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Volume 25, Issue 7
Displaying 1-27 of 27 articles from this issue
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Ichiro Shima, Hideaki Yamana, Hiromasa Fujita, Teruo Kakegawa, Yasuyuk ...1992 Volume 25 Issue 7 Pages 1917-1923
Published: 1992
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThiryteen-one cases of esophageal carcinoma invading the submucosal were analyzed regarding the degree of submucosal invasion, the growth patterns, the mode of invasion, and the expression of matrix metalloproteinase-2 (MMP-2). For the degree of submucosal invasion, the deeply invading type (sm3: 10 cases) was characterized by a tendency toward the superficial and protruding type (type 0-I), a high incidence of lymph node metastasis, vascular invasion, and post-operative recurrence. In contrast, the slightly invading type (sm1: 6 cases) was characterized by the slightly elevated type (type O-IIa), a low incidence of lymph node metastasis, vascular invasion, and recurrence. For the growth patterns, the majority of down growth type (13 cases) was in type O-I, and this type was associated with lymph node metastasis, while, almost all of the superficial spreading type (8 cases) was in type O-IIa, which was associated with blood vessel invasion and recurrence. On the other hand, in the mode of invasion, the group with diffuse invasion (G3, G4C, and G4D) had lymph node metastasis more frequently than the group with non-diffuse invasion (G1 and G2). In immunohistochemical staining, the expression of MMP-2 was detected in 9 (29%) cases. Its expression, however, was not detected in non-cancerous esophageal epithelia. A good correlation was found among the expression of MMP-2, lymphatic invasion, and post-operative recurrence.View full abstractDownload PDF (13032K) -
24 Hour pH Monitoring StudyMitsuaki Hashimoto, Masayuki Imamura, Yutaka Shimada, Takayoshi Tobe1992 Volume 25 Issue 7 Pages 1924-1929
Published: 1992
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThirty patients with esophageal carcinoma were subjected to 24-hour gastric pH monitoring. The intraluminal pH in the fundus and the antrum of the stomach was measured before surgery and in the gastric tube after esophagectomy. According to the pH frequency distribution curves, the patients were divided into four groups; type 1, high acidity; type 2, intermediate; type 3, low acidity; and type 4, antral high acidity groups. Median pH values through the night (0 a.m.-6 a.m.) and during prandial and postprandial periods were different among the four groups. Median pH values at the fundus at night were low in the type 1 and type 2 groups. In the type 1 and type 2 groups, there was no significant difference in median pH values or in the length of the periods when the pH remained below 3 between the pre-and post-operative readings taken at the fundus during the night. On the other hand, in the type 1 and type 2 groups there was a significant inverse corelation between the duration of the periods with an antral pH below 3 and the fasting serum gastrin concentration during the night. These results suggest that the gastric tube maintains its ability to secrete acid after esophagectomy and that there is a negative feedback mechanism between gastrin secretion and antral pH.View full abstractDownload PDF (10535K) -
Masayuki Shinoda, Iwao Takagi, Motokazu Suyama, Naoki Kuroda, Kazuo Ku ...1992 Volume 25 Issue 7 Pages 1930-1936
Published: 1992
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSTen cases of esophageal carcinoma with intramural metastasis to the stomach were clinicopathologically studied, and their outcome was compared with that of cases with intramural metastasis limited to the esophagus. The incidence was 4.7% of the 217 patients receiving resections in Aichi Cancer Center Hospital from January 1983 to June 1991. One tumor was located in the upper, 6 in the middle and 3 in the lower intra-thoracic esophagus. Histologic types were diagnosed as well-differentiated squamous cell carcinoma (SCC) in one case, moderately differentiated SCC in 6 and poorly differentiated SCC in 3. In the histologic examination for depth of invasion, 5 cases showed invasion into the adventitia and the other 5 cases into the adjacent structures beyond the adventitia.Lymph node metastasis to group 3 or beyond was present in 9 cases. Consequently, the pathologic stages of the 10 cases were classified as N according to the Guide Lines for the Clinical and Pathologic Studies on Carcinoma of the Esophagus in Japan. The 1-year survival rate of the patients with intramural metastasis to the stomach was 25.0% and all patients died within 2 years. On the other hand, the 1-year and 5-year survival rates of the patients with intramural metastasis within the esophagus were 60.6% and 23.3%, respectively. Various opinions on the staging of cases with stomach metastasis appear in the literature. Our study seems to justify classification of those cases as stage IV because of their poor outcome, which was very similar to that in other stage N cases with invasion into the neighboring organs.View full abstractDownload PDF (11182K) -
