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Volume 23, Issue 5
Displaying 1-30 of 30 articles from this issue
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Yuji Tachimori, Hiroshi Watanabe, Hoichi Kato1990 Volume 23 Issue 5 Pages 1029-1035
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSOut of 297 patients who underwent esophagectomy for thoracic esophageal cancer, 19 (6%) developed postoperative pneumonia. In 15 patients, aspiration, including silent aspiration, was the cause of pneumonia, and 11 had recurrent laryngeal nerve paralysis. For preventing pneumonia after esophagectomy, intrabronchial suction by means of a fiberscope was routinely performed for postoperative care. A minitracheostomy tube was inserted through the cricothyroid membrane in 13 patients for intrabronchial suction. Only one of the 10 patients in whom the tube was inserted within 14 days after esophagectomy developed pneumonia. Recently, injection for vocal fold paralysis by means of a flexible fiberscope was newly developed and performed in 16 patients. In 5 patients, it was performed within 7 days after esophagectomy. Intrabronchial suction by means of a fiberscope, minitracheostomy tube through the cricothyroid membrane and injection for vocal fold paralysis by means of a flexible fiberscope were useful for the prevention of postoperative pneuminia after esophagectomy.View full abstractDownload PDF (12569K) -
Hiromi Tanemura, Shigetoyo Saji, Sengai Tanaka, Takao Ito, Hiroo Oshit ...1990 Volume 23 Issue 5 Pages 1036-1043
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSDuring the last 12 years 1, 651 gastric cancer patients received operative treatment, and in 127 of them with synchronous liver metastases the effects of gastrectomy with and without hepatectomy or postoperative chemotherapy were defermined. In the patients with liver metastasis located in one lobe (H1) and having equivalent background factors, the survival rate for the gastrectomy + hepatectomy group (13 patients) was better than that for the gastrectomy alone group (8 patients). Three patients in the gastrectomy + hepatectomy group are still alive after more than three years, and the longest survival is over 4 years and 7 months after the operation. The results suggest that gastrectomy alone (reduction surgery) for patients with liver metastasis and numerous scattered peritoneal metastases (P2, P3) is not recommendable. Systemic chemotherapy or intra-arterial chemotherapy for the liver metastasis was effective in the group treated by reduction surgery, while it was ineffective in the groupView full abstractDownload PDF (14980K) -
Yuji Yamamoto, Tomishige Amano, Toshio Imada, Makaoto Akaike, Satoshi ...1990 Volume 23 Issue 5 Pages 1044-1050
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSNuclear DNA histograms of 21 gastric cancers with synchronous or metachronous liver metastasis were analyzed to investigate the characteristics of gastric cancer with liver metastasis. All of the gastric cnacers with synchronous liver metastasis were aneuploid and 75% of those with metachronous liver metastasis were also aneuploid. The mean heterogeneity index score (HIS) of the cancers was 78.62±36.21, a higher value than that of normal tissue (p<0.01). The mean HIS of cancers with vascular invasion was higher than that of those without vascular invasion (p<0.01), but there was no correlation between a high HIS and liver metastasis. Microscopic examination revealed that the incidence of the medullary or intermediate type of carcinoma was more frequent in patients with liver metastasis. It is suggested that high HIS gastric cancer can be a risk factor of liver metastasis because of its high incidence of vascular invasion, and that the amount of interstitial connective tissue can be also connected with liver metastasis.View full abstractDownload PDF (12050K) -
Eisuke Adachi, Takashi Matsumata, Ichiro Yoshino, Masaaki Sakaguchi, T ...1990 Volume 23 Issue 5 Pages 1051-1055
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSReal blood loss during hepatic resection was evaluated in 17 patients by the following equation: Real blood loss during surgery= (hematocrict value of blood taken by suction during surgery/hematocrit value in the preoperative blood examination) ×estimated blood loss during surgery. Eleven of the 17 patients had associated liver cirrhosis. Mean duration of the operation and weight of the resected liver were 290 minutes and 357g, respectively. The mean estimated blood loss during surgery was 1480 ml, and the mean hematocrit value of the blood suctioned during surgery was 23% (14-28%), which was 60% of that of the preoperative blood specimens. We concluded that the real blood loss during hepatic resection was about 60% of the estimated blood loss. Two units of red blood cells per patients were given perioperatively, and five of the 17 patients received no blood transfusion. No plasma transfusion was required in any patients. Neither liver failure nor disseminated intravascular coagulation was encountered in these patients, and the postoperative clinical course was uneventful. To date, none of the patients have post-transfusion hepatitis.View full abstractDownload PDF (8464K) -
