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Volume 24, Issue 1
Displaying 1-30 of 30 articles from this issue
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Kunimoto Nezu, Hoichi Kato, Yuji Tachimori, Hiroshi Watanabe, Masayuki ...1991 Volume 24 Issue 1 Pages 1-8
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSEleven cases of adenosquamous carcinoma of the esophagus were studied clinico-pathologically. Seven of them were early esophageal carcinoma. Endoscopic examination of the lesions revealed that seven were elevated, three stenotic and one superficial. Histological examination revealed that the adenocarcinomatous component was of the glandular type in 10 cases and signet ring cell type in one. Ten lesions showed a mixed histological distribution of adenocarcinomatous and squamous carcinomatous components, while one was a collision type of the two components. The prognostic data showed a better prognosis in patients with adenosquamous carcinoma of the esophagus than in those with squamous cell carcinoma, after curative resection with lymph node dissection.View full abstractDownload PDF (16070K) -
Youichi Imaoka, Takashi Matsushio, Kyoji Yamamoto, Hiromi Tokumura, Ts ...1991 Volume 24 Issue 1 Pages 9-13
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe long-term results of valvulofundoplastic esophagogastrostomy to prevent reflux esophagitis after proximal gastrectomy were evaluated. Thirty-four patients were divided into two groups, 18 three years or more after the operation (group A) and 18 less than three years after the operation (group B). Severe heartburn was seen in two patients of group B, in whom reflux esophagitis was seen endoscopically and the antireflux valve was apart from the anastomotic stoma. Patients in group A had only mild complaints. Group A patients also recover better in terms of body weight and dietary habit than those in group B. After 3-4 years, the size of the antireflux valve was reduced to about 80-85% of those measured in the postoperative period. Thus, it seems that an antireflux valve remains effective even after long interval. We think this procedure is easy and yet effective enough to prevent complications of poximal gastrectomy, such as reflux esophagitis.View full abstractDownload PDF (10224K) -
Takuji Iwase, Makoto Seki, Kunio Takagi, Tomoyuki Takahashi1991 Volume 24 Issue 1 Pages 14-20
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTo clarify the risk for gastric remnant cancer, we investigated the long-term prognosis of patients gastrectomized for benign gastroduodenal diseases. 2, 045 patients who underwent gastric surgery for benign diseases at the Cancer Institute Hospital, Tokyo, between 1946 and 1967 were followed up until the end of 1984. During the follow up period, 899 deaths were identified. There were 203 deaths from all cancers (22.7%) and 14 from gastric remnant cancer (1.6%). The relative risk of mortality was calculated as person-years at risk. A significant excess risk of dying from all cancers was observed among patients with an observation period of more than 20 years after surgery (O/E=1.46). Lung cancer mortality was significantly higher from the early postoperative stage (O/E=2.09). On the other hand, the risk of mortality from gastric cancer after gastrectomy was decreased both in the total cases (O/E=0.17) and in the cases in which more than 20 years had elapsed after surgery (O/E=0.27). The main cause of lower mortality from gastric remnant cancer was considered to be removal of the predisposing area of cancer in the stomach.View full abstractDownload PDF (11803K) -
Masatsugu Kitamura, Kuniyoshi Arai, Kaoru Miyashita1991 Volume 24 Issue 1 Pages 21-27
Published: 1991
Released on J-STAGE: November 22, 2011
JOURNAL FREE ACCESSWe investigated the standards for determining the surgical procedure for early gastric cancer according to the relationship between age, depth and macroscopic type of cancer, tumor size, histological type of cancer andlymph node metastasis, and that between the degree of lymph node dissection and prognosis of the disease. The subjects were 580 patients suffering from early gastric cancer. The incidences of lymph node metastasis in cases of mucosal cancer and submucosal cancer were 9/304 3.0% and 49/276 (17.8%), respectively. The incidence of lymph node metastasis among the total cases of early gastric cancer, which tended to decrease with age, was significantly lower in patients over 70 years old than the incidence in patients younger than 50 (p<0.05). Concerning macroscopic types, were found a high incidence of lymph node metastasis in the cases with depressed type (IIc). The incidence of lymph node metastasis rose with increase in the major axis. On histological investigation, we obtained similar results in both cases of mucosal and of submucosal cancer. The incidence of lymph node metastasis in the