treated effectively with anti-cancertherapy and irradiation as long as no metastatic lymph node.View full abstractDownload PDF (9151K) -
Toshiaki Ando, Masahiko Onda, Yukichi Moriyama, Noritake Tanaka, Shoji ...1990 Volume 23 Issue 4 Pages 889-893
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe perforation or penetration of digestive tract due to ingested fish bone is relatively rare, and preoperative diagnosis is very difficult. Two cases of small intestinal perforation and a case of anal penetration by ingested fish bone are reported. Preoperatively, one of the two intestinal perforated cases was diagnosed by abdominal CT, and the anal penetration case was diagnosed by digital examination. In previous Japanese reports, in addition to our three cases, 240 cases of this disease have been reported. Perforation or penetration appeared, in the decresing order of prevalence, in the anus, ileum, transverse colon, sigmoid colon, and esophagus. Even though most patients wre surgically treated, a preoperative diagnosis was unusual. Especially, there were only seven cases, besides ours, of preoperative diagnosis of intraperitoneal perforation or penetration, and most of these were diagnosed by abdominal CT, as in our case. In preoperative diagnosis, CT may be particularly helpful in patients in whom the perforation or penetrtion of the digestive tract is caused by ingested fish bone. In the previous reports, all patients that were preoperatively diagnosed had chronic inflammatory lesions. Our case is the first report in Japan of preoperative diagnosis of panpertonits due to intestinal perforation caused by ingested fish bone.View full abstractDownload PDF (9423K) -
Izumi Takeyoshi, Tomohiro Inoue, Susumu Ohwada, Masaaki Takeshita, Yuk ...1990 Volume 23 Issue 4 Pages 894-898
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe have experienced 3 cases of early carcinoma of the duodenal bulb. Case 1: A 63-year-old male who had been operated on because of rectal cancer complained of epigastralgia. An upper gastrointestinal (GI) series and endoscopic examination showed elevated lesions in the duodenal bulb and the antrum of the stomach. Carcinoma was strongly suspected from the biopsy specimens of the duodenal bulb. Gastrectomy, partial duodenectomy and lymph node dissection were performed. Histological examination revealed papillotubular adenocarcinoma located within the mucosa of the duodenal bulb and the stomach. Case 2: A 57-year-old female with no complaints was recommended to have a further precise examination after an upper GI series. An upper GI series and endoscopic examination showed an elevated lesion in the duodenal bulb. The biopsy specimens showed adenocarcinoma. Gastrectomy, partial duodenectomy and lymph node dissection were performed. Histological node dissection were performed. Histological examination revealed papillotubular adenocarcinoma located within the mucosa. Case 3: A 78-year-old male with no complaints was recommended to have a further precise examination of the duodenum after an upper GI series. An upper GI series and endoscopic examination showed an elevated lesion in the bulb and the 2nd portion of the duodenum. The tumor was 2 cm in diameter. The biopsy specimens showed adenocarcinoma. Gastrectomy, partial duodenectomy and lymph node dissection were performed. Histological examination revealed papillotubular adenocarcinoma located within the mucosa and submucosa without lymph node metastasis.View full abstractDownload PDF (10490K) -
Teruo Tsuru, Hiroyasu Mizoguchi, Shigeaki Aso, Kazuhiko Ohyama, Hiroak ...1990 Volume 23 Issue 4 Pages 899-903
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIt is comparatively rare to see a trachychromatic image of the tumor in an angiogram of an extrahepatic cholangiocarcinoma, but we experienced one case of extrahepatic cholangiocarcinoma with a trachromatic image. The patient was a 68-year-old male with upper abdomnal pain as the main complaint. After liver dysfunction was detected and he was hospitalized, cholangiocarcinoma was diagnosed on the basis of the results of a detailed examination. The histopathological diagnosis was papillary adenocarcinoma. As a result of an investigation of the cause of the trachychromatic image of the tumor, it was found that propagation of capillarie in the interstitium of this tumor was excellent, as revealed by pooling of contrast medium in the capillaries. The tumor base tissue was considered to be a gastrointestinal origin embryologically.View full abstractDownload PDF (9806K) -
