Sadao Anazawa

Circulating Alpha-2-Macroglobulin Levels and Depression Scores in Patients Who Underwent Abdominal Cancer Surgery

BACKGROUND Although depression is a predominant health care problem, it is difficult to diagnose in patients who underwent abdominal cancer surgery. Relevance of elevated levels of serum of alpha-2-macroglobulin (A2M) to psychological depression has been recently suggested. PATIENTS AND METHODS Serum A2M levels were measured and depression scores were determined by the Hospital Anxiety and Depression Scale before and 1 year after abdominal cancer surgery in 45 patients. RESULTS Serum levels of A2M and depression scores were significantly (P = 0.0006, P = 0.0045, respectively) increased after total gastrectomy compared with preoperative values, whereas there was no interval change in both measurements of patients having colorectal resection. Of the patients who had undergone distal or total gastrectomy for gastric cancer, serum A2M concentrations in a depressed group were significantly higher (P = 0.028) than those in non-depressed group. CONCLUSIONS Patients with total gastrectomy are predisposed to depression, and circulating A2M elevation may be implicated in the development of postoperative depression in these patients.

Influence of modest endotoxemia on postoperative antithrombin deficiency and circulating secretory immunoglobulin a levels.

Objective To evaluate the influence of modest endotoxemia on postoperative antithrombin deficiency and cholestasis. Summary Background Data It has not been determined whether endotoxin translocation in small amounts is a physiological phenomenon or whether it is a potential health hazard. Methods Blood endotoxin, antithrombin III (ATIII), secretory immunoglobulin A (sIgA), which was selected as a marker of cholestasis, C-reactive protein (CRP), and &agr;-1-antitrypsin (AAT) concentrations were measured from the 20 patients undergoing curative gastrectomy for gastric cancer preoperatively and postoperatively. Portal and systemic blood samples were taken for the analysis of endotoxin and interleukin-6 (IL-6) concentrations during surgery in these patients. Results Although plasma endotoxin levels showed a significant increase during surgery, we did not find a correlation with ATIII, sIgA, CRP, and IL-6 levels. Systemic blood endotoxin levels during surgery correlated with a postoperative rise of serum AAT levels. Plasma ATIII levels transiently decreased on the first and third postoperative day, and sIgA levels were shown to increase on the seventh postoperative day. There was a weak relationship between the extent of postoperative endotoxemia and a reduction in ATIII concentrations. Conclusions The influence of modest endotoxemia on postoperative antithrombin deficiency and cholestasis was limited, and increased translocational endotoxemia during abdominal surgery may be a physiological phenomenon to trigger off an acute-phase protein response.

Arterial Infusion Chemotherapy in Patient with Repeated Recurrent Tumor of Cecal Cancer: Report of a Case

Purpose: We report a patient with a repeated recurrent tumor after Right-hemicolectomy for advanced cecal cancer who was treated by intra-arterial infusions of 5-fluorouracil (5-FU). Methods: A computed tomography scan revealed a pelvic mass involving the psoas major muscle and quadratos lumborum muscle, in contact with the widely projecting toward L2-S2. The fluorodeoxyglucose-positron emission tomography (FDG-PET) revealed an accumulation spot in the same place. This case was deemed in operable, and one-shot bolus of 5-FU was administered through the tumor feeding arteries: the left 3rd, 4th lumbar, and ilio - lumbar arteries at a dosage of 250 mg/body from each artery. Results: A partial regression of the tumor was observed by computed tomography. The serum level of carbohydrate antigen 19–9 returned normal in 8 months. During chemotherapy, the side effect and complications were tolerable, and she experienced only grade-1 nausea caused by 5-fluorouracil. Conclusion: A long–time, intra-arterial 5-fluorouracil infusion could control effectively and safely.

