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Volume 42, Issue 4
Displaying 1-19 of 19 articles from this issue
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A. Kitano, N. Oshitani, H. Okabe, R. Fukushima, K. Kashima, S. Nakamur ...1989 Volume 42 Issue 4 Pages 485-491
Published: July 25, 1989
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSUlcerative colitis (UC) is a chronic inflammatory disease of the colon, which relapses and remits repeatedly. During the last two decades we have encountered 185 patients with UC.
Retrospectively, cases that were resistant to conservative treatment and fulfilled all of the following three criteria judged to be refractory UC cases : 1) chronic active type, 2) persistence in the active phase for more than 6 months after relapse, and 3) frequent repetition of relapse.
Fifteen cases of total colitis, fourteen cases of left-sided colitis and six cases of proctitis were diagnosed as refractory UC.
The ratio of the active phase to the total observation period was 51 % in refractory UC and 11 % in nonrefractory UC. Relapse was observed 0.3 times per year in total colitis, 0.3 times in left-sided colitis and 0.28 times in proctitis.
The majority of total colitis cases were treated with a combination of salicylazosulphapyridine and steroid. Nearly half of the left-sided colitis cases were given salicylazosulphapyridine alone and the remaining cases were treated by combined therapy.
The present findings suggest that UC may be transformed into a refractory form during prolonged medication.
Therefore, we must exercise the utmost caution in judging whether each case of UC should be given continuous conservative treatment or subjected to surgery.View full abstractDownload PDF (1046K) -
M. Takano1989 Volume 42 Issue 4 Pages 492-497
Published: July 25, 1989
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSThe operation wound resulting from surgical treatment of anal fissure usually shows delayed healing and/or stenosing scar formation. To prevent this, we have adopted the sliding skin graft (SSG) method, which was devised by Carmel in 1984 and introduced to Japan by Sakabe. The SSG method, although excellent for the prevention of recurrence and formation of substitute anoderm, has a drawback in that the transversely formed linear scar tissue between the SSG and the mucosa causes some degree of discomfort, pain, disturbed defecation and impaired elasticity. To improve this drawback, I considered the anatomical structure of the area, which is naturally dentate in order to make the anus distensible for passage of feces.
I am currently applying the form of the anatomical structure to the mode of surgery, i.e., creating a dentate line artificially at the joining point between the SSG and the mucosa, and have obtained good results. The surgical procedures and the results are reported here.View full abstractDownload PDF (2181K) -
H. Sato, N. Hiwatashi, M. Miura, K. Nakajima, H. Yamazaki, K. Suzuki, ...1989 Volume 42 Issue 4 Pages 498-504
Published: July 25, 1989
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSA trial of fecal occult blood testing (Hemoccult II Slides®) and questionnaires for the screening of colorectal cancer was performed in two towns every year for a 5-year period (1983-1987), during which 37, 768 individuals were screened. Of these patients, 668 (7.6 %) showed a positive result. A further 225 (2.5 %) who had bloody stools, a past history of colorectal diseases or a family history of colorectal cancers, as revealed by questionnaire, were added as a high-risk group. Seven hundred patients (88.5 %) were examined by both limited fiberoptic colonoscopy and double-contrast barium enema. Fifteen patients with cancer (0.17 %) (8 early cancer) were detected ; 67 % were Dukes' stage A and 33 % Dukes' stage C. Patients with adenoma accounted for 127 (1.44 %) of the total.
Consequently, this screening method was found to be suitable for large-scale mass survey. As 6 patients with cancer were discovered after the second year, yearly screening was considered to be necessary because of pick-up and early detection of false-negative cases. Additional time will be necessary before firm conclusions can be drawn.View full abstractDownload PDF (1256K) -
H. Azuhata, M. Mori, N. Matsumoto, H. Umeda, H. Kato, N. Takahashi, T. ...1989 Volume 42 Issue 4 Pages 505-509
Published: July 25, 1989
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSOf 196 patients who underwent resection of colorectal carcinoma in our department during the 5 years from 1983 to 1987, 35 with liver metastasis (synchronous in 25 and metachronous in 10) were analyzed with special reference to the therapy employed.
Among patients with synchronous liver metastasis, hepatectomy was performed in 4, transcatheter therapy in 11 and chemotherapy in 10, whereas among those with metachronous metastasis, hepatectomy was performed in 4, transcatheter therapy in 5 and chemotherapy in 1.
