Azusa Ozaki

Randomized controlled study of postoperative adjuvant immunochemotherapy with Nocardia rubra cell wall skeleton (N-CWS) and Tegafur for gastric carcinoma

SummaryWe performed a randomized controlled study of postoperative adjuvant immunochemotherapy with Nocardia rubra cell wall skeleton (N-CWS) and Tegafur for gastric carcinoma between September 1979 and March 1983. A total of 309 patients were entered into this trial. Of the 309 patients, there were 98 evaluable patients in the chemotherapy group and 115 evaluable patients in the immunochemotherapy group. In both groups, Tegafur was given as chemotherapy at a daily dose of 400 to 800 mg, starting at 24–29 days after gastrectomy. In the immunochemotherapy group, 400 μg of N-CWS was injected i. d. within the 2nd postoperative week. It was given weekly during the first month and subsequently monthly for as long as practicable. The patients were surveyed for length of survival in March 1985. The postoperative survival rate was analyzed for all cases, and for patients with various histopathological stages of carcinoma for comparison between the two treatment groups. No statistical difference was detected between the two groups in terms of age, sex, surgical curabilities, or stage of carcinoma. The overall survival rate for all patients was significantly higher in the immunochemotherapy group than in the chemotherapy group (p<0.05). With stage III plus IV disease, 53 patients from the chemotherapy group and 61 patients from the immunochemotherapy group were included for the analysis. As a consequence, a highly significant survival rate was observed in patients with stage III plus IV carcinoma in the immunochemotherapy group (p<0.005) as compared to the chemotherapy group. The overall 5-year (1800 days) survival rate after surgical treatment was 60.2% for the chemotherapy group and 73.2% for the immunochemotherapy group. In patients with stage III plus IV disease, the 5-year survival rates of the two treatment groups were 28.8% and 52.4%, respectively. Accordingly, the 50% survival period of patients with stage III plus IV cancer was 1800 days or more in the immunochemotherapy group, whereas it was only 722 days in the chemotherapy group. These results emphasize the effectiveness of N-CWS as an adjuvant immunotherapeutic agent in postoperative gastric cancer patients.The main side effects of N-CWS were skin lesions in the injected sites and fever, but these were temporary and not serious.

Pathological studies on esophageal varices treated with injection sclerotherapy

Injection sclerotherapy is one of the most effective treatments for esophageal varices. To investigate the fate of esophageal varices embolized with a sclerosant (ethanolamine oleate), we have examined at autopsy the esophageal wall of 14 patients with esophageal varices. When the sclerosant was injected into the varices, at first thrombi formed. After two weeks, granulation tissue appeared and the thrombi were gradually replaced. The granulation tissues were organized slowly after 3 months and in the organized granulation tissue, microscopic recanalization of vessels were seen in 8 out of 9 cases. There was no recurrence of the original varices andde novo varices occurred in one patient. These observations indicate that the varices embolized with ethanolamine oleate become organized in three months after the treatment, and accordingly the esophageal varices are cured. It became also clear that recurrence of the original varices did not occur after the organization.

A small mucinous cystadenocarcinoma of the liver detected by a fluid-fluid level on ultrasonography.

A case of small, borderline malignant biliary mucinous cystic tumor is presented. The patient initially presented to us 18 months earlier to undergo a sigmoid colon resection for sigmoid colon cancer. At that time, a liver cyst measuring 18×12mm was detected. On a follow-up abdominal ultrasonography study for colon cancer, the liver cyst had enlarged to 21mm in diameter and contained a fluid-fluid level 18 months after surgery. Histological examination of a needle biopsy specimen indicated possible adenocarcinoma. Lateral segmentectomy of the liver was performed. Histopathologically, the tumor was diagnosed as a mucinous cystic tumor, of border line malignancy, which had originated from a bile duct gland. It contained both mucinous and serous components, which were thought to have caused the formation of a fluid-fluid level within the cyst. In this case, the fluid-fluid level demonstrated by ultrasonography was beneficial in the early detection of a cystic tumor of the liver. This case may be the smallest reported cystadenocarcinoma of the liver yet published.

Fluoresence of metastasized lymph nodes in esophageal cancer following the administration of intravenous eosin yellow using a laser beam

Fifteen patients with esophageal carcinoma received the Photosensitizing dye Eosin Yellow (10 mg/kg) intravenously prior to surgery, and their para-esophageal lymph nodes were then examined for fluorescence using a laser beam at the time of operation. When the time interval between the injection of Eosin Yellow and the operation was 48 hours, 21 out of 22 (95.4 per cent) metastatic lymph nodes exhibited fluorescence and 25 out of 26 (96.2 per cent) non-metastatic lymph nodes did not exhibit fluorescence. This method proved to be invaluable for detecting metastatic lymph nodes macroscopically at the time of surgery for esophageal carcinoma.

CLINICAL EFFICIENCY IN COLOSTOMY EXAMINATION USING A NEWLY DEVISED BARIUM ENEMA APPLIANCE

人工肛門より明瞭な注腸造影を得るために, 内外2筒からなる陰圧型の人工肛門注腸補助器を開発した.これとgyroscopeとの併用により, 直腸癌術後などの人工肛門保有者30例に注腸X線検査を行い, つぎのような利点が判明した.すなわち (1) 残存結腸の完全な二重造影像が得られ,(2) 人工肛門周囲を汚すことなく検査が終了し,(3) 腸管穿孔の心配が全くないことなどである.これらの検査でわれわれの補助器が有用であった症例を紹介し, さらに人工肛門からの高圧浣腸にも応用しているのでその実際について説明した.

A new device for barium-enema examination following colostomy.

The authors developed a colostomy appliance for use during barium-enema examinations. It is 8 cm in diameter and 4 cm in height, and is made of acrylic resins. With the use of this device, 21 patients were fluoroscopically examined through the stoma; good contrast views of the lower intestinal tract were obtained in all cases without leakage of barium or air.

EVALUATION OF ARTERIAL PORTOGRAPHY IN CARCINOMA OF THE BILIARY TRACT

肝門部胆管癌10例, 胆のう癌6例を対象に術前, 門脈への浸潤の有無を知る目的で, 経動脈門脈造影を施行し, 門脈像と手術および剖検所見との対比より, その診断的意義を検討した.血管拡張剤を用いた経上腸間膜動脈門脈造影を行えば常に明瞭な門脈造影像を得ることができる.さらに門脈と胆管の位置関係を考慮して門脈を2分間 (正面, 第2科位) より撮影し, 得られた門脈造影所見は手術および剖検所見とよく一致し, 切除可否の決定の術式選択に有効であった.また胆管造影像で肝内胆管第2分岐部を越えて肝側に浸潤のおよぶ胆管癌では, 門脈への浸潤の可能性が高いことが判明した.