Yutaka Hamabe

Clinicopathological features of esophageal cancer simultaneously associated with gastric cancer

Background and Objectives: We usually use the stomach for esophageal substitution in the surgical treatment of esophageal cancer, although it is often associated with gastric cancer. In order to improve the likelihood of safe and curative surgery of esophageal cancer, we investigated the clinicopathological characteristics of synchronous esophageal and gastric cancer.

An experimental study of regional chemotherapy using CDDP-loaded microspheres for esophageal cancer.

AbstractPurpose. The purpose of this study was to assess the antitumor effects of cisplatin-loaded microspheres (CDDP-MS) and the efficacy of the administration of CDDP-MS into the mediastinum. Methods. To evaluate the antitumor effect, we first performed a paratumoral injection of CDDP-MS to FF6 tumor-bearing DA rats to compare its effect with that of the intraperitoneal injection of a CDDP solution at different doses. Results. In the CDDP-MS groups the tumor growth was effectively delayed in proportion to the dosage of CDDP-MS. All rats treated with the CDDP solution at a dose of 10 mg/kg died within 1 week, while no rats treated with CDDP-MS even at a CDDP dose of 20 mg/kg were lost. In the second experiment, which was designed to determine the delivery of the microspheres-released CDDP to various organs, CDDP-MS was injected directly into the mediastinum via the diaphragm in male Wistar rats. In the CDDP-MS group, the plasma CDDP concentration stayed significantly lower than that in the CDDP solution (intravenous) group while the tissue CDDP concentration in the paratracheal lymph nodes was higher. Moreover, the lymph node-to-kidney platinum ratio was eight times higher in the rats given CDDP-MS intramediastinally than in those given the CDDP solution intravenously. Conclusion. These results demonstrate that a high dose of CDDP can be administered with less systemic side effects by means of encapsulation in the microspheres, and that the administration of CDDP-MS into the mediastinum is more effective for delivering CDDP to the paratracheal lymph nodes. As a regional chemotherapy after esophageal cancer operation, the injection of CDDP-MS into the mediastinum for targeting of the lymph nodes thus promises to be an effective treatment.

Isolated Left Thoracic Isomerism with Lung Cancer: Report of a Case

Thoracic isomerism, or symmetric morphology, is frequently associated with cardiac and abdominal anomalies. We report an unusual case of isolated left thoracic isomerism with lung cancer. A 67-year-old woman was referred to our hospital for investigation of an abnormal shadow on a chest X-ray. Chest computed tomography (CT) showed bilateral hyparterial bronchi, and bronchofiberscopy showed bifurcation of the right main bronchus into two branches. Pulmonary arteriography subsequently revealed that the right pulmonary artery bifurcated at the hilum and that it was not a mirror image of the left pulmonary artery. No other malformations were found on echocardiography or abdominal CT scan. We performed segmental resection of right S1+2 and S3 for lung cancer and the patient had an uneventful postoperative course. It is important to clarify the anatomy of patients with thoracic isomerism before surgical manipulation.

A Case of Intractable Pleural Effusion after Thoracoscopic Microwave Coagulation Therapy for Hepatocellular Carcinoma

肝細胞癌に対する鏡視下局所凝固療法は侵襲が少なく徐々に普及しつつある。今回右横隔膜直下の病変に対し て,胸腔鏡下に経横隔膜的にマイクロウェーブ凝固療法を施行 し,術後に難治性胸水が出現した症例を経験した。 症例は63歳,女 性。肝S4/8お よびS8の肝細胞癌の再発に対して,深 部凝固用電極および鏡視下用の経皮経管用モ ノポーラー電極を用いて経横隔膜的に凝固療法が行われた。術中横隔膜穿刺部より腹水が胸腔内にわずかに流入 するのが認められたが,自 然に軽快する程度と判断し胸腔 ドレーンを留置し閉創した。その後約9カ 月にわたり 多量の胸水貯留が繰 り返し認められ,そ の都度穿刺排液が施行された。鏡視下用電極を用いて経横隔膜的に凝固 療法が行われたことにより,横 隔膜に小孔が形成されたことが胸水貯留の一因と考えられ,鏡 視下用電極を用い た経横隔膜的凝固療法を行 う際は横隔膜を切開して行 うか,ま たは穿刺部位の縫縮が必要 と考えられた。

Study on local chemotherapy of esophageal cancer in use of microspheres.

Peplomicin-containing poly (lactic acid)microspheres(PEP-MS)were prepared, and its long retention and lymphtropic delivery were studied. PEP-MS released 70% of PEP in saline within 24 hours. PEP and PEP-MS were injected into the esophageal wall of rabbits, and PEP concentration of peripheral venous blood and lymph of thoracic duct were measured from 5 minutes to 6 hours after injection. In group “PEP”, PEP concentration of peripheral venous blood and lymph of thoracic duct were same level, but in group “PEP-MS”, PEP concentration of lymph of thoracic duct was higher than of peripheral venous blood. One day after administration of PEP, PEP was not found in esophagus, lymph nodes, lung and kidney, But one day after administration of PEP-MS, PEP was found to still remain 3.0 μg/g in esophagus.

A case of esophageal cyst.

はじめに 食道に発生する嚢腫はまれであるものの,近 年食道 透視 ・内視鏡などの進歩とともにその報告例は増加し ている.し かしながら,食 道壁内に嚢腫が認められる ことはきわめてまれであり,特 に,上 皮の形態や発生 部位から食道壁内気管支嚢腫として報告されたものは これまでに13例の報告しかない1).今 回われわれは術 前に超音波内視鏡を施行し,有 用であった食道壁内気 管支嚢腫と考えられる症例を経験したので,若 干の文 献的考察を加えて報告する. 症例 患者:56歳,男 性. 主訴:上 腹 部痛. 家族 歴:特 記す べ き こ とな し. 既往 歴:昭 和45年 虫垂 切 除,昭 和45年 お よび昭和48 年痔核 切 除. 現病 歴:昭 和61年4月 上 旬 に上 腹部 痛 が 出現 したた め4月17日 に近 医 を受 診 し,上 部 消化 管 造影 お よび内 視鏡 に て食道 の粘 膜下 腫瘍 が疑わ れ,精 査 目的で5月 23日 当科 入院 とな った.な お,嚥 下 困難・ 胸 骨後 方痛 および不 快感 ・体 重減 少 はな か った. 現 症:身 長147cm,体 重47.5kg.栄 養 は 良好 で貧血 およ び黄 疸 はな く,全 身 の表在 リンパ節 の腫 脹 も認 め なか った. 入院 時検査 所見:血 液一 般,肝 機 能,腎 機 能 お よび 電解 質 な ど血 液化 学 で は異 常 な く,便 潜 血反 応 は陰性 で,心 電 図 ・肺 機能 検査 さ らに胸 部 ・腹部 単純 写真 に も異常 は なか った.ま た腫瘍 マ ーカ ーではcarcinoembryonic antigen(CEA)が3.6ng/mlで α-fetoprotein