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Volume 41, Issue 2
Displaying 1-13 of 13 articles from this issue
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Indication for Surgery in Patients with Poor PrognosisH. Kambe, T. Yoshida, Y. Haraguchi, Y. Daimon, T. Itano, H. Sakamoto, ...1988 Volume 41 Issue 2 Pages 115-119
Published: 1988
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSThirty-eight patients with ulcerative colitis were studied to determine the indication for surgery in cases with poor prognosis. Disease activity was evaluated according to the activity index, which is quantitatively assessed by utilizing multiple regression analysis. The prognosis was highly correlated with clinical severity and the extent of disease before treatment ; the more severe and extensive the disease, the poorer the prognosis. Four patients who underwent elective surgery and one patient who died of status DIC due to severe disease were classified into a poor prognosis group. We compared the clinical course of this poor prognosis group with that of a remission group. In the latter group, the activity index declined gradually after the beginning of therapy in patients with mild disease severity. However, the activity index of severely affected patients in the latter group did not show any significant decrease until three weeks after the beginning of therapy. In contrast, the activity index of the former group remained unchanged during the subsequent clinical course. We conclude that it may be possible to predict the clinical course after acute attacks by employing the activity index at three weeks of therapy, and that patients satisfying this criterion may be considered suitable candidates for surgery.View full abstractDownload PDF (359K) -
N. Saitoh, H. Sarashina, T. Arai, M. Nunomura, S. Taniyama, M. Yokoyam ...1988 Volume 41 Issue 2 Pages 120-127
Published: 1988
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSBetween June 1981 and July 1987, intrarectal echography was performed in 163 patients, CT in 121 patients and MRI (magnetic resonance imaging) in 52 patients with rectal cancer, in order to diagnose the depth of invasion.
Ultrasonographic diagnosis was classified into five groups-M′, SM′, PM′, SS′-S'. A′1-A′2, and Si'◊ Ai′, the accuracy rate being 85.7 % in the M' group, 71.4 % in SM′, 60.0 % in PM′, 90.2 % in SS′-S′·A′1-A′2 and 64.3 % in Si′◊Ai′.
Diagnoses by CT and MRI were classified into 3 groups-I, II and III, the accuracy rate by CT being 66.7 % in group I, 81.5 % in II and 32.1 % in M. The accuracy rate by MRI was 80.0 % in group I, 91.7 % in II and 50.0% in III.
Intrarectal echography was thus superior to CT and MRI for detailed diagnosis of the depth of invasion, and MRI was the best examination nodality for detecting infiltration of other organs.View full abstractDownload PDF (7168K) -
T. Takahashi, S. Ohki, Y. Ohmi, A. Iida, K. Furushima, H. Ike, N. Ohde ...1988 Volume 41 Issue 2 Pages 128-134
Published: 1988
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSBased on observations of 193 patients with colorectal cancer metastasis to the liver, the resection of liver matastasis was evaluated.
Among the 193 patients with liver-metastatic colorectal cancer, 99 (11.0%) had liver metastases identified at the time of resection of the primary lesion, while the other 94 patients (14.2 %) developed hepatic metastases after curative resection of colorectal cancer.
Sixteen patients with synchronous liver metastases (16.2%) and 23 with metachronous liver metastases (24.5 %) underwent removal of their hepatic metastases.
The five-year survival rate was 20.4 % in the synchronous group, and 24.9 % in the metachronous group.
In the metachronous group, 8 patients had one, 9 had two, and 6 had five metastatic masses each. All patients with five hepatic metastatic masses died of the disease.View full abstractDownload PDF (385K) -
M. Tomita, T. Shimoyama, K. Miyashita, N. Yamaoka, M. Yokota, S. Watab ...1988 Volume 41 Issue 2 Pages 135-138
Published: 1988
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSIn order to evaluate the degree of malignancy of colon cancer, we attempted to measure the tumor cellular DNA and RNA content using FACS IV. The indices of DNA and RNA in cancer cells taken from surgical specimens were closely correlated with the grade of clinical staging and prognosis.
In conclusion, the measurement of DNA and RNA indices in colon cancer cells is valuable for the prediction of prognosis.View full abstractDownload PDF (209K) -
R. Katayama, T. Yoon, M. Ohtsuka, S. Ishida, S. Anazawa, K. Sakurai1988 Volume 41 Issue 2 Pages 139-144
Published: 1988
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSThe results of colostomy closure in 33 patients were analyzed for contributing factors of postoperative complications. Stoma constructions were indicated for 14 colorectal carcinomas (42.4%), 5 diverticular diseases (15.2%), 3 Hirschsprung's diseases (9.1%), etc. Twenty-four stomas were loop colostomies (72.7%). Prior to laparotomy, the stoma was inverted and closed with tight interrupted sutures. Then the stoma resections and intraperitoneal bowel anastomosis for gastrointestinal continuity were performed.
There was no operative motality. The overall complication rate was 42.4% (14 complications on 14 cases), including 7 wound infections (21.2%), 4 anastomotic leaks or fecal fistuli (12.1%), 2 stenoses (6.1%) and one small bowel obstruction (3.0%). The complications were analyzed statistically to assess the correlation with age, underlying diseases, type of colostomy, time interval between construction and closure, antibiotic preparation, type of laparotomy, presence or absence of drains, duration of operation and blood loss volume. No significant relationship was found statistically between these factors.
