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Volume 60, Issue 3
Displaying 1-11 of 11 articles from this issue
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Review
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Y. Miyakura, H. Nagai2007 Volume 60 Issue 3 Pages 130-135
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSMicrosatellite instability (MSI) can be detected as changes in the length of microsatellite repeats, which can be present in 90% of HNPCC and 10-15% of sporadic colorectal cancers (CRCs). Methylation of the hMLH1 promoter region has been suggested to be the major mechanism for gene inactivation in sporadic MSI-H CRCs. Recently, germline methylation of the hMLH1 promoter region was detected in early-onset MSI-H CRCs which did not meet criteria for HNPCC. So far, eight CRC patients have been reported. We review the clinical and genetic features of distinctive MSI-H category with germline methylation. All eight patients developed colon cancers at a young age and four of them developed multiple primary cancers. Six of them lacked familial predisposition to the HNPCC related cancers in their first-degree relatives. Methylation of the hMLH1 promoter region occurred constitutively, for it was observed not only in peripheral blood lymphocytes, but also in miscellaneous organs. This methylation was hemiallelic in normal cells followed by inactivation of the other allele by chromosomal loss in cancers. Available affected individuals did not exhibit germline methylation. These findings suggest that constitutive hemiallelic methylation of the hMLH1 promoter region is associated with carcinogenesis in sporadic early-onset MSI-H CRCs and may increase the risk of multiple primary cancers.View full abstractDownload PDF (328K)
Original Article
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H. Ikeuchi, T. Yamamura, H. Nakano, M. Uchino, M. Nakamura, M. Noda, H ...2007 Volume 60 Issue 3 Pages 136-141
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSWe analyzed 755 cases of ulcerative colitis (US) treated with surgery in our department up to July 2005. Of those, patients over 60 yearts old (elderly) were studied for their clinical characteristics. Our results showed that the number of elderly patients with UC who underwent surgery has been increasing and in the most recent 5-year period, elderly patients accounted for 11.1% of all operations for UC. The operative procedures used varied depending on the preoperative condition of the patient. In a Comparison of prognosis following surgery between those who underwent elective and emergency surgery procedures, 7 (46.7%) of 15 patients who received emergency surgery died following the operation, which indicated a significantly poor prognosis. Among the causes of death, respiratory complications, sepsis derived from MRSA, and fungal infection were predominant. Elderly patients with severe UC have a lower reserve capacity than younger patients, thus an extremely poor prognosis is expected. We concluded that such surgery for elderly patients must be performed in a timely manner and recommend that close communication between the various physicians providing care be maintained.View full abstractDownload PDF (553K)
Clinical Study
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T. Kawamura, E. Cho, M. Miyata, M. Sakata, H. Kawabata, Y. Kori, M. Og ...2007 Volume 60 Issue 3 Pages 142-145
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSWe performed pediatric colonoscopy a total of 143 times in 32 patients between August 1988 and August 2004. Colonoscopic examinations were done for 30 patients using sedative drugs in endoscopy rooms and for two patients under general anesthesia in operating rooms. The examinations were conducted by a one-person technique without fluoroscopy.
The 32 patients consisted of 13 with ulcerative colitis, 4 with acute colitis, 3 with juvenile polyp, 2 with Crohn's disease and 10 with other lesions. Colonoscopy was used to make the final diagnosis in 15 patients who complained of hematochezia. We were able to reach the cecum in all patients who needed total colonoscopy. Oral lavage solution was efficient for patients except for children under the age of 10 who were not able to tolerate the ingestion. Premedication with sedative drugs was highly effective. No complication occurred during any procedure.
Pediatric colonoscopy is a safe and useful diagnostic method with proper preparation and premedication.View full abstractDownload PDF (402K)
Case Reports
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O. Ogura, M. Higashimoto, K. Nagata, T. Noguti, M. Maemura, H. Noma, Y ...2007 Volume 60 Issue 3 Pages 146-150
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSAnorectal malignant melanoma is a rare disease, and patients with this disease have a poor prognosis. Herein, we report a rare case of anorectal malignant melanoma with long survival by surgical resection and immunosurveillance therapy.
A 69-year-old female visited our hospital complaining of melena. Anorectal malignant melanoma was suspected by colonoscopy. After local resection in January 1998, the patient was diagnosed as anorectal malignant melanoma by pathologic analysis, and abdominoperineal excision of the rectum and lymphadenectomy were performed. After the first operation, each recurrence of the disease occurred in the small intestine, paracardiact fat, left mammary gland and axillary lymph nodes or gluteal fat between January 2000 through January 2003. Each recurrent lesion was removed by surgery. In addition, immunosurveillance therapy against the disease has been performed since April 2000, and no signs of recurrence in the patient have been observed to date.
