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Volume 28, Issue 8
Displaying 1-25 of 25 articles from this issue
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Masayuki Kurooka, Hajime Yamaguchi, Masayuki Itabashi, Hiroki Tamura, ...1995 Volume 28 Issue 8 Pages 1761-1765
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe examined endoscopic and pathological findings of superficial esophageal carcinomas and tried to determine indications for curative endoscopic mucosectomy. We examined 57 lesions of 0-IIc type and 0-IIb type (slightly depressed type and superficial flat type) superficial esophageal carcinomas in 53 patients who underwent surgery or endoscopic mucosectomy in the National Cancer Center Hospital, Tokyo. We classified them into seven groups as ep, mm1, mm2, mm3, sm1, sm2 or sm3 according to the depth of tumor invasion. In the pathological study, ep and mm1 carcinomas had no vessel invasion or lymph node metastasis, and could thus be cured with endoscopic mucosectomy. We tried to diagnose them by endoscopic findings, and these findings were confirmed by pathological study ofthe resected specimen. In the endoscopic study, ep and mml carcinomas could be defined as lesions which have all the following findings. 1) without deep depression, 2) without large granule or nodule on the surface, 3) without mucosal thickening around the depression, 4) without stiffiness. The rate of accuracy of diagnosis was 92.3%. Thus ep and mm1 carcinomas were suitable for curative endoscopic mucosectomy and we could diagnose them accurately from endoscopic findings.View full abstractDownload PDF (9292K) -
Hisashi Matsumoto, Koichi Miwa, Koichiro Tsugawa, Masataka Segawa, Hir ...1995 Volume 28 Issue 8 Pages 1766-1770
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe physical status of individuals after distal gastrectomy was evaluated in 74 patients with jejunal pouch interposition (JPI), 63 with Billroth I (B-I), and 41 with Billroth II (B-Il). Questionnaires revealed that the incidence of pyrosis and diarrhea was 5% (1/20) each in the JPI group, whereas it was 22% (7/32) and 31% (10/32), respectively, in the B-I, and 42% (5/12) and 75% (9/12) in the B-II group. This difference was significant. In RI scintigraphic study, the emptying time (T1/2) of the residual stomach was104±45 minutes in the JPI group, 29±6 in the B-I, and 50±37 in the B-II group. There was a significant difference between the JPI group and the other groups. Though labelled bile refluxed to the gastric remnant in all 4 and 3 patients with B-I and B-II, respectively, only 15% (2/12) of the patients with JPI had the regurgitation. The incidence of asynchrony between the bile and the food was 8% (1/12) in the JPI group, 25% (1/4) in the B-I group and 67% (2/3) in the B-II group. These data suggest that the JPI procedure improves the complaints after distal gastrectomy and gives the individual more physiological status than Billroth-type anastomosis.View full abstractDownload PDF (9729K) -
Yoshiaki Asami1995 Volume 28 Issue 8 Pages 1771-1779
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe carried out an experimental study on changes in hepatic blood circulation and hepatic oxygen supply after release of interruption of hepatic low-temperature perfusion with interruption of hepatic circulation. Adult mongrel dogs with 60 minutes' liver ischemia were divided into a hepatic lowtemperature perfusion group (n=10) and a non-perfusion group (n=8). On and after 30 minutes after release of interruption, the hepatic artery blood flow and portal vein blood flow decreased in the non-perfusion group but increased in the perfusion group with significant differences (p<0.01). On and after 30minutes after release of interruption, the hepatic oxygen supply decreased in the non-perfusion group, reflecting a decrease in the hepatic blood flow, but increased in the perfusion group with a significant difference (p<0.01). On and after 30minutes after release of interruption, the oxygen consumption did not increase in the non-perfusion group but increased in the perfusion group with a significant difference (30 and 60minutes after release, p<0.01; after 120minutes, p<0.05). These results suggest that hepatic low-temperature perfusion with interruption of hepatic blood circulaction increases the hepatic oxygen supply with an increase in hepatic blood flow after release of interruption, contributing to recovery from reperfusion injury resulting from hepatic warm ischemia.View full abstractDownload PDF (18928K) -
Shiro Yogita, Yoh Fukuda, Takahito Ohnishi, Masashi Ishikawa, Masamits ...1995 Volume 28 Issue 8 Pages 1780-1787
