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Volume 28, Issue 4
Displaying 1-44 of 44 articles from this issue
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Shoji Natsugoe, Mitsuhisa Sagara, Yoshihisa Tezuka, Kazunobu Tokuda, D ...1995 Volume 28 Issue 4 Pages 753-756
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSTo evaluate more precisely the depth of cancer invasion in patients with superficial esophageal cancer, additional sections were made from the 71 primary tumors, for detailed examination. The mucosal and submucosal layer were subclassified as ep, mm1, mm2, mm3, sm1, sm2, and sm3, according to the depth of cancer invasion. As result of detailed histologic examination, the depth of cancer invasion changed from ep to mm1 in three of six tumors, from mm1 to mm2 in one of five tumors, from mm3 to sm1 in one of six tumors, from sm2 to sm3 in five of 18 tumors, and from sm3 to pm in one of 14 tumors. The overall incidence of change in depth of cancer invasion was 15.5% (11/71). The macroscopic type of these tumors was type 0-IIb in ep carcinoma, type 0-IIc in mm carcinoma, and type 0-I in sm carcinoma. We considered that one important question stemming from this study was whether the deepest section of cancer invasion was taken from the resected specimen. No lymphatic or vessel invasion was newly found in these cases. In this study, the change of depth of cancer invasion was not affected by the treatment. Accordingly, we consider that the depth of cancer invasion may need to be examined by additional sections at least for tumors in which a discrepancy between the macroscopic finding and histologic diagnosis arises.View full abstractDownload PDF (8769K) -
Nobuhiro Sato, Keisuke Koeda, Kenichiro Ikeda, Kouki Ohtsuka, Yusuke K ...1995 Volume 28 Issue 4 Pages 757-765
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe influence of an intraoperative hepatic blood supply disturbance during esophageal cancer surgery for postoperative hyperbilirubinemia was investigated in 37 postsurgicalpatients. The arterial blood ketone body ratio (AKBR) and hepatic venous oxygen saturation were determined by using an optical catheter implanted into the hepatic vein for continuous monitoring, and both were found to be markers of hepatic oxygen demand and supply. The postoperative peak serum bilirubin level (peak-Bil) of each patient correlated with the intraoperative systemic hemodynamics, the intraoperative systemic hemodynamics, the total time during which the hepatic venous oxygen saturation was below 60% (Shv02), and the AKBR. Regression analysis revealed a significant correlation between the log (AKBR) and ShvO2 (r=-0.486, p<0.05). a significant correlation was also noted between the peak-Bil and log (AKBR) or Shv02 (r=-9, 464, p<0.01, r=0.499, p<0.05, respectively). However, despite these significant peak-Bil and AKBR or ShvO2 correlations, no relationship was found between the systemic hemodynamics and these parameters, suggesting that the AKBR and ShvO2 may be useful for monitoring latent liver hypoxia during surgery. These findings thus support the hypothesis that intrahepatic cholestasis occurring after esophageal cancer surgery results from a hepatic energy charge disturbance due to liver hypoxia during the surgical procedure.View full abstractDownload PDF (16337K) -
Tatsuhiko Hayashi, Atsushi Nashimoto, Otsuo Tanaka, Juei Sasaki1995 Volume 28 Issue 4 Pages 766-771
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSSixteen cases of lymph node-positive [n (+)] single intramucosal gastric cancer, resected in Niigata Cancer Center Hospital from 1966 to 1992, were analyzed in comparison with 770 lymph node-negative [n (-)] cases. The results were as follows.(1) The n (+) cases showed a higher frequency of undifferentiated type in histology, were larger in size and were younger than the n (-) cases.(2) All n (+) cases were depressed type (6 cases of type IIc and 8 cases of type IIc + III) except for 2 cases (1 case of type I and 1 case of type IIa + IIc). Twelve cases of the depressed type (85.7%) were accompanied with peptic ulcer in the lesion.(3) The n (+) cases included 10 cases of n1 (+), 5 cases of n2 (+) and 1 case of n3 (+).(4) No lymph node metastasis was seen in the elevated type of less than 2.0 cm in diameter, the depressed type of less than 2.0 cm in diameter, or any type located in the upper third portion.(5) There was only 1 patient over 70 years of age. From now on, as the number of aged patients increases, we should perform rational treatment for aged early gastric cancer patients considering the social indication.View full abstractDownload PDF (9740K) -
Masao Kondo, Yukifumi Kondo, Tsunemi Higashi, Norimitsu Hasegawa, Akir ...1995 Volume 28 Issue 4 Pages 772-777
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESS258 patients with type 5 cancer of the stomach were treated in our clinic from January 1980 to December 1989. These carcinomas were divided into three groups according to their gross appearance: 1. early-advanced cancer (53 cases)-preoperatively diagnosed as an early gastric cancer, but was pathologically advanced cancer; 2. IIc-advanced cancer (143 cases) preoperatively diaan advanced cancer, but macroscopically looked like an early IIc cancer; 3. unclassified cancer (62 cases) could not be assigned any type of gastric cancer. The average tumor size was largest in the unclassified cancers, 62.9 mm; 47.7 mm in IIc-advanced cancer and 39.1 mm in early advanced cancer. The early advanced cancer invading only the muscularis mucosa was 64.2% which was significantly higher than the other types (35.7% in IIc-advanced cancer, 32.8% in unclassified cancer) (p<0.01). In the early advanced cancer group, no evidence of histological lymph node metastasis was observed in 71.7% which was significantly higher than the others (p<0.01). And in the early advanced cancer group, lymphatic vessel invasion was observed at the low percentage of 30.2%. The frequency of microscopic vessel invasion was also low, 13.2%. Patients with the early advanced cancer and the IIc-advanced cancer had significantly better 5-year survival rates, 83.8% and 75.0%, respectively, compared with the unclassified group patients, 53.0% (p<0.05). These results suggest that type 5 cancer of the stomach includes various types of macroscopic findings and have different clinicopathological features. The classification into three groups may be useful for clinicopathological analysis.View full abstractDownload PDF (11086K) -
Ken-ichi Kumazawa, Shunsuke Haga, Toshihiko Hosokawa, Koichi Kubota, S ...1995 Volume 28 Issue 4 Pages 778-785
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe significance of the reduction of jaundice achieved by PTCD in patients with obstructive jaundice was evaluated through acomparison of data on liver function parameters obtained prior to PTCD and just before surgery in 52 patients with carcinoma of the pancreas or biliary tract who underwent radical surgery following PTCD. The serum total bilirubin level was decreased from 14.3±7.1 mg/dl to 2.4±1.6 mg/dl, with a marked improvement in the levels of GPT. and γ-GTP. Disturbed lipid metabolism involving total cholesterol and HDL also tended to be improved. However, there was no change in protein metabolism following PTCD; LCAT, in particular, remained low, moving from 49.6±19.0 nm/ml·hr·37°C prior to PTCD to 46.0±15.4 nm/ml·hr·E37°C after PTCD. The jaundice reduction rate “b” and the amount of bilirubin in daily excretory bile, i.e., parameters of the excretory function of the liver, were lower just before surgery than after PTCD. On the other hand, preoperative excretory function and the ability to synthesize protein were found to be lower in patients in whom the postoperative total bilirubin level was over 10 mg/dl than in those with lower bilirubin levels. These findings indicate that PTCD was useful for reducing jaundice, normalizing deviating enzymes and improving the disturbed lipid metabolism, but not for improving protein synthesis or excretory function, which are involved in postoperative jaundice.View full abstractDownload PDF (14788K) -