In conclusion, surgical resection could be useful in the therapy for anorectal malignant melanoma.View full abstractDownload PDF (990K) -
N. Hanabata, T. Mikami, S. Fukuda, T. Tsuji, Y. Ishiguro, Y. Sasaki, A ...2007 Volume 60 Issue 3 Pages 151-155
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSWe experienced two cases of pseudomembranous colitis (PMC) with peritonitis.
Case 1 : A 72-year-old Japanese woman complained of diarrhea after taking antibiotics (TFLX, CFPN-PI) because of bronchitis. We diagnosed her as PMS by colonoscopy. After taking VCM, her condition improved.
She took some antibiotics due to urinary tract infection about two weeks later, and complained of severe abdominal pain without diarrhea. Rebound tenderness and high fever suggested that she had peritonitis. Colonoscopy revealed recurrent PMC. Metronidazole was effective and she was discharged from our hospital.
Case 2 : A 62-year-old Japanese woman had severe abdominal pain with diarrhea. She had also rebound tenderness. Diagnosis as PMC was made by colonoscopy. It was revealed later that LVFX had been medicated by another doctor. After taking VCM, she became well and was discharged from our hospital.
Although it is usually easy to diagnose PMC, peritonitis may follow without adequate diagnosis and treatment. Marked wall thickening of the ascending colon was characteristic in our two cases.View full abstractDownload PDF (815K) -
A. Moriguchi, H. Nakaba2007 Volume 60 Issue 3 Pages 156-160
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSMuir-Torre Syndrome is defined as a rare hereditary disease that is combined with multiple sebaceous tumors and internal malignancies. In a 55-years-old man with facial keratoacanthoma, a left breast tumor of 1cm in diameter was extirpated which revealed sebaceous carcinoma histologically. In the past, he had been operated on four times because of gastrointestinal malignancies : At 37 y.o. : cecal cancer, Type 2, T2N0M0/right colectomy, 42 y.o. : transverse colon ca., Type 1, T1N0M0/partial resection, 52 y.o. : Rectal (Ra) ca., Type IIa+IIc T1N0M0/low anterior resection and at 53 y.o. : gastric cancer Type IIa+IIc, T1N0M0/hand-assisted laparoscopic distal gastrectomy. All tumors were diagnosed as well differentiated adenocarcinoma without lymph node metastasis. His family has a positive family history of internal malignancies : colorectal in his grandfather, lung in his father and stomach in his uncle.View full abstractDownload PDF (1053K) -
Y. Yamada, S. Yamamoto, S. Fujita, T. Akasu, S. Ishiguro, Y. Moriya2007 Volume 60 Issue 3 Pages 161-166
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSDiverticulum of the appendix is rarely encountered. Here, we report a case of appendiceal diverticulum treated with laparoscopic appendectomy with preoperative diagnosis of appendiceal mucocele. A 56-year-old man, complaining of narrow stool, was referred to our hospital for medical treatment of appendiceal tumor. Abdominal CT revealed a cystic lesion in the appendix, and colonoscopy revealed a small bulge at the bottom of the cecum.
Although a preoperative diagnosis was appendiceal mucocele for which open appendectomy, ileocecal resection, or right hemicolectomy is usually performed, the patient underwent laparoscopic appendectomy since the tumor was small.
Macroscopically, there was an appendiceal diverticulum on the side of the meso-appendix.
Microscopic examination also revealed a pseudodiverticula, lacking muscularis propria.
