Teruo Kakegawa

Ga-67 scan in patients with intrathoracic esophageal: Carcinoma planned for surgery

The authors evaluated Ga‐67 scan in 68 patients with intrathoracic esophageal carcinoma initially planned for surgery. Of these, 59 patients were staged pathologically or surgically; their Ga‐67 scan results were then compared with the results of pathologic or surgical investigations. Positive Ga‐67 scan results correctly predicted the presence of extraesophageal spread and lymph node metastases. Of 38 clinical Stage II patients, 15 (39%) could be Stage III by the results of Ga‐67 scan. However, two of four clinical Stage I patients (50%) and 35 of 38 clinical Stage II patients (92%) were eventually pathologic or surgical Stage III. This high conversion rate and the high incidence of Stage III in esophageal carcinoma patients may not justify routine use of Ga‐67 scan only for staging. Ga‐67 scan, however, was useful for planning radiotherapy, because missing extraesophageal extension or gross metastases from the radiation fields were detected in six patients of 51 so treated. Ga‐67 scan has its value in some patients with intrathoracic esophageal carcinoma.

Carcinoma within a middle esophageal (parabronchial) diverticulum: A case report and the review of the literature

A case of carcinoma developed in the middle esophageal (parabronchial) diverticulum is reported. In recent literature, 44 cases of carcinoma in esophageal diverticulum were reported. Most of the patients who had carcinoma in a diverticulum have a long-term history of symptom related to diverticula. Prognosis of these patients was poor because the carcinomas were far advanced when they were found. Therefore, the patient with esophageal diverticulum should be checked with esophagogram, esophagoscopy and biopsy, considering the possibility of development of carcinoma. Most of the cases of carcinoma in a diverticulum were treated with diverticulectomy. However, we consider that radical esophagectomy is a better method of treatment.

Cell Kinetic Study of Human Cancers Transplanted to Nude Mice

Using 3H-TdR pulse labelling, the cell kinetics of four, serially transplantable, human tumors were studied in athymic nude mice. Squamous cell carcinoma of the lung, tongue and esophagus showed relatively similar cell kinetic parameters. The growth of an oat-cell carcinoma was initially very slow in mice and its growth fraction was unexpectedly small with a relatively low labelling index. Its postmitotic phase was very short. It was concluded that the nude mice/human tumor system may be useful for cell kinetic studies of human tumors from the standpoint of tumor biology and therapy.

A turnover de-epithelialised deltopectoral flap to close fistulae following antethoracic oesophageal reconstruction

WITH modern surgical and anaesthetic techniques the mortality after oesophageal resection and reconstruction for cancer is now less than IO per cent. despite the fact that surgery is now offered to many elderly or poor-risk patients. For these patients antethoracic oesophageal reconstruction is the method of choice but the incidence of suture breakdown and subsequent fistula formation is higher than with other reconstructive procedures because of inadequate blood supply, malnutrition and high intraluminal pressure. These fistulae, once established, rarely heal spontaneously. This paper describes a method of closing such fistulae, with a turnover deepithelialised deltopectoral flap. TECHNIQUE

Study of a method for esophagography and its clincial value

Subjects of the present investigation are 20 control cases free from upper gastrointestinal diseases and nine cases with achalasia. Intraluminal pressure of the esophagus was measured with the use of an open-tip method. In the control cases, presence of W-shape pattern with three high pressure zones and two low pressure zones were verified. On the basis of this W-shape pattern, analysis was made of the resting pressure of the esophagus in nine cases with aehalasia. The results led to classify into four types. These are; disappearance of the W-shape pattern with the lowest resting pressure above 5 emH20 (Type 1), same as the above exeept for the lowest pressure below 5 cmH20 (Type II), prcsence of W-shape pattern with the lowest resting pressure above 5 cmH20 (Type III) and same as the above except for the lowest resting pressure below 5 emH20 (Type IV). Analytical data of the achalasia cases relatively well correlated with clinical findings and clarified significance of the pressure study for diagnosis and judgment of symptomatic severity. In analysis of deglutition pressure waves, it seems convenient to locate a point of pressure measurement in view of three high pressure zones and two low pressure zones.

Pathological and clinical observations on achalasia: Quantitative comparison of the ganglion cells in achalasia with normal esophagus

ACHALASIA of the esophagus has been called as cardiospasm or achalasia of the cardia and these nomencula tures are inclined to give misleading impression that lesion of the disease is localized in the gastro-esophageal junctional zone. Many authors have described pathognomonic changes of in t ramura l plexus or Auerbach s plexus only in the lower of the esophagus or the juxta-cardiac region. However only a few repor ts are found in the l i te ra ture concerning quant i ta t ive observat ion of the ganglion cells in t he whole length of the esophagus. Th i s report concerns quant i ta t ive measurement of the ganglion cells in two autopsy cases of achalas ia and one case of normal pat ient for control study. In these three autopsy cases, t ransverse block sections of 5 ram, in thickness were made successively in the whole length of the esophagus. And t h r e e step sections were made f rom every block to count the number of ganglion cells. Maximal number of ganglion cells in these th ree step sections were regarded as representat ive number of each block. In a normal eaophagus examined, ganglion cells appear at the upper end of smooth muscle and increase in number abrupt ly and become most abundant in the segment where smooth and s t r ia ted muscles are mixed wi th equal ratio. The same tendencies are observed in achalasia. However ganglion cells a re degenerated and scanty. Our histologic study shows tha t total gangl ion cell counts in two cases of achalasia are of 3 or 5% of those of normal pat ient and amount to 10 or 16% of normal when ganglionic segment in achalasia is compared with corresponding length of the normal esophagus. The aganglionic areas are observed in the thorac ic and abdominal esophagus distal to 11 or 13 cm. f rom crico-pharyngeus muscle in two cases of achalasia and these levels correspond to tha t of t racheal bifurcation. In none of twenty-eight pa t ien t with the disease, p r imary peristalsis reaches distal ly to the b i furca t ion level in cinefluorographical and manomete t r ic examination. The re fo re dysphagia in achalas ia is not only due to fa i lure of relaxat ion at the gastroesophageal junct ion but also due to aperistalsis in the body of the esophagus below bi furcat ion level, as Wangensteen et al. suggested the name dystonia. It would be worthy to re-emphasize tha t achalasia is the disease ent i ty in almost all uns t r ia ted por t ion of the esophagus and in teres t should not be focussed only upon gastro-esophageal junct ion.