Motomichi Urabe

Progress of gastric carcinoma diagnosis and long term surgical results of early carcinoma

In Japan diagnostic technic of G.I. tract progressed considerably within these 15 years, particularly X ray diagnosis and endoscopic diagnosis are so advanced and generalised overall Japan that early gastric cancer is now numerously detected every year not only in university but also in smaller clinics as well. In this paper macroscopic feature of early gastric cancer is classified in accordance with the classification proposed by Japan Endoscopic Society 1962.

A case of double cystic duct with cholecystolithiasis treated by laparoscopy

A case of cholecystolithiasis with double cystic duct treated successfully by laparoscopic surgery is reported. The patient was a 50-year-old female who presented with abdominal pain in the right upper quadrant. On admission, extracorporeal ultrasonography (US) revealed a hyperechoic area accompanied by an obscure acoustic shadow in the gallbladder. Endoscopic retrograde cholangiopancreatography (ERCP) revealed two cystic ducts that led separately from the same cluster of the gallbladder. After preoperative examination around the biliary tree, we determined that laparoscopic cholecystectomy was the treatment of choice. Intraoperative color Doppler US was useful for distinguishing the cystic duct from vessels. An ultrasound aspirator (UA) was also extraordinarily useful for skeltonizing the cystic ducts and the cystic artery. The postoperative course was not eventful. Our findings suggest that laparoscopic cholecystectomy, using an UA, is indicated in patients with an anomalous arrangement of the biliary system, since the use of the UA provides a clear delineation of the anatomy of Calots triangle.

Three Cases of Esophageal Granular Cell Tumor

Abstract: Although it has long been thought that granular cell tumor (GCT) is relatively uncommon in the esophagus, in recent years, reports of this disease have increased due to advances in endoscopic examination and endoscopic therapy. The authors recently experienced three cases of esophageal GCT, all of whom underwent endoscopic polypectomy. Endoscopic findings were consistent with Yamadas type I or II, the surface of the lesions being smooth and the color white or whitish‐yellow. These three cases were treated by endoscopic polypectomy. In case 1, the resection was made possible by raising the tumor with forceps under a 2‐channel‐scope. In case 2, the tumor was resectable following submucosal injection of physiological saline. In case 3, the tumor was resected via strangulation with a snare. The lesions described herein were diagnosed as benign and completely resected by polypectomy, though some showed differences in nuclear size or dyskaryosis. As numerous points remain to be clarified regarding the clinical characteristics of this tumor, and some tumors have been diagnosed as malignant despite being small, it appears that endoscopic polypectomy should be performed for the purpose of diagnosis as well as complete resection.

Search for immunobiological parameters predictive of clinical effects of OK-432 in patients with malignant ascites

Although OK-432, a potent BRM, has been known to induce the remarkable improvement of clinical conditions in cancer patients through its strong effects on their immune capabilities, no specific immune parameters have been identified to best predict the clinical outcome after the OK-432 treatment. In an attempt to identify early parameters indicative of the clinical effects, we have administered 0.1 mg of OK-432 intraperitoneally to a total of 12 patients with malignant ascites and examined peritoneal fluid and peripheral blood obtained on 4 days before, 1, 3, and 7 days after the OK-432 injection using various immunobiological assays. Four weeks later, clinical improvements were evaluated by the disappearance of malignant cells from and/or substantial decrease in ascites. Four patients (responders) showed the improvements while 8 patients (nonresponders) showed no clinical evidence for improvement. In a few parameters among the many examined, significantly different patterns of changes were noted between responders and nonresponders. Thus, in nonresponder patients MØ and T cell population returned to an initial low level after early increases (on days 1 and/or 3), while they remained increased day 1 through 7 in responders. In responder patients, the cytotoxicity of peritoneal mononuclear cells against K562 and Daudi cells were augmented on day 7, but not in nonresponder patients. Thein vitro stimulation of the mononuclear cells with OK-432 enhanced the cytotoxic activity and induced the interferon (IFN) production in the responders but not in nonresponders. These parameters will be useful for the early prediction of the expected clinical effects of OK-432.

Study of Distribution of Minute Gastric Cancerous Foci in Multiple Early Gastric Cancer Cases — In Order to Decide the Extent of Gastric Resection

In this study, we analyzed the relationship between the distribution of cancerous foci and the condition of the surrounding mucosa on the 28 cases of multiple early gastric cancer having the co-existence of minute cancerous focus. The macroscopic types of the minute foci were the IIb or IIe type, and only one focus was diagnosed by the preoperative examination. The main foci and the minute foci were mainly in the same surrounding gastric mucosa, and mainly showed the same histologic type. In cases that had cancerous focus located in the intermediate zone, the foci showed the tendency of multiplicity and the minute foci distributed widely in the intermediate zone.

Surgical trial with Omento-bursectomy for serosal exporsing gastric cascer.

本研究の目的は, きわめて予後の悪い漿膜露出胃癌に対する幽門側胃切除術における. omentobursectomy (以下O-B術) 施行例と非施行例を比較検討し, O-B術の評価をすることにある. 対象は1983年10月から1988年1月までに当科で手術され, 術中にS1～S3と判定された幽門側胃切除症例 (治癒切除例) のうち, O-B術施行37例 (O-B群) とO-B術非施行73例 (非OB群) である. 術後の組織学的診断でps(+)であった例はO-B群27例, 非O-B群39例で, その4年生存率はO-B群で68.9%, 非O-B群で58.0%であった. しかし両群間に統計学的有意差は認められなかった.以上の成績より, 漿膜露出胃癌に対する幽門側胃切除術におけるO-B術施行例は, O-B術非施行例と比べて良好な予後推移を示した.

The growth and extent of the depressed type of early gastric carcinoma.

陥凹性早期胃癌の発育進展を検討するため, 癌巣の大きさと組織型との関係に加え占居腺領域による特性をみた. 対象は教室の単発陥凹性早期胃癌298例である. その結果, 占居腺領域を問わず分化型腺癌例は癌巣が大きくなるにつれ, sm癌の頻度が増し, 癌巣の大きさと深達度に関連性がみられたが, 未分化型腺癌例はそれらに相関関係は認められず, とくに中間帯領域に占居する未分化型腺癌例に顕著であった. 以上より, 分化型腺癌例の発育進展は同心円状進展が示唆されたが, 中間帯領域の未分化型腺癌例の進展に関しては, 多中心性発育も考慮に入れるべきものと考えられた.