Kazuo Suga, Masato Furukawa, Toshnori Nakata, Toshiomi Kusano, Yiqin L ...1990 Volume 23 Issue 4 Pages 904-908
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSAdenosquamous cell carcinoma comprises both adenocarcinoma and squamous cell carcinoma coexisting in the same cancer nest. Such carcinoma originating in the intrahepatic bile duct has seldom, if ever been reported-Wef ound, only 15 cases in the literature. We have recently experienced 2 such cases (a 72-year-old man and a 69-year-old man). Examination of the 17 cases including our 2 revealed a sex ratio of 10: 7 without a great sex difference, right lobe and left lobe as the site of occurrence in 8 and 9 cases, respectively, and hepatic symptoms in particular as chief complain, folowed by icterus, etc. The treatment is, in principlex, extirpation of the tumor by hepatectomy, but with poor operative result and very unfavorable prognosis (15 of the patients died, the exception were our 2). The pathogenesis of the present disease may partially involve some chronic stimuli such as biliary retention and bile stones to the bile duct. It is suggested that cases with stenosis of the hepatic hilm and intrahepatic stones should be coped with, taking the possible complication of adenosquamous cell carcinoma into consideration.View full abstractDownload PDF (10136K) -
Masao Tayama, Junichi Sumimura, Kimihiko Nakagawa, Eiji Takahashi, Jun ...1990 Volume 23 Issue 4 Pages 909-913
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 30-year-old man was admitted to our hospital with right hypochondralgia and mild liver dysfunction. Abdominal X-ray and plain computed tomography revealed a smallcalcified lesion located at the hepatoduodenal ligament, endoscopic retrograde cholangio-pancreaticography revealed smooth compression stenosis at this lesion. He had suffered from tuberculous lymphadenitis of the neck 5 years before, and a tuberculosis skin test was positive. Operative findings included 2 lymphnode swellings (2 cm in diameter) around the choledochalduct. After cholecystectomy and resection of the lumphnodes, the common bile duct was dilated by Hegar's dilator and a T-tube was inserted. Tubercle baccilus was identified from these lymphnodes by the smear test. Intermittent liver dysfunction occurred during the postoperative course. The patient was discharged 46 days after surgery. The surgically treated cases of biliary tract stenosis caused by tuberculous lymphadenitis, are rare. Only 8 cases have been reported in the Japanese literature, and sporadically a few cases abroad. Lymphnode resection was performed in the 8 cases reported in Japan, and choledochojejunostomy was performed in three of those cases.View full abstractDownload PDF (9347K) -
Taihei Koh, Masahiko Miyata, Noritsugu Ogawa, Masaaki Izukura, Masahir ...1990 Volume 23 Issue 4 Pages 914-918
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of mediastinal pancreatic pseudocyst associated with esophageal hiatus hernia. The patient, a 54-year-old man who had a history of chronic pancreatitis, complained of epigastralgia and back pain. A gastrointestinal series showed displacement of the lower esophagus. Computed tomography revealed a 5 cm cyst behind the lower esophagus. Five months later, the mediastinal cyst had decreased in size to 2 cm in diameter and a new 7 cm cystic mass appeared at the tail of the pancreas. Distal pancreatectomy and extirpation of the mediastinal cyst through the esophageal hiatus hernia were performed. Thirty-five cases reported mediastinal pancreatic psuedocysts world-wide were reviewed. When there was communication between the mediastinal and abdominal cysts, the abdominal cyst was drained. But when there was no communication, external drainage or extirpation of the mediastinal cyst was performed.View full abstractDownload PDF (9581K) -
Hideki Machishi, Minoru Kurata, Makoto Suzaki, Hideaki Sakai1990 Volume 23 Issue 4 Pages 919-923