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe operative treatment of hepatocellular carcinoma (HCC) was examined in 55 patients with attention to recurrence after surgery. They underwent hepatic resection for hepatocellular carcinoma (HCC) and were followed up for one and a half years postoperatively. Three patients were excluded: one operative death (1.8%), and two patients with unequivocally noncurative disease. The overall recurrence rate was 46.2%. There were 22 recurrences in the remnant liver, and 87.5% of them had been recurred less than 18 months after surgery. Three patients had recurrences at the surgical margin. All of these patients had residual disease at the surgical margin (TW+) at the time of resection. Two had tumors larger than 5 cm in diameter. The 5-year survival rate was 23.0% in the patients who underwent curative resection (n=28) and 70.8% in the patients who underwent noncurative resection (n=24). The recurrence rates were 53.6% and 37.5%, respectively. Extent of tumor greater than resection (H>Hr) was the most common reason for non-curative resection. Resection less than a subsegmentectomy (HrO) were assosiated with a lower recurrence rate than resection of one or more segments. Furthermore, compared with subsegmentectomy for HCC less than 5 cm in diameter, HrS was not associated with better recurrence and survival rates. However, these differences were not significant. We conclude that extended hepatectomy is required for the treatment of HCC larger than 5 cm. On the other hand, tumors less than 5cm can be treated with limited resection.View full abstractDownload PDF (16360K) -
Nobuhiko Ueda, Ichiro Konishi, Teisuke Hirono, Hideaki Nezuka, Yutaka ...1995 Volume 28 Issue 8 Pages 1788-1793
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSTwenty-six patients with low junction of the cystic duct experienced in our department during the past 7 years and 6 months were analyzed to elucidate the clinical fingure and problems in cholecystectomy of septal structure between the cystic duct and the common bile duct. In 23 of 26 patients, excluding 3 patients with low junction at the right side wall, the cystic duct revolved around the posterior wall of the common bile duct. There was no patient with low junction at the anterior wall or revolution of the cystic duct around the anterior wall. In 21 patients assessed by cholangiography after cholecystectomy, the spiral portion of the cystic duct was resected, but the septal structure remained as it was. Pathological findings of septal structutre in 3 patients revealed complete disappearance of normal wall structure except for a little atrophic muscle-fiber remnant just below the epithelium of both the cystic duct and the common bile duct. Hard collagen fiber proliferating secondarily had infiltrated, so both walls of the cystic duct and the common bile duct were united in a body. In cholecystectomy of these patients, preparation of the cystic duct must be limited at the portion of the spiral structure in cholangiography, and it is necessary to recognize that more excessive preparation causes bile duct injury.View full abstractDownload PDF (11780K) -
Nobuo Murata, Akio Odaka, Masakazu Tada, Yasuo Idezuki1995 Volume 28 Issue 8 Pages 1794-1798
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe have compared metabolic and inflammatory response to surgical injury between laparoscopic cholecystectomy (LC) and open cholecystectomy (OC). Interleukin 6 (IL-6), interleukin 1 receptor antagonist (IL-lra), C-reactive protein (CRP) and body temperature were measured from just after the skin incision up to 72 hours. IL-6 concentrations were elevated just after surgery. The IL-6 concentrations in OC patients were 53.3±28.0 pg/ml (mean±SD), 31.6±12.3pg/ml, 29.0±12.8 pg/ml and 27.4±10.9 pg/ml, 4, 8, 12 and 24 hours after the skin incision, respectively. Those in LC patients were 16.2±10.7pg/ml, 16.5±8.8 pg/ml, 11.0±4.2 pg/ml and 9.0±9.4 pg/ml, 4, 8, 12 and 24 hours after the skin incision, respectively. These concentrations in LC patients were significantly lower at every time after surgery than in OC patients. The elevations of IL-lra, CRP and body temperature were less in LC patients than OC patients. We conclude that LC reduces metabolic and inflammatory responses more than OC.View full abstractDownload PDF (9901K) -
Wataru Adachi, Shoichiro Koike, Yoshinori Nimura, Shinji Nakata, Yoshi ...1995 Volume 28 Issue 8 Pages 1799-1805
