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Volume 31, Issue 1
Displaying 1-28 of 28 articles from this issue
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Yoshinori Takahashi1998 Volume 31 Issue 1 Pages 1-8
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSEndoscopic ultrasonography (EUS) was performed in 35 patients with esophageal cancer. We compared one by one EUS findings with clinicopathological findings in thoracic lymph nodes to determine the usefulness and limitations of EUS. The overall rate of detection was 33%. The detection rate differed depending on location and size, and detection rates of detection in the rt. thoracic paratracheal lymph nodes, rt pulmonal hilar lymph nodes and pulmonary ligament wre low regardless of size. The rates of detection rate of metastatic lymph nodes was 83%. EUS could diagnose metastatic lymph nodes over 4 mm in the non-bifurcation lymph nodes and pulmonal hilar lymph nodes group. New criteria were devised for diagnosing metastatic lymph nodes using EUS. A lymph node was determined to be metastatic if it had three or more of the following properties: 1) with notching 2) clear border 3) long axis (more than 6 mm) 4) a heterogeneous internal echo pattern. The accuracy, sensititity and specificity of the diagnosis were 92%(49/53), 82%(14/17), and 97%(35/36) respectively. EUS was uweful for diagnosis of metastatic lymph nodes over than 4 mm in the non-bifurcation lymph nodes and pulmonal hilar lymph node group.View full abstractDownload PDF (13827K) -
Tsuyoshi Kito, Yasuhiro Kodera, Yoshitaka Yamamura, Yasuhiro Shimizu, ...1998 Volume 31 Issue 1 Pages 9-14
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSOver the past 31 years, 119 patients with primary gastric lymphoma were treated at Aichi Lancer Center Hospital. Clinicopathological features and survival data of these patients were analyzed. The patients were stratified into three groups: those treated with surgery alone, those given multimodal therapy, and those treated without surgery. The 5-year survival rate for the 26 patients receiving multimodal therapy was 64.0%. Of the 8 patients treated without surgery, one survived for 6 years with chemotherapy alone. The patients treated with surgery alone were further stratified into three categories; early disease, advanced disease, and mucosa-associated lymphoid tissue lymphoma. The standard surgical procedure throughout has been D2 dissection. All 10 patients belonging to the early disease group have survived for over 5 years to date, including a case with nodal metastasis. Of the patients belonging to the advanced disease group, 25 underwent curative resections, 7 of which were total gastrectomies. Nodal metastasis was observed in 72.0% of the 25 patients, and the 5-year survival rate was 75.0%. Of the 36 patients belonging to the MALT lymphoma group, 28 were treated with total gastrectomy. Nodal metastasis was found in 44.4%, and the 5-year survival rate was 91.6%. Adequate surgery, supplemented with multidisciplinary therapy where appropriate, has led to excellent treatment results for primary gastric lymphoma.View full abstractDownload PDF (11355K) -
Comparative Study with Serum CEA ValueKeiji Kajihara, Hiroshi Ishikawa, Yuzuru Nakamura, Husao Kubota, Hiroy ...1998 Volume 31 Issue 1 Pages 15-20
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIn 360 resected cases of gastric cancer, the clinical significance of serum immunosuppresive acidic protein (IAP) values for gastric cancer was evaluated in comparison with that of serum carcinoembryonic antigen (CEA) values.(1) The positive rates of IAP and CEA were 18.6% and 14.7%, respectively. In 174 cases without early gastric cancer, those were 30.5% and 19.0%, respectively.(2) Both the serum IAP and CEA values showed a correlation with histological staging, lymphatic invasion, lymphnodal metastasis and liver metastasis.(3) The depth of invasion and venous invasion showed a significant correlation with serum IAP values, but not with serum CEA values.(4) Serum IAP values were positive in eight of nine values, but not with serum CEA values.(5) Serum IAP values were positive in eight of nine cases with liver metastasis, and that sensitivity and negative predictive value of IAP were very high, 88.9% and 99.7%, respectively. These results indicate that the serum IAP values is a useful tumor marker more than the seurm CEA values for preoperative evaluation of the cancer stage of gastric cancer.View full abstractDownload PDF (10030K) -
