Fumio Ishida

Changes in folate concentration in Yoshida sarcoma after administration of leucovorin or cisplatin

Both leucovorin (LV) and cisplatin (cis-dichlorodiammine platinum II, CDDP) act as modulators of 5-fluorouracil (5-FUra) by increasing the intracellular concentration of reduced folate. We measured intracellular folate levels following the administration of LV or cisplatin in tumor-bearing rats to determine the optimal schedules for their use as 5-FUra modulators. Donryu rats were inoculated with Yoshida sarcoma cells on the right flank. Seven days after tumor inoculation, the animals were injected with LV or CDDP. The kinetic and dose-related changes in intracellular folate concentration were analyzed by means of a binding assay. Folate levels in the tumor tissues were significantly higher than baseline 1 and 2 h after administration of LV and remained significantly high until 8 h after administration. Folate levels in the tumor tissues were significantly higher than baseline 1 and 2 h after cisplatin administration, then decreased to a rather low level 8 h after, and to a significantly lower level than baseline 24 h after administration. The folate levels in the tumor tissue increased in proportion to the dose of LV, but did not increase when the dose of cisplatin was increased from 1 mg/kg to 8 mg/kg. Repeat high-dose administration of LV and repeat low-dose administration of cisplatin are advocated when they are used as modulators of 5-FUra.

Reconstruction of jugular and portal blood flows using remodeled great saphenous vein grafts.

Remodeled great saphenous vein grafts were used to reconstruct both jugular and portal veins. The great saphenous vein was split longitudinally and sutured side-to-side to construct a vessel twice the diameter and one half the length of the original vessel. This graft was used with good results for reconstruction of the jugular veins in a patient after a bilateral neck dissection for tongue cancer and for a portal vein in a patient after resection for cancer in the head of the pancreas.

Advanced Gsstric Cancer in Association with Congenital Factor .CHI. Deficiency. A Case of Report.

先天性凝固第X因子欠乏症に進行胃癌を併発した症例に対して凝固因子製剤の投与下に根治術を施行した症例を経験したので報告した.症例は71歳の男性で, 平成4年11月, 鼻腔手術施行の際に大量出血を認め, 出血傾向の精査のため当院紹介となった.精査の結果凝固第X因子が45%と低下しており, 先天性凝固第X因子欠乏症と診断された.翌年4月, 空腹時の心窩部痛が出現, 精査の結果胃前庭部に長径6cmの2型の低分化腺癌を認めた, 手術に先駆けて第X因子を含有する複合型凝固因子製剤PPSB-HTによる輸注試験を行い手術時および術後の至適投与量を決定した.手術はPPSB (R), HT投与下に胃全摘, 脾, 横行結腸合併切除D4リンパ節郭清を行ったが, 術中および術後に異常な出血はみられなかった.凝固因子欠乏症に併発した消化器癌でも止血管理を厳重に行うことで安全に根治術が行えるものと考えられた.

Studies on Pharyngolaryngoesophagectomy Followed by Reconstruction with Free Jejunal Autograft for Hypopharyngeal and Cervical Esophageal Carcinoma.

われわれは, これまでに下咽頭・頸部食道癌19例に対し咽頭喉頭頸部食道切除術および遊離空腸移植による頸部食道再建を施行した.その結果, 術後合併症として縫合不全を1例 (5.3%) に, 創感染を3例 (15.8%) に, 腸重積を3例 (15.8%) に認めた.術後の経口摂取は全例で十分量可能となり, 患者自身の満足度も高かった.19例のうち術後8例が癌 (原病) 死し, 5年生存率は27.2%であった.その再発形式をみると, 局所4例, 肺転移2例, 脳転移2例であり, 胸部および腹部のリンパ節郭清を行わなかったために再発をきたした症例はなかった.咽頭喉頭頸部食道切除術は, 下咽頭, 頸部食道に癌腫が限局しており, かつ画像診断上, 胸部および腹部リンパ節に転移を疑わせない症例に対する切除術式として妥当であると思われた.また, かかる切除術後の頸部食道再建法として, 遊離空腸移植は安全で優れた方法と思われた.