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Volume 58, Issue 5
Displaying 1-7 of 7 articles from this issue
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Three-step Divided Surgery to One-step SurgeryH. Ikeuchi, H. Nakano, M. Uchino, M. Nakamura, M. Noda, H. Yanagi, T. ...2005 Volume 58 Issue 5 Pages 239-245
Published: 2005
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSWe clarified the preoperative treatment, clinical features, and changes in techniques in 634 patients with ulcerative colitis who underwent surgery in our department between August 1984 and December 2003. These patients were divided into 3 groups: patients who underwent surgery between 1984 and 1996 (Group A), those who underwent surgery between 1997 and 1999 (Group B), and those who underwent surgery between 2000 and 2003 (Group C). Preoperatively, the total dose of steroids and the rate of emergency surgery significantly decreased during the study period, possibly related to advances in medical treatment. Concerning techniques, three-step divided surgery was performed in 85.6% of the patients in Group A, two-step divided surgery in 60.5% of the patients in Group B, and one-step surgery in 56.1% of the patients in Group C. The perioperative mortality rate decreased from 3.4% to 1.3% during this period. The pouch functioned well in 91.5%, 96.9%, and 99.7% of the patients in Groups A, B, and C, respectively, suggesting improvement in the safety and results of surgery.View full abstractDownload PDF (2070K) -
M. Nagao, Y. Funayama, K. Fukushima, C. Shibata, K. Takahashi, H. Ogaw ...2005 Volume 58 Issue 5 Pages 246-249
Published: 2005
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSWe reviewed the clinical course of 19 patients (13 men and 6 women) who underwent long-term home parenteral nutrition (HPN) therapy. The average age was 38 years when HPN was started, and the mean duration of HPN therapy was 3.3 years. The primary diseases were Crohn's disease in 15 patients, non-specific small intestinal ulcers in 2 patients, and chronic idiopathic intestinal pseudo-obstruction in 2 patients. Indications for HPN therapy were short bowel syndrome in 10 patients, intractable anal lesion in 2 patients, intolerance to enteral nutrition therapy in 4 patients, and intractable postprandial abdominal bloating in 2 patients. Infection of the catheter was the most frequent complication associated with catheter, and 'port survival' rate was 40% in 2 years. Many metabolic complications such as liver dysfunction, excess or deficiency of micronutrients, and osteomalacia were observed. Although HPN therapy has an advantage in increasing patients' social activity, careful follow-up is necessary to avoid severe complications associated with HPN therapy.View full abstractDownload PDF (268K) -
T. Makino, H. Mishima, M. Ikenaga, T. Tsujinaka2005 Volume 58 Issue 5 Pages 250-254
Published: 2005
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSA 59-year-old man complaining of perianal pain was referred to our hospital. Sub-all-round perianal invasive erythema was observed. Pathological examination of pre-operative biopsy revealed a number of Paget cells in the epidermis (partially in the dermis). Dentate line was not involved and no lymph node or remote metastasis was observed. We determined the resection line by preoperative mapping biopsy. Perianal wide resection was performed, keeping a 3-cm safety margin around the main lesion, with the construction of a temporary stoma and V-Y skin flap reconstruction using the bilateral gluteus maximus muscle. Anal function was proved by postoperative barium enema to have been preserved and no recurrence has been observed up to now. We report a case of perianal Paget's disease resected curatively while preserving the anal function and review the Japanese literature on this disease.View full abstractDownload PDF (5326K) -
S. Hasegawa, S. Sadahiro, T. Suzuki, K. Ishikawa, S. Yasuda, H. Makuuc ...2005 Volume 58 Issue 5 Pages 255-259
Published: 2005
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSAnorectal malignant melanoma is rare and has a very poor prognosis. We report a case successfully treated without any sign of recurrence in the more than 7 years following surgery. A 74-year-old woman presented with a three-month history of anal bleeding. A biopsy specimen from the tumor revealed malignant melanoma. A pigmented mass 5.5 cm in diameter was found on the anterior wall of the anus. A satellite nodule 1.6 cm in diameter was found on the left wall of the anus. She underwent an abdominoperineal resection. Microscopic features were as follows: malignant melanoma mp, ow(-), aw(-), ew(-), satellite lesion was sm, n0. Adjuvant chemotherapy was not performed. Although the treatment of malignant melanoma is controversial (local excision or radical excision), curative operation is important for long-term survival.View full abstractDownload PDF (2390K) -
K. Ozawa, T. Kanai, H. Kurihara, T. Ishikawa, Y. Kanatake2005 Volume 58 Issue 5 Pages 260-265
Published: 2005
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSThere have been seven cases of necrotizing fasciitis treated in the hospital. All of them were male and were aged from 49 to 66 years old. Every case complained of perianal pain and five cases had high temperature. At the initial examination, remarkable redness and swelling of the perineum was found in every case, and partial necrosis of perianal skin had occurred in some cases. Inflammation had extended to the scrotum in two cases. WBC and CRP were remarkably elevated in all cases. When we performed incision and drainage with local anesthesia, we recognized phlegmonous tissue and a small amount of purulent discharge. It was found to be debriding necrotic tissue and extensive drainage, so we performed surgical treatment. In six cases, surgical treatment was performed under spinal anesthesia during which we recognized remarkable necrosis and a peculiar bad smell. Four cases were saved in the hospital by us; the other cases were transported to the college hospital and surgical treatment was performed under general anesthesia. All cases recovered.
Rapid and accurate diagnosis of necrotizing fasciitis is essential because it is a serious infection and prognosis is poor. If necessary, the patient should be transported to a hospital that has more facilities.View full abstractDownload PDF (1820K) -
M. Miyazaki, J. Kuromizu, T. Toyohara2005 Volume 58 Issue 5 Pages 266-271
Published: 2005
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSWe found rectocele diameter (>30 mm) to be of great value in determining when surgery is indicated. This study evaluated the results of transvaginal repair for symptomatic rectocele.
We performed a prospective study of 17 consecutive patients (17 females) with obstructed defecation caused by a symptomatic rectocele. Mean age at time of presentation was 53 (range : 27-67) years. All patients underwent a transvaginal rectocele repair. The presence of the following symptoms was evaluated : duration for defecation, difficulty of defecation, feeling of incomplete evacuation, use of laxatives, fecal incontinence, urinary incontinence, prolapsing of other pelvic organs, sexual life, satisfaction, and recommendation. Follow-up was obtained by questionnaire.
The questionnaire was obtained from 13 (76%) patients. There were no significant differences in duration for defecation, feeling of incomplete evacuation, and use of laxatives but good results were found for difficulty of defecation, satisfaction, and recommendation. One patient experienced fecal incontinence, two had urinary incontinence, and four had dyspareunia postoperatively.
Transvaginal rectocele repair was beneficial for patients with obstructed defecation, however, sometimes indefinite complaints remain. The operative indication for rectocele by depth should be taken carefully.View full abstractDownload PDF (467K) -
2005 Volume 58 Issue 5 Pages 272-302
Published: 2005
Released on J-STAGE: June 05, 2009
JOURNAL FREE ACCESSDownload PDF (3114K)
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