Search

The aim of this study was to clarify a correlation between acute inflammatory response to surgery and different laparotomy lengths in patients who underwent colorectal cancer resection via a single minimal laparotomy. Between April 2005 and May 2008, 131 consecutive patients (59 women, 72 men), who were scheduled to undergo elective surgery for resection of primary colorectal cancer using a single minimal skin incision, were enrolled in this study to investigate the correlation between postoperative acute inflammatory responses (as measured by serum C-reactive protein (CRP) levels and white blood cell count (WBC)) and different laparotomy lengths. According to the length of laparotomy, the patients were grouped into 3 categories, "small-incision" ( 7 cm), "medium-incision" (>7 and 14 cm), and "large-incision" (>14 cm) for comparison. Statistical analyses were conducted using the Kruskal-Wallis test with multiple comparison post-hoc and chi-square tests. The small-, medium-, and large-incision groups included 68 (51.9%), 42, (32.1%) and 21 (16.0%) patients, respectively. On the 1st postoperative day, median serum levels of CRP and WBC of the small-incision group were significantly lower than those of the medium-incision and large-incision groups (CRP, P=0.0051 and P=0.0015, respectively; WBC, P=0.049 and P =0.0007, respectively). In addition, the median serum levels of CRP and WBC on the 1st postoperative day were proportional to the length of laparotomy. These data suggested that the extent of acute inflammatory response may be proportional to length of laparotomy. In addition, only the use of small-incisions ( 7 cm) among the three investigated categories of laparotomy lengths may be a factor which is associated with statistical significance with minimal invasiveness of colorectal cancer resection., identifier:Acta Medica Nagasakiensia, 56(1), pp.13-18; 2011

Recent clinical studies have reported that microsatellite instability (MSI) colorectal cancers show a high sensitivity to 5-FU, but these reports are contradictory to findings from in vitro analyses. In this study, we analyzed the relationship between MSI phenotypes and the expression of 5-FU metabolic enzymes in human colorectal cancer specimens. MSI phenotypes in 174 sporadic colorectal carcinomas were determined and grouped into the following three categories based on the Bethesda guidelines: high-frequency MSI (MSI-H), low-frequency MSI (MSI-L), and stable microsatellite (MSS). The expressions of dihydropyrimidine dehydrogenase (DPD) and thymidine phosphorylase (TP) in tumor specimens were measured by enzymelinked immunosorbent assays. The ratio of TP to DPD expression (TP/DPD ratio) was calculated for each tumor. These three factors were compared with regard to MSI phenotypes by non-parametric and logistic regression analyses using cut-off values at their medians. MSI-L tumors were excluded from statistical analyses. Thirteen tumors were classified as MSI-H, 8 tumors as MSI-L, and 153 tumors as MSS. DPD expression did not differ between MSI-H tumors and MSS tumors. TP expression and the TP/DPD ratio were significantly higher in MSI-H tumors than in MSS tumors [TP, 160.1± 104.0 vs 97.3 ± 53.7 (Units/mg protein) (P=0.009); TP/DPD ratio, 3.04 ± 1.62 vs 2.07 ± 1.08, (P=0.016)]. These differences were also significant in multivariate analysis. In conclusion, these data suggest that 5-FU catabolic activity in cancer tissue does not differ between MSI-H and MSS tumors. However, 5-FU anabolic activity in cancer tissue is higher in MSI-H than in MSS colorectal carcinomas., Acta medica Nagasakiensia, 58(1), pp.1-7; 2013

Morphologically, liver metastases from colorectal carcinoma usually form as nodular tumor masses, whereas intraductal papillary growth in the bile duct is rare. A 65-year-old man underwent right hemicolectomy for advanced colon carcinoma, and histology of the primary carcinoma confirmed moderately differentiated adenocarcinoma with subserosal invasion, no vascular infiltration, and no lymph node metastasis. A liver tumor was found in the right paramedian Glisson pedicle and intraductal growth of cholangiocarcinoma was seen on imaging. We performed right hepatectomy and macroscopically, the resected specimen contained a growth in the bile duct lumen similar to cholangiocarcinoma. Histological examination revealed intraductal papillary proliferation of well-differentiated adenocarcinoma without vascular infiltration or lymph node metastasis in the hepatic hilum. Immunohistochemical staining revealed that the tumor cells were negative for cytokeratin-7 and positive for cytokeratin-20. Based on these findings, liver metastasis from colon carcinoma was diagnosed. Liver metastasis from colorectal carcinoma rarely arises as intraductal papillary growth in the bile duct, but the possibility of liver metastases with unusual morphology must be borne in mind for patients with a history of carcinoma in the digestive tract., Surgery Today, 41(2), pp.276-280; 2011

A rare case of cecal volvulus that was preoperatively diagnosed and surgically treated is herein reported. An 85-year-old woman was admitted to our hospital because of abdominal pain and distension concomitant with nausea and vomiting. She had no past history of laparotomy. Her abdomen showed distention with muscle rigidity and positivity for Blumberg's sign. Plain abdominal X-ray showed a markedly air-distended bowel segment in the right lower abdomen associated with dilated small intestine. An abdominal computed tomography showed extremely dilated bowel in the right lower abdomen that resembled a "coffee bean" in appearance. However, there was no evidence of air-distention in the descending colon. A colonoscopy did not show any bowel obstruction of the left side colon. We diagnosed a cecal volvulus associated with intestinal strangulation. An emergency laparotomy was thus performed. During the laparotomy, the ileocecal region, which was unfixed at the retroperitoneum, was found to be twisted clockwise 360°around the mesentery with the terminal ileum, thus resulting in a diagnosis of cecal volvulus. Since the colonic wall demonstrated vascular compromise and patchy gangrene, we therefore conducted an ileocecal resection without detorsion and reperfusion, followed by primary anastomosis. The patient recovered with minor complication. This case demonstrates the need for clinicians to consider cecal volvulus as a possible cause of acute abdomen. Abdominal computed tomography studies in such patients may enable early diagnosis. Resection without detorsion and reperfusion is the favored option for gangrenous bowel., Acta medica Nagasakiensia, 53(3), pp.73-76 ; 2009

Smaller incisions may be the major reason for reduced invasiveness of laparotomy. The aim of this study was to clarify the feasibility and safety of a minimal skin incision for colorectal cancer resection. Between April 2005 and February 2008, 122 consecutive patients (56 women, 66 men) were enrolled in this prospective study and scheduled to undergo resection for colorectal cancer using a single minimal skin incision. All of the operations were performed by a single surgeon. The patients were grouped into "small-incision" (?7 cm), "medium-incision" (>7 and ?14 cm), and "large-incision" (>14 cm) for comparison. The small-incision, medium-incision, and large-incision groups included 64 (52.5%), 38 (31.1%) and 20 (16.4%) patients, respectively. The median length of laparotomy incision in the small-incision and medium-incision groups (102 patients) was 7 (interquartile range 7-10) cm. There was no operative mortality. The group with larger length of skin incision had longer operation time, greater operative blood loss, higher rate of postoperative complications and longer postoperative stay. Failure of the small-incision was significantly associated with tumor location (splenic flexure/rectum) and tumor characteristics (adhesion/invasion of tumor into adjacent organs, and/or tumor diameter ?6.0 cm). This experience suggests that the majority of colorectal cancer resection can be safely accomplished via a median length of skin incision of 7 (interquartile range 7-10) cm., Acta medica Nagasakiensia, 53(2), pp.33-36 ; 2007

