Nihon Daicho Komonbyo Gakkai Zasshi
Online ISSN : 1882-9619
Print ISSN : 0047-1801
ISSN-L : 0047-1801
Volume 40, Issue 6
Displaying 1-16 of 16 articles from this issue
  • Y. Mishima, K. Yaegashi
    1987 Volume 40 Issue 6 Pages 689-698
    Published: 1987
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    We analized the characteristics of adenomatosis coli in Japan. Currently, 788 cases (550 families) have been registered to the Polyposis and Intestinal Disease Study Center.
    In the 39.0% of the families, no patient but the propositus was found (non familial case).
    The average age at diagnosis in the propositus group was found to be 34.6 years (men), and 31.9 years (female). Carcinoma was already present in 63.3% of the propositus group and in 22.9% of the call up group, respectively at the time of diagnosis.
    As to surgical treatment, standard operation (protocolectomy or total colectomy) had been employed in 55 % of the propositus group.
    Ten years survival rate was 63.8 % and 72.8 %, respectively. In the call up group, standard operation had been employed in 76.9% of patients.
    It was noted that the survival rate of total colectomy group had a decrease after 7-8 years postoperatively.
    Aside from colorectal carcinoma, several carcinoma ocurred to the patient of adenomatosis coli. They were carcinoma of stomach (33 cases), duodenum (10), small intestine (8), uterus (8) and thyroid (8).
    Conclusively, we would like to stress out the importance of a registration system for the longterm follow up and the treatment of adenomatosis coli.
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  • Y. Ohkura, K. Nakamura
    1987 Volume 40 Issue 6 Pages 699-707
    Published: 1987
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    At present, the adenoma-carcinoma sequence of colorectal carcinomas " The great majority of colorectal carcinomas arise from adenomas " strongly insisted by Morson (1972), was been accepted in the world. Familial adenomatosis coli (FAC) has been produced as one piece of evidence in the sequence. However, it has been not clarified histopathologically whether the sequence holds good in FAC. The purpose of this study is to analyse the sequence in FAC.
    Four cases of FAC totally resected the colorectum were histopathologically and morphometrically studied. Malignancies of polyps were objectively interpreted by using the indices of atypical grades (ING and ISA). The ING and ISA, ratio of area of adenomas to the flat mucosa, and number of polyps in unit area were measured by a computed image analyser.
    According to the sequence, it is obvious that the probability of malignant transformation of adenoma (P) will be estimated by the formula P=CA/(AD+CA) where CA is number of carcinoma and AD number of adenoma. In the 4 cases, the mean of P showed 0.017. In the same manner, P in common cases of colorectal adenomas and carcinomas is estimated as 0.2 from the literatures.
    Meanwhile, in a colorectal segment where adenomas were the most densely populated in the objects, the ratio of adenomatous area to the normal mucosa showed about 30%. When " P " is put as the probability of malignant transformation of adenoma and " P " as that of the normal mucosa per unit area, it is also clear according to the sequence that 3p: 7q=99 : 1 will hold good. Consequently, the ratio p/q is equal to 231. However, in the same way, the p/q estimated in common cases with adenomas or carcinomas of the colorectum become in about 100 times higher than that of FAC. Based on those data about-mentioned, it can be concluded that the probability of malignant transformation of adenoma in FAC is very low in comparison with that in common cases. Therefore, FAC dose not become as one piece of evidence providing we accept the sequence.
    In 76 carcinomas measuring less than 2 cm in largest diameter and morphometriacally interpreted by using the indices of atypical grades (ING and ISA), de novo carcinomas were 48 representing 63% of the total, and the remnant 28 (37%) were carcinomas with adenomatous component. The proportion of the de novo to carcinoma having arisen from adenoma is similar to that previously reported by us. Regarding probabilities of P and p/q, if the histogenesis "The major part of colorectal carcinomas (70 to 80%) may arise from the flat mucosa independently of adenomas" proposed by us (1985) is taken into consideration, those two values in FAC and the common cases will become more close.
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  • Especially Cronkhite-Canada Syndrome
    A. Goto, M. Tarao, N. Kano, H. Mimoto, E. Matsunami
    1987 Volume 40 Issue 6 Pages 708-720
    Published: 1987
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
  • J. Utsunomiya, H. Aioi, T. Yamamura, M. Matsumoto, S. Ohta, T. Kuroki, ...
