Masaji Hashimoto

Analysis of results of surgery performed over a 20-year period on 500 patients with cancer of the thoracic esophagus

This study was conducted to examine the long-term outcome of 500 patients who underwent surgery for cancer of the thoracic esophagus during the past 20 years. Favorable results were obtained with postoperative adjuvant radiation and chemotherapy and there were no surgical deaths in the last 5 years. The mortality rate decreased from 17% prior to 1980 to 5% between 1981 and 1993, this being most probably attributable to the decreased incidence of suture leakage. With respect to changes in surgical techniques, during the initial years we performed intrathoracic anastomosis, after which sternal manubrium resection with anterior mediastinal esophagogastrostomy was carried out. Subsequently, we invented a technique for performing esophagogastrostomy via the posterior mediastinum. The posterior mediastinum was selected as the most physiologic route, based on measurement of tissue oxygen tension. Using blood flow determinations obtained by laser-Doppler velocimetry, we concluded that the effectiveness of thicker gastric tubes was superior to that of thin tubes. Esophagogastrostomy was performed in a shallow field in the cervical region, with the anastomosis ultimately positioned in the superior mediastinum and covered with mediastinal pleura.

Direct measurement of doxorubicin concentration in the intact, living single cancer cell during hyperthermia

It is well known that the effect of doxorubicin on cancer cells is enhanced by hyperthermia. The mechanism of this phenomenon is not fully understood.

Abdominal tuberculoma mimicking a pancreatic neoplasm: report of a case.

We report herein a case of clinically solitary abdominal tuberculoma. A 28-year-old woman was admitted to hospital for treatment of an abdominal tumor shown to be located in the head of the pancreas and compressing the superior mesenteric vein by echosonography and computed tomography (CT). There were no clinical signs or symptoms of tuberculosis in the lungs or abdomen. Thus, under the diagnosis of a neoplasm of the pancreas, an exploratory laparotomy was performed which revealed tuberculosis. The patient made an excellent recovery on anti-tuberculous treatment, and no evidence of a tumor was seen on a CT scan performed 6 months after the initiation of treatment. Abdominal tuberculoma is often mistaken for a malignant neoplasm and the nonsurgical diagnosis of this entity continues to be a challange.

The intrapleural administration of recombinant interleukin-2 (rIL-2) to patients with malignant pleural effusion: Clinical trials

Recombinant IL-2 (rIL-2) was administered intra-pleurally according to an original protocol to 11 patients with malignant pleural effusion, 7 of whom suffered from breast cancer and 4 from esophageal cancer. The pleural effusions either disappeared or decreased roentgenographically, and malignant cells disappeared from all 13 pleural cavities in the 11 patients, confirming the validity of this therapy to be 100%. The mean survival time from the initial administration of rIL-2 was 15.9 months. We ensured that the concentration of IL-2 in the effusion was maintained at a high level for a sufficient period of time, and that the lymphokine-activated killer (LAK) activity of lymphocytes in the effusion was augmented. Fever, eosinophilia, and a transient increase in the pleural effusion were the main side effects, but the symptoms were temporary and not serious. The results of this study therefore suggest the efficacy of intrapleural rIL-2 for patients with malignant pleural effusion.

Gene Amplification of int-2 and erbB in Human Esophageal Cancer: Relationship to Clinicopathological Variables

Gene amplification is a relatively frequent event in human malignant tumors and is believed to play an important role in tumor progression. The int-2 and erbB genes are amplified more frequently than any other genes in human esophageal cancer. In order to investigate the correlation between these two proto-oncogenes and the clinical behavior of esophageal cancer, we examined DNA amplification of int-2 and erbB and analyzed their relationship to clinicopathological variables. Genomic DNA was extracted from 21 esophageal squamous carcinomas and normal esophageal mucosa, as well as from 4 metastatic tumors. We used Southern blot analysis for detection of gene amplification. Amplification of int-2 was observed in 13 of 21 cases (62%) and in all the metastatic tumors (4/4; 100%). We found a significant correlation between amplification of int-2 and the length of the primary lesion. Amplification of erbB was detected in 3 of 18 patients (17%). All patients who showed amplification of erbB also demonstrated amplification of int-2. These results suggest that amplification of int-2 or neighboring genes on 11q may participate in tumor progression and metastasis in patients with esophageal squamous cancer.

Malignant fibrous histiocytoma originating from the thymus

A 63-year-old man with a history of acute coronary syndrome presented with anterior chest pain that had lasted more than 3 months. During treatment for acute myocardial infarction on admission, computed tomography (CT) was performed incidentally, revealing an anterior mediastinal tumor 28 mm in diameter. CT findings after 3 months demonstrated an anterior soft tissue mass involving the left brachiocephalic vein and showing rapid growth. Radical resection of the tumor with thymectomy was performed. Histological examination showed storiform-pleomorphic malignant fibrous histiocytoma (MFH) originating from the thymus, and Hassall’s bodies were identified. Immunohistochemical staining showed tumor cells with positive results for vimentin and CD68. The Ki-67 index (MIB-1) was >50%, but other markers such as cytokeratin AE1/AE3, smooth muscle actin, S-100 protein, CD34, and CD45 were negative. Mediastinum MFH has been reported in 34 cases, but this appears to be a rare description of MFH originating from the thymus.

Analysis of Gene Amplification in Human Esophageal Cancer

The “multistep” of genetic alterations is necessary for cancer formation [1], but there are few reports dealing with both oncogenes and tumor suppressor genes in human esophageal cancer. To investigate the correlation between oncogenes and esophageal cancer, we examined gene amplification of the int-2 and erbB genes, and the p53 and DCC tumor suppressor genes by Southern blot analysis.

Report of a Case Who Underwent Resection of Reconstructed Gastric Tube after Operation for Esophageal Cancer due to Massive Upper Gastrointestinal Bleeding.

食道癌術後の後縦隔経路再建胃管に発生した潰瘍より大量出血を来し, ショック状態に陥った患者に対し胃管切除術を施行することにより救命しえた症例を報告する. 患者は72歳の男性で1988年6月1日, 食道癌根治術を施行され, 術後に計80Gyの頸部, 縦隔T字照射を受けている. 再発の兆候も見られず順調に経過していたが, 術後3年7か月後に突然下血, 吐血し, ショック状態となったため, 緊急入院し内視鏡を施行, 再建胃管に発生した潰瘍からの出血と判明し内視鏡的止血およびバルーンによる圧迫止血を試みるも止血できず胃管切開直視下縫合による止血術を2回施行するも再出血を来したため3回目の手術で開胸下に胃管切除術, 頸部食道皮膚瘻, 空腸瘻造設術を施行しようやく止血しえた. 患者は6か月後に有茎結腸による胸壁前食道再建術を受け現在経口摂取訓練中である. 本症例では術後の照射および酸分泌能の残存が潰瘍形成に関与していたものと考えられる.