Nihon Daicho Komonbyo Gakkai Zasshi
Online ISSN : 1882-9619
Print ISSN : 0047-1801
ISSN-L : 0047-1801
Volume 44, Issue 8
Displaying 1-18 of 18 articles from this issue
  • J. Iwadare
    1991 Volume 44 Issue 8 Pages 1125-1126
    Published: 1991
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    Atypical anal diseases represented by severe, relapsed, complicated and generally-complicated cases, for example are occasionally intractable. This feature article deals with hemorrhoids, anal fistula, anal fissure, and four other items, for each of which two doctors were asked to write their respective papers. We hope it is helpful.
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  • H. Ieda
    1991 Volume 44 Issue 8 Pages 1127-1133
    Published: 1991
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    We have performed surgery on 2, 442 patients with internal hemorrhoids over the past 3 years in our hospital. We have studied, in particular, the characteristics of and alternative treatment plans for cases of intractable internal hemorrhoids.
    The patients consisted of those in whom conventional surgery was impossible because of the severity and condition of the internal hemorrhoids, recurrent cases, patients complicated by other anal lesions, cases resembling internal hemorrhoids, and patients with complications at sites other than the anus.
    For these cases, it was necessary to determine the pathological condition and to make innovations in and take into account the type of surgical procedure to be used. The aim of the surgical procedure was to restore normal anal function as soon as possible.
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  • Y. Hongo
    1991 Volume 44 Issue 8 Pages 1134-1139
    Published: 1991
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    For about 9 years and 5 months, 1567 inpatients of hemorrhoids including cases complicated with anal fistula or anal fissure were operated on in my clinic. Among them, only 3 cases were hard to be cured after the operation because of the specific situations. Two of these were complicated with inflammatory bowel diseases and moreover, the main lesions were low intersphincteric fistulae and hemorrhoids of grades 1-2. Inflammatory bowel diseases were not predictable before the operation and were suspected because of the intraoperative feeling and the postoperative incurable wounds and hence became clear.
    Careless operations on patients with specific situations will easily lead to a serious condition. It is said that in some cases complicated with inflammatory bowel diseases, rectal excision was required because of complications apparently dating from the treatment of hemorrhoids. Although very rare when considering the total number of hemorrhoids, cau-tions can not be neglected in these cases. Referring to the literature, 2 cases I experienced are reported herein.
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  • Especially, Anal Fistulas Combined with other Anal Diseases, Crohn's Disease and Massive Necrotizing Cellulitis
    M. Kawano, M. Takano, T. Fujiyoshi, K. Takagi, M. Fujiyoshi, M. Hashim ...
    1991 Volume 44 Issue 8 Pages 1140-1149
    Published: 1991
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    The causes of intractability in anal fistulas were analysed as the following 4 factors : 1. combined systemic diseases, 2. local situations, 3. intraoperative factors and 4. postoperative factors. In this paper, 3 peculiar pathological statuses were found : 1. anal fistula combined with other anal diseases. 2. combined with intestinal Crohn's disease, and 3. massive necrotizing cellulitis.
    1. Anal fistulas combined with other anal diseases
    By our statistics, the most frequently combined other anal disease is hemorrhoids followed by anal fissure and stenosis. The frequency of the combination is higher as the fistula is more shallow and simple. When the fistula is combined with other anal diseases, they have to be treated simultaneously at the time of the operation. Special consideration must be taken when treating the combined lesions.
    2. Anal fistula combined with intestinal Crohn's disease
    In our hospital, among 93 cases of intestinal Crohn's disease, 72 cases (77.4%) was combined with anal fistulas, of which 15 cases (26.8%) belonged to deep, complicated fistulas. They have the characteristics of intractability and recurrence. In our hospital, they are treated surgically after improvement of the systemic status with good results in 40 cases (73%).
    3. Seven cases of massive necrotizing cellulitis were experienced in our hospital. It is massive suppuration of subcutaneous tissues, which starts as perianal abscess rapidly spreading from the perineum through scrotum and inguinal areas to abdominal wall and lower extremities. It is a serious condition caused by a mixed virulent infection. The tceatment consists of instantaneous opening of the infected areas combined with administra-tion of broad spectrum antibiotics and systemic supportive treatments. The results of our cases were all favorable.
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  • N. Matsuda
    1991 Volume 44 Issue 8 Pages 1150-1154
    Published: 1991
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    During the past two years, 56 of the 513 of fitula in ano were experienced the following conclusions.
    1. Most cases, primary openings were located posterior of the anal canal.
    2. Long history from onset.
    3. Average age was high.
    4. Most patients were male (90 %).
    5. Most cases were high grade fistula.
    6. Average healing time was long.
    7. Most patients had histories of inaccurate operations.
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  • Y. Ishiyama, K. Sasaki
    1991 Volume 44 Issue 8 Pages 1155-1160
    Published: 1991
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    The methods of surgical treatment for anal fissure are anal stretch, subcutaneous sphincterotomy, sliding skin gcaft, etc. Some investigators reporeed that anal stretch was not a useful technique for anal for anal fissure. But 3, 142 cases of anal fissure were treated by anal stretch in our outpatients clinic. In 817 cases of these patients, severe anal fissure with anal polyp and skin tag were treated by the same method. And some cases with anal fistel were operated on by the laying open method and anal stretch in outpatients clinic, too.
