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

Ileocecal actinomycosis : A case report and review of the literature

A case of actinomycosis in the ileocecal area of a 44-years-old man which manifested as a painful lump in the right iliac fossa is reported. Clinical and laboratory findings suggested the diagnosis of perityphlitic abscess due to acute appendicitis. Upon a laparotomy, a malignant tumor was suspected and so a right hemicolectomy was performed. Gram staining of cecum tissues demonstrated gram positive pleomorphic filaments. Postoperative penicillin therapy was successful. Despite the fact that infection accompanying an actinomycotic organism is relatively rare, the possibility of such an infection should be kept in mind because the organism is known to be commensal in the oral cavity, lungs and intestinal tract

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

Surgery for Perforation Complicating Colon Cancers

Eleven patients with perforation complicating colon cancers were clinically analyzed with respect to perforation sites and surgical outcome. In general, perforations complicating colon cancers are divided into two categor ies, free perforation and penetration with abscess or fistula formation. It is emphasized that surgical outcome for free perforation is unsatisfactory. Therefore, two-stage operation is recommended and the aim of the treatment should be first concentrated on peritonitis. In conclusion, complete resection of carcinoma is necessary in obtaining a satisfactory result

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

LOCAL RECURRENCE OF RECTAL CANCER

One hundred twenty-six rectal cancers were operated upon in the First Department of Surgery, Nagasaki University School of Medicine. Local recurrence occurred in thirty-three (26.2%). In this study, contributing factors in causing local recurrence were local excision of the surgical approach, advanced stage, depth of cancer invasion, location of carcinoma of the rectum below the peritoneal reflection (Rb) or above (Rba) and nodal involvement of n2 or more. As far as advanced rectal cancer and cancer location of Rb are concerned, it is suggested on the basis of this study that the incidence of local recurrence should be high

Clinical Value of Flow Cytometric DNA analysis in colorectal cancers

The distribution of DNA in colon cancers and its relationship to factors related to clinical features of cancer invasion and noncurative operation are evaluated by using paraffin-embedded specimens. The survival in patients with DNA diploid tumor is apparently much more satisfactory than that in patients with aneuploid tumor in stage B and C patients in accordance with advances in the disease stage. The deeper the depth of cancer invasion reaches, the more the number of DNA aneuploid tumor increased in the distribution. Non-curative operation was more frequently made in patients with DNA aneuploid tumor rather than in patients with DNA diploid one. In conclusion, analysis of the distribution of DNA contributes to assessment of the prognosis of colorectal carcinoma in combination with conventional prognostic parameter of clinicopathologic variables

Nuclear DNA Analysis in Hepatocelular Carcinoma in Comparison with Clinicopathologic Factors

Nuclear DNA patterns were analyzed in the 33 patients with primary hepatocellular carcinoma on the basis of clinicopathologic standpoint. It is concluded that biologic behavior of hepatocellular cancer cells in patients with DNA aneuploidy pattern displayed highly malignant potential, indicating severe atypism, rapid growth of rupturing, the presence of cancer invasion into the wall of portal vein and distant metastasis. Furthermore, the survival time in patients with DNA aneuploidy pattern in hepatocellular carcinoma was shorter than that in patients with diploidy one

Surgery for complications by diverticular disease of the colon

Surgical experience with fifteen complications of diverticular disease of the colon has been reported. These had a considerably long period from onset to operation except for perforation episode. Conservative treatment prior to surgery is of great benefit to avoid postoperative complications. The surgical outcome, thereafter is satisfactory and recurrence has not been experienced