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Volume 24, Issue 11
Displaying 1-28 of 28 articles from this issue
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Masaya Shiomi, Kitao Hachisuka, Akihiro Yamaguchi, Masatoshi Isogai, S ...1991 Volume 24 Issue 11 Pages 2689-2698
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe investigated the tumor malignancy in 37 patients with tumors of the gastric smooth muscle (14 with leiomyoma, 20 with leiomyosaicoma, and 3 with leiomyoblastoma) encountered during the past 19 years in our department. These patients were devided into 3 groups: Group A, consisting of 14 patients with leiomyoma; Group B, 13 patients with leiomyosarcoma or leiomyoblastoma who had no recurrence; and Group C, 6 patients with leiomyosarcoma or leiomyoblastoma who were treated by non-curative resection or had recurrence. Comparison of the tumor diameter, mitotic figures, cellularity, the area and morphology of the nucleus, and tumor morphology of the nucleus, and tumor fiber bundle formation among these groups suggested that the tumor diameter, mitotic figure, morphology of the nucleus, and tumor fiber bundle formation are important factors associated with tumor malignancy. Patients with tumors 5 cm or less in diameter showed a benign course while those with tumors more than 10 cm in diameter had a poor outcome. The outcome was also poor in patients showing mitotic figures exceeding a mean value in 10 visual fields (×400) of 3.0/HPF. The morphology of the nucleus was associated with tumor fiber bundle formation. The outcome was favorable in patients with a spindle shaped uncleus and obvious tumor fiber bundle formation but poor in those with a round nucleus and unclear fiber bundle formation.View full abstractDownload PDF (20093K) -
Masahide Yamaguchi, Kiyoshi Sawai, Shinji Okano, Nobuhiro Tsukuda, Kos ...1991 Volume 24 Issue 11 Pages 2699-2704
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe analyzed the records of 44 gastric cancer patients aged 80 years or older who had undergone gastrectomy (7 total, 3 proximal and 34 distal) between 1972 and 1990. Of these, 18 patients (40.9%) had stage 1 cancer, 11 patients (25.0%) has stage 4 cancer and 19 patients (43.8%) had preoperative organ impairment. The operative morbidity was 43.8% (19 patients) and the mortality rate was 4.5% (2 patients). However, there was no relation between preoperative organ impairment and postoperative complications. The cumulative 5-year survival rate was 46.1% overall. The 5-year survival rate for the patients without serosal invasion was 60.6%, as compared to 23.9% with serosal invasion (p<0.01). The degree of serosal invasion, lymph node involvement and tumor size were all found to be significantly associated with long-term survival, whereas sex, type of operation, and tumor grade were not. Twenty patients died in the long term. The main cause of death of patients with serosal invasion was cancer recurrence, while for those without serosal invasion death was due to other causes. It is concluded that gastrectomy for gastric cancer patients aged 80 or older can be performed safely and R1 lymph node resection gastrectomy should be recommended for patients without serosal invasion. More radical gastrectomy should be recommended for patients with serosal invasion.View full abstractDownload PDF (10354K) -
Takashi Maeba, Satoshi Tanaka, Masashi Waki, Yohichi Hirata, Keizoh Ch ...1991 Volume 24 Issue 11 Pages 2705-2711
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIn an attempt to prevent early recurrence of hepatocellular carcinoma (HCC) in the remnant liver we gave hepatic arterial infusion chemotherapy after hepatectomy. To determine its efficacy 46 patients with HCC were divided into two groups. In group A only hepatectomy was performed, while in group B hepatic arterial infusion chemotherapy with mitomycin C was given every two weeks in addition to chemolipiodolization by mitomycin C and doxorubicin every four months, following hepatectomy for a year through an implantable port system. There was no significant difference between the two groups in the patients' background factors except for the follow-up period. In group B 7 patients had recurrences within 2 years after hepatectomy, and in 6 of them the site of recurrence was in the remnant liver. The cumulative disease-free survival rate for group A and group B, respectively, were as follows: 1 year, 76%, 83%; 2 years, 76%, 52%; 3 years, 58%, 52%. The differences in disease-free survival rate and cumulative survival rate between the 2 groups were not statistically significant. We conclude that postoperative intermittent hepatic arterial infusion chemotherapy is not effective for prevention of early recurrence of HCC in the remnant liver.View full abstractDownload PDF (11331K) -
