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Volume 48, Issue 10
Displaying 1-14 of 14 articles from this issue
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J. Iwadare1995 Volume 48 Issue 10 Pages 1087-1093
Published: 1995
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSVarious operations, including non-surgical treatment, have been performed on ambulatory patients in the treatment of anal diseases, occupying the position between conser-vative treatment and surgical treatment requiring hospitalization.
Although a wider range of ambulatory patients will undergo operation an a result of popularization of day surgery, such operations are now indicated only for limited cases because of the risk of complication, such as postoperative hemorrhage.
At the present time, rubber-band ligation and injection therapy have been often used for hemorrhoid, stretching and lateral subcutaneous internal sphincterotomy for anal fis-sure, and the seton method for anal fistula.
At the time of implementation, care should be taken for indications and precautions of use of each procedure.View full abstractDownload PDF (461K) -
Y. Ishiyama, K. Sasaki1995 Volume 48 Issue 10 Pages 1094-1099
Published: 1995
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSThe purpose of this paper was to analyze the benefits of caudal anesthesia for anal operations and of anal stretch for the anal fissure at our outpatient clinic.
Three thousand seven cases with anal diseases underwent surgery last year. One third of them underwent surgical treatment under caudal anesthesia at our outpatient clinic. Enough analgesia for anal operations under caudal anesthesia was obtained, and the surgical procedures were performed safely.
Four hundred thirty-five patients suffering from anal fissure were treated at our clinic last year. Of the 435 patients with anal fissure, 428 underwent anal stretch at our outpatient clinic. Only 7 patients were hospitalized for several days.These data suggested that most cases with anal fissure can be completely treated by anal stretch at an outpatient clinic, and caudal anesthesia is a useful and safe technique for anal treatment at an outpatient clinic.View full abstractDownload PDF (339K) -
K. Noguchi1995 Volume 48 Issue 10 Pages 1100-1106
Published: 1995
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSSince the start of the ano-proctologic clinic of Ohba in 1953, every anal surgery has been carried out under local infiltration anesthesia. The patient returns home after surgery, and he visits the clinic as an outpatient from the next day. This unique method was recently taken over by Noguchi Clinic.
The essential points of this method are local anesthesia, certain hemostasis, and successful analgesia. Injection pain of local anesthesia is reduced by controlling pH of analgesics to normal plasma level (7.4) by buffer solution. Late postoperative bleeding from the pedicle is prevented by combination of Barron's rubber band and a reinforcing Z- or U- suture supported with an 'absorbable' pledget. Postoperative sedation of pain will be achieved by overall treatment with ointments, medicines, and medical advices concerning the anal sanitation or reasonable defecaton. Surgical techniques under local anesthesia were shown in prolapsing hemorrhoids, anal fistula, and anal fissure.View full abstractDownload PDF (5909K) -
Y. Masuda, K. Masuda, K. Masuda1995 Volume 48 Issue 10 Pages 1107-1112
Published: 1995
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSPainful pruritus ani is treated by local subcutaneous injection of 1% quinine solution. This treatment resolves both itching and pain. However, 10% solution of pepsin is intracu-taneously injected for refractory and intense anal itching, which is markedly alleviated by this treatment. By the original method of H. Masuda, 10% solution of pure pepsin was injected intracutaneously. Because of the poor availability of pure pepsin, 10% solution of lactose-containing pepsin is used but similar effects have been observed.
Treatment of local organic changes of the skin (e. g., rash, eczema, laceration) is facilitated by alleviation of itching. However once cured local lesions tend to be reactivated if local sanitary management of the skin is inadequate.
Topical intracutaneous injection of pepsin is performed to mitigate itching, the pri-mary symptom, and to treat the condition causing itching in the absence of the symptom.View full abstractDownload PDF (2456K) -
A. Kurokawa, K. Kitsuki, Y. Kurokawa1995 Volume 48 Issue 10 Pages 1113-1120
Published: 1995
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSThis paper describes our classic methods for the treatment of anal fistula and their availability.