A minilaparotomy approach (? 7 cm) for colorectal cancer resection is feasible and safe. Such minilaparotomy generally employs a small vertical incision. A low transverse abdominal incision (a K?stner incision) has been shown to be associated with cosmetic advantage, less postoperative pain, and fewer wound-complications than the midline incision. We report three cases (75-year-old female, 64-year-old male, and 74-year-old female) who underwent anterior resection of rectal cancer via a minilaparotomy approach employing the K?stner incision. No hand-port or laparoscope was used. The median body mass index was 18.9 (range, 18.3-19.3) kg/m2. The rectal tumors were located in the rectosigmoid and the upper rectum. There were no intraoperative complications. The median operating time and operative blood loss were 160 (range, 159-162) min and 80 (range, 30-90) ml, respectively. All tumors were curatively resected. The patients quickly returned to normal function without morbidity or mortality. No patients developed wound-related complications. During a median follow-up period of 27.4 (range, 26.8-29.0) months, all patients are alive without tumor recurrence. In addition, neither incisional hernia nor nerve damage developed. We conclude that the minilaparotomy approach employing a K?stner incision is a less invasive and an attractive method with a cosmetic advantage for rectal cancer resection in selected patients., Acta medica Nagasakiensia, 53(2), pp.51-54 ; 2007

Bile duct cystadenocarcinomas are rare cystic neoplasms of the liver. A 70-year-old woman with a cystadenocarcinoma with the invasion to the stomach as a submucosal tumor is presented. There were unrepresentative findings in a pre-operative examination, and it was difficult to distinguish whether this cystic tumor was malignant or benign. The tumor in the stomach was diagnosed as submucosal prior to operation, but was revealed as an invasive tumor from a bile duct cystadenocarcinoma in a left lobe of the liver during surgery. As it metastasized to the stomach and spread intraductally, a left lobectomy was performed. The operation was noncurative but the patient has been alive for 19 months since., Acta medica Nagasakiensia. 2004, 49(1-2), p.59-62

To clarify the relationship with development of colorectal cancer, we investigated chromosomal aberrations in 715 specimens of the colorectal neoplasm by cytogenetic analysis. A gain of chromosome 17 was observed in the transitional epithelium around non-polypoid carcinomas, although the normal epithelium exhibited diploidy. Most tubular adenomas were diploid, however, loss of chromosome 11 and gain of chromosome 17 were increased in adenomas in association with an increased villous component. DNA aneuploidy, aneusomy and p53 deletion were predominantly observed in carcinomas, even in early cancers. Alterations of chromosomes 11 and 18 reflected different tumor morphologies in the early carcinomas. Gains of chromosomes 11, 17 and 18, and deletion of chromosomes 11 and 17p and p53 became more frequent following an increase in the depth of invasion. Aneusomy of chromosome 11 was a risk factor for patient survival after operation. Gains of chromosome 20 and 20q13.2 were associated with liver metastasis. Aneusomy and translocations of chromosome 17 and the p53 locus were predominantly observed in patients with multiple cancers and hereditary non-polyposis colorectal cancer. Our results indicate that in the process of development of colorectal carcinomas, specific chromosomal aberrations might be related to each step of development, or an alternative pathway of de novo carcinogenesis., Acta medica Nagasakiensia. 2004, 49(1-2), p.25-32

Gastrointestinal stromal tumors (GISTs) are common form of submucosal tumors of the stomach. Treatment of recurrent GISTs had been unsuccessful because of resistance to chemotherapy and radiotherapy. Recently, GISTs were reported to markedly respond to the molecular target agent, imatinib mesylate. We present here a patient with recurrent GIST and c-kit mutation who was successfully treated with imatinib mesylate. A 66-year-old man underwent partial gastrectomy because of GIST. The tumor was 3 cm in size and positive for KIT expression. One year after the excision, spiral computed tomography (CT) scan revealed four intra-peritoneal recurrence lesions measuring 7, 4, 3 and 2 cm in diameter. One week after the CT scan, we started treatment with imatinib mesylate at 400 mg/day, which resulted within two months in 40% decrease in the sum of the longest diameter. The reduction of tumor size continued for more than 6 months. Analysis of the c-kit mutation of the primary tumor revealed the deletion of 18 bases in exon 11 (codon 551-557), while other exons showed no mutation. In this report, we showed the effectiveness of imatinib mesylate therapy for the recurrence of GIST, especially with c-kit mutation in exon 11., Acta medica Nagasakiensia. 2004, 49(1-2), p.63-66

To identify the effect of local treatments for hepatocellular carcinoma (HCC) in our associated institutes in Nagasaki prefecture, we performed a comparative study of hepatic resection and local ablative therapies, including alcohol injection, microwave coagulation and radio-frequency ablation. We examined the patient demographics, outcomes and tumor-free and overall survival between a hepatectomy group (n=210) and a local ablative therapy group (n=52). In the ablative therapy group, there were significantly more patients with cirrhosis and poorer hepatic function than in the hepatectomy group (p<0.001). Larger tumors and vascular involvement in the hepatectomy group were significantly more frequent than in the ablative therapy group (p<0.001 and p=0.002, respectively). The multivariate Cox regression analysis indicated no significant difference either in the time to the first recurrence of tumor after surgery or in mortality between ablative therapy and hepatectomy. By making full use of various modalities in each specialty, the satisfactory HCC treatment could be achieved at this stage., Acta medica Nagasakiensia. 2004, 49(3), p.87-91

The aim of this study was to clarify whether or not preoperative serum levels of sialyl Lewisa (CA19-9), sialyl LewisX (SLX), and sialyl Tn (STN) antigens are predictors for diffuse type gastric cancer. Eighty-two patients with diffuse type and 96 patients with intestinal type cancers were studied. Univariate logistic regression analysis showed that the following factors were significantly associated with diffuse type cancer: high levels of serum STN, young age (<62 years), female gender, tumor in the middle stomach, macroscopic type 3/type 4 cancer, presence of lymphatic invasion, peritoneal dissemination, stage III/IV, and non-curative resection. Multivariate analysis revealed that diffuse type cancer was independently related to young age (<62 years), female gender, tumor in the middle stomach, and macroscopic type 3/type 4 cancer. In conclusion, none of the preoperative serum levels of CA19-9, SLX, and STN were predictors for diffuse type cancer., Acta medica Nagasakiensia. 2003, 48(3-4), p.129-133

