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Volume 64, Issue 3
Displaying 1-12 of 12 articles from this issue
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Original Articles
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Hideo Watanabe, Kinnya Matsumoto, Sigeru Tomozawa, Yosito Ono, Masanor ...2011 Volume 64 Issue 3 Pages 127-132
Published: 2011
Released on J-STAGE: March 03, 2011
JOURNAL FREE ACCESSWe assessed the anal function of anal fissure with focus on the correlation of anal pressure and clinical feature. 1. Regarding anal resting pressure (ARP), the anal function deteriorated with aging in men and women in the normal case, whereas ARP clearly rose in cases with chronic anal fissure up to their 50's. 2. A high ARP was detected in the order of acute, subacute and chronic anal fissure, and a high ARP was not a cause but was thought to be the result of the anal fissure. 3. A correlation of y=ax+b was recognized between voluntary contraction pressure and ARP in both normal and chronic anal fissure cases. This result suggests that we can predict the strength of internal anal sphincter muscle based on the tonus of the anal canal in outpatient rectal examinations.
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Koichi Nagata, Atsushi Iyama2011 Volume 64 Issue 3 Pages 133-139
Published: 2011
Released on J-STAGE: March 03, 2011
JOURNAL FREE ACCESSObjective: The purpose of this study was to determine the effectiveness of manual carbon dioxide insufflation using a manometer in colonic distention for CT colonography.
Methods: One hundred forty asymptomatic subjects underwent CT colonography using either manual carbon dioxide insufflation with (study group, n=70) or without (control group, n=70) a manometer. CT data sets were assessed by two blinded observers who graded distention for six colonic segments using a 4-point scale. The insufflated gas volume for all subjects and the rectal pressure for the study group were recorded before scanning acquisitions.
Results: The insufflated gas volume used in the study group was greater than that in the control group. The mean distention scores for the study group were 3.64 and 3.78 in the initial and second scanning positions, respectively, versus 3.62 and 3.47 for the control group, respectively. Although overall colonic distention in the initial position did not differ between groups (p=0.578), the study group showed significantly improved distention in the second position compared to the control group (p<0.0001). The mean rectal pressures were 32.6mmHg and 31.2mmHg for the initial and second scanning positions, respectively.
Conclusion: Manual carbon dioxide insufflation using a manometer significantly improved colonic distention compared to insufflation without a manometer.
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Clinical Studies
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Yurika Satoh, Tatsuya Abe, Yoshikazu Hachiro, Masao Kunimoto, Tetsuhir ...2011 Volume 64 Issue 3 Pages 140-144
Published: 2011
Released on J-STAGE: March 03, 2011
JOURNAL FREE ACCESSPURPOSE: Changes after ALTA sclerotherapy have been identified by pathology experiments in rats, but it is difficult to grasp the changes over time in the living body.
We reviewed the changes over time in the living body by measuring the thickness of the submucosa (SM) after ALTA sclerotherapy.
METHODS: Forty-five patients were treated with ALTA sclerotherapy alone for internal hemorrhoids. We measured the thickness of the part that seemed to be thickest of the SMT with endoanal ultrasonography before and after ALTA sclerotherapy.
RESULTS: The average value of SMT did not change at three days and one month after treatment. However, SMT decreased from three months after treatment (p<0.01) and SMT decreased further from six months to one year.
CONCLUSION: The present study suggests that it may be useful to observe SMT to measure the effect after ALTA sclerotherapy.
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Mitsuo Nanba2011 Volume 64 Issue 3 Pages 145-149
Published: 2011
Released on J-STAGE: March 03, 2011
JOURNAL FREE ACCESSTwenty-three patients were enrolled in this study, including 12 colon cancer patients and 11 rectal cancer patients in whom laparotomy was performed to resect tumors, as well as lymph node dissection. Primary lesions and lymph nodes were visualized by MRI DWI and the mean maximum diameters of resected primary lesions and the largest lymph node were determined using fixed samples. In addition, the largest lymph node on MRI DWI was measured.
