The Japanese Journal of Gastroenterological Surgery
Online ISSN : 1348-9372
Print ISSN : 0386-9768
ISSN-L : 0386-9768
Volume 23, Issue 3
Displaying 1-25 of 25 articles from this issue
  • Teruo Kakegawa
    1990 Volume 23 Issue 3 Pages 685-694
    Published: 1990
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    Recent clinical and experimental studies on the surgical treatment of esophageal carcinoma, limiting lymph node dissection, are presented to clarify the present problems and future trends of this treatment. Betwee April 1980 and May 1989, we experienced 457 esophageal carcinomas, and 385 cancers, including 344 thoraci esophageal carcinomas were resected. We have obtained the following conceptions concerning lymph node dissection from these patients and experimental models. 1) We usually have to take a “safe surgical margin” to dissect regional lymph nodes curatively. 2) We should attempt “reasonable lymph node dissection according to anatomical characteristics and lymph flow” because en bloc dissection ranging from the cervical to the thoracoabdominal regions is impossible in thoracic esophageal carcinoma. 3) We have to perform “function preserving lymph node dissection” to maintain postoperative systemic functions. 4) We have an idea of “quality of life” in curative surgery for esophageal carcinoma considering the cancer's characteristics based on surgical oncology.
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  • Morihiko Toda, Iwao Sasaki, Hiroo Naito, Michinaga Takahashi, Seiki Ma ...
    1990 Volume 23 Issue 3 Pages 695-704
    Published: 1990
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    Experimental studies were carried out to investigate the effect of ileo-jejunal transposition (UT) upon the secretion of gastric acid and gastrointestinal hormones. UT, sham 1 operation and sham 2 operation were constructed in 16 Heidenhain pouch dogs and the following results were obtained. 1) Following UT hyperenteroglucagonemia was observed. 2) The integrated gastrin resopnse and acid output from Heidenhain pouch after test meal loading were markedly elevated in the UT group. 3) The plasma gastric inhibitory polypeptide (GIP) levels at 60 to 90 minutes after the test meal were significantly decreased in the UT group. In conclusion, hyperenteroglucagonemia and a marked rise in gastric acid output were observed after UT. These observations do not support the idea that enteroglucagon has an enterogastrone effect. The release of GIP was not found to be affected by hyperenteroglucagonemia
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  • Michinori Matsui, Osamu Kojima, Sadao Kawakami, Yasuo Uehara, Toshihar ...
    1990 Volume 23 Issue 3 Pages 705-708
    Published: 1990
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    This study was designed to investigate the relationship between gastric cancer in women and their endocrine environment. We compared 24 premenopausal female patients (20-39 y.o) with 152 postmenopausal patients (60-79y.o) with gastric cancer clinicopathologically. We also investigated the estrogen receptor positive rate in those patients. Gastric cancer in the premenopausal patients tended to be of the poorly differentiated type and scirrhous type more often than in the postmenopausal patients. The destrogen receptor positive rate in the premenopausal patients was 100% and tended to decrease with age. Our data suggest that gastric cancer in women are influenced by their endocrine status.
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  • Surgery and its Clinical Significance in Terms of the Decisive Factors of Prognosis
    Satoshi Ono, Shouetsu Tamakuma, Kazuo Hatsuse, Masayuki Nishida
    1990 Volume 23 Issue 3 Pages 709-715
    Published: 1990
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    e reevaluated the morbidity and its clinical significance of postoperative liver dysfunction associated with abdominal surgery for the past 5 years, during which evaluation of both preoperative liver function and postoperative liver support was established. The incidence of postoperative liver dysfunction was 17.3% in 1393 patients receiving major operations with the diagnostic criterion of serum GPT≥100 or total bilirubin>2 mg/dl as liver dysfunction. Liver dysfunction was more frequently associated with upper G.I. tract operations, general anesthesia with halothane, blood transfusions and perioperative infection as has often been reported. Then we divided these cases with GPT elevation into 3 types, early (within 4 days), late (after 15 days), and intermediate. In the early type, GPT elevation was mild and transient and seemed to be without any definite clinical significance, whereas in the late type, GPT elevation was very marked and of long duration with frequent association with sepsis. Also we divided 41 cases of bilirubin elevation into 3 types, one in which bilirubin elevation precedes GPT elevation, second in which the two are elevated simultaneously, and the third in which GPT elevation is followed by bilirubin elevation. In the first type the patient did not show any clinical manifestations, whereas the patient of the third type was often seriously ill, sometimes with progression to multiple organ failure or liver failure. On the basis of this clinical analysis, we concluded that the simultaneous complication of hyperbilirubinemia or sepsis seemed to be the decisive factor in the prognosis of postoperative liver dysfunction. Experimental data about the effects of endotoxin on bile stasis and the difference in the rate of decrease of GPT according to the background factors are also discussed.
