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Volume 55, Issue 10
Displaying 1-15 of 15 articles from this issue
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T. Yamana, K. Makita, J. Iwadare2002 Volume 55 Issue 10 Pages 799-806
Published: 2002
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSPelvorectal fistulas are relatively infrequent among anal fistulas, and can be first diagnosed by digital examination. To accurately evaluate the extent of pelvorectal fistulas, MRI is very helpful. With MRI, fistulas and abscesses are shown as high-intensity in T2-weighted images and Gadrinium enhanced T1-images. Pelvorectal fistulas are diagnosed when fistulas are found above the levator ani muscle in coronal images, and/or in the perirectal space in axial images, and/or cephalad to the coccyx in sagital images. Most cases of pelvorectal fistula show ischiorectal or high intersphincteric fistulas concomitantly. Fistula cancer may be suspected if irregularly shaped fistulas or a collection of mucinous material is seen. No significant differences are found in cases of pelvorectal fistulas in Crohn' s disease patients. However, Crohn' s cases sometimes show characteristic multiple fistulas.View full abstractDownload PDF (848K) -
K. Sato, T. Kotoh, K. Yamada, M. Takano, R. Maruyama2002 Volume 55 Issue 10 Pages 807-810
Published: 2002
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSI examined the diagnostic procedure for pelvirectal fistula. In this hospital, I do transanal ultrasound and magnetic resonance imaging (MRI) examination, in addition to conventional inspection and digital examination, in preoperative diagnosis.
Proper diagnosis rates were 77.8% in case of digital examination, 59.3% transanal ultrasound, and 52.6% MRI, when compared to those of 27 examples of pelvirectal fistulae experienced in our hospital from January 1999 to December 2001.
I think a diagnosis of pelvirectal fistula can be made adequately using inspection, digital examination, transanal ultrasound, and MRI, together.View full abstractDownload PDF (300K) -
M. Takano2002 Volume 55 Issue 10 Pages 811-817
Published: 2002
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSPelvirectal fistulas are the most intractable anal fistulas to radical treatment. To obtain good surgical results, we must know the fundamental pathologies and accomplish exact preoperative diagnosis assisted by MRI. The operations are based on sphincter-reserving procedures consisting of proper and meticulous management for the primary opening, primary abscess, presacral lesion, rectal perforation, and secondary branches. The procedures consist of closure of the primary opening, full opening or resection of fistulous tracts, sufficient drainage, and muscular stuffing. The recurrence rate is 15.3%, and most of recurrence occur with the same type of pelvirectal fistula which shows the need for more exact management of the initial operation, to lower the recurrence rate. We also must be careful about accompanied malignancy and specific infection.View full abstractDownload PDF (204K) -
J. Iwadare2002 Volume 55 Issue 10 Pages 818-823
Published: 2002
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSBetween 1990 and 1999, we surgically treated 96 patients with pelvirectal fistulas. Patients with Crohn's disease (17 cases), fistula cancer (5 cases), or multiple operations were excluded, so that 60 patients were finally included in this study.
The procedures included anal-preserving (33 cases), muscle-filling (19 cases), and others (8 cases). Fistulas recurred in 8 patients (20 percent). Information regarding time required for wound healing, postoperative incontinence, overall satisfaction, and QOL data were surveyed by a mailed questionnaire for 28 patients with pelvirectal fistulas (type IV) and 246 patients with ischiorectal fistulas (type III). In terms of overall satisfaction, no difference was found between type IV and type III.
