The Kurume Medical Journal
Online ISSN : 1881-2090
Print ISSN : 0023-5679
ISSN-L : 0023-5679
48 巻, 4 号
選択された号の論文の12件中1~12を表示しています
  • NAOFUMI ERIGUCHI, SHIGEAKI AOYAGI, TSUYOSHI TAMAE, KAZUNORI NISHIMURA, ...
    2001 年 48 巻 4 号 p. 255-259
    発行日: 2001/12/14
    公開日: 2009/08/11
    ジャーナル フリー
    Because of its location with respect to the biliary system, carcinoma of the ampulla of Vater is considered to manifest earlier in its course of development than carcinoma of the pancreas. The most common physical finding is jaundice, which occurs in 93-100% of cases [1, 2]. This retrospective study describes the results of the treatment and prognosis for double primary cancers in which cancer of the ampulla of Vater was associated with malignancies in other organs in 5 patients who were diagnosed and treated at Kurume University Hospital. The patients included 5 men with an average age of 72.8 years. There were 3 synchronous double and 2 metachronous double cancer patients. Regarding prognoses of these patients, 1 patient with associated lung cancer died because of postoperative complications after pneumonectomy, 1 patient died due to carcinomatosa peritonei developing from the ampulla Vater carcinoma, and 1 patient died because of metastatic liver tumors from the ampullary carcinoma. In multiple cancers including ampulla Vater carcinoma, gastrointestinal cancers such as gastric or colon cancer occur frequently. Therefore, a careful gastrointestinal examination should be done preoperatively. We report our experience with 5 cases of ampullary carcinoma associated with malignancies in other organs and review the literature.
  • PIN DONG, KAZUNARI SAKATA, YOSHIMI MIYAJIMA, KEI-ICHI CHIJIWA, KAZUNOR ...
    2001 年 48 巻 4 号 p. 261-266
    発行日: 2001/12/14
    公開日: 2010/02/08
    ジャーナル フリー
    To evaluate the predictive role of the oncogene p53, the proliferating marker Ki-67, angiogenic factors platelet-derived endothelial cell growth factor/thymidine phosphorylase (PDECGF/dThdPase) and vascular endothelial growth factor (VEGF) in primary hypopharyngeal carcinoma, we immunohistochemically studied a series of 84 primary hypopharyngeal carcinoma patients who were treated at the Department of Otolaryngology of Kurume University Hospital between 1990 and 1997. The correlation of each score according to the intensity and percentage of the labeled cells with the TNM stage, histological grade, metastasis and survival status was analyzed. The positive rate of p53 was 52.4%. The percentages of Ki-67 labeled cells in patients with or without metastasis showed a significant difference (p=0.011). VEGF also showed a significant difference between the live and death groups (p<0.05) and also among the differentiation group (p<0.05). A statistically significant correlation was also seen between the score of Ki-67 and VEGF (r=0.438, p<0.001) or the score of Ki-67 and PD-ECGF (r=0.259, p<0.001), respectively. In conclusion, the present study suggests that a correlation exists between proliferating and angiogenesis, and VEGF and Ki-67 are thus considered to be possible prognostic discriminators in hypopharyngeal carcinoma.
  • HISAFUMI KINOSHITA, KOTARO HASHINO, MITSUO HASHIMOTO, TAKAHITO KODAMA, ...
    2001 年 48 巻 4 号 p. 267-271
    発行日: 2001/12/14
    公開日: 2009/08/11
    ジャーナル フリー
    We evaluated the therapeutic principles for early gallbladder cancer based on clinicopathological characteristics and outcomes in 27 patients encountered at the Kurume University Hospital between January, 1975 and December, 1999. Concerning the depth of wall penetration, 15 patients had mucosal cancers (m-cancers), and 12 patients muscularis propria cancers(mpcancers). The gross patterns were lp (pedunculated) in 16 patients, ls (sessile) in 3 patients, lla (flat elevated) in 4 patients, and llb (flat) in 4 patients. The operative procedure used was cholecystectomy (C) in 12 patients, 4 of whom underwent lymph node dissection. Full-thickness cholecystectomy (FTC) was carried out in 3 patients, one of whom had lymph node dissection. Combination of C and gallbladder bed resection (GbBR) was performed in 7 patients, 6 of whom had lymph node dissection. Combination of C and bile duct resection (BDR), and lymph node dissection was performed in 1 patient. Combination of C and GbBR and BDR, and lymph node dissection was performed in 6 patients. All the patients who underwent lymph node dissection were negative for metastasis. Of the 27 patients, 2 underwent laparoscopic operation: one with m-cancer was 79 years old, and the other with mp-cancer 86 years old. In the m-cancers, no lymphatic, venous or perineural infiltration was observed. In contrast, in the mp-cancers, lymphatic and venous infiltration each were observed in 4 patients (33.3%), although no perineural infiltration was observed. A diagnosis of gallbladder cancer was made postoperatively in 6 patients, of whom 4 hadthe llb pattern and all were complicated by gallstone, indicating the difficulty of diagnosing the llb pattern. The 5-year survival rates for the m-and mp-cancers were as high as 90.9% and 80.8%, respectively. As a curative surgical technique for m-and mp-cancers, lymph node dissection should be performed in addition to FTC, GbBR, and BDR, in combination. When a postoperative histopathologic diagnosis of gallbladder cancer has been made, no second-look operation should be performed for m-cancers, but lymph node dissection of up to the second group should be performed for mp-cancers in a second-look operation.