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSTo clarify the group at high risk for peritoneal recurrence after resection for colorectal cancer, 30 patients with peritoneal dissemination and 279 without dissemination were comparatively studied. Furthermore, the rates of peritoneal and hepatic recurrence were investigated in 170 patients who had undergone potentially curative resection for colorectal cancer. Significant differences in many clinicopathological factors were observed between the groups with and without dissemination: location of tumor, longitudinal diameter, % circumferential diameter, macroscopic and microscopic types of tumor, macroscopic and microscopic depths of invasion, lymph node metastasis, lymphatic vessel invasion, and preoperative serum CEA level. The rate of peritoneal recurrence was more than 25%, which was higher than the rate of hepatic recurrence in patients with colorectal cancer of types 2, 3 or 4, more than 75% in circumferential diameter, and with serosal invasion. The rate of peritoneal recurrence was not strongly influenced by additional factors, such as serum CEA level, longitudinal diameter of tumor, lymph node metastasis, and histologic type of tumor. From these results, patients with tumors of type 2, 3 or 4, more than 75% in circumferential diameter and with serosal invasion are considered to be at high risk for peritoneal recurrence after surgery for colorectal cancer.View full abstractDownload PDF (13638K) -
Kazutaka Yamada, Kiyoshi Niwa, Shigeya Hase, Takashi Sameshima, Kouich ...1995 Volume 28 Issue 8 Pages 1806-1813
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe reviewed our experience with lymphadenectomy for lower rectal cancer during the past 17 years, dividing patients into 144 treated by radical abdominopelvic lymphadenectomy (RAPL group) and 108 who underwent conventional lymphadenectomy (CONV group). Compared with CONV, RAPL was adopted in younger patients or patients with more advanced cancer, but the operative mortality rates of the two groups were not different. Although the 10-year survival rate did not differ between the RAPL and CONV groups in patients with Dukes A or Dukes B tumors, the survival rate of the RAPL group showed some improvement in patients with Dukes C tumor. In the CONV group, the survival rate of patients who had Dukes C tumor with lymphatic invasion was significantly lower than that of patients without lymphatic invasion. Similar results were found for venous invasion. However, the survival of patients who underwent RAPL was not influenced by the presence of lymphatic or venous invasion. On the other hand, the incidence rates of metastasis of inferior mesenteric and iliopelvic lymph nodes in patients who underwent RAPL were 14.5% and 15.3%. Five-year survival in patients with only inferior mesenteric metastasis was 68.2%, that with only iliopelvic metastasis was 43.0%, while that with both inferior mesenteric and iliopelvic metastases was 0%. These results suggested that RAPL was worth adopting in patients with lower rectal cancer of Dukes C, although the efficacy of RAPL for improvement of outcome in patients with metastasis of both inferior and iliopelvic lymph nodes was limited.View full abstractDownload PDF (13377K) -
Katsuhiko Arai, Akira Sugita, Takeshi Yamanouchi, Tsuneo Fukushima, Hi ...1995 Volume 28 Issue 8 Pages 1814-1818
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe investigated bowel frequency, soiling (continence), and the ability to discriminate between flatus and feces in 12 patients who underwent mucosal proctectomy with ileo-anal anastomosis (IAA) and 6 patients who underwent restorative proctocolectomy with ileo-anal canal anastomosis (IACA). Clinically, IACA patients suffering from soiling were rare, compared with IAA patients. In manometric study, the resting anal pressure of patients with IACA was better than that of those with IAA. Therefore, we considered that soiling (or incontinence) was related to resting anal pressure, and we rcommend IACA for patients with anorectal disorder, rectovaginal fistula, and anal fissure. Preoperative anorectal manometry is important in selecting IAA or IACA for patients with ulcerative colitis.View full abstractDownload PDF (7468K) -
Report of a Successful Surgical Therapy CaseHajime Saitoh, Shichisaburou Abo, Michihiko Kitamura, Masaji Hashimoto ...1995 Volume 28 Issue 8 Pages 1819-1823
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe experienced reconstructed gastric tube-right main bronchial fistula after radical operation for esophageal cancer, and report successful surgical therapy by transposition of a pedicled pectralis major muscle flap. The patient was a 63-year-old man who underwent total thoracic esophagectomy with reconstruction of the gastric tube through the posterior mediastinal route for esophageal cancer, on July 14, 1993. As there were no findings of anastomotic leakage or passage disturbance on esophageal fluoroscopy, oral intake was started on the l3th postoperative day (POD). But he coughed up gastric content and saliva. He repeatedly suffered aspiration pneumonia, and nutrition support was performed using a central venous catheter and a jejunal feeding tube. On the 120th POD, gastric tube-right main bronchial fistula was detected on esophageal fluoroscopy. The second operation, closure of the fistula with transposition of a pedicled third intercostal muscle flap, was performed on November 21, 1993. But pyothorax occurred as a complication, and on the 40th POD, the fistula recurred. The third operation, with transposition of a pedicled pectralis major muscle flap, was performed on May 14, 1994. After the operation, he improved dramatically. The cause of the fistula was considered to be local circulatory disorder on the staple line of the autosuture on the gastric tube.View full abstractDownload PDF (9656K) -
