No abstract

Between 1979 and 1993, 665 Japanese patients with advanced gastric cancer underwent surgery at our hospital. These patients were divided into two groups, consisting of 102 patients with Borrmann type IV carcinoma, and the remaining 563 patients with all other types of gastric carcinoma, which were then compared clinicopathologically. In the patients with Borrmann type IV carcinoma, 77.4% of the lesions demonstrated poorly differentiated adenocarcinoma, and 99 patients were classified as Stage III or IV. The resection rate was 87.2% (89/102) with only 39 curative operations despite the fact that 70 total gastrectomies were performed. The incidence of peritoneal dissemination (29.4%) and serosal invasion (97.0%) was significantly higher in these patients. Microscopic lymph node metastasis was positive in 86.5%. The 5-year survival rate was 23.4% in the patients with a curative operation and 5.0% in those with a noncurative operation (p < 0.01). Peritoneal dissemination was most frequently noted in the recurrence patterns. We conclude that early detection and a curative operation are both essential to improve the prognosis of patients with Borrmann type IV gastric cancer. The addition of a potent postoperative chemotherapy regimen is also recommended.

We herein report the very rare case of a 68-year-old Japanese man with multiple jejunal lipomatosis and diverticulosis. He was admitted to our hospital with the chief complaint of melena and anemia. A barium study of the small bowel showed multiple lipomatosis and diverticulosis. An approximately 200-cm length of the jejunum was therefore resected. Thereafter, two diverticula and 215 lipomas were recognized in the resected specimen. A pathological examination showed mature adipose tissue with fibrous septa in the submucosal and muscularis propria. These findings were thus suggested to be due to the attenuation of the muscularis propria. The complications of lipomatosis are also discussed.

The preoperative diagnosis of both appendiceal carcinoma and pseudomyxoma peritonei is difficult because of the nonspecific nature of the associated symptoms. More than 50% of all patients with carcinoma of the appendix are diagnosed with and treated for acute appendicitis. In addition, there have been few reports on patients with an appendiceal carcinoma or pseudomyxoma peritonei in association with other synchronous or metachronous malignancies of the alimentary tract. We herein report the first known patient with synchronous early gastric cancer and pseudomyxoma peritonei, in which the origin was correctly identified preoperatively.

The fibrous remnants of porta hepatis at the level of hepatic portoenterostomy for extrahepatic biliary atresia were examined histologically, and the number of bile ductules calculated, the area of the largest bile ductule and total area of all bile ductules was estimated in 30 cases, using a computed picture analyzer. Although there was no correlation between the degree of postoperative bile drainage and the number of ductules or the area of the largest bile ductule , the total area of all bile ductules in cases of adequate bile drainage (100,500 +/- 9,900 mu2, mean +/- SEM, n = 13) was significantly larger than that of those with poor bile drainage (29,900 +/- 9,900 mu2, n = 7) (p less than 0.05). More effective bile flow was evident in those with over 50,000 mu2 of a total area of bile ductules, compared to those with less than 50,000 mu2. However, in 4 there was a good postoperative bile drainage, despite a small area of all bile ductules of the porta hepatis. Thus, the total area of all bile ductules rather than the number at the porta hepatis or an area of the largest bile ductule , seems to be an important factor relating to a better postoperative bile drainage in extrahepatic biliary atresia.