    In cases of relapse we recommend anal stretch again. We propose anal streech gently performed under caudal anesehesia. And in our follow up study, we didn't find any patient complaining about soiling and incontinence.
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  • K. Noguchi
    1991 Volume 44 Issue 8 Pages 1161-1166
    Published: 1991
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    Not only atypical anal fissures, but also fissure-like lesions around the anus were collected and classified according to the type of lesion such as rhagades, erosion, fissure, or ulcer. All thirty-nine diseases were briefly commented on according to diagnosis and treatment of their ulcerative lesions.
    Such diseases as Crohn's disease, ulcerative colitis, tuberculosis, syphilis, leukemia or anal cancer are well known as diseases which cause refractory anal ulcers. However, it was made clear that there are many other important illnesses or troubles which give rise to intractable anal ulcerations. These illnesses or troubles could be classified into dermatological disease, infectious disease, sexually transmitted disease, rare malignant disease, incurable disease with unknown etiology, iatrogenic disease, and so on.
    I think that it will be most important for an anal surgeon to inquire into the cause of anal ulcers with unknown etiology, and to solve the problem of treatment of a postoperative unhealing wound.
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  • M. Kosugi
    1991 Volume 44 Issue 8 Pages 1167-1177
    Published: 1991
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    There are many unusual lesions of the anus, perianal area and some other organs around the proctos included.
    Some local anal lesions, mainly post-operative complications, are difficult to treat. often unusual anal lesions are associated with general diseases, not easily cured.
    First, we should study unusual and rare anal lesions, and second we must keep in mind to rule out some related lesions as specific infection, non-specific inflammatory bowel diseases and malignant or benign tumors.
    I chose to present some lesions with my comments about diagnosis, how I do it, and care points.
    1) A plastic surgical approach for a complexed proctos with combined lesions of usual hemorrhoidal syndrome.
    2) Two cases of anal cloacogenic carcinoma with usual anal complaints.
    3) Pruritus ani and some dermal lesions, malignant included.
    4) Impaled trauma of the anus on an iron bar.
    5) Reduction of incarcerated rectal prolapse.
    6) Mucosal prolapse syndrome, acute hemorrhagic rectal ulcer, rectal cancer with peri-proctal abscess, perianal fistulae of tuberculosis, anal stricture and ulcer due to Crohn's disease.
    7) Massive bleeding after usual hemorrhoidectomy of a patient with hemophilia A, anal symptoms owing to orthopedics, and a case of rectal leiomyosarcoma.
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  • R. Ono
    1991 Volume 44 Issue 8 Pages 1178-1183
    Published: 1991
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    In this paper, we reported three cases of intractable anal diseases, and pointed out the clinical features of them.
    Case 1, a 66-year-old-man with Fourniers' syndrome, was admitted to our hospital because of progressively spreading cellulitis involving the perineum and scrotum. Mortality rate of this syndrome is high, however we could treat him immediately and correctly by making use of our experience of similar case which we struggled over 10 years ago.
    Case 2, a 20-year-old-woman with diffuse cavernous hemangioma of the anorectal region and sigmoid colon, was hospitalized with a long-standing history of intermittent massive rectal bleeding and anemia. We performed considerately low anterior resection instead of abdominoperineal resection because of her age. The remainder of the hemangioma in the lower part of the rectum and the anal canal caused various intractable conditions, such as bleeding, pain, perianal abscess ets..
    Case 3, a 45-year-old-man, had received radical operation for pelvi-rectal fistula at the beginning. But the post operative clinical features were very similar to that of fistula-cancer. Abdominoperineal resection of the rectum was performed 4 months later, and finally pathological study of the surgical specimen proved duplication of the rectum.
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  • [in Japanese]
    1991 Volume 44 Issue 8 Pages 1184
    Published: 1991
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
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  • S. Baba
    1991 Volume 44 Issue 8 Pages 1185-1188
    Published: 1991
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    Recent advancement of molecular biology is remarkable. It has been revealed that adenoma carcinoma sequence can be explained by the molecular biological changes, as Vogelstein advocated. The genes on 5q (21-22), 17p (13-1), 18q seem to play an important role for development of colorectal cancers.
    More recently, APC MCC gene was identified by our colleagues.
    How does a mutant suppressor gene lead to colon cancer? Following articles by leading researchers in this field might answer this question and solve the problems which we have to face presently.