Tomoyoshi Okamoto, Yoshinori Inagaki, Yutaka Shiino, Junta Nakamura, Y ...1995 Volume 28 Issue 4 Pages 786-792
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSHepatic microcirculatory flow (HMF) was measured by laser-Doppler velocimeter (LDV) with a semi-conductor laser using an ischemic model in the dog, and the usefulness of this method was evaluated by assessing liver viability from the standpoint of energy metabolism. The mechanism of ulinastatin's effect was also investigated using LDV. Clamping of the hepatic artery and portal vein was regarded as hepatic ischemia. Animals were divided to 3 groups as follows. The first was a group of 60 minutes' ischemia (A), the second, 90 minutes' ischemia (B), and the last, 90 minutes' ischemia+ administration of ulinastatin (C). HMF, energy charge (EC) and arterial ketone body ratio (AKBR) were measured before and after ischemia, and the survival rates and histological findings were compared between the groups. Comparisons between A and B, and B and C, showed that HMF, which was expressed as a relatively changed rate (%F), was linearly related to energy charge and %F at 30 minutes after reperfusion was predictive of survival outcome. The main action of ulinastatin's protective effect against liver damage was thought to be that of maintaining the microcirculation. The LDV with semiconductor laser was useful in monitoring liver viability, and this procedure is expected to be used in understanding the pathogenesis of liver damage.View full abstractDownload PDF (13836K) -
Shinichi Ueno, Heiji Yoshinaka, Gen Tanabe, Kouichi Kurita, Yoshito Og ...1995 Volume 28 Issue 4 Pages 793-798
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe evaluated the usefulness of ultrasonography (US) for detection of portal vein involvement (Vp) in preoperative patients with hepatocellular carcinoma (HCC) and compared the results with those of computed tomography during arterial portography (CTAP). In 118 patients (130 lesions) with HCC who underwent US (n=118) and CTAP (n=43) followed by surgery from January 1987 to December 1993, the preoperative imaging findings for Vp (0, 1, 2 or 3) were compared with postoperative histopathologic findings (vp 0, 1, 2 or 3), and ultrasonograms of 125 lesions (excluding vp2 and vp3 cases) were classified into 4 patterns according to the anatomical situation between the tumor and the nearest third order branch of the portal vein as follows: free, hit, contact and adhesion; and the incidence of vpl in each group was then calculated. We could indicate all of the vp2 and vp3 cases and 15-26% of the vpl cases by US and/or CTAP. A few cases were over or underestimated preoperatively. Sixty percent of contact and adhesion patterns on US were shown to have vpl. Therefore, we conclude that vp2 or vp3 cases are easily detectable by US and/or CTAP compared with the difficulty of vpl cases, and that contact and adhesion patterns on US should be examined carefully as to the vp factor with various other imaging modalities.View full abstractDownload PDF (11198K) -
Special Reference to its Histologic Classification and Significance of Combined Resection of Colorectal Cancer and Surrounding OrgansHiroo Oshita, Sengai Tanaka, Hiromi Tanemura1995 Volume 28 Issue 4 Pages 799-804
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSOf 458 patients with colorectal cancer operated on during a 10-year period, 89 (19.4%) had macroscopic invasion to the adjacent organs. Only 36 (40.4%) of them were verified microscopically to have tumor invasion to the adjacent organs, and in cases of well differentiated adenocarcinoma, the rate of the cases with submucosal, proper muscular and subserosal invasion was as high as 29.8%. The rate of lymph node metastasis was as relatively low as 44.3%, and it was shown that patients with lower grade differentiation in histologic type had a higher frequency of distant lymph node metastasis. Eighty two of the 89 patients (92.1%) underwent combined resection of the colorectal tumor and the adjacent organs, resulting in curative resection in 53 patients (59.6%). The five-year survival rate was as relatively high as 63.9% in colorectal cancers with macroscopic invasion, and no significant difference in prognosis was found among the all histologic types. Therefore, combined resection of the cancer and the surrounding organs is recommended for better prognosis in colorectqal cancers, if they are suspected to have direct invasion.View full abstractDownload PDF (11121K) -
Ichiro Hirai, Eiichi Ikeda, Hajime Iizawa, Toshihiko Sato, Kenji Okabe ...1995 Volume 28 Issue 4 Pages 805-812
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSDuring the past 11 years, a total of 1260 patients with colorectal carcinoma underwent surgery at our department. Histological examination revealed that 93 patients had poorly differentiated adenocarcinoma (por) and 7 had signet-ring cell carcinoma (sig). Regarding the clinical aspects, early diagnosis was rarely made in patients with either por or sig. Por and sig tumors thought to have a rapid growth. Five-year survival rates in patients with well, moderate and poorly differentiated carcinoma, including sig, were 67.9%, 42.3% and 37.4%, respectively. In this study, a further histological classification of por and sig was applied so that the unfavorable prognosis could be analyzed clinicopathologically. The medullary type of por had a 5-year survival rate of 79.6% after surgery, while no patient with the scirrhous type survived more than three years. An interesting suggestion of this study was that the medually and scirrhous types of por were revealed to have a smaller proportion of highly differentiated structure as compared with the intermediate type. It was presumed that the development of por, at least the medullary and scirrhous types, might be achieved without the early stage of differentiated carcinoma from the beginning of carcinogenesis. In conclusion, classification of por according to fibrous stroma would play an important role in the clinical study of colorectal carcinoma.View full abstractDownload PDF (15399K) -
Takeshi Marumori, Masatoshi Kawamura, Kouichi Takamura, Nobuo Komatsu, ...1995 Volume 28 Issue 4 Pages 813-818
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSImmunohistochemical staining of PCNA was performed on paraffinembedded sections of 52 colorectal cancers, and the fixation time of the specimens and clinicopathological variables were compared. Staining of AgNORs was also evaluated in the same specimens. When the fixation time of the specimens by masked formalin was set at 4, 12, 24 and 48 hours in the advanced part of cancer, the labeling index of PCNA decreased with time and 4 hours of fixation was significantly higher. When sites in normal mucosa and advanced and central parts of cancer were examined, the labeling index of PCNA was the highest in advanced part of cancer. With regard to clinicopathological factors, significant differences between PCNA and AgNORs were noted. It was concluded that PCNA seems to reflect the cell proliferating activity in cancer as well as AgNORs.View full abstractDownload PDF (10806K) -
Akira Tsunoda, Miki Shibusawa, Manabu Takada, Noboru Yokoyama, Yohji I ...1995 Volume 28 Issue 4 Pages 819-824