Mean survival in synchronous cases was 16 months in the hepatectomy group, 13 months in the transcatheter therapy group and 7 months in the chemotherapy group. On the other hand, in the metachronous cases, mean survival was 20 months in the hepatectomy group, 11 months in the transcatheter therapy group and 4 months in the chemotherapy group.
Recurrence of carcinoma in the remaining liver after hepatectomy was found in 2 of 4 patients with synchronous metastasis and in all 4 with metachronous metastasis. In contrast, no such recurrence has been noted to date in 2 of 4 patients who received continuous intra-arterial infusion chemotherapy following hepatectomy.View full abstractDownload PDF (735K) -
T. Shimoyama, T. Shimizu, R. Takahira, H. Kusano, H. Ishikawa, Y. Fuku ...1989 Volume 42 Issue 4 Pages 510-518
Published: July 25, 1989
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSThe vascular patterns of inflammatory bowel diseases (IBD) were morphologically investigated by microangiography of surgical specimens. Eighteen patients with IBD treated sugically since 1975 in our department were used for this study. 1) Microangiogram of ulcerative colitis (US) showed marked dilatation of the extra or intramular vessels when compared to those of the other diseases. 2) The vascular disarrangement of UC were mainly mucosal and submucosal vessels. Muscular and/or subserosal layers maintained the normal vascular pattern even though mucosal and submucosal vessels were extremely disarranged. 3) Although the microangiographic patterns of Crohn's disease (CD) varies with the histologic features, intramural vascular changes were frequently observed. 4) The hypovascularity in the area showing longitudinal ulcer and cobblestone appearance might be a response to the circulatory disturbance following inflammatory component of CD and was not necessarily related to the pathogensesis of the disease. 5) The lesions of primary ulcer of small intestine were usually located in antimesenteric border, of which the vascular patterns were hypovascular. Convergent vascular coursings toward the surface of ulceration were observed in IBD groups excluding UC or CD. In conclusion, microangiogram of IBD might offer a valueable findings in distinguishing many lesions.View full abstractDownload PDF (9728K) -
-Including D-type Carcinoid-K. Shirouzu, H. Isomoto, T. Kakegawa1989 Volume 42 Issue 4 Pages 519-525
Published: July 25, 1989
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSMost rectal carcinoids are so-called typical or classic carcinoids, and they metastasize relatively rarely. Recently, the existence of atypical carcinoid, especially D-type carcinoid, has become known. However, the clinical and pathologic features of this tumor are still unclear and no specific treatment has yet been established. The treatments given for 19 cases of rectal carcinoid including four D-type carcinoids were clinicopathologically examined, and the conclusions were as follows. (1) : Local resection including the muscle layer is sufficient treatment for typical carcinoid tumors less than 1 cm in size, since there is no metastasis and the prognosis is good. (2) : Radical surgery with lymphadenectomy is needed in cases of D-type carcinoid resembling oat cell carcinoma, because of the high risk of wide spread metastases, even when the size is less than 1 cm. (3) : It is consideres that the number or size of neurosecretory granules might be used to indicate the most desirable operation method.View full abstractDownload PDF (7352K) -
Y. Ogata1989 Volume 42 Issue 4 Pages 526-536
Published: July 25, 1989
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSAfter preoperative administration of OK-432 into peritumoral tissues in cases of rectal cancer, the anti-tumor immune response was analysed by the immunohistochemical avidin-biotin complex method with monoclonal antibodies specific to the mononuclear cell surface antigens. The two-color flow cytometry method was applied for studying cell markers. The NK cativity of lymphocytes isolated from tumorous lesions and regional lymph nodes was measured by 51Cr release assay.
After administration of OK-432, Leu 4+ cells and Leu 3a+3b+ cells were found to be augmented in active and invasive cancer lesions. Leu 2a+ cells were increased in number and predominantly expressed the cytotoxic T-cell function found in the distal regional lymph nodes. NK activity of tumor infiltrative lymphocytes was increased in half of the cases after administration of OK-432. The increased NK activity was associated with the result of the Su-PS result of the skin test for the delayed hypersentisivity reaction.
