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Volume 26, Issue 7
Displaying 1-37 of 37 articles from this issue
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Monitoring Influence in Lower Esophageal High Pressure ZoneToyohide Nakamura, Kimio Namatame1993 Volume 26 Issue 7 Pages 1913-1920
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSTo study the causal factors of refluex esophagitis after total gastrectomy, we performed an endoscopic observation and manonetric study of the lower esophageal high pressure zone (LEHPZ) in 59 postoperative patients. In 17 of the 59 patients, 24-hr pH monitoring measurement was conducted. The results were as follows. 1) Endoscopy revealed 11 cases of esophagitis (18.6%). The most frequent site of the esophagitis was around the oral side of anastomosis. 2) Among 3 reconstructive procedures, the p-Roux en-Y type was followed by esophagiits at the lowest incidence (8/50, 16%). 3) Under the definition that regurgitation to the esophagus was above pH 7.5 by 24-hr pH monitoring measurement, every factor of the reflux was higher in the esophagitis group than the free group. 4) The High Pressure Zone (Tone) was significantly preserved in the group with a resected esophagus of 5 mm or less. 5) HPZ (T) correlated inversely with the total percent of time and number of reflux episodes. We conclude that the preservation of HPZ (T) depends on the length of the resected esophagus. Either a low or no HPZ (T), or any factor of regurgitation is a high risk factor of alkaline esophagitis. For such high risk patients, close endoscopic observation is mandatory.View full abstractDownload PDF (14954K) -
Satoru Hayashi, Masayuki Matsumori, Masayoshi Okada1993 Volume 26 Issue 7 Pages 1921-1928
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe host defense mechanism in patients with esophageal cancer is markedly suppressed by surgical intervention in the presence of malignant tumor and malnutrition. In has been shown to cause a higher incidence of postoperative infection, and damages the tolerance for recurrence of the tumor. The immunological changes before and after surgery in 33 patients who underwent surgery for esophageal cancer was studied. Parameters such as blood leukocyte count (WBC), blood lymphocyte count, immunoglobulins (IgG, IgA), subsets of lymphocytes (Leu. 4, Leu. 3a, Leu. 2a, Leu. 7, Leu. 11), antibody-dependent cell-mediated cytotoxicity (ADCC), and natural killer (NK) activity were routinely measured. The effect of Lentinan on the immune response of patients after surgery was also evaluated. Lentinan was intravenously administrated at 2 mg every week to 18 of 33 patients from two weeks before the operation. Parameters such as total lymphocytes, IgG, IgA, CH50, Leu. 4, Leu. 3a/Leu. 2a, ADCC and NK activity were suppressed after surgery. Cell-mediated immunity (Leu. 3a/Leu. 2a, ADCC and NK activity) was further depressed and it remained so longer. The suppression of total lymphocytes, Leu. 3a/Leu. 2a, ADCC, NK activity and incidence of postoperative leukocytosis were less in the Lentinan-administrated group. The use of Lentinan was suggested to be feasible for immunity after esophageal surgery.View full abstractDownload PDF (14745K) -
Comparative Analysis of the MD and DEXA MethodsNobukuni Terata, Haruo Sano, Haruaki Ishibashi, Tohru Tani, Junsuke Sh ...1993 Volume 26 Issue 7 Pages 1929-1935
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe incidence of postgastrectomy bone disorder was assessed in gastric cancer patients who received a curative operation. The bone mineral content was measured using either microdensitometry (MD) method (n=81 patients) or dual energy X-ray absorptiometry (DEXA) method (n=55 patients). These two groups were comparable in age, sex (mostly women), and the period after gastric resection (significantly evident more than 3 years after surgery). A similar incidence of bone disorder was observed between the two methods, even though the scores of individual patients did not always show a good correlation. We further investigated the MD method (which was easily and conveniently performed by clinicians) and the DEXA method to exclude the effect of surrounding soft tissue and directly estimate the BMD value of the lumbar bone. The discrepancy between the MD and DEXA methods can be partially explained by the fact that the former includes cortical bone and the latter measures trabecular bone. Of interest is the fact that there was a good correlation between the ΣGS value of the metacarpal MD method and the bone mineral density (BMD) value of the calcaneal single energy X-ray absorptiometry (SXA) method, but not between that of the metacarpal MD and lumbar DEXA methods. There was a remarkable drop in the total score of the MD method after the administration of 1α-OH-D3. These improvements were noted in 12 of 19 cases.View full abstractDownload PDF (12560K) -
Takashi Mizutani, Masahiko Onda, Akira Tokunaga1993 Volume 26 Issue 7 Pages 1936-1943
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSEpidermal growth factor receptor (EGFR) shares homology with, but is distinct from, c-erbB-2 oncoprotein. While amplification of EGFR is found in both squamous cell carcinoma and adenocarcinoma, that of the c-erbB-2 gene is found only in adenocarcinoma. EGFR is shown to be coexpressed with c-erbB-2 in advanced gastric cancer with metastasis. This study was, therefore, designed to examine the expression of EGFR in human gastric cancer in comparison with esophageal and colonic cancer, and to examine the presence of c-erbB-2 in human gastric cancer xenografts of nude mice. The expression of EGFR was examined by 125I-EGF binding assay. Slot blotting and immunohistochemistry for c-erbB-2 were also done. EGF binding capacity of non-cancerous mucosa and cancer in esophagus was higher than that in stomach or colon. EGF binding capacity and the positive rate of EGFR in gastric cancer were higher than those in non-cancerous gastric mucosa, and those in undifferentiated gastric carcinoma were higher than those in differentiated gastric carcinoma. No difference in EGF binding capacity and the positive rate of EGFR was found in non-cancerous mucosa and cancer of colon. Both amplification and protein expression of c-erbB-2 were found in two differentiated adenocarcinomas of human gastric cancer xenografts in nude mice. The expression of EGFR and/or c-erbB-2 appeared to be related to the growth of human gastric cancer and its xenografts in nude mice. However, it is open to question whether coexpression of EGFR and c-erbB-2 in the tumor contribute to metastasis and/or invasion of cancer cells.View full abstractDownload PDF (15162K) -