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA prospective study was carried out to assess functional restoration after anterior resection in patients with colorectal cancer. Clinical and manometric assessment was made in 20 patients with rectal cancer preoperatively and 3, 6 and 12 months after the operation. According to the length of the residual rectum (LRR), the patients were divided into two groups. LRR was under 5cm in Group A, and it was 5 cm or over 5 cm in Group B. Eight patients who had sigmodiectomy were studied as a control. Results were correlated with the LRR and the time passed after the operation. The alteration of bowel habits (bowel movement frequency, discrimination between feces and gas, and urgency) were more evident in patients with an LRR shorter than 3 months after the operation, but they had improved by 12 months. In Group A, the anal canal resting pressure was significantly reduced 3 months after the operation, but it had returned to preoperative level by 12 months, while in Group B or control, it did not change significantly. The maximum to tolerable volume was significantly different among the three groups 3 months after the operation. It was lower in patients with a shorter LRR at each examination performed after the operation. These results suggest that anorectal function in patients who have an anterior resection is associated with the length of the residual rectum.View full abstractDownload PDF (11878K) -
Keiko Suzuki, Shingo Kameoka, Kiyotaka Nakajima, Masahiro Kaneki, Kyoi ...1995 Volume 28 Issue 4 Pages 825-830
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSFully-cut preparations of the pelvic plexus were made from specimens resected from 20 patients undergoing non-pelvic plexus-preservative surgery for rectal cancer, in order to determine invasion of rectal cancer into the pelvic plexus. Invasion into the pelvic plexus was present in 3 (15%) of the 20 patients, and invasion was also observed in the interstitium surrounding the pelvic plexus. In the patients with pelvic plexus invasion, neural invasion was present within the colon wall, particularly perineural space invasion, which has been found to be involved in local recurrence. In these patients, the parietal depth was categorized as ss (al) or deeper, and lymph node metastasis and lymphatic invasion were present, whereas there was no venous invasion. As for prognosis, local recurrence occurred in 2 of the 3 patients with pelvic plexus invasion, but in none of the negative patients. The presence of invasion into the pelvic plexus indicates the necessity of considering of neural invasion at the time of selection of an adequate technique for an autonomic nerve-preserving operation, and it was thought to be reliable if this preservative operation is used only for the patients with a parietal depth of pm or less, without lymph node metastasisView full abstractDownload PDF (12022K) -
Motohito Nakagawa, Makoto Sano, Koichi Aiura, Yoshito Arisawa, Seiichi ...1995 Volume 28 Issue 4 Pages 831-835
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA case of acute pulmonary embolism after esophagectomy effectively treated by thrombolysis with a tissue-type plasminogen activator is reported. A 68-year-old male postoperative patient with esophageal cancer suddenly developed severe shortness of breath with anxiety. He had had a total thoracic esophagectomy under right thoracotomy and a gastric tube reconstruction 3 days earlier. Arterial blood gas analysis revealed a PaO2 of 65mmHg and a PaCO2 of 39mmHg (FiO2 1.0). Acute pulmonary embolism was diagnosed by emergency pulmonary arteriography on the basis of the defect of blood flow in the right upper lobe branch. Thrombolytic therapy with a human recombinant tissue-type plasminogen activator (rt-PA) was performed. Arterial blood gas data were dramatically improved (PaO2 180, PaCO2 38, FiO2 1.0). In spite of the use of thrombolytic agents for postoperative pulmonary embolism, no side effects including bleeding tendency were observed. A pulmonary arteriography 23 days afterthe treatment showed markedly improved flow with complete dissolution of the clot. The diagnosisof pulmonary embolism after esophagectomy is difficult because of its nonspecific symptomatology which is similar to that of other usual postoperative respiratory complications. It is important to diagnose it definitively by pulmonary arteriography and treat it rapidly by thrombolytic therapy. Our experience suggests that rt-PA is an effective and safe agent for the treatment of postoperative acute pulmonary embolism.View full abstractDownload PDF (9566K) -
Hirohiko Satoh, Masaharu Nishi, Hiroo Takehara, Nobuhiko Komi1995 Volume 28 Issue 4 Pages 836-840
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA case of gastric leiomyosarcoma with cartilage formation is reported. The patient was a 60-year-old man. The tumor was located on the posterior wall of the middle body of the stomach. The intracanaliculartumor size was 44V37×26mm, and the extracanalicular size was 84×74×76mm. The tumor weighed 420g, and was of the mixed type in Skandalakis's classification. Histological examination of hematoxylin-eosin (HE) stained specimens revealed high cellularity of spindle cells with frequent mitosis. The part that showed leiomyosarcoma was positive for α-smooth muscle actin on immunohistochemical staining, and cartilage formation like cartilage differentiation was slightly basophilic on HE staining. The portion with cartilage formation like cartilage differentiation showed metachromasia on toluidin-blue staining, was stained blue with arushian blue stain and was positive for S-100 protain stain. Thus the diagnosis of gastric leiomyosarcoma with cartilage formation was made. As far as we investigated, a case of gastric leiomyosarcoma with cartilage formation has not been reported in Japan.View full abstractDownload PDF (8854K) -
Yoshihiro Sato, Susumu Ohwada, Yasuo Morishita1995 Volume 28 Issue 4 Pages 841-844
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSLeiomyoma of the lesser omentum is rare. There are only fourteen reported leiomyoma in the lesser omentum that was primary or metastasis from the uterus. A 52-year-old woman was admitted to our hospital because of nausea and abdominal pain. Barium radiograph and endoscopic examination of the stomach revealed an elevated lesion on the lesser curvature of the gastric body. CT scan with contrast medium demonstrated a fist-sized tumor with mosaic pattern. The border between the tumor and the stomach wall was not demarcated. Angiography showed a hypervascular tumor which was fed by a branch of the left gastric artery. Preoperative diagnosis was leiomyosarcoma of the stomach. Subtotal gastrectomy associated with the tumor of the lesser omentum was carried out. Macroscopically, the tumor was covered with the capsule, which showed only fibrotic adhesion without continuence to the stomach wall. Microscopically, the tumor was characterized by interlacing fascicles of spindle cells. The cell density of the tumor was increased. The tumor was diagnosed as a cellular leiomyoma. It was difficult to differentiate whether leiomyoma of the lesser omentum was primary or metastasis from the uterus, because our patient had myoma of the uterus.View full abstractDownload PDF (8177K) -
So Called Malignant CarcinoidYoshihiro Moriwaki, Syuuhei Morita, Takuya Kudo, Ken Yamanaka, Hiroyuk ...1995 Volume 28 Issue 4 Pages 845-849
