Carcinoembryonic Antigen (CEA) in Portal Blood in Colorectal Cancer Patients Correlation of Immunohistochemical Staining

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\u27s 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

Clinicopathological Study of Hepatocellular Carcinoma in Relation to Tumor Size

In order to evaluate the factors affecting the patient\u27s 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\u27s survival

Postoperative Course of Crohn\u27s Disease -In regard to Recurrence and Residual Disease at Anastomosis -

Twenty-seven patients with Crohn\u27s 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

Spontaneous Rupture of Hepatocellular Carcinoma

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