Nihon Daicho Komonbyo Gakkai Zasshi
Online ISSN : 1882-9619
Print ISSN : 0047-1801
ISSN-L : 0047-1801
Volume 53, Issue 1
Displaying 1-9 of 9 articles from this issue
  • H. Sato, M. Maruta, K. Maeda, T. Utsumi, Y. Okumura, K. Masumori
    2000 Volume 53 Issue 1 Pages 1-11
    Published: 2000
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    Lateral node metastasis, recurrence, and outcome were investigated in rectal cancer with and without autonomic nerve-preserving operation to clarify the effect of autonomic nerve-preserving operation on lateral node dissection. All patients undergoing curative surgery for middle and lower rectal cancer were classified into the following three groups : a group that underwent autonomic nerve non-preserving operation from 1980 and 1987 (group A, n=109), a group that underwent the nerve-preserving operation between 1988 and 1993 (group B, n=71), and a group that underwent non-preserving operation between 1988 and 1993 (group C, n=12). Our indications for nerve preservation since 1988 have been the absence of evidence of direct invasion of the autonomic nerve macroscopically in frozen sections during surgery. The 5-year survival rate of all cases with and without node metastasis was 33.8% and 76.8% respectively. There were no statistically significant differences in the 5-year survival rate between groups A and B according to Duke's staging, staging by the General Rules for Clinical and Pathological Studies on Cancer of the Colon, Rectum and Anus, and recurrence rate. However, the cumulative 5-year survival rate in group B was significantly better than in group A (P<0.05) in the lower rectum. There were no significant differences between group A and groups B and C in the 5-year survival rate. The 5-year survival rate in group B was significantly better than in group C (P<0.05). The autonomic nerve-preserving operation with lateral node dissection was concluded to provide as good an outcome as non-preserving operations with lateral node dissection within our indications.
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  • S. Yamamoto, K. Kotake, S. Igarashi, A. Ichikawa, Y. Koyama
    2000 Volume 53 Issue 1 Pages 12-19
    Published: 2000
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    This study was carried out to clarify the clinicopathologic and biological features of small advanced colorectal cancers (CRC). A total of 91 cases of CRC invaded muscularis propria were analyzed, and 11 cases 20 mm or less in size (cancer≤20 mm) were compared with the remaining 80 (cancer>20 mm). The depth of invasion of cancer≤20 mm was shallower than that of cancer>20 mm and patients with cancer≤20 mm were younger than those with cancer>20 mm. As for cancer differentiation, the proportion of moderately-differentiated cancer as compared to well-differentiated cancer was higher in cancer≤20 mm. Although the DNA ploidy pattern did not differ between the groups, the mean DNA index in cancer≤20 mm was significantly lower. As for the growth form according to the classification of Shimoda, all cancers were divided into two groups, polypoid growth type (PG) and non-polypoid growth type (NPG). The mean size of NPG was significantly smaller than that of PG and the incidence of NPG was more frequent in cancer≤20 mm. However, there was no difference in terms of clinicopathologic characteristics between PG and NPG.
    In conclusion, small advanced CRC may have the same malignant potential as ordinary advanced CRC so they should not be ignored.
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  • M. Fujita, M. Oya
    2000 Volume 53 Issue 1 Pages 20-26
    Published: 2000
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    The relationship of defecatory function and abdominal symptoms with motor function of the neorectum (oral side of the anastomosis) in 20 patients for more than 1 year after low anterior resection (LAR) of rectal cancer was studied. Manometric system with a microtip transducer placed at 15 cm from the anal margin was used. Contractile activity of the neorectum was recorded for a mean duration of 190 minutes and the results ware analyzed using Eight Star (Star Medical Japan). Four normal volunteers were used in the control group. The patients were divided after LAR into 2 groups according to bowel frequency, fecal incontinence, defecatory urgency, poor group (n=9) and good group (n=11). All patients of the poor group had strong contraction 50 mmHg or more in amplitud (a total of 265 times, median 9.4 times/H). Four patients of the good group (a total of 40 times, median 0.5 times/H) and only 1 subject of the control group (a total of 2 times, median 0 times/H) had strong contraction. The results suggested that frequent strong contraction of the neorectum is one of the causes of poor functional results after LAR.
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  • T. Yamamura, T. Ozasa, T. Suda, H. Matsuoka, K. Tanaka, H. Ikai, H. Oi ...
    2000 Volume 53 Issue 1 Pages 27-34
    Published: 2000
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    It has been reported that hematogenic metastasis often occurs in colorectal cancer with VEGF expression. The purpose of this study was to elucidate the significance of VEGF as a prognosticator for colorectal cancer. The cases of 156 patients with stage I -III colorectal cancer were reviewed. The correlation between VEGF expression and the hematogenic recurrence rate, and survival rate for patients with colorectal cancer were analyzed. The expressions of VEGF and microvessel were determined by immunohistochemical staining.