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  • Hiroshi Kohnosu, Kenji Tsukamoto, Takeshi Hironaka, Keitaroh Kan, Yosh ...
    1990 Volume 23 Issue 3 Pages 716-720
    Published: 1990
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    Prognostic factors causing recurrence of cancer after hepatectomy were studied in patients with hepatocellular carcinoma (HCC). In order to define the criteria of “Curative Operation” for HCC, pathological features were assessed in 97 cases. HCC accompanied by portal venous invasion (Vp) and/or intrahepatic metastasis (IM) showed a poor outcome in 1-and 3-year recurrence-free survival rates; only 50.3% and 16.3%, respectively. Of the gross types, simple nodular types showed a better outcome than other types in the recurrence-free rates; 84.3% at 1 year and 53.3% at 3 years. Both gross types and sizes in surgically resected HCC were correlated with the frequency of Vp or IM; 9/24 (21.4%) in single nodular types, 17/31 (54.8%) in single nodular and perinodular types, 19/23 (82.6%) in other types, 4/16 (25.0%) in HCC less than 2cm, 20/50 (40.0%) in HCC from 2 to 5 cm and 21/30 (70.0%) in HCC more than 5 cm in size. No significant differrence was observed between relative curative operations (RC) and relative noncurative operations (RN) in the recurrence-fwfree survivals according to the “Guide Line for Clinical and Pathological Studies on Primary Hepatic Carcinoma”. On the other hand, there were stastically significant differreces in 1-and 2-year early recurrence-free rates between modified RC and RN in view of the prognostic factors, including Vp, IM and gross types.
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  • with Specical Reference to Factors Affecting the Prognosis
    Norichika Matsui, Nobuyoshi Morita, Hiroshi Hiraoka, Izumi Etoh, Shinj ...
    1990 Volume 23 Issue 3 Pages 721-726
    Published: 1990
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    Twenty patients who underwent resection for carcinoma of the pancreas were reviewed clinicopathologically with respect to factors influencing their prognosis. The pancreatic cancer was characterized by mostly tubular adenocarcinoma spreading invasively into the surrounding tissues, and the incidence of invasion to lymphatic vessels, nerves and veins was 90%, 80% and 60%, respectively. Tumor size of more than 4 cm, capsular invasion of the tumor, and invasion to retroperitoneal tissues shortened the survival time. Invasion to veins and lymphatic vessels influenced the outcome, and was demonstrated in all cases in which the patient died of liver metastasis within one year after resection of the tumor. Therefore, methods for preventing liver metastasis as well as extended surgery should be used in the treatment for carcinoma of the pancreas.
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  • Motonori Okino, Hiroshi Tomie, Norichika Matsui, Kohichi Ueki, Nobuyos ...
    1990 Volume 23 Issue 3 Pages 727-731
    Published: 1990
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    We studied the correlation between postoperatively administered hemostatics and the incidence of adhesive ileus in 226 patients with gastric cancer, retrospectively. The incidence of adhesive ileus was 14% (20/149) in the menatetrenone-treated group and 3.9% (3/77) in the non-treated group. There was a significant difference between these two groups. In the group in which the patients had been given more than 400 mg of menatetrenone, the incidence of adhesive ileus was 18.8% (6/32), about four times that of the non-administered group. In the patients who had been administered other hemostatics (carbazochrome sodium sulfonate, tranexamic acid, hemocoagulase, conjugated estrogens), adhesive ileus did not occur more frequently than in the patients who had not been given the hemostatics. Prophylactic administration of a large dose of menatetrenone must be avoided, since the incidence of adhesive ileus may be increased by menatetrenone.