    1987 Volume 40 Issue 6 Pages 721-733
    Published: 1987
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    The current policy most widely accepted for management of adenomatosis coli is colectomy and ileorectal anastomosis. There was, however, occurrence of cancer in the retained rectum in 13 % of the cases during 10 years follow up in Japanese series and life long follow up on these cases is practically impossible in the usual clinical setting. As one of the responces to this problem, the practical procedure for proctocolectomy and ileoanal anastomosis has been investigated and our method with a J-ileal pouch was found to yield the functional result comparable to that of the ileorectal anastomosis with a technical complexity similar to the continent abdominal ileostomy. Ileoanal anastomosis can be justified in the selected case.
    Management of cancer in the organs other than the large bowel will be important issue to be studied.
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  • T. Masuda
    1987 Volume 40 Issue 6 Pages 734-740
    Published: 1987
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    DNA flow cytometry was performed on 51 freshly obtained colorectal carcinomas (29 colon cancers and 26 rectal cancers). DNA ploidy was diploid 19 and aneuploid in 32 tumors. DNA ploidy of tumor cells did not correlate with any of clinicopathological findings such as primary site, staging, histologic type, lymph node involvement, distant metastasis and histologic vascular invasion, but involvement of the distal lymph nodes and metastasis to the liver and peritoneum were found only in aneuploid tumors. The proliferation index (the fraction of tumor cells in S, G2 and M phase of the cell cycle) also did not correlate with any of clinicopathologic variables of colorectal carcinoma. However, tumors with the proliferation index of 30% or more showed histologic invasion of lymph vessels without exception.
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  • M. Ohta
    1987 Volume 40 Issue 6 Pages 741-746
    Published: 1987
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    The relationship between dietary factors, especially dietary fiber (DF), and the occurence of colorectal cancer (CC) was studied.
    Forty-five cases with CC and 45 cases having no gastrointestinal disease were subjected to the study. Meals were weighed for three consecutive days according to National Nutrition Survey, and daily intake of DF and nutrients were caluculated.
    DF intake in CC-group was 14.9g/day and was significantly less than that in control group (19.9g/day). In addition, intake of proteins, fats and carbohydrates was significantly lower in CC-group as compared to control group.
    Ratios of total calolie/DF and Fat/DF were higher, but not significantly, in CC-group than in control group. In conclusion, it was thought that DF might have a protective effect against colorectal cancer, and that the balance between DF intake and intake of other nutrients appeared to play an important role in the development of colorectal cancer.
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  • M. Tada, S. Shimizu, M. Ogawa, Y. Watanabe, K. Kawamoto, K. Kawai
    1987 Volume 40 Issue 6 Pages 747-754
    Published: 1987
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    We used Imunocult, a new immunological fecal occult blood test based on latex agglutination reaction. First, the influences of various technical factors on the reactivity were investigated, showing the following facts. (1) Reactivity of the fecal specimen remains stable for 4-5 days after acquisition ; the stability is increased after applied on the stick. (2) Proper amount of facal specimen should be applied on the stick, because excessive amount of stool tends to result in positive reaction. (3) The reaction time is not so strict, and a number of specimens can be examined at the same time. (4) False negative results due to the prozone phenomenon are hardly recognized.
    Subsequently, fecal specimens were collected from 43 patients with colorectal cancer (37 with advanced cancer, and 6 with early cancer), 32 patients with colorectal polyps and 162 normal subjects. The positive rate was 95.3% for cancer, 31.3% for polyp, and 6.2% in the normal subjects. The sensitivity and specificity of Imunocult to cancer ware calculated at 95.3% and 93.8%, respectively ; and the predicitive value of positive test and that of ne-gative test were 80.4% and 98.7% respectively. Analysis using ROC (Receiver Operating Characterisics) - Curve demonstrated that reliability is sufficiently high when the test was performed only twice.
    In conclusion, this test is suitable for screening of colorectal cancer, considering the high reliability in cancer detection, the simple operation, and the relatively low cost.
