Tsukuru Hashimoto

Local control in differentiated thyroid carcinoma with extrathyroidal invasion

BACKGROUND The clinical significance of microscopically locoresional-residual differentiated thyroid carcinoma is still an unsolved problem. METHODS Patients who underwent resectional management for advanced differentiated thyroid carcinoma were divided into complete (n = 58), microscopic (n = 37), macroscopic (n = 14), and distant (n = 22) groups. RESULTS Postoperative recurrence was similar in the complete (28%) and microscopic (22%) groups and was significantly lower than that of the macroscopic (57%) and distant (67%) groups. Age, gender, lymph node metastasis, and the residual status (complete and microscopic versus macroscopic and distant) were independent risk factors for recurrence. Postoperative survival of the complete and microscopic groups groups was better than that of the macroscopic and distant groups. Age and the residual status were independent prognostic factors for overall and cause-specific survival. CONCLUSIONS Postoperative recurrence and survival of patients with microscopic residual cancer were similar to those of patients with complete resection, and macroscopic residual cancer either in locoregional or distant loci was an ominous prognostic sign.

Radical resection of primary malignant melanoma of the gallbladder with multiple metastases : report of a case

We present herein an usual case of primary malignant melanoma of the gallbladder in a 51-year-old man in whom an exploratory laparotomy for melena revealed six malignant melanoma lesions located in the gallbladder, main pancreatic duct, stomach, duodenum, jejunum, and a mesenteric lymph node. Total pancreatectomy was performed and histologically, junctional activity was seen only in the gall-bladder, suggesting that this was the primary site. No melanotic lesions were found on the skin or eyes. The metastases to the main pancreatic duct and gastrointestinal tract appeared likely to have occurred as a consequence of the mucosal dissemination of the tumor cells shed into the bile. The post-operative course was uneventful and combined chemotherapy was administered for 16 months. No new metastatic lesions were found until 21 months postoperatively, when metastases were detected in the brain and thoracic spinal cord. These metastatic tumors were removed surgically, but the patient died from cerebral disturbance 26 months after the initial operation. Thus, we consider that aggressive surgical therapy was effective for extending the survival time and improving the quality of life of this patient.

Stimulatory effect of pancreastatin on gastric acid secretion in conscious dogs.

Pancreastatin, a new 49-amino acid peptide, has recently been isolated and characterized from extracts of the porcine pancreas. The objective of the present study was to examine the effect of various doses of pancreastatin on gastric acid secretion in conscious dogs that were prepared with chronic gastric cannulas. Pancreastatin, administered IV at 400 pmol.kg-1 x h-1, enhanced peptone meal [peptone (5%), phenylalanine (90 mmol/L), glucose (12 g/dL)]-stimulated gastric acid secretion by 50%; pancreastatin at 800 pmol.kg-1 x h-1 enhanced peptone meal secretion by 165% (P less than 0.05). Intravenous administration of pancreastatin did not affect basal or peptone-stimulated release of gastrin. In addition, IV pancreastatin (400 pmol.kg-1 x h-1) failed to influence basal gastric acid secretion. Pancreastatin did not affect acid secretion stimulated by 2-deoxyglucose, histamine, or pentagastrin. The present study shows that pancreastatin can selectively enhance gastric acid secretion by a mechanism independent of cholinergic, histaminergic, or gastrin input.

Effect of secretin on lower esophageal sphincter pressure in patients with esophageal achalasia

SummaryThe effect of a bolus intravenous administration of secretin (2.0 U/kg) on resting lower esophageal sphincter pressure (LESP) was investigated in seven patients with esophageal achalasia. Basal LESP before secretin injection in the patients was 60.113.4 mmHg (Mean±SEM), which was significantly higher than 26.9±2.5 mmHg in normal controls consisting of eight healthy volunteers. LESP significantly decreased within 1 min after the injection both in the patients and the controls. The maximum pressure change from each basal LESP was 31.2±5.2 mmHg in the patients, which was significantly greater than 12.1±1.8 mmHg in the controls. The effect of secretin disappeared within 5 min in the controls. The effect in the patients, however, lasted throughout the investigation time of 30 min. It is concluded that secretin has a long-acting effect on muscular relaxation of the lower esophageal sphincter in esophageal achalsia patients.

