Ryoji Katoh

A new fine probe for electric cautery during endoscopic surgery

Abstract. The present paper introduces a new fine probe for electric cautery (1.65 mm in diameter, 22 cm long) that can be connected to a conventional cylindrical hand-controlled cautery holder, which is monopolar and widely used in general surgery. When cautery was required, a 14-gauge intravenous catheter was inserted at an appropriate site under the guidance of a videoscope. After removing the steel inner needle, the extra tube was used as the fine surgical port for the cautery probe. The position of insertion could be altered according to the operating field. Cautery was performed by conventional methods. There was no bleeding or air leakage at the site of puncture during or after surgery. The puncture wound was closed without any sutures. Based on these results, the new fine probe for cautery can reduce the number of surgical ports required for instruments during video-assisted surgery, thus improving the ease and safety of endoscopic surgery.

MUCIN PRODUCTION AND SUBSEQUENT INTERSTITIAL FIBROSIS IN GASTRIC-CANCER WITH SIGNET-RING CELLS

The relation between the mucin production and the fibrous reaction was examined in 28 cases of gastric cancer with signet ring cells. Six of twelve cases had tubular adenocarcinomas in the group that the staining intensity ratio of Alcian blue to PAS(A-B/PAS) was less than 0.5. Of the sixteen cases eight had poorly differentiated adenocarcinomas and seven had signet ring cell carcinomas in the group that A-B/PAS was over 0.5. After mucosal replacement by tumour cells, four of six cases showed no fibrosis in the former group and five of seven cases showed submucosal fibrosis in the latter group. Signet ring cells were characterized by their destruction of mucosal architectures. Subsequent submucosal invasion and fibrosis depended on the types of tumour cells; tumour cells having the potential ability to form a gland invaded medullary with scarce fibrosis and those of weak intercellular adhesion invaded separately with interstitial fibrosis.

A Rare Case of Huge Gastric Carcinoma with Extramural Growth

A rare case of gastric carcinoma which grew extramurally and invaded into the transverse mesocolon and pancreas is reported. The patient was a 67-year-old female, complaining of anorexia, weightloss and abdominal distension. She was diagnosed as gastric carcinoma with extramural growth. Intraoperative findings included a fistsized, elastic hard tumor on the greater curvature that infiltrated into the transverse mesocolon and pancreas head(S3P0H0N1 stage4). Histopathologically, it was diagnosed as a poorly differentiated adenocarcinoma. The main tumor invaded deeply into the subserosal soft tissue(10× 8.5 × 6.5 cm). However upper part of the tumor appeared on the mucosal surface as a small erosion(1.2×0.9 cm in diameter).

A Case Report of Anal Carcinoma Associated with Perianal Pagetoid Lesion

肛門周囲Paget病を伴う肛門癌は, きわめてまれな疾患であり, 本邦では今回われわれが経験した症例を含めて9例が報告されているにすぎない.症例は74歳男性であり, 肛門周囲の疼痛と腫瘤を主訴として入院, 皮膚生検の結果肛門周囲Paget病と診断された.さらに肛門癌も合併していた.手術は腹会陰式直腸切断術を行ったがすでに両凧径部リンパ節転移を認めた.術後, 会陰部創に対しては計20Gyの腔内照射, 嵐径部に対しては計14Gyの電子線照射を行ったが, 会陰部皮膚の再発なども合併して初回手術後6か月で死亡した.組織学的には, アポクリン腺原発汗腺癌であったが, 今回の症例は汗腺癌がPaget病変を合併した貴重な症例と考えられた.また, 従来いわれているように肛門周囲難治性皮膚湿疹では, Paget病などの存在を十分考慮した診断が重要と考えられ, 積極的な外科的治療が必要と考えられた.