Mucoepidermoid carcinoma of the esophagus treated by endoscopic mucosal resection.

Mucoepidermoid carcinoma is a mixed cell tumor with both adenocarcinomatous and squamous components. We report a rare case of superficial mucoepidermoid carcinoma of the esophagus with mucosal gastric cancer. Endoscopic mucosal resection was performed on a 67-year-old man with a slight but defined depressed lesion of the thoracic esophagus and two lesions of mucosal gastric cancer. Histological examination revealed that the lesion of the esophagus was a mucoepidermoid carcinoma and the two lesions of the stomach were well-differentiated adenocarcinoma. Since the mucoepidermoid carcinoma had only slightly invaded the submucosal layer, it was thought to arise from the ductal epithelium of the esophageal gland or the stratified squamous epithelium of the esophagus. Radiation therapy with a total dose of 60 Gy was performed and there has been no recurrence or metastasis to other organs during 36 months of follow-up.

[Brain infarction related to hepatic arterial infusion chemotherapy].

We examined the occurrence of brain infarction with hepatic arterial infusion chemotherapy for liver cancer. One hundred and eighty-one cases of hepatic arterial infusion chemotherapy were carried out for liver cancer patients in 4 hospitals associated with Osaka University 2nd Dept. of Surgery. These included metastatic (n = 103) and primary (n = 78) liver tumors. The medication was mainly 5-FU with/without CDDP and IFN. Catheters were inserted via the left subclavian artery in 106 cases and via the femoral artery in 75 cases. Among these patients, brain infarctions occurred in seven patients. Occlusions were found in the cerebellum (n = 3), thalamus (n = 1), brain stem (n = 1) and TIA (n = 2). All these patients had catheterization from the left subclavian artery. Furthermore, 64 patients of Ikeda Municipal Hospital were examined and analyzed for brain infarction, in order to eliminate the difference between facilities (all patients in Ikeda Municipal Hospital were catheterized via the left subclavian artery). Many more brain infarctions occurred in metastatic liver cancer patients than in primary liver cancer patients. The hemostasis function deteriorated in primary liver cancer patients, and is thought to be involved in the brain infarction. Six of seven cases of brain infarction occurred in vertebral artery supply area. It may be that the occurrence of brain infarction was related to the flow of the blood vessels.

[Intra-arterial infusion therapy for unresectable liver metastasis of colorectal cancer].

Fifty-five colorectal carcinomas with metastatic liver tumor treated with intra-arterial 5-FU (> 5 g) infusion therapy at six hospitals were investigated retrospectively. The response rate reached 45%. The metastatic liver tumor from the rectum did not respond as well as that from the colon. Six patients could undergo liver resection and the infusion therapy was stopped in eleven patients due to a new extrahepatic lesion. The ratio of serum CEA levels of non-responders before infusion therapy and one month later was significantly higher and their survival period was shortened. This ratio indicated that this therapy could be continued.

Successful endoscopic resection of intramural metastasis after esophagectomy for esophageal cancer: a case report.

Carcinoma of the esophagus is often accompanied by intramural metastasis (IM) at the time of diagnosis, and the prognosis of patients with such metastasis is very poor. Here we report the case of a 60-year-old man who presented with a submucosal tumor in the wall of the cervical esophagus at 2 years after esophagectomy for thoracic esophageal cancer. The tumor was resected endoscopically and was histologically shown to be an IM of esophageal cancer. He has shown no recurrence and no metastasis during 2 years of follow-up after endoscopic resection and radiation therapy.

[Intraarterial infusion therapy for unresectable liver metastasis of colorectal cancer].