Takumi Hanai, Jiro Yura, Moritsugu Tanaka, Takashi Hashimoto, Keiichi ...1990 Volume 23 Issue 5 Pages 1056-1061
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSCefuzonam (CZON) was administered to 11 patients with hepatectomy who had a high risk of complication by abdominal infection, and its intracorporeal kinetics was investigated. Five of the patients had hepatic cirrhosi and six cases did not. After intravenous injection of 1 g of CZON the concentrations of CZON in the blood on urine and ascites on 1., 2, and 3. POD were investigated. The concentrations were measured by bioassay. CZON concentrations in the blood on 1. POD in the hepatic cirrhosis group and the non-hepatic cirrhosis group showed peak values at 1 hour of mean 37.1 and 30.2μg/ml respectively. The concentrations in urine at 2 hours on each postoperative day, excluding 3. POD of the hepatic cirrhosis group, gave the highest mean concentrations from 1, 980 to 3, 825μg/ml in both groups, indicating delayed excretion. The concentration in ascitic fluid showed a peak value of 21.9μg/ml only in the 2 hour-value on 1. POD in the hepatic cirrhosis group, without much change in the other time periods. Eight-hour values on 1., 2. and 3. POD in both groups gave higher mean values, from 6.3 to 12.5 μg/ml. In the prophylactic administration of CZON at 3 g/day this drug migrates in a higher concentration into the xascitic fluid and seems to be valuable as a prophylactic against abdominal infection.View full abstractDownload PDF (10732K) -
Kazuo Watanabe, Takehide Asano, Munemasa Ryu, Kaoru Sakamoto, Yoshihir ...1990 Volume 23 Issue 5 Pages 1062-1070
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIntraareterial infusion immunotherapy using Nocardia rubra cell wall skeleton-Lipiodol mixture (N-cws/Lip) was attempted in 24 patients with hepatocellular carcinoma and its safety and therapeutic efficacy were evaluated. 1) Frequent fever, vomiting and temporary hypotension developed, but because arterial ischemia was avoided, no gastroduodenal ulcer, cholecystitis, or liver dysfunction was associated with this therapy. 2) With a possible aid of host-mediated, activated immunity, the treatment decreased the AFP, decreased the size of the tumor on diagnostic imaging, and induced topical infiltration of lymphocytes and formation of granulation tissue with necrosis of the primary tumor, and necrosis of tumor emboli in the portal veins was induced. 3) The lymphocyte subpopulation in the peripheral blood of the patients after therapy consisted of a decreased Ts, and an elevated Th/Ts ratio as seen in the immunoactivated status. This immunotherapy is safe and it was suggested that activation of immunity working against tumor growth was involved in the mechanism of this immunotherapy.View full abstractDownload PDF (18314K) -
Tohru Segawa, Kunihide Izawa, Teiji Matsumoto, Kazuhide Ura, Toshifumi ...1990 Volume 23 Issue 5 Pages 1071-1077
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSRecords of 108 patients with hepatocellular carcinoma treated by hepatic resection in our department from January 1970 to December 1988 were reviewed. Various clinical and pathological factors of the cases were evaluated by analysis of the cumulative survival rates to clarify the prognostic factors after hepatic resection. One-, 3-and 5-year cumulative survival rates in this series were 67, 30 and 27 per cent respectively. Factors affecting the outcome of the patients were clinical stage classification, macroscopic stage classification, tumor size, histological intrahepatic metastasis and histological portal vein involvement. A better outcome was revealed in the patients with the factors of clinical stage classification I, macroscopic stage classification I, tumor size less than 5 cm, no histological intrahepatic metastasis and no portal vein involvement in the resected specimen. However, factors such as sex, hepatitis B-antigen, serum AFP levels before the treatment, macroscopic tumor invasion to the resected cut stump, histological tumor invasion to the tumor capsule and preoperative transcatheter arterial embolization did not influence the outcome.View full abstractDownload PDF (13007K) -
A Nationwide Survey Based on the Questionaire to the 133 InstitutesYoshio Tajima, Mikio Tezuka, Tsutomu Yaoita, Atsushi Kadowaki, Hiroaki ...1990 Volume 23 Issue 5 Pages 1078-1085