Yoshihiro Moriwaki, Syunsuke Kobayashi, Hirofumi Harada, Chikara Kunis ...1998 Volume 31 Issue 1 Pages 21-26
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe aim of this study is to compare the significance of risk factors for recurrence between of all cases just after the primary operation and disease free cases several years after the primary operation. We examined our gastric cancer patients who were disease free for 1, 2, 3, 4 and 5 years after the primary operation in regard to the relationship between the risk factor for recurrence and the disease-free interval. Serosal invasion (positive and negative) and infiltration pattern (α, β and γ) were significant as risk factors for recurrence after 5 postoperative years (p<0.01). Lymphatic metastasis (between n1 and n2), lymphatic permeation (between ly0+1 and ly2+3) and histological pattern (between differentiated and undifferentiated) were not significant as risk factors for recurrence after 4, 3 and 2 years, respectively. Concerning the pattern of recurrence after a long interval after the operation, local recurrence and dissemination was the dominant pattern in positive serosal invasion and inf γ cases and this pattern was similar to that in a short interval after the operatin. However, dissemination and lymphatic metastasis were the dominant pattern in recurrence after a long interval after the operation in n0, local recurrence and dissemination was dominant in n1 and local recurrence and dissemination was dominant in n2, unlike the pattern of recurrence in a short interval after the operation. Follow-up is necessary considering the fact that the significance of the risk factor for recurrence and the suspected pattern of recurrence after a long disease free interval from operation are different from those after a short interval from operation.View full abstractDownload PDF (12926K) -
Evaluation of the Nuclear Area of Cancer Cells Before and After ChemotherapyShinji Yanagisawa1998 Volume 31 Issue 1 Pages 27-35
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSTo evaluate the effects of preoperative chemotherapy for gastric cancer, we examined the histological effects and the changes in the nuclear area of cancer cells calculated with a morphometer. Twenty-nine patients with resectable gastric cancer were treated with continuous intravenous 5FU injection (300mg/m2/day) until the day before the operation. According to the Japanse classification of gastric carcinoma, histological changes showed Grade 0 in 8 cases, la in 13 cases, lb in 5 cases, and 2 in 3 cases. The mean nuclear areas (NA) were 46.2±6.86μm2 before chemotherapy and 57.7±10.80μm2 after chemotherapy. The NA was significantly enlarged after chemotherapy. The changes in the nuclear area ratio (NAR=NA after chemotherapy/NA before chemotherapy) were related to the histological effects, but the NAR had a wide distribution in cases of Grade la. Therefore the histological changes were devided into 2 groups. Group A was the non-effective group (15 cases). This group included the cases of Grade 0 and showed a minor response in Grade la. Group B was the effective group (14 cases). This group included the cases exhibiting a marked response in Grades la, lb and 2. According to this classification, the NAR was 1.12±0.170 in Group A and 1.42±0.235 in Group B. The NAR was more significantly related to the histological changes. Though histological effects were slight like the cases of Grade la, the nuclei of cancer cells were swollen after chemotherapy. It was suggested that the increase in NA was a good parameter for cytological effects of chemotherapy.View full abstractDownload PDF (17389K) -
Mitsuhiro Matsuda, Akio Ishikawa, Katsuhisa Tsuji, Akira Osada, Yuji Y ...1998 Volume 31 Issue 1 Pages 36-39
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIn this study, we examined the relationship between the trimethadione (TMO) tolerance test and the Child-Pugh score in patients with liver cirrhosis to determine if there is an advantage of the TMO tolerance test. The TMO tolerance test is based on the serum dimethadione (DMO)/TMO ratio (DMO is the only metabolite of TMO) 4 hours after oral administration of TMO. The DMO/TMO ratios were 0.33±0.07 in group A of the Child-Pough score, 0.26±0.10 in group B and 0.11±0.06 in group C. These defferences reached statistical significance (p<0.005). There was a significant correlation (r=- 0.186, p<0.0001) between the serum DMO/TMO ratio and the Pugh score. These data show that the TMO tolerance test is as useful for assessing the severity of liver cirrhosis as the Child-Pugh score.View full abstractDownload PDF (7679K) -
