Taiseki Kanemitsu

The transsphincteric and transsacral approaches for the surgical excision of rectal and presacral lesions

In the decade from 1981 to 1990, 30 patients underwent a posterior transsacral approach at the Aichi Medical University Hospital for their benign or malignant rectal lesions. The operation was classified into two procedures, consisting of the transsphincteric approach and transsacral approach, in order to cope with the condition of the anal sphincter muscles; whether they were divided or not. Eleven rectal tumors were successfully excised through the opened-up rectum by using the transsphincteric approach, and excellent results were obtained without any postoperative complications. Using the transsacral approach, 2 presacral dermoid cysts and 11 rectal lesions were easily removed under direct vision. Their prognoses were excellent. The transsacral approach was also applied for the resection of recurrent rectal cancers after a radical abdominoperineal resection in 6 patients suffering from intolerable local symptoms. All the patients were free from these uncomfortable local symptoms after the surgery. The posterior transsacral operation is thus considered to be of value not only for resecting benign rectal and presacral lesions, but also for resecting malignant rectal tumors in frail subjects who are unfit for radical operation and/or recurrent rectal cancer.

Minimal thyroid carcinoma: A report of nine cases discovered by cervical lymph node metastases

From 1962 to 1983, nine patients with minimal carcinoma of the thyroid were referred to Aichi Cancer Center Hospital and to Aichi Medical University Hospital for evaluation of enlarged lymph nodes in the neck. The radiographic study and scintigraphy of the thyroid were useful in detection of small thyroid lesions. In two cases, a lymph node biopsy was required for confirmation of the diagnosis. The thyroid lesions were histologically papillary carcinoma, in all the cases. A modified neck dissection with total thyroidectomy was carried out in five patients and modified neck dissection with thyroid lobectomy was done in four cases. Nine patients were followed for 6 months to 20 years and all the patients except one are alive.

Mitogenic Activity of Gelatin to Murine Spleen Cells

We reported previously that gelatin stimulates the growth of spleen cells in vitro. Tritium thymidine (3H-TdR) uptake into phytohemagglutinin (PHA)-stimulated spleen cells as well as intact spleen cells was augmented by gelatin. These findings suggest that gelatin serves as a mitogen for lymphoid cells. In this study, the target of action of gelatin was investigated. Tritium thymidine uptake into T cell-rich fraction was enhanced by incubation with 7.5 mg/ml of gelatin for 48 hours. The level of 3H-TdR uptake into B cell-rich fraction was not definitely increased by gelatin. Flow cytometric analysis confirmed these findings. Namely, it showed that treatment of spleen cells with 7.5 mg/ml gelatin increased a ratio of CD3-positive cells and decreased that of CD19-positive cells. Tritium thymidine uptake into natural killer cell-rich fraction was augmented by gelatin in a similar fashion to T cell-rich fraction. Tritium thymidine uptake into macrophages was very low and not affected by gelatin. Tritium thymidine uptake into macrophage-precursors was very low but was enhanced by gelatin. These findings suggest that gelatin could be used as an agent of cancer biotherapy.

Eisenin (L-pyroGlu-L-Gln-L-Ala), a new biological response modifier.

Eisenin (L-pyroGlu-L-Gln-L-Ala), a tripeptide extracted from a brown marine alga (Eisenia bicyclis Setchell) showed the immunological activity to augment natural cytotoxicity of peripheral blood lymphocytes (PBLs) in humans. This activity could be seen when it was added directly to 51Cr release assay, and also when PBLs alone were incubated with this compound for 0.5-1 h before addition to the 51Cr release assay. The resulting augmented cytotoxicity can be attributed to natural killer cells because treatment of eisenin-stimulated PBLs with anti-Leu 11b monoclonal antibody (mAb) plus complement completely abolished the augmented cytotoxicity, and, moreover, deletion of Leu 19-positive cells with anti-Leu 19 mAb (mouse IgG1) and anti-mouse IgG-coated magnetic beads showed the same effect. Eisenin could not augment natural cytotoxicity of Sephadex G-10 column-eluted cells. Eisenin rendered K-562 target cells resistant to lysis by PBLs stimulated by eisenin. Both amino acids, L-pyroglutamic acid and L-alanine, as well as a mixture of the three component amino acids of eisenin could augment the natural cytotoxicity. Therefore, it is considered that the structure responsible for the augmentation of natural cytotoxicity by eisenin may be that of the amino acids.

Clear Cell Carcinoma of the Thyroid. A Case Report

A rare case of clear cell carcinoma of the thyroid is presented herein. A 31-year-old male had a large soft tumor in the right lobe of the thyroid which showed a hot nodule on scintigram with99mTc. A right hemithyroidectomy was thus performed after the preoperative diagnosis of a functioning tumor had been made. At surgery, a tiny nodule behind the tumor was found and the histopathological diagnoses of the large tumor and the tiny nodule were clear cell carcinoma and papillary carcinoma, respectively. The thyroglobulin stain was positive in the cytoplasm of many clear cells and scattered colloid. This patient has been well without any evidence of recurrence over the past five years following surgery. The biological characteristics of clear cell carcinoma of the thyroid are discussed in this report.

Pheochromocytoma without specific symptoms

A 72-year-old Japanese woman with pheochromocytoma, who had had no characteristic symptoms was treated. A large retroperitoneal tumor was discovered incidentally by sonographic examination for mild upper abdominal pain and, with CT-scan and abdominal angiography confirmed that the tumor originated in the right adrenal gland. The tumor was suspected of being a pheochromocytoma because preoperative laboratory examinations revealed only a mild elevation of daily urinary excretions of adrenaline and noradrenaline. Provocation tests for pheochromocytoma and even angiographic examination revealed no diagnostic change in serum levels of catecholamines and distinctive clinical signs were nil. Thus, surgery was performed without preoperative prescription of any catecholamine blockade. During the surgery, the blood pressure and pulse rate fluctuated considerably. A non-functioning pheochromocytoma detected incidentally must be preoperatively managed as a functioning one, even in the absence of specific symptoms of pheochromocytoma.

Local recurrence of breast cancer: Treatment of nine patients with a recurrence in the skin flap of the chest wall

From 1975 through 1985, nine patients with a local recurrent lesion (LRL) of breast cancer to the skin flap of the chest wall were treated. Four had undergone primary mastectomies in our clinic and the other five were referred from other surgeons, following signs of recurrence. Aggressive topical therapy, such as resection or irradiation, proved effective in eradicating the LRL in all cases, thereby indicating that topical therapy is useful for improving quality of life. Adjuvant systemic chemo-immunoendocrine therapy is also required for patients with LRL, to increase longevity. Seven of the patients died of a distant metastasis within 66 months after the onset of LRL.

Clinico-pathological analysis on the colorectal cancer and study on polyp-cancer consequence.

1976年から10年間の単発大腸癌145症例を前期と後期に分け, その臨床病態の変化を検討した. 大腸癌の症例数は前期に比べ後期では2.5倍と著明に経年的に増加した. 発生部位も直腸癌の比率が減少し, S状結腸が増加した. 術式面でも, 結腸癌と異なり直腸癌では, 直腸切断術が減少し前方切除などの肛門温存術式が増加した.大腸ポリープの癌化に関する研究として, 正常大腸粘膜, ポリープ, 大腸癌のH3-thymidine標識像による細胞増殖動態を比較検討したところ, ポリープでは正常粘膜にある増殖帯と機能帯との区分が消失し, 組織異型度に相関して異常増殖像を生じ, ポリープ癌では癌の標識態度とほとんど差がなくなることを認めた.