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe report a patient with duodenal argyrophil cell carcinoma, who was curatively operated on.A 69-year-old male was admitted to the Yokohama Red Cross Hospital because of abdominal pain. Although the preoperative upper gastrointestinal series and gastroendoscopic examination and biopsy indicated antral gastric cancer, laparotomy was performed and a diagnosis of duodenal cancer was made. We performed pancreatoduodenectomy with regional lymph node dissection.Histopathological examination of the resected specimen revealed ribbon-like trabecular arrangement and irregular sized atypical cells positive for both Grimelius and Fontana-Masson method.We made a diagnosis of “duodenal argyrophil cell carcinoma (so called malignant carcinoid)”.Duodenal carcinoid is unrare.But most reported cases have been “classical carcinoids”.that were histologically conformed of uniform, round cells and cases with pleomorphic feature were very rare.The character of this tumor is discussed compared with that of“classical carcinoid”reported as a literature in Japan.View full abstractDownload PDF (10825K) -
Takashi Doi, Iwao Sasaki, Hiroo Naito, Yuji Funayama, Yasuhiko Kamiyam ...1995 Volume 28 Issue 4 Pages 850-854
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 42-year-old man complained of epigastric discomfort after gastrectomy for a duodenal ulcer. Endoscopic examination revealed an anastomotic ulcer. Blood chemistry tests revealed hypergastrinemia, hyperPTHemia, hypercalcemia, and hyperprolactinemia. The fasting plasma insulin level was within normal limits, but the postprandial plasma insulin level was very high. We detected tumors in the pituitary gland, parathyroid gland, and pancreas, so we made a diagnosis of multiple endocrine neoplasia type 1. Computed tomography and ultrasonography of the abdomen revealed that the pancreatic tumor was solitary and located in the pancreatic head. Pancreaticoduodenectomy was performed, and we detected a solitary tumor in the pancreatic head. Histological examination of the resected specimen revealed tumors not only in the pancreatic head but also in the duodenal wall. The duodenal tumors were very small and multiple, and could not be detected during the operation. Immunohistochemical study and mRNA expression of these tumors suggested that insulin was produced in the pancreatic tumor and gastrin was produced in the duodenal microtumors.View full abstractDownload PDF (9514K) -
Toshio Nishi, Katsuhiro Kawasaki, Shinichi Iwamoto, Yuichi Kawabata, Y ...1995 Volume 28 Issue 4 Pages 855-858
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA case of solitary tuberculoma of the liver is presented with a review of 25 cases reported in the Japanese literature. The patient was 77 years old. The serum CA19-9 level was elevated during a follow-up observation after surgery for sigmoid colon cancer. Abdominal CT, ultrasonography, ERCP and hepatic angiography revealed pancreatic body cancer and metastasis in S6 of the liver. Distal pancreatectomy and hepatic resection of S6 was performed. Pathological examination of the resected specimen of the liver disclosed tuberculoma composed of epitheloid cells and lymphocytes with caseous necrosis. Although solitary tuberculoma of the liver is rare, it should be included in the differential diagnosis of liver tumor.View full abstractDownload PDF (7712K) -
Yutaka Ozeki, Nagaki Matsubara, Mitsuharu Kokubo, Takashi Uchiyama1995 Volume 28 Issue 4 Pages 859-863
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 72-year-old man who had undergone cholecystectomy and choledochojejunostomy for cholelithiasis 6 years ago was transferred to our hospital because of chills, high fever and tarry stool. He had been found to have right intrahepatic gallstones by computed tomography (CT) one year ago. Severe anemia, leucocytosis and elevation of hepatobiliary enzymes were shown on admission. CT disclosed a calcification in the right lobe of the liver and multiple cystic lesions in the posterior segment of the liver. Hepatic angiography showed extravasation and pooling of contrast medium at the posterior branch of the right hepatic artery. Transmesenteric portography revealed obstruction of the right branch of the portal vein. Under a diagnosis of multiple hepatic abscesses, obstruction of the right portal vein and rupture of the hepatic arterial aneurysm due to intrahepatic gallstones, urgent right hepatic lobectomy was performed. Transcatheter arterial embolization was not indicated because of the obstruction of the portal vein. The removed gallstones were calcium bilirubinate stones, and the resected liver showed multiple abscesses in the posterior segment of the liver. His postoperative course was uneventful except for minor leakage from the choledochojejunostomy.View full abstractDownload PDF (9671K) -
Naoki Tomizawa, Teruo Kusaba, Susumu Ohwada, Yoshiyuki Sakata, Yuichi ...1995 Volume 28 Issue 4 Pages 864-868
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSAbout 70 patients with extrahepatic hepatocellular carcinoma (HCC) including three HCCs originating from the Riedel's lobe have been reported in Japan. We report herein a 57-year-old woman with HCC originating from the Riedel's lobe. She admitted for the right hypochondrial tumor. Ultrasonograms and computed tomograms showed a tumor growing from the posterior-inferior segment of the liver to extrahepatic areas. Celiac arteriograms showed a hypervascular tumor fed by two abnormal arteries from the right hepatic artery. Partial resection of the liver was performed. The tumor was a single nodular type with a capsule that was separatd from normal liver tissue. Histologically, the tumor was Edmondson II type of hepatocellular carcinoma.View full abstractDownload PDF (9506K) -
Tetsuo Ajiki, Hirohiko Onoyama, Isamu Yamada, Tatsuo Sako, Iwao Yamaza ...1995 Volume 28 Issue 4 Pages 869-873
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe report a case of synchronous double early cancers in the extrahepatic biliary tract of a patient who died of lymphnode recurrence 34 months after surgical resection. A 70-year-oldman was admitted because of a papillary tumor of the common bile duct. Pancreatoduodenectomy was performed under a diagnosis of bile duct carcinoma. By mapping the whole biliary tract, papillary adenocarcinoma confined to the fibromuscular layer of the bile duct and well-differentiated adenocarcinomalimited to the mucosal layer of the gallbladder were diagnosed with histological examination. The tumors, which were completely separated, showed no vessel invasion and no lymphnode metastasis. The biological behavior of the tumors as determined by immunohistochemical staining with CEA and CA19-9 was different. Vessel invasion is known to be rare among patients with early carcinoma of the biliary tract, whose prognosis is usually favorable. However, this patient died of recurrence, although both tumors were confirmed as double early carcinomas by mapping the whole biliary tract.View full abstractDownload PDF (9682K) -
Takahiko Misao, Izumi Eda, Masayasu Yamanaka, Hiroyuki Soga, Nobuyoshi ...1995 Volume 28 Issue 4 Pages 874-878
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSHamartoma of the spleen is a rare benign tumor. There have been 24 reported cases of this disease in Japan. We recently treated two patients with splenic hamartoma. The tumors were detected as hypoechoic and low-density masses by ultrasonography and computed tomography (CT). Dense enhancement was demonstrated by CT after enhancement in one case. The tumors were seen as areas of iso-low intensity on T1-weighted magnetic resonance images and of low intensity on T2-weighted images. Angiography revealed a hypervascular mass in the spleen in one case. Splenectomy was performed. The histological diagnosis was splenic hamartoma.View full abstractDownload PDF (8319K) -
Atsuyuki Maeda, Akihiro Yamaguchi, Masatoshi Isogai, Akihiro Hori, Yuk ...1995 Volume 28 Issue 4 Pages 879-883