Akihiko Mizoe, Hikaru Fujioka, Takashi Azuma, Junichiro Furui, Tsutomu ...1998 Volume 31 Issue 1 Pages 40-45
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIn the present study, in order to evaluate liver function during the perioperative period, serum levels of hyaluronic acid (HA) were measured. Blood samples were collected from 19 patients with hepatocellular carcinoma before hepatic resection and on the 1st, 3rd and 7th postoperative days (POD), and serum levels of HA were measured by the sandwich binding protein assay. The subjects were divided into 2 groups as follows. Group A, 14 patients, had an uneventful postoperative course, and Group B, 5 patients, had postoperative complications such as hepatic failure, liver abscess and intraperitoneal hemorrhage. The preoperative serum levels of HA had a significant correlation with the indocyanine green retention rate (ICG R15), the portal vein pressure, and the results of 99mTc-GSA scintigraphy. The preoperative serum levels of HA in the patients with clinical stage II were significantly higher than those of the patients with clinical stage I (p<0.02). The rates of the postoperative complications in the patients with preoperative HA serum levels over 100ng/ml were significantly higher than those in the patients with HA serum levels below 50ng/ml (p<0.05). Moreover, the postoperative serum levels of HA in Group B tended to be higher than those in Group A. On the 1st POD, there was a significant difference in the serum levels of HA between Groups A and B (p<0.01), whereas there were no significant differences in other parameters of liver function. These results suggest that serum levels of HA are useful parameters for evaluating liver function and predicting the outcome after hepatic resection.View full abstractDownload PDF (10372K) -
Kouichiro Hasegawa1998 Volume 31 Issue 1 Pages 46-50
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA selective thromboxan A2 (TXA2) synthetic enzyme inhibitor, CV-4151, was injected into an bile-induced acute pancreatitis model in dogs. Mongreal adult dogs were divided into 4 groups (group 1, untreated control: group 2, one-shot intravenous injection: group 3, continuous intravenous injection: group 4, continuous intraarterial injection) and the relative efficacy of each method of administration and the effects of CV-4151 were cmpared among the groups. Pancreatic tissue was harvested before and 1 and 3 hours after the induction of pancreatitis, and the levels of phospholipase A2 (PLA2), thromboxan B2 (TXB2), and 6-keto-PGF1α in the tissue were measured. The survival rate for eachgroup was determined. The results showed that PLA2 and TXB2 were suppressed significantly after 1 and 3hours in group 4 and 6-keto-PGF1α was suppressed significantly after 3 hours in group 4. Group 4 showed the highest survival rate among four groups. These findings indicate that a therapeutic effects similar to that seen in groups 2 and 3 can be expected from the continuous intraarterial injection of CV-4151. Furthermore, this method also yielded the highest survival rate.View full abstractDownload PDF (9131K) -
Yuji Inoue, Mamoru Suzuki, Katsotoshi Yoshida, Toru Tezuka, Ken Takasa ...1998 Volume 31 Issue 1 Pages 51-55
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe factors related to residual liver recurrence following hepatic resection were investigated in 40 patients with solitary liver metastasis from colorectal cancer. There is no significant difference in background factors between 14 patients with residual liver recurrence after hepatic resection and 11 patients with no residual liver recurrence after more than one year. The greater the tumor diameter, the more livers were resected. There is no significnt difference in freque ncy of residual liver recurrence after surgery among patients with a tumor diameter of less than 2cm, that of more than 2cm and less than 5cm and that of more than 5cm. Therefore these findings suggest that partial resection is suitable for the choice of the operative procedure because of its satisfactory surgical margin.View full abstractDownload PDF (8680K) -