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSSo-called mucin-producing pancreatic cancer is a new clinical entity that has been detected in Japn. It is of special interest that this disease has a better prognosis than ordinary pancreatic cancer. We report on a patient with mucin-producing pancreatic cancer, and in addition provide a clinical analysis of 45 cases previously reported in Japan. A 59-year-old man was admitted to our hospital with pain in the left upper quadrant of the abdomen and in the back. US, CT and ERCP findngs revealed a possible tumor of the body of the pancreas, and total pancreatectomy was subsequently performed. The pathological diagnosis on the resected specimen was papillary adenocarcinoma with slight invasion of the pancreatic parencyma. The patient had no signs of recurrence for almost 3 years after the operation. Then marked elevation of tumor markers was seen at a regular check up. He was readmitted to our hospital for evaluation, but he died of progressive dyspnea 1 month after readmssion. His postoperavie course lasted 3 years and 6 months. According to our review of past cases, the tumors in 16 of 39 patients (41.0%) showed invasion of the pancreatic parenchyma, and 4 of these 16 patients (25.0%) died of metastases. However, there were no deaths in the patients with no invasion. We conclude that tumor invasion of the pancreatic parenchyma is one of the poor prognostic factors in this condition.View full abstractDownload PDF (11060K) -
Kazuhiro Mori, Akio Yamaguchi, Nagayoshi Oota, Yoshiyuki Kurosaka, Tet ...1990 Volume 23 Issue 4 Pages 924-928
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe experienced a case of adenomatosis coli complicated with adrenocortical carcinoma. The patient was a 19-year-old man with epigastralgia as the chief complaint. In April 1987, right adrenectomy was performed under the diagnosis of a right adrenal tumor, and the diagnosis was established as benign adrenocortical adenoma. In June, a reoperation was performed for intraperitoneal relapse of the right adrenal tumor. In July, the patient was hosptalized for the third operation. On August 16, laparotomy was performed under the diagnosis of Gardner's syndrome and hepatic metastasis of the adrenal carcinoma. Foci of the relapse in the right subdiaphragmatic, caudate lobar and right adrenal local regions were resected and then total colectomy and ileocolostomy were performed. Histological examination confirmed the diagnosis as intraperitoneal relapse of adrenal carcinoma. Six months postoperatively, the patient died of a relapse adrenal carcinoma. The complication of adenomatosis coli by adrenal carcinoma has been reported only twice in the literature. It is so rare that we felt that we should report the present case, which seems to be the third.View full abstractDownload PDF (9766K) -
Hiroyuki Naitoh, Yoshimasa Kurumi, Noyuri Kizuki, Hiroshi Oka, Junsuke ...1990 Volume 23 Issue 4 Pages 929-933
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSBenign tumor of the liver is extremely uncommon compared with malignant tumor of the liver. It is rare to be detected during life because most of them are asymptomatic. But recently, it has been detected more frequently due to advanced radiographc diagnostic modality. We experienced a case of giant lipoma of the liver associated with lipoma of the colon and intrahepatic cholangiocarcinoma. Only 16 cases of lipoma of the liver pathologically proved have been reported in the worldwide lterature.View full abstractDownload PDF (8424K) -
Shinya Adachi, Muneaki Watanabe, Akira Osada, Azusa Ozaki, Yoji Iwasak ...1990 Volume 23 Issue 4 Pages 934-937
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 62-year-old male was admitted to the hospital with acute abdominal pain. X-ray films of the abdomen showed ileus due to sigma volvulus, and he underwent a repairing operation. After surgery, myxedematous skin appeared on his extremities, and thyroidal examination revealed the patient had had marked hypothyroidism with myxedema megacolon. For three months after the surgery he received thyroid hormone treatment, but paresis of the large intestine worsened. Accordingly, the sigmoid colon was resected. Histological examination revealed marked deposits of myxedematous material in the submucosa layer and the internal circurating muscles. He was discharged from the hospital and is living well with treatment with levothyroxine sodium.View full abstractDownload PDF (7833K) -
Katsuhiro Tanaka, Toshikatsu Taniki, Shunsuke Niki, Taizou Fukumoto, D ...1990 Volume 23 Issue 4 Pages 938-942
Published: 1990
