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Volume 24, Issue 8
Displaying 1-38 of 38 articles from this issue
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Akitoshi Kudo, Masaharu Hori, Keiichirou Ota, Toshifusa Nakajima, Mits ...1991 Volume 24 Issue 8 Pages 2099-2104
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIt is important to analyze lymph-node metastasis in order to select the best operative procedure prior to surgical intervention. A retrospective study of 59 patients with advanced gastric cancer operated on at the Cancer Institute Hospital from February 1988 to June 1989 was performed to compare the CT findings of lymph-node metastasis withe the pathologic reports. CT images were obtained with a 900s TOSHIBA following routine administration of contrast medium (0.5 ml/sec, 100-120 ml iv). CT scans were taken at a 1-cm slice thickness and 1-cm intervals, and the region of the stomach was magnified. The lymph-node metastasis of gastric cancer appeared as follows (1) round or flat (size>15 mm) (2) (a) moth-eaten, (b) packet-formed, (c) high density in periphery, low density in center, (b) relatively high density, and (e) mottled. CT examination has high diagnostic ability for lymph-node groups (3) (minor curvature) and (16) (paraaorta).View full abstractDownload PDF (11561K) -
Risk of Development of Carcinoma in the Gastric Remnant after GastrojejunostomyKen Kondo, Masaji Yamauchi, Ryuichiro Sasaki, Seiji Akiyama, [in Japan ...1991 Volume 24 Issue 8 Pages 2105-2112
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSAs a long-term follow up study, a total 2613 patients who had undergone partial gastric resection for benign gastroduodenal diseases between 1960 and 1964 were examined. The incidence of gastric stump carcinoma in 756 patients alive more than 20 years after gastroduodenostomy and in 299 patients after gastrojejunostomy was determined. Cancer was observed in two patients after gastroduodenostomy and in four after gastrojejunostom y.Th e incidence of cancer (0.539/1000 population) in male patients who had undergone gastrojejunostomy when they were less than 40 years old was four times higher than after gastroduodenostomy. Twenty-eight cancers in the gastric remnant after partial gastrectomy for benign disease were studied. Significantly more cacers (13/18) developed at the anastomotic site by gastrojejunostomy than by gastroduodenostomy (3/10) (p<0.05). Histologically well-differentiated cancer was found in gastritis cystica polypose of the gastrojejunostomy more than 20 years earlier have a higher risk of cancer at the site of anastomosis than the patients who had a gastroduodenostomy.View full abstractDownload PDF (15366K) -
Eiji Kanehira, Masaaki Nakagawa, Yukimitsu Kawaura, Kenji Omura, Hiros ...1991 Volume 24 Issue 8 Pages 2113-2118
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA total of 258 solitary early gastric cancers (149 m-cancers, 109 sm-cancers) were statistically analyzed to estimate the depth of invasion. The influence of seven objective variables was assessed by discriminant analysis to obtain the following discriminant function: Z (x) =-3.44×10-1x1-8.08×10-1x2 +2.08x3-6.79×10-1x4 +6.49×10-1x5 +5.62×10-1x6-2.15 (x1, x2, x3, x4, x5, and x6 are maximum diameter, gross appearance, location-1, histological type, location-2, and sex respectively). The accuracy of this estimation was 73.8% for m-cancer and 64.2% for sm-cancer. The incidence of lymph node metastasis was 0.7% for actual m-cancer and 20.2% for actual sm-cancer, and it was 1.3% for expected m-cancer and 19.3% for expected sm-cancer. Estimation of the depth of invasion in early gastric cancer using this discriminant function is as accurate as the conventional method. In addition, it could be useful for predicting lymph node metastasis.View full abstractDownload PDF (11689K) -
Keisuke Kanemitsu, Kiyoshi Sawai, Shinji Okano, Kosuke Seiki, Hiroki T ...1991 Volume 24 Issue 8 Pages 2119-2125
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe authors reviewed the records of 422 consecutive gastric cancer patients who underwent gastrectomy from 1983 through 1988. Of these, 226 patients (53.5%) did not receive perioperative transfusions. 105 patients (24.9%) received perioperative transfusions of less than 1000 ml and 91 patients (21.6%) received perioperative transfusions of 1000 ml or more. The cumulative 5-year survival rates were 80.5%, 46.4% and 32.6%, respectively. The differences between the groups were statistically significant. However, these patients with advanced age, nodal involvement, serosal invasion, progressive stage and total gastrectomy were more likely to have received a greater volume of blood. The 5-year survival rate for stage 2 and 4 patients not given transfusions was significantly higher than that for patients receiving transfusions, but no differences were found for stage 1 and 3. A negative relationship between perioperative blood transfusion and survival was demonstrated with stage 2 and 4 of gastric cancer.View full abstractDownload PDF (11847K) -
Hideki Kawasaki, Daisuke Wada, Nobuhiko Komi1991 Volume 24 Issue 8 Pages 2126-2135
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe effects of bile in the stomach on hypergastrinemia following selective proximal vagotomy (SPV) was investigated in a canine experimental model. Twelve weeks after the operation, peripheral plasma gastrin (IRG) and somatostatin (SRIF) responses to a test meal in the bile-exposed group were lower than those in the control group. Both integrated IRG and SRIF responses were significantly lower in the bile-exposed group (8.98±2.27, and7.14±1.62 ng·120 min/ml, respectively) than in the control group (15.26±2.97, and 11.87±2.71 ng·120 min/ml).Immunohistochemical staining revealed significantly decreased G and D cell populations in the antral mucosa of the bile-exposed group (30.5±3.9 and 22.1±1.9 cells/mm, respectively) compared with those of the control group (47.4±6.6 and 26.9±2.1 cells/min). These results indicate that bile in the stomach may decrease the G cell population and consequently inhibit hypergastrinemia following SPV. In addition, marked superficial gastritis with redness and petechie was seen in the antral mucosa of the bile-exposed group, which may be one cause of gastric ulceration following SPV.View full abstractDownload PDF (18458K) -
