Kazuo Orii

Splenic Artery Aneurysm of the Anomalous Splenomesenteric Trunk: Successful Treatment by Transcatheter Embolization Using Detachable Coils

A splenomesenteric trunk, which involves replacing the splenic artery from the superior mesenteric artery (SMA), is rare and occurs in less than 1% of patients. We report a case of an aneurysm involving the origin of the splenic artery that anomalously arose from the SMA, and which was successfully treated using Guglielmi detachable coils.

Randomized controlled study of postoperative adjuvant immunochemotherapy with Nocardia rubra cell wall skeleton (N-CWS) and Tegafur for gastric carcinoma

SummaryWe performed a randomized controlled study of postoperative adjuvant immunochemotherapy with Nocardia rubra cell wall skeleton (N-CWS) and Tegafur for gastric carcinoma between September 1979 and March 1983. A total of 309 patients were entered into this trial. Of the 309 patients, there were 98 evaluable patients in the chemotherapy group and 115 evaluable patients in the immunochemotherapy group. In both groups, Tegafur was given as chemotherapy at a daily dose of 400 to 800 mg, starting at 24–29 days after gastrectomy. In the immunochemotherapy group, 400 μg of N-CWS was injected i. d. within the 2nd postoperative week. It was given weekly during the first month and subsequently monthly for as long as practicable. The patients were surveyed for length of survival in March 1985. The postoperative survival rate was analyzed for all cases, and for patients with various histopathological stages of carcinoma for comparison between the two treatment groups. No statistical difference was detected between the two groups in terms of age, sex, surgical curabilities, or stage of carcinoma. The overall survival rate for all patients was significantly higher in the immunochemotherapy group than in the chemotherapy group (p<0.05). With stage III plus IV disease, 53 patients from the chemotherapy group and 61 patients from the immunochemotherapy group were included for the analysis. As a consequence, a highly significant survival rate was observed in patients with stage III plus IV carcinoma in the immunochemotherapy group (p<0.005) as compared to the chemotherapy group. The overall 5-year (1800 days) survival rate after surgical treatment was 60.2% for the chemotherapy group and 73.2% for the immunochemotherapy group. In patients with stage III plus IV disease, the 5-year survival rates of the two treatment groups were 28.8% and 52.4%, respectively. Accordingly, the 50% survival period of patients with stage III plus IV cancer was 1800 days or more in the immunochemotherapy group, whereas it was only 722 days in the chemotherapy group. These results emphasize the effectiveness of N-CWS as an adjuvant immunotherapeutic agent in postoperative gastric cancer patients.The main side effects of N-CWS were skin lesions in the injected sites and fever, but these were temporary and not serious.

Postsurgical radiation therapy for gastric carcinosarcoma with c-kit expression: A case report

Gastric carcinosarcomas are rare morphologically biphasic tumors, consisting of carcinoma and sarcoma components, with a poor clinical course. Here we report the case of a 70-year-old man with advanced Borrmann type III carcinosarcoma arising from the upper body of the stomach with extensive lymph node metastasis who underwent a total, but palliative, gastrectomy. Histology showed the tumor consisted of a biphasic structure of tubular adenocarcinoma and spindle cell sarcoma. Immunohistochemistry revealed sarcoma cells expressing c-kit (CD117) and CD34, which are criteria for gastrointestinal stromal tumors. Nine months after the surgical operation, tumor metastases had extended to the hepatohilar, retroperitoneal and mediastinal lymph nodes. Radiation therapy of 50 Gy markedly decreased the size of each of these nodes and reduced the risk of respiratory complications and jaundice. However, the patient died of respiratory failure due to bronchopneumonia with multiple lung metastases 22 mo after resection. Autopsy revealed severe necrosis in most of the lymph nodes with tumor metastases. Radiation therapy combined with gastrectomy should be considered to improve survival in patients with gastric carcinosarcomas that express c-kit.

Severe sinoatrial dysfunction after esophageal surgery : a case report

1 Department of Anesthesia and Critical Care Medicine, Tsukuba Gakuen Hospital, 2573-1 Kamiyokoba, Tsukuba, Ibaraki 305-0854, Japan 2 Department of Critical Care Medicine, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan 3 Department of Surgery, Tsukuba Gakuen Hospital, 2573-1 Kamiyokoba, Tsukuba, Ibaraki 305-0854, Japan 4 Department of Anesthesiology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan

Clinicopathological Study on the Long Term Survivors Following Resection of Hilar Bile Duct Cancer.

