-
Yukimitsu Kawaura, Kazuyuki Kawakami, Sakae Iwakami
1996 Volume 29 Issue 8 Pages
1721-1728
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL
FREE ACCESS
This experiment was designed to evaluate the role of reflux of gastric juice, bile or pancreatic juice in the genesis of reflux exophagitis. Barrett's esophagus and/or esophagel adenocarcinoma. Mongrel dogs were divided into four groups: reflux of gastric juice (group A, n=12), reflux of bile (group B, n=14), reflux of pancreatic juice (group C, n=12) and a control group with only laparotomy (group D, n=3). These dogs were observed over six years. Barrett's esophagus was seen after a mean of 38 months in eight of twelve dogs, dysplasia in three dogs after a mean of 52 months and esophageal adenocarcinoma in one dog after 72 months in group A. In four dogs, dysplasia after a mean of 41 months, and in one dog, esphageal adenocarcinoma after 60 months were observed in group B. Barrett's esophagus and adenocarcinoma were not seen in group C. These results suggested that Barrett's esophagus and/or adenocarcinoma may occur from reflux of not only gastric juice but also bile, but may not from reflux of pancreatic juice.
View full abstract
-
Hironori Tsujimoto, Takashi Ichikura, Shoetsu Tamakuma
1996 Volume 29 Issue 8 Pages
1729-1733
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL
FREE ACCESS
The purpose of this study was to determine the correlation between familial clustering of malignant neoplasms and expression of the p53 protein in gastric cancer. We made a survey of the family history of malignant neoplasms in 342 patients who underwent resections for gastric cancer from 1989 to 1993. Twenty-two patients had two or more first degree relatives with malignant neoplasms. They were divided into two groups: Group A consisting of 10 patients with two or more first degree relatives with gastric cancer, and Group B consisting of 12 patients with one or no first degree relative with gastric cancer. Two hundred and thirty-nine patients who had no relatives with any malignant neoplasms were used as the control group. There were no significant differences in the clinicopathologic features among the three groups. Formalin-fixed paraffin-embedded specimens of the tumor were stained immunohistochemically for the p53 protein and proliferating cell nuclear antigen (PCNA). Staining for the p53 protein was positive in 80% of the patients in Group A, 75% in Group B and 38% in the controlgroup. There were statistically significant differences between Group A and the control group and between Group B and the control group (p<0.01). We could not find any difference in the PCNA labeling index among the three groups. In conclusion, immunohistochemical staining for the p53 protein of the tumor tissue in patients with gastric cancer may be useful for detecting the risk for malignant neoplasms in their families.
View full abstract
-
Hideaki Irie, Naoki Hirabayashi, Masahiko Nishiyama, Noriaki Sakamoto, ...
1996 Volume 29 Issue 8 Pages
1734-1740
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL
FREE ACCESS
The efficacy of chromosomal analysis of gastric biopsy specimens was evaluated as a potential malignant marker by the fluorescence in situ hybridization (FISH) technique which allows chromosomal analysis within interphase cells. Seventy-six gastric biopsy specimens were studied, and the chromosomal numerical aberration was analyzed by using centromere probes specific to chromosomes 1, 7, 11, 17, respectively. The fraction of monosomy and polysomy (more than 3 copies per cell) showed a tendency of an increase in chromosoms 1, 7, 11 and 17 as the clinical stage advanced according to the TNM classification. The relationship between ploidy pattern and clinicopathological factors was investigated in 30 surgical cases. In the patients with polyploid tumors of chromosomes 7, 11, and 17, we found that the incidence of lymph node metastasis and lymph ductal invasion was significantly high (chromosome 7: p<0.05; chromosome 11: p<0.05; chromosome 17: p<0.05). In the patients with aneuploid tumors of chromosomes 1 and 11 we found that the incidence of peritoneal dissemination was significantly high chromosome 1: p<0.01; chromosome 11: p<0.05). In the patients with polyploid tumors in chromosome 17 we found a statistically significant high incidence of venous invasion (p<0.01). On the basis of these results, FISH analysis seems an effective method which could predict the malignant potential of gastric cancers before surgery.
