Acillary lymph nodes of 50 breast cancer patients were examined by ultrasonography (US) preoperatively and those findings were analyzed and compared with histological ones of the metastases.
Axillar dissections were performed to examine metastases histologically.
Metastatic lymph nodes were detected as definitely lower echoic lesions compared with fatty tissue with distinct or sometimes a little vague margin.
Results (US/palpation) were; 0.80/0.50 in sensitivity, 0.87/0.93 in specificity, and 0.84/0.76 in accuracy.
US showed a higher sensitivity but a lower specificity compared with palpation method. In addition, US could detect 6 cases of positive lymph nodes for which palpation failed to find.
From these findings US can be thought an available preoperative diagnostic method with fewer false-negative in detecting axillar metastasis of breast cancer.

View full abstract

In addition to the former report that has described the method and availability of CT imaging of regional lymphnodes of the breast, this paper offers the outcomes of CT diagnosis in visualizing the metastases in regional lymph nodes including 1a, 1b, 1c, 2, and 3.
1) CT visualization succeeded in 69.3% of all lymph nodes tested. When the lymph nodes were limited to those having diameters of 3mm or more, the figure was increased to 81.4%. 20 CT diagnosis of lymph node metastasis was rated as "accuracy" in 76.2%, "sensitivity" in 76.0%, or "specificity" in 76.5%. 3) CT diagnosis resulted in false-negative in 6 (31.6%) cases, but all the 6 cases were categorized into n1α (less than 3 metastases) and included no cases with n1β or severer. 4) In regions where metastasized lesions could not be palpated, CT succeeded in correctly diagnosing with so favorable rates as 90.2% in 1c; 87.2% in 2; and 66.7% in 3, which were similar in axillary resions.
These findings have suggested that preoperative diagnosis with CT can be used in whole regional lymph nodes of the breast, with clinically appreciable, results.

View full abstract

Surgical treatment for thymoma is studied by analyzing causes of postoperative recurrences and deaths by stages in 76 patients operated on for thymomas, consisting of 21 in stage I and 55 in stage II, III and IVa. Of the 76 patients, 41 had myasthenia gravis (MG) and 26 received irradiation. Recurrence of the tumor occurred in 4 patients in stage II, 2 of which associated with MG. Of the 4 patients, thymomectomy was carried out in one without postoperative irradiation, and total resection including normal thymus tissues (complete resection) in the remained 3 patients. Death after surgical treatment occurred in 10 patients, one in stage II, 7 in stage III, and 2 in stage IVa, each five of whom underwent complete resection and incomplete resection respectively with irradiation in each 2 of the 5. Causes of the deaths included tumors in 4 patients, MG in 4 and postoperative complications in 2.
These findings have suggested that stage I tumors may be treated with thymomectomy or complete resection with or without postoperative radiotherapy; stage II or more advanced tumors, especially those associated with MG, should be treated with complete resection as well as radiotherapy, where the tumor must be resected as complete as possible; and radiotherapy is effective for stage III and IVa tumors.

View full abstract

In order to know a relation between therapeutic results of mechanical valve replacement and the age at the operation, patients with acquired valvular heart disease were comparatively studied on their pre- and postoperative states by age group-According to age at the time of operation, the patients were classified into 3 groups; Group A: under 40, group B: from 40 to 59, and group C: over 60 years old-When analysed preoperative states, Group A and C had nonrheumatic lesions in higher rate, but no difference in other various values was found among the 3 groups. The operative mortality rate, days for ICU stay, postoperative incidence of cardiac or other organ failure, and the actuarial postoperative survial rate were also similar in all 3 groupsl Postoperative improvements in NYHA class were observed in group C as well as in group A and B. Systemic thromboembolism was not prevalent in group A and C, whereas the incidence of thromboembolism was 0.77%/patient-year in group B. Cerebral bleeding resulting from the reversed effect of anticoagulant therapy especially occurred in patients of group C, thus the incidence of this complication was 2.97%/patient-year in this group.
In conclusion, though the main causes of valvular heart disease were different in each age group, the results after mechanical valve replacement were similar and satisfactory. Cerebral bleeding was a fatal complication in the elderly patients, so strict management with anticoagulant therapy was necessary throughout the follow-up period.

