記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND/AIM: The impact of clinical response to taxanes plus ramucirumab (RAM) on overall survival (OS) has not been clarified for advanced gastric cancer (AGC), although this type of therapy is already in use as second-line chemotherapy (CTx). This study aimed to investigate the prognostic impact of the clinical response to taxanes plus ramucirumab (RAM) for AGC patients. PATIENTS AND METHODS: This study included AGC patients treated with paclitaxel (PTX) or nab-paclitaxel (nab-PTX) and RAM. A retrospective analysis of response and survival rates in consecutive medical records of patients was performed. RESULTS: Forty-two patients were enrolled. Median progression-free survival and OS were 5.4 months [95% confidence interval (CI)=4.440-6.361] and 11.8 months (95% CI=8.648-15.019), respectively. In Cox-hazard multivariate analysis, peritoneal metastasis [hazard ratio (HR)=2.830; 95% CI=1.320-6.067; p=0.008], and disease control rate (HR=0.310; 95% CI=0.129-0.741; p=0.008) were independent factors. CONCLUSION: The response to taxanes plus RAM CTx had an impact on the survival of patients with AGC.

DOI： 10.21873/anticanres.15634

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記述言語：日本語   出版者・発行元：(有)科学評論社  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Histiocytic sarcoma is a relatively new disease category and the gastrointestinal origin is sporadic. We report a case of a 74-year-old woman who underwent chemotherapy and proximal gastrectomy for extremely rare, advanced gastric histiocytic sarcoma. The resected specimen was subjected to numerous immunostainings to meet the diagnostic criteria of histiocytic sarcoma and was positive for the histiocyte markers’ cluster of differentiation 68 and lysozyme. The markers of Langerhans cells, follicular dendritic cells, and myelocyte were all negative. Six reports of surgical resection of histiocytic sarcoma originating in the stomach exist, including our case. We reviewed the clinical course and the histological and immunohistochemical diagnostic features of surgically resected gastric histiocytic sarcoma.

DOI： 10.1007/s12328-021-01438-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Chylous ascites associated with radical resection of gastric cancer is a serious clinical condition. Lymph node dissection is indispensable during gastrectomy for gastric cancer. However, postoperative chylous ascites prolongs the hospital stay and re-operation. There are few reports on this subject. Most cases of chylous ascites resolve without treatment, but the condition can result in substantial morbidity. The definition of chylous ascites is ambiguous and varies in the English literature. In this report, we discuss a case of chylous ascites in a 68-year-old man who underwent distal gastrectomy for early gastric cancer at our hospital. He was admitted 8 months after surgery with a main complaint of abdominal swelling. Abdominal puncture helped to diagnose chylous ascites with marked elevation of triglyceride level. The patient received a hypercaloric infusion through a central line, and octreotide acetate, but did not improve. After assessment of lymph outflow by lymph scintigraphy, surgical ligation of the lymph vessels was performed through laparotomy. The volume of milky-white ascites in the abdominal cavity was 3,000 mL. Macroscopically, the fluid was confirmed as flowing from behind the common hepatic artery. Thus, ligation was performed. Chylous ascites has not recurred at 12 months after the re-operation. In summary, a case of chylous ascites after radical gastrectomy for gastric cancer was successfully treated by surgery. We review and discuss the relevant literature.

DOI： 10.1272/jnms.JNMS.2021_88-310

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Reports of gastric collision tumors, comprising adenocarcinoma and gastrointestinal stromal tumor, are extremely rare. Here, we report the case of a 68-year-old male who was diagnosed with a lower-body, moderately differentiated, tubular-type adenocarcinoma and submucosal tumor and underwent an elective D2 distal gastrectomy. The tumor cells of the gastrointestinal stromal tumor were positive for H-caldesmon and CD117, weakly positive for smooth muscle actin and DOG-1, and negative for desmin, S-100 protein, CD31, and AE1/AE3. The tumor had grown into a mixed form of adenocarcinoma and gastrointestinal stromal tumor. Thus, we report the first case of a preoperatively diagnosed collision tumor in the stomach consisting of adenocarcinoma and gastrointestinal stromal tumor.

DOI： 10.1007/s12328-021-01343-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Diaphragmatic eventration in an adult patient is a rare condition. We describe a case of an elderly patient with hemidiaphragm dysfunction caused due to chronic constipation. A 67-year-old woman with a medical history of descending colon cancer that was treated 24 years before undergoing partial colectomy was admitted to our hospital with complaints of progressive shortness of breath and dyspnea on exertion for the past few months. She had no past history of any trauma. The patient had previously been suffering from chronic constipation after surgery. Physical examination revealed distension and incisional hernia of the abdomen. Chest X-ray demonstrated the high position of the left dome of the diaphragm with the megacolon gas. Chest and abdominal computed tomographic scans disclosed left diaphragmatic displacement containing the stomach and megacolon and abdominal incisional hernia. We performed open laparotomy, repair of abdominal incisional hernia using mesh, and diaphragmatic plication with nonabsorbable polyester suture and pledgets. Postoperative imaging confirmed the significant improvement of the patient's left lung space and clinical resolution of her respiratory symptoms. We describe the case of a patient with diaphragmatic eventration that was caused due to chronic constipation who underwent successful surgical repair.

DOI： 10.1007/s12328-020-01316-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

An 82-year-old Japanese man with alcoholic liver cirrhosis was referred to our hospital for treatment of advanced esophageal cancer. A protruding tumor was endoscopically observed in the middle thoracic esophagus, and pathological findings of the biopsy specimens revealed a squamous cell carcinoma. The clinical tumor staging was stage II (T3N0M0). The patient received two courses of neoadjuvant chemotherapy with 5-fluorouracil and nedaplatin. After the treatments, computed tomography showed significant reductions in the size of the target tumor. However, radical esophagectomy was not performed because the patient refused major invasive treatments. Instead, endoscopic resection was performed using a combination of polypectomy and endoscopic submucosal resection (ESD). To prevent bleeding during endoscopic treatment, we applied a detachable snare to the base of the tumor and cut the stalk using by an SB knife Jr, without hemorrhage. The pathohistology of the resected specimen was positively showed cancer cells on the margin of the esophageal carcinoma stalk. At 4 weeks after the initial operation, an additional ESD was successfully performed, which pathologically led to radical removal. The patient survived for more than 18 months after beginning the initial treatment. We describe a successful treatment using endoscopic resection after chemotherapy for advanced esophageal cancer with high surgical treatment risks.

DOI： 10.1007/s12328-020-01214-4

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

症例は60歳代男性で、4年前に下咽頭癌に対し咽喉頭頸部食道摘出術+両側頸部郭清+甲状腺右葉切除術+遊離空腸再建術を行い、病理診断はSquamous cell carcinoma(SCC)、pT2N2bM0 pStage IVbで外来経過観察中であった。上部消化管内視鏡(EGD)で上切歯列(DL)27cmの食道内に0-IIb病変を認め、内視鏡的粘膜下層剥離術(ESD)を施行し化学放射線療法を追加した。7年後のEGDにてDL35cmの食道内に粘膜下層進展病変を認め、生検にてSCC、cT1bN0M0、cStage Iの診断で、光線力学療法(PDT)を施行した。PDT治療後、照射部位にバルーン拡張を要し、さらに経過観察中2回の食道表在性新規病変を認め各々ESDを施行し、病理結果はいずれもSCC、pT1a-LPM、ly0、v0、pHM0、pVM0、pCur Aであった。初回の食道癌治療から10年経過現在、胸部・腹部CTにて再発やリンパ節転移、遠隔転移を認めることなく経過観察中である。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J04450&link_issn=&doc_id=20201225120009&doc_link_id=%2Fdw9poden%2F2020%2F009701%2F022%2F0061-0062%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdw9poden%2F2020%2F009701%2F022%2F0061-0062%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Primary racemose hemangioma of the bronchial artery is a rare congenital disease that is occasionally complicated by aneurysms. An asymptomatic 78-year-old man was referred to our hospital with an esophageal submucosal tumor that was endoscopically found in the upper thoracic esophagus in a health check-up. Physical examination findings were unremarkable. Contrast-enhanced chest computed tomography with three-dimensional image reconstruction and selective bronchial arteriography resulted in a definitive diagnosis of primary racemose hemangiomas of the bronchial arteries accompanied by left bronchial artery aneurysm. Because rupture of a bronchial artery aneurysm can cause critical life-threatening hemorrhage, bronchial arterial embolization using coils and a mixture of N-butyl-2-cyanoacrylate and iodized oil was thus performed for bronchial artery aneurysm. Postoperative course was uneventful, and the patient was discharged on the third postoperative day. Computed tomography performed after 6 months revealed no enhancement of the aneurysms. In conclusion, we report a case of an asymptomatic primary racemose hemangioma of the bronchial artery accompanied by an aneurysm that mimicked a submucosal esophageal tumor. We also reviewed other Japanese case of primary racemose hemangioma of the bronchial artery accompanied by aneurysm based on the literature.

DOI： 10.1007/s12328-020-01172-x

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: A Bochdalek hernia (BH) is a congenital defect of the diaphragm that generally presents in the newborn as life-threatening cardiorespiratory distress. In contrast, the diagnosis of a BH in adults is rare. Surgical repair for adult BH is recommended, but the optimal surgical method remains unclear. CASE PRESENTATION: A 75-year-old woman presented with progressive dyspnea and back pain, and a diagnosis of BH was made based on chest X-ray and computed tomography. Laparoscopic evaluation revealed a defect in the left posterior attachment of the diaphragm, and a left-sided BH without hernia sac was diagnosed. Parts of the stomach, small intestine, colon, pancreas, and spleen had prolapsed into the left thoracic cavity, without ischemic change, and these herniated organs were reduced to the abdominal cavity. A direct closure of the hernia orifice was possible by the laparoscopic suture technique using a mesh reinforcement. The patient made an uneventful recovery, and no recurrence was found in the 2-year follow-up. CONCLUSION: A recently published study reviewing detailed cases of repair of adult BH from 1999 to 2019 identified 96 cases, including the present case. The number of reports on laparoscopic and/or thoracoscopic surgery for BH in adults has recently increased, and the approach for repairing BH should be selected carefully on a case-by-case basis.

DOI： 10.1186/s40792-020-01003-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Solitary pulmonary metastasis from esophageal basaloid squamous cell carcinoma (BSCC) components is an extremely rare recurrence of esophageal squamous cell carcinoma (SCC). CASE PRESENTATION: A 68-year-old Japanese woman was found to have a suspected malignant mass, approximately 2 cm in diameter, in her left lower pulmonary lobe, at 66 months after undergoing a curative esophagectomy with three-field lymph node dissection for esophageal SCC with a focal basaloid component. After a CT-guided biopsy, pathological examination indicated a metastasis from esophageal BSCC components. She underwent a thoracoscopic partial resection of the left lower pulmonary lobe for the solitary pulmonary metastasis. The pathohistology of the resected specimen led to diagnosis of metastatic esophageal BSCC, which showed immunohistochemical findings similar to those of the primary esophageal carcinoma. The patient received two courses of adjuvant chemotherapy (5-fluorouracil, docetaxel plus nedaplatin) and recovered to resume a normal life with maintenance therapy. However, multiple lung and brain metastases were diagnosed at 2 years after the pulmonary metastasectomy. She survived 5 years and 6 months after the pulmonary metastasectomy, but died at 10 years and 6 months after her initial esophagectomy. CONCLUSION: This was a rare surgical resected case of solitary pulmonary metastasis from esophageal BSCC components.

DOI： 10.1186/s40792-020-00957-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Pyogenic spondylodiscitis is an extremely rare complication of esophagectomy for esophageal cancer. CASE PRESENTATION: A 70-year-old Japanese man, with a previous medical history of type 2 diabetes mellitus, coronary artery disease, and laryngeal cancer, received neoadjuvant chemotherapy and underwent thoracoscopic esophagectomy with gastric tube reconstruction for advanced esophageal cancer. Cervical esophagogastrostomy with circular-stapled end-to-side anastomosis was performed. However, partial necrosis in the gastric tube developed to form refractory anastomotic fistula. Two months after the initial surgery, debridement and free jejunal transfer reconstruction with the pectoralis major muscle flap were performed. Although the postoperative course of the second surgery was uneventful, the patient complained of severe lower back pain and fever. The patient was diagnosed with pyogenic spondylodiscitis according to the results of the magnetic resonance imaging. Enterobacter cloacae were isolated from the arterial blood culture. Sensitive antibiotics were administered continuously, and the patient required to use a lumbar corset for 2 months. Subsequently, his physiological signs and symptoms had completely disappeared. CONCLUSION: To the best of our knowledge, this case study is the first study that reported pyogenic spondylodiscitis of the lumbar spine, a complication of cervical anastomotic fistula after surgery for advanced esophageal cancer.

DOI： 10.1186/s40792-020-00922-w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Correctly distinguishing metastasis and sarcoid-like reaction in patients with mediastinal lymphadenopathy is clinically important in esophageal cancer. A patient was a 52-year-old Japanese woman with superficial esophageal squamous cell carcinoma and rare case of sarcoid-like reaction. The patient was admitted with pharyngeal discomfort and an upper gastrointestinal endoscopy detected a superficial tumor in the middle thoracic esophagus. Biopsy confirmed a diagnosis of squamous cell carcinoma. Chest computed tomography (CT) showed enlarged lymph nodes around the trachea and in the bilateral hilum of the lung that were found to accumulate label on positron emission tomography CT. One course of chemotherapy in 5-fluorouracil, docetaxel and cisplatin did not affect the lymphadenopathy, which suggested that it was reactive rather than metastatic. The patient had undergone thoracoscopic esophagectomy with lymph node dissection. The pathohistology of the dissected lymph nodes showed noncaseating epithelioid-cell granuloma and no malignant cells. No clinical findings indicative of systemic sarcoidosis were observed, leading to a diagnosis of sarcoid-like reaction with the esophageal cancer. The patient has survived without recurrence for 4 years after beginning the initial treatment. Monitoring the response to chemotherapy may be helpful in distinguishing between metastasis and sarcoidosis-associated lymphadenopathy in esophageal cancer.

DOI： 10.1007/s12328-020-01156-x

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記述言語：日本語   出版者・発行元：(株)へるす出版  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

症例は80歳,女性.胸部痛,嚥下困難を主訴に来院.上部消化管内視鏡で胸部上部から中部に隆起性腫瘍を認め,生検の病理組織検査で食道類基底細胞癌と診断された.胸部CTで,全周性の食道壁肥厚と腫瘍部近傍のリンパ節腫大を認め,cT3N1M0,cStageIIIと診断した.術前5-FU(600mg/m2,day1-5),Nedaplatin(45mg/m2,day1)併用化学療法を選択し,2コースを施行した.腫瘍の著明な縮小を認め,抗腫瘍効果はpartial response(CT-cT2N0M0 cStageII)でダウンステージが得られたと判断した.術前化学療法から約4週間後に,腹臥位胸腔鏡下食道切除術,腹腔鏡下胃管作成術,胸骨後経路にて頸部食道胃管吻合術を施行した.切除標本の病理組織検査で,元来腫瘤が存在した食道病変部位には腫瘍細胞を認めず,脈管侵襲・リンパ節転移も認めなかったため,化学療法の効果判定はGrade 3と診断した.5-FU/Nedaplatin併用化学療法は進行食道類基底細胞癌に対する術前化学療法レジメンの選択肢になり得る.(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J03156&link_issn=&doc_id=20200713170012&doc_link_id=10.3919%2Fjjsa.81.1090&url=https%3A%2F%2Fdoi.org%2F10.3919%2Fjjsa.81.1090&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(株)日本臨床社  

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記述言語：日本語   出版者・発行元：(株)日本臨床社  

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記述言語：日本語   出版者・発行元：(株)日本臨床社  

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記述言語：日本語   出版者・発行元：(株)日本臨床社  

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記述言語：日本語   出版者・発行元：(株)日本臨床社  

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記述言語：日本語   出版者・発行元：(株)日本臨床社  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

胃癌治療における抗癌剤治療の変遷と、胃癌治療のKey DrugであるS-1治療における予後マーカーとしての大腰筋面積の有用性について概説した。S-1は、術後補助化学療法のみならず、進行胃癌に対する化学療法において重要なKey Drugとしての揺るぎない位置づけを確立している。切除不能・再発胃癌に対する一次化学療法では、標準治療のひとつとしてFluoropyrimidine+Cisplatin療法が使用され、日本ではS-1+Cisplatinが標準治療であった。二次化学療法に関しては、過去よりIrinotecanもしくはTaxan系薬剤が多く使用されてきていた。診療上、ルーチンで検査するCT所見による大腰筋面積を計測することは簡便であり、かつ予後を反映するサロゲートマーカーとして有用である。また、術後化学療法において、大腰筋量を維持してS-1治療を完遂することが重要である。

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

症例1は74歳、男性。胸部食道癌に対し胸腔鏡下食道亜全摘、開腹胃管再建術(後縦隔経路)を施行した1年11ヵ月後、左側腹部痛を主訴に受診した。画像検査で左胸腔内へ小腸が脱出しており、食道裂孔ヘルニアの診断で腹腔鏡下に小腸を還納し食道裂孔を縫縮した。症例2は79歳、男性。胸部食道癌に対して胸腔鏡下食道亜全摘、腹腔鏡下胃管再建術(後縦隔経路)を施行した2ヵ月後、左胸部痛、呼吸困難、下血を認め受診した。画像検査で左胸腔に横行結腸が脱出しており、腹腔鏡下に結腸を還納し食道裂孔を縫縮したうえで胃管と縫合固定した。食道癌術後の横隔膜ヘルニアは比較的まれな疾患であるが、無症候性でも重篤化の危険があり、手術適応とされる。食道癌術後食道裂孔ヘルニアに対する腹腔鏡下修復症例は本邦においては8例のみの報告であるが、低侵襲であり術野を確保しやすい腹腔鏡下修復術は、本疾患に有用な術式と考えられる。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J02824&link_issn=&doc_id=20190221450019&doc_link_id=10.11231%2Fjaem.39.109&url=https%3A%2F%2Fdoi.org%2F10.11231%2Fjaem.39.109&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語  

DOI： 10.1186/s40981-018-0203-0

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Tokyo  

Phlegmonous gastritis is a rapidly progressive bacterial infection of the stomach wall. It has a high mortality rate and aggressive treatment, either with antibiotics or surgical resection, is required. Here, we report an extremely rare case of phlegmonous gastritis associated with advanced esophageal cancer. A 65-year-old Japanese man was urgently admitted to the hospital due to pyrexia and gastrointestinal symptoms. Abdominal computed tomography revealed widespread diffuse thickening of the gastric wall. On endoscopic examination, an ulcerative mass was detected at the lower thoracic esophagus, and a markedly elevated submucosal lesion was present in the middle of the stomach body. Biopsy specimens taken endoscopically from the esophageal tumor confirmed a diagnosis of squamous cell carcinoma. Gastric biopsy cultures were positive for Streptococcus viridans, leading to a diagnosis of phlegmonous gastritis associated with esophageal cancer. After the patient’s condition improved with preoperative antibiotic administration, we performed a thoracoscopic esophagectomy, a total gastrectomy and a reconstruction of the gastrointestinal tract using a pedicled right colon. Histological examination of the resected specimen confirmed that the gastric mass was compatible with a phlegmon.