Tomoki Ueda, Makoto Usami, Ichiro Yasuda, Mitsutoshi Ogino, Hiroshi Ka ...1991 Volume 24 Issue 11 Pages 2712-2720
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSBlood levels of PIVKA-II, KM01 and AFP were measured and evaluated in 70 patients including 35 with hepatocellular carcinoma (HCC), 18 with liver cirrhosis and 6 with extrahepatic disease. The sensitivity and specificity were 40.4% and 97.1% for PIVKA-U, 51.4% and 71.4% for KMO1 and 65.7% and 91.4% for AFP respectively. There were no statistical significant correlations among the tumor markers, showing that each marker is independent. The combination assay of PIVKA-II, KMO1 and AFP was evaluated for screening HCC cases. The sensitivity was improved to 85.7% for HCC cases and to 82.4% for cases of resectable HCC. It was concluded that measurement of PIVKA-II, KMO1, AFP and of the combination of these markers is useful for the diagnosis of HCC.View full abstractDownload PDF (12650K) -
Toshiyuki Itamoto, Toshimasa Asahara, Kouji Katayama, Shinya Nomura, S ...1991 Volume 24 Issue 11 Pages 2721-2726
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe clinical significance of PIVKA-II measurement was evaluated in 29 cases of resected hepatocellular carcinoma (HCC), compared with that of AFP measured in 106 cases of HCC. Positive rates for PIVKA-11 and AFP were 58.6% and 64.2%, respectively before surgery. We found that the PIVKA-II-positive rate increased with tumor size, especially in all patients with tumors greater than 5 cm in diameter. The PIVKA-II-positive rate in patients with small HCC (T≤2 cm) was only 37.5%, but all had portal invasion or intrahepatic metastasis confirmed by histopathological examination. By these findings, we recognized that although the tumor is smaller, it is probably not an early cancer if a high PIVKA-II level has been detected in the course of disease. Our results also showed that 70.6% of the PIVKA-II-positive cases had portal invasion and 49.2% of the AFP-positive cases had that, indicating significant difference (p<0.01) between both positive rate. Similarly, regarding the factor of capsule invasion, PIVKA-II was also a more sensitive marker than AFP. We conclude that PIVKA-II measurement is a more reliable test for the detection of the degree and the behavior of HCC than the routine AFP test.View full abstractDownload PDF (10859K) -
Participation of Vagal Nerve and Sensory NeuronsToku Takahashi, Chung Owyang1991 Volume 24 Issue 11 Pages 2727-2731
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSGallbladder pressure was measured by a pressure transducer inserted into the gallbladder lumen. Infusion of CCK8 (2.5-80 ng/kg/min) increased gallbladder pressure in a dose-dependent fashion. Atropine, hexamethonium and truncal vagotomy antagonized gallbladder responses to low doses of CCK8 (2.5-5 ng/kg/min) but had no effect on doses above 10 ng/kg/min. Atropine or hexamethonium had no further inhibitory effect on guinea pigs which had undergone truncal vagotomy. Fasted guinea pigs achieved a postprandial peak plasma CCK level of 8 pM, which was most closely approximated by the 5 ng/kg/min intravenous CCK8 infusion. CCK8 (5 ng/kg/min)-induced contraction was significantly reduced by chronic treatment with sensory neurotoxin, capsaicin. Doses of CCK8 which produce physiologic plasma CCK levels are suggested to act via stimulation of sensory neurons and presynaptic cholinergic neurons in a vagal nerve and finally stimulate the release of acetylcholine from nerve terminals of postsynaptic cholinergic neurons, whereas infused doses of CCK8 which produce supraphysiologic CCK levels may act directly on gallbladder smooth muscle.View full abstractDownload PDF (9810K) -
Nobuhiro Takiguchi, Hiromi Sarashina, Norio Saitoh, Masao Nunomura, Ha ...1991 Volume 24 Issue 11 Pages 2732-2738
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTo evaluate the utility of CEA and CA19-9 as indicators of the effects of preoperative irradiation for rectal cancer, we studied the relationship between tissue localization or serum level of these antigens and the grade of irradiation effect. Thirty-two out of 63 patients were treated by surgery alone, and the other 31 cases were given preoperative irradiation. In tissue CEA staining, almost all cancer glands showed focal or diffuse cytoplastic staining in each group except one case. In tissue CA19-9 staining, there were 16 positive cases in the non-irradiated group and 15 in the irradiated group. There were only two diffuse cytoplasmic staining cases in the non-irradiated group and 8 in the irradiated group. In those patients having no liver metastasis, the reduction ratio of the serum CEA value after irradiation was 46.5±14.1% in the nonresponding patients, while it was 60.3±19.2% in the responding patients. In patients with liver metastasis, the serum CEA level increased 14.5% on average, and the serum CA19-9 level increased as well, when compared with the level in the preirradiation stage independent of the irradiation effects. In conclusion, tissue immunoreactivity is maintained after irradiation and determination of serum CEA and CA19-9 levels before and after irradiation is thought to be useful for estimating the effect of irradiation.View full abstractDownload PDF (13839K) -