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  • H. Yuki, J. Yokota, T. Muto
    1991 Volume 44 Issue 8 Pages 1189-1194
    Published: 1991
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    It is widely accepted that genetic alterations have causative roles for the development of human cancer. Recent advance in molecular biology has made it possible to clarify the process of stepwise accumulation of genetic alterations during tumor progression. Such genetic alterations are roughly classified into two groups ; "activation of oncogene " and "inactivation of tumor suppressor gene". In the past 10 years, more than 50 oncogenes and several candidate tumor suppressor genes have been cloned. Oncogenes are activated by several molecular mechanisms, including point mutation, amplification and rearrangement, while tumor suppressor genes are inactivated by loss and mutation. Tumor type specificity and/or association with staging of these alterations have been observed. Determination of pathogenetic and biological significance of these genetic alterations will help us to understand the molecular mechanisms of a diversity in the behavior of tumor cells.
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  • H. Ando, I. Nishisho, Y. Miyoshi, Y. Miki, A. Horii, H. Nagase, Y. Nak ...
    1991 Volume 44 Issue 8 Pages 1195-1199
    Published: 1991
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    Recent studies revealed that multiple alterations of oncogenes and tumor suppressor genes were accumulated during development of colorectal tumor. Activation of Ki-ras oncogene with point mutation is frequently detected in malignant tumors, as well as, in benign adenomas. Based on detailed studies on chromosomal deletions in tumor, two candidate tumor suppressor genes, p53 on chromosome 17p and DCC gene on chromosome 18q, were identified. These two genes are often inactivated in colorectal cancers by deletion, point mutation or insertion. Cytogenetic and linkage studies have shown that chromosomal region 5q21 harbors the gene responsible for familial adenomatous polysosis (FAP). Furthermore, this chromosomal region is often deleted in sporadic colorectal tumors. Recently, we have isolated a gene (MCC gene) located at 5q21 region that is mutated in colorectal cancers and a candidate for the putative colorectal tumor suppressor gene.
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  • K. Toshitani, Y. Yanagawa, T. Sasazuki
    1991 Volume 44 Issue 8 Pages 1200-1205
    Published: 1991
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    Familial polyposis coli (FPC) is an autosomal dominant genetic trait characterized by numerous colorectal adenomatous polyps in the second or third decade. Molecular and genetic analydis of FPC is important for understanding the mechanism of tumorigenesis in colon and rectum. Recene progresses in molecular analyses of oncogenes and tumor suppressor genes in colorectal tumorigenesis were reviewed comparing the FPC with sporadic cases. We obtained evidences that the K-ras gene were activated in dome FPC tumors and observed frequent loss of heterozygosity on chromosome 5, 14, 17, 18 and 22. These results indicate that accumulation of variofs genetic alterations is involved in colorectal tumorigenesis in the FPC.
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  • T. Monden, H. Morimoto, H. Nakanishi, M. Fukunaga, T. Shimana, T. Mori
    1991 Volume 44 Issue 8 Pages 1206-1213
    Published: 1991
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    Expression of p 53, a tumor suppressor gene product, was studied immunohistologically in microwave (MW)-fixed paraffin sections of 98 colorectal carcinomas and 44 adenomas. Using a monoclonal antibody (PAb 1801), nuclear p53 was successfully detected in 62 (62.2%) out of 98 carcinoma cases, while no staining for p53 was demonstrated in the adjacent normal mucosa. There was no correlation between the incidence of p53 expression in colorectal carcinomas and clinicopathologic features such as tumor size or depth of invasion.
    In colorectal adenomas, only 4 (9%) out of 44 adenomas were found to express p53. This expression of p53, however, was restricted to only a few glands within tubular or tubulo-villous adenomas with moderate dysplasia.
    Thus, the expression of p53 protein was characteristic of carcinomas and seemed to reflect the disturbance of the regulation mechanism for cell proliferation.
    The present study demonstrated the usefulness of MW fixation for the preservation of p53. Furthermore, the immunohistochemical detection of p53 in MW-fixed paraffin sec-tions is expected to provide valuable information on the mechanism of' carcinogenesis in colorectal epithelium.
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  • I. Horikawa, M. Oshimura
    1991 Volume 44 Issue 8 Pages 1214-1219
    Published: 1991
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    The existence of tumor-suppressor genes has been primarily suggested by three lines of evidences : 1) Various transformed phenotypes are often suppressed in hybrids between normal and tumorigenic cells, and re-expression of the phenotypes in the hybrids is associated with loss of specific chromosomes. ; 2) non-random chromosome deletions in a variety of tumors ; 3) loss of heterozygosity in specific chromosomal regions in a variety of tumors. Results from transfer of candidate normal human chromosomes that might carry tumor-suppressor genes into various tumor cell lines, strongly support an idea that multiple tumor-suppressor genes are involved in a carcinogenic process of a given tumor. Three types of suppression were observed ; a) Induction of cellular senescence, b) Suppression of both the in vitro transformed properties and tumorigenicity, c) Suppression of the tumorigenicity. These findings further suggest the existence of functionally distinct tumor-suppressor genes. The loss of a suppressive function can be either genetic or epigenetic.
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  • 1991 Volume 44 Issue 8 Pages 1220-1284
    Published: 1991
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
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  • 1991 Volume 44 Issue 8 Pages 1285-1338
    Published: 1991
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
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