Stage IVS neuroblastoma

This is a review of the findings in 10 cases of stage IVS neuroblastoma, that have been observed in the First Surgical Department of Hokkaido University Hospital. The patients under the age of 1 yr in stage IVS neuroblastoma have a favorable prognosis; the survival rate was 70%. The regressions were histologically confirmed as maturation of the neuroblastoma cells to ganglioma cells. The lymphocyte counts and T-cell function were well maintained in the surviving patients but both were markedly reduced in the patients who later died. The treatment should be conservative so that immune mechanisms are not inhibited and should be withheld until respiratory failure or progressive signs toward stage IV are identified.

Thyroid cancer in childhood

Thyroid cancer in childhood is a relatively rare condition. Often it shows biological characteristics different from those seen in adults. Based upon 10 cases in our clinic and 57 cases collected from the Japanese literatures, clinical features, pathology, treatment and prognosis of thyroid cancer in childhood are discussed. Pathogenesis is most likely to be related to hormonal changes during adolescence and previous radiation of the neck region. Cervical lymph nodes swelling was the chief complaint in 84.6 per cent of the cases. On the other hand, pulmonary metastases were recognized in the early stages in 33.5 per cent of the cases. Radical excision of the tumor with modified radical neck dissection is the treatment most frequently employed even in the presence of lung metastases. However, hypoparathyroidism and recurrent nerve injuries should be avoided at all cost in view of long life expectancy and the difficulty in treating them satisfactorily. Prognosis could be as good for children as it is for adults except in cases with early lung metastases.

Operative treatment of alveolar echinococcosis of the liver

This study is based on the experience with 51 cases of hepatic alveolar echinococcosis underwent operative treatment up to the end of 1976. Hepatic resection was carried out in 28 cases with overall operative mortality of 25 per cent, but no death occurred in the last 10 years period during which 12 cases were subjected to the procedure. This apparent improvement of the result is ascribed to the establishment of the strict criteria for operative intervention, i.e., when less than three segments are involved, the hepatic hilum is not highly involved, and the inferior vena cava is not invaded. Marsupialization is employed when hepatic resection is not indicated and the lesion shows liquefaction. Ten cases underwent the procedure with one operative death. Biliary tract reconstruction was carried out in two cases with hilar involvement, but the prognosis was poor. Eleven cases were only with celiotomy. The follow-up studies indicated that the hepatic resection offers the best hope for cure followed by marsupialization. Unlike unilocular echinococcosis in which a cyst grows expansively, the alveolar echinococcosis should be considered clinically malignant, in that it grows invasively and often shows metastatic lesions. Surgical intervention at its early developmental stage is the only definitive way of the treatment. Only recent advances in diagnostic procedures and development of type specific serological studies made it possible to bring the disease under control.

Carcinoma arising in the cyst of the liver--report of three cases--

A generally recognized concept dictates that surgical intervention for non-parasitic cysts of the liver is mostly palliative such as aspiration of the content, suture and closure, internal or external drainage, marsupialization, and unroofing of the cyst, while total excision of the entire cyst, which sometimes necessitates hepatic resection, is not usually recommended.3, 6, 9 The results of these lesser procedures have been acceptable, favoring those conservative procedures. This paper presents three cases with carcinoma arising in the cysts of the liver. Review of the present cases with five comparable cases appearing in the literature revealed that young female population and left lobe of the liver are frequently involved. Hence the general trend for palliative procedures should be reassessed. Possible malignancy should be considered when a patient belongs to this category, the cystic content is not clear, or the cystic wall presents irregular texture with nodules. The carcinomatous changes would have been of higher incidence than reported if the entire cysts had been more carefully examined.

[Clinical and pathological considerations of Plummer's disease (author's transl)]

Four cases of Plummer's disease were experienced and its clinical and pathological characteristics were considered. Clinically, three cases were thyrotoxic or slightly toxic, but one was non-toxic. Thyroid scintigrams showed hot nodules which revealed autonomic production of thyroid hormone, and the depleted uptake of 131I in the thyroid glands around the nodules was recovered to normal after the surgical extripation of the nodules. Histologic findings of the extripated nodules were follicular adenoma or adenomatous goitor. On electron-microscopy, epithelial cells of the thyroid follicules in the nodules from all cases contained numerous secretory granules significantly increased in number, while development of the general cytoplasmic organelles varied from case to case. Capillaries in the nodules were fenestrated. Thus, the nodules were electron-microscopically revealed active secretion of thyroid hormone. The electron-microscopical examinations may be useful in the study of Plummer's disease.

Free groin skin flaps

The operative technique of free groin flap transfer is described and some typical results presented. The overall complete success rate in 47 cases was 80 per cent, but complete necrosis only occurred in II per cent of the transferred flaps.