Yoshihiro Oohata

Complete ten-year postgastrectomy follow-up of early gastric cancer

The postoperative courses of 109 patients with early gastric carcinoma treated from 1970 through 1976 were followed for 10 years. The cumulative 5-year survival rate was 96 percent and the 10-year survival rate was 92 percent. In this series, there was no significant difference in the survival rates between the mucosal cancer and submucosal invasion groups or between patients with and without lymph node metastasis. Five patients died from the recurrent cancer. The other causes of death were metachronous primary cancer in eight patients, synchronous primary cancer of sigmoid colon or rectum in two, cerebrovascular accident in six, heart disease in six, other causes in four, and unknown causes in four. Although the prognosis of early gastric cancer is remarkably good, patients should be carefully followed over a long period for late recurrence of the primary cancer and possible metachronous cancer of the other organs.

Clinical and manometric evaluation of anorectal function following low anterior resection with low anastomotic line using an EEA stapler for rectal cancer.

Anorectal function was evaluated in eight patients who had low anterior resection of the rectum with a low anastomotic line, using an EEA™ stapler, with determination of function based on periodic manometric studies and clinical symptoms. Immediately following surgery all patients suffered from frequent bowel actions and soiling. These symptoms improved with time and most patients could enjoy almost normal daily life by the sixth postoperative month. One month after surgery, anal canal resting pressure and maximum squeeze pressure were significantly reduced and rectoanal inhibitory reflex was absent; neither showed a distinct tendency to improve thereafter. Rectal sensation and reservoir capacity, which also were seriously impaired, recovered satisfactorily by the time of the six-month examination. This suggests that an improvement of clinical symptoms following this operation is dependent upon the recovery of reservoir capacity and sensation of the neorectum, and that this operative procedure is a functionally acceptable option for low rectal cancer.

Treatment of desmoid tumors in Gardner's syndrome. Report of a case.

Aggressive desmoid tumors present difficult problems among patients with Gardners syndrome. Recently, attention has been directed toward metabolic or hormonal manipulation of these tumors. A 21-year-old woman with Gardners syndrome was admitted because of recurrent abdominal wall tumors. She was treated with nonsteroidal anti-inflammatory drugs, tamoxifen, and ascorbate for seven months. During this therapy, CT scan showed a gradual increase in size of the tumors. Subsequent resection of the abdominal tumors and the colon was performed. Although these three types of drugs were administered to prevent postoperative recurrence, an abdominal wall desmoid tumor that invaded the mesentery developed within nine months. The known treatments, that is, chemotherapy, irradiation, and surgical resection are discussed in view of this experience.

Change in colonic motility after extrinsic autonomic denervation in dogs

Changes in colonic motility were compared indogs undergoing autonomic denervation of the paraaorticand presacral (group A), paraaortic (group B), ormesocolonic region (group C), and sham operation (group D). Five bipolar recording electrodes wereplaced into the seromuscular layer of the colon andrectum. The numbers of continuous electrical responseactivity and contractile electrical complex after an intragastric olive oil injection were smallerin group A than in the other groups (P < 0.05) fromthree weeks through six months after denervation. Thisdifference was significant even in the proximal colon. These data suggest that the pelvic plexus mayplay an important role in colonic motility including theproximal colon. The damage to the plexus did not recoverfor at least six months after denevation. Pelvic plexus injury may thus be one ofpossible explanations for the prolonged change in bowelhabit after anterior resection of the rectum.

Rapidly and infiltratively growing crohn's carcinoma of the small bowel: Serial radiologic findings and a review of the literature

We carried out a retrospective evaluation of serial changes in the small bowel radiographs of a patient with small bowel cancer accompanied by long-standing Crohns disease. During the 8 months before diagnosis, marked morphological changes were noted. A solitary and irregular protrusion, and rapidly growing stricture under careful medical management of the underlying disease may indicate the development of cancer.