  • TOMOTAKA KAWAYAMA, REI FUJIKI, TORU RIKIMARU, KOTARO OIZUMI
    2001 年 48 巻 4 号 p. 273-279
    発行日: 2001/12/14
    公開日: 2009/08/11
    ジャーナル フリー
    The mortality of the influenza virus pneumonia is on the increase caused by the decline of the vaccination for the influenza virus in Japan. The purpose of our research is to study the clinical feature of severe influenza virus pneumonia that caused acute respiratory failure. This study included 68 patients with adult influenza virus infection who consulted our hospital between October 1997 and May 1999. Six (8.8%) of 68 were diagnosed as having influenza virus pneumonia that caused acute respiratory failure. All patients with influenza virus pneumonia showed severe conditions with respiratory failure and a high-risk group. Two super high age patients had emergency status with unconsciousness. A super high age patient with influenza virus pneumonia died of aspiration pneumonia 118 days after admission. All patients with influenza virus pneumonia were received antibiotics. Although 4 of 6 patients did not respond to antibiotics, adrenocorticosteroids were administered. As the result, 3 of 4 patients, healing was achieved. We concluded that adrenocorticosteroids might be useful for treating severe influenza virus pneumonia under the administration of appropriate antibiotics.
  • Feasibility and Preliminary Result
    NAOFUMI HAYABUCHI, YUKIHIRO TODA, YUTA SHIBAMOTO, ETSUYO OGO, NORIMITS ...
    2001 年 48 巻 4 号 p. 281-284
    発行日: 2001/12/14
    公開日: 2009/08/11
    ジャーナル フリー
    To utilize the high lympholytic effect of corticosteroids with minimal systemic adverse effects, we used intraarterial corticosteroid infusion in the treatment of 8 patients with primary central nervous system lymphoma (PCNSL). One patient had recurrent PCNSL, while the other patients had primary disease. Following standard radiotherapy with or without some systemic or intrathecal chemotherapy, prednisolone (60-100 mg in total) or dexamethazone (12mg in total) was rapidly infused through the carotid arteries in all patients and also through the left vertebral artery in 5 patients. No acute or late complications of this treatment were observed. All 8 patients achieved complete or partial response. Four patients died of the disease, while the other 4 were alive with (1 patient) or without (3 patients) disease at 8-37 months after treatment, giving a 2-year survival rate of 55%. Intraarterial administration of high-dose corticosteroids appears to be a feasible treatment modality. This method may be used in preradiotherapy setting to evaluate response of PCNSL in future studies.
  • An Experimental Study
    HITOSHI ODA, YUTAKA OGATA, KAZUO SHIROUZU
    2001 年 48 巻 4 号 p. 285-293
    発行日: 2001/12/14
    公開日: 2009/08/11
    ジャーナル フリー
    We have investigated the antimetastatic effect of TNP-470 against postoperative lung metastasis following the removal of human colon cancer xenotransplanted into nude rat. The KM12SM human colon cells were injected into the cecal wall. At 5 weeks after the injection, the cecum was removed including the tumor. Then, TNP-470 was administered continuously by subcutaneous injection pump at a dosage of 30 mg/kg/week. The Control Group received no administration of TNP-470. Group A and Group B received administration of TNP-470 just after the cecal removal for 4 and 2 weeks, respectively. Group C received 2 weeks' administration of TNP-470 from week 3 after the removal. The survival rate of each group was calculated, and any lung metastasis was evaluated macro and microscopically. At 7 weeks after the removal, lung metastasis was detected in all rats of the Control Group, and in 4 of 8 rats in Group C. In Groups A and Group B, only one rat developed lung metastasis. The 30 week-survival rate in Group A and that in Group B was significantly higher than that in the Control Group or Group C. Moreover, the incidence of lung metastasis at the time of death or 30 weeks after the removal in Group A, and in Group B, was lower than that in Control Group or Group C. The angiogenesis inhibitor, TNP-470 showed an excellent antimetastatic effect against postoperative lung metastasis from transplanted human colon cancer.