To clarify the clinical usefulness of measuring branched chain amino acids and tyrosine ratio (BTR), which is correlated with Fischer's ratio, we examined the serum BTR level in 33 patients with liver diseases. Serum levels of branched-chain amino acids (BCAAs) and tyrosine were measured by the new enzymatic method, which costs inexpensive and is immediate compared to measuring Fischer's ratio. BTR was calculated as ratio of concentration of BCAA to tyrosine. BTR was correlated with levels of albumin, transaminase and cholinesterase and was lower in patients with chronic viral hepatitis, Child B cirrhosis and portal hypertension. In 19 patients who underwent hepatic resection included 8 for major hepatectomy, resected volume, blood loss, operation time and background of liver diseases were not associated with changes of BTR after hepatectomy. In patients with prolonged jaundice, postoperative BTR level was significantly lower between day I and 7 after hepatectomy. We concluded that serum BTR level was correlated with poor liver function and monitoring of BTR levels after hepatectomy may be useful to evaluate degree of hepatic damage after liver surgery., Acta medica Nagasakiensia. 2003, 48(1-2), p.29-33

From 1991 to 2001, we performed 5 re-operations with limited posterior sagittal anorectoplasty (PSARP) for low imperforate anus in girls who had anteriorly located anus after primary surgery. Four girls were diagnosed with anocutaneous fistula and one girl with anovestivular fistula. Primary operations were one cutback anoplasty and four anal transplantation. None of them underwent colostomies before re-operation with the limited PSARP. The sphincter muscle was cut through a median perineal skin incision and then the rectum was placed at the center of the complex muscles. This limited PSARP could give good anal function and satisfactory cosmetic appearance, Acta medica Nagasakiensia. 2003, 48(1-2), p.51-54

This study was designed to provide an immunohistochemical analysis of tumor biological factors in 28 patients who underwent hepatectomy for cholangiocellular carcinoma (CCC). Analyzed factors were microvessel counts (stained by CD34) and proliferating cell nuclear antigen (PCNA). PCNA L.I. was correlated with serum level of CA19-9, which was correlated with a higher recurrence rate and shorter patient survivals. Microvessel counts were negatively correlated with tumor size. Furthermore, the microvessel count in CCC with mass-forming (MF) plus periductal infiltrating (PI) type associated with poorer survivals, was significantly lower compared to that of CCC with MF type or PI type. Neither microvessel counts nor PCNA L.I. were associated with any other clinicopathologic factors or cancer recurrence. The five-year overall and cancer-free survival rates were 26% and 13%, respectively. Patients with MF plus PI type, poorer differentiated carcinoma, stage 4A and higher CA19-9 level had shorter cancer-free and overall survivals after hepatectomy (p<0.05). Cancer-free and overall survivals in patients with lower microvessel counts tended to be slightly worse but were not significantly different. Although tumor microvessel count and proliferating activity were correlated with prognostic clinicopathologic parameters, both factors might not be prognostic markers for predicting CCC recurrence and patient survival., Acta medica Nagasakiensia. 2003, 48(1-2), p.23-27

The serum hyaluronic acid (HA) levels are associated with liver regeneration after hepatectomy. In the present study, the HA concentrations were examined to evaluate the relationship with changes of hepatic volume after right portal vein embolization (PVE). The HA level of serum samples from 10 patients who underwent PVE before hepatectomy of the right lobe was measured, and the results were compared to the changed volume of embolized right lobe and unembolized left lobe of the liver. The mean serum HA level in patients with chronic viral liver disease (CVLD) (202+/-118 ng/ml) was significantly greater than in those without CVLD (70+/-24 ng/ml) (p<0.05). The volume of embolized liver decreased 72+/-96 CM3 (-8.9+/-5.5 %), while the volume of unembolized liver increased 106+/-67 CM3 (+8.9+/-5.5 %) 2 weeks after PVE. HA concentrations after 2 weeks of PVE (296+/-216 ng/ml) tended to be greater than that before PVE (134+/-108 ng/ml) but not statistically significant (p=0.105). There were no correlations between serum HA levels before PVE and the changes of hepatic volume in embolized and unembolized lobe after PVE. Our results indicate that the measurement of HA level is not useful for predicting the effect of PVE., Acta medica Nagasakiensia. 2002, 47(1-2), p.43-46

Angiogenic factors play a major role in tumor growth and metastasis. Vascular endothelial growth factor (VEGF)- D is a ligand for VEGF receptor-3 (VEGFR-3/Flt-4), which mainly expressed on the lymphatic endothelium. Recent experimental studies have shown that VEGF-D induces tumor lymphangiogenesis and promote metastatic spread of tumor cells via lymphatic vessels. However, the contribution of VEGFD to lymph node metastasis in human colorectal cancer is less understood. We therefore examined VEGF-D and VEGFR-3 expression in patients with colorectal cancer. Sections of formalin-fixed and paraffin-embedded specimens from 76 colorectal cancers were immunohistochemically stained for VEGF-D and VEGFR-3. Staining for VEGF-D was positive in the cytoplasm of tumor cells in 43 of 76 examined tumors (56.6%). Staining for VEGFR-3 was positive in endothelial cells in 38 (50.0%) tumors. Univariate analysis showed that both VEGF-D and VEGFR-3 expressions correlated significantly with lymph node metastasis, histological type and depth of tumor invasion. However, logistic regression analysis indicated that VEGF-D expression, but not that of VEGFR-3, was an independent predictor for lymph node metastasis. Our data suggest that VEGF-D plays an important role in lymph node metastasis in colorectal cancer., Acta medica Nagasakiensia. 2002, 47(3-4), p.155-160

Sialyl Lewisa (CA19-9) and sialyl LewisX antigens (CSLEXI) may play a role in tumor metastasis by serving as functional ligands in the cell adhesion system. To determine their prognostic value, we examined preoperative serum levels of CA19-9, CSLEXI, and carcinoembryonic antigen (CEA) in 64 female patients with primary breast cancer who underwent radical mastectomy. The patients were divided into two groups, termed the low- and high-antigen groups based on a value selected as a diagnostic cut-off. Correlation between the serum antigen levels, various established clinicopathologic factors, and prognosis were studied by univariate and multivariate analysis. The high- CEA group was at a more advanced stage (including T factor, N factor, M factor, and Stage) than the low-CEA group. Patients with high serum levels of CEA had shorter disease- specific intervals than those with low serum levels (P <0.0001), whereas disease-specific intervals did not differ between low- and high-CA19-9 or CSLEXI groups. A Cox's regression multivariate analysis revealed a high serum CEA level as an independent factor for worse outcome, separate from Stage. In conclusion, an elevated preoperative serum CEA level was a predictor for poor outcome after radical mastectomy for breast cancer, while CA19-9 and CSLEX1 were not., Acta medica Nagasakiensia. 2002, 47(1-2), p.37-41