View full abstract
-
A Study on the Prognostic Value using Multivariate Analysis
Keiichi Fujino, Takashi Ichikura, Kazuo Hase, Soichi Tomimatsu, Kazuhi ...
1996 Volume 29 Issue 8 Pages
1741-1745
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL
FREE ACCESS
Intraoperative peritoneal lavage cytology was performed in 201 patients with gastric cancer to determine the relationship between positive cytology, pathological findings, and prognosis. The incidence of positive cytology was 17.9% and increased in parallel with cancer progression. In patients with macroscopic serosal invasion the incidence of positive lavage cytology was 0% in S0 and S1, but 38.7% in S2 and S3. The patients in whom the diameter of cancer invasion in the subserosal layer was 4 cm or more had a higher rate (38.9%) than those with a diameter less than 4cm (10.5%). Patients with infiltrative type γ (INFγ) had a higher incidence of positive cytology. Results according to depth of invasion showed that survival rates in patients with positive lavage cytology were lower than those with negative lavage cytology. Also the patients with positive lavage cytology and a higher recurrence rate, especially peritoneal recurrence. Prognostic factors were determined in 88 patients with curative gastrectomy for advanced cancer by multivariate analysis using Cox's proportional hazard model. The nodal stage (p=0.008) and the peritoneal lavage cytology (p=0.023) together with depth of invasion were independent prognostic factors. The peritoneal lavage cytology can be an independent predictor for future peritoneal dissemination and prognosis.
View full abstract
-
Tsukasa Azuma, Fujio Hanyu, Mitsuji Nakamura, Toshihide Imaizumi, Tats ...
1996 Volume 29 Issue 8 Pages
1746-1753
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL
FREE ACCESS
The ultrasonographic diagnosis of anomalous arrangement of the pancreaticobiliary ductal system without dilatation of the common bile duct was investigated in 18 patients who were selected from among 38 patients with such an abnormal confluence. The remaining 20 patients were excluded because of complication of the gallbladder carcinoma. In 9 of 12 patients who could be examined in detail, the gallbladder wall was visualized as a two-or three-layered structure and the innermost layer was found to be thickened and irregular. Histopathological examination of resected tissue of the gallbladder suggested that these findings most probably represented mucosal hyperplasia. Considering the absence of such characteristic changes in 20 control patients without the pancreaticobiliary anastomotic anomaly, it appears that efficiency in US diagnosis of anomalous arrangement of the pancreaticobiliary ductal system without dilatation of the common bile duct can be increased if evaluations in screening tests are made with these specific changes in mind. Endoscopic ultrasonographic images were more distinct than US images; much the same findings were obtained by EUS as by US in 9 of 11 patients, and the confluence of the pancreatic and bile duct was confirmed in 7 of 11 patients. Accordingly, if such characteristic changes as were revealed by US in this study are found, then the EUS study is warranted. If there is a reasonable suspicion that the patient has an abnormal confluence, as suggested by the changes in the gallbladder wall, endoscopic retrograde cholangiopancreatography (ERCP) should be performed to make a definitive diagnosis.
View full abstract
-
Hitoshi Hara, Kunio Okajima, Hiroshi Isozaki, Sinshou Morita, Takashi ...
1996 Volume 29 Issue 8 Pages
1754-1759
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL
FREE ACCESS
To clarify the indications for pylorus-preserving pancreatoduodenectomy (PpPD) in patients with cancer in the pancreatic head region, we evaluated the state of lymph node metastasis and paragastric lymph node metastasis in 56 patients with cancer in the pancreatic head region. They underwent D
2 or more extensive lymph node dissection and were adequately examined by postoperative histopathological examination during the past 16-year period. Lymph node metastasis was frequently observed in patients with pancreatic head cancer of the infiltrative type and duodenal infiltration, those with cancer of the papilla of Vater of the ulcerative tumor type and pancreatic infiltration, and those with distal bile duct cancer of the infiltrative type and pancreatic infiltration. According to the histological type, patients with moderately to poorly differentiated cancer frequently had lymph node metastasis. Paragastric lymph node metastasis was observed in three patients with pancreatic head cancer and one with distal bile duct cancer, but none with cancer of the papilla of Vater. All three patients with pancreatic cancer showed the infiltrative type and infiltration to the second part of the duodenum. The patient with distal bile duct cancer showed the nodular infiltrative type and poorly differentiated cancer. No direct infiltration of cancer to the first part of the duodenum or the stomach was observed. These results suggest that the indications for PPPD are pancreatic head cancer not accompanied by duodenal infiltration, cancer of the papilla of Vater, and distal bile duct cancer not accompanied by pancreatic infiltration.
