Ikuzo Yokoyama

Effect of arterial administration of high-molecular-weight anticancer agent SMANCS with lipid lymphographic agent on hepatoma: a preliminary report.

A clinical evaluation of arterial infusion of high-molecular-weight antitumor agent SMANCS dissolved in lipid lymphographic agent (thiodol) in 44 patients with mostly unresectable hepatoma is described. The treatment regimen demonstrated significant merits both therapeutically and diagnostically. Marked antitumor effects were shown in the decreased serum alpha-fetoprotein levels (86% of cases) and tumor size (95% of cases), and in survival period and histological findings. Furthermore, there was increased diagnostic sensitivity using CT scan, plain X-rays or ultrasound. The procedure of selective arterial administration of 3-4 mg of SMANCS in 3-4 ml of ethiodol per dose was simple to perform and was required only once every 3-4 weeks. Both ethiodol and the drug accumulated more selectively in tumor than in any other tissues and their activity remained for more than 3 weeks. Only minimal side-effects were associated with SMANCS and ethiodol during this study.

Studies on anticancer treatment with an oily anticancer drug injected into the ligated feeding hepatic artery for liver cancer

In six adult patients with nonresectable liver cancer, as well as in mature New Zealand white rabbits with implanted VX2 carcinoma in the liver, the artery feeding the hepatic lobe with the malignant lesion was ligated, and an oily contrast medium (Lipiodol Ultra‐Fluid) was injected into the hepatoproximal lumen of the ligated artery of the liver with carcinoma. The oily contrast medium was detected in all the branches of the artery injected, and thereafter was found only in tumor tissue for 7 days experimentally and for 16 months clinically. Taking advantage of this phenomenon, the therapeutic effect of the injection of an oily anticancer drug (bleomycin oil suspension) into the hepatoproximal lumen of the ligated hepatic artery was investigated in rabbits with VX2 carcinoma of the liver. The mean concentration level of bleomycin in the tumor tissue was 2.4 ± 0.4 μg/g 1 week after the injection of bleomycin oil suspension (1.5 mg potency/kg) in three rabbits. However, its concentration level in nontumorous tissue of the liver was undetectably low in two rabbits, but 0.6 μg/g in the third rabbit. The group of rabbits receiving an injection of bleomycin oil suspension into the ligated artery had a significantly longer mean survival time than those of the experimental group receiving an injection of saline solution of bleomycin into the ligated artery as well as the three other groups treated (P < 0.02, N = 5 for each group). It may be concluded that an oily anticancer drug injected into the hepatoproximal lumen of the ligated hepatic artery can intensify the anticancer effects of a ligation of the hepatic artery for liver cancer. Cancer 52:2193‐2200, 1983.

Treatment of carcinoma of the gallbladder in Japan

Clinical records of 2567 patients (1717 female and 850 male) with primary carcinoma of the gallbladder in Japan, during the past 19 years, were collected by questionnaires sent out to the main 100 surgical institutes in Japan. Eighty-seven per cent of the patients were over fifty years of age. Gallstones were found in 58.8% of 1496 patients. About 50% of the patients with gallstones had cholesterol group stones. Of the 2269 patients who underwent surgical interventions, radical operations were performed in 467 patients (20.6%). Of the 467 patients, a correct preoperative diagnosis was made in only 77 patients (16.3%). Patients in Nevins Stages I and II, whose lesions had been confined to the muscle layer, showed a good survival rate with only simple cholecystectomy or extended cholecystectomy, while the patients in Stages III, IV and V, whose lesions had spread beyond the muscle layer, showed poor results even with more aggressive surgical approaches. The poor prognosis of the lesions in Stages III, IV and V might be due to inappropriate aggressive procedures. For the lesions involving all the layers of the gallbladder wall, radical resection, such as extended cholecystectomy plus pancreatoduodenectomy, or extended right lobectomy plus pancreatoduodenectomy, might be recommended.

A non-resectable hepatoma after hepatic artery ligation combined with infusion chemotherapy —An eight-year survival

A 69-year-old man with a large hepatoma in the right lobe extending in part to the medial segment of the left lobe was treated by ligation of the right hepatic artery combined with continuous infusion of a total dose of 5500 mg of 5-fluorouracil (5-FU) into the left hepatic artery. Postoperative celiac arteriogram and liver scintigram revealed a marked regression of the tumor size. After four weeks he was discharged in a satisfactory condition. Seven years and two months after the initial treatment he was readmitted because of a concomitant cancer of the cardia. Total gastrectomy was performed with a favorable result. A second look for the previous hepatic tumor during total gastrectomy revealed a fibous tissue containing scatterd nodules of hepatocellular carcinoma on the right lateral surface of the liver instead of the previous large tumor in the right hepatic lobe. He survived for eight years after the first operation.

PRE-AND POST-OPERATIVE ELEMENTAL DIET FOR CANCER OF THE ESOPHAGUS OR THE CARDIA

食道噴門癌25症例に術前後の栄養管理として成分栄養法 (ED) を試みた. 術前は数経鼻的に胃・十二指腸にチューブを留置し, 術後は胃管に作成した胃瘻あるいは空腸瘻から術後の腸蠕動の回復をまつことなく, 術後第1日目から持続点滴法により24時間連続投与した. 術前ED施行例では入院時から手術までに平均3%の体重増加がみられた. 術後ED施行例の血清アルブミン値は術後普通経管栄養食投与群に比して術前値に対する減少率は軽度であった. またED施行群では術後6日目に窒素平衡が正に転じた. 術後縫合不全, 術後乳糜胸の症例にも有効であった.

CLINICAL STUDIES ON SOME METABOLISMS AFTER TOTAL PANCREATECTOMY

膵全摘術を4例に施行し, 術後の代謝, 特に糖代謝と消化管ホルモンの変動とについて検討した.糖代謝に関しては, 術後早期のcatabolic phaseでは糖5-6gに1単位の, anabolic phaseになると糖8-10gに1単位のinsulinでcontrolできた.感染時の血糖調節のcontrolは困難であった.消化管ホルモンの動態については30K抗体に対するIRGの存在は認められたが, 血糖上昇作用の有無については不明であつた.経ロブドウ糖負荷ではIRG値は上昇した.arginine負荷ではglucagon分泌は誘発されなかった.食餌負荷によるgastrin分泌反応は全くみられなかった.