When a three‐stage operative procedure was performed in 200 cases of upper and midthoracic esophageal cancer, the operative mortality was 2.5% compared with 9.7% mortality of 236 patients treated by a one‐stage operation. Resectability also was extended with this method. Animal studies of transplanted tumors revealed that amputation of the primary lesion in addition to irradiation, when performed early, provides the most satisfactory result with the longest survival time. Lymph node metastasis associated with surgical manipulation was definitely prevented by preoperative radiotherapy. The effect of irradiation is greater in patients treated with preoperative concentrated irradiation than in those treated with fractional preoperative irradiation. In 191 patients with esophageal cancer 2000 to 2500 rads given over four to five days of concentrated irradiation was most practical and acceptable. This treatment caused no increase in operative mortality, operative difficulty or disturbance in hematopoetic and hepatic function. In those patients with cancer of the upper and midthoracic esophagus treated by irradiation plus surgery the 4‐year survival rate was 31.8% and the 5‐year survival rate was 37.5% in contrast to a 4‐year survival rate of 15.4% and a 5‐year survival rate of 19.1% in those patients treated by resection only. The authors conclude that preoperative irradiation, especially concentrated irradiation, should be added to the surgical treatment of upper and midthoracic esophageal cancer.
A 40-year-old man with pain and a mass in the right hypochondrium had histological evidence of metastatic tubular adenocarcinoma of the right kidney, originating in the mucosa of pars descendens duodeni. This patient was suspected of having 2 primary cancers: one in the duodenum and the other in the cecum.
Endoscopic evaluation of the hypertrophic pyloric stenosis in the adult was discussed on 10 of 19 cases in Japan including our 4 cases. Nine diffuse forms (by Skoryna) showed "protruded lesion, deformity, irregularity and stenosis of the pyloric ring, pyloric narrowing unaffected by anticholinergic agents, and irregular mucosal folds adjacent to the pylorus". One focal form showed only a tumor like lesion on the lesser curvature of the pylorus. Associated gastric ulcers should be carefully observed. Frontal view type upper GI endoscope should be used for the diagnosis of the hypertrophic pyloric stenosis in the adult.
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