View full abstract
-
Haruhiko Okamoto, Yasuo Sakai, Hidetoshi Saitoh, Kimitoshi Shimamura, ...
1996 Volume 29 Issue 8 Pages
1760-1767
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL
FREE ACCESS
Endoscopic resection has become the most valuable method for diagnosis and treatment of colorectal lesions, especially for adenomas and early cancers. We investigated the incidence of lymph node metastasis of colorectal submucosal invasive cancer (sm cancer). In 146 surgical cases of sm cancer, 15 (10.3%) had lymph node metastasis. No lymph node metastasis was detected in the patient with pedunculated cancers which were smaller than 15 mm or in those with sessile cancers whose depth of invasion was smla. These lesions, mucosal cancers and adenomas, seem to be curatively treated by endoscopic resection. Clinically there are many differences between pedunculated and sessile lesions. We should choose appropriate treatment according to the shape of the colorectal tumor. Most of the pedunculated tumors should be resected endoscopically. Then sm cancers should be resected endoscopically. Then sm cancers should be treated by a curative operation except for those smaller than 15 mm with no lymphatic or vascular invasion. Sessile tumors should be treated according to accurate preoperative diagnosis of depth of invasion, because it is easier to distinguish the depth of invasion of sessile tumors than pedunculated tumors. Sessile sm cancers except for those whose depth of invasion is smla with no lymphatic or vascular invasion, should be treated by a curative operation. Massively invasive sessile sm cancer preoperatively diagnosed should also be treated by a curative operation. Sessile smla cancers with little invasion should be resected endoscopically and diagnosed histologically, then the treatment to be given next should be determined.
View full abstract
-
Masahiro Ishigooka, Jun Ikeue, Yasuyuki Takahashi
1996 Volume 29 Issue 8 Pages
1768-1771
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL
FREE ACCESS
We report a case of recurrence in the cervical and upper mediastinal lymph nodes four years after resection of esophageal mucosal cancer. A 53-year-old male patient had undergone thoracoabdominal subtotal esophagectomy with lymph node dissection (RII) for IIc type esophageal mucosal carcinoma in 1988. Histopathological findings were as follows: Moderately differentiated squamous cell carcinoma, 0-IIc type, 0.7×0.6cm in size. m
3 in depth, no lymphatic and vascular invasion, no lymph nodeinvolvement. Four years after the operation, recurrence was strictly examined upper mediastinal lymph nodes swelling was detected by CT scanning. At that time he complained of sever hoarseness. We treated him by chemo-radio therapy, but he died of multiple liver and lung metastasis after six months. It is generally considered that the prognosis of esophageal mucosal cancer is good. We treated this patient surgically, but recurrence or metastasis of the cancer was found. Therefore we believe that it is very important in the future to predict in which kinds of patients with esophageal mucosal cancer, especially m
3 in depth, there is a trend toward recurrence or metastasis.
View full abstract
-
Suguru Sawada, Takeshi Morimoto, Yasuhiro Kodera, Akihito Torii, [in J ...