These results revealed that the anti-tumor immune activity in the primary tumor regional lymph nodes was intenified by administration of OK-432 into the tumor tisseView full abstractDownload PDF (6193K) -
T. Noto, Y. Norihisa, M. Ikeda, Y. Tokuda, S. Yasuda, T. Tajima, T. Mi ...1989 Volume 42 Issue 4 Pages 537-541
Published: July 25, 1989
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSIn order to activate the immune potential of lymphocytes that infiltrate around colonic cancer tissues and the regional nodes, we directly injected OK 432 into the tumor body. Lymphocytes in regional nodes that were taken from patients who had received the local OK 432 injection showed cytotoxic activities against various cell lines from malignant diseases while no such activities were apparent in cells from patients who had not received OK 432. Interestingly, strong LAK (lymphokine-activated killer) activities could be induced by coculturing the lymphocytes from the regionol lymph nodes with recombinant IL-2, whereas no obvious difference appeared in LAK activities between the OK 432-pretreated group and the non-treated group. Again, no apparent statistical difference between these two groups could be found in the number or proportional ratio of lymphocyte subset taken from cancer tissue and regional nodes by immunocytochemical and numerative studies with FACStar. We never encountered NK cells in the regionol nodes.View full abstractDownload PDF (1797K) -
N. Miyajima1989 Volume 42 Issue 4 Pages 542-552
Published: July 25, 1989
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSThe gracilis muscle transplantation for patients with anal incontinence has been reported since Pickrell, but the tesults are not satisfactory. In this study, the pudendal nerve was experimentally transplanted into gracilis muscle to get physiological function same as the external anal sphincter.
The gracilis muscle showed 55.8% of type 1, 12.6% of type 2A, 30.9% of type 2B and 0.7% of type 2C fiber distribution in ATPase stain. In contrast, the external anal sphincter showed 0.9% of type 1, 98.4% of type 2A and 0.7% of type 2C and type 2B fiber was not seen. Two weeks after the pudendal nerve transplantation, almost all fibers of the gracilis muscle changed into type 2C which were said to be primitive. After 3 weeks, type 2B fiber disppeared and 95.2% of type 2A fiber was seen. After 8 weeks, the gracilis muscle got to have almost the same fiber type distribution as the external anal sphincter.
Electromyographically, 4 weeks after the pudendal nerve transalantation the gracilis muscle showed contraction M wave with the stimulation of the transalanted pudendal nerve.
Therefore, it may be possible to reconstruct the similar muscle functioning same as the original external anal sphincter.View full abstractDownload PDF (6917K) -
S. Haraoka, M. Mori, H. Satoh, T. Mizoguchi, Y. Hirohashi, H. Nakashir ...1989 Volume 42 Issue 4 Pages 553-556
Published: July 25, 1989
Released on J-STAGE: February 05, 2010
JOURNAL FREE ACCESSPseudodiverticulum of the appendix is relatively rare in Japan, but a high incidence of associated complications, including perforation and abscess formation, has been reported. Two cases of appendiceal diverticulum are described here with a brief review of the Japanese literature.
Case 1 : A 42-year-old male, who had been admitted to the Department of Urology with urinary bladder cancer, complained of right lower quadrant pain with marked muscle guarding and showed leukocytosis. A preoperative diagnosis of acute appendicitis was made and energercy appendectomy was undertaken. On gross appearance, there was a small diverticulum at the antimesenteric side near the base of the appendix. Microscopic examination revealed phlegmonous change of the appendix with pseudodiverticulitis.
Case 2 : A 69-year-old male was admitted to our Department with rectal cancer and a small diverticulum of the ascending colon. During laparotomy for abdomino-perineal resection of the rectum, a small cystic mass was found at the apex of the mesoappendix. Additional appendiectomy was therefore undertaken to avoid postoperative complications.
Bearing in mind, high incidence of associated complications of appendiceal diverticulum, prophylactic or incidental appendectomy should be undertaken when this condition is revealed by preoperative barium enema or during laparotomy.View full abstractDownload PDF (4300K) -
K. Ishibashi, K. Yokogi, H. Igari, Y. Kurihara, R. Kasukawa1989 Volume 42 Issue 4 Pages 557-561
Published: July 25, 1989
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSCase 1 : A 58-year-old man was admitted with complaint of abdominal pain. He had been appendectomized on the occasion of gastrectomy for gastric ulcer. The barium enema study showed the semipedunculated polypoid lesion with diameter of 1.1× 1.1 cm at the bottom of the cecum. The colonoscopic examination showed a smooth-surfaced submucosal tumor with dimple on the top surrounded with “doughnut-like” fold at the same portion found by the barium enema. The cecumectomy was carried out. The histological findings of the resected specimen revealed a foreign body granuloma with silk string. This case was diagnosed as inversion of the appendiceal stump clinically.
