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Volume 58, Issue 1
Displaying 1-9 of 9 articles from this issue
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Questionnaire Survey on Very Low Resection with Peranal Coloanal Anastomosis for Lower Rectal CancerN. Tomita, M. Watanabe, M. Kameyama, Y. Takao, K. Sunouchi, Y. Ogata, ...2005 Volume 58 Issue 1 Pages 1-12
Published: 2005
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSA multi-institutional questionnaire survey was performed to know the present situation of very low resection with coloanal anastomosis for lower rectal cancer in Japan. Answers were obtained from colorectal surgeons in 68 institutes. It was shown that this operation has been performed in 47 institutes (70%) and the number of this operation differed greatly among the institutes. Also, the objectives of this operation including the tumor location or the stage of the disease, and the operative procedures in the treated cases differed among the institutes. The total incidence of anastomotic breakdown was 74 out of 733 cases (10%), and the local recurrence rate in the 27 institutes which had long-term follow-up data (> 1 year after operation) was 40 out of 413 cases (10%) and the rate of anal dysfunction was 35 out of 325 cases (11%). At present, this operation cannot be considered to be a standard operation for lower rectal cancer. Further studies of longterm follow-up an larger nnmhnrc of cases are naaded.View full abstractDownload PDF (795K) -
K. Yamada, H. Samura, S. Ogata, S. Hisano, M. Fukunaga, S. Tanimura, Y ...2005 Volume 58 Issue 1 Pages 13-18
Published: 2005
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSBackground : Treatment for locally advanced rectal cancer with posterior invasion remains a difficult clinical problem. The aim of this study was to elucidate the prognostic significance of sacral resection for these lesions.
Methods : Between 1991 and 2002, 36 patients who underwent sacral resection, including total pelvic ex-enteration with sacral resection (TPES) in 25 patients and abdominoperineal resection with sacral resection (APRS) in 11 patients, for locally advanced primary or recurrent rectal cancer with posterior invasion were studied retrospectively for survival according to the degree of posterior invasion. The posterior invasion was histologically classified as invasion to the sacral cortex and the presacral connective tissues (PCT), which contain the fibrous layer of periosteum and parietal endopelvic fascia.
Results : A significant difference in survival after sacral resection was seen according to the grade of histological posterior invasion (p=0.0492) . The 5-year survival rates were 0% in 8 patients with invasion to the sacral cortex, 14.8 % in 9 patients with invasion to PCT, and 49.8 % in 19 patients without the invasion.
Conclusion : Sacral resection may benefit patients with posterior invasion of advanced rectal cancer, although alternatives should be explored in patients with histological invasion to the sacral cortex.View full abstractDownload PDF (464K) -
H. Sato, K. Maeda, T. Hanai, K. Masumori, M. Matsumoto, Y. Koide, H. A ...2005 Volume 58 Issue 1 Pages 19-24
Published: 2005
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSTwenty-seven patients with ischemic colitis who were referred to Fujita Health University between 1988 and 2002 were studied to clarify the clinical features of ischemic colitis after colorectal surgery. The patients were divided into two groups : the patients undergoing colorectal surgery (POIC, 10 cases) and the patients without previous colorectal surgery (NOIC, 17 cases). Gangrenous colitis was seen in 1 of POIC and transient colitis was seen in 26. Among 10 patients of POIC, low anterior resection was performed in 8 patients, sigmoidectomy and right hemicolectomy in 1 patient each. The main feeding artery was divided at its root in every operative case. Predisposing factors of ischemic colitis were seen in 5 (63.6%) of POIC. They were more frequently seen in NOIC than in POIC with a significant difference. Abdominal pain appeared in 3 (33.3%) of POIC as the first symptom and in 4 (44.4%) of POIC during the course. It more frequently ap-peared in NOIC than in POIC as the first symptom and the symptom during the course, although there were no significant differences. Ischemic change occupying more than a half the circumference of intestinal wall was found in 2 (22.2 %) of POIC. Although transient ischemic colitis after colorectal surgery tended to occur without an underlying disease or conditions, severe symptoms rarely occur. However, if ischemic colitis occurs in a patient with severe underlying disease, it is important to remember that severe colitis such as gangrenous colitis could occur.View full abstractDownload PDF (474K) -
An Analysis of Items Associated with Surgical Techniques by Quantification Theory II (Discriminant Analysis of Qualitative Data)M. Nozawa, M. Matsushima, H. Nakamura2005 Volume 58 Issue 1 Pages 25-34
Published: 2005
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSThis study compares two different surgical techniques for anal fissure : anal dilatation (AD), and lateral subcutaneous internal sphincterotomy (LSIS), and statistically analyzes the indication for each surgical procedure by multidimensional analysis (quantification theory II) using the clinical symptoms and measurement values of anal sphincter pressure before and after surgery. We enrolled a total of 95 patients who had undergone AD (n=55) or LSIS (n=40) in our hospital from April to September 2002.