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIn the 17th Congress of Japanese Society of Biliary Surgery, we reported a nationwide survey of postgastrectomy cholelithiasis, which has recently been attracting attention as one of the complications of gastrectomy. A total of 3, 179 cases of postgastrectomy cholelithiasis were reported including 2, 479 operated cases. We speculate that there might be many cases of asymptomatic cholelithiasis, juding from the fact that follow-up or conservatively treated cases were frequent. Gastrectomy was carried out for gastric cancer in the most cases. As for reconstruction, Billroth-1 and Billroth-2 type anastomoses were commonly performed. Pigment gallstones including calcium bilirubinate gallstones and blackstones were the most frequent as shown by macroscopic classification of the gallstones. The frequency of choledocholithiasis or intrahepatic lithiasis was high. Bacteria were frequencly detected in the bile of operated cases. The decreased gallbladder contractility, cholestasis and vagotomy were mainly considered attributable to the pathogenesis of postgastrectomy cholelithiasis.View full abstractDownload PDF (16780K) -
Ikuo Oikawa, Koichi Hirata, Hiroshi Hayasaka1990 Volume 23 Issue 5 Pages 1086-1093
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe studied the effect of single and combined administration of caerulein, hydrocortisone and FOY-305 on the regeneration of the remnant pancreas after 90% pancreatectomy in rats. After a sham operation or a 90% pancreatectomy, rats were given with the three agents either singly or in combination. After the rats were killed, the pancreas was weighed and examined for tissue amylase activity, tissue protein content and total DNA content. The results were as follows: 1) In the sham operation group, caerulein produced a significant trophic effect and the trophic effect in the combined administration group was greater than that in the single administration group. 2) In the 90% pancreatectomized group, hydrocortisone produced significant trophic effect and the trophic effect in the combined administration group was greater than that in the single administration group. These data show that the effect of the combined administration of caerulein, hydrocortisone and FOY-305 on the growth of the pancreas was greater than that of the drugs given singly.View full abstractDownload PDF (15853K) -
Rapid Radioimmunoassay of GastrinYasuaki Hattori, Masayuki Imamura, Takayoshi Tobe1990 Volume 23 Issue 5 Pages 1094-1101
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe have developed a rapid assay of gastrin by which immunoreactive gastrin (IRG) can be measured within 1.5 hours by changing the incubation condition of anti-gastrin antibody. The sensitivity of this method was 20 pg/ml, and the precision was satisfactory; 4.8±2.4% in the intraassay coefficient of variation, 3.8±1.0% in th interassay coefficient of variation. The results of the rapid assay were correlated with the conventional method: the regression equation was y=-26.97+1.052x, and correlation coefficient was 0.994. This rapid gastrin assay was used in the Intraoperative Secretin test (IOS test) for three patients with Zollinger-Ellison syndrome. The curability of resection for gastrinoma (s) in these patients could be confirmed intraoperatively with the IOS test. The rapid IRG assay system was sensitive enough to use in the I0S test at high levels of IRG concentration, but its sensitivity needed to be improved when the IRG concentration was lower.View full abstractDownload PDF (16255K) -
Yozo Watanabe, Hidenori Tsumura, Toshiyuki Nakagawa, Hideki Sakurai, H ...1990 Volume 23 Issue 5 Pages 1102-1108
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSPancreatoduodenectomy with total stomach preservation and selective proximal vagotomy (SPV) were performed in 2 patients with chronic pancreatitis, 3 patients with malignant tumors and 2 patients with benign tumors. The range of doudenal resection extended from the level 1 cm proximal to the pyloric ring and covered 80 to 90% of the duodenum. SPV was generally performed in the conventional manner, but since this blocks the blood supply to the lesser curvature in the upper portion of the stomach, the right gastric artery was preserved and the right gastroepiploic artery was ligated at the root. Reconstruction was performed in accordance with a modification of Child's method in 6 cases and Imanaga's method in 1 case. As compared to pancreatoduodenectomy with preservation of the duodenal bulb, the present procedure is of wider applicability for malignant tumors, and lymph node dissection up through the scond group was possible. The postoperative time elapsed before removal of the stomach dtube averaged 4.6 days, and no gastric emptying impairment was observed during the eraly postoperative period. the quantity of food ingested after surgery was large, and recovery of body weight was favorable. As regards postoperative gastric acid secretion, both the basal acid output and maximal acid output were markedly decreased.View full abstractDownload PDF (14591K) -