Purpose. The purpose of this study was to determine whether the type of operation [sphincter-saving resection (SSR) or abdominoperineal resection (APR)] for primary adenocarcinoma of the rectum at or below the peritoneal reflection affects survival after non-curative surgery. Methods. This retrospective study included 42 patients who underwent non-curative surgery by the following two types of operation between 1989 and 1998: (1) SSR (n=19 patients) included low anterior resection with either double-stapling technique (n=16) or transanal coloanal anastomosis (n=3); (2) APR (n=23). 'Non-curative' resection implied 'Curability B' and 'Curability C' defined by the Japanese Classification of Colorectal Carcinoma. Outcome measure was diseasespecific survival. Univariate and multivariate Cox's regression analyses were used to evaluate data. Median follow-up was 17.2 months at study conclusion. Results. Disease-specific survival after non-curative surgery did not differ between the two types of operations. Multivariate analyses showed that the type of operation was not a significant independent variable in predicting disease-specific survival after surgery. One variable - 'Curability' - was significant predictor of outcome after surgery. Conclusions. The type of operation (SSR or APR) did not affect survival after non-curative resection for adenocarcinoma of the rectum at or below the peritoneal reflection., Acta medica Nagasakiensia. 2002, 47(3-4), p.139-144

Aims: Outcome in minilaparotomy and laparoscopic-assisted approaches to colon cancer resection was compared retrospectively. Methods: The 'minilaparotomy approach', defined as a complete resection performed through a skin incision of 7cm or shorter ('moving window method'), was achieved in 47 patients with colon cancers (Tis/T1/T2/T3/T4) between 1997 and 1998 (minilaparotomy group). A laparoscopic-assisted approach was used in 30 patients with colon cancers (Tis/T1) between 1994 and 1996 (laparoscopic-assisted group). Results: Age, gender, prior laparotomy, tumor location, weight, height, body mass index, operation time, blood loss, and type of colectomies and anastomosis were similar in both groups. Median incision lengths in the minilaparotomy group were longer than in the laparoscopic-assisted group (7.0 versus 6.0cm). Maximal tumor diameter, number of lymph nodes removed, and proximal and distal margins in the minilaparotomy group were larger than in the laparoscopicassisted group. The minilaparotomy group had more advanced staged tumors; however, times until initial walking, flatus, fluid and solid food, time with urinary catheter, analgesic usage, postoperative hospital stay, and postoperative complication frequencies were similar. In neither group was there tumor recurrence at the laparotomy wound or port sites. Conclusion: Minilaparotomy and laparoscopic-assisted approaches to colon cancer resection were similar in terms of early return of function and discharge., Acta medica Nagasakiensia. 2001, 46(3-4), p.25-32

Aqua oxidation water is a new disinfectant with a bactericidal activity based on high oxidation-reduction potential and acidity. We compared the effectiveness of aqua oxidation water and povidone iodine against the surgical site infection (SSI). The bacteriological effect against several organisms and the efficacy of both disinfectants were almost similar. However, the duration of treatment with aqua oxidation water was shorter than that with the povidone iodine in healed wounds (p<0.05) and the number of patients treated with aqua oxidation water who reported pain was smaller than that with povidone iodine (p<0.05). Our results indicated that aqua oxidation water useful and effective for the treatment of incurable SSI., Acta medica Nagasakiensia. 2001, 46(1-2), p.33-37

Background: Unfortunate complications in some patients who undergo minimally-invasive resections for colorectal cancer using a minilaparotomy are the development of postoperative wound infection or tumor recurrence at in the minilaparotomy site. These complications are potentially avoidable. In an effort to prevent these problems, we designed an easy-to-use device named the Lap-Protector TM. The purpose of this study was to evaluate the efficacy of the Lap-Protector TM in preventing bacterial infection and tumor recurrence at minilaparotomy incision sites. Patients and Methods: Ninety-eight colon cancer patients who underwent minimally-invasive resections using minilaparotomy (minilaparotomy or laparoscopic-assisted approach) with the assistance of the Lap-Protector TM between January 1999 and August 2000 were compared with 87 patients treated without this device between January 1997 and December 1998. Postoperative wound infection and tumor recurrence rates at the minilaparotomy site were retrospectively analyzed. Results: Patient characteristics (age, sex, body mass index, and frequency of diabetes mellitus), tumor location, operative procedures, and pathological parameters were similar between the two groups. Four patients (4.6%) in the control group developed postoperative wound infections versus none in the Lap-Protector TM group (P=0.047). With a median follow-up of 8.3 (range, 1.3 to 19.3) and 29.7 (range, 8.4 to 54.4) months in the Lap-Protector TM group and control group, respectively, neither group has recorded a tumor recurrence at the minilaparotomy site. Conclusion: The Lap-Protector TM appears to prevent wound infection after minimally-invasive resections for colon cancer using a minilaparotomy. Longer follow-up to evaluate tumor recurrence rates at the minilaparotomy site is necessary., Acta medica Nagasakiensia. 2001, 46(1-2), p.55-60

Background- Two distinct morphologic types of colorectal cancer have been described in recent studies: polypoid growth type (PG-type) and nonpolypoid growth type (NPG-type). Materials and Methods- We investigated possible biological and clinical differences between 37 PG-type and 156 NPGtype cancers using both univariate and multivariate analyses (logistic and Cox regression models). Results- Unlike NPG-type cancers, PG-type cancers had a high proportion of well-differentiated adenocarcinoma cells, a high likelihood of being early colorectal cancers (carcinoma in situ and cancer invades submucosa), and a low frequency of lymph node metastasis. On average, such PG-type cancers also carried a better prognosis than NPG-type cancers (P=0.01). In particular, PG-type cancer patients with stage IV tumors had a better prognosis than NPG-type cancer patients (P=0.02). In fact, after performing a Cox regression analysis, we found that colorectal cancer growth type is an independent prognostic variable, separate from histologic type or stage. Conclusions- PG-type colorectal cancer is less aggressive and has a favorable prognosis compared to NPG-type cancer., Acta medica Nagasakiensia. 2000, 45(1-2), p.51-59