View full abstract

A diagnosis of Exulceratio simplex (Es) or Es-like lesion has recently been made under endoscopic observation. Treatment, i.e. hemostasis, is also often done endoscopically. Reports on a follow-up study after endoscopic manegement, however, are extremely rare. Therefore, clinical value of endoscopic manegement for Es is still unknown. This paper reports on a follow-up study of endoscopic treatment for 16 cases of Es and Es-like lesion.
In 3 out of 16 cases, operative hemostasis was performed; each one underwent subtotal gastrectomy, wedge resection of the bleeding point, and simple closure of the bleeding artery, respectively.
All of the other 13 cases were successfully treated with endoscopic hemostasis. i.e. local injection of pure ethanol (ETH method). Four not of these 13 cases died of preexisting severe complications but not of recurrence of Es. There is no sign of recurrence in the remained 9 cases during the observation periods ranging from 25 to 59 months. These results indicate a clinical significance of endoscopic hemostasis of Es and Es-like lesion.

View full abstract

Recently, the autosuture has been introduced to Japan and comes to a wide use even in esophago-jejunostomy. Since 1984 we have been carrying out esophago-jejunostomy in total gastrectomy cases using an autosuture EEA made in the U.S. In this paper, the autosuture anastomosis is compared to manual one to clarify its merits and demerits.
Subjects were 187 cases undergone total gastrectomy (ρ-Roux-Y anastomosis) at our department for recent 12 years (January 1976-December 1988), which included 85 cases of manual anastomosis and 102 of autosuture one.
The following results could be drawn;
1) When compared to the manual group, a lower tendency in the occurrence of postoperative complications such as failure of the sutures, hemorrhage, and stricture, or postoperative reflux esophagitis was shown in the autosuture group.
2) In the static pressure curve of the esophagus, the autosuture revealed greater tone and length and a lower pressure garadient, particularly which was as lower as showing a negative quantity.
These findings appear to indicate a superiority of the autosuture to the manual one in esophago-jejunostomy.

View full abstract

Therapeutic problems in 15 patients with partially resected hepatocellular carcinomas were studied.
Significant differences in preoperative values of ICG-R₁₅, OGTT linearity index, serum platelet counts and postoperative score of hepatic function were noted between patients with and without esophageal varices. Three patients who underwent partial hepatectomies combined with non shunting operations for esophageal varices were complicated by postoperative hepatic failure. For the limitation of anatomical aspect, 4 patients were not curatively resected due to TW factor.
These results suggested that simultaneous surgical treatment for esophageal varices complicated with hepatocellular carcinoma should cause some damages to patients who were indicated partial hepatectomies, therefore preoperative endoscopic sclerotherapy should be first selected for these patients. For the local recurrence of partially resected hepatocellular carcinoma, propylactic portal infusion chemotherapy is considered to be a useful postoperative thrapy.

View full abstract

Cumulative recurrence rate and modes of intrahepatic recurrence were studied on 59 patients underwent curative and relative curative hepatectomies. Intrahepatic recurrences were occurred in 24 patients (40.7%) and the cumulative recurrence rate was significantly higher in patients underwent noncurative hepatectomies, and in those with large tumor sizes (>3cm in diameter)and positive tumor invasion to the portal vein at the time of hepatectomy. Eight solitary intrahepatic and 16 multipe intrahepatic recurrences were noted. Relevant factors to multiple recurrent modes included factor T, stages and positive tumor embolus in the portal vein. In all solitary recurrent cases including 3 resection cases, active regional therapies such as transcatheter arterial embolization and continuous intrahepatic arterial infusion chemotherapy were successfully performed. In the multiple recurrent cases, however 7 cases could not receive such regional therapies but only systemic chemotherapy because of impaired liver function. Cumulative survival rate after recurrence in patients with solitary recurrences was significantly better than those in multiple ones. Regional therapies are effective in prolonging the survival period of patients bearing intrahepatic recurrences after hepatectomy.

