Pre-operative estimation of complete resection for patients with oesophageal carcinoma

Three hundred and seventy-nine patients were studied retrospectively regarding the possibility of a complete resection of the oesophageal carcinoma based on the combined findings of pre-operative oesophagogoraphy and computed tomography (CT). One hundred and four out of 129 patients (96.1%) having lesions which did not demonstrate all three of the aforementioned factors (a lesion shorter than 8 cm, a normal oesophageal axis, and normal contact of the lesion with neighboring organs in CT) underwent a complete resection of the oesophageal lesion. Fifty-three percent of the patients ( ) with a lesion showing only one of these factors had a complete resection. Whereas, on the other hand, a complete removal of the malignancy was only possible in 22% of the patients with two or all three of the findings. Moreover, as a result of further analysis limited for resected cases, the number of positive factors in these pre-operative findings correlated with the advancement of the surgical stage, which reflected a curability in surgery and a rate of postoperative complications. In order to make adequate plans for the treatment of patients with advanced oesophageal cancer, the finding of (i) the length of lesion, (ii) a deep ulceration and deformity of the oesophageal axis and (iii) any abnormal contact in CT, are considered to be very useful.     

Univariate and multivariate analyses of the prognostic significance of discontinuous intramural metastasis in patients with esophageal cancer

A review of 167 cases of esophageal carcinoma without preoperative treatment revealed 24 (14.4%) to have intramural metastasis (IM) within the esophagus. Among the clinicopathologic factors, the length of the lesions (P < 0.01), lymph node metastasis (P < 0.001), and the depth of the invasion of the tumor (P < 0.0001) were found to be statistically significant different factors between the two groups of patients both with and without intramural metastasis. The survival curve for patients with IM was significantly lower than that for patients without IM (P < 0.0001). A univariate analysis revealed that the depth of invasion, lymph node metastasis, IM (P < 0.0001), and the length of the lesion (P < 0.001) all had a significant correlation with the prognosis. Moreover, in a multivariate analysis, the depth of the invasion (<0.001), length of the lesion (0.001), and IM (0.049) were all determined to be significant prognostic factors. Therefore, IM is considered to be one of the independent significant prognostic factors for predicting a poor prognosis in esophageal cancer. © 1994 Wiley-Liss, Inc.     

Multiple occurrence of carcinoma in the upper aerodigestive tract associated with esophageal cancer: Reference to smoking,drinking and family history

Smoking and drinking habits as well as family history were examined in 143 men with esophageal cancer, including 30 who had associated second cancers of the upper aerodigestive tract (UADT) and 113 who did not. The risk of second cancers of UADT associated with the main lesions of the esophagus was evaluated, using odds ratios (ORs). As a result, the ORs of second cancers for current smoking and drinking were 5.3 and 7.6 respectively. The ORs significantly increased to 12.7 and 14.7 in heavy smokers and in heavy drinkers respectively. Furthermore, the risk of second cancer also significantly increased (8-fold) in patients who had close relatives with UADT cancer, compared to those without family history of any cancer. However, there were no differences in smoking or drinking habits regardless of family history. Our data thus suggest that a family history of UADT cancer as well as heavy smoking and drinking are clearly associated with multiple occurrence of UADT cancer. Therefore, careful and frequent examination for appearance of any second lesions are required for patients in these high-risk groups.     

Correlation between hyperthermoradiosensitivity and clinical effect in carcinoma of the esophagus

The correlation between hyperthermoradiosensitivity evaluated by an in vitro succinate dehydrogenase inhibition (SDI) test and the histopathologic effects of hyperthermochemoradiotherapy (HCR therapy) were investigated in 43 patients with carcinoma of the esophagus. The succinate dehydrogenase (SD) activity of tissue fragments taken at biopsy was assayed after exposure to heat (43 degrees C.) and radiation (6 grays) was done. The sensitivity to radiation plus heat treatment was estimated by the percentage of SD activity of the treated cells, compared with that of the control cells. The 43 patients were divided into three groups according to the degree of SD activity after exposure to radiation plus heat treatment. The SD activity was less than 50 per cent in group 1 (highly sensitive), between 50 and 70 per cent in group 2 (moderately sensitive), more than 70 per cent in group 3 (less sensitive). Eighteen of 20 in group 1, 11 of 17 in group 2 and two of six in group 3 were classified as being histopathologically "effective" for HCR therapy. The two year survival rate for groups 1, 2 and 3 were 55.5, 34.9 and zero per cent, respectively, while there were no statistical differences with regard to prognostic factors. These data suggest that in vitro activities of SD correlate well with the clinical effectiveness of HCR therapy. Therefore, it is recommended that a SD inhibition test be included among the guidelines for clinical management.     

Epidemiologic Survey of Children with End-Stage Renal Disease

We performed an epidemiologic study on the basis of a questionnaire survey of 162 children with end-stage renal disease (ESRD). Sixty-nine (43%) of our 162 children, including 25 detected at mass screening of urine, were found by chance hematuria and/or proteinuria. The three major causes of ESRD in our children were chronic glomerulonephritis (CGN) in 56, congenital anomalies of the urinary tract in 30, and nephrotic syndrome (NS) in 27. The renal pathology in 39 children with CGN or NS was focal glomerular sclerosis in 15, diffuse mesangial GN in 7, IgA GN in 5, membranoproliferative GN in 3, membranous GN in 3, and unclassified in 6. Forms of dialysis initiated were hemodialysis in 91 children, continuous ambulatory peritoneal dialysis (PD) in 66, and intermittent PD in 5. Renal transplantation was performed on 38 children, and the graft and the patient survival rates were 76% and 89%, respectively. The survival rate of our 162 children for a mean follow-up of 8.1 years was 77%. In conclusion, an integrated program of maintenance dialysis and transplantation provides a favorable life for children with ESRD.     

