Kazuhiro Okagawa

A prospective analysis of subacute thyroid dysfunction after neck irradiation

PURPOSE Exposure of the thyroid to therapeutic doses of external irradiation has been demonstrated to induce thyroid dysfunction. This study was designed to assess the relationship between irradiation and early thyroid dysfunction, prospectively. METHODS AND MATERIALS Twenty patients in whom the thyroid was incidentally exposed to therapeutic doses of irradiation were studied. The dose given to the thyroid was 40-54 Gy over 4-7 weeks. Thyroid function tests, including serum thyroid stimulating hormone (TSH), free thyroxine (free T4), free triiodothyronine (free T3), antithyroglobulin antibody, and antimicrosomal antibody, were performed prior to irradiation and at 3, 6, and 12 months after radiotherapy. RESULTS Serum TSH levels did not change significantly at 3 months after irradiation (mean TSH level: 1.33 microU/ml before irradiation, 1.74 microU/ml at 3 months, p = 0.11). However, a significant elevation was noted at 6 months (mean TSH: 3.50 microU/ml at 6 months, p = 0.0001, vs. preirradiation), when TSH levels were higher than preirradiation levels in 19 of 20 patients. After irradiation, 13 patients remained in a euthyroid state (euthyroid group), while in the other 7 patients hypothyroidism occurred (hypothyroid group) and thyroid hormone-replacement therapy was performed. After 6 months, elevation of TSH was less significant in the euthyroid group, whereas elevation of TSH persisted continuously and exponentially in the hypothyroid group. Thyroid autoantibodies did not turn positive in any patient during follow-up. CONCLUSIONS Damage of the thyroid develops in most patients when the organ is exposed to radiation. This radiation-induced damage is initially manifested within 6 months after irradiation.

ACUTE RADIATION THYROIDITIS

PURPOSE Radiation-induced thyroid dysfunction is considered a late effect. We prospectively assessed acute reactions of the thyroid to external neck irradiation. METHODS AND MATERIALS This study included 22 patients in whom the thyroid was incidentally exposed to therapeutic doses of radiation. Thyroid function tests included measurements of serum thyroid stimulating hormone (TSH), free and total triiodothyronine (T3) and thyroxine (T4), thyroglobulin, and antithyroid antibodies. These tests were performed before radiotherapy (baseline values), after approximately 40 Gy had been administrated, 2 weeks after the end of radiotherapy, and 3 and 6 months after the beginning of radiotherapy. RESULTS Mean serum levels of TSH were 1.53, 0.55, 0.78, 2.14, and 7.57 microU/ml before radiotherapy, after 40 Gy irradiation, 2 weeks after the end of radiotherapy, and 3 and 6 months after radiotherapy, respectively. Thus, levels of TSH exhibited two phases: a significant decrease during radiotherapy (thyrotoxic phase) and an increase after radiotherapy (hypothyroid phase) (baseline vs. 40 Gy: p < 0.0001, baseline vs. 6 months: p = 0.003). Increases of thyroid hormones were subtle during radiotherapy. CONCLUSIONS We believe that radiation promotes release of excessive amounts of thyroid hormones during radiotherapy owing to suppression of TSH secretion. In addition to the late damage (hypothyroidism), thyrotoxicosis occurs when the thyroid gland receives a therapeutic doses of external radiation.

Effective Intra-Arterial Chemotherapy for Acinar Cell Carcinoma of the Pancreas

A 41-year-old man with a huge pancreatic tumor (acinar cell carcinoma) was treated by intra-arterial infusion chemotherapy with 5-fluorouracil (5-FU), mitomycin C (MMC) and cisplatin (CDDP). The tumor was significantly reduced, and he underwent a pancreaticoduodenectomy with complete excision of the tumor. Unfortunately multiple metastatic liver tumors were noted 5 months after resection. These tumors could also be markedly reduced by intra-arterial chemotherapy and the survival period was prolonged to 18 months. He suddenly died of sepsis but not from the pancreatic carcinoma. This case shows that intra-arterial infusion chemotherapy with 5-FU, MMC and CDDP can be an effective regimen for the treatment of acinar cell carcinoma of the pancreas.

Successful treatment of an esophageal hemangioma by endoscopic injection sclerotherapy: Report of a case

We report herein the case of a 46-year-old man in whom an esophageal hemangioma was successfully treated by endscopic injection sclerotherapy (EIS). The patient was admitted to hospital after a routine upper gastrointestinal series demonstrated a filling defect in the esophagus. Endoscopy, computed tomography (CT) images, and magnetic resonance imaging (MRI) subsequently revealed a hemangioma in the middle esophagus. EIS was performed using 99% ethanol and 1% polydocanol, and 4 weeks later, the tumor had almost disappeared. This patient has since been followed up carefully with periodic endoscopy and barium studies and additional sclerotherapy will be performed if necessary.

Quadruple cancer including bowen's disease after arsenic injections 40 years earlier: Report of a case

This report describes the successful treatment of quadruple cancer including Bowens disease in a 71-year-old man who had been given injections of salvarsan, an arsenic compound, for syphilis more than 40 years earlier. Resection of a skin lesion on his chest subsequently confirmed a diagnosis of Bowens disease, 3 years after which he was operated on for concurrent gastric cancer and sigmoid colon cancer. A fourth cancer was discovered on his left vocal cord 2 weeks after this operation; it was resected 2 years later. A discussion of multiple malignant neoplasms and the possible relationship between arsenic and cancer is presented following this case report.