View full abstract

A sequential arterial bypass has been recommended as the surgical treatment for severe lower limb ischemia in patients with complex multi-segmental arterial occlusion. To evaluate this alternative technique clinically, sequential grafting was performed on 14 limbs; 14 patients with the manifestations of intermittent claudication (2), rest pain (8) and nonhealing ulcers (4). Sequential aortofemoro-popliteal bypass grafting was performed on 7 limbs, ilio-femoro-popliteral bypass grafting on 3 limbs and femore-femoral crossover-popliteal bypass grafting and femoro-popliteral-posterior tibial bypass grafting on 2 limbs each.
Among the 14 patients, one died in the perioperative period from cardicac arrest and another succumbed to renal failure 57 months after surgery. A total graft occlusion of the sequential graft occurred in two patients during the 57 month follow-up period. One patient (22 months after a sequential bypass) showed a symptomatic remission while undergoing a conservative therapy, but the another (7 months after operation) required an amputation below the knee.
Measurement of the segmental Doppler arterial pressure revealed a significant increase in the ankle brachial index from 0.31±0.22 before the operation to 0.83±0.17 three weeks after the operation. Ten limbs showed a remission in the clinical symptoms, while 2 limbs showed no change during the 57 month follow-up period.
Sequential bypass grafting is considered to be a useful alternative method for limb preservation.

View full abstract

The venous ulcers of the lower extremities caused by venous occlusion or venous valve incompetence are refractory to treat and liable to recur. For the past 10 years, 12 cases of venous ulcers with varicose veins of lower extremities were subjected to surgery. Preoperative evaluation by Doppler blood flowmeter and venography revealed that all cases had the valve incompetence of superficial and perforating veins, and the deep veins were all patent. At surgery the ulcer and severe lesions of stasis dermatitis were excised, and the skin grafting was added to the stripping and ligation. Postoperative complications included an edema of the cruris, wound infection at the grafting site, peripheral neuralgia and decreased sense of the foot in one case each. However the complications were all improved at the discharge from hospital. All ulcers were cured in the follow-up periods of 8 months to 9 years the average of 6.1 years, and all cases returned to the former jobs including standing works. The results of surgical therapy for venous ulcers were favorable depending on detection of the cause and choice of the appropriate operation. There was no problem on the concomitant operation of the resection of the ulcer, skin grafting and vein stripping, by paying attention to the infection.

View full abstract

The cost of surgical treatment in 237 gastrectomysed patients with gastric cancer was analysed according to the histological classification, stage radicallity of lymph node dissection (R) and four-year overall survival rate, and the results were:
1) The total hospital charge in early gastric cancers was one third of that in the advanced ones.
2) In stage II and III, the charge for operative method R₃ was the most expensive. In stage IV, the charge for operative method R₀ or R₃ was more expensive than others.
3) It costed 48 cases (20%) over two million yen, in which cases operated on by operative method R₂ or R₃ were common.
4) A large amount of hospital charge was mainly accounted for expensive drugs, intravenous drip infusions, blood transfusion, and surgical treatments.

View full abstract

Jugular venous aneurysm occurs so rarely that only 19 cases including this case have been reported in Japan, in which venous aneurysm was found at the left external jugular vein.
A 7-year-old boy complained of a soft tumor on the left supraclavicular fossa that was first found 5 months before and started to enlarge with pain from about a month before. The tumor 20×20mm in size was Valsalva test-positive. Ultrasonography and venography revealed a venous aneurysm, which was excised under local anesthesia. Histopathologic findings revealed that the vein had an organic thrombus on its dilated lumen without abnormalities on the vascular wall.

View full abstract

Nonepithelial malignant tumors of the breast are relatively uncommon diseases, and few cases of the stromal sarcoma of the breast has been reported. Recently, we experienced a case of 76-year-old woman who had been referred to our hospital due to a well-difined, elastic hard mass in her left breast. The diagnosis of cystsarcoma phyllodes was determined by clinical findings and simple left mastectomy was performed. The histopathological diagnosis was stromal sarcoma of the breast. The patient has been discharged as her wound cured, and kept under medical surveillance for three months. Nowadays, no symptoms of recurrence nor remote metastasis has occurred.
We also reviewed previously reported 16 cases of this uncommon disease, and discussed the matter of diagnosis and therapies.

