Toshiko Hisaki

Bone disorder following partial and total gastrectomy with reference to bone mineral content

To study post-gastrectomy metabolic bone disorders, we measured the radial bone mineral content (BMC), serum levels of calcium, inorganic phosphorus, alkaline phosphatase, and 25-hydroxyvitamin D(25-OH-D) in 59 patients with partial- and 39 patients with total gastrectomy. Total gastrectomy patients manifested a higher incidence of decreased BMC levels than did partial gastrectomy patients (56 per centvs. 25 per cent). Patients subjected to the Billroth II procedure, especially females, manifested abnormally low BMC values. The decline in BMC was age-related; it was pronounced in females. At 10 years postoperatively, many of the partial gastrectomy patients manifested markedly low BMC levels; in totally gastrectomized patients this finding was made at less than 5 years postoperatively. Approximately 30 per cent of our patients showed abnormalities in serum minerals, alkaline phosphatase or 25-OH-D.

Total Gastrectomy in the Aged with Special Reference to Postoperative Convalescence and Return to Normal Life

The postoperative convalescence and return to normal life were evaluated in 43 patients over 70 years of age who underwent total gastrectomy. In the aged, preoperative abnormal findings and postoperative complications were more frequent than in younger patients. The rate of death in aged patients experiencing postoperative complications was 25%. On the other hand, while postoperative convalescence and return to normal life were delayed in aged patients who had been curatively operated, the return to normal life was relatively good. Based on our results we suggest that total gastrectomy should not be ruled out in aged patients.

Serum zinc and copper changes after gastrectomy in aged patients with gastric cancer

Serum zinc and copper levels were evaluated in patients with gastric cancer who had undergone gastrectomy. These patients were divided into two age categories; namely, the aged group, comprising 39 patients over the age of 70 years, and the younger group, comprising 23 patients younger than 50 years. The data before and after surgery were compared between the two groups. Serum zinc levels in the aged group were significantly lower than those in the younger group, both before and after surgery. Serum copper levels, however, did not differ significantly between the two groups. The serum Cu/Zn ratio was also analyzed according to the histological stages of cancer (stages I to IV), and compared between the two ageclassified groups. The aged group showed a higher Cu/Zn ratio at all stages, whereas in the younger group, the ratio was significantly higher at stage IV than in the earlier stages. Preoperative serum zinc, copper, and the Cu/Zn ratio were studied in relation to the complication of anastomotic leak after surgery. The Cu/Zn ratio in the aged patients with this complication was significantly higher than that in the aged patients without it. These results suggest that the Cu/Zn ratio may be an important factor in determining nutritional parameters in the aged.

Efficacy of endoprosthesis for internal biliary drainage in patients with nonresectable carcinoma of the proximal bile duct

Surgical endoprosthesis as an internal biliary drainage was performed as a palliative treatment for 12 patients with a nonresectable carcinoma of the proximal bile ducts. In most of these patients jaundice was relieved, they were able to return to their homes, and their survival was substantially prolonged. The efficacy of this procedure was more favorable, compared to the results in patients in whom external drainage or cholangiojejunostomy was performed.

Long-Term Survival of an Elderly Patient with Carcinosarcoma of the Gallbladder after Cholecystectomy.

Carcinosarcomas, often referred to as malignant mixed tumors, are rare neoplasm. We reported herein a carcinosarcoma of the gallbladder in an elderly patient with long-term survival (4 years). The operation carried out was open cholecystectomy under the preoperative diagnosis of chronic cholecystitis and tumor of the gallbladder. Anticancer chemotherapy after cholecystectomy was performed by oral low-dose FT therapy. He was alive with no evidence of disease 48 months after surgery. Long-term survival for only cholecystectomy treatment as in this case may be possible if oral low-dose FT anticancer therapy is effective against carcinosarcoma of the gallbladder.