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 32 year-old woman was admitted to our hospital with a complaint of constipation. Colonoscopy and barium enema examination showed a nearly 10 cm longstenosis of the Ra, Rs 10 cm proximal to the anal verge. The mucosa of the rectum was intact and histologically normal. Computed tomography (CT) showed 2 cm wide, low density area around the rectum. During an operation the rectum, the uterus and the overies were found to be tightly adhesive. Especially around the rectum, a 3 cm wide mass existed. pathological examination showed the mass around the recutm was encapsulated normal fatty tissue without malignancy, and with little fibrous or inflammation. We diagnosed it as pelvic lipomatosis.View full abstractDownload PDF (9617K) -
In Esophageal CancerKaichi Isono1990 Volume 23 Issue 4 Pages 943-947
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe evaluate the extensive thoracic esophageal cancer opration in comparison with the standard operation from the standpoint of quantity, degree of operative invasion, postoperative complications and operative complaints based on inquiries to the patients. The extensive operation was significantly better in some cases from the point of quantity. The degree of operative risk was high. Attention should be paid to recurrent nerve paralysis as a postoperative complication. The patients had more complaints during the first 3 postoperative years. The patients who recognized their disease as cancer complained more and were less active, as compared to those not recognizing cancer.View full abstractDownload PDF (8957K) -
Katsu Hirayama, Tetsuro Nishihira, Michihiko Kitamura, Shozo Mori1990 Volume 23 Issue 4 Pages 948-952
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSCervical and extended upper mediastinal lymph node dissection for thoracic esophageal carcinoma was evaluated in relation to the quality of life. During the period from 1986 through 1988, 89 thoracic esophageal carcinoma were resected in our department with R-II or R-1 I lymph node dissection through right thoracotomy. Such extended lymphadenectomy was compared with the conventional lymphadenectomy in regard to postoperative pulmonary function and performance status. Eleven of the 89 patients underwent extended lymphadenectomy while the others underwent the conventional lymphadenectomy. There were no direct operative deaths in either group. Mucosal changes in the trachea and bronchi were somewhat more pronounced in the extended lymphadenectomy group than in the conventional lymphadenectomy group, although there was no significant difference. On the other hand, the damage to the cough reflex and the incidence of temporary recurrent laryngeal nerve palsy were significantly higher in the extended lymphadenectomy group. However, there was no difference in the incidence of pulmonary complications between the two groups. Patients surviving more than 6 months after the operation were asked about their life style, via a questionaire. There were no differences in performance status and dietary habits betweent he two groups. Furthermore, the pulmonary function of patients with extended lymphadenectomy was somewhat better than in those with conventional lymphadenectomy long after the operation. Although extended lymphadenectomy causes great surgical stress, these results suggest that a high value should be placed on extended lymphadenectomy in relation to the quality of life.View full abstractDownload PDF (8976K) -
Hiroshi Habu, Masashi Kono, Masao Tani, Toru Honda, Fumio Kando, Naoya ...1990 Volume 23 Issue 4 Pages 953-958
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTo analyze the effects of operative procedures on the quality of life, a questionnaire was mailed to 318 patients who survived more than one year after the resection of gastric cancer. Replies came from 291 patients (92%). The questionnaire consisted of 13 questions which were divided into six items: I Symptom & Doctor's visit, II Meal & Defecation, III Activity & Work, IV Economic state, V Mental state and VI recreation & Friends. Each question was evaluated with scores from 2 (satisfactory) to 0 (unsatisfactory). Statistical differences between the mean scores for each item was examined in the two groups of patients who had undergone different operative procedures. The mean scores for items I, V and VI, and total score in patients who had undergone total gastrectomy (n=87) were significantly lower than those in patients who had had partial distal gastrectomy (n=204). The mean scores for itesm I, III, V and VI, and the total score in patients with combined resection of the neighboring organ (n=43) were statistically lower than those in patients without it (n=248). Presence or absence of thoracotomy yielded no significant difference in the scores for all items. The score of item IV in patients with extended lymph node dissection (N3 or more) was lower than that in patients without it. The scores for all six items in patients having symptom were significantly lower than those in patients without it. To cure the present symptom seems to be effective in improving the quality of the patient's life.View full abstractDownload PDF (10019K) -
