Masaaki Nakagawa

Mastectomy with and without immediate breast reconstruction using a musculocutaneous flap

We compared surgical cosmetic results in 83 patients who underwent mastectomy with immediate breast reconstruction (MIBR) using a myocutaneous flap with those of 153 patients with breast cancer who underwent mastectomy without breast reconstruction. Cosmetic results were significantly better in patients who underwent MIBR than radical mastectomy or extended MIBR, although no intergroup difference existed in the reconstructive technique. Neither did any difference exist in the incidence of complications between patients undergoing MIBR and mastectomy without breast reconstruction, or between patients undergoing modified mastectomy and radical or extended mastectomy. Finally, MIBR did not appear to adversely effect recurrence or overall survival. We conclude that MIBR using a myocutaneous flap is an acceptable treatment option for patients with breast cancer.

Successful salvage of aortoesophageal fistula caused by a fish bone

We report saving the life of a 66-year-old woman with an aortoesophageal fistula caused by a fish bone. In this case, a hemostastic clip, which was applied to the lesion during emergency endoscopy, facilitated the subsequent diagnosis of this fistula by diagnostic imaging. Compressive hemostasis was effective in controlling preoperative bleeding.

Small Intestinal Metastasis from Esophageal Carcinoma Associated with Small Intestinal Obstruction: Report of a Case

The small intestine is rarely involved with metastatic tumors from outside the abdomen, and few case reports have been documented in the literature. We describe herein what to our knowledge is the third case of a solitary metastasis from squamous cell carcinoma (SCC) of the esophagus being found in the jejunum, causing small intestinal obstruction.

Lymphoepithelioma-like esophageal carcinoma: Report of a case

We herein report the rare case of a patient suffering from lymphoepithelioma-like poorly differentiated squamous cell carcinoma of the esophagus. The patient was a 74-year-old woman in whom an esophageal tumor was found during an operation for thyroid cancer. After performing a subtotal thyroidectomy and cervical esophagectomy, esophageal reconstruction was performed using a free jejunal graft. Based on the results of the pathological examination, the esophageal tumor was diagnosed to be primary lymphoepithelioma-like esophageal cancer, not metastasis of either unknown nasopharyngeal cancer or thyroid cancer. Since surgery, she has survived postoperatively for more than 4 years with no evidence of recurrent disease.

Immunohistochemical analysis of gastrointestinal carcinoids.

SummaryClinicopathological and immunohistochemical analyses were performed on ten samples of gastrointestinal carcinoids resected in Ishikawa Prefectural Central Hospital. All samples showed positive reaction to chromogranin A. Serotonin was detected in 8 samples, somatostatin in 4 samples, gastrin in 2 samples. Glucagon/Glicentin in 1 sample, and PYY production in 2 samples. CEA production was detected in 8 samples, and microvascular invasion was observed in 6 of these 8 patients. The PCNA/cyclin labeling index (L.I.) of the cases with metastases was significantly higher than those without metastases. In conclusion, the expression of CEA and the PCNA/cyclin L.I. may be useful markers of the malignant potential of carcinoid tumors.

Pneumothorax caused by metastatic carcinoma of the breast

We report a rare case of pneumothorax caused by metastatic carcinoma of the breast, in a 69-year-old woman who was admitted to our hospital with severe chest pain. Four years previously, she had undergone modified radical mastectomy for a left breast tumor. Chest X-ray examination and computed tomography (CT) scan on current admission revealed right pneumothorax and bilateral pulmonary tumors. Although operation is not usually indicated in such circumstances, the patient had persistent air leakage for 7 days, despite receiving effective closed cather drainage, making right thoracotomy necessary. During the operation, an open bronchopleural fistula in the metastatic tumor of the upper lobe, infiltrating close to the visceral pleura, was observed. Wedge resection, including the necrotic tumor, was thus performed. Microscopic examination of the resected specimen showed poorly differentiated adenocarcinoma, consistent with metastasis from breast carcinoma. This is the second reported case of pneumothorax caused by metastatic carcinoma of the breast.

