All issues
Volume 52 (2019)
- Issue 12 Pages 695-
- Issue 11 Pages 611-
- Issue 10 Pages 551-
- Issue 9 Pages 485-
- Issue 8 Pages 405-
- Issue 7 Pages 345-
- Issue 6 Pages 281-
- Issue 5 Pages 239-
- Issue 4 Pages 191-
- Issue 3 Pages 137-
- Issue 2 Pages 83-
- Issue 1 Pages 1-
- Issue Special_Issue P･･･
- Issue Supplement2 Pag･･･
- Issue Supplement1 Pag･･･
Volume 30, Issue 4
Displaying 1-29 of 29 articles from this issue
- |<
- <
- 1
- >
- >|
-
A Study of the Inhibitory Effect of the Grafted Skin ContractionMotoko Saito, Takashi Sakamoto, Masao Fujimaki, Motohiro Nozaki1997 Volume 30 Issue 4 Pages 809-814
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSReconstruction after resection of the esophagus requires the use of digestive organs such as stomach, jejunum or colon. To avoid this sacrifice of the GI tract, many attempts to create an artificial esophagus have been reported. However, anastomotic leakage and stenosis remain major problems. To overcome these problems, we developed a new type of artificial esophagus using an artificial dermis (AD), a lattisimus dorsi muscle flap and a split-thickness skin graft (STSG) in rabbits (AD group). In this study, the effect of AD in preventing contraction was examined, by comparing the AD group with an STSG only group (STSG group). In the AD group, histological examination revealed a thick pseudodermis between the STSG and the muscle, which was similar to a full-thickness skin. The reconstruction rates in the AD group and STSG group were 43.4±4.1% and 61.0±10.2% respectively. The regular arrangement of collagen fibers in the pseudodermis inhibited contraction of the grafted skin. These findings suggest that the AD may be useful in creating a more suitable hybrid artificial esophagus.View full abstractDownload PDF (11246K) -
Chikara Kusano, Masamichi Baba, Sonshin Takao, Souji Sane, Mario Shima ...1997 Volume 30 Issue 4 Pages 815-822
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe aim of this study was to assess the impact of oxygen transport variables on the outcome in 133 patients who underwent esophagectomy via a right thoracotomy and laparotomy for esophageal carcinoma. These patients were divided into two groups; The first group, 94 patients, had esophagectomy during the period 1991-July 1994, and the second groups, 39 patients, underwent the same operation during the period August, 1994-Feruary, 1996. In the first group, oxygen delivery at 6 hours after surgery in the patients with either an anastomotic leakage or respiratory failure was significantly lower than for those patients without complications. However, oxygen delivery in both groups did not differ significantly after the 1st postoperative day. In the second group, we increased oxygen delivery by using dobutamine and blood transfusion to more than 600 ml/min/m2 during the period up to 12 hours after surgery. The results in the second group indicate significant reduction of morbidity and mortality when compared with the first group. In particular, anastomotic leakage (28.7% to 10.3%), respiratory failure (19.1 to 5.1%), and hospital death (8.5 to 0%) were significantly reduced. These results suggest that oxygen delivery at 6 hours after esophagectomy would be the decisive factor for postoperative complications. Furthermore, it is considered that an increase in oxygen delivery during the initial 12 hours after surgery reduces morbidity and mortality.View full abstractDownload PDF (14397K) -
Suefumi Aosasa, Satoshi Ono, Takashi Ichikura, Hoshio Hiraide, Hidetak ...1997 Volume 30 Issue 4 Pages 823-829
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe purpose of this study is to investigate the effect of a perioperative administration of protease inhibitor in reducing surgical stress. The effectivensss was examined from the viewpoint of the systemic inflammatory response syndrome (SIRS) and plasma cytokine levels. The patients who underwent esophageal resection were divided into two groups: (1) gabexate mesilate was administered immediately post-operatively: (2) administration of the same drug was started pre-operatively and administered through and after the operation (peri-operatively) and administered through and after the operation (peri-operatively). The peri-operative group showed lower heart rate, and recovered from SIRS earlier than the post-operative group. Plasma interleukin-6 levels, interleukin-8 levels, and serum C-reactive protein levels were lower in the peri-operative group than in the post-operative group. The results indicate the reduction of surgical stress by peri-operative gabexate mesilate administration.View full abstractDownload PDF (12844K) -
Yoshihisa Koyama1997 Volume 30 Issue 4 Pages 830-837
