Sadamitsu Inutsuka

Characteristic Radiographic Features of Pulmonary Carcinoma Associated with Large Bulla

Primary lung cancer closely associated with a large bulla was investigated in an attempt to elucidate radiographic features of the tumor. On the basis of findings in 7 of our patients plus data on another 25 patients in the Japanese literature, we propose three major patterns of neoplasm development: nodular opacity within or adjacent to the bulla, partial or diffuse thickening of the bulla wall, and secondary signs of the bulla (changed diameter, fluid retention, and pneumothorax). As the incidence of occurrence of a pulmonary carcinoma in association with bullous disease is high, these radiographic findings will aid in early detection of a malignant lesion.

A solitary peutz-jeghers type hamartomatous polyp in the duodenum — A case report—

A 56-yr-old woman with a solitary hamartomatous polyp confined to within the third portion of the duodenum, underwent a successful endoscopic polypectomy. The histological findings were identical to Peutz-Jeghers polyp but all the other clinical features of Peutz-Jeghers syndrome were absent.

Radical lymphadenectomy for rectal cancer facilitated by a carbon particle infusion lymphangiography

For the intraoperative visualization of the para-aortic nodes and those around the iliac vessels, a fine carbon particle solution was infused into the bilateral pedal lymphatic vessels of 12 patients with rectal carcinoma. A low anterior resection with radical lymph node dissection was then performed while preserving pelvic autonomic nerves. Of 444 lymph nodes removed from the iliac arterial region, 430 were stained with carbon black (96.8%), even though the black staining was not perfect in the nodes of the inferior mesenteric arterial region. All of the lateral black stained nodes were clearly visible and hence could be easily excised. The average number of dissected nodes in one patient was 43.8 in this dissection with carbon particle infusion, which was larger than those of conventional lymph node dissection. We then examined the length of time that a postoperative indwelling bladder catheter was needed as an indication for autonomic nerve damage, and it was ascertained that less damage occurred in this operation compared to other types of dissections, such as conventional or extended lymph node dissection.

A new trial in endoscopic diagnosis for stomach cancer: Intra-arterial dye (IAD) method

Forty gastric cancers were examined by endoscopy before and after the injection of Evans blue or indigo carmine dye into the celiac artery. Seventeen of these lesions were also examined after injection of vasomotor drugs. The authors conclude that these techniques permitted more precise endoscopic deliniation of the size and extent of cancerous lesions, particularly those otherwise obscured by overlying, intact epithelium.

Fatal interstitial pneumonitis induced by low dosage of bleomycin in an esophageal cancer patient

One-shot intratumor injection of 60 mg oil-bleomycin prior to subtotal esophagectomy induced fatal, acute interstitial pneumonitis in a 53 year-old esophageal carcinoma patient. The progression of bleomycin-induced pneumonitis was rapid and the patient succumbed to respiratory insufficiency 41 days after surgery (58 days after bleomycin administration). Autopsy revealed bilaterally increased lung weight and the organ was of rubbery consistency and anthracotic. Histology showed advanced interstitial fibrosis, numerous lymphocytes in alveolar septi and fibrinous exudate, macrophages and desquamative cells within the alveolar spaces.In the present case, pneumonitis was due not to patient age or dosage level of bleomycin, but rather to the administration method.

Serum testosterone level of patients with gastric carcinoma before and after gastrectomy

The serum testosterone level (STL) was determined in 84 male and 32 female patients with gastric carcinoma and in 58 male and 20 female patients with benign diseases as a control group. The STL of the male patients with carcinoma was lower (446 ± 149 ng/dl) than that of the male control group (532 ± 132 ng/dl) (P < 0.001). Even 17 male patients of the early carcinoma showed lower STL (440 ± 117 ng/dl) than the normal group (P <0.001). In the female patients, it was also lower (31.6 ± 16.0 ng/dl) than in the control group (46.3 ± 15.3 ng/dl) (P <0.005). The postoperative STL of the cases surviving the gastrectomy was higher than the preoperative data in 32 male patients (P <0.005) as well as in 12 female patients (0.025 > P > 0.01), whereas it obviously decreased in the patients who died of recurrence. Therefore, it appears that gastric carcinoma decreases the STL by some mechanism.

Onlay fundic patch method applied in spontaneous rupture of the esophagus: a case report.

A successful attempt using the onlay fundic patch method for treatment of spontaneous rupture of the esophagus (SRE) was reported. A 38-year old male presented with left chest pain and a preoperative diagnosis of SRE was made. Surgery was performed 16 hours after the onset of symptoms and a 3 cm esophageal tear just above the level of the diaphragmatic hiatus was noted. The esophageal tear was repaired by the onlay fundic patch method through left thoracotomy and the postoperative course was uneventful and recovery was complete.A search of the literature has yielded only one case of SRE that was improved with onlay fundic patch by Thal and Hatafuku (1964) and this method is useful for the immediate and late repair of rupture of the esophagus.

An adapter for stapling of a colorectal anastomosis

A technique involving the use of an end-to-end anastomosing stapler for low anterior resection has been modified to allow for a low colorectal anastomosis with an anus-pushing rubber adapter. The facility and safety of this procedure, under direct vision, has been confirmed.

Clinical characteristics of the carcinoma of the stomach and its localization.

The result of follow-up study and the localization of gastric carcinoma subjected to the operation at the Second Department of Surgery, Faculty of Medicine, Kyushu University during 7 year period from 1963 to 1969 form the basis of the present communication. The curative resectability was 70.3 per cent in the carcinoma of the distal third of the stomach (A), 82.9 per cent in that of the middle third (M) and 55.3 per cent in that of the proximal third (C); the 5-year survival rate was 48.6 per cent in the cancer of A, 81.1 per cent in that of M and 49.1 per cent in that of C respectively. In the carcinoma of A incidence of high grade penetrative invasion into the gastric wall as well as metastatic involvment was high. It is noteworthy that the tendency of the metastasis was found even in those with low grade penetration. In the carcinoma of M the incidence of high grade penetration as well as lymphatic metastasis was relatively low. The hepatic metastasis and peritoneal dissemination were also not frequent. In the carcinoma of C the incidence of high grade penetration was very high and the lymphatic metastasis was frequently observed in those with high grade penetration. Biological characteristics of the carcinoma of the stomach in each location and their therapeutic significance are discussed.

Kumacone II: An adapter to aid in the placement of a purse-string suture in very low anterior rectal resection

We have designed an adapter called the “Kumacone II”, being a bottle-shaped rubber device which greatly aids in placing a purse-string suture, even at the lowest level near the anorectal junction of the rectum. When this adapter is used, performing the anastomosis is much less time-consuming and not as much training is needed as for low anterior resection using conventional manual suturing. In a clinical study, the incidence of leakage and incontinence was nil in five out of five patients.