Masato Funasaka, Takeshi Nakamura, Yoshiki Tabuchi, Yasuyuki Tada, Tor ...1992 Volume 25 Issue 7 Pages 1937-1941
Published: 1992
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSTen leiomyosarcomas and 8 leiomyomas of the stomach were examined clinicopathologically, and the nuclear DNA patterns in 6 of the myosarcomas and 5 of the myomas were analyzed by flow cytometry (FCM) using paraffin-embedded tissues. The average size (103 cm) of the myosarcomas was significantly (p<0.01) larger than that (4.9 cm) of the myomas, and there was a negative correlation (Y=23.3-0.35X, r=-0.907, p<0.01) between tumor size and survival period among 5 patients died of the disease. The average number of mitoses was also significantly (p<0.05) higher in the myosarcomas (49.3/100 HPF) than the myomas (2.6/100 HPF). All the myomas and 1 of the myosarcomas showed a diploid pattern, and none of these patients died of the disease. Five myosarcomas showed an aneuploid pattern (mean DI=1.72), and 3 of patients died of the disease. These data indicate that tumor size, number of mitoses and analysis of DNA patterns by FCM are valuable for determining the grade of malignancy and therapeutic method, and predicting prognosis for patients with leiomyomatous tumors of the stomach.View full abstractDownload PDF (10939K) -
Masahiko Nishiyama, Kazuhiro Yoshida, Takashi Yorishima, Takashi Tanak ...1992 Volume 25 Issue 7 Pages 1942-1947
Published: 1992
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe outcome of surgery in 52 gastric cancer patients 80 years of age and older was investigated, especially from the viewpoint of deterioration in mental status. The occurrence of postoperative complications including deterioration in mental status was closely related to the surgical procedure. The incidence was 31% (11/35) in subtotal gastrectomy, 67% (8/12) in total gastrectomy, 100% (3/3) in resection of lower esophagus and cardia, 100% (1/1) in resection of lower esophagus and total gastrectomy, and 100% (1/1) in transhiatal esophagectomy and total gastrectomy. Delirium, which developed in 14 of 52 patients (27%), was the most common postoperative complication. The incidence and average period of occurrence were 32% (8/25) and 4.5 days in subtotal gastrectomy, 43% (3/7) and 7.0 days in total gastrectomy, and 100% (3/3) and 10.0 days in resection of lower esophagus and cardia. Activity score of daily living estimated by Nishimura's scale in patients with total gastrectomy decreased from 39.9 to 33.0 (p<0.05, student t-test), although improvement of senile dementia was observed in the patients who had undergone subtotal gastrectomy. We conclude that the outcome of subtotal gastrectomy is favorable considering the postoperative complications and mental changes in patients 80 years of age and older. Nevertheless, to prevent the major morbidity associated with surgery, scrupulous care is needed for the patients who require more aggressive surgical procedure.View full abstractDownload PDF (11021K) -
Akihiko Watanabe, Katsunori Nakatani, Hidetomo Sawada, Yukishige Yamad ...1992 Volume 25 Issue 7 Pages 1948-1952
Published: 1992
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSSerum sialyl Tn antigen (STN) and several other tumor markers in 47 preoperative patients with gastric cancers and 138 postoperative outpatients followed up for gastric cancers were measured. The preoperative positive rates of serum STN, carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), sialyl Lex-i (SLX) and carbohydrate antigen 72-4 (CA72-4) in the patients with gastric cancers were 14.9%, 15.4%, 15.4%, 6.4% and 14.0%, respectively. Serum STN levels correlated with CA19-9 and CA72-4 but not with CEA and SLX. The preoperative positive rates of STN were higher in advanced stages such as stage III and IV with peritoneal metastases or distant lymph-node metastases. The positive rate of STN in the recurrent cases was significantly higher than that in non-recurrent cases (p<0.01). These results suggest that measurement of STN is useful for prediction of the clinical stage and the diagnosis of the recurrence of gastric cancer.View full abstractDownload PDF (9065K) -