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThis study was performed to investigate the effective route of administration of Adriamycin (ADR) combining with ADR solution or lipiodol to hepatic VX-2 tumor in the Japanese white rabbit and after intraarterial and intraportal infusion of ADR, the concentrations in the tumor, various organs and blood levels were measured. The intraarterial administration was resulted in significantly greater tumor uptake of ADR. The phamacological efficasy uptake of ADR in the three kinds of intrarterial infusion was compared among the following three groups: Group 1, administration of ADR aqueous solution alone, Group 2, administration of ADR aqueous solution between lipiodol injections (sandwich group), Group 3, ADR suspended in lipiodol (Lip-Uro-ADR group). ADR concentrations of the blood, the tumor and the organs were evaluated among the three groups. The ADR level of the tumor was significantly (p<0.01, p<0.02) higher in Group 3 than in the other groups. But, no significant difference was seen in the ADR levels of each organ among the three groups. These results suggest that the intraarterial infusion of ADR into a hepatic tumor may be the most the effective route and that a lipiodol-urografin ADR emulsion may enhance the therapuetic effects by increasing ADR uptake by the liver tumor.View full abstractDownload PDF (15080K) -
Fumichika Kitamura, Shigetoyo Saji, Daizo Fukada, Kiichi Miya, Katsuyu ...1997 Volume 30 Issue 4 Pages 838-845
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSFor the purpose of prediction of metachronous liver metastasis on curatively resected colorectal cancer, immunohistochemical expression of p53, c-erbB-2, CD44, nm23 and proliferating cell nuclear antigen labeling index (PCNA LI) was compared between 33 cases with metachronous liver metastasis (metachronous group) and 66 cases without liver metastasis (control group). Control group was frequency (1: 2) matched with metachronous group for tumor location, depth of invasion, and histological typing. PCNA LI (p=0.0070), CD44 positive late (p=0.0033) and nm23 negative late (p=0.0227) of metachronous group were significantly higher than those of control group. Receiver operating characteristic (ROC) curve of PCNA LI indicated that the most compatible cut off value for liver metastasis was 60. On the other hand, expression of p53 or c-erbB-2 showed no correlations with metastasis. On metachronous group, CD44 positive cases had significantly shorter disease free intervals (DFI) than negative cases (p=0.0128), and nm23 negative cases had relatively shorter DFI than positive cases (p=0.0737). Cumulative survival of CD44 positive cases was relatively lower (p=0.0636) than that of negative cases. PCNA LI≥60 cases had the highest positive predictive value (PV-pos) on one test (0.23), and PCNA LI≥60 and nm23 negative cases showed the highest one on two tests (0.62) for liver metastasis. From above results it is suggested that immunohistochemical expression of CD44, nm23 and PCNA LI is useful for prediction of metachronous liver metastasis on curatively resected colorectal cancer.View full abstractDownload PDF (16528K) -
Kimihiko Funahashi, Kazunori Tsujita, Toshitsugu Miki, Junichi Koike, ...1997 Volume 30 Issue 4 Pages 846-852
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe determined the histological type and Ki-67 labeling index (Ki-67 LI) in the infiltrated region of 56 colorectal cancers (Dukes A: 9 cases, B: 15 cases, C: 18 cases, D: 14 cases). The results were as follows: 1) Histological heterogeneity was shown in 33.9%, and the histological type changed to a lower grade in the deepest region of the tumor. 2) The tumor with a lower grade of histological type or with mucin was postulated to be more malignant in view of the proliferating activity of the tumor cells. 3) The rate of proliferation of a tumor with regional lymph-node metastasis or with vessel invasion was higher than that of a tumor without them. Therefore, we believe that determination of the grade of the histological type and proliferating activity in the infiltrated region is important, when we determine the grade of malignacy of colorectal cancer.View full abstractDownload PDF (9954K) -
Hisanori Shiomi, Tohru Tani, Yoshihiro Endo, Kaoru Endo, Tohru Shirais ...1997 Volume 30 Issue 4 Pages 853-857
