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Volume 53, Issue 10
Displaying 1-11 of 11 articles from this issue
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K. Yoshioka, H. Yonekura, M. Nakano, S. Iwamoto, R. Yoshida, H. Takada ...2000 Volume 53 Issue 10 Pages 957-961
Published: 2000
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSPathophysiological assessment and treatment of rectocele were reviewed, mainly through MEDLINE. Rectocele is defined as a herniation of the anterior rectal and posterior vaginal wall in the vaginal lumen. Rectocele is a significant cause of anorectal symptoms and is often associated with obstructed defecation, although it has been detected at defecography in some asymptomatic patients. A paradoxical pattern of a contraction instead of relaxation of the puborectal muscle during straining is frequently observed in patients with defecation disturbances, and it is often considered the primary cause of symptoms. Biofeedback can be recommended to patients with a paradoxical pattern of the puborectal muscle. Surgery has been performed for symptomatic rectocele, particularly with suprasphincteric portion. Repair of a rectocele has traditionally been performed through the vaginal approach. Some surgeons have described the need for transrectal rectocele repair. Surgical procedures using both approaches have achieved relatively good functional results. Complications after surgery have been relatively infrequent.View full abstractDownload PDF (438K) -
S. Amano2000 Volume 53 Issue 10 Pages 962-968
Published: 2000
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSAnorectal manometry, inclusive of straining anorectal pressure, was performed on 10 normal women and 23 women with rectocele. Anal resting pressure and squeezing pressure were significantly increased in patients with rectocele, but there was no significant change in anorectal reflex, rectal sensation, and rectal compliance. However, for anal straining pressure, one of anorectal pressures, those of patients with rectocele were significantly increased compared with those of normal subjects. Moreover, the pressure difference between anal straining pressure and abdominal pressure (anismus index) with rectocele was positive. This tendency was significant for the patients with paradoxical sphincter contraction. The anismus index was correlated with disability of evacuation (evacuation grade). Technique for transanal, or perineal anterior anorectoplasty, achieved that paradoxical sphincter contraction was disappeared, although being without depth of anterior rectal wall into the vagina, and the anismus index and evacuation grade were improved. These results suggest that paradoxical sphincter contraction during straining with rectocele is a specific factor for anismus.View full abstractDownload PDF (509K) -
Relationship to Physique, Bowel Habits, and DeliveryS. Sadahiro, T. Suzuki, K. Ishikawa, N. Tokunaga, S. Yasuda, T. Tajima ...2000 Volume 53 Issue 10 Pages 969-972
Published: 2000
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSRectocele is a primary cause of intractable obstructed defecation, but the role of the rectocele is controversial. The aim of this study was to identify the factor having the greatest influence on the laxity of the rectovaginal septum. A total of 635 female patients were studied. Information on age, body weight, height, bowel frequency, laxative use, and number of vaginal deliveries was obtained by questionnaire. Laxity of the rectovaginal septum was assessed by rectal digital examination, and the patients were divided into two groups; negative or positive for rectocele. Anorectal symptoms were present in 63% of the patients with rectocele, and in 34% of the patients without rectocele, and the differences were significant (P=0.001). The frequency of rectocele increased significantly as the number of vaginal deliveries increased. Multivariate analysis revealed that age, physique, and bowel habits have little influence on laxity of the rectovaginal septum, but that the presence of anorectal symptoms, and the number of vaginal deliveries, have a major effect on it. Twenty-five patients with large rectoceles in our series had no symptoms of defecation difficulty, and none of the 7 patients who complained of defecation difficulty had large rectoceles. Our results suggested that laxity of the rectovaginal septum is closely related to vaginal delivery, but the etiology of symptomatic rectocele depends not only on the size of the bulge but on the presence of other anorectal conditions.View full abstractDownload PDF (304K) -
Y. Torigoshi, T. Gotoh, M. Takatsuki, S. Kubota, T. Teramoto2000 Volume 53 Issue 10 Pages 973-978
Published: 2000
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSThe findings of dynamic defecography of 24 rectocele cases were studied, in comparison with 18 normal subjects.
