All issues
Predecessor
Volume 67, Issue 6
Displaying 1-8 of 8 articles from this issue
- |<
- <
- 1
- >
- >|
Original Articles
-
Tetsuo Yamana, Yoshihiko Takao, Kazuhiko Yoshioka, Toshiki Mimura, Aki ...2014 Volume 67 Issue 6 Pages 371-379
Published: 2014
Released on J-STAGE: May 31, 2014
JOURNAL FREE ACCESSPurpose: The use of sacral neuromodulation (SNM) to treat fecal incontinence (FI) has been officially approved in the EU since 1994 and the US since 2011. The purpose of this trial, the first prospective study conducted in Asia, was to determine the safety and efficacy of SNM in accordance with the government approval protocol in Japan.
Methods: Candidates for SNM who provided informed consent were enrolled in this institutional review board-approved multicenter prospective trial. Experiencing more than two incontinent episodes per week, not just staining, was part of the inclusion criteria. Patients showing >= 50% improvement during test stimulation received chronic implantation of the InterStim System (Medtronic; Minneapolis, MN). The primary efficacy objective was to demonstrate that >= 50% of subjects would achieve therapeutic success, defined as >= 50% reduction of incontinent episodes per week at 6 months compared with baseline.
Results: A total of 22 patients underwent test stimulation with a 95% success rate, and 21 (12 females) with a mean age of 66.6 years and a mean duration of FI of 4.8 years received chronic implantation. At 6 months, 85.7% of subjects achieved therapeutic success (p=0.0007). Incontinent episodes significantly decreased from a mean of 14.9 per week at baseline to 3.1 at 6 months (p=0.0135). Anal manometry showed that preoperative maximum resting pressure (28.4mmHg) had significantly increased (39.1mmHg) at 6-month follow-up (p=0.0026). There were no reported unanticipated adverse device effects associated with InterStim Therapy.
Conclusions: SNM using InterStim System is a safe and effective treatment for Japanese patients with FI.View full abstractDownload PDF (1785K) -
Fumikazu Koyama, Hisao Fujii, Yoshiyuki Nakajima, Akira Sugita, Toshim ...2014 Volume 67 Issue 6 Pages 380-389
Published: 2014
Released on J-STAGE: May 31, 2014
JOURNAL FREE ACCESSWe report the results of a questionnaire survey on perianal diseases associated with ulcerative colitis (UC) distributed by the Surgical Group of Intractable Inflammatory Bowel Disease Subsidized by the Ministry of Health, Labour, and Welfare of Japan. The questionnaires were sent to 21 surgical group institutions and 94 proctology hospitals, and replies were received from 15 institutions (71.4%) and 30 hospitals (31.9%). Of 2,932 and 2,365 UC cases collected from the institutions and hospitals respectively, 253 (8.6%) and 505 (21.4%) perianal diseases occurred, respectively. In the surgical group institutions, the majority of the perianal diseases were fistulas/abscesses in patients both before (52.5%) and after (73.3%) proctocolectomy. In the proctology hospitals, the majority of the perianal diseases were hemorrhoids (55.7%) before proctocolectomy and fistulas/abscesses (55.3%) after proctocolectomy. In particular, fistulas/abscesses might recur after surgery for UC if they have already developed in the past. Moreover, rectovaginal fistulas were seen in 1.1% of patients in the surgical group institutions. Therefore, intensive management is necessary for lesions involving the anterior wall of the anorectal region in female patients.
Perianal diseases associated with UC are not rare, but morbidities are relatively frequent. Therefore, in daily practice, it is important to be aware of the potential for perianal lesions in patients with UC.View full abstractDownload PDF (1074K)
Case Reports
-
Shinya Imada, Tatsushi Shingai, Toshinori Sueda, Shingo Noura, Masayuk ...2014 Volume 67 Issue 6 Pages 390-395
Published: 2014
Released on J-STAGE: May 31, 2014
JOURNAL FREE ACCESSA 62-year-old man underwent right hemicolectomy with a diagnosis of ascending colon cancer, and a stoma was established with regard to postoperative ileus. He underwent stoma closure 11 months after stoma establishment, and developed an intestinal obstruction again. He could start oral ingestion after a decompressive procedure and use of steroids, but abdominal X-ray showed cystic emphysema in the right lower quadrant of the abdomen and pelvis. An abdominal enhanced CT scan showed cystic emphysema along the intestine wall at the center of the anastomosis site of two colorectal surgeries, and intra-abdominal free air. We decided to observe the patient's clinical course conservatively, because findings suggestive of peritonitis and perforation were absent. Thereafter, there was no change on physical examination, and his cystic emphysema and intra-abdominal free air disappeared spontaneously. Intestinal cystic emphysema associated with postoperative intestinal anastomosis is extremely rare, so we describe this case with some bibliographical comments.View full abstractDownload PDF (1578K) -
Reiko Tanaka, Michihiko Miyazaki2014 Volume 67 Issue 6 Pages 396-401
Published: 2014
Released on J-STAGE: May 31, 2014
JOURNAL FREE ACCESSAn 81-year-old man was treated with methotrexate (MTX) for rheumatoid arthritis (RA) since 2005. Regarding the course of RA, autoantibody to galactose-deficient IgG (CARF) extremely increased and he suffered melena in December 2012. He was diagnosed as proctitis of ulcerative colitis (UC). He received rectal betamethasone and oral mesalazine administration, but he abandoned the treatment. About 3 months later, he had moderate melena, and was diagnosed as total colitis of UC. He was admitted to our hospital, and received oral prednisolone and mesalazine administration, but his symptoms did not improve so he was transferred to Osaka National Hospital and received leukocytapheresis, but it was not effective. Therefore, he received intravenous infliximab (IFX) injection and successfully attained remission and maintenance of UC. We describe this case of intractable UC during the course of RA treated with MTX. It is considered that MTX induced the appearance of UC occurring in RA, and that one of the mechanisms of coexistence of RA and UC is the collapse of immune tolerance due to drugs.View full abstractDownload PDF (4058K) -
