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Volume 28, Issue 11
Displaying 1-15 of 15 articles from this issue
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Tetsuro Nishida, Sumitaka Arima, Kitaro Futami, Kouichi Yamasaki, Tsuy ...1995 Volume 28 Issue 11 Pages 2131-2138
Published: 1995
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe evaluated 393 gastric cancer patients who underwent curative or relatively non-curative resection and compared the number of metastatic lymph nodes with other clinico-pathologic variables as to postoperative disease free interval. Recurrent cases were 60 of 393 (15.3%), and sites of recurrence were peritoneum (25 cases, 41.7%), lymph nodes (15 cases, 25%), liver (12 cases, 20%), remnant stomach (4 casee, 6.7%) and others (4 cases, 6.7%). Relatively more correlative clinico-pathologic variables between postoperative disease free interval were gross type, stage, depth of invasion, extent of lymph node metastasis and number of metastatic lymph nodes. Disease free rates according to number of metastatic lymph nodes 93% (0-3; group a), 72% (4-10; group b), 32% (11-26; group c), 22% (27-; group d), with significant differences between each 2 groups. In group a and c, there were no significant differences according to the extent of lymph node metastasis (from n1 to n3, 4), stage (from stage II to stage IV) and depth of invasion (from pm to se. sei). The number of metastatic lymph nodes proved to be a relatively independent prognostic factor by comparing the coefficient of correlation between the 2 factors. Multivariate analysis using Cox's proportional hazard model revealed that the number of lymph node metastases was the most important prognostic indicator for recurrence in patients with curative or relatively non-curative stomach resection.View full abstractDownload PDF (14403K) -
Masami Niki, Kunio Okajima, Hiroshi Isozaki, Eiji Nakata, Tadashi Ichi ...1995 Volume 28 Issue 11 Pages 2139-2144
Published: 1995
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTo clarify the role of hHGF in gastric cancer, we compared preoperative serum hHGF levels in 57 gastric cancer patients with clinicopathological factors. The results were as follows: 1) The serum hHGF concentration was significantly higher in patients with advanced gastric cancer than in those with early gastric cancer. 2) There were no significant differences between the histological type, stromal type and infiltrative growth type. 3) In advanced gastric cancer, its concentration was significantly higher in patients with lymphnode metastasis than in those without lymph node metastasis, and significantly higher in patients with liver metastasis than in those without liver metastasis, whereas there was no significant difference in serum hHGF levels between patients with and without peritoneal dissemination. These results suggest that preoperative measurement of the seurm hHGF concentration in patients with gastric cancer is useful for estimating the clinical stage of gastric cancer, and for the extent of distant metastasis to lymph nodes, and metastasis to the liver.View full abstractDownload PDF (10726K) -
Ra Sachi, Masahiko Onda, Akira Tokunaga, Goro Asano1995 Volume 28 Issue 11 Pages 2145-2150
Published: 1995
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA study was performed to examine immunohistochemically the T-and B-Iymphocyte, and S-100 protein positive cells populations of regional lymph nodes in patients with gastric cancer. Immunohistochemically, a decrease of T-lymphocytes and dendritic cells, and an increase of B-lymphocytes were observed in metastatic lymph nodes. A decrease of CD4 positive lymphocytes and degenerative change of these cells were also observed. Changes in the level of immunologic parameters in the distribution of immunocytes in regional lymph nodes with or without metastasis may be linked to the progression of cancer.View full abstractDownload PDF (13314K) -
Evaluation of Computed Tomography Appearance of Perihepatic Fluid CollectionShojiro Miyazaki, Ken Takasaki, Keiko Ueno, Masashi Tsugita, Masakazu ...1995 Volume 28 Issue 11 Pages 2151-2158
Published: 1995
