Cm In Longest Diameter Research Articles

A CASE OF BASALOID CELL CARCINOMA OF THE ESOPHAGUS

Most cancers of the esophagus are squamous cell carcinoma. We experienced a case of basaloid cell carcinoma of the intrathoracic esophagus. A 62-year-old man, who had been treated for alcoholic cirrhosis and esophageal varices at the department of internal medicine in our hospital, was found out having an elevated tumor 2cm in longer diameter in Ei by barium meal study and esophagoscopy. With biopsy of the lesion, a squamous cell carcinoma of the esophagus was suspected. Under left thoracotomy and laparotomy, resection of the lower esophagus and upper portion of the stomach, splenectomy, and esophagogastrostomy were carried out. The tumor was Ao, N(-), Mo, and Plo, and the operation resulted in curative resection. The resected tumor was 2.2×1.5cm in size, and well demarcated and protruded. Histologically, basaloid cell carcinoma was confirmed. The tumor infiltrated into the submucosal layer without lymph node metastasis. Postoperative course was uneventful and the patient was discharged from the hospital one month after the operation. The patient is doing well eight months after the surgery.

A CASE OF GIANT ESOPHAGEAL LEIOMYOMA DEVELOPED INTO THE THORACOABDOMINAL SPACE

A case of giant esophageal leiomyoma with 15cm in long diameter developed into the thracoabdominal space is reported with some considerations of the literature. A 34-year-old male with epigastralgia had been pointed out a protrusion in the lower esophagus 11 years before. Upper gastrointestinal series revealed a stenosis from the intrathoracic middle esophagus to cardial lesion. Endoscopic examination revealed a submucosal tumor in the esophagocardiac lesion. CT and MRI showed a giant submucosal tumor circumfused the esophageal lumen and developed into the thoraco-abdominal space. Lower esophagectomy and upper gastrectomy reconstructed with jejunal transfer were performed under the left anterolateral thoracotomy and laparotomy. The resected tumor was 15×10.5×10cm in size, and benign leimyoma histopathologically. Postoperative course was uneventful. The patient was discharged from the hospital on the 25th postoperative day.

A CASE REPORT OF SOLITARY SPLENIC METATASIS FROM A CECAL CANCER

A rare case of splenic metastasis from a cecal cancer without any other distant metastasis is reported here. The patient was a 58-year-old male. There was a previous history of undergoing a right hemicolectomy for a cecal cancer (P0, H0, ss, n1(+), M(-), stage IIIa, well differentiated adenocarcinoma in December 1993. He was checked by abdominal computed tomography (CT) in October 1994 because in extremely high serum level of tumor marker (CA19-9) was found in a follow up study. He was admitted to the hospital because abdominal Ct showed a tumor 9cm in longer diameter in the spleen. Abdominal ultrasonography showed an oval echoic area with internal heterogenous echo in the spleen. Abdominal angiography revealed an avascular area in the same potion. In these circumstances, a splenectomy was performed for a suspected meatstatic splenic tumor. Histophatological findings of the resected splenic tumor revealed the same histological type as the cecal cancer had. It was diagnosed as metastasis of the cecal cancer to the spleen without any other distant metastasis.

Results of a limited resection for compromised or poor-risk patients with clinical stage I non-small cell carcinoma of the lung

Patients with stage I non-small cell carcinoma of the lung may be unable to undergo a standard curative resection, such as lobectomy, due to various medical reasons. Whether or not a limited resection is superior to radiotherapy in these patients, both in terms of long-term prognosis and treatment morbidity, is unknown.We retrospectively reviewed our results in treating compromised or poor-risk patients with clinical stage I non-small cell carcinoma of the lung who had received either a limited resection or radiotherapy. Seventeen patients underwent a limited resection (nine wedge resections and eight segmentectomies), while 18 patients received radiation therapy.The five-year survival rates for patients in the limited resection group and the radiation treatment group were 55.0 and 14.4 percent, respectively. A log-rank analysis showed a significant difference between the two groups (p = 0.004). Furthermore, the survival rate of the patients having a limited operation was significantly better than that of patients achieving either complete response or partial response from radiotherapy (18.8 percent at five years, p = 0.008). Recurrence at the surgical margin occurred in four patients in whom the tumor was greater than 2 cm in longest diameter. The incidence of severe treatment-related complications was not different between the limited operation group and the radiotherapy group (11.8 compared to 11.1 percent).The results indicate that a limited resection for patients with poor-risk clinical stage I carcinoma of the lung has an advantage over radiotherapy, especially for tumors measuring less than 2 cm in longest diameter.

