Esophago-pleuro-cutaneous fistula. A case report

In a sixty-three year old Japanese man with a history of long standing pulmonary tuberculosis, an unusual esophago-cutaneous fistula developed. The possibility of esophago-pleuro-cutaneous fistula was considered, because there was an old tuberculosis causing lung abscess of hilar lymph node adenopathy and which facilitated development of an extensive fistulous tract. The patient was effectively treated by palliative surgical procedure. This may be the first report of a benign esophago-pleuro-cutaneous fistula.

Studies on anticancer treatment with an oily anticancer drug injected into the ligated feeding hepatic artery for liver cancer

In six adult patients with nonresectable liver cancer, as well as in mature New Zealand white rabbits with implanted VX2 carcinoma in the liver, the artery feeding the hepatic lobe with the malignant lesion was ligated, and an oily contrast medium (Lipiodol Ultra-Fluid) was injected into the hepatoproximal lumen of the ligated artery of the liver with carcinoma. The oily contrast medium was detected in all the branches of the artery injected, and thereafter was found only in tumor tissue for 7 days experimentally and for 16 months clinically. Taking advantage of this phenomenon, the therapeutic effect of the injection of an oily anticancer drug (bleomycin oil suspension) into the hepatoproximal lumen of the ligated hepatic artery was investigated in rabbits with VX2 carcinoma of the liver. The mean concentration level of bleomycin in the tumor tissue was 2.4 +/- 0.4 microgram/g 1 week after the injection of bleomycin oil suspension (1.5 mg potency/kg) in three rabbits. However, its concentration level in nontumorous tissue of the liver was undetectably low in two rabbits, but 0.6 microgram/g in the third rabbit. The group of rabbits receiving an injection of bleomycin oil suspension into the ligated artery had a significantly longer mean survival time than those of the experimental group receiving an injection of saline solution of bleomycin into the ligated artery as well as the three other groups treated (P less than 0.02, N = 5 for each group). It may be concluded that an oily anticancer drug injected into the hepatoproximal lumen of the ligated hepatic artery can intensify the anticancer effects of a ligation of the hepatic artery for liver cancer.

Studies on anticancer treatment with an oily anticancer drug injected into the ligated feeding hepatic artery for liver cancer

In six adult patients with nonresectable liver cancer, as well as in mature New Zealand white rabbits with implanted VX2 carcinoma in the liver, the artery feeding the hepatic lobe with the malignant lesion was ligated, and an oily contrast medium (Lipiodol Ultra-Fluid) was injected into the hepatoproximal lumen of the ligated artery of the liver with carcinoma. The oily contrast medium was detected in all the branches of the artery injected, and thereafter was found only in tumor tissue for 7 days experimentally and for 16 months clinically. Taking advantage of this phenomenon, the therapeutic effect of the injection of an oily anticancer drug (bleomycin oil suspension) into the hepatoproximal lumen of the ligated hepatic artery was investigated in rabbits with VX2 carcinoma of the liver. The mean concentration level of bleomycin in the tumor tissue was 2.4 +/- 0.4 microgram/g 1 week after the injection of bleomycin oil suspension (1.5 mg potency/kg) in three rabbits. However, its concentration level in nontumorous tissue of the liver was undetectably low in two rabbits, but 0.6 microgram/g in the third rabbit. The group of rabbits receiving an injection of bleomycin oil suspension into the ligated artery had a significantly longer mean survival time than those of the experimental group receiving an injection of saline solution of bleomycin into the ligated artery as well as the three other groups treated (P less than 0.02, N = 5 for each group). It may be concluded that an oily anticancer drug injected into the hepatoproximal lumen of the ligated hepatic artery can intensify the anticancer effects of a ligation of the hepatic artery for liver cancer.

Effect of arterial administration of high-molecular-weight anticancer agent SMANCS with lipid lymphographic agent on hepatoma: a preliminary report

A clinical evaluation of arterial infusion of high-molecular-weight antitumor agent SMANCS dissolved in lipid lymphographic agent (thiodol) in 44 patients with mostly unresectable hepatoma is described. The treatment regimen demonstrated significant merits both therapeutically and diagnostically. Marked antitumor effects were shown in the decreased serum alpha-fetoprotein levels (86% of cases) and tumor size (95% of cases), and in survival period and histological findings. Furthermore, there was increased diagnostic sensitivity using CT scan, plain X-rays or ultrasound. The procedure of selective arterial administration of 3-4 mg of SMANCS in 3-4 ml of ethiodol per dose was simple to perform and was required only once every 3-4 weeks. Both ethiodol and the drug accumulated more selectively in tumor than in any other tissues and their activity remained for more than 3 weeks. Only minimal side-effects were associated with SMANCS and ethiodol during this study.

[Intra-arterial injection of an oily antineoplastic agent in hepatic cancer]

A lymphographic agent, Ethiodol, injected via the hepatic artery was found to remain selectively in the tumor vessels of hepatoma for a long time in our clinic. Taking advantage of this selective continuous peripheral embolization, a lipophilic high molecular anticancer agent, SMANCS (Copolymer of styrene maleic acid conjugated to Neocarzinostatin) dissolved in Ethiodol was administered via the celiac axis or the hepatic artery with Seldinger's method. Anticancer effect was examined by histological findings of specimens removed using hepatic resection (13 cases) and autopsy (1 case) in 14 patients receiving this treatment. Anticancer effect of this treatment became clear through histological findings. In the patients administered SMANCS more than 0.26 mg per 1 cm2 of maximum cut-surface area, complete or widespread necrosis of the tumor occurred, whereas non-cancerous liver tissue remained unaffected.