Yoshiyuki Nakai, Eizo Okamoto, Akihiro Toyosaka, Shusaku Habu, Masahar ...1995 Volume 28 Issue 8 Pages 1824-1828
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA resected case of synchronous triple cancers confined to the digestive tract (esophagus, stomach and colon) is descrived. A 59-year-old man visited our hospital for detailed examination of the stomach following a mass screening for gastric disease. Endoscopic examination revealed a 0-IIb+IIc cancer in the middle esophagus and a O-IIc cancer at the gastric angle. Preoperative bariumenema and colon fiber revealed a polyp in the descending colon. Endoscopic polypectomy for the colon polyp and endoscopic mucosal resection for the esophageal cancer were performed. Depth of invasion wasshown to be m and mm3 for the colon and esophagus. Total resection of the thoracic esophagus was performed and reconstruction was done by a thin stomach roll through the retrosternal route. The gastric cancer was resected by surgical operation. Triple cancers of the esophagus, stomach and colon are rare, with only 14 cases having been reported in Japan. Among those cases, only two were triple cancers, and ours was the only early synchronous triple cancer.View full abstractDownload PDF (9329K) -
Yutaka Nishida, Toichi Kushibuchi, Shoichi Nishimura, Junsuke Shibata, ...1995 Volume 28 Issue 8 Pages 1829-1833
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWhen a 53-year-old man with dysphagea underwent barium esophagograms in our hospital, a filling defect of 8 cm in length was revealed at the Im to Ea regions of the esophagus. Endoscopy showed a protruding tumor with ulceration in the middle portion of the esophagus (37 cm distal to the incisors). The biopsy substantiated moderately differentiated squamous cell carcinoma. The resected specimen, showing the ulcerative and localized type, measured 7×5.5 cm, and invaded throught the adventitia. The histological findings of the specimen exhibited the solid and trabecullar pattern of basal cell-like small cell nests, which contained the components of the squamous cell carcinoma with cornified features in some portion. Thus the diagnosis was basaloid-(squamous) carcinoma of the esophagus, with a stagegrouping of a2 n2 M0P10, stage III. Despite postoperative recombinant chemotherapy of cisplatin and 5-fluorouracil, lung metastasis was noticed. Eventually the patient died of lung, liver and intraperitoneal lymph node metastases 8 months after surgery, in spite of chemotherapy and irradiation.View full abstractDownload PDF (9798K) -
Takehiro Hachisuka, Yasushi Kato, Masayuki Miyauchi, Masahiko Shinohar ...1995 Volume 28 Issue 8 Pages 1834-1837
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe preoperatively performed intracaval endovascular sonography in two cases of liver tumor adjacent to the inferior vena cava (IVC) to formulate the operative strategy. Case 1 was a 60-year-old man who was admitted to our hospital because of hepatocellular carcinoma in segment 8. As tumor invasion to the IVC was suspected, preoperative intracaval endovascular sonography was performed. The wall of the IVC was visualized as an echogenic band by sonography, so tumor invasion to the IVC was diagnosed as negative. The finding was confirmed in the operation and right lobectomy was safely performed. Case 2 was a 72-year-old man who was diagnosed with cholangiocarcinoma. As tumor invasion to the IVC was strongly suspected, preoprative intracaval endovascular sonography was performed. Part of the wall lacked respiratory movement. However, the wall was well visualized as an echogenic band, so tumor invasion was diagnosed as negative. Although inflammatory tumor adhesion to IVC was found, right lobectomy was safely performed. Intracaval endovascular ultrasonography was considered to be useful in making an accurate diagnosis of liver tumor invasion to the IVC and in formulating the operative strategy.View full abstractDownload PDF (8189K) -
Takahito Nakagawa, Yoshie Une, Kazuhiro Ogasawara, Kazuhito Misawa, To ...1995 Volume 28 Issue 8 Pages 1838-1842
