Achalasia of the esophagus is a disease of unknown etiology characterized by disordered esophageal motility. The purpose of this study was to investigate the difference between the motor disturbances of achalasia and that of the vagotomized esophagus. Bilateral vagotomy was performed at the cervical portion in one side and in the hilum in another side on 70 dogs. The post-operative observation was done from 3 days to 10 months. The effect of vagotomy were evaluated by the changes in esophageal motility, as determined by clinical observation, roentgenography and manometry. All tests of the motor function were done while these dogs were unanesthetized. 1. After bilateral vagotomy, they vomited all fluid and food immediately after recovering from anesthesia. Weight loss was remarkably recognized after vagotomy in all cases. The operative mortality rate within 2 weeks was 58.6% and 1 month survival rate was 27.1%. 2. Cinefluorography revealed marked dilatation of the lower portion of the esophagus and retension of contrast medium after swallowing in all of the vagotomized dogs. Esophagograms revealed a narrowing at the gastroesophageal junction and a mild dilatation of the terminal esophagus. No normal peristaltic wave was seen in all cases. 3. Manometrically, the frequency of the response after deglutition was seriously reduced and there was only observed a simultaneous contraction in the lower portion of the esophagus after vagotomy. The resting pressure at the gastroesophageal sphincter in vagotomized dog was significantly decreased and sphincteric relaxation was poor or absent. No recovery of peristaltic contraction was recognized even in 7 months after vagotomy. 4. The specimens of the esophagus were stained by Hematoxylin-eosin in 6 vagotomized dogs and the ganglion cells were examined. Degeneration or absence of myenteric ganglion cells was not noted histologically. 5. The motility difference between the esophagus of achalasia and the vagotomized esophagus was that the resting pressure of the gastroesophageal sphincter was within normal limit in case of achalasia but decreased in vagotomized dogs. Furthermore, changes of the Auerbach's plexus was not observed in vagotomized dogs.
1. Previously we used side-viewing fibergastroscope type, CL (FGS-CL) for the observation of the colon as the basic study of the fibercolonoscopy. Of the 27 cases examined by FGS-CL, we succeeded in insertion into the transverse colon in 2 cases and into the descending colon in 13 cases, comprising 56% (15/27). The figure of the scope along the sigmoid colon was found important for the further insertion. We presented one case of colon carcinoma successfully observed and biopsied by side-viewing scope. 2. Owing to the recent advance in the fibercolonoscope, thorough examination of the entire colon has become possible. Of the 27 cases examined by, we introduced the fibercolonoscope (FCS, Machida) into the transverse colon and the cecum in 84%. We explained how we succeeded in introduction of the FCS into the cecum, and emphasized the difficulty in passing the sigmoid colon and especially the transverse colon. 3. We introduced the fibersigmoidscope (FSS, Machida), produced for the observation of the sigmoid colon where lesions are common next to the rectum. In all the cases examined by the FSS we succeeded in observation of the sigmoidcolon. We showed one case of carcinoma of the sigmoid colon which previously we failed to find both by barium enema and romanoscopy. 4. Finally we compared the efficiencies of side- and frontal-viewing fiberscope for the colonic examination.
Leiomyosarcoma of esophagus is an uncommon disease, so any paper reporting that a patient with leiomyosarcoma of esophagus survived over 5 years after operation connot be found in Japan. Our case, 52 years old man, was admitted to National Cancer Center Hospital complaining dysphagia. Examination revealed that the tumor existed at the mid-thoracic esophagus. Operation was done at Dec. 9, 1964. The tumor was enucleated easily. Histological diagnosis of this tumor was leiomyosarcoma of esophagus. Three years and two months after the operation, tumor in the m. biceps brachii of right arm was enucleated. And 3 years and 4 months after the first operation, tumor in the m. flexor digitorum superficialis of right arm was also enucleated. Then, 4 years and 8 months after the first operation, tumor in the m. brachialis of right arm was enucleated. Histologically, these three intramuscular tumor was diagnosed as metastatic leiomyosarcoma. This patient, although 3 intramuscular metastasis was found and operated upon, is now well and working healthy, 5 years after the operation for esophagus.