Yasuhisa Yamamoto

Primary osteosarcoma of the breast

Presented herein is a case of primary pure osteosarcoma of the breast. A 59‐year‐old woman noticed a left breast tumor. Mammography showed a cluster of crushed stone‐like calcifications, which gave the tumor a raw cotton‐like appearance. Malignancy was suspected on fine‐needle aspiration cytology of the tumor. An excisional biopsy was performed. The tumor was 2.0 × 2.4 cm in size. Histopathologically the tumor was composed of diffuse atypical cells with mitosis and a lot of bone. Atypical cells were thought to be neoplastic osteoblasts. Multinucleated osteoclastic cells were interspersed with osteoblasts. Spindle cells were found at the verge of the tumor. A few entrapped tubular structures were seen. Immunohistochemistry indicated that neoplastic osteoblastic cells of the tumor were stained positively for vimentin, but negatively for epithelial markers; which suggested that the tumor cell elements originated from epithelial cells. This tumor was diagnosed as primary extraskeletal osteosarcoma. Partial resection was additionally performed around the excisional biopsy without dissection of the axillary lymph nodes. Bone radionuclide scan after operation showed no abnormal uptake. At 5 years after surgery no recurrence was seen.

Surgical treatment for the recurrence of colorectal cancer

We report the results of a retrospective study conducted on patients who developed recurrence following surgery for colorectal cancer, and present a practical plan to improve the survival rates. Of 974 patients who underwent surgery for colorectal cancer in our hospital during the 20 years between 1974 and 1993, 152 developed recurrence, as local recurrence in 70 (7.2%), as liver metastasis in 47 (4.8%), and as pulmonary metastasis in 35 (3.6%). The number of patients who underwent reoperation or curative resection was 54 (77.1%) and 13 (24.1%), respectively, of those with local recurrence, 16 (34.0%) and 6 (37.5%) of those with liver metastasis, and 6 (17.1%) and 6 (100.0%) of those with pulmonary metastasis. The 3- and 5-year survival rates were 13.4% and 8.9%, respectively, after reoperation for local recurrence, 14.4% and 0%, after reoperation for liver metastasis, and 53.3% and 53.3% after reoperation for pulmonary metastasis. Although evaluation was difficult owing to the small number of patients with lung metastasis, resection of a pulmonary lesion resulted in a good outcome. Furthermore, a significant difference in 3- and 5-year survival rates was observed between patients who underwent reoperation and those who underwent conservative treatment, for whom the survival rates were 0% and 0% following local recurrence, 4.6% and 0% following liver metastasis, and 0% and 0% following lung metastasis, at 3 and 5 years, respectively. These findings indicate that aggressive surgery for recurrence may result in a better outcome.

Aggressive Angiomyxoma Occurring in the Scrotum : Report of a Case

The authors recently treated a case of aggressive angiomyxoma occurring in the left scrotum. A 61-year-old Japanese man was diagnosed as having an inguinal irreducible hernia that descended to the bottom of the scrotum preoperatively. However, during the operation a large tumor was found between the spermatic fascia and the skin pressing the testis upward. The tumor measured 20×15×15 cm, was yellowish with a smooth surface encapsulated by a membrane similar to the pleura, and the cut surface was gelatinous. The histological findings indicated that the tumor had thick-walled vessels which had prominently increased in size, delicately waved collagen fibers, and stromal cells in a myxoid background. The patient has remained recurrence-free as of 11 months after surgery.

Duodenal atresia secondary to intrauterine midgut strangulation by an omphalocele

Presented here is the first instance of duodenal atresia due to intrauterine midgut strangulation and necrosis in a tight omphalocele defect in a newborn infant with myelomeningocele and hypoplasia of both lower extremities.

Forskolin-stimulated adenylylcyclase activity: a marker to assess islet cell viability following cold storage in different solutions and to predict islet cell function following transplantation.