differentiated types was significantly lower than in the undifferentiated types (p<0.05). In particular in patients over 70 years old with the differentiated type, the incidence of lymph node metastasis was low. The metastasis to the lymph node in the second group could be seen only in No.7 lymph node. As for the relationship between the degree of lymph node dissection and prognosis of patients, there was no difference between lymph node dissection in the first group (R1) and in the second group (R2). Consequently, in patients over age 70 suffering from gastric cancer with complications, if gastric cancer is theoretically regarded as differentiated mucosal cancer, lymph node dissection of R1 (including No.7 lymph node in the second group) is probably the proper method.View full abstractDownload PDF (13322K) -
Hiroshi Fujimasa1991 Volume 24 Issue 1 Pages 28-37
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTo study the involvement of nerve regeneration in recurrence of ulcers after vagotomy, morphologic changes of the intramural nerve elements in the stomach were observed by light and electron microscopy over a maximum of 4 years after selective proximal vagotomy combined with transgastric myotomy and the effect of acid reduction by gastric analysis. Histomorphological observation revealed long term degeneration and defluxion of the nerves at the inferior TGM and amputation neuroma at the superior TGM after a long period had passed. These findings indicate that although the capacity for regeneration existed at the edge of the nerve, it could not always become a recommunication path to compatible tissue, and thus there was little possibility for regeneration of the nerve. Because the effect of acid reduction continued, sufficiently expanded surgery like SPV + TGM as applied in this study was considered not to lead to functional regenaration.View full abstractDownload PDF (21776K) -
Takesada Goto, Takehide Asano, Kazuo Watanabe, Toshio Nakagohri, Takas ...1991 Volume 24 Issue 1 Pages 38-44
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSSurgical tissue injury accelerates the transfer of amino acids from skeletal muscle to the liver for protein synthesis required for the maintenance of immunocompetence and wound healing. For clinical measurement of this function, we developed a new indicator, the amino acid utility index (AAUI), by using the rate of muscle release of amino acid (m-RR) and the rate of central plasma clearance of amino acids (CPCR-AA) reported by Clowes et al in 1984. They are the indexes of muscle proteolysis and whole body protein turnover, and AAUI is expressed by the formula.
AAUI (ml/μmol) =CPCR-AA/m-RR
Thirty patients were studied before and after recovery from surgical stress and were divided into four groups. In group 1, the control, seven patients with normal liver function had received esophagectomy. In group 2, nine patients had received hepatectomy of one segmentectomy or smaller resection. In group 3, ten patients had received hepatectomy of 2 or 3 segmentecotmies. In group 4, four patients had died of liver failure after hepatecotmy. According to the degree of surgical stress, the values of m-RR as well as CPCR-AA were increased in each group on the 2nd post-operative day. But the values of AAUI were 7.8±0.9 (group 1), 8.2±2.1 (group 2), 4.7±2.1 (group 3) and in group 4 marked decrease below 3.0 was noted during the immediate postoperative period. This finding suggests that AAUI can be a clinical prognostic index for estimating hepatic function without the influence of surgical stress.View full abstractDownload PDF (11128K) -
Hiroyuki Suzuki, Masaru Miyazaki, Toshio Isono, Katsuji Okui1991 Volume 24 Issue 1 Pages 45-50
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe effect of intraportal infusion with acarubicin (ACR) and lipiodol (LP) on normal liver and regenerating liver was studied in rats. In normal liver intraportal infusion of ACR and LP had no effect on the serum transaminase level or the aminopyrine breath test (ABT). In regenerating liver, hepatic DNA synthesis was significantly inhibited 24 hours after two-thirds hepatectomy by intraportal infusion with ACR and LP, but the peak of hepatic DNA syntheis was delayed at 36 to 48 hours after hepatectomy. The decrease of the ABT and the increase in serum transaminase level were more marked in regenerating liver than in normal liver, but there were no intragroup differences. The ABT values depressed after hepatectomy had returned to normal 3 weeks after the operation. No deaths occured until 21 days after infusion and hepatectomy. These data show that intraportal infusion with ACR and LP caused no obvious damage to normal liver. Although the infusion in regenerating liver induced slight suppression and delay in DNA synthesis, the hepatic functional mass depressed after hepatectomy soon recovered to the normal level. In conclusion this study suggests that intraportal infusion with ACR and LP is a safe therapeutic modality even after hepatectomy.View full abstractDownload PDF (11868K) -