Yoshinao Kotoura, Yoshio Ishikawa, Hiroshi Ashida, Naoki Hashimoto, To ...1990 Volume 23 Issue 5 Pages 1109-1115
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTo evaluate the preoperative diagnosis for the extension of the carcinoma of the papilla of Vater, we retrospectively compared 27 patients with this disease regarding the stage classification, prognostic factors, preoperative major symptoms, macroscopic appearance of the tumor, direct cholangiogrmas and hypotonic duodenograms.(1) Among the major symptoms, fever and abdominal pain were not distinctive between the stage. But the occurrence of jaundice and bilirubin level of 10 mg/dl appeared to be boundaries distinguishing stages I and II from stage III and IV.(2) Although many cases of protruding type were judged by macroscopic examination to be stage I or II, it seemed to be impossible to judge exactly the development of the disease by this method.(3) Neither direct cholangiograms of the distal bile duct nor hypotonic duodenograms was effective enough to make distinctive estimations. But in 22 of 27 cases (81%) simultaneous analysis of these two enabled us to estimate and classify distinctively between stages I and II and stages III and IV, and this was considered to be useful in selecting the operative method for the carcinoma of the papilla of Vater.View full abstractDownload PDF (12651K) -
Makoto Ikenaga, Yukihiko Oshima, Masao Shimizu, Norio Goto, Tatsuhiko ...1990 Volume 23 Issue 5 Pages 1116-1120
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe reviewed in 21 cases of colonic perforation experienced, sites of perforation, its causes, the clinical signs, time and types of the operations performed and their postoperative courses. 21 cases (21.6%) out of the 97 cases of perforation of the alimentary tract excluding cases of appendicitis were those of colonic perforation, and 12.1% of the 173 cases of operation performed of the colon were those of colonic perforation. Though it was not always easy to make diagnoses of perforation of he colon definitely because of the low 33.3% recognition rate for free air in the peritoneal cavity, we were able to operate on 11 cases (52.4%) as early as 6 hours after onset of the disease and to save all the cases. We studied 8 cases of perforated carcinoma of the colon (6.1% of all operated cases of cancer of the colon) and applied curative dissection in all 8 cases. The 5-year survival rate (Kaplan-Meier method) in the perforated cases was not significantly different from that in the non-perforated cses. so even in perforated cases of cancer of the colon, active curative treatment should be performed.View full abstractDownload PDF (9672K) -
Takashi Kodama, Mitsuaki Okita, Yoshio Takesue, Mikio Fujimoto, Hitosh ...1990 Volume 23 Issue 5 Pages 1121-1129
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTo study the influence of surgical defense system, granulocyte function (Luminol dependent chemiluminescence, elastase release) and plasma levels of the acute phase proteins were measured. Blood samples were obtained continuously before and after surgery from 93 patients with gall-stones, cancer of the stomach or cancer of the colon and rectum. Immediately after the operation, granulocyte function was increased but plasma levels of the acute phase proteins were decreased. The increase in the granulocyte function and the drop in the plasma levels of the acute phase proteins in the patients with cancer of the colon and recutm or stomach were more severe than those in the patients with gallstones. Furthermore, these values returned to the preoperative levels much earlier in the latter group. These changes almost paralleled the degree of the surgical aggresion. It was therefore suspected that the changes caused by surgical aggression might easily lead to tissue damage by the granulocytes. Considering that postoperative infection occurs in these immunocompromised states, it is necessary to deal carefully with such infections.View full abstractDownload PDF (17104K) -
Masaaki Yokota, Shuhei Iida, Nobuyuki Toshima, Ichiro Uyama, Masazumi ...1990 Volume 23 Issue 5 Pages 1130-1134
