Since 1983, esophagectomy with 3-field lymph node dissection has been performed for thoracic esophageal carcinoma in our surgery clinic. Recently, the number of aged patients with esophageal carcinoma has increased. In this series, we investigated the suitability of 3-field lymph node dissectin for aged patients. During the period from January 1983 to December 1992, a total of 251 patients with thoracic esophageal carcinoma were curatively operated in our clinic. They were divided into two groups, an aged-group (over 70 years old, 65 cases) and a non-aged-group (under 69 years old, 186 cases). 1) A highly incidence of preoperative disorder was noted in the aged group. 2) There was no peculiar complication in aged patients, but, complications were more frequent in the 3-field dissection group than the 2-field dissection group. Severe complications like perforation of the trachea occurred in 3-field lymph node dissection group. 3) The hospital mortality rate was similar in both groups. 4) The relative 5-year survival rates of patients with 2-field lymph node dissection were similar in the two groups. The relative 5-year survival rates of aged patients with 3-field lymph node dissection was 8.0%, significantly lower than the 35.9% in non-aged patients. Considering the results, it is better to choose the surgery with rational lymph node dissection for aged patients with thoracic esophageal carcinoma.

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Three hundred fifty-eight gastric cancer patients over 64 years old who underwent gastrectomy were classified into three groups according to age. Group A was 65 to 74 years of age (n=244), group B was 75 to 79 years of age (n=74) and group C was 80 years of age or older (n=40). As a general rule, combined resection was not performed and modified radical dissection (D1) was performed in group C. The results were as follows: The mean operative time was 234 minutes in group A, 193 minutes in group B and 193 minutes in group C. The differences among these three groups were significant. Mean intraoperative blood loss was 672g, 517 g and 327g, respectively. The differences between group A versus group C and group B versus group C were significant. Mortality rates in the groups were 2.5%, 2.7% and 5.0%, respectively, and the differences were not significant. The incidence of postoperative complications was about the same. The cumulative 5-year survival rates in the groups were 58.7%, 47.9% and 31.1%, respectively. The difference between group A and group C was significant. And also when operative death and death due to other disease were excluded, the 5-year survival rate was higher in group A than in group B and higher in group B than in group C. However, the differences in survival among those three groups were not significant. We concluded that limited surgery is performed for patients with gastric cancer in aged 80 and over, postoperative compilations can be controlled same as those in aged under 80, while the survival would be lower in aged 80 and over than in aged under 80.

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The status of lymph node metastasis according to clinicopathological factors such as macroscopic type, tumor size, histologic type and depth of cancer invasion was evaluated in 144 patients with solitary early cancer in the middle part of the stomach who were undergoing resection. Lymph node metastases were observed in six patients, 4.2% (one in mucosal and five in submucosal cancer). No lymph node metastasis was found in mucosal cancer of less than 5.0cm in diameter. Lymph node metastasis was noted in submucosal cancer with massive invasion to the submucosal layer, macroscopic elevated and depressed types, cancers more than 5.1cm in diameter or poorly differentiated adenocarcinoma. Therefore, segmental gastrectomy and lymph node dissection of first group nodes including No.7 of the second group nodes may be suitable for 1) all mucosal cancers, 2) submucosal cancers, cancers less than 5.0cm in diameter, macroscopically elevated or depressed types or differentiated adenocarcinoma. Moreover, it is necessary to select standard surgery for submucosal cancer that is more than 5.1cm in diameter, elevated and depressed types or poorly differentiated adenocarcinoma.