DOI： 10.1007/s12328-018-0867-z

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Tokyo  

Asymptomatic T1 (invaded submucosa) esophageal carcinoma rarely metastasizes to the brain. A 53-year-old Japanese man complaining of right hemiparesis and convulsion was admitted to our hospital. Brain imaging demonstrated a ring-like, enhanced brain tumor in the left parietal lobe. The pathological findings of the resected tumor were consistent with a metastatic adenocarcinoma from the gastrointestinal tract. Additional examinations revealed an elevated-type tumor in the lower third of the thoracic esophagus. The patient underwent thoracoscopic esophagectomy with lymph node dissection followed by reconstruction with gastric tube substitution. The immunohistochemical findings of the resected specimen were similar to those of the metastatic brain tumor. Although the patient received adjuvant chemotherapy (5-fluorouracil, docetaxel plus cisplatin), a solitary small brain metastasis was detected 4 months after esophagectomy. Excision of the sequential metastases with whole-brain radiation therapy and gamma-knife therapy were performed. The patient survived for 50 months after beginning the initial treatment. This report describes a rare case of brain metastases from T1 esophageal adenocarcinoma in a patient without gastrointestinal symptoms.

DOI： 10.1007/s12328-017-0803-7

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(株)へるす出版  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer New York LLC  

Introduction: We introduced laparoscopic simulator training for medical students in 2007. This study was designed to identify factors that predict the laparoscopic skill of medical students, to identify intergenerational differences in abilities, and to estimate the variability of results in each training group. Our ultimate goal was to determine the optimal educational program for teaching laparoscopic surgery to medical students. Methods: Between 2007 and 2015, a total of 270 fifth-year medical students were enrolled in this observational study. Before training, the participants were asked questions about their interest in laparoscopic surgery, experience with playing video games, confidence about driving, and manual dexterity. After the training, aspects of their competence (execution time, instrument path length, and economy of instrument movement) were assessed. Results: Multiple regression analysis identified significant effects of manual dexterity, gender, and confidence about driving on the results of the training. The training results have significantly improved over recent years. The variability among the results in each training group was relatively small. Conclusions: We identified the characteristics of medical students with excellent laparoscopic skills. We observed educational benefits from interactions between medical students within each training group. Our study suggests that selection and grouping are important to the success of modern programs designed to train medical students in laparoscopic surgery.

DOI： 10.1007/s00464-017-5643-5

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

症例は79歳男性。早朝空腹時に上腹部痛を主訴に来院した。左腎癌に対し腹腔鏡補助下左腎摘除術を施行した既往がある。腸閉塞の診断で緊急入院し、ロングインテスティナルチューブを挿入した。ロングインテスティナルチューブ造影では、左腎摘除時の背部12mmポートサイトに小腸が嵌頓していた。3D-CTでは、小腸が左結腸間膜を貫いて後腹膜腔に入り、背部ポートサイトに嵌頓後に再度左結腸間膜を貫いて腹腔内に戻る所見が得られた。以上から内ヘルニアと後腹膜ポートサイトヘルニアによる腸閉塞と診断し、緊急手術を施行した。術中所見では、小腸が左結腸間膜裂孔を経て後腹膜腔に陥入した内ヘルニアを認め、さらにその小腸が左腎摘除時の背部ポートサイト孔の腹壁欠損部にRichter型に嵌頓していた。左結腸間膜裂孔ヘルニアとその嵌頓小腸の後腹膜ポートサイトRichter型ヘルニアを同時に認めた報告はまれであり文献的考察を加えて報告する。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1155/2018/8685371

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その他リンク： http://downloads.hindawi.com/journals/cris/2018/8685371.xml

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Tokyo  

Non-occlusive mesenteric ischemia (NOMI), which can lead to multifocal and segmental intestinal necrosis without demonstrable occlusion in the main mesenteric artery, is associated with extremely high mortality. Because these intestinal ischemic changes can progress, it is difficult to make a definitive determination intraoperatively as to whether resection of damaged intestine is required. A 62-year-old man who underwent esophagectomy for advanced cervicothoracic esophageal cancer complained of severe abdominal pain on postoperative day 4. Enhanced computed tomography revealed pneumatosis intestinalis in the wall of the small bowel. Emergency laparotomy revealed ischemia in segments of the small intestine suspicious for NOMI. Intraoperative evaluation of the mesenteric and bowel circulation was performed under indocyanine green (ICG) fluorescence. Although the ischemic bowel segments were visible, open-abdomen management was undertaken so that mesenteric and bowel circulation could be reexamined 24 h later. During the second-look operation, the small intestine was able to be preserved because intestinal perfusion was confirmed on revisualization under ICG fluorescence. The present case demonstrated that open-abdomen management and repeat visualization under ICG fluorescence are effective in preserving damaged intestine during surgery for NOMI.

DOI： 10.1007/s12328-017-0779-3

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

症例は80歳,女性.右下腹部腫瘤を主訴に来院した.18歳時に急性虫垂炎・汎発性腹膜炎に対し虫垂切除術と33歳時に同部位の腹壁瘢痕ヘルニア修復術の既往がある.以前から手術創皮下に硬結を自覚していたが,半年前より増大傾向を認め当科を受診.腹部所見は,右下腹部切開創に3cm大の無痛性腫瘤を触知した.腹部CT検査では,創部皮下に腹膜と連続する腫瘤であり,Schloffer腫瘍を疑った.全身麻酔下で腫瘍摘出術を施行した.腫瘍より暗赤色の液体が少量漏出した.標本の病理所見は,異物や炎症性肉芽腫はなく,明瞭な細胞質を有する異形細胞の乳頭状増殖を認め明細胞癌と診断したが,組織学的に子宮内膜はみられなかった.経過良好で術後3日目に軽快退院した.過去に婦人科疾患の既往はなく,術後に婦人科悪性疾患を検索したが異常を認めなかった.自験例は,術後創部局所に存在した外性子宮内膜症が悪性転化した可能性があると思われた.(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J03156&link_issn=&doc_id=20180117150027&doc_link_id=10.3919%2Fjjsa.78.2742&url=https%3A%2F%2Fdoi.org%2F10.3919%2Fjjsa.78.2742&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

68歳男。胸部上部食道扁平上皮癌にて胸腔鏡下食道切除、3領域リンパ節郭清、腹腔鏡下胃管作成、後縦隔経路再建を行った。術後32ヵ月に第5頸椎に転移を認め、化学放射線療法(CRT)にて完全寛解が得られたが、CRT後22ヵ月に嚥下時の違和感が出現し、上部消化管内視鏡検査にて胃管内に腫瘍を認めた。各種検査所見および経過より、食道癌術後・CRT治療後の胃管内再発食道扁平上皮癌と診断した。上縦隔への放射線照射後であることに加え、外科手術はリスクの観点から患者が希望されなかったことから、インフォームドコンセントを得て光線力学療法(PDT)の方針となった。PDTを6回施行した後の上部内視鏡検査では、腫瘍周堤の平低化を認めた。初回治療から13ヵ月経過しているが、経口摂取を含めた日常生活動作を維持し、現在も治療継続中である。

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J04450&link_issn=&doc_id=20171218070025&doc_link_id=%2Fdw9poden%2F2017%2F009101%2F034%2F0132-0134%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdw9poden%2F2017%2F009101%2F034%2F0132-0134%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：英語   出版者・発行元：INT INST ANTICANCER RESEARCH  

Brain metastases originating from esophageal or gastric cancer are rare, accounting for 2.1-3.3% of all brain tumors registered in Japan. There are no established therapeutic measures for brain metastases, which accordingly have a poor prognosis. We present here a patient who survived for 5 years after surgery and gamma knife treatment of a cerebellar metastasis from esophagogastric adenocarcinoma. The primary gastric cancer was treated by laparotomy with total gastrectomy, splenectomy, and D2 lymphadenectomy. It was diagnosed as a esophagogastric junction Siewert type II tumor, type 3, tub1-2, pT3 (SS), pN1, and stage IIB on histopathological examination of the surgical specimen. Five months postoperatively, a solitary cerebellar metastasis was identified and surgically removed, followed by 20 Gy administered by gamma knife stereotactic radiosurgery; the patient received no subsequent treatment such as chemotherapy. Five years after the primary surgery, there have been no recurrences and the patient has a good quality of life. There are very few case reports of long-term survival after surgical treatment of cerebellar metastases from esophagogastric junction cancer. We report our experience and review published case reports of surgical treatment of brain metastases from gastric cancer.

DOI： 10.21873/invivo.11192

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：INT INST ANTICANCER RESEARCH  

Aim: Cisplatin plus 5-fluorouracil (5-FU) or S-1 is a standard therapy for gastric cancer (GC). However, cisplatin is emetic and potentially nephrotoxic. Oxaliplatin may be less toxic, but few basic data are available for this setting. Here, we evaluated oxaliplatin for GC, by testing surgical specimens. Materials and Methods: We evaluated effects of oxaliplatin and 5-FU, alone and in combination, on surgical specimens from 11 patients with GC, using collagen gel droplet embedded culture drug tests. Results: Oxaliplatin was less efficacious than 5-FU, and its synergistic effect was less in tumors highly sensitive to 5-FU than in those with low sensitivity. Tumor differentiation and drug sensitivity were not correlated. Conclusion: Although oxaliplatin monotherapy had little effect on GC, we saw a limited synergistic effect of oxaliplatin with 5-FU in 5-FU-sensitive patients. Collagen gel droplet embedded culture drug tests may predict this synergistic effect, and help select candidates for this or other regimens.

DOI： 10.21873/anticanres.12093

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Purpose: The purpose of this study is to evaluate the effectiveness of salvage endoscopic argon plasma coagulation (APC) therapy for local failure occurring after definitive chemoradiotherapy (CRT) in patients with inoperable esophageal cancer.
Patients and Methods: A total of 47 patients with esophageal squamous cell carcinoma received CRT from January 2009 through November 2011 in our hospital. Thirty-five of these patients were excluded because of long-term disease-free status or because they received salvage surgery, systemic chemotherapy, or best supportive care. The other 12 patients had local relapse (n=8) or residual lesions (n=4) after definitive CRT and received salvage APC therapy. Local failures after definitive CRT were divided into 2 groups: the superficial growth group (n=6) and the submucosal growth group (n=6). The primary endpoints were relapse-free survival and overall survival after 60 months of follow-up.
Results: Six patients in the superficial growth group and 1 patient in submucosal growth group had a complete response after salvage APC. The rates of both relapse-free survival and overall survival were higher in the superficial growth group than in the submucosal growth group. No complications occurred after APC.
Conclusions: Salvage APC is a potentially curative treatment for patients who have local failure associated with superficial tumors after CRT for esophageal squamous cell carcinoma.

DOI： 10.1097/SLE.0000000000000454

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記述言語：日本語   出版者・発行元：(株)へるす出版  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

DOI： 10.11641/pde.91.Supplement_90

J-GLOBAL

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：英語  

DOI： 10.1007/s13691-017-0279-9

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：英語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：英語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

腰ヘルニアにおいても鼠径ヘルニア同様,近年Tension-freeの概念に基づいた人工繊維素材を用いた修復法が報告されている。今回われわれは,成人鼠径ヘルニア用半吸収性メッシュ(ULTRAPRO plug:以下,UPP)を用いて修復した特発性上腰ヘルニアの1例を経験した。症例は87歳の女性。左背部腫瘤を主訴に受診した。左背部に7×5cm大,無痛性で用手還納が可能な腫瘤を認めた。腹部CT検査で左上腰三角より皮下へ脱出する下行結腸を認め,上腰ヘルニアと診断し手術した。背部アプローチで,上腰三角部に脱出するヘルニア嚢を確認し還納した。ヘルニア門の直径は約3.5cmであり,UPP(Mサイズ)を用いて修復した。術後3日目に退院し,術後2年経過した現在再発を認めていない。半吸収性で術後の異物感が少ないUPPは,形状もヘルニア門に適合することから,上腰ヘルニア修復術に有用であった。(著者抄録)

DOI： 10.11231/jaem.37.421

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記述言語：英語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

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記述言語：英語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：英語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

Background: Laparoscopic anti-reflux surgery (LARS) is generally the treatment of choice for patients with gastroesophageal reflux disease (GERD). This report describes our experiences in performing LARS on patients with GERD, and focuses retrospectively on the pathophysiology of individual patients and the current status of Japanese patients who have undergone LARS. We demonstrate that patients with non-erosive reflux disease resistant to proton pump inhibitors (PPI-resistant NERD) and high-risk giant hernia, whom we are sometimes hesitant to treat surgically, can be safely and successfully treated with LARS (depending on the pathophysiology of individual patients).
Methods: Between January 2007 and June 2015, 37 patients underwent LARS at Nippon Medical School Hospital. These patients were retrospectively subgrouped according to pathophysiology; 9 of them had PPI-resistant NERD (Group A), 19 had a giant hiatal hernia (Group B), and 9 had erosive esophagitis (Group N). Patient characteristics, intraoperative bleeding, operation duration, perioperative complications, and length of hospital stay were determined, along with symptomatic outcomes and patient satisfaction.
Results: Patients in Group A were the youngest (average: 43.9 years), and those in Group B were the oldest (75.9 years) (P=0.002). The percentage of high-risk patients, as determined by performance status (P=0.047) and American Society of Anesthesiologists physical status classification (P=0.021), was highest in Group B, whereas the percentage of patients with mental disorders was highest in Group A (P=0.012). There were no significant differences among the groups in terms of intraoperative bleeding, surgery duration, or postoperative hospital stay. Thirty-three patients (89.2%), including all 19 in Group B, expressed excellent or good postoperative satisfaction levels.
Conclusions: The characteristics of the patients who underwent LARS at our hospital differed according to pathophysiology and from those in western countries. Satisfactory outcomes depended on the pathophysiology of individual patients.

