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Two cases of pelvic kidney with other associated congenital anomalies were demonstrated using ultrasonography (US) and computed tomography (CT). Urogenital anomalies are not uncommon, but Riedel's hepatic lobe is a rare anomaly in patients with pelvic kidneys.

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We conducted clinical studies on the efficacy and safety of cefbuperazone (CBPZ) on surgical infections with the following results. 1) In evaluable 32 patients, CBPZ was evaluated to be clinically effective in 23 (71.9%) and the efficacy rate was better in those who were administered 4 g/day of CBPZ (87.5%, 14/16) than in those who were given 2 g/day (57.1%, 8/14). 2) Antibacterial activity of CBPZ was evaluated in 41 isolated bacterial strains. Pathogen eradication rate by bacterial species was 75.6% (31/41). CBPZ exerted excellent antibacterial effects on Escherichia coli (100%, 8/8) and anaerobic bacteria such as Bacteroides (88.9%, 8/9). Resistant bacteria to CBPZ were Enterococcus faecalis and Pseudomonas aeruginosa. 3) No serious side effects were noted in any of the 34 patients who entered in this study. Abnormal laboratory test results were noted in 2 patients (5.9%) and they were transient elevation of transaminases and alkaline phosphatase. From the results shown above, CBPZ appears to be a highly useful antibiotic for the treatment of surgical infection.

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The antitumor effects of transnodal cancer chemotherapy were studied using rat models. After inoculation of AH-66 tumor cells into the iliac lymph nodes (target lymph node), emulsionized bleomycin (BLM emulsion) or BLM water solution was injected into an intact popliteal lymph node and chronological changes in BLM levels in the target lymph node were measured. In the target lymph node of the iliac lymph node, the level of BLM emulsion continuously was greater than 2 micrograms/g for 9 hours after the injection, while the level of BLM water solution decreased rapidly. The antitumor effects were quantitatively estimated in the tumor of the target lymph node. The ratio of necrotic area in the BLM-emulsion-treated group was significantly greater than that in the emulsion- or saline-treated groups. Survival rate in rats treated with BLM emulsion was significantly higher than that in control groups and was slightly higher than that in the group given BLM water solution iv. The concentration of BLM in the serum and lung in case of transnodal administration of BLM was much lower than that in rats given an iv administration of BLM water solution. These findings suggest that transnodal administration of BLM emulsion is an effective and safe treatment for metastatic lymph nodes, at least in rats.

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The serum testosterone level (STL) was determined in 84 male and 32 female patients with gastric carcinoma and in 58 male and 20 female patients with benign diseases as a control group. The STL of the male patients with carcinoma was lower (446 +/- 149 ng/dl) than that of the male control group (532 +/- 132 ng/dl) (P less than 0.001). Even 17 male patients of the early carcinoma showed lower STL (440 +/- 117 ng/dl) than the normal group (P less than 0.001). In the female patients, it was also lower (31.6 +/- 16.0 ng/dl) than in the control group (46.3 +/- 15.3 ng/dl) (P less than 0.005). The postoperative STL of the cases surviving the gastrectomy was higher than the preoperative data in 32 male patients (P less than 0.005) as well as in 12 female patients (0.025 greater than P greater than 0.01), whereas it obviously decreased in the patients who died of recurrence. Therefore, it appears that gastric carcinoma decreases the STL by some mechanism.

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To prevent the high incidence of anastomotic leakage in a bypass operation for unresectable carcinoma of the esophagus, we devised a two stage bypass procedure, in which the anastomosis of the cervical portion of the esophagus to the gastric tube is delayed for about two weeks after the first operation. With this approach, the short segment of the cervical part of the esophagus adequately adheres to the surrounding tissue by the time of the second operation, and the anastomotic site no longer responds to the strong force accompanying deglutition. One-half of the anastomotic leaks which occurred on the one stage procedure was reduced to nil when the two stage approach was done.