Fifty-three percent of the patients healed within 6 months with type IV fistulas, 72% with type III fistulas. There was no difference in the changed sense of sphincter tightening ability between type IV (56%) and type III (54%). Although solid stool incontinence was infrequently reported (12% in type IV; 5% in type III), a significant number of patients reported liquid stool (53% in type IV; 40% in type III) or gas incontinence (54% in type IV; 41% in type III). Forty percent of the patients with type IV and 25% with type III reported lifestyle restrictions. Finally, 64% of the type IV patients, undergoing an anal-preserving procedure, reported significant loss in sphincter tightening ability.View full abstractDownload PDF (177K) -
Y. Tsujinaka, Y. Hamahata, K. Matsuo2002 Volume 55 Issue 10 Pages 824-828
Published: 2002
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSAmong 4, 281 cases of anorectal fistulas treated during the last 8 years, 136 cases were pelvirectal fistulas (3%), including Intersphincteric fistula : Extrarectal extension, Transsphincteric fistula : High blind, and supralevator penetration, Suprasphincteric fistula, and Extrasphincteric fistula. The male-to-female ratio was 14 : 1, and the average age was 46 years old. latrogenic high complicated fistulas and repeated surgical treatments were thought to be a major reason for the difficulty in dealing with pelvirectal fistulas. The overall recurrence rate was 19.9% (27 cases), and 10 cases underwent third or fourth treatment. Use of seton is a preferable choice for young proctologists encountering this type of complicated fistula, but experts can treat and cure a pelvicrectal fistula using various types of advancement flap repairs.View full abstractDownload PDF (391K) -
A. Kurokawa, K. Kitsuki, Y. Kurokawa2002 Volume 55 Issue 10 Pages 829-833
Published: 2002
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSThis paper describes our seton methods for the treatment of pelvirectal fistula and their availability. The subjects were 726 patients with anal fistula : 11 cases of subcutaneous fistula, 540 of low intersphincteric fistula, 55 of high intersphincteric fistula, 102 of ischiorectal fistula, and 18 of pelvirectal fistula.
The following results were obtained. 1) Each type of fistula could be treated with the seton treatment in our office. 2) The mean healing period was 45.9 days. 3) Delayed healing, more than 3 months, appeared in high anal fistula (high intersphincteric fistula, ischiorectal fistula and pelvirectal fistula). 4) The incidence of deformity and/or minor insufficiency occurred in 7 patients (1.0%) : 3 cases of low intersphincteric fistula, 1 of high intersphincteric fistula, 2 of ischiorectal fistula and 1 of pelvirectal fistula. 5) Recurrence occurred in 7 patients (2 cases of pelvirectal fistula).
In conclusion, our seton methods seem to be extremely useful in the office treatment of pelvirectal fistula.View full abstractDownload PDF (1608K) -
Y. Matsuda, K. Kawakami, K. Kimura, M. Asano, H. Kaneko, N. Saigusa, H ...2002 Volume 55 Issue 10 Pages 834-840
Published: 2002
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSPelvirectal fistula is a rare disease that represents only 0.4-2.9% of all types of fisutula-ani in Japan. It has features of anal pain, fever, purulent discharge, and buttock dullness. These patients may have a past history of fistula-ani and visit the hospital because of recurrence or complications. The diagnosis of this fistula is made by digital examination immediately, however imaging examinations using TAUS, CT, and MRI are very useful for the complicated type of pelvirectal fistula, and it is rather credible than a finger examination. At the pelvirectal abscess, an enough incision and drainage could be reduced the degree of fistula type, and penetration into the rectal wall has a slightly high incidence compared with an ischiorectal-type fistula. At surgery, we use Hanley' s variant method. The postoperative healing period was 3 months, on average, and the recurrence rate was 33 %in our study. As postoperative anal function were apt to be unsatisfactory, we should apply sphincter preserving operation in future.View full abstractDownload PDF (5576K) -
Endoscopic Ultrasound Using a Microscanner and Magnifying EndoscopyA. Matsunaga, M. Nomura, K. Uchimi, D. Hirasawa, [in Japanese], [in Ja ...2002 Volume 55 Issue 10 Pages 841-845
Published: 2002