Rectocele cases showed significantly larger cele and longer perineal descent than normal cases. Many rectoceles were associated with mucosal prolapse syndrome (MPS). For patients complaining of outlet ostruction with, a rather small sac and no perineal descent, peranal repair of the sac is justified. For patients with a larger sac (<3cm) and perineal descent, with or without symptomes of digital evacuation, transvaginal anterior levator plasty is justified.
When NIPS is associated, mucosectomy must be added. To evaluate the operative effect and predict postoperative recurrence, dynamic defecography is useful.
Dynamic defecography is an indispensable examination for management of patients with rectocele.View full abstractDownload PDF (6001K) -
K. Maeda, M. Maruta, T. Utsumi, H. Sato, Y. Koide, M. Matsumoto2000 Volume 53 Issue 10 Pages 979-983
Published: 2000
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSRectocele is an anatomical disorder in which the rectal wall protrudes anteriorly and causes defecatory disorders. A rectocele with clinical symptoms, such as difficulty in defecation, sould be considered for treatment. Conservative treatment should be conducted initially for a symptomatic rectocele, and surgical treatment should follow if conservative treatment fails. Conventional surgical treatments, with excision or ligation of the rectum or vaginal wall, have sometimes failed to improve the defecatory disorders and anatomical disorders. These conventional treatments are not suitable for improving urinary or stool incontinence. Technique and results of anterior levatorplasty, to improve these combined disorders, are described herein.View full abstractDownload PDF (2127K) -
M. Takano2000 Volume 53 Issue 10 Pages 984-993
Published: 2000
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSIf a rectocele is viewed as simply a pouch formation of the rectovaginal wall that can only be gotten rid of by surgery, all incidental abnormalities of the rectocele cannot be cured. In the first place, the existence of complex abnormalities must be understood, and they must be assertained through multiple examinations. Then the data must be analyzed, and comprehensive treatment must be performed according to that data. The abnormalities often accompanying a rectocele are 1. stretched and weakened anterior sphincters, 2. paradoxical movement of the sphincters, 3. a damaged pudendal nerve, 4. descents of the perineum and intrapelvic organs, 5. anal diseases, like hemorrhoids, 6. spastic colon and rectum, and so on. Some of the above-mentioned abnormalities are directly related to the pathogenesis of rectocele, and the others contribute to persistency, aggravation, or multiplication of the symptoms. Accordingly, the treatment of rectocele must be comprehensive, consisting of a proper pharmacological treatment, dietary treatment, correction of defecation habits, biofeedback, surgery, etc..View full abstractDownload PDF (787K) -
Y. Shimada2000 Volume 53 Issue 10 Pages 994-999
Published: 2000
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSSystemic chemotherapy in metastatic colorectal cancer was reviewed in recent literature. In meta-analysis, chemotherapy could contribute to a prolonged progression-free period and overall survival. Chemotherapy is now progressing from days of old-fashioned 5-FU to newer century, which was realized by the modulation with leucovorin, and the introduction of new active agents : irinotecan and oxaliplatin. New standard chemotherapy is 5-FU+Leucovorin+/-irinotecan, at present. These clinical evaluations on new chemotherapy were mainly done in foreign countries. Considering the expansion of the number of colorectal cancer patients in Japan, a clinical study group for colorectal cancer should be organized urgently, to conduct a large-scale comparative study.View full abstractDownload PDF (511K) -
T. Kato, T. Hirai2000 Volume 53 Issue 10 Pages 1000-1007
Published: 2000
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSThis paper outlines the results of recently reported trials of adjuvant chemotherapy and chemoradiation therapy for colorectal cancer. In an American study, MeCCNU/VCR/5-FU therapy given following surgery has been reported to improve survival. In 1990, an NIH consensus conference recommended 5-FU/levamisole therapy for Dukes' C colon cancer, as a standard. More recently, regimens of 5-FU plus leucovorin in colon cancer have been shown to reduce mortality. For rectal cancer, chemoradiation was recommended as a standard therapy.
