All issues
Predecessor
Volume 72, Issue 2
Displaying 1-9 of 9 articles from this issue
- |<
- <
- 1
- >
- >|
Clinical Study
-
Yoshiko Aikawa, Satoshi Matsuda, Kazuhiko Kawakami, Katsuhiko Nakai, K ...2019 Volume 72 Issue 2 Pages 53-57
Published: 2019
Released on J-STAGE: January 30, 2019
JOURNAL FREE ACCESSWe conducted a verification clinical study on the safety and efficacy of the local application of calcium channel blocker ointment (nifedipine ointment) in patients with chronic anal fissures who had failed to respond to conservative treatment.
A group of 40 patients with chronic anal fissures were treated with nifedipine ointment, and pain (Face Scale (FS)) and anorectal mean resting pressure (MRP) were measured. Assessment was possible in 32 cases. After application, FS pain decreased significantly both during defecation and at rest compared to that before treatment.
Those who progressed to surgery were considered the unresponsive group. If the remaining patients are considered the effective group, the efficacy rate was 87.5%. MRP in the unresponsive group was significantly higher than that in the effective group, and no signs of a significant decrease in MRP were noted after treatment, compared to baseline. The only adverse drug reaction reported was headache in 1 patient.
Nifedipine ointment acts by relaxing the smooth muscles of the anus, thus decreasing MRP, and it is thought to promote wound healing. However, although significant improvements in pain relief were observed during this study, the MRP failed to decrease, suggesting that factors other than MRP may be associated with pain relief.View full abstractDownload PDF (459K)
Case Reports
-
A Case of Giant Appendix Mucinous Carcinoma Invaded Into the Abdominal Wall and Right Gluteal RegionMasayasu Kawasaki, Naoto Mizumura, Satoshi Okumura, Shou Toyoda, Hiros ...2019 Volume 72 Issue 2 Pages 58-64
Published: 2019
Released on J-STAGE: January 30, 2019
JOURNAL FREE ACCESSThe patient was a 79-year-old woman with the chief complaint of a right gluteal mass. The cystic mass of the appendix had progressed to the right posterior abdominal wall and the subcutaneous tissue of the right gluteal region. The total size was 17 × 14 cm. In cooperation with orthopedic surgeons, we performed right hemi-colectomy with the abdominal wall, right iliac bone and right gluteus medius muscle resection, and finally we could resect the tumor en-bloc. After the resection, a large abdominal wall defect remained, so we performed reconstruction of the abdominal wall in cooperation with plastic surgeons. Pathologically, we diagnosed the tumor as stage 2C mucinous adenocarcinoma of the appendix. We have followed up the patient without adjuvant chemotherapy. No recurrence has been observed for four years and three months, and the patient retains a high quality of life. Even if mucinous cancer of the appendix is far advanced, we can expect long-term survival with curative resection. It is also possible to obtain a good quality of life by abdominal wall reconstruction, so we should try aggressive surgical treatment in cooperation with surgical doctors of other departments.View full abstractDownload PDF (2569K) -
Masami Ueda, Masakazu Ikenaga, Katsuya Ohta, Takeshi Chihara, Masayosh ...2019 Volume 72 Issue 2 Pages 65-70
Published: 2019
Released on J-STAGE: January 30, 2019
JOURNAL FREE ACCESSA male in his sixties presented with abdominal pain and vomiting. Enhanced-contrast abdominal CT revealed a mass of 80 mm × 65 mm × 60 mm continuous with the cecum, multiple liver metastases, and peritoneal dissemination and small bowel obstruction arising due to the ileocecal tumor. We performed sufficient depressurization with a nasal ileus tube and a double-hole type ileostomy and a tumor biopsy on day 6 after admission. Colonoscopy revealed a protruding lesion accompanied by necrosis in the cecum. Pathological examination revealed atypical small cells connectively proliferated and positive epithelial and neuroendocrine markers, resulting in the diagnosis of neuroendocrine carcinoma (NEC). Based on the colorectal cancer guidelines, FOLFOX + bevacizumab therapy was administered in four courses but was ineffective, and the patient died on day 122 after the first visit. NEC of the colon is relatively rare, and its prognosis remains poor. The treatment guidelines for NEC of the colon have not yet been verified, and multidisciplinary treatment with both surgery and chemotherapy is required in view of the high-grade malignancy of NEC. Herein, we report a case of NEC of the ileocecum coexisting with multiple liver metastases and bowel obstruction with a literature review.View full abstractDownload PDF (1528K) -
Manabu Yamamoto, Keiji Hirata, Masazumi Tuneyoshi, Takayuki Toyonaga, ...2019 Volume 72 Issue 2 Pages 71-75
Published: 2019
Released on J-STAGE: January 30, 2019
JOURNAL FREE ACCESSThe case was a 54-year-old female with anal carcinoma with pagetoid spread. She underwent laparoscopic Miles' operation, and was administered S-1 p.o. for 1 year after the operation. She has been doing well without any recurrence for 3 years.
