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Volume 60, Issue 2
Displaying 1-11 of 11 articles from this issue
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Original Articles
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K. Haku2007 Volume 60 Issue 2 Pages 55-60
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSThe aim of this study was to assess the usefulness of circumferential subcuticular wound approximation (CSWA) for skin suture in stoma closure.
The subjects were 66 patients who underwent a stoma closure at our institution, and were divided into two groups : simple suture group (SG) of 33 patients undergoing conventional simple skin suture ; and CSWA group (CG) of 33 undergoing CSWA. The two groups were retrospectively compared regarding their clinical characteristics, early postoperative complications and postoperative hospital stay.
There was no significant difference between the two groups regarding their clinical characteristics. The wound infection rate was significantly lower in the CG (0%) than the SG (27%) (p=0.002), as was the overall complication rate (CG 9% vs. SG 36%, p=0.017). Concerning the other complications, no difference was found between the two groups. The hospital stay was significantly shorter in the CG (mean 16 days) than the SG (22 days), although this might have been influenced by the recent tendency to reduce the hospital stay. The postoperative skin scar after CSWA was usually a tiny round scar of 5 to 20mm in diameter, which was cosmetically superior to a liner scar of 70 to 80mm in length after conventional simple skin closure.View full abstractDownload PDF (712K) -
M. Kawakami, T. Yamaguchi, H. Matsumoto, M. Yasutome, Y. Iwasaki, K. A ...2007 Volume 60 Issue 2 Pages 61-68
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESS(Objective) The aims of this study were to evaluate the bowel function and male sexual function following radical surgery for lower rectal cancer.
(Methods) Clinical defecatory functions were prospectively collected from medical records on patients undergoing ultralow anterior resection (height of anastomosis was <2cm from the dentate line) at half, one, and three years postoperatively. Functional data were also collected by a questionnaire from patients undergoing curative rectal cancer surgery. Sexual function was also investigated in men.
(Results) With increasing time after the ultralow anterior resection, there were significant reductions in the median stool frequency and need of antidiarrhea drugs. The questionnaires on function showed that patients with an ultralow anastomosis had more toilet urgency, and had more occasional liquid staining compared with patients with higher anastomosis.
Erection was possible in 71% of patients, and ejaculation was possible in 60% of patients. Subgroup analysis showed that erectile and ejaculatory functions were much better in patients with the autonomic nerve completely preserved.
(Conclusions) Long-term functional results of ultralow anterior resection are satisfactory. The nerve-sparing procedure resulted in a low frequency of sexual dysfunction.View full abstractDownload PDF (816K) -
A. Tsunoda, N. Yasuda, K. Nakao, N. Yokoyama, G. Kamiyama, T. Marumori ...2007 Volume 60 Issue 2 Pages 69-76
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSThe objectives of the present study were to test the reliability and validity of the Japanese version of European Organization for Research and Treatment of Cancer QLQ-C30 (CR38J). The module consists of 38 items covering four functional scales and eight symptom scales. This module was tested among 81 colorectal cancer patients on four occasions. The timing was prior to treatment, one to two months later, and three months following the second assessment. For purposes of test-retest reliability, the patients completed the CR38J one week following the third assessment. Multitrait scaling analysis confirmed the satisfactory construct validity of the module. Cronbach's alpha coefficients for seven of nine scales exceeded the 0.7 criterion at one or both assessments. The test-retest reliability was satisfactory for the functional scales but unsatisfactory for half of the symptom scales. On the basis of comparisons of known groups, selective scales distinguished between patients differing in the location of disease, performance status and the presence of a stoma. The findings suggest that CR38J is associated with satisfactory reliability and validity.View full abstractDownload PDF (307K)
Clinical Study
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T. Yagyu, H. Yanagi, H. Ikeuchi, M. Noda, R. Yoshikawa, M. Gega, H. Na ...2007 Volume 60 Issue 2 Pages 77-82
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSThe use of the bikini line skin incision approach to RPC with IAA for ulcerative colitis (UC ; n=12) and familial adenomatous polyposis (FAP ; n=4) was evaluated. Sixteen female patients underwent the procedure and were analyzed. The average age was 27.1 and the operation time was 236.7 minutes. Blood loss was 196.3 ml and postoperative hospitalization was 24.5 days No intraoperative or major postoperative complications occurred. Operative and postoperative parameters were similar to the conventional midline incisional approach group except for significantly longer operation time (236.7 vs. 208.9 mins ; P<0.05).