Keiichi Ino, Yoshio Yamaoka, Takashi Takayasu1991 Volume 24 Issue 8 Pages 2136-2142
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSDuring the past 5 years and 4 months, we have performed hepatic resection on 308 patients with hepatocellular carcinoma (HCC). Of these 308 patients, we examined 271 who had been completely followed up more than 3 months in our outpatient service. These 271 patients were divided into two groups according to age; an elderly group, age 70 years or more (n=37) and a non-elderly group, age less than 70 years (n=234). Preoperative liver function tests, operative procedure, size of the lesion, histological diagnosis of the surrounding parenchyma, postoperative complications, and 30-day mortality rate in the two groups were compared. There were no statistically significant differences in their backgrounds. There was, however, a statistically significant difference in the 4-year survival between the elderly and the non-elderly groups (72% and 35%, respectively, p<0. 05). We have been treating patients with HCC by extensive surgery. The present results suggest that, since hepatic resection for HCC in the elderly is not risky as conventionally thought, it is considered worthwhile to perform extended hepatectomy for HCC even in elderly patients.View full abstractDownload PDF (13264K) -
Kazuo Watanabe, Takehide Asano, Munemasa Ryu, Kaoru Sakamoto, Masahiro ...1991 Volume 24 Issue 8 Pages 2143-2148
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe emergence of a new tumor after surgery for hepatocellular carcinoma may be due to either recurrence of the residual tumor or multicentral tumorigenesis in a cancerprone liver. From this standpoint the effects of preoperative N-cws/Lipiodol immunotherapy via the hepatic artery were evaluated. Patients who underwent curative surgery for hepatocellular carcinoma were entered into this study. They consisted of 11 patients who received no treatment at the initial presentation as the treatment group and 22 patients with various treatments other than immunotherapy as a control group. In the treatment group N-cws/Lipiodol was given via the hepatic artery preoperatively and N-cws was delivered intracutaneously after surgery. In the control group various treatments were given with clinical consideration in each instance. In the treatment group seven of the eight survivals were free of the tumor and the longest survival period was five years and two months after the treatment. emergence of all tumors in this group occurred within one year. In the control group nine of the 12 survivals were free of the tumor and the longest survival period was three years and two months. In four of the 13 patients who developed a tumor after surgery the tumor appeared two years or longer after surgery. In the treatment group no tumor developed two years or later postoperatively and therefore the four-years-or-longer survival rate improved significantly. The suggested mechanism is that activation of tumor immunity via this immunotherapy suppresses new tumorigenesis in the cancer-prone liver.View full abstractDownload PDF (12149K) -
Hirotake Sugasawa, Masaru Miyazaki, Katsuji Okui1991 Volume 24 Issue 8 Pages 2149-2154
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIn CCl4-induced liver injury of rats, a hepatic microsomal functional mass measured by the 14C-aminopyrine breath test (ABT) was assessed, following 40% partial hepatectomy, and hepatic protein synthesis was also measured. The CCl4 group had lower ABT values than the normal group, but the difference was not significance. After 40% partial hepatectomy, the ABT values decreased in the CCl4 group more than in the normal group (p<0.05), and the return to the normal values was retarded in the CCl4 group, survivors after 40% partial hepatectomy had higher ABT values (68±29%) preoperatively than that of deaths (16.9±2.7%). The difference was significance (p<0.05). Hepatic protein synthesis in the CCl4 group was 3.6-fold greater than that in the normal group and was inversely correlated with the values of ABT (r=0.881 p<0.001). However there was no difference in hepatic protein content between the two groups. In conclusion, ABT is a good indicator of hepatic functional reserve in CCl4-induced liver injury. Enhancement of hepatic protein synthesis would induce depression of the hepatic functional reserve measured by ABT.View full abstractDownload PDF (11020K) -
Yasuhiko Kamiyama, Iwao Sasaki, Tetsuya Matsuo, Yoshio Matsuda, Hiroo ...1991 Volume 24 Issue 8 Pages 2155-2162
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSTo determine the effect of the duration of obstructive jaundice on acute gastric ulceration and on the prevention by biliary drainage of acute gastric ulcers in rats with obstructive jaundice, ulcer indices (UI), gastric mucosal potential difference (GMPD) and intragastric pH (IGpH) were measured inrats jaundiced for 2 and 4 wk with or without biliary drainage and subjected to restraint and water immersion stress. UI were also measured in rats jaundiced for 6 wk. The UI values in the rats jaundiced for 4 wk were higher than in the rats jaundiced for 2 wk. The UI values were highest in the rats jaundiced for 6 wk. The biliary drainage was effective in the rats jaundiced for 2 wk, but not in t ose jaundiced for 4 wk in the prevention of acute gastric ulcers. Acute gastric ulcers were induced only by biliary drainage in the rats jaundiced for 4 wk. The decreases in GMPD were prevented by biliary drainage in both the rats jaundiced for 2 wk and those jaundiced for 4 wk, but its effect was more evident in the 2-wk jaundiced rats than in those jaundiced for 4 wk. The IGpH in each group of rats was not influenced by the duration of obstructive jaundice or the biliary drainage. These results suggest that 1) long duration of obstructive jaundice aggravates acute gastric ulcers and damages the gastric mucosal deffense mechanism; 2) long duration of jaundice reduces the preventive effect of biliary drainage on gastric ulcerations and acute gastric ulcers are induced by biliary drainage when jaundice is very prolonged.View full abstractDownload PDF (14799K) -
