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Volume 30, Issue 12
Displaying 1-18 of 18 articles from this issue
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Katsuyuki Kunieda, Shigetoyo Saji, Yoshihiro Kawaguchi, Motohisa Katoh ...1997 Volume 30 Issue 12 Pages 2231-2238
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe studied the clinicopathological characteristics, cell proliferating activity and the formation of a basement membrane by immunohistochemical staining, using a proliferating cell nuclear antigen (PCNA) monoclonal antibody and an anti-laminin monoclonal antibody, in gastric cancer patients showing elevation of serum α-fetoprotein. The subjects were 16 patients consisting of 5 with stages Ia+Ib, 1 with stage II, 3 with stages flla+Ilfb and 7 with stages IVa+IVb. Eight patients (50%) showed type 2 of macroscopic type and 12 cancers were located in the distal part of the stomach. Poor medullary type was significantly predominant in the high AFP group. Six patients (37.5%) had synchronous liver metastases and 3 showed metachronous metastases. The frequency of liver metastasis in the high AFP group was significantly higher than in the low AFP group. The 5 year survival rate was 25.0%, and 2 patients with stage Ia and II died of liver metastasis. The rate of positive tissue AFP staining was 81.3%. The PCNA-labeling index in the high AFP group (63.9%) was significantly higher than in the low AFP group (44.1%). The rate of positive laminin staining in the high AFP group was significantly higher than that in the low AFP group. From the above results, it is sugested that the proliferative activity and frequency of formation of a basement membrane in gastric cancer patients with elevation of serum AFP are higher than those in AFP-negative gastric cancer patients. It is also suggested that these characteristics have some relationship with a high frequency of liver metastasis.View full abstractDownload PDF (14048K) -
Motoki Ninomiya, Toshiyuki Ikeda, Hikaru Asakura, Youki Moriyama, Tada ...1997 Volume 30 Issue 12 Pages 2239-2246
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe have applied a gastrectomy with preservation of both the autonomic nerves and the pylorus accompanied with D2 dissection for early gastric cancer located in the middle or lower thirds of the stomach. We performed this procedure for 41 cases between December 1993 and December 1995. There was no case of dumping syndrome, reflux esophagitis, anastomotic leakage, postoperative cholelithiasis or recurrence of cancer. Mortality was observed in no case. Thogh prolongation of gastric emptying was observed in more than half of cases and the symptom of gastric stasis was observed in 12 cases (29.3%), most of them were transient. X-ray and gastrointestinal fiberscopic examination revealed that pyloric function and peristalsis of antrum were kept well six mothes after operation. Furthermore, recovery of the body weight was superior three months after operation in this procedure group comparing conventional distal gastrectomy group. We conclude that this function preserving operation is a rational approach to mainining curability and the function of upper abdominal organs after gastrectomy.View full abstractDownload PDF (14676K) -
Kazuo Hatsuse, Hideki Aoki, Michinori Murayama, Tsukasa Aihara, Nozomi ...1997 Volume 30 Issue 12 Pages 2247-2252
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSSixty-seven patients underwent hepatic resection for hepatocellular carcinoma from 1985 to 1995. They were divided into 4 groups. The St group consisted of 41 patients with a solitary hepatocellular carcinoma; the BL group, of 12 patients with hepatocellular carcinoma, concomitant with early hepatocellular carcinoma of well-differentiated type or borderline lesions designated by the General Rules for the Clinical and Pathological Study of Primary Liver Cancer; the MO group, of 3 patients with multicentric occurrence; and the IM group, of 11 patients with intrahepatic metastases. Histopathological examination of the background liver revealed that the frequencies of liver cirrhosis in the BL group and the MO group were significantly higher than those in the IM group and the St group. Associated lesions were situated in the same segment in the IM group more frequently than in the BL and MO groups. Portal vein invasion was more marked in the IM group than in the other groups. Cumulative survival rates for the St group and the BL group were significantly better than for the IM group. But there were more recurrences within two years in the patients with invasion into the portal vein in the St group and the BL group. Cumulative 5-year disease-free survival rates of the St group were 45.8%. On the other hand all patients had recurred within 3 years in the BL group and within 2 years in the IM group. The above findings suggest that multicentric occurrence including borderline lesions tends to occur in patients with liver cirrhosis, and the prognosis after their resection is better than for intrahepatic metastasis, in spite of the high recurrence rates in the remnant liver.View full abstractDownload PDF (11399K) -
