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Volume 33, Issue 6
Displaying 1-12 of 12 articles from this issue
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Kiichi Aoki, Kenichiro Ikeda, Nobuhiro Sato2000 Volume 33 Issue 6 Pages 693-702
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe conducted a prospective randomized clinical trial to determine whether additional total parenteral nutrition (TPN) after esophageal cancer surgery has better effect on amino acid metabolism and wound heal-ing than enteral nutrition (EN) with and without TPN, EN alone (EN group), or EN+TPN (EN+TPN group). Twenty thoracic esophageal cancer patients who underwent total esophagectomy and reconstruction with a gastric tube and right thoraco-laparotomic cervical manipulation were preoperatively randomized to either the EN group (n=10) or the EN+TPN group (n=10). In both groups, EN was started at 5 kcal/kg (non-protein calories) on postoperative day (POD) 3 and was gradually increased to 30 kcal/kg/day on POD 8. In the EN group, 5% glucose in electrolyte solution was administered. In the EN+TPN group, TPN was started at a dose of 20kcal/kg/day on POD 1 and on the following days a total of over 30 kcal/kg/day was maintained by TPN plus EN. There were no significant differences between the two groups in regard to arteriovenous differences in plasma amino acids (branched-chain amino acids, glutamine, and alanine), total protein, albumin, rapid turn-over proteins, factor XIII, prolyl hydroxylase, or fibronectin. In the EN+TPN group, blood urea nitrogen on PODs 5 and 7, and accumulated urinary nitrogen excretion were significantly higher than in the EN group. These results suggest that the additional TPN cannot prevent muscle breakdown and promote wound heal-ing. The additional TPN combined with EN is unnecessary for postoperative thoracic esophageal cancer patients.View full abstractDownload PDF (117K) -
Hitoshi Kotanagi, Emi Sato, Satoshi Murakoshi, Tomokazu Takahashi, Mas ...2000 Volume 33 Issue 6 Pages 703-708
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTo establish an effective examination system for preoperative evaluation of liver metastasis by colon can-cer, we analyzed the sensitivity, cost, and efficacy of computed tomography (CT) and ultrasonography (US) in 354 patients (including 63 patients with liver metastasis). The presence or absence of liver metastasis was ultimately diagnosed 5 years after the operation. The sensitivity, specificity, and accuracy for detecting liver metastasis were 65%, 94%, and 89%, respectively for CT, 57%, 97%, and 91%for US, and 65%, 93%, and 88%for CT plus US, and there were no significant differences among them. Neither CT nor US could fully detect intrahepatic cancer spread. The cost of detection of one patient with liver metastasis was 6, 298 points for plain CT, 20, 169 points for enhanced CT, and 5, 773 points for US. It was concluded that CT plus US should not be employed for preoperative assessment of liver metastasis, because 1) the detection rate of the two modalities is not significantly different, and 2) these modalities do not compensate for each other's defects. From the standpoint of the cost-benefit relationship, US should be selected for preoperative evaluation of liver metasta-sis. Key words: preoperative assessment of liver metastasis from colon cancer, detection rate of liver metastasisView full abstractDownload PDF (45K) -
Kumi Hasegawa, Kenichi Sugihara, Masayuki Enomoto, Keigo Yoshinaga2000 Volume 33 Issue 6 Pages 709-715
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIn this study, we examined the clinicopathological features and outcomes of obstructive colorectal can-cers to determine the optimal surgical treatment for such cases. Of all operative colorectal cancers treated at our facility in 1978-1998, 46 caser (5.0%) were found to be obstructive and eligible as obstructive group in this study participation. In comparison with 872 non-obstructive cases (control group), obstructive group showed the higher incidence of hepatic metastasis, peritoneal dissemination, post operative death rate, and lower resectability. The outcomes for obstructive group were worse than control group. We compared the clinicopathological features and outcomes of 36 resectable cases in obstructive group with non-obstructive re-sectable 108 cases, who were extracted from control group matched in gender, age depth of invasion and loc-ation of tumor. There were no differences between the two resectable cases except for the size of tumor. The similar curative resectability were observed, and no differences in the outcomes were found. In conclusion, our findings indicate that radical operations for advanced colorectal cancer even in obstructive cases offer an improved chance of long-term survival.View full abstractDownload PDF (54K) -
Nobuyoshi Miyajima, Katsuyuki Takahashi, Tatsuo Yamakawa2000 Volume 33 Issue 6 Pages 716-720