Osamu Hosokawa, Shin Yamazaki, Kunishige Watanabe, Yutaka Tanigawa, Ya ...1993 Volume 26 Issue 7 Pages 1944-1950
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSFrom 1971 to 1990, a total of 1523 patients with early gastric cancer underwent gastric resection in our hospital. Of these, 17 patients (1.1%) had microscopic cancer-positive surgical stumps. We conducted clinicopathological and follow-up investigations in these cases. From the standpoint of morphological features 8 of the 17 cases were the superficial spreading type, 4 were multiple cancerous lesions and 2 coexisted with IIb lesions. Cancer-positive stumps of eight cases were under 10mm in width and the others more than 10mm. In 12 cases, cancer cells had invaded the end of the resected stump. In 8 cases cancer cells had spread to the wedge of the superficial layer of the gastric mucosa, in one case of the deep layer, in 8 cases of all layers. As a result of examining the residual stomach, we found residual gastric cancer in 6 cases and re-resected then. Four cases were of the superficial spreading type, cancer-positive stumps of 5 cases were more than 10mm in width, and in 4 cases cancer cell spread to the wedge of all layers.View full abstractDownload PDF (12454K) -
Yoshitaka Yamamura, Tsuyoshi Kito, Junichi Sakamoto, Takashi Hirai, Ke ...1993 Volume 26 Issue 7 Pages 1951-1956
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe influence of cancer infiltration at the resection margin (infilt (+)) on prognosis for 683 patients who underwent non-curative gastric resection from 1965 to 1984 was studied. The three-year survival rates (3YSR) were evaluated statistically. 3YSR of aw (+) and ow (+) were 40.6% and 36.0%. 3YSR were 32.8% in patients with a single factor of N>R relatively non-curative resection and 10.0% in patients with two factors of N>R relatively noncurative resection plus infilt (+) (p=0.0001). In N>R absolutely non-curative resection, 3YSR of N>R alone was 12.8% and that of N>R plus inilt (+) was 4.8% (not significant, NS). In S3, 3YSR of S3 alone and S3 plus infilt (+) were 28.6% and 0% (NS). 3YSR were 27.8% and 6.3% in patients having the single factor of P1 and P2-3 alone, and 21.4% and 0% in patients with the factors of P1 and P2-3 plus infilt (+) (NS). 3YSR were 5.7% in patients with more than two non-curative factors alone and 3.4% in patients with more than two factors plus infilt (+). From these results, it was concluded that the prognosis for the patients having positive infiltration at the resected margin was not wrong in those with a large tumor burden.View full abstractDownload PDF (9053K) -
Yuji Yamamoto, Tomishige Amano, Toshio Imada, Norio Aoyama, Hiroharu S ...1993 Volume 26 Issue 7 Pages 1957-1962
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe antitumor activity of concomitant Cis-diamminedichloroplatinum (CDDP) and caffeine treatment and its chromosomal effects were studied using by a human gastric cancer cell line, STKM-1. The growth rate was 57% after 3 hours of treatment with CDDP (2 μg/ml), but it was reduced to 23% and 9.3% respectively by incubation with 1 mM and 2 mM caffeine following treatment with CDDP. Thus, the antitumor effect of CDDP was enhanced by caffeine. The incidence of gaps or breaks in the chromosomes after treatment with CDDP (2 μg/ml) was 1.816±1.509/cell and the incidence of exchange was 0.184±0.565/cell. When the cells were incubated with 1 mM caffeine for 24 hours beginning just after CDDP treatment, the incidence of gaps or breaks increased to 4.206±3.162/cell and that of exchanges to 0.760±0.938/cell. The same results were obtained by incubation with caffeine for either 24 or 48 hours after CDDP treatment. These findings indicate that caffeine may inhibit DNA repair, and should enhance antitumor activity when used concomitantly with CDDP in the treatment of gastric cancer.View full abstractDownload PDF (10646K) -
Takashi Ichikura, Soichi Tomimatsu, Kazuhiko Uefuji, Yasushi Okusa, Ke ...1993 Volume 26 Issue 7 Pages 1963-1968
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSLymph node involvement is recognized to be an important prognostic determinant in gastric cancer. We analyzed 426 patients who underwent a potentially curative resection for gastric cancer invading the muscularis propria or deeper to determine whether the number of metastatic lymph nodes or the nodal stage based on the sites of positive nodes is a better prognostic indicator. In those with more metastatic lymph nodes, survival was decreased. From the survival analysis we were able to divide the patients into three groups based upon the number of positive nodes: 0 to 4 (group A), 5 to 12 (group B), 13 or more (group C). Survival decreased in the order of groups A, B and C in each of the n1 (+), n2 (+) and n3, 4 (+) groups. Significant differences in survival were observed between groups A and B, and between groups A and C in the n1 (+) patients (p<0.01). The differences in survival were also significant between each pair of the three groups in the n2 (+) patients (p<0.01), although the difference was not statistically significant in the n3, 4 (+) patients because of the small number of cases. On the other hand, when the group A patients were analyzed, the n1 (+), and n2 (+) patients had as good an outcome as the n (-) patients. There were no significant differences in survival among the n1 (+), n2 (+) and n3, 4 (+) patients in groups B and C. These results suggest that the number of metastatic lymph nodes is a better prognostic indicator than the nodal stage based on the sites of positive nodes.View full abstractDownload PDF (10581K) -
Hideki Ura, Ryuichi Denno, Koichi Hirata1993 Volume 26 Issue 7 Pages 1969-1976