Shuichi Ishiyama, Akira Fuse, Hiroshi Kuzu, Kiyoshi Kawaguchi, Masaru ...1997 Volume 30 Issue 12 Pages 2253-2256
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSRational resection of the right dorsal liver for hepatic hilar bile duct carcinoma was proposed. While the importance of the caudate lobe has been recognized, the rational right resecting limit of the dorsal liver is still contraversial. In order to determine the rational limit, we examined 63 liver casts made of silicon rubber about the anatomy of the bile ducts of the hepatic hilus and the right dorsal liver. The distances from the junction of the hepatic ducts to the junction of the lateral bile ducts (B2 and B3), and of the posterior ones (B6 and B7) were 2.58 cm and 2.11cm, respectively. These distances are considered the bilateral resecting limits of the bile ducts in the generally performed radical operations for this disease. Most of the bile ducts (94.3%) from the paracaval portion of the caudate lobe flowed into the more duodenal or left side than into the junction of the B6 and B7. We found that there was liver parenchyma (dorso-lateral paracaval portion) fed by the portal branches originating from the posterior portal trunk in 59.3% of the cases and that 87.5% of the corresponding bile ducts flowed into the posterior bile duct trunk. From these findings, we believe that we have to resect the right side bile duct over the junction of the B6 and B7, and that we have to resect not only the caudate lobe but also the dorso-lateral paracaval portion when hepatectomy for hepatic hilar bile duct carcinoma is performed from the left side.View full abstractDownload PDF (8037K) -
Shun-ichi Shiozawa1997 Volume 30 Issue 12 Pages 2257-2264
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSSerial changes in bilirubin excretion kinetics in bile were examined during the process of biliary drainage for obstructive jaundice, and the relationship of its kinetics to jaundice-protracting factors, the duration of jaundice (2-week group, 6-week group) and biliary tract infection (infection group) was also investigated. Findings were compared in 3 groups in an experimental external biliary drainage model using adult mongrel dogs. In all 3 groups, daily bile bilirubin excretion (V-Bil) reached a maximum 2 to 3 days after biliary drainage was initiated and gradually decreased thereafter, then remained constant for 10 or more days after biliary drainage. However, daily bile bilirubin excretion in the 6-week group and the infection group were lower than in the 2-week group even during the initial stage of biliary drainage, and bilirubin excretion capacity didn't improve during the ovrall follow-up period (p<0.0001). V-Bil correlated with the rate of decrease of serum bilirubin (p=0.010). Bilirubin excretion capacity after biliary drainage was initiated may be governed by maximal bilirubin excretion capacity when the liver is exposed to maximal bilirubin load during the initial stage of biliary drainage (p =0.002). These findings suggest that V-Bil is a new index that may allow early prediction of the effects of external biliary drainage.View full abstractDownload PDF (14479K) -
Analysis of Nuclear DNA Content, MIB-1 Score and Expression of the p53 ProteinYasuo Yamada, Hidemi Yamauchi, Kenji Kakizaki1997 Volume 30 Issue 12 Pages 2265-2273
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIn order to evaluate prognostic factors in patients with carcinoma of the middle and lower bile duct, MIB-1/Ki-67-derived tumor proliferative activity, expression of p53 protein and nuclear DNA content together with clinicopathology were studied retrospectively. Cytophotometric DNA analysis was performed in 20 of 28 specimens. MIB-1 and p53 were measured by immunohistochemistry in all specimens by the avidin-biotin complex method. The MIB-1 score was defined as the percentage of MIB-1-positive cells. There were significant differences in survival between the stage IV and stage I-III groups, and between the patients with pancreatic infiltration and those without it (p<0.05). When the cut-off point of the mean DNA content was set at 5c, the patients with mean DNA content over 5c had a significant survival disadvantage compared with those below 5c (p<0.05). The patients with MIB-1 scores below 10% had a significant survival advantage compared with those over 10% (p<0.01). The survival was not affected by expression of p53 protein. Histological factors and stage did not correlate with mean DNA content, MIB-1 score or expression of p53. A significant linear correlation was observed between mean DNA content and MIB-1 score. These results suggest that the mean DNA content and MIB-1 score may be significant prognostic factors independent of histological factors and that expression of p53 protein does not affect the clinical outcome in patients with carcinoma of the middle and lower bile duct.View full abstractDownload PDF (16407K) -