View full abstract

Four patients with idiopathic Budd-Chiari syndrome with occlusion of the hepatic veins and significant obstruction of hepatic segment of the inferior vena cava were presented. All but one patients were treated with transatrial bimanual finger fraction method and trans-infrahepatic inferior vena cava thromboendoarterectomy. For postoperative restenosis or reocclusion, percutaneous transluminal angioplasty was applied. All patients required a total of two four times of angioplasties during follow-up period ranged from 24 to 79 months. All three patients redeveloped swelling and pigmentation by venous congestion of their legs and showed remarkable improvement of endoscopic findings of esophageal varix and ICG liver function examination. No serious complication was reported.
In conclusion, this operation is a safe method for Budd-Chiari syndrome, even in the case of long segment obstruction; percutaneous transluminal angioplasty is a safe and effective mode of therapy in the management of postoperative restenosis of the inferior vena cava; and adjoining successful angioplasty is accompanied by long term dramatic regression of clinical symptoms.

View full abstract

We have experienced a total of 8 patients operated on for pulmonary arteriovenous fistula in the past, consisting of each four males and females with the average age of 34.7 years. One of the 8 patients had a multiple arteriovenous fistula in the bilateral lungs, and two were complicated by Rendu-Osler-Weber disease. Lobectomy and segmentectomy were performed in 5 and 3 patients respectively.
To reserve the pulmonary function, limited lung resections were applied in the recent 4 cases, including segmentectomy in 3 and middle lobe lobectomy in one case.
The most recent case, a 57-year-old female who had an abnormal shadow in the right lower lung field on a chest X-ray film, was diagnosed as right pulmonary arteriovenous fistula complicated by Rendu-Osler-Weber disease. Pulmonary arteriogram revealed a solitary arteriovenous fistula in the right lower lobe. Pulmonary segmentectomy including affected part of the lung was performed. The postoperative course was uneventful, and she was descharged on the 18th day after operation.

View full abstract

Sclerosing hemagioma of the lung is a relatively rare disease, and has been ragarded as a benign tumor arising in the alveolar epithelial cells. Recently, however, the malignant cases have been found. We report two cases of the disease, together with a review of the domestic reference.
Case 1 is a 42-year-old female who had a round shadow, 4×3cm in size with smooth and clear edge, in the right lower lung field, which was found at physical examination. Bronchographic examination showed a suppressed peripheral branch B⁵, in which incisurae were found by CT. The middle lobe was resected.
Case 2 is a 48-year-old female who had atelectasis of the middle lobe and a round shadow of 3×2.5cm in chest X-ray film taken at when she suffered from fever. Bronchographic examination revealed a narrowed and suppressed introitus of the middle lobar branch, a convergence of peripheral branches, and a passage of the contrast medium into around the tumor. Bronchial angiography revealed a new formation of the peripheral vessels of the tumor, that is, so-called melon-peel-like stitched vascularity. The middle lobe which presented atelectasis as well as the tumor was resected.
In both case 1 and 2, pathologic findings suggested a sclerosing hemangioma without heterologous cells in the tumor and no sign of lymph node metastasis.

View full abstract

A case of corrosive gastric necrosis has been reported. This case was a 46-year-old man who ingested the nitrate (60%, 150ml) for suicide attempt. Two hours after the ingestion, he was admitted to the hospital only complaining of slight tender pain in the epigastrium.
Upper gastrointestinal series revealed a dilatation of gastric angle and rigidity of both curvatures. Endoscopically, the yellowish-brownish discoloration and the hemorrhagic erosion were observed on the lower esophagus and whole stomach.
At 17th day of the hospitalization, he was attacked severe epigastric pain with bloody vomitus. Emergent surgery was performed and rank odor bloody ascites, necrotic whole stomach and dense adhesion of the surrounding organs were demonstrated.
In the case of caustic ingestion, clinical signs and symptoms are not related parallelly to the severity of the injury. Therefore, it is difficult to determine the necessity of surgical intervention for this disease. The usefulness of endoscopic examinaiton has been emphasized, in which it is suggested that discloration of the gastric mucosa or the base of ulcer to brownblack manifest the full-thickness necrosis. On the other hand, it is recognized that the radiological diagnosis has not so helpful findings on acute stage. But in this case, intramural air sign of the gastric wall could be detected in the plain X-ray films at the 6th hospitalized day, retrospectively. These variable signs are considered the findings suspecting a mucosal gangrene.