Tohru Segawa, Kunihide Izawa, Shigeki Tokunaga, Kazuhide Ura, Teiji Ma ...1991 Volume 24 Issue 1 Pages 51-58
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSPreoperative CT scans obtained after transcatheter arterial embolization using Lipiodol and gelatin sponge (Lp-CT) in 30 patients with resected hepatocellular carcinoma (HCC) were reviewed. The findings of preoperative Lp-CT were compared with macro-and microscopic findings of the resected specimen in this study. There were 27 males and 3 females. The mean age was 59.5 years. The accumulation pattern of Lipiodol (Lp) in the main tumors on CT was divided into 4 types according to the extent of Lp accumulation: type I, diffuse type (16 cases); type II, mottled type (7); type III, spotty type (4); type N, minute type (3). Small nodules of the cancer were often seen in type I, while large nodules were often found in type N. Serum a-fetoprotein levels after transchatheter arterial embolization with Lp (Lp-TAE) were reduced in 80% of the cases in type I, 50% in II, 25% in III and 80% in N. The mean necrotic rate of the main tumor was 79.6% in I, 52.1% in II, 13.8% in III, 63.3% in IV. Seven cases, all of whom were type I, showed complete necrosis of the main tumor in the resected specimen. The necrotic rate of trabecular type HCC was higher than that of solid, pseudoglandular type. CT findings after Lp-TAE can be helpful to elucidate the effects of Lp-TAE on hepatocellular carcinoma.View full abstractDownload PDF (14806K) -
Akira Usuba, Ryoichi Motoki, Mitsunori Takahara, Kazuhito Matayoshi, Z ...1991 Volume 24 Issue 1 Pages 59-67
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTo determine the relationship between blood coagulatory disturbance and obstructive jaundice, we studied the hypercoagulable state in 12 patients with obstructive jaundice due to pancreas head cancer, common bile duct cancer or chronic pancreatitis who had undergone radical resection after choledochal drainage. Before the choledochal drainage, the hypercoagulability was higher in patients with more than 20 mg of total bilirubin (TB) per dl than in patients with less than 20 mg/dl. After the choledochal drainage, the hypercoagulabe state disappeared, while a low level of antithrombin III (AT III), slight platelet aggregation and fibrinolytic activity remained. The hypercoagulability increased markedly again immediately after the operation and a correlation between hemorrhage and the rate of decrease in platelet count (PLT) was noted. A marked decrease in PLT and/or AT III immediately after the operation often warned of multiple organ failure and/or insufficiency of anastomosis. The postoperative hypercoagulable state was reversed within a week in uneventful cases, while it was delayed in cases complicated by multiple organ failure and/or insufficiency of anastomosis.View full abstractDownload PDF (15023K) -
Takao Nakagawa, Tadashi Suzuki, Masatake Ishikawa, Kiyotaka Nakajima, ...1991 Volume 24 Issue 1 Pages 68-72
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIn managing abdominal trauma, newer noninvasive imaging techniques such as ultrasonography and CT usually make an accurate diagnosis possible as far as injuries to paranchymatous organs are concerned. However, in diagnosing injuries to luminal organs, nothing decisive is yet available, except of intraabdominal free air radiological observation. In the last 7 years and 4 months, 380 cases of abdominal trauma were experienced at our institution. The ultrafine laparoscope with a 3.4-mm or 2.0-mm external diameter was used in 22 of these cases where injuries to luminal organs were suspected and indication for surgery was at issue. Intraabdominal organ injuries were demonstrated in 21 cases and in 12 cases (57.1%), direct observation of the injured site was possible. Laparoscopic findings were decisively indicative for an emergency operation in 5 cases (22.7%); i.e., 3 cases of gastrointestinal tract rupture and 2 cases of progressive intraabdominal bleeding. The other 17 patients with minor laparoscopic findings improved with conservative therapy, and it can be said that proper determination of the indication for an emergency operation was made in all 22 cases. Three patients with iatrogenic injury were included, and all of them were spared unnecessary laparotomy. From the above, it may be concluded that in managing abdominal trauma where the indication for surgery is difficult to assess, laparoscopy is a quite useful diagnostic aid.View full abstractDownload PDF (9270K) -
Akira Kaneko, Kuniyasu Yamashita, Takuro Ogata1991 Volume 24 Issue 1 Pages 73-80
