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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.

A 47-year-old man was pointed out having a retroperitoneal tumor on ultrasonography at a medical checkup in March 1993, and was kept under medical observation. In May 1994 the patient was referred to the department because of an enlargement of the tumor. On preoperative imaging diagnosis, the tumor positioned on the left side of the aorta and at the inferior margin of the pancreas, and was 50 mm in longer diameter, almost spherical in morphology and cystic with a solid part. The feeding vessels were branched from the dosal pancreatic artery. During surgery, it was found that the tumor continued to the superior mesenteric plexus. The tumor was extirpated by resecting a part of the plexus. Histologically, it revealed findings of paraganglioma that the tumor was positive for two staining methods, and that polymorphologic cells with hranular cytoplasm solidly proliferated associating with small vessels. This paper describes this very rare case of retroperitoneal paraganglioma together with a review of the Japanese literature.

In order to clarify the predictive risk factors of postoperative pulmonary complications after surgery for esophageal cancer, 33 cases undergoing esophagectomy under thoracotomy were evaluated using univariate analysis and stepwise logistic regression analysis. In our department, postoperative pulmonary complications are defined as those demanding respiratory management for more than one week or those needing oxgen administration for more than 2 weeks. Postoperative pulmonary complications were observed in 9 cases (27.3%). With univariate analysis, FEV1.0/m2, MVV/m2 and bledding volume during surgery were significantly different between the cases with and without pulmonary complications, with stepwise logistic regression analysis, FEV1.0/m2, bleeding volume during surgery and duration of thoracotomy were selected as predictive factors of pulmonary complications. Risk score=0.742+0.0001517×bleeding volume during surgery+0.002655×duration of thoracotomy-0.796×FEV1.0/m2 was obtained by multivariate statistical analysis. Significantly high incidence of pulmonary complications was observed in patients with risk socre more than 0.36, These results suggested that to prevent postoperative pulmonary complications, over surgery should be avoided especially in the patients with obstructive pulmonary dysfunction.

The aim of this study is to evaluate the usefulness of intraoperative continuous hyperthermic peritoneal perfusion therapy (CHPP) combined with paraaortic lymph node dissection for the patients with serosal exposed gastric cancer. The survival and recurrent rates between CHPP combined (CHPP(+)) group (n=29) and CHPP not combined (CHPP(-)) group (n=35) were discussed. In 7 peritoneal disseminated cases the apoptosis index before and after CHPP were examined at several lesions of peritoneal dissemination. The 3-year survival rates were 42.6% in CHPP(+) group and 46.4% in CHPP(-) group and the rates in n4(-) cases were 72.5% and 48.1% respectively. The rates of peritoneal recurrence were 31.0% in CHPP(+) group and 34.3% in CHPP(-) group. Especially in the n4(-) cases, the rates were 16.7% in CHPP(+) and 30.8% in CHPP(-). And no peritoneal recurrence was observed in n4(-) cases with the mean intraperitoneal temperature was more than 42°C. The apoptosis index was 3.5±2.3% before CHPP or 51.5±7.5% after CHPP. In conclusion, CHPP is effective as a local therapy and paraaortic node dissection combined with CHPP is useful for the patients with no paraaortic lymph node metastasis and those whose mean intraperitoneal temperature had been maintained at more than 42°C.

We describe a case of schwannoma of the colon with a cyst in a 55-year-old female. The patient, who was suffering from constipation since 5-6 years before, underwent enema for searching its cause, and was found to have a polyp-like lesion 4.0 cm in diameter in the descending colon. Endoscopic examination of the low gastrointestinal tract revealed a 2/3-circumference hemispheric, large, submucous, and tumor-like lesion in the same region. It was a mild degree of colitis by biopsy. Abdominal ultrasonography revealed a low echoic lesion 3 cm in diameter, probably indicating a cyst, below the left kidney. Abdominal CT also showed a cystic lesion near the left kidney. From these findings, a diagnosis of submucous tumor of the colon was made. Laparotomy was carried out, and the tumor of the descending colon was palpated that coincided with the result of preoperative examination. Partial excision of the descending colon including the tumor was performed. The excised tumor was 4.5×3.5×3 cm in dimension, and a cystic tumor covered with thick wall in its section. Histopathological diagnosis led to schwannoma. Schwannomas of the colon and rectum are considered rare from a fact that, including this case, only 23 cases of the disease have been reported in this country.