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSCongenital esophago-bronchial fistula in the adult is extremely rare and its accurate diagnosis is difficult. Recently we treated a patient who provided significant information concerning the occurrence, pathogenesis, and explanation for the functional closure and late diagnosis of this anomaly. The patient was a 68-year-old man, who had two diverticula on the right wall of the mid-esophagus. A tiny fistula originating in the distal diverticulum had gradually developed during four years to a thicker one which directly communicated with the right B7 segmental bronchus. Another thick chord, which had not been detected by X-ray examination, was present between theproximal diverticulum and the right lower lobe of the lung. Repair was carried out by fistulectomy with an uneventful recovery. According to the criteria proposed by Brunner and Karasawa, the disease in this case was assumed to be of congenital origin. Several aquired factors, such as reduced tissue elasticity with aging, heavy smoking and ingestion of alcohol, and frequent aspirations into the lung, will accelerate the force which enlarges the inside wall of the narrow duct.View full abstractDownload PDF (11252K) -
Akihiko Nakagawa, Yoshifumi Hiramatsu, Yoshifumi Kojima, Toshiaki Sana ...1990 Volume 23 Issue 5 Pages 1135-1138
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSSkin disease associated with a visceral malignant tumor is known as syndrome dermato-tumorale or paraneoplastic dermatosis. Various skin diseases in this category such as paraneoplastic dermatoses have been reported, although the etiology is not known. The skin changes characteristically develop in synchrony with or around the time of appearance of the malignant tumor. The 69-year-old woman reported here revealed the abovecharacteristics. Her skin disease was prurigo chronica multiforme and it was accompanied by advanced esophageal cancer. Prurigo chronica multiforme developed rapidly in her limbs and body concominant with the progress of dysphagia, and faded gradually after esophagectomy. This is the first report of prurigo chronica multiforme as a paraneoplastic dermatosis associated with esophageal cancer in Japan.View full abstractDownload PDF (7062K) -
Akira Yamamoto, Masaki Fujimura, Masamitsu Hirano, Shinichi Ooshima, I ...1990 Volume 23 Issue 5 Pages 1139-1143
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTwo cases of emphysematous gastritis are reported here. Case 1: The patient was a 46-year-old man who ingested nitrate (60%, 150 ml) in suicide attempt. On the 17th day of hospitalization, emergency surgery was performed for perforated peritonitis with shock and intraperitoneal bleeding. The lower esophageal region and the whole stomach were necrotic. Bubble-and streak-like collections of gas appeared at the 6th hospitalized day in the gastric wall on plain abdominal X-ray film. Case 2: The patient was a 72-old woman who was pancreaticoduodenectomized for duodenal papilla cancer. Hematemesis and bleeding from pancreatico-jejunal anastomosis appeared at the 18th post operative day (P.O.D.). Necrosis of the residual stomach and pancreas and intra-splenic gas appeared on abdominal computed tomography at the 25th P.O.D. Then, emergency laparotomy was performed. Plain X-ray on the 21st P.O.D. showed gas shadows on the intragastric wall indicating bubbly and frothy gas mixed with ingesta. The gas was due to infection of the necrotic tissues caused by disturbnce of circulation and corrosion. In our cases, the gas shadows on plain X-ray film appeared before the clinical signs and the symptoms of gastric necrosis and perforation. So in this disease early diagnosis may be possible by plain X-ray film, and serious illness may be avoided.View full abstractDownload PDF (10257K) -
Taichiro Sato, Shigehiko Shichino, Yukihiko Akita, Takeo Kawamura, Shi ...1990 Volume 23 Issue 5 Pages 1144-1148
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSMetastatic tumors in the spinal epidural space are not an infrequent finding, and metastasis from gastric cancer is especially rare. A 58-year-old man, in September 1988, complaining of indefinite lumbago, pain in the right femoral region and slight dysuria. Ordinary radiographs of spine showed spondylitis ankylopoetica. A myelogram revealed no block in lumbar region. In January 1989, the persistent pain was followed by progressive leg weakness. A myelogram showed a complete block at L-3, and a metastatic spinal epidural tumor was suspected. Early gastric cancer was discovered, however, and laminectomy was performed for the rapid progressive diplegia of legs. He lived for five months postoperatively. Four cases of metastatic spinal epidural tumor from gastric cancer was have been reported in Japan. The primary gastric cancers have not been able to be detected preoperatively and definite treatment for the primary tumor has never been performed.View full abstractDownload PDF (9817K) -
Takashi Hashimoto, Juro Yura, Yasunobu Shimizu, Tatsuya Suzuki, Masaka ...1990 Volume 23 Issue 5 Pages 1149-1153