Forty-two colorectal carcinomas with metastatic liver tumor at four hospitals were investigated retrospectively. The number of patients in H factor 1, 2 and 3 were 8, 12 and 21, respectively. The diameter of the maximum liver tumor ranged from 10 to 160 mm (average 45 mm). The number of liver tumors were from 1 to 50 (average 7.3). The 6-, 12-, 18-, 24- and 32-month cumulative survival rates were 88, 67, 36, 24%, and 7%, respectively. The response rate reached 45%, and the survival period of the responder was significantly more prolonged than that of the unresponder (p = 0.04). No significant survival periods were recognized in terms of the method of injection, injected drug and the amounts of 5-FU. But the response rate of FP injection was best. Patients serum CEA levels at 1 or 3 months were decreased, and the survival periods were significantly longer than for increased patients. No significant difference was found among the side effects, the amounts of 5-FU, and the method of injection. The patients injected with MMC frequently suffered from G 2 or G 3 side effects.

Effective intra-arterial chemotherapy for acinar cell carcinoma of the pancreas.

A 41-year-old man with a huge pancreatic tumor (acinar cell carcinoma) was treated by intra-arterial infusion chemotherapy with 5-fluorouracil (5-FU), mitomycin C (MMC) and cisplatin (CDDP). The tumor was significantly reduced, and he underwent a pancreaticoduodenectomy with complete excision of the tumor. Unfortunately multiple metastatic liver tumors were noted 5 months after resection. These tumors could also be markedly reduced by intra-arterial chemotherapy and the survival period was prolonged to 18 months. He suddenly died of sepsis but not from the pancreatic carcinoma. This case shows that intra-arterial infusion chemotherapy with 5-FU, MMC and CDDP can be an effective regimen for the treatment of acinar cell carcinoma of the pancreas.

Successful treatment of an esophageal hemangioma by endoscopic injection sclerotherapy: report of a case.

We report herein the case of a 46-year-old man in whom an esophageal hemangioma was successfully treated by endoscopic injection sclerotherapy (EIS). The patient was admitted to hospital after a routine upper gastrointestinal series demonstrated a filling defect in the esophagus. Endoscopy, computed tomography (CT) images, and magnetic resonance imaging (MRI) subsequently revealed a hemangioma in the middle esophagus. EIS was performed using 99% ethanol and 1% polydocanol, and 4 weeks later, the tumor had almost disappeared. This patient has since been followed up carefully with periodic endoscopy and barium studies and additional sclerotherapy will be performed if necessary.

Electron spin resonance signals of non-heme iron as an indicator of ischemia-reperfusion injury of the liver.

Although many different methods have been proposed to assess the viability of preserved or reperfused liver, none of them are definitive. In this study, we investigated the usefulness of electron spin resonance (ESR) spectrometry in the rat liver ischemia model. Ischemia was induced in Wistar rats weighing 250-300 g by clamping the portal triad. At 15, 30, 60, or 90 min after the clamping, the liver was reperfused by removing the clamp. Liver specimens obtained before and after the clamping and also 30 min after reperfusion were frozen with liquid nitrogen and analyzed at 140K by ESR spectrometry. Two significant signals of g-values of 2.0 and 1.96 were observed with the fresh liver. The former was thought to be a mixture of CoQ, flavin, and succinate radicals. The intensity of this signal did not change throughout the experimental period. The latter was regarded as the signal from non-heme irons of mitochondria. The intensity of this signal decreased as the ischemic time became longer (the ratio to the signal intensity of the fresh liver was 0.69 +/- 0.19, 0.22 +/- 0.08, 0.20 +/- 0.05, and 0.18 +/- 0.09 at the end of 15, 30, 60, and 90 min of ischemia, respectively). After reperfusion, each ratio recovered to 0.95 +/- 0.12, 0.77 +/- 0.06, 0.56 +/- 0.15, and 0.37 +/- 0.20, respectively. This suggests that detectable signals with Fe(II)-Fe(III) decreased and became undetectable as the reduced form of non-heme irons under the anoxic state. Then, after reperfusion, the reduced form of non-heme irons decreased and the oxidized form increased. Incomplete recovery was thought to be due to decrease in the viability or function of liver cells. ATP and energy charge had the same tendency as the non-heme iron signal observed with ESR. There was a significant correlation between the non-heme iron signal and energy charge (y = 0.73x + 0.32, r = 0.78, P < 0.001), demonstrating that the signal intensity reflects the viability or function of liver cells. This study suggests that the signal from non-heme irons detected by ESR can be a good parameter of the metabolic state of the liver in ischemia and reperfusion. This method is simple and quick and should be applicable in clinical liver transplantation.