Primary lesions could be delineated in 18 cases (78%). The mean maximum diameter of the delineated primary lesions was 50mm, which was significantly different from that of five lesions that measured 20mm and could not be well delineated (p<0.01). Of the 18 cases, lymph nodes could be visualized in 11, and five cases were found to be metastasis-positive by histological examination. For these five cases, the mean maximum diameter of all metastasis-positive lymph nodes visualized in the fixed samples was 10.8mm (range 6-15mm). In these cases, the mean maximum diameter of lymph nodes on MRI DWI was 10.8mm (range 4-14mm) and these sizes were similar. On the other hand, seven cases whose lymph nodes could not be visualized were found to have no lymph node metastases based on histological examination and the mean maximum diameter of the lymph nodes was 8mm (range 4-14mm), not indicating a significant difference from the former. Therefore, lymph nodes that could be visualized were likely to contain metastases.
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Case Reports
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Takashi Nonaka, Hidetoshi Fukuoka, Hiroaki Takeshita, Terumitsu Sawai2011 Volume 64 Issue 3 Pages 150-153
Published: 2011
Released on J-STAGE: March 03, 2011
JOURNAL FREE ACCESSWe report a rare case of colonic cancer in a 34-year-old woman who was 25 weeks pregnant who visited the hospital because of constipation and positive fecal occult blood test. Total colonoscopy showed a type-2' tumor in the sigmoid colon and the histological finding of a biopsy specimen showed well differentiated adenocarcinoma. After waiting for fetal development until 31 weeks, labor was induced because no metastasis was found by computed tomography and ultrasonography. The puerperal course was almost good, so she was operated on for sigmoid colon cancer 7 days after the birth. The mother and baby were discharged from the hospital without any complications. When treating malignant tumor in pregnancy, it is necessary to consider the treatment method in view of various factors related to the pregnancy.
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Takashi Inoue, Tomohide Mukogawa, Hirofumi Ishikawa2011 Volume 64 Issue 3 Pages 154-158
Published: 2011
Released on J-STAGE: March 03, 2011
JOURNAL FREE ACCESSWe report a case of rectal cancer with a large extramural mucus lake. A 55-year-old man who had a positive fecal occult blood test was admitted to our hospital. Colonoscopy showed a lower rectal cancer and biopsy specimens indicated well-differentiated adenocarcinoma. A large extramural tumor close to the rectal cancer was found in computed tomography (CT) and magnetic resonance imaging (MRI). He underwent Miles' operation with D3 lymph node cleaning. The mucus lake existed in the extramural tumor. Microscopic findings showed tumor cells in or around the mucus lake. We finally diagnosed mucinous adenocarcinoma. He was alive with no recurrence 18 months after the surgery.
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Keiko Hamasaki, Takayuki Nakazaki, Hidetoshi Fukuoka, Fumitaka Akama2011 Volume 64 Issue 3 Pages 159-163
Published: 2011
Released on J-STAGE: March 03, 2011
JOURNAL FREE ACCESSA 73-year-old man visited a hospital complaining of constipation. Abdominal CT showed wall thickening of the rectum and dilatation of the oral-side intestine, suggesting rectal cancer. A trans-anal decompression tube was inserted on that day, but during the night he pulled the tube out by himself. He then suffered strong abdominal pain, and so the tube was inserted again. Abdominal CT revealed perforation of the rectum. Although he was brought to our hospital by ambulance, he was in shock. We performed Hartmann's operation on him. His abdominal cavity was filled with stool and the tube was exposed from the anterior wall of the Rs part of the rectum. A type-2 tumor of 60×47mm was sited in the same area. The histopathological diagnosis was well-differentiated tubular adenocarcinoma.
There have been case reports of perforation caused by a trans-anal decompression tube, but our case is very rare.