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The indication of omitting the No.1, 5 and 6 lymph node dissection for the early gastric cancer of the M region was examined. The subjects consisted of 378 cases of single gastric cancer of the M region (early stage 199 cases, advanced stage 179 cases) and a total 230 cases of m cancer in the same period. In the M region, metastasis in the lymph node was observed in 2.9% (3/105) of m cancer, all of which were undifferentiated IIc type with Ul (+). There were 2 cases (1.9%) of metastasis in the No.1 lymph node but no metastasis was found in the No.5 nor 6. In 94 cases of sm cancer, 1 case (1.1%) of metastasis was seen in the No.1, and 3 cases (3.2%) of metastasis in the No.5 and 6. In 125 cases of m cancer of other area, 2 cases of metastasis in the lymph node were seen in the depressed type with Ul (+). In 146 cases of the depressed m cancer, rate for metastasis in the lymph node was 1.2% (1/75) for differentiated type and 5.6% (4/71) for undifferentiated type. In relation to Ul, that rate was 0.0% (0/68) for Ul (-) and 6.4% (5/78) for Ul (+). No metastasis was observed in the tub₁, Ul (-). tub₂ and undifferentiated type with Ul (-). Furthermore, the relation between the metastasis and diameter of the carcinoma was examined and the following M localized m cancer was considered as a candidate for omission of No.5 and 6 lymph nodedissection; elevated type of 5.0cm diameter or less; as for depressed type (IIc) of tub₁ of 4.5 cm or less, Ul (-). tub₂ of 4.0 cm or less and undifferentiated Ul (-) of less than 1.0cm diameter. From additional examination, it was determined that there was a possibility to omit the dissection of No.1 and 5 lymph node in the m gastric cancer that is located in the greater curvature.

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Human hepatocyte growth factor was induced with two peaks within 24 hours after performing precutaneous transhepatic right branch of portal vein embolization (PTRPE) in the cirrhotic as well as the non-cirrhotic liver. Furthermore it was induced again with the same two phasic peaks within 24 hours after right lobectomy of the liver following the procedure. The left lobe was enlarged by 1.21 times in volume in the cirrhotic liver, and by 1.24 times in the non-cirrhotic liver on the 14th day after PTRPE. The values of ICG retention rate improved by the 14th day, and the level of serum retinol binding protein recovered by 90% of the pre-PTRPE level on the 21st day in both the cirrhotic and non-cirrhotic liver. PTRPE seemed to be effective in making the portal circulation in the liver shift into that of the post right lobectomy, and preventing rapid changes in the portalcirculation after lobectomy. The most beneficial time for lobectomy seemed to be 2 to 3 weeks after the procedure.

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Fifty-seven cases of pyogenic liver abscesses during the last 10 years were reviewed for therapeutic methods and prognosis. Percutaneous transhepatic abscess drainage was performed in 37 cases. The patients with a solitary cystic lesion recovered completely with percutaneous hepatic abscess drainage under echographic guidance. But most of the patients with multilocular or multiple lesions did not recover within two weeks with only abscess drainage. The therapeutic results of abscess drainage for a solitary liver abscess improved, but those of multilocular or multiple liver abscesses were still not good. Transcatheter regional hepatic arterial infusion with antibiotics was performed in 16 cases with multilocularor multiple liver abscess. Systemic antibiotic therapy or abscess drainage for these cases prior to this method did not show good results. The antibiotics were infused for 4 to 38 days continuously or intermittently without major complications. The method was effective for 15 cases, but not effective for 1 case. This method should be attempted if percutaneous abscess drainage is not effective.

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After VX2 hepatoma models were prepared using Japanese white rabbits, we carried out fundamental studies on the photodynamic therapy with PH-1126, a photosensitizer, and krypton laser in the treatment of hepatoma; namely, accumulation of PH-1126 in livers of these models was measured 48 hours after administration at a dosage of 3 mg/kg, using 2 methods, endoscopic photometer and macroscopic observation with a surgical microscope. More, we also determined the therapeutic effects of the photodynamic therapy with a krypton laser at 80 J/cm² 48 hours after administration of PH-1126. The tumor models were as follows: Control: rabbit hepatoma treated by intratumoral three-point irradiation without PH-1126. Group 1: non-contact surface irradiation method (used with fiber of the forward irradiation type). Group 2: intratumoral one-point irradiation method. Group 3: intratumoral three-point irradiation method.(Omnidirectional fiber was used in Groups 2 and 3) Anti-tumor effects were examined as to (1) inhibitory effect on tumor growth and (2) necrotizing rate. It was found that use of the 3-point irradiation method gave significantly better therapeutic results compared with the other three methods. The survival time was also significantly prolonged in the 3-point irradiation group. From these results, it was confirmed that the photodynamic therapy with PH-1126 is useful as a new multidisciplinary therapy for hepatoma.