Special Reference to the Minute Cancer in Multiple Early Gastric CancerKuniyoshi Arai, Masatsugu Kitamura, Kaoru Miyashita1992 Volume 25 Issue 7 Pages 1953-1957
Published: 1992
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSSixty cases (86 lesions) of minute cancer among cases of multiple early gastric cancer were analyzed, and the problems of limited operation (LOP) and endoscopic mucosal resection (EMR) for early gastric cancer were examined. The frequency of the cases with multiple lesions or minute cancer (less than 5 mm in diameter) among the cases of early gastric cancer, which has recently been increasing, were 18.9% and 7.8% respectively. Clinicopathological features of minute cancers were the high frequency of IIb (61.6%), well-differentiated adenocarcinoma (80.2%) and mucosal cancer (98.8%). Although many lesions were often found near the main lesion, 5.8% of these were more than 8 cm away from it. Furthermore, there were 35 cases (58.3%) in which all the lesions of except the main lesion were minute cancers. In conclusion, LOP or EMR should be carefully performed taking into consideration the possible existence of minute cancers.View full abstractDownload PDF (9367K) -
Toshiya Ochiai, Kenichi Takayasu, Fumihiko Wakao, Noriyuki Moriyama, Y ...1992 Volume 25 Issue 7 Pages 1958-1964
Published: 1992
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIn 85 patients with hepatocellular carcinoma (HCC) who underwent ultrasonography, enhanced computed tomography (CT), angiography and portal angiographic CT (P-CT) followed by surgery from June 1987 to January 1991, the non tumorous perfusion defect (NTPD) which appears on P-CT was studied radiologically. NTPD of the liver, ranging from 0.2 to 7.0 cm in diameter, was observed in 16 patients (18.8%) and did not show any specific location in the liver. The most common NTPD was round (66.8%). More sophisticated studies than angiography suggested the following possible cause of NTPD in five cases (31.2%): i) direct inflow into the intrahepatic portal vein via the cystic vein, accessory portal vein or pericholedochal vein in one patient each; ii) obstruction of the peripheral portal vein due to macroscopic tumor thrombi in one patient and iii) a precancerous lesion in one, because it had grown and was enhanced by contrast medium 4 months later, which strongly suggested overt HCC. When a diagnostic perfusion defect is seen on P-CT, one should consider the NTPD described above which is independent of overt HCC.View full abstractDownload PDF (12653K) -
Saiho Ko, Takashi Nishiwada, Syusaku Yoshikawa, Masami Yagi, Yoshiyuki ...1992 Volume 25 Issue 7 Pages 1965-1968
Published: 1992
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIntrahepatic and extrahepatic spread of hepatocellular carcinoma was investigated in 20 autopsy cases. Intrahepatic spread, both vascular invasion and intrahepatic metastasis, was negative or minimal in sigle nodular type tumors, and severe in other types of tumors. Metastatic lymph node lesions were N0 in 8 cases and N3 in 12 cases. Distant organ metastasis was found mainly in the lung (11 cases) and adrenal gland (6 cases). All 4 patients with no distant organ metastasis had single nodular type tumors, and died of severe liver cirrhosis. Tumor stage classification (TMN) of the single nodular type tumors revealed 1 case of stage 1, 1 cases of stage 3, and 2 cases of stage 4A. All cases of other types of tumors were stage 4B. Preautopsy diagnosis of extrahepatic tumor spread presents serious problems. It may cause the wrong choice of therapeutic modality. Hepatic hilar and pancreaticoduodenal lymph nodes should be dissected for radical resection of hepatocellular carcinoma. Liver transplantation could be considered for a single nodular type tumor with severe liver cirrhosis.View full abstractDownload PDF (7930K) -
Makoto Takahashi, Yoshihiro Okada, Harumi Tanaka, Kazuhide Ono, Fumio ...1992 Volume 25 Issue 7 Pages 1969-1974
Published: 1992
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSOf 602 cholecystectomies performed during a 10-year period in our Division of Surgery, 86 (14.3%) were concomitant with other intra-abdominal operations (concomitant cholecystectomy), and were reviewed to determine the effects on morbidity. The number of patients undergoing concomitant cholecystectomy has increased yearly and the rate of concomitant cholecystectomy among overall cholecystectomies has been more than 20% for the past 3 years. More than 40% of the patients were in their 70s or 80s. The primary intra-abdominal disorders necessitating celiotomy were 33 gastric cancers, 9 colorectal cancers, 6 hepatocellular carcinomas, 3 esophageal varices, hereditary spherocytoses and others. Eighty-six cases of gallbladder disease (80 of gallbladder stones and 6 of gallbladder polyps) were detected and diagnosed pre-operatively by ultrasonographic imaging, and almost none of the patients had symptoms related to the gallbladder diseases at the time of surgery. Therefore, concomitant cholecystectomy was performed without any difficulty and post-operative morbidity attributable to cholecystectomy was negligible (1 bile leakage, 1 intra-abdominal abscess) compared with that in patients for whom cholecystectomy was the sole operation. We think that concomitant cholecystectomy is safe and does not increase morbidity.View full abstractDownload PDF (10551K) -