Hirohiko Kojima, Masakazu Ueda, Kimio Wada, Hiroshi Asano, Kohji Oshim ...1991 Volume 24 Issue 11 Pages 2739-2742
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 76-year-old man had a radical operation for esophageal carcinoma in July 1988. One year and five months later abdominal ultrasonography which was performed as a follow-up screening examination for his study revealed a tumor in the lower part of the right kidney. Radical right nephrectomy was performed successfully in December 1989. Pathological diagnosis of the esophageal cancer and the renal cell tumor was squamous cell carcinoma and clear cell renal carcinoma respectively. Ultrasonography is a noninvasive and useful tool as a follow-up examination for a cancer patient, and also contributes to improving the results of surgery and the patient's quality of life.View full abstractDownload PDF (7691K) -
Shinpei Takeda, Wataru Takiyama, Shigemitsu Takashima, Kouichi Mandai1991 Volume 24 Issue 11 Pages 2743-2747
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA rare case of leiomyosarcoma arising at the esophagogastric junction is reported. A 70-year-old woman presented with dysphagia. A barium examination of the upper gastrointestinal tract showed a large (about 10 cm) submucosal tumor at the esophagogastric junction. An endoscopic examination revealed a submucosal tumor with bridging folds and ulceration extending from the lower esophagus to the cardia. Histological examination of the biopsied specimen showed simple necrotic tissue without malignancy. By CT an irregular-shaped tumor (9×8×7 cm) was found with some low density areas. An esophagogastrectomy was carried out. Macroscopic examination of the surgical specimen revealed a submucosal tumor with pronounced ulcertion and necrosis. Histological examination showed spindle shaped dense proliferation of anaplastic tumor cells with many mitotic figures to form tightly packed tumor cell nests, diagnosed as leiomyosarcoma. Metastatic foci were histologically found in the regional lymph nodes. A follow-up 6 months after the operation disclosed hepatic metastasis and the patient has been treated with chemotherapy. We suggest that dissection of the primary lesion with removal of regional lymph nodes and appropriate chemotherapy would be the best therapeutic modality for advanced leiomyosarcoma of the digestive tract.View full abstractDownload PDF (9687K) -
Kiyoshi Kishi, Kazuyoshi Kato, Kiyoshi Mizumoto, Yoshihiro Kawamura1991 Volume 24 Issue 11 Pages 2748-2752
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe experienced a case of carcinoma arising in the reconstructed gastric tube after a radical operation for esophageal cancer. This patient, a 66-year-old man, underwent total thoracic esophagectomy and retro-sternal reconstruction by a gastric tube for esophageal cancer 6 years earlier. This time, Borrmann 4 type advanced cancer was discovered in the lower part of the gastric tube under the chief complaint of dysphasia. Although total resection of the gastric tube and ante-thoracic reconstruction using the right half of the colon was performed, the operation was noncurative because of direct invasion into the pericardium and the mediastinal pleura. Pathological examination revealed moderately differentiated adenocarcinoma, scirrhous, positive first grade lymph node metastasis, stage IV. The patient is doing well nine months after the operation. Forty-seven such cases reported in Japan by 1990, including our case, were reviewed and discussed. Careful follow-up study after esophageal surgery is necessary to detect early cancer of the gastric tube.View full abstractDownload PDF (9870K) -
Takao Inada, Yoshiroh Ogata, Iwao Ozawa, Shouichi Hishinuma, Hideaki S ...1991 Volume 24 Issue 11 Pages 2753-2757
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe have recently experienced two patients with gastric cancer forming a tumor embolus in the extrahepatic portal vein. Case 1. A 66-year-old man was referred to our hospital because of gastric cancer with liver metastasis. He had an elevated alpha-fetoprotein (AFP) level. At the operation, a tumor embolus was seen from the left gastric vein to the portal vein, and it was resected with the portal vein. Post-operative immunohistochemical study revealed that AFP was produced by the gastric carcinoma. Case 2. A 50-year-old man who had been suffering from upper abdominal pain and severe anemia was admitted for surgery. Preoperative abdominal CT and angiography indicated a tumor embolus from the superior mesenteric vein to the portal vein. Total gastrectomy was carried out, but the tumor embolus could not be completely removed.View full abstractDownload PDF (9564K) -
