Tomishige Amano

Randomized, controlled study on adjuvant immunochemotherapy with PSK® in curatively resected colorectal cancer

A randomized, controlled trial of adjuvant immunochemotherapy with PSK®(Kureha Chemical Industry Co., Tokyo, Japan) in curatively resected colorectal cancer was studied in 35 institutions in the Kanagawa prefecture. From March 1985 to February 1987, 462 patients were registered. Four hundred forty-eight of those patients (97.0 percent) satisfied the eligibility criteria. The control group received mitomycin C intravenously on the day of and the day after surgery, followed by oral 5-fluorouracil (5-FU) administration for over six months. The PSK®group received PSK®orally for over three years, in addition to mitomycin C and 5-FU as in the control group. At the end of February 1990, the median follow-up time for this study was four years (range, three to five years). The disease-free survival curve and the survival curve of the PSK®group were better than those of the control group, and differences between the two groups were statistically significant (disease-free survival,P=0.013; survival,P=0.013). These results indicate that adjuvant immunochemotherapy with PSK®was beneficial for curatively resected colorectal cancer.

Postoperative functional evaluation of pylorus-preserving gastrectomy for early gastric cancer compared with conventional distal gastrectomy.

BACKGROUND Malnutrition, gallbladder dysfunction, dumping syndrome, reflux esophagitis, and gastritis of the remnant stomach are unfavorable sequelae in patients undergoing gastrectomy. Operative procedures should be improved to ensure such patients a satisfactory quality of life. METHODS After operation, gallbladder function, reflux gastritis, gastric emptying, and caloric intake were evaluated in 20 patients with early gastric cancer undergoing pylorus-preserving gastrectomy (PPG) and 25 patients undergoing conventional distal gastrectomy (CDG). RESULTS The resting gallbladder area increased significantly after CDG. In contrast, after PPG the gallbladder area showed no significant change and the contraction rate decreased slightly. After CDG, emptying was much more rapid for the first 30 minutes after ingestion of a meal. Although delayed emptying was observed early after PPG, the rate of emptying increased with time. Gastric pH was lower and gastric mucosal injury was milder in patients undergoing PPG. These results are attributed to preserved pyloric function. The caloric intake and changes in body weight after operation were similar in both the CDG and PPG groups. CONCLUSIONS PPG has advantages over CDG in terms of gallbladder function, the condition of the remnant stomach, and gastric emptying, PPG should be used in carefully selected patients with early gastric cancer to improve their quality of life.

Intrathoracic omental herniation through the esophageal hiatus: report of a case.

We report herein an extremely rare case of intrathoracic omental herniation through the esophageal hiatus. In fact, according to our review of the literature, only eight other cases have been reported, most of which were misdiagnosed as mediastinal lipoma after being identified as an intrathoracic mass. We report herein the ninth case of intrathoracic omental herniation through the esophageal hiatus. A 54-year-old obese woman was admitted to our hospital for investigation of a chest roentgenographic abnormality. She was asymptomatic, and her physical examination and laboratory data were all within normal limits. Her chest X-ray demonstrated a large, sharply-defined mass, and a computed tomography scan of the thorax indicated a large mediastinal mass with fat density. A thoractomy was performed under the diagnosis of a mediastinal lipoma which revealed an encapsulated fatty mass, 10×7.5×6 cm in size, that proved to be an omental herniation through the esophageal hiatus. There was no herniation of the stomach or intestines into the thorax. The esophageal hiatus was repaired after the omental mass and hernia sac had been resected. This case report serves to demonstrate that whenever a mass of fat density is recognized in the lower thorax, an omental herniation should be borne in mind as a possible differential diagnosis.

Gastric emptying after pylorus-preserving gastrectomy in comparison with conventional subtotal gastrectomy for early gastric carcinoma.

It is well known that surgical intervention on the stomach will greatly alter gastric function and gastric emptying. In this study, we evaluated the difference in postoperative gastric remnant emptying following pylorus-preserving gastrectomy (PPG) and conventional subtotal gastrectomy (CDG) using sulfamethizole capsule food. The subjects comprised 18 patients who underwent PPG and 23 who underwent CDG for early gastric carcinoma. While delayed gastric emptying was observed early after PPG, 1 year after PPG it was markedly accelerated compared with that measured in the early postoperative period. However, it was slower than that in the CDG patients. On the other hand, rapid gastric emptying was observed early after CDG and did not change with time. These findings stress that although PPG results in stasis in the early postoperative period, it seems to prevent unduly rapid emptying.

Endobronchial hamartoma treated by an Nd-YAG laser: Report of a case

Endobronchial hamartomas are only rarely encountered. They cause irreversible lung damage due to bronchial obstruction if not diagnosed early and treated properly. Among the various treatments for this rare disease, a surgical resection remains the most popular. We herein report a case of a 53-year-old man presenting with an endobronchial hamartoma which was successfully excised by laser irradiation via a rigid bronchoscope, along with a review of 113 patients with this disease reported in the literature.