This case was diagnosed as anal carcinoma with pagetoid spread. Forty-two cases diagnosed as anal carcinoma with pagetoid spread have been reported in the Japanese literature since 1970. Poorly-differentiated adenocarcinoma was diagnosed in more than half of the patients with anal/rectal carcinoma with pagetoid spread.View full abstractDownload PDF (1336K) -
Ikuma Shioi, Toshiyuki Yamazaki, Hiroaki Uehara, Yoshihiro Miyagi, Aki ...2019 Volume 72 Issue 2 Pages 76-81
Published: 2019
Released on J-STAGE: January 30, 2019
JOURNAL FREE ACCESSWe report a case of osteomyelitis of the pubis secondary to surgical site infection following colorectal cancer surgery. A 61-year-old male diagnosed with advanced upper rectum cancer and early descending colon cancer underwent laparoscopic low anterior resection and left hemicolectomy. However, four months after the initial surgery, a remnant cancer was observed. It was removed by super-low anterior resection. A median incision reaching the pubis was made without any exposure of the pubis. A surgical site infection, which developed after surgery, was drained; this led to the resolution of the infection. Four weeks after the second surgery, the patient developed bilateral groin pain and gait disturbance. Computed tomography revealed osteolysis of the pubis, indicating osteomyelitis. The patient was started on oral antibiotics; however, due to the progressive symptoms and computed tomography findings, the patient underwent debridement surgery. The patient was treated with intravenous antibiotics for 35 days and was discharged without any complications. Osteomyelitis of the pubis is a rare surgical complication and can lead to gait disturbance and chronic pain if treatment is delayed. Early diagnosis is critical in patients exhibiting symptoms suggesting osteomyelitis of the pubis after surgery for colorectal cancer surgery to avoid serious outcomes.View full abstractDownload PDF (2029K) -
Yoichi Kono, Makoto Matsushima, Joji Kuromizu, Kazunori Suzuki, Yutaka ...2019 Volume 72 Issue 2 Pages 82-87
Published: 2019
Released on J-STAGE: January 30, 2019
JOURNAL FREE ACCESSA 35-year-old man underwent hemorrhoidectomy. Four days after the operation, his platelet count had reduced to 0.5×104/μL. We diagnosed drug-induced severe thrombocytopenia and discontinued the medicine that might have been the cause. Transfusions of concentrated platelets were executed, which were effective and his platelet count normalized.
A 62-year-old man underwent fistulectomy. Five days after the operation, his platelet count had reduced to 0.8×104/μL. We diagnosed drug-induced severe thrombocytopenia and discontinued the medicine that might have been the cause. Transfusions of concentrated platelets were executed, which were effective and his platelet count normalized.
Drug-induced severe thrombocytopenia is rare but is a high-risk factor of postoperative bleeding. We must be careful of drug-induced thrombocytopenia when administering antibiotics and analgesics in hemorrhoidectomy and fistulectomy.View full abstractDownload PDF (466K) -
Kaori Tanaka, Noriaki Kojima, Takuo Nishina2019 Volume 72 Issue 2 Pages 88-92
Published: 2019
Released on J-STAGE: January 30, 2019
JOURNAL FREE ACCESSAppendiceal diverticulitis is a relatively rare disease and it is difficult to make a preoperative diagnosis. However, with the improvement of imaging diagnosis, the number of cases that can be preoperatively diagnosed has increased. We report two cases of appendiceal diverticulitis presenting as multilocular cystic lesions by preoperative CT examination. Patient 1 was a 43-year-old woman and patient 2 was a 40-year-old man. They were admitted to our hospital because of right lower abdominal pain. Abdominal CT revealed multilocular cystic lesions of the appendix. We diagnosed appendicitis and proceeded with conservative treatment because malignancy could not be ruled out. After antibiotic therapy, we performed appendectomy on patient 1, and ileocecal resection with lymph-node dissection on patient 2. The resected specimens showed multiple appendiceal diverticula with no tumor lesion. The pathological diagnosis of both cases was appendiceal diverticulitis. A characteristic lesion of appendiceal diverticulitis is regarded as the diverticulum protruding from the appendix and air around the appendix. Appendiceal diverticulitis with multilocular cystic lesions has rarely been reported, so we report these two cases with a review of the literature.View full abstractDownload PDF (1373K) -
Ichirou Kawashima, Ryou Okamoto, Tetsuya Murasawa, Naoki Matsuda2019 Volume 72 Issue 2 Pages 93-97
Published: 2019
Released on J-STAGE: January 30, 2019
JOURNAL FREE ACCESSA woman in her 70s was admitted to our hospital because of an unpleasant itching in her perianal region and anal incontinence. Rectal examination found an irregular mass at anal 1-4 point with the size of 4.0×2.0 cm. A skin biopsy showed the mass to be Bowen's disease. The lesion had spread in the range of a half circle of the anal left side and reached the anal verge. Wide local excision with a 6-mm margin on the anal mucosal side and a 5-mm margin on the skin side was performed under general anesthesia. The defect after resection was reconstructed via dermal flap formation. The pathology was the same result. Six months after the operation, she was admitted to our hospital because of perianal pain and mucosal prolapse. Complications after anorectal surgery include fecal incontinence, anal stenosis and pruritus. It is important to cooperate with dermatologists to treat perianal Bowen's disease not only to avoid local recurrence but also to maintain anal function.View full abstractDownload PDF (2636K)
-
2019 Volume 72 Issue 2 Pages Mics02_1
Published: 2019
Released on J-STAGE: January 30, 2019
JOURNAL FREE ACCESSDownload PDF (341K)
- |<
- <
- 1
- >
- >|