Yoshihiro Kawakami

Noguchi Thyroid Clinic and Hospital Foundation

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Two Resected Cases of Biliary Cysadenocarcinoma of the Liver.

The Japanese Journal of Gastroenterological Surgery (1991)

Kazuyuki Matsushita Munemasa Ryu Tomoaki Sano Kazuo Watanabe Masahiro Fujita

近年報告例が増加している肝嚢胞腺癌のうち, 肝嚢胞腺腫から発生した症例と, 単純性肝嚢胞から発生した症例の2例を経験したので報告する.症例1は49歳男性.主訴は突然の上腹部痛, 肝外側区域の一部に乳頭状増殖を示す嚢胞を認め, 肝左葉切除術を施行したところ, 肝嚢胞腺腫から発生した嚢胞腺癌であった.症例2は73歳の女性.肝左葉の単純性嚢胞で5年間経過観察中, 嚢胞の一部に腫瘍の増生を認めたため, 肝左葉切除術を施行した.病理診断は単純性嚢胞から発生した嚢胞腺癌であった.肝嚢胞腺癌の本邦報告例106例中, 記載の明らかな69例を調べると, 単純性肝嚢胞から発生27例, 肝嚢胞腺腫から発生18例, 本来の肝嚢胞腺癌24例であった.この内, 単純性肝嚢胞の経過観察中に発生したものは4例で, 単純性肝嚢胞でも, 癌化を念頭におき, 注意深い経過観察が必要であると思われた.

10.5833/jjgs.24.2041

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Multimodal treatment including N-cws/lipiodol immunotherapy for hepatocellular carcinomas. Its safety and therapeutic efficacy.

The Japanese Journal of Gastroenterological Surgery (1990)

Kazuo Watanabe Takehide Asano Munemasa Ryu Kaoru Sakamoto Yoshihiro Fujita

肝細胞癌24症例に対して, N-cws/Lipiodol動注免疫療法を試み, その安全性と治療効果を検討した.1) 発熱を主とし, 嘔吐, 一過性の血圧低下などあるも, 動脈阻血が無いため胃, 十二指腸潰瘍, 胆嚢炎などの合併症はなく, 特に肝障害を全く残さなかった.2) AFPの低下, 画像上での腫瘍陰影の縮小をもたらし, また投与局所に, リンパ球浸潤, 肉芽腫形成などの反応を惹起し, 同時に主腫瘍や門脈腫瘍栓の壊死をきたすなど宿主介在性と考えられる効果を認めた.3) 末梢血中のリンパ球サブセットは, 動注加療によりTs低下, Th/Ts比の上昇など, 免疫賦活の側へ変動した.以上の結果より本治療方法は安全であり, 投与した局所に十分な効果が期待できるとともに, その作用機序には, 抗腫瘍性に働く免疫の賦活の関与が示唆された.

Lipiodol

Therapeutic effect

10.5833/jjgs.23.1062

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CT DIAGNOSIS OF METASTASIS IN REGIONAL NODES OF THE BREAST

The journal of the Japanese Practical Surgeon Society (1989)

Yoshihiro Kawakami Masahiro Fujita Kazuo Watanabe Munemasa Ryu Ichiro Honda

In addition to the former report that has described the method and availability of CT imaging of regional lymphnodes of the breast, this paper offers the outcomes of CT diagnosis in visualizing the metastases in regional lymph nodes including 1a, 1b, 1c, 2, and 3. 1) CT visualization succeeded in 69.3% of all lymph nodes tested. When the lymph nodes were limited to those having diameters of 3mm or more, the figure was increased to 81.4%. 20 CT diagnosis of lymph node metastasis was rated as "accuracy" in 76.2%, "sensitivity" in 76.0%, or "specificity" in 76.5%. 3) CT diagnosis resulted in false-negative in 6 (31.6%) cases, but all the 6 cases were categorized into n1α (less than 3 metastases) and included no cases with n1β or severer. 4) In regions where metastasized lesions could not be palpated, CT succeeded in correctly diagnosing with so favorable rates as 90.2% in 1c; 87.2% in 2; and 66.7% in 3, which were similar in axillary resions. These findings have suggested that preoperative diagnosis with CT can be used in whole regional lymph nodes of the breast, with clinically appreciable, results.

