Hiroshi Tanimura

Carcinosarcoma of the stomach

Abstract Carcinosarcoma of the stomach is a very rare tumor, there being only twenty-three cases reported in the literature. A case is presented which we believe qualifies as a true carcinosarcoma of the stomach in a sixty-five year old woman. The literature pertaining to carcinosarcoma of the stomach is reviewed and the nature and possible pathogenesis of carcinosarcoma are discussed on the basis of histologic examinations of many sections of a totally resected stomach.

Reconstruction with bilateral gluteus maximus myocutaneous rotation flap after wide local excision for perianal extramammary Paget's disease

PURPOSE: Extramammary Pagets disease is a rare dermatosis. Wide local excision is recommended in patients with perianal extramammary Pagets disease. After wide local excision, it is necessary to do reconstruction, with preservation of bowel function. We present here two cases of perianal Pagets disease, in which the patients were treated by reconstruction with bilateral gluteus maximus myocutaneous rotation flap after wide local excision. PATIENTS AND METHODS: A 55-year-old woman and 58-year-old man were admitted with anal pain and bleeding. Histologic examination of the perianal lesion revealed the presence of typical Pagets cells, and no underlying carcinoma and no distant metastasis was detected in either patient. Wide local excision, including the rectal mucosa, was performed, with reference to intraoperative frozen sections. Surgical defect was overlapped with bilateral gluteus maximus myocutaneous rotation flap, and the anus was reconstructed. RESULTS: Postoperative bowel function and quality of life were well preserved, and flaps healed satisfactorily. Patients have had no recurrence and have been able to return to work. CONCLUSION: Bilateral gluteus maximus rotation flap may be useful after wide local excision of perianal extramammary Pagets disease without underlying invasive carcinoma.

Repeated piezoelectric lithotripsy for gallstones with and without ursodeoxycholic acid dissolution: A multicenter study

The use of bile acid dissolution therapy in extracorporeal shockwave lithotripsy of gallstones, remains controversial. Our study examined whether chemolitholysis after sufficient disintegration enhanced stone clearance within 6 months of the first lithotripsy. A total of 143 patients who developed one to three radiolucent stones measuring⪯30 mm in diameter were randomly separated into two treatment groups: 47% were given lithotripsy alone, and 53% lithotripsy plus ursodeoxycholic acid (UDCA). Repeated piezoelectric lithotripsy was given, with no limit on the total number of treatment sessions, to pulverize or disintegrate stones into fragments<3 mm. Stones were disintegrated in 97% of all patients, and the fragments were ⪯2 mm in 50% of these patients. According to an intention-to-treat analysis, 52% in the lithotripsy alone group and 58% in the UDCA group were free of stones 6 months after the first lithotripsy (P=0.61). Of the patients with fragments⪯2 mm, 71% in the former and 86% in the latter group were free of stones 6 months after the first lithotripsy, with no significant difference between the groups. Biliary pain occurred in 25% of all patients, including 3 with acute cholecystitis. We concluded that the sufficient disintegration of gallstones achieved with repeated lithotripsy enhanced the early clearance of fragments, regardless of whether chemolitholysis was employed.

Enhancement of Tumor Cell Susceptibility to Tumor-Infiltrating Lymphocyte by Treatment with Cisplatin

The tumor cell susceptibility to tumor-infiltrating lymphocytes (TILs) was investigated to be augmented by pretreatment with CDDP in vitro. The susceptibility of autologous tumor cells and KATO-III cells was enhanced by treated with 2 μg/ml of CDDP for 12 h measured by 4-h and/or 16-h 51Cr-release assay. And, on that time, the binding ratio to TILs was increased, although expression of surface antigens of CDDP-treated tumor cells were not altered. Thus, it was suggested that the effect of CDDP on tumor cells susceptibility to TILs caused by the enhancement of binding to effector cells.