Takeshi Iwanaga, Hiroshi Furukawa, Masahiro Hiratsuka, Shingi Imaoka1990 Volume 23 Issue 4 Pages 959-962
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSPostoperative states after two different surgical operation methods were compared in the patients with Borrmann type-4 gastric carcinoma. One is left upper abdominal evisceration accompanied with Appleby's method (Group A) as a super-extended operation, and the other is total gastrectomy with pancreaticosplenectomy (Group B) as a conventional operation. The postoperative status was worse in Group A than Group B in terms of some parameters. However, the difference between the two groups were small, and the postoperative survival rate in stage II and III was better in Group A than Group B. Therefore, the super-extended operation may be indicated for such patients. Meanwhile, the quality of lfe of one suffering from cancer should be evaluated by each patient individually though the patient's judgement is influenced by his or her own viwe of life, religeous beliefs, etc., as well as attitude toward the surroundings. That is, the degree of mental maturity is thought to play the most important role in each patient's decisions regarding the quality of life.View full abstractDownload PDF (7361K) -
Tatsuya Yoshikawa, Fujio Hanyu, Mitsuji Nakamura, Toshihide Imaizumi, ...1990 Volume 23 Issue 4 Pages 963-966
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe reviewed our experience with 50 patients who had hepatopancreatoduodenectomy (HPD) for carcinoma of the bile duct and the gallbladder. Thirteen patients died within one month after HPD for an operative mortality rate of 26%. The operative mortality rate was strongly related to the extent of hepatic resection. In the patients who had pancreatoduodenectomy and extended right hepatectomy, the operative mortality rate was 63%, whereas it was 3.2% in those with pancreatduodenectomy and partial or segmental hepatic resection. Nineteen (38%) of the 50 patients had curative operations. Thirty six patients were selected for survival study. Three-year survival rate was 19%. The three-year survival rate for the patients with curative operation was 46%. Among the 16 patients who have survived more than one year after the operation, 13 (81%) have achieved a good quality of daily living (PS 0 in 1 and PS 1 in 12), which was not related to the extent of hepatic resection. HPD can produce good survival and a favorable postoperative performance status for patients with carcinoma of the bile duct and the gallbladder.View full abstractDownload PDF (7935K) -
Takukazu Nagakawa, Keiichi Ueno, Tetsuo Ohta, Hironobu Kobayashi, Taka ...1990 Volume 23 Issue 4 Pages 967-972
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSExtended operation have been performed since the end of 1973 in order to improve the reuslts of surgery for carcinoma of the pancreas and biliary tract. Though the problem of incomplete resection still remains in extended operations for carcinoma of these areas, this report introduced the operative procedures and the surgical results of the extended operations, and appraised the extended operations from the viewpoint of the quality of life. The quality of life was investigated for patients with combined resection of the liver and pancreas, resection of the nerve plexus of the pancreas head, and dissection of lymph nodes. Resection of the nerve plexus around the superior mesenteric artery was thought to have the greatest effect on the quality of life among these three factors. In the future, pancreatoduodenectomy will increase for carcinoma of the gallbladder, but will decrease for carcinoma of the hilar bile duct. Dissection of lymph nodes around the abdominal aorta and combined resection of the portal vein and the superior mesenterc artery will be more necessary to improve results of surgery for carcinoma of the pancreas life.View full abstractDownload PDF (10253K) -