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  • M. Nunomura
    1987 Volume 40 Issue 6 Pages 755-765
    Published: 1987
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    During the 13 years from 1972 to 1984, 63 cases of colorectal cancer, infiltrating to the proper muscle layer, were experienced, and were evaluated on the basis of clinicopathological findings.
    Pm colorectal carcinoma was classified into three groups (pm1, pm2, pm3) according to the depth of invasion into the proper muscle layer.
    Most of the pm colorectal carcinomas were located in the rectum (72%). The incidence of pm colorectal carcinoma according to macroscopic classification showed that the ulcerative type had a higher percentage (68%) than the elevated type (32%). As the carcinoma invaded deeper into the proper muscle layer, the incidence of vascular invasion and lymph node meta-stasis tended to become higher. Lymph node metastasis of the elevated type (10%) was less frequent than that of the ulcerative type (21%), and was confined to the regional lymph node (n1). Therefore, it is indicated that R2 operation preserving normal physiological function is reasonable for the elevated type and pm2 group, while more radical surgery is indicated for the ulcerative type.
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  • F. Konishi, K. Kanazawa, T. Muto, Y. Morioka
    1987 Volume 40 Issue 6 Pages 766-769
    Published: 1987
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    Previous reports on blood coagulation in ulcerative colitis have described increased values of Factor VIII, Factor IX, fibrinogen and platelet count, suggesting a state of hypercoagulability. The frequency of thrombosis in ulcerative colitis has been reported to be 1 to 2 per cent. In spite of such previous repors, there have been almost no studies on factor XIII in active ulcerative colitis. Factor XIII is considered to play an important role in the wound healing process. In our present study, we measured plasma factor XIII in 37 samples from 24 patients with ulcerative colitis of varying severity. W e found that the level of factor XIII was decreased during the active stage of ulcerative colitis and its value was inversely correlated with the severity of the disease. W e postulated that the mechanism responsible for the decrease of factor XIII in active colitis is the possible consumption of this factor in the inflamed colon.
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  • T. Itoh, T. Tobe, K. Ogawa
    1987 Volume 40 Issue 6 Pages 770-776
    Published: 1987
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    Absorption of HRP via rat rectal mucosa was examined histochemically under electron microscope. At 1, 5, 15, and 60 min after infusion of HRP (1-5mg/cc) with a mixed emulsion of lipid (oleic acid 10 mM)-bile salt (sodium glycocholate 10 mM) as an adjuvant into rectal lumen through a catheter, rectum was fixed and chopped at 40-50 μm. These tissue slices were incubated in Karnovsky medium to detect exogenous HRP. They were then postfixed, dehydrated and embedded under ordinary conditions for the electron microscopic observafion. After only 1 min of administration, the uptake of HRP could be localized to the intercellular spaces of the epithelial cells. After 60 min, a lot of HRP was found in phagocytes of lamina propria, but not in the intercellular spaces. Without this adjuvant, no absorption of HRP could be found. During the course of these experiments, rectum retained its normal ultrastruuctural appearance. HRP uptake was accomplished directly through tight junctions of the epithelial cells rather than by endocytosis. It was assumed that this adjuvant made the tight junctions of rectal epithelium loose or leaky to some extent.
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  • M. Takano, T. Fujiyoshi, H. Hidaka, K. Takagi, Y. Iwami, T. Tanaka, I. ...
    1987 Volume 40 Issue 6 Pages 777-785
    Published: 1987
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    For the treatment of anal abscesses, it has been a rule to incise and drain the abscesses for the first stage and perform the radical operations for the second stage.
    However, recently advanced techniques for the sphincter function preserving operation of anal fistulas made me try to apply the methods for the treatment of anal abscesses, with the results that 314 abscesses were primarily operated for the past 4 years, and the sphincters were conserved as much as possible. The analyses of thier postoperative courses and results show the more rapid healing period, lower incidence of the complications (8 cases 2.5%) and recurrence (5 cases 1.6%) compared with the results of anal fistulas. All the more, what was gratified by the patients was that all the periods of ailment, hospitalization and taking-off were so much shortened.