Yuji Honda, Hiroshi Iino, Yoshiaki Miyasaka, Takayoshi Sekikawa, Yoshi ...1997 Volume 30 Issue 12 Pages 2274-2281
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe purpose of this study was to investigate the influence of the coexistence of advanced colorectal carcinoma on cell proliferation and changes in oncogene expression in the epitherial cells of colorectal polyps. We examined relationship between the degree of cell differentiation of the polyps and the labeling indices of proliferating cell nuclear antigen (PCNA L.I.) and expression of p53 protein in 57 colorectal polyps and normal mucosas from 32 patients with advanced colorectal carcinoma (ACC) obtained by surgical procedure or endoscopic polypectomy. Material used for control study including 49 colorectal polyps from 35 patient without ACC and 7 normal mucosas from 7 patients without any colon tumor. PCNA L.I. expression was closedly correlated with the degree of epithelial cell differentiation of the polyps in the both groups. The PCNA L.I. levels of expression in patients with ACC were higher than those of patients without ACC except in cases of normal mucosa or the carcinomas had invaded to the submucosal layer. Moreover, positive cell rates of the polyps also correlated closedly with the degree of epithelial cell differentiation of the polyps. Consequently it was suggested that the epithelial cells of the polyps with ACC had higher proliferation livels and more frequent changes of oncogene expression than those of polyps without ACC.View full abstractDownload PDF (14355K) -
Naoto Kurihara, Hisashi Shinohara, Hajime Yonekawa, Takao Machimura, T ...1997 Volume 30 Issue 12 Pages 2282-2286
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 42-year-old woman who had a sigmoidectomy for sigmoid colon carcinoma in 1983 and right hemicolectomy for ascending colon carcinoma in 1989 was admitted with a chief complaint of epigastric discomfort in 1995. She was diagnosed by endoscopy as having two advanced gastric carcinomas. Total gastrectomy with splenectomy and Roux-en Y reconstruction was performed on September 28, 1995. Two lesions of type 3 advanced gastric carcinoma on the anterior and posterior walls of the body, and five lesions of type 0-IIa early gastric carcinoma on the antrum and body were observed independently. The two lesions of type 3 advanced gastric carcinoma were histologically diagnosed as moderately differentiated adenocarcinoma invading the subserosal layer. Three of the five lesions of type 0-IIa early gastric carcinoma were diagnosed as well-differentiated adenocarcinoma invading the mucosal layer and the other two were diagnosed as well-differentiated adenocarcinoma invading submucosal layer, respectively. These lesions of gastric carcinoma were stained positively by immunohistochemical staining for p53 and Ki-67, and were negative for c-erbB-2 and bcl-2. Chronic gastritis with intestinal metaplasia was observed, which was positive for Helicobacter pylori infection. It is important that we establish a high risk group by finding out factors, which may predict future occurrence of multiple cancers.View full abstractDownload PDF (9791K) -
Yoshimitsu Kojima, Masato Fujisaki, Tetsuaki Kameyama, Shinobu Hirahat ...1997 Volume 30 Issue 12 Pages 2287-2291
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 25-year-old man complaining of emesis and anemia was referred to our hospital on suspicion of pyloric stenosis. Endoscopic examination revealed the stenosis of the pylorus, but the endoscope passed through it without difficulty. A retroperitoneal tumor was suspected based on the abdominal CT scan findings, a definite diagnosis was impossible and while undergoing other examinations, the patient unexpectedly developed acute profuse melena. Angiography revealed no significant source of bleeding, and his anemia progressed. Finally, exploratory laparotomy was performed. A polypoid tumor with a maximum diameter of 5 cm was found to arise from the posterior aspect of the first portion of the duodenum to distal to the ligament of Treitz and causing retrograde jejunoduodenal intussusception with the proximal jejunum into the third portion of the duodenum. The source of the hemorrhage was the leading tumor and the tumor was histologically diagnosed as a Brunner's gland hamartoma. Anatomically the intussusception of the duodenum is quite rare. Classification of duodenal intussusception, the mechanism of it and the X-ray findings were discussed.View full abstractDownload PDF (10438K) -
Miwa Churiki, Iwao Ikai, Masayuki Yamamoto, Toshio Matsushita, Masato ...1997 Volume 30 Issue 12 Pages 2292-2296
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe report a 17-year-old male patient with hepatocellular carcinoma (HCC) without hepatitis. His first complaint was severe epigastralgia which suggested tumor rupture. CT and US revealed multiple tumors in both lobes of the liver. But emergency selective angiography did not reveal extravasation, and transcsatheter arterial chemoembolization was performed. With no particular findings in the upper and lower gastrointestinal tract, he was diagnosed as having primary liver cancer. He had neither hepatitis B or C virus related antigens nor antibodie. One year after the onset, he was referred to our hospital and underwent a left trisegmentectomy of the liver. He is doing well without recurrence 19 months after surgery. This is a rare case of juvenile HCC without a past history of viral hepatitis.View full abstractDownload PDF (8953K) -
