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Volume 63, Issue 7
Displaying 1-7 of 7 articles from this issue
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Original Articles
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Jun Hasegawa, Yasumasa Takii2010 Volume 63 Issue 7 Pages 399-406
Published: 2010
Released on J-STAGE: July 02, 2010
JOURNAL FREE ACCESSObjective: We examined the clinicopathological factors, to clarify the significance of absolute valuation and relative valuation for determining indications for subsequent intestinal resection.
Methods: A total of 156 cases with colorectal submucosal carcinoma were classified into the superficial type and the protruded type, and each group was compared with absolute valuation and relative valuation.
Results: There were 97 protruded type cases and 59 superficial type cases. No significant difference in lymph node metastasis of superficial lesions was found in any levels of submucosal invasion in both classifications. In protruded lesions sm3 showed significantly more lymph node metastasis than sm1 in relative valuable, and no significant difference was found in any levels of submucosal invasion in absolute valuable. No significant difference was found in the depth between positive lymph node metastasis and negative. In superficial lesions the minimal depth of submucosal invasion was 500μm in positive lymph node metastasis, whereas in protruded lesions the minimal depth was 400μm.
Conclusion: The relative valuation appears to be useful to forecast the risk of lymph node metastasis in protruded lesions, but the absolute valuation appears to be useful to understand the limit of lymph node metastasis in both superficial and protruded lesions. Both absolute valuation and relative valuation should be used for determining indications for subsequent intestinal resection.
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Tetsushi Kinugasa, Yoshito Akagi, Kenta Murotani, Masaki Ushijima, Ich ...2010 Volume 63 Issue 7 Pages 407-414
Published: 2010
Released on J-STAGE: July 02, 2010
JOURNAL FREE ACCESSThe optimal timing for surgery in ulcerative colitis (UC) remains controversial. This study aimed to assess whether the risk factor for colitic cancer and the indication for cytapheresis were related to timing for surgery in UC patients. All 39 patients who underwent a colectomy and ileostomy from 2001 to 2009 in our university were identified from our database covering patient details, preoperative therapy, operative indication, complications, and last follow up. We performed statistical analysis including a tree model with these data. The operations included 30 elective surgery and nine emergency surgery. As for postoperative complications, the tendency was that many serious complications occurred with emergency surgery than with elective surgery. Cytapheresis reduced the percentage of colitic cancer in UC patients. On the other hand, when the contraction of the disease period was more than 133 months in the cytapheresis group, the percentage of colitic cancer in UC patients increased through statistical analysis. Our results suggest that the risk factor of colitic cancer in UC patients becomes clear. These findings can become one indicator of how we select the optimal timing for surgery in UC patient.
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Clinical Study
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Takaaki Yano, Yasuhide Matsuda, Michio Asano, Kazuhiko Kawakami, Katsu ...2010 Volume 63 Issue 7 Pages 415-418
Published: 2010
Released on J-STAGE: July 02, 2010
JOURNAL FREE ACCESSIt is well known that incision and drainage is the most popular method of treating anorectal abscesses. However, no consensus has been reached on the appropriate method of anesthesia, use of drain, type of drain, and duration of its placement.
In this study between November 2003 and April 2008, 131 patients were diagnosed with a perianal abscess and underwent initial incision and drainage at our hospital. We retrospectively examined all 131 patients and evaluated the effect of using a drain. We investigated the following factors that we believe might affect recurrence: method of anesthesia, use of drain, type of drain, and duration of its placement. Recurrence was defined as the recurrence of an abscess or the formation of an anal fistula.
Out of a total of 131 patients, 45 experienced recurrence, and 86 were cured without recurrence. A significant difference was observed only in the type of drain, meaning a hard drain is more effective than a soft drain in terms of recurrence. However, the type of anesthesia, and the use of a drain had no statistically significant effect on recurrence.
In conclusion, we would like to recommend a hard drain rather than a soft drain when a drain is required.
