Clinicopathological study of mucous pooling referred to as mucinous component (MUC) in colorectal submucosal invasive carcinomas.

We investigated the significance of a pool of mucin, individually termed mucinous component (MUC), at the leading invasion edge of colorectal submucosal invasive carcinoma (SIC). In particular, we studied the correlation between pathological adverse prognostic factors and stainability of the mucosubstances and tumor-associated glycoconjugates in MUC. We demonstrated that MUCs were present in 21% of SICs, and 20% of SICs with MUC were involved in metastasis or recurrence, while only 6% of SICs without MUC were positive for it (p=0.005). SICs with MUC showed strong staining of carcinoembryonic antigen and Ulex europaeus I in the MUCs as well as in the cancer cells with high-grade atypia. Moreover, the mucins in MUCs predominantly stained for sialomucin. This study was the first to investigate the importance of mucous nodules in colorectal SIC. We concluded that MUC in SIC would be an important adverse prognostic factor, and that we should at least consider employing a similar treatment strategy for it to advanced colorectal carcinoma.

Abdominosacral repair for a rectovaginal fistula with anastomotic stenosis after low anterior resection report of a case.

The management of a postoperative rectovaginal fistula after low anterior resection for rectal cancer is difficult and requires reconstruction of the anastomotic site and fistula. The results of reconstructive operation are often unsatisfactory. Herein, we describe our reconstruction technique using the posterior approach through the vaginal lumen for a high rectovaginal fistula repair. This reconstructive operation is useful for postoperative rectovaginal fistulas accompanied by severe stenosis of the anastomotic site following low anterior resection for rectal cancer.

[A complication with hepatic arterial infusion chemotherapy--a case of sepsis related to catheter tip dislocation to the duodenal bulb].

Extra-arterial dislocation of a catheter is one of the complications with hepatic arterial infusion chemotherapy. The authors report a case of sepsis related to catheter tip dislocation to the duodenal bulb. A 69-year-old man underwent sigmoidectomy for sigmoid colon cancer and partial hepatectomy for synchronous metastasis to the liver. We performed hepatic arterial catheterization via the femoral artery, and the patient underwent prophylactic hepatic arterial infusion chemotherapy with 5-FU. Thirty months later, computed tomography during arteriography (CTA) using a port system revealed the dislocation of catheter tip to the duodenal bulb. He showed no symptoms, so we kept him under observation. Sepsis occurred because of the dislocated catheter 39 months later. After removal of the catheter, the symptoms of sepsis disappeared.

Ileosigmoid anastomosis with exclusion of transected ileal loop for intestinal fistula following total cystectomy of bladder cancer. Report of a case.

We report in this article a new technique of surgical treatment of enterocutaneous or enterovaginal fistula after total cystectomy for three cases of bladder cancer. The surgical outcome was successful in these patients, showing good performance status after this operation. It would seem that this technique is a good indication for enteric fistulas in the bottom of the pelvic cavity, which were difficult to be managed even under the control of total parenteral nutrition.

[Complete responses in patients with unresectable liver metastases from colorectal cancer with weekly high-dose 5-FU plus one-shot CDDP HAI].

Thirty-two patients with unresectable liver metastases from colorectal cancer, treated by intermittent hepatic arterial infusion of high-dose 5-FU combined with CDDP, were assessed. As a result of this treatment, the overall response rate was 65.6%, and eight patients (25%) which contained three autopsy cases revealed a complete response. The mean doses of 5-FU and CDDP which was administered in the eight patients were 24.3 g and 65 mg, respectively. One of the eight patients showed complete disappearance of liver metastasis on the CT scan after arterial infusion of 4.5 g of 5-FU, and necrosis or disappearance of the tumor was present in more than 2/3 of the whole lesion. Autopsy showed focal or zonal necrosis, distorted reconstruction of architecture, and cholangiolitis of the liver which were administered more than 15 g of 5-FU. Intermittent hepatic arterial infusion of high-dose 5-FU combined with CDDP is proved to be a useful locoregional chemotherapy for liver metastasis from colorectal cancer. We should evolve new treatment modalities for extrahepatic metastases, as HAI combined with the systemic chemotherapeutic regimen.