A Unique Method of Closure for an Aortocaval Fistula in Association with a Ruptured Abdominal Aortic Aneurysm: Report of a Case

We report herein the case of a 78-year-old man in whom an aortocaval fistula caused by spontaneous rupture of an abdominal aortic aneurysm (AAA) was successfully treated by a unique surgical technique. The aortocaval fistula had been revealed by an aortography after the patient presented with high-output heart failure. During the operation, massive bleeding from the fistula was evident. The fistula measured 2 cm in diameter, and was located between the right posterior wall of the AAA and the inferior vena cava (IVC). Direct suturing of the defect in the IVC failed to close the fistula because the tissue around it would not hold together due to degeneration. However, the bleeding was finally able to be controlled by plugging the fistula with isolated and properly trimmed omentum packed within the excluded aneurysmal sac. Unfortunately, the patient died due to respiratory failure on the 201st postoperative day. A pathological autopsy revealed that the aortocaval fistula had been closed by fibrous tissue and that the IVC was patent. Although such a drastic operative measure to repair an aortocaval fistula has never before been reported, it could be an alternative when direct closure proves unsuccessful.

A Case of Bronchopleural Fistula Associated with Esophageal Surgery Successfully Closed by Injection of Fibrin Glue under Bronchoscopic Observation.

食道癌術後に発生した膿胸は治療に難渋することが多く, さらに気管支瘻を併発した場合は特に治療困難となる.気管支瘻に対する治療としては有茎性大網充填術, 有茎性筋肉充填術の外科的治療が行われているが, 胃管再建の食道癌術後早期の気管支瘻ではこれらの外科的治療が困難である.今回, 気管支をバルーン閉塞させてフィブリングルーを注入する方法が有効であったので報告する.症例は61歳の女性で, 胸部食道癌に対して食道亜全摘・胃管利用胸骨後径路再建を施行した.腫瘍は気管分岐部-左主気管支に浸潤しており, 潰瘍底が一部残存した.これに起因すると考えられる右膿胸を発生し胸腔ドレナージ, 胸腔内洗浄を施行したが, air leakを多量に認め気管支瘻の併発を認めた.術後43日目に気管支鏡下にB6bをバルーン閉塞させフィブリングルー3mlを注入したところ, air leakは消失し気管支瘻は閉鎖された.

Comparison of postoperative results following terminal esophagoproximal gastrectomy and esophageal transection for esophageal varices

The results of 44 terminal esophagoproximal gastrectomies (TEPG) and 53 esophageal transections (ET) for esophageal varices, performed during the period between January, 1975 and March, 1989, were retrospectively compared. The results examined prognosis, recurrence of esophageal varices and late postoperative complications. The 5-year survival rates for patients who underwent selective or prophylactic surgery were 85.9% following TEPG and 81.6% following ET. However, the 10-year survival rate for the former group was significantly lower than that for the latter group at 59.3% versus 70.0% (P<0.05) because of the number of deaths due to hemorrhage and liver failure caused by anastomotic ulcers. The respective 5-year recurrence rates of varices for the TEPG and ET groups were 18.4% and 26.4%, respectively, while the 10-year recurrence rate for the former group was again significantly lower than that for the latter group at 27.1% versus 53.7% (P<0.01). As for postoperative late complications, reflux esophagitis and/or anastomotic ulcers were found twice as frequently after TEPG as after ET. Thus, although TEPG was more effective for preventing variceal recurrence it left the potential for an anastomotic ulcer to develop, which was the dominant cause of death more than 5 years after surgery.

Comparison of the prognosis of surgical treatment and endoscopic injection sclerotherapy for esophageal varices.

過去13年間に当科で108例の食道静脈瘤に対して直達手術療法 (食道離断術50例, 胃上部切除50例, 胃上部静脈郭清ならびに摘脾8例) を行った. また過去7年間に95例の内視鏡的硬化療法を行った. 肝硬変患者に限っての生存率は, 手術療法では3生率79.2%, 5生率72.2%, 10生率57.5%, 内視鏡的硬化療法 (非手術既往例42例) では3生率71.2%, 5生率53.4%であり, 両者の間には有意差は認められなかった. しかし, 硬化療法では静脈瘤の再発率が高いので, 耐術適応のある患者には, 手術療法が第1選択と考えられる.(肝障害が重度で, 手術適応外で, 硬化療法でも対処し難いものには食道静脈瘤の原疾患である肝臓に対する根治療法としての肝移植が必要かもしれない.)

A battery powered operating table with a removable stationary column base and a detachable table top.

AC and DC powered operating tables were investigated from the viewpoint of safety and the following results were obtained: 1) With the increase in supply voltage, leakage from cables increased prominently. Only a low leakage cable showed a low leakage value. 2) AC powered operating tables showed a high leakage current, especially when in remote control. 3) A battery powered operating table with a freely removable driving base and detachable table top function, which we developed, proved to have a satisfactory durability for actual clinical use and an exteremely low level leakage of electricity (0.1–0.3 μA). Moreover, our design incorporates every merit guaranteed by the usual operating table.