Hriomi Hamada, Takayoshi Yasuda, Yoshio Katsuki, Kouichi Kudou, Hideno ...1991 Volume 24 Issue 11 Pages 2758-2762
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe experienced 3 cases of gastric carcinoid. Two of the 3 patients were 55-year-old men and the other was a 52-year-old man. Their early clinical symptoms before diagnosis were mainly epigastralgia and/or epigastric discomfort. In case 1, the preoperative diagnosis was gastric carcinoid. In case 2, simultaneous duplicate cancers in the sigmoid colon were detected by preoperative examinaiton. In case 3, metastasis to the medial segment of the liver was found preoperatively. The operations were total gastrectomy with resection of the body and tail of the pancreas and the spleen in case 1, subtotal gastrectomy and sigmoidectomy in case 2, and total gastrectomy and partial resection of medial segment of the liver in case 3. In cases 1 and 2, metastasis to regional lymph nodes was observed. In case 3, tumor invasion reached the submucosal layer. Argentaffin granules were seen in 2 cases. As for prognosis, patient 1 is alive 4 years after the operation although metastasis developed 1 year and 8 months after surgery. Patients 2 and 3 are surviving without recurrence 10 and 8 months respectively, after surgery. Gastric carcinoid has been reported to have a high incidence of metastasis to the lymph nodes and to the liver. To prevent metastasis it is necessary to perform gastrectomy and dissection of the lymph node.View full abstractDownload PDF (9052K) -
Haruyuki Inoue, Hideo Ise, Yoshinobu Takahashi, Osamu Kitayama, Yutaka ...1991 Volume 24 Issue 11 Pages 2763-2767
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSAgenesis of the right lobe of the liver is an extremely uncommon congenital anomaly. We present a case report of a 60-year-old Japanese female patient. She was admitted with the complaint of right hypochondralgia. On admission she had slight jaundice. PTC revealed that there was no right hepatic duct and that the left duct was constricted at the hepatic hilus with intrahepatic dilation and contained stones. CT showed aplasia of the right lobe with compensatory hypertrophy of the left lobe and an ectopic position of the gallbladder. The right hepatic branch of the hepatic artery was not seen on an angiogram. The preoperative diagnosis was hepatolithiasis with agenesis of the right lobe of the liver. On laparotomy, the right lobe of the liver was found to be absent, and the left hepatic duct was bent around the hepatic hilus with many black stones peripheral to it. The operation included cholecystectomy with choledocholithotomy and T-tube drainage as well as left hepaticotomy with left hepaticojejunostomy. Twenty-five cases of right hepatic lobe agenesis have been found since 1956. Our patient is the second reported in Japan. This case was a bit different and probably the first case in the world in which the absence of the lobe has been complicated by hepatolithiasis and black stones, and these black stones are thought to be caused by the anomaly.View full abstractDownload PDF (8258K) -
Susumu Yamaguchi, Kenji Kikuchi, Akira Hanai, Osamu Akaishi, Suehiro N ...1991 Volume 24 Issue 11 Pages 2768-2772
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSExtrahepatic cancer is a relatively rare disease. Its pathogenesis has not been clarified. Its diagnosis and treatment are said to be different from those of the usual hepatoma. We encountered three cases of extrahepatic hepatocellular carcinoma. Case 1 is that of a 38-year-old woman. Her pedunculated tumor was resected by partial hepatectomy. She is alive 4 years and 9 months after the operation. Case 2 is also that of a 39-year-old women. Her pedunculated tumor accompanied by chronic hepatitis was resected by partial hepatectomy. She is alive 2 years and 8 months after the operation. Case 3 is that of a 61 years old man. His protrusive tumor associated with multiple tumors in a cirrhotic liver was resected by left hepatectomy. He died 7 months after the operation. Angiography is suggested as a superior diagnostic procedure along with ultrasonography, computed tomography and examination for tumor markers. Prognosis for a pedunculated tumor is better than for a protrusive tumor after surgery.View full abstractDownload PDF (9900K) -
Tsutake Okamoto, Kohji Tsuruta, Tokio Onodera1991 Volume 24 Issue 11 Pages 2773-2777