A CASE REPORT OF PRIMARY EPITHELIOID LEIOMYOSARCOMA OF THE SIGMOID MESENTERY

We experienced a rare case of primary leiomyosarcoma of the mesentery. A 67-year-old man was admitted to the clinic because of a lower abdominal mass. The mass was fist sized and movable in the lower abdomen. Abdominal ultrasonography and computed tomography revealed an irregular shaped tumor with a clear margin and a heterogeneous inside pattern. Magnetic resonance imaging showed the tumor enhanced strongly with magnebist. Upper G.I. series and Barium enema examination showed no abnormal shadow. We suspected a leiomyosarcoma of the mesentery and operated on. During a lapar-otomy, two tumors 14cm and 3cm in longer diameter with a pedicle arising in the sigmoid mesentery were found. The two tumors were easily extripated by dissecting the pedicle from the mesentery. Pathological findings showed the tumor being epithelioid leiomyosarcoma.

Trans-anal reinforcing sutures after double stapling for lower rectal cancer: Report of two cases

To safely avoid the construction of a covering stoma in patients with advanced lower rectal cancer undergoing laparoscopy assisted colorectal surgery (LACS), we added circumferential manual reinforcing sutures via the transanal approach at the site of mechanical anastomosis. In June 2008, LACS was performed for a tumor of 6 cm in longer diameter in the Rb region of the lower rectum approximately 5 cm from the anal verge. After intraperitoneal coloproctal anastomosis was performed in the pelvis by the double stapling technique (DST), reinforcement was provided by manual trans-anal suturing (trans-anal reinforcing sutures: TARS). A covering stoma was constructed because this was a high-risk case. Complications such as mild wound infection and stoma trouble occurred, and the patient was discharged after conservative therapy. In June 2008, LACS was performed for a tumor of 5 cm in longer diameter in the Ra region of the lower rectum approximately 7 cm from the anal verge. After intraperitoneal colorectal anastomosis was performed in the pelvis by DST, TARS were added to avoid a covering stoma. Minor leakage occurred postoperatively, but this was controlled conservatively and the patient was discharged. In patients having surgical treatment of advanced lower rectal cancer, good results were obtained by adding circumferential reinforcing sutures via the trans-anal approach at the site of ultra-low anastomosis after DST.

Nest Architecture of the Australian Paper Wasp Ropalidia Romandi Cabeti , With a Note on its Developmental Process (Hymenoptera:Vespidae)

Nest architecture of Ropalidia romandi cabeti was described, based on 2 incipient (an active and an abandoned) nests and 3 developed ones. Developed nests were spherical, or hemispherical when built under flat surfaces, consisted of several to more than 10 horizontal combs with oval or irregular shapes. Each comb was suspended by many pedicels from the upper one. Since several combs were simultaneously constructed at the same story, they often produced irregular interconnections that caused complex stair‐like, or “semispiral” structures. Combs were entirely surrounded by an outer envelope with a small entrance hole at the lower tip. The envelope was probably constructed after the first group of combs had been completed. Materials for both cells and envelope were plant fibers glued together with salivary secretion. The surface of envelope was more thickly coated with the secretion than cell walls. The largest nest had about 30,000 cells in more than l0 stories of combs that had a surface area of 1,933 cm2. Its dimensions were 21.5 cm in longer diameter and 17.5 cm in height.

