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Volume 26, Issue 12
Displaying 1-28 of 28 articles from this issue
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Shinya Kusachi, Yoshinobu Sumiyama, Sadahito Usui, Masumi Kurashige, J ...1993 Volume 26 Issue 12 Pages 2733-2739
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSPostoperative MRSA infection after esophageal resection was studied with regard to the management of fluid infusion, anastomotic technique and antibiotic ilrophylaxis with cefazolin (CEZ). In goup A (without management), the patients were administrated the ringer lactate at 642 ± 69 ml/h, developed pulmonary edema due to hypoalubuminemia (2.6 ± 0.2 g/dl) and needed controlled respiration postoperatively. This caused respiratory tract infection in 17.4% of the cases, and the incidence of MRSA infection was 8.7%. In group B (with management), perioperative infusion of ringer lactate was diminished to 72.4 ± 6.9 ml/h, fresh frozen plasma was administrated at 1.5 ± 2.0 ml/h/kg, and serum alubumine was maintained at2.8 ± 0.1 g/dl. Since the average term of controlled respiration was shortened from 38.7 hours in group A to 4.9 hours in group B, nosocominal infection was prevented. And cervical abscess caused by anastomotic leakage was not developed in group B. Although second or third generation cefem of antibiotics and aminoglycosides were given to group A patients for plopylaxis, cefazolin, a first generation cefem of antibiotic, was administrated in group B, to prevent MRSA infection. The incidence of postoperative MRSA infection was 8.9% in group A, and 0% in group B. There was a significant difference between the two groups. It seemed that fluid restoration with fresh frozen palsma stabilized the circulation, shortened the duration of controlled respiration and diminished respiratory tract secretions. This prevented MRSA contamination. The administration of cefazolin inhibited the colonization of MRSA. We concludethat not only management for nosocomial infection but also fluid restoration and selection of antibiotics for postoperative prophylactic use are needed for the management of postoperative MRSA infection in patients with esophageal resection.View full abstractDownload PDF (13973K) -
Kiyoshi Maeda, Yong-Suk Chung, Naoyushi Onoda, Yasuyuki Kato, Yuichi A ...1993 Volume 26 Issue 12 Pages 2740-2744
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe expression of proliferating cell nuclear antigen (PCNA) was investigated by immunohistochemical study in 82 early gastric cancer patients to estimate the correlation between the proliferation kinetics and the depth of invasion, or the lymph node metastasis. PCNA labeling index in cases with submucosal invasion (sm cancer) was significantly higher than in cases with mucosal invasion (m cancer). Also, in patients with lymph node metastasis, labeling index was significantly higher than in those without lymph node metastasis. Therefore, the PCNA labeling index may be useful as a parameter of depth of invasion and lymph node metastasis. Furthermore, six sm cancer patient with lymph node metastasis had high PCNA labeling index (≥40%), and there was no lymph node metastasis in cases with low PCNA labeling index (<30%). As a result of this study, we conclude that reduced radical gastrectomy can be applied for patients with low PCNA labeling index.View full abstractDownload PDF (9615K) -
Hironobu Kimura, Masahiro Kanno, Hiroyuki Takamura, Hajime Arakawa, Ki ...1993 Volume 26 Issue 12 Pages 2745-2748
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSFlow cytometric (FCM) DNA studies were performd on cell suspensions of biopsy specimens from gastric mucosa in 73 patients with gastric cancer. DNA aneuploidy was detected in 49 tumors (67.1%), that is, in5l.7% (15/29) of early gastric cancers and77.3% (34/44) of advanced gastric cancers. The DNA index (DI) ranged from 1.0 to 2.8. A significant correlation was found between the DI of biopsy materials and that of surgically obtained ones (r=0.9426). Serosal invasion, lymph node metastasis, lymphatic invasion, and vascular invasion were significantly higher in aneuploidy than in diploidy (p<0.05). The prevalence of aneuploidy in endoscopically obtained specimens may provide additional prognostic information and information on biologic variables.View full abstractDownload PDF (8085K) -