Recurrent valvular pneumoperitoneum caused by a minute gastric ulcer —A case report—

A rare case of valvular pneumoperitoneum is reported. A 49-year-old Japanese man underwent an emergency laparotomy under a tentative diagnosis of perforating panperitonitis on the 19th post-open heart surgery day. A large volume of free intraperitoneal gas was revealed, but no identification of gastrointestinal perforation. On the 17th postlaparotomy day, pneumoperitoneum recurred. On the 41st postalaparotomy day, a tiny gastric perforation was detected with an oral contrast medium. The patient died of liver failure due to serum hepatitis. The autopsy revealed a minute gastric ulcer scar 2 mm in diameter in the mucosa of the fornix, which was thought to have caused the valvular pneumoperitoneum. A literature review was made of 8 reports on 11 cases. In two cases of valvular pneumoperitoneum, the perforating site could not be found even during laparotomy. It is suggested that either gastrointestinal series or endoscopy must be carefully repeated in order to identify the perforating site.

Surgical clinicopathologic study of malignant fibrous histiocytoma.

Fifteen men and six women, ranging in age from 20 to 79 years, with malignant fibrous histiocytoma comprised this series. Amputation of the right lower extremity was performed in one patient, wide resection in 7 and marginal excision in 9, respectively. In the other 4 patients, a non-curative resection was carried out. Adjuvant chemotherapy was prescribed post-operatively for 12 patients. Histologic grade of the surgical specimens was Stage I in 3, II in 6, III in 8 and IV in 4. Among fourteen patients living from 10 months to 9 years and 9 months after the operation, the 7 subjected to a wide resection are all disease free. Seven patients died of a local recurrence or a distant metastases. The survival rate of the patients with Stages I, II is significantly higher than those with Stages III, IV. These results show that a wide resection is to be favored and that staging is useful to estimate the prognosis.

An Adult Case of Duodenal Anomaly

A distal gastrectomy reconstruction using the Billroth II procedure was performed for epigastralgia and liver dysfunction caused by a duodenal anomaly in an adult. Hypotonic duodenography revealed the duodenum to be obliterated at the junction of the second and third portion, while the third portion was joined to the first portion. Endoscopic retrograde cholangiopancreaticography (ERCP) and ultrasonography showed a normal construction of the common bile and pancreatic ducts, as well as gallstones. To prevent ingested food from the stomach from entering the obliterated second portion, a distal gastrectomy (Billroth II) was thus performed. The patient has remained asymptomatic for 4 years since surgery. A distal gastrectomy reconstructed by a gastrojejunostomy is thus considered to be an effective method for improving the symptoms caused by food stasis in the obliterated second portion of the duodenum.

Carcinoma Overlying Leiomyoma of the Esophagus

We describe a case in which esophageal carcinoma invaded a coexisting leiomyoma. A 45-year-old Japanese man had complained of slight dysphagia and showed an abnormal shadow on the chest X ray film 10

Clinical assessment of Barrett's esophagus after total gastrectomy.

Barrett様食道は下部食道粘膜が扁平上皮に代わり円柱上皮におおわれた病態である.胃全摘術施行症例に対して内視鏡検査ならびに食道粘膜生検を行った結果, 23例中5例にBarrett様食道の発生が確認された.さらにBarrett様食道は食道炎症例 (23例中13例) にのみ認められた.5例のBarrett様食道上皮は組織学的検索により全例, intestinal typeと診断された.本症の病因は先天説ならびに後天説に大別されるが詳細な発生機序は明らかでない.今回得られた事実より胃全摘術後のBarrett様食道は逆流性食道炎の臨床過程において, 吻合部に隣接する空腸粘膜が口側へ進展したものであることを示唆された.

A case of reflux esophagitis: evaluation of reflux by 24 hour monitoring of esophageal pH.

はじめに 逆流性食道炎は胃液あるいは十二指腸液の食道内逆 流により食道粘膜が障害されることにより惹起 され る。患者は胸やけ,胸 痛,逆 流感などを訴え,高 度に なると潰瘍からの出血による吐血あるいは疲痕狭窄に よる聴下困難を生じる。本症に対する内視鏡ならびに 生検による器質的診断 1ン ちあるいは食道内圧測定によ る機能的診断に関する報告めゆは数多 くみられる。しか し, これらの診断法は,逆 流現象を直接 とらえている わけでなく,本 症の病態はいまだ完全に解明されたと はいえない。 それに対し,24時 間食道 pH測 定は逆流現象を生理 的な条件下において定性的,定 量的にとらえる事が可 能であり,逆流性食道炎の正確な診断法 といえる弱。今 回,わ れわれは長期の病悩期間を有 した逆流性食道炎 の 1例 に対し,手術前後に24時間食道 pH測 定を行い, 本症の病態生理に関して若子の知見を得たので報告す る。