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSPostoperative diagnosis based on computed tomography (CT) was investigated for the early recognition of intra-abdominal infectious disease following hepatectomy. This study included 159 patients in whom CT was undertaken during postoperative hospitalization, among 637 patients who had undergone hepatectomy during the 7-year period from 1987 to 1994. The CT findings of 75 patients with infection and 84 patients without infection were compared. Fluid collection at the resection margin was observed in 66 and 63 of the patients with and without infection, respectively. The significant CT findings observed in the patients with infection were (1) uneven fluid collection indicated by a high attenuation value, (2) gas in fluid collection, (3) irregularity of the fluid collection margin, (4) marginal enhancement, and (5) complications of pleural effusion. These findings were more significant in patients with hyperthermic symptoms than in those without such symptoms. The investigation of postoperative CT findings in post-hepatectomy patients makes the diagnosis of intra-abdominal infection more certain, and appears to be useful for applying treatment with drainage.View full abstractDownload PDF (16211K) -
Satoshi Takeyama1995 Volume 28 Issue 11 Pages 2159-2167
Published: 1995
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe effect of arterio-portal shunt was studied under the condition of 40% hepatectomy and dearterialization. Eighteen mongrel dogs were divided into three groups. Hepatic arterial ligation with hepatectomy was carried out in the first group (HAL), ligation of the hepatic artery with hepatectomy followed by arterio-portal shunt was performed in the second group (APS), and simple hepatic resection was done in the third group (CON). In spite of hepatic arterial ligation, total hepatic blood flow per unit liver weight was relatively maintained, even in the HAL group, due to a 40% reduction in liver mass. In the HAL group, hepatic oxygen consumption after dearterialization significantly decreased to 72%, and the oxygen extraction ratio declined similarly. The biochemical data and histopathological findings of the APS group were almost the same as the CON group. In the HAL group, however, severe liver dysfunction diagnosed with biochemical parameters and marked ischemic changes under the light microscope were observed. AgNOR (a sign of liver regeneration) demonstrated a satisfactory reaction in th APS group, as well as the CON group, but was significantly inhibited in the HAL group. In conclusion, even if adequate portal blood flow per liver weight were preserved, liver insufficiency is inevitable because of the oxygen uptake decline in liver tissue, due to the low oxygen content of the portal blood. This investigation suggests, therefore, that preserving adequate liver tissue oxygen content is a vital component of liver support.View full abstractDownload PDF (21191K) -
Kazuo Hatsuse, Hideki Aoki, Kenji Tsuboi, Michinori Murayama, Takuo In ...1995 Volume 28 Issue 11 Pages 2168-2173
Published: 1995
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThis study was carried out to evaluate the significance and problems of hepatic resection for borderline lesions, concomitant with hepatocellular carcinoma (HCC) which were detected by computed tomography during angiography (angio CT), in terms of recurrences within one year of the resection. There were 39 lesions in 20 patients. Eleven of the 20 patients (55%) had multiple lesions including early HCC and borderline lesions that suggested multicentric occurrence. Recurrences in the remnant liver were found in four out of twenty patients (20%) within a year of hepatic resection. There were more recurrences in the remnant liver in patients with multiple lesions than in those with a single lesion. In patients with multiple lesions who underwent relative noncurative resection or operative ethanol injection therapy because lesions occupied bilateral lobes, there were more recurrences in the remnant liver. Recurrences in the remnant liver occurred in patients with liver cirrhosis more than in patients with chronic hepatitis. There were many recurrences with multiple lesions. The detection by angio CT of multiple lesions and the resection of as many lesions as possible, contributd to the decrease in the number of recurrences within a year of hepatic resection. However, why there were many multiple recurrences that were impossible to re-operate on after hepatic resection is a question which still remains to be studied.View full abstractDownload PDF (11333K) -