1996 Volume 29 Issue 8 Pages
1772-1776
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL
FREE ACCESS
A 67-year-old female was admitted for investigation of liver dysfunction. Abdominal ultrasound examination and computed tomography revealed a solid tumor of approximately 4cm in diameter between the stomach and the liver. Selective celiac angiography revealed a hypervascular mass whose blood flow was supplied by the left gastric artery. An operation was performed in May 1994 under the diagnosis of an exogastric leiomyoma. At laparotomy a pedunculated exogastric tumor was found arising from the lesser curvature of the gastric upper body as a 0.5 cm pedunculus. A wedge resection was performed. Microscopically, hematoxylin-eosin stained sections showed that the tumor consisted of spindle cells arranged in a palisade and the tumor was diagnosed as a neurilemmoma because glial fibrillary acidic protein staining was positive in the tumor cells. According to the literature, only 3 cases of pedunculated exogastric neurilemmoma including ours have been reported in Japan (1974-1995). An exogastric pedunculated configuration is rare. No particular difference was found between these cases and non-pedunculated neurilemmoma. Histopathological diagnosis was reported to be rarely obtained prior to the resection. Wedge resection of the stomach turned out to be adequate therapy for our patient, although a standard treatment regimen for this rare disease has not been established to date.
View full abstract
-
Yasutaka Hachiya, Hirokazu Noshiro, Kazuo Chijiwa, Takashi Ueki, Hirok ...
1996 Volume 29 Issue 8 Pages
1777-1781
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL
FREE ACCESS
We experienced a rare case of cholangiocarcinoma combined simultaneously with gastric cancer. A 69-year-old male was admitted to our hospital because of dilated intrahepatic bile duct and mass in the lateral segment of the liver diagnosed on enhanced CT scan and ultrasound examination. Endoscopic retrograde changiography showed obstruction of the bile duct in the lateral segment of the liver. Angiography showed encasement of the left hepatic artery. Simultaneously endoscopic study of the upper gastrointestinal tract showed a Iia + IIc lesion at the antrum of the stomach. Therefore we preoperative diagnosed cholangiocarcinoma associated with gastric cancer. Distal partial gastrectomy, left hepatectomy and left caudate lobectomy with lymph node dissection were performed for these lesions. The patient was died of peritoneal carcinomatosis caused by advanced cholangiocarcinoma after surgery. We found only six case reports of cholangiocarcinoma combined simultaneously with gastric cancer in Japan. Because cholangiocarcinoma shows a poor prognosis, protection of peritoneal carcinomatosis and more extended radical resection would needed to improve its prognosis.
View full abstract
-
Takafumi Bandoh, Hiroshi Toyoshima
1996 Volume 29 Issue 8 Pages
1782-1786
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL
FREE ACCESS
We present two uncommon cases of a large portosystemic shunt under normal portal pressure. The patients (58-and 65-year-old men) developed disturbances of consciousness associated with electroencephalographic (EEG) abnormalities and severe hyperammonemia after a gastrectomy for peptic ulcer, 20 years and 31 years earlier, respectively. Neurological examinations and liver function tests were within normal limits except for the ICG. Large portosystemic shunts between the coronary gastric vein and the left renal vein were demonstrated by transarterial portography, and identified during the operation. The portal system was verified to be normotensive, 140 and 103 mm saline in each case, respectively, and histological examination of the liver revealed no parenchymal disease. Immediately after surgical removal of the shunts, the hyperammonemia and EEG abnormalities as well as disturbed consciousness returned to normal. Both the corkscrew apperance of the peripheral hepatic arteries and atrophy of the liver seen before the operation improved. ICG retention rates returned to almost normal values. We discuss the probability that the extraordinary portosystemic shunts were due to a local pressure rise in the coronary gastric vein following the previous gastrectomy. We present this bizarre syndrome as one of the postgastrectomy complications.
View full abstract
-
Reiichiro Tanaka, Akira Kamasako, Shunsuke Kawamoto, Keita Miki, Ichir ...