Yoshiko Kaku, Masaaki Mitsutsuji, Tomoko Tanaka, Takeshi Iwasaki, Etsu ...2014 Volume 67 Issue 6 Pages 402-407
Published: 2014
Released on J-STAGE: May 31, 2014
JOURNAL FREE ACCESSA 62-year-old woman was referred to our hospital with abdominal fullness which had appeared in March 2011. Abdominal ultrasonography and abdominal CT scan demonstrated ascites, and tumor marker CEA was elevated in serum (207.8 ng/ml). Colonoscopy revealed a type-2 tumor of the sigmoid colon and pathological analysis of a biopsy sample suggested a well-differentiated adenocarcinoma consistent with mucinous adenocarcinoma. We performed surgery under the tentative diagnosis of pseudomyxoma peritonei derived from sigmoid colon cancer in April 2011. The abdominal cavity was filled with a large amount of gelatinous ascites. Combined resection of the sigmoid colon, bilateral ovaries, uterus, appendix, and greater omentum was conducted. Histopathological examination of the resected specimen confirmed a well-differentiated adenocarcinoma with mucinous adenocarcinoma in the sigmoid colon tumor. The depth of tumor invasion was SI (abdominal wall) and the tumor disseminated to bilateral ovaries, uterus and greater omentum but the appendix was normal. Sigmoid colon cancer was therefore considered to be the origin of pseudomyxoma peritonei. As recurrence was noticed 11 months after the operation, peritoneum resection was performed and the patient continues to be observed. We report this rare case of pseudomyxoma peritonei occurring in sigmoid colon cancer.View full abstractDownload PDF (1902K) -
Atsushi Shirahata, Sumito Satou, Tadashi Matsumoto, Yasuo Ishida2014 Volume 67 Issue 6 Pages 408-412
Published: 2014
Released on J-STAGE: May 31, 2014
JOURNAL FREE ACCESSA 70-year-old man presented at our hospital with a chief complaint of melena. He was diagnosed with hemorrhage due to rectal cancer; colostomy was performed after detecting malignant bowel obstruction. On postoperative day 1, severe melena was observed and the patient developed hemorrhagic shock, which was an oncologic emergency. It was difficult to achieve endoscopic hemostasis, but after achieving hemodynamic stabilization using the initial treatment, an angiographic examination was performed. Contrast radiography was used to determine the intratumoral tortuosity of the superior rectal artery, and a pseudoaneurysm was detected (diameter 9.7mm). The patient was diagnosed with hemorrhage, which was caused by the tumor-induced rupture of the superior rectal artery, and embolization was performed. The postoperative course was uneventful; the patient was discharged and received outpatient chemotherapy.View full abstractDownload PDF (1019K) -
Yoshihisa Shibata2014 Volume 67 Issue 6 Pages 413-417
Published: 2014
Released on J-STAGE: May 31, 2014
JOURNAL FREE ACCESSWhile developmental cysts which occur in the perineum are commonly known as cystic masses, rare cases of synovial bursitis that developed in the region from the pelvis to the sacrococcyx have also been reported. The author experienced a case of coccygeal synovial cyst which developed as a mass accompanied by pain and was excised after temporary disappearance. The patient was an 80-year-old female presenting with kyphosis who visited the author's hospital for a perineal mass of 5 cm in diameter accompanied by tenderness. A diagnosis of subcutaneous epidermoid cyst in the midline of the buttock was made and the patient was scheduled to undergo surgery. However, because the cyst diminished spontaneously, the patient was placed under observation at her request. Two years later, the subcutaneous epidermoid cyst reincreased in size, so the patient underwent an operation combining resection of the coccyx. A histopathologic diagnosis of synovial cyst in the coccyx was made. Two years after the surgery and at the time of reporting, no relapse has been found. Although the occurrence of synovial cyst (synovial bursitis) in the body trunk and the limbs has been reported in the orthopedic field, the disease rarely develops in the perineum (coccyx). Therefore, the author examined this case including consideration of the need for total resection.View full abstractDownload PDF (2372K) -
Hironobu Baba, Takatoshi Matsuyama, Hidenori Takahashi, Satoshi Okazak ...2014 Volume 67 Issue 6 Pages 418-421
Published: 2014
Released on J-STAGE: May 31, 2014
JOURNAL FREE ACCESSA 38-year-old woman was referred to us with a large intrapelvic tumor discovered during a health examination. Magnetic resonance imaging (MRI) and computed tomography (CT) showed an 8-cm presacral cystic tumor and the sacrococcyx was partially defective. Under the preoperative diagnosis of sacrococcygeal cystic tumor, surgical resection was carried out. First, we separated the rectal wall from the tumor with a transperineal approach, then resected the tumor by a presacral approach with excision of the coccyx. Histopathological examination showed a mature cystic teratoma. Sacrococcygeal teratoma is a relatively rare congenital retroperitoneal tumor in adults. Because of some reports about its malignant change and recurrence, the primary treatment is complete surgical excision and the sacrococcygeal approach. Even though there are no specific standards for therapy, this combined laparoscopic abdominosacral approach is considered to be a useful treatment with the objective of complete resection and safety and for cosmetic reasons.View full abstractDownload PDF (1363K)
- |<
- <
- 1
- >
- >|