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA rare case of primary malignant lymphoma of the appendix is reported, together with a review of 20 cases in the Japanese literautre. A 64-year-old man complaining of right lower quadrant abdominal pain underwent surgery under a preoperative diagnosis of appendiceal abscess. An enlarged, white, hard appendix was encountered, and a hard mass in the ileocecal mesentery was also palpated. Right hemicolectomy with lympohnode dissection was performed. Postoperative histological examination revealed a primary malignant lymphoma of the appendix which was to non-Hodgikin's lymphoma, diffuse large cell type according to the LSG classification. Adjuvant chemotherapy was added but he died of lymphnode recurrence one year and eleven months after the operation. Primary malignant lymphoma of the appendix is an extremely rare disease, and only 20 cases have been reported in the Japanese literature. Most of the cases were first diagnosed as having acute appendicitis, and appendectomy was performed. The definite diagnosis was obtained by postoperative histological examination. Extensive excision with regional lymphnode dissection should be performed in the case of this disease, and if necessary, postoperative therapy should also be added. However the prognosis is generally poor.View full abstractDownload PDF (10589K) -
Hisashi Matsumoto, Genichi Nishimura, Yukei Suzaki, Hidehiro Tajima, T ...1995 Volume 28 Issue 4 Pages 884-887
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe report five year survival in a case of colon cancer with peritoneal dissemination treated by continuous hyperthermic peritoneal perfusion (CHPP). A 74-year-old woman underwent right hemicolectomy and CHPP for ascending colon cancer with tubercular type dissemination, CHPP was repeated after confirmation of the disappearance of dissemination by second look operation. About 3 years after the first operation, obstruction of the small intestine and the recurrence of tubercular dissemination on the peritoneum and mesenterium were observed when the patient underwent laparotomy because of nausea and vomiting. After the part with obstruction was resected completely and dissemination was eliminated as far as possible, CHPP was done for the third time. Although the intestinal obstruction could be observed as type 2 in the gross specimen, the histologic appearance showed that the disseminated nest involved the intestinal lumen. This case suggests that CHPP is a useful therapeutic surgical strategy for colon cancer with peritoneal dissemination.View full abstractDownload PDF (7957K) -
Tatsuya Yoshikawa, Fujio Hanyu, Mitsuji Nakamura, Tatsuo Araida, Tsuka ...1995 Volume 28 Issue 4 Pages 888-891
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe aim of this study was to clarify the advantages and disadvantages of lymphadenectomy for gallbladder cancer. One hundred fifty seven gallbladder cancer, resected with microscopically cancer free surgical margins, were studied. The surgical results for each depth of cancer invasion were examined and recorded according to the General Rules for Surgical and Pathological Studies on Cancer of the Biliary Tract (Japanese Society of Biliary Surgery) M cancer (35 cases): No lymph node metastasis was founded and no patient died even among those with R-number. Pm cancer (7 cases): Lymph node metastasis in the fi rst barrier of the lymph node was seen in 1 patient. Advanced cancers (115 cases with ss, se or si): The rate of operative deaths was 0% in RO, 4.4% in Rl, 2, and 14% in R3. The rate of the operative deaths was correlated with R-number. R3 (n=13) lymphadenectomy only for the cases with binf (-) n (+) fielded a better 5-year survival rate than that for Rl, 2 (n=9). The survival rate for R3 was 70%, whereas that for Rl, 2 was 26%. We concluded that for advanced cancer, extended R3 lymphadenectomy is especially effective for the cases with n (+) binf (-) and a cancer free-surgical margin, whereas the disadvantage of extended R3 lymphadenectomy was the high operative mortality compared to R2 or more reduction lymphadenectomy.View full abstractDownload PDF (7773K) -
Appraisal of Extended Lymphnode Dissection for Carcinoma of the Papilla of Vater and Distal Bile DucHisafumi Kinoshita, Toshimichi Nakayama, Shuichi Fukuda, Junji Shibata ...1995 Volume 28 Issue 4 Pages 892-897
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe authors investigaged the advantages and disadvantages of extended lymph node dissection in carcinoma of the papilla of Vater and carcinoma of the distal bile duct. The subjects included 85 former cases and 55 latter cases treated from January 1965 to December 1993. In carcinoma of the papilla of Vater, lymph node metastasis occurred in 37 cases (43.5%): 21.2% in No.13a, b, 12.9% in No.14 and 1.2% in NO.16. Thirty-four patients including 7 n2 cases survived more than 5 years. Dissection of No.14 lymph node induced intractable diarrhea in 3 patients, one of whom died as a result of a diarrhea-related complication. Three patients suffered from local recurrence at the No.14 lymph node. In carcinoma of the distal bile duct, lymph node metastasis occurred in 25 cases (45.5%): 16.4% in No.13a, 16.4% in No.12b2, 9.1% in No.14 and 1.8% in No.16. Dissection of No.14 lymph node induced intractable diarrhea in 4 patients. Local recurrence in the retroperitoneal region was found in 8 patients. The long-term survivors and the site of recurrence indicate the importance of No.14 and No.16 dissection. However, No.14 dissection may involve resection of the superior mesenteric periarterial plexus, cause postoperative intractable diarrhea, and lead to malnutrition, adversely affecting the patient's quality of life. Lymph node dissection should be conducted considering the progress of carcinoma.View full abstractDownload PDF (10429K) -
Akimasa Nakao, Akio Harada, Toshiaki Nomami, Tetsuya Kaneko, Shin Take ...1995 Volume 28 Issue 4 Pages 898-902
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSLymph node metastasis and extrapancreatic nerve plexus invasion of carcinoma of the pancreatic head region was histopathologically studied. Lymph node metastasis was observed in 70% of duct cell carcinomas of the pancreatic head (n=101), 39% of common bile duct carcinomas (n=23) and 43% of papilla Vater carcinomas (n=28), respectively. Perigastric lymphb node metastasis was observed in 12% of pancreatic head carcinomas and was restricted to the subpyloric region (N. 6), with 0% in common bile duct carcinomas and 4% in papilla Vater carcinomas. Lymph node metastasis around the superior mesenteric artery (SMA) (No.14) and para-aorta (No.16) was observed in 23% and 25% in pancreatic head carcinoma, 9% and 9% in common bile duct carcinoma, and 0% in papilla Vater carcinoma, respectively. Neural invasion was observed in 88% of pancreatic head carcinoma, 83% of common bile duct carcinoma and 14% of papilla Vater carcinoma. Extrapancreatic nerve plexus invasion was noted in 75% of pancreatic head carcinoma with intrapancreatic neural invasion. A significant relationship was observed (p<0.001) between prognosis and extrapancreatic nerve plexus invasion, but not between prognosis and lymph node metastasis in pancreatic head carcinoma. Wide dissection of the paraaortic lymph node caused massive ascites leakage after surgery, and complete dissection of the nerve plexus around the SMA caused severe diarrhea. Postoperative nutritional support is necessary for patients with extensive surgery.View full abstractDownload PDF (10033K) -
Tomoyuki Kato, Takashi Hirai, Yasuhiro Kodera, Akihito Torii, Katsuhik ...1995 Volume 28 Issue 4 Pages 903-907
