Haruhiko Makino

Staging of palpable tl-2 invasive breast cancer with helical ct

BackgroundThe purpose of this study was to evaluate the accuracy of contrast-enhanced high resolution helical computed tomography (CT) for assessing locoregional staging of palpable Tl-2 invasive breast cancer. Methods: Helical CT studies of 156 lesions from 156 patients with invasive breast cancer before breast-conserving surgery were examined. A lesion was defined as positive if focal enhancement was detected by CT within 100 seconds after contrast material administration. After resection, tumors were histopathologically mapped and comparison made with the extent of contrast enhancement.ResultsHelical CT enabled detection of all 156 index tumors. CT enabled detection of 28 of 43 multifocal lesions (65%) and five of five multicentric lesions (100%). In 24 of 33 lesions (73%), CT revealed additional cancers not seen on mammography. The extent of tumor significantly correlated with CT measurements (r=0.76,p<0.0001).ConclusionHelical CT of the breast is an accurate preoperative imaging modality for assessing the locoregional staging of Tl-2 invasive breast cancer.

Disease-free survival for 6 years and 4 months after dissection of recurrent abdominal paraaortic nodes (No. 16) in gastric cancer: Report of a case

We herein report the case of a 63-year-old woman who underwent curative surgery consisting of a subtotal gastrectomy with D2 lymph node dissection for advanced stomach cancer in June 1984, and later underwent systemic dissection of recurrent abdominal paraaortic lymph nodes by a retromesenteric approach in June 1989. Metastatic nodes were found in nos. 16b1 (interaorticocaval), 16b2 (interaorticocaval), and 280 (aortic carinal). One of the resected nodes, which was histologically diagnosed as being poorly differentiated adenocarcinoma, measured approximately 10×7 cm and infiltrated the inferior caval vein. There was no distant metastasis except for nodal metastases. Since the reoperation, the patient has been disease-free for 6 years and 4 months, and she continues to visit our hospital as an outpatient. The findings of this case therefore suggest the significance of paraaortic lymph node dissection. To our knowledge, this is the first report in the world of a gastric cancer patient who has remained disease-free for more than 5 years after the systemic dissection of recurrent paraaortic lymph nodes.

The prevalence of hereditary breast/ovarian cancer risk in patients with a history of breast or ovarian cancer in Japanese subjects.

Aim:  Women at high risk for hereditary breast/ovarian cancer require specific management strategies for cancer prevention and early detection. The authors sought to determine the prevalence of family histories suggestive of a hereditary breast/ovarian cancer syndrome in patients with a personal history of breast or ovarian cancer in Japanese women.

A Case of Megacolon with Intussusception Prolapsing through the Anus

原因となりうる腫瘍性病変を伴わずに腸重積を来し, 肛門外まで脱出した巨大結腸症の1例を経験したので報告する. 症例は38歳の女性で, 排便時に肛門からの腸管脱出を来し当院を受診した. 直腸診で直腸壁は保たれていることから, 直腸よりも口側の腸重積および肛門外脱出と診断し, 緊急手術を施行した. 腸重積を整復後, S状結腸を切除した. 切除腸管に腸重積の原因となる腫瘍性病変は認められなかった. 腸重積を来し肛門外まで脱出した症例は本邦では30例ほどが報告されており, すべて腸重積の原因となる腫瘍性病変を伴っていた. 自験例は巨大結腸症で, 腸重積の原因となる腫瘍性病変も伴っておらず, 非常にまれな例であった. 本症においては原因病変の有無を含めた的確な診断と, 手術の際に無理な整復を行わないことが重要である.

Features of Treatment of Gastric Cancer in Niigata. Rational Surgery for Early Gastric Cancer.

新潟県は胃癌の多発県のひとつであり, 当院はその約1割を手術している.主に早期胃癌 (EGC) に対し, 外科的局所切除 (SLR) 112例, 腹腔鏡下楔状胃切除 (LAP) 5例, 幽門保存胃切除術 (PPG) 51例, 噴門側胃切除術 (PXG) 38例, 大網温存縮小胃切除術 (OPG) 377例を施行したので各種縮小術式につき臨床評価を加えた.【成績】(1) SLRには術後の愁訴は殆どなかった.再治療を要したのは6例 (再発2例, 多発4例) であるが, 姑息切除の1例を除き胃癌死はなく他病死を含む5生率は81.9%であった.(2) LAPには, 再発例はなく全例生存中である.(3) PPGは残胃炎, 食道炎が少なく, 体重の回復は良好であったが, 残胃への胆汁逆流は24%に認められた.再手術は2例に施行されたが, 全例外来通院中である.(4) PXGに胃癌死はないが, 5生率は84.2%である.(5) OPGは術後イレウスの発生が少なく, 現在まで原病死はない.【結語】EGCに対し, QOLの向上をはかり, 遠隔成績を損なうことなく合理的縮小手術が可能であった.