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSFor the last 4 years, we have been carrying out preoperative percutaneous transhepatic portal embolization (PTPE) with dehydrated ethanol in 5 patients who had unresectable hepatocellular carcinoma (HCC). They underwent right hepatectomy after PTPE for the right portal vein. The mean volume of the left lobe had increased from 348.4 ±120.3 to 563.0 ± 149.6cm3 2 weeks after PTPE, and to 675.0 ± 173.1cm3 4 weeks after PTPE. The mean volume of the embolized right lobe had decreased from 912.0 ± 329.6cm3 to 841.0 ± 261.9cm3 2 weeks after PTPE, further to 668.0 ± 350.1cm3 4 weeks after PTPE. When the dose of the injected dehydrated ethanol exceeded 20ml, the hepatic necrosis was widespread, with a concomitant increase in the serum ALT level. Four weeks after PTPE with higher dose ethanol, the volume of the right lobe had decreased to 57 ± 23%, whereas, that of the left lobe had increased to 249 ± 80%. Histopathologically, the cells of the embolized right lobe were eosinophilic in H-E staining, and the left lobe hepatocytes were bright and contained many secretion granules. We suggest that PTPE with dehydrated ethanol may extend the indications for liver resection for HCC because of its favorable effect on the future residual liver volume.View full abstractDownload PDF (8972K) -
Kazuhiro Takeuchi, Hiroji Nishino, Masaichi Ohira, Teruyuki Ikehara, Y ...1995 Volume 28 Issue 8 Pages 1843-1847
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSGenerally mixed hepatocellular and cholangiocellular carcinoma (MHCC) shows high malignancy as it has both the characteristics of hepatocellular carcinoma (HCC) and cholangiocellular carcinoma (CCC). Many cases of MHCC already have metastatic regions in the lung or lymph nodes when they are found clinically. Here we report two rare cases of MHCC resected curatively. Case 1: The patient was a 41-year-old man. US showed an abnormal tumor about 5 cm in diameter at the anterio-inferior segment of the liver, and right trisegmentectomy was performed. Case 2: The patient was a 56-year-old man. US showed a tumor about 3 cm in diameter at the posterio-inferior segment of the liver, and partial resection was performed. Histological findings in both cases showed the mixed type of MHCC according to Allen' s classification. Histologically, the HCC component and CCC component were mixed closely in Case 1, but the border of the two components was clear in Case 2. These findings may suggest that the origins were different in two cases. Hepatectomy associated with lymph node dissection of the hepatoduodenal ligament was performed in both cases, and the patients survived 42 and 16 months without reccurrence. This may suggest that if MHCC is supected at pre-or intraoperative examination, it is important to add lymph node dissection.View full abstractDownload PDF (9538K) -
Shinsaku Funamoto, Sanshirou Kigawa, Syuji Hirai, Yoshitomo Koshida, A ...1995 Volume 28 Issue 8 Pages 1848-1852
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 38-year-old man was admitted to our hospital complaining of epigastralgia. The serum CA19-9 level was extremely high at 29, 316 U/ml on admission. Abdominal ultrasonography, computed tomography, endoscopic retrograde cholangiography (PTCC) and abdominal angiography revealed the impacted gallstones with cholecystitis. The cytological finding of aspirated bile at PTCC was class III. The possibility of malignancy could not be ruled out. The patient was operated on laparoscopically. The gallbladder showed wall thickening and two cholesterol class stones. The histological finding was xanthogranulomatous cholecystitis with no evidence of malignancy. The serum CA19-9 level returned to normal after surgery.View full abstractDownload PDF (10028K) -
Shinji Mitsue, Gen Tanabe, Kouichi Kawaida, Yasuyuki Kobayashi, Shinic ...1995 Volume 28 Issue 8 Pages 1853-1857
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 66-year-old man presented with early intrahepatic cholangiocarcinoma with intraductal papillary growth. Abdominal US showed a high echogenic mass in the left hepatic duct. The left lobe, the caudate lobe and the left hepatic duct were resected. The tumor showed expansive growth in the left hepatic duct without invasion to the parenchyma of the liver. Histologically, the tumor showed various structual atypia with little mucin production, and was limited to the mucosa. Immunohistologically, intestinal-type apomucin was expressed in this tumor, but mammary-type was not. We diagnosed this tumor as an early intraductal papillary cholangiocarcinoma. The patient is doing well without the evidence of recurrence 50 months after surgery. Seven cases of intraductal cholangiocarcinoma including our case have been reported in the Japanese literatures. All the tumors except ours have been reported as mucin-producing cholangiocarcinomas. Patients with intraductal papillary cholangiocarcinoma which is limited to the mucosa of fibromuscular layer could be given a good prognosis by surgery.View full abstractDownload PDF (9103K) -