Aims: We examined the preoperative serum levels of sialyl Lewisa (CA19-9) and carcinoembryonic antigen (CEA) in 262 colorectal cancer patients, in order to clarify whether or not the prognostic value of CA19-9 after curative surgery is superior to that of CEA. Patients and Methods: The patients were divided into two groups: low or high antigen groups (higher or lower than a selected diagnostic-based cut-off value). For evaluation of the prognostic value of CA19-9 and CEA, the disease-free interval was studied. Results: The disease-free interval of patients with a high serum levels of CA19-9 or CEA was significantly shorter than for those patients with a low serum level of the particular antigen (P<0.0001 and P=0.0009, respectively). The disease-free interval of patients with stage I/II tumors who had a high CA19-9 level was significantly shorter than in those patients with stage I/II tumors with low CA19-9 levels (P=0.0020). In contrast, the disease-free interval of patients with stage I/II tumors who had a low or high CEA level did not differ. Cox s regression analysis revealed that a high serum level of CA19-9 or CEA was an independent predictor for short disease-free interval after curative surgery, separate from stage (Hazard ratio=2.65 or 1.68, respectively, versus a low serum level of each respective antigen) . Conclusions: These data suggest that the preoperative serum level of CA19-9 was a stronger prognostic factor after curative surgery than CEA. Furthermore, in contrast to CEA, CA19-9 provides more prognostic information than that obtained by conventional staging methods in patients with stage I/II tumors., Acta medica Nagasakiensia. 2000, 45(1-2), p.47-50

PURPOSE: The purpose of this study was to investigate the effects of omental pedicle graft (OPG) wrapping to limit leakage from compromised double-stapled anastomoses after anterior resection for rectal cancer. PATIENTS AND METHODS: Between 1994 and 1997, a prospective study was conducted on 80 consecutive patients who had undergone double-stapled anastomoses after anterior resection for rectal cancer. Decisions to perform OPG were made intraoperatively because of compromised doublestapled anastomoses. RESULTS: Twenty-one patients (26%) received OPG to protect anastomosis, the remainder of patients had no OPG. Ten of the 21 patients underwent OPG for stapler-related operative complications, 5 for rectal carcinoma with stenosis, 3 for obstructive colitis or diverticulitis in the sigmoid colon, and 6 for very low anterior resection with coloanal anastomosis after total mesorectal excision. Three of 21 patients had more than one indication for OPG. The two types of patients were comparable with respect to patient characteristics and operative procedures, although tumor diameter in the OPG patients was significantly larger than in the non-OPG patients. Anastomotic leakage was noted in 1 non-OPG patient (2%) but in none of the OPG patient. There were no statistically significant differences between the two types of patients with regard to postoperative course and anastomotic or other postoperative complications. CONCLUSION: We conclude that OPG wrapping provides an effective protection for a compromised anastomosis of anterior resection in selected patients with rectal cancer, Acta medica Nagasakiensia. 1999, 44(1-2), p.40-46

Purpose: Carcinoma of the splenic flexure is uncommon and it is associated with a high risk of obstruction. However, survival after resection of this tumor is controversial. The aim of this study was to evaluate cancer specific long-term survival after surgery for splenic flexure cancers compared to survival for the colon cancer at other sites. Patients and Methods: Of 500 patients undergoing surgery for colon cancer, 16 (3.2%) had cancers of the splenic flexure. Clinicopathological features and cancer specific longterm survival after curative resection were evaluated. Results: Splenic flexure carcinomas were found to be associated with a high risk of obstruction (4 out of 16; 25.0%) and a high risk of penetration/perforation (1 out of 16; 6.2%) compared with colon cancers at other sites (P <0.0001 and P=0.0128, respectively). Operative mortality rate for patients with carcinomas of splenic flexure was significantly higher than that of other sites (6.3% versus 0.8%; P=0.0319). However, resection for splenic flexure tumors was usually possible, and there was no difference in cancer specific long-term survival after surgery between the patients with splenic flexure cancers and the other site colon cancers (P=0.3505). Conclusions: Carcinoma of the splenic flexure has a similar prognosis to colon cancer at other sites., Acta medica Nagasakiensia. 1999, 44(3-4), p.45-48

Local recurrence in the pectoralis muscle after modified radical mastectomy for breast cancer is rare. We encountered a 53-year-old woman who developed a small nodule on her right antero-lateral chest wall after modified radical mastectomy. Excision biopsy of the mass lesion was performed, and pathological examination revealed a local recurrence in the pectoralis major muscle. Resection of the pectoralis major and minor muscles, subclavicular lymph nodes dissection and postoperative radiation therapy were performed. After operation, no local recurrence appeared, but the patient died of multiple liver and bone metastases two and a half years later., Acta medica Nagasakiensia. 1997, 42(3-4), p.58-60

The records of patients with ulcerative colitis (UC) who underwent operation at our hospitals between 1973 and 1995 were reviewed. The clinical course of the disease was the chronic relapsing-remitting type in seven, chronic continuous type in four, acute attack of the relapsing-remitting type in six, and fulminant colitis (toxic megacolon) in two patients. The most common indication for surgery was a condition refractory to conservative therapy. Four patients with massive bleeding, perforation and toxic megacolon underwent emergency operation. The surgical procedures performed were ileoanal anastomosis (IAA) in four, ileoanal canal anastomosis (IACA) in one, ileorectal anastomosis (IRA) in five, proctocolectomy and permanent ileostomy (PCI) in four, and colectomy in five patients. The mortality rate was 5.2%. During follow-up, drug therapy with sulfasalazine (salazosulfapyridine) in colectomy or IRA patients was necessary to control inflammation in the remaining rectal mucosa. One patient with segmental colectomy for severe colitis required removal of the remaining colon 1 year later. Three out of four patients undergoing total proctocolectomy and IAA had a good postoperative course with an average of six bowel movements in 24 hours, but one patient with a long rectal cuff was returned to a PCI because of a cuff abscess. The PCEEA instrument was sufficient to perform IAA and IACA. Carcinoma in the remnant rectum occurred in one patient 20 years after Hartmann's procedure. In conclusion, total proctocolectomy, which has the advantage of removing all diseased mucosa with its potential for inflammation, dysplasia, and carcinoma, may be preferable for extensive long-standing UC., Acta medica Nagasakiensia. 1996, 41(3-4), p.71-75

The prognostic significance of carcinoembryonic antigen (CEA) values in the drainage vein of the tumor (portal blood levels of CEA) of colorectal cancer patients were evaluated by examining the correlation with the peripheral blood levels of CEA and histopathologic findings of the tumor. 1) Portal blood levels of CEA were significantly increased by the operative procedure. Mean values of CEA in portal blood were higher than those in peripheral blood. Portal blood CEA was correlated with Dukes' staging, and revealed higher positive rates than CEA in peripheral blood in each stage. Elevated CEA levels were noted in those who had cancer infiltration extending through the proper muscle layer. There was a close correlation between portal CEA and CEA content in cancerous tissue (ng/g, wet weight) (p<0.05), but no significant correlation between peripheral CEA level and cancerous tissue CEA (r = 0.372). The mean values of portal CEA in aneuploidy were significantly higher than those in diploidy. These findings indicate that circulating CEA in peripheral blood might be influenced by the metabolic process of CEA in the liver as well as cancer progression rather than CEA production of the tumor. 2) The 5 year survival rate of the patient's group with a negative rate of portal CEA (93%) was far better than that with a positive rate (57%). This study suggested that the portal blood level of CEA in colorectal carcinoma may be very useful for assessment of the patient's survival., Acta medica Nagasakiensia. 1996, 41(3-4), p.52-56