Kazuhisa Shitoh, Noriyuki Endoh, Tomoo Shirakura, Youji Yoshida1997 Volume 30 Issue 12 Pages 2297-2301
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe encountered a patient with a spontaneous cholecystocutaneous fistula associated with carcinoma of the gallbladder. The patient, a 94-year-old man, who had had a cerebral infarction and chronic subdural hematoma and cholecystitis, was referred to our hospital for a tumor-forming skin fistula in the right hypochodrium. a gree-brownish discharge through this fistula resembled biliary juice, but fistulography did not reveal communication with the biliary tract. The cytological diagnosis of this discharge was class II. The patient received resection of the fistula and drainage because of his age. But after this operation the borwnish exudation did not cease, and repeated fistulography revealed communication between the skin and the gallbladder. Therefore cholecystectomy and fistulectomy were performed as the second operation. The postoperative pathological analysis revealed adenocarcinoma on the site between the cystic duct and the neck of the gallbladder, although it was not seen in the gallbladder base communicating with the fistula. We thought that in this case cholecystitis with obstruction in the cystic duct caused the perforation in the gallbladder based and the penetration into the abdominal wall. In patients with a past history of biliary tract problems, spontaneous cholecystocutaneous fistula should be considered if a tumor-forming fistula is encountered in the right hypochondrium, and also chlecystocholedocholithiasis and carcinoma of the gallbladder should be considered.View full abstractDownload PDF (8805K) -
Kenichi Sakamoto, Takahiko Fukuchi, Naoki Futamura, Kuniyasu Shimokawa1997 Volume 30 Issue 12 Pages 2302-2306
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe report a case of endocrine cell carcinoma (ECC) arising in the appendix diagnosed as recurrence following appendectomy. The patient was a 65-year-old man who received an appendectomy and had been diagnosed as having carcinoid of the appendix located in the central region of the appendix 6 years earlier. He was admitted to the hospital complaining of right lower abdominal pain, nausea and vomiting. He was diagnosed as having recurrence of the carcinoid arising in the appendix or a small intestine tumor and an operation was performed. The tumor was found to have infiltrated the submucosal layer of the ascending colon, cecum and terminal ileum. Tumor cells showed cellular and structural atypia to a high-degree and positivity for Grimelius' stain. Defining this case as a recurrence was considered adequate from reexamination of specimens from the previous appendectomy. It was suggested that keeping in mind the existence of a group of patients having a poor prognosis is significant in the diagnosis and treatment of carcinoid arising in the appendix.View full abstractDownload PDF (8951K) -
Yoshiyuki Ishii, Masahiko Watanabe, Seiichirou Yamamoto, Youhei Chiba, ...1997 Volume 30 Issue 12 Pages 2307-2311
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe report a case of ileus due to extended venous thrombosis in a patient with congenital antithrombin III deficiency who was treated by open surgery and medication. On January 2, 1995, a 38-year-old man was diagnosed at another hospital as having an acute abdomen. A partial resection of the jejunum was performed because of necrosis of the small intestine due to idiopathic mesenteric venous thrombosis. After his discharge, the patient was readmitted to a closer hospital with the complaint of vomiting and was diagnosed as having ileus. He was transferred to our hospital on March 20, 1995, after conservative therapy for ileus was ineffective and a thrombus of the portal vein was detected. Through our examinations, congenital antithrombin III deficiency was diagnosed and a mechanical stenosis of the small intestine was detected. Surgical treatment for ileus was performed on May 10, 1995. Venous thrombosis was not induced during this postoperative course. This case of congenital antithrombin III deficiency is significant in that venous thrombosis was not induced during the postoperative course, despite the administration of antithrombin III, heparin and warfarin.View full abstractDownload PDF (9817K) -
Eiji Meguro, Yoshiyuki Tamasawa, Yusuke Kimura, Hidenobu Kawamura, Sho ...1997 Volume 30 Issue 12 Pages 2312-2316