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  • Masahiro Tachi, Sintaro Sakurai, Seigo Nakamura, Ichiro Kimura, Motota ...
    1990 Volume 23 Issue 3 Pages 732-738
    Published: 1990
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    Between 2/86-2/88, 103 pts were evaluated. The pt drank 1.2 L of a 7.5% solution of mannitol during the morning of the day before surgery, combined with oral antibiotics and perioperative intravenous antibiotics. The mean time to complete the preparation was 8 hours. 96 pts thought this type of preparation was good. 12 pts vomited and 4 pts complained abdominal pain. No significant changes occured in the serum level of electrolytes, however, pts lost an average of 0.6 kilograms during preparation. The adequacy of bowel preparation was assessed at each operation, 68 pts had satisfactory results, however, 46 pts had moderate and large amount of intestinal gass. Samples of colonic contents were compared in pts prepared by oral mannitol alone, oral mannitol with oral antibiotics and in pts who didnot undergo any preparation. In the pts without reciving oral antibiotics, the mean number of microflora except E-coli was significantly lower than that of controles and oral antibiotics reduced all colonic microflora including E-coli. The postoperative infection developed in only one case (perineal wound infection). We conclude the 1-day mechanical preparation with 7.5% mannitol combined with oral antibiotics is a safe, effective and simple method for reducing the septic complications.
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  • Toshimasa Yamaguchi, Tomoaki Urakawa, Mitsuharu Nakamoto, Hiroaki Tana ...
    1990 Volume 23 Issue 3 Pages 739-744
    Published: 1990
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    Between 1977 and 1988, 277 patients with 300 colorectal carcinomas were operated on, of whom 29 (10.5%) had a large bowel obstruction. The peak age of the time of obstruction was in the fifth decade. The duration of symptoms was short, and more than 50% had symptoms for less than one month. The site of greatest risk was the upper colon (cecum, ascending, transvers, descending). Only 6.1% of the sigmoidal and rectal tumors and 16.5% of other segments caused obstruction. The all over 5-year survival rate in this series was 29.5%. The rate was 49.6% for those who had a curative operation. None of those undergoing a non-curative or a palliative operations survived more than 2 years. The resectability of those obstructing carcinomas was 86.2%. Resection with immediate anastomosis was performed in 23 patients consisting 12 out of 13 patients with right colon and 11 out of 14 with left colon resection. Resection after colostomy was undertaken in only 4 patients.
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  • Hidetaka Mochizuki, Kazuyoshi Yoshimura, Tsukasa Yoshizumi, Eiji Takeu ...
    1990 Volume 23 Issue 3 Pages 745-752
    Published: 1990
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    The condition of plasma endotoxin concentration, determined by Toxicolor Test®(LCT), of more than 50 pg/ml is defined as hyperendotoxemia. Sixty-one patients were given a diagnosis of hyperendotoxemia during an investigation period of 4 years and 5 months. Of these patients, 43 had septic foci (41 had gram-negative rod infections and 2 had fungal infections), 9 had no evidence of infectious foci but severe hepatic damage, and the other 9 had a severely advanced malignant tumor with slight infection such as respiratory or urinary tract infection. Septic hyperendotoxemic patients showed significantly higher rates of shock, vital organ damage and mortality than septic patients without hyperendotoxemia (p<0.01). Septic hyperendotoxemic patiens wiht shock and those who died showed significantly higher plasma endotoxin concentrations than those without shock and those who survived.(p<0.03). It is suggested that plasma endotoxin of septic patients has a significant influence on the clinical course and that endotoxin concentration determined by LCT has a significant meaning for the estimation of septic patients' prognosis. It is speculated that hyperendotoxemia with a severely advanced malignant tumor might have some influence on the emaciation of those patients through the production of cachectin from macrophages. On the other hand, highly concentrated plasma endotoxin in patients with fungal infection or severe hepatic damage seemed to have no relation to the clinical course. Considering the non-specific factors present in the lysate of LCT and activated by non-specific substances such as β-glucan, it is suggested that the results detemined by LCT in such patients might not reflect the exact plasma endotoxin concentration.