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe subtotal duodenectomy was performed in a patient with hemophilia because of.a massive and serious submucosal duodenal hematoma. The patient was a 15-year-old boy who was admitted to our hospital 18 hours after being kicked in the abdomen. The duodenectomy was performed with saving of the pyloric ring and the papilla. The reconstruction was performed without changing of anatomical situation; The duodenal bulbus was anastmosed to the jejunum which was placed in the post-duodenectomized space. The papilla was anastomosed to the jejunum as a patch. The postoperative gastrointestinal fluoroscopy was revealed a good pyloric function. However, cimetidine 200 mg/day was necessary to prevent duodenal anastmosal bleeding until the suture thread was removed by duodenal endscopy. The cause of anastomosal bleeding was considered as a result of hemophilia and for the duodenectomy was considered to be useful for any other benign duodenal diseases.View full abstractDownload PDF (8932K) -
Tomohiro Takeda, Satoshi Tanaka, Shinya Yamamoto, Takashi Maeba1990 Volume 23 Issue 5 Pages 1154-1158
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 77-year-old women was admitted with right quadrant pain. Four days after the onset, an operation was performed under a diagnosis of acute cholecystitis. Laparatomy disclosed a perforation of the duodenal at the middle aspect of the descending portion and abscess formation posteiror to the head of pancreas, accompanied by biliary phregmon of the adjacent stractures. Becouse of severe inflammatory change of the duodenal wall surrounding the perforation, primary closure was not attempted, but distal gastrectomy was performede in the Billroth II fashion; a drainage tube was placed in the abcess, and an additionlly T-tube was placed in the common bile duct for billiary drainage. The postoperative course was umcomplicated and the patient was cured and discharged. Retrospective inspection of the gastroduodenal roentgenogram, examined by a physician two months prior to the present illnes, revealed a diverticulum at the descending portion of duodenum, and this made us cofident that its perforation had caused the disease. A preoperative X-ray study show a low density area behind the head of the pancreas and gas accumlation in the retroperitonial space, observed on CT scan and film respectively. These findings were highly indicative of duodenal perforation.View full abstractDownload PDF (9288K) -
Naoto Kawakita, Tomoaki Urakawa, Mitsuharu Nakamoto, Toshimasa Yamaguc ...1990 Volume 23 Issue 5 Pages 1159-1163
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe have had seven cases of acute mesenteric arterial occlusive disease at our department and have evaluated the clinical features and the prognostic factors of this disease. The mean age was 68.3 years and all the cases were complicated with cardiovascular and other disorders. Acidosis was observed in five cases (71.4%) and leukocytosis in four cases (57.1%). All the patients underwent massive resection of small intestine. Four of these (57.1%) died shortly thereafter. The mean age at death was 75.8 years. It was 78 hours on an average between the onset of the disease and the surgery. This interval tended to be longer than it was in survivors, namely 16 hours. Whereas 75.0% of the patients with leukocytosis count died, only 33.3% of the cases with normal leukocyte count. Of the four dead patients, three died as a result of incomplete suture or perforated gastrointestinal tract, probably associated with pre-operative impaired blood circulation. To improve the prognosis of acute mesenteric arterial occlusive disease, it is important to agressively resect the intestinal tract to avoid postoperative necrosis. Furthermore, it seems essential prior to such surgical procedure, to diagnose this disease early by using angiography and so forth.View full abstractDownload PDF (9409K) -
Takumi Ochiai, Noburu Sakakibara, Noboru Azuma, Hiroyuki Nakagawa1990 Volume 23 Issue 5 Pages 1164-1167
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThere are many variations in the biliary system, and one of these is an accessory hepatic duct. A case of a comparatively rare accessory hepatic duct was experienced, and is reported. The patient was a 38 year-old woman who was administered an analagesic at another hospital for right hypochondralgia on January 2, 1989. However, the pain reappeared in the same place on January 6 and she was admitted to the authors' department as an emergency patient. On an abdominal ultrasonogrm, many strong echoes were observed in the gall bladder, and choleithiasis was diagnosed. By endoscopic retrograde cholangiopancreatography a cystic duct opening into an accessory hepatic duct was found. Cholecystectomy from the cystic fundus was performed. After it was confirmed by operative cholangiography that there was no damage to the accessory heptic duct, choledochotomy was performed. This accessory hepatic duct was a comparatively rare case of type II according to the classification of Miyakawa.View full abstractDownload PDF (7878K) -