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSThe diagnosis accuracy of the depth of invasion of early colorectal cancer by conventional colonoscopy (CS), endoscopic ultrasonography using a microscanner(MS), and magnifying endoscopy (ME) was evaluated. The accuracy of CS (215 lesions), MS (250 lesions), and ME (54 lesions) in the diagnosis of the depth of cancer invasion was 90%, 91% and 87%. Records of CS (215 lesions), MS (189 lesions), and ME (56 lesions) from patients with early colorectal cancer were reviewed by three groups of endoscopists classified according to experience (group A, more than 10 years ; group B, 3-4 years ; group C, less than 3 years). The accuracy of each of the three examinations in the diagnosis of the depth of cancer invasion were compared among the three groups. The accuracy of CS increased with experience (group A : group B : group C=90% : 83% : 66%) . The accuracy of MS and that of ME were similar between the groups (90% :81% :77%, and 89% :89% :77 %). It is possible for experienced endoscopists to make a .precise diagnosis on cancer invasion with CS alone. MS and ME contribute to drastic improvement of diagnostic accuracy of cancer invasion for inexperienced or moderately experienced endoscopists.View full abstractDownload PDF (346K) -
M. Matsukawa, T. Kouda, T. Yamamoto, N. Hiratsuka2002 Volume 55 Issue 10 Pages 846-850
Published: 2002
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSCancer involvement into the submucosal layer (sm cancer) was divided into sm-mild cancer (cancer involvement into the submucosal layer less than 750 micron meter) and sm-massive cancer (more than 750 micro meter). We could not look for a characteristic radiological finding of type IIa and type I sm-massive cancer. Characteristic radiologic findings of sm-massive cancer were deformity of colonic wall in the cancer. One-third of polypoid type of sm-massive cancers were recognized a barium fleck of the lesion. Depressed type of sm-massive cancers were recognized a round barium fleck, smooth margin around the depression or convergency of mucosal folds in double contrast method.View full abstractDownload PDF (4376K) -
S. Okabe, K. Sugihara2002 Volume 55 Issue 10 Pages 851-857
Published: 2002
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSWe investigated risk factors for lymph node metastasis (LNM) using 254 lesions of colorectal submucosal invasive carcinomas (SIC) treated in Japan, and studied curability of 87 cases of T1 rectal carcinoma treated by transanal excision (TAE) at MSKCC. We used the absolute amount of submucosal invasion, composed of sm depth and sm width, and single cell infiltration (SCI), as pathological predictors of LNM. Sixteen lesions of SIC had LNM, showing 1050μm in sm depth and 3.25mm in sm width, at the lowest value. An independent prognostic factor of LNM was lymphatic vessel invasion (LVI), as a result of multivariate analysis. As for comparative study of TAE and radical resection (RAD) for T1 rectal carcinoma, there was no difference in the local recurrence rate, and adjuvant therapy did not benefit them. We concluded that SICs should be followed by subsequent colon resection with lymph node dissection if they show submucosal invasion of more than 1000mm in sm depth or 3mm in sm width and are positive for LVI or SCI, with exclusion of those diagnosed as purely well-differentiated adenocarcinoma. TAE without adjuvant therapy is adequate treatment for most T1 rectal carcinomas.View full abstractDownload PDF (4171K) -
T. Masaki, H. Matsuoka, N. Abe, Y. Izumisato, T. Mori, M. Sugiyama, Y. ...2002 Volume 55 Issue 10 Pages 858-866
Published: 2002
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSTo elucidate objective and useful risk factors for lymph node metastasis or local recurrence (locore-gional failure; LRF) in early invasive (T1) colorectal carcinomas, 51 lesions were immunostained using anti-E-cadherin, a-catenin, β-catenin, CD44 variant 6, MMP-7, and laminin-5 y2 chain antibodies, and associations between LRF and clinicopathologic factors were examined statistically. Univariate analysis revealed histol-ogy (p=0.02), budding (0.004), β-catenin (nuclear pattern) (p=0.01), and laminin-5 γ2 chain expression (p=0.001) were significantly associated with LRF. Multivariate logistic regression analysis showed that Β-catenin (nuclear pattern) (p=0.029) and laminin-5 γ2 chain expression (p=0.002) were independently and significantly associated with LRF. All four cases with LRF were positive for these two antibodies, and sensi-tivity, specificity, and positive and negative predictive values of these two factors were 100%, 91%, 50%, and 100%, respectively. Immunostaining of β-catenin and laminin-5 γ2 chain may be useful to determine addi-tional surgery after local treatment of TI colorectal carcinomas.View full abstractDownload PDF (6684K) -
Review of the Literature, Including Comparison of Classification by Relative and Absolute ValueT. Ohta, Y. Orii, M. Murakami, R. Satoh, M. Fujiya, Y. Saitoh, Y. Kohg ...2002 Volume 55 Issue 10 Pages 867-872
Published: 2002
Released on J-STAGE: December 03, 2009