Shusei Ishida, Naoto Ohono, Satoru Toyota, Tae Myong Yoon, Kenji Ikeuc ...1992 Volume 25 Issue 7 Pages 1975-1983
Published: 1992
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSTwo hundred thirty-three cases (288 lesions) of early colorectal cancer were analyzed clinicopathologically to assess if morphology on the cut surface helps determine the therapeutic plan. Materials consisted of 166 cases (220 lesions) of mucosal cancer (m) and 67 (68 lesions) of submucosal cancer (sm). Histopathological data from these cases were examined and compared, with particular emphasis on the growth mode of the malignancy. The growth type of early colorectal cancer was divided into two types, those accompanied by intramucosal polypoid growth (PG-ca) and those with non-polypoid growth (NPG-ca). Of the 68 lesions of sm cancer, lymph node metastasis occurred in 8 patients (11.8%). The incidence of nodal metastasis by morphologic findings on the cut surface 17.2% (5/29) in the NPG-ca type as against 7.7% (3/39) in the PG-ca type. Tumors of the NPG-ca type tended to be smaller (less than 2.0 cm in diameter) than those of the PG-ca type and showed massive invasion of submucosal tissue and 72.4% (21/29) positivity for lymphatic vessel permeation. Therefore those cancers of the with non-polypoid growth type are considered to carry a high risk of lymph node metastasis and a colectomy with lymph node dissection would be the treatment of choice.View full abstractDownload PDF (15733K) -
Eiji Miyahara, Koji Ikejiri, Soichirou Maekawa, Yasuhiro Yoshida, Shig ...1992 Volume 25 Issue 7 Pages 1984-1988
Published: 1992
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSDuring the past 11 years, 600 patients with colorectal carcinoma were treated in our surgical department. Twenty-five of the cancers, which accounted for 42% of our series, were diagnosed as poorly differentiated adenocarcinoma. The clinicopathological features of these poorly differentiated adenocarcinoma were investigated. The poorly differentiated adenocarcinomas had a stronger tendency to deeply invade the bowel wall, submucosal venulae and lymph ducts, than the well-and moderately differentiated adenocarcinomas. The cumulative 5-year survival rate for patients with poorly differentiated adenocarcinoma was 18.6%, which compared unfavorably with the rates of 73.1% and 49.5% for well-and moderately differentiated adenocarcinoma respectively. Furthermore, the 5-year survival rates for patients with stages II and III of poorly differentiated adenocarcinoma were significantly lower than for those with well-and moderately differentiated adenocarcinoma. These lower survival rates for patients with poorly differentiated adenocarcinoma were believed to be caused by not only the severely advanced clinical stage at the time of the operation but also by the biological and cytological malignancy in itself.View full abstractDownload PDF (9501K) -
Yasutomo Azumi, Takeshi Yamasaki, Yoshihiko Furuya, Yoshiki Horita, Yu ...1992 Volume 25 Issue 7 Pages 1989-1993
Published: 1992
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSMost esophageal cancers are squamous cell carcinomas. We recently encountered a case of primary early adenoacanthoma occurring in the midesophagus. We herein report this case. The patient was a 59-year-old woman who visited the hospital with a chief complaint of dysphagia. Fluoroscopy of the esophagus revealed a serrated filling defect, 4.5 cm in long diameter, in the middle thoracic esophagus. By endoscopic biopsy, the diagnosis of adenoacanthoma of the esophagus was made. After preoperative irradiation with 30 Gy, subtotal resection of the thoracic esophagus was performed. Sections revealed a slightly irregular depressed lesion, 2.3×1.3 cm, 8 cm aboral to the esophagogastric junction. Histopathologically, the tumor showed proliferation of squamous cell carcinoma cells centering around the ulcerated portion and in part of the adenomatous portion. The border between the two components was sharp. The depth of invasion was submucosal. Both types of lesions showed moderate degeneration due to preoperative irradiation. The efficacy of irradiation was evaluated as Ef2. This case was diagnosed as primary early esophageal adenoacanthoma, sm, n0, M0, Pl0 and R-stage 0.View full abstractDownload PDF (9375K) -
