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Volume 23, Issue 9
Displaying 1-26 of 26 articles from this issue
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Ryuji Mizumoto1990 Volume 23 Issue 9 Pages 2175-2184
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSApproximately 20 years ago, using Child's criteria I pointed out that theindication for hepatic resection in cirrhotic patients was remarkably limited. In the present study, the preoperativeestimation of operative risk and the possibility of extending operative indications for heaptic surgery wereinvestigated, according to the clinical results for 469 patients with liver diseases who visited our clinic for about 13years. 1) Limitation in hepatectomy: The patients with a total risk of 4 calculated by various liver function tests or ICG Rmax of the remnant liver of 0.2-0.4 were at the limit of hepatectomy. Other factors influencing prognosisshould be considered, such as histological findings of active hepatitis and HBV infection, disturbances in thecoagulation-fibrinolysis system, poor nutritional status, hemodynamic changes in the liver during surgery and changes in cardiac, respiratory and renal functions. 2) Management of poor risk patients and surgical results: Recently, even the critically ill patients with severely impaired liver functions have been albe to undergo hepatic resection withthe extension of surgical indications, achieving a good long-term outcome with intensive care before andafter surgery, and introduction of the following management procedures: (1) partial splenic embolization for thepatients with severe functional disturbances in the coagulation-fibrinolysis system, (2) aggressive nutritionalsupport with BCAA administration, (3) maintenance of hepatic blood flow by infusion of PGE1, etc. Our experimentaltrials for extending the operative indications and extended hepatectomy are also described.View full abstractDownload PDF (21126K) -
Hiroyuki Deguchi, Yoshiki Tabuchi, Kizuku Imanishi, Yoichi Saitoh1990 Volume 23 Issue 9 Pages 2185-2190
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe relationship between the carcinoembryonic antigen (CEA) levels of draining venous blood (d-CEA) and the draining-peripheral (d-p) CEA gradient, and postoperative survival was examined in 39 patients with CEAproducing gastric cancer. The mean (17 ng/ml) and positive rate (39%) greater than5 ng/ml in 26 living patients were significantly lower than those (227 ng/ml and 77%) in 13 patients who died ofcancer recurrence within 3 years. The mean value (199 ng/ml) of the d-p CEA gradient in the living patients was also significantly lower than that (15 ng/ml) in the patients who died. The survival curve of 20 patients with positive d-CEA was significantly lower than that of 19 patients with negative d-CEA, and the 3-year survival rates were 45% in the former and 78% in the latter. The survival curve of 16 patients with a positive d-p CEA gradient greater than 5 ng/ml was also significantly lower than that of 23 patients with a negative gradient, and the 3-year survival rates were respectively 50% and 69%. These results suggest that d-CEA and the d-p CEA gradient may be usedas prognostic indicators in gastric cancer patients. And patients with positive d-CEA and d-p CEA gradients must be treated clinically as patients having poor prognosis.View full abstractDownload PDF (12851K) -
Mitsuru Sasako, Taira Kinoshita, Keiichi Maruyama, Kenzoh Okabayashi, ...1990 Volume 23 Issue 9 Pages 2191-2195
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSComplete local excision of early gastric cancers is expected to give as good results as radical surgery if we can determine the lesions having no lymph node metastases. 1440 cases of single early gastric cancer resected in National Cancer Center Hospital (NCCH) from 1962 to 1985 were analysed: Hb cancers of any size, IIc less than 2.1cm in diameter without ulcerative change, and Ha less than 2.1 cm in diameter had no lymph node metastases. Based on this data, a prospective trial of local excision was started in NCCH in April 1988. Considering errors for safety, Ha cancers less than 1.6 cm, gastritis type lesions less than 1.6 cm and focal cancers in adenoma were consiedered indications for local excision. Endoscopic local excision is prefered so far as it is possible. The resected specimens are to be examined histologically. If a lesion limited to the mucosal layer is resected completely and has no vessel involvement, the patient will be folowed up intensively. If the cut margin is involved by cancer in the mucosal layer, additional interventional wider local excision is made. In cases where submucosal invasion or vessel involvement is seen, radical gastrectomy is added. Eleven patients were eligible for this treatment system. Eight of them were treated successfully by local excision, and the rest underwent additional intervention. All patients are now disease free and are being followed up intensively. This treatment system enables us to perform local therapy as a curative treatment without reducing the possibility of a cure.View full abstractDownload PDF (10628K) -