Tadashi Watanabe, Katsuki Ito, Kozo Kiriyama, Masashi Yamauchi, Seiji ...1990 Volume 23 Issue 4 Pages 973-978
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSSeventeen patients (8 males and 9 females) with local recurrence of rectal cancer were treated by total pelvic exenteration (TPE) combined with sacral resection. The mean operation time and blood loss were 7.3 hours and 5.580 ml, respectively. No operative death occurred, but there were four postoperative complications, a perineal abscess, and three intestinal fistulas. The impact of the treatment on the quality of life was determined by the survival rate, effect of sacral resection, stomal care, and a questionnaire given to the patients. Survival curves constructed according to the Kaplan-Meier method showed that the patients with TPE have a survival rate of about 60% in comparison with a two-year survival rate of 13% in the palliated group. Two patients are alive at 56 months and 75 months with no evidence of disease. Perineal pain was relieved and walking and sitting were not affected by sacral resection. Nine patients who were interviewed required approximetely 1 hour for urinary and colostomy stomal care. In comparison with abdominoperineal resection patients, work, social activity, and psychological state were worse for TPE patients, but in the questionnaire no difference was found in diet, sleep, and bathing, which were ranked according to a 0-4 scale. Ths procedure seems to be a reasonable treatment for palliation and for full recovery in certain patients. However early detection of local recurrence, multimodal therapy including radiotherapy and chemotherapy, and psychological therapy are required to develope a good prognosis and quality of life.View full abstractDownload PDF (9785K) -
Masayuki Yasutomi1990 Volume 23 Issue 4 Pages 979-984
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSPatients with colorectal cancer who received radical surgery from 1975 to 1988 were evaluated from the viewpoint of the extended surgery and postoperative quality of life (Q.L.). Assessment was by questionnaire on the colostomy after abdominoperineal resection (APR). APR is regarded as an extendd operation, because 68% of rectal cancers are treated by a sphincter saving operation and only 32% by APR. In spite of guidance by enterostomal therapists, 75.8% of 132 APR patients complained of irregular bowel movements, 37.9% of expulsion of gas and 34.8% of an offensive odor. Dietary restriction was common and 59.1% of the patiens with APR refrained from overeating and from eating irritating and fatty food. After pelvic node disseaction, 51.2% of the patients showed mild or moderate dysuria and 43.5% severe dysuria, while the incidence was 31% and 12.5%, respectively, after conventional dissection. Erectile male impotence was increased to 85.9% after pelvic node dissection from 71.2% after conventional dissection. 78.1% of patients returned to work and 21.2% retired from work after pelvic node dissection, while the corresponding figures were 86.5% and 13.5% after conventional dissection. Metastasis to the pelvic nodes occurred in 18 (12.2%) of 148 rectal cancer patients examined by the clearing method. The rate was increased to 30.8%, when we included cancers infilirating deeper beyond the muscle layer and located 6 cm or less from the anal verge. The actuarial survival was improved 6.2% after pelvic node dissection. Pelvic node dissection should by limited to cancers with a hgher incidence of nodal involvement.View full abstractDownload PDF (10783K) -
Makoto Hashizume, Seigo Kitano, Hiroya Wada, Kazuo Tanoue, Keizo Sugim ...1990 Volume 23 Issue 4 Pages 985-989
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIn 64 patients with portal hypertension, the vascular pattern of the lower esophageal varices was classified into two types, palisading and bar types; the gastric varices were classified into cardiac and fundic types, basedon the percutaneous transhepatic portography. The patients with the bar type of esophageal varices had poorer liver function and more of them had a history of bleeding from the esophageal varices than the patients with the palisading type (p<0.05). Significantly more small venous dilation appeared in patients with the bar type after sclerotherapy. It was more difficult to sclerose the esophageal varices of the giant bar type and the tumorous type of gastric varices by sclerotherapy alone than by surgery or the combination therapy of percutaneous transhepatic obliteration of the varices with sclerotherapy. Thus, treatment should probably be designed in each patient according to the vascular pattern of the lower esophagus.View full abstractDownload PDF (10134K) -