Masayuki Matsumori, Takuro Okubo, Tomoichiro Mukai, Takuro Tsukube, Yo ...1992 Volume 25 Issue 7 Pages 1994-1998
Published: 1992
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSLeiomyosarcoma of the esophagus is a rare neoplasm, with only 95 cases having been reported in the literature. We report two resected cases of giant leiomyosarcoma of the esophgus. Patient 1, a 39-year-old male with multiple metastase of the right lobe of the liver, underwent resection of the thoracic and abdominal esophagus with lower lobectomy of the right lung via a right thoracotomy and a left thoraco-abdominal incision. The tumor measured 18×15×8 cm and weighed 1500 g. Forty days after the first operation, a extended right hepatic lobectomy was performed for hepatic metastasis. The patient was discharged from the hospital 20 days after the second operation and was doing well, but died one year after the second operation due to multiple mediastinal and liver metastase. Patient 2, a 46-year-old male, underwent resection of the lower thoracic esophagus with lower lobectomy of the left lung via a left thoraco-abdominal incision. The tumor measured 13×10×8 cm and weighed 800 g. The patients is currently doing well. The clinical features and surgical treatment of leiomyosarcoma of the esophagus are discussed.View full abstractDownload PDF (10135K) -
Tadahiko Enoki, Nobuyoshi Morita, Hiroshi Hiraoka, Fumihito Aikawa, Te ...1992 Volume 25 Issue 7 Pages 1999-2003
Published: 1992
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe report a case of giant liver cell adenoma. A 21-year-old woman complained of an epigastric painless tumor. The patient had never taken any hormonal drugs such as contraceptives. Preoperative examination revealed a hypervascularized liver tumor in the medial segment, and left lobectomy was performed. Macroscopically, the tumor was encapsulated by a fibrous capsule and its boundary was distinct. Although the lateral segment was atrophic, the right lobe was almost normal and no daughter nodules were detected macroscopically and ultrasonographically. Histologic examination of the surgical specimen showed cord-like growth of tumor cells, which resembled hepatocytes and were devoid of any atypism and capsular invasion. Furthermore, no portal triad could be observed. A cirrhotic appearance was not seen in the non-tumorous part of the liver. These findings were identical with those of liver cell adenoma.View full abstractDownload PDF (10024K) -
Takuo Shinozaki, Masahiro Fujimoto, Shun-ichi Matsukawa, Satoshi Yamag ...1992 Volume 25 Issue 7 Pages 2004-2008
Published: 1992
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe report a case of carcinoid tumor of the gallbladder in a 49-year-old woman. The tumor was a solid mass, measuring 8.3×6.3 cm. The tumor was diagnosed histologically as an atypical carcinoid, with negative reaction to Grimelius staining and immunohistologically positive for neuron-specific enolase. Electronmicroscopy of the tumor cells revealed a few neurosecretory granules in the cytoplasm. For metastatic liver tumors, the patient was treated with hepatic arterial infusion of 5-FU. Adriamycin, Mitomycin C. She is alive 2 years and 5 months after the operation although hepatic metastases have been developed.View full abstractDownload PDF (8999K) -
Morifumi Akiyama, Yasuhiro Mizushima, Gakuyo Karasawa, Ryuichi Denno1992 Volume 25 Issue 7 Pages 2009-2013
Published: 1992
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA case of cholangiocellular carcinoma originating in the caudate lobe is presented. The patient, a 69-year-old woman, was operated on initially for cholelithiasis and a T-tube was inserted into the choledochus. After the operation cholangiography through the T-tube revealed shadow defects in the right hepatic duct. After cholangioscopy, biopsies and computed tomography, we made a diagnosis of papillary carcinoma of the right caudete lobe. At the second operation the right caudete lobe was found to be occupied by the tumor but the liver capsule was still intact. Curative surgery, which included right hepatic lobectomy with total caudate lobectomy and resection of the extra hepatic bile duct, was performed. The histopathological finding was papillary adenocarcinoma which had colloidal proliferation into the distal parenchyma of the right caudete lobe. The patient has now been enjoying a normal social life for 3.5 years with no signs of recurrence.View full abstractDownload PDF (9061K) -
