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Esophageal liposarcoma is extremely rare, and only 13 cases have been reported so far. We herein report a case of this disease which was successfully treated and also include a literature review. A 68-year-old man visited our hospital due to progressive dysphasia. An esophagography revealed an exophytic mass in the cervical esophagus. On endoscopy, the tumor showed subepithehal growth with a positive cushion sign. MRI revealed the tumor to be composed of two components separated by a septum. The tumor was completely resected through an esophagotomy. The glossy tumor was found to be a pedunculated submucosal tumor, which was histologically found to be a myxoid liposarcoma. The patient had an uneventful postoperative course with a normal esophageal function. Because of the pedunculated configuration and the low-grade malignant nature of these tumors, a tumor resection with a negative surgical margin through an esophagotomy may be the most appropriate treatment in these cases.

PURPOSE: The aim of this study was to assess the efficacy and safety of combination chemotherapy with docetaxel and TS-1. PATIENTS AND METHODS: Five patients with advanced gastric cancer were treated with a combination chemotherapy regimen consisting of docetaxel and TS-1. All patients had undergone prior chemotherapy. Docetaxel at a dose of 30 mg/m^2 was intravenously administered on Day 1 and 8, and TS-1 at a dose of 80mg/m^2 /day was orally administered for 2 weeks followed by 1 drug-free week. RESULTS: Three of the 5 patients showed a partial response, of a response rate of 60%. Two of the 5 patients had stable diseases. One patient experienced grade 3 leukocytopeniia, grade 2 diarrhea and grade 2 alopecia. In the other patients, only low grade toxicities (grade 1 or 2 leukocytopenia, neutrocytopenia and anemia) were seen. CONCLUSION: The combination chemotherapy of docetaxel and TS-1 was found to be effective and well tolerable by advanced gastric cancer patients. This combination may be useful as a second-line chemotherapy., 論文

Since February 1999, we have employed a bilayer patch device (PROLENE Hernia System: PHS) for the treatment of adult groin hernia. The patch comprises three components: an underlay patch, an onlay patch and a cylindrical connector. The underlay patch is similar to that used in preperitoneal repair. The onlay patch is similar to that used in Lichtenstein repair, and the cylindrical connector is similar to the mesh plug. We studied a series of 192 patients with adult inguinal hernia treated surgically at our hospital. Patients were divided into three groups based on repair type. Thirty-eight PHS repairs were compared with 57 laparoscopic hernioplasties and 97 conventional hernioplasties, which were performed between January 1995 and December 1999. PHS repair was markedly superior to the conventional methods in terms of postoperative pain, ambulation and hospital stay. PHS repair was also advantageous over laparoscopic hernioplasty with regard to operation time, cost, anesthesia required and operative technique. With PHS, mean operation time was shortened, costs were relatively low, general anesthesia was not required, and the operative technique was quite easy. We believe that PHS repair will become a standard procedure for adult inguinal hernia repair., 論文

A case of mediastinal teratoma in a 5-year-old girl is herein reported. She presented with chest pain and an abnormal shadow on the chest X-ray findings. CT and MRI demonstrated a right anterior mediastinal cystic tumor measuring 5cm in diameter with areas of calcification, solid lesions and fatty tissue, and right pleural effusion. Tumor markers such as AFP, h-CG, and urinary VMA and HVA were all within the normal limits. Tumor involvement to the adjacent organs was suspected based on the diagnostic imaging findings before operation. Subsequently, we performed a right thoracotomy with a possible diagnosis of potentially malignant teratoma. Fortunately, the tumor was localized with inflammatory adhesions to the lung, aorta, and pericardium. The tumor was completely resected. The tumor was oval shaped and measured 5cm in size. On cut section, the tumor contained a small amount of brown fluid. The tumor was cystic with intracystic polypoid projections. Histologically, the tumor was composed of pancreatic tissue, gastrointestinal tissue, bone tissue and fatty tissue. It was finally diagnosed to be a benign, mature teratoma. The patient showed an uneventful postoperative course and is presently doing well with no evidence of recurrence. This case and other similar reported cases suggest that it is difficult to differentiate inflammatory adhesions from tumor infiltration to adjacent organs based on the diagnostic imaging findings alone., 論文