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  • Tetsuro Shimizu, Hiroshi Kato, Iwao Yamashita, Tomohiro Saito, Shigeru ...
    1990 Volume 23 Issue 3 Pages 753-757
    Published: 1990
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    We report a case of small cell carcinoma of the esophagus, on which multidisciplinary therapies combined with thermotherapy provided approximately a nine-month extention of survival. The patient was a 75-year-old male. In July 1987, he began to develop a hoarse voice and dysphagia. Following a diagnosis of cancer of the esophagus made at another hospital, he was admitted to our hospital on November 16. A variety of examinations and tests upon admission showed it was a non-resectable esophageal cancer extending to the ImEilu. Biopsy revealed small cell carcinoma of the esophagus. From November 30, the patient received 47 Gy of radiotherapy in total and immunochemotherapy consisting in total of BLM 65 mg, CDDP 150 mg, 5FU 4500 mg, VP-16 180 mg, OK432 57.2 KE and PSK 99 g. In addition, local thermotherapy was conducted nine times. Such multidisciplinary therapies caused the disapperance of not merely the symptoms but also the tumor shadow on esophagograms. In July 1988, however, the patient was readmitted for multiple liver metastasis. On August 6, he died. In conclusion, the local efficasy of combined radiotherapy and thermotherapy was expected, but more effective chemotherapy was considered necessary.
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  • Toshimi Sakai, Motonori Saku, Hideaki Naitoh, Ryunosuke Kumashiro, Sad ...
    1990 Volume 23 Issue 3 Pages 758-761
    Published: 1990
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    Two cases of chronic phlegmonous gastritis treated surgically after pancreatitis are reported. The patients were 65-year-old man and 70-year-old man, who underwent total gastrectomy under the preoperative diagnosis of gastric carcinoma of the scirrhous type. The intraoperative finding confirmed the diagnosis of gastric carcinoma because of the markedly thickened and rigid gastric wall tightly adhering to the pancreas body. However the histological diagnosis of the resected specimen of the stomach was phlegmonous gastritis of the chronic type. Chronic phlegmonous gastritis is exceeding rare and it is often difficult to differentiate it from gastric carcinoma preoperatively. It is considered that gastrectomy is the best method for treating chronic phlegmonous gastritis.
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  • Yoshiaki Murakami, Yuji Imamura, Hitoshi Sewake, Mikio Fujimoto, Yoshi ...
    1990 Volume 23 Issue 3 Pages 762-766
    Published: 1990
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    We report a case of heterotopic gastric mucosa in the gallbladder which was diagnosed accidentally by abdominal ultrasonography. The patient was a 44-year-old male who had no symptoms. Ultrasonography revealed a high-echoic polyp with a size of 10.4 mm and the shape of YAMADA-III type at the body of the gallbladder. Endoscopic retrograde cholangiography revealed a polypoid lesion. Considering the possibility of a malignant polyp, cholecystectomy was performed, but malignancy was not found by frozen section pathological examination. Postoperative pathological examination of the polyp showed a gastric fundal-type mucosa which was located at the mucosal layer of the gallbladder. This case is the 7th case of heterotopic gastric mucosa in the gallbladder in the Japanese literature. Heterotopic gastric mucosa is a rare disease and it is too difficult to diagnose it preoperatively, but its detection will be increased by development of imaging examinations.
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  • Shuichiro Suzuki, Toyoichi Tsuzawa, Mitsuyoshi Shimoda, Isao Shirosaki ...
    1990 Volume 23 Issue 3 Pages 767-771
    Published: 1990
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    Gastric cancer combined with cancer of other organs is not rare. However, double cancer ofthe pancreas and stomach is relatively rare. There are few cases in which a resection can be perfomed for both cancers. We have encountered a case of double cancer of the stomach and pancreas in which a resection could be performed for both the gastric cancer and the pancreatic cancer. The case is a 56-years old man. Diagnosed as having a double cancer of the stomach and pancreas before the operation, he was underwent a surgical operation. A resection was performed consisting of total gastrectomy and combined resection of the pancreasand spleen. Irradiation in a dose of 40 Gy during the operation was applied mainly to the posterior detachment after the resection of the pancreatic cancer. With peritoneal recurrence at the 4th month and peritonitis carcinomatosa at the 9th month after the operation, the patient died. There are 9 reported cases of double cancer of the stomach and pancreas which perimitted curative operation including ours. Of these, only 4 cases were diagnosed as double cancer of the stomach and pancreas before operation. In the daily treatment and operation, we should try to carefully examine while always keeping cancer of other organs in mind.
