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In order to clarify the predictors of postoperative respiratory complications in patients over 80 years old who had undergone gastrectomy for gastric cancer with lymph node dissection to the extent of group 1 or 2, 21 patients were divided into two groups according to postoperative respiratory complications, eight with and 13 without complications. Univariate analysis revealed %VC, VC/m2 and FEV1.0/m2 as the predictor for respiratory complications, and Nutritional Risk Index or performance status (PS) had a tendency to be the predictor. The following formula which means possibility of postoperative respiratory complications, Y=1.184+0.186×curability-0.645×VC/m2+0.216×PS was elicited by stepwise logistic analysis. Y value of 0.47 established as the cut off point obtained accuracy in 90.5%, sensitivity in 90.5% and specificity in 92.3%. In order to prevent postoperative respiratory complications, preoperative exercise of respiratory function to raise vital capacity should be involved and an adequate method of operation should be selected by taking PS and stage of gastric cancer into consideration.

A 55-year-old man was admitted to the hospital because of epigastralgia and was found having a tumor of the esophagus by upper gastrointestinal endoscopy. It was a yellowish white elevated lesion 30mm in size covered with normal esophageal mucosa and placed at Ei portion of the posterior wall of the esophagus. Endoscopic ultrasonography demonstrated a normoechoic mass with homogenous internal echo in the submucosal layer. Endoscopic resection was impossible because of its size. It was resected under laparotomy. Histologically, the resected tumor was made from many foamy cells having amount of eosinophilic cytoplasm which showed positive reaction for S-100 protein. NSE and PAS stains. The diagnosis of granular cell tumor was made. In Japan 152 cases of esophageal granular tumor have been reported in detail. Follow-up, endoscopic resection and/or surgical resection were performed for these tumors. We confirm that endoscopic resection in the first choice for esophageal granular cell tumor, considering its size, histological depth of invasion and the sign of malignancy.

A 56-year-old man who had been operated on for a cancer of the thoracic esophagus was admitted to the hospital with a suspicion of pleural recurrence on February 28, 1996. On March 14, dyspnea along with hallucination and disorientation appeared. Since severe impaired ventilation was noted, endotracheal intubation was emergently performed and the patient was entered the ICU. At that time, Ca level was 18.6mg/dl, showing significant hypercalcemia, and the white blood cell count increased to 18, 100/mm8. PTH-rP level in blood was as high as 260Pmol/ml. The elevated Ca level gradually decreased with a combinated use of elsitonine and bisphosphonate and his clinical condition became better, however, the Ca level converted to increase gradually since April 7, and appearance of arrhythmia and aggravation of ventilatory impairment were associated. On May 8, the patient died of abrupt cardiac arrest, when the white blood cell count was 21, 600/mm3 and Ca level was 14.8mg/dl. It is thought that hypercalcemia in this case might be caused by pleural recurrence of the esophageal cancer based on an increase in PTH-rP, and the cause of his death might be due to hypercalcemia crisis because the increase in Ca level was correlated with the clinical symptoms.