Takando Sakairi, Hiroyuki Shikishima, Morio Tsukada, Michio Matsumura, ...1992 Volume 25 Issue 7 Pages 2014-2017
Published: 1992
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSHyperplasia of the islet cells of Langerhans is a rare disease associated with hypoglycemic episodes. We report a case of this disease. The patient was a 31-year-old man who was admitted to our hospital because of frequent hypoglycemic episodes. He was diagnosed as having hyperinsulinemia, but various imaging examinations did not disclose any neoplasm, although an increase in immunoreactive insulin was detected in the pancreas body and tail by sampling with percutaneous transhepatic portal vein catheterization (PTC). Although a precise preoperative diagnosis was not obtained, distal pancreatectomy was performed under the suspicion of insulinoma in the pancreas body and tail. The final diagnosis was made pathologically as hyperplasia of the islet cells of Langerhans. No hypoglycemic episodes have occurred during the follow-up period of 2 years. For deciding the extent of pancreatectomy, preoperative sampling by PTC and recognition of intraoperative hyperglycemic rebound were useful.View full abstractDownload PDF (7610K) -
A Case of Intraluminal Duodenal Diverticulum with Duodenal Stenosis Caused by Adult Annular PancreasTomohiro Saito, Yoshinobu Yokoyama, Yutaka Ansai, Isao Shirosaki, Fumi ...1992 Volume 25 Issue 7 Pages 2018-2022
Published: 1992
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe experienced a case of intraluminal duodenal diverticulum (IDD) complicated by adult annular pancreas. The patient was a 38-year-old woman with general fatigue, appetite loss, nausea and vomiting as the chief complaints. Hypotonic duodenography and endoscopic examination revealed stenosis in the upper part and saccular formation in the middle of the second portion of the duodenum. The findings on CT scan suggested the parenchyma of pancreas around the narrow segment of the upper part of duodenum. The operative findings proved the complication of IDD and complete annular pancreas. Simple excision of the diverticulum at its base was carried out, and conventional gastrectomy was performed with Billroth-1 reconstruction. The microscopic appearance of the resected specimen was characterized by normal duodenal mucosa lining both sides of the diverticulum and the lack of proprial muscle. Only one previous case of complication of IDD and duodenal stenosis caused by annular pancreas has been reported in the Japanese literature.View full abstractDownload PDF (9463K) -
Takumi Tamura, Keizo Chikaishi, Hisao Wakabayashi, Takashi Maeba, Sato ...1992 Volume 25 Issue 7 Pages 2023-2026
Published: 1992
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA case of mucin-producing pancreatic cancer with long-term survival is reported. The patient, a 59-year-old woman, complained of general fatigue and thirst. ERCP revealed typical findings of Vater's papilla and filling defects in the dilated main pancreatic duct. Total pancreatectomy was performed under the diagnosis of so-called mucin-producing pancreatic cancer. A papillomatous tumor was observed macroscopically in the main pancreatic duct of the pancreatic head. Histologically, the tumor was non-invasive papillary adenocarcinoma and no lymph node metastasis was observed. The patient has been living without any specific restriction in daily life and with no signs of recurrence for 5 years after the operation. Because of the pathological features of this tumor, it is difficult to determine the spread of the tumor even at the operation and there are many controversies about the surgical margin. However, since the tumor has a better prognosis than ordinary pancreatic cancer and there is a possibility of long-term survival, it is necessary to select the most appropriate surgical resection including total pancreatectomy.View full abstractDownload PDF (7678K) -
Tsutomu Nomura, Masahiko Onda, Akira Tokunaga, Kiyohiko Yamashita, Nor ...1992 Volume 25 Issue 7 Pages 2027-2031
Published: 1992