For clinical islet cell transplantation, short-term storage of islet cells is likely to be necessary, and it is imperative that the islet cells be kept as viable as possible during the period. However, there are little data on which preservative solutions are most suitable for the storage of islet cells after isolations or before transplantation. To estimate islet cell viability and transplantation success rate in the present study, adenylylcyclase activity was measured with a rapid new fluorometric assay in rat islet cells prior to transplantation, because cAMP plays an essential role in determining islet β-cell viability and responsiveness to various hormonal stimuli. Adenylylcyclase activity was measured in islet cells stored for different periods of time (0, 3, 16, 24, 48, 96 h) and in different preservative solutions. Approximately 1,000 islet cells from each preservation group using University of Wisconsin (UW) solution were transplanted to streptozotocin-induced diabetes mellitus (DM) rats. Transplant success was evaluated by measuring blood glucose levels. Preoperative adenylylcyclase activity was compared with posttransplant islet cell function. The adenylylcyclase activity of UW solution was significantly higher than that of Euro-Collins solution and lactate-Ringers solution through the different preservation time periods. Preoperative adenylylcyclase activity correlated well with posttransplant islet cell function in a rat model of DM. We conclude that adenylylcyclase activity can be used as a marker to assess islet cell viability as well as differences in preservation media and may predict islet cell transplant success.

Cryosurgical hemorrhoidectomy: How to prevent the postoperative swelling and prolapse

Cryosurgical hemorrhoidectomy was performed on 171 patients with excellent results achieved in the great majority. The key to successful results is based on the prevention of prolapse of the edematous tissue after freezing. To prevent the edema, it is important to pull out the hemorrhoid as much as possible during the freezing, to freeze only on the rectal side of the anal verge, to carefully avoid freezing the anal verge, and to freeze the hemorrhoids in two or three stages when they are large. Less than satisfactory results were achieved in 11.7% of the patients. The anal discomfort and discharge in these patients were related to prolapse of the frozen tissue. Cryosurgery is an effective method of treatment for hemorrhoids if care is taken to use the proper technique.

Local Recurrence After Local Excision of Early Rectal Cancer

The advantage of local excision for early rectal cancer, excluding fiberscopic polypectomy, is that it allows preservation of the anal function of the sphincter. We treated 75 patients with early rectal cancer and carried out local excision in 29 of these cases during the period from 1974 to 1992. Three of these 29 patients were reoperated upon immediately because of massive invasion to the submucosa at the margin of the removed specimen. Two other cases experienced local recurrences and required additional surgery.

Cryosurgical Treatment For Local Recurrence Of Rectal Cancer

During the last 19 years we have used cryosurgery as part of a multidisciplinary therapy to treat 12 patients with local recurrence of rectal cancer. This treatment was chosen to provide these patients with the palliative benefits of minimal bleeding and to reduce tumor bulk. The survival time following resection therapy in 30 cases after relapse was significantly greater than that for the 12 cases receiving cryosurgical treatment. However, local destruction of the recurring cancer by cryosurgery resulted in effective control of the tumor.

Effect of ATP on antitumor activity of various antitumor drugs in mice tumor cells in vitro.

マウス培養細胞を用い, ATPの癌細胞および正常細胞の増殖, 膜透過性におよぼす影響を検討した. さらに本物質の癌化学療法への応用を目的として, 各種抗癌剤との併用実験を行った. ATPにより, 癌細胞では著明な細胞膜透過性の亢進, cell viabilityの低下がみられたのに対し, 非癌化細胞におけるこれらの変化は軽微で, ATP作用は癌細胞に特異的であった. ATP処理後の癌細胞における各種抗癌剤の抗腫瘍効果は, 5-FU, ADM, MMC, ACNUでは相加的, VCRでは相乗的に増強した. また, 正常細胞に対する抗癌剤の細胞毒性はATPの併用により増強されなかった. これらの結果からATPを用いることにより, 選択的癌化学療法が期待できるものと思われた.