Kiyoaki Mizusawa

Negative correlation between cholecystectomy and the subsequent development of large bowel carcinoma in a low-risk Japanese population

The incidence of previous cholecystectomy in a series of 541 patients with colorectal cancer and 1832 patients with stomach cancer was studied. Five patients (0.92 percent) with colorectal cancer and eight (0.44 percent) with stomach cancer had undergone previous cholecystectomy. To avoid biases in the two groups of patients, 416 pairs of patients, comparable in sex, age, and time of admission for cancer treatment, were matched from each group to compare the number of patients who had undergone previous cholecystectomy. Within these matched pairs, three patients with colorectal cancer and two with stomach cancer had histories of cholecystectomy. Hence, no substantial difference was noted between the two groups. In a follow-up study of 461 patients who had undergone cholecystectomy for gallstones, large bowel carcinoma and stomach carcinoma developed in one and six patients, respectively, during an observation period of four to 36 years. The ratio of patients with large bowel cancer to those with stomach cancer observed in this survey was almost equal to the value estimated for the population of Tottori Prefecture, where the majority of the patients reside.The incidence of larg bowel carcinoma is not increased among cholecystectomized patients in a low-risk Japanese population.

A prospective cohort study on the development of colorectal cancer after gastrectomy

A prospective cohort study was conducted to examine whether an association exists between gastric surgery and the subsequent development of colorectal carcinoma. One thousand nine hundred twenty-seven patients (1316 men and 611 women) who had undergone curative gastrectomy for gastroduodenal diseases in the First Department of Surgery, Tottori University Hospital, during the 18-year period from 1964 to 1981, were followed to determine the incidence of the development of large-bowel carcinoma after gastric surgery. The age-, sex-, and calendar-specific population at risk was calculated by the person-years method. The observed number of colorectal cancers after gastrectomy was 19 (15 men, 4 women) compared with 9.69 expected carcinomas. The difference between the observed and expected numbers was statistically significant. The authors believe that patients with previous gastrectomy are at high risk for colorectal carcinoma.

Induction of diffuse necrotizing enterocolitis by anticancer chemotherapy

SummaryFulminant, necrotizing colitis is a frequent, and generally fatal, complication of severe granulocytopenia, occurring during the treatment of hematological malignancies. In these cases, the patient complains of severe peritonitis, including nausea, vomiting, abdominal pain, diarrhea or melena, and a high temperature. Here, a rare case of anticancer chemotherapy-induced diffuse necrotizing enterocolitis throughout the entire intestinal tract is presented, which developed in a patient who did not have a hematologic malignancy but who had colon cancer, the only clinical symptom of which was watery stools, without any evidence of peritoneal irritation. Full attention should be paid to progressive diarrhea in patients with malignancies during anticancer chemotherapy.

Clinical evoluation of DNA ploidy content in early gastric cancer with recurrence.

早期胃癌再発例13例, 非再発例41例を対象に原発巣の核DNA量を測定し, 深達度, 肉眼型, 組織型, リンパ節転移の有無別に比較検討を行った.再発例の癌腫では54%にhigh ploidyが認められ, 非再発例に比べて多い傾向にあった.また, 従来, 早期胃癌の中で再発が高率と考えられているsm癌, 隆起+陥凹型, 分化型腺癌, リンパ節転移陽性例においても, 再発例には非再発例に比べてhigh ploidyを示す癌腫が高率に認められた.このため, 早期胃癌の中でもhigh ploidyを示すものでは再発は念頭においた広範なリンパ節郭清と術後の化学療法が必要であり, また, 深達度mでlow ploidyを示す症例では, リンパ節転移や術後再発が少ないことから, 縮小手術も可能であると考えられた.

Relationship between the size of lesions and intramural spread of gastric cancer. With particular reference to the features of carcinoma of the upper portion of the stomach.

下部胃癌123例, 中部胃癌101例, 上部胃癌50例につき粘膜面からみた肉眼的癌巣の広がり (肉眼的癌巣面積) と組織学的にみた癌巣の広がり (組織学的癌巣面積) を比較し, 壁深達度との関係を検討した. 肉眼的癌巣面積と組織学的癌巣面積はよく相関しており, 組織学的癌巣面積が16cm2以下の場合, 進行癌の占める割合は下部胃癌15/102 (14.7%), 中部胃癌19/73 (26.0%), 上部胃癌18/33 (54.5%) と上部胃癌で有意に高く, 同じ大きさの胃癌であっても胃上部の癌はより進行した癌が多かった. さらに, 全摘胃を用いて粘膜筋板の厚さを胃の各部位ごとに測定したところ, 胃上部ほど粘膜筋板は薄く, 粘膜筋板が癌の壁深達に何らかの関わりをもっている可能性が示唆された.