To disclose the existing state of treatments and results of synchronous hepatic metastases from colorec-tal cancer, a multi-institutional questionnaire study was conducted in 1997. Following that study, a next study was done to reveal the conclusive results, including 5-year survival, of the registered 3, 212 cases. However, only 446 cases among the accumulated 1, 843 cases were available for analysis, due to a lack of survival data.
According to multivariate analysis for this limited study, hepatic resection was the most effective treat-ment for all stages of metastatic tumors, especially H1 stage, those metastatic numbers 3 or less, and tumor diameter 2.0 cm or under. Hepatic arterial infusion therapy was the second effective for H2 stage, H3 stage, those metastatic numbers 4 or more, and tumor diameter 2.1 cm or over. Systemic chemotherapy was some-what effective for more advanced staged cases with H3 and those metastatic numbers 5 or more.

View full abstract

We reviewed published reports on colorectal carcinoma complicating ulcerative colitis (UC) in Japan. Among the total of 312 patients who developed carcinoma associated with UC, 73% were at 10 years or more after the initial attack and 83 % had total colonic involvement. The proportion of patients in whom cancers were multifocal, infiltrating, and poorly differentiated was 29 %, 44 %, and 45 %, respectively. Carcinoma was detected at a significantly earlier stage in the surveillance group than the non-surveillance group who under-went ordinary clinical care only (P < 0.005). Among 'the patients initially diagnosed as having low-grade dys-plasia in the surveillance group, 77% (10/13) developed early cancer on follow-up, compared with 50% (3/6) in high-grade dysplasia, and 21% (3/14) in carcinoma (P<0.05). These results suggest that colonoscopic sur-veillance can be an useful aid in allowing the detection of carcinoma at an early stage. However, an addi-tional marker of detecting individuals at high risk for the development of colorectal cancer seems necessary to reduce the high percentage of the patients with Dukes' grade C or worse even in the surveillance group.

View full abstract

A 65-year-old male came to our hospital with a chief complaint of anal pain. Digital examination revealed a painful induration around the anus. Because he was a heavy drinker, liked fish, had full dentures, and had histories of a gastrectomy and a hemorrhoid operation, periproctal abscess due to a penetrated fish bone through the anus was suspected. Ultrasonography showed a hypoechoic mass around the anus, and a hyperechoic thin foreign body in it. He was diagnosed as having a periproctal abscess due to a penetrated fish bone, and excisional drainage and removal of the fish bone were performed, which went well.
We found 13 case reports in the Japanese literature that described fish bone penetration or perforation of the rectum or anus. Almost all the cases had an abscess around the rectum or anus, but there were no cases of periproctal abscess due to penetrated fish bones that were diagnosed preoperatively by ultra-sonography and/or X-ray examination in these cases.
A case of periproctal abscess due to a penetrated fish bone is relatively rare, but it should be kept in mind when a patient has great potential for perforation or penetration of the digestive tract by a ingested fish bone.

View full abstract

A 75-year-old female consulted a family doctor with left hip mass at November 2001. She was introduced to our hospital to close examination. Left hip mass is elastic hard, baby hand size, and surround 3/4 laps of anal canal in physical. Ultrasonography, CT (pelvis) and MRI (pelvis) revealed multiple tasseled cysts. The contrast shadow was seen only the partition of cysts in CT and MRI. Aspiration cytology was class II.Opere-tion was done with a diagnosis of Presacral Epidermoid cyst. Epidermoid cyst adhere to tail bone very hard. Presacral Epidermoid cyst was developed from tail bone, and spreeds on a large size to surround of anal canal.

View full abstract

The mechanism of hemorrhoidal bleeding was estimated by measuring platelets, the coagulation system, and fibrinolysis, as well as by observing hemorrhoidal tissues, in patients with hemorrhoidal bleeding. Compared with normal volunteers, high fibrinolytic activity and a high titer of platelet derived growth factor (PDGF) were noticed ; however, the coagulation system was not significantly different in patients with hemorrhoidal bleeding. In resected hemorrhoidal tissues, thrombi were separated from the vessel wall and were floating in the blood stream. A large number of dilated vessels were present above the lamina muscularis around the Herrmann line. It is presumed that hemorrhoidal bleeding occurs in injured angiogenetic dilated vessels denuded in the anorectum under stimulation by PDGF, and that it reoccurs by enhanced fibrinolysis.

View full abstract