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The prognosis of the hepatectomized patients with hepatocellular carcinoma was predicted with a neural network. A neural network with 9 neutons for the input layer, 14 neurons for the middle layer and 1 neuron for the output layer was constructed. Preoperative data (AST, ALT, ALP, hepaplastine test, ICGR 1.5, total liver volume, residuall liver volume, platelet and total bilirubin) of 58 hepatectomized patients (49 and 9 patients were discharge from and died at hospital, respectively)whose prognoses were already known, were learned by the neural network with teaching signals (1 for discharged, 0 for hospital death). After 100, 000 times of learning, the output of the neural network converged satisfactorily and gave the correct answer in all except one case. With the learned neural network, the prognoses of 11 patients with hepatocellular carcinoma were estimated prospectively. The prognoses of these patients, 10 of them were discharged and one of whom died of hepatic dysfunction, were predicted correctly. It was concluded that the neural network was a powerful tool for predicting the prognosis of hepatectomized patients with hepatocellular carcinoma.

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In connection with reported higher incidences of gallstone disease (GS) after gastrectomy, we had examined changes in the composition of gallbladder (GB) bile collected through external cholecystostomy from subtotal-gastrectomized dogs with truncal vagotomy. Black stones containing calcium bilirubinate developed in 3/7 gastrectomized dogs but not in 4 external-cholecystostomied control dogs. Analysis of bile suggested that altered bile composition possibly related to bile infection may be a lithogenic factor and that gastrectomy may promote the process of lithogenesis. The high possibility of bile infection through cholecystostomy, however, urged further investigations utilizing canine models without cholecystostomy. Bile was obtained from 5 pylorus-preserving gastrecotmized (PPG), 6 Billroth-II gastrectomized and truncal-vagotomized (B-II) and 6 control (sham operation) dogs by GB puncture during laparotomy at gastric surgery, 6 and 12 postoperative months. Five PPG and 6 control dogs incurred neither bile infection nor GS. Though free bile acids were detected in GB bile from 2/5 PPG dogs, there were no other remarkable changes in bile acids composition in these groups. B-II dogs incurred bile infection in 3/6 (two at 6 months, one at 6 and 12 months) and GS in 3/6. Bile culture was positive for 2/3 dogs with GS. A more marked alteration in bile acids composition was found in B-II dogs compared with those in other two groups. B-II may be more liable to bile infection and subsequent derangement of bile composition with a resultant high incidence of GS.

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Detection of gallbladder cancer in its early stage is still difficult in spite of the development of various diagnostic procedures. Due to its minimally invasive approach, laparoscopic cholecystectomy (LC) has been adopted internationally in the very short time since its introduction. To the best of our knowledge, however, few have applied this technique to the systematic diagnosis and treatment of elevated lesions of the gallbladder (ELG) of undetermined malignancy. When LC is performed as “total biopsy” of the gallbladder (GB) for ELG, the procedure becomes both diagnostic and therapeutic. Using this technique, we have experienced two patients with carcinoma of the GB out of 24 patients having ELG. One was limited to the mucosal layer (m) and the other showed invasion into the proper muscle layer (pm) as determined by intraoperative H-E frozen-section examination. In the latter case, an anomalous arrangement of the pancreato-biliary ductal system was found by direct intraoperative cholangiogram using a newly designed sheath with a round-tipped stylet. Therefore, the case was converted to open surgery, and the following additional operative procedures were performed: partial hepatectomy which included the GB bed and resection of the extra-hepatic bile duct and the extended dissection of the regional lymph nodes. ELG of undetermined maligancy under 20 mm in diameter is best treated by LC because we can obtain accurate and prompt pathological information about the disease, such as the degree of malignancy and invasion. In conclusion, LC may enable us to perform the most reasonable operative procedure for ELG, thereby avoiding insufficient or unnecessary extensive resection.