1996 Volume 29 Issue 8 Pages
1787-1791
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL
FREE ACCESS
Reports of a portal hepatic venous shunt (PHVS) via an intrahepatic portal vein aneurysm (IPVA) are extremely rare, though they have gradually increased with the development of the diagnostic imaging technology of today. We present a case of a PHVS via an IPVA effectively treated with ligation of a portal vein branch. A 71-year-old man with early gastric cancer (IIa, sm, tub
2, n
0) was admitted for an operation, and CT and MRI revealed a PHVS via an IPVA measuring 3×3×4 cm in the anterior lateral segment (S
3) of the left lobe of the liver. There was no ascites or esophageal varices, but there was splenomegaly. His laboratory data were: prothrombin time 100%; total serum bilirubin 1.2mg/dl; HCV positive; white blood cell count 3100/mm
3; platelet count 11×10
4/mm
3; plasma ammonia 130μ/dl; ICG15 47%. Although there are no abnormalities were found by electroencepharography, neurological examination revealed scanning speech and gait ataxia and other abnormalities. He had Child class A liver cirrhosis except such neurological symptoms. On 11/29/94 we performed ligaton of a portaI vein branch (P
3) and a partial gastrectomy and splenectomy. Portal vein pressure showed no change after the operation (16.5→16.4cmH
2O). Laboratory data were improved after the operation: plasma ammonia 31μg/dl; ICG 15 26%. Neurological symptoms were also improved significantly. Endoscopy has revealed no esophageal varices yet.
View full abstract
-
Nobuhiko Ueda, Ichiro Konishi, Yutaka Yoshimitsu, Nagayoshi Ohta, Naot ...
1996 Volume 29 Issue 8 Pages
1792-1796
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL
FREE ACCESS
A case of cholesterol hepatolithiasis with multiple cholesterin granulomas is reported. A 68-year-old man was operated on under the diagnosis of choledocholithiasis and hepatolithiasis limited to the lateral segment. Two of the choledocholiths were mixed stones. The mixed stones were compacted in the bile duct branches of B2 and B3 in the resected specimen of the lateral segment. Multiple small nodular lesions which were fused were seen in the parenchyma of the liver near the resected side. Pathologicaly, cholesterin crystals were found in the bile ducts containing stones, and cholesterin granulomas were found around the bile ducts. The small nodular lesions consisted of severe chronic inflammation with fibrosis containing multiple cholesterin crystals and cholesterin granulomas. The speculated etiology was that the lesions were formed as a result of repair of severe frequent cholangitis in the lateral segment due to the bile duct stones with the destructin of small bile ducts, scattering the cholesterin crystals in the bile juice. Severe dysplasia of the epithelium was also seen in part of the septal bile duct.
View full abstract
-
Hideyuki Ishida, Takeo Iwama, Kuniaki Kitago, Zenro Nihei, Yoshio Mish ...
1996 Volume 29 Issue 8 Pages
1797-1801
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL
FREE ACCESS
A rare case of juvenile adenomyomatosis of the gallbladder associated with congenital bile duct dilatation and anomalous pancreatico-biliary dilatation is reported. A 13-year-old girl complaining of epigastralgia was admitted and was diagnosed as having adenomyomatosis of the gallbladder, an anomalous pancreatico-biliary union, and cylindrical dilatation of the common bile duct with intrahepatic involvement, by abdominal echography and endoscopic retrograde cholangiopancreatography. She underwent cholecystectomy and resection of the extrahepatic bile duct with hepatico-jejunostomy. Histological examination of the removed gallbladder revealed proliferation of fibromuscular tissue and Rokitansky-Aschoff sinuses. Including this case, there are 5 cases of adenomyomatosis of the gallbladder associated with an anomalous pancreatico-biliary union in the Japanese literature. The age at diagnosis ranged from 13-35 years. The generalized type of adenomyomatosis and type IIa of anomalous pancreatico-biliary union according to Komi's new classification were characteristics common to all cases. Our case and one other were also associated with Todani's type IVa of congenital bile duct dilatation. From the analysis of the reported cases, it is suggested that one of the etiologies of juvenile adenomyomatosis of the gallbladder may be an anomalous pancreatico-biliary union.
View full abstract
-
Yuki Hirose, Takeo Tanaka, Hikoichirou Sirosaki, Toshio Matsushita, Hi ...