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  • Masahiro Kanno, Yasuyuki Deguchi, Kazuhiko Omote, Ryuichi Akimoto
    1990 Volume 23 Issue 3 Pages 772-776
    Published: 1990
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    It is very rare to encounter a metastatic tumor of the gallbladder. A 44-yearold male patient was hospitalized with complaints of epigastric discomfort and an abdominal full feeling. Preoperative gastroendoscopic findings showed a Borrmann 3 type gastric cancer and ultrasonqgraphic findings showed multiple echogenic lesions of the gallbladder. Operative findings revealed advanced gastric cancer with paraaortic lymphnode metastasis (N4), peritoneal dissemination (P2) and gastric serosal invasion (S2). Multiple nodules were palpated in the gallbladder but its serosa was normal. Subtotal gastrectomy and cholecystectomy were performed. The resected specimen showed a Borrmann 3 type gastric cancer and multiple submucosal tumors of the gallbladder. Histological findings of both specimens showed the same poorly differentiated adenocarcinoma with lymphatic vessel invasion (ly2) and CEA staining. We considerd that the gallbladder metastasis was occured through the lymphatic route from the gastric cancer.
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  • Noritaka Maniwa, Seiji Marubayashi, Hiroshi Yahata, Yasuhiko Fukuda, T ...
    1990 Volume 23 Issue 3 Pages 777-781
    Published: 1990
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    A spontaneous hepatic encephalopathy due to a rare giant porto-systemic shunt was successfully treated by resection of the shunt. The patient was a 55 year-old male with liver cirrhosis and splenomegaly. Laboratory data were total bilirubin 2.6mg/dl, ICGR1544.5%, white blood cells 1800 and platelets 62000. A shunt vein with a diameter of 3.4 cm ran through the retro-peritoneal cavity from the superior mesenteric vein to the point just below the renal vein of the inferior vena cava. Shunt resection and splenectomy were performed. The portal pressure level was stable during the operation and the portal blood flow become hepato-fugal after the operation. White blood cells and platelets increased and the data on NH3, ICG, bile acid and endotoxin were improved after the operation. Portal thrombosis developed after the operation but anticoagulant therapy was effective. Peri-gastric devascularization was not performed but esophageal varix was not progressive. For the treatment of porto-systemic shunt resection is available but caution must be exercised for liver cirrhosis, esophageal varix and portal thrombosis.
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  • Hiroaki Nagano, Morito Monden, Koji Umeshita, Mitsukazu Gotoh, Masato ...
    1990 Volume 23 Issue 3 Pages 782-786
    Published: 1990
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    A 55-year-old man was admitted to Osaka University Hospital for hepatocellular carcinoma in January 19g6. Computed tomography (CT) one month after chemoembolization with lipiodol, adriamycin and gelfoam cube, revealed multiple nodules in the right lobe of the liver. Biopsy of the non-cancerous liver on laparoscopy revealed the presence of chronic inactive hepatitis. The results of liver function tests, such as ICG clearance and protein synthesis, showed moderate impairment. The volume of the right lobe, estimated by CT, was approximately 69.5g of the whole liver. Judging from ICG Rmax and other indexes, right lobectomy wascontraindicated at this time. Therefore, portal branch ligation was performed as the first-step operation in February 1986. Six weeks later, CT showed marked atrophy of the right lobe and compensatory hypertrophy of the left lobe, the right lobe accounting for 51.570 ofthe whole liver. Portal branch ligation had no deleterious effects on liver function, and right lobectomy was indicated. The patient underwent the second operation 47 days after portal branch ligation. At laparotomy, marked hypertrophy of the left lobe was confirmed. Intraoperative ultrasonography showed that there were no metastatic nodules in the left lobe, and right lobectomy was performed. The patient had an uneventful postoperative course and was discharged 68 days after the resection. He is now alive 3 years and 1 month after the resection with tumor recurrence in the residual liver and the right adrenal gland. Portal branch ligation followed by liver resection is considered to be useful therapeutic modality, when the volume of the resecting liver is too large for one-stage resection.