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThis study evaluated the influence of quantitative factors of metastatic lymph nodes, such as the number of metastasized nodes and frequency of metastasis, on the prognosis after curative gastrectomy in 733 patients. As a result, only in n2 cases could these factors be regarded as prognostic limiting factors. On the other hand, an evident difference in survival rates in n1, n3 cases could not be found according to these factors. The number of positive second regional lymph nodes was considered more useful to predict the outcome of n2 cases than the simple addition of metastasized nodes. The frequency of lymph node metastasis (F) reflected the outcome of n2 cases very closely. The five-year survival rates according to F-value were as follows: F<10% 62.9%, 10%≤F<10% 46.1%, 20%≤F<50% 29.7%, F≥50% 7.1%. As a result of univariate analysis of the postoperative survival rate, these quantitative factors proved to limit the prognosis of n2 cases the same as or more than depth, and they seemed to be independent factors.View full abstractDownload PDF (13626K) -
Xiao Chun Ma, Nobukuni Terate, Masashi Kodama, Ryoji Kushima, Takanori ...1993 Volume 26 Issue 7 Pages 1977-1982
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSBlood sialyl-Tn antigen (STN) levels were studied in 137 patients with gastric cancer. High STN levels were observed in 20 cases (15%). STN levels were not correlated with those of CEA or CA19-9. STN levels were higher in advanced cancers, such as stage III and stage N. Serosal invasion was seen in 14 out of the 20 cases, and lymph node metastasis was detected in 17 cases. On histological examination, the gastric cancers with high STN levels were found to be undifferentiated cancers. On immunohistochemical analysis, STN-positive cancer cells were identified in every cases. The PCNA-indices of the cancer cells were than more 50% in high-STN gastric cancers. STN levels decreased after gastrectomy, but in several cases, they remained high, thereby indicating residual tumor after the operation. Recurrence occurred in several cases, and the STN level became high again. These results suggested that STN is correlated with the penetration and proliferation of cancer cells, etc, and the measurement of STN is useful in assessing the clinical stage and the recurrence of gastric cancers.View full abstractDownload PDF (10815K) -
Shiro Kawamura, Michio Kato, Tohru Morishita, Masakazu Ohno, Masato Fu ...1993 Volume 26 Issue 7 Pages 1983-1989
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA total of 511 patients with poorly differentiated adenocarcinoma of the stomach were histologically classified into medullary type (91 cases), intermediate type (148 cases), and scirrhous type (272 cases) based on the amount of interstitial connective tissue. Among them, the medullary and scirrhous types were compared with regard to clinicopathological findings and prognosis of the patients. Patients with the medullary type were also studied with regard to postoperative survival correlating to the degree of lymphocytic infiltration. Our results indicated that the patients with the medullary type tended to be older and to be male, and the tumor tended to be located in the lower third of the stomach and to be Borrmann type 1 and 2, ps (-), n4, and stage I. Patients with the scirrhous type tended to be younger and to be female, and the tumor tended to show whole stomach extension and to be Borrmann type 3 and 4, ps (-), and stage III. On the other hand, there was no significant difference between the two types in terms of macroscopic peritoneal dissemination and liver metastasis. The postoperative survival rates for the two types were not significantly different according to histological staging (stage) and prognostic serosal factor (ps). Likewise, the amount of interstitial connective tissue did not appear to affect prognosis. In the medullary type, however, the patients with lymphocytic infiltration tended to have a better prognosis than those without lymphocytic infiltration.View full abstractDownload PDF (13404K) -
Norio Yoshimura, Takashi Hamashima, Chol-Joo Lee, Yoshio Ohsaka, Kazun ...1993 Volume 26 Issue 7 Pages 1990-1995
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSAlthough the development of veno-venous bypass technique during orthotopic liver transplantation (OLT) has decreased the mortality and morbidity of the patients, bleeding or thrombosis due to hemostatic disorders, especially during the anhepatic phase of surgery, are serious problems in OLT patients. In the present study, therefore, we assessed the efficacy of the molecular markers used to evaluate coagulation and fibrinolysis status during the anhepatic phase of surgery using a swine model. Total hepatectomy was performed in the swine (female, BW=20kg, n=6) and maintained for 150 minutes with veno-venous bypass. Thrombin-antithrombin III complex (TAT) and fibrin monomer test (FM test) were analyzed as molecular markers of the coagulation state, and FDP-D dimer (DD) and plasmin-α2 plasmin inhibitor complex (PIC) were analyzed as molecular markers of the fibrinolytic state. PT, fibrinogen (Fng), AT-III, heparastin (HP), FDP, tissue plasminogen activator (t-PA) and platelet counts were also analyzed as conventional parameters. TAT levels displayed a remarkable elevation in the early anhepatic phase, but FM test showed a slow change from (-) to (+) between 60 and 120 min of the anhepatic phase. On the other hand, DD levels displayed a remarkable elevation in the late anhepatic phase. PIC did not show any significant change. These data suggested that coagulation disturbances due to a consumption of elements developed in the early anhepatic phase and that fibrinolytic disturbances developed in the late period. Since molecular markers are more sensitive than conventional parameters, sequential determination of TAT and DD is recommended to evaluate the hemostatic status in the anhepatic stage of OLT.View full abstractDownload PDF (10090K) -
Shojiro Miyazaki, Takeshi Takasaki, Toshiyuki Hayashi, Masakazu Yamamo ...1993 Volume 26 Issue 7 Pages 1996-2002