In the present study, the expression of protease indicated by cathepsin B (CB) and the expression of extracellular matrix indicated by laminin (LN) and tenascin (TN) was immunohistochemically examined in 25 gallbladder carcinomas. The incidence of expression of .CB and TN in normal epithelium was 1/25 (4%) and 0/25 (0%), respectively, and significantly increased in carcinomas (14/25 : 56% and 21/25 : 84%, respectively) (p<0.01). The LN expression was detected in the basement membrane of all normal epithelium, and the incidence of LN expression was significantly decreased in the carcinomas (7/25: 28%) (p<0.01). The incidence of CB expression in poorly differentiated adenocarcinomas (1/8: 13%) was significantly lower than that in papillary, welland moderately differentiated adenocarcinomas (11/15: 74%) (p<0.01). However, these responses were not significantly related with other histologic features or nuclear DNA ploidy pattern. The LN expression of the hepatic metastasis group (4/6 :67%) was significantly greater than that in the non-metastatic group (3/19 :16%) (p<0.05). The expressions of CB, LN and TN were not associated with the postoperative prognosis. In conclusion, the increased expressions of CB and TN, and the decreased expression of LN were cancerassociated alterations. The expression of CB was correlated with the histological grade of differentiation, and the expression of LN was correlated with the hepatic metastasis., Acta medica Nagasakiensia. 1996, 41(3-4), p.38-44

Between September 1992 and July 1996, 2 patients with type I early gastric cancer, 3 with type IIa, and 14 with type IIc, totaling 19 patients underwent laparoscopic partial gastrectomy (gastric wedge resections in 17 and Billroth II distal gastric resection in 2). There were 12 men and 7 women. Mean age was 65.4 years ranging from 44 to 86. Gastric lesions were located on the anterior wall in 7, posterior wall in 8 and lesser curvature in 4. In 15 of 19 patients, we performed laparoscopic surgery by a lesion lifting method using plastic T-fasteners. Average operative time was 164.8±49.6 min (range 85-252) in all, 153.7±46.7 min for the lesion lifting method, and 227 ± 33 min for diatal gastrectomy. Average blood loss was 44.1 ± 57.3 ml, 30.9 ± 43.7 ml, and 97 ± 61 ml, respectively. Mean hospital stay after surgery was 13.6 ± 6.8 (6-30) days. There was no mortality and no postoperative complications. The average size of tumors in type I, IIa and lie was 30 mm, 17.3 mm and 20 mm, respectively. In histologic examination, 16 cases were differentiated carcinoma and the remaining 3 cases were signet cell carcinoma. One of 4 cases diagnosed as SM cancer preoperatively was m (mucosal) cancer, two were sm (submucosal), and one was mp (muscularis propria) cancer histologically, but no one was involved in regional lymph nodes. These results indicate that laparoscopic partial gastrectomy will play an increasing role in the treatment of early gastric cancer without lymph node involvement as well as benign gastric tumors., Acta medica Nagasakiensia. 1996, 41(3-4), p.57-65

To determine the clinical features and problems presented by a pancreatic pseudocyst, eighteen patients managed at our hospitals since 1980 were reviewed. Males predominated with a ratio of 16: 2, and the average age was 36.2 years. Pseudocyst was located in the pancreatic head in 6, in the body in 6, in the tail in 5 and multiple pseudocysts in one case. The cause of pancreatic pseudocyst was chronic pancreatitis in 9 (including 8 patients with histories of alcoholism), acute pancreatitis in 2 and trauma in 7 patients, respectively. Three patients were associated with pancreatic calculi. Rupture of pseudocyst occurred in one patient with multiple cysts. Autopsy showed acute pancreatic necrosis and penetration to the stomach and duodenum. The indications for surgery were principally cyst-related symptoms(infection, hemorrhage, enlargement and compression of adjacent organs) and differential diagnosis from malignancy. Most of the patients underwent internal drainage ; 9 cystojejunostomy, 2 cystogastrostomy). Three patients underwent cystojejunostomy with longitudinal pancreaticojejunostomy for chronic pancreatitis. Massive hemorrhage after cystogastrostomy occurred in one patient with infected pseudocysts, which required removal of the cysts. Postoperative outcome of the 17 surgical patients was excellent in 16 patients. Only one patient died of pancreatitis associated with alcohol abuse, resulting in a 5.9% mortality. This study suggests that adequate internal drainage by pancreaticojejunostomy to treat the underlying pancreatic disease is most important to obtain an excellent prognosis in patients with pseudocysts., Acta medica Nagasakiensia. 1995, 40(1-4), p.18-21

In order to more fully understand the morphological characteristics of villous tumors of the colorectum, the vascular patterns of six colorectal resection specimens were microangiographically studied. Grossly, villous adenomas were of two main types: pedunculated polyps and carpet-like lesions. Pedunculated villous adenomas had many large stalk vessels in a broad short pedicle, representing a large blood supply to the tumor. The carpet-like lesions were composed of continuous clusters of polyps with stalk vessels and the flat elevated lesions among polyps and at the periphery showed similar vascular patterns to the mucosa of normal colon. In lesions with cancer invasive to the proper muscle layer, scattered ulcerations due to the destruction of polyps were also observed, corresponding to at least a Dukes B lesion. The above findings could represent very important additional information for endoscopic treatment or local excision for the prevention of hemorrhagic complicatios or incomplete removal of tumor., Acta medica Nagasakiensia. 1994, 39(1-3), p.172-175

To select the sensitive anticancer agents for the treatment of patients with carcinoma, chemosensitivity should be timely assessed from biopsy specimen for patients with gastric carcinoma. Histogram of DNA analysis from biopsy specimens revealed the disappearance of GZM accumulation in reflection of effects of anticancer drugs prior to the appearance of clinical signs. In conclusion, DNA analysis from biopsy specimens is of great value in assessing the efficacy of anticancer drugs in the course of drug treatment and also in knowing the drug sensitivity to the tumor timely., Acta medica Nagasakiensia. 1993, 38(2-4), p.222-225

To clarify the features and problems presented by a peripheral cholangiocarcinoma (CCC), seven patients with hepatectomy from the First Department of Surgery, Nagasaki University School of Medicine (6 patients), and from Department of Surgery, National Ureshino Hospital (one patient) were reviewed. Men predominate with ratio of 5:2, and an average age was 65.4 years. Tumor location was left lateral segment in 4 patients, right lobe, middle lobe and posterior segment in one, respectively. Three patients were associated with hepatolithiasis. Underlying liver disease was found in 4 patients (57%); cirrhosis in 3 patients, and chronic hepatitis in one. Initial symptoms were abdominal pain, fever and palpable abdominal mass. In imaging modalities available, the detection rates of tumor were 100% in CT and 67% in US and angiography, respectively. Combination of MRI and CT clearly showed tumor characteristics. The serum CEA was slightly elevated in 5 patients (83%), but serum CA19-9 rose strikingly in 3 patients. Most tumors showed an infiltrating growth along intrahepatic bile duct, with a portal vein thrombus and/or satellite tumors frequently. In 3 patients, early recurrence with intrahepatic metastasis occured within the first 6 months. The patient of poorly differentiated adenocarcinoma containing a squamous or signet ring cell carinoma showed an extremely poor prognosis. This study suggests that early detection of small CCC and an extended resection are the most important factors for the survival of patient., Acta medica Nagasakiensia. 1993, 38(2-4), p.237-241