Hidejirou Kawahara, Katsuya Hirai, Teruaki Aoki, Keiichi Sato, Masashi ...1998 Volume 31 Issue 1 Pages 56-60
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIn a retrospective study, we found that there was a strong relationship between the anastomosis technique and anastomosis recurrence. In particular, patients operated on by the double stapling technique (DST) had significantly higher anastomosis recurrence than those in whom other anastomosis techniques were used. After that, advanced rectal cancer patients with DST in the 3 years from 1992 to 1994, were evaluated for the purpose of determining the usefulness of intraluminal lavage in the operation using DST for rectal cancer. The results showed that only if sufficient preoperative intraluminal preparation was carried out, desquamated cancer cells were decreased, and the anastomosis recurrence rate was decreased from 11.8% to 5.8%. However, there was no anastomosis recurrence in 48 patients carried out intraluminal lavage. Therefore it is extremely useful to perform intraluminal lavage just prior to the anastomosis to prevent anastomosis recurrence, and it is conceivable that intraluminal lavage is an essential manipulation in rectal cancer operations using DST.View full abstractDownload PDF (9293K) -
Yasuhiko Miura, Chikara Kunisaki, Hidenobu Masui, Tetsuya Takahashi, K ...1998 Volume 31 Issue 1 Pages 61-65
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe experienced a case of basaloid-squamous cell carcinoma of the esophagus with muscle metastasis. A 58-year-old man was admitted to the department of Orthopedic Surgery with a left shoulder tumor. It was diagnosed as a metastatic shoulder tumor by biopsy. Moreover, thickening of the wall of the lower esophagus was detected by computed tomography, and carcinoma of the esophagus was diagnosed by endoscopy. A curative operation for the shoulder tumor was performed. Two months later, he was operated on for esophageal cancer in our department. The patient had been well for 6 months after surgery, but brain metastasis was occurred after that. Histopathologically the tumor was basaloidsquamous cell carcinoma of the esophagus. About 30 cases of this carcinoma have been reported in Japa. We think that our case is very rare because of the muscle metastasis.View full abstractDownload PDF (9285K) -
Hiromi Shimomukai, Masaharu Yamada, Mikiyo Miyata, Yoshikazu Takahashi1998 Volume 31 Issue 1 Pages 66-70
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSSimultaneous gastric cancer in identical twins is reported. We operated on a female patient whose lesion was similar in location, macroscopic type and microscopic type to that of her twin sister although extension of their lesions were very different. Only 8 pairs of gastric cancer in identical twins have been reported in Japan. Most authors have emphasized hereditary factors. We did not consider heredity to be important because the number of reports is very small in Japan where gastric cancer is very common. Past reports have shown that lesions in identical twins resemble each other macro and microscopically. We speculate that the resemblances are due to the same genes at brith and the accumulation of similar genetic mutations after birth.View full abstractDownload PDF (7959K) -
Akira Suzuki, Jin-ichi Kameyama, Yousuke Sakai, Shun Kudou, Akiko Take ...1998 Volume 31 Issue 1 Pages 71-75
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSAcute emphysematous cholecystitis is a rare disease caused by gasproducing bacteria. Abdominal imaging examinations reveal abnormal gas in the gallbladder lumen and pericholecystic space. We experienced two cases of acute emphysematous cholecystitis. Case 1: A 68-year-old man. He was admitted to our hospital because of upper abdominal pain. Abdominal imagings showed air in the gallbladder and he was diagnosed as having acute emphysematous cholecystitis. He was treated with intravenous fluids and antibiotics, and then his general condition improved. A cholecystectomy was performed 18 days after admission. Pathological examination of the surgical specimen revealed acute gangrenous cholecystitis. By cultivation of bile juice