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe relationship between the presence or absence of cancer infiltration of the liver incision surface and recurrence at the cut end was investigated in 106 patients who underwent hepatectomy for hepatocellular carcinoma. Seventy-one (67.0%) of the patients were TW (tumor wedge) positive. Recurrence in the remaining liver was observed in 37 (52.1%) of the TW positive patients and 16 (45.7%) of the TW negative patients. Recurrence at the cut end was observed in 4 (7.5%) of the 53 patients with recurrence in the remaining liver, and all 4 of these patients were TW positive. The incidence of recurrence in the remaining liver, 46.5%, among the TW positive patients, excluding the patients with recurrence at the cut end, was approximately equal to that in the TW negative patients, and the results of investigation in patients with recurrence at the cut end suggest that determination of TW can lead to an improvement in prognosis. With regard to the rate of survival without recurrence, however, there was no difference between TW positive and TW negative patients. This phenomenon was considered to depend on the circumstances, i.e., the significance of TW in recurrence is less than that of extracapsular infiltration, tumor embolism of the portal vein, intrahepatic metastasis and tumor size, since the incidence of recurrence at the cut end in patients with recurrence in the remaining liver was low. All of the patients with recurrence at the cut end showed a TW of 5 mm or less, suggesting that one of the scales by which TW can be determined is a TW of 5 mm or more.View full abstractDownload PDF (14372K) -
Satoru Miyazaki, Tsuguo Sakamoto, Keishi Kuwata, Yoshirou Yamazaki, Ha ...1993 Volume 26 Issue 7 Pages 2003-2008
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSPerivaterian duodenal diverticula has been known to cause biliary and pancreatic disorders. To establish a correlation between duodenal diverticula and biliary lithogenesis, we reviewed 12, 321 patients who had an upper gastrointerstinal series and analyzed 467 patients who underwent biliary surgery during the at five years. The incidences of duodenal diverticula in males and females were 4.9% and 9.1%, respectively. 92.2% of the diverticula were located in the second duodenal portion, and 95.6% of them were solitary. The incidence of duodenal diverticula increased significantly with age. Common bile duct stones were highly associated with duodenal diverticula (17/33 cases, 51.5%), in contrast to the lower incidence of diverticula in cases of gall bladder stones (51/329 cases, 15.8%) and polyps (8/49 cases, 16.3%). A significant correlation was also found between the diameter of the common bile duct and diverticula (r=0.43, p<0.05). The incidence of bilirubin stones in patients with diverticula was 84.4%, significantly higher than that in patients without diverticula (28.1%). The present study provided further evidence that duodenal diverticula contributed to biliary lithogenesis.View full abstractDownload PDF (11404K) -
Shoji Uetsuji, Osamu Yamada, A Hon Kwon, Shuji Kurimoto, Sohei Satoi, ...1993 Volume 26 Issue 7 Pages 2009-2012
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe problem of whether or not cholecystectomy should be performed for silent gallstones is discussed. There have been many clinical investigations of symptomatic and asymptomatic gallstones. However, there have been few pathohistological investigations of gallbladder with silent stones. We experienced 39 cases (210.4%) with silent gallstones in 375 patients operated on for gallstones. The 375 cases were divided into three groups, severe, moderate, and mild, according to the grade of inflammatory cellular infiltration in the mucosal layer of the gallbladder. These three histological groups were 51.7%, 33.0%, and 15/3% of the symptomatic gallstone cases, respectively, and 48.7%, 23.1%, and 28.2% of the asymptomatic gallstone cases. There was no significant pathohistological difference between symptomatic and asymptomatic gallstones. Even if the case is silent gallstone, there are histological findings of severe cholecystitis in gallbladder, symptomatic possibility or the potentiality of canceration, and the restriction of life due to carrier of gallstone. Moreover, laparoscopic cholecystectomy that is less of surgical stress, popularizes these days. Therefore, we consider cholecystectomy appropriate for silent gallstones.View full abstractDownload PDF (7049K) -
Ryoko Sasaki, Senji Kanno, Masahiko Murakami, Yoshiro Hayakawa, Yutaka ...1993 Volume 26 Issue 7 Pages 2013-2019
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIn order to determine the indication for pylorus preserving pancreaticoduodenectomy (PPPD) and the appropriate method of lymphnode dissection, the mode of lymphnode metastasis was investigated clinicopathologically in 21 cases of carcinoma of the distal bile duct and 18 cases of ampulla of Vater. 1) The rate of lymphnode metastasis was 28.6% in carcinoma of the distal bile duct and 38.9% in carcinoma of the ampulla of Vater. 2) There were no significant relationships between tumor length, depth of invasion, histological differentiation and lymphnode metastasis. 3) The lymphnode metastases were frequently noted at No.(13) b (23.8%) and (17) b (9.5%) in carcinoma of the distal bile duct, and at No.(13) a (22.2%), (13) b (16.7%) and (8) (16.7%) in carcinoma of the ampulla of Vater. No.(16) lymphnode metastasis was observed in 5.9% of cases of carcinoma of the distal bile duct, and No.(14) in 9.1%, and No.(16) in 7.7% of cases of carcinoma of the ampulla of Vater. 4) Statistically there were no significant correlations between lymphnode metastasis and prognosis either in carcinoma of the distal bile duct or ampulla of Vater. 5) Among the 7 patients who underwent PPPD, death by cancer was observed in only one case. These results suggest that PPPD is the choice of operation in most patients with carcinoma of the distal bile duct and ampulla of Vater. It is especially important to dissect the lymphnode around the celiac trunc, supramesenteric artery and aorta.View full abstractDownload PDF (12420K) -
Tetsuji Fujita, Makoto Odaka, Miwako Matsumoto, Kenji Sakurai1993 Volume 26 Issue 7 Pages 2020-2025