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe report multidisciplinary treatment including surgery, immunotherapy, endocrine therapy, radiation and medication for a desmoid tumor in a Japanese patient with Gardner's syndrome. The patient was found to have polyposis coli with osteoma of the mandible at the age of 14 yr. syndrome. The patient was found to have polyposis coli with osteoma of the mandible at the age of 14 yr, and was diagnosed as having Gardner's syndrome. In 1984 he underwent total colectomy because of cancer of the sigmoid colon and polyposis coli. A mass removed from the left lower rectal sheath of the abdominal wall 2 years after colectomy was found to be a desmoid tumor histologically. In 1987, he underwent re-excision of a recurrent tumor in the abdominal wall and intratumor injeciton of OK-432, an immunostimulant bacterial preparation, for a retroperitoneal tumor which could not be removed because of infiltration into neighboring tissues. Postoperatively, he was given toremifene, an anti-estrogen, orally daily for 6 months. A CT series revealed that the retroperitoneal tumor had become small after treatment with OK-432 and toremifene. In 1988, he underwent re-excision of the recurrent tumor in the abdominal wall and radiation treatment for the retroperitoneal tumor. Thereafter no marked change in the abdominal and retroperitoneal tumors was observed for 2 years until metastatic lung cancer was revealed by chest X-ray in April 1990. The patient died 7 years after the colostomy. The multidisciplinary treatment employed might have contributed to the control of the desmoid tumor in this patient, although attempts to control the spread of cancer derived from polyposis coli failed.View full abstractDownload PDF (10082K) -
Hiromi Iwagaki, Akio Hizuta, Toshikazu Kimura, Yasuyuki Nonaka, Sadano ...1992 Volume 25 Issue 7 Pages 2032-2035
Published: 1992
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSChanges in the intestinal microflora of a patient after total colectomy were determined. The patient was a 20-year-old man who was diagnosed as having familial polyposis coli. Total colectomy with an ileo-anal anastomosis was performed, and the ileostomy was closed 8 months later. The intestinal microflora, fecal pH, fecal moisture and fecal organic acid were determined 1, 3, 4, 10 and 12 months after the operation. The fecal moisture and fecal pH gradually decreased after the operation. After closure of the ileostomy, the fecal moisture and pH were normalized, and the composition of the fecal organic acid was also normalized. These fecal changes were proportional to the increase in the anaerobic/aerobic ratio. These results suggest that the intestinal flora plays a role in ileal compensation or colonization.View full abstractDownload PDF (6483K) -
Yoshiaki Murakami, Takashi Yokoyama, Takashi Kodama, Yoshio Takesue, M ...1992 Volume 25 Issue 7 Pages 2036-2040
Published: 1992
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA case of carcinoid tumor of the colon in a 23-year-old woman is described. The patient complained of left flank pain and her serum LDH level was high. Ultrasonography and computed tomography revealed a 10×5 cm mass in the left upper abdomen. Barium enema revealed obstruction of the colon in the splenic flexure. Under the suspicion of a malignant tumor which originated from the wall of the colon, laparotomy was performed. Because the tumor invaded the left kidney and tail of the pancreas, left hemicolectomy with resection of the left kidney, spleen and tail of the pancreas was performed. Subsequent pathological findings revealed a carcinoid tumor with metastasis to lymph nodes which was classified as Soga's “mixed type”, and the tumor was composed of non-argentaffin, non-argyrophil endocrine cells. Carcinoid tumor of the colon in a young woman is very rare, but this tumor is characteristic of carcinoid tumor originating from the hindgut, most cases of which are “mixed type”, composed of non-argentaffin, non-argyrophil endocrine cells. A review of 45 cases of carcinoid tumor of the colon reported in Japan is also described.View full abstractDownload PDF (10161K) -
Yoshito Yamashita, Masaichi Ohira, Yoshiyuki Kawazoe, Teruyuki Ikehara ...1992 Volume 25 Issue 7 Pages 2041-2045
Published: 1992
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSTwo cases of intussusception caused by colon cancer are reported with a review of the literature. In case 1 the patient was a 22-year-old woman with abdominal pain and melena. An ultrasonography and a barium enema revealed an intussusception into the right transverse colon and it was reduced by the barium enema. The following barium enema and colonoscopy revealed that the intussusception was caused by type 1 carcinoma of the caecum, and a curative operation was performed. In case 2 the patient was a 75-year-old man with melena. A barium enema revealed type 1 sigmoid cancer. A colonoscopy after abdominal pain revealed an intussusception caused by the cancer. Intraoperatively, without reduction, a curative operation was performed. We compared 37 cases so far reported in Japan, including our 2 cases, with 294 cases of colon cancers which were resected in our surgical department. The main sites of the intussuscepted cancer were the sigmoid colon (51.4%) and the caecum (32.4%). The tumor size was not related to the frequency of intussusception, and it was relatively easy for early cancers to intussuscept. Almost all the colon cancers associated with intussusception (93.1%) were of the non-infiltrating type.View full abstractDownload PDF (9104K) -