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTwo patients with hepatocellular carcinoma (HCC) growing into the extrahepatic bile duct are presented. One patient showed a clinical picture of obstructive jaundice because of clot formation in the common bile duct. The tumor was successfully removed by hepatic lobectomy with resection of the extrahepatic bile duct in each patient. One patient died three months after surgery, developing rapid tumor recurrence in the residual liver, whereas the other patient survived for seven years, despite pulmonary metastasis and rupture of esophageal varices which were managed surgically. Such long-term survival after resection of HCC growing into the bile duct is extremely rare. The patient ultimately died of hemorrhagic pneumonia without any evidence of recurrent tumor at autopsy. The doubling time of alpha-fetoprotein (T2AFP) and a DNA histogram of the tumor cells were studied. The first patient showed a short T2AFP of 27 days and an aneuploid pattern in the DNA histogram. On the other hand, the second showed a long T2AFP of 216 days and a tetraploid pattern in the DNA histogram. Thus, there were differences in T2AFP and the DNA histograms of the tumor cells between the two patients, which suggests there might be a difference in tumor character.View full abstractDownload PDF (9673K) -
Kazuhide Ura, Satoshi Tamaki, Toshiaki Shiogama, Teiji Matsumoto, Tosh ...1991 Volume 24 Issue 11 Pages 2778-2781
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 52-year-old man was admitted to our department because of chronic alcoholic pancreatitis. His main pancreatic duct was markedly dilated, and many pancreatic stones were detected by CT scanning. Other imaging examinations showed no evidence of pancreatic cancer. However, serological tests revealed that tumor markers, CA19-1, Dupan-2, Elastase-I were elevated, in spite of his Lewis blood type being Le (a-, b-). After side-to-side pancreaticojejunostomy, all the tumor markers except Dupan-2 returned to the normal level. In cases of malignant disease, serum CA19-9 can be elevated even if the red blood cell type is Le (a, b-). However, there has been no such report on benign diseease.View full abstractDownload PDF (7961K) -
Shoichi Hishinuma, Yoshiro Ogata, Junichi Matsui, Iwao Ozawa, Takao In ...1991 Volume 24 Issue 11 Pages 2782-2786
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIn an attempt to improve the postoperative nutritional status and quality of life of pancreatic cancer patients, two patients with cancer of the pancreatic body accompanied by tumor invasion around the celiac axis underwent a new operative procedure. The celiac axis was divided at the origin from the aorta. The common hepatic artery was divided just proximal to the gastroduodenal artery and the left gastric artery was divided at its periphery. Then the pancreatic body and tail and the spleen were removed with the celiac axis. In one of the patients, the portal vein was also resected because of cancer invasion. Great care was taken to preserve the inferior pancreaticoduodenal artery which arose from the superior mesenteric artery. Blood supply to the stomach and liver was provided via this artery. These two patients received both intra-and post-operative irradiation to the tumor bed. No postoperative complications were encountered. Pathological examination of the resected specimens revealed that in both patients the resections were non-curative resection because of exposure of cancer at the surgical margins. The first patient developed peritonitis carcinomatosa and had two exploratory operations for relief of the bowel obstruction. However, he has survived 41 months without local or hepatic failure. Unfortunately, the second patient died from an accident 4 months after the operation. Recurrence was obscure. Up to now, this operative procedure for cancer of the pancreatic body has not been reported.View full abstractDownload PDF (10052K) -
Naoto Fukuda, Junji Ishiyama, Hitoshi Amano, Yasuhisa Mochizuki, Hirak ...1991 Volume 24 Issue 11 Pages 2787-2790
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA case of leiomyosarcoma of Meckel's diverticulum accompanied by intra-peritoneal bleeding is reported because of its rarity in the literature. The patient, a 75-year-old man who was admitted to our hospital for diabetes mellitus, suddenly complained of vomiting. Physical examination showed anemia and very low blood pressure (60mmHg). Intra-peritoneal bleeding was found by ultrasonography and abdominal puncture. A ruptured soft tumor, 6 × 6 cm in size, was present at the tip of Meckel's diverticulum which was found about 80 cm proximal to Bauhin's valve at surgery. About 1000 ml of bloody ascitic fluid was seen in the peritoneal cavity. Partial resection of the ileum and peritoneal lavage were performed. histological examination revealed diffuse growth of atypical spindle cells with nuclear variation, and a diagnosis of leiomyosarcoma was made.View full abstractDownload PDF (7358K) -