Long-term total parenteral nutrition and osteoporosis : report of a case

A patient who had been supported with total parenteral nutrition (TPN) for over 8 years is herein presented, with emphasis on the changes observed in calcium metabolism. The patient was a 31-year-old female, who had undergone a subtotal jejunal and ileal resection for superior mesenteric artery occlusion. TPN was started soon after the surgery. She had been on TPN support for 105 months. Back pain developed at 97 months after the initiation of TPN. During her course, the serum calcium levels were judged to be within the normal ranges, while the 1α, 25(OH)2Vit.D declined. Intermittent hypercalciuria was occasionally observed. Both the serum level of calcium and urinary calcium loss correlated closely to the amount of calcium infused, but they were not influenced by the amount of vitamin D (ergocalciferol) received. The serum level of parathormone and calcitonin were also within the normal ranges. The patients vertebral bone, which was obtained at autopsy, revealed histopathological changes characteristic of osteoporosis. Based on the above, we conclude that a careful monitoring of the amount of calcium infused is called for to prevent bone disease in patients on long-term parenteral nutrition.

The Concomitant Effects of Cis-diamminedichloroplatinum and Caffein on the Proliferation and Chromosomal Changes.

ヒト胃癌細胞株STKM-1を用いてCis-diamminedichloroplatinum (以下CDDP) とカフェイソとの併用抗腫瘍効果と染色体におよぼす影響について検討した.CDDP (2μg/ml) 3時間接触で57%の増殖率であったが, CDDP接触後カフェイソ1mM持続接触にて23%に, 2mMにて9.3%に低下し, 抗腫瘍効果の増強が認められた.CDDP (2μg/ml) 処理後の染色体におけるgap/breakの出現頻度は1.816±1.509/Cell, exchangeの出現頻度は0.184±0-565/Ce11であった.CDDP処理直後からカフェイン1mMを24時間接触させるとgap/breakの出現頻度は4-206±3.162/Cell, exchangeは0.760±0.938/Cellと増加した.CDDP処理後24, 48時間後にカフェインを接触させても同様の結果が得られた.以上より, カフェインはDNA修復阻害作用を有し, 胃癌に対する化学療法において, CDDPとの併用で抗腫瘍効果の増強が期待された.

Clinicopathological Studies and Therapeutic Results on the Duodenal Extension of the Gastric Cancer Located in the Lower Portion.

幽門輪と胃癌の進行度・予後との関係を調べる目的で, 下部胃癌症例162例を対象にし, 幽門輪に接した, または幽門輪を越えて十二指腸へ進展した胃癌 (幽門輪群) と, 幽門輪から離れた胃癌 (非幽門輪群) との間で臨床病理学的成績を比較・検討した.その結果, 幽門輪群は非幽門輪群に比べて進行癌の頻度が有意に高かった.リンパ節転移率も幽門輪群で有意に高率であった.しかし予後的漿膜面因子PS (+) 例のみの比較では両群間に差がなかった.組織学的分化度では両群間に有意な差を認めなかったが, 十二指腸進展例では, 組織型が分化型のものは限局性に, 未分化型は浸潤性に進展する傾向が認められた.治療成績では治癒切除例の5年生存率は幽門輪群40.7%, 非幽門輪群69.3%で, 幽門輪群で不良であった.しかしps (+) 症例のみに限定すると生存率による差はなかった.

Effects and Limitation of Endoscopic Incisional Dilatation on Castrointestinal Anastomotic Strictures.

消化管吻合部狭窄の治療法として, 内視鏡的切開およびブジーによる拡大術の適応と限界について検討した.吻合部狭窄35例 (瘢痕性26例, 癌性9例) を対象とした.瘢痕性狭窄の長さによる狭窄解除率をみると, 2cm未満14/15 (93.3%), 2cm以上3cm未満8/9 (88.9%), 3cm以上0/2 (0%) であった.一方, 癌性狭窄は0/9 (0%) と効果不良であった.効果不良例13例 (瘢痕性4例, 癌性9例) の内, 癌性3例を除く10例に他の治療を加えた.3例 (瘢痕性1例, 癌性2例) に手術, 7例 (瘢痕性3例, 癌性4例) に食道ブジー挿管術を施行した.手術では, 狭窄が解除出来たのは1例のみで他は試験開腹および合併症死におわった.食道ブジー挿管術は7例全例狭窄を解除でき退院可能であった.皮膚管瘢痕性狭窄1例のみ皮膚瘻孔を形成し手術を要した.食道ブジー挿管術は難治性吻合部狭窄の非観血的治療法として有用であった.

Diagnosis and surgical treatment for multiple primary cancer of the esophagus and the stomach.

同時性に発生した食道胃重複癌切除症例7例を対象とし, その診断, 手術および治療成績について検討した.術前に7例中5例が食道, 胃病変ともに正しく診断されたが, 特に鑑別診断上重要と思われたのは食道癌の胃壁内転移であった.手術々式はリンパ節郭清を考慮し, 胸部食道病変に対しては胸部食道全摘が, 胃病変に対しては病巣がAまたはMに存在する場合, あるいはCに存在し進行癌と考えられる場合には胃全摘術が, Cに存在し早期癌と考えられる場合には噴門側切除が行われた. しかし, 治療成績は不良で7例中5例が術後1年以内に死亡した. また, 2例が術後肺合併症で死亡した点から手術適応の決定は慎重にすべきと思われた.