A CASE OF RETROPERITONEAL SEROUS CYST PRESENTING WITH AN ABOMINAL TUMOR

Retroperitoneal masses are commonly parenchymatous tumors, and rarely serous tumors. In this paper a case of retroperitoneal serous cyst presenting with an abdominal tumor is described. A 70-year-old woman was admitted to the hospital because of a right lateral abdominal tumor which was pointed out to be a retroperitoneal tumor by abdominal ultrasonic examination at elsewhere. On admission, a fist-sized, well-defined, and elastic hard tumor was palpated. Abdominal ultrasonography, CT, and MRI revealed a cystic lesion in the retroperitoneum. Gastrointestinal series and abdominal angiography showed no abnormalities. Under a diagnosis of retroperitoneal cyst, the cyst was extirpated. The extripated cyst was about 11cm in longer diameter and about 170g in weight, containing yellow transparent serous fluid. Histopathologically it was solitary cyst covered with columnar epithelia with a calcified part. No histological findings indicating the origin were found.

A prospective trial of early detection of pancreatic cancer by ultrasonographic examination combined with measurement of serum elastase 1

The accuracy of ultrasonographic examination combined with measurement of elastase 1 levels for early detection of pancreatic cancer was evaluated prospectively. Abdominal ultrasonographic examination and measurement of serum elastase 1 levels were done within 2 weeks after the initial visit to the clinic in a total of 2098 patients older than 35 years of age with symptoms suggesting pancreatic disease. Those in which one or both of these examinations had abnormal results underwent additional tests such as endoscopic retrograde cholangiopancreatography and computed tomography. Of those with pancreatosonograms with abnormal results with or without abnormally high serum elastase 1 levels, 19 patients eventually were found to have pancreatic cancer. No patients with pancreatic cancer, a normal level of serum elastase 1, and a pancreatosonogram with normal results were found, but follow-up studies revealed one pancreatic cancer in 189 patients after technically unsatisfactory ultrasonographic examination. In 9 (45%) of the 20 cases detected in this study, the pancreatic cancers were resectable, and two (10%) were less than 2.0 cm in longest diameter. These findings indicate that this combined examination is useful for early detection of pancreatic cancer. However, no pancreatic cancer was found in patients with abnormally high serum elastase 1 levels without a pancreatosonogram with abnormal results. Moreover, a combination of ultrasonographic examination and measurement of the elastase 1 level did not raise the diagnostic accuracy over that of ultrasonographic examination alone. These findings indicate that ultrasonographic examination alone is useful in screening for early pancreatic cancer.

TWO RESECTED CASES OF LEIMYOSARCOMA OF THE ESOPHAGUS WHICH WERE SUCCESSFULLY DIAGNOSED PREOPERATIVELY

Primary leiomyosarcoma of the esophagus is a rare disease. It is hardly diagnosed preoperatively, because it is a submucosal tumor. Recent experience with 2 cases of leiomyosarcoma of the esophagus, in which we were able to perform radical operation under the definite diagnosis resulting from preoperative examinations, is reported.Case 1 is an 81-year-old woman complaining of dysphagia. An esophagogram revealed a tumor of 6 cm in longer diameter in Ei region. Esophagoscopy showed a protruded lesion lobulating like a polyp, locating at 30 cm from the incisor line. As as result of biopsy, it was diagnosed as leiomyosarcoma. Intrathoracic anastomosis of the esophagus and remnant stomach under left thoracoabdominal incision was performed. The excised tumor was 3.5×6.0cm in size, presenting as protruded type with lobulation. Histopathologically it was leiomyosarcoma of the esophagus with a metastasis in the left cardiac lymph node.Case 2 was a 61-year-old man complaining of dysphagia and hematemesis. An esophagogram revealed a tumor 8 cm in longer diameter in the EiC region, presenting as tumor type with ulceration. Esophagoscopy showed a protruded lesion with a high of about 2.5 cm locating at 40 cm from the incisor line, which was accompanied with deep ulcer on the anal side. As a result of biopsy, it was found a leiomyosarcoma. Jejunal interposition between the esophagus and remnant stomach under left thoracoabdominal incision was performed. Excised specimen was 4.5×6.0×4.0 cm in size. Histopathologically it was a leiomyosarcoma.