JOURNAL FREE ACCESSThere are two popular invasion depth classification systems in Japan in the evaluation of colorectal submucosal carcinomas. One is the classification by relative value, and the other is by the absolute value of the amount of submucosal invasion. Using the former classification, submucosal carcinomas are divided into sml (cancer limited the within the upper third of the submucosal layer), sm2 (cancer limited to within the middle third of the submucosal layer) and sm3(cancer invasion to the lower third of the submucosal layer). The relative value classification is useful in the evaluation of surgically resected specimens, because the risk of lymph node metastasis is significantly higher in sm2 and 3 cancers compared with sml cancers. However, it has disadvantages that evaluation of invasion depth is insufficient in endoscopic mucosal resection (EMR) specimens, and the thickness of the submucosal layer is variable in each part of submucosal cancers resulted in incorrect evaluation of submucosal invasion classification. Absolute value classification, which measures the vertical submucosal invasion distance, is useful because it can be applied for both surgically resected and EMR specimens. According to previous reports, the definitive submucosal invasion distance for curative endoscopic resection (ER) is still unclear. Additionally, it is sometimes difficult in the measurement of submucosal invasion distance in polypoid-type submucosal cancers, because the muscularis mucosa is sometimes unclearly determined in those lesions. For extension of the indication for ER for sm2-3 carcinomas as minimum invasive therapy, it is important to establish histological criteria of an absolute value invasion grading system using the invasion distance in colorectal submucosal carcinomas.View full abstractDownload PDF (1911K) -
K. Togashi, F. Konishi, M. Sakuragi, H. Horie, K. Koinuma, H. Kawamura ...2002 Volume 55 Issue 10 Pages 873-877
Published: 2002
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSSubmucosally invasive colorectal cancers without lymphatic channel or venous invasion, poorly differentiated adenocarcinoma including invasive front and 1000μm or more invasion from muscularis mucosae were proven to have no risk of metastasis. They are considered to be good indications for endoscopic resection. Based on Japanese guideline, submucosal cancers with over 300μm invasion below muscularis mucosae were considered to be the indication for bowel resection. However, our data showed that submucosal cancers with 1000μm or less invasion do not need additional surgery after endoscopic resection. Strict criteria of lymphatic channel invasion will reduce additional surgery without recurrences. A number of submucosal cancers had undergone radical surgery with regional lymph node dissection, despite of the fact that theses cancers had no chance of metastasis as they did not have any risk factors such, as described in this study. To treat such cancers appropriately, it is required that submucosal cancers with 1000μm or less invasion should be endoscopically differentiated from those with over 1000μm invasion. Our data suggested that irregularity of the surface and bleeding are the important colonoscopic findings for differentiation between the two.View full abstractDownload PDF (3983K) -
M. Igarashi, T. Katsumata, K. Kobayashi, M. Sada, S. Yosizawa2002 Volume 55 Issue 10 Pages 878-883
Published: 2002
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSWe studied the problems of recurrence and metastasis after endoscopic resection of colo-rectal sm cancers. Our adaptation of endoscopic resection of sm cancers was smS (cancer invasion within 1, 000μm from the musculalis mucosa). We have experienced one patient who had a recurrence at 22 months after endoscopic resection. The recurrence rate was 0.53 % in 186 lesions. No patients had hepatic metastasis or metastasis of other organs after endoscopic resection of sm cancers. There were 5 patients (6.2%) with lymphoid metastasis in the surgical resected patients because of having positive risk factors after endoscopic resection. Our criteria for adding colectomy after endoscopic resection of sm cancers were positive at the cut end, massive invasion (cancer invasion over 1, 000μm from the musculalis mucosa), positive for vascular invasion, poorly differentiated adenocarcinoma, and budding at the depths of the invasive area. These factors were appropriate to prevent recurrence and metastasis after endoscopic resection of sm cancers ; however, the number of over-surgery patients was large in the circumstances. To decrease the over-surgery cases, it was necessary to extract new risk factors. In addition, it is necessary to perform surveillance colonoscopy to watch for local recurrence and new colonic tumors after endoscopic resection of sm cancers.View full abstractDownload PDF (1692K) -
2002 Volume 55 Issue 10 Pages 884
Published: 2002
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSDownload PDF (80K)
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