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Ten patients with central type of cholangiocarcinoma and 13 patients with hilar bile duct cancer underwent hepatic resection at our institution during the past 12 years. In this study, differences in the clinicopathological features and modes of spread of carcinoma between these two types of carcinomas were investigated. The gross appearance of these two carcinomas was different; cholangiocarcinomas formed tumor nodules extending in the liver parenchyma, whereas hilar bile duct cancers often showed infiltrative growth along the bile ducts. The mean tumor volume of cholangiocarcinoma was significantly larger than that of hilar bile duct cancer. Invasion to the portal vein or hepatic artery was found in half of both groups, but invasion to adjacent sites such as stomach, duodenum, colon and diaphragm was more frequent in cholangiocarcinomas. Metastases to the lymph nodes (No.12, 13, 8), and lymphatic, vascular and perineural invasion were frequently found in both types. The incidence of a positive surgical margin at the intrahepatic bile duct was higher in hilar bile duct cancer than in cholangiocarcinoma. Patients with hilar bile duct cancer who underwent resection had a relatively better prognosis, with a 5-year survival rate of 62.5%. Most of the patients with cholangiocarcinoma were in the advanced stages, resulting in the wide spread of carcinoma and a poor prognosis with a 3-year survival rate of 17.9%. Thus, these two types of carcinomas had differences in modes of spread and prognosis, although they showed some similar clinicopathological features.

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In pancreatobiliary surgery, radical operations with combined resection of the hepatic artery and/or portal vein are sometimes performed. In order to monitor the patency of anastomosis of the vessles, an implantable Doppler miniprobe was developed. Doppler miniprobe fixation to the vessels with bioabsorbable polyglycoride(PGA)felt was devised, and an experimental study to examine this method was performed. First, bioadaptation of the bioabsorbable PGA felt and dummy probes to the aorta and the inferior vena cava was studied for six weeks. Then we attempted to detect the flow velocity of the artery, portal vien and inferior vena cava. Results of the first study were as follows. In two weeks, the PGA felt was not absorbed and the dummy probes could not be removed. After four weeks, more than 50% of the PGA felt was absorbed, and the dummy probes could be removed easily. results of the second study were as follows. The flow could be detected clearly in arteries up to 2 mm in diameter. Recording of the maximum flow velocity depended upon the sampling point and the diameter of the vessels. Flow of the portal vein and the inferior vena cava could also be detected. According to the results of this experimental study, the possibility of implantable Doppler monitoring of reconstructed major vessels in pancreatobiliary carcinoma was verified.

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Eighty patients who underwent curative resection of rectal carcinoma were studied to determine the prognostic value of tumor biological attitude in metastasized lymph nodes (LN) and the host response in non-involved LN. Patients with budding (bd) and/or extracapsular spread (ext-cap) in metastasized LN (AT (+)) showed a worse survival curve than patients without bd or ext-cap (AT (-)) (p<0.001). AT (+) patients had higher overall and local recurrence rates than AT (-) patients (p<0.001, p<0.01, respectively). The patients with two or three high grade responses of paracortical hyperplasia, germinal center hyperplasia, and sinus histiocytosis in non-involved LN (NA (+)) showed better survival curves than those with only one high grade response or none (NA (-)) (p<0.05). The patients with larger non-involved LN also showed a better survival curve than those with smaller ones (p<0.01). NA (+) patients showed a significantly lower incidence of AT (+) than NA (-) patients (p<0.05). It was indicated that bd and ext-cap in metastasized LN represented a vigorous biological attitude of the tumor and that the response in non-involved LN represented the host response to the tumor. Therefore, both tumor biological attitude in metastasized LN and host response in non-involved LN were thought to have prognostic value for rectal cancer.

