Sumio Mizunoya

CYP1A1 CYP2E1 and GSTM1 polymorphisms are not associated with susceptibility to squamous-cell carcinoma of the esophagus

We investigated the genetic polymorphisms of CYPIAI, CYP2EI and GSTMI in Japanese esophageal cancer patients (n = 53) with a histological diagnosis of squamous‐cell carcinoma, to determine whether susceptibility to esophageal cancer is associated with these polymorphisms. There were no significant differences in the frequency distribution of any one of the 3 polymorphisms between esophageal cancer patients and 132 healthy Japanese controls. The genotype distributions in tobacco smokers or alcohol drinkers were also quite similar for male patients and male controls. The age at onset of esophageal cancer was also similar for patients with any genotype of the 3 polymorphisms. We conclude that the 3 polymorphisms are unlikely to be associated with esophageal cancer susceptibility. Int. J. Cancer 71:192–195, 1997.

Effective Intra-Arterial Chemotherapy for Acinar Cell Carcinoma of the Pancreas

A 41-year-old man with a huge pancreatic tumor (acinar cell carcinoma) was treated by intra-arterial infusion chemotherapy with 5-fluorouracil (5-FU), mitomycin C (MMC) and cisplatin (CDDP). The tumor was significantly reduced, and he underwent a pancreaticoduodenectomy with complete excision of the tumor. Unfortunately multiple metastatic liver tumors were noted 5 months after resection. These tumors could also be markedly reduced by intra-arterial chemotherapy and the survival period was prolonged to 18 months. He suddenly died of sepsis but not from the pancreatic carcinoma. This case shows that intra-arterial infusion chemotherapy with 5-FU, MMC and CDDP can be an effective regimen for the treatment of acinar cell carcinoma of the pancreas.

Successful treatment of an esophageal hemangioma by endoscopic injection sclerotherapy: Report of a case

We report herein the case of a 46-year-old man in whom an esophageal hemangioma was successfully treated by endscopic injection sclerotherapy (EIS). The patient was admitted to hospital after a routine upper gastrointestinal series demonstrated a filling defect in the esophagus. Endoscopy, computed tomography (CT) images, and magnetic resonance imaging (MRI) subsequently revealed a hemangioma in the middle esophagus. EIS was performed using 99% ethanol and 1% polydocanol, and 4 weeks later, the tumor had almost disappeared. This patient has since been followed up carefully with periodic endoscopy and barium studies and additional sclerotherapy will be performed if necessary.

A Case of Bronchopleural Fistula Associated with Esophageal Surgery Successfully Closed by Injection of Fibrin Glue under Bronchoscopic Observation.

食道癌術後に発生した膿胸は治療に難渋することが多く, さらに気管支瘻を併発した場合は特に治療困難となる.気管支瘻に対する治療としては有茎性大網充填術, 有茎性筋肉充填術の外科的治療が行われているが, 胃管再建の食道癌術後早期の気管支瘻ではこれらの外科的治療が困難である.今回, 気管支をバルーン閉塞させてフィブリングルーを注入する方法が有効であったので報告する.症例は61歳の女性で, 胸部食道癌に対して食道亜全摘・胃管利用胸骨後径路再建を施行した.腫瘍は気管分岐部-左主気管支に浸潤しており, 潰瘍底が一部残存した.これに起因すると考えられる右膿胸を発生し胸腔ドレナージ, 胸腔内洗浄を施行したが, air leakを多量に認め気管支瘻の併発を認めた.術後43日目に気管支鏡下にB6bをバルーン閉塞させフィブリングルー3mlを注入したところ, air leakは消失し気管支瘻は閉鎖された.

Comparison of postoperative results following terminal esophagoproximal gastrectomy and esophageal transection for esophageal varices

The results of 44 terminal esophagoproximal gastrectomies (TEPG) and 53 esophageal transections (ET) for esophageal varices, performed during the period between January, 1975 and March, 1989, were retrospectively compared. The results examined prognosis, recurrence of esophageal varices and late postoperative complications. The 5-year survival rates for patients who underwent selective or prophylactic surgery were 85.9% following TEPG and 81.6% following ET. However, the 10-year survival rate for the former group was significantly lower than that for the latter group at 59.3% versus 70.0% (P<0.05) because of the number of deaths due to hemorrhage and liver failure caused by anastomotic ulcers. The respective 5-year recurrence rates of varices for the TEPG and ET groups were 18.4% and 26.4%, respectively, while the 10-year recurrence rate for the former group was again significantly lower than that for the latter group at 27.1% versus 53.7% (P<0.01). As for postoperative late complications, reflux esophagitis and/or anastomotic ulcers were found twice as frequently after TEPG as after ET. Thus, although TEPG was more effective for preventing variceal recurrence it left the potential for an anastomotic ulcer to develop, which was the dominant cause of death more than 5 years after surgery.

Comparison of the prognosis of surgical treatment and endoscopic injection sclerotherapy for esophageal varices.

過去13年間に当科で108例の食道静脈瘤に対して直達手術療法 (食道離断術50例, 胃上部切除50例, 胃上部静脈郭清ならびに摘脾8例) を行った. また過去7年間に95例の内視鏡的硬化療法を行った. 肝硬変患者に限っての生存率は, 手術療法では3生率79.2%, 5生率72.2%, 10生率57.5%, 内視鏡的硬化療法 (非手術既往例42例) では3生率71.2%, 5生率53.4%であり, 両者の間には有意差は認められなかった. しかし, 硬化療法では静脈瘤の再発率が高いので, 耐術適応のある患者には, 手術療法が第1選択と考えられる.(肝障害が重度で, 手術適応外で, 硬化療法でも対処し難いものには食道静脈瘤の原疾患である肝臓に対する根治療法としての肝移植が必要かもしれない.)