Osamu Kimura, Kazuo Kurayoshi, Seiji Moriwaki, Masao Yonekawa, Michio ...1990 Volume 23 Issue 9 Pages 2196-2201
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe nuclear DNA content was microspectrophotometrically measured in 54 early gastric cancinomas, 13 with tumor recurrence and 41 without them, to determine if there is a predominance of a particular DNA ploidy pattern in early gastric cancer with tumor recurrence among cases with the same depth of invasion, macroscopic type, histological type and lymph node metastasis. DNA distribution patterns were grouped into low and high ploidies. The incidence of high ploidy was 54% in early gastric cancers with recurrence and tended to be higher than in the cases without recurrence. Recurrence of early gastric cancer has been reported to be frequent in patients with submucosal invasion, mixed type, differentiated adenocarcinoma and lymph node metastasis. The incidence of high ploidy was higher in eraly gastric cancers with tumor recurrence than in cases without them among cases of the same clinicopathological stages mentioned above. These findings suggest the clinical value of DNA analysis for prediction of tumor recurrence in patients with early gastric carcinoma. Patients with cancers with high ploidy should be treated with intensive therapeutic regimens directed against tumor recurrence, even if they have received curative resection of early gastric cancer. Furthermore, mucosal cancers with low ploidy should be treated by a limited operation.View full abstractDownload PDF (10662K) -
Hideo Tezuka, Hiroyoshi Suzuki, Youichi Kitamura, Tsuyoshi Sasagawa, S ...1990 Volume 23 Issue 9 Pages 2202-2208
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSDeaths from recurrence in 42 of 1662 patients with resected early gastric cancer were studied (recurrent rate, 2.5%).(1) The recurrent rate was higher for submucosal cancer than for mucosal cancer (3.9% and 1.3% respectively).(2) The recurrent type was most frequently hematogenous, mainly in the liver (43.8%), which was followed by the lymphatic type (28.1%).(3) As for the time of recurrence, 73.9% were within 5 years, in particular 60% of hematogenous recurrence appearing within 3 years, while others (26.1%), mainly local recurrence, appeared after 5 years.(4) Compared with patients with no recurrence, vascular invasion and lymph node metastasis had a notably higher rate in those with recurrence (41.7% and 38.9% respectively, significant at p<0.05).(5) The types of submucosal layer invasion were most frequently lymphatic (28.6%), then venous invasion followed by welldifferentiated tubular adenocarcinoma. We suspected there was a certain relationship between submucosal layer invasion and recurren type.(6) Lymph node resection higher than R2 reduced the recurrent rate from 3.3% to 2.2% compared with that of RO-1 except hematogenous recurrence.View full abstractDownload PDF (12580K) -
Shigeru Fujimoto, Ram Dhoj Shrestha, Masashi Kokubun, Kokuriki Kobayas ...1990 Volume 23 Issue 9 Pages 2209-2214
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIntraperitoneal hyperthermic perfusion (IPHP) combined with surgery was performed for 31 gastric cancer patients with peritoneal dissemination and/or serosal inasion. The clinical results of this IPHP treatment were compared with findings in 30 gastric cancer patients with much the same background factors who underwent surgery alone within the same period of time (control group). The survival rates for the IPHP group surpassed those for the control group at p=1.46 × 10-4. One-, two-, and three-year survival rates for the IPHP group were 81.9%, 52.1%, and 26.1%, respectively, whereas those for the control group were 40.3%, 11.8%, and 0%, respectively. Survival rates of 21 patients with peritoneal dissemination given IPHP were better than 9 patients not given IPHP, with p=2.37 × 10-5. The IPHP and control groups with serosal invasion included 10 and 21 patients, respectively, and the survival rates for the former was superior to that of the latter, with a significantly statistical difference at p=0.0153. The incidence of death due to peritoneal recurrence was 6.5% (2/31 patients) in the IPHP group and 63.3% (19/30 patients) in the control group, and the difference being significant at p=2.27 × 10-6. These results show that the combination of surgery and IPHP is efficacious for far-advanced gastric cancer with peritoneal dissemination and/or serosal invasion.View full abstractDownload PDF (10504K) -
Masatsugu Kitamura, Kuniyoshi Arai, Kaoru Miyashita, Goro Kosaki, Tazu ...1990 Volume 23 Issue 9 Pages 2215-2220