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A case of penetrating injury to the cervical esophagus caused by a chopstick is reported herein. The patient, a 19-year-old woman, fell while carrying dishes, and her right neck was penetrated by the chopstick. She visited our hospital without removing the chopstick, and the diagnosis of esophageal injury was established endoscopically. Extripation of the chopstick and primary closure of the esophagus was done. Thirty-five cases of traumatic esophageal injury reported in Japan, including our case, were reviewed. The mortality rate of the conservatively treated cases was 66.7% (2/3), in contrast to 3.2% (1/31) in the surgically teated cases. If primary closure is delayed beyond 24 hours of injury, the rate of leakage is 80% (4/5) in contrast to 9.1% (1/11) in within 24 hours. Three (25%) of the 12 drainage cases needed reoperation. Therefore, early diagnosis and eary surgical intervention is essential for traumatic esophageal injury. Twenty-three Japanese cases of penetrating injury by chopstick, including our case, were reviewed. In 17 cases of simple removal of the penetrating chopstick, 10 cases needed extripation of the divided piece, and 2 cases with injuries of the digestive tract, despite complete removal, needed surgical treatment later on. In selected patients with complete removal of the chopstick and without injury of the digestive tract, conservative treatment may be appropriate.

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Granular cell tumors are usually found in the skin, tongue or breasts. They seldom originate in the gastrointestinal tract, especially in the stomach. A case of granular cell tumor in the stomach which we experienced is described in this report. The patient was a 58-year-old male. His chief complaint was precordial pain. A Yamada type II polpoid lesion with a smooth surface, a dimple in the center and bridging folds located in the greater curvature of the middle body of the stomach was detected by upper gastrointestinal roentgenography and endoscopy. It was diagnosed as a submucosal tumor based on endoscopic ultrasonographical finding. A gastrectomy was performed because of the possibility of malignancy. The cut surface of the tumor measuring 20×15×15mm was yellowish-white. Histologically it was diagnosed as a granular cell tumor.

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We report a case of resected gastric and transverse colonic cancers with synchronous adrenal metastasis which is free from recurrence for 2 years and 9 months after the operation. The patient was a 67-year-old man with occult blood in his stool and was diagnosed as having synchronous gastric and transverse colonic cancers. A huge adrenal metastasis was found on the CT scan, whereas no metastasis to the lung, liver, lymph nodes, or peritoneum was seen. We thought that it was possible to remove the visible tumors, and performed lower esophagectomy, total gastrectomy, resection of the adrenal metastasis, and transverse colectomy with lymph node dissection. Histological findings of the adrenal tumor were compatible with gastric cancer, and also revealed that the hematogenous metastasis was from the gastric cance, because normal adrenal tissue was present between the adrenal tumor and the main lesion. This is the first case, as far as we could tell from the literature in which synchronous adrenal metastasis of gastric cancer was removed at the time of gastrectomy.

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A 61-year-old man underwent subtotal distal gastrectomy for early cancer of the angle and antrum of the stomach. Microscopically, both lesions invaded the submucosal layer. Serum AFP, which was normal preoperatively, increased remarkably along with the growth of multiple liver metastases after four months. Immunohistochemical AFP staining of the resected specimen of the stomach revealed positive cells, leading to the diagnosis of liver metastasis from AFP-producing gastric cancer with multiple early gastric cancer. Only eighteen cases of AFP-producing early gastric cancer have reported in Japan. About the half of them had been metastasized to the liver. Histopathologically, most cases were poorly differentiated adenocarcinoma with medullary proliferation.

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A case of arteriovenous malformation (AVM) of the pancreas head is described. A 36-year-old man was admitted to our hospital with complaints of tarry stool and severe epigastralgia. Laboratory studies revealed anemia only. Abdominal ultrasonography, CT scan, and MRI demonstrated a tumor in the pancrease head. The celiac trunk and superior mesenteric angiography revealed a hypervascular lesion in the pancreas head and early filling of the portal vein. The diagnosis of AVM was obtained. Doppler ultrasound was useful not only to diagnose the AVM, but also to determine the range of resection. Pylorus-preserving pancreaticoduodenectomy was performed. Histological examination of the resected specimen revealed abundant abnormal vessels including arteries and veins. AVM in the pancreatic region is a relatively rare condition. To our knowledge, only 40 cases have been reported in Japan. In many cases, gastrointestinal bleeding was present. Since AVM has multiple feeding arteries, transarterial embolization is not always effective, but surgical resection would be a radical treatment.