View full abstract

A case of squamous cell carcinoma arising in the body of the stomach is reported to describe its characteristics and the tissue generation, together with some discussion of the literature.
The patient was a 59-year-old male, with the cheif complaint of epigastric pain. Gastroscopy revealed a tumor (Borrmann type II) on the posterior wall of the body of the stomach. Biopsy of the lesion was performed, and squamous cell carcinoma diagnosed. The pyloric side of the stomach was resected and R2 curettage was performed. squamous cell carcinoma diagnosed. The pyloric side of the stomach was resected and R2 curettage was performed. Adenocarcinomatous tissue was not found in any other region. Metastasis to lymph nodes was positive to group II. Squamous cell carcinoma was noted in all the metastatic lesions.
Cases of squamous cell carcinoma in which adenomatous tissue is not observed, as in this case, are very rarely found; there have only been six such cases documented thus far in Japan.

View full abstract

A duodenal lipoma in a 65-year-old woman with descending colon cancer and cholelithiasis was recently experienced. The duodenal lipoma was detected as an elevated lesion at the 3rd portion of the duodenum in upper GI series, but not observed endoscopically. Left hemicolectomy, R2 lymph node dissection, cholecystectomy, and tumor extripation with duodenotomy were performed. The duodenal lesion was exactly diagnosed as lipoma according to intraoperative finding and histological finding postoperatively.
Duodenal lipoma is a rare disease, and 51 cases have been reported in Japan. The characteristics and symptoms of the disease, and treatment methods were discussed together with reference to the literature.

View full abstract

A case of duodenal carcinoid with acholecystopathy has been reported.
A 73-year-old man was found to have a duodenal polyp by gastric endoscopy. Hypotonic duodenal roentgenography revealed a submucosal tumor of the duodenum. Moreover, computed tomography (CT) and endoscopic retrograde series of the cholepancreatic duct (ERCP) demonstrated no evidence of the cholecyst nor cystic duct. These findings had suggested a submucosal tumor of the duodenum with acholecystopathy, and duodenotomy and tylectomy were peformed. Postoperative pathologic findings indicated a carcinoid. During operation, only white corpus restiforme could be found on the floor of liver, which was consistent with the diagnosis of acholecystopathy. He has passed away an uneventful postoperative course for 3 years, and no signs of recurrence have been found.

View full abstract

The patient was a 58 year-old woman with recurrent Crohn's disease who had undergone surgical intervention three times. Curative operation was difficult to perform on this patient because of formation of a internal fistula between the small intestines with severe intra-abdominal adhesion. The bypass with an exclusion was carried out and brought on a remission. Therapeutic effect of the bypass with mucous fistula was demonstrated.

View full abstract

We have experienced ten cases of pseudomembranous enterocolitis following antibiotic therapy, all in which histological examinaitons revealed the patched pseudomembranous formation. The disease was as common in females as shown in the male-to-female ratio of 2:8. Early symptoms were commonly diarrhoea, fever and abdominal pain in the 8 survival cases, while nausea, vomitting and abdominal distention (palalytic ileus) in the 2 non-survival cases. Those symptoms appeared 7.25±10.27 days after antibiotic therpy in the former and 2±1.41 days in the latter, indicating a significant shorter duration from the chemotherapy to the onset of initial symptoms in the non-survival cases. Two out of the survival cases were accidentally injected the same antibiotic as previous causative one for the disease, but no clinical signs and symptoms were found.

