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Volume 60, Issue 4
Displaying 1-8 of 8 articles from this issue
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Reviews
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—from basic to clinical—M. Takaki2007 Volume 60 Issue 4 Pages 191-197
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSIntegrative defecation reflex is mainly composed of recto-rectal excitatory reflex and recto-internal anal sphincter inhibitory reflex. Moderate rectal distension elicits rectal reflex contractions and simultaneous internal anal sphincter reflex relaxations. Both reflexes are controlled by (1) sacral excitatory reflexes mediated via pelvic nerves, (2) lumbar inhibitory reflexes mediated via lumbar colonic nerves, (3) intrinsic reflexes mediated via the enteric nervous system. The lumbar inhibitory reflexes are suppressed by the pontine defecation reflex center, where the afferents are pelvic nerves. Under less potent suppression by pons, the lumbar inhibitory reflexes contribute to the fecal continence in the rectum and internal anal sphincter. The potent disinhibition of the lumbar inhibitory reflex by pons plays a key role in defecation reflex. The plasticity of these reflex pathways is shown as follows : (1) 4-9 days after destruction of extrinsic reflex pathways (lumbo-sacral cords), unchanged recto-rectal reflex contractions and synchronous recto-internal anal sphincter relaxations occurred, indicating that intrinsic reflexes are able to compensate the defect of extrinsic reflex pathways and (2) 8 weeks after sectioning of intrinsic reflex nerve pathways the defecation reflex recovered to a similar level to that of the control. These results suggest the possibility of developing a new therapy for storing the anal function using the plasticity of the reflex pathways.View full abstractDownload PDF (766K) -
A. Takeda, I. Koyama, H. Shimada, T. Ochiai2007 Volume 60 Issue 4 Pages 198-204
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSBecause alterations of the p53 tumor suppressor gene are the most commonly observed and can occur early in the carcinogenic process, the accumulation of mutant p53 often leads to the production of p53 autoantibodies in the sera. The aim of this study was to evaluate the clinical implications of serum p53 autoantibodies in patients with colorectal cancer. We employed the latest version of the p53 autoantibodies EIA Kit in 278 patients with colorectal adenocarcinoma. Ninety of 278 patients (32.4%) were positive for serum p53 autoantibodies (primary : 32.2%, recurrent : 35.0%), which was almost the same as the sensitivities of CEA. When the sensitivities of p53 autoantibodies and CEA were evaluated according to clinical staging, the titration of p53 autoantibodies was more significantly associated with stage 0, I, II colorectal cancer than CEA. Seventy-three patients who showed preoperative positivity were followed by serial evaluation after resection. Negative conversions after resection were significantly higher in the Curability A group than in the Curability B or C group. Surveillance of p53 autoantibodies is a rapid and easy test for predicting prognosis after curative operation, and would appear to be useful in the development of a method of early diagnosis and as a postoperative monitoring marker for colorectal cancer.View full abstractDownload PDF (627K)
Original Articles
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T. Utsunomiya, O. Shibata, S. Kikuta, Y. Horichi, T. Kawano, T. Yao2007 Volume 60 Issue 4 Pages 205-212
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSHistological features were investigated in 33 cases (31 males and two females) who had more than two fistulas originating in different internal openings. Sixty-seven percent of anal fistulas (45/67) were taken through the external anal sphincter and 27% of internal openings (18/67) were found at the 6 o'clock position. An anal gland was observed in fistulous tracts in 49% of cases (37/67). The fistulous tract for most types extended in a radial direction to an external opening. There were no cases with supralevator fistula. A few cases, even in the type of fistulous tract with abscess, were found to have abscess formation in the adipose tissues, even though inflammatory cells had permeated into the surrounding adipose tissue. Many branched types of anal glands were recognized in the tracts of the fistulas with or without abscess. The anal gland wall, which was lined with stratified columnar or transitional epithelia in which mucous secretion was observed, was destroyed. However, outbreak of the glandular wall was not noticed in the metaplastic squamous epithelia, which did not produce mucus. It is concluded that anal fistulas with multiple internal openings did not tend to spread inflammation, transformed into an anal gland lined with squamous metaplastic epithelia and tended to cease inflammation along the fistulous tracts, whereas the gland lined with columnar epithelia was easily infected.View full abstractDownload PDF (1063K) -
T. Abe, Y. Hachiro, M. Kunimoto2007 Volume 60 Issue 4 Pages 213-217
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSPURPOSE : This study compared the outcome of sclerosing therapy for internal hemorrhoids with a novel sclerosing agent, ALTA, with that of ligation and excision (LE).
METHODS : This study included 276 patients in the ALTA group and 138 patients in the LE group. ALTA and LE were compared among patients in whom three or more hemorrhoids were treated. The patients were clinically evaluated preoperatively, at 4 weeks and 3 months after treatment.
RESULTS : Operation time and hospital stay were significantly shorter in the ALTA group (p<0.01). The patients in the ALTA group experienced less postoperative pain. At 3 months, no differences in the resolution of symptoms were observed between the two groups. The overall incidence of complications was significantly less in the ALTA group (p<0.01). The mean follow-up period was 8 months. There was no significant difference between the groups for recurrence.