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSMalignant tumors originating in the large intestine, excluding the anus and lower rectum, are mostly adenocarcinoma, and tumors with squamous cell components are rare. We encountered a male with primary squamous cell carcinoma in the ascending colon. After thorough examination this 60-year-old male with abdominal pain was diagnosed as having a tumor in the ascending colonaccompained by liver metastasis. Palliative resection by right hemicolectomy was performed. Histopathological examinations showed the absence of tubular structures and demonstrated poorly differentiatedsquamous cell car-cinoma. To our knowledge, only 40 cases of primary squamous cell carcinoma of the colon have been reported since the first report by Schimidtmann (1919). Squamous cell carcinomaof the colon had a poorer prognosis than adenocarcinoma of the colon, and only slight treatment efficacy can be expected. No other lesions that appeared to be primary were observed during the patient'scourse, suggesting that this was a case of primary squamous cell carcinoma in the colon.View full abstractDownload PDF (9963K) -
Yasuji Takao, Tetsuo Futami, Sakae Miyake, Nozomi Kawasato, Shuhei Ota1997 Volume 30 Issue 12 Pages 2317-2321
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe patient was a 47-year-old man who underwent reconstruction of the urinarybladder following low anterior resection and subtotal cystectomy for rectosigmoid cancer in May, 1990. The tumor was firmly adhering to the ileum nd the bladder. It could be resected en bloc with a part of the ileum and the urinary bladder wall, preserving the bladder neck. The histopathological findings showed that the tumor was well differentiated adenocarcinoma with se, n1, ly1, v0, ow (-), aw (-) and ew (-). Reconstruction of the bladder was performed by ileocecal cystoplasty, accompanied by anastomosis of the cecum to the bladder neck and the ileum to the ureters by the submucosal tunnel procedure, and it led to voluntary urination. The volume of the reconstructed bladder is 260 ml, the residual urine volume is 0 ml and he urinates 4 or 5 times a day at present, 6 years after the operation. Hydronephrosis, urinary tract infection, incontinence in the daytime, and recurrence have not occurred. Cases of total cystectomy preserving voiding function for invasion of colorectal cancer to the bladder have rarely been reported, but we believe this procedure is of great benefit for improving the quality of life of the patients after pelvic exenteration.View full abstractDownload PDF (9231K) -
Naotaka Kadoya, Ryouhei Izumi, Hisashi Hirosawa, Seiichi Yamamoto, Wat ...1997 Volume 30 Issue 12 Pages 2322-2326
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA case of rectal cancer with synchronous multiple liver metastases treated by surgical resection of the primary lesion and the liver metastases after transcatheter arterial embolization (TAE) therapy is described. The patient was a 59-year-old woman. Low anterior resection and TAE forliver metastases of segments 2-3, 6, 7, 8 were performed. Liver metastases were diminished, showing a partial response after the first TAE treatment. The serum carcinoembryonic antigen level was down from 61.6 ng/ml to 2.5 ng/ml. Anticancer drugs Farmorubicin, CDDP and MMC were used for the TAE therapy. Hypervascularity of the liver metastases was not detected by angiography, but computed tomography during the hepatic arterial angiography showed fine vascularity in the tumor. The liver metastases were well controlled by three additional TAE treatments. Finally we resected the liver metastases 19 months after the operation on the primary lesion, and the patient is doing well 39 months afterthe first operation.View full abstractDownload PDF (10748K) -
Akira Fuse, Ichiro Hirai, Hiroshi Kuzu, Shuichi Ishiyama, Masahiro Ura ...1997 Volume 30 Issue 12 Pages 2327-2331
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSGallbladder ablation by injection of hot contrast medium was attempted in three patients.Surgical cholecystectomy was considered a less desirable option because of unresectable malignant tumors (2 case) and the patient's poor health (1 case).To prevent further episodes of cholecystitis and because of the patient's desire not to have an external drainage catheter, thermal ablation of the gallbladder was planned.After the skin and deeper tissue around the catheter and gallbladder mucosa anesthetized with lidocaine, boiling contrast medium was injected one or two times into the gallbladder for 30 sec-2 min. Thermal alblation was performed again by the same protocol in one patient.None of the patients experienced severe pain during the procedure or complications after procedure.The drainage tubes could be removed after thermal ablation in two patients.No demonstrable gallbladder lumen was seen in one patient. Gallbladder ablation with boiling contrast medium may offer a simple, safe, and effective alternative to surgical cholecystectomy in selected patients.View full abstractDownload PDF (9197K) -
[in Japanese]1997 Volume 30 Issue 12 Pages 2357
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSDownload PDF (2031K)
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