Kimihiro Nakajima, Hiroyuki Kato, Shunichi Okushiba, Tetsufumi Kojima, ...1991 Volume 24 Issue 8 Pages 2163-2168
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA modified selective distal splenorenal shunt (DSRS) with splenopancreatic gastric disconnection (SPGD) was evaluated in patients with portal hypertension. DSRS with SPGD is believed to isolate the stomach from the collateral portal circulation more completely than without SPGD. Six patients underwent standard DSRS (incomplete group) and 18 patients underwent DSRS with SPGD (complete group). In the complete group, the portal perfusion grade (PPG) remained low, but the postoperative portal vein/superior mesenteric vein diameter was significantly lower after the operation and collateral pathways were demonstrated in the incomplete group only. On the other hand, in the complete group, the portal perfusion grade was good in the late period. In conclusion, the addition of SPGD to DSRS maintains portal vein perfusion flow and shunt selectivity.View full abstractDownload PDF (9989K) -
Hiroshi Ishikawa, Toru Nakagoe, Teruhisa Shimizu, Tatsuo Hirano, Hiroy ...1991 Volume 24 Issue 8 Pages 2169-2175
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA clinicopathological study and flow cytometric measurements on DNA ploidy pattern were carried out in 34 cases with multiple synchronous carcinomas of colon and rectum. In 44% of the patient, the carcinomas were situated in a single segment (especially sigmoid colon). The incidence of early carcinoma (m, sm) and well differentiated adenocarcinoma was high in 2nd cancer compared to 1st cancer. The 5-year survival rate was improved in patient with multiple carcinomas (75%) compared with single carcinomas (68%). As for DNA pattern, 27 carcinomas were DNA diploidy, and the other 10 were DNA aneuploidy in 37 carcinomas from 14 patients. There was no relationship between DNA ploidy pattern and gross type, histologic type, depth of invasion. In 7 of the 14 cases, all tumors within each colon and rectum were diploidy, in 4 cases the tumors differed with respect to DNA ploidy; and in 3 cases all tumors were aneuploidy, but DI from the tumors were different each other. These findings suggest that multiple synchronous carcinoma of colon and rectum may arise as multiple origin.View full abstractDownload PDF (12396K) -
Kazunori Tsujita, Kimihiko Funahashi, Masashi Watanabe, Hiroshi Nakamu ...1991 Volume 24 Issue 8 Pages 2176-2182
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe DNA content of 201 large bowel carcinomas was measured by flow cytometry to evaluate the prognostic significance of DNA ploidy and DNA index (DI). DNA ploidy correlated with lymphatic vessel invasion, venous invasion, lymph node metastasis, liver metastasis and Dukes' stage. Among all patients those with aneuploid cancer had a significantly worse outcome than those with diploid cancer. When patients were divided by Dukes' stage, the patients with aneuploid tumor had a significantly worse survival than those with diploid tumor in the cases of Dukes' B. The cumulative survival rate was worse in DNA aneuploid with DI above 1.41 than in aneuploid with DI below 1.40. In multivariate analysis by quantification theory type II, Dukes' stage, depth of invasion, and presence or absence of hepatic metastasis were stronger predictors of survival than DNA content, and DI had a closer connection with prognosis than DNA ploidy. These results sugest that not only DNA ploidy but also classification of aneuploid according to DI are valuable prognostic indicators in large bowel carcinoma.View full abstractDownload PDF (12318K) -
Yoshihiro Nishida, Mitsuharu Nakamoto, Tomoaki Urakawa1991 Volume 24 Issue 8 Pages 2183-2189
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSAmong 120 patients who received a resection for colorectal cancer in our department from January 1985 to December 1989, we selected 21 elderly patients (17.5%) aged 80 or above (elderly group), whom we thought to be most characteristic of the elderly, and clinicopathologically compared them with patients aged 79 or below (control group). The elderly group demonstrated the following tendency, (1) a higher rate of lung disease requiring treatment as well as abnormality in the circulatory system, respiratory system, and total protein amount (p<0.05), (2) higher incidence in the right colon, (3) a higher rate of ss-al (61.9%) in the depth of wall invasion, (4) a lower rate of v0 (29.4%) in vascular invasion (p<0.05), (5) a higher rate of lymph node metastasis above n2 (23.5%), (6) a lower rate of stage I, a higher rate of both stage W and V, and therefore more advanced cases, (7) almost the same rate of curative resection (71.4%), (8) a higher rate of postoperative complications (42.9%) and operative deaths (4.8%). Thus in the elderly, postoperative complications directly lead to death, so it is necessary to carry out pre-and postoperative management with great care.View full abstractDownload PDF (12768K) -
Masahiro Tsubaki, Katsuji Takemura, Masayuki Ando, Masanori Tada, Hiro ...1991 Volume 24 Issue 8 Pages 2190-2195
