Relation between ultrasonographic and histologic findings of tracheal invasion by differentiated thyroid cancer.

Between 1988 and 1999 a total of 24 patients with differentiated thyroid cancer invading the airway underwent various types of tracheal resection at the Osaka Police Hospital. Preoperative ultrasonographic (US) findings in these patients were compared with postoperative histologic results of the resected specimens to confirm the relation between the preoperative and postoperative diagnoses and to determine the indications for operative procedures. Preoperative US revealed cancer invasion to the adventitia in 2 cases, to the intercartilage space in 13, and to the tracheal mucosa in 9. Histologically, cancer invasion to the adventitia was confirmed in 4, to the intercartilage space in 10, and to the mucosa in 10. Among 13 cancer invasion instances to the intercartilage revealed by US, overdiagnosis occurred in 3 cases and underdiagnosis in 1. The actual overall diagnostic rate by US was 83.3%, which is a great improvement over other available methods. In conclusion, preoperative US findings of the trachea agreed with the histologic findings of the resected specimens, indicating US to be the first choice when making decisions about resecting the trachea and about the operative procedure.

Video mediastinoscopic division of a congenital esophagobronchial fistula with esophageal diverticulum by a paraesophageal approach.

We treated a patient with an esophagobronchial fistula accompanied by stomach cancer. Using an endo-stapling technique, the fistula was divided video mediastinoscopically by a paraesophageal approach through the esophageal hiatus in the diaphragm.

Inflammatory pseudotumor of the abdomen: report of a case.

We report herein the case of a 38-year-old woman in whom a large tumor, 15 cm in diameter, was detected in the right lower quadrant of the abdomen. The tumor was removed and histological examination indicated that it was an inflammatory pseudotumor (IPT). IPT is not completely understood, but according to the few documented cases of IPT of the abdomen, its clinical behavior is benign and no recurrence has ever been reported. Thus, local resection is the most effective treatment.

Role of endogenous somatostatin in postprandial hypersecretion of neurotensin in patients after gastrectomy.

OBJECTIVE: The purpose of this report is to elucidate the mechanism of the hypersecretion of neurotensin (NT) after gastrectomy. SUMMARY BACKGROUND DATA: NT secretion induced by fat ingestion is increased after pancreatoduodenectomy or distal gastrectomy. The hypersecretion of NT in the patients undergoing resection of the upper gastrointestinal tract is suppressed by an exogenous somatostatin (SST) analog. METHODS: We observed simultaneously the secretion of NT and SST in the same patients before and after gastrectomy (n = 7). We also observed the secretion of these hormones induced by intraduodenal (ID) fat infusion in the normal volunteers (n = 6). RESULTS: The response of plasma NT to fat ingestion was significantly increased after gastrectomy compared with that before gastrectomy. The response of plasma SST after gastrectomy was significantly suppressed. The response of plasma NT and SST after ID fat infusion in the normal volunteers was similar to the gastrectomized state. CONCLUSION: Diminution of SST secretion, probably caused by the lack of SST cells in the distal part of the stomach, may play a role in augmenting NT secretion after gastrectomy.

Recurrent valvular pneumoperitoneum caused by a minute gastric ulcer--a case report.

A rare case of valvular pneumoperitoneum is reported. A 49-year-old Japanese man underwent an emergency laparotomy under a tentative diagnosis of perforating panperitonitis on the 19th post-open heart surgery day. A large volume of free intraperitoneal gas was revealed, but no identification of gastrointestinal perforation. On the 17th postlaparotomy day, pneumoperitoneum recurred. On the 41st postlaparotomy day, a tiny gastric perforation was detected with an oral contrast medium. The patient died of liver failure due to serum hepatitis. The autopsy revealed a minute gastric ulcer scar 2 mm in diameter in the mucosa of the fornix, which was thought to have caused the valvular pneumoperitoneum. A literature review was made of 8 reports on 11 cases. In two cases of valvular pneumoperitoneum, the perforating site could not be found even during laparotomy. It is suggested that either gastrointestinal series or endoscopy must be carefully repeated in order to identify the perforating site.

[The discussion of the need of mediastinal lymph node dissection in the surgical treatment of lung cancer].

The need of lymph node dissection in the case of operative lung cancer with negative mediastinoscopy was discussed. As a preliminary study, the N-number obtained from the mediastinoscopy and that of postoperative examination was compared. The rate of agreement of N-number was as high as 96%. Secondary, 183 cases of lung cancer with squamous-or adenocarcinoma pathologically T-1 or 2. N-0 and P-0 or 1 were picked up and examined. In those cases, the result of 3 years survival rate was 80% in the cases of absolute curative operation and 60% in that of relative non-curative cases, and 5 years survival rate was 70% and 52% respectively, and the cases of absolute curative operation was statistically excellent than that of another group. However, the background of the two groups was different to some degree on account of the advancement of the cancer and the age of the patients. Therefore, the randomized study as for the lymph node dissection in the cases of negative mediastinoscopy was finally performed. In the 30 cases of squamous cell carcinoma where dissection was carried out in 13 cases and not done in 17 cases, the result of 3 years survival was 84% (dissecting group) and 89% (non-dissecting group), and 5 years survival was 73% and 63% respectively. In 23 cases of adenocarcinoma (13; dissecting, 10; non-dissecting), the result of 3 years survival was 100%, 63% and that of 5 years survival rate was 100%, 63% respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case report of primary liver cancer with cerebral metastasis after hepatic resection].

A 67-year-old male, who had a left hepatectomy for hepatocellular carcinoma, was readmitted to our hospital because of a left hemiparesis. A brain computed tomography scan and an r-carotid angiogram revealed a large mass involving the right parietal area, and thus a brain tumor removal was performed. A histological diagnosis of the removed brain tumor found it to be a metastatic, hepatocellular carcinoma. The patient died of pulmonary congestion due to lung metastasis, approximately 2 years and seven months after hepatectomy, and 1 year and three months after the removal of this metastatic brain tumor. In selected cases, the removal of a metastatic brain tumor seems to bring about improvements in the quality and duration of life.