DOI： 10.1272/jnms.84.25

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

症例1:74歳男。3年前に不安定狭心症に対し右胃大網動脈(RGEA)を用いた冠動脈バイパス術(CABG)を受けていた。今回、下血を認め、画像所見より早期胃癌と診断し、D1+郭清の幽門側胃切除術を施行した。症例2:65歳男。8年前に不安定狭心症に対しRGEAを用いたCABGを受けていた。今回、胸痛、黒色便を認め、画像所見より早期胃癌と診断し、D1+郭清の幽門側胃切除術を施行した。症例3:87歳男。胸痛を主訴とした。12年前に不安定狭心症に対しRGEAを用いたCABGを受けていた。今回、胸痛を認め、画像所見より2型進行胃癌と診断し、D2郭清の幽門側胃切除術を施行した。3例とも肝外側区域の腹側にRGEAバイパス血管を同定し、血管鞘を露出し可及的に郭清して温存した。症例2は退院後に右冠動脈狭窄部への経皮経管的冠動脈形成術を行った。3例とも手術周術期に特に問題はなく、症例1と2は無再発生存中であるが、症例3は術後2年に他病死した。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J04260&link_issn=&doc_id=20170313400006&doc_link_id=130005438770&url=http%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130005438770&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

掲載種別：研究論文（学術雑誌）   出版者・発行元：Japan Surgical Association  

DOI： 10.3919/jjsa.78.2742

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ACADEMIC PRESS INC ELSEVIER SCIENCE  

Background: Chronic pain and discomfort is a notable complication after inguinal hernia repair. This study assesses the incidence and degree of chronic pain and discomfort after primary inguinal hernia repair performed in our hospital and aims to clarify its relationship to the type of mesh placement.
Materials and methods: A retrospective analysis was conducted of 334 patients (378 lesions) who underwent primary inguinal hernia using the Lichtenstein (onlay mesh), Ultrapro Plug (UPP; onlay plus plug mesh), modified Kugel Patch (onlay and underlay mesh), or laparoscopic transabdominal preperitoneal (TAPP; underlay mesh) procedure. Postoperative pain was assessed using a numerical rating scale at postoperative 2-3 wk, 3 mo, and 6 mo. Postoperative discomfort was assessed 6 mo afterward.
Results: Questionnaire responses were received for 378 lesions (100%) after 2-3 wk, 229 (60.6%) after 3 mo, and 249 (65.9%) after 6 mo. The majority of chronic pain experienced was mild, and no patient suffered from severe pain. The level of pain tended to be less for the TAPP procedure than for other methods. Discomfort at rest was significantly less for TAPP versus Ultrapro Plug (P < 0.01), and discomfort with movement was significantly less for TAPP versus modified Kugel (P < 0.05).
Conclusions: Onlay mesh appears to be a risk factor in chronic pain and discomfort. The lower level of chronic pain and discomfort with underlay mesh placement is considered to result from the reduced risk of nerve damage in this procedure than in the onlay mesh placement procedure. (C) 2016 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.jss.2016.08.027

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

Background: When percutaneous endoscopic gastrostomy is not feasible, a gastrostomy tube may be inserted for enteral access by a laparoscopic or open technique. The aim of this study was to compare the postoperative pain of laparoscopic versus open gastrostomy in patients with complete obstruction caused by advanced esophageal cancer.
Methods: Fifteen patients who had undergone either a reduced port access laparoscopic gastrostomy/jejunostomy (LGJ, n=7) or open gastrostomy/jejunostomy (OGJ, n=8) between July 2011 and December 2015 were retrospectively studied. Variables examined comprised age, sex, body mass index (BMI), operative time, blood loss volume, and American Society of Anesthesiologist physical status (ASA-PS) scores. The degree of postoperative pain was also assessed in both groups during the first seven postoperative days.
Results: The patients in the two groups were comparable in age, sex, BMI, ASA-PS scores, intraoperative blood loss or postoperative complication rates. Operative time was shorter in the LGJ group than the OGJ group. No patients in the LGJ group required conversion to open laparotomy. Tube feedings were started on postoperative Day 1 in both groups; there were no postoperative complications. The duration of rescue nonopioid analgesic use was significantly shorter in the LGJ than the OGJ group (1.3 versus 3.5 days; P=0.0005). There was a significant difference in frequency of postoperative nonopioid analgesic use: 7.9 times in the LGJ group versus 17.9 times in the OGJ group (P=0.0219).
Conclusions: LGJ is associated with less postoperative pain than OGJ in patients with complete obstruction caused by advanced esophageal cancer.

DOI： 10.1272/jnms.83.228

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

We compared the therapeutic outcomes of mediastinoscopy- assisted transhiatal esophagectomy (MATHE) with transthoracic esophagectomy (TTE), and with video-assisted thoracoscopic esophagectomy (VATS-E) for the treatment of esophageal cancer. Twenty patients underwent MATHE in our institute from 2001 to 2005 were enrolled. We evaluated the therapeutic outcomes, including perioperative complications and longterm prognosis after surgery, and compared these with 15 patients who underwent TTE during the same time period and 15 who underwent VATS-E at a later date. MATHE was performed safely and the long-term prognosis were satisfactory compared with TTE. However, the number of dissected mediastinal lymph nodes, total blood loss, and sophistication of the procedure were inferior to VATS-E. MATHE represents a less invasive surgical procedure. However, in light of the risk of leaving lymph node metastasis around the tracheal bifurcation in patients with tumor invasion beyond the muscularis mucosa, MATHE should only be adopted in a minority of patients.

DOI： 10.1097/SLE.0000000000000348

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

症例は49歳,女性。10年前より年に1〜2回程度,右下肢痛を伴う下腹部痛を認めていたが,半日程度で症状は自然に消失しており,坐骨神経痛と診断されていた。今回,右下肢痛を伴う下腹部痛が軽快せず,当院救急外来を受診した。直腸診にて直腸に壁外性腫瘤を触知し,同部位の圧痛および右下肢痛の増強を認めた。腹部CT検査を行い,右坐骨ヘルニア嵌頓と診断した。緊急手術を施行し,右坐骨孔にRichter型に嵌頓した小腸を認め,牽引し解除した。腸切除は施行せず,ヘルニア門を卵巣で被覆した。坐骨ヘルニアはまれな疾患であるが,原因不明の繰り返す下腹部痛に坐骨神経痛を伴う場合には,坐骨ヘルニアを鑑別診断としてあげ,現病歴・既往歴の十分な聴取をしたうえでの直腸診が有用であると考えられた。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

We report the first documented case of pancreatic metastasis from a gastrointestinal stromal tumor of the stomach. A 42-year-old Japanese man presented with severe abdominal discomfort. Computed tomography of the abdomen showed a huge heterogeneous mass consisting of cystic and solid components in the left upper abdomen. F-18-Fluorodeoxyglucose positron-emission tomography revealed high tracer uptake in the abdominal mass. After total gastrectomy with lymphnodectomy was performed, a hard mass was palpated in the pancreatic tail. The pancreatic tumor was also resected under the therapeutic strategy. Histological examinations of the resected gastric and pancreatic specimens revealed that both tumors consisted of uniform spindle cells with a fascicular growth pattern and were immunohistochemically positive for CD34 and CD117/KIT. Gene sequencing analysis of DNA from each tumor revealed an identical deletion of 21 nucleotides in exon 11 of the gene KIT. On the basis of these results, we concluded that the pancreatic tumor was a metastatic tumor from the gastrointestinal stromal tumor of the stomach.

DOI： 10.1272/jnms.83.133

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PubMed

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：英語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

目的:内視鏡外科手術の普及に伴い食道癌に対して胸腔鏡下食道切除を行う施設は増加している.しかし,内視鏡下手術では従来の手術法と異なった手術操作の工夫が必要となる.今回,食道癌における内視鏡下手術時の新たな後縦隔経路胃管挙上法を考案した.方法:食道癌に対して胸腔鏡下食道切除,腹腔鏡補助下胃管作成を施行した37症例を対象とし,従来から行ってきた後縦隔経路胃管挙上法(従来法,14例)と新たな胃管挙上法(ビニールトンネル法,23例)で,挙上時に生じた偶発症の内訳と発生率を比較した.結果:従来法では3例(21.4%)の偶発症(右気管支動脈損傷,胃管捻れ,牽引テープの断裂)が生じた.一方,ビニールトンネル法では偶発症を認めなかった.結語:内視鏡下食道癌手術時の小開腹創から頸部への後縦隔経路胃管挙上において,ビニールトンネル法は安全かつ極めて簡便に施行可能であり実臨床で有用な手技と考えられた.(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J01066&link_issn=&doc_id=20160311070002&doc_link_id=10.4030%2Fjjcs.41.8&url=https%3A%2F%2Fdoi.org%2F10.4030%2Fjjcs.41.8&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1155/2016/9407357

PubMed

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

<p>【目的】高齢者胃癌における腹腔鏡下胃切除術の術前リスク評価をPOSSUMとE-PASSスコアで検討した．【方法】腹腔鏡下胃切除術57例（75歳以上の高齢者群17例，75歳以下の非高齢者群40例）を対象とし，両群間でPOSSUM，E-PASSスコアを比較検討した．【結果】POSSUMのphysiological score（PS）は非高齢者群に比して有意に高齢者群は高値であったが，operative severity（OS）scoreは差がなかった．PS＜19かつOS＜11のlow risk groupは両群ともに術後合併症はなかったが，高齢者群の術後合併症５例中４例（80％），非高齢者群の10例中４例（40％）がPS≧19かつOS≧11のhigh risk groupであった．E-PASSの総合リスクスコアでは両群間に差がなかった．【結語】POSSUMスコアは高齢者の腹腔鏡下胃切除術の術前リスク評価に有用であると思われた．</p>

DOI： 10.4030/jjcs.41.559

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: A clear operative view of the middle and lower mediastinum is possible in prone position during video-assisted thorocoscopic surgery of esophagus (VATS-E), but the working space in the upper mediastinum is limited and lymph node dissection along the left recurrent laryngeal nerve (RLN) is difficult in this position. METHODS: Esophagectomy and lymph node dissection are performed for pneumothorax by maintaining CO2 insufflation in the prone position. Working space in the left upper mediastinal area for lymph node dissection around RLN is limited in this position. To create space, the residual esophagus is stripped in the reverse direction and retracted toward the neck after the stomach tube is removed through the nose. Lymph node dissection is performed after stripping the residual esophagus. RESULTS: We could obtain a clear operative field in the upper left mediastinum by stripping the residual esophagus in the prone position, enabling safe and straightforward lymph node dissection along the left RLN. The rate of permanent RLN paralysis was 1.2%. CONCLUSIONS: Lymph node dissection along the left RLN after esophageal stripping is possible in the prone position during VATS-E.

DOI： 10.21037/jovs.2016.11.01

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

We report a case of previously unreported metastasis to the spermatic cord from esophageal squamous cell carcinoma. A 63-year-old Japanese man underwent laparoscopy-assisted esophageal bypass surgery for an advanced esophageal cancer. An elastic hard tumor was found in the right lateral inguinal fossa on intraoperative laparoscopy, and laparoscopic enucleation was performed. Histological examination of the resected tumor revealed a moderately differentiated squamous cell carcinoma, compatible with metastasis from the esophageal cancer. Two months after the operation, computed tomography revealed a heterogeneously enhanced groin mass (20 mm in diameter) involving the right spermatic cord. To our knowledge, this is the first reported case of a solitary metastasis to the spermatic cord from esophageal squamous cell carcinoma.

DOI： 10.1272/jnms.82.304

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/ases.12209

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PubMed

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記述言語：英語   出版者・発行元：NATURE PUBLISHING GROUP  

DOI： 10.14309/00000434-201510001-01628

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

左上大静脈遺残に右上大静脈欠損を合併した食道癌に切除術を行った報告例は非常に少ない.症例は72歳,男性.食欲不振を主訴に近医を受診し,食道扁平上皮癌を指摘され当科紹介となった.既往歴は,連合弁膜症(大動脈弁閉鎖不全症,僧帽弁閉鎖不全症)であった.3D-CT検査で左上大静脈遺残,右上大静脈欠損が判明した.腹臥位胸腔鏡下食道切除,腹腔鏡補助下胃管作製,後縦隔経路で食道再建術を施行した.胸腔鏡所見で,右上大静脈欠損,無名静脈,通常より極めて細い奇静脈弓を認めた.術中の循環動態は安定していた.術後合併症はなかった.食道癌手術を安全に施行するために,術前に大血管異常を診断することは重要であると思われた.(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J03156&link_issn=&doc_id=20151112170011&doc_link_id=10.3919%2Fjjsa.76.2422&url=https%3A%2F%2Fdoi.org%2F10.3919%2Fjjsa.76.2422&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

DOI： 10.1007/s13691-015-0207-9

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(株)医学書院  

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

症例は38歳,女性.嚥下困難を主訴に近医を受診.食道粘膜下腫瘍を指摘され当科紹介となった.上部消化管内視鏡検査では頸胸部食道に隆起性粘膜下病変を認め,生検の病理組織所見で核異型・分裂像著明な紡錘形細胞が錯綜状に配列し,Ki-67染色は高度陽性であった.食道原発平滑筋肉腫の疑いにて,胸腔鏡手技を併用した喉頭温存食道全摘術を施行し,後縦隔経路で挙上した胃管・有茎遊離空腸・咽頭の再建術を施行した.切除標本の免疫組織染色では,desmin・α-SMAが陽性,c-kit・CD34・S-100蛋白・keratinは陰性であり,平滑筋肉腫と診断した.術後の嚥下機能は良好であった.術後半年以上経過するも再発徴候は認めていない.頸胸部食道平滑筋肉腫に対して,胸腔鏡下手術を併用し根治性を担保でき,さらに頭頸部外科・形成外科との合同手術で喉頭機能を温存することができた症例を経験したので報告する.(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J03156&link_issn=&doc_id=20150806090021&doc_link_id=10.3919%2Fjjsa.76.1656&url=https%3A%2F%2Fdoi.org%2F10.3919%2Fjjsa.76.1656&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

症例は86歳,女性.主訴は,数年前からの食後上腹部不快感と嘔吐.胸部X線検査にて左胸腔内に異常ガス像を認めた.上部消化管内視鏡検査では,胃の変形が高度で,胃体中部から幽門側への内視鏡到達は困難であった.上部消化管造影および胸部CT検査では,横隔膜上の縦隔内に全胃が軸偏位を伴って脱出していた.Upside down stomachを呈したIII型食道裂孔ヘルニアと診断し,腹腔鏡下に胃還納,食道裂孔縫縮,メッシュ留置による食道裂孔の補強,噴門形成術を施行した.術後経過は順調で,再発は認めていない.食道裂孔ヘルニアは比較的頻度の高い疾患であるが,軸捻転を伴うupside down stomachを呈したIII型食道裂孔ヘルニアは稀な疾患であり,今回われわれは腹腔鏡下手術を施行した1例を経験したので,若干の文献的考察を加えて報告する.(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J03156&link_issn=&doc_id=20150612050013&doc_link_id=10.3919%2Fjjsa.76.998&url=https%3A%2F%2Fdoi.org%2F10.3919%2Fjjsa.76.998&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

A 56-year-old woman with an 8-year history of dysphagia and chest pain received a diagnosis of diffuse esophageal spasm by esophageal high-resolution manometry (HRM). Approximately 2 years of medical therapy was ineffective, and the patient's symptoms were worsening. Therefore, surgery was considered to be the most optimal treatment for this patient. The right thoracoscopic approach was selected because a long myotomy from the distal to proximal level of the esophagus was needed based on the HRM findings. The operation was performed in the prone position with establishment of pneumothorax. The total length of the myotomy was 16 cm, and the operation was finished within 2 hours. After the operation, the symptoms were considerably improved and no contractions were detected by HRM. The HRM findings before the operation were classified as rapid contractions with normal latency based on the 2012 Chicago classification of esophageal motility. Treatment for patients with rapid esophageal contractions with normal latency has not been previously described; however, treatment for diffuse esophageal spasm was considered to be pertinent to this patient. In conclusion, right thoracoscopic esophageal long myotomy in the prone position with establishment of pneumothorax may be useful when a proximal-level esophagomyotomy is required based on preoperative mapping by HRM.

DOI： 10.1097/MCG.0000000000000123

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PubMed

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

症例は82歳,女性。逆流性食道炎のため内服加療中であった。逆流症状増悪,嗄声,咳嗽を自覚,当院受診。外来でショック状態となり集中治療室に入院した。誤嚥性肺炎による急性呼吸促迫症候群と診断され,呼吸器管理,昇圧剤,抗生剤投与などの加療を行った。約1週間で軽快,一般病棟へ転棟した。胸腹部CT,上部消化管造影,上部消化管内視鏡にてIII型食道裂孔ヘルニアを認め,それによる逆流が誤嚥性肺炎の原因と考えられたため,腹腔鏡下逆流防止術(Toupet法+メッシュによる食道裂孔補強)を施行した。術後経過は良好で,術後5日目に退院。入院期間は29日であった。本邦ではまだ腹腔鏡下逆流防止術は一般的ではないが,高齢者で重篤な誤嚥性肺炎を認めたIII型食道裂孔ヘルニア症例において,肺炎治療後すみやかに本手術を行うことは,逆流による肺炎の再燃を防ぐとともに早期の社会復帰を可能にする点で有用であると考えられた。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J02824&link_issn=&doc_id=20150420590015&doc_link_id=10.11231%2Fjaem.35.275&url=https%3A%2F%2Fdoi.org%2F10.11231%2Fjaem.35.275&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Superior mesenteric artery (SMA) syndrome is an uncommon disease resulting from compression and partial obstruction of the third portion of the duodenum from the SMA. A 77-year-old man, who did not have a history of surgery, experienced repeated vomiting and developed abdominal distension. Abdominal CT showed a narrowed third portion of the duodenum, with a distended stomach and proximal duodenum. The patient was diagnosed as having SMA syndrome and was initially treated conservatively, but his condition did not improve. Single-incision laparoscopy-assisted duodenojejunostomy was performed. The patient recovered well and was discharged from hospital on postoperative day 8. Laparoscopic treatment is feasible for the treatment of SMA syndrome given its safety and minimal invasiveness. This is a report of the first case of single-incision laparoscopy-assisted duodenojejunostomy. This procedure is safer and less invasive than a conventional laparoscopic approach in a patient with SMA syndrome.