collected during the operation, Clostridium species was detected. Case 2: An 85-year-old man. He was admitted to our hospital because of upper abdominal pain. Abdominal imagings showed air in the gallbldder and the bile duct. With a diagnosis of acute emphysematous cholecystitis, percutaneous transhepatic gallbladder drainage was immediately performed, however, it was unsusuccessful. On the day of admission emergency laparotomy was carried out. The histopathological findings of the gallbladder showed phlegmonous inflammation. Culture of the bile was positive for Clostridium perfringens. In these two cases the postoperative course was good, and the patients were discharged on the 14th and 16th postoperative days respectively.View full abstractDownload PDF (10115K) -
Atsushi Miyamoto, Masatomo Tada, Chikara Ebisui, Makoto Okazaki, Toshi ...1998 Volume 31 Issue 1 Pages 76-80
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe report an extremely rare case of Kasabach-Merritt syndrome due to splenic hemangioma. The patient was a 68-year-old woman who was referred to our hospital for further evaluation of purpura in the extremities. The results of hematological analyses on admission showed severe thrombocytopenia. In addition, abdominal ultrasonography and computed tomography revealed a large splenic tumor. Abdominal magnetic resonance imaging demonstrated a tumor of heterogeneous intensity on a T2 weighted image and it was suspected that the low and high intensity corresponded to acellular areas of infarction and vascular pools respectively. Under a diagnosis of splenic hemangioma associated with Kasabach- Merritt syndrome, splenectomy was performed. The tumor was 5.5×4.0×3.6cm in diameter, and histological study revealed a hemangioma with an intravascular thrombus. The number of platelets returned to the normal level immediately after surgery. It was suggested that magnetic resonance imaging is useful for diagnosis and that splenectomy is the best therapeutic option in a case of splenic hemangioma complicated with Kasabach-Merritt syndrome.View full abstractDownload PDF (8780K) -
Toshiro Ogata, Naofumi Satoh, Susumu Ohwada, Yoshiki Takai, Isao Kobay ...1998 Volume 31 Issue 1 Pages 81-84
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe report two cases of appendicitis with the elevation of serum carbohydrate antigen 19-9 (CA19-9) and normal serum carcinoembryonic antigen (CEA) levels. The histological diagnosis was appendicitis with granulomatous change. CA19-9 levels decreased after surgery. Serum levels of CA19-9 may be elevated in both inflammatory and malignant disease of the gastrointestinal tract. If serum levels of CEA are with normal limits, the appendiceal disease may be benign despite of the elevation of CA19-9 levels.View full abstractDownload PDF (7499K) -
Eiji Meguro, Yoshiyuki Tamasawa, Yusuke Kimura, Koki Otsuka, [in Japan ...1998 Volume 31 Issue 1 Pages 85-89
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe encountered an adult with bladder cancer that had metastasized to the jejunum, a rare mode of metastasis, inducing intussusception. A 67-year-old woman, who had undergone surgery for bladder cancer 2 years earlier visited our hospital because of to discomfort in the upper abdomen and weight loss. Ultrasonography and CT scanning of the abdomen suggested intussusception, and laparotomy was performed. Intussusception with a tumor in its front area was observed in the jejunum about 20cm anal to Treitz's ligament. Partial jejunectomy was performed. Close examination of the abdominal cavity showed no lymph node metastasis, liver metastasis, or peritoneal dissemination. However, the tumor showed growth centerning in the submucosal layer and was a transitional cell carcinoma characterized by metastatic ability. A diagnosis of metastasis of bladder cancer was made. Intussusception due to metastasis of small-intestinal tumors is rare, and lung cancer and renal cancer have been reported as primary lesions. This intussusception has a poor prognosis.View full abstractDownload PDF (9559K) -
Kiyotaka Fukura, Hiroshi Suenaga, Kazuyuki Hagiwara, Takashi Aikou1998 Volume 31 Issue 1 Pages 90-94