  • MITSUE TAKEYA
    2001 年 48 巻 4 号 p. 295-306
    発行日: 2001/12/14
    公開日: 2009/08/11
    ジャーナル フリー
    The intrinsic factors involved in the temperature-dependent impairment of neuronal activity in hippocampal CA2-CA1 regions were investigated using optical recording techniques. At 32°C, stimulation of the Schaffer collaterals in the hippocampal CA2 region evoked depolarizing optical responses that spread toward the CA1 region. The optical response was characterized by fast and slow components that were mainly related to the presynaptic action potentials and excitatory postsynaptic response, respectively. The increase of the temperature to 38°C was associated with a reversible depression of the neuronal activity in the hippocampal brain preparations. The depression of neuronal activity was irreversible when the temperature was increased to 40°C. In the presence of 22mM glucose, the depression of the neuronal activity at 38°C was significantly attenuated. Pyruvate (22mM), but not lactate (22mM), also improved the depression of neuronal activity induced by the temperature increase. Adenosine (200 μM) strongly depressed the excitatory postsynaptic response, but not presynaptic action potentials. 8-Cyclopentyl-1, 3-dimethylxanthine (8-CPT) (10 μM), an adenosine A1 receptor blocker, attenuated the adenosine-induced depression of the excitatory postsynaptic response. 8-CPT (10 μM) prevented the impairment of the excitatory postsynaptic response induced by the increase of the temperature to 38°C. In contrast, the depression of presynaptic action potential at 38°C was not prevented by 8-CPT (10 μM). Nω-nitro-L-arginine methyl ester (L-NAME), a nitric oxide synthase (NOS) inhibitor, and methylcobalamin (10 μM), a vitamin B12 analogue, attenuated the inhibition of pre- and postsynaptic activities induced by the increase of the temperature to 38°C Glibenclamide, a KATP channel blocker, did not protect neuronal activity from the effects of the increase of the temperature. These results suggest that the heat-induced depression of neuronal activity is mediated by multiple factors, such as impairment of energy metabolism and increase in extracellular adenosine and nitric oxide (NO) levels in hippocampal neurons.
  • Significance in the Long-term Follow-up Study
    KAZUO SHIROUZU, YUTAKA OGATA, YASUMI ARAKI, TERUO SASATOMI, YASUHIRO N ...
    2001 年 48 巻 4 号 p. 307-319
    発行日: 2001/12/14
    公開日: 2010/02/08
    ジャーナル フリー
    We clarify the significance of total mesorectal excision (TME), lateral lymphadenectomy (LLA), and of autonomic nerve preservation (ANP) compared to conventional surgery (CVS), for lower rectal cancer. All 458 patients curatively resected between 1962 and 1997 were retrospectively investigated. In Period I from 1962-1974, when CVS only was performed, in Period II from 1975-1984, TME or TME+LLA was performed, and in Period III from 1985-1997, TME+ANP, TME+ANP+LLA, or TME+LLA was performed. In Dukes A+B disease, there was no significant difference among the three periods, regardless of operation methods. In Dukes C disease, in Period I, CVS (42 patients: pts) had a local recurrence (LR) rate of 45.2% and 5-year disease-free survival (5YDFS) rate of 33.3%. In Period II, TME+LLA (82 pts) had a lower LR rate of 26.8% (p=0.0628) and higher 5YDFS 51.0% (p<0.05) vs CVS. In Period III, TME+ANP (12 pts) had LR 25.0% and 5YDFS 55.6%, TME+ANP+LLA (45 pts) had LR 13.3% (p<0.005, vs CVS) and 5YDFS 56.1 % (p<0.01, vs CVS), and TME+LLA (18 pts) had LR 16.7% (p<0.05, vs CVS) and 5YDFS 20.8%. Also, CVS had the lowest curability rate 64.8% and the highest mortality rate 7.2%. TME and/or LLA was significant for reducing LR and improving survival in patients with Dukes C lower rectal cancer, compared to CVS. ANP was beneficial with LLA. TME+ANP was suitable for Dukes A or B disease.
  • Report of a Case
    NAOFUMI ERIGUCHI, AKIRA MATSUNAGA, SHOJI TOKUNAGA, YASUHIKO FUTAMATA, ...