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSTwo hundred and seventy-two patients with advanced lower rectal cancer who received curative resection from 1975 to 1991 were reviewed. Five-year survival rates were 61.5% in the patients without pelvic lymphadenectomy (No PLA) and 79.5% in the patients with intra-abdominal combined with extra-peritoneal pelvic lymphadenectomy (Abd+Extra). The difference between the two groups was significant. The pelvic recurrence rate in the No-PLA gruop was 20.6%, whereas it was 5.4% in the Abd+Extra group, also a significant difference. It seemed that inadequate pelvic lymphadenectomy such as blunt dissection causes the prognosis to be worse than No PLA. Although extended pelvic lymphadenectomy decreased the incidence of pelvic local recurrence and prolonged postoperative survival, there were increased incidences of urine-voiding dysfunction. Urine-voiding dysfunction appeared in 80% of Abd+Extra but only 11% of No PLA. Autonomic nerve-preserving surgery was performed from 1987 in order to decrease urinary and sexual dysfunction. The five-year disease-free survival rate of the nerve preserving operation was 81.8%, and there was no local recurrence. The voiding dysfunction rate was 12.5% in patients with complete nerve preservation, almost the same as in No PLA. Erectile dysfunction was seen in 26.7% and ejaculatory dysfunction in 66.7% of male patients.View full abstractDownload PDF (9313K) -
Takayuki Morita, Fumihiko Nakamura, Takashi Itoh, Jun Suzuki, Kenichi ...1995 Volume 28 Issue 4 Pages 908-913
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe significance of extended lymph node dissection was studied from the viewpoint of curability of rectal cancer and quality of life after surgery. Carcinoma metastasized mainly along the inferior mesenteric artery (IMA) to its base, while lateral lymphb node involvement occurred in cases with many metastatic lesions toward the IMA. The 5-year survival rate of lower rectal cancer was 36%, with a high incidence of lateral lymph node metastasis nad local recurrence. We introduced extended lymph node dissection in 1984, which included radical en block excision of the adipose tissue around the aorta and lateral lymph node dissection from the extraperitoneal approach. A better 5-year survival rate was attained with this procedure (1984-1990) than previously (967-1983) in n0 and n1 groups, but no improvement was seen in the n2 grop. Postoperative urinary and sexual disturbances were recognized in most patients without bilateral pelvic nerve preservation, and deteriorating quality of life was observed after surgery. For improved better curability and fewer sequelae, extended lymph node dissection should be balanced with unilateral pelvic nerve preservation in surgery for rectal cancer.View full abstractDownload PDF (10056K) -
Yoshihiro Moriya, Kennichi Sugihara, Takayuki Akasu, Shin Fujita1995 Volume 28 Issue 4 Pages 914-917
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA total of 403 patients with invasive lower rectal cancer received curative resection with lateral dissection and were classifiled into two groups, an “extended” group [270] who received so-called extended surgery and a “nerve-sparing” group [133] who received nerve-sparing surgery with lateral dissection. In the extended group, more than half of the patients were not satisfied with long-term urinary function. On the other hand, more than eighty percent of patients who received bilateral pelvic nerve preservation had acceptable urinary function. In terms of Dukes' C tumors, the disease-free 5-year survival rates were 46% for patients in the extended group and 59% for patients in the nerve-sparing group. On the basis of the number of lymph nodes involved, the survival rate was significantly decreased in patients with more than four positive nodes compared to those with up to three positive nodes. Intrapelvic local recurrence rates were 14% in the extended group, and 13% in the nervesparing group. Our current policy calls for agressive application of extended surgery with partial preservation of autonomic nerves for patients with advanced lower rectal cancer.View full abstractDownload PDF (8772K) -
Keiichiro Ohta, Mitsumasa Nishi, Shigekazu Ohyama, Shou Ishihara, Tosh ...1995 Volume 28 Issue 4 Pages 918-922
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSAccording to the examiantion of clinicopathological findings of surgical results in cases with paraaortic node (No.16) involvement, the efficacy of No.16 dissection was observed for curability B, upper, middle and entire stomach cancer, semi-early, localized and intermediate type cancer with a small number with No.16 involved. The dissection of No.16 should be performed in mp, ss stomach cancer with more than n1 on the upper and lower parts of the stomach, n2 on the middle part and in se, si stomach cancer with lymph node involvement. However, since systematic dissection of No.16 sometimes triggers postoperative complications, the ideal proper dissection might be based on studies of anatomical lymphatic flow.View full abstractDownload PDF (9139K) -
Masatsugu Kitamura, Kuniyoshi Arai, Yoshiaki Iwasaki1995 Volume 28 Issue 4 Pages 923-926
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe advantage of para-aortic lymph node (No.16) dissection and quality of life was studied from the viewpoint of clinico-pathological findings and their prognosis. No.16 lymph nodes were dissected in 343 cases, and metastasis was seen in 79 (23.0%). The metastatic rate increased with the depth of cancer. High metastatic rates were seen in types 3 and 4, and in the histologically undifferentiated type. The five year survival rate of patients with No.16 metastasis (P0 and H0) was 18.8%. The n3 (-) group among cases with n4 (+) group showed a significantly better outcome than the no (+) group (p<0.05). Concerning the relationship between No.16 dissection and QOL, blood loss was greater and the length of surgery was longer than in the No.16 non-dissected group. Serum alubumin in the No.16 dissected group was significantly decreased on the 7th and 14th day. The exudate volume from drainage of the No.16 dissected group was much higher than in the non-dissected group on the first and second postoperative day. Body weight in the dissected group decreased further than in the non-dissected group. The extent of ingesting foods was slightly worse in the No.16 dissected group and the duration from discharge to work was longer than in the non-dissected group. Postoperative complications in the No.16 dissected group were the same as in the non-dissected group. In conclusion, it is considered that No.16 lymph node dissection does not have an obvious disadvantage for patients from the viewpoint of prognosis and postoperative QOL.View full abstractDownload PDF (8008K) -
Youichi Kitamura, Hiroyoshi Suzuki, Tsuyoshi Sasagawa, Hidetoshi Oguma ...1995 Volume 28 Issue 4 Pages 927-931
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe studied extensive lymph no9de dissection (D4) in patients with gastric cancer from two aspects, quality of life (QOL) and postoperative survival rate. The subjects were 2 592 patients with single incipient gastric cancer, which we experienced in the period from 1981 to 1990. Better survival rates were obtained in stages II and III with D4 than with standard lymph node dissection (D2). QOL was studied over 3 years in 25 D4 patients and 25 D2 patients with no relapses, and no difference was found between the two groups. D4 should be theoperative method of choice in stage II and III of gastric cancer.View full abstractDownload PDF (7511K) -
Shigeru Takahashi, Hajime Tokuda, Hiroshi Matsushige, Atsushi Takenaka ...1995 Volume 28 Issue 4 Pages 932-936