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSGlutamine (Gin) is the preferred fuel by enterocytes and so on and this has been documented in a number of animal studies. But plasma Gln levels under surgical stress have not been confirmed in man. Plasma Gln levels of 39 patients who underwent gastroenterological surgery and 12 patients during fasting were measured. The change rate of plasma Gln levels was negative after surgical stress. It was lowest at post-operative-day 1 and nearly 0%/day at post operative-day 4. Total parenteral nutrition (TPN) tends to suppress the decline in plasma Gln levels, but there was no way to raise plasma Gln levers except by food intake. Moreover, plasma Gin levels decline further after 2 weeks of surgical stress or fasting under TPN. In these circumstances, 3 or 4 days are necessary to e equal Gln consumption and Gln supply from muscle. For muscle Gln lakc the supply does not catch up with Gln consumption after 2 weeks of fasting, and Gln supplementation is indicated.View full abstractDownload PDF (9194K) -
Nozomi Idota, Kazuo Hatsuse, Akifumi Watanabe, Yasuhiro Ohbuchi, Hidek ...1997 Volume 30 Issue 4 Pages 858-862
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe report a case of adult right-sided Bochdalek hernia with concomitant perforation of a duodenal ulcer. A 64-year-old female was admitted to our hospital, complaining of sudden upper abdominal pain. Chest X-ray showed pneumothorax and elevation of the diaphragm in the right chest, and abdominal free air under the left diaphragm. Emergency surgery revealed perforation of a duodenal ulcer, and bowel herniation from the ileal terminus to the transverse colon through the dorsolateral defect of the right diaphragm. The defect was 8 × 5 cm in size and no hernia sac was detected. The duodenal ulcer perforation site was packed with major omentum. The diaphragm defect was closed with double interrupted sutures. This is apparently the 110th case of adult Bochdalek hernia having been reported in Japan. Adult right-sided Bochdalek hernia is very rare and only 5 cases, including ours, have been reported in Japan.View full abstractDownload PDF (9537K) -
Tetsu Shiraishi, Nobuhiro Kawamura, Toru Yamaoka, Ken Kondo, Tsuyoshi ...1997 Volume 30 Issue 4 Pages 863-866
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSLocal hepatic tuberculosis, of nodular form, is extremely rare. A 48-year-old man presented with fever and right hypochondralgia. Based on the results of laboratory studies, ultrasonography, computed tomography and angiography, we suspected a malignant tumor of the right hepatic lobe. To make a definitive diagnosis, percutaneous liver needle biopsy was performed. An epithelioid granuloma surrounding caseous necrosis, compatible with tuberculoma, was revealed. After 6 months of antituberculous therapy, the hepatic lesion had disappeared completely on the imaging studies. This diagnosis is quite often missed as tuberculomas mimic hepatic malignant tumors. In most of cases, the definitive diagnosis can ultimately be comfirmed by histological and bacteriological study of the resected specimen, and in only a few cases in the literature, has the correct diagnosis been made by histological examination of a percutaneous liver needle biopsy.View full abstractDownload PDF (7432K) -
Fumihiro Uchikoshi, Noriyuki Ito, Kaori Matsumoto, Yasuaki Fukumoto, W ...1997 Volume 30 Issue 4 Pages 867-871
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSObstructive jaundice due to a benign, nonparasitic liver cyst is rare. We report a case of obstructive jaundice due to a large liver cyst, which was successfully treated by laparoscopic dome resection. A 75-year-old man complaining of general fatigue was admitted for investigation. He was found to have jaundice, and further examination revealed that a large liver cyst which was compressing the bi-lateral hepatic ducts at the hilum was the cause. To relieve the jaundice and improve the hepatic functions, percutaneous, trans-hepatic drainage of the cyst was carried out before laparoscopic dome resection. On day 7, he was discharged with no symptoms or complications and continues in good condition. As laparoscopic dome resection is a less invasive procedure than ethanol injection therapy, it reduces the postoperative hospital stay, and allows an earlier return to normal activity. We propose, therefore, that this procedure should be the first choice for treatment of a symptomatic liver cyst.View full abstractDownload PDF (8281K) -
Koichi Nakagawa, Takahito Yagi, Nobutomo Moriya, Shinya Ohe, Masaaki H ...1997 Volume 30 Issue 4 Pages 872-876
