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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

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, Acta medica Nagasakiensia. 1996, 41(3-4), p.52-56

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 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

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

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, 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

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

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, Acta medica Nagasakiensia. 1991, 36(1-4), p.185-190

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

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