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  • T. Tominaga, K. Hayashi, T. Mori, G. Kosaki
    1987 Volume 40 Issue 6 Pages 786-790
    Published: 1987
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    The sympathetic and parasympathetic nervous systems were preserved using a CUSA (Cavitron Ultrasonic Surgical Aspirator) during radical resection of rectal cancer in 18 patients. The effects of preservation of the autonomic nervous system on urination and defecation were studied in these patients, and the results were compared with those from groups of patients who had undergone low anterior resection (LAR) (18 cases; control-I) and abdominoperineal resection (APR) (16 cases; control-II) without preservation of the autonomic nervous system. Desire to urinate appeared in 1-5 days (median 2 days) after surgery in the CUSA-treated group, and in 2-32+ days (14+ days) and 1-41+ days (25+ days) in the LAR and APR groups, respectively. Urethral catheters were removed 2-10 days (6 days) after surgery in the CUSA group, and 4-61 days (12 days) in the LAR and 6-67 days (22 days) in the APR group, after surgery respectively. In the APR group, three patients retained urethral catheters for longer than 1, 000 days after surgery. No difference in defecation was observed between the CUSA-treated group and the two control groups. Preservation of the autonomic nervous system in receal surgery was thus considered extremely important and further developments in surgical techniques and instruments should be performed.
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  • S. Sadahiro, T. Ohmura, Y. Isobe, K. Kubouchi, Y. Yamada, O. Tamura
    1987 Volume 40 Issue 6 Pages 791-795
    Published: 1987
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    A case of leiomyosarcoma is reported which recurred at the enucleation site four years after surgery. On the first occasion, the patient, a 47-year-old man, visited our clinic with a complaint of anal pain. Enucleation was performed following a diagnosis of submucosal tumor which occupied one third of the rectal circumference. The histological diagnosis was leiomyoma. Four years later, leiomyosarcoma was found at the same site ; after diagnosis, abdominoperineal resection was performed. Microscopically, the specimen obtained at the first admission showed minor cellular atypism, lack of marked cellularity and few mitoses. It is often difficult to distinguish benign from malignant smooth muscle tumors. Close follow-up and radical surgery when necessary are important in those patients.
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  • T. Ikehara, M. Okuno, K. Nishino, Y. Kato, K. Umeyama, A. Kitano, K. K ...
    1987 Volume 40 Issue 6 Pages 796-800
    Published: 1987
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    Recently we experienced a case of lipoma of the colon. The patient was a 68-year-old woman with a chief complaint of abdominal pain. Barium enema examination revealed a smoothly contoured polypoid lesion in the ascending colon. Colonofiberscopic findings showed a pedunculated polyp which was elastic-soft and slightly yellow. Lipoma was suspected and colonoscopic polypectomy was performed without any complications. The resected specimen was 1.7×1.5×1.5cm in size. The pathological diagnosis was submucosal lipoma. Endoscopic polypectomy for colonic lipoma has been reported in 23 cases in the Japanese literature. If a colonic submucosal tumor, such as a lipoma, is pedunculated or semipedunculated and snaring is feasible, endoscopic polypectomy would be an advisable from of treatment.
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  • N. Takei, K. Ishimoto, S. Yamamoto, K. Koh, H. Yukawa, M. Sakaguchi, K ...
    1987 Volume 40 Issue 6 Pages 801-805
    Published: 1987
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    Although mechanical bowel preparation with antibiotic administration prior to elective colonic surgery has been done occasionally, the effects have not been satisfactory. However, because an elemental diet (ED) is known to be resorbed in the upper intestine and to be bulk-free, several surgeons have recently reported its usefulness for preoperative preparation of the colon. Of 283 cases of colorectal carcinoma operated on over a period of 12 years from 1970 to 1981, we selected 54 pairs for a mechanical preparation group and on ED matched for age, sex and site of carcinoma. We performed statistical analysis of the incidence of colonic dehiscence and postoperative wound infection.
    The ED group was associated with a significantly lower rate as compared with the menchanical preparation group. No statistical difference was revealed between the two groups in the incidence of wound infection after abdominoperineal resection and in anastomotic dehiscence. We therefore recommend ED as a means of preoperative bowel preparation.
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  • [in Japanese]
    1987 Volume 40 Issue 6 Pages 806
    Published: 1987
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
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