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Biomedical subjects

T Kakegawa

Publications and source records attributed to T Kakegawa.

At least 163 records · Page 9Linked to original sources
PubMed1991

Pharyngoesophageal bypass using a free jejunal graft for corrosive stricture--a case report.

The management of corrosive strictures of the esophagus involving the pharynx and/or larynx continues to be a challenge to surgeons. This paper presents a case of a corrosive stricture extending from the hypopharynx to the cervical esophagus associated with complete obstruction of the larynx, which was successfully treated by pharyngoesophageal bypass using a free jejunal graft. Postoperative recovery was smooth without any complications, and swallowing was restored. Three months after the bypass operation, the patient underwent laryngoplasty. Although aspiration occurred immediately after the laryngoplasty, six months later she was again able to tolerate the oral intake of semisolid food without any need for supplementary nutritional support. Reconstruction of a short segment of the pharyngoesophageal stricture by a free jejunal graft restores almost normal swallowing provided that dilatation of the lower esophagus is achieved.

Adult↗
PubMed1991

Surgical treatment for aspiration following esophageal reconstruction--a report of two cases and the techniques involved.

Severe aspiration following esophageal reconstruction is often very difficult to treat while preserving the larynx. However, we have successfully adopted a modified surgical procedure previously employed for aspiration caused by neurological diseases or head and neck cancer surgery. We report herein the use of this modified procedure against aspiration in 2 cases following esophagectomy. In the first case, a combination of cricopharyngeal myotomy, infrahyoid myotomy and laryngeal pull-up, with approximation of the thyroid cartilage against the hyoid bone and that of the hyoid bone against the mandible, were performed simultaneously with the primary esophagectomy. In the second case, cricopharyngeal myotomy, infrahyoid myotomy, laryngeal pull-up and infrafold silicone injection were performed three months after the primary operation. Good results were achieved in both cases. Thus, for any case at risk of aspiration after esophagectomy or for any case with severe aspiration following esophagectomy that does not respond to swallow therapy, these operative rehabilitation procedures should be performed before laryngectomy is considered.

Esophagectomy↗
PubMed1991

A prospective clinicopathologic study of venous invasion in colorectal cancer.

We performed a long-term prospective study on venous invasion of colorectal cancer. The degree of venous invasion was divided into four stages (V0 through V3). Venous invasion was classified into three types by location (Vx, Vy, and Vz). Hepatic metastasis occurred in 27%, 33%, and 20% of patients with V2, V3, and Vz tumors, respectively. Local recurrence occurred in 33% and 15% of the V3 and Vz groups, respectively. However, there were no significant differences among the groups in terms of the rate of pulmonary metastasis. The 6-year survival rate for Dukes' stage B tumors was 94%, 88%, and 74% in the V0, V1, and V2 groups, respectively. There was a significant difference in the survival rate between patients with V0 tumors and V2 and V3 tumors. However, no significant difference was noted in the location. In Dukes' stage C tumors, on the other hand, the survival rate was 77%, 56%, and 44% in the V1, V2, and V3 groups, respectively. Also, it was 85%, 73%, and 45% in Vx, Vy, and Vz cases, respectively. Significant differences were noted between V1 and V3 (or V2), and between Vz and Vx (or Vy). It appears that the degree and location of venous invasion influence not only hepatic metastasis, local recurrence, and survival rates but also have prognostic value.

Aged↗
PubMed1991

Effect of acetylpolyamines on in vitro protein synthesis and on the growth of a polyamine-requiring mutant of Escherichia coli.

The functions of acetylpolyamines were examined with respect to stimulation of protein synthesis and cell growth. Unlike polyamines, acetylpolyamines could not lower the optimal Mg2+ concentration of protein synthesis, and the degree of stimulation of protein synthesis by acetylpolyamines was small. The addition of N1-acetylspermine did not stimulate cell growth of a polyamine-requiring mutant of Escherichia coli MA261, although acetylspermine was accumulated in the cells. Acetylspermine did not interfere with polyamine stimulation of protein synthesis and cell growth of E. coli MA261. The binding of acetylpolyamines to RNA was very weak, and the binding of polyamines to RNA was not disturbed significantly by the presence of acetylpolyamines. When the growth of E. coli MA261 was stimulated by addition of polyamines, significant amounts of acetylpolyamines were also formed in the cells. These results suggest that acetylation of polyamines, together with polyamine excretion, may regulate the intracellular level of the parent polyamines when excess amounts of polyamines accumulate intracellularly.