Yozo Aoki, Hiroshi Tanimura, Hiroaki Kawashima, Masakazu Sasaki, Koshi ...1990 Volume 23 Issue 4 Pages 990-995
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSMultiple slice dynamic computed tomography (CT) scan using the table-sliding rapid sequence scan wasperformed in 103 patients to assess its usefulness in diagnosing pancreatc lesions and in deciding about operability.In acute and chronic pancreatitis, with deffuse lesions, the characteristic features could be obtained better from theimage than from the time-density (T-D) curves. In pancreatic cysts, the existence of the lesion could be identifiedeven on plain CT, and the T-D curves revealed the more conspicuous characteristics of the disease. It is importantto distinguish pancreatic cancer from tumor-forming chronic pancreatitis. By the present CT scan using contrastmedium, with pancreatic cancer the undamaged area was imaged, but no image was produced by the cancerousarea; in tumor-forming chronic pancreatitis, the imaging pattern at an early stage was similar to that in pancreaticcancer, but with the lapse of time, the swelling area was also imaged, thereby making perfect differentiationbetween two diseases possible. The accurate diagnosis rates of pancreatic cancer by plain CT were 0, 75, and 85% in T1, T2, and T3, respectvely, and for the first time 100% in T4; the rates by the present CT technique were 100% all incases of pancreatic cancer including T1 cases.View full abstractDownload PDF (11245K) -
Masahiro Yoshida, Masahiko Ozaki, Hiroshi Yamamoto, Takamitus Ariga, S ...1990 Volume 23 Issue 4 Pages 996-1000
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSMagnetic resonance imaging (MRI) was evaluated for diagnosing lymphnode metastasis of colorectalcarcinoma in 26 patients (9 with ascending, transverse and descending colon carcinoma, 17 with rectosigmoidcarcinoma). The detectability of lymph node near A. colica dextra, media and sinistra is not so good. The lymphnodes around the aorta were clearly detected by coronal and sagittal images. The lymph nodes around theintrapelvic arteries were detected by oblique images. The detectability of lymph nodes around the aorta andintrapelvic arteries is 24% in 0-5 mm nodes, 89% in 5.1-10 mm nodes and 100% in over 10 mm nodes. Metastaticlymph nodes were detected by MRI at a 94% rate. Using this method, it is easy to detect lymph nodes, and MRIshould be quite useful for determining lymphadenectomy.View full abstractDownload PDF (9227K) -
Junichi Sakamoto, Tadashi Watanabe, Tomoyuki Kato, Hiroki Murayama, Ki ...1990 Volume 23 Issue 4 Pages 1001-1005
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSH-15, a mouse monoclonal antibody was established and selected for a tumor localization study because theantigen was shown to be expressed in a high percentage of primary and metastatic colorectal cancers. The epitoperecognized by H-15 is a neuraminidase sensitive glycoprotein (200 kd) and close cross reactivity with sialyl-Leadeterminant was detected by the inhibition test. Tumor imaging with human colorectal tumor bearing nude miceusing 125I-labeled H-15 was successful. H-15 labeled with 131I was given intravenously over a dose range of 0.2mg-10 mg to 28 patients with colorectal tumors. No significant toxicity or side effects were seen. Direct tumorimaging was successful in 4 out of 20 hepatic metastases and 3 out of 8 local lesions from days 4-6 after theantibody injection. Thus, tissue biopsy specimens and scintigraphy have proved that imaging of metastaticcolorectal cancer is possible with monoclonal antibody 11-15. For the precise localization of tumor imaging, 99m Tc-MPD was infused simultaneously, and the specific location was demonstrated by a subtraction study.View full abstractDownload PDF (9143K) -
Kimio Namatame, Masahiko Ookubo, Naohito Hamai, Mikio Makuuchi, Hiroko ...1990 Volume 23 Issue 4 Pages 1006-1010