View full abstract

A case of jejunal diverticulosis with massive melena, of which bleeding point was locally diagnosed by preoperative angiography, is reported.
A 52-year-old male with the complaint of massive melena was admitted in pre-shock state. As anemia was not improved by conservative therapy and selective superior mesenteric angiogram revealed a bleeding lesion in the jejunum, emergency operation was performed. Two diverticula were recognized at the mesenteric border of the jejunum about 50cm and 130cm below the ligament of Treitz. Both of them were bilocular, and linear ulcers were found at their septums. A stump of artery was exposed in the ulcer of oral side diverticulum and the source of the bleeding was found macroscopically.
Histopathologically a linear ulcer and ruptured artery at the bottom of the ulcer were shown and the additional discussion was made from a point of clinical surgery.

View full abstract

The authers describe a case of lymphangioma of the sigmoid colon that is a rare one among the rare nonepitherial tumors of the sigmoid colon. In addition 53 lesions of 52 cases of the disease roported in Japan were reviewed.
A 69-year-old man complained of abdominal pain. Barium enema examination revealed a hemispherical torose lesion at the sigmoid colon. Endoscopy of the colon exhibited a smooth surface and a possible retention of liquid. Accordingly he was diagnosed to have a cystic disease and operated on. Resected specimen revealed a lesion of 5×4cm in size involving clear liquid internally. Histologically, it was a cavernous cystic type.
A review of the domestic 52 cases with the average age of 55.6 years (20-78 years) revealed that the disease was more common in men rather than women as shown as the male-to-female ratio of 35-to-17. The site where the cyst was most frequently found was the transverse colon in 20 cases followed by the ascending colon in 15 cases. It was common that the patients were operated on under a preoperative diagnosis, submucous tumor, however, polypectomy might enable us to make the definite diagnosis.
Lymphangioma of the sigmoid colon is comonly treated with surgical resection, but endoscopical polypectomy is available if it is indicatable.

View full abstract

Hematogenic metastatic pattern of rectal cancer usually takes a multiple form, and metachronically isolated metastatic tumors are rarely resectable.
We have encounted such a rare case, in which both metastatic liver and lung cancers developed 3 and 8 years respectively after the initial resection of primary rectal cancer, were successfully resected. The patient, a 68-yearold woman, showed a normal serum CEA level pre and post initial surgery, however, it suddenly turned into so high level might be a valuable indicator for preoperative diagnosis of recurrence.
Postoperative course was uneventful and she has a disease-free period for 2 years with no sign of recurrence.

View full abstract

A case of gallbladder stone associated with portal cavernous transormation is reported, which was diagnosed by angiography and confirmed by cholecystectomy. The portal vein of hte patient, a 60-year-old female, was not obstructed but stenotic, and wormlike collateral vessels were seen. At the stenotic portions calcified lymph nodes were commonly observed. Mild inflammation of the gallbladder and normal bile duct and pancreas were seen, indicating that lymphadenitis, of which cause could not be clarified, probably caused the portal obstruction.

View full abstract

We propose herein to report a recently observed case of gallstone ileus with cholecystoduodenocolic fistula. A 69-year-old woman was suspected an intestinal obstraction because of her complains of intermittent vomitting and upper abdominal pain. Pneumobilia in the plain roentgenogram of the abdomen suggested a gallstone ileus. Further examinations were performed under controlling of water, electrolytes and nutrition with total parenteral nutrition.
Upper gastrointestinal roentgenogram showed an impacted filling defect in the distended jejunum, and an abnormal early appearance of contrast meal in the ascending colon via a fistula from the duodenum. Computed tomography of the abdomen showed two stone densities in the jejunum, one is impacted and the other is floating (density No. 135-141). Findings of Barium enema demonstrated a duodenocolic fistula. Endoscopic findings of the duodenum showed two separated fistulas and endoscopic retrograde chorangiogram showed an appearance of cholecystoduodenocolic fistula.
Preoperative diagnosis was established as gallstone ileus with cholecystoduodenocolic fistula. Transvers colostomy, separation of the cholecystoduodenal fistula, closure of the duodenal wall and additional distal gastrectomy were performed. The postoperative course was uneventful.

