Shinichi Taguchi

Comparison of three-field esophagectomy for esophageal cancer incorporating open or thoracoscopic thoracotomy.

Background: Thoracoscopic esophagectomy for esophageal cancer has been performed as an alternative to open surgery to reduce surgical trauma. However, its effect on pulmonary function, exercise tolerability, and quality of life is unknown. Methods: Fifty-one patients with esophageal cancer underwent thoracic esophagectomy with radical lymphadenectomy by posterolateral thoracotomy (29 cases) or thoracoscopic surgery (22 cases). Patients performed spirometry and exercise tolerance testing and completed a quality-of-life questionnaire before and 3 months after surgery. Results: Pre-to-postoperative change in vital capacity was 74.3 ± 10.6% in the thoracotomy group and 84.9 ± 10.4% in the thoracoscopy group (p = 0.021). Maximum oxygen uptake was similar, but dyspnea was the more common factor limiting exercise tolerance postoperatively in the thoracotomy group. Change in pre-to-postoperative performance status was 1.20 ± 0.62 in the thoracotomy group and 0.55 ± 0.51 in the thoracoscopy group (p = 0.0003). Conclusions: Thoracoscopic esophagectomy for esophageal cancer has better preservation of pulmonary function and quality-of-life.

Codeine Phosphate—Induced Hypersensitivity Syndrome:

OBJECTIVE To report a case of drug-induced hypersensitivity syndrome related to codeine phosphate. CASE SUMMARY A 19-year-old Japanese man was prescribed codeine phosphate 10 mg 3 times daily and several other drugs for cold symptoms. About 20 days later, an erythematous, maculopapular rash appeared and progressed to erythroderma; a spiking fever also developed. He had splenomegaly and generalized lymphadenopathy on admission. Laboratory examinations showed atypical lymphocytosis, eosinophilia, and increased liver enzyme values. The platelet count slowly decreased after admission. The increased numbers of megakaryocytes in bone marrow and platelet-associated immunoglobulin (Ig) G antibodies in serum were compatible with a diagnosis of immune thrombocytopenic purpura. A significant increase in IgG antibodies to human herpesvirus 6 (HHV6) and transient viremia were helpful in diagnosing hypersensitivity syndrome. The results of patch tests were positive for codeine phosphate. An objective causality assessment revealed that an adverse drug event was probable. DISCUSSION Codeine is an opioid analgesic. Severe adverse cutaneous reactions rarely occur. As of March 3, 2004, our case is, to our knowledge, the first report of hypersensitivity syndrome attributed to codeine phosphate. Drug-induced hypersensitivity syndrome is an acute, potentially life-threatening, idiosyncratic adverse reaction caused mainly by aromatic anticonvulsants. It is characterized by the triad of fever, skin rash, and internal organ involvement. Reactivation of HHV6 is involved in the pathogenesis of this syndrome and may have also caused the immune thrombocytopenic purpura in our patient. CONCLUSIONS Codeine phosphate may rarely be associated with hypersensitivity syndrome. Clinicians should be aware that the potentially fatal syndrome can be caused by various drugs.

A Case of Submucosal Basaloid Carcinoma of Cervico-thoracic Esophagus

症例は64歳の男性. 平成14年1月初旬より嚥下困難が出現し, 食道造影で頸胸境界部食道の右側に約2.5cmの隆起性病変を認め, 上部消化管内視鏡検査では, 門歯列より約20cmの食道右壁に1pl型の隆起性病変を認めた. CT, 超音波検査では明らかなリンパ節転移, 血行性転移は認めなかった. 以上より, T2N0M0, Stage IIの頸胸境界部食道癌と診断し, 平成14年5月8日に胸腔鏡下食道切除術および3領域リンパ節郭清術を施行した. 腫瘍は肉眼的に径22×16mm, 1pl型で, 病理組織診断では類基底細胞癌であった. 深達度はsmでly0, v1, pN0, pStage Ibであった. 類基底細胞癌は非常にまれであり, 予後不良とされている. リンパ節転移のない表在型は予後がよいとの報告もあるが, 頸胸境界部食道に発生した表在型類基底細胞癌は本邦では報告例がなく, また細胞増殖能が高いことより再発に留意し経過観察中である.