Case 2 : A 44-year-old male was admitted with chief complaint of general fatigue. His appendix was removed previously. The barium enema study showed a semipedunculated polyp diameters of 1.5×1.5 cm in size at the bottom of the cecum. The findings of the colonoscopic examination were quite similar to those of case 1. Based on the similarity of the findings to case 1 in both X-ray and endoscopic examination, this case was also diagnosed as inversion of the appendiceal stump.View full abstractDownload PDF (4840K) -
T. Naganuma, U. Masamune, T. Mukoujima, M. Takeda, N. Mizuguchi, T. Ku ...1989 Volume 42 Issue 4 Pages 562-567
Published: July 25, 1989
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSA case of intestinal obstruction caused by Meckel's diverticulum forming the apex of an Intussusception is reported.
A 58-year-old female with intermittent periumbilical pain had been treated by a local doctor since December, 1985, and was admitted to Akita Medical Center in June, 1986, because of anorexia and lower abdominal pain. A diagnosis of intestinal obstruction was made from plain abdominal X-ray findings. An operation was performed on the day of admission under a diagnosis of intussusception of the ileum invaginating into the ascending colon. The necrotizing ileum with Meckel's diverticulum at the apex of the intussusception showed invagination into the cecum. The histology of the resected specimen revealed inverted Meckel's diverticulum with heterotopic gastric mucosa. A diagnosis of intestinal obstruction caused by an inverted Meckel's diverticulum forming the apex of an intussusception was thus confirmed. In addition, previously reported cases of intussusception due to Meckel's diverticulum were briefly reviewed.View full abstractDownload PDF (3525K) -
Y. Ogawa, M. Tanaka, S. Imamine, A. Ono, K. Kunichika, K. Murakami, Y. ...1989 Volume 42 Issue 4 Pages 568-571
Published: July 25, 1989
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSA 33-year old female patient with ischemic colitis of the descending colon is reported. She suffered colic pain in the lower abdomen, followed by bloody diarrhea. Colonofiberscopy performed 4 days after onset revealed three shallow longitudinal ulcers in the descending colon. A ghost like appearance, neutrophil infiltration, diffuse hemorrhage in the mucosa and exudate in the submucosal layer were observed in a colonic biopsy specimen. Colonofiberscopy performed after 19 days of hospitalization revealed a normal mucosa in the descending colon, and the patient was diagnosed as having transient ischemic colitis. As ischemic colitis is frequent in patients over 50 year old, this patient was relatively young. The patient was positive for RA, anti-nuclear antibody and anti-DNA antibody, so that it is suspected that the present case of ischemic colitis might hove been due to collagen disease.View full abstractDownload PDF (2780K) -
T. Nishi, K. Okajima, A. Fujiwara, Y. Kawashima, S. Morita, A. Hara, T ...1989 Volume 42 Issue 4 Pages 572-577
Published: July 25, 1989
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSPlatelet counts following surgery for colorectal carcinoma (30 cases of colon carcinoma, 32 cases of rectal carcinoma) were investigated in order to clarify alterations in platelet number during a seven-day period after surgery and the relationships between platelet conut, the factors affecting it and postoperative complications were studied.
Platelets showed a nadir on the 2nd postoperative day (POD), increased gradually after the 3rd POD and recovered to the preoperative number on the 5th POD. Platelet counts significantly exceeded the preoperative values on the 7th POD. Operation time, bleeding and blood transfusion volume were significantly correlated with the postoperative decrease in platelets. Cases with severe decreases in platelet count, especially those with a count of less than 120×103/μl on the 3rd POD had a significantly high rate of occurrence of postoperative complications. However, there was no significant relationship between leukocyte count and the occurrence rate of postoperative complications.
From this study, it was suggested that the recognition of postoperative alterations in platelet count provides important information for the early diagnosis of complications, chiefly infection, following surgery for colorectal carcinoma.View full abstractDownload PDF (786K) -
M. Tada, A. Iso, H. Ohtsuka, M. Ogawa, S. Shimizu, Y. Aoki, K. Kawai1989 Volume 42 Issue 4 Pages 578-582
Published: July 25, 1989
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSVarious attempts have been made to elucidate the factors associated with drug ressistance in ulcerative colitis. However, consensus has not yet been reached on this problem. We have already postulated that mucosal circulatory insufficiency is one of the causative factors based on assessment of mucosal blood flow and histological observation.
