Masayuki Niwa

Combination therapy of transcatheter chemoembolization and percutaneous ethanol injection therapy for unresectable hepatocellular carcinoma.

The therapeutic effectiveness of a combination therapy — pretreatment with transcatheter arterial chemoembolization (TACE) followed by percutaneous ethanol injection (PEI) therapy — for large (>3 cm in diameter) unresectable hepatocellular carcinoma (HCC) wa compared with that of TACE alone. PEI therapy was performed in 24 cases of unresectable HCC that had previously been treated with TACE using doxorubicin 30–60 mg or epirubicin 50–90 mg. In all, 2–10 ml of 90% ethanol mixed with carbocaine was repeatedly injected through a 21-gauge, closed-end needle (PEIT needle) for a median of 3.6 injections and 31.1 ml of ethanol. As adverse effects, transient localized pain and a burning sensation were observed in 75.0% of the cases; fever, in 66.7%; and transient hypotension, in two cases. A small unresectable tumor is a good indication for PEI therapy. In cases with a larger tumor, i.e., measuring more than 3 cm in diameter, or multiple tumors, the 1-year survival rate obtained with this combination therapy, i.e., TACE and PEI, was 87.0%, and the 2-year survival rate was 65.2%. These rates were greater than those obtained with TACE alone. Accordingly, additional PEI therapy was effective for larger tumors and multiple tumors previously treated with TACE.

Morphological Study of Pancreas Divisum in Niigata Using ERCP

Abstract: The morphological characteristics and incidence of pancreas divisum (PD) in Niigata were investigated by studying 16,646 cases diagnosed by ERCP. These cases had been patients in 16 hospitals located in Niigata prefecture.

The diagnostic evaluation of ERCP in pancreatic and biliary carcinoma

SummaryEndoscopic retrograde cholangiopancreatography (ERCP) was performed in 77 cases of pancreatic carcinoma, 47 cases of carcinoma of the common bile duct and 45 cases of carcinoma of the gall bladder. In order to evaluate ERCP in pancreatic and biliary carcinoma, success rates of desired duct cannulation and some problems in the interpretation of ERCP findings were discussed. In 2 cases (2.6%) of pancreatic carcinoma, 6 cases (13.0%) of carcinoma of the common bile duct and 8 cases (17.8%) of carcinoma of the gall bladder were failed to visualized the desired ducts by ERCP. In pancreatic carcinoma, false negative cases in the interpretation of ERCP findings were encountered in 4 cases (4.6%). Similarly, false positive cases were encountered in 12 patients (13.6%). On the other hand, 4 false negative.were encountered in cases of which carcinoma of the gall bladder could not detected and 4 false positive cases were encountered in cases with inflamatory disease of the common bile duct.

Endoscopic Surgery for Early Gastric Cancer and the Points Which Demand Special Attention

Endoscopic therapy for early gastric cancer has recently progressed. Our methods are endoscopic resection, and our criteria for endoscopic resection are as follows: ①well defined mucosal cancer of the elevated or flat type less than 2cm in size, ②well defined mucosal cancer of the depressed type less than 1cm in size and histologically differentiated adenocarcinoma, and with no peptic ulcer within the lesion. Eighty-five cases and 94 lesions were treated by endoscopy. Seven patients later died: six died of other diseases but one died of cancer itself after laser therapy. Seventeen patients were subsequently treated by surgical procedures after endoscopic therapy. Two patient died, namely, one died of myeloma and the other of suicide. The points which demand special attention are as follows: ①observance of strict indication, ②combination with superficial spreading of flat cancer ③multiple lesions of cancer, ④ill-defined minimal cancer, and ⑤other malignancies which occur during post-treatment after endoscopic therapy. It is important to select and perform the most appropriate endoscopic therapy according to strict criteria. However, endoscopic therapy must be undertaken even if the criteria does not so warrant. We emphasize that the surgical treatment should be selected on the incomplete endoscopic resection or recurrence, because the margin of the cancer lesion will have become ill-defined after endoscopic therapy.