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSInterposition of the intestine, mostly the large intestine, into the right subphrenic space is known as Chilaiditi's syndrome. This is a case report of a 79-year-old man with the complaint of abdominal pain. We diagnosed this case as Chilaiditi's syndrome with ileus, from a chest X-ray which showed an intestinal gas-filled loop in the right upper quadrant. An abdominal X-ray showed air-fluid levels and marked distension of the bowel loops. A radiograph with contrast medium was taken using a long tube. Strangulation due to incarceration of the small intestine was observed. To avoid a recurrence of this condition, an operation was undertaken. This case suggests the necessity of identifying the interposing organ and whether it is a transient or persistent type.View full abstractDownload PDF (9039K) -
Yasuo Shinoda, Masatoshi Sasaguchi, Syuji Yamada, Teiji Motojima, Yuki ...1998 Volume 31 Issue 1 Pages 95-99
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA case of myoepithelial hamartoma of the small intestine, which is particularly rare among benign tumors of the small intestine, was observed. The patient was a 70-year-old man. He was examined in this hospital with the chief complaint of upper abdominal pain. On CT of the abdominal region, targer-shaped thickening of the small intestine was observed from the upper left to the lateral region of the abdomen, and the illness was diagnosed as intussusception. The symptom was not alleviated by palliative therapy, nd progress of intussusception was observed in reexamination by CT. He was diagnosed as having intussusception caused by a tumor in the small intestine and received a laparotomy. A 40-cm intussusception of the jejunum at 80-cm from the ligament of Treitz was found. After manual repositioning, a tumor 4.0×2.5×2.5cm in size was palpated in the front portion of the intussusception. A 15-cm length of the jejunum including the tumor was resected. In the histological study, growth of smooth muscle and mixed ductal proliferation were found in the internal circular muscle layer, and the illness was diagnosed as myoepithelial hamartoma. The course after the operation was good, and he was discharged on the 21 st day of hospitalization.View full abstractDownload PDF (9591K) -
Eiichi Kihana, Shigeru Kurisu, Takeshi Hatta, Takashi Koyama, Yasuhumi ...1998 Volume 31 Issue 1 Pages 100-104
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA previously healthy 25-year-old man, with multiple cafe au lait spots, presented with vomiting and a sudden onset of abdominal pain. Ultrasound examination and a CT scan showed a 6×7 cm tumor in the pelvic cavity. At laparotomy, the tumor, which protruded from the subserosa of the jejunum, 20cm on the anal side from Treitz's ligament, was excised. The tumor was well encapsulated but partly ruptured and bleeding. Further inspection revealed three other tumors 0.5cm in diameter, located in the jejunum, 60, 70 and 100cm apart from Treitz's ligament. Histologically, the main tumor was composed of spindle-shaped cells with an interweaving bundle pattern. The three small tumors showed the same histological findings. Immunohistochemically, the tumor cells were partly positive for S-100 protein and for NSE, but negative for desmin and for smooth muscle actin. From the above evidence the tumor was diagnosed as a gastrointestinal stromal tumor (GIST), neural type, low grade malignant.View full abstractDownload PDF (9116K) -
Haruhiko Cho, Manabu Shiozawa, Fumiyasu Fukano, Isao Tamura, Shinichir ...1998 Volume 31 Issue 1 Pages 105-108
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 66-year-old man with upper abdominal pain was admitted to the hospital. Abdominal CT and arterial blood gas data suggested the possibility of strangulated ileus and intestinal necrosis. During surgery, a diverticulum tied a loop of ileum and caused intestinal necrosis. Histopathological examination showed a diverticulum with all layers of the ileum. No ectopic mucosa was seen. Strangulation by a knot is the least known method of complicating Meckel's diverticulum. Such a type of diverticulum is characteristic in that it has a long neck and an ampulla at its distal end.View full abstractDownload PDF (6350K) -
Hirokazu Matsutomo, Akihiko Gotoh, Toyoo Nitta, Masayoshi Ichihashi, M ...1998 Volume 31 Issue 1 Pages 109-113
