Nobuo Ogino

Significance of Biologic Aggressiveness and Proliferating Activity in Papillary Thyroid Carcinoma

Papillary thyroid carcinoma is a frequent thyroid cancer. Many factors have been reported to be of prognostic importance, but the significance of biologic factors suggesting aggressiveness and proliferating activity has not been sufficiently documented. Conventional prognostic factors such as age, extrathyroidal invasion, lymph node and distant metastasis, and biologic factors including histologic differentiation, DNA ploidy, S-phase and G2M-phase fractions, and expression of CD44 variant 6 (CD44-v6) obtained from 131 patients who underwent surgery for papillary thyroid carcinoma at Osaka Police Hospital were analyzed retrospectively. Age was closely related to extrathyroidal invasion, G2M-phase fraction, and CD44-v6 expression. Extrathyroidal invasion was independently related to age, gender, and lymph node metastasis. The grade of lymph node metastasis was related to extrathyroidal invasion, gender, distant metastasis, and CD44-v6 expression. Distant metastasis was associated with aneuploid tumors. Cause-specific survival was independently related to biologic factors including extrathyroidal invasion, distant metastasis, DNA ploidy and S-phase fraction. These results suggest that biologic factors indicating aggressiveness and proliferating activity are important for papillary thyroid carcinoma.

Independent prognostic factors in breast cancer patients.

BACKGROUND Recently tumor microvessel density has been shown to be a powerful prognostic tool in breast cancer. We attempted to assess its significance as a prognostic factor. METHODS We analyzed the medical records of 100 patients using univariate and multivariate analyses of nine factors as follows; age, tumor size, nodal status, estrogen receptor, C-erbB2, p53, microvessel density, DNA ploidy pattern, and S-phase fraction. RESULTS Nodal status and microvessel density were independent prognostic indicators for both survival and relapse-free survival. Microvessel density was independent in the node-negative subgroup for survival, but not independent in the node-positive subgroup, while it was independent in both the node-negative and node-positive subgroups for relapse-free survival. Short-term survival rates in the high and low vessel density subgroups were almost the same, and all patients with early death were node-positive. CONCLUSION Microvessel density was an important prognostic factor especially in node-negative patients and more significant in long-term survival.

Omental transposition and skin graft in patients for advanced or recurrent breast cancer.

Nine patients, including 4 with primary advanced breast cancer (stage IV) and 5 with local recurrent cancer, underwent chest wall reconstruction using an omental flap and mesh skin grafting. In 2 of these patients the defect of bony chest wall was reconstructed with an acryl-resin plate and omental flap. The postoperative course in all patients was uneventful, except for a slight necrosis on the transposed mesh skin. Flail chest or dypsnea did not occur in those with a bony chest wall reconstruction. The immediate postoperative performans status in 6 of 9 patients and also quality of life improved.

A case of microangiopathic hemolytic anemia associated with breast cancer: Improvement with chemoendocrine therapy

Microangiopathic hemolytic anemia (MAHA) is a term which describes the association of hemolytic anemia with red cell fragmentation caused by microangiopathy mechanically. This paper reports a 45 year-old woman with bone metastases from breast cancer. She developed MAHA and disseminated intravascular coagulation (DIC). Although the prognosis of MAHA associated with malignant tumor has been very poor, she achieved remission of the syndrome after chemoendocrine therapy.

Clinical study for pancreatic fistula after distal pancreatectomy with mesh reinforcement

BACKGROUND The purpose of this cohort study was to determine whether distal pancreatectomy with mesh reinforcement can reduce postoperative pancreatic fistula (POPF) rates compared with bare stapler. METHODS In total, 51 patients underwent stapled distal pancreatectomy. Out of these, 22 patients (no mesh group) underwent distal pancreatectomy with bare stapler and 29 patients (mesh group) underwent distal pancreatectomy with mesh reinforced stapler. The risk factor for clinically relevant POPF (grades B and C) after distal pancreatectomy was also evaluated. RESULTS Clinical characteristics were almost similar in both the groups. The days of the mean hospital stay and drainage tube insertion in the mesh group were significantly fewer than those in the no mesh group. The mean level of amylase in the discharge fluid in the mesh group was also significantly lower than that the in no mesh group. The rate of clinically relevant POPF (grades B and C ) in the mesh group was significantly lower than that in the no mesh group (p=0.016). Univariate analyses of risk factors for POPF (grades B and C) revealed that only mesh reinforcement was associated with POPF (grades B and C). Moreover, on multivariate analyses of POPF risk factors with p value<0.2 in univariate analyses by logistic regression, mesh reinforcement was regarded as a significant factor for POPF(grades B and C). CONCLUSIONS The distal pancreatectomy with mesh reinforced stapler was thought to be favorable for the prevention of clinically relevant POPF (grades B and C).

A Case of Lactic Acidosis from Vitamin B1 Deficiency during Total Parenteral Nutrition.

患者は86歳, 女性の進行膵頭部癌症例.高カロリー輸液 (総合ビタミン剤非配合) 施行中に, 温熱化学療法を契機に経口摂取不良となり, 高カロリー輸液21日目に急激な意識低下 (II-20), 末梢循環不全, 呼吸促拍を認め, 腹痛を訴えた.血液ガス分析でpH7.193, Base Excess-16.6mEq/lと著明な代謝性アシドーシスを認め, 7%炭酸水素ナトリウムを計480ml投与したが改善しなかった.発症より16時間後ビタミンB1欠乏を疑い, 塩酸チアミン150mgを静注したところ, 1時間後にpH7.507, BaseExcess 3.8mEq/lとなり, 4時間後に意識レベルは1-2に改善した.発症時の血清乳酸値は119mg/dlと異常高値を示し, 血中ビタミンB1値は13ng/mlと異常低値であったがそれぞれ塩酸チアミン静注後正常化した.本症例を含めた高カロリー輸液施行中のビタミンB1欠乏による乳酸アシドーシスの報告例48例について文献的に考察した.