Two Japanese trials have demonstrated that regimens of mitomycin C plus 5-FU, or regimens of mitomycin C plus UFT, reduce pelvic recurrence rates and improve survival. Results of three recent studies were discussed. Immuno-chemotherapy, preoperative and postoperative chemoradiation, and nrennerative infusion of 5-FU did not improve the 5-year survival rate.View full abstractDownload PDF (591K) -
J. Sakamoto, C. Hamada, J. Kato, S. Kodaira, M. Yasutomi, H. Nakazato, ...2000 Volume 53 Issue 10 Pages 1008-1017
Published: 2000
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSRandomized trials and meta-analyses of randomized trials evaluating the efficacy of adjuvant therapy for colorectal cancer have been reviewed. Demonstration that adjuvant therapy with 5-fluorouracil (5FU) plus leucovorin can result in reductions in tumor recurrence and cancer death after surgery for large bowel cancer has been a major therapeutic advancement in the `90th, and current clinical trials and meta-analyses of those trials may yield further incremental improvements. The efficacy of oral 5-fluorouracil and its prodrugs has recently been evaluated by a meta-analysis of five large-scale Japanese randomized trials for curatively resected colorectal cancer, comparing chemotherapy by oral fluorinated pyrimidines with untreated controls, in a total of 7, 981 patients. The result of this meta-analysis showed a significant benefit for chemotherapy over surgery alone in terms of survival (hazard ratio, 0.913, p=0.041) and disease-free survival (hazard ratio, 0.833, p=0.0000). These findings should rekindle discussion among Western investigators as to if such potential advantages as decreased economic cost and enhanced patient convenience will justify their widespread use. Meta-analysis is also useful in evaluating the efficacy of treatment in special subsets (e.g. Dukes'B study by the IMPACT group), or in comparing different treatment schedules (i.e. bolus versus continuous administration by the MAGIC group), and it may be useful in solving various clinical questions.View full abstractDownload PDF (751K) -
T. Kubota2000 Volume 53 Issue 10 Pages 1018-1022
Published: 2000
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESS5-Fluorouracil will elucidate its cytotoxicity to inhibit DNA synthesis and RNA polymerase by FUTP, While its rate-limiting catabolizing enzyme is dihydropyrimidine dehydrogenase (DPD).
We have assessed pyrimidine nucleoside phosphorylase (PyNPase) and DPD activity, to compare the chemosensitivity of 5-FU and 5'-DFUR. Tumor samples were obtained from 16 patients with advanced colon carcinoma. PyNPase activity was analyzed using the HPLC method, and DPD activity was assessed according to the methods of Naguib et al. HDRA was conducted according to the methods of Furukawa et al. When the chemosensitivity to the two drug forms was compared, it was observed that one specimen was sensitive to both drug forms, 3 specimens were exclusively sensitive to5'-DFUR, 5 specimens were exclusively sensitive to 5-FU, and the other 7 specimens were insensitive to both drugs, without significant. High PyNPase activity was associated with high chemosensitivity to 5'-DFUR, and high DPD activity correlated with low chemosensitivity to 5-FU. We suggest that the activity of PyNPase and DPD represents a reliable indicator for chemosensitivity to 5'-DFUR and 5-FU, respectively.
Recent study suggests that the combination of 5-FU+leucovorin+CPT-11 will be a promising regimen for advanced and recurrent colon cancer.View full abstractDownload PDF (378K) -
W. Ichikawa, H. Uetake, M. Kirihara, H. Yamada, Y. Shirota, M. Tajima, ...2000 Volume 53 Issue 10 Pages 1023-1028
Published: 2000
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESS5-fluorouracil is the most commonly used drug for the treatment of colorectal cancer (CRC). Thymidylate synthase (TS) has been well known to be a target enzyme of 5-FU, which is initially catabolized through dihydropyrimidine dahydrogenase (DPD) in liver and tumor. We previously described the positive correlation between DPD enzyme activity and mRNA expression in CRC. In thirty-seven chemotherapy-navi CRC tumors, expression of DPD mRNA was significantly related to 5-FU sensitivity in histoculture drug response assay. Expression of DPD mRNA in primary tumor could predict the anti-tumor effect of 5-FU for metastatic and disseminated diseases in 20 CRC patients. The combination of TS and DPD mRNA levels represented a more precisely predictive marker for 5-FU chemosensitivity.
CRC tumors with both low TS and low DPD mRNA expression might be candidates for 5-FU-based chemotherapy.View full abstractDownload PDF (381K)
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