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIntraoperative detection of lymph node metastases of colorectal carcinoma was attempted with 67-Ga citrate and Navigator. 67-Ga citrate was injected intravenously in 10 patients with colorectal carcinoma 96 hours before surgery. Immediately after the surgical specimens were resected, the lymph nodes were divided and gamma ray intensity was counted with Navigator and a hand-held detector probe. A total of 157 lymph nodes were resected. Histopathological examination revealed that 137 of them were metastasis-negative and the remaining 20 were positive. The intensity of the gamma energy of each lymph node/background ratio (L/B ratio) was calculated and the cut-off value was determined to be 2.0. The L/B ratio of all metastasis-positive lymph nodes was over 2.0, and 97.2% of metastasis-negative lymph nodes could be identified. Based on these findings, intraoperative lymph node metastasis was detected in 10 cases of colorectal carcinoma in which la-paroscopic surgery was performed. Before lymphadenectomy, the marginal vessels on both the proximal and the distal side of the tumor, the feeding artery, and the drainage vein were clamped. The gamma-detecting probe was then applied just along the tumor and the regional lymph nodes. Metastasis to the lymph nodes could be predicted in every case. In conclusion, detection of lymph node metastasis with 67-Ga citrate and Navigator is very useful in choosing the operative method and the range of lymphadenectomy, especially in laparoscopic colorectal surgery in which palpation is impossible.View full abstractDownload PDF (68K) -
Satoshi Hata, Sadao Amano, Kenichi Sakurai, Hiroshi Fujii, Eichi Paku, ...2000 Volume 33 Issue 6 Pages 721-724
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA case of resected adrenal metastasis of esophageal cancer is reported. A 67-year-old male underwent esophagectomy for esophageal cancer. Macroscopic examination of the resected specimen showed a type-2 advanced esophageal cancer, 13 cm in diameter, located in Mt-Lt. Histological examination disclosed poorly differentiated squamous cell carcinoma, pT3N2M0→Stage III. Eight months later, hematological examination showed a high serum SCC level, and computed tomography disclosed an abnormal low density mass, 5.5 cm in diameter, in the left adrenal gland, suggesting metastasis of esophageal cancer. Since no metastases could be identified in other organs, left adrenalectomy was performed. The resected specimen showed an elastic hard tumor, measuring 6.5×5.5×4.0 cm, with a white and solid cut surface. Histological examination revealed the same findings as in the esophageal cancer. The patient is currently doing well with no signs of recurrence 14months after adrenalectomy. To our knowledge, only one previous report of successful resection of postope-rative adrenal metastasis of esophageal cancer has been documented in the literature.View full abstractDownload PDF (89K) -
Keisuke Uehara, Hiroshi Hasegawa, Hidemasa Nagai, Seiji Ogiso, Masaya ...2000 Volume 33 Issue 6 Pages 725-729
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 71-year-old man was admitted to our hospital with nausea and vomiting. Upper gastrointestinal fluoroscopy showed a compression at the duodenal 1st portion without irregularity of the mucosa. Abdominal CT and MRI demonstrated a mass with size of 6 cm adjoining to the duodenum. He was diagnosed as having submucosal tumor of the duodenum and underwent partial resection of the duodenum. Histological findings showed spindle cells with funicular pattern. Immunohistochemically, the tumor showed negative for SMA (smooth muscle actin) and S-100 protein, but positive for c-kit (CD117) and CD34. Then, the tumor was diagnosed as uncommitted type gastrointestinal stromal tumor (GIST). Recently, the concept of the gastrointestinal stromal tumor has become to be popular among surgeons. This case is presented with some notes on the relevant literature.View full abstractDownload PDF (95K) -
Toshiaki Ichihara, Takashi Saito, Katsuhiko Suzuki2000 Volume 33 Issue 6 Pages 730-734
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThis report presents a 70-year-old man with gallbladder tumor, which was detected by ultrasonographic study at a near by clinic. The patient was referred to our hospital for further examination and treatment. On admission, alpha-fetoprotein (AFP) value was 336 ng/ml and carcinoembryonic antigen (CEA) 32 ng/ml. Ultrasonography, computed tomography and magnetic resonance imaging studies showed irregularity of the gallbladder wall. Angiography revealed a hypervascular tumor surrounded by several thick vessels. Based on a diagnosis of gallbladder cancer, partial hepatectomy (segment 4a, 5, and parts of 6 and 8), cholecystectomy and cholangiojejunostomy were performed. The resected tumor was 7×5×5 cm in size, and had invaded to the liver bed and the intrahepatic bile duct. Histopathological diagnosis was moderately differentiated adeno-carcinoma of the gallbladder. On the 42th postoperative day, AFP was 4 ng/ml and CEA 1.4ng/ml indicating normalized values. The localization of tumor markers was different in cancer cells. There have been 20 re-ports of AFP, CEA-producing gallbladder cancer in Japan. Almost all cases had liver metastasis.View full abstractDownload PDF (138K) -
Takayuki Kaneko, Sigenori Sugihara, Hironori Kobayashi, Hiroaki Harada ...2000 Volume 33 Issue 6 Pages 735-739
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSRecent advances of treatment for esophageal and lung cancer have contributed to the prolongation of survival for these cancer patients. Therefore, a second cancer after resection for these cancers has become troublesome. We experienced one case with cancers of the esophagus, pulmonary and pancreas. This case was a 71-year-old patient who underwent esophagectomy for esophageal cancer and right upper lobectomy for lung cancer, concurrently. Nine years after surgery, CT scan and magnetic resonance cholangio-pancreaticography showed a cystic lesion on the pancreatic head. This lesion was clinically diagnosed as a in-traductal papillary adenocarcinoma of the pancreas. The major problem in surgery was preservation of feed-ing artery of the gastric roll used for reconstruction of esophago-gastrostomy after esophagectomy.