Surgical Approach for Recurrent Encapsulating Peritoneal Sclerosis A Case Report

症例は55歳の男性で, 慢性腎不全に対して1993年9月に腹膜透析が導入された. 腹膜炎のため, 2002年5月に血液透析に移行した. 保存的治療に抵抗性の被. 性腹膜硬化症 (以下, EPS)と診断され同年11月に初回の手術 (被嚢剥離術) が施行された. その後, EPS再発によるイレウスとなり保存的治療では改善せず, 2004年4月に再手術(被嚢剥離術) が施行された. 初回と同様に小腸全体が硬い厚い膜で被われ癒着していた. さらに, 初回術後の癒着もあったが被嚢をすべて剥離した. 術中2か所で小腸を損傷したためにその口側で人工肛門を造設した. 手術時間6時間30分, 出血量728g.術後11日目で全粥摂取可能となり内科に転科転床した. EPSに対する手術治療は成績不良かつ致命的合併症の発生率が高いとされていた. 術前の全身状態, 感染を確実にコントロールし, 慎重な手技を徹底することで, EPSに対する再手術は可能と考える.

A Case of Poorly Differentiated Early Rectal Adenocarcinoma with Tubulo-Villous Adenoma

症例は42歳の男性で, 主訴は便への血液の付着. 注腸X線および内視鏡検査で直腸 (Ra) に表面不整でひだの集中を伴う約20mm大のIspを認め, 生検で低分化腺癌を認めた. 対麻痺を有するため, ハルトマン手術を施行した. 病理組織学的診断は腺管絨毛腺腫内低分化腺癌であり, 深達度はsm2, 第1群リンパ節に転移を認めた. 両端に腺管絨毛腺腫が存在し, その中央に低分化腺癌が位置する極めてまれな分布形態を示し, 免疫染色では癌部にのみ一致したp53蛋白の過剰発現を認めた. K-ras癌遺伝子の点突然変異は, 腺管絨毛腺腫, 癌部のいずれにも認めなかった. 本症例は, 組織像および分子生物学的検討よりadenoma-carcinoma sequenceを経由した低分化腺癌と考えられ, 低分化腺癌の発生を考察するうえで貴重な症例であった.

Management of Early Colorectal Carcinoma Defined by Endoscopic Findings

Two hundred seventy-one cases (330 lesions) of early colorectal carcinoma were analyzed to assess the primary treatment modality by endoscopic findings. All cases were classified into two groups, namely intramucosal polypoid growth-type (PG-ca; 287 lesions), and nonpolypoid growth-type (NPG-ca; 41 lesions), according to histological findings. Two hundred forty-one lesions of PG-ca were intramucosal carcinomas (m-ca) and 46 were submucosal carcinomas (sm-ca). All 43 lesions of NPG-ca were sm-ca. The incidence of massive invasion to submucosa was greater in NPG-ca (53.8%) than in PG-ca (8.9%). Lymph node metastasis was detected in 5 lesions, (11.6%) of NPG-ca and in 4, (1.4%) of PG-ca. In contrast, over 80% of nodular tumors with depressions defined by colonoscopic findings were NPG-ca and all of the lobular type were PG-ca.

Hepatic resection of colorectal carcinoma metastases. Recurrent patterns after curative hepatic resection and hepatic lymphnode involvement.

大腸癌肝転移切除症例18例の再発様式について検討した. 根治的肝切除後の再発様式は残存肝再発57%, 肺転移29%, 原発巣局所再発14%であった. 原発巣が左側結腸症例, および肝転移の進展度がH2症例では残存肝における再発が多かった. 肝転移巣の発見時期が同時性と異時性の症例とでは, 同時性に対する肝切除後の再発率が高かった. 肝切除後残存肝再発は半年以内に出現するものが多かった. 18症例中術中に肝所属リンパ節転移を16.7%と高頻度に認め, 肝切除時にリンパ節郭清 (特に肝門部および肝十二指腸間膜リンパ節) を施行する必要性が示唆された. 肝所属リンパ節転移をきたした症例の原発巣はn, v, lyの各因子の進行したものが多かった.