Although preoperative diagnosis is important in the treatment of appendiceal diverticulum because of high incidence of perforation, the preoperative images are not so effective for detecting this disease. Moreover, the preoperative images of appendiceal diverticulum sometimes closely resemble those of appendiceal mucocele. Therefore, we recommend that laparoscopic appendectomy should be considered as the initial treatment for a small appendiceal tumor showing a cystic lesion in the appendix by preoperative image study, including appendiceal mucocele and diverticulum.View full abstractDownload PDF (1023K) -
Y. Morimoto, M. Ookura, H. Iwagaki, K. Kawamoto, Y. Yoshida, T. Itou2007 Volume 60 Issue 3 Pages 167-172
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSA 53-year-old man was admitted because of constipation and was diagnosed by endoscopy and a biopsy as having poorly differentiated adenocarcinoma of the rectum. A low-anterior resection was performed. Pathological examination of the rectal tumor showed INFb ; ss ; ly2 ; v0 ; and n1 (+), stage IIIa ; and it was diagnosed as a malignant carcinoid. Twenty-nine months after the first operation, the tumor recurred, and a second resection operation was performed. A histological examination showed a highly increased mitotic rate and a high proliferation index (68%, Ki-67 positive cells). It was considered that the histologic appearance of the primary rectum and the metastatic tumor suggested neuroendocrine carcinoma, and the working diagnosis was histologically reinterpreted. After the second operation, the patient received CDDP and UFT chemotherapy. Seventeen months after the second operation, the tumor recurred in the pelvis. A third resection operation was performed, but five months after this operation, the tumor progressed, spread to the lymph nodes and brain, and the patient died. Neuroendocrine tumors are heterogeneous and potentially aggressive and can be distinguished from other tumors because their growth and cytologic features are typical. A case of brain metastasis from neuroendocrine carcinoma is rare. We discuss neuroendocrine carcinoma and review the literature.View full abstractDownload PDF (927K) -
M. Hotokezaka, K. Uemichi, S. Kubo, H. Hamanaka, SI. Jimi, H. Hidaka, ...2007 Volume 60 Issue 3 Pages 173-177
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSA 21-year-old man was admitted following a fall from the 3rd floor of a building. He had lumbosacral pain, sensory disturbance in the perianal region, fecal incontinence and urinary disturbance. Radiological study showed transverse fracture of the second and third sacral bones. A longitudinal bilateral foraminal fracture of the sacral bone was also found. The third, fourth, fifth and coccygeal bone were dislocated anteriorly.
Anorectal manometric study showed no squeeze pressure (SP) in the anal canal on the 6th and 14th post-injury days (PID). He underwent surgical decompression including circumferential removal of the second to the fourth sacral bones on PID 32. Anorectal manometric study showed SP was 4.9 mmHg on PID 49. On PID 83, SP increased to 28.6 mmHg and incontinence of solid feces was improved and on PID 200, SP was improved to 53.8 mmHg, and he had no gas incontinence thereafter.
Anorectal manometric study showed the recovery of anorectal function preceding improvement of the patient's symptom in a patient with sacral bone fracture. Recovery of anorectal function was evaluated objectively by anorectal manometric study.View full abstractDownload PDF (531K) -
Y. Shibata2007 Volume 60 Issue 3 Pages 178-185
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSSacral region epidermis cyst in an adult is a comparatively rare disease.
We report 3 cases in which we adapted our approach to the tumor size and removed the tumor surgically by transendothelial sacrum and intraperitoneal speculum assistance.
Case 1 : A 49-year-old woman had perianal pain and was diagnosed. We performed extirpation using the transsacral approach for a cystic tumor of diameter 5cm in the rectum outside of the right rear buttocks. Case 2 : We made a checkup in gynecology for abdominal pain in a 25-year-old woman and found retroperitoneal tumor with oophoron internal bleeding. We performed transperitoneal (laparoscopic assist) tumorectomy for a mass of 9cm in diameter. Case 3 : A 53-year-old woman with an oppressive feeling in the buttocks underwent extirpation by the transsacral approach upon diagnosis of a presacral cystic tumor of median left side of the buttocks. The tumors of three cases have a film, and are diagnosed as epidermoid cyst histopathologically without invasion to the surrounding organs. This disease is an embryonally persistent benign tumor, but extirpation (complete excision) of low invasiveness is necessary, because there are reports on the malignant degeneration, the rate of infection is high, and recurrences are observed.View full abstractDownload PDF (1398K) -
M. Endo, K. Katsumata, Y. Mori, M. Enomoto, S. Suzuki, M. Hisada, T. W ...2007 Volume 60 Issue 3 Pages 186-190
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSA 38-year-old woman was admitted because of lower abdominal pain. Because decompression of the intestine was unsuccessful, the patient was operated on 5 days after admission. Ileocecal resection was performed. Pathological diagnosis was intestinal endometriosis. She was discharged on postoperative day 19. After discharge, melena occurred on menses, so colon fibroscopy was performed. A stricture was found in the sigmoid colon, and so she underwent hormonal therapy for endometriosis of the rectum. Bowel endometriosis is when endometrioma develops in the wall of the intestine. Thirty-eight cases of intestinal obstruction caused by endometriosis in the ileum have been reported including our case. It is difficult to make a current preoperative diagnosis of intestinal endometriosis by X-ray examination and endoscopy, so we must keep this disease in mind for intestinal obstruction, which is difficult to diagnose preoperatively in young women.View full abstractDownload PDF (827K)
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