The surgical technique (AD or LSIS) was significantly associated with study items such as postoperative characteristics of stool, gender, presence or absence of associated lesions, duration of morbidity, presence or absence of recurrence, and postoperative pain (significance level, p<0.05). However, there was no correlation between the surgical procedure and patient evaluation in both AD and LSIS groups, with both being effective. Selecting patients in whom the treatment is likely to be effective based on calculated scores, we can actively perform AD, provided that anal manometry shows a preoperative MSP exceeding 160 mmHg and a preoperative MRP exceeding 80 mmHg.View full abstractDownload PDF (657K) -
S. Haneda, Y. Funayama, K. Fukushima, C. Shibata, K. Takahashi, A. Has ...2005 Volume 58 Issue 1 Pages 35-38
Published: 2005
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSRectovaginal fistula is uncommon complication in ulcerative colitis and the treatment is complicated. We herein report a surgically treated case of rectovaginal fistula associated with ulcerative colitis. Thirty-eight-year-old woman who experienced first attack of ulcerative colitis in 1989 when she was 25 years old. Three months after the flare-up of colitis in November 2001, she found the passage of flatus and feces from the vagina. She visited our hospital for the treatment of rectovaginal fistula. At the admission, colitis was in remission. With barium enema study, the fistula from the anterior wall of the rectum connecting with the vagina was identified. The staged surgical repair of the fistula without colectomy was planned. Transvaginal repair of the fistula and loop ileostomy was undertaken for the first step, and she underwent closure of ileostomy at the second step. At one year follow-up after closure of ileostomy, recurrence of fistula was not found. In conclusion, repair of fistula was of benefit to the case with rectovaginal fistula associated ulcerative colitis in remission.View full abstractDownload PDF (1646K) -
A. Ohki, T. Masaki, H. Matsuoka, N. Abe, Y. Atomi2005 Volume 58 Issue 1 Pages 39-43
Published: 2005
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSMultiple granular cell tumors (GCTs) of the intestine are reportedly very rare. In this report, we present the case of a 55-year-old male patient with multiple GCTs of the right colon. Colonoscopy revealed four submucosal tumors (SMTs) measuring 15 mm in diameter. The tumors were yellowish-white. Three SMTs were removed by endoscopic polypectomy, and the remaining SMT by laparoscopy assisted colectomy. All lesions were well demarcated and limited to the submucosa. A pathological examination revealed that the resected margins of all the lesions were free of tumor cells vertically and horizontally. The tumors had eosinophilic granules in the cytoplasm, which showed a positive PAS reaction. Immunohistochemically, the tumors were strongly positive for the S-100 protein and NSE. On the basis of these findings, all the four tumors were identified as GCTs. This is the sixth case report of multiple GCTs of the colon in Japan. The differential diagnosis between GCTs and other SMTs is often difficult. A complete local resection is required for the accurate diagnosis of GCTs.View full abstractDownload PDF (3777K) -
M. Takeda, H. Sarasina, M. Numomura2005 Volume 58 Issue 1 Pages 44-47
Published: 2005
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSThe periproctal abscess is not uncommon, but we encountered a patient with a liver abscess in whom pyretolysis was not achieved after drainage. The patient was immediately admitted due to an abscess in the perianal region, and incisional drainage was performed, but pyretolysis was not achieved. Abdominal echography revealed a liver abscess measuring 8 cm in the S6 area. The patient was referred to a general hospital, and on the same day, percutaneous transhepatic aspiration drainage (PTAD) was performed. In general, drainage for a periproctal abscess achieves pyretolysis; however, we report a patient with a liver abscess in whom pyretolysis was not achieved.View full abstractDownload PDF (1451K) -
S. Umegae, Y. Ookita, T. Iwanaga, Y. Yamamoto, M. Noji, T. Kitagawa, K ...2005 Volume 58 Issue 1 Pages 48-52
Published: 2005
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSIt is recognized that human deficiency virus (HIV) -related anorectal diseases are relatively common. Therefore, HIV infection might be diagnosed from the presence of anorectal diseases. Our patient was incidentally diagnosed with HIV infection from the results of preoperative blood examinations for perianal fistula. His perianal fistula developed with anal human papillomavirus infection in the anal crypts. It has been reported that HIV-related anal diseases include condyloma acuminatum, malignant lymphoma and amebiasis. To our knowledge, there have been no case reports concerning squamous papilloma developing in the anal crypts. In patients with anal papillomavirus infection related to HIV, malignant change of anal disease is common. Monitoring CD4 lymphocyte counts has been reported to be useful for early detection of malignant change. Recently, the incidence of HIV infection has been increasing, therefore anorectal surgeons should recognize that early detection and management of HIV-related anorectal diseases are indispensable in clinical practice. We herein report one case of squamous papilloma developing in the anal crypts from HIV infection which was found during operation for perianal fistula.View full abstractDownload PDF (2399K) -
2005 Volume 58 Issue 1 Pages 53-58
Published: 2005
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSDownload PDF (782K)
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