The subjects were 253 patients with anal fistula: 29 cases of subcutaneous fistula, 188 of low intersphincteric fistula, 15 in high intersphincteric fistula, 17 of ischiorectal fistula, and 4 of pelvirectal fistula.
The following results were obtained.
1. Each type of fistula could be treated with the classic methods in our office.
2. The mean healing period was 42.7 days.
3. Delayed healing (more than 8 months) appeared in 3 patients.
4. The incidence of faecal and/or flatus incontinence occurred in 3 patients: 1 case of high intersphincteric fistula and 2 of ischiorectal fistula.
5. Recurrence occurred in only 4 patients.
In conclusion, our classic methods seem to be extremely useful in the office treatment of anal fistula.View full abstractDownload PDF (3107K) -
M. Takano1995 Volume 48 Issue 10 Pages 1121-1128
Published: 1995
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSTo obtain better results from treatment of anal diseases by outpatient procedures, the effectiveness and durability are required in addition to safety, painlessness and simplicity. Three hundred and sixty-two patients, who received various outpatient procedures at Coloproctology Center Takano Hospital in 1982, were followed up, and the results were as follows: 50.6% of them are symptom-free, 19.9% had recurrence and were treated conservatively, 19.3% had recurrence and were treated as outpatients, 10.2% had recurrence and undewent surgery.
Even if recurrence occurred in these cases, they had been symptom-free for 3 years and 10 months in average. The recurrence rate and duration of effectiveness of outpatient treatment according to the methods were: sclerotherapy 49.5% (3 years), ligation method 7.7% (8y. 2m.), combination of sclerotherapy and ligation 42.1% (3y. 2m.), lateral inter-nalsphincrotomy O, manual dilatation 16.7% (9y. 2m.), and ligation and excision 41.7% (7 y. 2 m.).
The above-mentioned data show good effectiveness and durability of outpatient treatment when they are selected appropriately and good techniques are used.View full abstractDownload PDF (561K) -
T. Muto1995 Volume 48 Issue 10 Pages 1129-1136
Published: 1995
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSRecent advances in pathogenesis, pathophysiology and management of ulcerative colitis (UC) were briefly reviewed. Although the real cause of UC has not been clarified yet, maltifactorial pathogenesis of mucosal inflammation has been increasingly elucidated in recent years.
Various cytokines and neutrophiles seem to play an important role in activating mucosal inflammation. Several new drugs to control local inflammatory process are being investigated in experiments by using monoclonal antibody against individual proinflammatory factors. A new treatment for UC, leukocytapheresis is now under clinical trial and expected to be benefitial in treating intractable disease. It has to be emphasized that surveillance colonoscopy is essential for the early diagnosis of colonic carcioma complicating long standing disease.View full abstractDownload PDF (1728K) -
H. Watanabe1995 Volume 48 Issue 10 Pages 1137-1143
Published: 1995
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSIn 1993, manual on the management of patients with ulcerative colitis from a practical point of view, incorporating factors such as pretreatment examinations, dietary guidance, advice during pregnancy and postpartum, etc. was made by the Investigation and Research Committee for Inflammatory Bowel Disease organized by the Japanese Ministry of Public Welfare. It is believed that this manual covers blind spots presently existing in the clinical management of ulcerative colitis.
In 1994, the courses of pregnacy in 36 women with ulcerative colitis and 6 women with Crohn's disease were investigaed by a questionnaire sent to members of the above Committee. As a result, it seems that the exacerbation rate in ulcerative colitis throughout both pregnancy and postpartum is not higher than that in nonpregnant patients when the disease activity at the time of conception is in the remission stage or in the mildly active stage in all pregnancies, and that Salazopyrin and prednisolone do not have a great influence on fetuses and infants, although the possibility of stillbirth can not by denied.View full abstractDownload PDF (420K) -
N. Hiwatashi, T. Hayakawa1995 Volume 48 Issue 10 Pages 1144-1152
Published: 1995
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSWe reviewed the recent topics in the treatment of ulcerative colitis.
