Fusahiro Nagao

MRI and CT Findings of the Paraesophageal Organs and Mediastinal Lymph Nodes with Invasion or Metastasis of Esophageal Carcinoma

As means for assessing the extent of an advanced esophageal carcinoma, magnetic resonance imaging (MRI) [1] and X-ray computed tomography (CT) [2] are new additions to the conventional fluoroscopy. However, these methods remain to be evaluated as to their efficacy in visualizing the extraesophageal invasion of cancer or its metastasis to the mediastinal lymph nodes. In the present study the MRI or CT findings in advanced esophageal carcinoma were compared with the findings on operation or autopsy.

Abstracts of selected papers presented at the 73rd general meeting of The Japanese Society of Gastroenterology

S OF SELECTED PAPERS PRESENTED AT THE 73RD GENERAL MEETING OF THE JAPANESE SOCIETY OF GASTROENTEROLOGY Tokyo, Japan, April 7-9, 1987 Chairman : Shinroku ASHIZAWA, M. D.

Plasma amino acids changes after hepatic resection with special reference to hepatic reserve.

肝硬変併存肝癌における術後血漿アミノ酸の推移と肝予備能との関連を検討した. 47例の肝切除のうち肝硬変併存肝癌は22例に施行した. 肝硬変併存症例における肝不全発症例は3例 (13.6%) に見られた. 総アミノ酸濃度は肝不全非発症と発症例では術前には差が認められなかったが, 術後第1～3病日には発症例が非発症例の約3.5倍に達した.BCAA/AAAモル比では術前1.8, 1.2, 第1～3病日には1.2, 0.9と発症例が低い傾向であった. 第7病日には非発症例は術前値に復帰したが, 発症例では低値を持続した. 肝予備能として, グルカゴン負荷テストによる10分値でのΔcyclicAMP/ΔBS比を算出し, 肝不全発症との関連を検討すると, 発症例では2.7, 非発症例では30.9となり, アミノ酸モル比と正の関係を見た. ICGR15とアミノ酸モル比との相関は認められなかった. Fisher液の投与はとくに肝硬変併存例では, 第1～3病日のモル比が全例低下するため, 積極的に行っている. 肝不全発症例に対し, 時期の判断を誤ったためか, 血漿交換を行っても救命しえなかった. 術後第7病日にもモル比が術前に復帰しない症例は肝不全発症予備群と考え, 積極的な治療が望まれる.

The estimation of preoperative combined modality therapy for liver carcinoma.

実質臓器での肝癌の治療成績向上のために術前合併療法の必要性を検討した. 当施設における術前合併療法は, 肝細胞癌にはリピオドール, 化学療法, 肝動脈塞栓術と温熱療法を, 胆管細胞癌には放射線法療を行っている. 肝癌切除後再発率は, 術前合併療法では4/17例, 23.5%であり, 切除のみの群は12/16例, 75.0%と合併療法は良好な結果であった. 生存率に関しても術前合併療法群は5年生存率は61.6%, 切除のみの群では4年生存率37.8%であった. 組織学的変化では, 残存腫瘍細胞の存在がみられなかった症例が4/22例, 18.2%に, 有効例が11/22例, 50.0%にみられ, 合併療法の効果期待がもたれ, 今後積極的に施行すべきと考えた.

A procedure to elongate the stomach tube in the esophageal replacement

When the stomach tube has to be lengthened in case of antethoracic esophageal replacement, a circumferential seromuscular incision is made and the lesser curvature side of the tube is cut through, in the same line of incision. The rent produced is longitudinally suture-closed, by which a definite elongation (about 2 cm by each incision), is obtained. In our department the antethoracic use of the stomach tube has been carried out since 1968, the elongation procedure was started in 1973 as a trial, then its application became more frequent since 1978 and was performed whenever the tube seemed to be deficient in length. The stomach tube was used in 40 cases, of which 17 underwent the elongation procedure. With regard to the suture leak at the site of the antethoracic esophagogastric anastomosis, the incidence was 50 per cent from 1968 to 1972, 54 per cent from 1973 to 1977 and 22 per cent in the last 5 years. Thus, a distinct improvement has occurred with time.

