Laparoscopic gastrotomy in intragastric surgery for early gastric cancer: a new technique.

Laparoscopic surgery has been widely applied not only in cholecystectomy but also in gastrointestinal operations. In previous reports the authors proposed their original operative technique, laparoscopic intragastric surgery (LIGS),' in which all trocars and surgical instruments are inserted directly into the gastric lumen to perform the resection of mucosal or' submucosal lesions of the stomach. The purpose of this article is to introduce laparoscopic gastrotomy as a new technique for removing early gastric cancer by LIGS.

[Comparative study of the combined effect of HCFU and dipyridamole (DP) in colorectal carcinoma--TS inhibition rate. Kinki Cooperative Study Group of Chemotherapy for Colorectal Carcinoma].

In the forty-seven medical centers in the Kinki district, a comparative trial was conducted to investigate the enhancement of the efficacy of HCEU due to dipyridamol (DP), which is a biochemical modulator in patients with colorectal cancer who have had a curative resection. The trial consisted of two comparative groups: one group (Group A) received HCFU only for five days before operation and for two years from the second week, and the other group (Group B) was given HCFU + DP for the same trial period as Group A. The total number of patients collected was 653 (Group A: 327 patients; Group B: 326 patients) during the two-year trial period from October, 1991. Thymidylate Synthetase (TS) activity in the primary lesions, which is an index of proximity effect, was measured, and the TS inhibition rate (TSIR) was calculated from the activities. The results showed that the TSIR in the primary lesions for the HCFU + DP group (Group B: 0.33) was significantly higher than that of the HCFU group (Group A: 0.27) (p = 0.0006). There was no increase in the side effects of HCFU due to combined administration with DP. From the above results, the therapy with HCFU + DP is expected to be useful for patients with colorectal cancer who have undergone curative resection.

[Treatment of patients with hepatoma and esophageal varices].

Fifty-nine patients with hepatoma associated with advanced esophageal varices who received a variety of therapeutic modalities in the past 10 years at our department were reviewed. Our therapeutic modalities are hepatic resection, hepatic artery ligation (HAL) and trans-arterial embolization (TAE) for those with hepatoma and non-shunting treatment (NST; esophageal transection or Hassab's procedure) and endoscopic sclerotherapy (ST) for those with esophageal varices. A patient selection was made by our own criterial developed by a multiple regression analysis for the hepatoma and KICG value for esophageal varices. Out of 59.16 underwent hepatic resection and NST. Eight survived more than 2 years. The longest survivor has been living for 4 yr and 4 months. Two-year survival rate is 69.8%. Another 16 underwent HAL and NST. Two-year survival was 14.6%. Another 7 underwent ST following hepatic resection or HAL. Five of the 7 received an emergency ST. Hemostasis was achieved in all of them. Two-year survival was 21.8%. The remaining 20 underwent ST and TAE; 13 received an emergency ST with 85% of hemostasis rate. None of them survived more than 2 years. From these data, it is suggested that a proper selection of patients for a proper therapeutic modality improves the prognosis even in those with hepatoma associated with advanced esophageal varices.

Endoscopic extraction of foreign bodies from the duodenum: four cases in infancy.

Four cases of foreign bodies in the duodenum were treated using a flexible fibre-optic panendoscope. All the patients were boys and eight months to four years of age. The ingested foreign materials were an injection needle, a marking pin, a hairpin and a curtain hook. Endoscopic extraction was attempted, because the ingested objects might cause perforation or obstruction of the gastrointestinal tract. Until recently, they had to be carefully watched or prophylactic operation suggested. Under general anaesthesia, duodenal endoscopy was easily performed and extraction of foreign bodies was not found to be difficult during infancy. This is considered to be a safer and less hazardous way than careful watching or prophylactic operation.

Thoracoscopic surgery combined with a supraclavicular approach for removing superior mediastinal tumor.

This report introduces our new technique of thoracoscopic surgery combined with a supraclavicular approach for removing superior mediastinal tumor. A 68-year-old woman noticed a tumor palpable in the left supraclavicular fossa. The patient had no pain around the neck and shoulder. A radio-opaque shadow 6 cm in diameter was detected in her left apical lung field on chest roentgenogram. Chest CT and MRI showed that the tumor was located in the superior mediastinum, extending up to the thoracic inlet, and there was no invasion of the surroundings. At first, a thoracoscopic examination was performed to assess the possibility of the excision. After dissecting the tumor from the mediastinal tissue and the first costovertebrae as far as possible by thoracoscopic surgery, a supraclavicular approach was used to enter the thoracic cavity. Complete resection of the tumor was successfully performed by thoracoscopic surgery combined with a supraclavicular approach. The tumor was removed in a plastic bag through the supraclavicular defect. Postoperative histopathology revealed that the tumor was a benign neurogenic one. A satisfactory follow-up of 5 postoperative days was observed without any complications, and the patient was discharged. The procedure was safe, easy, and minimally invasive to perform. Moreover, the supraclavicular approach could be used to add trocar port if needed.