1996 Volume 29 Issue 8 Pages
1802-1806
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL
FREE ACCESS
A case of absence of the gallbladder and a review of 96 reports from the Japanese literature are reported. A 59-year-old man received laparotomy under the diagnosis of chronic cholecystitis and intrahepatic gallstones. At surgery a small lump which seemed to be a cystic duct and the dilated common bile duct were observed, but the gallbladder was not identified. Hepatectomy (S3) was performed for intrahepatic gallstones. Of the 73 reported cases in which complications were discussed, the common bile duct appeared to be normal in 24 cases (32.8%) and was dilated in 26 cases (35.6%). Twnety three cases also had choledocholithiasis with dilatation of the common bile duct. A significant difference in mean age was found between the group with the normal common bile duct and the group with dilatation or choledocholithiasis. In conclusion absence of the gallbladder makes the common bile ductdilate gradually, and some symptoms manifest with aging. 6 reports with the intrahepatic gallstone werefound including our case.
View full abstract
-
Testuji Yamada, Shingo Yagi, Shigeichi Fujioka, Kei Tsuchida, Yasuhiko ...
1996 Volume 29 Issue 8 Pages
1807-1811
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL
FREE ACCESS
Small cell carcinoma of the gallbladder is extremely uncommon and difficult to treat. We report two cases of this disease. Case 1: An 81-year-old man who underwent low unterior resection for rectal carcinoma in October 1991 was admitted in November 1993 because of gastric cancer. At the operation, a tumor of the gallbladder was also found. So gastrectomy with lymph node dissection and extended cholecytectomy were performed. Case 2: A 80-year-old woman was admitted in July 1993 because of acute peritonitis. At the emergency operation, a perforation and a tumor of the gallbladder were found. So cholecystectomy performed without lymph node dissection. Histological examination of the gallbladder in both cases revealed small cell carcinoma. Patinet 1 with triple cancers of the stomach, gallbladder and rectum is still alive, patient 2 died 2 months after the operation. Survival analysis of the 18 reported cases of this disease in Japan supported the efficacy of the combination therapy in comparison to surgery alone.
View full abstract
-
Tetsuya Abe, Haruhiko Chigira, Takehito Katoh, Yoshihisa Shibata, Shig ...
1996 Volume 29 Issue 8 Pages
1812-1815
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL
FREE ACCESS
A case of omental actinomycosis caused by perforation by a fishbone is reported. A 62-year-old woman was admitted complaining of an abdominal mass. A firm, fixed mass measuring 15 cm in diameter was palpated in the right lower quadrant of the abdomen. Barium enema study revealed serrated changes in the transverse colon. Computed tomography showed a nonhomogeneous mass adherent to the transverse colon. Laparotomy was performed under a diagnosis of omental tumor. An inflammatory tumor of the omentum involving the transverse colon and the stomach was removed by partial resection of the colon and the stomach. The resected specimen showed abscess formation around a fishbone, which was histologically diagnosed as actinomycosis. Six cases of abdominal actinomycosis caused by fishobones have been reported in Japan. In most of these cases, an abdominal mass was noted, and the fishbone was likely to perforate the lower intestinal tract. The correct preoperative definitive diagnosis was not made in any case. In conclusion, actinomycosis should be considered in the management of an abdominal mass of unknown origin.
View full abstract
-
Hirofumi Uchino, Ryo Sekiya, Masayoshi Nishitani, Junichi Shiiba, Yasu ...
1996 Volume 29 Issue 8 Pages
1816-1819
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL
FREE ACCESS
A case of idiopathic granulomatous appendicitis is reported. An 8-year-old girl complained of right lower quadrant pain two weeks before admission. She was admitted to our hospital with loss of appetite and high fever. Preoperative ultrasonographic examination revealed thickening of the appendiceal wall surrounded with a low echoic space. The patient was diagnosed with appendicitis with local abscess, and an appendectomy was performed. A small amount of turbid ascitic fluid was observed in the peritoneal cavity. The appendix was greatly swollen (7×3cm) with local abscess formation. The rest of gastrointestinal tract was normal in appearance. Histopathological examination showed multiple granulomas composed of epitheloid cells and multinucleated giant cells mainly in the submucosal layer of the resected tissue, suggesting idiopathic granulomatous appendicitis. The patient's clinical course was satisfactory and she was discharged on the 13th postoperative day.
View full abstract
-
Shun Kudoh, Hiroshi Kawamura, Yuko Suzuki, Masami Matsuzaki, Moriyuki ...