Toshiaki Shiogama, Hiroshi Fukui, Yasutaka Tsurunaga, Akimasa Mizutani ...1995 Volume 28 Issue 8 Pages 1858-1861
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSSeveral therapeutic efforts have been attempted to achieve closure of pancreatic fistula, none of which has been uniformly successful. We report a case of intractable pancreatic fistula occurring after pancreatoduodenectomy that was successfully cured by fistulo-jejunostomy. The patient was a 50-yearold man who underwent pancreatoduodenectomy for bile duct carcinoma. After removal of the stent tube inserted into the pancreatic duct, pancreatic juice started to discharge from thedrain set on the pancreas and pancreatic fistula developed. In addition to conventional therapy for pancreatic fistula, somatostatin analogue was administered. This decreased fistula output but failed to achieve complete healing. The pancreatic fistula persisted with 150-200 ml/day of amylase-rich effluent. Fistulogram showed pancreatic duct but no flow of contrast material into the jejunum anastomosed with the pancreas at pancreatoduodenectomy. Therefore, conservative therapy was stopped and he underwent surgical treatment 50 days after occurrence of the fistula (75 days after pancreatoduodenectomy). Atlaparotomy, pancreatic fistulo-jejunostomy was performed. The postoperative course was good, and the patient was discharged 42 days after fistulo-jejunostomy. He was healthy at the last follow-up, one yearand four months later.View full abstractDownload PDF (8046K) -
Jiro Nasu, Shoichi Hishinuma, Jiro Ando, Iwao Ozawa, Junich Matsui, Ta ...1995 Volume 28 Issue 8 Pages 1862-1866
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 54-year-old woman was admitted to our center with a mass in the right upper abdomen. Computed tomography (CT) revealed a huge tumor located in the head of the pancreas. The patient underwent pancreaticoduodenectomy with combined resection of the portal vein. The tumor, measuring 11× 8×6cm, was well-encapsulated and was histologically diagnosed as acinar cell carcinoma of the pancreas. Immunochemical staining of the cancer cells was positive for proteinase inhibitors. Electron microscopy showed zymogen granules, which confirmed the diagnosis of acinar cell carcinoma. All surgical margins were free of tumor, and no lymph node metastases were identified by histological examination. The patient had been well until eight months after the operation, when a large liver metastasis, which was not shown on CT scans three months earlier, was manifested. The liver metastasis was treated by transcatheter arterial embolization, but it continued to grow. The patient died of hepatic failure nine months after the operation. Autopsy revealed the solitary liver metastasis, 15cm in diameter, and the residual pancreas was totally replaced by tumor. Encapsulated acinar cell carcinomas of the pancreas are generally considered to carry a good prognosis, but this case suggests that even such tumors have a high risk of recurrence following resection. It should be kept in mind that untreatable recurrence can soon follow removal of the tumor.View full abstractDownload PDF (9549K) -
Nobuyuki Uchida, Yasuhiro Yanagita, Kazuo Arai, Yuichi Shoda, Yukio Na ...1995 Volume 28 Issue 8 Pages 1867-1871
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESShe patient was a 53-year-old man who visited the hospital with the complaint of upper abdominal pain. Ultrasonography, computed tomography and magnetic resonance imaging revealed a unilocular cystic tumor which was 10.0×5.5cm in size and accompanied by calcification. It was situated among the liver, the stomach and the pancreas. Under a diagnosis of cyst of the lesser omentum or the liver, laparotomy was performed. The cystic tumor was located only in the lesser omentum and was not connected with the other organs. Fenestration was performed. Histologically, the diagnosis of lymphangioma was established. A lesser omental cyst is very rare, only 27 cases have been reported in the Japanese literature.View full abstractDownload PDF (8498K) -
Soichi Tomimatsu, Takashi Ichikura, Shoetsu Tamakuma1995 Volume 28 Issue 8 Pages 1872
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSDownload PDF (2065K) -
Masatoshi Tanaka1995 Volume 28 Issue 8 Pages 1873-1877
