Kazuyoshi Suzumura

The effectiveness of administering a minimal dose of octreotide long-term prior to surgery for insulinoma: report of a case.

We report herein the case of an 80-year-old woman with insulinoma who was regarded as an unsuitable candidate for immediate surgery due to her advanced age and obesity, for whom octreotide, a long-acting analogue of somatostatin, was used to improve her hypoglycemia and hyperinsulinemia without hyperalimentation. Administering a minimal dose of octreotide for a long period resulted in the improvement of leg edema, weight control, and cardiopulmonary function, and resection of the pancreatic tumor was safely carried out without any complications.

Malignant “Triton” tumor in the thyroid —A case report—

This report presents a very rare case of a malignant “Triton” tumor developing in the thyroid. Although malignant “Triton” tumors have often been known to develop in cases of neurofibromatosis, Von Recklinghausens disease, this patient showed no clinical evidence of that disease. Total thyroidectomy including left standard radical neck dissection was followed by postoperative irradiation to the neck. Despite this, local and distant metastases developed four months after treatment and the recurrent foci did not respond to chemotherapy or irradiation. The clinical course of this case mimicked that of anaplastic carcinoma of the thyroid and interestingly, a minimal lesion of papillary adenocarcinoma was found to exist concurrently in the thyroid gland of this patient.

Effect of gelatins on human cancer cells in vitro

Three types of gelatins were tested for their antiproliferative activities in vitro against three human tumor cell lines (K-562; erythroleukemia, HCT-15; colon carcinoma, AGS; gastric carcinoma) with viable cell count and tritium-thymidine ((3)H-TdR) uptake by those cells. Porcine skin (PS) gelatin exerted the strongest antiproliferative activity of all three gelatins. Bovine bone (BB) gelatin did not exert such an activity. PS gelatin exerted antiproliferative activity against K-562 cells also in a serum-free medium. The serum-free medium contains two growth factors, insulin and transferrin, as well as nutrients. The activity of PS gelatin was not interfered by addition of insulin and transferrin to the medium. Effect of diluting a K-562 cell-concentration on the activity of PS gelatin was tested. Diluting the cell concentration did not affect the activity of PS gelatin. Moreover, the conditioned medium in which K-562 cells had been cultured did not stimulate the proliferation of K-562 cells. In conclusion, PS gelatin suppress the proliferation of human tumor cell lines in vitro. The antiproliferative activity of PS gelatin might not be attributed to trapping growth factors or autocrine mediators.

Clear Cell Carcinoma of the Thyroid. A Case Report

A rare case of clear cell carcinoma of the thyroid is presented herein. A 31-year-old male had a large soft tumor in the right lobe of the thyroid which showed a hot nodule on scintigram with99mTc. A right hemithyroidectomy was thus performed after the preoperative diagnosis of a functioning tumor had been made. At surgery, a tiny nodule behind the tumor was found and the histopathological diagnoses of the large tumor and the tiny nodule were clear cell carcinoma and papillary carcinoma, respectively. The thyroglobulin stain was positive in the cytoplasm of many clear cells and scattered colloid. This patient has been well without any evidence of recurrence over the past five years following surgery. The biological characteristics of clear cell carcinoma of the thyroid are discussed in this report.

Pheochromocytoma without specific symptoms

A 72-year-old Japanese woman with pheochromocytoma, who had had no characteristic symptoms was treated. A large retroperitoneal tumor was discovered incidentally by sonographic examination for mild upper abdominal pain and, with CT-scan and abdominal angiography confirmed that the tumor originated in the right adrenal gland. The tumor was suspected of being a pheochromocytoma because preoperative laboratory examinations revealed only a mild elevation of daily urinary excretions of adrenaline and noradrenaline. Provocation tests for pheochromocytoma and even angiographic examination revealed no diagnostic change in serum levels of catecholamines and distinctive clinical signs were nil. Thus, surgery was performed without preoperative prescription of any catecholamine blockade. During the surgery, the blood pressure and pulse rate fluctuated considerably. A non-functioning pheochromocytoma detected incidentally must be preoperatively managed as a functioning one, even in the absence of specific symptoms of pheochromocytoma.