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTwenty seven patients with malignant lymphoma of the stomach treated at our surgical department weredi vided into two groups, a curative resection group (20 cases) and a non-curative resection group (7 cases). The result of their surgical treatment and the chemotherapeutic schedule for these types of malignancies were studied. Although the five-year survival rate for the curatie resection group was relatively favorable at 78. 4%, that of the non-curative resection group was poor at 35. 7%. In curative cases, the relationship between the presence or absence of lymph node involvement and the survival rate revealed no significant difference in the five-year survival rate. The five year survival rate for ten lymph node positive patients was 89. 5% and that for seven lymph node negative patients was 84. 6%, except that three patients died of other diseases. Two of the five patients with extensive invasion to surrounding organs (S3-cases) survived ten or more years after extensive resection. As in the patients with gastric cancer, these results show that a good result can be obtained through a curati ve resection with adequate lymph node dissection or through lymph node dissection combine with resection of the invaded organs. The optimal post-operative chemotherapy as one of the multidisciplinary therapies was also an important factor in improving the prognosis of gastric malignant lymphoma.View full abstractDownload PDF (11637K) -
Tokihiro Yoshikawa, Masatsugu Kitamura, Kuniyoshi Arai1990 Volume 23 Issue 9 Pages 2221-2226
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSEighty-seven cases of advanced gastric cancer diagnosed as early gastric cancer before surgery were studied to determine the indication of limited lymph node dissection for early gastric cancer. Most of the tumor of advanced gastric cancer diagnosed as early cancer were macroscopically depressed type and undifferentiated carcinoma histologically. About half of these cancers was diagnosed as advanced cancer only by histologi cal examination. But the outcome for the patients with these cancers was relatively good, similar to that for patients with early gastric cancer. Lymph node metastasis was rare in the patients with differentiated carcinoma diagno sed as mucosal cancer before surgery, even though the depth of the cancer invasion was proved to be beyond the submucosal layerh istologically. Limited lymph node dissection (R1-operation) for the patients with early gastri c cancer keeps up an operative radicality, even in the presence of advanced cancer diagnosed as early cancer, if that operation isi ndicated only for the patients with differetiated carcinoma diagnosed as mucosal cancer before surgery.View full abstractDownload PDF (10974K) -
Hisashi Matsumoto, Yutaka Yonemura, Kouichiro Tsugawa, Hironobu Kimura ...1990 Volume 23 Issue 9 Pages 2227-2231
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSRegional differences in DNA indices (DIs) in 57 advanced gastric carcinoma were analyzed and evaluated for heterogeneity from the aspect of DIs in the primary tumor and between primary and metastatic tumors by flow cytometry. Five or six samples were taken from different primary tumor sites. Intratumoral differences in DIs were observed in 36 of 57 cases (63%). In contrast with DIs of primary and liver metastatic tumors, the tumor cell population which had a high DI in the primary tumor had a tendency to be found in the metastatic lesion (70%). Therefore, heterogeneity of DIs, as revealed from the DNA ploidy pattern, must be considered for giving a prognosis and the decide on the treatment. Investigation of differences in DIs between primary and metastatic tumors may suggest the expectation of recurrence or the mechanism of metastasis.View full abstractDownload PDF (9155K) -
Tetsuaki Mizuta, Yukio Ishihara, Akira Saito, Kazuhiro Karikomi, Takeo ...1990 Volume 23 Issue 9 Pages 2232-2237
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe have studied the incidence and clinical significance of gallstones after gastrectomy in 110 patients with gastric cancer operated on between 1981 and 1986. A control group consisted of 33 patients with colo-rectal cancer operated on in the same period. Gallstones developed in 31% of all patients (34/110) during the 2. 5-year to 8. 5-year postgastrectomy follow-up and mostly within 4 years of gastrectomy. The majority of them were small and multiple and did not show an acoustic shadow on echograms of the gallbladder. Some of them dissolved spontaneously. The incidence of gallstones was 51% (20/39) after total gastrectomy, 20% (14/71) after subtotal gastrectomy and 9% (3/33) after resection of colo-rectal cancer. The incidence of gallstones was significantly higher after total gastrectomy than subtotal gastrectomy and colo-rectal resection. However, there was no statistical difference between subtotal gastrectomy and colo-rectal resection. Four patients developed symptoms and subsequently required biliary surgery. All of them received reconstruction by the Roux-Y technique after total gastrectomy. Cholelithiasis appears to be one of the major complications after total gastrectomy. It may be related mainly to the vagotomy performed at gastrectomy.View full abstractDownload PDF (12868K) -