Pancreato-duodenectomy was successfully performed and its right gastroepiploic artery was preser-vated. In Japan, patient with second cancer following treatment of primary esophageal or pulmonary can-cer have increased. Intensive observation for follow-up period may be necessary for early detection of second cancer and for improvement of the prognosis for such patients.View full abstractDownload PDF (141K) -
Masanori Nishioka, Masashi Ishikawa, Norikazu Hanaki, Toru Kikutsuji, ...2000 Volume 33 Issue 6 Pages 740-744
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIt has been reported that desmoid tumors usually develop in the abdominal wall or cavity after prophy-lactic colectomy in most cases of Gardner's syndrome. We describe a rare case of desmoid tumor that devel-oped in the submandibular region in a young female with Gardner's syndrome. A 14-year-old woman came to our hospital with a complaint of lockjaw caused by a giant tumor in the submandibular region. Magnetic reso-nance imaging showed that the mass, 11cm×10cm in size, was a hypointense area on the T1W1 image and slightly hyperintense area on the T2W1 image. It pressed against the pharynx and larynx. Colonoscopic ex-amination revealed five small polyps in the colon. Because the tumors adhered to the surrounding organs through rigid connective tissue and bones, complete extirpation of the tumor was impossible, and the patient was treated with sulindac postoperatively. The tumor was diagnosed as a desmoid tumor by pathological ex-amination. The patient's lockjaw has been gradually improving since the operation. Colon cancer and de-smoid tumor are the most common causes of death in Gardner's syndrome. The number and size of adenomas and desmoid tumors have been reported to be reduced by sulindac therapy. Sulindac chemoprevention is im-portant for managing patients with polyposis and unresectable desmoid tumors.View full abstractDownload PDF (89K) -
Takashi Shiroko, Naoki Yokoo, Yasuhito Kitakado, Hisaya Azuma, Takami ...2000 Volume 33 Issue 6 Pages 745-749
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 55-year-old man was admitted to our hospital because of a positive occult blood test result in stool ex-amination. Barium enema revealed several elevated lesions between the cecum and the transverse colon, and the biggest lesion, one with a stalk was in the bottom of the cecum. Endoscopic examination showed a dark-red tumor covered with mucus and a wide stalk in the cecum. After biopsy of a specimen, it was diagnosed as a tubular adenoma with moderate atypia (Group III). Ileocecal resection with lymph node dissection was per-formed, assuming a cecal polyp with low-grade malignancy. The tumor, 40×30 mm in size at the base of the appendix, was intussuscepting into the cecum like polyp type IV, in Yamada's classification. The tumor was diagnosed histologically as a tubular adenoma of the appendix. Benign tumors, especially tubular adenomas originating from the appendix, are rare. Only 14 cases, including ours, have been reported in Japan.View full abstractDownload PDF (103K) -
Hiromitsu Takeyama, Eiko Ohara, Yoshimi Akamo, Moritsugu Tanaka, Takuj ...2000 Volume 33 Issue 6 Pages 750-754
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe case of a 46-year-old man with multiple granular cell tumors of the colon is reported. The patient was admitted to our hospital with the chief complaint of abdominal pain. Barium enema and colono-fiberscopic examination revealed 3 submucosal tumors (SMT), 2-mm and 5-mm SMTs in the ascending colon and a 5-mm SMT in the rectum, with a large polyp in the cerum. The SMT in the rectum was removed by polypectomy, the polyp and the two SMTs in the ascending colon were resected by ileocecal resection. Histologically, the polyp showed adenoma. The three SMTs had the same histological features, composed of closely packed polygonal cells containing delicate acidophilic granules, and positive for S-100 and NSE (neuron-specific-enolase) and negative for dementin. The diagnosis of granular cell tumor was made. This is the third case report in Ja-pan of multiple granular cell tumors of the colon.View full abstractDownload PDF (108K) -
Tsuyoshi Igami, Hiroshi Hasegawa, Seiji Ogiso, Masaya Shiomi, Masato M ...2000 Volume 33 Issue 6 Pages 755-759
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA Case of Rectal Carcinoid Tumor 12 mm in Diameter with Lymph Node Metastasis A 26-year-old woman with abdominal pain was diagnosed by endoscopic ultrasonography as having a rectal carcinoid tumor limited to the submucosal layer at Rb and pararectal lymph node swelling. We performed transsacral resection of the rectal tumor at the patient's request. The rectal carcinoid measured 12×12mm. Tumor invasion was limited to the submucosal layer, and lymph node metastasis was one of three of resected pararectal lymph node. We have followed the patient for 7 years since surgery with no evidence of recurrence. Only 12 cases of lymph node metastasis by rectal carcinoid tumors smaller than 20mm and limited to the submucosal layer have been reported in the Japanese literature.View full abstractDownload PDF (92K)
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