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSAKA-2, a USSR-made anastomotic device, whose feature is using compression rings instead of staples, is currently used in some clinics. By using the colons of 48 adult mongrel dogs, the healing process in AKA-2 intestinal anastomosis, which has not yet been pricisely reported, was examined by histology, microangiography and the pressure resistance test. Three dogs died due to anastomotic leakage but the others showed no serious complications. The compression rings were usually expelled between the 3rd and 5th days. Histologically, a slight inflammatory cell reaction was observed at the anastomotic site, but a severe inflammatory process or abscess formation did not occur. Pronounced proliferation of fibroblasts appeared from the 3rd day and the wound healing was almost completed on the 7th day. Throughout all healing processes, stenosis and excessive granulation formation were not observed. Microangiographic study showed that cross blood flow at the anastomotic area appeared on the 5th day and was increased on the 7th day. The mean pressure resistance also increased to 257±11.4 mmHg on the 7th day. The present study shows that AKA-2 is a useful device for intestinal anastomosis, since it does not leave any foreign materials such as staples. It ensures the quick wound healing of the layer-to-layer formation with no stenosis.View full abstractDownload PDF (17007K) -
Yuichi Machiki, Hirotoshi Ohta, Kaoru Azekura, Makoto Seki, Masashi Ue ...1991 Volume 24 Issue 1 Pages 81-88
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSNine hundred seventeen patients who underwent surgery for colorectal cancer during 1976-1985 at Cancer Institute Hospital were studied retrospectively to compare the clinicopathological features and operative risks in 114 aged greater than or equal to 75 (GE75) and 803 less than 75 (LT75). There was no significant difference in the rate of curative resection between GE75 and LT75. The clinicopathological study revealed that the colorectal cancer in GE75 had a higher grade of malignancy. Cancer invasion to neighboring organs was more frequently observed in GE75 (p<0.01). Lymph node metastasis and peritoneal dissemination tend to be more frequent, and clinical stage also to be more advanced in GE75. Thus, there was statistically significant difference in 5-year cumulative survival rates between GE75 and LT75 (p<0.001), in spite of the fact that the analysis excluded patients who died of other diseases or died within a month. The evaluation of operative risk revealed higher in GE75. A statistically significant difference was observed in frequency of postoperative death within a month and postoperative complications, especially respiratory dysfunction and multiple organ failure between GE75 and LT75 (p<0.01). Cardiovascular, pulmonary and renal dysfunction estimated preoperatively were significantly observed in GE75 (p<0.01). There was good correlation between these preoperative assessment and rate of postoperative death within a month. The operative indication for colorectal cancer in GE75 should be the same as those for any younger group. Careful preoperative assessment of cancer grade and operative risks correcting preoperative general conditions may improve the survival rate.View full abstractDownload PDF (14569K) -
Hiroshi Kashiwagi, Fumio Konishi, Tomoyuki Sato, Takashi Kataoka, Hiro ...1991 Volume 24 Issue 1 Pages 89-93
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSClinical courses of 10 patients with brain metastasis from colorectal carcinoma were retrospectively analyzed; seven patients received surgical treatment, either total or partial removal of the metastatic tumor, and three received conservative treatment only. In the surgically treated group, one patient lived 15 months after removal of the brain metastasis, and only two died of brain metastasis. On the other hand, all three non-surgically treated patients died within three months after the detection of brain metastasis, two of them died of brain metastasis, two of them died of brain metastasis. Surgical treatment was effective in alleviating neurological symptoms to some extent in all patients, but conservative maneuvers afforded slight temporary relief in only one of the three. We are of the opinion that surgical removal of a brain metastasis from colorectal carcinoma can not only alleviate neurological symptoms but also prolong patient' lives.View full abstractDownload PDF (9400K) -
Naomi Kawata, Masaroh Hayashi, Kenji Inoue, Kengo Tsunekawa1991 Volume 24 Issue 1 Pages 94-97
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA case of diverticulum that developed from the abdominal portion of the esophagus is reported. A 67-year-old male complained of epigastralgia and body weight loss. Upper gastro-intestinal roentgenography and endoscopy revealed a diverticulum of the esophagus just above the esophago-gastric junction, 2 cm in size. It was small but his symptoms were significant, so resection with laparotomy was performed. Partial fundoplication was added to avoid gstro-esophageal reflux. Histologically the resected specimen was true diverticulum. In the esophagus, parapharyngeal, epibronchial, and epiphrenic diverticulum are common, but only one case like ours have been reported.View full abstractDownload PDF (6693K) -