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe compared the new TNM classification (4th edition) by UICC and the Japanese Research Society (IRS) classification widely used in Japan. Both of them were assessed retrospectively by studying the records of 258 cases of cancer of the colon and rectum treated in our institute from 1974 to 1978. The new TNM classification was useful for predicting the outcome of cancers of the colon and rectum. However, it dose not include the evaluation of lymph-node metastasis. In this study, 5-year survival rates for subgroups of stage III were statistically different. The JRS classification was not useful for predicting the outcome of stage III and N. In this study, 5-year survival rate for the sin0m0 cases including stage III was high (85.7%) and that of the n2.3 cases including stage N was higher than that of the n1 cases including stage III. Both of the two classifications were meaning, but, they have many problems for predicting the outcome of cancers of colon and rectum.View full abstractDownload PDF (10967K) -
Haruhumi Makino, Koji Soeda, Kazuaki Okuyama, Teruo Kouzu, Shouichi On ...1991 Volume 24 Issue 8 Pages 2196-2200
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe report a case of hemorrhagic esophageal ulcers. The patient, a 41-year-old man who had been salesman of household drugs, had four sequential episodes of hematemesis. An incision was made in the stomach at the first, but the location of the bleeding could not be detected. At the second episode, emergency endoscopy showed esophageal ulcers in the middle part of the esophagus (Lm), and in the inferior part of the esophagus (Li) with bleeding. Ethanol was injected into the ulcer in Li. At the third episode, he was admitted to our clinic. Endoscopy on admission revealed exposed vessels in the ulcer in Lm and a healing tendency in the ulcer in Li. He had hematemesis a fourth time with hemorrhagic shock, and arterial bleeding in the ulcer in Lm was noted, but hemostasis by endoscopy could not be performed. An emergency operation was started soon after a blood trnasfusion. After the esophagus ligated at the both side of the ulcer in Lm through a right thoracotomy, his shock improved dramatically and an esophagectomy was performed successfully. The resected specimen contained two irregular and deep ulcers. He was discharged with no complications on the 64th postoperative day. We assume that these ulcers were drug-induced considering his occupation and habits. We recommend operative ligations of the esophagus at the upper and lower sides of the ulcer, if massive and uncontrolled bleeding with shock develops.View full abstractDownload PDF (9304K) -
Masayuki Nakamura, Takuo Murakami, Norifumi Johno, Hiroto Hayashi, Hir ...1991 Volume 24 Issue 8 Pages 2201-2205
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 60-year-old man visitd a hospital because of dysphagra. Upper gastrointestinal series and endoscopic eromination revealed an esophageal elevated lesion and two gastric elevated lesions. On biopsy, the esophageal lesion was diagnosed as esophageal carcinoma, but the gastric lesions had no signs of malknancy, which led us to suspect gastric submucosal tumors. Histological findings after surgery ld to the conclusion that the gastric lesions were due to metastases of esophageal carcinoma to the gastric wall. Esophageal carcinoma metastatic to the gastric wall is relatively rare. The clinical features and possible treatment of these lesions are discussed.View full abstractDownload PDF (9112K) -
Satoshi Takiguchi, Kiyoaki Watanabe, Katsuhiko Kawakami, Mitsuya Honda1991 Volume 24 Issue 8 Pages 2206-2210
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSAFP-producing early gastric cancer, which is a very rare cancer with only 5 previous reported cases in Japan, occurring in a 58-year-old man in described. He reported no symptoms. Upper GI study showed an elevated lesion at the antrum and endoscopy revealed a Borrmann type-3 lesion. The histological diagnosis of the biopsy specimen was well-differentiated adenocarcinoma. In the preoperative study, serum AFP, as well as CEA, was slightly elevated. Subtotal gastrectomy with R2 lymph node dissection was performed. The resected specimen showed IIa + IIc-type early gastric erncer. In histological examination, the lesion in the mucosalayer was found to be mainly moderately'differentiated adenocarcinoma and that in the submucosal layer was on the whole poorly-differentiated adenocarcinoam. Staining for CEA was positive in the former and AFP was stained positively in the latter. Serum CEA and AFP levels decreased to within norrnalimits in the 2 months after operation. The patient is alive without no sign of hepatic metastasis or recurrence, 10 months after operation.View full abstractDownload PDF (8867K) -
Yasuhiro Matsugu, Makoto Takahashi, Shinkichiro Yoshioka, Masazumi Oka ...1991 Volume 24 Issue 8 Pages 2211-2215
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIn 1965 Nikorai et al first reported the concept of “gastritit cystica” for the torose mucosal polypoid lesion found at the gastrojejunostomy site in gastrectomized patients. There have been few reports describing patieiits with remnant gastric carcinoma which resulted from gastritis cystica polyposa. We recently encountered a patient who revealed the correctness of this concept. A 71-year-old man who received hemigastrectomy for a duodenal ulcer 36 years ago developed a circular sessile polypoid lesion at the gastrojejunostomy site. Histologically this lesion showed characteric findings of gastritis cystica polyposa such as hyperplasia of the juvenile foveolar gastric epithelium, and hyperplaria and cystic dilatation of the glands. It was of great interest that the foci of well differentiated adenocarcinoma were scattered throughout this gastritis cystica palyposa lesion. From these histologic observations we now support the strong relationship of gastritis cystica polyposa to developing cancer.View full abstractDownload PDF (9875K) -
Keishi Kondo, Mitsuo Kusano, Akihumi Yamashita, Takashi Munakata, Shin ...1991 Volume 24 Issue 8 Pages 2216-2220