Effects of doxorubicin on cancer cells after two-thirds hepatectomy in rats

A rat model of liver metastases generated by intraportal injection of syngeneic tumor cells after two-thirds hepatectomy was used to determine the optimal regional chemotherapeutic modality for early hepatic metastases. WKA rats had viable tumor cells injected directly into the portal vein after two-thirds hepatectomy. Ten rats were used as a control; the remaining groups were given doxorubicin (4/3 mg/kg) injected directly into the hepatic artery at 24 hr, 72 hr, and 7 days (after liver regeneration) postoperatively. The mean survival period in each group was 21.0, 20.0, 20.5, and 20.7 days, respectively, compared with those treated with doxorubicin (4 mg/kg) injection at 24 hr, 72 hr, and 7 days postoperatively, with a mean survival period in each group of 20.0, 21.6, and 25.6 days, respectively. When a comparison was made with regard to the doses of doxorubicin administered, statistically significant differences in survival rates were recognized between the rats that had doxorubicin (4 mg/kg) injection 7 days postoperatively and the others (P < 0.01). Based on these findings, we believe that appropriate adjuvant chemotherapy should be given after the liver regeneration phase. © 1995 Wiley-Liss, Inc.     

Clinicopathologic study of patients with Borrmann type iv gastric carcinoma

Between 1979 and 1993, 665 Japanese patients with advanced gastric cancer underwent surgery at our hospital. These patients were divided into two groups, consisting of 102 patients with Borrmann type IV carcinoma, and the remaining 563 patients with all other types of gastric carcinoma, which were then compared clinicopathologically. In the patients with Borrmann type IV carcinoma, 77.4% of the lesions demonstrated poorly differentiated adenocarcinoma, and 99 patients were classified as Stage III or IV. The resection rate was 87.2% (89/102) with only 39 curative operations despite the fact that 70 total gastrectomies were performed. The incidence of peritoneal dissemination (29.4%) and serosal invasion (97.0%) was significantly higher in these patients. Microscopic lymph node metastasis was positive in 86.5%. The 5-year survival rate was 23.4% in the patients with a curative operation and 5.0% in those with a noncurative operation (p < 0.01). Peritoneal dissemination was most frequently noted in the recurrence patterns. We conclude that early detection and a curative operation are both essential to improve the prognosis of patients with Borrmann type IV gastric cancer. The addition of a potent postoperative chemotherapy regimen is also recommended. © 1995 Wiley-Liss, Inc.     

The quality of life is sustained after operation for carcinoma of the esophagus

An interview was conducted to determine the quality of life, both objectively and subjectively, in 64 patients without a recurrence of the disease more than one year after esophageal resection and reconstruction with a gastric tube for carcinoma of the thoracic esophagus. Despite the decrease in body weight, the patients appeared to be well adjusted and had a most optimistic attitude toward their illness. The laboratory data showed normal values, postoperatively. As there was no evidence of a diminished quality of life in these patients, we consider that physicians should recommend surgical therapy for patients with carcinoma of the esophagus.     

Clinical Usefulness of Determining the Rate of Thermal Clearance within Heated Tumors

Between June 1987 and June 1988, 28 patients (28 tumors) withliver, retroperitoneal, intrapelvic, or superficial tumors weretreated with hyperthermia combined with radiotherapy and/orchemotherapy. Hyperthermia was administered once or twice aweek for 30-60 min per session, up to a total of 2–11sessions, with an 8-MHz RF capacitive heating device. Bloodflow in the tumors was evaluated from the rate of thermal clearance(TCR) using the bio-heat transfer equation. The TCR was measuredin the middle of the first heating session and at the end ofthe last heating session by turning off the output power ofthe heating device. For 9 patients, contrast-enhanced CT scanswere taken and CT numbers at the centers of tumors were measuredbefore and after the entire course of hyperthermia. Changesin TCR were closely related to average tumor center temperature,changes in CT number, and tumor response. When smaller and moresuperficial tumors were treated by hyperthermia combined withradiotherapy and/or chemotherapy that consisted of many heatingsessions and during which a high average tumor center temperaturewas achieved, a better tumor response was obtained. The betterthe tumor response, the higher the local control rate became.The cause-specific survival rate of patients who achieved goodtumor responses was higher than that of patients who showedpoor tumor responses. Changes in TCR and CT number in heatedtumors were useful and important indicators of tumor responseto hyperthermia.     

Hot spring bath and Legionella pneumonia: an association confirmed by genomic identification

A 59-year-old man developed pneumonia 9 days after bathing in a hot spring spa. Bilateral shadows on his chest radiograph rapidly progressed after admission. He was successfully treated with erythromycin and rifampicin. Legionella pneumophila serogroup 6 was recovered from an intratrachial specimen and a significant elevation was observed in a paired indirect fluorescent antibody to Legionella. Persistent slight fever and chest rentogenographic shadows resolved after administering low-dose prednisolone to treat organizing pneumonia shown by transbronchial lung biopsy. The same serotype of Legionella was recovered from the water of the hot spring spa where the man had bathed. When the extracted DNA of these two strains showed identical restriction fragments by pulsed-field gel electrophoresis, we had direct evidence that hot spring spas can be a source of Legionella pneumonia.