Haruhiko Nagami, Takayoshi Fukuda, Katsuhiro Tamura, Masahisa Nakagawa ...1991 Volume 24 Issue 1 Pages 98-102
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe experienced a 74-year-old woman with advanced gastric carcinoma of which the components were hepatoid adenocarcinoma coexisting with chorioepithelioma in the stomach. This case was stage IV {P0, H1, n1 (+), sei} carcinoma and total gastrectomy (R2), distal pancreatectomy and partial transverse colectomy were performed. Histopathological investigation of the surgically removed specimen revealed widespread hepatoid adenocarcinoma with medullary proliferation and, in the fundus, chorioepithelioma which was composed mainly of trophoblasts with synchitiotrophoblastic giant cells, bleeding and necrotic tissues. Immunohistochemical study revealed AFP in the hepatoid adenocarcinoma and hCG in the chorioepithelioma. We speculate that, regarding the histogenesis of the tumor in our case, the development of the gastric carcinoma cells represents a retrodifferentiation of adenocarcinoma cells to the levels of embryonal carcinoma cells and then dysdifferentiation of the embryonal carcinoma cells to both hepatoid adenocarcinoma and chorioepithelioma. The serum AFP level in this patient decreased after surgical removal of the tumor, but she died of progressive proliferated liver metastasis with a significantly increased serum hCG level.View full abstractDownload PDF (10096K) -
Ryoichi Akimoto, Noboru Mizobuchi, Shoji Tsuchiya, Heiwa Furuya, Tadam ...1991 Volume 24 Issue 1 Pages 103-107
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSAccording to the General Rules for the Gastric Cancer Study of the Japanese research Society for Gastric Cancer, in early gastric cancer invasion of the tumor is limited to the mucosa or the mucosa and submucosa of the stomach. But we experienced a very rare case of early gastric cancer which metastasized to not only the inguinal lymph nodes but also the bilateral ovaries. The patient was a 53-year-old woman from whom a biopsy specimen was taken from a right inguinal lymph node and given a diagnosis of signet-ring cell carcinoma. Its primary lesion was in the antrum of the stomach. Although the invasion of the gastric wall was limited to within the submucosal layer, lymph nodes metastasis spread to the paraaortic and inguinal regions. Five months after gastrectomy, a reoperation was performed because of metastatic ovarian tumors. The patient died six months after the reoperation from pnumonitis and peritonitis carcinomatosa. In Japan, 12 cases of superficial gastric cancer with lymph node metastases beyond the paraaortic region, including this case, have been reported. Furthermore, only six patients with superficial gastric cancer had ovarian metastases. This case is a really rare one from the concept of early gastric cancer. In order to think about the prognosis of early gastric cancer like these cases, considering each of their stages might be very important.View full abstractDownload PDF (9438K) -
Masao Kondoh, Yukifumi Kondoh, Yuji Sawaguchi, Hiroshi Shiroto, Shohei ...1991 Volume 24 Issue 1 Pages 108-112
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA rare case of gastric cancer with acanthosis nigricans is reported. A 50-year-old man complained of hyperpigmentation and verruca of the skin, which was histologically diagnosed as acanthosis nigricans. Examination of the upper GI tract revealed IIc-like advanced gastric cancer and a papillomatous change in the esophageal mucosa. Total gastrectomy was performed, but it was non-curative because of mutiple metastases in the para-aortic lymph nodes. Acanthosis nigricans is usually associated with malignant lesions, of which gastric cancer is by far the most common. In the past 10 years, 56 cases of malignant acanthosis nigricans have been reported in Japan. In 45 cases (80.4%) it was associated with gastric cancer, only two of which were early gastric cancer. This indicates that most patients with acanthosis nigricans have advanced gastric carcinoma probably because of ignorance of the high incidence of gastric cancer. As a result curative resection could not be performed. Therefore, it is important to investigate the upper GI tract periodically from the early stage while investigating a case of acanthosis nigricans.View full abstractDownload PDF (8925K) -
Takeo Nishimori, Satoru Kunito, Zensuke Yanagi, Kanji Tokura, Kenzo As ...1991 Volume 24 Issue 1 Pages 113-118