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe treated 375 patients with hepatocellular carcinoma (HCC) by percutaneous ethanol injection, hepatic resection and transcatheter arterial embolization between January 1984 and June 1989, and followed up those patients until July 1994. Percutaneous ethanol injection, hepatic resection and trans-catheter arterial embolization were independently introduced as initial treatment in 151, 63 and 168 patients with HCC, respectively. Among patients with HCC less than 20mm in diameter with well-preserved liver function, the survival rates after percutaneous ethanol injection and hepatic resection were 61% and 62% for 5-year survival, and 22% and 28% for 7-year survival. There was no significant difference in outcome. Among patients with HCC between 21 mm and 30 mm in diameter, however, those treated by percutaneous ethanol injection had a better outcome than those treated by transcatheter arterial embolization, but had a worse outcome than those who received hepatic resection. Investigation of patients who survived over 5 years led us to understand that early diagnosis of either a recurrence or a second new grough of HCC was an important prognostic factor after percutaneous ethanol injection.View full abstractDownload PDF (9069K) -
Masatoshi Okazaki1995 Volume 28 Issue 8 Pages 1878-1882
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSTranscatheter hepatic arterial chemoembolization (THCE) for HCC has the dual aim of producing tumor ischemia by embolization of the arterial supply to the tumor and increasing the time that chemoth-erapeutic agents act on the target area. Although there is a wealth of clinical experience with THCE for HCC in Japan, the indications for THCE for advanced HCC such as HCC with portal vein tumor thrombus (PVTT) are still unclear. We performed THCE in patients with advanced HCC according to our selection criteria under pre-, intra-, and post-THCE intensive care, which have reduced the mortality associated with THCE in these patients. In this paper, we describe our experience, selection criteria and approach to THCE for patients with advanced HCC.View full abstractDownload PDF (10210K) -
Special Reference to Microwave Coagulation TherapyNaoki Yamanaka1995 Volume 28 Issue 8 Pages 1883-1888
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe present study reports the usefulness of microwave coagulation therapy (MCT) as a new option in the treatment of hepatocellular carcinoma. Twenty-three patients were treated using a microwave monopolar electrode (output 100 watts), from July 1992 to the end of 1994 under open (n=15) or laparoscopic control (n=8). The tumors, superficially located and ranging from 1.3 to 6.5cm in size, were coagulated from the tumor margin toward its center for a total radiation period of 28±9.6 minutes. Postoperative complications were minimal, and the liver chemistries (leaking enzymes, bilirubin, albumin, prothrombin time) returned to the preoperative values within 7 days in most patients. Regular diet was started within a few postoperative days. Follow-up imaging (dynamic CT scan, angiography) suggested complete necrosis. In conclusion, the advantages of MCT include negligible blood loss, technical safety, early recovery, and strong necrotic effect. MCT can be a useful treatment option for hepatocellular carcinoma with severe liver cirrhosis, together with hepatectomy, embolization and ethanol injection.View full abstractDownload PDF (10229K) -
Ken Takasaki1995 Volume 28 Issue 8 Pages 1889-1893
Published: 1995
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSSurgical resection of the primary tumor together with intrahepatic metastases in the surrounding liver tissue is the most effective therapy for hepatocellular carcinoma. Apart from improving radicality, future efforts should be directed toward enhancing safety by minimizing surgical damage and promoting the patient's prompt return to society. Improved safety of the operation requires an understanding of the limits to which patients can tolerate resection, as evaluated by using a table for estimation of remaining liver function. All types of resection should be performed systematically by using Glisson's sheath pedicle transection method. Perioperative management should be simple and avoid unnecessary use of lifesupport equipment. Adherence to this policy resulted in a mean postoperative hospital stay of 16.1 days. In addition, 70% of all patients recovered normally after the operation and were discharged after a mean postoperative hospital stay of 10.9 days. Delayed discharge was caused by late removal of the drain due to the presence of bile in the drainage postoperatively. This was apparently caused by damaging small bile ducts during ablation of the intrahepatic Glisson's sheath branch. Avoidance of this complication is one of our future goals.View full abstractDownload PDF (7889K)
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