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe analyzed from the both clinical and pathological viewpoints. 206 cases operated on for early gastric cancerduring the period between 1975 and 1987. The incidence of lympn node metastasis was 4% from m cancer and 11.9%from sm cancer. Lymph node metastasis occurred in differentiated type and elevated types. In clinicopathologicalanalysis, we considered that limited gastrectomy for early gastric cancer was indicated n type I and type IIa tumorsless than 2 cm in diameter. IIc without a co-existing ulcer was also indicated. Endoscopic ultrasonography was usedto determine the depth of early gastric cancerous invasion. The correct diagnostic rate was 100% for IIc withoutco-existing ulcer and elevated type of m cancer less than 2 cm in diameter. The rate for IIc type sm cancer was71.4%. We concluded that eadoscopic ultrasonography pattern analysis was useful for diagnosingthe depth ofcancerous invasion in limited gastrectomy for early gastric cancer.View full abstractDownload PDF (8953K) -
Masayuki Imamura, Yutaka Shimada, Yasuaki Hattori, Takayoshi Tobe1990 Volume 23 Issue 4 Pages 1011-1015
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe have developed two useful tchniques for curative resectioning of multiple microgastrinomas. The Selective Arterial Secretin Injection test (SASI test) demontratis the feeding artery of gastrinomas, and the Interoperative Secretin test (IOS test) estimates the curability of the resection during the operation. These tests have beendeveloped on the basis of the direct action of secretin in stimulating gastrinoma cells to release gastrin. Tenpatients with Zollinger-Ellison syndrome were examined by SASI test and gastrinomas were located in all of them, though diagnostic imaging techniques or portal venous blood sampling also located some of them. Based on theresults of the SASI test, pancreatoduodenectoy was performed in four patients. All of them had multiple microgastrinomas and have been cured so far. The ISO test was useful in each case to determine the extent ofradicality of the operation. We hope that these two tests will be used routinely in performing curative resection ofgastrinomas.View full abstractDownload PDF (8689K) -
Masato Sakon, Morito Monden, Mitsukazu Gotoh, Toshio Kanai, Kouji Umes ...1990 Volume 23 Issue 4 Pages 1016-1021
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTo investigate the mechanisms involved in the generation of PIVKA-II (protein induced by vitamin K absenceor antagonist-II) in HCC (hepatocellular carcinoma), the amount of vitamin K (K1, MK4, MK7) or PIVKA-II inplasma was measured. The plasma level of vitamin K was not decreased in patients with HCC compared with thatin normal subjects; it was increased in patients with liver cirrhosis (VK1, MK4, VK1 + MK4 + MK7). The plasma evel or positivity rate of PIVKA-II was decreased by the administration of vitamin K. This indicates that themetabolism or availability of vitamin K might be impaired in HCC. In patients with biliary or pancreatic disease, allcases with positive PIVKA-II underwent PTBD (percutaneous transhepatic biliary drainage), indicating that notonly vitamin K deficiency but also its impaired metabolism due to obstructive jaundice might account for thesynthesis of PIVKA-II. Since the impairment of vitamin K metabolism is considered to be one of the characteristicsof HCC, PIVKA-II must be measured without vitamin K administration and if administrated, it should be carefullyevaluated considering the effects of vitamin K on PIVKA-II.View full abstractDownload PDF (10139K) -
Diagnostic and Therapeutic Application of the in Situ Hybridization TechniqueTakahito Yagi, Tadashi Horimi, Takahiro Okabayashi, Izuru Tanaka, Douf ...1990 Volume 23 Issue 4 Pages 1022-1027
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe used the histo in situ hybridization (HISH) technique to study the relationship between oncogene mRNA expression and survival rate and the pathological factors in gastric cancers. In excised specimens the prognosis waspoor in cases those had moderate or marked c-Ha-ras mRNA expression. The degree of expression was mutually related to the degree of lymphnode metastasis. In biopsy specimens, the prognosis in the cases that expressedc-mycmRNA was also extremely poor, the 2-year survival rate being only 38.9%. The investigation of pathological factor ssuggested that the expression of oncogene mRNA may be a new moleculo-pathological factor in gastric cancer andan indicator of malignant potency. It appears that the pre-operative detection of oncogene mRNA in biopsyspecimens can be utilized to diagnose and treat gastric cancer.View full abstractDownload PDF (8614K)
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