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 13-year-old boy was admitted to our hospital complaining of right lower quadrant pain. Barium enema and total colonoscopy discloseed a type 2'tumor in the caecum, which was histopathologically a Burkitt's lymphoma by biopsy. Computed tomography (CT), ultrasonography and 67Ga-scintigraphy demonstrated regional lymph node involvement. A right hemicolectomy with D3+α lymph node dissection was performed. Histologically the tumor had a “starry sky” pattern, and immunophenotypical analysis showed that the neoplastic cells were CD10 antigen positive and CD21 antigen negative, suggesting of early B cell origin. Both immunoglobulin heavy chain and c-myc oncogene were found to be rearranged by southern blot analysis. On post-operative day 14, combined systemic chemotherapy (modified Japan Leukemia Study Group ALL-93 protocol) and intrathecal injection of MTX and Ara-C were given. There has been no sign of recurrence, as of 12 months after the surgery. The outcome of intestinal Burkitt's lymphoma is poor, because of frequency of a leukemic change or CNS relapse. Nonetheless, it was suggested that aggressive debulking of the tumor include an extensive resection of the lymphnodes (over D3) and that intensive adjuvant chemotherapy may provide better prognosis in therapy to limit intestinal Burkitt's lymphoma.View full abstractDownload PDF (8718K) -
Shingo Iwata, Toshimi Yasunaga, Rei Takahashi, Yoshio Yamaoka1997 Volume 30 Issue 4 Pages 877-880
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSLeiomyoblastomas are rare smooth muscle tumors occurring most commonly in the stomach of adults. We report an unusual occurrence of leiomyoblastoma causing an inguinal hernia. A 45-year-old woman underwent repair of a left inguinal hernia. The excised hernia sac contained a tumor with a smooth surface originating from the round ligament of the uterus. Histological diagnosis of the resected tumor was leiomyoblastoma. Leiomyoblastoma arising from the round ligament of the uterus, which appeared as an inguinal hernia, has not been reported.View full abstractDownload PDF (6768K) -
Naoki Nishiwaki, Makoto Kataoka, Yoshiyuki Kuwabara, Hiroyuki Kawamura ...1997 Volume 30 Issue 4 Pages 881-885
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSAmyloidosis is a metabolic disease characterized by the extracellular deposition of amyloid protein which causes widespread damage to the gastrointestinal tract. Emergency surgery for amyloidosis is rare, with only 18 reported cases. We report two such cases. In case 1 the patient was a 53-year-old male with a history of rheumatoid arthritis. An emergency operation was carried out for general peritonitis due to intestinal perfortion. In case 2 the patient was a 72-year-old male, also with a history of rheumatoid arthritis. An emergencyoperation was carried out for ileus. Amyloidosis is a systemic disease. At the operation for amyloidosis, damage to the heart, kidney and liver was found to cause a high mortality rate. According to a statistical study of fatal cases of rheumatoid arthritis, gastric ulcers hare recently decreased but amyloidosis is increasing to become the third cause of death. These two cases showed that establishment of therapy for amyloidosis was necessary.View full abstractDownload PDF (8872K) -
Clinical Study of CD44 Variant mRNA Expression in Gastric CancerKeigo Yamamichi, Yoshihiko Uehara, Tsunehide Osawa, Tokio Okusa, Kanji ...1997 Volume 30 Issue 4 Pages 886-890
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSCD44 is a cell surface adhesion molecule involved in cell-cell and cell-matrix interactions. CD44 exists in a standard form and in multiple isoforms, each generated by alternative splicing of up to 10 variant exons (termed v1-v10) encoding parts of the extracellular domain. Expressions of CD44 and its variants are associated with cancer progression and metastasis. We examined the expression of CD44 containing a segment encoded by variant exon 6 (CD44v6) mRNA in 73 cases of gastric cancer using molecular biological examination of surgical specimens. The level of CD44v6 mRNA expression was significantly higher in patients with lymph node metastasis and liver metastasis. In 48 curatively resected patients, the level of CD44v6 mRNA expression significantly correlated with recurrence. Furthermore, there was a significant survival advantage in patients iwth a low level of CD44v6 mRNA expression as compared to those with high expression. We also examined the level of CD44v6 mRNA expression in endoscopic biopsy specimens from 25 cases of gastric cancer. The expression of CD44v6 mRNA in biopsy specimens was similar to that in surgical specimens from the same patient. These results suggest that the level of CD446v mRNA expression is a potential prognostic indicator and may be useful as a preoperative predictor of distant metastasis and recurrence in patients with gastric cancer.View full abstractDownload PDF (9021K) -
Shoji Nakamori, Masao Kameyama, Shingi Imaoka, Takushi Yasuda, Toshiyu ...1997 Volume 30 Issue 4 Pages 891-896
