1/44. Laparoscopic ultrasound guidance for laparoscopic resection of benign gastric tumors.Laparoscopic excision of gastric leiomyoma is technically feasible and safe, but it may fail to localize the exact placement of the lesion because of the lack of tactile sensitivity. The authors present two cases of small gastric leiomyomas that were resected by a totally laparoscopic approach, assisted with intraoperative laparoscopic ultrasonography because the lesions could not be palpated. A gastric wedge resection with tumor-free margins was performed with an endostapler device. Use of a harmonic scalpel to divide the gastroepiploic vessels facilitated the laparoscopic procedure.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/44. cardiac tamponade originating from primary gastric signet ring cell carcinoma.A 45-year-old man with dry cough and dyspnea was referred by a medical practitioner for evaluation of heart failure on February 10, 1996. Chest X-ray revealed increased cardiothoracic ratio, and ultrasonographic echocardiography disclosed massive pericardial effusion with right ventricular collapse. cardiac tamponade was diagnosed and pericardiocentesis was performed. Ten days after admission, the pleural effusion had become more pronounced, and thoracocentesis was performed. carcinoembryonic antigen level was elevated in both the pericardial and pleural effusion, and cytology implicated adenocarcinoma, which suggested malignant effusion. Endoscopic study disclosed gastric cancer in the posterior wall of the upper body, and the histopathological diagnosis was signet-ring cell carcinoma. The patient died of respiratory failure on May 2, 1996, and autopsy was performed. The final diagnosis was gastric cancer with pulmonary lymphangitis, pericarditis, and pleuritis carcinomatosa, accompanied by enlargement of mediastinal and paraaortic lymph nodes. Interestingly, the primary signet-ring cell carcinoma of the stomach was situated mostly in the mucosa. Deep in the submucosal region, there was prominent invasion of the intralymphatic vessels, without direct destruction of the mucosa muscularis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/44. Anesthetic management of high-risk cardiac patients undergoing noncardiac surgery under the support of intraaortic balloon pump.patients with severely impaired left ventricular function, an uncorrectable coronary artery disease, and a recent myocardial infarction are at high risk of cardiac complications after major noncardiac surgery. We present two patients with extensive three-vessel coronary artery disease who underwent intraperitoneal surgery under the support of intraaortic balloon pump (IABP). In one patient, the IABP was inserted urgently because of the development of chest pain with significant ST depression on arrival in the operating room, and the other patient was managed with prophylactic IABP. There were no intraoperative or postoperative cardiac events in either patient. Thus, IABP should be considered in the perioperative management of patients with severe cardiac diseases.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/44. Four resections for hepatic metastasis from gastric cancer: histochemical analysis of cell proliferation, apoptosis, and angiogenesis.In a patient with gastric cancer (GC) associated with one synchronous and three metachronous hepatic metastases (HM), who underwent four hepatectomies, we carried out histochemical investigations regarding cell proliferation, apoptosis, and angiogenesis in the GC and HM. Tissue samples were taken from the primary GC and four HM. Ki-67 immunostaining was performed to evaluate cell proliferation and determine the labeling index (Ki-67 LI; ie, the percentage of cancer cells with nuclei stained for Ki-67). Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end labeling (TUNEL) was performed to evaluate apoptosis and determine the apoptotic index (ie, the percentage of TUNEL-positive cells), and immunostaining for factor viii-related antigen was performed to evaluate angiogenesis and measure microvessel density (MVD). The Ki-67 LI was 43.2% in the primary GC and 39.9% in the synchronous HM, and the LI increased with the number of resections of metachronous HM. The apoptotic index was 3.36% in the primary GC, and 5.30% in the synchronous HM, and the index decreased after further resections of the metachronous HM. The MVD was 35 in the primary GC, and 22 in the synchronous HM, and it increased with the number of resections of metachronous HM. The primary GC in this patient may have strongly influenced the growth of HM through effects on cell proliferation, apoptosis, and angiogenesis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/44. Microvascular endothelial abnormality in skeletal muscle from a patient with gastric cancer without dermatomyositis.We found a microvascular endothelial abnormality in a biopsy specimen from the gastrocnemius muscle of a patient with gastric cancer, who had severe myalgia and angialgia in the calf region with the symptoms of thrombophlebitis. There were no definite findings of inflammatory myopathy in histochemical and immunohistochemical studies. Electron microscopic examination revealed the accumulation of abnormal mitochondria in the subsarcolemmal area, and a fair number of degenerating capillaries. Immunohistochemical analysis of procoagulant or anticoagulant factors revealed marked reduction of thrombomodulin (TM) expression on small vessels and capillaries. Although a reduction of TM on small vessels has been observed around perifascicular atrophic fibers in patients with dermatomyositis, histochemical findings of the present patient showed no perifascicular atrophy or severely degenerating fibers. These pathological findings in the patient may be related to a malignant neoplasm and may be one of the causes of disseminated intravascular coagulation (DIC), which is the main complication of malignant neoplasms. Further studies are necessary to determine whether the reduction of TM on the small vessels and capillaries in skeletal muscle is a predictor of some severe condition such as DIC or a rare pathological finding in some special condition such as scirrhous carcinoma with thrombophlebitis.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
