Sadanobu Abe

A case of granulocyte-colony stimulating factor producing gallbladder cancer

Ever since the identification of the colony-stimulating factor (CSF), granulocyte-CSF (G-CSF)-producing tumors have often been reported, and have been attracting attention, especially in pulmonary cancer. However, there have been only a small number of reports of G-CSF-producing tumors in cases of gastrointestinal cancer, and only four cases of G-CSF-producing gallbladder cancer have been reported so far. Recently, we encountered a 73-yr-old man with G-CSF-producing gallbladder cancer. The leukocyte count in the peripheral blood increased to the maximum of 75,200/mm3 during the course of observation, and mature neutrophils accounted for 97% (segmented forms: 89%, band forms: 8%). The serum G-CSF concentration was high (129 pg/ml). The leukocyte count became normalized postoperatively, and the serum G-CSF concentration also decreased (50 pg/ml). The tumor was diagnosed as undifferentiated adenocarcinoma of the pleomorphic type on the histopathologic examination. Numerous tumor cells were stained with the anti-G-CSF antibody. Detailed findings of the patient are presented here together with some discussion of the literature.

Characteristics of Esophageal Peristaltic Motor Activity After Distal Partial Gastrectomy

Postoperative disorders after gastrectomy have been attracting attention due to the improvement in the operative results of gastric cancer. Gastroesophageal reflux disease is one of the postgastrectomy complications which affects the quality of life of the patient. The incidence of reflux esophagitis after gastrectomy is high and it tends to be refractory once it occurs [1]. There are many reports about alkaline reflux esophagitis after total gastrectomy, but only a few papers report on esophagitis after distal partial gastrectomy. Understanding the pathophysiology of reflux esophagitis after distal partial gastrectomy is important for therapy. The aim of the study presented here was to determine the mechanisms of reflux esophagitis following distal partial gastrectomy.

Assessment of the Surgical Treatment of Reflux Esophagitis Complicated by Esophageal Stricture

It was some 40 years ago that acid reflux esophagitis associated with hiatus hernia was first reported by Allison et al. [1] in 1951. Since then, reflux esophagitis has been common in the American and European countries, with cases in Japan occurring infrequently. Recently, however, increasing numbers of cases have been diagnosed as reflux esophagitis in Japan due to demographic reasons associated with the aging of society and the westernization of life styles in particular with respect to diet and advances in diagnostic techniques such as esophageal manometry [2], pH monitoring [3], and esophageal scintigraphy [4]. This change of circumstances has caused treatment of the disease to be notably improved: Good results have been reported with histamine H2 receptor antagonists and proton pump inhibitors [5, 6]. However, some cases of reflux esophagitis are resistant to these treatments and develop esophageal stricture during the course of the disease.

Experimental and clinical studies on the function and surgery of esophagogastric junction.

食道胃接合部の機能異常を呈する代表的疾患にachalasiaと逆流性食道炎があり, 食道胃接合部の機能の詳細とこれら疾患の機能再建について検討し, 次の結論を得た.1.食道胃接合部の生理的括約筋の概念は, 下部食道括約筋lower esophageal sphincterのみでなく, 横隔膜脚まで広げられるべきである.2.achalasia 11例, 逆流性食道炎10例に手術的機能再建術を施行し, 全例満足すべき結果が得られた.3.achalasiaや裂孔ヘルニアに合併した逆流性食道炎に対しては, 手術侵襲が少なく, 治療効果が良好であることから早期に積極的な手術適応とすべきである.