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Tsutomu Masuda, Naoki Inatsugi, Shusaku Yosikawa, Hideki Uchida, Hiroy ...2011 Volume 64 Issue 3 Pages 164-169
Published: 2011
Released on J-STAGE: March 03, 2011
JOURNAL FREE ACCESSA 60-year-old man was referred to our hospital because of melena. Barium enema study showed a type-2 tumor of the sigmoid colon. Colonoscopy showed a tumor with a white-coated crater in the sigmoid colon. Abdominal CT scan showed multiple paraaortic lymph node metastasis. Sigmoidectomy with dissection of group-3 lymph nodes and partial resection of the metastatic paraaortic lymph node were performed. The histological diagnosis was adenosquamous carcinoma. Six weeks after the operation, m-FOLFOX6 was started. After 6 courses, the paraaortic lymph node metastasis had disappeared. m-FOLFOX6 was effective for adenosquamous carcinoma of the colon with multiple paraaortic lymph node metastasis.
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Sayaka Miyake, Wataru Ueda, Yuuki Arimoto, Koji Sano, Kiyotaka Okawa, ...2011 Volume 64 Issue 3 Pages 170-177
Published: 2011
Released on J-STAGE: March 03, 2011
JOURNAL FREE ACCESSA man in his forties was referred to a local clinic due to appetite loss and leg edema, and anemia and hypoproteinemia were found by blood examination. He was referred to our hospital where gastroscopy was performed, and numerous polyps were found in the stomach. By colonoscopy, a type 2 tumor was identified in the cecum and some polyps were found around the tumor and rectum. Histopathological examination of the polyps in the stomach and duodenum and rectum led to a diagnosis of juvenile polyposis. However, the tumor in the cecum was diagnosed as well-differentiated adenocarcinoma and so an operation was performed.
Cases of juvenile polyposis have been reported to be poorly related with malignant tumor since they are classified as hematoma. However, the number of reports of juvenile polyposis accompanied by malignant tumor has been increasing. The SMAD4 germline mutation and BMPR1A germline mutation were reported as genes which are related to juvenile polyposis.
Here, we report a rare case of juvenile polyposis accompanied by colon cancer and recognized SMAD4 germline mutation, and also review the related literature.
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Toshitada Fujita, Kentaro Kawasaki, Masakazu Ohno, Jota Mikami, Shunji ...2011 Volume 64 Issue 3 Pages 178-184
Published: 2011
Released on J-STAGE: March 03, 2011
JOURNAL FREE ACCESSA 70-year-old man complained of constipation. After various examinations he was diagnosed with unresectable rectal cancer with direct invasion to the prostate and remote lymph node metastasis. Sigmoid colostomy was performed, and he was treated with chemotherapy consisting of levofolinate/5-fluorouracil/irinotecan (FOLFIRI). After completion of 14 courses of chemotherapy, bevacizumab was added to FOLFIRI. However, the patient developed grade-2 hypertension and kidney dysfunction after completion of four courses so bevacizumab was discontinued and four courses of FOLFIRI were administered. Abdominal CT of the primary tumor suggested that the patient had progressive disease, but PET-CT did not demonstrate remote metastasis.
The Hartmann operation was performed, and pathological evaluation of resected specimens showed complete regression of both the tumor and lymph node metastasis.
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Toshio Sekioka, Masahiko Saitou, Toshiki Tanaka, Kuniharu Hirata, Soro ...2011 Volume 64 Issue 3 Pages 185-192
Published: 2011
Released on J-STAGE: March 03, 2011
JOURNAL FREE ACCESSA 73-year-old woman who drank 1L of a liquid cleansing agent for colonoscopy complained of severe abdominal pain and distention. An emergency CT study and colonoscopy revealed a giant impacted fecalith in the sigmoid colon which caused colonic ileus. The fecalith was removed colonoscopically. Barium enema study showed a giant sigmoid diverticulum, 3cm in diameter, so a laparoscopy-assisted sigmoidectomy was performed. At operation, the giant sigmoid diverticulum was located on the antimesenteric border. Histopathologic study revealed a lack of proper muscle layer in the diverticulum. There have been only 28 reported cases of giant colonic diverticulum in Japan, which are reviewed here. The appearance of a balloon in CT study is an important sign in the diagnosis of giant colonic diverticulum.
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How I do it
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Yuji Inoue, [in Japanese], [in Japanese], [in Japanese], [in Japanese]2011 Volume 64 Issue 3 Pages 193-195
Published: 2011
Released on J-STAGE: March 03, 2011
JOURNAL FREE ACCESSDownload PDF (368K)
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