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe investigated the possibility of genetically detecting the rare colorectal cancer cells in blood and lymph nodes histologically negative for metastasis. Using an RT-PCR assay system for the detection of rare circulating colorectal cancer cells, employing cytokeratin (CK) mRNA expression as a marker, four of 22 samples were found to be positive for CK. One stage II patient and three stage IV patients were positive for CK in drainage-vein blood. One of the three stage IV patients was positive for CK in both drainage-vein and peripheral blood. None of the d22 samples examined were immunocytologically negative for anti-CK antibody. We also screened 109 colorectal cancers from patients without histologically detectable lymph node metastasis for mutations of the K-ras or p53 oncogene and identified 44 tumors as being positive for one of the two mutations. Among the 44 patients with mutation positive tumors, 20 had the same mutation in lymph nodes as in the primary tumors. Furthermore, among the 20 patients with genetically positive lymph nodes, 13 had recurrences within 5 years after surgery, while none of the patients with genetically negative lymph nodes developed recurrence. These data indicate that the rare colorectal cancer cells in blood or lymph nodes, histologically negative for metastasis, are geneticaly detectable. This genetic detection system may be clinically applicable for stratifying patients who are at high versus low risk for recurrence.View full abstractDownload PDF (11702K) -
Naoko Hayashi, Hiroshi Egami, Sadamu Takano, Michio Ogawa, Shoji Nakam ...1997 Volume 30 Issue 4 Pages 897-900
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe mutant-allele-specific amplification (MASA) method is capable of detecting one tumor cell containing genetic changes in a sample containing 10, 000 normal cells. We screened 120 colorectal cancers from patients who had no histologically detectable lymph-node metastasis at the time of operation for K-ras and p53 mutations, and examined corresponding regional lymph nodes at the genetic level by the MASA method. Somatic mutations were identified in 71 tumors; 27 of 37 patients with genetically positive lymph nodes had a tumor recurrence within 5 years of surgery; none of 34 patients without genetically confirmed lymph node metastasis had a recurrence. Thus, we found that tumor cells in lymph nodes identified by this genetic method had prognostic significance. We also analyzed DNA samples from pancreatic juice for the K-ras mutation, to diagnose pancreatic cancer in the early stage. K-ras mutations in pancreatic juice were detected in 4 of 5 (80%) with pancreatic cancer. Hence, clinical application of the MASA method may be useful for determining the prognosis of cancer patients and for detecting cancer in the early stage.View full abstractDownload PDF (7753K) -
Masazumi Takahashi, Hiroyuki Yamaoka, Yasushi Ichikawa, Shinji Togo, H ...1997 Volume 30 Issue 4 Pages 901-905
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSImmune responses to ras oncogenic proteins were studied in pancreatic and colon cancer patients. Positive rates for serum anti-rasantibody were significantly higher in patients with pancreatic cancer (80%, 4/5, p<0.05) and colon cancer (40%, 51/150, p<0.01) as compared to normal donors (5%, 2/40). The anti-rasantibodies recognized normal or mutated segments of p21rasprotein, and 73% of colon cancer patients had antibodies to the carboxyl terminus of p21 ras protein. T lymphocyte detection rates for specific ras peptides were significantly higher in patients with pancreatic cancer (40%, 6/15, p<0.01) and colon cancer (24%, 6/25, p<0.01) as compared to normal donors (0%, 0/20). We attempted to elicit cytotoxic T lymphocytes (CTL) specific forraspeptides, and found that CD4+CTL specific for the normal carboxyl terminus of the p21rasprotein could be elicited from peripheral blood lymphocytes from one of the three patients with pancreatic cancer. The results suggest that diagnosis of the existence, based on serum antibodies to rasoncogenic proteins, and immunotherapy with CTL specific forrasoncogenic proteins are promising future medical treatments for pancreatic and colon cancer patients.View full abstractDownload PDF (10198K) -
Tadamichi Hirano, Jiro Fujimoto, Hidenao Yamamoto, Takahiro Ueki, K. W ...1997 Volume 30 Issue 4 Pages 906-909
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe examined a simple and highly efficient in vivo method of gene transfer into rat hepatocytes using Hemagglutinating Virus of Japan (HVJ) and nuclear protein. The E. coli β-galactosidase (β-gal) gene was encapsulated in liposomes and incubated with HVJ to form vesicle complexes. These vesicle complexes were introduced into the rat liver portal injection. These injection methods were also performed on rats which had undergone partial hepatectomy 24 hrs prior to the injection. In the rats which received portal injection, 31.9±11.5% of the hepatocytes were stained with X-gal. This expression was bardly detectable 28 days after injection. However, in the partially hepatectomyzed rats, more than 20% of hepatocytes expressed β-gal protein 28 days after injection. The transcription of β-gal m-RNA was comfirmed by RT-PCR. We conclude that this gene transfer method is efficient andwould facilitate the development of genetic treatments for various liver diseases.View full abstractDownload PDF (7379K) -