Cosmetic results were superior. Our procedure enabled us to perform safe, simple RPC with IAA without special laparoscopic equipment with no severe complication. It also has cosmetic merit and would be useful for young females.View full abstractDownload PDF (765K)
Case Reports
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Y. Akamaru, T. Yumiba, Y. Yamasaki, A. Ito, T. Momiyama2007 Volume 60 Issue 2 Pages 83-88
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSAnorectal malignant melanoma is relatively rare and the prognosis is extremely poor. We report a case of anorectal melanoma followed up for four years. A 79-year-old woman presented to our hospital with anal bleeding in November 2000. Colonoscopy revealed anal polyps and endoscopic mucosal resection was performed for the lesions. The pathological examination demonstrated amelanotic malignant melanoma by immunohistochemical staining. She underwent local excision for recurrence in October 2001. When local recurrence was seen again, the tumor had become moderately pigmented. She underwent abdominoperineal resection in July 2003, however, she died of peritonitis melanomatosa in December 2004. Multiple metastatic tumors were identified in the lung, liver, heart and so forth in autopsy. It is interesting that although the primary tumors appeared pigmented, metastases were amelanotic. We suggest that curative operation, i.e. abdominoperineal resection, is necessary for long-term survival of anorectal malignant melanoma.View full abstractDownload PDF (1796K) -
T. Shibata, K. Tohara, S. Wada, Y. Uchida, T. Noguchi, K. Kawahara2007 Volume 60 Issue 2 Pages 89-94
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSThe patient was a 57-year-old woman who developed right hypogastric pain, visited a clinic, and was referred to our hospital. Physical examination revealed tenderness in the right lower part of the abdomen. Hematologically, elevations in WBC and CRP were noted. Ultrasonography and computed tomography of the abdomen showed a swollen appendix and a pelvic abscess.
Based on these findings, the patient was diagnosed as having perforated acute appendicitis. She underwent emergency surgery and the appendix was resected. At laparotomy, the swollen appendix was found to be adhered to the retroperitoneum. Histological findings revealed the mucosa of the resected appendix to be normal, and the muscular layer of the appendix contained endometrial tissues. As the preoperative diagnosis of appendiceal endometriosis was difficult, a detailed histopathological diagnosis was important.View full abstractDownload PDF (949K) -
J. Shimazaki, Y. Watanabe, T. Nakachi, H. Ubukata, I. Nakada, T. Tabuc ...2007 Volume 60 Issue 2 Pages 95-99
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSA 71-year-old woman with systemic lupus erythematosus complained of anal bleeding. Barium enema and colonoscopy revealed an elevated tumor above the peritoneal reflection of the rectum. A biopsy specimen showed no specific findings other than chronic inflammation. To establish a pathological diagnosis, a low-anterior resection with lymph node dissection was performed. The resected tumor measured 4.0 cm in maximal diameter. Microscopically, it was composed of diffuse proliferation of atypical lymphoid cells, which were positive for CD20, but negative for CD5, on immunohistochemical staining. The tumor was diagnosed as a B-type non-Hodgkin's lymphoma, with low-grade features : mucosal associated lymphoid tissue (MALT) type. The dissected lymph node showed no definite evidence of lymphoma cell infiltration, and this lesion was diagnosed as a clinical stage I rectal lymphoma.