Case 1 (a 53-year-old man, postoperative status for hepatocellular carcinoma, follow-up of 1.5 years) developed anal pain on defecation. A barium enema showed a segmental stricture. Colonoscopy revealed a multinodular mass with no obvious ulcer 4 cm from the anal verge. Endoscopic ultrasonography showed a mucosal mass with a preserved layer structure of the rectal wall. A biopsy of the lesion showed the characteristic features of fibromuscular proliferation in the lamina propria. He underwent a colostomy because of rectal stricture. He remained asymptomatic after the colostomy. Case 2 (a 54-year-old man, postgastrectomy status for gastric carcinoma, follow-up of 10 months) presented with thin stool and rectal pain on defecation. A barium enema revealed a segmental stricutre. Colonoscopy showed a multipolypoid mass with no ulceration 5 cm from the anus. A pelvic CT scan showed a mucosal mass with a normal layer structure of the rectal wall. The bioptic findings were identical to those of Case 1. He also underwent a colostomy and showed a good recovery. The two above described patients were both misdiagnosed to have rectal carcinoma, especially linitis plastica on the colonoscopic appearances. A biopsy of the lesion may lead to an accurate diagnosis of mucosal prolapse syndrome. A colostomy is thus considered to be a useful alternative treatment as a temporary strategy for such patients., 論文

Colonovesical fistula is one of the serious complications of colonic diverticulitis. We herein report four cases of colonovesical fistula due to colonic diverticulitis. There were 2 men and 2 women. The mean age of the patients was 62.2 years (range, 50-76 years). The main clinical presentation included pneumaturia, fever, intractable cystitis and others. Barium enema study among diagnostic modalities was most sensitive to an accurate diagnosis. Operative procedures were sigmoidectomy with or without fistulectomy. There were no severe complications after surgery. Sigmoidovesical fistula due to colonic diverticulitis should be included in a differential diagnosis in patients with pneumaturia, intractable cystitis, fever and others. Sigmoidectomy may be a treatment of choice., 論文

The advanced pancreatic carcinoma of the uncus is accompanied by major vascular invasion, including the superior mesenteric vein (SMV) and the superior mesenteric artery (SMA). Surgical resection of such tumors is often abandoned due to the technical difficulty of vascular reconstruction. We herein present the case of an extended resection for advanced pancreatic carcinoma with invasion to both the SMV and SMA, which was performed by a two-step passive bypass of the portal flow using the Anthron bypass tube (VTT type). A 56-year-old male presenting with complaints of abdominal fullness and pain, was diagnosed to have a pancreatic tumor of the uncus. He was thus referred to our department for surgical treatment on January 24, 1997. Abdominal ultrasonography showed a mass at the pancreatic uncus. Enhanced computed tomography revealed an irregular high density area around the low density tumor. Angiography of the SMA showed an encasement of the arterial wall and the portal phase showed extensive invasion of the tumor to the SMV at its bifurcation of the gastro-colic trunk, iliac vein, and jejunal vein. Markedly developed collateral vessels of the marginal colic vein were also obvious. At laparotomy on Feb. 4, 1997, a tumor involving both the SMV and SMA was found to be located at the uncus of the pancreas, without any peritoneal dissemination, liver metastasis or lymph node swelling, which led us to perform a local resection of the tumor. To avoid intestinal congestion during the operation, apassive bypass of the portal flow to the umbilical vein was established in a two-step manner in addition to the normal operative procedures : first to the middle colic vein and then to the SMV. The tumor was successfully resected by a combined resection of the SMV, which was reconstructed by an interposition of the common iliac venous graft, while the tumor, which extended toward the left side beyond the SMA, was separately resected, after a routine pancreatoduodenectomy of the right side of the tumor. Intra-operative radiation to the retroperitoneal neural plexus was also performed after the resection. In conclusion, the above described surgical procedures may be useful as a new strategy for the resection of pancreatic cancer of the uncus., 論文

Inflammatory fibroid polyps (IFPs) of the small intestine are relatively rare. We report a case of IFP of the ileum presenting with intussusception, and we review the pertinent literatures. A 39-year-old woman was admitted to our hospital because of intermittent abdominal pain and vomiting. Abdominal ultrasonography and computed tomography revealed small bowel obstruction due to intussusception. An emergency laparotomy was performed because of signs of impending acute intestinal obstruction. At surgery, ileo-colic intussusception caused by an ileal polyp was found. A partial resection of the ileum including the polyp was carried out. Pathological diagnosis of the polyp was IFP. IFP should be included in the differential diagnosis of adult intussusception. IFPs have no malignant potential, and surgical resection is curative.