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSRecently, the gut has come to be considered as a central organ in stress states. The purpose of this study is to investigate the amino acids and cytokine exchange across the gut. Portal and peripheral venous blood samples were obtained simultaneously from 24 patients who underwent abdominal surgery, two hours after the start of the operation, and levels of amino acids, cytokines, insulin, and glucagon were measured. There were no significant differences in portal-peripheral venous amino acid levels of 19 amino acids, excluding glutamine. Portal blood levels of glutamine were significantly (p<0.02) lower than those in the peripheral venousblood (371.06±97.01nmol/ml vs 452.38±80.29nmol/ml, mean±SD). The peripheral venous blood levels of glutamine were negatively correlated with portal blood levels of interleukin 6 (r=-0.46, p<0.05). Portal blood levels of glutamine were negatively correlated with the peripheral venous glucagon/insulin concentration ratio (r=-0.46, p<0.05). These data suggest that cytokines may play a role in glutamine uptake by intestinal epithelial cells.View full abstractDownload PDF (10748K) -
Toshio Uematsu, Kenji Tsuchie, Keisuke Iwata, Takahiko Aoyama, Takao K ...1993 Volume 26 Issue 7 Pages 2026-2030
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSZenker's diverticulum is occasionally encountered but rarely operated on. We report a surgical case of Zenker's diverticulum associated with a thyroid adenoma. The patient is a 77-year-old man with a complaint of dysphagia for five years. he has been aware of a cervical tumor for one year. Cervical computed tomography showed a thyroid tumor of the right lobe and an oval gas collection on the left of the trachea which was characteristic of Zenker's diverticulum. Zenker's diverticulum was confirmed by esophagography and esophagoscopy. Diverticulectomy and right thyroid lobectomy were performed. The thyroid tumor was 90×70×35mm insize and was histologically proved to be follicular adenoma. The resected diverticulum was 25×15mm in sizeand was composed of squamous epithelium and a thin muscular layer. Zenker's diverticulum is regarded as a pulsion diverticulum. In our case, it is suggested that the incidentally associated thyroid tumor enlarged the Zenker's diverticulum, causing dysphagia by compressing the trachea and esophagus.View full abstractDownload PDF (9776K) -
Shuichi Murata, Hidenori Maruoka, Katsumi Kiyosaki, Rin-ichiro Wakasa, ...1993 Volume 26 Issue 7 Pages 2031-2034
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe following was our clinical experience with a patient with spontaneous rupture of the stomach probably induced by overdistention of the stomach resulting from a large pool of blood during treatment of a hemorrhagic gastric ulcer. A 72-year-old woman was admitted to our facility because of hematemesis. An endoscopic examination of the stomach revealed a large quantity of blood in the stomach. The source of the hemorrhage, however, could not be identified. About 48 hr after admission, the patient had severe hematemesis again, resulting in shock At laparotomy, 3.2 liters of blood was removed from the abdominal cavity and about 15-cm longitudinal tear was observed at the lesser curvature of the stomach. An ulcer on the posterior wall of the corpus of the stomach adhered to the spleen and the tail of the pancreas. Therefore, total gastrectomy combined with splenectomy and resection of the tail of the pancreas was performed. Histological examination revealed a 4.5×2-cm Ul-IV ulcer on the posterior wall of the corpus of the stomach, with rupture of an artery at thesite of the ulcer. It was presunled thatin the stomach inflated with blood, hematemesis causedthe intragasthc pressure to increase drastically, causing the lesser curvature to rupture. This case is the third documented adult case of spontaneous rupture of the stomach in Japan.View full abstractDownload PDF (8299K) -
Hiroyuki Kawamura, Makoto Kataoka, Yoshiyuki Kuwabara, Yasuyuki Kureya ...1993 Volume 26 Issue 7 Pages 2035-2039
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA case of leiomyoblastoma of the stomach that showed an unusual growth pattern is reported. The patient was a 69-year-old female who was admitted with a chief complaint of abdominal mass the size of a fist in the right epigastric region. Ultrasound examination indicated that the mass was cystic in the upper and lower poles and solid in the center. MRI defined a gastric submucosal tumor which had grown beyond the gastric wall. After endoscopic biopsy, bleeding was observed from the biopsy site, and emergency operation was performed. Laparotomy revealed a pedunculated tumor growing extramurally from the pyloric greater curvature. Wedge resection of the stomach, including the mass, was performed. A diagnosis of low grade malignant leiomyoblastoma was made histologically. About 10% of leiomyoblastoma is malignant, and extended gastrectomy is considered to be needed in case of multiple tumors or when the tumor has markedly invaded the gastric wall. However, when the tumor grows as a pedunculated extragastric lesion, no invasion into the gastric wall is observed, and no lymph node enlargement is noted as in our case, wedge resection is considered to be sufficently curative.View full abstractDownload PDF (10640K) -
Matsuhei Tanaka, Yoshio Kaneko, Ken-ichi Ietsugu, Chihiro Yoshida1993 Volume 26 Issue 7 Pages 2040-2044
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe experienced a case of alpha-fetoprotein (AFP)-produing gastric carcinoma of a 27-year-old man with accompanying acromegaly. His chief complaint was hematemesis. He was diagnosed with acromegaly at the age of 24, and underwent resection of the pituitary gland. Gastrofiberoscopy revealed a Borrmann type 2 gastric carcinoma just below the cardia, which seemed to be the source of bleeding. Endoscopic biopsy revealed poorly differentiated adenocarcinoma. Although abdominal computed tomography, ultrasonography and laboratory data did not sustain liver cirrhosis nor hepatitis, the serum AFP level was high, 53.1ng/ml (normal range≤20ng/ml). No distant metastasis was detected and proximal gastrectomy was performed. Borrmann type 2 gastric carcinoma measuring 3×2.5cm was located on the anterior wall of the cardia. The carcinoma showed invasion of the tunica muscularis, expansive growth and no vascular permeation. The resected specimen was examined immunohistochemically and no AFP was found in the carcinoma, but the level of serum AFP was normalized to 3.8ng/ml 21 days after surgery. Our final diagnosis was AFP-producing gastric carcinoma accompanied by acromegaly.View full abstractDownload PDF (10778K) -
