Hidenobu Kai

Infected hepatic cyst in a patient with multiple hepatic cysts: report of a case diagnosed by change of ultrasonographic findings.

Liver cysts are commonly observed, but infection of a liver cyst is a rare complication. Although patients have clinical symptoms, such as a high-grade fever and abdominal pain, diagnosing an infected cyst by abdominal ultrasonography, computed tomography (CT) with contrast medium and magnetic resonance imagings (MRI) is not always easy. We experienced an unusual case who had only clinical symptoms, such as high-grade fever and a right quadrant abdominal pain, but no imaging findings when admitted. Careful observation using ultrasonography once a week revealed signs of an infected cyst containing echogenic fluid 32 days after admission. We performed percutaneous transhepatic cystic drainage. When a patient has liver cysts and complains of high-grade fever and abdominal pain, liver cysts should be considered as a focus of sepsis, and we recommend repeat use of ultrasonography or CT, even if no typical findings occur the first time.

Heat, drugs, and radiation given in combination is palliative for unresectable esophageal cancer

From April 1966 to April 1986, 101 men and women with unresectable squamous cell carcinoma of the esophagus were treated in our clinic. Since 1983, 21 were treated with a combination of hyperthermia, chemotherapy, and radiotherapy (group I). Before 1983, for another 80 patients, radiation plus chemotherapy had been prescribed (group II). Nine of 21 patients in group I had an unresectable carcinoma due to an advanced tumor, 9 had an associated severe clinical status, and 3 refused surgery. Out of 80 in group II, 50 had a far advanced tumor, 21 had a poor clinical condition, and 9 refused operation. With regard to staging, for 21 in group I, 6 were classified as Stage I, 5 as Stage II, 7 as Stage III, and 3 as Stage IV. As to the 80 in group II, those in Stage I, II, III, and IV accounted for 8, 22, 39, and 11, respectively. The median doses of each modality, for patients in group I, were 6 times of hyperthermia at 42-45 degrees C for 30 minutes, 40 Gy of X ray and 30 mg of bleomycin. For patients in group II, a median dose of 56 Gy of X ray was given. Response rates determined by esophagograms and endoscopies for the patients in groups I and II were 76.2% (16/21; 4 CRs, 12 PRs) and 39.2% (31/79; 2 Crs, 29 PRs), respectively (p less than 0.001). The effective rates determined by improvement in quality of life (relief of pain and dysphagia) for groups I and II were 61.9% and 37.2%, respectively. A longer survival was obtained for patients in group I (median survival: 9 months vs 6 months). Especially for the patients classified as Stage I, a significantly longer survival was obtained with a combination of hyperthermia, chemotherapy, and radiotherapy (p less than 0.01).

Preoperative hyperthermia combined with radiotherapy and chemotherapy for patients with incompletely resected carcinoma of the esophagus.

Two hundred eighty‐nine patients with squamous cell carcinoma of the esophagus underwent subtotal esophagectomy from December 1965 to June 1986. Resection of esophageal carcinoma was absolutely noncurative in 64 patients (20%) due to invasion to the surrounding structures. These 64 patients were subdivided as follows into three groups based on the type of preoperative treatment: Group I included 16 patients without preoperative treatment; Group II included 38 patients with preoperative radiotherapy combined with chemotherapy (average doses: radiation 37.3 Gy, 1‐(2‐tetrahydrofuryl)‐5‐fluorouracil [tegafur] 8.4 g); Group III included 10 patients who underwent preoperative hyperthermia (42°C to 45°C) combined with chemotherapy and radiotherapy (average doses: radiation 33 Gy, bleomycin 33.9 mg, or cis‐diamine dichloroplatinum 75 mg, hyperthermia 6.2 times). There were no significant differences in terms of postoperative therapy among the three groups. The median survival times for patients in Groups I, II, and III were 6, 7.5 and 11 months, respectively. The 2‐year survival rates for patients in Groups I, II, and III were 0, 15.6%, and 34.3%, respectively. The prognosis in Group III was superior to that for Group I (P < 0.05) and Group II. These results suggest that preoperative hyperthermia combined with radiotherapy and chemotherapy could prolong survival even in patients who have had noncurative resection.

Postoperative long-term immunochemotherapy for esophageal carcinoma - 5 year survival

Two groups of patients with esophageal carcinoma were studied retrospectively: Group I as controls, included 50 patients who underwent esophageal resection mainly combined with preoperative radiation therapy during the period from 1965 to 1971; and Group 2 included 83 patients who were given the same treatment plus post-operative radiation and adjuvant postoperative long-term cancer immunochemotherapy during the period from 1972–1979. The one, two and five-year survival rates were 32.0, 14.0 and 12.0 per cent in Group 1, and 55.4, 35.8 and 21.5 per cent in Group 2 respectively. There were significant differences in one-year (p<0.02) and two-year (p<0.05) survival rates between the two groups. We also found that adjuvant therapy was effective in patients with no lymph node metastasis, while it was less effective in those with lymph node metastases.