1996 Volume 29 Issue 8 Pages
1820-1824
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL
FREE ACCESS
A rare case of mucinous cystoadenocarcinoma of the appendix with pseudomyxoma, concomitant with gastric cancer is reported. A 61-year-old woman admitted to our hospital on January 11, 1995, with abdominal distension. She was diagnosed as having early gastric cancer with ascites of uncertain origin. At the operation, the abdominal cavity was found to be filled with approximately 500g of a mucinous and gelatinous fluid, and a ruptured mucinous appendiceal tumro was found. Gastrectomy and ileocecal resection with intra-peritoneal lavage by a large quantity of warm physiological saline were performed. Pathological examination revealed double cancers of gastric cancer and mucinous cystoadenocarcinoma of the appendix, associated with pseudomyxoma. The patient has no sign of recurrence at present, a year after the operation. To our knowledge, synchronous double cancers consisting of an appendiceal cancer associated with pseudomyxoma and a gastric cancer are extremely rare, and have not been previously reported in Japan.
View full abstract
-
Masanori Ozawa, Kohei Ochiai, Masahiro Fujita, Hiroshi Moriya, Hitoshi ...
1996 Volume 29 Issue 8 Pages
1825-1829
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL
FREE ACCESS
A very rare case of solitary adrenal metastasis from carcinoma of the colon is reported. A 46-year-old man underwent an emergency operation for acute peritonitis caused by perforation of a simple ulcer of the ileum. At the same time, cancer of the descending colon was detected and left hemicolectomy was performed. Ten months after the operation, a high serum CEA level was found and further examination revealed a right adrenal tumor. The tumor was easily resected and histologically showed moderately differentiated adenocarcinoma similar to that of the prior colon cancer. Thus the tumor was diagnosed as a solitary adrenal metastasis because of absence of recurrent foci. Six cases with resection of solitary adrenal metastasis from cancer of the colon and rectum are seen to this time in Japan. The almost patients were males and an increase of a tumor marker was useful for diagnosing cancer recurrence. It was suggested that the metastatic adrenal tumors developed expansively and that adrenalectomy was not only easy to performe, but also beneficial for prolonging survival time.
View full abstract
-
Nobuhiro Suehara, Yasuaki Aoki, Takayasu Itoh, Eishi Nagai, Hideki Kis ...
1996 Volume 29 Issue 8 Pages
1830-1834
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL
FREE ACCESS
We report on a 9-year-old boy with von Recklinghausen's disease who developed ahuge retroperitoneal tumor continuous with spinal tumors. He had a history of café-au-lait spots and multiple subcutaneous tumors on his entire body from birth. He was admitted to our hospital with complaints of anal prolapse and anal discomfort. A large lower abdominal tumor was detected by palpation. The tumor was diagnosed as a neurofibroma based on transrectal needle biopsy. CT scan and MRI demonstrated a large retroperitoneal tumor occupying the pelvic cavity. The tumor communicated with spinal tumors through the sacral canal, and extended to the dorsal space of the pancreas. First we excised the bilateral caudal spinal tumors. Laparotomy was performed secondarily. The tumor invaded to the urinary bladder and the colon along the nervous system and vessels. We resected the tumor together with the sigmoidal colon, but preserved the lower rectum and the urinary bladder at his parents' request. The notworthy feature of this case is the rarity of a huge retroperitoneal tumor in a child with von Recklinghausens disease. Except for two cases, similar cases have not been reported in the literature.
View full abstract
-
Seiki Matsuno
1996 Volume 29 Issue 8 Pages
1835-1839
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL
FREE ACCESS
The role of and indication for a surgical approach for acute and chronic pancreatitis are discussed in this paper. For patients with acute pancreatitis, a surgical approach is accepted in cases complicated by infected pancreatic necrosis, a pancreatic abscess and an acute pseudocyst. Some patient with necrotizing pancreatitis will become secondarily infected. The procedure of surgical intervention for infected pancreatic and peripancreatic necrosis is necrosectomy with sufficient drainagae such as closed lavage or open drainage. Pancreatic abscesses and infected pseudocysts require a different form of management than infected pancreatic necrosis. New surgical procedures have been introduced recently in the field of chronic pancreatitis. They are called Beger's procedure and Frey's procedure. There is a tendency to choose pancreatic function-preserving surgery for patients with chronic pancreatitis. Frey's procedure, longitudinal pancreatico-jejunostomy with coring out of the head of the pancreas, is preferable as a safer and more effective procedure for pain relief.