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIn order to determine the indications for D4 dissection for gastric cancer, complications, postoperative body weight loss and survival rates were compared with those of conventional methods of dissection. In our study D4 dissection was performed in 239 cases, conventional D3 in 117 cases and D2 in 480 cases. In the patients treated with D4 dissection, complications were more frequent (21.8%), blood loss was greater, duration of operation was longer and the mortality rate was much higher (5.0%) than in those tresated with conventional dissection. There was no significant difference in postoperative body weight loss between those who underwent D2 and D4 dissection. On the other hand, the outcome of patients who underwent D4 dissection was most favorable in stage II (78.4% at 5 years), IIIa (59.5%), IIIb (55.3%), IVa (50.5%) and IVb (11.8%). These mortality rates suggest that D4 dissection is effective for the cases more advanced than stage IIIa.View full abstractDownload PDF (8286K) -
Nobutoshi Ando, Soji Ozawa, Kazuyuki Tsujizuka, Hiroharu Shinozaki, Yo ...1995 Volume 28 Issue 4 Pages 937-941
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSNinety-two patients with cancer of the thoracic esophagus who underwent 3-field dissection (3F) from 1986 to 1992 were compared with 57 patients who underwent conventional 2-field dissection (2F) from 1982 to 1987 from the viewpoints of survival rates and postoperative complications. Analyzing the number of dissected nodes revealed that the degree of mediastinal dissection in 3F was more developed. No significant differences in overall survival rates were observed between 3F and 2F. However in the following cases, significant differences in survival rates were observed between 3F and 2F: cases of stage 0-III, cases in which the number of positive nodes was three or fewer, cases in which positive fields with lymph node netastasis were one or none and cases in which tumor location was the middle thoracic esophagus. That is to say, 3F was effective for moderately advanced cases, but not effective for far advanced cases. No significan differences in the incidence of postoperative complications, namely pulmonary complications and recurrent laryngeal nerve palsy, were observed between 3F and 2F. A satisfactory correlation was observed between c-erbB oncogene amplification and the number of positive nodes. Therefore, it would be possible to differentiate between moderately advanced and far advanced cases by preoperative estimation of lymph node metastasis. C-erbB oncogene would be useful for determining the indication for 3-field dissection.View full abstractDownload PDF (9630K) -
Hideaki Yamana, Teruo Kakegawa, Hiromasa Fujita, Ichiro Shima, Yuji To ...1995 Volume 28 Issue 4 Pages 942-946
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe advantage of extended lymphadenectomy for intrathoracic esophageal carcinomas was investigated in 301 patients who reveived radical surgery under the various types of lymphadenectomy, between 1975 and 1993. As time passed, the extent of lymph node dissection was gradually spread. Group A (n=39) underwent lower mediastinal and abdominal lymphadenectomy. Group B (n=30) underwent lymph node dissection around the right paratracheal, lower mediastinal and abdominal regions. Group C (n=114) underwent radical lymphadenectomy around the bilateral mediastinal and abdominal area. Group D (n=110) underwent extended radical lymph node dissection around the cervicothoracoabdominal area, and Group E (n=8) underwent especially extended lymphadenectomy along with total esophagectomy and laryngectomy due to massive lymph node metastasis in the cervicothoracic area. The postoperative survival rate improved according to extent except in Group E. Eight cases in Group E had severe lymphgenous metastasis to the cervicothoracic region with an average of 16 positive nodes. Patients who survived well for more than 5 years, had lymph node metastasis within 3 nodes regardless of the extent of lymphadenectomy. On the other hand, several patients with involvement of 4 to 10 nodes survived more than 3 years by undergoing extended radical lymphadenectomy. Almost all patients with involvement of more than 10 nodes died of early recurrence. Comparing the incidence of postoperative complications between Groups C and D, Group D showed a higher percentage of recurrent nerve paralysis, while no differences were found in other complications. Operative and hospital mortality showed no differences between the 2 groups. These results indicate that extended lymphadenectomy (3-field dissection) may improve patients' prognosis when they have intermediate advanced carcinoma of the thoracic esophagus.View full abstractDownload PDF (9673K) -
Masahiko Tsurumaru, Harushi Udagawa, Yoshiaki Kajiyama, Kenji Tsutsumi ...1995 Volume 28 Issue 4 Pages 947-950
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSSix hundred thirty-three cases of squamous cell carcinoma of the thoracic esophagus were reviewed. Of these, 284 cases underwent two-field dissection (D2) and 348 cases received three-field dissection (D3). These two groups were analyzed in terms of the advantages and disadvantages of three-field dissection. The average number of lymph nodes resected per case was 36.9 for the D2 group and 110.5 for the D3 group. This difference of number implied that lymph node dissection was performed more extensively and more precisely in the D3 group than in the D2 group. A higher incidence of lymph node metastasis to n4 was observed in the D3 group, accounting for the possibility that distant node metastasis might remain in some patients in the D2 group. As a disadvantage of D3, postoperative pulmonary complications developed at a higher rate (26.4%) in the D3 group than in the D2 group (18.1%). The mortality rates within 30 postoperative days were 2.9% for the D3 group and 1.8% for the D2 group. However, the D3 group had a statistically significantly better 5 year survival rate even when both operative death and hospital death were included. In conclusion, D3 has great advantages in improving long term survival despite the high incidence of complications. It can be justifiably used as a standard procedure for radical surgery of carcinoma of thoracic esophagus.View full abstractDownload PDF (7572K) -
Efficacy of Three Field Dissection Based on Preoperative StagingHiroko Ide, Reiki Eguchi, Tsutomu Nakamura, Kazuhiko Hayashi, Kazunari ...1995 Volume 28 Issue 4 Pages 951-955
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe studied the surgical results and prognoses of 426 patients with thoracic esophageal cancer who underwent esophagectomy from May 1985 to 1993. Of these, 184 patients had three-field lymph node dissection (3F), 137 patients had two-field dissection with extended upper-mediastinal node dissection (2F), and 105 patients had two-field dissection with standard mediastinal node dissection (2S). We indicated 3F for patients with upper thoracic esophageal cancer, those diagnosed with cervical node metastasis by ultrasonography (US), and those with upper mediastinal node metastasis. The rate of lymph node metastasis was 80.9% (30.4%: cervical) in 3F, 60.9%, in 2F, and 56.2% in 2S. Motality rates were not different among the 3 groups. The cumulative 5-year survival rate after employment of 3F, 40.2%, was improved compared with the one before, 23.4% (p<0.0001). The cumulative 5-year survival rates of patients (C>0) in 3F, 2F, and 2S were 42.9%, 56.5%, and 40.4%, respectively. The prognosis of 3F was better than that of 2F in patients with lymph node metastasis, those in stage IV, and those with 1-3 metastatic nodes. The 5-year survival rate of patients with cervical node metastasis in 3F was 31.3%, similar to those in patients with mediastinal or abdominal node metastasis. This showed that cervical node dissection was beneficial for the survival of patients with cervical node metastasis. On the other hand, there was no difference in survival between 3F and 2F in patients who did not have metastatic lymph nodes or those with submucosal cancer. These facts suggest that our indication for 3-field dissection based on preoperative staging might be effective to improve the survival of patients with thoracic esophageal cancer.View full abstractDownload PDF (9540K) -