Tsunaaki Sakakibara, Kenji Matsumoto, Katsuhiko Nouga, Isao Yokoyama, ...1991 Volume 24 Issue 11 Pages 2791-2795
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA rare case of jejunal mesenteric liposarcoma, which developed 5 years after resection of a left femoral liposarcoma (myxoid type), is reported. A 49-year-old man was referred to our hospital with left abdominal pain. Computed tomographic findings showed a tumor originating in mesenteric soft tissues, and superior mesenteric arteriography revealed not a tumor stain but arterial encasement. Laparotomy revealed a jejunal mesenteric tumor about 40 cm distant from Treitz's ligament. The tumor was completely resected and histopathological findings indicated a liposarcoma (myxoid type). The postoperative course was uneventful. On the basis of the clinical course and laboratory data, this was believed to be a case of heterochronous double liposarcoma.View full abstractDownload PDF (9531K) -
Kazuo Ohashi, Hisao Fujii, Katsuhiko Yamamoto, Saburo Sado, Masayuki N ...1991 Volume 24 Issue 11 Pages 2796-2799
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSMesenteric cysts are uncommon enough to excite surgical interest in view of their diverse presentation and lack of a definitive diagnostic test. It is occasionally diagnosed when laparotomy is performed because of its complications such as intestinal obstruction and peritonitis. A case of mesenteric cyst pre-operatively diagnosed as an ovarian cyst is reported. A 16-year-old woman visited our hospital because of an upper abdominal pain and was diagnosed as an ovarian cyst by ultrasonography. Laparotomy revealed a mesenteric cyst of the ileum. The cyst was resected with segment of ileum and post-operative period was uneventful. A review was carried out of mesenteric cysts reported in the past five years in Japan. Correct preoperative diagnosis was made in 35% of the cases, a slight improvement over a previous review. When both ultrasound examination (US) and computed tomography (CT) were performed, the ratio moved up to 62%. Therefore we conclude that the combination of US and CT is an effective method for diagnosing mesenteric cysts.View full abstractDownload PDF (8695K) -
Naoki Imai, Hiroshi Tanabe, Susumu Watanabe1991 Volume 24 Issue 11 Pages 2800-2803
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA case of primary malignant lymphoma of the appendix is reported, together with a review of the cases in the Japanese literature. A 42-year-old man complaining of lower abdominal pain consulted a neighborhood physician. He was subsequently referred to us with the diagnosis of acute appendicitis. We diagnosed his condition as perforative appendicitis, and thus performed an appendectomy. The post-operative histological diagnosis was non-Hodgkin's lymphoma, diffuse, large cell type according to the LSG classification. On the 10th day after surgery, a right hemicolectomy with regional lymphnode excision was performed for radical treatment, but no malignant lymphoma was found in any of the specimens. Primary malignant lymphoma of the appendix is an extremely rare disease, and to date only 21 cases have been reported in the Japanese literature. Most of the cases were diagnosed as acute appendicitis, and appendectomy was performed. The definite diagnosis was obtained by post-operative histological examination. Radical resection was performed in only 7 cases (33.8%). Three of 9 patients with lymph node metastasis, and 7 of 8 patients without it reportedly survived. In the case of such a disease, a radical operation should be performed. If necessary post-operative therapy should also be given.View full abstractDownload PDF (8659K) -
Yoshimi Akamo, Isamu Mizuno, Tatsuo Ichino, Tetsuya Yamamoto, Tamotsu ...1991 Volume 24 Issue 11 Pages 2804-2808
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe recently saw a case of fulminating amebic colitis presenting as an acute abdomen. A 45-year-old man was admitted to our department with pain in the right lower quadrant of the abdomen and diarrhea. The white cell count was 12, 700 and abdominal examination showed signs of peritoneal inflammation. A Gastrografin enema revealed a large ulcer in the cecum. In spite of the use of antibiotics, the patient's condition continued to deteriorate. Because of the increasing risk of perforation of the ulcer, an ileocecal resection was performed. The diagnosis was not determined until trophozoites of Entamoeba histolytica were found in the resected specimen by periodic acid Schiff staining. After the correct diagnosis was made, an antiamebic drug was administered orally. The patient was cured after 12 days of antiamebic drug therapy. Only when the correct diagnosis is made and the proper therapy instituted early enough is it possible to prevent the morbidity and mortality that attend fulminating amebic colitis. Therefore, we should make the diagnosis promptly and institute the appropriate treatment.View full abstractDownload PDF (8807K) -