6/44. Solitary metastasis to the uterine cervix from the early gastric cancer: a case report.Metastasis of gastric cancer to the uterine cervix is rare, and a case of metastasis to the uterine cervix from early gastric cancer has never before been reported. We here present a patient who underwent a gastrectomy due to asymptomatic early gastric cancer found by chance and who subsequently suffered from a solitary metastasis to the uterine cervix from the primary early gastric cancer. Similar to Krukenberg tumors of the ovary, lymphatic dissemination is regarded as the route of metastasis from the stomach to the uterine cervix. We surmise that the present metastasis occurred through the lymphatic channel because lymph vessel permeations were found in both the primary lesion of the stomach and the metastatic lesion of the uterine cervix.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/44. Endoscopic comparison of two cases: distal resection of reconstructed gastric tube.Recently, with the improvement of the prognosis of esophageal cancer, subsequent gastric cancer has increased. However, the standard surgical treatment for such patients has not been established as of yet. Since the patient's physical condition is relatively poor after Ivor-Lewis esophagectomy, it is important that surgical strategies must be decided according to both physical and cancerous conditions. Hence, various surgical procedures have been reported to date. The authors experienced two cases with cancer occurring in the reconstructed gastric tube after Ivor-Lewis esophagectomy. One was subsequent primary gastric cancer, and the other was metastatic gastric cancer. Distal resection of the gastric tube including the dissection of the right gastroepiploic vessels was carried out in both cases. Vascular reconstruction by utilizing microsurgery technique was attempted for each case, but failed in one case. After surgery, four sessions of endoscopic examinations were carried out. In the early period, we could identify mucosal ischemic change in the remnant gastric tube in the case without successful vascular reconstruction. On the contrary, no ischemic change was revealed in the other with successful vascular reconstruction. Hence, we came to the conclusion that vascular reconstruction must be added to the cases, which undergo distal resection of the reconstructed gastric tube with regional vascular dissection.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/44. Mucosal metastases in malignant melanoma.BACKGROUND: We present the case of a patient with malignant melanoma stage IV according to the American Joint Committee on Cancer (AJCC) classification and an unusual pattern of metastasis to the mucosa of the esophagus, the stomach, the bladder and the palatine tonsil. CASE REPORT: A 38-year-old male patient with metastatic malignant melanoma of stage III (AJCC) was admitted for initiation of adjuvant therapy. 4 months earlier a primary melanoma of the left upper leg had been excised and 2 months later the patient had undergone a left inguinal lymph node dissection revealing 2 metastatic lymph nodes. On admission the patient complained of a sore throat and right cervical lymphadenopathy. He underwent a tonsillectomy and a lymphadenectomy which both revealed melanoma metastases. A PET scan using F-18-fluorodeoxyglucose (FDG) showed focal metabolic activity in the middle mediastinum. Two cycles of dacarbazine (DTIC) chemotherapy were performed during which the patient developed cutaneous metastases, dyspepsia, and mild hematemesis. gastroscopy revealed bleeding from mucosal metastases of the esophagus and stomach. A few weeks later the patient developed macroscopic hematuria. A cystoscopy was performed and showed metastases to the mucosa of the bladder. Nutrient vessels of these bladder metastases were embolized in order to control bleeding. The patient is currently alive with progressive disease. RESULTS: This case presents common and uncommon sites of metastatic melanoma to the mucosa with the typical clinical manifestations in a single patient.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/44. A case of small mucosal gastric carcinoma with lymph node metastasis: a case report.We have experienced a case of small early mucosal gastric cancer with lymph node metastasis. The patient was a 75-year-old woman diagnosed as having early gastric cancer type 0 IIa on the greater curvature of the antrum. We performed distal gastrectomy, with Billroth I method reconstruction. The tumor lesion was on the greater curvature of the antrum. Metastasis was discovered in the number 4d lymph node, histologically. The tumor was type 0 IIa confined to the mucosa, 1.0 cm in diameter and differentiated histological type, and no ulcer scar could be seen in tumor lesion. However, the tumor was massively invading to the mucosal membrane, with positive lymph vessel invasion, and was of mixed histological type. This was a rare case of small early mucosal cancer 1.0 cm in diameter with lymph node metastasis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/44. Two cases of early gastric carcinoma with synchronous liver metastasis.We have experienced two cases of early gastric cancer with synchronous liver metastasis. One patient was a 64-year-old man diagnosed as having early gastric cancer type 0 IIa at 15 x 10 mm on the lesser curvature of the cardia. The other patient was a 58-year-old man diagnosed as having early gastric cancer type 0 IIa IIc at 24 x 18 mm on the posterior wall of the antrum. The histological findings showed that proliferation of moderately differentiated tubular adenocarcinoma with hepatoid pattern was massively invading to the deep layer of the submucosa, with positive lymph vessel, vein invasion and lymph node metastasis, in both cases. These results suggested that elevated or mixed macroscopic type, differentiated adenocarcinoma massively invading to the deep layer of submucosa, positive lymph vessel and vein invasion, lymph node metastasis, and hepatoid adenocarcinoma were risk factors for liver metastasis from early gastric cancer.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
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