Taiju Hashimoto1995 Volume 28 Issue 11 Pages 2174-2183
Published: 1995
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe relationship between tissue damage in tumor and non-tumor regions following transcatheter arterial embolizsation (TAE) and active oxygen/cytokines was studied in clinical cases (n=30) and in VX2 tumor-bearing rabbits used as models of hepatic carcinoma (n=20). Body temperature, white blood cell count, AST, ALT, LDH, superoxide dismutase (SOD) activity, interleukin-6, and nitric oxide (NO) were all temporarily increased in the clinical cases 1 day after TAE, but returned to the preoperative levels on the 7th day. Stepwise regression analysis of AST, ALT, and LDH revealed that NO was most closely correlated with liver injury. In the animal study, both SOD activity and thiobarbituric acid reactive substances increased just after operation, more in the tumor region than in the non-tumor region. In the tumor region, a large amount of lipid hydroperoxide was detected as an electron spin resonance signal on the 1st postoperative day, and necrosis of the tumor region and infiltration of neutrophiles and macrophages into the surroundings were histopathologically observed. From these results, it was suggested that active oxygens would be involved in tissue damage following TAE.View full abstractDownload PDF (19083K) -
Kazuto Sasaya, Yasushi Kaneko, Masakazu Iwamoto1995 Volume 28 Issue 11 Pages 2184-2193
Published: 1995
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe studied experimentally the effects of cisplatin (cisdichlorodiamine platinum: CDDP) on intestinal anastomosis in the Wistar male rat. We performed intestinal anastomosis under the ether anesthesia and fixed a thin sponge at the anastomotic site; at the same time cisplatin (3 mg/kg body weight) was injected intraperitoneally or intravenously. One week after the operation the anastomotic site was resected. We measured the hydroxyproline content in the sponge, carried out microscopic examination, and measured the bursting pressure. The mean hydroxyproline levels of the intraperitoneal injection group, the intravenous injection group, and the control group were 0.29mg/g, 1.61mg/g, and 2.02mg/g, respectively. We recognized a statistically significant difference in each group. Upon microscopic examination, the scores of granulation and collagen formation in the intraperitoneal injection group were decreased significantly. The bursting pressures in the intraperitoneal injection group were decreased significantly (the means of the intraperitoneal injection group, the intravenous injection group, and the control group were 145 mmHg, 205 mmHg, and 216 mmHg, respectively). Hyperbaric oxygen therapy was not significantly effective for impaired anastomotic healing by intraperitoneal cisplatin injection. One week after the anastomotic operation, when we injected cisplatin into the peritoneal cavity, impairment of the anastomotic healing was not seen.View full abstractDownload PDF (17659K) -
Yutaka Ogata, Tatsuhisa Morodomi, Akira Ookita, Kazuo Shirouzu, Hiroha ...1995 Volume 28 Issue 11 Pages 2194-2199
Published: 1995
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe have studied the expression of matrix metalloproteinase 9 (MMP-9/gelatinase B) in colorectal tumors at various developmental stages. A Total of 26 adenoma, 23 early stage colorectal adenocarcinoma and 88 advanced cancer specimens were each fixed in formalin and embedded in paraffin. Then 3μm sections were examined by immunohistochemical technique (avidin-biotin peroxydase complex method) using anti-human MMP-9 sheep IgG, MMP-9 was demonstrated in tumor cells, neutrophils and monocyte-macrophages in colorectal tumor tissue. Whereas normal epithelial cells of colonic mucosa remote from the tumor were consistently negative for MMP-9, mucosal epithelial cells in close association with adenoma or adenocarcinoma were often positive for this enzyme. The incidence of MMP-9 expression was 9% in mucosal epithelial cells, 23% in adenoma cells, 43% in early stage adenocarcinoma cells, and 52% in advanced adenocarcinoma cells. In advanced cancers, the incidence of MMP-9 expression in the tumor cells was 83% in cases associated with synchronous liver metastasis, 58% in cases of metachronous liver metastasis, and 32% in cases without liver metastasis. The rate of MMP-9 expression in tumor cells was increased with decreasing grade of histological differentiation. However, there was no relationship between MMP-9 expression in tumor cells and other histopathological factors. These results suggested that MMP-9 was expressed according to tumor development and progression, and that MMP-9 produced in tumor cells may play an important role in hematogenous metastasis in colorectal cancer.View full abstractDownload PDF (13590K) -