Axillary lymph nodes

10.3919/ringe1963.50.2107

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Quality Control of Physicians Undertaking Ultrasonographic Breast Cancer Screening

Nihon Nyugan Kenshin Gakkaishi (Journal of Japan Association of Breast Cancer Screening) (2012)

Hideyuki Hashimoto Takae Kajiwara Atsuko Soda Yumiko Yanase Tomoko Sakaki

乳癌の患者数は年々増加しており，それに伴い死亡数も増加している。そのため二次予防である早期発見，早期治療を目指した乳癌検診に対する期待と意義は非常に大きいと考える。近年，乳房超音波検診の導入について，有効性に対する比較試験が実施されており，検診における精度管理はとても重要である。超音波検診のシステムとして，1人の医師が走査と判定を行う場合と，技師が走査を行いその画像を医師が判定する二つの方法が挙げられる。走査をする際には病変を落とさないように心掛け，その多くの所見の中から精査の必要のない症例を落とすことが判定者に求められる能力である。この指標が要精検率であり，検診効率や医療経済にも関わる数値である。千葉県では平成14年より乳房超音波検診を開始し，当初は10%を超えていた要精検率が最近は3%台を維持している。判定者として効率の良い検診を実施するためには，静止画を撮像する技師とのコミュニケーション，信頼関係はもちろんのことであるが，技師の育成やトレーニング，超音波検診のシステムを構築する力量も必要である。このスキルに相応しい資格は，医師であること以外，学会の専門医，講習会の修了が挙げられるが，これらはスタートラインに立つための最低限であり，どれも十分とは言えない。超音波検診を精度高く，効率よく行うには，この判定者が読影のみの精度管理に徹するのではなく，技師の育成を含めた広い視野を持って検診業務に当たる必要がある。

Breast Cancer Screening

10.3804/jjabcs.21.242

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A case of fibrolamellar carcinoma of the liver.

Kanzo (1993)

Masayuki Hirokawa Munemasa Ryu Kazuo Watanabe Satoshi Watanabe Yoshihiro Kawakami

典型的所見を有する肝のFibrolamellar carcinoma(以下FCL)の一切除例を報告した.症例は21歳男性,日本人,主訴は右季肋部痛,腹部単純CTで肝内側区域および前区域にlow densityな腫瘍を認めた.dynamic CTでは腫瘍中心部は濃染されなかった.腹部血管造影検査では著明なneovascularityが認められた.手術は肝中央2区域切除術を施行した.切除標本では腫瘍中心部に星芒状の瘢痕組織と石灰化を認めた.組織学的には好酸性の胞体を持つ腫瘍細胞が大小の胞巣を形成し,胞巣の間を太いlamellarな走行を示す膠原線維が介在しておりFCLと診断された.FCLの画像診断上の特徴を欧米および本邦報告例について検討した.FCLはFNHと臨床的,肉眼的に酷似しており鑑別診断が問題となるが,鑑別の要点は中心瘢痕部の血管がFNHでは豊富でFCLは乏しいという点である.この点に注目した鑑別にdynamic-CT, MRIが有用であると考えられた.

10.2957/kanzo.34.29

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Citations (5)

Analysis of Present State and Results of Breast Cancer Screening in Chiba Prefecture.

Nihon Nyugan Kenshin Gakkaishi (Journal of Japan Association of Breast Cancer Screening) (1998)

Yoshihiro Kawakami

千葉県では, 平成2年以降女性のがん罹患率 (年齢調整・訂正) で乳癌が第1位となり (がん登録事業報告, 平成4年統計値, 乳 : 1,136人, 胃 : 942人, 子宮 : 524人), しかも増加を続けている。また乳癌死亡率も増加している (人口10万対死亡率 : 平成元年8.2が平成6年12.1に漸増) 。これらのことは検診事業が現状では十分に機能していないことを示している。千葉県対がん協会では, 従来の触診法によって見逃されてきた癌の早期発見を目的としてMMG検診車を導入した。この1年間に3,948人を試験実施し, 10例の乳癌 (内9例が触診では非触知) が発見された (要精検率 : 6.9%, 発見率 : 0.25%) 。MMG検診は独自事業であるため経費や運用面でたいへん困難であるが, 受診者の反響は良好であった。

10.3804/jjabcs.7.155

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Two cases of hepatic hemoangiomyolipoma.

Kanzo (1991)

Kazuyuki Matsushita Munemasa Ryu Kazuo Watanabe Masahiro Fujita Ichirou Honda

肝血管筋脂肪腫の2例について報告した.症例1は51歳女性.腹部単純X線CTにて肝内側区域に直径1.5cmのlow densityの腫瘍を認め,造影剤にてenhanceされた.術中の超音波検査ではhigh echoを示した.症例2は47歳男性.単純X線CTで肝後区域に直径3cmのlow densityな腫瘍を認め,造影剤でenhanceされた.血管造影検査の毛細管相で腫瘍は濃染された.術中の超音波検査では腫瘍は全体がhigh echoで一部low echoな部分が見られた.症例1, 2とも肝切除が施行され,病理組織学的に確診された.さらに肝血管筋脂肪腫報告55例について検討した,画像診断上の特徴は超音波でhigh echo,単純X線CTでlow density,血管造影で腫瘍濃染が見られることであり,今後肝癌との鑑別可能例が増すものと思われる.