Sulphasalazine (SASP) had been used in the management of mild to moderately active ulcerative colitis as an effective agent. The therapeutic activity of SASP is attributable to 5-aminosalicylic acid (5-ASA). In Western Country, new 5-ASA derivatives have been developed and are used clinically. Adverse effects of them are less than SASP. In Japan, double-blind comparative study between Pentasa (coating of 5-ASA microgranules with ethylcellulose) and sulphasalazine was performed, and the results showed that Pentasa had clinical efficacy and safety. For moderately active to severe ulcerative colitis, clinical trials of steroid pulse therapy and leukocytapheresis therapy are now in progress. And new topically active corticosteroids are tried as an enema. Their characteristics are poor absorption and/or high first-pass metabolism and higy affinity to the glucocorticoid receptor, so the systemic corticoid effects are low. Furthermore, as the recent advances in the pathogenesis of ulcerative colitis, eicosanoids inhibitors and immunomodulators have been developed and clinical trials are in progress.View full abstractDownload PDF (548K) -
T. Matsui, T. Yao1995 Volume 48 Issue 10 Pages 1153-1161
Published: 1995
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSIn recent years. long-term prognosis of ulcerative colitis has been elucidated and reported from both hospital study and community study. In this review, these excellent newlypublished studies were analyzed on the view points as follows : (1) the long-term prognosis, and cumulative survival rate, (2) causes of recurrence, seasonality of recurrence, (3)long-term change of extent of disease, characteristics of segmental colitis, and (4) cumulative risk of cancer development.View full abstractDownload PDF (1856K) -
K. Hatakeyama, Y. Sakai, T. Suda, K. Shimamura1995 Volume 48 Issue 10 Pages 1162-1168
Published: 1995
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSRecently, patients with ulcerative colitis who have undergone surgery due to intractability to medical treatment are increasing. In order to determine indication and optimal timing for an operation in patients with ulcerative colitis, retrospective analyses were performed. Between January, 1984 and March, 1995, 54 patients underwent ileal W pouch-anal anastomosis. Of these, there are 27 patients with intractable ulcerative colitis to medical treatment of steroid hormone.
We obtained the following conclusions as a surgical indication of intractable ulcera-tive colitis. (1) patient whose frequency of relapsing is more than once a year since the onset, of disease. (2) patient whose frequency of hospitalization is more than once a year since the onset of disease. (3) patient whose duration for hospitalization is more than 10% of the duration in disease. (4) patient whose total cumulative dosage of predonisolone is more than 10, 000mg. (5) patient whose monthly mean dosage of predonisolone is more than 300mg since the onset of disease. (6) patient whose side effect of steroid is remarkable.View full abstractDownload PDF (503K) -
T. Fukushima, T. Yamanouchi, M. Yamamoto, F. Kito, T. Takahashi, Y. Ob ...1995 Volume 48 Issue 10 Pages 1169-1175
Published: 1995
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSIn the past one hundred years, surgeons have been working on the ideal surgical treatment of ulcerative colitis.
At first, various irrigations and/or bowel rest methods, including ileostomy or appendicostomy, had been employed until World War Two. Then, colonic resection became safe and popular and was accepted widely ; subsequently, and sphincter preserving method became dominant. For the last 15 years, restorative proctocolectomy of Real pouch anal anastomosis has been the standard procedune.
The procedure has two advantages, namely, complete resection of colorectal mucosa and preservation of anal sphincter. However, this operation has some disadvantages, rather high morbidity and postoperative anal dysfunction, pouchitis and several metabolic complications.
To overcome these disadvantages, surgeons are improving operative technique and methods.View full abstractDownload PDF (429K) -
1995 Volume 48 Issue 10 Pages 1176-1205
Published: 1995
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSDownload PDF (958K) -
1995 Volume 48 Issue 10 Pages 1206-1236
Published: 1995
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSDownload PDF (1007K)
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