Masahide Kaji, Yutaka Yonemura, Yasuo Hirono, Kouichirou Tsugawa, Sach ...1997 Volume 30 Issue 4 Pages 910-914
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe first screened for c-met expression in human gastric cancer cell lines, MKN-28, MKN-45 and TMK-1, by Northern blot analysis. The rank order of c-met mRNA abundance in these cell lines was MKN-45>TMK-1>MKN-28. Next, to test whether the growth and invasion of gastric cancer cells depend on c-met, we prepared phosphorothioate-type antisense oligonucleotides that were complementary to human c-met mRNA. We conducted experiments to determine whether blocking expression of the c-met gene with the antisense molecules affected either the proliferative or the invasive phenotype of the cancer cells. The growth of MKN-45 cells was markedly inhibited by the antisense c-met oligonucleotides, in a dose-dependent manner, but not by sense controls. The antisense oligonucleotides also effectively inhibited the migration of TMK-1 cells. These results indicate that c-met gene products may be causally related to the proliferation or invasion of gastric cancer cells, and that antisense c-met DNA has therapeutic potential in that it may facilitate circumventing the progression of gastric cancers.View full abstractDownload PDF (9674K) -
Tadashi Nomizu, Fumiaki Watanabe, Yoshio Yamaki, Atsuo Tsuchiya, Rikiy ...1997 Volume 30 Issue 4 Pages 915-919
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSOne of the characteristic clinical features of hereditary nonpolyposis colorectal cancer (HNPCC) is an increased fequency of multiple colorectal cancers or synchronous or metachronous occurrence of endometrial cancer. Extensive surgical procedures involving total or subtotal resection of the large bowel with or without hysterectomy are required to achieve the best surgical outcome for HNPCC. Extended operations, however decrease the patient's quality of life. The indications for extended operation are thus determined precisely by genetically diagnosing germline mutations in i.e., hMSH2, hMLH1 or replication errors in tumors.View full abstractDownload PDF (9165K) -
Toshio Yagyu, Nobuteru Kikkawa, Hideyuki Mishima, Isamu Nishisyou, Eis ...1997 Volume 30 Issue 4 Pages 920-924
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSBetween 1977 and 1995, 303 patients with colorectal polyps containing adenocarcinoma invading as far as the submucosa (colon 177, upper rectum 55, lower rectum 71) were treated. Sixteen of 232 patients with invasive polyps of the colon and upper rectum and 6 of 71 patients with invasive polyps of the lower rectum were found to have metastatic lymph nodes. Histologically, all specimens were examined to evaluate the risk for metastasis. The findings revealed that lymphovascular channel invasion (p<0.01), histologic type of the invasive front (p<0.05) and level of invasion correlated with the risk of metastasis. Further analysis in the lower rectal group showed that among these patients, the incidences of lymph node metastasis via lymphovascular channel invasion, histologic type of the invasive front and level of invasion were nearly equal to the respective incidences in the colon and upper rectal groups. Our findings suggest that these three risk factors are also useful in the lower rectal group of patients, for determining the indications for bowel resection following endoscopic polypectomy or local excision. Recently, as coloanal anastomosis after rectal resection has become well established, sphincter-preserving operation has been applied for a large majority of bowel resection for invasive polyps of the lower rectum.View full abstractDownload PDF (9695K) -
Haruhiko Okamoto, Yasuo Sakai, Takeyasu Suda, Katsuyoshi Hatakeyama1997 Volume 30 Issue 4 Pages 925-929