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSEnteroliths are infrequently encountered. We report here a case of a surgically treated enterolith with perforation and ileus. A 68-year-old woman presented with lower abdominal pain. Physical examination at admission showed tenderness with Blumberg sign of her lower abdomen and a painful mass was palpated in the right lower quadrant. Plain abdominal X-ray film showed abnormal intestinal gas and calcified stone shadows in the pelvic cavity. Pelvic computed tomography revealed calcified stone shadows in the bowel. Blood laboratory studies showed 15, 600 leucocytes per mm3 and 14.8mg of CRP per dl. An emergency operation was carried out. During laparotomy, segmental stenosis and a pin-hole perforation in the ileum 40cm orad from ileocecal portion were detected, and intestinal stones were palpated in the lumen. Part of the ileum was resected and a calcium enterolith was diagnosed by chemical analysis by infrared rays. In the present case, stenosis of the ileum due to adhesion after appendectomy was considered to have caused stagnation of the intestinal contents, which led to formation of the enterolith.View full abstractDownload PDF (8001K) -
Yoshihiro Yamada, Naohiro Tomita, Takushi Monden, Hidenori Takahashi, ...1998 Volume 31 Issue 1 Pages 114-118
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSMalignant neoplasms sometimes contain calcifications. However it is very rare that the ossification is seen in the tumor tissue. In this paper, we report a case of undifferentiated carcinoma of the transverse colon with ossification. The patient was a 63-year-old man who was diagnosed as having advanced transverse colon carcinoma with multiple liver metastases and peritoneal dissemination. Partial resection of the transverse colon and omentectomy were performed. The pathological examination revealed that the tumor was undifferentiated carcinoma with an area of squamous cell carcinoma-like, basal cell carcinoma-like or choriocarcinoma-like components. Interestingly, the ossification was seen in part of the tumor tissue. In the literature, there are not many reports on malignant tumors with ossification. As for the mechanism of ossification, involvement of the metaplastic change from fibroblasts to osteoblasts can be suspected in this case.View full abstractDownload PDF (9047K) -
Nobuhiro Tokunaga, Sotaro Sadahiro, Takashi Noto, Seiei Yasuda, Masaya ...1998 Volume 31 Issue 1 Pages 119-123
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSOf 51 patients who underwent curative resection of submucosal invasive colorectal carcinoma, four had tumor recurrences. Two primary tumors were located in the rectum and two in the sigmoid colon. The configuration of all the primary lesions was subpedunculated type. Three patients underwent subsequent transabdominal colonic resection after endoscopic polypectomy. One patient initially underwent transanal resection. Two had metastatic lymph nodes at the colonic resection. The histologic type of the primary carcinomas was well to moderately differentiated adenocarcinoma without undifferentiated carcinoma. One patient had recurrence in the liver only, one in the lung only, one lymph node recurrence only, and one had recurrences in multiple sites. Tumor location in the sigmoid colon and rectum, a subpedunculated polyp, and moderately differentiated adenocarcinoma are risk factors for recurrence of curatively resected submucosal invasive colorectal carcinoma.View full abstractDownload PDF (11640K) -
Hiroshi Watanabe1998 Volume 31 Issue 1 Pages 124-127
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSNow the 8th Edition of “Guide Lines” for the Clinical aqnd Pathologic Studies on Carcinoma of the Esophagus was published in 1992. Fifteen years ago, we had stopped the preoperative radiotherapy, and the area of lymph node dissection in surgical treatment for esophageal cacer have been changed that the dissected area became wide. By these changes of treatment, the contents of present rules is of no clinical use. We are revising the rules from 1992. As a important points to revise the rules, we has always trying to meet four requirements; 1) useful, to be simple; 2) to be internationally acceptable; 3) to be adequate for statiscal studies; 4) to be not against the fundamental medical canceptions. Now, residual tumor classification (R), grade of lymph node dissection (D), and curability (A, B, C classification) were revised.View full abstractDownload PDF (7222K) -