DOI： 10.1111/ases.12140

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

(目的)当科における食道破裂・穿孔症例の診断,治療と転帰を検討する。(対象)2003〜2013年までの食道破裂・穿孔15例(特発性4例,医原性11例)を対象とした。(結果)特発性の縦隔内限局型2例は保存的治療を,胸腔内穿破型2例は手術療法を行った。食道アカラシアおよび食道狭窄のバルーン拡張術,内視鏡的逆行性胆管膵管造影用の内視鏡ファイバー,咽頭部通過用のガイドチューブ,食道癌に対する粘膜剥離術など内視鏡関連の医原性穿孔は9例で,全例保存的治療で軽快した。一方,胸部大動脈瘤ステント留置に伴う食道穿孔2例は,胸腔内穿破型で手術療法を行ったが,1例は縦隔炎から敗血症で死亡した。(結語)特発性,医原性を問わず縦隔内限局型は,適確なドレナージを行えば治癒率は良好であったが,胸腔内穿破型は,診断治療法が進歩した今日では,特発性・医原性に沿った治療方針の再検討が必要であると考えられた。(著者抄録)

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記述言語：日本語   出版者・発行元：Japanese Society for Abdominal Emergency Medicine  

症例は，65歳の男性。嚥下困難を主訴に来院し，精査で下咽頭癌と胸部食道癌の重複癌と診断した。下咽頭癌に化学放射線療法を施行し腫瘍が消失した後に，食道癌に対して右開胸食道切除，腹腔鏡補助下胃管作製，胸腔内吻合を施行した。胸管は横隔膜上でクリップし合併切除した。術後第9病日に右胸腔ドレーンを抜去し，経口摂取を開始した。術後第10病日に両側胸水が出現し，胸腔ドレナージを施行し，性状から乳糜と診断した。禁食，中心静脈栄養，ソマトスタチンアナログ投与などの保存的治療を行ったが，排液量が増加したため術後第22病日に緊急開腹手術を行った。挙上胃管右背側に腹部大動脈を認め，大動脈腹側かつ膵頭上縁でリンパ管を同定し結紮した。周囲にフィブリン糊を塗布し手術を終了した。術後の胸水排液量は減少し，経口摂取再開後も排液量が増加しないため，ドレーンを抜去した。再手術から12日目に軽快退院した。

DOI： 10.11231/jaem.35.623

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その他リンク： http://search.jamas.or.jp/link/ui/2015376219

記述言語：日本語   出版者・発行元：The Medical Association of Nippon Medical School  

Laparoscopic incisional hernia repair with mesh is widely performed in Western countries as a treatment that is considered more reliable than conventional open repair. However, this procedure is not common in Japan. We report our experiences with this procedure using a new type of mesh (Ventralight ST ^TM, Medicon, Osaka, Japan). This procedure is indicated for almost all patients with incisional hernia but was difficult to perform for patients with giant hernia of the flank after nephrectomy. The procedure is performed with the patient in the supine position and 4 or 5 ports. One port is a 12-mm port, and the others are 5-mm ports. First, the 12-mm port is inserted in the left hypochondrium by the optical method. After pneumoperitoneum is established, we observe the abdominal cavity with a 5-mm flexible endoscope and insert the other ports, while dissecting peritoneal adhesions as necessary. We measure the hernia and trim the mesh to secure at least a 3-cm overlap with the normal abdominal wall. We insert the mesh through the 12-mm port, lift it to make tight contact with the abdominal wall by means of a transfixed thread, and fix the mesh with spiral tackers. We have performed this procedure for 14 patients. The mean operative duration was 127 minutes, and the average postoperative hospital stay was 5.9 days. There were no complications except for seroma, and the patient satisfaction was extremely high. In conclusion, laparoscopic incisional hernia repair with mesh is a useful and promising treatment that will, we believe, be introduced in many institutions in Japan.

DOI： 10.1272/manms.11.16

CiNii Books

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その他リンク： https://jlc.jst.go.jp/DN/JLC/20007059658?from=CiNii

記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

71歳,男性。主訴は空腸瘻造設部の腸管脱出。約6年前に当科でT1食道癌に対し縦隔鏡補助下食道切除術,胃管再建,空腸瘻造設を施行した。手術終了し抜管後,喉頭痙攣による気道閉塞をきたし,低酸素脳症および遷延性意識障害となった。術後6年が経過し,経管栄養チューブは14-Fr尿道バルーンカテーテルを使用していた。何の契機もなく突然に,空腸瘻造設部から腸管の粘膜面が反転した状態で約10cm体外へ脱出・嵌頓をきたし,一部壊死を認めたため,緊急手術を施行した。脱出・嵌頓した腸管を切除し,機能的端々吻合を行い,吻合部の肛門側空腸に空腸瘻を再造設した。栄養チューブには8-Fr成分栄養チューブを使用した。切除標本の先進部に腫瘍はなかったが,小腸全層が壊死していた。長期間の空腸瘻による栄養管理中に,栄養チューブの刺入部から腸管が脱出し嵌頓した症例を経験したので報告する。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J02824&link_issn=&doc_id=20150126490017&doc_link_id=10.11231%2Fjaem.34.1497&url=https%3A%2F%2Fdoi.org%2F10.11231%2Fjaem.34.1497&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

A 56-year-old woman who received surgery for left breast cancer 10 years previously underwent 18F-fluorodeoxyglucose positron-emission tomography (FDG-PET) for postoperative follow-up. FDG-PET revealed high uptake of tracer in the esophagogastric junction. A slightly elevated, lobular lesion was found in the lower third of the esophagus on upper gastrointestinal endoscopy. An endoscopic biopsy revealed squamous cell carcinoma. We performed thoracoscopic subtotal esophagectomy. Histopathological examination showed a polypoid spindle cell tumor arising from superficial squamous cell carcinoma. Immunohistochemically, the spindle cells were immunopositive for vimentin and AE1/AE3, and a carcinosarcoma of the esophagus was diagnosed. MIB-1 labeling indexes estimated by Ki-67 immunostaining showed that the proliferative rate of the sarcomatous component was markedly higher than that of the carcinomatous component. This is the rare reported case of esophageal carcinosarcoma that showed increased accumulation of tracer on FDG-PET.

DOI： 10.1272/jnms.81.401

Web of Science

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

A 60-year-old Japanese man with no chief complaints underwent 18F-fluorodeoxyglucose positron-emission tomography (FDG-PET) during a medical check-up. FDG-PET revealed high tracer uptake in the left supraclavicular and axillary regions but no significant uptake in the esophageal region. However, upper gastrointestinal endoscopy revealed an ulcerative tumor in the middle third of the esophagus. Endoscopic biopsy revealed moderately differentiated squamous cell carcinoma. The patient underwent chemoradiotherapy. Follow-up FDG-PET and computed tomography after therapy revealed a complete response in the lymph nodes. The patient underwent subtotal esophagectomy with gastric tube reconstruction through the posterior mediastinum. However, metastasis to the axillary lymph nodes was detected 16 months after surgery, and lymph node dissection was performed. To our knowledge, this is the first reported case in which the primary site of esophageal squamous cell carcinoma was discovered on the basis of axillary lymph node metastasis detected with FDG-PET.

DOI： 10.1272/jnms.81.395

Web of Science

PubMed

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記述言語：日本語   出版者・発行元：(株)南江堂  

69歳男性。進行食道癌に対して胸腔鏡下食道切除術+腹腔鏡補助下胃管再建術ほか、後縦隔経路で頸部食道胃管吻合術が施行された。術後は集中管理室にて気管内挿管下で人工呼吸管理が行われ、術後第1病日目には人工呼吸管理下に咳嗽反射の減弱を認めるも気管内挿管チューブが抜去された。だが、抜管3時間後も喀痰排出が不十分であり、短期間の改善は無理と判断され、輪状甲状膜切開法による気管カニューレを施行した。以後、術後第7病日目には患者は強い咳が出て、喉頭を通して気管内分泌物を喀出するまで回復、気管カニューレを抜去してドレッシングで覆ったが気管カニューレの抜去直後に胸部に限局した皮下気腫が確認された。更にその3時間後には顔面、胸部に広がる著明な皮下気腫となり、軽度の呼吸困難を訴えた。胸部X線およびCTを行なったところ、両側胸部皮下に広範囲に及ぶ皮下気腫と縦隔気腫が認められた。以後、対処として人工呼吸管理ができる準備を行なった後に気切孔から皮下に入り込んだエアーの脱気とエアリーク部位の確認を目的に頸部創を局所麻酔下に解放した。その結果、皮下気腫は軽減し呼吸状態は改善、上部消化管内視鏡をはじめ気管・気管支ファイバーでも気管膜様部の損傷は認められなかった。次いで翌日には皮下気腫の減少に加え、3日後の胸部X線像では皮下気腫、縦隔気腫、気胸は消失し、患者は術後第14病日目に開放創を再縫合し、第19病日目に退院となった。

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J00393&link_issn=&doc_id=20141029130017&doc_link_id=issn%3D0016-593X%26volume%3D76%26issue%3D11%26spage%3D1295&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0016-593X%26volume%3D76%26issue%3D11%26spage%3D1295&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

症例は77歳の男性で、進行頸部食道癌にて17年前に咽喉頭食道全摘、頸部リンパ節郭清、非開胸食道抜去、後縦隔経路胃管挙上による咽頭胃管吻合術、前縦隔気管孔形成術(グリロー手術)を施行した。嚥下困難が出現したため上部消化管内視鏡検査を施行し、再建胃管内に全周性の隆起性病変を認め、生検にて腺癌であった。腫瘍は胃管内腔を完全閉塞していたため、細径内視鏡は腫瘍部を通過できなかった。0.038インチガイドワイヤーでさえも腫瘍を越えなかった。内視鏡下にアルゴンプラズマ凝固法にて2回焼灼し、腫瘍の壊死脱落から内視鏡を十二指腸へ挿入できた。透視下にカバー付き食道メタリック・ステントを留置し、経口摂取が可能となった。(著者抄録)

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J04260&link_issn=&doc_id=20141024470005&doc_link_id=%2Fcw1nimed%2F2014%2F001004%2F006%2F0182-0185%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcw1nimed%2F2014%2F001004%2F006%2F0182-0185%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：日本医科大学医学会  

残胃癌に対する腹腔鏡補助下残胃全摘術について検討した。残胃癌に対し腹腔鏡補助下残胃全摘術を施行した2例(症例1:85歳男、症例2:71歳男)を対象とした。腹腔鏡補助下残胃全摘術の適応は、初回手術が良性疾患、悪性疾患に関係ないがBillroth-I法で再建している症例、残胃癌がcT2N1M0までの進行度とした。手術時間は、症例1が218分、症例2が299分で、術中出血量は5mL、50mLであった。術後合併症は、症例1でせん妄状態を呈したが、前回手術後のせん妄状態の程度より軽度で、第13病日に軽快退院した。症例2は、食道空腸吻合の縫合不全を認めたが、保存的治療で術後24病日に治癒し、第45病日に軽快退院した。

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J04260&link_issn=&doc_id=20141024470004&doc_link_id=%2Fcw1nimed%2F2014%2F001004%2F005%2F0178-0181%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcw1nimed%2F2014%2F001004%2F005%2F0178-0181%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：英語   出版者・発行元：(一社)日本癌学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

症例は65歳,男性.食道癌に対して胸腔鏡下食道切除,腹腔鏡補助下胃管作製,後縦隔経路で頸部食道胃管吻合術を施行.既往歴に気管支喘息,慢性閉塞性肺疾患があった.術中に肺上葉と中葉に多発肺嚢胞を認めたが,手術操作での肺損傷はなかった.第1病日に突然喘息発作を呈し,胸部X線にて著明な皮下気腫,右気胸とエアーリークを認め胸腔ドレナージチューブを追加挿入した.保存的治療にて皮下気腫と右気胸は軽減したがエアーリークは残存した.胸部CTにて感染を伴った難治性気胸と診断,第31病日に気管支ファイバー下にシリコン製栓型気管支充填剤:Endobronchial Watanabe Spigot(EWS)を用いた気管支充填術施行した.EWS施後エアーリークは減弱,右肺の虚脱は消失した.胸腔ドレナージチューブ抜去,第58病日に軽快退院となった.食道癌術後の難治性気胸に対するEWS充填術は非常に有用であると考えられた.(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J03156&link_issn=&doc_id=20141007210019&doc_link_id=10.3919%2Fjjsa.75.2462&url=https%3A%2F%2Fdoi.org%2F10.3919%2Fjjsa.75.2462&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

76歳男。1ヵ月前から労作時の息切れと下痢を自覚した。血液検査で貧血を認めた。腹部超音波検査およびCT検査にて腹腔内に腫瘤を指摘された。腹部CT検査では、右下腹部に直径約50mm大の境界明瞭で軽度造影効果のある腫瘤を認めた。カプセル内視鏡検査では、下部空腸と思われる部位に粘膜の発赤を伴う粘膜下腫瘍を認めた。ダブルバルーン小腸内視鏡検査では、下部小腸に表面平滑で周堤隆起を伴った潰瘍性腫瘍を認めた。腫瘍の肛門側に点墨とクリッピングを施行し、潰瘍底から生検で小腸GISTと診断した。臍部で単孔式腹腔鏡下小腸切除術を施行した。術後経過は順調で、8日目に退院した。腫瘍径が5cm、核分裂数が10/50HPF以上で、壊死を伴っているため高リスクと診断し、外来にて経過観察中である。

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J04450&link_issn=&doc_id=20140625210042&doc_link_id=%2Fdw9poden%2F2014%2F008401%2F048%2F0134-0136%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdw9poden%2F2014%2F008401%2F048%2F0134-0136%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

The present review describes the histological markers of Barrett's esophagus (BE) that make it possible to distinguish between Barrett's carcinoma (BC) and gastric carcinoma. With regard to high-grade dysplasia, the indications for endoscopic resection (ER) or major surgery for management of BC cannot be decided on the basis of biopsy histology, and the choice between them should be made according to BC invasion depth. Therefore, we recommend that the term well-differentiated tubular adenocarcinoma' be used rather than high-grade dysplasia' (intraepithelial neoplasia). High-grade dysplasia is regarded as BC in Japan and other countries such as Germany. Such lesions should not be treated by endoscopic ablation but by ER, because components of invasive carcinoma are frequently present in the mucosa and submucosa, and knowledge obtained from ER samples is needed for additional therapy. Further studies on the relationship between the incidence of nodal metastasis and mucosal depth in mucosal BC are needed to decide the indications for ER. Suchstudies should involve subserial microscopic examination of slices 2-3mm thick. To resolve the issue of regression of high-grade dysplasia, international experts in gastroenterological pathology need to conduct histopathological reviews of the first and last samples taken from such cases, as there are large differences between North American, European, and Japanese pathologists in the criteria used for histological diagnosis of dysplasia and adenocarcinoma without clear invasion, and both interobserver and intraobserver variations have been reported. Future studies will need to focus on which carcinomas are curable by ER.

DOI： 10.1111/den.12160

Web of Science

PubMed

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

A case of esophageal small cell carcinoma successfully treated with combination therapy consisting of preoperative chemotherapy, radiation therapy, and surgical resection. A 76-yearold man presented with a small cell carcinoma measuring 6 cm in diameter in the middle third of the thoracic esophagus. After preoperative therapy, the gross tumor was completely resected. The patient eventually died of metastatic disease 25 months after diagosis. We discuss the treatment of esophageal small cell carcinoma.

DOI： 10.1272/jnms.81.97

Web of Science

PubMed

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記述言語：日本語   出版者・発行元：(株)南江堂  

胃癌術後局所再発による消化管狭窄に対するSEMS留置の有用性および問題点を検討した。術後消化管癌性狭窄を呈しSEMSを留置した5例を対象とした。OTW法で挿入した食道用ステントが3例、十二指腸用ステントの2例はTTS法で行った。いずれの症例でも3日以内にSEMSの開存を確認した。GOOSSスコアではSEMS留置前は0であったが、SEMS留置後は2.4と有意に高値を示した。SEMS留置による出血、穿孔、瘻孔形成、逸脱はなかったが、食道用SEMSを挿入した2例で腫瘍増生による再狭窄を認めた。在宅へ移行できた3例はすべて男性で、在宅移行率は60%であった。在宅移行が可能であった症例の平均在院日数は11日であった。SEMS留置後に外科治療を追加施行した症例はなかったが、姑息的全身化学療法は3例で行い、SEMS留置後の60日生存率は60%で、全例の平均生存日数は97.4日で、6ヵ月以内に原病死した。

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J00393&link_issn=&doc_id=20140226030015&doc_link_id=issn%3D0016-593X%26volume%3D76%26issue%3D3%26spage%3D305&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0016-593X%26volume%3D76%26issue%3D3%26spage%3D305&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

食道癌術後長期生存例の増加にともない、再建胃管癌例も増えている。今回、年代別で胃管癌の臨床病理学的項目、治療、予後などの変化について、当科の胃管癌9例と本邦報告156例を集計した165例において3期に分けて検討した。臨床病理学的検討では、発生部位は胃管下部に多く、組織型は7割が管状腺癌であり、年代で有意な差は認めなかった。内視鏡検査での発見症例が最近10年では7割を占め、早期発見例も年々増加していた。2003年以前に内視鏡治療を行った症例は20%であったが、最近10年では約40%まで増加し予後も改善傾向を示した。胃管癌の特徴を理解し、定期的な検査で早期発見することで、さらなる予後の改善につながると考えられた。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J01118&link_issn=&doc_id=20140312200008&doc_link_id=1390282681379600768&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390282681379600768&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本消化器内視鏡学会  

A 77-year-old man underwent total pharyngo-laryngo-esophagectomy, radical neck lymph node dissection, reconstruction using the gastric tube through the posterior mediastinal route and anterior mediastinal tracheostomy with bipedicled upper thoracic apron flap (Grillo) for advanced cervical esophageal cancer. Seventeen years later, the patient complained of dysphagia. Upper gastrointestinal endoscopy revealed an elevated lesion in the reconstructed gastric tube and the biopsy specimen showed adenocarcinoma. A small-bore endoscope could not pass through the tumor because of generalized narrowing of the reconstructed gastric tube. Even a 0.038 inch guide wire could not pass through the tumor. Endoscopic argon plasma coagulation was repeated twice, and the endoscope could be inserted to the duodenum by necrotic deciduation of the tumor. A covered-type self-expandable metallic esophageal stent was placed under fluoroscopic guidance, which has enabled the patient to take food orally.

