Tatsuo Hattori

Treatment of spontaneous esophageal rupture with a covered self-expanding metal stent.

Spontaneous esophageal rupture is a life-threatening condition requiring immediate treatment. Surgical treatment usually is required, but conservative treatment can be pursued in selected cases.1,2 Covered self-expanding metal stents have proven useful in palliating malignant esophageal perforations and fistulas, but such implants seldom have been used in cases of benign esophageal rupture.3-5 We operated on a 56-year-old man with spontaneous esophageal rupture; when his general condition deteriorated after surgery, a covered self-expanding metal stent was placed to seal the persistent esophageal leak. After the procedure the patient’s vital signs stabilized, and the stent was removed safely by endoscopy 28 days later. Stent placement may be indicated in other similar cases.

A new enzymatic assay for total diamines and polyamines in urine of cancer patients

SummaryA detailed procedure of a new photometric assay for total diamines and polyamines in human urine using soybean seedling amine oxidase (SSAO) as an enzyme reagent is described. It is based on the unique substrate specificity of SSAO that the enzyme is active toward all diamines and polyamines. The amines were purified from urine by cation-exchange chromatography and incubated with SSAO. Hydrogen peroxide formed in the oxidase reaction was measured photometrically by coupling 4-aminoantipyrine with phenol in the presence of peroxidase. For its simplicity and sensitivity, our method seems useful for routine clinical investigation. The data obtained from normal subjects and patients of various cancers are presented to validate the present method.

A fluorometric assay for total diamines in human urine using human placental diamine oxidase.

The detailed procedure for a new fluorometric assay for total diamines in human urine is described. The diamines were purified from the urine by cation-exchange chromatography and incubated with human placental diamine oxidase. Hydrogen peroxide formed in the diamine oxidase reaction was measured fluorometrically by converting homovanillic acid to a highly fluorescent compound in the presence of peroxidase. Because of its simplicity and high sensitivity, our present method seems useful for routine clinical investigation. The data obtained from normal subjects and patients suffering from various forms of cancer are also presented.

Clinicopathological features of superficial spreading and nonspreading squamous cell carcinoma of the esophagus

OBJECTIVES:Superficially spreading carcinoma of the esophagus, consisting mainly of intraepithelial carcinoma, is not as rare as was previously thought. Despite the surgical significance of this entity, no general definition has been established, and the clinical features of this disease remain to be clarified.METHODS:A total of 54 patients with superficial carcinoma of the esophagus (defined as carcinoma limited to the epithelium or superficially invading the lamina propria or submucosa) were classified into two groups according to the longitudinal extent of the lesion. A total of 13 patients with superficially spreading carcinoma (defined as a superficial carcinoma measuring >5 cm and consisting mainly of intraepithelial carcinoma) were compared to 41 patients with nonspreading esophageal carcinoma.RESULTS:One patient with superficially spreading carcinoma had a positive resection margin because of multiple cancerous lesions. The only significant difference in the clinical and pathological features of the two groups was a higher prevalence of associated multiple cancerous lesions in patients with the superficially spreading type.CONCLUSIONS:Superficially spreading carcinoma of the esophagus is often associated with multiple cancerous lesions. For endoscopists and esophageal surgeons, it is important to define the proximal extent of intraepithelial cancer and the presence of multiple cancerous lesions to perform curative resection.

Esophageal intramural pseudodiverticulosis treated by balloon dilatation: report of a case.

A 72-year-old man presented with a 17-year history of dysphagia, which had gradually become worse in recent months. A barium esophagogram showed stenosis of the upper thoracic esophagus with multiple tiny flask-shaped outpouchings along the region of stenosis. Based on this characteristic appearance, we diagnosed esophageal intramural pseudodiverticulosis. He underwent successful balloon dilatation of the stenosis and his dysphagia resolved. Dynamic esophagography showed improved passage through the esophagus. He has been well and not suffering from dysphagia for 4 years since the balloon dilatation.