Complication rate was high after closure of colostomy. It is concluded that careful surgical technique as well as adequate preparation are needed to reduce complications.View full abstractDownload PDF (388K) -
T. Tanaka, T. Noguchi, S. Akimoto, T. Yuri, T. Igarashi, Y. Mukubou, H ...1988 Volume 41 Issue 2 Pages 145-150
Published: 1988
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSA 54-year-old man underwent anterior resection with intraoperative radiation following preoperative irradiation for carcinoma of the rectum in August 1984, and subsequently was suffering from severe diarrhea and abdominal pain. One year and two months later he was admitted to our hospital with a sudden onset of lower abdominal pain, nausea and vomitting. The symptoms were so severe that emergency laparotomy was performed. There was no evidence of recurrent tumor, but the terminal ileum, from a point 30cm. proximal to the cecum was found to be dark red, constricted and fixed to the urinary bladder. In addition, another two parts of the ileum from a point 50cm. to that segment showed dark red. These damaged ileum were resected. Pathological examination revealed that there was thickness of the endothelium of arteriole and thromboses of the venule and mucosal damage (ie, ulceration, necroses). These vascular changes had resulted in radiation enteritis induced by preoperative radiotherapy. After the operation severe diarrhea continued until March 1986, when the granning diarrhea and pain became unbearable.
At reoperation, another part of ileum was found to be dark red and constricted. There was a recurrent episode of radiation injury of small intestine. We report this case for the recognition of high-risk clinical factors and attention to careful selection or preparation of the patients with cancer for radiotherapy.View full abstractDownload PDF (3720K) -
M. Ando, S. Okabe, K. Nakajima, H. Wakayama, K. Ishii, K. Sangjin, Y. ...1988 Volume 41 Issue 2 Pages 151-156
Published: 1988
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSColovesical fistulas develop because of a congenital abnormality, a traumatic incident, inflammation or malignancy. Three patients with colovesical fistula were encountered at Tokyo Medical and Dental University Hospital over the last three years. The causes of these fistulas were diverticulitis of the sigmoid colon in case 1 and cancer in case 2. They recieved surgical treatment, and the postoperative courses were uneventful. The third patient with colovesical fistula, which developed after aorto-bifemoral bypass procedure because of Leriche syndrome, was treated by colostomy of the transvecse colon, but the fistula did not heal, and he died due to an other condition on the 134th postoperative day. Autopsy findings revealed stenosis and atrophy of the left colon. Ischemic change in the colon due to atherosclerosis and previous surgery had some relation to the pathogenesis of this fistula.View full abstractDownload PDF (4231K) -
O. Tsuruta, Y. Matsuo, N. Matsukuma, H. Ikeda, R. Maekawa, K. Omagari, ...1988 Volume 41 Issue 2 Pages 157-162
Published: 1988
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSWe experienced two cases of non-specific inflammatory cecal tumor occuring long after appendectomy. Case 1 was a 22-year-old male with periumbilical pain. Barium enema study showed narrowing with a crowded granular appearance of the ascending colon and cecum. Case 2 was a 54-year-old male with pain in the right lower quadrant of the abdomen. Barium enema study and colonoscopy showed narrowing with a cobbleston-like appearance of the ascending colon. Both patients were thought to have Crohn's disease. Medical treatment consisted of oral medication, but there was no improvement of the symptoms or stenosis. Right hemicolectomy was therefore performed because of remaining stenosis. In both cases, the surgical specimen showed crowded inflammatory polyps and histological findings included transmural inflammation and non-caseating granuloma. As Crohn's disease was suspected, the two cases were closely followed up. No recurrence has been recognized for 12 years in case 1 and for 5 years in case 2. Consequethy, it seems reasonable to assume that these inflammatory changes were secondary to appendectomy, probably due to rest abscess. We must therefore keep such cases in mind when we encounter ileocecal protuberant lesions.View full abstractDownload PDF (5713K) -
R. Hayashi, N. Kikkawa1988 Volume 41 Issue 2 Pages 163-166
Published: 1988
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSWe recently carried out vaginal reconstruction by use of a unilateral gracilis myocutaneous flap. The patient was a 39-year-old woman in whom rectal cancer had invaded to the posterior wall of the vagina. After abdominoperineal resection including vaginectomy, reconstruction of the vagina was performed immediately. The gracilis myocutaneous flap for vaginal reconstruction was first reported by McCraw and associates in 1976. This technique is able to move enough tissue volume for the repair of a large defect after radical procedures such as pelvic exenteration and extensive abdominoperineal resection. It also alows simultareous reconstruction of a functional vagina. We often encounter shortening and narrowing of the vagina after abdominoperineal resection including vaginectomy, making it impossible for these patients to have sexual intercourse. The reconstruction of a functional vagina immediately is of significant importance especially in younger women. The gracilis myocutaneous procedure thus seems to he a worthwhile and appropriate technique.View full abstractDownload PDF (2628K) -
1988 Volume 41 Issue 2 Pages 167-170
Published: 1988
Released on J-STAGE: June 05, 2009
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1988 Volume 41 Issue 2 Pages 171
Published: 1988
Released on J-STAGE: June 05, 2009
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1988 Volume 41 Issue 2 Pages 171a-184
Published: 1988
Released on J-STAGE: June 05, 2009
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1988 Volume 41 Issue 2 Pages 185-226
Published: 1988
Released on J-STAGE: June 05, 2009
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