Atsushi Kosaka, Shunichi Nakagawa, Minoru Tanaka, Hideo Suzuki, Kazuki ...1993 Volume 26 Issue 7 Pages 2045-2049
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe report a case of carcinoma of the stomach of the extragastric development type and review the literature on 66 cases including ours reported in Japan. A 64-year-old man complained of left upper abdominal pain and a mass palpable in the upper abdomen. Computed tomography, ultrasonography, and angiography revealed a large tumor at the lesser curvature of the body of the stomach. An upper gastrointestinal series and gastric endoscopy revealed a gastric carcinoma and subtotal gastrectomy was performed. No continuous invasion to other organs was seen. Histologically, the tumor was diagnosed as moderately differentiated adenocarcinoma. Our review of the literature revealed that the most common symptom was the presence of an upper abdominal mass and that the most common location was the lower portion of the greater curvature of the body. In most cases the carcinoma had invaded to Dther organs such as the pancreas, abdominal wall, and liver. The outcome was poor, with only 8 of the 66 patients surviving more than one year.View full abstractDownload PDF (8586K) -
Hideki Nishio, Hiroshi Hasegawa, Takatoshi Matsumoto, Michio Kanai, Se ...1993 Volume 26 Issue 7 Pages 2050-2054
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSLymphangioma of the duodenum is a rare tumor and only 16 cases have been reported since 1965 in Japan. This report describes a case of lymphangioma, with characteristic macroscopic findings, of the duodenum and a review of 17 cases including ours. A 45-year-old woman, without complaints, consulted our hospital for further examination of the upper gastrointestinal tract because of abnormal findings in the upper GI series. Hypotonic duodenography and gastrointestinal endoscopy revealed an elevated lesion with a central concavity in the second portion of the duodenum, and its surface was transparent, smooth and gelatinous. Under that, a yellow tumor which looked like gathered small nodules could be seen. The biopsy suggested lymphangioma. Partial resection of the duodenum was performed and it was diagnosed pathologically as cavernous lymphangioma.View full abstractDownload PDF (8306K) -
Junichi Sumimura, Hiroaki Takenaka, Yasuaki Miki, Toshiya Bessho, Tosh ...1993 Volume 26 Issue 7 Pages 2055-2059
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe report a 52-year-old man with multiple cavernous hemangiomas in both lobes of the liver. The diameter of his seven tumors ranged from 30 to 63 mm. Computed tomography and ultrasonography suggested a diagnosis of metastatic liver tumors. Magnetic resonance imaging showed low intensity lesions on Tl-weighted images and high intensity lesions with a clear margin on T2-weighted images. Hepatic angiography showed pooling of contrast medium from the early arterial phase to the late stage of the venous phase. From the angiography and MRI findings, hemangioma was suspected. Histopathological examination of the resected specimen revealed a diagnosis of cavernous hemangioma. Giant cavernous hemangioma is usually a solitary lesion, so our case is relatively rare and also showed interesting imaging findings.View full abstractDownload PDF (9489K) -
Kazuo Hatsuse, Satoshi Shohno, Nozomi Idota, Michinori Murayama, Yoshi ...1993 Volume 26 Issue 7 Pages 2060-2064
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSPostoperative jaundice is recognized as a sign of hepatic failure after hepatic resection. We examined the pathogenesis and therapy for postoperative jaundice in 6 patients who underwent hepatic resection for bile duct cancer with obstructive jaundice. The preoperative serum maximal total bilirubin level significantly affected the degree of postoperative jaundice, whereas the resection rate and blood loss were insignificant. Five parameters indicating the liver functional reserve (prothrombin time, serum ammonia, serum endotoxin, arterial ketone body ratio, and consciousness level) were measured. The endotoxin was higher and the consciousness level was lower in relation to the increase in jaundice, but the other 3 parameters were not related to jaundice. Positive ratios of the 5 parameters increased with the increase of jaundice. But there was one patient whose positive ratio was only one, in spite of an increase in jaundice. This patient was suspected of having so-called intrahepatic cholestasis. Jaundice derived from liver function impairment is an indication for plasma exchange, which should begin when the positive ratios of the 5 parameters increase, and the total bilirubin is more than 8 mg/dl. For intrahepatic cholestasis, adrenocortical hormone was thought to be an effective treatment.View full abstractDownload PDF (9616K) -
Yoshihiro Masuko, Yoshie Une, Yasuaki Nakajima, Naoki Sato, Kazuhito M ...1993 Volume 26 Issue 7 Pages 2065-2068
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSBetween January 1985 and March 1992, 193 hepatocellular carcinomas (HCC) were resected in our institute. Four patients (2.0%) with HCC originating from the caudate lobe (CL) were studied. Their mean age was 59.4±6.4 years. All of them were male. No differences were observed between CL and those of the other segments in the frequency of hepatitis-B antigen, liver cirrhosis, serum a-fetoprotein, Edmondson's classification, macroscopic stage of tumor or intrahepatic metastasis. All cases of HCC in CL were associated with tumor thrombus in the portal vein, while 26.9%-39.1% of HCC in other segments were associated. Nevertheless, the cumulative 5-year survival rate of HCC in CL was 33%, which was almost equal to HCC of other segments. The higher incidence of tumor thrombus of the portal vein in CL does not decrease the prognosis of HCC in the caudate lobe treated by hepatectomy.View full abstractDownload PDF (6701K) -
Tatsumi Iida, Hideo Itoh, Yoshifumi Katagiri, Hironori Arakawa, Tomoyu ...1993 Volume 26 Issue 7 Pages 2069-2073
