Hepatic metastasis from esophageal cancer treated by surgical resection and hepatic arterial infusion chemotherapy.

We herein describe a successful surgical resection of esophageal cancer with syncronous liver metastasis and report the first case of a partial response to hepatic arterial infusion chemotherapy for recurrence of esophageal hepatic metastasis after hepatectomy. Hepatectomy and subsequent hepatic arterial infusion chemotherapy with cisplatin and 5-fluorouracil is thus recommended as an effective treatment for liver metastasis from esophageal cancer.

Primary malignant melanoma of the rectum.

We present a case of primary malignant melanoma arising in the rectum of a 71-year-old woman who had presented with intermittent rectal bleeding following bowel movement 2 months previously. Digital and sigmoidoscopic examination of the rectum revealed a 3 x 2 x 1 cm exophytic tumor with a granular surface in the rectum 35 mm from the dentate line. No increased pigmentation was detected. Biopsy revealed degenerated mucosa accompanied by severe infiltration of inflammatory cells, but no malignant cells. The tumor and normal mucosa surrounding the tumor was excised 12 days after the biopsy. Light microscopy revealed the tumor to consist of malignant melanocytes and showed that the tumor was surrounded by normal mucosa. Immunohistochemical staining with antimelanoma antibody and HMB-45 substuntiated the diagnosis. Clinical and laboratory examination excluded the presence of melanoma at sites other than rectum. The patient refused an abdomino-perineal resection of the rectum and combination chemotherapy was performed. She died 18 months after the initial operation due to local recurrences and metastases to pelvic lymph nodes, liver, and lung.

Endoscopic and manometric study of the cardia in post-gastrectomy patients.

This study was undertaken to clarify the incidence of hiatus hernia and the functional changes in the cardia of post-gastrectomy patients. One hundred and four post-gastrectomy patients and 399 non-gastrectomy patients were selected for endoscopic study, and the diagnosis of hiatus hernia was made by observing the shape of the cardia inside the stomach. A manometric study was also done on 12 patients with gastric carcinoma and 14 patients with gallstones. Hiatus hernia was observed in 37.5 per cent of the post-gastrectomy patients, this incidence being significantly higher than the 19.3 per cent of the non-gastrectomy patients (p less than 0.01). In the latter group alone the incidence of hernia steadily increased with advancing age. In the post-gastrectomy patients, reflux esophagitis and heartburn were observed in 20.2 per cent and 27.9 per cent, respectively. These incidences tended to be higher in the patients with hernia but there were no significant differences. The manometric study revealed that lower esophageal sphincter pressure was significantly decreased after gastrectomy, but not after cholecystectomy.

[A case of early stage double carcinomas arising in the duodenum and stomach].

The first Japanese case of early stage double carcinomas arising in the duodenum and the stomach is reported. The patient, a 69-year-old man, visited our hospital chiefly complaining of an epigastric pain. X-ray and endoscopic examinations of the upper gastrointestinal tract revealed a slightly depressed lesion at the antrum of the stomach and a pedunculated polyp at the 2nd portion of the duodenum. A pancreatoduodenectomy combined with a subtotal gastrectomy was performed and reconstruction was accomplished by the Billroth 1 procedure. A pathologic study of the removed specimens revealed two foci of carcinoma limited to the mucosal layer of the stomach and the duodenum and lymph nodes without metastasis. The postoperative course of the patient was uneventful.

Endoscopic study of the stomach after selective proximal vagotomy in patients with duodenal ulcer.

Forty patients with duodenal ulcer who underwent selective proximal vagotomy (SPV) with pyloroplasty were examined of intestinal metaplasia before operation, with no increase staining methods, before and after operation. Follow-up periods were between 2 and 9 years after SPV. Reduction rates of acid secretion by SPV were 79% in BAO and 62% in MAO. Five patients were observed to have a slight degree of intestinal metaplasia before operation, with no increase after operation. In the remaining 35 patients, staining areas were not observed either before or after operation. The acid-secreting area demonstrated by endoscopic congo red staining tended to become atrophic after SPV. It can be concluded that the reduction of gastric secretion by SPV does not result in rapid development or progress of intestinal metaplasia of the gastric mucosa.

Gastric carcinoma and intestinal metaplasia. Significance of types of intestinal metaplasia upon development of gastric carcinoma.

For clarifying significance of subtypes of intestinal metaplasia upon the development of stomach carcinoma, 34 stomachs surgically removed for mucosal carcinoma were morphologically studied. Intestinal metaplasia was divided into incomplete and complete types by alcian blue-PAS staining. The incomplete type has been understood as an immature stage of the development of the metaplasia as previously reported by us. In this, study, it was revealed that the incomplete type of metaplasia showed more dysplastic features than the complete type. Analysis of the metaplasia of the gastric mucosa surrounding cancer tissue revealed that well differentiated adenocarcinoma frequently came into contact with the incomplete type of metaplasia in small cancer, less than 1 cm. This relationship became less evident as carcinoma became larger. In poorly differentiated carcinoma, however, any correlations between types of metaplasia and size of cancer were not demonstrated. From these results, it was suggested that well differentiated adenocarcinoma arises from the incomplete type of metaplasia.

Surgical evaluation of endoscopic retrograde cholangiography for biliary tract diseases.

We attempted to clarify the surgical usefulness and limitation of endoscopic retrograde cholangiography (ERC) by comparing with drip infusion cholangiography (DIC). ERC was carried out on 144 patients with clinical symptoms of biliary tract diseases. The success rate was 71.5 per cent. Indications for surgery were found in 83.9 per cent of the patients with positive ERC findings and in 50.5 per cent of the patients in whom ERC was successful. The false positive rate in ERC, as revealed during the surgery was 2.3 per cent. Failure of ERC occurred in 41 patients. Failure of cannulation was attributed to para-vaterian diverticulum in 11, post-gastrectomy states in 5, the duodenal papilla covered by a polyp or a large fold in 2, and choledocho-duodenal fistula in 1. The failure of cannulation in 22 could not be clearly defined. As ERC was successful in 3 out of 9 patients in whom this approach was unsuccessful in the first trial, ERC should probably be repeated if such was indeed required pre-operatively. Diagnostic significance of DIC before ERC revealed that such plays a definite role in screening patients.