Shoji Uetsuji, Manabu Yamamura, Yoshinori Okuda, Keigo Yamamichi, Osam ...1990 Volume 23 Issue 9 Pages 2238-2243
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe clinical evaluation of the point of junction of the cystic duct with the common hepatic duct by various cholangiographic procedures including an intraoperative one and by operative findings was performed in 428 surgical patents with biliary disease. A cystic duct inserted very low down with a correspondingly long cystic duct was found in 24 cases and the clinical significance of this abnormality was investigated by comparing these patients with 300 patients with cholelithiasis without low junction of the cystic duct. In the patients with low junction of the cystic duct to form a short common bile duct, several complications including gallstone pancreatitis (6 cases), Mirizzi syndrome (6), Confluence stone (2), gallbladder cancer (2), and congenital dilatation of the cystic duct (1) were found preoperatively. The anatomically anomalous junction of the cystic duct with the common bile duct may cause stagnation of bile and/or reflux of pancreatic juice into the bile duct and cause a condition similar to the anomalous arrangement of the choledocho-pancreatic ductal junction and also may result in difficulties at surgery.View full abstractDownload PDF (11183K) -
Masato Takamori1990 Volume 23 Issue 9 Pages 2244-2250
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe studied the protective effect of perfusion of allopurinol, an inhibitor of xanthine oxidase and suppresser of production of free radicals, on mucosal damage of the small intestine after ischemia and resumption of blood flow. Conclusions were drawn particularly from the changes in Na+-K+ ATPase actvity observed in the intestinal villi of the canine. Na+-K+ ATPase activity was significantly lower in the groups perfusedand treated with or without the superoxide production inhibitor than in the control group (p<0.05). In the group given the superoxide production inhibitor in conjunction with perfusion, the reduction in Na+-K+ ATPase activity was significantly suppressed (p<0.05). The results show that Na+-K+ ATPase activity in the small intestine declines as a result of mucosal damage after ischemia and resumption of blood flow. Furthermore, the decline is caused by the involvement of free radicals, and that the administration of allopurinol as a superoxide production inhibitor is effective in protecting the mucous membrane of the small intestine after ischemia and resumption of blood flow.View full abstractDownload PDF (14403K) -
Naoki Oda, Hiromi Sarashina, Norio Saitoh, Masao Nunomura, Masayuki Yo ...1990 Volume 23 Issue 9 Pages 2251-2255
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA retrospective review of 78 colorectal cancers with liver metastasis (synchronous, 51; metachronous, 27) out of 407 colorectal cancers resected in our institute was undertaken to detect the risk factors of liver metastasis. The average size of primary tumors with synchronous metastasis to the liver was significantly larger than that of tumors with no metastasis. Furthermore, the invasive type of tumor with a crater showed a higher incidence of liver metastasis than the limited type of tumor with a crater, although the site of the primary tumor had no relation to the incidence of metastasis. From the pathological point of view, the following findings were considered to be important risk factors of liver metastasis: 1) moderately differentiated type, 2) invasion into the perirectal adiose tissue in the rectum or to the serosal surface in the colon, 3) severe involvement of lymph nodes (n2), 4) marked lymphatic and hematogenous permeation (1y3, v2). It was concluded that total judgment based on many factors including the above pathological findings was important for the precise prediction of liver metastasis in colorectal cancer.View full abstractDownload PDF (9839K) -
Akira Usuba, Gohichi Endoh, Mitsunori Takahara, Kazuhito Matayoshi, Ak ...1990 Volume 23 Issue 9 Pages 2256-2263