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA rare case of a granular cell tumor of the stomach is reported. A 39-year-old woman visited our hospital in March, 1985 because of the epigastric pain. Radiologic and endoscopic examination of gastrointestinal tract revealed a protruding and semispherical lesion with a clear boundary and smooth surface in the posterior wall of the middle body of the stomach. The lesion had a small depression at the top of the tumor and a bridging fold. The diagnosis was a submucosal tumor of the stomach. Gastrectomy was performed and the resected specimen showed a protruding and semispherical lesion, 18×13 mm in diameter, 7mm in height. A perpendicular section of the tumor was a yellowish-white and clearly lined submucosal mass. Histologically, it was a granular cell tumor, which might be derived from Schwann cell by immunohistochemical study. The postoperative course was uneventful. Granular cell tumors usually arise in the skin or soft tissue and rarely occur in the gastrointestinal tract, especially in the stomach. As far as we know, this is the 9th case in Japan.View full abstractDownload PDF (10662K) -
Shigeyoshi Itoh, Akira Kubo, Toshimichi Takahashi, Ryoto Suzuki, Kohsu ...1991 Volume 24 Issue 1 Pages 119-123
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe association of cholelithiasis with some hemolytic diseases including spherocytosis and the surgical treatment of cholelithiasis have been well documented. But cholelithiasis with unstable hemoglobinopathy has not been reported. We present a case of cholecysto-choledocholithiasis after past splenectomy with unstable hemoglobinopathy. The patient was a 17-year-old male. Splenectomy was performed because of unstable hemoglobinopathy when he was 4 years old. He was admitted to our hospital with the chief complaint of epigastralgia. Abdominal ultrasonography revealed gall stones. Cholecystectomy, choledochotomy and transduodenal-sphincteroplasty were performed. The calculi in the gall bladder and common bile duct contained 90% bilirubin calcium and 10% calcium carbonate. In general splenectomy is the surgical treatment for hemolytic disease. In addition to this operation, indications for simultaneous prophylactic cholecystectomy and splenectomy or sphincteroplasty deserve further study.View full abstractDownload PDF (8705K) -
Masaki Doi, Tsugo Sakakibara, Makoto Katoh, Akeo Hagiwara, Tetsurou Ya ...1991 Volume 24 Issue 1 Pages 124-128
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe experienced two patients with nonfunctioning ilset cell tumor of the pancrease. In case 1, a 41-year-old woman was admitted with consultation of multiple pancreatic tumors from another hospital. Resected specimen after the pancreaticoduodectomy with resection of pancreatic body revealed three tumors located in the pancreatic head and body. Histopathological examination led to diagnosis of malignant islet cell tumor. In case 2, 24-year-old woman was admitted with further examination of left upper abdominal mass. As the tumor was extruded from surface of pancreatic tail, extirpation of the tumor was carried out. Histopathological diagnosis was islet cell tumor, but malignancy was not able to be ruled out. As in both cases any clinical syndromes due to hormonal hypersecretion were historycally not recoginized and pre-operative fasting plasma levels of insulin, glucagon and gastrin were normal, nonfunctioning islet cell tumors were suggested. In general it is well known that islet cell tumor is slow growing and has a relatively good prognosis if thought histopathological diangosis is malignant. In our two cases any findings of recurrence were also not seen one year and six months after the operation. So, we suggest that active surgical resection is important to control of islet cell tumor, even in case of multiple tumors.View full abstractDownload PDF (10656K) -
Takanori Shimura, Masaru Suzuki, Tsuyoshi Tsukamoto, Masao Sanada, Yos ...1991 Volume 24 Issue 1 Pages 129-133
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA case of solid and cystic tumor of the pancreas is reported. The patient is a 24-year-old woman with the chief complaint of epigastric pain. All the laboratory tests were unremarkable, except elevation of Elastase-1. Ultrasonography, computed tomography and angiography revealed a cystic tumor in the pancreatic head. At laparotomy, the tumor was easily enucleated. Gross pathological examination revealed encapusulation, cystic degeneration and hemorrhagic necrosis. Microscopically, the tumor cells formed papillary configurations or microcystic structures. Immunocytochemical studies for neuron specific enolase and α1-antitrypsin were positive, but they were negative for pancreatic enzymes and hormones. Electron microscopic study did not reveal any particular cytoplasmic granules. These findings were compatible with solid and cystic tumor of the pancreas. The patient has been followed for 10 months with no evidence of recurrence.View full abstractDownload PDF (9413K) -