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSLocal treatments such as endoscopic resection, transanal local resection and TEM (Transanal Endoscopic Microsurgery) are useful methods of diagnosing and treating rectal lesions, especially adenomas and early cancers. We investigated the incidence of lymph node metastasis of colorectal submucosal invasive cancer (sm cancer). Among 168 surgical cases of sm cancer, 15 (8.9%) had lymph node metastasis. No lymph node metastasis was detected n those with pedunculated cancers smaller than 15 mm or in those with sessile cancers in which the depth of invasion was smla. These lesions, mucosal cancers and adenomas, appear to be curatively treated by local resection. Accuracy in diagnosing the depth of submucosal invasion between preoperative endoscopic diagnosis and pathological diagnosis (sm1 versus sm2 and sm3) was 78.9% for pedunculated tumors and 88.5% for sessile tumors. We have never diagnosed smla cancer as sm2 or sm3 cancer. The treatment ratios for sm cancers in the rectum and colon were as follows. Bowel resection: 23.5%, 46.8%, local treatment followed by bowel resection: 35.3%, 23.5%. The role of local resection is important as curative treatment for tumors with a clinical diagnosis which is neither sm2 nor sm3 cancer. Furthermore it is more important in the rectum than in the colon in trems of diagnostic treatment as well as minimally invasive or palliative therapy for the tumors carrying the possibility of lymph node metastasis.View full abstractDownload PDF (8801K) -
Toshihito Sawada, Takeshi Hayakawa, Takehiko Dohi, Masaki Ueno, Yoshih ...1997 Volume 30 Issue 4 Pages 930-935
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSPreserving defection, urination and sexual functions while maintaining radicality is a point which must be considered in choosing endoscopic versus surgical resection in early rectal cancer. The exact diagnosis of the depth of invasion is the msot important point in selecting the appropriate treatment. Detecting vascular invasion is essential determining whether minimally invasive, reduction surgery is feasible. The ratio of lymph node metastasis in early rectal cancer was 4.8% in sml cases and 19.3% in sm2, 3 cases. When we divided the cases into vascular invasion (-) and vascular invasion (+) groups, there was a significant difference between the ratios of lymph node metastasis (the former-0.0% and the later-2.6%). In order to avoid rectal amputation for lesions of the lower part of the rectum (P and Rb near by P), treatment selection should be based strictly and precisely on determination of the depth of invasion and the existence of vascular invasion as revealed in samples obtained by endoscopic or local resection. The ratio of lymph node metastasis was extremely low in sm2, 3 cases without vascular invasion, and in smi cases. Therefore, endoscopic or local resection is feasible in most of these cases, such that rectal amputation can be avoided. In cases requiring extensive and lymph node dissection, D1 lymph node dissection (upper side D2 and lateral side D1) is preferred over D2 or D3 dissection, because all cases with lymph node metastasis were n1 (+). We consider this to be the only treatment which guarantees full preservation of autonomic function.View full abstractDownload PDF (10739K) -
Yasumi Araki, [in Japanese], [in Japanese], [in Japanese], [in Japanes ...1997 Volume 30 Issue 4 Pages 936-940
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIn 142 patients with early rectal cancer and 78 with rectal creeping tumor, we evaluated the significance of endoscopic ultrasonography (EUS) in the preoperative diagnosis of cancer invasion and also compared different techniques: endoscopic mucosal resection and transanal endoscopic surgery. As a result, the diagnostic accuracy for depth of cancer invasion was increased to 87.9% with EUS (7.5 MHz), though protuberant lesions of 5 mm or more in height were difficult to diagnose because of tumor echo. Compared with endoscopic mucosal resection capable of removing tumors up to 2 cm in diameter, transanal endoscopic surgery proved to be more useful, as this technique was applicable to removing tumors up to 13 cm in diameter, was not influenced by tumor size or location and permitted resection with a sufficient safety margin.View full abstractDownload PDF (7433K) -
Kenji Hibi, Masaki Nogaki, Katsuki Ito, Hiroshi Takagi1997 Volume 30 Issue 4 Pages 941-943
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSPreservation of physical function and operative radicality are important in surgery for low rectal tumors. In this study, we performed local excision for 103 rectal villous tumor cases and examined the prognosis of these cases. Seven cases experienced recurrence in the lower rectum, but complete cure was achieved with another local excision. Therefore, local excision should be performed first for lower rectal villous tumors, if the cancer is in an early stage. However, we consider retreatment, such as low anterior resection with preservation of physical function, to be required for cancers with submucosal invasion. In all cases, follow-up studies after local excision, i. e., regular endoscopic and digital examinations, are important for assuring a good prognosis.View full abstractDownload PDF (6138K) -