DOI： 10.11280/gee.56.3786

Scopus

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

症例は,84歳の男性。貧血を主訴に来院し,精査にて胸部進行食道癌と診断した。既往歴は,78歳時に脳梗塞,心房細動,2型糖尿病であった。全身状態は比較的良好で手術を強く希望された。胸腔鏡下食道切除,開腹にて胃管作製し胸骨後経路で頸部食道胃管吻合術を施行した。術後第2病日に尿量減少,腎機能低下から持続的血液濾過透析療法を施行し,第3病日も継続して除水した。第4病日に軽度の腹痛を訴えたが,腹部X線検査から腸管運動の減弱と判断した。第5病日に不穏状態となり腹部CT検査を行い門脈ガス血症と腸管嚢胞様気腫症を認め,代謝性アシドーシスが増悪したため,緊急開腹となった。術中所見では,回腸末端の口側90cmの小腸が非連続的に壊死していたが,上下腸間膜動脈の拍動は触知でき,壊死部腸管切除術を施行した。病理学的に非閉塞性腸間膜虚血症と診断した。術後は集中治療室にて集学的治療を行ったが,多臓器不全で死亡した。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 70-year-old man who underwent two sessions of thoracoscopy-assisted ligation of the thoracic duct to treat refractory chylorrhea after radical esophagectomy for advanced esophageal cancer received conservative therapy. However, there was no improvement in chylorrhea. Then, transabdominal ligation of the lymphatic/thoracic duct at the level of the right crus of the diaphragm was performed using fluorescence navigation with indocyanine green (ICG). The procedure successfully reduced chylorrhea. This procedure provides a valid option for persistent chylothorax/chylous ascites accompanied by chylorrhea with no response to conservative treatment, transthoracic ligation, or both.

DOI： 10.1155/2014/464017

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   出版者・発行元：The Japanese Society of Gastroenterology  

食道癌術後長期生存例の増加にともない，再建胃管癌例も増えている．今回，年代別で胃管癌の臨床病理学的項目，治療，予後などの変化について，当科の胃管癌9例と本邦報告156例を集計した165例において3期に分けて検討した．臨床病理学的検討では，発生部位は胃管下部に多く，組織型は7割が管状腺癌であり，年代で有意な差は認めなかった．内視鏡検査での発見症例が最近10年では7割を占め，早期発見例も年々増加していた．2003年以前に内視鏡治療を行った症例は20％であったが，最近10年では約40％まで増加し予後も改善傾向を示した．胃管癌の特徴を理解し，定期的な検査で早期発見することで，さらなる予後の改善につながると考えられた．<br>

DOI： 10.11405/nisshoshi.111.512

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その他リンク： http://search.jamas.or.jp/link/ui/2014160646

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Korean Gastric Cancer Association  

We report an extremely rare case of primary squamous cell carcinoma of the stomach. A 69-year-old man was admitted to our hospital with a 2-month history of dysphagia and tarry stools. Endoscopic examination revealed a cauliflower-shaped protruding mass along the lesser curvature of the gastric cardia. Biopsy of the lesion revealed squamous cell carcinoma of the stomach. Computed tomography revealed a thickened stomach wall and a mass protruding into the gastric lumen. Total gastrectomy with splenectomy, distal pancreatectomy, and Roux-en-Y reconstruction was performed, together with a lower thoracic esophagectomy via a left thoracotomy. Histopathological examination of the specimen revealed well-differentiated squamous cell carcinoma of the stomach. Postoperative follow-up was uneventful for the first 18 months. However, multiple liver metastases and para-aortic lymph node metastasis developed subsequently. Despite systemic combination chemotherapy, the patient died because of progression of the recurrent tumors. Here, we review the characteristics of 56 cases of gastric squamous cell carcinoma reported in Japan. © 2014 by The Korean Gastric Cancer Association.

DOI： 10.5230/jgc.2014.14.1.58

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PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Society of Gastroenterology  

This study investigated gastric tube cancer (GTC) to clarify the clinicopathological characteristics in different generations. We analyzed 165 cases with metachronous GTC
9 cases from our institution and 156 from reported Japanese cases. Cases were divided into 3 groups to provide a detailed analysis of age-specific variations. GTC most commonly occurred in the lower gastric tube, and the most common histological type was tubular adenocarcinoma (70%). There were no age-related variations in the site and histological type of GTC. The incidence rate of endoscopic detection increased from 2003 to 74% in 2012, and the incidence of early GTC detection also significantly increased in this period. The rate of endoscopic treatment before 2003 was approximately 20%, and it doubled over the 10-year course of the study. The recent progress made in the diagnosis and treatment of GTC may have contributed to an improvement in its prognosis.

Scopus

PubMed

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

Esophageal squamous cell carcinoma is the sixth most common cause of cancer death in Japan. Surgery was previously the mainstay of treatment, but because of high rates of local and systemic recurrence, multidisciplinary management is being evaluated. In this article, we introduce the recent addition of neoadjuvant chemotherapy to the surgical management of resectable esophageal squamous cell carcinoma, clinical stage II and III, following the randomized control trial JCOG 9907. Neoadjuvant chemoradiotherapy has recently been approved for esophageal squamous cell carcinoma because it offers an opportunity for marginnegative resection, improved locoregional control, and increased survival rate. Less-invasive endoscopic procedures, such as thoracoscopic esophagectomy and laparoscopy-assisted gastric tube reconstruction, are options for the resection of noninvasive esophageal cancer. We performed thoracoscopic esophageal mobilization with the patient in the prone position. Compared with esophagectomy with right trans-thoracotomy, thoracoscopic esophagectomy has the advantage of a lower incidence of respiratory complications, which are a significant predictor of postoperative mortality. Additionally, other recent surgical treatments are described.&lt;br&gt;

DOI： 10.1272/manms.10.134

CiNii Books

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

症例は68歳の男性で,進行食道扁平上皮癌にて,胸腔鏡下食道切除・腹腔鏡補助下胃管作製・後縦隔経路で頸部食道胃管吻合術を施行した.術後第2病日に,咳嗽反射の減弱と喀痰排泄不良にて輪状甲状膜切開で小型気管内チューブを挿入した.第7病日に突然呼吸困難および皮下気種を認めた.胸部CT検査,上部消化管内視鏡および気管支ファイバーを施行し,気管膜様部損傷・気管再建胃管瘻と診断した.気管膜様部損傷部に小型気管内チューブが入り込んでいたため,術後気管粘膜の虚血性変化と小型気管内チューブによる気管壁への持続的刺激が原因と推測した.胸腔ドレーンを挿入後,呼吸・循環状態は改善したが,救命のためカバー付き気管・気管支メタリック・ステントを留置し,瘻孔を閉鎖した.経口摂取が可能となり軽快退院となった.(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J03156&link_issn=&doc_id=20131202120007&doc_link_id=10.3919%2Fjjsa.74.2997&url=https%3A%2F%2Fdoi.org%2F10.3919%2Fjjsa.74.2997&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：日本医科大学医学会  

Zenker's diverticulum is a pulsion diverticulum that occurs at a weak site in the posterior wall of the pharyngoesophagus between the inferior constictor of the pharynx and the cricopharygeus muscle, i.e. Killian's triangle. Zenker's diverticulum is rare in Japan. We performed diverticulectomy with cricopharyngeal myotomy for Zenker's diverticulum via the external cervical approach with the patient under general anesthesia. The huge diverticulum was resected with the use of a large-diameter (45Fr) esophageal bougie. Patients with a large diverticulum are at risk for postoperative surgical complications, such as pneumonia and reccurent laryngeal nerve paralysis.<br>

DOI： 10.1272/manms.9.190

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER JAPAN KK  

We performed surgery for proton pump inhibitor-resistant non-erosive reflux disease patients whose symptom index, confirmed by combined multichannel intraluminal impedance-pH monitoring, was positive. Laparoscopic Nissen fundoplication was performed in five patients and laparoscopic Toupet fundoplication in 3 patients. In 6 of 8 patients, non-acid or minor acid reflux caused the symptoms. Satisfaction percentages assessed 1 year postoperatively were 12.5 % (excellent) and 87.5 % (good).The number of total reflux events decreased to 28.5 +/- A 14.4 % postoperatively. The symptom index decreased from 63.8 to 20.8 %. It is controversial whether the surgery reduces weakly acidic reflux to the same degree as acid reflux. Previous reports discuss the effect of laparoscopic Nissen fundoplication on acid and weakly acidic reflux; however, the results of these studies are contradictory. In our cases, laparoscopic Toupet fundoplication as well as Nissen fundoplication improved symptoms, and reduced acid and non-acid reflux similarly. These findings strongly support the importance of surgical intervention in proton pump inhibitor-resistant non-erosive reflux disease patients.

DOI： 10.1007/s10388-013-0360-1

Web of Science

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記述言語：日本語   出版者・発行元：(株)医学書院  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

症例は,62歳男性。前医にて胸部食道癌に対し,右開胸開腹食道亜全摘,後縦隔経路胃管再建,腸瘻造設術を施行したが第10病日に胃管壊死と診断した。胃管壊死部切除と健常部を胸壁前に埋没,頸部食道皮膚瘻を造設した。食道再建術目的にて当科に転院となった。開腹にて有茎遊離空腸を採取,頸部食道と埋没した胃管の間に有茎遊離空腸を間置した。第4病日に嘔吐と腹痛を訴え,腹部CT検査を行った。門脈ガス血症と腸管嚢胞様気腫症を認め,緊急開腹となった。手術所見では腸瘻造設部肛門側の空腸が腹膜と癒着し,その癒着部と腸瘻造設部の2点を基点として肛門側の全小腸が背側から尾側へ入り込み内ヘルニアとなっていた。これを整復し,腸管壊死は認めなかったため腸管切除は行わなかった。術後早期に経口摂取可能となり第21病日に軽快退院した。食道癌術後の内ヘルニアに起因して発症した門脈ガス血症と腸管嚢胞様気腫症の報告は極めてまれと思われた。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J02824&link_issn=&doc_id=20130827380022&doc_link_id=10.11231%2Fjaem.33.913&url=https%3A%2F%2Fdoi.org%2F10.11231%2Fjaem.33.913&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：日本医科大学医学会  

73歳女。約1ヵ月前から嚥下困難が出現し、上部消化管内視鏡検査で胸部下部食道から胃噴門部まで占拠する腫瘍を認めた。上部消化管バリウム造影検査所見では、胸部下部から噴門部にかけて長径6cmの鋸歯状腫瘍を認めた。上部消化管内視鏡検査所見では、門歯列30cmから噴門までにカリフラワー状の隆起性腫瘍を認めた。病変部の病理組織検査では、高分化管状腺癌であった。切除可能なSiewert type II食道胃接合部進行腺癌と診断した。胸部操作は腹臥位にて胸腔鏡下食道切除を施行した。開脚仰臥位に体位変換し、腹腔鏡下胃管作成、腸瘻造設、後縦隔経路で胃管を挙上、頸部食道胃管吻合を行った。術後経過は良好で、術後第20病日に軽快退院した。術後2ヵ月目からTS-1内服治療を行った。術後30ヵ月経過したが、再発は認めていない。

DOI： 10.1272/manms.9.160

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J04260&link_issn=&doc_id=20130624400004&doc_link_id=%2Fcw1nimed%2F2013%2F000903%2F005%2F0160-0163%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcw1nimed%2F2013%2F000903%2F005%2F0160-0163%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(株)南江堂  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J00393&link_issn=&doc_id=20130322030011&doc_link_id=issn%3D0016-593X%26volume%3D75%26issue%3D4%26spage%3D400&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0016-593X%26volume%3D75%26issue%3D4%26spage%3D400&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：日本語   出版者・発行元：日本医科大学医学会  

A 54-year-old male with a chief complaint of dysphagia was admitted to our hospital. Upper gastrointestinal endoscopy and esophagogram revealed a submucosal tumor in the cervico-thoracic esophagus, and pathological examination of the biopsy specimens revealed a squamous cell carcinoma. Computed tomography of the neck and chest showed cT4N0M0, cStage III. The patient received neoadjuvant chemotherapy (NAC) with cisplatin and 5-FU. Follow-up examinations after NAC evaluated a stable disease. The patient underwent larynx-preserving thoracoscopic esophagectomy. Reconstruction was done using a gastric tube through the retrosternal route and free jejunum graft with micro-vascular anastomosis. The postoperative course was uneventful and the patient had been able to eat most foods without aspiration. We herein describe the importance of team management for a cervico-thoracic esophageal cancer.<br>

DOI： 10.1272/manms.9.20

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

It is now evident that changes in microRNA are involved in cancer progression, but the mechanisms of transcriptional regulation of miRNAs remain unknown. Ski-related novel gene (SnoN/SKIL), a transcription co-factor, acts as a potential key regulator within a complex network of p53 transcriptional repressors. SnoN has pro- and anti-oncogenic functions in the regulation of cell proliferation, senescence, apoptosis, and differentiation. We characterized the roles of SnoN in miRNA transcriptional regulation and its effects on cell proliferation using esophageal squamous cell carcinoma (ESCC) cells. Silencing of SnoN altered a set of miRNA expression profiles in TE-1cells, and the expression levels of miR-720, miR-1274A, and miR-1274B were modulated by SnoN. The expression of these miRNAs resulted in changes to the target protein p63 and a disintegrin and metalloproteinase domain 9 (ADAM9). Furthermore, silencing of SnoN significantly upregulated cell proliferation in TE-1 cells, indicating a potential anti-oncogenic function. These results support our observation that cancer tissues have lower expression levels of SnoN, miR-720, and miR-1274A compared to adjacent normal tissues from ESCC patients. These data demonstrate a novel mechanism of miRNA regulation, leading to changes in cell proliferation. © 2012 Elsevier Inc.

DOI： 10.1016/j.bbrc.2012.11.005

Web of Science

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PubMed

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記述言語：日本語   出版者・発行元：一般社団法人 日本消化器内視鏡学会 関東支部  

A 56-year-old man was hospitalized for treatment of severe acute abdominal pain. Chest X-ray and abdominal CT showed the presence of free air intra-abdominally. A clinical diagnosis of acute generalized peritonitis due to gastro-duodenal perforation was made and emergency surgery was performed. At the time of surgery, a 3 cm-diameter perforation was identified on the anterior wall of the duodenal bulb, and treatment effected by omental patch. On the 12th day post-operatively, endoscopy confirmed that no leakage was present at the previously-perforated site in the duodenum. On day 17, food debris appeared unexpectedly at the surgical site due to wound dehiscence. Abdominal enhanced CT showed the presence of free air from the front of the duodenal bulb extending through the intra-abdominal space to the skin wound. Whilst fasting combined with a course of antibiotics, treatment for the site of leakage was performed. Using regular clips and nylon yarns under endoscopy, the hole was reefed and leakage of contrast medium significantly abated. Subsequently inflammation reduced dramatically. The patient&#039;s condition discernibly improved and finally resolved without the need for invasive surgery.