Five hundred and nine patients who underwent surgery for colorectal cancer during 1970-1988 at the First Department of Surgery, Nagasaki University School of Medicine, were studied retrospectively to compare the clinicopathological features in 65 cases older than 75 years of age and 409 ranged from 40 to 75 years of age. Older patients revealed a high frequency of right-sided tumors including the transverse colon (32.3%). The older patient group presented with a fewer Dukes stage D in 3.1% of cases compared with 16.4% of the middle age group with low incidences of hepatic metastasis (p <0.05), but there were no significant differences in lymph node involvement and peritoneal dissemination. A few vascular invasion was found on histologic examination in the older group, but no significant differences in the frequency of gross appearance, cell differentiaion, lymphatic invasion were observed among two groups. DNA ploidy pattern in the older group was also similar to that in the middle age group. The overall perioperative mortality rate was 1.4% (older : 1.5% ; control : 1.5% ; not significantly). Curative resection rates were 84.6% in older and 76.0% in middle age patients. Overall 5-year survival rate were 65.4% in older and 54.1% in control group. However, 14.5% of the older patients died from non-cancer related causes. The 5-year survival rate by exclusion of these cases was 72.4% with similar rate of control group. This study suggests that age should no longer be considered a major risk factor for surgical outcome in colorectal cancer, and that the preoperative indication and careful preoperative assessment including operative risks may improve the patient's survival., Acta Medica Nagasakiensia. 1992, 37(1-4), p.32-36

The remedial operation for the control of sympotoms was carried out in 6 cases with severe dumping syndrome. Three male cases and 3 female cases were treated, and its age at the initial gastrectomy ranged from 24 to 64 years old, and 5 cases with gastric ulcer and 1case with gastric cancer were observed as primary diseases. As the initial operative procedures, distal subtotal gastrectomy in 5 cases, distal hemigastrectomy in one case and Billroth II type anastomosis in 5 cases with gastric ulcer were performed, and 1case with gastric cancer was reconstructed by Billroth I type anastomosis. Dumping symptom developed from 3 weeks to 1 month after gastrectomy in all cases except 1, and body weight loss due to labor disturbance and malnutrition was observed. They have been suffering from the syndrome for 3 to 27 years, and remarkable rapid transit of gastric contents was observed on both roentgenograph and gastric scintigram before surgery. As reoperation, the jejunum was interposed reversibly from 5 to 9cm between the gastric remnant and duodenum. Re-surgery was necessitated in 1 case, while improvement of symptoms was observed in remaining cases, and reduction of the emptying time of gastric contents was observed by imaging diagnosis., Acta Medica Nagasakiensia. 1992, 37(1-4), p.120-126

The Carcinoembryonic antigen (CEA), CA19-9 and Tissue Polypeptide Antigen (TPA) levels in portal blood in colorectal cancer patients were studied in correlation with the peripheral blood levels and histopathologic findings in order to know serum levels increased. 1) Portal blood CEA, CA19-9 and TPA increased by operative maneuver. 2) Mean values of these markers in portal blood were higher than those in peripheral blood. 3) Portal blood CEA was correlated with Dukes' staging, and revealed higher positive rates than CEA in peripheral blood in each stage. Portal CA19-9 changed within normal value and strikingly rose in Dukes' D stage. Portal TPA tends to be higher in all stages and correlated with grades, but the value in Dukes' D were lower than that of peripheral blood. 5) Moderately differentiated adenocarcinoma revealed the highest level of portal CEA (P<0.05), but portal CA19-9 and TPA did not indicate any correlation with cell differentiation. 6) The mean values of portal and peripheral CEA, CA19-9 and TPA showed significant elevation in those with infiltration of cancer cells extending through the proper muscle layer. This study suggests that the mechanism of these markers' transfer from tumor into the portal vein is the most important decisive factor of the peripheral levels., Acta medica Nagasakiensia. 1991, 36(1-4), p.185-190

Clinicopathologic features in 35 patients below the age of 40 years with colorectal carcinoma were reviewed and compared with those of a control group containing 409 patients ranging from 40 to 74 years of age. All cases in this series were experienced at the First Department of Surgery, Nagasaki University School of Medicine, during the 18 years from 1970 to 1988. 1) Young patients accounted for 6.7% of all cases with colorectal cancer, and this group included more female patients than in the elderly control group. 2) The young patient group presented with advanced lesions (Dukes' stage C) in 54.3% of cases compared with 35.6% of the old patient group with significantly high incidences of lymph node involvement. There were no significant differences in the hepatic metastasis and peritoneal dissemination among two groups. 3) Mucinous carcinoma and vascular invasion were frequently found on histologic examination in the young group, which suggested the highly malignant potentiality, but no significant difference in DNA ploidy pattern was observed between the young and the control group. 4) Curative resection rates were 71.4% in young and 68.1% in elderly patients. Overall 5-year survival was 56.9%. Five-year survival in 25 patients undergoing potentially curative resection increased to 74.4% with the similar rates of the control group. Improved 5-year survival following potentially curative resection stresses the need for early diagnosis and treatment., Acta medica Nagasakiensia. 1991, 36(1-4), p.6-11

A case of gastritis cystica polyposa is presented. A 45-year-old woman developed gastritis cystica polyposa at the gastroduodenostomy anastomotic site four years after Billroth II gastrectomy for adenomatous polyp. There was no association of gastric cancer in the lesion., Acta medica Nagasakiensia. 1990, 35(1-4), p.29-32

One hundred and twelve consecutive cases with blunt hepatic trauma between January 1, 1965 and December 31, 1988 at the First Dpartment of Surgery, Nagasaki University were reviewed. Fifty-seven patients had minor injuries, 33 moderate injuries and 22 severe injuries. Sixty-five patients (58%) sustained also one of more associated injuries. Out of 43 patients over the last ten years 30 were diagnosed by US or CT. Eighty-eight patients (78.3%) underwent laparotomy ; laparotomy and drainage alone in 13, suture and packs in 57, debridement and minor liver resection in 11 and right lobectomy in 9. The results of treated patients were assessed according to the grading of liver injury and assocated injury. The overall mortality was 13.4% (15 of 112). True liver-related mortality due to hemorrhage was 26.7% (4 of 5), and the other 11 patients who died were due to refractory shock and the development of multiple organ failure (MOF). Twenty-one patients were conservatively managed with only one death, and the other 20 survivors had no complications and healed completely from 6 to 12 months after trauma. Although lobectomy or resectional debridement are advocated as an operative procedure for massive injury, a conservative management for mild or moderate ruptures is still recommended as far as possible., Acta medica Nagasakiensia. 1990, 35(1-4), p.157-163