A Case Report of Celiac Axis Compression Syndrome Combined with Gastric Cancer. Diagnosis by Doppler Ultrasonography.

胃癌の手術を契機に超音波検査で発見された腹腔動脈起始部圧迫症候群 (celiac axis compressionsyndrome: 以下, CACSと略記) の1例を報告する.症例は50歳の男性.既往歴として幼少時より月に1～2度腹部仙痛を自覚.主訴は嚥下困難で, 噴門部癌の診断のもとに当科に紹介入院-術前の超音波検査にて, 腹腔動脈起始部の狭窄と総肝動脈の遠肝性血流を認めCACSと診断した.左開胸開腹下に胃全摘術, 摘脾術を施行した.術中に内側弓状靱帯による腹腔動脈起始部の圧迫を確認し, 靱帯を切離した.電磁流量計により測定した総肝動脈血流量は靱帯切離前後で40ml/分から115ml/分に増加した.術後に腹痛の発生を認めず, また術後の超音波ドプラ検査にて総肝動脈の求肝性血流を確認した.超音波検査はCACSの診断および治療効果判定に有用と思われた.

Preoperative Prediction of Severe Intestinal Ischemia in Strangulation Ileus.

絞扼性イレウスにおける腸管循環障害の重症度と腸管切除の必要性を予測することは容易ではない.われわれは過去12年間に当院救急外科に来院した絞扼性イレウス65例を対象とし, 多変量解析を用いてその可能性を検討した.腸管切除群35例と腸管非切除群30例の2群に分け, 各術前因子を比較した.また, 各術前因子から腸管切除長, 腸管切除の必要性を解析した.結果: 体温, 白血球数, 核の左方移動率, Creatinine Phosphokinase値, 血糖値の5因子において, 腸管切除群は非切除群に比べ有意に高値を示した.重回帰分析では腸管切除長は白血球数, 核の左方移動率, CPK値と有意に重相関し, このうちCPK値が最も相関に寄与していた.また, 体温, CPK値, 血糖値の3因子からなる判別式が算出され, その正判別率は90.9%であった.これら術前5因子は絞扼性イレウスにおける腸管切除の必要性を判別し, 術前における腸管循環障害の重症度を推定する指標となることが示唆された.

Cancer cell emboli in the pectoral lymphatics of patients with breast cancer

In order to investigate the possibility of local recurrence in the pectoral muscles of patients who undergo modified radical mastectomies, the cancer cell involvement of the lymphatics associated with the pectoralis major muscle was studied in 39 patients who underwent a standard radical mastectomy for Stage I–III breast cancer. Cancer cell emboli were found in the transpectoral lymphatics of 2 patients (2/39=5.1 per cent) and in the pectoral fascial lymphatics of 6 patients (6/39=15.4 per cent). Two patients with fascial lymphatic cancer cell emboli were from a group of 14 patients with intramammary lymphatic tumor emboli of a low degree (ly 1). The other 6 patients with cancer cell emboli in either the pectoral fascia or the transpectoral lymphatics were from a group of 11 patients with intramammary lymphatic tumor emboli of a moderate degree (ly 2). There was a significant relationship between the intramammary and the pectoral lymphatic cancer cell emboli (Chi square test: p<0.05). The results of this study therefore indicate that lymphatic cancer cell emboli in the pectoral fascia and muscle are an important risk factor for patients who undergo a modified radical mastectomy.

A case report of celiac axis compression syndrome.

<1989年 5月 8日受理>別 刷請求先 !福田 宏 嗣 〒737 呉市青山町3-1 国 立呉病院外科 現症 i身長153cm,体 重53kg.頭 部,胸 部,腹 部に 理学的に異常所見を認めず,心 寓部に血管雑音を聴取 しなかった。心寓部に痢痛発作を認めたのみであった。 心寓部痢痛の特徴は,1食後約30分 ~ 1時間後に出現, 2食事摂取量と痛みは相関,3 食事内容と痛みは無関 係,4 腹筋緊張,心 名部の圧迫,下 肢伸展にて痛みが 増強,5 仰臥位,下 肢を屈曲すると痛みは軽減,6 腹 痛は,精 神的ストレスとは無関係,な どであった, 入院時検査成績 :血液 一般検査,血 液生化学校査で 特記すべき異常所見は認められなかった。上部消化管 造影,腹 部超音波検査,腹 部 computed tomography (CT)検査では,冒 ,十 二指腸,肝 臓,膵 臓,胆 道系, 尿路系に器質的病変はみいだせなかった。 側方向腹部大動脈造影で,腹 腔動脈は大動脈からの 分岐直後で前方より圧迫され75%狭 窄していた (図 1).上腸間膜動脈造影で,8‐ 4前後ア ーケードを介して 固有肝動脈へ造影剤の逆流がみられた (図2), 以上より腹腔動脈の外因性狭窄病変により心寓部の 痢痛発作を呈する,腹 腔動脈起始部圧迫症候群と診断 し, percutaneous transiuminal angioplasty (以 下