Acetylation↗
PubMed1991

Gastric cancer following gastrectomy for benign gastroduodenal disease.

Twenty-four cases of resected remnant cancers following partial gastrectomy were retrospectively investigated for benign gastroduodenal disease. The time interval between the initial gastrectomy and the remnant gastrectomy was more than 10 years in 19 (79%) patients and less than 10 years in 5 (21%) patients. There were 2 cases with remnant cancer at stage I, 1 at stage II, 3 at stage III and 13 at stage IV for the all cases with a time interval of more than 10 years. Early-type remnant gastric cancer has a frequency of only 5%. The proportion of positive lymph node metastases was high, in 84%.

Aged↗
PubMed1991

Zero operative mortality for gastric cancer with hepatic cirrhosis.

Thirty-two cases of gastric cancer associated with hepatic cirrhosis were reviewed, retrospectively. These patients represented 1.3% of 2590 patients with gastric cancer who were treated over the 23 year period from 1966 to 1988. The male to female ratio was 9.7:1 for gastric cancer patients with hepatic cirrhosis (mean age, 63.2 years) and 2:1 for all patients with gastric cancer (mean age, 61.2 years). Among the 32 patients, one was inoperable, and 31 patients underwent surgical exploration. The gastric cancers were resected in 28 patients (90.3%), while the cancers in 3 patients (9.7%) were non-resectable. Twenty-two patients underwent curative resections with a five-year survival rate of 51%. Postoperative complications occurred in 6 patients (20%), but no anastomotic leakage occurred. There were no operative mortalities. On the basis of the present study, different surgical procedures are indicated depending on the preoperative hepatic conditions for patients with gastric cancer accompanied by hepatic cirrhosis.

Female↗
PubMed1991

Multiple organ failure (MOF) after intestinal operations--a clinical and statistical study of the past 5 years.

Multiple Organ Failure that occurred in 35 cases out of a total of 1498 cases after intestinal surgery were studied by an analysis of the clinical and statistical data from the past 5 years (1984-1988). 1. The incidence of MOF after intestinal surgery was 2.3%. 2. Twenty-eight of MOF resulted from severe infections. 3. The incidence of infection was highest after esophageal operations. 4. Hepatic failure was the most common type of primary organ failure and renal failure was the second most common. 5. The prognosis for MOF was very poor with a survival rate of 8.7%.

Digestive System Surgical Procedures↗
PubMed1991

Early gastric cancer following gastrojejunostomy without gastrectomy.

Two rare cases involving distal gastrectomies for gastric cancer after an earlier gastrojejunostomies without gastrectomy for duodenal or gastric stricture due to a duodenal or pre-pyloric ulcer are reported. The time interval between the initial gastrojejunostomy and the resection of the distal stomach with gastrojejunal stoma were 17 and 36 years. One patient underwent reconstruction by Billroth II and the other by Roux-en-Y end-to-side gastrojejunostomies, both retrocolically without any peri or postoperative complications. The histological classification was confirmed for both as type IIc mucosal early gastric cancer. Only 6 other primary early gastric cancers following gastrojejunostomies without gastrectomy have been reported in the Japanese literature.

Duodenal Ulcer↗
PubMed1991

Early mucosal gastric cancer with extra-perigastric (n2) lymph node metastasis.

During the 10 years from 1977 to 1986, a total of 314 cases of early gastric cancer were resected. Of these, 43 (14%) had lymph node metastases, with 6 cases of mucosal (m-) cancer and 37 of submucosal (sm-) cancer. Among the patients with positive lymph node metastases, 37 (86%) had metastases in the Group 1 regional lymph nodes. Eight patients had metastases in the Group 2 lymph nodes, and these involved 2 cases of m-cancer and 6 of sm-cancer. Lymph node metastasis is generally believed to occur in only about 3% of m-cancer, and then mainly in the Group 1 lymph nodes. Here, 2 rare cases of early gastric m-cancer with positive extra-gastric lymph node metastasis are reviewed in detail, with special attention to the surgical management.