肝門部胆管癌切除57例中治癒切除は13例で, 非治癒切除は44例である.このうち9例が5年以上生存し, StageはII;1例, III;3例, IV;5例で, 6例が治癒切除, 3例が非治癒切除である.術式 (胆道癌取扱い規約) は肝門部胆管切除 [hilar bile duct resection (HBDR)];2, HBDR+pancreatoduodenectomy (PD);1, HBDR+拡大肝右葉切除+尾状葉 (SI) 切除;1, HBDR+拡大肝左葉切除 (SI合併切除4例);5例である.組織学的深達度では9例中4例 (40.4%) が他臓器に浸潤し, 1例のみが外膜にとどまる症例であった.肝実質に癌浸潤のある症例は9例中5例 (55.6%) で, リンパ節転移例は3例のみであった.剥離面に癌浸潤の明かな症例が3例あり, 肝臓側胆管断端に癌浸潤を認める症例は1例のみであった.3年以上生存例 (13例) の検討では剥離面及び肝臓側胆管断端の癌浸潤陽性頻度は3年末満死亡例 (36例) に比べて有意 (p<0.05) に低くこの2因子が重要な予後決定因子である事が示された.

Evaluation of preoperative radiation combined with chemotherapy for prevention of local recurrence of rectal cancer.

化学療法を併用した直腸癌術前照射療法 (42.6Gy) が, 術後の局所再発防止にどのような効果を与えているかを知るため, 非照射群37例と照射群44例を臨床病理学的に検討した.局所再発 (術後観察期間平均3年10か月) は非照射群7例18.9%, 照射群2例4.5%であった.局所再発因子の組織学的検討では, 照射群は非照射群に比べ壁深達度a2症例の低値, ew (外科的剥離端までの距離) 2mm未満症例の低値, およびリンパ節転移n2以上の症例の低値がみられ, 両群間に有意差が認められた.さらに照射群のa2症例, ew 2mm未満症例からの局所再発は, 非照射群に比べ明らかに低下していた.これに対し照射群におけるn2以上の症例からは, 非照射群と同様に高い再発率が認められた.以上の結果, 術前照射療法による局所再発の低下は, 壁深達度やewに起因した再発の減少によるところが大きく, 一方リンパ節転移陽性の症例では照射群といえど厳重な経過観察が必要と考えられた.

Intense accumulation of indium-111 leukocytes in peritonitis carcinomatosa

In order to detect the infectious foci in a case of terminal recurrent cancer of the sigmoid colon with intense inflammation, In-111 oxine leukocyte scintigraphy was performed. Leukocytes labeled with In-111 oxine quickly localized within the region of peritonitis carcinomatosa and could be imaged after 4 hours. With time, high activity appeared in this area. And 48 hours after injection, the large intestine was clearly seen. However, no activity was seen in the main recurrent tumor. This suggested that the labeled leukocytes had accumulated in regions of inflammation rather than in malignant tissue.When performing In-111 leukocyte scintigraphy for diseases in which tumor cells and in-flammation are mixed, distinguishing the two components is particularly important, and time-sequential scanning is very useful.

Clinical effect of preoperative irradiation and local administration of anticancer agents on tumor regression for rectal cancer.

進行直腸癌に対する術前照射療法の治療効果を高めるため, 抗癌剤の腫瘍内局注併用法を施行した.その治療効果を比較するため, 非照射25例, 照射単独15例, 局注併用21例の切除標本を用い癌巣の分布を比較した.照射前の注腸X線像をもとに壁深達度の改善が著しいと判定された症例は, 照射単独例4例 (26.7%), 局注併用例11例 (52.4%) であった.それぞれの組織構築図を作製し検討した結果では, 局注併用例は照射単例に比べ, 壁外浸潤 (a1以上) とew2mm以下の鯛がより狭くなっている傾向が示唆された.さらに局注併用例のうち著しい照射効果のみられた症例では, 癌胞巣の退行性変化 (のう胞状病変など) が広く認められた.

Effective colostomy irrigation using a new devised appliance.

新しく開発した吸引式洗腸器の有用性を知る目的で, 従来より使用されていたストッパー式洗腸器と比較検討した.対象はMiles手術後の結腸終端人工肛門保有者で, それぞれの洗腸器を使用していた15症例 (計30症例) について対面調査を行った.その結果, 吸引式洗腸器の長所としては穿孔の危険が少いこと, 速やかに完全な洗腸が行えること, 臭気もなく清潔に行えることが挙げられた.一方, ストッパー式洗腸器に比べ十分な指導を必要とするなど, いくつかの短所も示唆された.以上の結果から, 本洗腸器は若い知識人に適しており, さらに狭窄様人工肛門症例の洗腸にも威力を発揮していることが明らかとなった.

EVALUATION OF ARTERIAL PORTOGRAPHY IN CARCINOMA OF THE BILIARY TRACT

肝門部胆管癌10例, 胆のう癌6例を対象に術前, 門脈への浸潤の有無を知る目的で, 経動脈門脈造影を施行し, 門脈像と手術および剖検所見との対比より, その診断的意義を検討した.血管拡張剤を用いた経上腸間膜動脈門脈造影を行えば常に明瞭な門脈造影像を得ることができる.さらに門脈と胆管の位置関係を考慮して門脈を2分間 (正面, 第2科位) より撮影し, 得られた門脈造影所見は手術および剖検所見とよく一致し, 切除可否の決定の術式選択に有効であった.また胆管造影像で肝内胆管第2分岐部を越えて肝側に浸潤のおよぶ胆管癌では, 門脈への浸潤の可能性が高いことが判明した.