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA case of malignant gastrinoma arising in the duodenum is reported. The patient was a 57-year-old man who underwent subtotal gastrectomy and Billroth II anastomosis following a diagnosis of duodenal ulcer. A month later epigastric pain and hematemesis developed. Because of suspected gastrinoma, he was referred to our hospital for evaluation and treatment. His fasting serum gastrin concentration was 600 pg per ml, and the results of intravenous secretion and glucagon injection tests were consistent with gastrinoma. Ultrasonography and CT scanning failed to reveal the presence of any tumor in the pancreatic rqion. Selective angiography of the common hepatic artery and percutaneous transhepatic venous sampling of gastrin suggested the presence of an 8-mm mass in the duodenum or the head of the pancreas. At surgery no tumor was found in the duodenum or pancreas, and total gastrectomy, excision of the duodenal remnant and dissection of the lymph nodes behind the head of the pancreas were performed. A tumor was found in the duodenal remnant. Microscopically, the tumor and the lymph node lesions were diagnosed as gastrinoma and metastases. Two days after excision of the tumor and the lymph nodes the serum gastrin level had dropped to 45 pg per ml. The patient is alive without recurrence five years after the second operation.View full abstractDownload PDF (9594K) -
Koji Okuda, Satoshi Taniwaki, Kazusaburo Ando, Kazuharu Shigetomi, Ats ...1991 Volume 24 Issue 8 Pages 2221-2225
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe performed a central lobectomy on a patient with hepatocellular carcinoma. In addition to occlusion of the afferent vessels, to decrease intraoperative hemorrhage during hepatectomy, we occluded the right hepatic vein and middle hepatic vein at the hepatocval junction using balloon catheters inserted transhepaticaly under intraoperative ultrasonic guidance. The afferent vessels of the right lobe and the right hepatic vein were occluded during parenchymal resection along the right hepatic vein. Total inflow occlusion by Pringle's method and occlusion of the middle hepatic vein were performed during resection near the middle hepatic vein. The intraoperative bleeding volume was 1, 100 ml, the postoperative maximum serum GOT level was 381. K.U. and the maximum serum bilirubin level was 2.3 mg/dl This method should be useful for systematic resection along the hepatic vein or for the resection of a tumor located at the confluence of the hepatic vein.View full abstractDownload PDF (10482K) -
Two Patients with Growing Cavernous Hemangioma of the Liver-Quantitative Documentation of the GrowthJunichi Yoshida, Susumu Yamasaki, Masatoshi Makuuchi, Tadatoshi Takaya ...1991 Volume 24 Issue 8 Pages 2226-2230
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe growth of hepatic cavernous hemangiomas in two patients who underwent resection was documented by computed tomography and subsequent volumetry. In patient I, 40-year-old woman, the tumor increased from 4.6 to 7.2 cm in diameter and from 58 to 244 ml in volume during a 3.5 year period. In patient 2, 67-year-old man, the tumor increased from 7.5 to 17 cm in diameter and from 123 to 1434 ml in volume over 10.5 years. The major indication of the operations was the growth of the hemangiomas. This quantified documentation of growing hepatic hemangiomas, a novelty in the literature, suggested the need of long-term follow-up of hepatic hemangioma.View full abstractDownload PDF (9243K) -
Motoshi Yasui, Nobuhisa Ando, Hideki Nozaki, Michimasa Toyama, Susumu ...1991 Volume 24 Issue 8 Pages 2231-2235
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSRecent progress in detecting early hepatocellular carcinoma (HCC) has increased the number of patients who undergo hepatectomy. The incidence of postoperative recurrence from a remnant, however, has also increased, and the prognosis may be altered by prophylactic measures. This is a report of a 55-year-old male patient who received three supplemental resections. Left hepatic lobectomy was carried out for liver-cirrhosis-complicated HCC extending over S2 to S4. About 15 months later, a second hepatic resection was performed for tumor recurrence in S6. Seventeen months after the second resection, a third resection on S7 and S8 by thoracolaparotomy was performed, and a fourth resection on S6 was carried out 10 months later. At present, 5 years and 7 months after the first hepatectomy, the patient is well without any symptoms of tumor recurrence. Thorough follow-ups by not only serum a-fetoprotein determination but also ultrasonography and computed tomography after the first operation are very necessary for those patients with liver cirrhosis as an underlying disorder, as there is a high incidence of tumor recurrence. Supplemental resection can be performed only when the liver function is comparatively unchanged from the function at the first operation, because extensive bleeding i expected in the process of denuding the sites of adherence. Therefore, careful denudation, and acquisition of a wide operative filed should be achieved. A transphrenic approach through thoracotomy, as in this case, is often useful.View full abstractDownload PDF (9840K) -
Toshiharu Tsuzuki, Kozo Kawada, Masakazu Ueda, Shin Takahashi, Kunio N ...1991 Volume 24 Issue 8 Pages 2236-2240
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSPatients with hepatocellular carcinoma with tumor thrombus extending into the right atrium usually die within a short period. The only way to treat these patients is to resort to hepatic resection with removal of the tumor thrombus under cardiopulmonary bypass. A 57-year-old man had a tumor, 4 cm in diameter, in the left medial segment of his cirrhotic liver with tumor thrombus extending from the middle hepatic vein into the right atrium. The patient underwent resection of the left medial segment and part of the right anterior segment with removal of the tumor thrombus. He was discharged from hospital with uneventful recovery but died of recurrence in the remnant liver five months after surgery. It was proved that the surgery was technically feasible. Long-term survival is now the issue.View full abstractDownload PDF (9665K) -