View full abstract

We encountered a very rare case of traumatic disruption of the pancreas accompanied with traumatic renal infarction.
Although vital signs and urine volume were stable, the disruption of the pancreas and the left renal infarction were suspected by abdominal CT scanning. The body of the pancreas and splenic vein were disrupted. Distal pancreatomy and simultaneous splenectomy were done. The left kidney which seemed to show irreversible infarction was removed.
Many cases of traumatic renal infarction have been reported in Europe and the U.S.A., but only 19 cases have been reported in Japan. Almost of these cases were diagnosed several days after injury. This case could be diagnosed relatively earlily, however, the kidney already fell in irreversible infarctin. We conclude that it is necessary to diagnose much earlier, bearing a suspicion of this disease in mind, in order to salvage the kidney by some ways such as recanalization, renal autotransplantation and by-pass grafting.

View full abstract

A 44 year-old male was admitted to our hospital because of a rapidly increasing abdominal tumor. Angiography and computed tomography led to a pre-operative diagnosis of tumor originating in the left kidney. Tumor-resection with descending colonectomy was performed. The tumor measured about 24×19×11cm with retroperitoneal invasion. Histopathological diagnosis was renal tuberculosis.

View full abstract

It is a fact that we are hardly available an effective drug for advanced renal cancer, and the efficacy rate is as low less than 10% even if multiple drug regimens were included. We have experienced a case of renal cancer in which interferon sustained infusion therapy was succeeded in reducing an inferior vena cava extension due to tumor cells.
A 50-year-old female presented with right upper abdominal tumor. X-ray examinations (CT scan, MRI, Echo, and Angiogrphy) show the right renal cancer with a large involvement of vena cava, which was estimated as Stage IIIA. To reduce the tumor embolus of inferior vena cava, the catheter was inserted to the renal artery, and preoperative chemotherapy was performed.
In combination with our modified VAU therapy, consisting of intra-arterial local injection of vinblastin+ lipiodol, and adriamycin every 4 weeks and daily oral administration of UFT, r-interferon-α-2a was given continuously using infusion pump.
After 3 months the tumor thrombus markedly reduced, and the reponse rate resulted in 70%. The right nephrectomy was performed with partial resection of inferior vena cava easily and safely.
Side effects observed by the interferon sustained infusion regimen were as the same level as those by the intra-muscular administration, which were transient and mild. These findings have indicated that the intraarterial infusion of interferon-α is a useful and safe method for renal cancer.

View full abstract

A 63-year-old male had developed massive ascites caused by liver cirrhosis. An umbilical hernia was complicated to a rupture at the extremely distended abdomen. About 7, 000ml of the ascites gushed out.
His general condition did not appear so serious at transportation to the hospital. The emergency operation was carried out. The hernia sack adherent to the skin was resected as a whole. Then the peritoneum, the rectus muscle with sheats and the skin were sutured edge-to-edge tightly.
His postoperative course was not eventful except infection on the abdominal wall resolved by antibiotics. There was no evidence of recurrence of the hernia.

View full abstract

A 78-year-old hypertensive man complained of an enlarging and painless pulsating tumor in the lowe third of the left forearm. Since angiographic findings showed an aneurysm of radial artery and a sufficient blood supply to distal hand, aneurysmectomy without reconstruction was done. In the macroscopic findings the aneurysmal size was 6×4×3cm and the continuity around the wall was reserved. The organized thrombus and the relative fresh thrombus formed layer to layer in the mural cavity. Pathologically atherosclerotic change was clearly seen at the aneurysmal wall.
His postoperative course was uneventful and no ischemic change on the maniphalanx was found.
Atherosclerotic true anerysm of radial artery was actually rare.

View full abstract

During recent 5 years, prosthetic reconstruction using PTFE (IMPRA^R) was performed in 27 cases of 22 patients with arterio sclerosis obliterans (ASO). Early obstruction within 6 months was encountered in 2 cases (7.4%) and anastomotic stenosis due to an intimal thickning was experienced in 3 cases (11.1%). Thrombectomy was performed in the patients with early obstruction and regrafting was needed for stenosis of intimal proliferation. Cumurative event free rate was 70.3% during 42 months postoperatively. Anastomotic stenosis caused by the intimal thickning happened despite administration of antiplatelet agents. Balloon angioplasty through the prosthetic wall is a possible surgical procedure alternative to regrafting to enlarge an anastomotic stenosis.

View full abstract