Bone metabolic analysis in patients with primary hyperparathyroidism

Surgical treatment for primary hyperparathyroidism (PHPT) improves not only the calcium and phosphate metabolism but also the bone metabolism. This study was conducted to analyze the bone metabolism after PHPT operations. Bone mineral density (BMD) was measured by dual-photon absorptiometry in 50 patients before and after operation. Osteocalcin (OC) and alkaline-phosphatase activity (Alp) in serum were measured before and after surgery as markers of bone formation, and urinary deoxypiridinorine (DPD) as an index of osteoclast activity. The 50 patients under study were 40 women (80%) and ten men (20%). Increases in BMD at the lumbar spine were remarkable at three months following operation. Slow but steady progress was made until six months, reaching a plateau thereafter. The increase in BMD of lumbar spine was approximately 10%. Urinary DPD was the most sensitive among the three bone metabolic markers. Although serum Alp and OC remained high after operation, urinary DPD was normalized earlier. The discrepancy of bone formation and resorption was shown after operation and this contributed to the increases in BMD in the first six months.

Necrosis of Large Hepatocellular Carcinoma Induced by Preoperative Portal Vein Embolization: A Case Report

A 71-year-old man consulted our hospital because of a huge liver tumor. He had consumed a considerable amount of alcohol over 40 years. He received medications for hypertension and diabetic mellitus. In the laboratory data, hepatitis virus was negative. Tumor markers AFP and PIVKA-II were elevated to 143,360 ng/ml and 244,000 mAU/ml, respectively. In contrast-enhanced CT, the tumor recognized in the right lobe of liver was heterogeneously enhanced in the early phase and had low density in the late phase (Fig. 1). The preoperative diagnosis was HCC, and right liver lobectomy was planned. The FLR was 265.8 ml and its ratio was 26.6 % according to CT volumetry. Percutaneous transhepatic portal embolization for the right portal vein was performed to increase the FLR. Hepatic arteriography and portgraphy were also performed, and tumor stain was recognized in arteriography (Fig. 2). The left lobe was hypertrophied 3 weeks after PVE, and the

Local recurrence of breast cancer: Treatment of nine patients with a recurrence in the skin flap of the chest wall

From 1975 through 1985, nine patients with a local recurrent lesion (LRL) of breast cancer to the skin flap of the chest wall were treated. Four had undergone primary mastectomies in our clinic and the other five were referred from other surgeons, following signs of recurrence. Aggressive topical therapy, such as resection or irradiation, proved effective in eradicating the LRL in all cases, thereby indicating that topical therapy is useful for improving quality of life. Adjuvant systemic chemo-immunoendocrine therapy is also required for patients with LRL, to increase longevity. Seven of the patients died of a distant metastasis within 66 months after the onset of LRL.

Clinico-pathological analysis on the colorectal cancer and study on polyp-cancer consequence.

1976年から10年間の単発大腸癌145症例を前期と後期に分け, その臨床病態の変化を検討した. 大腸癌の症例数は前期に比べ後期では2.5倍と著明に経年的に増加した. 発生部位も直腸癌の比率が減少し, S状結腸が増加した. 術式面でも, 結腸癌と異なり直腸癌では, 直腸切断術が減少し前方切除などの肛門温存術式が増加した.大腸ポリープの癌化に関する研究として, 正常大腸粘膜, ポリープ, 大腸癌のH3-thymidine標識像による細胞増殖動態を比較検討したところ, ポリープでは正常粘膜にある増殖帯と機能帯との区分が消失し, 組織異型度に相関して異常増殖像を生じ, ポリープ癌では癌の標識態度とほとんど差がなくなることを認めた.