    2001 年 48 巻 4 号 p. 321-324
    発行日: 2001/12/14
    公開日: 2009/08/11
    ジャーナル フリー
    A 61-year-old woman was admitted to our hospital with abnormal findings of abdominal computed tomography. Whereas she had neither fever nor abdominal pain, a cholecystitis was suspected. Ultrasonography showed a mass in the gallbladder with several stones, and an unclear border between the gallbladder and liver. Computed tomography showed a large mass in the gallbladder with findings that seemed to indicate hepatic invasion and para-aortic lymph node metastasis. On the basis of these findings, we made a diagnosis of gallbladder cancer associated with hepatic invasion and lymph node metastasis. We treated this gallbladder tumor by hepatic arterial infusion chemotherapy via catheter with cisplatin and 5-fluorouracil. Four weeks after administration of the anti-cancer drugs, the tumorous lesion of the gallbladder could not be detected by abdominal imagings, and the gallbladder wall revealed no irregular findings. During laparotomy, the gallbladder showed signs of chronic cholecystitis, and a cholecystectomy was performed. Findings of the resected specimens showed severe inflammation, fibrosis, and bleeding in the gallbladder wall with infiltration by many foamy cells. Histopathological diagnosis was xanthogranulomatous cholecystitis. We report here a case of xanthogranulomatous cholecystitis mimicking gallbladder cancer and review the literature.
  • A Case Report
    KEISHIRO AOYAGI, KIKUO KOUFUJI, SHOJIRO YANO, NAOTAKA MURAKAMI, MOTOSH ...
    2001 年 48 巻 4 号 p. 325-330
    発行日: 2001/12/14
    公開日: 2009/08/11
    ジャーナル フリー
    We have experienced a case of advanced gastric cancer with para-aortic lymph node metastasis effectively treated by neoadjuvant continuous low dosage 5-fluorouracil and cisplatin (FP regimen). The patient was a 67-year-old man diagnosed as having advanced gastric cancer type 4 with para-aortic lymph node metastasis. This patient was treated by continuous infusion of 5-fluorouracil (5-FU) 500 mg/day, for 28 days, and infusion of Cisplatin 10 mg/day over 1 hr on days 1-5, 8-12, 15-19, and 22-26. At 4 weeks later, a CT revealed that swelling in the para-aortic lymph node had disappeared, and the thickening in the stomach wall had diminished. This patient underwent a curative operation, and both the serum level of carcinoembryonal antigen (CEA) and carbohydrate antigen (CA 19-9) decreased to normal. These results suggested that the FP regimen was an effective neoadjuvant treatment for advanced gastric cancer with para-aortic lymph node metastasis.
  • NOBUTAKA IWAKUMA, YASUMI ARAKI, YOSHIAKI TSUJI, ATSUSHI MATSUMOTO, HIR ...
    2001 年 48 巻 4 号 p. 331-333
    発行日: 2001/12/14
    公開日: 2009/08/11
    ジャーナル フリー
    We present a case report of a 62-year-old man with adhesive ileus caused by paracolostomy hernia. The patient underwent enterosynechotomy for ileus and colopexy for paracolostomy hernia laparoscopically. This procedure has benefits of prevention of recurrent adhesive ileus and early Dostooerative recovery of the intestinal tract.
  • A Report of Two Cases
    KEISHIRO AOYAGI, KIKUO KOUFUJI, SHOJIRO YANO, NAOTAKA MURAKAMI, MOTOSH ...
    2001 年 48 巻 4 号 p. 335-338
    発行日: 2001/12/14
    公開日: 2009/08/11
    ジャーナル フリー
    We have experienced two cases of long-term survival after surgery for gastric cancer case with liver metastasis. One case was of a 66-year-old male patient diagnosed as having type 1 advanced gastric cancer located in the posterior wall of the lower body with liver metastasis. The stage of this case was POH1 N1T2M0 stage IV. This patient underwent distal gastrectomy with D2 lymph node resection, partial hepatectomy of the S3 region including the metastatic liver tumor and coagulation of metastatic liver tumors in the S6 and S7 regions. This patient was treated by intrahepatic arterial infusion of 5-FU, CDDP and peroral administration of UFT after surgery. This patient has died at 3 years and 7 months after surgery. The other case was of a 55-year-old male patient diagnosed as having type 2 advanced gastric cancer located in the lesser curvature of the cardia with liver metastasis. The stage of this case was POH1N1T3 M0 stage IV. This patient underwent total gastrectomy with D2 lymph node dissection, wedge resection of the S8 region including the metastatic liver tumor and coagulation of a metastatic liver tumor in the S4 region. This patient was treated by obstruction of the hepatic artery using coils, peroral administration of UFT, lentinan, MMC, and continuous low-dosage 5-FU and CDDP after surgery. This patient has died at 3 years and 6 months after surgery. These results suggest that for long-term survival in cases of gastric cancer with liver metastasis, hepatectomy or coagulation of the metastatic tumor with postoperative chemotherapy are indicated in cases that have no non-curative factors and only a few metastatic tumors.
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