Takeshi Kitahara, Kenzo Onoe, Keita Watanabe, Syuusei Tominaga, Kazuno ...1991 Volume 24 Issue 11 Pages 2809-2813
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA case of undifferentiated carcinoma of the sigmoid colon, which occurred in a pedunculated polyp and had multiple liver metastases, is reported. A 64-year-old man was admitted to Nagahori Hospital because of lower abdominal pain and melena. Barium enema and colonoscopy revealed a pedunclated polyp in the sigmoid colon. When endoscopic polypectomy was scheduled, multiple liver metastases were revealed by the echography and the computed tomography. The sigmoid colon was surgically removed and liver biopsy was performed on January 6, 1989. The resected polyp measured 10 ×8 mm. Histologically, most part of the polyp was composed of villo-tubular adenoma. In the rest medium-sized spindleshaped cancer cells were noted, which invaded the submucosa. In the liver metastases, larger polygonal cancer cells were seen. Immunohistochemically, the tumor cells were positive for neuron-specific enolase. The patient died 5 months later. Undifferentiated carcinoma of the colon is rarely reported in Japan. This is the 5th case in the literature. Even if it develops in an adenomatous polyp and is confined to the submucosal layer, colonic undifferentiated carcinoma is biologically aggresive and has a poor prognosis.View full abstractDownload PDF (8811K) -
Takeo Yonekura, Kazuyasu Nakao, Nobuhiro Fujita, Katsuaki Maeda, Masay ...1991 Volume 24 Issue 11 Pages 2814-2818
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 19-year-old male was diagnosed as multiple cancer in the colon and rectum combined with gastric cancer. A distal gastrectomy and a subtotal colectomy were carried out. Reconstructions were performed with the gastroduodenostomy and the colo-rectal anastomosis. Histological examination of the tumor in the stomach revealed signet ring cell carcinoma infiltrating into the subserosal layer. Histological examinations of the subserosal layer. Histological examinations of the resected specimens of the colon and rectum revealed a submucosal-infiltrated (sm) Ia type cancer (moderately differentiated adenocarcinoma; mda), a subserosalinfiltrated invasive ulcerative type cancer (mda), and an sm localized IIc type cancer (mucinous carcinoma; mc) in the rectum, and an sm and a mucosal-infiltrated (m) Ia type cancer (well differentiated adenocarcinomas), an sm localized IIc type cancer (mda), two proper-muscular-infiltrated tumorous type cancers (mc) and four polypoid adenomas in the sigmoid and descending colon, and a cancer in adenoma in the transverse colon. He lives in safe without signs of recurrence 25 months after surgery. One hundred forty-five cases of colon and rectal cancer in persons less than 20 years old have been reported in Japan. There were six patients with multiple colon and rectal cancer in addition to this patient. Among these, one had familial polyposis, two had Turcot syndrome, one had non-familial polyposis, one had multiple cancer in the sigmoid colon and one had multiple cancer in the transverse colon. Except for the patients with Turcot syndrome, this is the first case of colon and rectal cancer combined with the cancer of another organ.View full abstractDownload PDF (10165K) -
Yoichiro Yamanaka, Masahiko Onda, Kaku Egami, Norio Matsukura, Shigeki ...1991 Volume 24 Issue 11 Pages 2819-2823
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 17-year-old Japanese youth was admitted to our hospital with complaints of abdominal distension and both pain and numbness in the right lower extremity. Computed tomography and magnetic resonance imaging on admission revealed a huge tumor in the right retroperitoneum. A biopsy specimen was taken by laparotomy and it revealed malignant hemangiopericytoma. After radiation by Linac (total 40 Gy) and chemotherapy with cisplatin (total 320mg), the tumor was reduced by 48%, to a size that would make surgical extirpation possible. After ascertaining that the tumor had not increased in size during the next 5 months, we went ahead with our original plans to perform extirpation. As a preliminary procedure to minimize bleeding during the operation, we selectively embolized of 3 right lumbar arteries and a branch of the right internal iliac artery, which were feeder vessels of the tumor. Three days later, surgical extirpation was carried out. After receiving postoperative chemotherapy, the patient was discharged from the hospital, and was followed in the Outpatient Clinic. There were no signs of recurrence or metastasis during the 13 months after the first chemotherapy, which means the patient survived for at least 1 year and 9 months after admission. Malignant hemangiopericytoma of the retroperitoneum is still rare in Japan, and the prognosis is very poor. To our knowledge, no patients have survived 2 years or longer. What makes this case noteworthy is that combined modality therapy appears to be an effective treatment for malignant hemangiopericytoma.View full abstractDownload PDF (11215K) -