Hikaru Fujioka, Kyou Komuta, Takahito Tsurifune, Satoshi Kondo, Shiget ...1991 Volume 24 Issue 8 Pages 2241-2245
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 54-year-old man with a fibrous polyp of the gallbladder is reported. The patient had no symptoms, but ultrasonography showed an isoechoic polypoid lesion of the gallbladder and subsequent endoscopic retrograde cholangiography demonstrated a irregularly spherical filling defect in the fundus. Under suspicion of a carcinoma in the gallbladder, a cholecystectomy with resection of the liver bed was performed. The mucosa of the gallbladder was almost normal. A pedunculated polyp, 20×17×15 mm in size, was found in the fundus. Histologically, the polyp was composed of loose connective tissue with a vascular network and an inflammatory infiltrate. There was no evidence of malignant change. These findings were consistent with those of fibrous polyp. This type of polyp is very rare.View full abstractDownload PDF (9334K) -
Kenji Kobayashi, Kenzo Yasui, Mitsunori Yasue, Seiichi Miyaishi, Hiroa ...1991 Volume 24 Issue 8 Pages 2246-2250
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 51-year-old man who underwent choledocholithotomy in 1985 was admitted to a nearly hospital complaining of epigastralgia in January 1990. In 1985 an adenoma was found in the distal common bile duct after the choledocholithotomy. In January 1990, epigastralgia occurred again, and so percutaneous transhepatic cholangio drainage was performed and the size and shape of the tumor were not changed obviously. A biopsy of the tumor using a snare revealed papillary adenoma with severe atypia. A pancreaticoduodenectomy was carried out for three reasons: first, the tumor might have malignant potential; second, the tumor was irregular polypoid lesion and third the clinical symptom was caused by this tumor. The final histopathological examination revealed papillary adenocarcinoma of the bile duct with invasion to the fibromascular layer. The diagnostic and therapeutic problems with a tumor in the distal bile duct are discussed from this experience.View full abstractDownload PDF (9885K) -
Haruhiko Nagami, Katsuhiro Tamura, Takahiko Nohara, Tsuyoshi Yamamoto, ...1991 Volume 24 Issue 8 Pages 2251-2255
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe experienced a case of cholelithiasis with hourglass deformity of the gallbladder caused by adenomyomatosis accompanied by early gallbladder cancer. The patient, a 72-year-old woman, was diagnosed as having cholelithiasis with hourglass deformity of the gallbladder by endoscopic retrograde cholangiography and underwent cholecystectomy. An approximately 2.5 cm stone was found at the fundus of the surgically removed gallbladder, and histopathological examination of the specimen revealed chronic cholecystitis at the fundus of the gallbladder, segmental adenomyomatosis with proliferation of Rokitansky-Aschoff sinuses at the body of the gallbladder and an early cancer lesion in the gallbladder measuring 4.7 cm×4.0 cm (well-differentiated adenocarcinoma, m RAS ss) at the neck side of the gallbladder. In the Japanese literature, only six cases including our case of gallbladder cancer accompanied by adenomyomatosis have been reported to date. In the five cases other than ours, the cancer lesion was seen at the fundus side of the lesion of adenomyomatosis, while in our case, it was seen at the neck side of adenomyomatosis and it is speculated that this case leads to the theory that adenomyomatosis of the gallbladder may change into cancer.View full abstractDownload PDF (9484K) -
Yasutomo Azumi, Kazuo Miyamura, Yoshihiko Furuya, Shinichi Nakayama, Y ...1991 Volume 24 Issue 8 Pages 2256-2260
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe report a recently observed case of serous cystadenoma occurring at the same time in the head and body of the pancreas, with a review of the literature. The patient was a 49-year-old woman who visited the hospital with a chief complaint of abdominal discomfort. Ultrasonography of the abdomen disclosed multilocular cysts, 3 cm in diameter in the head of the pancreas and 1.5 cm in diameter in the body. Careful examination suggested multiple serous cystadenoma of the pancreas and resection of the head and body of the pancreas with duodenectomy was performed. Examination of the excised specimens showed that the mass in the head of the pancreas measured 5×3×4cm, was definitely demarcated from the surrounding pancreatic parechyma, and consisted of multiple cysts of 2-16 mm, containing serous fluid. The main pancreatic duct was slightly stenosed. the mass in the body of the pancreas was 1.5 cm in diameter and was composed of many cysts of 1-6 mm. Histopathologically, a diagnosis of serous cystadenoma occurring in the head and body of the pancreas was made. The literature was discussed in regard to differentiation from mucous cystadenoma by diagnostic imaging as compared with pathological findings.View full abstractDownload PDF (9465K) -
Keishiro Aoyagi, Kota Yatsuka, Hiroshi Umetani, Tetsuro Nakagawa, Shoj ...1991 Volume 24 Issue 8 Pages 2261-2265
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA case of leiomyosarcoma of the greater omentum was reported. The patient was a 41-year-old man who was admitted to our hospital with upper abdominal discomfort. Upper gastrointestinal barium contrast studies revealed no typical abnormal findings. Ultrasonography and computed tomography of the upper abdomen revealed a low density mass beneath the greater curvature of the stomach and gallbladder stones. Tumor markers such as CEA/AFP/CA19-9 were within normal limits. Laparotomy revealed a mass measuring 18×17 cm on the omentum, which was soft and mucinous and bled easily. Metastases were found in the left lateral inferior part of the liver and the anterior wall of the corpus of the stomach. We resected the tumor of the omentum and the metastatic sites. Pathological examination of the resected specimen revealed a leiomyosarcoma. The origin of the leiomyosarcoma of the omentum was considered to be the smooth muscle of the vessels.View full abstractDownload PDF (9098K) -