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA case of simultaneous operation for hepatocellular cartinoma (HCC) and ischemic heart disease is reported. A 68-year-old man complained of abdominal pain. Examinations revealed a liver tumor in segment 6, 30mm in diameter, and also revealed coronary artery stenosis and obstruction. His liver function and other labolatory data were normal, and hepatectomy was recommended for HCC based on our data. His coronary artery disease was also suitable for bypass graftings, because of the good cardiac function. Coronary artery bypass grafting (CABG) and partial hepatectomy were performed simultaneously on March 17, 1992. The patient was discharged from our hospital uneventfully on the 21st postoperative day. We conclude that simultaneousperformance of hepatectomy and CABG is an effective therapeutic approach for HCC combined with ischemic heartdisease.View full abstractDownload PDF (10121K) -
Noriyuki Ishine, Yasuhiko Ohno, Akihiro Sasaki, Kiyoshi Hirose, Yoshih ...1993 Volume 26 Issue 7 Pages 2074-2078
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThere are many case reports about double primary cancers, but few about double primary cancers of the liver and the lung. We experienced a case of subsegmentectomy of the liver and right upper lobectomy of the lung for synchronous double primary cancers of the liver and the lung at the same time. A 62-year-old man complained of a sense of general fatigue. Abdominal computed tomography (CT) revealed a space-occupying lesion in the S5 area of the liver. Ultrasonography (US), magnet resonance imaging (MRI) and hepato-arteriography were performed. Hepatocellular carcinoma was suspected from several examinations. On admission, a coin lesion was revealed in the right upper pulmonary field by chest X-ray. Chest CT and chest X-ray tomographies were studied. Squamous cell carcinoma of the lung was suspected. Our final diagnosis of this case was synchronous double primary cancers of the liver and the lung. We performed right upper lobectomy of the lung and S5 subsegmentectomy of the liver at the same time. Histologically, the cancers were moderately differentiated squamous cell carcinoma and Edmondson-II hepatocellular carcinoma. Recently double primary cancers have increased, and many reports discuss their etiology and their treatment. We must determine the stage of each cancer and general condition of the patient, and select the method and order of the operation. We conclude that the synchronous double primary cancers should be operated on radically at the same time if possible.View full abstractDownload PDF (9969K) -
Tsumio Yamamori, Yasuko Yamada, Yoshihiro Kato, Fumichika Kitamura, To ...1993 Volume 26 Issue 7 Pages 2079-2083
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 3-year-old boy was admitted to our hospital in August 1979, complaining of vomiting and abdominal pain for one week. Five days later he was slightly jaundiced and his abdomen was very distended. At surgery, a large amourt of bile-stained ascitic fluid was removed and a small perforation was found in the wall of the posterior segmental duct that was exposed extrahepatically. Two weeks later, cholangiography through an indwelling 1-tube catheter showed dilatation of the anterior and the posterior segmental ducts and the left hepatic duct. Nine years after the operation cholangiograms obtained by ERCP still showed markedly dilated left hepatic and lateral segmental ducts. The findings in the dilated extrahepatic bile ducts were similar to those described in cases of intrahepatic calculi. But the stone was not in the bile duct at the time of ERCP examination.View full abstractDownload PDF (9465K) -
Michinori Murayama, Kazuo Hatsuse, Shintaro Terahata, Hideki Aoki, Sho ...1993 Volume 26 Issue 7 Pages 2084-2088
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 33-year-old man complained of jaundice and upper abdominal pain. Abdominal ultrasonography revealed obstructive jaundice with tumor of the liver hilum, and we performed percutaneous transhepatic bile drainage. Cholangiography, computed tomography, magnetic resonance imaging, and angiography provided the diagnosis of hilar cholangiocarcinoma, and we performed left trisegmentectomy with resection of the portal vein. A total of 45 Gy of postoperative radiation was given to the site of anastomosis. The intrahepatic tumor invaded into the liver hilum, measuring 3.0×2.3×4.5cm. The cut surface was gray-white, round in shape and revealed a cystic lesion in the center of the tumor. Microscopically, the center of the tumor with cyst was mucoepidermoid carcinoma, accompanied with the feature of adenocarcinoma at the peripheral site. Mucoepidermoid carcinoma arising from the intrahepatic bile duct is very rare, and no case of long-term survival has been described. A patient with mucoepidermoid carcinoma of the liver, who is alive 20 months after surgery and has no sign of recurrence, is reported.View full abstractDownload PDF (9854K) -
CEA and DNA Ploidy Pattern by Flow CytometryKuniaki Aridome, Sonshin Takao, Kenji Yano, Yusei Haraguchi, Takashi A ...1993 Volume 26 Issue 7 Pages 2089-2093
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA case of synchronous double cancers in the extrahepatic biliary tract is described. A 63-year-old man was admitted to our hospital with a complaint of jaiundice, which was successfully managed with PTCD by a former doctor. PTC, ERC, CT imaging and ultrasonography revealed a tumor mass in the distal common duct and multiple stones both in the gallbladder and common bile duct. Pylorus-preserving pancreaticoduodenectomy concurrent with cholecystectomy was performed. Postoperative examination of the resected specimens indicated another tumorous lesion in the gallbladder, in addition to the distal common bile duct tumor and biliary stones. Both tumors were histopathologically diagnosed as well-differentiated tubular adenocarcinoma. However, neither connection of growth between the two tumors nor vessel invasion by the tumors was observed. Furthermore, the biological behavior of the tumors as determined by immunohistochemical staining with CEA and DNA ploidy pattern with flowcytometrywasdifferent.Thus, thetumorswereconsiderdsynchronousdoublecancersintheextrahepatic biliary tract. To our knowledge, only 34 such cases including our own have been reported in the Japanese literature.View full abstractDownload PDF (10062K) -