to Tumor E mbolus in the Hepatic Vein of Hepatocellular CarcinomaYasuo Miyoshi, Yo Sasaki, Shingi Imaoka, Takashi Shibata, Tadashi Yasu ...1990 Volume 23 Issue 5 Pages 1168-1172
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTo two cases of hepatocellular carcinoma with tumor emboli in the hepatic vein, we performed hepatectomy after Lipiodol transcatheter arterial chemo-embolization (LPD-TAE). We estimated the histological effect of LPDTAE on these tumor emboli in the hepatic vein. The conclusion was as follows: in case 1, the tumor embolus in the right hepatic vein was completely necrosed. Daughter nodules were diagnosed histologically as solid type Edmondson grade II hepatocellular carcinoma. The angiographic appearance showed no “thread and streaks” sign in this embolus. In case 2, the effect was only partial necrosis of the tumor embolus in the right hepatic vein. Histologically, sinusoidal type Edmondson grade III hepatocellular carcinoma was found in the tumor embolus and daughter nodules. Angiographically, the “thread and streaks” sign was clearly recognized in this embolus. Then, like these cases, the existence of the angiographic “thread and streaks” sign might lead to poor effect of LPD-TAE to tumor embolus in the hepatic vein of hepatocellular carcinoma.View full abstractDownload PDF (11303K) -
Hiroki Akamatsu, Kuniya Nakajima, Yasuo Matsuda, Masahiro Fujikawa, Sy ...1990 Volume 23 Issue 5 Pages 1173-1177
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSSpontaneous internal biliary fistula is rare, its incidence being reported as 1 to 5 per cent of biliary system operations. A case of choledochoduodenal fistula is presented. The patient was a 54-year-old woman who was admitted complaining of upper abdominal pain and fever. The fistula was diagnosed preoperatively by means of an upper GI contrast series and endoscopic retrograde cholangiopancreaticography (ERCP). At the operation, cholecystectomy, division of the fistula and T-tube drainage were performed. She had mild liver dysfunction postoperatively but recovered soon. She was discharged 2 months after the operation. In addition to our case, 95 cases of choledochoduodenal fistula reported in the 10-year period from 1979 to 1988 were reviewed. There were no specific clinical symptoms. Abdominal pain, fever and jaundice were the most common. ERCP was the most useful diagnostic method, and its prevalence is thought to result in an increase in reports of this disease, especially parapapillary fistula.View full abstractDownload PDF (8004K) -
Yoji Shiogai, Koichi Matsuda, Hajime Abe, Masashi Kodama1990 Volume 23 Issue 5 Pages 1178-1181
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSBoth acute obstructive suppurative cholangitis (AOSC) and non-ketotic hyperosmolar coma (NKHC) are fatal diseases if they are left untreated. A 63-year-old male patient with a previous history of non-insulin-dependent diabetes was successfully treated with hypotonic saline infusion and intravenous administration of insulin for NKHC which occurred on the 4th postoperative day after an operation for treatment of AOSC due to choledocholithiasis. The patient recovered completely by the 7th postoperative day. In this case the contrubuting causes of NKHC were a past history of non-insulin-dependent diabetes, severe infectious biliary disease, emergency surgery, total parenteral nutrition, hepatopathy, senility of the patient, etc. In general, NKHC is well treated with massive infusion of hypotonic saline solution and appropriate administration of insulin. NKHC is a disease usually treated by a physisian but in surgical patients the incidence of NKHC has been incresing because of the wider use of total parenteral nutrition and increasing numbers of diabetic patients. Therefore, surgeons also should be familiar with rapid and correct diagnosis and treatment of NKHC.View full abstractDownload PDF (8977K) -
Toshiomi Kusano, Masato Furukawa, Toshinori Nakata, Yiqin Lin, Kazunor ...1990 Volume 23 Issue 5 Pages 1182-1185