Some patients with autoimmune disorders associated with hemopoietic organ-related cancer, especially malignant lymphoma, have been previously reported in the literature. However, patients with autoimmune disorders associated with primary colorectal lymphoma are rare. We report a case of primary rectal lymphoma in a patient with systemic lupus erythematosus, and discuss this rare case.View full abstractDownload PDF (655K) -
T. Sumi, K. Katsumata, Y. Murakosi, T. Suda, T. Ogata, K. Yoneda, Y. Y ...2007 Volume 60 Issue 2 Pages 100-104
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSWe experienced a case of strangulated ileus caused by epiploic appendages. The patient was a 52-year-old man who presented to our clinic with the chief complaint of vomiting. He had no history of previous surgery. He was diagnosed as having ileus and, was hospitalized. Conservative treatment was given and the patient got better until the 7th hospital day, when acute abdominal pain occurred and required emergency surgery. Upon the operative findings indicative of strangulated ileus of the small intestine caused by a loop of epiploic appendages of the sigmoid colon, a partial ileectomy was performed. There have been very few reports of strangulated ileus caused by epiploic appendages and this is the 17th case in Japan. We present this case with some references to the literature.View full abstractDownload PDF (581K) -
T. Makino2007 Volume 60 Issue 2 Pages 105-109
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSA 57-year-old woman admitted for fever and general fatigue was found in colonoscopy to have a type 2 tumor in the lower rectum. Biopsy showed primary squamous cell carcinoma of the rectum. Because computed tomography (CT) showed that the main tumor had invaded the uterine cervix, we conducted preoperative chemoradiation, i.e., external irradiation of the entire pelvis (50 Gy) and chemotherapy with 5-FU and CDDP administered with no major adverse effects. We conducted low anterior resection of the rectum with lateral lymph node dissection. Histological examination showed that the main tumor was replaced by scar tissue with no viable cells in the specimen, yielding complete response (CR). Most postoperative days followed a favorable course except for dysuria and soiling, which were improved through conservative measures. The patient has been free from recurrence for 12 months. Preoperative chemoradiation thus appears to be promising for patients with advanced low rectal cancer.View full abstractDownload PDF (814K) -
T. Nagamine, T. Gonda, T. Sakimoto, T. Kitaoka, H. Nakada, M. Yokoyama ...2007 Volume 60 Issue 2 Pages 110-115
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSA 33-year-old man underwent laparotomy for recurrent intestinal obstruction and diffuse cavernous hemangioma of the rectum. Total proctectomy with colo-anal anastomosis and appendectomy was performed since the vermiform appendix was also found to be involved in hemangioma at laparotomy. In addition to the intestinal hemangiomas, this patient was associated with vascular disorders including hemangioma in the gluteal skin, arterio-venous fistula between the internal iliac vessels, and venous aneurysm in the lower extremity. Based on these findings, this patient is very rare with no similar cases previously reported, and may be related with systemic vascular disorders although clearly discriminated by blue rubber bleb syndrome.View full abstractDownload PDF (1125K) -
J. Koike, K. Funahashi, T. Gotoh, M. Watanabe, A. Kurihara, N. Saitoh, ...2007 Volume 60 Issue 2 Pages 116-119
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSThis is a report of a metachronous anal metastasis in sigmoid colon cancer. A 74-years old man with a history of anal bleeding was admitted to hospital. Colonoscopy revealed a cancer occupying 2/3 of the lumen at the sigmoid colon, 35 cm proximal from the anal verge. He underwent radical sigmoidectomy. Histopathological examination revealed a moderately differentiated adenocarcinoma, ss, ly (2), v (2), infβ, n1, ow (-), aw (-), stage IIIa, curA. A follow-up abdominal computed tomography after eight months showed a metastatic liver tumor located on S7 measuring approximately 3cm in diameter. He underwent further surgery for partial hepatectomy. One year after his initial surgery, he complained further episodes of anal bleeding. Anoscopic findings showed that a polypoid lesion was located on the anal skin, and was suspected of Sigmoid cancer implantation. Histopathological examination revealed the tumor was located on anal skin, partially in the subcutaneous layer, and similar to that of the previous sigmoid colon cancer. It is very rare to find an example of anal metastasis in sigmoid colon cancer.View full abstractDownload PDF (685K)
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