Nobuhiro Tokunaga, Hisashi Shinohara, Hidetane Onishi, Takashi Bettsho ...1991 Volume 24 Issue 11 Pages 2824-2826
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSAn 85-year-old weak female was admitted with the complaint of continuous pain extending down the inner surface of her right thigh to her right knee. An abdominal roentgenogram in the upright position revealed dilated loops of small intestine with air fluid levels. She was initially treated conservatively, and then an exploratory operation was performed through a low midline incision. The operative diagnosis was a right incarcerated obturator hernia. The patient did well up to 21 weeks after the operation. She returned to the hospital with vomiting and epigastralgia. She also complained of continuous pain over the medial aspect of the left thigh upon admission. The previous incision site was opened and she was found to have a left incarcerated obturator hernia. Bilateral obturator hernias occurring at different times are rare, this being the 4th reported case. In all other reported cases, an obturator hernia on the contralateral side occurred within 6 months after reduction of the hernia on the first side. The abdominal aspect of the contralateral obturatory foramen should be inspected during laparotomy for obturator hernias.View full abstractDownload PDF (6203K) -
Effectiveness of Ursodeoxycholic Acid on the Treatment of Malnourished StateMikio Imamura, Mitsuhiro Kimura, Hidemi Yamauchi1991 Volume 24 Issue 11 Pages 2827-2831
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe have experienced a case of severe malnutrition after two consecutive operations on the alimentary tract, a total gastrectomy and a massive resection of the distal small intestine together with the ileocecal valve. The patient was a 59-year-old man who underwent a total gastrectomy for gastric cancer, and a massive small bowel resection for strangulation obstruction. After these operations, he suffered from short bowel syndrome manifested by frequent bowel movements, marked loss of body weight, milk intolerance, and iron-deficiency anemia. Plasma levels of total bile acid were also markedly reduced. The patient was treated by enteral hyperalimentation, and was administered ursodeoxycholic acid and lactase in addition to digestive enzymes and conventional stegnotics. These treatmens were very effective for improving his malnourished state. Postprandial plasma total bile acid concentrations increased and the release of cholecystokinin was kept at a good level.View full abstractDownload PDF (9049K) -
Takashi Mizutani, Masahiko Onda, Akira Tokunaga, Takeshi Okuda, Hirosh ...1991 Volume 24 Issue 11 Pages 2832-2836
Published: 1991
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSSurgery for patients with polycythemia vera (PV) is frequently accompanied by postoperative complications, such as respiratory distress syndrome and disseminated intravascular coagulation (DIC), making the prognosis extremely poor. We have performed gastrointestinal surgery on three patients with PV, and the outcome was successful in one of them. Patient 1: A 66-year-old woman underwent total gastrectomy because of gastric cancer, after preoperative treatment with interferon. She recovered despite complication by respiratory failure, and was discharged on the 63rd postoperative day (POD). Patient 2: A 56-year-old man with diabetes mellitus underwent subtotal gastrectomy because of gastric cancer after preoperative treatment with interferon. Postoperatively, his condition was complicated by respiratory failure and perforation of the suture line, and the diabetes became worse. He died of multiple organ failure on the 54th POD despite a second manipulative operation. Patient 3: A 68-year-old man was diagnosed as having peritonitis due to acute cholecystitis. We performed cholecystectomy and abdominal drainage after phlebotomy. Respiratory and renal failure occurred postoperatively in spite of dialysis and intensive respiratory care using a respirator, and successive DIC and sepsis were additional complications. The patient died on the 59th POD. In conclusion, patients with PV require great care before, during and after surgery, since DIC can occur after surgical mainpulation, associated hemorrhage or thrombosis, and there is a risk of complicating multiple organ failure.View full abstractDownload PDF (9654K)
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