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  • Atsushi Kimura, Kenichi Takayasu, Tatsuya Yamada, Masatoshi Makuuchi, ...
    1990 Volume 23 Issue 3 Pages 787-790
    Published: 1990
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    Recent progress in diagnostic imaging such as ultrasonography, computed tomography and percutaneus transhepatic portography, allows better comprehension of the anatomy of the intrahepatic portal and venous systems. We report here a patient with an abnormal intrahepatic portal system; cul-de-sac-like dilatation of the right anterior portal vein coming off from the left portal vein, agenesis of the umbilical portion of the left portal vein and the development of a right hepatic round ligament. This entity most likely originates in abnormal development of the fetus. It is indispensable for hepatectomy to understand the intrahepatic portal system as seen in diagnostic modalities.
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  • Yoshimi Kitagawa, Masatoshi Akita, Hiroshi Hasegawa, Akihiko Ohta, Hid ...
    1990 Volume 23 Issue 3 Pages 791-795
    Published: 1990
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    We recently encountered a case of gallbladder carcinoma with a cholecystoduodenal fistula and a cholecystocolic fistula. A 68-year-old woman was admitted to our hospital with the chief complaint of right hypochondralgia and fever. Abdominal ultrasonography and abdominal CT scan showed a mass, 7× 8 cm, in size, at the right hypochondral lesion, and hypotonic duodenography revealed internal fistulas between the gallbladder and duodenum and between the gallbladder and colon. Resection of segments 4a, 5 and 6 of the liver, and pancreaticoduodenectomy with right hemicolectomy were performed, and examination of the excised specimen revealed a cholecystoduodenal fistula and a cholecystocolic fistula. Histologic diagnosis was adenosquamous cell carcinoma. The prognosis of advanced gallbladder carcinoma is very poor, but in this case lymphnode metastasis is negative and good prognosis can be expected, so we think the treatment of advanced cases such as this one should be extended surgery.
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  • Senji Kanno, Takayuki Sudo, Ryoko Sasaki, Yoshiyuki Tamasawa, Hidehiro ...
    1990 Volume 23 Issue 3 Pages 796-800
    Published: 1990
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    This is a report of two cases of solid and cystic tumor of pancreas. Both tumors occurred in young women (each 12 years) who presented with an abdominal mass. The patients in the second case presented with jaundice and general itching four months ago. Both tumors were large (8.1×8.0 cm, 75 g; 7.5×6.5 cm, 180 g), one requiring a 70% distal pancreatectomy and the other a pancreatoduodenectomy. Gross pathologic examination revealed apparent encapsulation, cystic degeneration and hemorrhagic necrosis. Microscopically, the tumors were charactrized by distinctive solid and cystic patterns. In the first case, immunocytochemical the staining (PAPmethod) for a1-antitrypsin was postive. Both patients presented here are alive and well after six and seven years postsurgery.
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  • Hideki Idei, Tomoaki Urakawa, Mitsuharu Nakamoto, Toshimasa Yamaguchi, ...
    1990 Volume 23 Issue 3 Pages 801-805
    Published: 1990
    Released on J-STAGE: August 23, 2011
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    We encountered three cases of necrosis and perforation of the intestinal wall due to abdominal angitis complicated with connective tissue disease. Case 1 was a 52-year-old male, case 2 was a 69-year-old female, and case 3 was a 46-year-old female. The underlying diseases were, respectively, periateritis nodosa, rheumatoid arthritis, and systemic lupus erythematosus. All cases had severe abdominal pain and the site of necrosis and perforation was ileum. The surgery performed was resection of the lesion and direct anastomosis. Colostomy of the transverse colon was also performed in case 1. In the small arteries of the resected intestinal segments, hypertrophy of the tunica intima, stenosis of the lumen and fresh thrombus were observed. Complete occulusion and recanalization were also noted in some areas. After surgery, cases 1 and 2 died within 12 days and 2 days, respectively in one case due to recurrence of the necrosis and perforation and in the other due to multiple organ failure. Case 3 has survived 7 months at the present. Necrosis and perforation of the digestive tract due to abdominal angitis complicatd with connective tissue disease apperas as one of the symptoms of systemic angitis. Therefore, determination of the range of resection of the gastrointestinal tract is important at operation. In addition, careful systemic therapy after operation by the use of intravenous hyperalimentation, steroids, and antibiotics is important.