Miki Shibusawa, Wataru Matsui, Takashi Kato, Ippei Kamiji, Hiroto Yosh ...1991 Volume 24 Issue 1 Pages 134-138
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThis paper reports a case of Crohn's disease of the ileocecum with ileovesical fistula manifested by urinar y tract infection. This patient was a 63-year-old female undergoing hemodialysis because of chronic renal failure, who visited our hospital because of pyuria. Barium enema X-ray examination revealed ileocolic type Crohn's disease with an ileovesical fistula. Ileocecal resection and partial cystectomy were performed. Macroscopic examination of the terminal ileum showed a wall thickening and a cobble-stone appearance around the ileovesical fistula. Proximately a longitudinal ulcer 25 cm in length was also observed. Microscopic findings of a cross section of the terminal ileum showed transmural inflammation and fissuring ulcers. Thirty-three cases of ileovesical fistula due to Crohn's disease have been reported in Japan, there were only two women including this case. This seems to be the first report in which the ileovesical fistula was demonstrated in a patient with Crohn's disease complicated by chronic renal failure.View full abstractDownload PDF (8804K) -
Tomoji Nishimoto, Seiichii Akioka, Mitsuhiro Fujino, Hiroyuki Ameno, S ...1991 Volume 24 Issue 1 Pages 139-142
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA case of hemorrhagic Meckel's diverticulum, which was difficult to diagnose preoperatively, is descrived. The patient was a 22-year-old woman who had had repeated episodes of unexplained digestive bleeding intermittently from the age of 17 years. The patient was evaluated by close examinations of the digestive tract, 99mTc phytate abdominal scan, 99mTc pertechnetate abdominal scan, and angiography at each episode, but no findings were obtained except that 99mTc phytate abdominal scan revealed an accumulation in the lower abdomen. She developed massive bloody stool in August, 1989 and was admitted to the hospital. Although the site of hemorrhage could not be determined, laparotomy was performed with suspicion of Meckel's diverticulum. A Meckel's diverticulum 3×4 cm was found in the small intestine 50 cm from the ileal terminal and was resected. This Meckel's diverticulum had no ectopic tissues but showed an annular ulcer near its base. In young patients repeatedly presenting with unexplained digestive bleeding, laparotomy should be considered with hemorrhagic Meckel's diverticulum in mind if 99mTc phytate abdominal scan is positive for accumulation in the lower abdomen.View full abstractDownload PDF (7528K) -
Takashi Sakakibara, Minoru Moriwaki, Hitoshi Funabiki, Noburu Sakakiba ...1991 Volume 24 Issue 1 Pages 143-147
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 63-year-old man was admitted to our hospital with FUO. Progressive anemia and ileus were present. A small intestinal series and angiography led to a preoperative diagnosis of ischemic enteritis with right direct inguinal hernia. Partial ileorectomy and hernioplasty were performed. In the patient, the contents of the hernia were identical with those of a lesion of the ileum, which showed signs of moderate arteriosclerosis. Increasing intestinal pressure due to the hernia, combined with moderate arteriosclerosis, was thought to be the cause. Histologically, the main lesion consisted of granulation of the surface and fibrosis in the muscles. Fever and bleeding were present without sudden abdominal pain or peritonitis in the relatively slow course of the disease.View full abstractDownload PDF (10429K) -
Hitoshi Yasui, Masahiro Shimizu, Akira Yamada, Tomoyuki Maeda, Yoshino ...1991 Volume 24 Issue 1 Pages 148-152
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of resectable metachronous quadruple cancer which was confined to the gastrointestinal tract (cancer of the ascending colon, early gastric cancer, rectal cancer and cancer of the remaining stomach) during an 18-year period. The patient was a 75-year-old man. For each cancer a radical operation was performed (right hemicolectomy, distal gastrectomy, abdominoperineal excision of the rectum and total excision of the remaining stomach). Thereafter, the patient showed no recurrence. These four cancers were detected during long-term follow-up of chronic diseases, and could be surgically treated in the relatively early stage. In this case a particular factor responsible for the multiple cancers could not be found. Up to now 107 cases of quadruple and quintuple cancers have been reported in Japan. In 15 of these cases the cancers were confined to the gastrointestinal system. In our statistical survey of multiple cancers in autopsied cases, the incidence of multiple cancers in the total cases of malignant neoplasms has doubled over the past 10 years, and the level of multiplicity has been high. Therefore, attention should be paid to multiple cancers before and after surgery.View full abstractDownload PDF (10027K) -