A Case of Primary Lymphosarcoma of the Lung

27才女性の原発性肺リンパ肉腫例を経験した. 無症状. 胸部レ線左中肺野に腫瘍所見. 気管支造影にて左B5, B6枝が軽度狭小. Gaシンチグラム左中肺野にも異常取込み像. 開胸下, 腫瘍は左上葉下部中心に発育しているのを認める (葉外発育なし), 腫瘍の性状はやゝ白色をおび, ゴム様弾性実質性である. 術式は左上葉切除. 他に腫瘍の存在する所見なく, 摘出腫瘍の組織像は肺リンパ肉腫と診断された.

Proceedings of the 19th autumn meeting from October 18 to 20, 1977-Nara, Japan

The first step in the formation of bile acids is 7uhydroxylation of cholesterol. Subsequently 7ahydroxycholest-4-en-3-one is formed, which is a common precursor of the two primary bile acids, cholic acid and chenodeoxycholic acid. 5,BCholestane-3~t , 7a -d io l , a p recursor of chenodeoxycholic acid is formed from the A4-3-keto intermediate by a pathway which involves the reduction of the keto group and the saturation of the double bond but not a hydroxylation at C-12, while a pathway involving the 12a-hydroxylation of the A4-3-keto intermediate leads to the formation of 5flcholestane-3~, 7a, 12a-triol, which is a precursor of cholic acid. The C2~-bile alcohol intermediates , 5flcholestane-3a, 7t~-diol and 5,g-cholestane-3tz, 7t~, 1 2 ~ t r i o l , a r e t h e n t r a n s f o r m e d i n t o chenodeoxycholic acid and cholic acid by the degradation of the side chain which entails an moxidation followed by fl-oxidation. Chenodeoxycholic acid is also formed by a number of different pathways differing only with respect to the stage of nuclear transformation at which oxidation of the side chain is initiated. A number of cholestanepolyols such as 5flcholestane-3ct, 70t, 12ct, 25-tetrol are accumulated in the bile and feces of patients with cerebrotendinous xanthomatosis. No 26-hydroxylated bile alcohols are accumulated. The results suggest that there exists an alternative pathway of cholic acid biosynthesis involving the 25-hydroxylated bile alcohol as an intermediate. (2) Analytical methods of bile acids in biological materials

Barium-spray method to improve radiographic and endoscopic views of gastric and duodenal lesions

By applying a fine barium spray to lesions targeted at endoscopy, the authors have obtained strikingly clear, almost stereoscopic, views. Subsequent radiographic exposures are enhanced by this technic.

On the relation between the magnitude of gastric bleeding and the vascular status of gastric wall

in ulcus II grade, 15 cases in ulcus III and 9 cases in ulcus IV. 4. In 35 cases of non eroded, exposed arterial lesion in bleeding gastric ulcer, their bleeding source was demonstrated in 25 cases from the bottom of ulcer, in 7 cases from surrounding gastri t is of ulcer and in 3 cases from distant gastri t is of ulcer. 5. The main source of bleeding gastri t is was found in 8 cases from mucosal ulcers which had multiple lesions, in 4 cases f rom follicular erosion, 3 cases from atrophic gastri t is with intestinal mucosal metaplasia, in 5 cases from intramucosal hemorrhage which was mainly demonstrated on the antrium or antrium and its greater cavature, in 2 cases from subacute gastri t is and 1 case under the lamina muscularis mucosae.

An evaluation of the long term results of gastric freezing for ulcer-symptoms

SummaryThe effect of gastric freezing to ulcer symptoms and gastric secretory function seemed to be rather remarkable within a short time after freezing and the effectiveness showed much lower percentage than by gastrectomy for ulcer.This procedure considered to be a suitable one for a conservative treatment of ulcers especially for the patients who are not indicated for surgery.