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  • Satoru Nishimura, Satoru Matsusue, Shunzo Koizumi, Sadao Kashihara
    1990 Volume 23 Issue 3 Pages 806-809
    Published: 1990
    Released on J-STAGE: August 23, 2011
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    A case of ischemic stenosis of the small intestine was successfully managed. A 61-yera-old male developed abdominal pain, vomiting and diarrea after an aortobifemoral bypass for Leriche yndrome. He was diagnosed by computerized tomography as having an intrabdominal abscess, and was transferred o our department for drainage. Although he underwent a drainage procedure, his complaints remained the same. Besides, mechanical obstruction of the small intestine supervened. He was maintained on intravenous hyperalimentation, and examined further. Abdominal angiography revealed stenosis of the superior mesenteric artery, and he was thought to have mechanical obstruction due to an ischemic process. He underwent a laparotomy, which disclosed segmental stenosis of the small intestine associated with an atrophic mesenterium limited to the stenotic segment. Resection of the stenotic small intestine and end-to-end anastomosis relieved his symptoms. Histological examination revealed fibrous granulation throughout the wall of the small intestine and obliterating endarteritis of the mesenteric artery. It is thought that timely diagnosis and therapeutic intervention with adequate nutritional support are essential for optimal care of this disease.
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  • Takashi Funato, Masayoshi Ichihashi, Hiroshi Inui, Makoto Tarao, Akihi ...
    1990 Volume 23 Issue 3 Pages 810-814
    Published: 1990
    Released on J-STAGE: August 23, 2011
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    Obturator hernias are comparatively rare and the mortality rate is high. However, with the spread of the concept of this disease and recent improvement in the preoperative diagnostic rate, the feasibility of a noninvasive hernia reposition operations will come into question in the future. This paper presents a case of obturator hernia successfully treated by non-invasive reduction and describes its indications together with some literature revies. The patient was an 84-year-old woman. She presented at our Emergency Outpatient Clinic with sudden stomachache and right femoral pain. Vaginal examination and computed tomography of the pelvis on suspition of obturator hernia reverled a mass at the region of the right obturator foramen. Transvaginal reduction under the definitive diagnosis of this disease resulted in dramatic improvement of the symptom, and the foramen became palpable. Subsequent elected operation for the sake of precaution disclosed neither circulatory disturbance in the samll intestine nor responsible lesion except at the region of the foramen. The operation was ended by closure of the formen, without enterectomy.
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  • Katsushi Yada, Kousuke Hayashi, Toshihiko Aki, Junichi Takahashi, Tets ...
    1990 Volume 23 Issue 3 Pages 815-819
    Published: 1990
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    We experienced a case of 4 synchronous multiple carcinomas of the large intestine after resection of carcinomas of the uterine body and the ovary. A 27-year-old female was admitted to our hospital complaining of melena and constipation. She had a past history of bilateral oophorectomy and hysterectomy with lymph node dissection at age 20. Barium enema examination revealed ascending colon and sigmoid colon carcinomas and rectal polyps. At the operation, two polyps were found at the rectum and one of them was of doubtful malignancy. Therefore, we performed a right hemicolectomy, sigmoidectomy and amputation of the rectum with lymph node dissection. The histological findings of the cancers of the ascending colon and the sigmoid colon were well differentiated adenocarcinoma and mucinous carcinoma respectively and both of the rectal polyps were moderately differentiated adenocarcinoma. Although we could not clarify the hereditary background of her cancer, our case was thought to be very intersting because it has much in common with the cancer family syndrome.
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  • Eigo Otsuji, Toshio Takahashi, Toshiharu Yamaguchi
    1990 Volume 23 Issue 3 Pages 820
    Published: 1990
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
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