Keizo Sugimachi1991 Volume 24 Issue 1 Pages 153-156
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIn the last 2 decades, there has been a striking improvement in Japan in the prognosis of gastric cancer. Much of the improvement is attributed to the increased early detection of the cancer and the standardization of prophylactic lymphadenectomy. However there are limitations to surgery. Here, an effective combined therapy has to be considered. Since the 1980s, the clinical values of prophylactic splenectomy in total gastrectomy has remained an open question. Limited operation for early gastric cancer and extensive en bloc resection for advanced cancer are recently advocated treatments. Although such approaches warrant further attention, it must be stressed that radicality, safety of surgery and the alleviation of symptoms for such patients play a critical part in determining the treatment of choice.View full abstractDownload PDF (7574K) -
Toshio Takahashi1991 Volume 24 Issue 1 Pages 157-161
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSActivated carbon particles are taken up by lymphatics and regional lymph nodes become black up to the para-aortic nodes, when the particles are injected into the stomach wall. Para-aortic nodes are confirmed as the terminal regional nodes of the stomach by the activated carbon particles. Para-aortic lymph node dissections were carried out by the activated carbon particle technique and it was revealed that incidence of metastasis was higher than that of N3. Para-aoritc lymph node metastasis occurred frequently in the patients with gastric cancer involving serosa. The five-year survival for the patients with Stage II and III was 71.0% for R4 lymph node dissection (para-aortic node dissection), 54.7% for R3 dissection and 54.0% for R2 dissection.View full abstractDownload PDF (9296K) -
Takahiko Funabiki1991 Volume 24 Issue 1 Pages 162-166
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSExtended radical gastrectomy for advanced gastric cancer consists of wide gastric resection, extended lymphnodal dissection and saccate bursectomy. In patients with cancer involving the proximal one-third region (C) total gastrectomy is necessary, but in the other patients distal subtotal gastrectomy is recommended. Lymphnodal dissection through the 1st, 2nd and 3rd groups (R3 in The General Rules for the Gastric Cancer Study by the Japanese Research Society for Gastric Cancer) is performed with Cooper scissors, leaving only the artery, vein and bile duct. Saccate bursectomy is aimed to prevent cancer cell dissemination from the lesion invading the serosa of the posterior gastric wall. The rate of metastasis to the third lymphnodal group (n3) was 17.1% in all, 31.8% in cases of ps (+) in histological depth of invasion, and 63.6% in stage IV. Therefore, extended lymphnodal dissection (R3) has to be performed for cases of ps (+). The survival rate was increased by extended lymphnodal dissection in stage III and stage IV. No recurrence of peritoneal dissemination was seen after saccate bursectomy in the cases of posterior wall ps (+).View full abstractDownload PDF (8329K) -
Takeshi Oohara1991 Volume 24 Issue 1 Pages 167-171
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSFrom 1961 through 1976, when we had performed reduced operations or extended operations on 300 patients with early gastric cancer, we found little difference between the 5-year survival rate and the 10-year survival rate (97.1%: 97.7%, 94.8%: 96.2% respectively). The reduced operation means radical gastrectomy with dissection of Group 1 and No.7 lymph nodes (R1 + No.7). Therefore, we have been prospectively performing reduced operations for early gastric cancers from 1976 of the present time, and have arrived for the present at the following conclusions: 1) When we can diagnose intramucosal (m) cancer preoperatively, and can detect Stage 1 (S0P0H0N0) and not touch the induration with the hand intraoperatively, we consider that the reduced operation is suitable. 2) Of prospectively operated 116 patients, six had cancer involvement in group 1 lymph nodes (n1 (+)), but no cancer involvement in group 2 lymph nodes (n2 (-)). All patients had curative resections. Up to the present, there has been no recurrence or death among patients. Therefore, we consider that it is good to perform the reduced operation on these patients cases, in other words it is a reasonable operation.View full abstractDownload PDF (8395K) -
Yoshinobu Sato, Sumio Inoue, Takeshi Nagao, [in Japanese], Nobuo Akiya ...1991 Volume 24 Issue 1 Pages 172
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSDownload PDF (2259K)
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