Acta Medica Nagasakiensia. 1986, 31(1-4), p.294-302

Acta Medica Nagasakiensia. 1986, 31(1-4), p.276-287

Acta Medica Nagasakiensia. 1986, 31(1-4), p.253-268

In order to evaluate the factors affecting the patient's survival, 32 patients of hepatic resection in which the liver had a sollitary hepatocellular carcinoma (HCC) smaller than 5 cm in size were studied. 1) Chronic liver diseases were associated in 96.9 % of patients. Minor resection was done in 30 patients, and right hepatectomy in two. 2) 87.5 % of all cases were diagnosed during periodic follow-up examination for the patients with chronic liver disease, mostly cirrhosis. For small HCC, ultrasonography (US) had the highest detection rate (90%) compared with CT (66.7%) and angiography (55.6%). Preoperative serum AFP values were abnormal in 73%. 3) Grossly, all tumors were nodular or expanding and none was diffuse. Encapsulation appeared to be complete as tumor grew. Portal vein tumor thrombus (12.5%) and/or satellite tumor (31.2%) were frequent in those with larger than 2 cm in diameter. 4) The mortality rate was 9.4% and the hospital mortality rate was 6.3 %. The survival rate of the group with small HCC was far better than that of the groups with HCC larger than 2 cm in size (p<0.05 ). Above findings indicate that early detection of the tumor without portal vein thrombus and/or satellite tumor, and an adequate hepatic resection such as subsegmentectomy or segmentectomy are most improtant for the patient's survival., Acta medica Nagasakiensia. 1988, 33(1-4), p.228-234

Two patients with rectal cancer induced by irradiation for the treatment of uterine cancer were reported. Surgical outcome for radiation-induced cancer was satisfactory as far as the primary focus was well controlled. Definition of radiation-induced cancer also was discussed. It is the most important factor to be a long time interval of more than 10 years by detection of rectal cancer after irradiation and to reveal a histologic pattern concerning irradiation tissue damage., Acta medica Nagasakiensia. 1988, 33(1-4), p.83-86

Twenty-seven patients with Crohn's disease who were operated on at the First Department of Surgery, Nagasaki University School of Medicine and followed-up after surgery were reviewed. Involved portion of intestinal tract were 10 in small bowel only, 14 in both small and large bowels, and 3 in large bowel. Major indication for surgery were obstruction, fistula, peritonitis and intractability of medical therapy. Twenty-two patients underwent radical resection and the other 5 patients had the disease left behind at anastomosis. The recurrence rate was 25.9% (7 out of 22), and early recurrence was found in small bowel diseases with longitudinal ulcerations or multiple aphthoid ulcers. Initial recurrence occured near the suture line, which showed no wide spreading in subsequent periods. Two cases with both small and large bowel disease required reoperation over 5 years after initial surgery because of stenosis. Three out of five cases with residual disease at the intestinal resection margin had a good condition, but the other three cases with skip sigmoid disease were intractable for medical therapy. Most suture line recurrence and residual disease at anastomosis were sufficiently managed by postoperative medication for long periods of time. Long-term follow-up study showed a good quality of life in about 75% of these cases. In conclusion, conservative resection rather than the sacrifice of normal bowel should be recommended for an extended disease of small bowel., Acta medica Nagasakiensia. 1989, 34(2-4), p.126-133

Carcinoma-containing CEA was measured as compared with normal tissues and metastases in the lymph nodes and the liver. The high CEA production was remarkable in the potent malignant tumors and metastases in the liver and the lymph nodes as compared with those in normal colon tissues as well as in non metastatic lymph nodes. It is reasonable to consider that high plasma CEA may well indicate advancing or highly potent malignant diseases or recurrence of colon cancers due to destruction of vascular structure by cancer invasion., Acta medica Nagasakiensia. 1988, 33(1-4), p.146-148

The Carcinoembryonic antigen (CEA) levels in portal blood in 87 colorectal patients were studied in correlation with the immunoreactivity of tumor CEA stained by immunoperoxidase method in order to examine how serum CEA increases. Portal blood CEA increased by operative maneuver. Portal blood CEA was correlated with the Duke's staging, and revealed higher positive rates than CEA in peripheral blood in each stage. The amount of CEA in well differentiated and moderately differentiated adenocarcinoma was higher than that of poorly differentiated adenocarcinoma. However, moderately differentiated adenocarcinoma revealed the highest level of portal blood CEA (p<0.05). Significant increase of portal CEA was observed when CEA was found in cytoplasm and stroma immunohistochemically besides in strongly positive stain, and when cancer was proved pathologically to invade over the intestinal wall. This study suggests that how CEA is transported from the tumor to the portal vein which is the most important decisive factor of the CEA level in peripheral blood., Acta medica Nagasakiensia. 1988, 33(1-4), p.221-227

Of 105 patients of hepatocellular carcinoma (HCC) treated during 1970-1988, twelve patients had spontaneous rupture of carcinomatous nodules. 1) Of previous 6 cases, five were treated by conventional surgical procedures such as packing and suture, and all died. One case underwent right lobectomy following guaze pack and lived for 15 months. 2) The recent 6 cases underwent emergency transcatheter arterial embolization (TAE ) and two died of hepatic failure due to severe cirrhosis. The other 4 cases had successful control , of bleeding which allowed further treatment of HCC ; hepatectomy in 3 and repeated TAE in one. 3) All cases had precirrhosis or cirrhosis. Pathologically, ruptured tumors expansively growing with capsule invasion of cancer cells, and portal tumor thrombus were recognized in resected or autopsy specimens. DNA aneuploid HCC on flow cytometric DNA analysis were found in 4 out of 5 cases. In conclusion, hepatic resection following embolization, when possible, would seem to be rational treatment for spontaneous rupture of HCC, although the prognosis is still extremely poor despite successful control of bleeding., Acta medica Nagasakiensia. 1989, 34(2-4), p.203-208

An exceedingly rare case of perforated early gastric cancer is reported. A 47-year-old man developed a peritonitis due to perforation of early gastric cancer. Emergency operation was performed and followed by uneventful recovery. The histologic examination of the surgical specimen showed early gastric cancer (EGC) of type III, composed of signet ring cell carcinoma. Thirteen years after surgery, the patient died of a cerebrovascular accident with no evidence of tumor recurrence. The rarity of this complication in EGC is discussed and the Japanese literature reviewed., Acta medica Nagasakiensia. 1988, 33(1-4), p.185-188