    The 5-year survival rate for VEGF+ patients was 67.8%, and that for VEGF- patients was 85.7% ; the difference was significant. Twenty-two of 72 (31%) patients who were positive for VEGF and 11 of 84 (13%) patients who were negative for VEGF had hematogenic recurrence; the difference was significant. Microvessel density was high in patients with hematogenic recurrence and in VEGF+ patients. Serum CEA value was the most significant variable in the multivariate analysis of the clinicopathological prognostic factors in colorectal cancer. The 5-year survival rate for VEGF+/CEA+ patients was 47.2%, which was significantly lower than that for VEGF+/CEA-, VEGF-/CEA+, and VEGF-/CEA- patients. Eighteen (50%) of the 36 VEGF+/CEA+ patients had hematogenic recurrence, which was significantly higher than the hematogenic recurrence rate in VEGF+/CEA-, VEGF-/CEA+, and VEGF-/CEA- patients. Thus the combination criterion of VEGF and serum CEA value should be a useful pronosticator for colorectal cancer, and the prognosis of VEGF+/CEA+ patients was quite poor.
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  • S. Ogawa, M. Itabashi, S. Kameoka
    2000 Volume 53 Issue 1 Pages 35-43
    Published: 2000
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    A method to detect new metastatic lymph nodes from colorectal cancer was devised by making the best use of characteristics of helical CT, and its usefulness was investigated. The use of 1-mm axial images and MPR images, obtained with helical CT, was superior in locality identification to conventional methods. The diagnostic accuracy rate in 51 patients examined was 86.3% for paraintestinal lymph nodes and 82.2% for intermediate lymph nodes. Nodes showing enhancement only in their marginal regions or in the mottled form at 40 seconds after contrast medium injection or those showing no enhancement at either 40 or 120 seconds after injection were considered to be metastasis-positive. The diagnostic accuracy rate in 28 patients, determined according to the qualitative criteria eatablished from the contrast-enhanced findings, was markedly higher, 96.4% for paraintestinal lymph nodes and 94.7% for intermediate lymph nodes, compared with those obtained by conventional methods. In diagnosis with helical CT, the use of 1-mm axial images and MPR images improved the identification of locality, and a nearly perfect diagnosis could be made when a qualitative diagnostic factor was added, indicating extreme usefulness of this diagnostic method.
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  • S. Kimura, K. Suzuki, T. Aizawa, A. Shioya, H. Kanazawa, M. Tanaka
    2000 Volume 53 Issue 1 Pages 44-49
    Published: 2000
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    A 71-year-old female was admitted to our hospital because of a palpable egg-sized mass in the right lower quadrant on May 12, 1998. Barium enema disclosed a roundish extraluminal ileocecal mass, 65X50 mm in size, which was shown to be filled with water density material by pelvic CT scan. Colonoscopy revealed a hemispherical elevation of the cecum around the orifice of the appendix, and the biopsy of the reddened orifice led to a sudden drainage of whitish pus into the colonic lumen. The detection of E. coli from the pus indicated diagnosis of perityphlitic abscess probably due to acute appendicitis. After conservative therapy with Fosfomycin, the palpated ileocecal mass gradually decreased in size and disappeared endoscopically. However, subsequent barium enema showed a tumor, 40×30 mm in diameter, at the same site, and so the patient underwent radical operation on May 28, 1998, by which the organized inflammatory mass was resected. A rare case of perityphlitic abscess due to appendicitis, which was endoscopically observed and also diagnosed by the preoperative drained pus to the colonic lumen through biopsy was presented.
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  • H. Kimura, K. Koganei, M. Shinozaki, D. Minabe, S. Fujii, F. Kito, T. ...
    2000 Volume 53 Issue 1 Pages 50-55
    Published: 2000
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    There were four cases of stercoral perforation of the colon at Yokohama Municipal Citizen's Hospital. They were one male and three females with a mean age of 62.3 years. Three of them had been constipated until the onset. They developed sudden onset of abdominal pain associated with vomiting, followed by anal bleeding in one case and shock in two cases. Abdominal free air was recognized in only one case by plain abdominal X-ray, while accumulation of ascitic fluid was recognized in three cases by ultrasonography. All of them underwent emergency operation after the diagnosis of perforation of the digestive tract and generalized peritonitis. The site of perforation was rectosigmoid colon in all cases. A hard stool mass was found in either abdominal cavity or at the site of perforation, and a large amount of hard stool was present in the surrounding colon. Resection of the perforated segment, drainage and colostomy were performed in three of them, and exteriorization was performed in the remaining case. The postoperative course of the four cases was uneventful without serious complication. Perforated stercoral ulcer was either round or spherical in share macroscopically. and the surrounding of the perforation was compressed microscopically.
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  • Y. Ojima, H. Nakatsuka, T. Kurihara, K. Toyota, H. Ohshiro
    2000 Volume 53 Issue 1 Pages 56-61
    Published: 2000
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
    The usefulness of computed tomography (CT) in the diagnosis of acute appendicitis was studied. CT was performed in 32 patients who were suspected to have acute appendicitis. Direct findings (abnormal appendix) were seen in 24 patients and suggestive findings were seen in 16 patients. Acute appendicitis was diagnosed in 25 patients with the help of CT findings, and the other seven patients was not found in acute appendicitis by CT. The diagnosis of appendicitis was made histopathologically in 21 cases. The benefits of CT in the diagnosis of acute appendicitis were (1) high correct diagnosis rate, (2) avoidance of unnecessary appendectomy, (3) demonstration of abscess and perforated appendicitis, (4) demonstration of retrocecal appendix, and (5) selection of anesthesia method. The demerits were (1) radiating of X-rays and (2) expensive cost. If was concluded that CT is a useful aid in the diagnosis of acute appendicitis.
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  • 2000 Volume 53 Issue 1 Pages 62
    Published: 2000
    Released on J-STAGE: June 05, 2009
    JOURNAL FREE ACCESS
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