Protective effect of platelet-activating factor antagonist on ischemia-induced liver injury in rats.

Platelet-activating factor (PAF), one of the chemical mediators related to inflammation reaction, is also involved in the pathologic state induced by endotoxin or ischemia. PAF antagonist has been reported to block the action of PAF and protect cells from its deleterious effects. The effects of a PAF antagonist, CV-6209, were evaluated in this study by means of a partial liver ischemia model, in which ischemia was induced by clamping only part of the liver without causing intestinal congestion. This model allowed the study of ischemic liver injury without influence from other organs. After 30, 60, and 90 minutes of ischemia, the bile flow, ATP level, and energy charge of the ischemic lobes were compared for the effects with and without CV-6209. After 60 minutes of ischemia, those that had received CV-6209 showed more bile production and higher ATP level and energy charge, with values of 0.25 +/- 0.05 ml/hr, 3.9 +/- 0.9 nmol/mg dry liver weight, and 0.61 +/- 0.02, respectively. In contrast, the values for the control group were 0.05 +/- 0.05 ml/hr, 1.7 +/- 0.8 nmol/mg dry liver weight, and 0.43 +/- 0.08, respectively. Other liver function tests (aspartate aminotransferase and lactate dehydrogenase levels) could also be improved if an appropriate dose of PAF antagonist were administered. The results imply that PAF, as has been suggested in other studies on ischemic injury, plays a role in liver ischemia and that its deleterious effects can be blocked by PAF antagonist. We conclude that the PAF antagonist offers promise in the field of liver surgery, including liver transplantation, as a means of protecting the liver from ischemic injury.

[The relationship between postoperative prognosis and positivity of PIVKA-II in patients with hepatocellular carcinoma].

The relationship between postoperative prognosis and plasma level of PIVKA-II (Protein induced by vitamin K absence or antagonist-II) was studied in 56 patients with hepatocellular carcinoma. The survival rate was significantly lower in patients with positive PIVKA-II when compared with that with negative PIVKA-II. Similar results were also obtained in cases with tumor not less than 6cm in diameter (group A, 43 cases). In accordance with these results, the frequency of intrahepatic metastasis or portal tumor thrombus was significantly increased in PIVKA-II positive cases and thereby the macroscopic stage became more advanced although no significant difference was observed in curability. Tumor diameter and frequency of massive type were also increased in PIVKA-II positive patients and all of eight cases with massive type were PIVKA-II positive. Furthermore, all patients with massive type had both intrahepatic metastasis and portal tumor thrombus and their prognosis was extremely poor when compared with that with nodular type, in whom the survival rate was not different between PIVKA-II positive and negative cases. Thus, the poor prognosis of PIVKA-II positive patients might be due to the increased frequency of massive type although the cause-effect relationship remains to be elucidated.

[The efficacy of intra-arterial infusion chemotherapy in patients with metastatic liver tumors].

The efficacy of intra-arterial infusion chemotherapy for the treatment of liver metastasis was investigated in 28 colorectal cancer patients, 3 gastric cancer patients and 5 breast cancer patients between April 1986 and May 1991. 1. The long-term intra-arterial infusion chemotherapy was a simple and safe method in cancer patients. 2. We examined the serial serum CEA level in cancer patients and found that the serial change in CEA level correlated well with response to chemotherapy. The efficacy of this treatment was approximately 60% in colorectal cancer, 30% in gastric cancer, 80% in breast cancer. Intra-arterial infusion chemotherapy may be an effective treatment for the patients with liver metastasis from colorectal cancers and breast cancers. 3. In 8 colorectal cancer patients, the serum CEA level decrease to half of the pretreatment level. However, in all cases it increased significantly within 6 months postoperatively. Almost the same trend was observed in two cases of breast cancer. Our results suggest that we should give careful consideration to the resistance to anti-cancer drugs and develop a new protocol in order to obtain further satisfactory results.