Misoprostol in the treatment of duodenal ulcers in the people's Republic of China: A comparative, double-blind, multicenter study

In recent years, it has become mandatory for many pharmaceutical companies to conduct country-specific clinical studies which are needed for obtaining regulatory approvals for their drugs. Such studies are important to delineate possible racial or environmental (lifestyle) differences which could not have been predicted from data obtained in other populations. A double-blind, randomized, double-dummy, multiclinic, comparative trial examined the tolerance and efficacy of misoprostol (200 μg QID) and cimetidine (200 mg QID) for the treatment of duodenal ulcers in the People's Republic of China. The trial characteristics and monitoring complied with the standards in the United States of America and the People's Republic of China. Two hundred consenting outpatients of either sex, aged 18–75 years, who had duodenal ulcers (not less than 0.3 cm in longest diameter and not more than 2 ulcers) were enrolled. Endoscopy, physical examination, and laboratory assessments wereperformed on entry and after 4 weeks of treatment. The effects of the treatment on ulcer healing, dyspeptic symptoms, tolerance, and adverse drug reactions were determined. Both treatment groups were well matched for demographic characteristics and disease severity at entry to the study. Misoprostol showed equal efficacy to cimetidine in inducing ulcer healing (60.7% vs. 67.9% for misoprostol and cimetidine, respectively, P > 0.05) and resolving dyspeptic pain. The extent of duodenal ulcer healing achieved by misoprostol in this study is essentially similar to the ulcer healing rates noted in many other worldwide studies, indicating the absence of racial differences in response to misoprostol. The adverse effects observed for misoprostol and cimetidine were also very similar. Both drugs were very well tolerated; however, slightly more patients experienced transient diarrhea with misoprostol (6.4%) than with cimetidine (3.8%). In conclusion, this trial supports the world- wide efficacy and tolerance of misoprostol for the treatment of duodenal ulcers and indi- cates the absence of racial influences on the safety and efficacy of misoprostol. © 1992 Wiley-Liss, Inc.

Postoperative radiotherapy for stage IB carcinoma of the uterine cervix

Sixty patients, treated with postoperative radiation therapy following radical hysterectomy and pelvic lymphadenectomy for stage lb carcinoma of the uterine cervix between Jan. 1980 and Dec. 1984 at Department of Radiation Oncology, Yonsei University College of Medicine, were retrospectively analysed. The minimum follow-up period was 5 years. The indications for postoperative radiotherapy were positive pelvic lymph node (34 pts), a large tumor size more than 3 cm in longest diameter (18 pts), positive surgical margin (10 pts), deep stromal invasion (10 pts), and lymphatic permeation (9 pts). The overall 5-year survival rate was 81.8%. The univariate analysis of prognostic factors disclosed tumor size (less than 3cm, greater than or equal to 3cm) and the status of the surgical margin (positive, negative) as significant factors (tumor size; 88.1% vs 6.3%, surgical margin; 85.5% vs 60%, p less than 0.05). Age (less than or equal to 40, greater than 40 yrs) was marginally significant (90.2% vs 73.1%, p less than 0.1). Multivariate analysis clarified two independent prognostic factors; tumor size (p = 0.010) and surgical margin (p = 0.004). Analysis of the tumor factors with the radiation dose disclosed a better survival rate for patients with a positive surgical margin who were given over 50 Gy than for those who were given below 50 Gy in patients (4/4, 100% vs 2/6, 33.4%; p = 0.06). Significant complications requiring surgical correction were not observed. In conclusion, it is believed that the status of the surgical margin and tumor size both have important prognostic significance, and that a radiation dose over 50 Gy is advisable for patients with a positive surgical margin.

Effectiveness of discriminant analysis of serum CA 19-9 and elastase 1 in diagnosis of pancreatic carcinoma.