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An extremely rare case of liver abscess due to penetration by a fish bone is presented. A 56-year-old man visited our department with the complaint of right upper abdominal pain. Abdominal ultrasonography, CT and MRI revealed a tumor in liver segment 6. Based on these findings, we diagnosed this tumor as hepatocellular carcinoma. In laparotomy we found a granulomatous abscessof the liver due to the penetration by a fish bone through the duodenum. We removed the fish bone andsutured of the site of penetration of the duodenum. A total of 384 cases of intestinal perforation orpenetration by fish bone have been reported in Japan, and only 7 of them, including our case, were cases of penetration to the liver. Although it is difficult to correctly diagnose this disease, in cases of penetration to the liver, it seems to be possible by finding linear calcification in the lesion on diagnostic imaging.

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A rare case of cholangiocellular carcinoma presenting with pyrexia and remarkable leukocytosis is reported. A 78-year-old man was admitted to our hospital for remittent high fever and leukoctosis. Computed tomography(CT)and ultrasonography(US)showed a low density lesion and hypoechoic lesion in the caudate lobe of the liver, respectively. A diagnosis of liver abscess was made, and percutaneous transhepatic drainage was tried unsuccessfully. A needle biopsy specimen at that time revealed undifferentiated carcinoma. Because multiple mass lesions throughout the liver detected by additional CT scan after admission, radical surgery was abandoned. He developed jaundice and died with clinical manifestations of multiple organ failure 32 days after admission. At autopsy, an expansive solid tumor occupied the caudate lobe, and multiple lesions scattered throughout both lobes of the liver were found. However, neither tumor embolism, direct invasion into the portal vein, nor dilatation of the intrahepatic bile duct was evident. Histological and immunochemical examiantions revealed poorly differentiated adenocarcinoma of the liver, and the tumor was finally diagnosed as cholangiocellular carcinoma. Specimens from the liver showed remarkable leukocyte infiltration and focal necrosis in Glison's sheath; the bone marrow showed hyperplasia. Enzyme immunoassay of the serum demonstrated abnormal levels of granulocyte colony-stimulating factor(129 pg/ml). These clinical findings indicate that granulocyte colonystimulating factor might originate from cholangiocellular carcinoma and elicit pyrexia and granulocytosis.

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We experienced a case of spontaneous biloma. A 73-year-old man with abdominal pain suffered from cholecysto-choledocholithiasis. CT scan demonstrated a cystic mass at the left upper abdomen. Ab-dominocentesis under ultrasound guidance obtained bile juice resembling exudation. We diagnosed biloma, resected the fibrous scar at the left lobe of the liver, and performed cholecystectomy and choledocholithotomy. Biloma mainly occurs traumatically or iatrogenically. Spontaneous biloma is very rare, and only 17 cases have been reported.

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We report 2 cases of gallbladder cancer diagnosed by intra-operative biliary aspiration cytology. Case 1 was a 66-year-old man in whom US and CT revealed slight wall thickness of the gallbladder, which was filled with stones. Case 2 was a 73-year-old woman in whom US revealed slight wall thickness of the gallbladder and some stones, while CT showed edematous wall thickness.These patients were preoperatively diagnosed as having chronic cholecystitis with stones. Before cholecystectomy intra-operative biliary aspiration cytology demonstrated class V, so appropriate procedures could be chosen. Pre-operative diagnosis of gallbladder cancer is so difficult that some cases with wall thickness are not diagnosed until the post-operative histological examination is performed. For such cases, intra-operative biliary aspiration cytology is a very useful diagnostic method with few complications.

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A case is reported of solitary pulmonary metastasis from primary mucinous cystadenocarcinoma of the vermiform appendix. A 60-year-old woman complaining of right lower abdominal mass was admitted. Barium enema examination and CT findings of the abdomen suggested primary carcinoma of the vermiform appendix. On exploration, a tumor of the ileocecal region invading to the sigmoid colon and duodenum was found, so right hemicolectomy with sigmoid colectomy and partial resection of the duodenum was performed. Histological evaluation reveaeld mucinous systadenocarcinoma of the appen-dix. Four years after the operation, a solitary pulmonary metastasis of the left lung was found, and wedge resection was performed. The histological findings of the pulmonary tumor showed metastatic mucinous carcinoma origniating from carcinoma of the vermiform appendix. The patient is alive five years after the second operation. A review of the literature revealed that distant metastasis of primary mucinous cystadenocarcinoma of the vermiform appendix is very rare, so we reported this case.

