Clinical and Pathological Features of Gastric Carcinoma in the Young

Twenty-two cases, or 23 lesions, of the so-called "gastric cancer in the young" under the age of 30 years were studied, in comparison with the adult cases in the fifties and the elderly cases over 70 years, and their unique clinico-pathological features were described. The early symptoms of gastric carcinoma in the young patients are similar to those of peptic ulcer, and often diagnosed as gastric ulcer at first and treated as ulcer patients, but peptic ulcer was found in only 9.1 %. All cases in this study had gastrectomy. Twelve of 23 lesions were early gastric carcinoma of superficial depressed type. All other advanced cancer belonged to the infiltrative type, and there was no localized type. Of these 23 lesions, 70% located in the middle third region of the stomach. Histologically, 87.0 % were poorly differentiated adenocarcinoma. Involvement of the serosa of gastric wall was found in only 36.4%, and lymph node metastasis was negative in 54.5%. Eighteen of 22 patients are still alive at this moment, and 13 of them (59.1%) survived longer than five years after surgery, and are well without any sign of recurrence. Prognosis of gastric cancer in young patients was regarded as poor owing to its biological specificity, but actually it could be as good as in other age groups, if the diagnosis was made early enough and lesions were removed properly. For that purpose, needed are repeated endoscopic and biopsy examinations as often as possible in all cases of gastric ulcer of the young

Superficial Carcinoma of the Esophagus

Four cases of esophageal carcinoma in which the invasion is limited to the mucosal layer (m-carcinoma) and 7 cases of it in which the invasion invades the submucosal layer (sm-carcinoma) are studied. In the cases of m-carcinoma, both lymphatic invasion and blood vessel invasion were not found. On the other hand, lymphatic invasion was noted in 4 cases among 7 cases of sm-carcinoma, and in these 4 oases, lymphatic invasion or blood vessel invasion was demonstrated in the primary sites. Among 4 patients who had lymph node metastasis, 2 died of the recurrence of carcinoma, and the other 2 died of other diseases. The prognosis of patients without lymph node metastasis was satisfactory. The best way to elevate the prognosis of esophageal carcinoma is to discover it at the stage of m-carcinoma, and in order to achieve it, endoscopic observation combined withh the Lugol-staining method is most influential. It is also recommended to perform the esophageal endoscopic examination with patients visiting us with other diseases

Instrumental Perforation of the Esophagus A Case Report and Review of Literature

Thanks to the improvement of the types of the endoscope and the progress of its techniques, the incidence of esophageal perforation has been decreasing recently. It should be pointed out, however, that esophageal perforation is a very serious iatrogenic disease requiring an early diagnosis and an adequate drainage in order to save the lives of patients. A woman at the age of 68 received gastrofiberscopical examination under suspicion of gastric ulcer, but immediately after the inspection, the patient had severe epigastric pain and dyspnea, and in five hours subcutaneous pneumatosis appeared on her neck. Chest X-ray pictures revealed mediastinal pneumatosis in high degree and pneumothorax on the left, and blood gas analysis showed the decrease in PO2 and the rise in PCO2. Since the patient fell into the state of shock, esophagography and esophagoscopy were not performed, but operation was given immediately. Hematoma was found at a site immediately above the diaphragm and on the left posterior wall, and abscess was formed in the mediastinum. We did not suture the injured region, but drinage of the mediastinum and the left thoracic cavity was given. After the operation, tracheostomy was performed, and her respiration was managed with a ventilator, simultaneously placing the nasogastric tube within the stomach to reduce the pressure inside it. In 15 days after operation, food intake was resumed, and in 46 days the patient was discharged in good health. Thus, it is important for esophageal perforation to give drainage as early as possible at a most appropriate position, which will enable us to same the patient in dyspnea and shock in esophageal perforation

Causative Mechanism of Reflux Esophagitis induced by Digestive Secretions

Mechanisms producing reflux esophagitis were experimentally evaluated to clarify a direct action of digestive secretions to the esophageal mucosa. Mucosal lesions of reflux esophagitis were grossly composed of erosion, ulceration and loss of normal lustrous appearance. Based on histological examination, the degrees of erosion, ulceration and cell infiltraiton were also compared with respect to the severity of reflux esophagitis. Causative mechanisms of reflux esophagitis due to gastric juice alone are different from those due to another digestive secretions in relation to either the gastrectomized status or not

Surgical Treatment for Carcinoma of the Esophagus Involving the Trachea, Bronchus and Lung in Terms of its Prognosis and Pathological Study

Key word: Carcinoma of the esophagus, A3 involving the trachea, bronchus, lung, pathology, prognosis. A total of 10 patients with carcinoma of the esophagus involving the trachea, bronchus and lung were operated upon. Their clinical features and histological patterns of cancer invasion were evaluated. In 5 patients involving the lung, the preoperative irradiation therapy was histologically effective in encircling the cancer lesions by induced scar formation. It was possible to render the resection to enhance its radicality. In 5 patients involving the trachea or the bronchus, it has become apparent that the membranous portion is more susceptible to cancer invasion and the structures of the cartilages on the tracheal and bronchial walls have a strong resistance to cancerous spread. The extent of cancer invasion on the trachea or bronchus was considerably limited. The sharp dissection at the site of occurrence of cancer invasion as an operative procedure of choice is sometimes beneficial in attempt to enhance the operative radicality when cancer invasion reaches to the adventitial layer. The prognosis, however, was not improved by an extended resection. It seems to be closely related to n-factor. None of them survived exceeding one year after surgery