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As complete dissection of metastatic lymph nodes in the upper mediastinum is impossible in conventional surgery for esophageal carcinoma, we devised a form of intraoperative local adjuvant cancer chemotherapy for metastatic lymph nodes of the mediastinum, via tracheal bifurcation lymph nodes located at the anatomical pivot in the upper mediastinal lymph flow. Emulsion type bleomycin (BLM) was injected into the bifurcation lymph nodes of mongrel dogs, and BLM was identified in the pulmotracheal lymph nodes within 20 minutes. When the cervicothoracic lymph nodes in the ipsilateral side were dissected beforehand, the BLM levels in the contralateral side doubled those seen in the controls. In rabbits with VX2 carcinoma, the level of BLM decreased in lymph nodes with metastasis, however, the spread was still evident even when about 75 per cent of the nodes were occupied with metastasis.

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A forty year-old Japanese woman complained of slight hematemesis and severe pain on swallowing. Fluoroscopic examination showed typical esophagograms of "double barreled esophagus" or "mucosal stripe". An esophageal ulceration, probably where the dissection re-entered the usual lumen, was endoscopically evident at the lower end of the mucosal bulging. A large, shallow ulcer of unknown cause was also identified in the just anal area from the esophago-gastric junction. She recovered with conservative treatment of fasting, cimetidine and sodium alginate.

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Hyperthermo-chemo-radiotherapy was prescribed preoperatively for eight patients with carcinoma of the esophagus. Histological study of the resected specimens showed marked effect in two, moderate effect in four and slight effect in two. In those with marked effect, there were no viable neoplastic cells, and severe necrosis and complete destruction were evident on the mucosal surface. These two patients have had no recurrence, now at 27th and 31st postoperative months. Those findings suggest that hyperthermo-chemo-radiotherapy is effective for selected patients with carcinoma of the esophagus.

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The value of the cough reflex and its pressure and flow in the immediate postoperative period was measured in patients who underwent subtotal oesophagectomy and reconstruction for oesophageal cancer and other thoracic surgery. Twenty-two patients with subtotal oesophagectomy and reconstruction were found to have an extensive reduction in cough reflex and force, compared with those who had undergone pulmonary lobectomy. Damage to the vagal nerve caused by dissection of the paratracheal lymph nodes, and injury to the diaphragm during operation for oesophageal cancer appeared to be responsible for the inability to cough. It was of interest that the patients who showed a high value of cough reflex and force in the immediate postoperative period had few pulmonary complications. The postoperative measurement of cough ability may be a useful indicator for safe extubation of the intratracheal tube, as a means of preventing pulmonary complications after thoracic surgery. Continuous mechanical ventilation and frequent suction to remove retained secretions are strongly recommended for the patients who are unable to cough properly.

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Two forms of effective, supplemental, intraoperative chemotherapy for carcinoma of the esophagus have been devised, i.e., Bleomycin (BLM)-Spongel aimed at prevention of a local recurrence and trans-lymph-nodal administration of BLM for prevention of recurrence in the intramediastinal lymph nodes. Fifty-one patients given one or both of these local cancer chemotherapy had a lower incidence of local and/or lymph node recurrence in twelve months after surgery than did the controls. As both procedures are simple and there are few adverse effects, further application of this form of chemotherapy is warranted.

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A safer and more reliable method of esophageal reconstruction, using a gastric tube, is described. Th procedure to create an elongated gastric tube involves separate cutting of the seromuscular and mucosal layer along the line extending parallel to and 4 cm from the greater curvature of the stomach. The end of the cervical esophagus is anastomosed to the posterior wall of the gastric tube in end-to-side fashion. In addition, circumferential cutting of the seromuscular layer of the gastric tube about 5 cm from the anastomotic line is performed to avoid tension resulting from postoperative shrinkage of the gastric tube due to muscle contraction. Combination of these methods resulted in compete elimination of anastomotic leakage.

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