Kaoru Azekura, Masaki Akada, Tsutomu Masuda, Masashi Ueno, Hirotoshi O ...1997 Volume 30 Issue 4 Pages 944-949
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSNine cases with an early cancer of the low rectum underwent surgery using two rational conservative surgical procedures; namely, transanal mucosal resection (TMR) and local resection with wide (regional) mesorectal excision (WM method of local resection). In TMR (the same as the procedure used by Parks), the tumor is dissected in one piece with a disk of mucosa leaving exposed circular muscle, and cancers of M' to SM' slight invasion in the preoperative depth evaluation are indication for this operation. Submucosal cancer is subdivided according to Kato's classification (sml, sm2 and sm3). After TMR the m to sml cancers are followed endoscopically and the sm2 cancers undergo additional radical surgery. Three of the four cases in which depths of cancer invasion were corrected after TMR and could undergo rational treatments. With this new operative procedure, “WM method of local resection”, cancer is excised with a margin of 10 mm or less adding a wide (100 mm or more orally) mesorectal dissection. This procedure is indicated for sm2 cancer. Five cases were operated on using this method; one case with positive nodes also underwent APR. No recurrence was recognized in the mean follow-up term of 17 months.View full abstractDownload PDF (10357K) -
Eiji Kanehira, Kazunori Hikishima, Kenji Omura, Tetsuyuki Sunohara, Ta ...1997 Volume 30 Issue 4 Pages 950-954
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSTransanal endoscopic microsurgery (TEM), utilizing an operative rectoscope with a diameter of 40 mm, was performed in 27 rectal cancer cases. The clinical results are presented herein. Our series included 20 early and 7 advanced carcinomas, of which 5 of the latter received TEM as a palliative treatment. Mean tumor diameter was 3.1 cm, maximum 8.5 cm. En bloc resection was successful in 92.6% of the series, while the cut-margin was tumor positive in one advanced case. Mean operative time was 81.7 minutes. There were no complications. Very few patients complained of pain and most began walking on POD 1. Low anterior resection was added in 3 patients, and abdominoperineal rectal amputation in one. During the follow-up period, ranging from 1 month to 3.1 years, no recurrences were noted in the early cancer cases. One palliative case died of a cause unrelated to the cancer and another was found to have a local recurrence. TEM contributes to safe and minimally invasive en bloc resection in early rectal cancer and to palliative treatment for advanced cancer cases.View full abstractDownload PDF (9604K) -
Shu Kuramoto, Kaoru Kobayashi, Toshiki Mimura, Kazuki Yamasaki, Masano ...1997 Volume 30 Issue 4 Pages 955-960
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe treatment of flat early cancers of the rectum represents a subject of considerable dabate. We investigated lesion types, postoperative complications and the courses of 41 cases of flat early rectal cancers encountered from January 1985 to November 1995. These cancers were treated utilizing our preferred standard of treatment. This standard can be outlined as follows: (a) mucosal cancers under 20 mm in diameter should be treated endoscopically; (b) mucosal cancers over 20 mm and cancers involving the submucosal layer except Type B should be surgically resected, omitting lymph node dissection; but (c) Type B requires lymph node dissection. Clinicopathological features were as follows: male 23, female 18; depth m 20, depth sm 21; average age 61.5 years; Elevated type with depression, Type B indicating that moderately differentiated adenocarcinoma massively involves the submucosal layer. Of the mucosal cancers, only one involving the dentate line necessitated resection by rectal amputation; the others were treated while preserving anal function. Treatments for cancers involving the submucosal layer and number of relevant cases were endoscopic resection (3); posterior approaches (4); low anterior resection (4) sacro-abdomino-sacral resection (4); and rectal amputation (4). The last four types of operations included lymph node dissection. Only one recurrence was observed among Type B treated by low anterior resection with D3 dissection. The other operations, whether omitting or including lymph node dissection, were successful. Frequent use of posterior approaches is useful for treating flat early cancers of the lower rectum while preserving anal function without increasing the recurrence rate.View full abstractDownload PDF (10992K) -
[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...1997 Volume 30 Issue 4 Pages 961-962
Published: 1997
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSDownload PDF (2543K)
- |<
- <
- 1
- >
- >|