Haruhisa Hara, Michio Asano, Syuzi Asai, Yoshizi Kato, Syohachiro Furu ...1992 Volume 25 Issue 7 Pages 2046-2049
Published: 1992
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe patient was a 59-year-old woman. Biopsy following discovery of blood in the stool revealed a melanoma in the anorectal area. Abdominoperineal resection was subsequently performed. The patient has survived for 10 years with no recurrence. The tumor was 4 cm in diameter with a tumor depth of pm. There was no metastasis to the lymph nodes. Histological analysis showed the growth to be an amelanotic melanoma. Including our patient, only 9 patients surviving more than 5 years have been reported in Japan. The 5-year survival rate for patients with abdominoperineal resection is fairly low (18.7%), and no patients are reported to have survived more than 5 years when excision was localized. We compared patients who survived more than 5 years with those who died within 2 years, and found that the conditions for longer survival were: 1) tumor diameter of less than 5 cm, 2) tumor depth of pm or less, 3) abdominoperineal resection with wide-ranging lymphadenectomy performed regardless of whether metastasis to lymph nodes had occurred.View full abstractDownload PDF (6390K) -
Kazuhiro Sakamoto, Hiroshi Nozaki, Yasuhiro Ishii, Yasuo Hayashida, No ...1992 Volume 25 Issue 7 Pages 2050-2054
Published: 1992
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSRectal cancer is uncommon in young adults. In people under 19 years of age, it is extremely rare. As a result, no more than about 51 cases have been reported in Japan. The present case concerns rectal cancer in a 19-year-old male with a family history of cancer. The patient consulted a physician complaining of diarrhea and hematochezia. He was subsequently admitted to our hospital because of a possible diagnosis of rectal cancer. His paternal family history revealed cancer in 11 out of 38 persons over three generations. There were 4 cases of colorectal cancer, 3 cases of gastric cancer, 2 cases of uterine cancer, one case of bladder cancer, and one case of pancreatic cancer. A barium enema showed constriction of the entire circumference of the Ra-Rs area of the rectum. A fiberscopic examination revealed a tumorous protrusion with an irregular, hemorrhagic mucosa. Biopsy revealed a poorly differentiated adenocarcinoma. The initial operation was a low anterior resection. The resected specimen was rectal cancer (diffuse type) measuring 12×8 cm. Histological examination revealed mucinous carcinoma. Thirty months after the initial operation a tumor was discovered in the patient's pelvis. CT revealed invasion of the abdominal wall and partial invasion of the wall of the bladder. Tumor resection and adjuvant chemotherapy and radiotherapy were performed. Approximately 4 years have passed since the patient's initial surgery. At present the patient is in good health and suffers no problems with respect to urination or defecation.View full abstractDownload PDF (9521K) -
Suguru Kase, Susumu Kodaira, Tatsuo Teramoto, Kousei Hisa, Kazuo Furuk ...1992 Volume 25 Issue 7 Pages 2055-2059
Published: 1992
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe studied 7 cases of anal carcinoma associated with anal fistula, which were treated in our institute from January 1970 to September 1991. The patients consisted of 6 men and one woman with an average age of 59.1 years ranging from 43 to 77 years. The period from the onset of anal fistula to the diagnosis of carcinoma ranged from 4 to 47 years with a mean of 22.9 years. Their chief complaints were anal mucinous discharge and/or bleeding, anal pain, palpitation of perianal hard nodules and anal stenosis. All patients were treated by abdominoperineal resection consisting of 4 curative and 3 non-curative resections. Histological findings varied, with 3 mucinous and 3 well/moderately differentiated adenocarcinomas and one squamous cell carcinoma. Although 4 of the 7 cases were diagnosed at the first diagnostic trial, the repeated biopsies failed to reveal the cancer cells in the other 3 cases until the final diagnosis. We concluded that repeated diagnostic trials including extended excision of the fistula are required for patients who have a long history of anal fistula with mucinous discharge and hard nodules, to differentiate the onset of anal carcinoma.View full abstractDownload PDF (10605K)
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