Delayed Infection of a Lymphocele Following Mastectomy with Immediate Breast Reconstruction : Report of a Case

We report herein a rare case of delayed infection of a lymphocele following mastectomy with immediate breast reconstruction. A 38-year-old woman presented to our hospital 7 months after undergoing a left-modified radical mastectomy with an immediate breast reconstruction, following the sudden development of a giant mass in the left thoracoabdominal region as well as a high fever and shivering. Ultrasonography and a computed tomographic scan revealed massive fluid retention extending from the left axilla to the lower abdominal region. Puncture drainage was performed three times and the injection of an antibiotic directly into the cyst resulted in resolution of the fluid. This massive retraction of fluid was considered to have resulted from a delayed infection of an axillary lymphocele.

Significance of systemic inflammatory response syndrome after surgical treatment for thoracic esophageal cancer

We studied the significance of Systemic Inflammatory Response Syndrome (SIRS) state after surgical treatment of thoracic esophageal cancer. From January 1991 to December 1995, 35 patients received thoracic esophageal cancer surgery. Thirty three patients (94.3%) were in the SIRS state after surgery and mean duration of SIRS was 3.4 days. Duration of SIRS was statistically longer in patients with pulmonary complications. Patients with hyperbilirubinemia (> or = 3.0 mg/dl) after surgery had longer duration of SIRS. Induction therapy did not affect the duration of SIRS. Collectively, duration of SIRS is an indication of complications, especially of pulmonary complications, after surgical treatment of thoracic esophageal cancer, and blood bililubin score after surgery correlates to duration of SIRS. These suggest that we must pay special attention to patients with long duration of SIRS or hyperbilirubinemia after thoracic esophageal surgery.

A Trial of Estimation of Invasion Depth in Early Gastric Cancer by Discriminant Analysis.

単発早期胃癌258例 (m癌149例, sm癌109例) を対象として, 統計学的手法により深達度診断を試みた.数量化可能な客観的パラメーター7項目をもちいて判別分析を行った結果, m癌とsm癌の2群を最もよく分離する下記の判別関数を得た.Z (x) =-3.44×10-1x1-8.08×10-1x2+2.08x3-6.79×10-1x4+6.49×10-1x5+5.62×10-1x6-2.15ただしx1に長径, x2に肉眼型, x3に占拠部位1, x4に組織型, x5に占拠部位2, x6に性別を代入する.正診率はm癌で73.8%, sm癌で64.2%であった.リンパ節転移率は, 真のm癌では0.7%, 真のsm癌109例では20.2%であった.これに対し判別関数上のm癌では1.3%, sm癌では19.3%であった.今回得られた早期胃癌の深達度診断法は従来のX線, 内視鏡検査所見を指標とする深達度診断に比べて遜色のない正診率であり, リンパ節転移の予測も含め, 臨床上有用と考える.

Clincal evaluation of tumor detection of tumor marker following curative operation for gastric cancer.

術前腫瘍マーカー値が正常であった胃癌治癒切除患者を対象として, 術後腫瘍マ-カーの測定が再発の早期発見に有用か否かの検討を加えた.腫瘍マーカーはcarcinoembryonic antigen, α-fetoprotein, carbohydrate antigen19-9の3種を測定し, 対象患者440例のうち88例に術後再発を認めたが, 腫瘍マーカー陰性再発例は52例 (59.1%) を占めていた.術後のcombination assayによる腫瘍マーカー陽性率はCEAが11.1%と最も高かった.術後腫瘍マ-カ-低値群では15.1%に, 高値群では37.5%に再発が認められた腫瘍マーカ-高値群に再発率が高い (p<0.01) ことより, 腫瘍マーカーの測定は有用性のあるものとおもわれた.