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe aim of this study was to evaluate hypercoagulability to establish measures to prevent postoperative complications such as multiple organ failure and disseminated intravascular coagulation. The subjects were 21 patients with diseases of he digestive tract, 12 undergoing emergency surgery because of diffuse peritonitis and 9 undergoing emergency surgery because of massive hemorrhage. In the peritonitis group, thrombin activity was increased but platlet generation and fibrinolysis were within the normal range before surgery. Immediately after surgery, all three activities increased although they returned to normal withiin a week except for patients with multiple organ failure. Fibrinopeptide A, fibrinogen and antithrombin III levels reflected the clinical course most accurately. In the hemorrhage group, thrombin activity, platelet generation and fibrinogen were increased before surgery. There was a close correlation between hemorrhage on the one hand and the rate of decrease in platelet count and prothrombin time on the other. Multiple organ failure developed in most of the patients in the postoperative course, and recovery was delayed. Platelet count and prothrombin time reflected the clinical course most accurately. We conclude that hypercoagulability emerges before surgery and that it is closely related to postoperative complications.View full abstractDownload PDF (14796K) -
Kazunori Tashiro, Masato Furukawa, Toshinori Nakata, Toshiomi Kusano, ...1990 Volume 23 Issue 9 Pages 2264-2268
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSCarcinoma of esophageal diverticular orgin has rarely been reported. Recently, we experienced a case of early esophageal carcinoma originating in the middle esophageal diverticulum. This is the 16th case of intraesophagodiverticular carcinoma so far reported in our country. The patient is a 68-year-oldman, who was hospitalized in our department for persistent retrosternla pain. Esophagography revealed a recess about 2 cm in diameter having a ledge-like protuberance, near the posterior wall of a diverticulum of 1.5 cm in diameter situated in the right wall of the middle thoracic esophagus, about 4 cm anally from the bifurcatio tracheae. Endoscopy also revealed an irregular recess-type lesion in the adoral posterior wall of a diverticulum located in the right esophageal wall about 28 cm from incisor, leading to the diagnosis of superficial recess-type esophageal carcinoma. Subtotal esophagectomy was performed after preoperative irradiation. The pathological diagnosis was early, poorly differentiated squamous cell carcinoma, sm, n (-), Mo, plo, stage O. Histological examination suggested that the carcinoma had proliferated in the propria mucosa, muscularis mucosa and submucosa so as to surround the diverticulum thus, to have originated from inside the esophageal diverticulum.View full abstractDownload PDF (10243K) -
Yutaka Nishida, Nobukuni Terata, Haruaki Ishibashi, Junsuke Shibata, M ...1990 Volume 23 Issue 9 Pages 2269-2273
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 63-year-old man was referred to our hospital suffering from a chronic subdural hematoma. The plain X-ray of the abdomen taken on admission showed abnormal calcification in the upper left quadrant. Radiological and endoscopic examination revealed a tumor at the fundus which was suggestive of malignancy, however, the biopsyyielded normal findings. Microscopic examination of the resected specimen showed an amyloid deposit in the gastric wall, especially in the submucosal layer. The amyloid material was found to be AL type, and there were some calcifications and a few ossifications among the amyloid deposits. Further histological evaluation of the liver, rectum and bone marrow showed no deposits, and the urine was negative for Bence Jones protein. Therefore the condition was diagnosed as localized gastric amyloidosis with calcification. According to our review localized gastric amyloidosis have been reported only 20 cases and there are no reports about associated calcification.View full abstractDownload PDF (9180K) -
Tetsuya Kaneko, Kennichi Sumi, Michio Maeta, Nobuaki Kaibara, Sigemasa ...1990 Volume 23 Issue 9 Pages 2274-2278
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 62-year-old man undergoing an exploratory laparotomy for Stage IV (N4, S3, H3, P0, Borrmann 2 type, poorly differentiated) adenocarcinoma was treated by intensive chemotherapy consisting of etoposide 100 mg (days 3, 4, 5, i.v.), adriamycin 30 mg (days 1, 6, i.v.) and cis-platinum 50 mg (days 2, 7, i.v.) (EAP therapy). After this treatment, a marked reduction in the size of the primary, metastatic liver and lymph node tumors was observed by X-ray, endoscopy and CT. Upon reoperation 4 months after the initial laparotomy, partial gastrectomy, dissection of the metastatic lymph nodes and cannulation into the hepatic artery were performed. Almost all of the cancer cells in the primary tumor and lymph node metastases had dissappeared as a result of EAP therapy. This preoperative chemotherapy may be expected to increase resectability and possibly survival time.View full abstractDownload PDF (8930K) -
Shin Oguma, Yutaka Okubo, Shingo Matsuura, Noriyuki Iwama1990 Volume 23 Issue 9 Pages 2279-2283