The accuracies of assays of serum CA 19-9 and elastase 1 in the diagnosis of pancreatic carcinoma were investigated by the cutoff method and discriminant analysis of data on 98 patients with pancreatitis, 65 patients with pancreatic carcinoma, 107 patients with benign diseases of other organs, and 108 patients with cancer of other organs. Comparison of the diagnostic accuracies of the cutoff method and multivariate analysis of CA 19-9 and elastase 1 showed that the latter was better for diagnosis in terms of its specificity. The performance of multivariate analysis was validated on independent data consisting of 52 patients with pancreatitis, 27 patients with pancreatic carcinoma, 79 patients with benign diseases of other organs, and 29 patients with cancer of other organs. Multivariate analysis of CA 19-9 and elastase 1 was very useful for differentiation of patients with and without pancreatic carcinoma: 24 (88.9%) of 27 patients with pancreatic carcinoma were correctly classified. Moreover, by this method, all patients with pancreatic carcinoma of less than 2 cm in longest diameter and 81.3% of those without jaundice were correctly classified.

A STUDY OF EARLY GASTRIC CANCER DETECTED BY MASS SCREENING

A retrospective study has been made on resected 541 cases of early and primary gastric cancer for past 22 years, to know characteristics of early gastric cancer detedted by mass screening. The cases were divided into screening group (n=86) and non-screening group (n=455). 1) In both groups tumors commonly occurred in M-region and lesser curvature site. A greater number of sinking type macroscopically or differenciated type histologically was observed. 2) A lower occurrence in the anterior wall and higher occurrence in the posterior wall were noted in the screening group. 3) The most commonly detected tumors were 1.1 to 2.0cm in longer diameter in both groups. In the screening group no case of minute carcinoma was detected, while minimal for large mass 5cm or more. 4) In the screening cases m cancer was more commonly found than sm cancer, showing lower anginal invasive rate and metastasis rate to the lymph nodes. Accordingly, mass screening can not be expected to detect minute carcinoma because of its essential objective of screening. However, it is advantagous to detecting a large number of early gastric cancers less than 5cm in diameter, accompaning neither vascular invasion nor lymph node metastasis. Further spreded use of mass screening is desired.

子ウシに認められた異常冠状静脈洞の1例

An anomalous coronary sinus emptying into the left and right atria was observed in an 8-monthold female Japanese black calf. The V. cordis magna, V. ventricularis sinistra posterior (V. cordis caudalis) and V. cordis media drained normally into the coronary sinus. The left end of the coronary sinus opened into the left atrium through an oval orifice 1 cm in longer diameter, while the right atrial ostium of the coronary sinus was completely obstructed. The four Vv. cordis dextrae from the lateral wall of the right ventricle drained into an anomalous common stem above the coronary groove. The posterior part of this stem was continuous with the coronary sinus and the anterior part opened into the right atrium through an oval orifice 3 mm in longer diameter.

Value of ultrasonographic examination combined with measurement of serum tumor markers in the diagnosis of pancreatic cancer of less than 3 cm in diameter.

Ultrasonographic examinations and measurements of CA 19-9 and elastase 1 were done simultaneously in 14 patients with resectable pancreatic cancer of less than 3.0 cm in longest diameter and 48 patients with pancreatitis. Although a pancreatic mass was detected ultrasonically in only six (42.9%) of the patients with tumors of less than 3.0 cm in diameter, one or more of the abnormal ultrasonic findings (a pancreatic mass and dilatation of the pancreatic and/or bile duct) was significantly more frequent in patients with pancreatic cancer than in those with pancreatitis. An abnormally high level of CA 19-9 and/or elastase 1 also was significantly more frequent in patients with pancreatic cancer than in those with pancreatitis. The rates of detection of pancreatic cancer by ultrasonography only and by measurement of tumor markers only were 92.9% and 100%, respectively, but the specificities and predictive values of positive results by each of these tests alone were low. Thirteen (92.9%) of 14 pancreatic cancers were found in patients giving positive results by both ultrasonography and measurement of tumor markers, whereas no tumors were found in patients giving negative results in both of these examinations. A combination of these two examinations raised the specificity and predictive value of positive results to 87.5% and 68.4%, respectively, but had little or no influence on the sensitivity or predictive value of negative results. Therefore, patients in whom ultrasonographic findings are abnormal and in whom the serum levels of tumor markers also are abnormally high should be examined more extensively. This combination of examinations indicates the possibility of earlier detection of pancreatic cancer.