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Case Reports
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Karin Tanaka, Hiroshi Serizawa, Tomohisa Kadomura, Shojiro Morinaga, S ...2010 Volume 63 Issue 7 Pages 419-425
Published: 2010
Released on J-STAGE: July 02, 2010
JOURNAL FREE ACCESSA 38-year-old Japanese male was admitted to our hospital for abdominal expansion and a giant tumor. At 34 years old, he was diagnosed with FAP (familial adenomatous polyposis) because more than 100 polypoid lesions from 3 to 10mm in diameter were identified in the upper and lower GI tract by endoscopy. One of the biopsied specimens from the colonic polypoid lesions showed adenocarcinoma, and he was followed up once a year by endoscopy. On admission, a CT scan showed a giant tumor 28cm in diameter occupying the entire abdominal cavity. APC gene mutation was detected. The tumor and the involved tissue were resected and histopathologically diagnosed as a mesenteric desmoid tumor. Periodical examination by endoscopy and CT scan after the operation has shown no recurrence for more than five years. Gardner's syndrome has been reported to accompanied with a desmoid tumor in 3.5-17.5% of cases; however, the clinical features of sporadic Gardner's syndrome remains unclear, and the relationship between the APC gene and the disease requires further investigation.
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Tomonori Ohsawa, Kensuke Kumamoto, Ikuya Takeuchi, Toru Ishiguro, Sato ...2010 Volume 63 Issue 7 Pages 426-433
Published: 2010
Released on J-STAGE: July 02, 2010
JOURNAL FREE ACCESSWe report a case of papillary thyroid carcinoma associated with familial adenomatous polyposis (FAP) with a review of the literature. A 32-year-old woman with FAP was diagnosed as having polypoid cancer in the sigmoid colon. She was diagnosed as having a mass in the left lobe of the thyroid by computed tomography and ultrasonography performed as screening examinations before total proctocolectomy. Cytological examination of the thyroid mass revealed papillary carcinoma. A subtotal thyroidectomy was performed two months after total proctocolectomy. The pathological diagnosis was a cribriform-morula variant of papillary thyroid carcinoma. Genetic analysis of the APC gene by the protein truncation test and direct sequencing showed that the germline mutation was 7 bp deletion (TATAGTTTA→TA) at codon1179 and the somatic mutation of thyroid tumor was TGT→GT (T deletion) at codon 607. These mutations cause stop codons, resulting in truncated products of the APC gene. These results suggest that inactivation of both alleles of the APC gene is associated with tumorigenesis in the thyroid in patients with FAP.
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Kouichi Fujimoto, Hajime Ohnishi, Yasuhisa Yamamoto, Takehisa Ohnishi, ...2010 Volume 63 Issue 7 Pages 434-439
Published: 2010
Released on J-STAGE: July 02, 2010
JOURNAL FREE ACCESSCapillary hemangioma combined with ulcerative colitis (UC) is comparatively rare.
A 44-year-old female was treated for UC with 5-ASA and predoinisolon. Symptoms showed only chronic anemia, but no melena was evident. By chance, capillary hemangioma was found by further exam for UC. The sigmoidal lesion was a pedunculated polyp 20mm in diameter with a long stalk. It was resected endoscopically as a benign polyp. Histological examination of the removed polyp demonstrated multiple capillaries filled with erythrocytes in the colonic lamina propria. Finally, histological diagnosis revealed capillary hemangioma.
Sixty-two cases of colonic hemangioma including our case have been reported in Japan, and the pedunculated polypoid form of hemangioma has been confirmed in only 10 of these cases.
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Hiroshi Sashiyama, Yasunobu Tsujinaka, Yukihiro Hamahata, Keigo Matsuo ...2010 Volume 63 Issue 7 Pages 440-443
Published: 2010
Released on J-STAGE: July 02, 2010
JOURNAL FREE ACCESSA 53-year-old male was impaled by an iron rod used in reinforced concrete at a construction site. He had slight anal pain, but the pain was not so severe, so he did not seek immediate medical treatment. Three weeks later the anal pain started getting worse. He went to a primary care physician, and was transferred to our hospital for treatment of a severe perirectal abscess. On admission, he could not walk alone due to severe anal pain and dehydration. Rectal digital examination showed a large defect of the half lumen of the rectal wall on the posterior side. Then under the diagnosis of traumatic rectal perforation, the perirectal abscess was drained with a diverting stoma construction. Abscess healing was delayed due to uncontrolled diabetes mellitus. After the closure of the perforation, the diverting stoma was closed seven months after the initial surgery. Impalement rectal injuries are usually treated immediately after the injury, but in case of a trans-anal rectal injury, the symptom are sometimes weak, such as in our case, so treatment could be delayed. Because a delay of treatment leads a poor prognosis and complications, early diagnosis and treatment of an impalement injury is important for improvement of the prognosis.
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