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe presented a rare case of choledochocele with a cystic stone. A 59 year-old woman was admitted to Furukawa Minshu Hospital with epigastric pain. She underwent surgery because laboratory findings showed evidence of cholangitis. Intraoperative cholangiography revealed a choledochocele approximately 1.5 cm in diameter which contained a stone approximately 8 mm in diameter consisting of bilirubin calcium. However no stone was found in the gall bladder nor in the intra or extra bile duct. Operative findings also showed that our case was type “B” according to Scholz's classification. Of 48 cases reported in the Japanese literature, there were three rare cases like ours in which there was a stone only within the cyst. On the other hand, in our case pathological examination showed mild inflammatory changes in the cyst, which was covered with duodenal mucosa. In our patient's operation, an incision was made in the cyst wall after sphincterotomy. Incision of the wall was thought to be adequate surgical treatment for choledochocele, because cases of choledochocele with carcinoma are extremely rare compared with other types of choledochal cysts.View full abstractDownload PDF (9836K) -
Nobutaka Tanaka, Masakazu Nobori, Yasushi Harihara, Shunya Shindo, Man ...1990 Volume 23 Issue 9 Pages 2284-2288
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 71 year old woman underwent distal pancreatectomy and splenectomy for ductal carcinoma and an associated large cyst of the pancreas tail. Preoperative differential diagnosis from cystadenocarcinoma was difficult because the cyst did not communicate with the main pancreatic duct, there was a papillary projection at the cyst wall, and the boundary between the cyst wall and the tumor mass was not clearly defined by endoscopic ultrasonography. Pathologic examination of the resected specimen showed that the tumor was a conventional papillo-tubular adenocarcinoma and that it constituted part of the wall of the retention cyst. Though this is a rare combination, the situation should be kept in mind to differentiate it from cystadenocarcinoma.View full abstractDownload PDF (8893K) -
Takao Sumiyoshi, Masahiro Sakata, Akihiko Ohokado, Junn Wakuya1990 Volume 23 Issue 9 Pages 2289-2293
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSAn 11-year-old boy admitted with a preshock condition because of panperitonitis underwnt a laparotomy under the diagnosis of panperitonitis due to perforation of the appendix. Exploration revealed appendiceal perforation, abscess cavities mainly in the ileocoecal region and the Douglas' pouch. Moreover, another abscess cavity filled with a large amount of turbid bile-like fluid was encountered in the left upper abdomen. An appendectomy with drainage of the peritoneal cavity was perormed. On the first postoperative day, a large quantity of bile discharge from the drainage tube inserted in the left upper abdomen was observed. A reoperation was carried out with a diagnosis of jejunal perforation on the third postoperative day. Intraoperative examination showed two free punched out type, round perforations, 2 mm in diameter on the side of the upper jejunum. Direct oversewing for the oral perforation and wedge resection for the other were carried out. Pathological diagnosis of the resected specimen was nonspecific ulcers of the jejunum and perforation of the ulcer. Etiologically it seemed that panperitonitis owing to appendiceal perforation may have been related to ulcer formation and perforation of the jejunum according to an unusual clinical course, intraoperative findings and pathological findings. On reviweing the literature for the last 20 years, there were no similar reports on multiple jejunal perforations which was followed by panperitonitis.View full abstractDownload PDF (9925K) -
Yuji Imamura, Takashi Yokoyama, Hiroaki Tsumura, Yoshiaki Murakami, Hi ...1990 Volume 23 Issue 9 Pages 2294-2298
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe recently experienced two cases of multiple hemorrhagic ulcers of the intestine. They ware associated with hematopoietic malignancy and had interesting pathological fundings. Case 1. The patient was a young woman (10 y) in whom melena developed after chemotherapy for the leukemic changes of malignant lymphoma. Case 2. The patient was male (53 y) in whom bloody stool appeared with abdominal pain during the past two years in which refractory anemia with an excess of blasts was diagnosed and corticosteroids had been given. Both case massive bleeding had continued and necessitated surgical resection, but ulcers recurred. From the pathological study, in case 1 the ulcerative lesion have been made by invasions of malignant cells and cytomegalovirus. In case 2 we could detect only an infiltration of inflammatory cells around ulcers and the findings indicating nonspecific ulcers. In adition we could not detect an increase in neutrophils superoxide production by chemiluminescense during postoperative peroid, which is considered one of the host defense reactions to a surgical intervention, and he had a severe bacterial infection. These two cases suggested that not only an infiltration of atypical cells into the diementary tract but also bacterial and viral infections in a suppression of hostdefense which was induced by advanced hematopoietic diseases or iatrogenic factors, such as chemotherapy and steroid therapy, might cause hemorrhagic multiple ulcers.View full abstractDownload PDF (11756K) -