Hideo Kato, Takeaki Shimizu, Osamu Sato, Katsujuki Uchida, Kazuhiro Ts ...1993 Volume 26 Issue 7 Pages 2094-2098
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe frequently experience double cancers in the stomach and an other organ. However, gastric cancer is rarely combined with cholangiocarcinoma. We report a case of advanced gastric cancer found simultaneously with cholangiocarcinoma. The patient was a 73-year-old man admitted to our hospital because of palpitation and shortness of breath. Laboratory tests revealed elevation of serum CEA and CA19-9 levels. Endoscopic study of the upper gastrointestinal tract showed a Borrmann 2 type tumor at the upper body of the stomach. A plain CT scan showed an irregular low density area which was enhanced by contrast medium, in the lateral segment of the liver. These lesions were successfully resected in one stage operation by total gastrectomy with splenectomy and distal pancreatectomy and left hepatic lobectomy. The resected specimens showed a 4.0×2.7cm Borrmann 2 type lesion in the upper body of the stomach and a 6.5×3.5×8.0-cm nodular infiltrating tumor in the lateral segment of the liver. Microscopic examination revealed moderately differentiated adenocarcinoma in the stomach and welldifferentiated tubular adenocarcinoma in the liver. The postoperative course went well, and the patient is still alive more than 1.5 years after the operation. We concluded that positive surgical treatment which may give a good prognosis should be considered, if it is possible to perform a radical operation for the double cancer.View full abstractDownload PDF (9475K) -
Hidehiro Yamamoto, Hajime Yamamoto1993 Volume 26 Issue 7 Pages 2099-2103
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 54-year-old female outpatient with myotonic dystrophy (MD) had received conservative treatment for ileus for three months: however, she alternately showed amelioration and deterioration. During laparotomy, an intestinal stone about the size of a hen's egg was found in the small intestine, causing enterolith ileus. The stone was extirpated by enterotomy and the postoperative course was good. MD is a systemic disease which causes myopathy of skeletal muscles, motor dysfunction of visceral smooth muscles and various symptoms in systemic organs and tissues. It has been pointed out that the formation of intestinal stones is caused by mechanical factors, such as stagnation of intestinal contents due to a diverticulum, blind pouch, stenosis, etc., as well as chemical factors. In the present case, motor dysfucntion of the smooth muscles of the small intestine due to MD was considered to have caused stagnation of the intestinal contents, which led to the formation of the intrestinal stone. Thus, we report here a case of surgically treated enterolith ileus that accompnied MD.View full abstractDownload PDF (9025K) -
Hidetaka Yamanaka, Mitsuo Nenohi, Hiroyuki Katoh, Yoshihumi Ogura, Ryu ...1993 Volume 26 Issue 7 Pages 2104-2108
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe report a case of primary non-specific ulcer of the small intestine complicated by perforation at the mesenteric site in the jejunum. A 67-year-old man was admitted to our clinic, complaining of severe lower abdominal pain. Chest and abdominal plain X-ray films showed free air in the bilateral subphrenic spaces. Therefore he underwent partial resection of the jejunum in an emergency operation, because intestinal perforation was observed in the distal jejunum at the mesenteric side, 100cm anal to the Treize ligament. Pathological examination of the resected specimen revealed a primary nonspecific ulcer of thesmall intestine. This disease found in the jejunum is not common; only 15 cases including ours have been reported in Japan. Patients with jejunal ulcers were older than those with ileal ulcers. The nonspecific ulcer in the ileum usually occurred at the antimesenteric site, but the mesenteric site was slightly predominant in the jejunum. Some of the patients with perforated ulcers showed fetalism, and emergency diagnosis and surgery are warranted.View full abstractDownload PDF (10086K) -
Katsunori Tauchi, Shyuuichiro Suzuki, Takuya Nagata1993 Volume 26 Issue 7 Pages 2109-2113
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA case of primary benign fibrous histiocytoma (BFH) of the sigmoid colon is reported. The patient, a 63-year-old man, complained of high fever and abdominal pain. A barium enema, endoscopic study, computed tomography, magnetic resonance imaging and abdominal angiography revealed an intramural mass in the sigmoid colon, but we could not distinguich between a maligmant tumor and a severe inflammatory change. A sigmoidectomy and partial resection of the ileum was performed. Microscopically, spindle-shaped cells with a storiform pattern were seen from the subserosa to the muscular layer. They had immunohistochemical characteristics of histiocytes, few mitoses and mild atypia. The histological diagnosis was BFH. The postoperative course was uneventful and he showed no sign of recurrence. There are 15 previous reports of malignant fibrous histiocytoma of the gastrointestinal tract, but no report of BFH of the gastrointestinal tract was found in the literature. This is the first reported case of primary BFH in the gastrointestinal tract.View full abstractDownload PDF (9958K) -
Kiyoshi Maeda, Hiroji Nisino, Nobuya Yamada, Shigehiko Nishimura, Atsu ...1993 Volume 26 Issue 7 Pages 2114-2118
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 58-year-old woman was admitted to our hospital with chief complaint of right hypochondralgia and had felt the so-called carcinoid syndrome. Barium enema and endoscopy revealed a rectal mass 9mm in diameter, and abdominal CT and ultrasonography revealed the huge tumor in the right lobe of the liver. These tumors were histologically diagnosed as rectal carcinoid with liver metastasis. Rectal resection with lymphadenectomy and extended right lobectomy of the liver were performed. The patient is currently healthy 7 months after surgery.View full abstractDownload PDF (9625K) -
Katsunari Takifuji, Hiroshi Tanimura, Yugo Nagai, Yoshihiro Nakatani, ...1993 Volume 26 Issue 7 Pages 2126
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSDownload PDF (2089K)
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