[Use of a lipid lymphographic agent, lipiodol, as a carrier of high molecular weight antitumor agent, smancs, for hepatocellular carcinoma]

Two advantages of the present therapeutic approach were described. Firstly, a selective deposition of lipiodol in tumor tissue was verified, thus more precise and accurate diagnosis by X-rays was possible either by CT or plain X-ray film. Secondly, pronounced accumulation of smancs in tumor tissue was observed, which established highly effective chemotherapy of unresectable hepatoma of 22 cases and 12 other cases based on (a) decrease in alpha-fetoprotein (86%), (b) tumor size (95%) and histology. Drug was given via the hepatic artery mostly 3-4 mg in 3-4 ml of lipiodol once every 3 to 4 weeks. Most patients have experienced a total dose of 6-8 mg in two cycles, but drug activity lasted more than 3 weeks. Neither hematosuppression nor anaphylaxis was observed. Major side effect was transient fever (38-39 degrees C) in about 50% of the cases which lasted no more than one week. Other minor side effect was abdominal pain during or after arterial infusion which lasted for about 20 min. Liver function was affected very slightly if any. Mild leukocytosis was observed in 65% of the patients.

Treatment of carcinoma of the gallbladder in Japan

Clinical records of 2567 patients (1717 female and 850 male) with primary carcinoma of the gallbladder in Japan, during the past 19 years, were collected by questionnaires sent out to the main 100 surgical institutes in Japan. Eighty-seven per cent of the patients were over fifty years of age. Gallstones were found in 58.8% of 1496 patients. About 50% of the patients with gallstones had cholesterol group stones. Of the 2269 patients who underwent surgical interventions, radical operations were performed in 467 patients (20.6%). Of the 467 patients, a correct preoperative diagnosis was made in only 77 patients (16.3%). Patients in Nevin's Stages I and II, whose lesions had been confined to the muscle layer, showed a good survival rate with only simple cholecystectomy or extended cholecystectomy, while the patients in Stages III, IV and V, whose lesions had spread beyond the muscle layer, showed poor results even with more aggressive surgical approaches. The poor prognosis of the lesions in Stages III, IV and V might be due to inappropriate aggressive procedures. For the lesions involving all the layers of the gallbladder wall, radical resection, such as extended cholecystectomy plus pancreatoduodenectomy, or extended right lobectomy plus pancreatoduodenectomy, might be recommended.

Simultaneous occurrence of renal cell adenocarcinoma and urothelial carcinoma of the renal pelvis in the same kidney diagnosed by preoperative angiography

An unusual case of dissimilar histologic neoplasms in the same kidney is presented. An 86-year-old man had renal cell carcinoma and urothelial carcinoma in the same kidney eight years after therapy for urinary bladder carcinoma. These two different types of neoplasms were identified preoperatively by angiography. A peculiar hamartoma was also found in the same kidney.

A non-resectable hepatoma after hepatic artery ligation combined with infusion chemotherapy--an eight-year survival

A 69-year-old man with a large hepatoma of the right lobe extending in part to the medial segment of the left lobe was treated by ligation of the right hepatic artery combined with continuous infusion of a total dose of 5500 mg og 5-fluorouracil (5-FU) into the left hepatic artery. Postoperative celiac arteriogram and liver scintigram revealed a marked regression of the tumor size. After four weeks he was discharged in a satisfactory condition. Seven years and two months after the initial treatment he was readmitted because of a concomitant cancer of the cardia. Total gastrectomy was performed with a favorable result. A second look for the previous hepatic tumor during total gastrectomy revealed a fibrous tissue containing scattered nodules of hepatocellular carcinoma on the right lateral surface of the liver instead of the previous large tumor in the right hepatic lobe. He survived for eight ears after the first operation.

Gastric gland metaplasia after jejunoileal by-pass surgery for morbid obesity

A 56-year female is described who developed recurrent oxalate nephrolithiasis six years following jejunoileal by-pass surgery for morbid obesity. Subsequently a revision of the jejunoileal by-pass was performed when it was recognized that the site of the anastomosis showed segmental dilatation proximal to the anastomosis. A unique microscopic finding was true gastric gland metaplasia consisting of parietal cells and mucus neck cells in the ileal mucosa of the resected specimen.

Gastric gland metaplasia in the small and large intestine

Fifty-six surgical specimens with various ulcerative intestinal disorders were microscopically investigated for evidence of gastric gland metaplasia. Thiry-one specimens (55-4%) showed pyloric gland metaplasia. Among the 31 patients with pyloric gland metaplasia, five showed true gastric metaplasia, consisting of parietal cells, chief cells, and mucous neck cells. The percentage of true gastric metaplasia among pyloric gland metaplasia was as high as 16%, an overall frequency of 9% among various ulcerative intestinal disorders. The mechanism of pyloric gland metaplasia and true gastric metaplasia is not understood, but may occur secondary to submucosal response to ulcer healing and subsequent alteration of the intraluminal condition in the intestine.

Effects of hexamethonium and other ganglionic blocking agents on electrical activity of the esophagus induced by vagal stimulation in the dog

Electrical activity of the dog's esophagus was evoked by electrical stimulation of the vagus nerve and recorded by using a suction electrode placed on the serosal surface of the esophagus. Neuromuscular blocking agents (d-tubocurarine and succinylcholine) blocked this activity, while atropine had no effect. Hexamethonium (in doses which did not effect neuromuscular transmission in the diaphragm) and high doses of nicotine significantly depressed the evoked esophageal electrical activity, while lower doses of nicotine facilitated the response. The results suggest that a certain proportion of the striated muscle of the esophagus is innervated by processes from the intermediate ganglion cells in the Auerbach plexus.