CONCLUSION : According to the results of this study, we consider ALTA as the preferred treatment for hemorrhoidal prolapse without external hemorrhoids and skin tags.View full abstractDownload PDF (390K)
Case Reports
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R. Ookura, H. Ishizu, K. Okada, H. Masuko, T. Miki, Y. Kondo2007 Volume 60 Issue 4 Pages 218-223
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSAn 88-year-old man, who had been diagnosed as having a tumor of the sigmoid colon three months earlier but not treated because of high age, was seen at our hospital because the tumor prolapsed from the anus at defecation. Physical examinations revealed that the tumor of the sigmoid colon prolapsed from the anus with bleeding. The prolapse could not be reduced preoperatively, and an emergency operation was performed. Upon laparotomy an intussusception of the sigmoid colon into the rectum was recognized. The intussusception and prolapse could be reduced manually, and then sigmoidectomy was performed. The congestive change was strongly recognized in the prolapsed sigmoid colon. The pathological diagnosis was Is type well-differentiated adenocarcinoma (carcinoma in adenoma) the size of which was 42×64mm with the invasion depth of SM3. No lymph node metastasis was found. The postoperative course was uneventful.View full abstractDownload PDF (896K) -
A. Kurihara, K. Funahashi, T. Goto, J. Koike, K. Okamoto, N. Saitoh, H ...2007 Volume 60 Issue 4 Pages 224-228
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSA 52-year-old man had repeated episodes of deep perirectal and perianal abscesses and previously underwent incision, drainage and colostomy a total of three times at another hospital. This time the patient was observed to have a gelatinous discharge, and he was referred to our hospital and admitted. The anal fistula was diagnosed as type III+IV after various tests. It was diagnosed as Group 3 by biopsy, but no definitive diagnosis of cancer was made. However, there was anal pain and a gelatinous exudate discharging from a secondary opening. Therefore, malignancy was strongly suspected. In the treatment, considerations were made for the difficulty of treatment for this case which was complicated by repeated occurrences, patient complaints of mental and physical distress, and a decrease in QOL. Under sufficient IC, we finally performed abdominal-sacral resection of the rectum. Histologically, there was only inflammatory cell infiltration and marked fibrosis, and no findings of malignancy were observed. The treatment of an anal fistula should preserve the function of the anus, but such preservation might be difficult for a refractory and complex anal fistula due to the pathological condition. It is necessary to carefully select the treatment method by considering the patient's social background.View full abstractDownload PDF (902K) -
K. Uchimoto, F. Koyama, M. Nagao, T. Inoue, H. Fujii, T. Mukogawa, T. ...2007 Volume 60 Issue 4 Pages 229-233
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSThe present patient was a man in his 50s who was referred to our hospital after being diagnosed with advanced rectosigmoid cancer and irregularity of the anterior wall of the lower rectum at a nearby clinic. Endoscopy revealed two lesions 3.5 cm apart, with the lower rectal lesion exhibiting a pit pattern (type II). Biopsy showed fibromuscular obliteration. The patient was suspected of having mucosal prolapse syndrome secondary to the strain caused by difficulty in defecating as a result of cancer-induced stenosis. However, biopsy at our hospital revealed the presence of G5 in part of the lower rectal lesion. Since rectal resection was a therapeutic option depending on the malignancy of the lower rectal lesion, EMR was performed to obtain a definitive diagnosis. Histological findings of EMR specimens demonstrated moderately differentiated adenocarcinoma primarily involving the submucosa. The lower rectal lesion was thus diagnosed as an anal intramural metastasis of rectosigmoid cancer. Abdominoperineal resection was successfully performed without residual disease.
We herein report an important case of a patient who was diagnosed preoperatively as having an MPS-like intramural metastasis of rectosigmoid cancer and for whom an appropriate surgical procedure was selected.View full abstractDownload PDF (849K) -
R. Yasuoka, S. Morita, Y. Kadotani2007 Volume 60 Issue 4 Pages 234-238
Published: 2007
Released on J-STAGE: October 31, 2008
JOURNAL FREE ACCESSCase 1 : This case was a 74-year-old man who had been using an ointment for the treatment of internal hemorrhoids on three occasions for roughly six months. Peritoneal dialysis was performed, and since acute anemia and positive occult blood were observed, the patient underwent upper and lower gastrointestinal endoscopy. Since there was considerable bleeding from the periphery of a rectal submucosal tumor, the tumor was removed transanally. Case 2 : This was a 79-year-old man who had been using an ointment for the treatment of circumferential internal and external hemorrhoids on four occasions for roughly three weeks. Since there was little improvement in pain or other symptoms and the formation of a tumor was partially observed, the tumor was removed. Pathological findings in both cases indicated rectal oleogranuloma. Rectal oleogranuloma occurs extremely rarely as an adverse side effect of ointments. Although symptoms are reported to diminish as a result of discontinuing use of the ointment and observing the condition once a definitive diagnosis has been made, the two cases reported here eventually underwent surgery due to hemorrhage and pain caused by impacted hemorrhoids, after which a definitive diagnosis was obtained.View full abstractDownload PDF (683K)
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