Aged↗
PubMed1991

Early gastric cancer associated with synchronous liver metastasis.

During the 14 years from 1976 to 1989, 1442 gastric cancers were resected in the Department of Surgery at Kurume University. 546 (37.9%) were primary early gastric cancers. One (0.2%) of these was associated with a synchronous liver metastasis. In the advanced gastric cancers, the rate of synchronous liver metastasis was 12.8%. However, synchronous liver metastasis with an early gastric cancer is quite rate. Only 19 cases have been reported in the Japanese literature. A case involving an early cancer, 10 mm in diameter, that was associated with liver metastasis is reported.

Cardia↗
PubMed1991

Early gastric cancer with juxta regional lymph node metastases.

During the 12 years from 1977 to 1988, a total of 425 cases of early gastric cancer (EGC) were treated by resection. Of these, 53 (13%) had lymph node metastases, occurring in 6 cases of mucosal cancer (m-cancer) and 47 cases of submucosal cancer (sm-cancer). Among the patients with positive lymph node metastases, 46 (87%) had metastases in the Group 1 perigastric regional nodes, and 8 (2%) had metastases in Group 2 lymph node. These data support the general view that lymph node metastasis occurs in only 2-5% of m-cancers and 15-20% of sm-cancers, and then mainly in Group 1 lymph nodes. A rare case of early cancer with Group 3 juxta regional lymph node metastasis (n3+) is described in this report with special attention to the surgical management and postoperative chemotherapy.

Female↗
PubMed1991

Gastric cancer invading the esophagus--improved management.

From 1978 to 1989, a total of 1272 patients with gastric cancer were admitted to Kurume University Hospital. Of these, 1184 (93%) underwent gastric resections. Of the resected cancers, 140 cases were gastric cancers invading the esophagus, as confirmed by postoperative pathological studies. For all 168 gastric cancers invading the esophagus, the resectability rate was 83% (140/168). These cancers were subdivided chronologically, with those during 1978-1983 included in Group 1 and those during 1984-1989 in Group 2. Group 2 patients were treated with a higher proportion of aggressive extended radical operations, such as combined resections of the diaphragm and lymph node dissections as far as the paraaortic lymph nodes (N4). The resectability rate was 76% in Group 1 and 93% in Group 2, due to the more aggressive operations. A lower esophagectomy with a total gastrectomy, mainly from a left thoracoabdominal approach, was performed for 71% of the patients in Group 1, and for 90% in Group 2. Lymph node metastasis was related to the extent of esophageal invasion and inversely related to the 5 year-survival rate. In all cases of esophageal invasion of less than 1 cm, there were no mediastinal lymph node metastases, and the 5 year-survival rate was 76%. On the other hand, when esophageal invasion was more than 4 cm, 50% had mediastinal lymph node metastases and the 5 year-survival rate was zero. The tumor size was also related to lymph node metastasis. When the maximal tumor length was less than 5 cm, a negative lymph node metastasis was found in 78% of cases, and the 5 year-survival rate was 76%.(ABSTRACT TRUNCATED AT 250 WORDS)

Esophageal Neoplasms↗
PubMed1991

Spontaneous portacaval shunts in patients with gastric cancer and hepatic cirrhosis.

Two rare cases of a spontaneous portacaval shunt occurring in patients with gastric cancer and hepatic cirrhosis are retrospectively reviewed with special attention for the operative indications and techniques. One patient underwent proximal gastrectomy for a IIa cancer in the C region with splenectomy and closure of the splenorenal shunt, and died two years and 3 months later due to hepatic failure. The other patient underwent distal gastrectomy for IIa + IIc, IIc double cancers in the M and A regions with splenectomy through an upper transverse abdominal incision that ligated and divided the paraumbilico-caval shunt, and is alive and well 1 year and 2 months, postoperatively. The ICG-R15 was markedly decreased and the K-ICG and ICG-Rmax were improved following the operation in both cases. The preoperative chronic encephalopathy and hyperammonemia disappeared postoperatively in both cases.