Shin-ichi Nishiyama, Masatomo Ootsuka, Nobuki Matsunami, Terutoshi Nak ...1990 Volume 23 Issue 9 Pages 2299-2303
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe reported a case of nephrotic syndrome in which there was a primary mesenteric venous thrombosis at puerperium. A 24-year-old woman treated for nephrotic syndrome for the previous seven months was admitted to PL General Hospital for delivery. On the 18th day after the delivery she experienced a sudden onset of upper abdominal pain, and signs of peritoneal irritation gradually appeared. Peritoneal puncture revealed bloody ascitic fluid. Exploratory laparotomy was carried out on the 6th day after the initial symptoms, with the diagnosis of acute peritonitis. A dark necrotic section of the small bowel extending from about 1 m distal to the ligament of Treitz to about 80 cm proximal to the ileocecal valve was found. Multiple mesenteric veins of the necrotic segment were thrombosed and the venous blood flow was found to be interruped. An approximately 3 m segment of the small bowel was resected, and side-to-side anastomosis was carried out between the healthy bowel segments. The finding of thick-walled bowel loops on a pre-operative abdominal CT scan was helpful in the diagnosis. Although a thrombostatic defect could not be detected pre-or postoperatively, we suggest that the pathogenesis may have been related to the hypercoagulable status in the puerperal state and to the nephrotic syndrome. We believe that postoperative anticoagulant therapy and careful long-term observation should be required for these patients because of the high incidence of reinfarction.View full abstractDownload PDF (11323K) -
Yasuhiro Kodera, Hiroyuki Suenaga, Yuuichi Suzuki, Masatoak Megita, Ke ...1990 Volume 23 Issue 9 Pages 2304-2307
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA case of hitherto unreported intestinal anisakiasis with massive gastrointestinal hemorrhage as the chief complaint is reported. A 37-year-old male presented with melena as the chief complaint, and fell into a state of shock while endoscopy and other procedures failed to make a diagnosis. Abdominal angiography revealed an area of hypervascularity at the proximal end of the jejunum. An emergency operation was carried out and close inspection revealed a mass at the proximal end of the jejunum, which was thought to be the bleeding point and was duly resected. Histological section revealed a submucosal granuloma with remnants of the Anisakis larvae with eosinophilic infiltration in the central abscess, hence the above diagnosis. The high titer of anti-anisakis antibody supported the diagnosis.View full abstractDownload PDF (7334K) -
Seiji Miura, Akihisa Nemoto, Hisayasu Aoki, Yutaka Satoi, Kenjiro Amin ...1990 Volume 23 Issue 9 Pages 2308-2312
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA case of diffuse vascular ectasia of the left colon is reported. A 52-year-old woman was admitted to our hospital because of passing dark red blood by rectum. She had had two other episodes of gross rectal bleeding. Colonoscopic examination clearly showed bleeding, small erosions in the descending colon and non-bleeding diverticula in the sigmoid colon. A barium enema examination was performed three days later and showed longitudinal ulcer scars in the descending colon. Microscopically the biopsied specimen suggested vascular leiomyoma, but inferior mesenteric arteriography and abdominal computed tomography did not reveal tumors or vascular lesions. In view of the long history and histological findings it was decided to resect the descending and signoid colon. Histological examination of the resected specimen showed proliferation of the dilated, tortuous vessels associated with increased collagenous fibers in the submucosal layers. The anomaly expanded the submucosa involving almost the entire length of the resected colon. Vascular ectasia of the colon is usually a localized lesion ocurring mainly in the right colon, but multiple lesions and lesions of the left colon have been reported. Baum et al. postulated that vascular ectasia is an acquired and age-related change in the colonic vasculature caused by ischemia. The present case might imply an increase in the incidence of colonic vascular ectasias among Japanese people.View full abstractDownload PDF (10139K) -
Masashi Kato, Kazuo Kinoshita, Toshiharu Sawa, Sotohiro Yoshimitsu, Yu ...1990 Volume 23 Issue 9 Pages 2313
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSDownload PDF (2161K) -
Takeo Nishimori, Masahiro Okuno, Masayoshi Nagayama, Teruyuki Ikehara, ...1990 Volume 23 Issue 9 Pages 2314
Published: 1990
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSDownload PDF (2077K)
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