Recurrent fibrolamellar hepatocellular carcinoma with biliary invasion: Successful resection

A jaundiced 17-year-old man was diagnosed as having a local recurrence of fibrolamellar hepatocellular carcinoma 2 years and 4 months after left hepatic trisegmentectomy with total caudate lobectomy had been performed. The patient had a tumor occupying the upper part of the extrahepatic and intrahepatic bile ducts. Complete resection of the recurrent tumor was carried out. The patient remains well 3 years after the second surgery. Fibrolamellar hepatocellular carcinoma, a rare type of liver cancer, is a well defined disease entity with distinct clinical and histopathological features and a favorable prognosis. The good prognosis seems to warrant aggressive surgical intervention in patients with recurrences. Therefore, additional surgery for tumor recurrence should be considered. To our knowledge, this is the first report of a case in which a recurrent tumor of fibrolamellar hepatocellular carcinoma invaded the entire bile duct wall was successfully resected.

Vigorous achalasia with high-amplitude esophageal body contractions: a case report

A 25-year-old woman presented with dysphagia and chest pain in November 1999. Esophagography revealed esophageal stasis with spindle-shaped tapering at the cardia without dilatation of the lower esophagus. Manometry showed a hypertonic sphincter with incomplete relaxation on swallowing. Esophageal body contractions were simultaneous with an amplitude in excess of 200 mm Hg with tertiary contractions. These findings were not compatible with “classic” achalasia, but with vigorous achalasia. The patient underwent pneumatic dilatation with immediate relief of her symptoms. However, improvement in dysphagia and chest pain was temporary, necessitating four sessions of dilatation over three and a half years. The literature on this rare esophageal motility disorder is reviewed.

Mucosa-associated Lymphoid Tissue in Lymphoma of the Rectum.

症例は83歳の女性. 排便時出血で受診し, 直腸診で腫瘤を指摘され入院となった. 注腸造影X線検査では上部直腸から下部直腸にかけて半球状の腫瘤を認め, 大腸内視鏡検査では肛門縁から5cmに表面が平滑で中心に陥凹を伴う隆起性病変を認めた. 生検組織診断では上皮の異型はなかった. 以上より平滑筋肉腫を疑い, 低位前方切除術を施行した. 切除標本肉眼所見では3.5×3cmの中心に陥凹を伴う半球状の腫瘍を認め, 病理組織学的所見では腫瘍細胞は主に中型の異型リンパ球でcentrocyte-like cellの形態をとり固有筋層にまで浸潤し, 粘膜ではlymphoepithelial lesionを形成していたが, リンパ節転移はなかった. 以上よりlow grade MALTリンパ腫と診断した. 直腸MALT リンパ腫は自験例を含め本邦では14例しか報告がなく, その検討においても, 局所切除例では再発が50%に認められるため, 正確な診断に基づきリンパ節郭清を含めた根治的切除が必要と考えられた.

Hepatic Falciform Artery: Report of 3 Cases.

肝鎌状動脈を認めた3例を経験したので報告する. 頻度は腹部血管造影156例のうち1.9%であった. 肝動注化学療法を施行する際は本動脈の処理を行うべきである.症例1: 乳癌肝転移にて施行した血管造影で左肝動脈より分岐する肝鎌状動脈を認めた. 肝動脈CTで内側枝・外側前枝の分岐部から腹側に向かい, その後腹直筋直下を臍方向に走行する肝鎌状動脈が描出された.症例2: 小腸平滑筋肉腫の肝転移にて施行した血管造影で中肝動脈から臍方向に走行する肝鎌状動脈を認めた. 選択的造影では深下腹壁動脈との吻合が描出された. 肝動注化学療法の前に塞栓術を施行した.症例3: 胆嚢癌の診断で施行した血管造影で肝鎌状動脈が描出されたため, 手術時に肝鎌状間膜, 肝円索を採取した. 病理組織学的に外膜が肥厚した径1mmの動脈を認めた.

A Case Report of Primary Hypertrophic Pyloric Stenosis in Adult.

症例は46歳の男性. 18歳時胃潰瘍の既往がある. 5年前から食後の腹部膨満感があり流動食を主食としてきたが, 1994年7月吐血し入院した. 胃潰瘍, 十二指腸潰瘍による幽門狭窄症と診断し胃切除術を施行した. 切除標本にて胃角部の潰瘍と幽門部筋層の肥厚を認めた. 病理組織学的に幽門部には2次性の筋層肥厚を示唆するような炎症性細胞浸潤, 線維化やAuerbach 神経叢の変性を認めず, 原発性の筋肥厚性幽門狭窄症と診断した. 成人の筋肥厚性幽門狭窄症は極めてまれな疾患であるが, 幽門狭窄をきたす疾患のひとつに本疾患を想起し, 特徴的なX線, 内視鏡所見に注意すれば術前診断も可能と考えられた.