Fistula↗
PubMed1991

The effect of bile juice reflux on the development of remnant stomach carcinoma.

Experimental studies have revealed that duodenogastric reflux subsequent to gastrectomy was one of the most significant factors for the development of carcinoma in the remnant stomach. For this reason, the binding of carcinogenic agents to the nucleic acids in the gastric mucosa exposed to the duodenal contents were studied using an organ culture method. The intracellular DNA levels bound with carcinogenic agents were significantly increased in the mucosa of the remnant stomach, as compared to the parietal mucosa in the whole stomach. The remnant stomach may therefore provide an environment that enhances the development of cancer.

Bile Reflux↗
PubMed1991

Surgical management of adenocarcinoma in the gastric cardia.

From 1979 to 1988, a total of 1083 patients with gastric cancer underwent resection at Kurume University Hospital. Among these cancers, 183 (16.8%) were located in the upper third of the stomach. Of these, 56 (5.2%) were adenocarcinomas in the esophagogastric (E-G) junction. Cancer in this area was designated as cardia cancer when the focus of the cancer was macroscopically located within 2 cm of the E-G junction line and the tumor was less than 8 cm in diameter. The incidence of early gastric cancer in the cardia was only 13%, while the incidence for stage III advanced cancer was high at 46%, and the positive lymph node metastasis rate was 59%. Thirty-nine (70%) were cured by resection with a 5-year-survival rate of 64%, while for non-curative resection, this was only 10%. Twenty-two cases of either advanced cardia or advanced CE cancer underwent combined resection of the diaphragm. The rate of invisible metastasis to the diaphragm was 20% in our experimental study. The two year-survival rate for a combined resection of the diaphragm was 64%, while the rate for those who did not undergo a required combined resection was 42%.

Adenocarcinoma↗
PubMed1991

Occurrence of desmoid tumors following surgery for familial adenomatosis coli--report of two cases.

Twenty-five patients with adenomatosis coli were subjected to operations, and two in which desmoid tumors appeared after the operation on familial adenomatosis coli are described here. These patients were 26 and 37 year-old males. After the total colorectomy, each tumor was associated with soreness and was palpated in the lower abdominal wall, and operations were performed. The histological findings from the resected specimens, 12 cm and 34 cm in size, indicated desmoid tumors. Poliposis of the large intestine with desmoid tumors, as a complication, has been reported in 23 previous cases in Japan.

Adenomatous Polyposis Coli↗
PubMed1991

[Recent surgical treatment of thoracic esophageal carcinoma].

Nowadays, surgery for a thoracic esophageal carcinoma is accomplished safely, however, there still remain many problems concerning curative resection. Cancerous recurrences of the lymph node is still high against to lymph node dissection around thoracoabdominal region. Therefore, surgery should endeavour to prevent such lymphatic recurrences. In the patients with a carcinoma in the upper or middle third of the esophagus, who underwent extended radical esophagectomy, a significantly high incidence of metastasis in the recurrent nerve lymphatic chain was noted in comparison with that in patients with that in those who underwent standard radical resection. Complete resection of the recurrent nerve lymphatic chain is generally difficult through the thoracic approach alone, and such approach might be the factor causing the poor prognosis after standard radical surgery for an upper or middle thoracic esophageal carcinoma. Accordingly, extended radical surgery by the cervicothoracoabdominal approach can produced improved surgical curability for an upper or middle thoracic esophageal carcinoma. On the other hand, pulmonary complications are still a major postoperative complication following radical esophagectomy due to extended radical lymphadenectomy around the paratracheobronchial region. So, it is now clear that we should preserve the right bronchial artery and pulmonary nerves branched from the vagus nerve during the thoracic procedure, if these unaffected by cancerous invasion. Adopting this procedure resulted in a marked decrease in the incidence rate of postoperative severe pulmonary complications. Finally, in the near future we expect to develop criteria to select the best treatment for each specific individual based on preoperative studies of the biological characteristics of the carcinoma.

Esophageal Neoplasms↗