Yoshiyuki Furukawa, Y Shiga, N Hanyu, Y Hashimoto, H Mukai, K Nishikaw ...1995 Volume 28 Issue 4 Pages 956-960
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe aim of this study was to evaluate the effect of Chinese herbal medicine in the treatment of bowel obstruction and on gastrointestinal motility. The Chinese herbal medicine we used was Dai-kenchu-to. Method: Gastrointestinal motility was investigated in 4 dogs. Strain gauge transducers were implanted at the antrum, duodenum, jejunum and ileum. A gastrostomy tube was inserted in the gastric fundus and jejunum to infuse Dai-kenchu-to. The contractile frequency and amplitude were analyzed to examine the influence of 1g Dai-kenchu-to on gastrointestinal motility for 2 hours during fed and fasting states. Furthermore, the value of this medicine was clinically evaluated in 69 bowel obstruced patients without operative indication. In 20 patients, 7.5-15.0g of Dai-kenchu-to was administered daily through a nasogastric tube, ileus tube or peroraly, and 49 patients were treated by other drugs. Results: The frequency and amplitude of the antrum, duodenum and jejunum significantly increased during the fasting and fed states after the infusion of Dai-kenchu-to. In the fasting state, contractile amplitude became 80% of the natural phase III contraction after administration. In the fed state, contractile amplitude and frequency significantly increased after administration. In the groups administered Dai-kenchu-to, the hospitalized period was 21.8±2.4 days and in other groups it was 27.7±2.9 days. There were significant differences between these two groups. Conclusion: Dai-kenchu-to significantly increases gastrointestinal motility. This medicine may have a useful effect in the treatment of bowel obstructed patients.View full abstractDownload PDF (9169K) -
Akira Gochi, Shuhei Hirose, Katsuaki Sato, Satoshi Hiramatsu, Akira As ...1995 Volume 28 Issue 4 Pages 961-965
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSHange-shashin-to or Rikkunshi-to was administered for four weeks to patients who had digestive symptoms following gastrectomy, to evaluate the cumulative rates of disappearance of subjective symptoms and the duration required for symptoms to disappear. In the evaluation of the rate of disappearance of loss of appetite, the group of patients who received Hange-shashin-to showed improvement early in the test. At the end of the test, the two groups of patients had similar rates of improvement. The rates of disappearance of heavy feeling in the stomach were approximately the same for both groups. There was no difference in the rate of disappearance of heartburn between the two groups. In the evaluation of the rate of disappearance of nausea and vomiting, the group given Hange-Shashin-to showed early improvement, while the group given Rikkunshi-to had a higher rate of final improvement than the former. In evaluation of the time it took for subjective symptoms to disappear, the group that received Hangeshashin-to showed early disappearance of symptoms of nausea, vomiting, loss of appetite, heavy feeling in the stomach, abdominal distension, epigastric pain and borborygmus, while the group that received Rikkunshi-to also demonstrated early disappearance of symptoms of nausea, vomiting and epigastric pain, but the former group showed better results than the latter. In overall evaluation, Hange-shashin-to was found to be highly effective in patients who were of average build, of medium body surface area and underwent subtotal gastrectomy for gastric cancer, and Rikkunshi-to was highly effective in patients who were slim, of small body surface area, and underwent total gastrectomy for gastric cancer. The result verified how to original use of each drug.View full abstractDownload PDF (9384K) -
Yoshinobu Hattori, Seisaku Kamibayashi, Hirofumi Satoh, Michihisa Koji ...1995 Volume 28 Issue 4 Pages 966-970
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSPatients with early anastomotic stenosis after gastrectomy were treated with the Kampo medicine Bukuryo-in. We investigated histologically the anastomosis of rats treated with Kampo medicine. Of 64 patients who underwent gastrectomy, 25 complained of stenotic symptoms within four weeks after surgery. Fourteen of these 25 patients were treated with Bukuryo-in (group A), and the remaining 11 had no treatment (group B). Of 14 patients treated with Bukuryo-in, 12 experienced relief of stenotic symptoms within a week.The duration of the symptoms was five days in grop A, significantly shorter than 13.2 days in group B.There was no significant difference in dilatation of the gastric remnant, or passage through the anastomosis as evaluated by Gastrografin between groups A and B. Billroth I anastomosis was performed on Donryu rats, and they were divided into three groups: eight rats treated with Bukuryoin, eight with Rikkunshi-to, and five with water. We investigated the volume of the gastric remnant, pH of the gastric juice, and histology of the anastomosis 5 days after surgery. Bukuryo-in treatment improved submucosal edema of the anastomosis compared with water treatment. There was no significant difference in the volume of the gastric remnant or pH of the gastric juice among the three groups. These results suggest that Bukuryo-in decreases submucosal edema of the anastomosis, and Bukuryo-in treatment promptly improves stenotic symptoms.View full abstractDownload PDF (9184K) -
Takashi Okamoto, Motonori Sairenji, Hisahiko Motohashi, Syoji Takemiya ...1995 Volume 28 Issue 4 Pages 971-975
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSChanges in cellular immune response and nutritional condition following administration of chinese harbal medicines have been presumed as background factors for the improvement of QOL after surgery. In experiments in mice, it has been clarified that administration of Juzen-taiho-to contributes facorably to body weight gain. We also demonstrated that a cachectic condition in mice induced by TNF is improved by Juzen-taiho-to. Increase in body weight was observed in the group fed mixed Juzen-taiho-to after injection of TNF. The tumor strain colon-26 with cachectin-inducing action was transplanted in mice. Prolongation of survival was observed in the group administered Juzen-taiho-to compared with the contrl group. The increase in the rate of body weight gain in the group adminisstered Juzen-taiho-to was prominent. Elevation of NK activity in the group administered Jiuzen-taiho-to was also observed compared with that in the control group.View full abstractDownload PDF (9531K) -
Yuji Imamura, Takashi Yokoyama, Yoshiaki Murakami, Yoshio Takesue, Tak ...1995 Volume 28 Issue 4 Pages 976
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSDownload PDF (2243K) -
Toshiyuki Adachi, Haruhiko Inufusa, Yoshihiro Nakatani, Masato Nakamur ...1995 Volume 28 Issue 4 Pages 977
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSDownload PDF (2256K)
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