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Volume 62, Issue 5
Displaying 1-6 of 6 articles from this issue
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Original Articles
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Yoshihiro Ohmi, Hiroshi Inaba, Haruo Sekino, Shingo Hasegawa, Takuma O ...2009 Volume 62 Issue 5 Pages 307-322
Published: 2009
Released on J-STAGE: May 01, 2009
JOURNAL FREE ACCESSPurpose
We performed primary-focus open operations to treat anorectal fistulas and assessed the condition of 125 patients at 5 years or more after the operation.
Subjects and Methods
During the period between May 1991 and May 2002 we performed primary-focus open operations (excision including the primary opening, primary fistulous tract, internal anal sphincter, primary focus, subcutaneous external anal sphincter or incision and creation of an open wound) to treat 125 cases of anal fistula (low 8, high 117). The postoperative course was confirmed from the contents of the patients' charts and by a questionnaire survey by mail.
Results
1. Wound healing occurred in 117 (94%) of the 125 cases. 2. There were no recurrences in 88 (70%) of the cases. 3. Anal manifestations developed in 12 (24%) of the 50 cases in which it was possible to determine the condition of the anus postoperatively, and manifestations of anal sphincter muscle incompetence associated with the operation were seen in 11 (22%) of them, i.e., gas leakage in 5 cases, underwear soiling in 2 cases, fecal incontinence occasionally in 3 cases, and frequently in one case.
Conclusions
We concluded that primary-focus open surgery is partially effective as a curative operation for anal fistulas.
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Makoto Yoshida, Satoshi Ikeda, Takao Hinoi, Masanori Yoshimitu, Yuji T ...2009 Volume 62 Issue 5 Pages 323-327
Published: 2009
Released on J-STAGE: May 01, 2009
JOURNAL FREE ACCESSHereditary non-polyposis colorectal cancer (HNPCC) is an important clinical entity. Due to several clinical features such as its relatively high incidence and the occurrence of multiple cancers at a relatively young age, early diagnosis will benefit the patients and their families. However, the selection which is generally performed at present is insufficient. We propose a simple selection criterion for clinical use. We examined 372 colorectal cancer cases which underwent surgery in our department from January 2003 to May 2007. Ninety-five cases were selected based on our criteria; 25 cases underwent gene counseling, 18 cases received genetic screening after counseling. Seven of the 18 patients had HNPCC-related genetic abnormality. Our selection criterion is useful for selecting patients.
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Kazuya Momosaki, Yasumi Araki, Toshihiro Noake, Takaaki Nagae, Yuji To ...2009 Volume 62 Issue 5 Pages 328-333
Published: 2009
Released on J-STAGE: May 01, 2009
JOURNAL FREE ACCESSPurpose: Transanal-endoscopic-microsurgery (TEM) is an excision method for high-rectal carcinoids. Here we report the clinical outcomes achieved in 19 cases using a new video-assisted gasless TEM method.
Method: Video-assisted gasless TEM uses a CCD camera and video monitor connected to a squint-type hard mirror under horizontal pressure and without ventilation. We have applied this new method in the treatment of 19 cases.
Results: The tumor diameters ranged from 4 to 12mm, with an average distance from the anal ring of 11cm. The average operation time was 63 min. The average diameter of the excised tissue was 34.8±6.1mm. In all the cases, there was no postoperative complication. Rectectomy was performed in two cases due to positive intraoperative macroscopic findings of invasion to the lymph duct. The average follow-up period was 46 months, and no cases of recurrence or metastasis have been observed.
Conclusion: Video-assisted gasless transanal endoscopic microsurgery (V-TEM) was an effective treatment for the safe removal of small (less than 15mm) high-rectal carcinoids that were without metastasis and remaining within the submucosal layer.
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Case Reports
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Keiji Hirata, Masaki Akiyama, Kohichi Arase, Kazunori Shibao, Aiichiro ...2009 Volume 62 Issue 5 Pages 334-339
Published: 2009
Released on J-STAGE: May 01, 2009
JOURNAL FREE ACCESSAlthough the great majority of patients with intractable ulcerative colitis (UC) can withdraw from steroid hormone therapy after total proctocolectomy, some require steroid readministration for extraintestinal manifestations (EIMs). We treated UC-related arthritis after total proctocolectomy using methotrexate (MTX). Since 2001, 20 patients with UC could withdraw from steroid therapy after total proctocolectomy, but three reported multiple arthralgia after steroid cessation. In these three, total prednisolone doses exceeded 10,000mg. All three were treated with low-dose MTX, successfully leading to the improvement of arthritis. Eventually, one withdrew completely from steroid treatment, one reduced daily steroid doses, and one avoided steroid readministration. No major adverse effects were encountered for MTX. Among EIMs, arthritis usually deteriorates or develops after total proctocolectomy, impairing patients' quality of life. Although no definite evidence exists for the effectiveness of MTX on UC or UC-related arthritis, low-dose intermittent MTX treatment appears to be a therapeutic option in UC-related arthritis.
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Takayuki Nakazaki, Keiko Hamasaki2009 Volume 62 Issue 5 Pages 340-344
Published: 2009
Released on J-STAGE: May 01, 2009
JOURNAL FREE ACCESSA 56-year-old woman was admitted to our hospital because of thyroid tumor. She was treated by low anterior resection and hysterectomy for rectal cancer. The pathological findings of the rectal cancer were moderately differentiated adenocarcinoma, se, ly1, v1, n1, stage IIIa. Afterward, she had multiple lung metastasis, so we administered an anticancer drug (UFT, S-1). She visited our hospital because of a neck tumor in June 2007. Serum CEA level was elevated at 106ng/ml. A hard mass of size 4cm was palpable in the right lobe of the thyroid. Needle aspiration cytology of the thyroid tumor showed class v. As the tumor was growing rapidly and there was a risk of oppression of the trachea, we performed subtotal thyroidectomy in August 2007.
The tumors were 3.5×2.0cm in the right lobe and 1.1×0.7cm in the left lobe. Pathological findings showed that the tumors consisted of abnormal glands with necrosis, consistent with metastasis of rectal cancer. We report a rare case of thyroid metastasis from rectal cancer with a review of the literature.
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Akira Takehara, Masahiro Hada, Kazushige Shibahara, Masatoshi Sasaki2009 Volume 62 Issue 5 Pages 345-349
Published: 2009
Released on J-STAGE: May 01, 2009
JOURNAL FREE ACCESSA 16-year-old man was referred to our hospital because of abdominal pain, vomiting, diarrhea and bloody stool. Abdominal CT scan showed intussusception of the ascending colon and cecum at hepatic flexure, but we could not find the cause of intussusception and so performed a colonoscopy. The colonoscopy showed intussusception at the hepatic flexure and a mucosal elevated lesion on the edge. Biopsy of the elevated lesion was done, and the intussusception was easily reduced by air injection.
His stool culture was positive for Escherichia coli O-157, and the pathological finding of the biopsy revealed only inflammatory change and no tumor cells. Therefore we diagnosed the case as intussusception caused by Esherichia coli O-157. After reduction of intussusception, he was discharged from hospital without recurrence or complication.
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