Masahiko Tsurumaru1998 Volume 31 Issue 1 Pages 128-132
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIt is well known that thoracic esophageal carcinoma develops wide spread lymph node metastasis including the neck, mediastimum and abdomen. However, there has been no reliable randomized trials which gave the definite answer to the question to what extent lymph node dissection should be done for esophageal carcinoma in order to obtain better survival rate. Statistical analysis allows us to use Cox regression model to evaluate effectiveness of extensive lymph node dissection including the neck for better prognosis. Cox regression analysis suggested that extensive lymph node dissection might yield better survival rate with the risk ratio of 0.5501 compared to limited lymph node dissection. In this paper, radical operation for thoracic esophageal carcinoma will be discussed mainly concerning its procedures. According to studies on distribution of metastatic lymph nodes, three fields including the neck, mediastinum and abdomen were involved despite of location of a main tumor, though the rate of patients with metastatic node per patients dissected was different in accordance with a location of a main tumor. This is one of the evidences which require extensive lymph node dissection including the neck. The main part of lymph node dissection is continuous clearance along both sides of the recurrent laryngeal nerves in the upper mediastinum and the neck. In the neck, the region below the omohyoid muscle should be dissected because approximately 90% of metastatic nodes were included within this region. Meticulous procedures with patience would be mandatory for less postoperative morbidity.View full abstractDownload PDF (8389K) -
Michihiko Kitamura1998 Volume 31 Issue 1 Pages 133-137
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe rate of death within one month after operatikon was 1% and the safety of surgery for esophageal cancer was considered to be established. But the rates of postoperative complications were still high and distinct postoperative management should be required. In this paper, 1) ordinary physiological changes and laboratory findings in patients after surgery for esophageal cancer, 2) standard postoperative management of respiration, circulation, fluid and nutrition, antibiotics and pain, and 3) treatment for postoperative complications such as pulmonary failure and circulatory disturbance were mentioned. The importance of preoperative functional evaluation of patients, modifivation of the management after operation based on the findings and procedures during operation, early detection of abnormal findings and early treatment for postoperative complications, and close cooperation with the anesthesiologist with regard to perioperative management, especially for respiratory and fluid therapy, should be stressed.View full abstractDownload PDF (10989K) -
Nobutoshi Ando1998 Volume 31 Issue 1 Pages 138-142
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSAdjuvant therapy following surgery has been the mainstream in surgical adjuvant therapy in Japan. A randomized controlled trial (RCT) by the JEOG showed no significant differences in survivals between the surgery plus radiation group and the surgery plus chemotherapy (CDDP/VDS) group. The JEOG subsequent RCT also showed no significant differences in survivals between the surgery alone group which consisted of thoracotomy and laparotomy with three-field dissection and the surgery plus chemotherapy (CDDP/VDS) group. The JEOG subsequent RCT comparing surgery with and without chemotherapy (CDDP/5-FU) is now in the middle of the follow up period. Otherwise in western countries, neoadjuvant therapy, especially neoadjuvant chemotherapy or chemoradiotherapy has become popular from 1980's. However it is still uncertain whether neoadjuvant therapy offers the advantage on survival or not. Salvage surgery for the suspected T4 tumors has become to be available following downstaging by means of chemoradiotherapy and to be possible new strategy for far advanced esophageal cancer.View full abstractDownload PDF (8409K) -
Makoto Itoh, Tomohumi Nakano, Kimitsune Monma, Yuichi Itoh, Munetsugu ...1998 Volume 31 Issue 1 Pages 143
Published: 1998
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSDownload PDF (1918K)
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