Mitsuru Dohke, Hiroyuki Kato, Toshiji Motohara, Shunichi Okushiba, Tos ...1995 Volume 28 Issue 11 Pages 2200-2204
Published: 1995
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 64-year-old male patient was admitted to our hospital for obstructive jaundice. Due to carcinoma of the middle portion of the bile duct that invaded the right hepatic artery, a pyloric ring-preserving pancreatoduodenectomy was performed, with reconstruction of the right hepatic artery. PTBD was performed, and cholangiogram revealed an obstruction in the middle portion of the bile duct. A celiac angiogram revealed an encasement on the right hepatic artery. The patient was diagnosed as having bile duct carcinoma with invasion to the right hepatic artery. Pancreatoduodenectomy was planned. During the operation, the tumor could not be stripped from the right hepatic artery, and therefore, we dissected the artery with the tumor. Back flow from the right hepatic artery (from the liver side) was slight. We reconstructed the right hepatic artery with the jejunal artery of the efferent limb, for reconstruction of the biliary tract. The postoperative course was uneventful. Postoperative angiogram indicated that the right hepatic artery was patent. In this case the communication of the right and left hepatic arteries was poor. Thus, reconstruction of the right hepatic artery was considered necessary to prevent hepatic failure. The jejunal artery of the efferent limb is an alternative choice in reconstruction of the hepatic artery in pancreatobiliary surgery.View full abstractDownload PDF (9525K) -
Zenichi Morise, Kazuo Yamafuji, Tetsuya Takahashi, Atsunori Asami, Koj ...1995 Volume 28 Issue 11 Pages 2205-2209
Published: 1995
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA case of extended necrotizing pancreatitis complicated with bacterial infection was treated successfully by our new surgical method, direct retroperitoneal open-drainage. A 69-year-old woman complaining of epigastralgia and severe back pain was hospitalized and treated for acute pancreatitis for about a month. Then she developed shock and underwent surgery. The CT findings just before the operation revealed a large amount of necrotic tissue complicated with bacterial infection spreading widely throughout the retroperitoneal space, from the peripancreatic space to the pelvic cacity. We made a long oblique incision from the root of the 12th rib to the anterior superior spina iliaca on the left side of her back to obtain a direct approach to the retroperitoneal space. The necrotic tissue was removed bluntly. The skin and muscle edge of the wound was turned over, and sutured to the skin around the wound. The wound was laid open. The same procedure was performed on her right back one week after that. Lavage and debridement were performed twice a day via these bilateral wounds. The infection in the retroperitoneal space was controlled completely after about one month. Although several surgical treatments for extended necrotizing pancreatitis has been advocated, they all involve trans-peritoneal approaches after laparotomy and may be frequently insufficient for drainage and removal of infectious necrotic tissue spreading throughout the retroperitoneal space. Our new method could achieve adequate drainage for the widespread infectious necrotic tissue in the retroperitoneal space under a minimally invasive operation.View full abstractDownload PDF (12106K) -
Naomi Kawata, Masao Hayashi, Akifumi Miyoshi, Takashi Funatsu, Shingo ...1995 Volume 28 Issue 11 Pages 2210-2214
Published: 1995