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The patient was a 47-year-old man who had developed melena twice before, but the origin of the melena was not identified. On November 9, 1990, because of massive melena, colorectal endoscopy was carried out, revealing hemorrhagic ulcers in the cecum. The patient underwent ileocecal excision on December 26, 1990. During the operation, no lesion was found in the large intestine, but punched out ulcers were noted at three points of the small intestine. These ulcers were histologically classified as non-specific inflamed ulcers. This is a rare case in terms of the location and onset of this disease. However, a diagnosis of simple ulcers was made on the basis of the characteristic ulcers, and the absence of signs suggestive of Behcet's disease. Although the incidence of postoperative recurrence is high for simple ulcers, the present patient, who received prophylactic salazosulfapyridine therapy for 2 years after surgery, has not developed any sign of recurrence during the past 4 years. Thus, salazosulfapyridine was effective in preventing postoperative recurrence of this disease.

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The patient was a 61-year-old man with the chief complaint of abdominal tumor. Three years earlier, in 1989, he had undergone partial resection of the stomach for early gastric cancer. Abdominal ultrasonography, computed tomography and MRI revealed a tumor that had developed from the mesenterium. Laparotomy was performed on May 25, 1992. A tumor was found in the mesenterium of the jejunum approximately 110cm from Treitz's ligament. The tumor was extirpated without resection of the intestine. The resected elastic hard tumor, measuring 11.5×10.5×10.5cm, showed a smooth surface, was whitish and had a solid cut surface. Microscopic view showed spindle-shaped fibroblasts and their production of abundant collagen fibers. The histological diagnosis was intra-abdominal desmoid tumor. These has been o evidence of recurrence as of 2 years and 6 months after surgery. This is a rare case of intra-abdominal desmoid tumor without polyposis coli, only 38 cases have been reported in the Japanese literature. We discussed the clinical findings of this desmoid tumor.

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We report here three cases of gangrenous ischemic colitis with characteristic endoscopic findings. Case l was an 84-year-old man, case 2, a 77-year-old woman, and case3, a 59-year-old man.Allpatients had melena as a initial symptom and few abdominal findings.Endoscopy performed within 12 hours after the onse trevealed extensive and circumferential multiple submucosal hematomas. One patient (case1) died of MOF 5 days later. The other two patients (cases 2 and 3) underwent emergency laparotomy for stimulation symptoms of the peritoneum after a stable condition of 5 to 7 days, but onepatient (case 2) died of MOF. Ablation of the mucosa was extensive on the regions of the isolated colon where the above-mentioned findings were endoscopically confirmed. These results indicated that circumferential multiple submucosal hematomas were previously suggestive of ablation of the mucosa and that the extent could be a factor indicating surgical treatment.

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We report a case of small cell carcinoma of the lung with sigmoid colon stenosis due to lymph node metastasis. The patient was a 42-year-old male who had received radiochemotherapy for small cell carcinoma of the lung. Lower abdominal pain appeared and narrowing of the feces was noted, and then he was referred to our department. An elastic hard, immovable mass was palpated in the left lower abdomen. Blood chemistry findings showed abnormally high values for CEA and CA19-9, and the occult blood reaction for the feces was positive. A barium enema showed a filling defect in the sigmoid colon, and colonoscopy revealed an elevated lesion associated with a central depression and extramural compression. Sigmoidectomy was performed. Intraoperative findings showed swellings from the periaortic lymph nodes to the sigmoid mesocolonic lymph nodes and stenosis of the sigmoid colon caused by invasion of the wall of the enlarged parietal lymph node. The histopathological findings revealed lymph node metastasis of small cell carcinoma of the lung. He died of sepsis during chemotherapy 16 weeks after the operation. Small cell carcinoma of the lung seems to have a high potential for malignancy and shows distal organ metastasis frequently, but cases with metastasis to the large bowel are extremely rare.

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