The Generation of CD4 Cytotoxic T Lymphocyte Augmented by Immobilized Anti-CD3 Antibody and Interleukin-2

The DNA synthesis and the proliferative response of autologous tumor specific cytotoxic T lymphocytes (CTLs) induced by autologous mixed lymphocyte tumor cell culture, remarkably increased by activation with immobilized anti-CD3 Ab and IL-2 compared with IL-2 alone. The cytotoxicity of the activated CTLs was kept against autologous tumor cells, moreover was induced against KATO-III and Daudi. The cytotoxicity was inhibited by anti-HLA class I and anti-HLA-DR MoAb in 4-h CRA and anti-HLA-DR MoAb in 16-h CRA against autologous tumor cells. In addition, the cytotoxicity was inhibited by the elimination of CD8+ cells for 4 h and that of CD4+ cells in 16-h CRA using negative selection against autologous tumor cells. Major cell surface antigens of these CTLs was CD3+, CD4+ CD25+ CD45RA-, helper T cell, and the activated CTLs which produced IL-2. It is concluded that the CTLs activated with immobilized anti-CD3 Ab and IL-2 were CD4+ CTLs having not only killer function but helper function and were one of the effective strategies in adoptive immunotherapy by the direct cytotoxicity and the induction of killer cells in vivo.

A Case of Mesenteric Fibromatosis with a Giant Abdominal Tumor

家族性大腸ポリポーシスやGardner症候群などによく合併することで知られているmesenteric fibromatosisは単独で腹腔内に発生することはきわめてまれである.7kgの巨大腹部腫瘤を形成し腸間膜原発と考えられるmesenteric fibromatosisの1例を経験したので, 文献的考察を加えて報告した.患者は50歳の男性で, 急激な腹部膨満感を主訴に来院, 全身状態は非常に良好で画像診断では消化管の圧迫所見と下大静脈の閉塞・側副血行を認めた.悪性の後腹膜腫瘍と診断, 下大静脈の合併切除も考慮し手術を施行した.比較的容易に腫瘍は摘出しえ, 小腸原発のmesenteric fibromatosisと診断された.本症は著明な線維性組織の増触・浸潤を示すが転移をしないという特徴のある良性疾患であり腫瘍の完全摘除が比較的容易であることが多く臨床所見に惑わされることなく積極的な外科治療が望まれる.

Dumping syndrome after gastrectomy

was cooled as low as 15~ as tempera ture of an te r ior wall of body (measured with a needle thermis ter) . The other par t s of s tomach were es t imated to range within 15_+3~ as indicated by a pre l iminary study. Wi th this gastr ic tempera ture , cooling was carr ied out for 60 minu tes and following observations were performed. (1) Gastric specimens (27 in total) were obtained before and 24 hrs , 4, 7 and 10 days af ter cooling. Histologically these specimens had edema, thrombosis, hyperemia and round cell infiltration, the most f requent change being edema af ter 24 hrs (24%) and round cell infi l trat ion af te r 4 to 10 days (80 to 33%). The parietal cell count was noted decreased (20 to 25%) in specimens af ter 24 hrs , 3 and 7 days and re turned to the control level af ter 10 days. The chief cell count was noted decreased in all kind specimens. (2) Free Hydrochloric acidity (1 case) was noted to be profoundly decreased (83%)a f t e r 24 hrs and to be same as control af ter 7 days and above the control (40%) af ter 14 days. (3) Gastric e lec t romyography revealed an excited moti l i ty on inser t ion of the balloon. With cooling started, frequency of motion decreased markedly and this decrease re turned to the control level along the recovery of normal gas t r ic tempera ture (4) E. C. G. (9 cases) general ly showed only bradycardia, and one case T wave became reversed. (5) Portal pressure rose as much as 40 mmHzO only with inflation of the balloon and approximated to the control when balloon was deflated. Cooling itself did not cause noticeable change. In conclusion, there was no grave irreversible ha rms caused by gast r ic cooling with p resen t magnitude, but it is also worth an at tent ion tha t gastr ic cooling has disadvantages as well as advantages f rom the view point of controll ing hemorrhage or its recurrence .