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 72-year-old man consulted our hospital complaining of subfever, weight loss and left hypochondralgia. The superficial lymph nodes and spleen were not palpable. Abdominal echography and computed tomography revealed a tumor in the spleen which was detected by gallium scintigraphy as a strong accumulation. We operated on him under a diagnosis of suspected malignant lymphoma. The tumor of the spleen extended to the tail of the pancreas, and No.10, 11, 18 lymph nodes were swollen. Total splenectomy with partial pancreatectomy and lymph node cleaning was achieved. The resected tumor was elastic hard, measured 15×12×12cm in size, and was solid, white-yellow, and welI-defined. The histological diagnosis was Hodgkin's disease, mixed cellularity which invaded the pancreas, and metastases of No.10, 11, 18 lymph nodes. Six courses of postoperative chemotherapy with cyclophosphamide, vincristine, procarbazine and predonizolone were given. He is well and asymptomatic in a follow-up period of 3 years 6 months. Most cases of Hodgkin's disease occur from superificial lymph nodes. This is a very rare case of primary Hodgkin's disease of the spleen.View full abstractDownload PDF (8843K) -
Toru Ii, Toshiaki Yasui, Hiroshi Ito, Kazuhiro Mori, Toru Kamata, Ryui ...1995 Volume 28 Issue 11 Pages 2215-2219
Published: 1995
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a rare case of small bowel volvulus caused by a lipoma of the mesentary. We also present a distinctive pattern on the coronal view of preoperative magnetic resonance imaging (MRI). A 60-yearold man was admitted to our hospital because of paraumbilical pain of persist severity. On physical examination the abdomen was soft and flat with mild paraumbilical tenderness. Laboratory data showed minimal leucocytosis. Abdominal computed tomography (CT) showed a fatty mass of 8 cm in diameter on the right flank. Some coronal views of abdominal MRI demonstrated whirling mesentery adjacent to the mass and a whirl-like pattern of the small bowel loops. Angiogram demonstrated a distorsion and high-grade stenosis of the superior mesenteric artery and a whirlpool arrangement of jejunal and ileal arteries. The patient was diagnosed as having small bowel volvulus caused by a lipoma of the mesentery, and underwent an emergency operation. At surgery, counterclockwise derotation was performed and the lipoma was removed by resection of both the mesentery and small bowel around the lipoma. He had an uneventful recovery and was discharged on the 31st postoperative day. Although the indication for MRI at abdominal emergency has been restricted in comparison with CT, we consider MRI to be useful in the diagnosis of small bowel volvulus.View full abstractDownload PDF (10021K) -
Hiroshi Nimura, Nobuyoshi Haniu, Teruaki Aoki, Masaru Naruse, Youichi ...1995 Volume 28 Issue 11 Pages 2220-2224
Published: 1995
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSMalignant lymphoma with the primary focus in the colon, particularly in the sigmoid, is a rare disease. T-cell lymphoma, in particular, is very rare. We have encountered a patient with perforative peritonitis due to malignant lymphoma with the primary focus in the sigmoid that was strongly suspected preoperatively. The 72-year-old male patient was referred to this hospital by another hospital which he visited complaining of pain in the left lower abdomen. Ultrasonography and colonic enema before surgery revealed malignant lymphoma of the sigmoid, and colonic enema revealed perforation in the region. Sigmoidectomy and drainage were performed. The patient was pathologically diagnosed after surgery as having malignant pleomorphic large cell lymphoma with T-cell phenotype classified as multiple and highly malignant lymphoma. Abdominal ultrasonography and colonic enema proved effective for the differential diagnosis of malignant lymphoma from inflammatory intestinal diseases or cancer. Postoperative chemotherapy for malignant lymphoma remaining in the descending colon was largely unsuccessful, and peritonitis due to tumoral perforation recurred, requiring colectomy of the left half and drainage. T-cell lymphoma, compared with B-cell lymphoma, is characterized by poor prognosis, and surgical resection of the primary focus including at least the involved lymph node is required.View full abstractDownload PDF (10796K) -
Eishi Totsuka, Seiji Itoh, Gen Kashiwaya, Toshiaki Yoshioka, Kazuhiro ...1995 Volume 28 Issue 11 Pages 2225
Published: 1995
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSDownload PDF (2234K)
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