Chikao Yasunaga, Fumio Inoue, Yasuaki Mori, Toshiro Koga1991 Volume 24 Issue 8 Pages 2266-2270
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe reported a case of primary AA type amyloidosis, which involved the gastrointestinal tract. A 66-year-old man was admitted with the complaint of epigastric pain and vomiting. An X-ray film of the abdomen showed a large amount of as and fluid retention in the small intestine. A laparatomy was performed under suspicion of adhesion due to a past appendectomy. The operation showed no obstructive lesion in the gastrointestinal tract but there were multiple swollen lymph nodes in the mesenterium. Pathological examination revealed amyloid deposition in the lymph node. The amyloid was immuno-histochemically type AA. Postoperative endoscopic examination revealed amyloid deposition in the stomach and colon: it was especially severe and extensive in the stomach. No preceding disease was revealed by postoperative examination. That suggested that this was a case of primary amyloidosis of the AA-type. The patient was put on intravenous hyper-alimentation and treated with dimethyl sulfoxide but he died of a gastrointestinal hemorrhage and electrolyte imbalance. We believe that an intraoperative biopsy of lymph node is diagnostically valuable when the origin of ileus is unknown.View full abstractDownload PDF (9255K) -
Takafumi Kusaka, Takashi Shimazaki, Akira Kawashima1991 Volume 24 Issue 8 Pages 2271-2274
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA case of familial colic polyposis concurrent by mesenteric leiomyoma was experienced. The patient was a 34-year-old woman, who received total colorectectomy and ileostomy for familial colic polyposis two years earlier. An abdominal tumor pointed out 17 months postoperatively induced us to attempt tumorectomy, which however, ended in simple laparotomy. Biopsy revealed mesenteric leiomyoma. Gardner's syndrome is known to be concurrent by various types of diseases not only of the digestive tract, but also of other panblasto-originating organs, but may rarely be concurrent by mesenteric leiomyoma. The pathogenesis of benign tumorous lesions concomitant with Gardner's syndrome presumably but not definitely involves a congenital anomaly somewhere in the tissue repair mechanism, leading to abnormal tissue hyperplasia. In the present case, there is a possibility of surgically induced mechanical stimulation of the mesentery, leading to abnormal tissue hyperplasia and subsequent mesenteric leiomyoma.View full abstractDownload PDF (8380K) -
Tetsuro Matsuda, Shigenori Akagi, Shinpachiro Nomi, Ikuya Fujiwara, Sh ...1991 Volume 24 Issue 8 Pages 2275-2279
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe experienced three cases of obstructive colitis associated with advanced carcinoma, which are presented with a review of the literature. Case 1: A 65-year-old-man with rectal obstruction due to type-2 cancer was operated on. A circular ulcer 20 cm in length had penetrated the normal mucosa 33 cm proximal to the obstruction. Case 2: A 58-year-old-woman was diagnosed as having a sigmoidal cancer with obstructive colitis, and a left extended hemicolectomy was carried out. A shallow ulcer 33 cm in length with a granular surface and edema was found 12 cm proximal to type-2 cancer. Case 3: A 58-year-old-woman was also operated on under the preoperative diagnosis of obstructive colitis secondary to a sigmoidal cancer. A broad lesion with a linear ulcer running longitudinally for 32 cm was found 7 cm proximal to type-2 cancer. The intervening mucosa was congested and pushed up by submucosal edema and hemorrhage. It is usually difficult to make an exact diagnosis of the condition prior to surgery because of the obstruction. Therefore, in case of a colectomy we should always be careful not to leave an associated lesion behind.View full abstractDownload PDF (10781K) -
Shinpei Takeda, Wataru Takiyama, Shigemitsu Takashima, Kouichi Mandai1991 Volume 24 Issue 8 Pages 2280-2283
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA rare case of adenocarcinoma of the colon with an extramural progression is reported. The patient, a 65-yearold woman, presented with anal bleeding. Barium examination of the colon revealed a long (about 9 cm) stenotic lesion and extramural compression on the wall of the sigmoid colon. Colonoscopic examination revealed stenosis of the sigmoid colon with edema of the mucosa. The histologic findings of the biopsy material were edematous mucosa of the colon with no malignancy. By ultrasonography and X-ray CT, an irregular-shaped tumor with a diameter of 5 cm, invading the sigmoid colon and the body of the uterus, was detected. A radical sigmoidectomy was carried out with hysterectomy and bilateral salpingo-oophorectomy. Histologic examination of the operative specimens revealed moderately differentiated adenocarcinoma of the sigmoid colon, prominently proliferating into the surrounding tissues. The findings of a long stenotic lesion and extramural compression by colonography are characteristic of this tumor, as a review of the literature indicated. Abdominal X-ray CT and ultrasonography are useful for diagnosis of this type of colon cancer.View full abstractDownload PDF (9122K) -
Hiroki Akamatsu, Masaki Kamegashira, Muneyuki Fujita, Atsushi Okawa, M ...1991 Volume 24 Issue 8 Pages 2284-2287