Skip Metastases Extending to the Esophagus in Carcinoma of the Cardia

Eight cases with skip metastases to the esophagus in carcinoma of the cardia were pathologically analyzed in the genesis. These lesions were characterized by 1) deeply invaded carcinoma outside the gastric wall in carcinoma of the cardia 2) extended cancer spreading across the esophagocardiac junction 3) much more prominent histologic vascular invasion (ly) on the basis of histologic findings. We allege from this study that wide resection of the esophagus is necessary for the treatment of carcinoma of the cardia in which cancer in the cardia extends outside the gastric wall and spreads across the esophagocardiac junction

Spontaneous regression of mediastinal seminoma

A 27-year-old man was transferred to our hospital with the complaint of facial edema and diagnosis of giant anterior mediastinal tumor. But soon after admission, the size of the tumor decreased remarkably, although he had no particular treatment. As the tumor was not completely regressed, surgical resection was performed subsequently, and examination of the specimen showed small foci of seminoma within the area of dense fibrous scar tissue, originated from the thymus. While regression of germ cell tumors are well recognized in cases of nonseminomatous germ cell tumors, this phenomenon of primary mediastinal seminoma was not reported previously

Comparative Study between the jejunum and Colon as Substitute for the Esophagus in Terms of Blood Flow

The advantages over a substitute for attaining the continuity following resection of the esophagus were experimentally compared between the jejunum and the colon in terms of changes in blood flow in the vascular pedicles under the influence of mechanical tension, induced systemic hypoxia and hypotension. Blood flow of the pedicled jejunal and colonic grafts used were measured with the use of direct collection through catheter introduced to the pedicled vessel. 1) As for tension-load added to the pedicle, the colon was much more tolerable rather than the jejunum. When a 40g tension was added to the jejunum, blood flow was remarkably reduced whereas there was no significant change in the colon even when a 100g tension was added. 2) As for the influence of induced hypoxic load, blood flow to the pedicled grafts was reduced when the arterial Po2 fell to below 70mg and Pco2 over 50mg. 3) As for the influence of induced systemic hypotensive load, it was significantly reduced to below about 30% of the normal systemic blood pressure in the similar patterns between the jejunum and the colon

Comparison between Prolonged Administration of Oral Etoposide and UFT Combined with Intravenous Cisplatin-based Chemotherapy in Postoperative Non-small Cell Lung Cancer: a Randomized Trial

Oral administration of etoposide or UFT is generally used in outpatient treatment of non-small cell lung cancer (NSCLC) after surgery in Japan. We examined the effectiveness of etoposide and UFT with relation to disease-free survival, overall survival and toxicity in postoperative NSCLC patients. In this study, a total of 50 patients were randomized to receive either, 25mg/day of etoposide, on a 2 week cycle (Group I- 25 cases) or 300mg/day of UFT, continuous administration (Group II-25 cases), after a Mitomycin C, Cisplatin and Vindesine, intravenous (i.v.). Disease-free and overall survival were better in Group II with 20 complete cases than in Group I with 15 complete cases. Furthermore, Group II achieved better disease-free and overall survival rates than Group I with reference to stage IIIA and lymph node metastasis groups. There were no instances of severe toxicity in either group. Results of this study showed that prolonged oral administration of 25mg/day of etoposide is ineffective compared with oral UFT in NSCLC patients after surgical treatment. New randomized clinical trials of 50mg/day of etoposide will be necessary to determine usefulness and toxicity

Temporary Division of the Superior Vena Cava For Extended Left Atriotomy ; Left-sided Atrioventricular Valve Repair in Corrected Transposition of the Great Arteries

The extended left atriotomy which combines the standard approach with the superior approach by concomitant temporary division of the superior vena cava (SVC) is a safe and useful method in the case of a small atrium. The approach used here is a modification of that which was reported by Selle and Kyger. This technique made it possible to sufficiently expose the laterally situated small left atrium in the case of corrected transposition of the great arteries (cTGA) which requires repair of the left-sided atrioventricular valve (tricuspid valve). In recent mitral surgery, median sternotomy is used with cannulation of the ascending aorta and both venae cavae to establish cardiopulmonary bypass. Although there are some approaches for left atriotomy, the standard procedure is to use vertical left atriotomy immediately posterior and parallel to interatrial sulcus. And in the case of combined mitral with tricuspid valve surgery, a right atriotomy with incision of interatrial septum has been employed to allow excellent exposure of the left atrium and mitral and tricuspid valve including subvalvular supporting structures. Surgical exposure of the mitral valve is often difficult by the conventional approach, especially in the patient with a small left atrium and a deep chest. In the case of cTGA too, sufficient exposure of the left atrium can not be obtained under median sternotomy on accout of anatomical abnormality. We performed prosthetic valve implantaion to the left-sided atrioventricular valve which is tricuspid valve in structure in the case of cTGA by means of new approach with the incision of the lateral to superior wall of the left atrium combined with division of the SVC temporarily. This technique was introduced by Selle 1) in a recent article