Ulinastantin (UST) was used to treat a 49-year-old female patient with ulcerative colitis, in whom mucosal circulatory insufficiency was considered to be the cause of drug resistance. As a result, erosions and ulcers subsided along with the recovery of mucosal blood flow ; UST was thus considered to be effective in this case.
Many investigators have reported mucosal circulatory insufficiency and intravascular coagulation in cases of ulcerative colitis. The present case showed that UST can be an alternative drug for ulcerative colitis resistant to conventional therapy.View full abstractDownload PDF (5561K) -
S. Ohhigashi, S. Haga, H. Katoh, M. Mori, H. Umeda, N. Matsumoto, H. A ...1989 Volume 42 Issue 4 Pages 583-587
Published: July 25, 1989
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSA total of 393 patients with colorectal cancer were treated in our department between January 1969 and August 1983. Among these patients, 19 were young, aged 39 years or less. Excluding 2 cases of colorectal cancer associated with familial polyposis and ulcerative colitis, 17 cases were analyzed, and the following findings were obtained. 1) Young patients accounted for 4.3% of all patients with colorectal cancer, showing no particular sex difference. 2) There were 10 cases of colon cancer and 7 of rectal cancer, the lesions being located in various areas almost evenly. 3) Among young patients, advanced cancers were frequent, showing the closest relation with lymphnode metastasis. There were no significant differences in the depth of invasion, hepatic metastasis, peritoneal metastasis or histological type between younger and older patients. 4) Although the rate of resection was 100 % in young patients, the rate of curative resection was as low as 52.9 %. 5) The outcome was unfavorable in young patients as a whole, early death occurring in many cases. However, all the young patients who underwent curative resection are still alive, showing a good postoperative course. Therefore, early detection is particularly important in young patients with colorectal cancer, and the prognosis seems to be favorable if curative resection is possible.View full abstractDownload PDF (829K) -
J. Masuda, M. Yokoi, M. Konishi, M. Matsushima, Y. Tsujinaka, Y. Ohomi ...1989 Volume 42 Issue 4 Pages 588-591
Published: July 25, 1989
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSThe analgesic effect of epidural buprenorphine and droperidol was studied on 350 postoperative patients following anal surgery (hemorrhoid, fistula, fissure). 350 cases were divided into 3 groups. Group 1 (150 cases); Only intraoperative spinal anesthesia using Neopercamin S®. Group 2a (100 cases); Intraoperative spinal anesthesia using NPS® and postoperative injection of buprenophine 0.10-0.15mg through epidural catheter, five times (every 12 hours). Group 2b (100 cases); Same as group 2a, but added droperidol 2.5mg through epidural catheter first two times.
The results suggested that the epidural administration of Buprenorphine was effective means for postoperative analgesia, but slight urinary disturbance, transient fever and nausea were occured.The epidural administration of droperidol in combination with buprenorphine was useful to prevent nausea and vomiting and also to reinforce and to prolong the analgesic effect of buprenorphine.View full abstractDownload PDF (639K) -
M. Kimura, N. Hiwatashi, M. Miura, H. Yamazaki, K. Nakajima, T. Toyota1989 Volume 42 Issue 4 Pages 592-596
Published: July 25, 1989
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSA study was performed to investigate combined treatment with Corticotropin (ACTH) and glucocorticoid for severe attacks of ulcerative colitis unresponsive to glucororticoid therapy including the intensive intravenous regimen. The series included three men and four wowen, with an average age of 23 yr. Before administration of ACTH, prednisolone was given at a dosage of 30-60 mg daily (except for a 10-year-old girl, who was given a dosage of 20 mg) for 3-26 days, and total parenteral nutrition was used for four patients. However these treatments were ineffective. ACTH, at 20 units every 12 hours, was intramuscularly given (except for the 10-year-old girl, who received 10 units). Five patients achieved remission with the combined therapy after a mean period of 5.6 days. One patient showing clinical improvement without remission and one showing no change required urgent surgery. Combined treatment with ACTH and glucocorticoid is therefore considered to be effective for severe attacks of ulcerative colitis that are resistant to glucocorticoid therapy.View full abstractDownload PDF (578K) -
1989 Volume 42 Issue 4 Pages 597-673
Published: July 25, 1989
Released on J-STAGE: October 16, 2009
JOURNAL FREE ACCESSDownload PDF (17254K)
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