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

A 70-year-old male with a chief complaint of dysphagia was admitted to our hospital. Upper gastrointestinal endoscopy revealed an advanced tumor at the middle and lower third of the esophagus, and pathological examination of the biopsy specimens revealed a moderately-differentiated squamous cell carcinoma. Computed tomography of the chest showed cT3N1M0, cStage III. The patient rejected radical esophagectomy, and received definitive chemoradiotherapy (CRT) with docetaxel, nedaplatin and 5-FU. Follow-up examinations after CRT evaluated a partial response. However, an endoscope could not pass through the stricture in the esophagus. The patient underwent single-port gastrostomy to improve nutritional status and hypoproteinemia. On 5 months after CRT, the patient has improved nutritional condition, and laparoscopy assisted esophageal bypass operation was performed. Postoperatively, the patient was able to eat most foods for 9 months. The patient died by the carcinomatosis 10 months after bypass operation.<br>

DOI： 10.1272/manms.8.260

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：金原出版(株)  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：金原出版(株)  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2012373232

記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J04260&link_issn=&doc_id=20120817090005&doc_link_id=%2Fcw1nimed%2F2012%2F000803%2F006%2F0207-0210%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcw1nimed%2F2012%2F000803%2F006%2F0207-0210%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：金原出版(株)  

83歳男。嚥下困難を主訴とした。上部消化管内視鏡で門歯より27cmに半周性の3型の腫瘍を認め、生検で扁平上皮癌の診断を得た。CTで胸部中部食道壁肥厚を認め、左気管支および大動脈浸潤が疑われた。Mt、3型、cT4N0M0、Stage IIIの食道癌と診断し、根治的化学放射線療法(タキソテール30mg/m2・day1、ネダプラチン10mg/body、5-FU 250mg/m2・day1-5、外照射1.8Gy/day×30)を施行した。肉眼的および組織学的に腫瘍は消失しCRと判定したが、3ヵ月後に局所再発を認めた。化学放射線療法の奏効で比較的長期的な予後が望めることから、バイパス術の適応と判断し、腹腔鏡補助下食道バイパス術を施行した。術後に縫合不全を認めたが保存的治療で軽快した。原病死するまでの7ヵ月間、腸瘻からの経管栄養を併用したが、軟食の経口摂取が可能であった。

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPANDIDOS PUBL LTD  

The urinary trypsin inhibitor (UTI) is responsible for most of the antitryptic activity in urine and is excreted in increased amounts in urine under certain pathological conditions such as cancer and bacterial infections. Our aim in this study was to better understand the mechanisms responsible for the increase in UTI excretion on surgical stress and thus to better appreciate the information provided by inflammatory mediators. Thirty-one consecutive patients who underwent radical esophagectomy for esophageal cancer were investigated in this study. We determined serum UTI and polymorphonuclear cell elastase (PMNE), urine UTI and evaluated the effectiveness of preoperative administration of methylprednisolone on the postoperative clinical course and adverse inflammatory reactions. The results revealed that urine UTI and serum PMNE levels in the steroid group were significantly lower than those in the non-steroid group. In addition, UTI levels correlated positively with scrum levels of aminotransferases. More importantly, the maximum level of urine UTI in patients without complications was lower than that in patients with complications. These results suggest that urine UTI provides useful information concerning postoperative clinical course, and that preoperative administration of methylprednisolone may contribute to decrease postoperative complications following esophagectomy.

DOI： 10.3892/etm.2012.554

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPANDIDOS PUBL LTD  

Evidence-based guidelines for the prevention of surgical site infection (SSI) have been published by the U.S. Centers for Disease Control and Prevention (CDC). According to these guidelines, a wound should usually be covered with a sterile dressing for 24 to 48 h when a surgical incision is closed primarily. However, it is not recommended that an incision be covered by a dressing beyond 48 h. In this study, patients were stratified into two groups for analysis: patients whose surgical wound was sterilized and whose gauze was changed once daily until postoperative day 7 (7POD; group A); and patients whose surgical wound was sterilized and whose gauze was changed once daily until 2POD (group B). We evaluated the incidence of SSI, nursing hours and cost implications. The results showed that there was no significant difference in SSI occurrence between the two groups (group A, 10% vs. group B, 7.3%). By contrast, the average nursing time differed by 2.8 min (group A, 3.8 min vs. group B, 0.9 min). The material costs per patient were also reduced by $14.70 (group A, $61.80 vs. group B, $47.10). In conclusion, we applied our knowledge of the evidence-based CDC guidelines to determine whether 48-h wound management can be made easier, more uniform and more cost-effective compared to conventional wound management. The results of the present study showed that surgical wound management methods can be more convenient and inexpensive.

DOI： 10.3892/ol.2012.687

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

66歳,男性。主訴は,呼吸困難,腹部膨満感と吐血。3年前に慢性肺気腫,右肺気腫性嚢胞と診断されていた。胸部CTにて右巨大肺嚢胞の圧排による縦隔偏位を認めた。また胸部X線撮影ならびに腹部CTで消化管穿孔を示すfree airを,腹部所見で筋性防御を認めたため消化管穿孔による腹膜炎と診断した。右肺気腫性嚢胞の膨張によると思われる呼吸状態の増悪を認め,右肺気腫性嚢胞と腹膜炎に対し同時に緊急手術を施行した。手術直前に手術室にて上部消化管内視鏡検査を行い,胃角部および十二指腸前壁に活動期の潰瘍を確認した。開腹下に十二指腸潰瘍穿孔部への大網充填術と腹腔内を十分に洗浄し,Douglas窩,右横隔膜下,網嚢孔にドレーンを留置した。胸部は胸腔鏡補助下に右肺嚢胞切除術を施行した。術後は,急性肺水腫,大葉性肺炎を合併し人工呼吸器管理を必要としたが,集学的治療で軽快した。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J02824&link_issn=&doc_id=20120823340012&doc_link_id=10.11231%2Fjaem.32.935&url=https%3A%2F%2Fdoi.org%2F10.11231%2Fjaem.32.935&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：AMER ASSOC CANCER RESEARCH  

Background: Patients with lung cancer with mutations in EGF receptor (EGFR) tyrosine kinase have improved prognosis when treated with EGFR inhibitors. We hypothesized that EGFR mutations may be related to residential radon or passive tobacco smoke.
Methods: This hypothesis was investigated by analyzing EGFR mutations in 70 lung tumors from a population of never and long-term former female smokers from Missouri with detailed exposure assessments. The relationship with passive smoking was also examined in never-smoking female lung cancer cases from the Mayo clinic.
Results: Overall, the frequency of EGFR mutation was 41% [95% confidence interval (Cl), 32%-49%[. Neither radon nor passive-smoking exposure was consistently associated with EGFR mutations in lung tumors.
Conclusions: The results suggest that EGFR mutations are common in female, never-smoking lung cancer cases from the United States, and EGFR mutations are unlikely due to exposure to radon or passive smoking. Cancer Epidemiol Biomarkers Prey; 21(6); 988-92. (C) 2012 AACR.

DOI： 10.1158/1055-9965.EPI-12-0166

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

アカラシアは下部食道括約筋(LES)の弛緩不全および食道体部の蠕動障害により、嚥下障害をきたす1次性食道運動障害の代表的疾患である。アカラシアの確定診断は食道内圧検査により行われるが内視鏡検査も有用である。LES弛緩不全を認めない場合には、下部食道を深吸気時に観察すると柵状血管の下端を含めた全体像が観察されるが、アカラシア患者では深吸気時にも柵状血管の全体像は観察されず、下部食道の狭窄部に集中する全周性の襞像が観察される。アカラシアのバルーン拡張術は有効な治療法の1つである。拡張術において重要なことは拡張時のバルーンの切れこみを消失させることであるが、切れこみは低圧な状態でも消失させることが可能であり、ゆっくりと低圧にて加圧することが重要である。最も使用される30mmバルーンでの当科における拡張術の治療成功率は約75%である。治療成功率に関連する因子は年齢であり、30歳未満の患者に対するバルーン拡張術の成功例はないが、30〜40歳未満の患者での治療成功率は約60%、40歳以上では約85%である。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J01118&link_issn=&doc_id=20120524110002&doc_link_id=1390001206401297536&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390001206401297536&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

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記述言語：日本語   出版者・発行元：(一社)日本Shock学会  

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記述言語：日本語   出版者・発行元：(一社)日本Shock学会  

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記述言語：英語   出版者・発行元：AMER ASSOC CANCER RESEARCH  

DOI： 10.1158/1538-7445.AM2012-3623

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

80歳以上の高齢者進行食道癌3例に対するドセタキセル/ネダプラチン/5-フルオロウラシル併用化学放射線療法(CRT)の抗腫瘍効果と有害事象の程度を報告した。抗腫瘍効果は、症例1は肉眼的、組織学的に腫瘍は消失しCR、症例2は組織学的にも癌細胞を検出せず、さらに頸部リンパ節転移巣も消失しCRと判定した。症例3では癌細胞は組織学的に認めず、CRと判定した。奏効率100%、CR率100%であった。有害事象は、症例1はGrade 2の白血球減少、症例2はGrade 3の白血球・好中球減少を認めた。症例1のみGrade 2の消化器症状を認めた。予後・転帰は、症例1ではCRT終了後42ヵ月を経過したが腫瘍の再発・再燃あるいは放射線治療の晩期障害等も認めていない。症例2はCRT終了10ヵ月目、症例3はCRT終了から22ヵ月目に死亡した。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J04260&link_issn=&doc_id=20120501350009&doc_link_id=%2Fcw1nimed%2F2012%2F000802%2F013%2F0143-0146%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcw1nimed%2F2012%2F000802%2F013%2F0143-0146%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(株)日本メディカルセンター  

H.pylori感染以外の胃発癌リスクとしてBillroth(B)II法術後に多い吻合部周囲の残胃癌は,腸上皮化生を背景粘膜としており,胆汁など十二指腸液の逆流,胃内pHの中性化が原因と考えられ,このことより除菌治療だけでは胃癌発生抑制効果が不十分と考えられる.胃切症例の経年的内視鏡観察による累積再発生率と萎縮性胃炎,腸上皮化生など高危険粘膜を内視鏡生検,ペプシノーゲン法,胃内pHで検討した結果,累積再発生率は有意に粘膜切除を含む局所切除後&gt;BII法後&gt;BI法後の順で高く14.3%,7.5%,1.9%であった.胃癌発生例では組織学的Updated Sydney System 4段階(0〜3)評価でinflammation(炎症によるリンパ球浸潤)がスコア2以上で再発生6例/29例と有意に高く,除菌治療でも慢性炎症が改善しない症例が高リスクと考えられた.炎症,胆汁逆流,胃内中性化の高リスク症例をプロスペクティブに観察して4年後にESD治療を行った症例を提示する.(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(有)科学評論社  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

In spite of the undisputed importance of altered expression patterns of microRNAs (miRNAs) in various cancers, there is little information on the clinicopathologic significance of cancer-related miRNAs (MIR21, MIR143, MIR144, MIR145, and MIR205) in esophageal squamous cell carcinoma (ESCC). We examined the expression levels of the precursor and mature miRNA genes in ESCC using real-time polymerase chain reaction (PCR). We also investigated the mRNA expression levels of processing elements (RNASEN, DGCR8, and DICER1) that participate in miRNA-biogenesis pathway. Furthermore, we analyzed the relationships between the expression levels of these five miRNAs and the clinicopathologic parameters of ESCC patients. The expression levels of mature MIR21 and mature MIR145 were higher in ESCC than those in normal epithelium (P &lt; 0.05). The mature/pre ratio of MIR21 in ESCC was higher than that in normal epithelium (P &lt; 0.05). With regard to miRNA-processing elements, the expression level of RNASEN was higher in ESCC than in normal epithelium (P &lt; 0.05). Furthermore, altered expression of these miRNAs was related to the clinicopathologic features of ESCC patients. The high expression of mature MIR21 and mature MIR205 was associated with lymph node positivity in ESCC patients (P &lt; 0.05). The high levels of expression of mature MIR143 and mature MIR145 were associated with recurrence of metastasis in ESCC patients (P &lt; 0.05). The findings may imply that miRNA biogenesis is aberrantly accelerated in ESCC. Analysis of the expression levels of miRNAs should provide useful information for evaluation of the staging, prognosis, and treatment of ESCC patients.

DOI： 10.1111/j.1442-2050.2011.01177.x

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その他リンク： http://orcid.org/0000-0003-4698-460X

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

We report a case of esophageal squamous cell carcinoma (ESCC) directly invading the liver and causing a pyogenic liver abscess. The patient was a 66-year-old man who presented with dysphagia. Esophagography, endoscopic study, and computed tomography (CT) showed a mass lesion in the lower third of the esophagus. A high fever developed on hospital day 17 and another CT scan revealed a liver abscess, 50 x 45 mm, in the left lateral lobe of the liver. Although imaging demonstrated a liver abscess continuous with the tumor, we performed percutaneous transhepatic drainage, followed thereafter by distal esophagectomy and total gastrectomy with a left lateral segmental resection of the liver. The pathological findings confirmed a diagnosis of ESCC with direct invasion (T4N1M0, stage IVa in the TNM classification). The patient had an uneventful postoperative recovery. Microscopic examination of the resected specimen revealed the expansive growth of tumor cells into the hepatocellular tissues. To our knowledge, this is the first report of the direct invasion of esophageal cancer to the liver causing a pyogenic liver abscess; however, it should be borne in mind when a patient with esophageal cancer becomes febrile.

DOI： 10.1007/s00595-010-4455-1

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

We describe a 54-year-old man in whom esophageal carcinoma was diagnosed and who underwent video-assisted thoracoscopic surgery of the esophagus (VATS-E) in the prone position. initially, the patient was fixed in a semiprone position, from which he could be rotated to a prone or left lateral position. Four ports were inserted, and then the patient was rotated to the prone position. Once the patient was prone, gravity caused the lung to move downwards. Next, the chest cavity was inflated with a CO(2) insufflation pressure of 6 mm Hg. Esophagectomy was then performed, and the lymph nodes in the middle and lower mediastinum and along the right recurrent laryngeal nerve were dissected. In the left upper mediastinum, lymph node dissection was performed after the residual esophagus was stripped. Stripping of the residual esophagus created sufficient working space and a clear operative field for lymph node dissection. VATS-E in the prone position has achieved remarkable results in Japan. It allows a clear operative view of the middle and lower mediastinum, but the working space in the upper mediastinum is limited. Our results indicate that esophageal stripping in prone VATS-E allows for safe and straightforward lymph node dissection along the left recurrent laryngeal nerve. Our technique overcame the difficulties usually encountered with this type of lymph node dissection. (J Nippon Med Sch 2011; 78: 199-204)

DOI： 10.1272/jnms.78.199

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER TOKYO  

A 64-year-old man visited our hospital complaining of abdominal discomfort. A 2-cm-long 0-IIc + IIa esophageal superficial carcinoma was detected in the middle third of the thoracic esophagus with endoscopy and esophagography. Computed tomography (CT) did not detect any metastasis. The patient underwent video-assisted thoracic surgery of the esophagus (VATS-E). Anastomotic leakage and a thoracic abscess were detected 16 days after the operation. Repeated thoracic drainages and conservative therapy with enteral nutrition were continued for approximately 1 month, but an esophago-mediastinal fistula and small mediastinal cavity remained. Additional drainage using interventional radiology (IVR) reduced the size of the cavity, but could not cure the esophago-mediastinal fistula, 68 days after the operation. The occurrence of an esophago-respiratory fistula followed by a thoracic abscess is a very serious and frequently fatal complication. We performed endoscopic clipping and filling with fibrin glue and succeeded in closing the fistula. Oral intake was started after training in swallowing, and the patient was discharged from hospital 172 days after the operation. One year after the operation he has no sign of a recurrence of the tumor or fistula. We demonstrated a case in which an esophago-mediastinal fistula was successfully repaired by endoscopic clipping with fibrin glue after an operation.

DOI： 10.1007/s10388-011-0263-y

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：英語   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

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記述言語：日本語   出版者・発行元：(NPO)日本気管食道科学会  

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記述言語：英語   出版者・発行元：AMER ASSOC CANCER RESEARCH  

DOI： 10.1158/1538-7445.AM2011-3187

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記述言語：日本語   出版者・発行元：(NPO)日本気管食道科学会  

食道癌術後縫合不全に続発した食道縦隔瘻に対して、手術時に挿入した胸腔ドレーンまたは追加や再挿入による胸腔・縦隔ドレナージを施行し、大半は自然閉鎖するが、改善せずに難渋することがある。留置したドレーンによる排膿が不十分で、エコーガイド下が困難であれば、CTガイド下穿刺ドレナージが有効である。しかし、それでも瘻孔の改善を認めない症例が3例あり、追加治療として方法1.食道ステント挿入、2.経鼻胃管による消化管内からの胸腔・縦隔ドレナージによる排膿、3.内視鏡下クリッピングとフィブリン糊散布にて瘻孔閉鎖を施行し、瘻孔閉鎖が認められ治癒し得た。これらの治療は、手術と比較して侵襲も小さく有効な治療法と考える。(著者抄録)

DOI： 10.2468/jbes.62.183

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：英語   出版者・発行元：The Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.78.54

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：AMER ASSOC CANCER RESEARCH  

Purpose: Esophageal cancer is one of the most aggressive and deadly forms of cancer; highlighting the need to identify biomarkers for early detection and prognostic classification. Our recent studies have identified inflammatory gene and microRNA signatures derived from tumor and nontumor tissues as prognostic biomarkers of hepatocellular, lung, and colorectal adenocarcinoma. Here, we examine the relationship between expression of these inflammatory genes and micro RNA (miRNA) expression in esophageal adenocarcinoma and patient survival.
Experimental Design: We measured the expression of 23 inflammation-associated genes in tumors and adjacent normal tissues from 93 patients (58 Barrett&apos;s and 35 Sporadic adenocarcinomas) by quantitative reverse transcription-polymerase chain reaction. These data were used to build an inflammatory risk model, based on multivariate Cox regression, to predict survival in a training cohort (n = 47). We then determined whether this model could predict survival in a cohort of 46 patients. Expression data for miRNA-375 were available for these patients and was combined with inflammatory gene expression.
Results: IFN-gamma, IL-1 alpha, IL-8, IL-21, IL-23, and proteoglycan expression in tumor and nontumor samples were each associated with poor prognosis based on Cox regression [(Z-score)&gt;1.5] and therefore were used to generate an inflammatory risk score (IRS). Patients with a high IRS had poor prognosis compared with those with a low IRS in the training (P = 0.002) and test (P = 0.012) cohorts. This association was stronger in the group with Barrett&apos;s history. When combining with miRNA-375, the combined IRS/miR signature was an improved prognostic classifier than either one alone.
Conclusion: Transcriptional profiling of inflammation-associated genes and miRNA expression in resected esophageal Barrett&apos;s-associated adenocarcinoma tissues may have clinical utility as predictors of prognosis. Clin Cancer Res; 16(23); 5824-34. (C)2010 AACR.