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIntussusception in adults is rare, accounting for about 5% of all intussusceptions. Its most common clinical symptoms are abdominal pain, abdominal distension and hematochezia according to the literature. An adult case of intussusception due to sigmoid colon carcinoma, which caused water-electrolyte imbalance and severe hypoproteinemia, is reported. The patient was a 64-year-old man, who was admitted suffering from massive mucus diarrhea. His general condition was poor owing to dehydration, at the time of admission. Sigmoidoscopy was performed after the diarrhea stopped but revealed no apparent lesion. The patient was then discharged and followed up on an outpatient basis. Three months later he was readmitted because of recurrence of diarrhea. Intussusception due to sigmoid colon carcinoma was diagnosed by fiberoptic colonoscopy and a sigmoidectomy was performed. This patient developed clinical symptoms like so-called depletion syndrome associated with a villous tumor of the colon and the rectum since a large amount of mucoid material excreted secondary to intussusception was lost without reabsorption by the colon because of the closeness of the intussusception to the anus. The diagnosis of intussusception is relatively easy by endoscopy, but care must be taken when an intussusception is spontaneously reduced.View full abstractDownload PDF (7109K) -
Yasushi Murakami1991 Volume 24 Issue 8 Pages 2288-2292
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSProblems in the treatment of carcinomas in the hypopharynx and cervical esophagus were discussed. For complete resection of carcinomas, safety margins should be decided by careful consideration of the extent of submucosal invasion that varies primarily because of differences in directional preponderance of submucosal lymphatic drainage in each region. Bilateral neck dissection should be performed because of the high incidence of metastasis to regional nodes. Postoperative irradiation and maintenance chemotherapy were stressed as indispensable.View full abstractDownload PDF (10161K) -
Hiroko Ide1991 Volume 24 Issue 8 Pages 2293-2298
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSFrom January 1976 to September 1990, 64 carcinomas of the hypopharynx and cervical esophagus were resected in our department. Total esophagectomy was performed in 39 patients (61%), whose average age was 64 years and who had mainly Ce-Celu carcinoma. From the aspect of curability, there was no difference between partial and total esophagectomy. Concerning the organs for substitution, stomach was used in 92% of the total esophagectomies and 56% of all resections. On the other hand, free jejunal graft after partial resection was used in 38% of all cases. The rate of postoperative complications when stomach was used after blunt dissection was 31%, which is bit higher than for free jejunal grafts (18%). In the resected specimen in total esophagectomy, the rate or remnant cancer with a resected edge is low, even 0% an the anal site. Thirty-three percent of the patients receiving total esophagectomy had multiple cancers. The 5-year survival rate after curative resection pharyngogastrostomy with blunt dissection was 41.7%, and that after free jejunal graft was 26.2%. Because of the high incidence of synchronous intrathoracic carcinoma and carcinoma of the cervical esophagus and hypopharyns, reconstrucion by stomach with blunt dissection is a useful method requiring no special technics of microvascular anastomosis except for patients with stomach disease.View full abstractDownload PDF (10432K) -
Masao Fujimaki1991 Volume 24 Issue 8 Pages 2299-2302
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIn patients with carcinoma of the cervical esophagus who have low grade disease and good prognosis or who had previously received a gastrectomy, an isolated pedicled segment of colon is used as first choice for esophageal reconstruction. It is possible to isolate a considerable length of colon for reconstruction, regardless of the route selected, to be brought up through, and patients will achieve good nutrition after the operation by preserving the stomach. An isolated segment of transverse colon or right colon is commonly used for reconstruction and it is placed in an isoperistaltic position. Because of the variation in vascular patterns, it is imperative at the operation to determine the vascular arrangement for transplantation. Then it is important for an adequate length of the isolated segment of the colon to be measured along its marginal artery to be brought up straight to the hypopharynx. In the cervical phase, if the caliber of the lumen of the hypopharynx is different from that of the upper end of the transplant, anastomosis of the two requires equalizing their calibers.View full abstractDownload PDF (7279K) -
Kiyonori Harii1991 Volume 24 Issue 8 Pages 2303-2307
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSReconstruction of the cervical esophagus following resection of a cancer in the hypopharynx and cervical esophagus is a challenging problem for surgeons. Vascularized free intestinal transfer has recently come to be recommended as an ideal procedure for immediate reconstruction. The origins of this procedure can be traced back to the pioneering work of Seidenberg et al. in 1959 and Nakayama et al. in 1962, but there have been only a few reports of successful clinical results because of the uncertainty and difficulty involved in the anastomosis of intestinal vessels of less than 3 mm without a microscope. The introduction of microvascular anastomosis resulted in a dramatic revival of this procedure because the anastomosis of intestinal pedicle vessels 2 to 3 mm in diameteris easily and safely accomplished under a microscope. In this paper, the author introduces the technical points important for free intestinal transfer, describing the successful (94.8%) results of his 116 transfers (115 jejunum and one ileum) between January 1981 and December 1989 at the National Cancer Center Hospital and the University of Tokyo.View full abstractDownload PDF (10826K) -
Katsuhiko Horii, Hiroaki Kinoshita, Kazuhiro Hirohashi, Shoji Kubo, Ry ...1991 Volume 24 Issue 8 Pages 2308
Published: 1991
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSDownload PDF (1990K)
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