COMPARISON OF BLOOD FLOW ASSESSMENT BETWEEN LASER DOPPLER VELOCIMETRY AND THE HYDROGEN GAS CLEARANCE METHOD IN ISCHEMIC INTESTINE IN DOGS

Blood flow of the colon and the ileum was measured before and after intestinal devascularization by laser Doppler velocimetry and the hydrogen gas clearance technique in 10 dogs in order to evaluate the clinical usefulness of laser Doppler velocimetry. The submucosal blood flow of the colon and the ileum measured by the hydrogen gas clearance method was significantly decreased, as was the subserosal blood flow of both sites measured by laser Doppler velocimetry. There was a linear relationship between the flow values using the two methods both in the colon (r = 0.7192, p less than 0.001) and in the ileum (r = 0.7646, p less than 0.001). These data suggested laser Doppler velocimetry may be a useful method to assess the degree of intestinal ischemia because of its noninvasiveness and good correlation with submucosal blood flow by the hydrogen gas clearance technique.

Correlation between macroscopic morphologic features and malignant potential of colorectal sessile adenomas

PURPOSE AND METHODS: To clarify malignant potential of colorectal sessile adenomas, we investigated 46 colorectal sessile adenomas surgically resected from 44 patients. Lesions were divided into three types according to their macroscopic morphologic features: nodular-type (19 adenomas), villous-type (7), and creeping-type (20). Clinicopathologic features were investigated and compared among these three types. RESULTS: Frequency of focal carcinoma in the nodular-type, villous-type, and creeping-type adenoma was 37, 29, and 55 percent, respectively. Frequency of submucosal invasion in these three types were 11, 14, and 20 percent, respectively. Irrespective of the type, large lesions (>3 cm) tended to have a higher frequency of submucosal invasion than did smaller ones (60vs.20 percent;P=0.063). Large creeping-type adenomas (>3 cm) had a definitely higher frequency of submucosal invasion than smaller ones (36vs.0 percent;P<0.05). Lymphatic or vascular invasion of carcinoma was present only in the lesion with submucosal invasion: 5 percent in the nodulartype; 14 percent in the villous-type; 20 percent in the creeping-type. Lymph node metastasis was present only in the creeping-type lesion. CONCLUSIONS: The large creeping-type adenomas (>3 cm) have a definitely high frequency of submucosal invasive carcinoma. Endoscopic polypectomy or local resection may be adequate for most sessile adenomas. However, we recommend segmental resection of the colon with regional lymph node dissection for a creeping-type adenoma that is larger than 3 cm because of increased risk of submucosal carcinomatous invasion and lymph node involvement.

The possible presence of a separate disease entity in nonfamilial polyposis of the large intestine

Familial adenomatosis coli (FAC) traditionally has been diagnosed as the presence of more than 100 colonic adenomas, even if no familial occurrence is present. In the present communication, clinical features of FAC have been compared in detail to detect differences between familial and nonfamilial cases with regard to colonic and extracolonic lesions and to discover whether they constitute the same disease entities. No significant difference was found in the incidence of extracolonic lesions. The average number of colonic polyps in the nonfamilial cases of patients over 30 years old was 1128, the number of polyps was significantly higher in the familial cases (3154). When three patients with approximately 100 polyps were excluded, the mean number of colonic polyps in nonfamilial cases became 2608. This was similar to that of familial cases. Furthermore, the occurrence of approximately 100 polyps was extremely rare in familial patients who were over 30 years old. Therefore, most of the nonfamilial cases can be considered to be familial probands of FAC, but some, such as the three cases in the present study, may be a different disease entity, such as recessive adenomatous polyposis or multiple colonic adenomas.

Effect of a new prostacyclin analogue on anastomosis of ischemic colon in dogs

The effect of a new prostacyclin analogue OP-41483 on ischemic colonic anastomosis was investigated in dogs. Colonic ischemia was produced by devascularization of the marginal vessels in the left colon and graded into three degrees by measuring colonic blood flow with a hydrogen gas clearance method. The agent was administered intravenously after devascularization using a continuous infusion pump. The parameters studied were colonic blood flow in the submucosal layer, rate of anastomotic leakage, β-glucuronidase activity and protein content of the colonic mucosa, and histologic changes. After administration of the agent, blood flow increased significantly and β-glucuronidase activity at the anastomotic site was well preserved at a relatively high level in spite of ischemic change. The anastomotic leakage rate was significantly decreased. The present study proved that administration of this new prostacyclin analogue minimizes ischemic damage, and may be of considerable importance in ischemic colonic anastomoses.