DOI： 10.1158/1078-0432.CCR-10-1110

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：英語   出版者・発行元：AMER ASSOC CANCER RESEARCH  

DOI： 10.1158/1538-7445.AM10-1755

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記述言語：英語   出版者・発行元：AMER ASSOC CANCER RESEARCH  

DOI： 10.1158/1538-7445.AM10-815

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DOI： 10.1016/j.gie.2010.03.519

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Medical Association of Nippon Medical School  

An 80-year-old woman was admitted to our hospital with severe chest and back pains after vomiting. Computed tomography (CT) of the chest revealed left-sided pneumothorax and pleural effusion. Some food was drained from an inserted chest tube, and we diagnosed spontaneous esophageal rupture (Boerhaave's syndrome). A left thoracotomy was performed 7 hours after the onset of symptoms. A 3-cm perforation was discovered in the lateral wall of the distal esophagus. The perforation was repaired with a primary two-layered closure and covered with pericardial fat. The patient had a good postoperative course and was discharged 1 month after surgery. This case suggests the importance of early surgical treatment, even in elderly patients with spontaneous esophageal rupture.

DOI： 10.1272/jnms.77.338

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：AMER ASSOC CANCER RESEARCH  

Purpose: The dismal outcome of esophageal cancer patients highlights the need for novel prognostic biomarkers, such as microRNAs (miRNA). Although recent studies have established the role of miRNAs in esophageal carcinoma, a comprehensive multicenter study investigating different histologic types, including squamous cell carcinoma (SCC) and adenocarcinoma with or without Barrett&apos;s, is still lacking.
Experimental Design: miRNA expression was measured in cancerous and adjacent noncancerous tissue pairs collected from 100 adenocarcinoma and 70 SCC patients enrolled at four clinical centers from the United States, Canada, and Japan. Microarray-based expression was measured in a subset of samples in two cohorts and was validated in all available samples.
Results: In adenocarcinoma patients, miR-21, miR-223, miR-192, and miR-194 expression was elevated, whereas miR-203 expression was reduced in cancerous compared with noncancerous tissue. In SCC patients, we found elevated miR-21 and reduced miR-375 expression levels in cancerous compared with noncancerous tissue. When comparing cancerous tissue expression between adenocarcinoma and SCC patients, miR-194 and miR-375 were elevated in adenocarcinoma patients. Significantly, elevated miR-21 expression in noncancerous tissue of SCC patients and reduced levels of miR-375 in cancerous tissue of adenocarcinoma patients with Barrett&apos;s were strongly associated with worse prognosis. Associations with prognosis were independent of tumor stage or nodal status, cohort type, and chemoradiation therapy.
Conclusions: Our multicenter-based results highlight miRNAs involved in major histologic types of esophageal carcinoma and uncover significant associations with prognosis. Elucidating miRNAs relevant to esophageal carcinogenesis is potentially clinically useful for developing prognostic biomarkers and identifying novel drug targets and therapies. (Clin Cancer Res 2009;15(19):6192-200)

DOI： 10.1158/1078-0432.CCR-09-1467

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-LISS  

Inhibitor of growth 2 (ING2) is associated with chromatin remodeling and regulation of gene expression by binding to a methylated histone H3K4 residue and recruiting HDAC complexes to the region. The aim of our study is to investigate the regulation of ING2 expression and the clinical significance of upregulated ING2 in colon cancer. Here, we show that the ING2 mRNA level in colon cancer tissue increased to more than twice than that in normal mucosa in the 45% of colorectal cancer cases that we examined. A putative NF-kappa B binding site was found in the ING2 promoter region. We confirmed that NF-kappa B could bind to the ING2 promoter by EMSA and luciferase assays. Subsequent microarray analyses revealed that ING2 upregulates expression of matrix metalloproteinase 13 (MMP13), which enhances cancer invasion and metastasis. ING2 regulation of MMP13 expression was confirmed in both ING2 overexpression and knock down experiments. MMP13 expression was further induced by coexpression of ING2 with HDAC1 or with mSin3A, suggesting that the ING2-HDAC1-mSin3A complex members regulates expression of MMP13. In vitro invasion assay was performed to determine functional significance of ING2 upregulation. ING2 overexpressed cells exhibited greater invasive potential. Taken together, upregulation of ING2 was associated with colon cancer and MMP13-dependent cellular invasion, indicating that ING2 expression might be involved with cancer invasion and metastasis. Published 2009 UICC. This article is a US Government work and, as such, is in the public domain in the United States of America.

DOI： 10.1002/ijc.24437

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ACADEMIC PRESS INC ELSEVIER SCIENCE  

The Akt-Mdm2 pathway plays an important role in carcinogenesis in a variety of malignant tumors. However, the Akt-Mdm2 pathway in esophageal squamous cell carcinoma (ESCC) has not been fully studied. We investigated the proteins and mRNA expression of Akt and Mdm2 to elucidate the roles of these proteins in ESCC. We also examined the effect of Akt knockdown on Mdm2 expression in ESCC cells. ESCC tissue samples were obtained from 23 individuals who underwent surgical resection with no preoperative treatment. Akt1-3 and Mdm2 gene and protein expression were analyzed. The effect of siRNA-mediated Akt knockdown on Mdm2 expression was also studied, using ESCC cell lines. Akt1 and Mdm2 immunoreactivity was detected in 77.8 and 66.7% of tumor specimen from ESCC patients, respectively. Akt1 and Mdm2 mRNA expressions were correlated and significantly elevated in tumor tissue (p&lt;0.0001 and p&lt;0.05, respectively). The siRNA-targeted reduction of each Akt isoform reduced Mdm2 protein expression. The overexpression of Akt1 and Mdm2 may be related to esophageal carcinogenesis. Furthermore, Akt expression regulates Mdm2 expression, which may in turn regulate the function of wildtype p53. These results may provide the basis for future preventative or clinical therapies for esophageal cancer. (C) 2008 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.yexmp.2008.11.013

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記述言語：日本語   出版者・発行元：Japan Surgical Association  

症例は63歳，男性．発熱と肛門痛を主訴に来院．直腸（Rb）に進行癌を認め，潰瘍底の穿通による骨盤内膿瘍を合併していた．fecal diversion目的で回腸人工肛門を造設し，炎症所見が改善した後，術前化学照射線療法（chemoradiation therapy:以下CRT）を行った（5-FU 500mg+CDDP 10mg/day，1-5days，照射線量は計40Gy）．有害事象および感染病巣の再燃はなかった．CRT終了から6週目に内括約筋切除を伴う肛門温存直腸切除術を施行した．病理所見はpA，pN1，M0，stageIIIa．腫瘍組織内に多くの壊死組織巣を認め，組織学的効果判定はGradeIbであった．術後1年を経過し再発の徴候は無い．穿通合併直腸癌は局所再発の危険性が高いので術前CRTの意義は大きい．CRTを行う上で，骨盤内の感染をコントロールしておく必要があり，回腸人工肛門造設が有効であった．

DOI： 10.3919/jjsa.70.1782

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その他リンク： http://search.jamas.or.jp/link/ui/2009247448

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPANDIDOS PUBL LTD  

The genomic region containing PIK3CA was found to be amplified in esophageal squamous cell carcinoma (ESCC) tissue. PIK3CA at 3q26, which encodes the p110 alpha catalytic subunit of phosphatidylinositol (PI) 3-kinase, is a unique intracellular signal transducer characterized by its lipid substrate specificity. In order to characterize PIK3CA in ESCC, we investigated hot-spot mutations in exons 1, 9 and 20, the copy number gain, the expression levels of mRNA and protein. Analysis in exon 9 of the PIK3CA gene revealed mutation in 7.7%0 (4 of 52) of ESCC samples. No mutation was detected in either exon 1 or exon 20. Copy number amplifications of PIK3CA were found in 12 of the 45 patients (26.7%). PIK3CA mRNAs were examined in 37 ESCC patients as determined by quantitative RT-PCR and the mean mRNA level of PIK3CA in ESCC tissues was 2.61-fold higher compared with that in corresponding non-tumorous esophageal epithelia (P &lt; 0.001). Immunohistochemically, positive immunoreaction for PIK3CA was detectable in 33 of 66 (50.0%) ESCC cases, while it was not detectable in the remaining 33 cases. Furthermore, comparing the cases with negative staining with those with positive staining for PIK3CA, the presence of node metastasis was significantly correlated with those with positive staining (P &lt; 0.05). This study is the first report providing comprehensive analysis of PIK3CA expression in ESCC. These results indicate that PIK3CA may play a crucial role in the development of ESCC and serve as an indicator for lymph node metastasis.

DOI： 10.3892/ijo_00000202

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We herein report on the successful surgical treatment of Crohn's disease with enteroliths formed in the ileum. A 58-year-old man presented with abdominal colicky pain, and long-standing constipation. He was diagnosed as ileus due to enteroliths and was initially managed conservatively, but improvement was not observed either clinically or on radio imaging. We, therefore, performed a laparotomy, which revealed Crohn's disease with enteroliths in the ileum. Because the enteroliths in the ileum were not mobile and could not be broken manually, we carried out a segmental bowel resection with the removal of the enteroliths. The pathology report revealed Crohn's disease with enteroliths. Intestinal obstruction caused by enteroliths associated with Crohn's disease occurs rarely, and is difficult to be diagnosed and managed.

DOI： 10.3814/2009/653965

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Background: Earlier studies have identified the minimal overlapping region of amplification at 3q26 in esophageal squamous cell carcinoma (ESCC) by comparative genomic hybridization (CGH) analysis. These include PIK3CA which encodes the p110 alpha catalytic subunit of phosphatidylinositol (PI) 3-kinase, a telomerase RNA component (TERC), a squamous cell carcinoma-related oncogene (SCCRO), ecotropic viral integration site-1 (EVI-1), and a Ski-related novel oncogene (SnoN). In the present study, we investigated the mRNA levels of four candidate genes (TERC, SCCRO, EVI-1, and SnoN) to determine whether genes other than PIK3CA are targets for amplification at 3q26 in ESCC. And also, we examined SnoN expression in ESCC samples.
Methods: Fifty-nine representative cases with ESCC were selected from our archives. We performed quantitative RT-PCR of four candidate genes (TERC, SCCRO, EVI-1, and SnoN) and immunohistochemistry for SnoN. Finally, we correlated these findings with the clinicopathological characteristics to determine their interrelationship.
Results: Among the four genes we tested, only SnoN mRNA was consistently overexpressed in primary ESCC, compared with those in corresponding nontumorous esophageal epithelia (P &lt; 0.001). Immunoreactive SnoN was detectable in 31 of 59 (52.5%) esophageal squamous cell carcinoma specimens. The levels of SnoN expression were found to correlate with the depth of invasion and recurrence (P &lt; 0.05). Furthermore, patients with positive staining for SnoN displayed more unfavorable outcomes than patients with negative staining (P &lt; 0.05).
Conclusion: SnoN is likely to be the target of the amplification at 3q26 in ESCC and plays an important role in the development of ESCC, influencing disease-specific survival.

DOI： 10.1245/s10434-008-9986-y

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：金原出版(株)  

61歳、女。上部消化管スクリーニングで食道癌を認め、当科紹介となった。上部消化管造影検査にて胸部上部食道の後壁中心に約1cmの隆起性病変を認めた。上部消化管内視鏡下生検にて扁平上皮癌と診断した。胸部CTにて胸膜の癒着が疑われたため、縦隔鏡補助下食道切除術、胃管再建術、頸部吻合を施行した。病理所見よりPoorly differentiated squamous cell carcinoma、ly0、v0、T1b、pStageIIと診断した。第5病日より胸水増加、無気肺を認め、胸腔ドレーンより白濁した胸水が排出され、乳び胸と診断した。オクトレオチド投与、リピオドールによるリンパ管造影を行ったが効果はなかった。造影より気管分岐部近傍で胸管からリピオドール漏出を認め、術後第35病日に胸管結紮術を施行した。再手術後、胸水量の増加や白濁は認めていない。

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その他リンク： http://search.jamas.or.jp/link/ui/2008165632

記述言語：日本語   出版者・発行元：金原出版(株)  

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その他リンク： http://search.jamas.or.jp/link/ui/2008104983

記述言語：英語   出版者・発行元：BLACKWELL PUBLISHING  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：英語   出版者・発行元：MOSBY-ELSEVIER  

DOI： 10.1016/j.gie.2007.03.981

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：AMER ASSOC CANCER RESEARCH  

Lung cancer is primarily caused by tobacco smoking, but susceptibility is likely modified by common genetic variation. In response to many forms of cellular stress, including DNA damage, the p53 protein functions to induce cell cycle arrest, DNA repair, senescence, or apoptosis. We hypothesized that common TP53 haplotypes modulate pathways of lung carcinogenesis and lung cancer susceptibility or prognosis. To investigate our hypothesis, 14 polymorphisms in TP53, including haplotype tagging and coding single nucleotide polymorphisms, were genotyped in two studies from the greater Baltimore, Maryland area. One study is a case-control study and the second is a case-only study for which TP53 mutational spectra data are available. African Americans with Pro-T-A-G-G haplotypes of the combined TP53 polymorphisms TP53_01 (rs1042522), TP53_65 (rs9895829), TP53_66 (rs2909430), TP53_16 (rs1625895), and TP53_11 (rs12951053) had both an increased risk for lung cancer (odds ratio, 2.32; 95% confidence interval, 1.18-4.57) and a worsened lung cancer prognosis (hazards ratio, 2.38; 95% confidence interval, 1.38-4.10) compared with those with Arg-T-A-G-T haplotypes. No associations of TP53 polymorphisms with lung cancer were observed in Caucasians. In the case-only study, several polymorphisms in TP53 and TP53 haplotypes, overlapping regions of TP53 associated with risk and prognosis in African Americans, were associated with increased odds of somatic TP53 mutation in lung tumors in Caucasians. In conclusion, common genetic variation in TP53 could modulate lung cancer pathways, as suggested by the association with lung cancer in African Americans and somatic TP53 mutation frequency in lung tumors.

DOI： 10.1158/1055-9965.EPI-06-0790

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We report a case of perforation of the esophagus associated with mediastinitis and pneumomediastinum during endoscopic treatment. The patient was successfully treated by means of nonsurgical computed tomography-guided mediastinal drainage. Esophagoscopy demonstrated a scar on the 14th day at the perforation site. This nonsurgical treatment with computed tomography-guided mediastinal drainage is proposed as a less invasive treatment for iatrogenic perforation of the esophagus.

DOI： 10.1272/jnms.73.337

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

56歳男。胃部不快感が出現し、上部消化管内視鏡で異常を指摘された。背臥位二重造影で胃前庭部後壁に淡いバリウム貯留像を近接して2ヶ所に認め、近傍の大彎側には壁変形を認めた。立位圧迫像では中心部にごく淡いたまりを伴う長径1.5cmの類円形陰影欠損を2ヶ所認め、隣接する大網は陥入していた。内視鏡では胃前庭部大彎から後壁にかけて3ヶ所の周堤を伴う潰瘍性病変が近接してみられ、病変部位と周辺粘膜とは段差があり、境界明瞭であった。潰瘍形態は5型で、生検所見は腺癌であった。遠隔転移などは認めず、幽門側胃切除術を施行した。病理組織学的所見は粘膜面から粘膜下層にかけて類似した形態の中分化型腺癌が、潰瘍性病変および潰瘍性病変に挟まれた胃粘膜から連続して広がっており、最深部では固有筋層まで浸潤していた。最終的に中分化型腺癌、T2(MP)、INFβ、ly1、v1、N0と診断した。

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：AMER ASSOC CANCER RESEARCH  

In lung tumors, the p53 tumor suppressor gene is commonly mutated with a characteristic mutation spectrum. The amount of and alterations in plasma DNA, such as mutations in p53, were associated with several cancers. Few studies used quantitative methods of high sensitivity. Previously, we observed p53 mutations in the noncancerous tissue that differed from those in lung tumors using the highly sensitive p53 mutation load assay. Based on our observation of an increased p53 mutation load in nontumorous lung tissue in smokers, we hypothesized that plasma DNA may contain mutant p53 indicative of tobacco smoke exposure and will be an effective biomarker of lung cancer or smoking exposure. We modified the p53 mutation load assay to detect mutations at p53 codons 248 and 249, common mutations in lung cancer, in plasma DNA samples with a sensitivity of 1:5,000. The assay was applied to a set of lung cancer cases (n = 39), hospital controls (n = 21), and population controls (n = 20) from a larger study. Controls were selected to consist of equal numbers of both ever and never smokers. The p53 mutation load (mutated p53 copies per total number of p53 copies) was associated with smoking (P = 0.06), but not with lung cancer (P = 0.59). Most of the individuals with p53 mutations observed in plasma DNA were ever smokers and the p53 mutation load was higher in those who smoked for longer durations (P = 0.04). In summary, we were able to detect p53 mutations in plasma DNA from healthy individuals and our data suggest that p53 mutations in plasma DNA may be a marker of carcinogen exposure from tobacco smoke.