Echo (communications protocol)

10.2957/kanzo.32.1046

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STUDY OF COMPUTED TOMOGRAPHY ON REGIONAL LYMPH NODES OF THE BREAST

The journal of the Japanese Practical Surgeon Society (1989)

Yoshihiro Kawakami Yoshihiro Fujita Kazuo Watanabe Munemasa Ryu Ichiro Honda

Palpation as a preoperative test, which is routinely performed in the majority of cases to examine lymph nodes in the breast, appears insufficient. Particularly, preoperative state of the lymph nodes is important in decisionmaking process for restricted surgery. This report describes a detailed investigation of CT obtained from the axillary region (AX. CT); CT scanner (3mm in width) takes several views of the affected breast and lymph nodes, and a map of the regional lymph nodes isdrawn. Comparison of the map with the extirpated specimens resulted in the following findings: 1) AX. CT could determine 16.6±3.7 lymph nodes per case. Successful drawing rate was 68.0% (n=21) when compared to extirpated ones (24.4±7.8). 2) Regional determination of drawn lymph modes could be attained from distances from the axirally vein. 3) In lymph nodes 3mm or more in diamete, various findings including shape, internal structure, adhesion between lymph nodes each other, and spiculation were shown. 4) The above findings and CT values could successfully estimate the metastasized lymph nodes.

Axillary lymph nodes

Palpation

10.3919/ringe1963.50.650

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THE NUMBER OF METASTATIC NODES AS A PROGNOSTIC FACTOR IN ADVANCED BREAST CANCER

The journal of the Japanese Practical Surgeon Society (1996)

Naohito Yamamoto M Miyauchi Yoshihiro Fujita Kazuo Watanabe Yoshihiro Kawakami

To determine the adjustment to high dose adjuvant chemotherapy with autologous hematopoietic stem cell transplantation for advanced breast cancer, we examined the prognosis of breast cancer patients based on the number of metastatic nodes. The examination was made on 182 patients with breast cancer operated on in the hospital from 1973 to 1992 who had four or more metastatic axillary nodes with or without metastatic internal mammary nodes, excluding stage IV cancer patients. These patients were classified into two groups according to the number of metastatic nodes. A cut off number of metastatic nodes was set up, and used to divide the patients into two groups. The first group had the same or more number of metastatic nodes than the set up value, and the second group had less. The 10-year disease free survival rate of the two groups were statistically analysed and an univaliant analysis was used between the groups classified by each number of metastatic nodes. The most significant P-value was found between the groups classified by 11 metastatic nodes. The 10-year disease free survival rate of 11 or more metastatic nodes group (28.8%) was significantly poorer than that of the group under 11 (56.2%) (p<0.0001). The same analysis was made on 126 patients with metastatic nodes limited in the axillary region. The results were almost the same. The 10-year disease free survival rate of schirrous carcinoma patients with 7 to 10 metastatic nodes (32.3%) was as poor as that of the 11 or more metastatic nodes group. It suggests that high dose adjuvant chemotherapy is needed to gain better prognosis not only for the patients who have 11 or more metastatic nodes but also for schirrous carcinoma patients with 7 to 10 metastatic nodes, both patient's groups with a high recurrence rate of about 70%.

Axillary nodes

Breast carcinoma

10.3919/ringe1963.57.1306

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CARCINOID IN THE PAPILLA OF VATER -REPORT OF A CASE AND REPORTED CASES IN THE JAPANESE LITERATURE-

The journal of the Japanese Practical Surgeon Society (1988)

Satoshi Watanabe Munemasa Ryu Kazuo Watanabe Yoshihiro Fujita Ichiro Honda

A case of carcinoid developing from the papilla of Vater was examined together with 18 cases reported in Japan, with emphasis on prognosis. The frequency of tumors in the papillar region was also investigated histologically. A 61-year-old male was found to have carcinoid during conservative treatment for gastric ulcer, and was subjected to pancreaticoduodenectomy. The lesion was a tumor of 2.5 cm in diameter, histologically of the trabecular type and having a depth of invasion to submucosal layer. There was no metastasis to the regional lymph nodes or other organs such as the liver. The patient has been well and without any signs of recurrence for two years. Summary of 19 cases: Lymph node metastasis was noted in seven patients during operation, and depth of invasion was greater than sm. Four patients attained five-year survival, while local recurrence was found in one, liver metastasis in six and death from tumor within one year in four. Conclusion: The high frequency of carcinoid should be taken into account in diagnosing submucosal tumors of the papilla of Vater. As mentioned above, the disease is highly malignent, and radical operation including lymph node dissection as well as follow-up examination centering upon the liver should be adopted to obtain a favorable prognosis.

Major duodenal papilla

Carcinoid tumors

Ampulla of Vater

10.3919/ringe1963.49.1972

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Citations (1)