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of multicentric pappilary cholangiocarcinoma resected mainly from the standpoint of how to detect tumor-free margin of the bile bucts. A 67-year-old man had complained of an upper abdominal pain with low grade fever. Direct cholangiography revealed many polypoid lesions mainly in the hepatic ducts after percutaneous biliary drainage. The preoperative diagnosis was biliary papillomatosis. Intraoperative ultrasonography was done. It revealed many isoechoic masses in the right intrahepatic bile ducts. The right hepatic duct and the common hepatic duct. No similar polypoid lesions were found in the left intrahepatic bile ducts. Therefore, extended right hepatic lobectomy with resection of the caudate lobe, the bile duct in the hepatoduodenal ligament, and regional lymphnode dissection were performed. Intraoperative cholangiofiberscopic examination of the hepatic bile duct also demonstrated no residual tumors. Left hepatico-jejunostomy (Roux-en-Y) was performed for biliary reconstraction. Macroscopic examination of the surgical specimen showed many pedunculated papillary polypoid tumors in the whole biliary tract. Histological examination showed papillary adenocarcinoma and lymphnode metastasis in the hepatoduodenal ligament. We emphasize that intraoperative ultrasonographic examination was to detect tumorfree surgical margine of the biliary tree and regional useful lymphnodes dissection for malignant papillomatosis.View full abstractDownload PDF (8496K) -
Hirotaka Iwase, Yasuyuki Kureyama, Masanobu Kiriyama, Yukashi Ito, Yos ...1990 Volume 23 Issue 5 Pages 1186-1190
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA rare case of pancreas cancer with osteoclast-like giant cells is reported. A 54-year-old man with epigastralgia and jandice was diagnosed by endoscopic retrograde cholangiopancreatography as having intra-and extrahepatic choleithiasis. Laparotomy revealed a hard tumor invading the hepatoumbilical ligamentum and neck of the gall bladder. The choledochus was packed with coagula. A cholecystectomy with drainage of the choledochus was carried out. The adenocarcinoma with osteoclast-like giant cells was diagnosed by a intraoperative histological examination of the invasive tumor portion. The patient died 1 month after the operation due to hepatic falire. A hen's egg-sized tumor was found in the head of the pancreas at autopsy. Generally, adenocarcinoma of the pancreas with osteoclastic giant cells been distinguished from the pleomorphic type. They have been reported to be highly locally invasive. The histogenesis of giant cells observed in this kind of tumor has been controversial. However, recent repots using electron microscopic or immunohistochemical investigations suggested an acinar cell origin of these giant cells rather than histiocytic cells, in spite of their osteoclast-like appearance.View full abstractDownload PDF (9122K) -
Norihiro Yuasa, Yuji Nimura, Naokazu Hayakawa, Junichi Kamiya, Shoji M ...1990 Volume 23 Issue 5 Pages 1191-1195
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA case of metastasis of rectal carcinoma to the pancreas is reported. The patient was a 57-year-old man. Metastatic tumors were revealed in the pancreas and the pelvic cavity by computed tomography 18 months after radical surgery for rectal carcinoma. However no metastases were found in the lung, liver, or bones. Endoscopic retrograde cholangiopancreatography revealed an obstruction of the main pancreatic duct at the head of the pancreas, and the condition was histologically diagnosed as pancreatic metastasis by duodenoscopic biopsy of the pancreatic duct. The patient underwent pancreatoduodenectomy with partial resection of the superior mesenteric vein. The surgical specimen revealed regional lymph-node metastases, a tumor thrombus in the superior mesenteric vein and intraductal growth of the tumor in the pancreatic duct. Unfortunately, the tumor in the pelvic cavity could not be resected bacause of severe intraabdominal adhesion. Therefore radiation therapy and intraarterial infusion chemotherapy were carried out. Nevertheless, this experience suggested the validity of aggressive surgery for locarized metastasis of the pancreas.View full abstractDownload PDF (10847K) -
Shin-ichi Yamasaki, Shigetoshi Morimoto, Masaru Tsuyuguchi, Nao-omi Ta ...1990 Volume 23 Issue 5 Pages 1196-1199
Published: 1990
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 62-year-old woman was admitted because of rectal prolapse. The colon was prolapsed through the anus about 10 cm and the leading point of the colon was a 4×4 cm hard tumor. The diagnosis was intussusception prolapsing through the anus with a tumor as the leading point. A low anterior resection was performed. The histological diagnosis was diffuse lymphoma; medium sized cell type according to the Lymphoma Study Group's classification.View full abstractDownload PDF (7544K) -
Tetsuya Hirano, Tadao Manabe, Takayoshi Tobe1990 Volume 23 Issue 5 Pages 1200
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSDownload PDF (1967K)
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