DOI： 10.1158/0008-5472.CAN-06-0991

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記述言語：英語  

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記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）   出版者・発行元：MEDIMOND PUBLISHING CO  

To test the hypothesis whether cytokeratin-19 fragment (CYFRA 21-1) in bronchoalveolar lavage fluid (BALF) reflects broncho-cpithelial cell damage following major surgery, we measured the CYFRA 21-1 and inflammatory mediators in BALF. Bronchoalveolar lavage was performed through a bronchoscope on 4 and 20 hr after esophgectomy in 20 patients. Postoperatively, acte lung injury (ALI) was observed in 6 patients (30%). The CYFRA 21-1 levels in patients with ALI were significantly higher than those in control. Neutrophils count/elastase level in BALF correlated with the levels of CYFRA 21-1. The CYFRA 21-1 levels in the BALF arc accurate indicators of the inflammatory intensity in the alveolar structures.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Mucoepidermoid carcinoma of the esophagus (MEC) is uncommon and has not been fully investigated. The biological behavior and clinical aspects of MEC were studied. The clinical features of eight patients with MEC were compared with 51 cases of squamous cell carcinoma of the esophagus (SCC). Proliferating cell nuclear antigen (PCNA), p53, and carcinoembryonic antigen (CEA) were stained in the resected specimens by immunohistochemistry Seven out of 8 cases (87.5%) had stage III by TNM classification. Four cases died of widespread metastases and 2 cases died of local recurrence within 2 years after the surgery. Neither chemotherapy and radiotherapy were effective against MEC. Overall median survival periods were 10.8 months for MEC and 32.1 months for SCC (P&lt
0.05). When patients in stage III alone were compared, MEC tended to have a worse prognosis than SCC (P=0.058). Immunohistochemical studies revealed that the positive rates of PCNA and CEA were significantly higher in MEC than in SCC (P&lt
0.05), while there was no significant difference in p53 positive rate. Esophageal MEC had an aggressive biological nature and was resistant to adjuvant therapies. The poor prognosis of esophageal MEC may be caused by high proliferative and metastatic potential.

DOI： 10.1272/jnms.70.401

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: The presence of lymph node metastasis is the most important prognostic factor in esophageal squamous cell carcinoma. Molecular biology techniques have improved the ability to recognize micrometastasis in lymph nodes, bone marrow, and peripheral blood. Previous studies have demonstrated that cytokeratin 19 reverse transcriptase-polymerase chain reaction can detect tumor cells even when lymph nodes appear normal histologically. However, the presence of pseudogenes for cytokeratin 19 have reduced the specificity of reverse transcriptase-polymerase chain reaction, thereby reducing its clinical worth as a sensitive diagnostic technique.
Methodology: We examined the expression of mRNA for cytokeratin 19 using a newly designed set of primers, and compared the results with data from histologic examinations. Samples were obtained from tumors, intact tissues, resected lymph nodes and in 10 patients who underwent esophagectomy via right thoracotomy with lymph node dissection in the neck, mediastinum and abdomen.
Results: All tumors, non-cancerous tissues were positive for cytokeratin 19 by reverse transcriptase-polymerase chain reaction. However, 2 of the 6 lymph nodes that appeared normal on histologic examination were positive for cytokeratin 19; sensitivity and specificity were 100% and 67%, respectively.
Conclusions: Reverse transcriptase-polymerase chain reaction using new primers for cytokeratin 19 detected micrometastasis in specimens of lymph nodes from patients with squamous cell carcinoma. This method may increase the accuracy of tumor staging and provide clinicians with valuable information that will help individualize treatment options.

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記述言語：日本語   出版者・発行元：(NPO)日本がん検診・診断学会  

1650名(男719名・女931名)を対象にp53血清抗体の同定を癌検診に用い,アンケート調査を行い,解析した.陽性率は若年齢層と高年齢層に高い傾向を示し,特に30歳代と80歳代は50歳代に比べ有意に高かった.発癌の危険因子とされる癌家族,喫煙,飲酒などは今回の検討で,p53血清抗体の陽性率に影響を及ぼさなかった.また,強陽性3例中,胃癌,直腸癌各1例が検出され,陽性者9例中1例に肝転移を伴う結腸癌が,弱陽性49例中,早期胃癌,結腸癌が各1例検出された.癌検出率は全体で0.3%,弱陽性以上の陽性例では8.2%であった

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BLACKWELL PUBLISHING ASIA  

The effect of preoperative chemotherapy on prognosis is still controversial. We have investigated the relationship between responses to preoperative chemotherapy and prognosis after curative operations in patients with esophageal squamous cell carcinoma. Thirty-nine patients received preoperative chemotherapy with continuous infusion of 500 mg/m(2) of 5-fluorouracil (5-FU) and intravenous injection of 20 mg/m(2) of leucovorin every 12 hours for 5 days. On the 5th day alone, 70 mg/m(2) of cisplatin was also infused. The effect was evaluated approximately 14 days after the end of one course of chemotherapy. The rates of responders and non-responders were 64.1% and 35.9%, respectively. After an interval of 21-28 days, transthoracic esophagectomy was performed. Significant histological effect by chemotherapy was found in responders compared to non-responders (P &lt; 0.05). Responders had a significantly better prognosis than non-responders by Log-rank test (P &lt; 0.01). This suggests that preoperative chemotherapy may contribute to better prognosis when the tumor is sensitive to chemotherapy.

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DOI： 10.1007/s00534-002-0830-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BLACKWELL PUBLISHING ASIA  

A 63-year-old man presented to our hospital with persistent dysphagia. Radiologic and endoscopic examination disclosed a 2.0-cm exophytic tumor in the middle third of the esophagus. An endscopically obtained biopsy specimen was found to represent undifferentiated small cell carcinoma. Computed tomography of the chest, abdomen, and cervical region was performed, as were gallium and bone scintigraphy. Metastasis to an adjacent lymph node was detected, without metastasis to distant organs. After neoadjuvant chemotherapy with carboplatin ( CBDCA) ( 400 mg/m(2)) and etoposide (VP-16) ( 100 mg/m(2)), endoscopy and barium-swallow esophagography showed regression. Thoracic esophagectomy then was performed with mediastinal, abdominal and cervical lymph node dissection. The resected tumor was polypoid, measuring 0.5 x 0.5 cm. The lesion consisted mainly of small anaplastic cells, but included a small focus of squamous cell carcinoma. The patient has survived for more than 7 months with no further treatment and no evidence of recurrent disease.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BLACKWELL PUBLISHING ASIA  

The aim of this study was to evaluate the effect of preoperative chemotherapy on metastatic lymph nodes and on the outcome of patients who underwent esophagectomy for advanced squamous cell carcinoma of the esophagus. Fifty-nine patients with potentially resectable squamous cell carcinoma of the esophagus were studied. Twenty patients ( group A) were treated by preoperative chemotherapy with cisplatin, 5-uorouracil, and leucovorin, followed by surgery. Thirty-nine patients underwent surgery alone ( group B). A total of 2591 resected lymph nodes were histologically evaluated for metastasis and the effect of chemotherapy. The metastasis rate in the resected lymph nodes, the number of metastatic lymph nodes, and outcome of the patients were statistically analyzed between groups. In group A, the clinical and pathological response rates were 75% and 75% respectively. The metastasis rate in the resected lymph nodes was significantly higher in group B (P &lt; 0.01). The mean number of metastatic lymph nodes was significantly lower in group A ( P &lt; 0.05). Furthermore, the mean number of metastatic lymph nodes was significantly lower in the chemotherapy responders than in non-responders. The survival rate in group A was better than in group B ( P = 0.07). Preoperative chemotherapy reduced the number of metastatic lymph nodes and may contribute to improving the outcome of the patients who have undergone esophagectomy for squamous cell carcinoma of the esophagus.

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

53歳男.クローン病による小腸狭窄に対して大腸内視鏡を用いてバルーン拡張術を施行し,良好な結果を得た.本症例では炎症による回盲弁変形及び終末回腸の可動性低下の為に,内視鏡の病変部到達が非常に困難であった.狭窄部は直視できず,透視下にガイドワイヤーを進め,バルーン拡張術に成功した.本拡張術は繰り返し行える低侵襲で比較的安全な手技である.クローン病のように再狭窄や再手術率の高い疾患に対しては,短腸症候群やポリサージェリーを回避する為にも有用な治療法と考えられた

DOI： 10.11641/pde.59.2_114

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その他リンク： http://search.jamas.or.jp/link/ui/2002124914

記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

過去18年間に手術した5歳以下の幼児急性虫垂炎症例を進行度病型別に臨床的に検討した.虫垂炎総計2396例に対する頻度は1.5%,小児917例の3.8%であり,病型はカタル性8例(23%),化膿・蜂巣性9例(26%),壊疽性6例(17%),穿孔性12例(34%)であり,穿孔症例が最も高頻度であった.これらを保存的治療可能なカタル性,化膿・蜂巣性をI群(17例),手術適応となる壊疽性,穿孔性のII群(18例)に分けて比較すると,臨床症状では嘔吐・下痢,理学的所見としてBlumberg・筋性防御,検査項目では体温,白血球数がII群で高値を示した.病悩期間は平均I群1.7日,II群で3.4日で有意差を認めた.急性胃腸炎や感冒として治療されていた症例を含め,3日以上経過観察されたような症例は壊疽性,穿孔性症例が多く緊急手術が必要な確率が高い為,基本的に診断が確定した5歳以下の虫垂炎症例に対しては,可及的速やかに手術に臨むべきである

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We describe herein a case of asymptomatic primary malignant melanoma of the esophagus. A 65-year-old man presented with a 4-cm filling defect in the middle third of the esophagus on a routine barium swallow. Subtotal esophagectomy accompanied by lymph node dissection was performed through a right thoracotomy. Postoperatively, the patient received five cycles of systemic chemotherapy with dacarbazine (DTIC), nimustine hydrochloride (ACNU), and vincristine (VCR) (DAV therapy), but ultimately died of generalized metastatic disease 15 months after surgery. Malignant melanoma of the esophagus has an extremely poor prognosis despite various therapeutic efforts.

DOI： 10.1046/j.1442-2050.2001.00193.x

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

It has been reported that circulating anti-p53 antibodies (p53—Ab) in the serum are detected in some cancers. To investigate the usefulness of detecting p53–Ab, we measured the circulating p53–Ab in comparison with squamous cell carcinoma antigen(SCC-Ag) in patients with esophageal carcinoma. Serum specimens from 46 esophageal cancer patients (42 squamous cell carcinomas, 3 mucoepidermoid carcinomas and 1 basaloid squamous carcinoma) and 13 healthy subjects were studied. Serum p53–Ab was measured by an enzyme-linked immunosorbent assay. Surgically resected specimens from 43 patients were immunohistochemically stained for p53. Serum SCC-Ag was measured by a radioimmunoassay. The results were analyzed with the clinical data and outcome. Serum p53–Ab was detected in 13 (28%) of the 46 patients, but not in any of the healthy subjects. The positive rate was 0% (0/6) in stagel, 60% (3/5) in stage IIA, 30% (3/10) in stage IIB, 29% (7/24) in stage III and 0% (0/1) in stage IV. There was no difference in the outcome between the p53–Ab-positive and p53–Ab-negative patients. Immunohistochemically, 30 (70%) of the 43 specimens stained positively for p53. Serum p53–Ab was detected in 43% (13/30) of the patients with tumors which stained positively for p53. There was a close correlation between positivity for p53 immunostaining and positivity for p53–Ab(p&lt
0.01). An elevated level of SCC-Ag was found in only 13% of the patients, and most patients positive for SCC-Ag already had advanced disease with lymph node metastasis and invasion to the adventitia. In conclusion, serum p53–Ab was detected in Japanese esophageal cancer patients at a frequency similar to that reported in Western countries. Serum p53–Ab may be a potentially useful molecular marker for detection and screening of esophageal cancer. Further studies of a large population may be required to elucidate the true diagnostic usefulness of measuring the serum p53–Ab. © 2000, The Medical Association of Nippon Medical School. All rights reserved.

DOI： 10.1272/jnms.67.110

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記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）   出版者・発行元：MEDIMOND S R L  

Fifteen patients following major surgery were studied for tumor necrosis factor-alpha (TNF-alpha), to causes an inflammatory response. Five patients developed sepsis on postoperative days (POD) 5 through 7.
TNF-alpha in sera was measured by ELISA. Serum NOx (nitrate and nitrite) was measured by Greiss method.
In the patients without sepsis, the levels of TNF-alpha increased after surgery. In the patients with sepsis, the TNF-alpha level was significantly higher than those in the patients without sepsis and correlated significantly with NOx after POD 5. Increases in NOx and TNF-alpha may result in inflammatory responses and tissue injury in Postoperative sepsis.

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

Cisplatin(CDDP)単回大量投与を含む癌化学療法施行時の食道癌患者(9例,11クール)を対象に,ondansetron hydrochloride(OND)を静脈内(4mg,1日)及び経口投与(4mg,4日間)し,制吐効果を検討した.観察した5日間を通じて悪心のコントロール(良好以上)は70%以上であった.嘔吐のコントロール(major以上)は80%以上を示した.悪心・嘔吐に対する抑制効果(有効以上)はCDDP投与当日72.7%であり,5日間を通じての総合判定では88.9%を示した.ONDによる可能性が疑われた総ビリルビン値の上昇とLDHの上昇が各1例でみられたが,いずれも軽微なものであった.以上より,ONDの静脈内及び経口投与の組合せは,食道癌に対する化学療法施行時の悪心・嘔吐に対して著明な抑制効果を示し,その有用性が示唆された

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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A 61 year-old woman came to our hospital with dysphasia that had persisted for 2 months. Endoscopy and barium swallow showed a protruding tumor, about 6.0 cm long, in the midportion of the esophagus. A biopsy specimen showed squamous cell carcinoma of the esophagus. Computed tomography (CT) scan revealed adventitial involvement and lymph node metastases beneath the carina. After 2 courses of chemotherapy with cisplatin (CDDP) 100 mg for 1 day, 5-Fluorouracil (5-FU) 800 mg for 5 days, and leucovorin 30 mg for 5 days, complete regression of the tumor was observed by endoscopy and barium esophagography. Transthoracic esophagectomy with lymph node dissection was performed. Histologically, the muscle layers of the resected esophagus had been replaced by fibrous tissue; however, small foci of basaloid squamous carcinoma (BSC) were found in the submucosa. Six months after surgery, a CT scan revealed a metastatic lymph node around the right main bronchus. Chemotherapy and radiotherapy resulted in the disappearance of the metastasis. The patient has survived for more than 3 years since surgery with a good quality of life.

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=1999&ichushi_jid=J00660&link_issn=&doc_id=19990219330011&doc_link_id=10.11641%2Fpdensks.53.0_73&url=https%3A%2F%2Fdoi.org%2F10.11641%2Fpdensks.53.0_73&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：一般社団法人 日本消化器内視鏡学会  

Mucoepidermoid carcinoma of the esophagus is very rare. Two surgical cases were described with a review of the literature. Endoscopy revealed elevated lesion, mostly covered with intact squamous epithelium. These tumors had a mixed squamous and glandular pattern with mucin. Case 1 was resistant to preoperative chemotherapy, and the patient died ten months after operation with metastases to the brain and the lungs. In case 2, there has been no evidence of recurrence for 21 months after operation. Resected tumors showed positive mucin stains. Further, CEA, p53 and PCNA were positively stained immunohistochemically.

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

58歳男,61歳男,共に内視鏡所見は,周囲粘膜とほぼ同じ色調を呈する隆起性病変を示し,病理所見は扁平上皮癌成分と腺癌様成分の混在する典型像を示した.症例1は術前化学療法を施行するも奏効度は不変,術後10ヵ月で脳・肺転移にて死亡した.症例2は術後1年9ヵ月を経過し再発を認めず通院中である.病理学的検討では,粘液染色陽性でCEA,p53,PCNAの免疫組織学的染色でも陽性像が得られた

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=1998&ichushi_jid=J00192&link_issn=&doc_id=19981005180005&doc_link_id=10.11280%2Fgee1973b.40.1164&url=https%3A%2F%2Fdoi.org%2F10.11280%2Fgee1973b.40.1164&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

記述言語：日本語   出版者・発行元：(一社)日本癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本癌学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本消化器内視鏡学会 関東支部  

A 55-year-old man was admitted to our hospital accompanied by massive bloody stool. Four years ago the patient was attacked by cerebral infarction, and has been treated with ticlopidine (100mg/day) . We could not find the souce of the hemorrhage by the upper gastrointestinal endoscopy. Colonoscopic finding was a Borrmann 1 type advanced cancer in the ileocecal region. The tumor was histologically diagnosed as carcinonid (mixed type) and the patient underwent an operation of the right half colon resection.&lt;br&gt; The tumor was 4cm×3.5cm in size, with relatively smooth surface. Tumor cells infiltrated to the serosa. Lymph node metastasis were extended to N&lt;sub&gt;2&lt;/sub&gt;. HE stain showed nodular solid nests, partially with trabecular and rosette-like structure. Grimelius arglophil reaction and Fontana-Masson argentaffin reaction were both positive in the tumor.&lt;br&gt; Ileocecal carcinoid is very rare in Japan, compared with western countries and USA. Our review of the literature revealed only 13 cases of ileocecal carcinoid except our case in Japan. Our report was a rare case of cecal carcinoid that seemed to cause massive bleeding due to ticlopidine.

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

J-GLOBAL

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記述言語：英語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：英語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

J-GLOBAL

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記述言語：英語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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