View full abstract
-
Toshihide Imaizumi
1996 Volume 29 Issue 8 Pages
1840-1845
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL
FREE ACCESS
We evaluated the effectiveness of minimal invasive surgery for pancreatic tumors treated in our institution. Minimal invasive surgery was intended to effectively preserve pancreatic and digestive functions with resection of entire tumors without recurrence. During the application of this procedure for pancreatic tumors with no lymph node metastasis, we carefully evaluated whether the tumors were restricted to within the pancreas or were resectable with a small amout of extrapancreatic tissue adjacent to the lesion. Pathological diagnosis indicated that pancreatic tumors treated with this method were mostly limited to flat type mucin-producing tumors. adenomas, insulinomas and solid cystic tumors. Intraductal papillary adenocarcinomas and carcinomas in situ were able to be treated with minimal invasive surgery, where the tumors had no extrapancretic invasion or metastasis. There are several options of surgical procedure for pancreatic tumors. partial pancreatectomy with preservation of the duodenum is sometimes indicated for tumors located in the pancreatic head. Minimal invasive surgery is also expected to be a useful option in the future.
View full abstract
-
Osamum Ishikawa
1996 Volume 29 Issue 8 Pages
1846-1850
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL
FREE ACCESS
Adenocarcinoma of the pancreas is commonly observed to spread into the peripancreatic connective tissues by microscopic examination, which may explain the high incidence of loco-regional recurrence after conventional pancreatectomy. Thus, using a wide range of lymphatic and connective tissue clearance (extended pancreatectomy), we have succeeded in both improving the long-term survival rate (5-yrsurvival rate=27%) and significantly decreasing loco-regional recurrence. In contrast to conventional pancreatectomy, long-term survivors were obtaiend even amongst patients with nodalinvolvement or invasion to the portal vein. However, for tumors of more than 4 cm in size, with nodal involvement in the n2-group and extensive invasion to the portal vein long-term survival was not expected. Most patients who had received this procedure took at least one year to fully recover. Thus, the present paper outlines the surgical techniques in extended pancreatectomy that we employ, and it is concluded that the careful selection of cases for this aggressive surgery is most important.
View full abstract
-
Masaaki Oka
1996 Volume 29 Issue 8 Pages
1851-1855
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL
FREE ACCESS
Multidisciplinary therapy for pancreatic cancer, including surgery, chemotherapy and radiotherapy, has been performed. However, the prognosis remains poor. Extended pancreatectomy frequently impairs the patient's quality of life due to malnutrition. We performed lymphatic and neural tissue dissection around the superior mesenteric artery, partially preserving the nerve plexus, for pancreatic cancer. This procedure decreased the frequency of diarrhea and prevented malnutrition after surgery. Intraoperative radiotherapy (IOR) improved the survival rate in patinets with curative resection. We performed adoptive immunotherapy (AIT) using lymphokine-activated killer (LAK) cells or cytotoxic T-cells (CTLs) in patients with unresectable pancreatic cancer. AIT using CTLs was more effective than AIT using LAK cells. This result suggests the efficacy of specific immunotherapy for pancreatic cancer. Recently, it has been reported that MUC1 specific CTL, which recognize the mucin core protein MUC1, killed pancreatic tumor cells in an MHC-unrestricted fashion. We also demonstrated that pancreatic tumor cells expressed MUC1 while normal pancreatic cells did not. We treated three patients with unresectable pancreatic cancer by AIT using MUC1 specific CTLs. One patient who received a total of 3×10
10 MUC1 specific CTLs showed neither tumor progression nor increases in levels of tumor markers, such as CA19-9, CA125 and Span-1, during therapy. These results suggest that AIT using MUC1 specific CTLs may be a useful therapy for patients with pancreatic cancer.
View full abstract