Hyperthermo-chemo-radiotherapy for carcinoma of the esophagus

Hyperthermo-chemo-radiotherapy was prescribed preoperatively for eight patients with carcinoma of the esophagus. Histological study of the resected specimens showed marked effect in two, moderate effect in four and slight effect in two. In those with marked effect, there were no viable neoplastic cells, and severe necrosis and complete destruction were evident on the mucosal surface. These two patients have had no recurrence, now at 27th and 31st postoperative months. Those findings suggest that hyperthermo-chemo-radiotherapy is effective for selected patients with carcinoma of the esophagus.

Clinical Efficacy of the Stapled Anastomosis in Esophageal Reconstruction

We have clinically evaluated Russian and American stapling devices used for esophageal reconstruction and compared the results following stapled anastomosis with those following hand-sutured procedures, both performed by the same surgeon. With the Russian stapler, anastomoses performed in 17 patients with carcinoma of the thoracic esophagus resulted in only one (5.9%) anastomotic leak; in 12 hand-sutured anastomoses and in 11 anastomoses done with an American stapler, no anastomotic complication occurred. Thus, a long gastric tube with good blood supply is of paramount importance, and if the technical details of surgical stapling can be overcome, a stapled anastomosis appears to be as safe as a manual suturing for patients undergoing esophageal reconstruction.

Assessment of the blood flow in various gastric tubes for esophageal substitutes

Abstract Comparative studies were done on canine gastric tubes of various widths with the objective of obtaining the maximal blood flow at the proposed area of anastomosis, when the gastric tube was to be used as an esophageal substitute. The left and the right gastric arteries and veins and the short gastric artery and vein were divided, and the lesser curvature side was variously dissected in parallel to the greater curvature. The tissue blood flow, as determined by the hydrogen clearance method, revealed the highest value in the 3-cm-wide gastric tube. The vascular network was well preserved in various sized gastric tubes, except in those of 1.5 cm. These findings suggest that a gastric tube of potential length with a sufficient blood supply can be realized by optimal tailoring.

Combined effects of hyperthermia, bleomycin, and X rays on Ehrlich ascites tumor

The combined effects of water-bath hyperthermia at 42.5 degrees C for 30 min, 1/10 LD50 Bleomycin iv, and 200 rad x irradiation were studied in DDD strain male mice with Ehrlich ascites tumor. The objective was to acquire data on the optimum regimen for a combined administration of these three modalities. The treatments were given 10 days after the inoculation of 2 X 10(6) of the cells into the right hind limb. Concomitant application of the three modalities led to an 80% regression. A single modality produced no significant effect and a 30-50% regression occurred when only two modalities were combined. To assess the influence of timing and sequence, hyperthermia was applied at 1, 2, 4, and 6 hr before, after, or simultaneously with the combination of Bleomycin and 200 rad X ray. A significant effect was obtained in the case of concomitant application of the three and hyperthermia was effective when applied within 2 hr before or after administration of Bleomycin plus irradiation. This enhancement disappeared at 4-hr intervals.

Ileal perforation in diffuse intestinal Behçet disease: Report of a case

Abstract Intestinal ulcers in Behçet disease tend to cause perforation, and postoperative recurrence is common with a high mortality rate. The optimal therapeutic strategy has yet to be elucidated, particularly in cases of diffuse intestinal involvement. We herein present a case of diffuse intestinal Behçet disease with ileal perforation. A 57-year-old Japanese woman was referred to our institution with complaints of intractable oral ulcers and abdominal pain. The patient underwent an emergency laparotomy for perforated peritonitis in spite of the intravenous administration of prednisolone (1.5 mg/kg) under total parenteral nutrition. Macroscopically, an inflamed ileum measuring 1.6 m in length was resected, including a 1-cm perforated ulceration. Innumerable small and deep ulcers were also observed, consisting of nonspecific inflammation. The patient has been free from any recurrence of intestinal ulcers while being treated with prednisolone, colchicine, and a low-residue diet for 1.5 years.

Fatal colorectal cancer in juvenile polyposis syndrome

The patient was admitted to Kyushu Central Hospital at the age of 22 years because of abdominal pain and iron-deficiency anemia (hemoglobin level, 7.4g/dl). He had neither congenital deformity nor a family history of gastrointestinal carcinomas. Gastrointestinal investigations revealed a few tiny gastric polyps and nine colorectal polyps, measuring up to 4cm in diameter. A barium meal follow-through study showed no abnormality in the small intestine. Histologic examination of biopsy specimens taken from the gastric polyps demonstrated mild foveolar hyperplasia in relatively abundant stroma. Six colonic polyps, each more than 1cm in diameter, were removed by endoscopic polypectomy with a cautery snare, as described in a previous report.1 All of the resected polyps were histologically consistent with typical juvenile polyp. The largest pedunculated polyp