Takao Suzuki, Takenori Ochiai, Matsuo Nagata, Yoshio Gunji, Takeo Yoko ...1993 Volume 26 Issue 12 Pages 2749-2755
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIn order to investigate the value of EAP therapy as a postoperative adjuvant chemotherapy for advancedgastric cancer, 12 patients with stage Itr gastric cancer and 13 patients with stage IV gastric cancer were treated by10 mglbody of mitomycin C on the day of surgery and 3 courses of EAP therapy (etoposide 60 mg/m2 ×3, adrimycin20 mg/m2 ×2, cisplatin 40 mg/m2 ×2) 3 weeks, 3 months and 6 months after surgery. Since bone mairow toxicityand nephrotoxicity were controllable, the treatments were carried out safely in all cases. The survival rate of the EAP therapy group was significantly better than that of the historical control goup in stage IV (p=0.0358), whereas there was no significant difference in stage III. The results of questionnaires indicated that the patientscould tolerate the side effects of EAP therapy. In conclusion, EAP therapy is a safe and effective treatment as apostoperative adjuvant chemotherapy for advanced gastric cancer.View full abstractDownload PDF (11486K) -
Kazuaki Kido, Ryunosuke Kumashiro, Chiaki Sano, Shigemichi Yamasaki, K ...1993 Volume 26 Issue 12 Pages 2756-2766
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIn 42 lesions of 20 cases of multiple gastric carcinoma, the c-Ki-ras oncogene was examined to investigate the characteristics of that carcinoma caused from gastric mucosa. A point mutation at c-Ki-ras was observed in 7 (35%) of 20 cases of multiple gastric carcinoma. The mutation ratio was statistically significantly higher than that of single gastric carcinoma, in which the point mutation was found in 6 (10.7%) of 56 cases. The mutation rate in 42 lesions of 20 cases of multiple gastric carcinoma was significantly higher in the main lesions (35.0%) than in the sublesions (9.1%). The point mutation was more found having more malignant potential cases example for in multiple gastric carcinoma than single gastric carcinoma, advanced case than early case, main lesion than sublesion, so point mutation might be showing its malignant potential. In cases showing the c-Ki-ras mutation in the sublesions of multiple gastric carcinomas, types of c-Ki-ras mutations that differed from those in the main lesions were found. Therefore, it was suggested that observation of the c-Ki-ras mutation type may be helpful in judging metastasis and infiltration in multiple gastric carcinoma lesions.View full abstractDownload PDF (20054K) -
Koichi Sato, Hiroshi Nozaki, Noburu Sakakibara1993 Volume 26 Issue 12 Pages 2767-2774
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSGraft viability after liver transplantation was studied from the aspects of donor fasting period and cold ischemic time (CIT) of liver preservation. Bile output during 3 hours after liver transplantation decreased according to the prolongation of CIT when the fasting period was morethan 48 hours. Survival rates up to 30 days were extremely poor: 0% with 48 hours of starvation and 6 hours of CIT, and 72 hours of starvation with both 1 and 6 hours of CIT. However, less than 6 hours of cold preservation in Euro-collins solution seemed to be safe. Liver tissue ATP was significantly lower with 72 hours of starvation, and ADP and adenylate energy charge were also lower with both 48 and 72 hours of starvation. Moreover, these concentrations gradually decreased as CIT was prologned. Electron micrographic findings showed vacuoles in the parenchymal cells and blebs in the sinusoid with more than 48 hours of starvation. Sinusoidal endothelial cells were degenerated and detached with 6 hours of CIT. In conclusion, it was suggested that 48 hours of starvation and 6 hours of CIT, and 72 hours of starvation and more than 1 hour of CIT decreased graft viability after liver transplantation, and could be associated with poor posttransplant results.View full abstractDownload PDF (15629K) -
The Results of Long Time Observation upon the Hepatic Artery Ligated LiverKiyotaka Ito1993 Volume 26 Issue 12 Pages 2775-2783
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSPartial portal arterialization to prevent hepatic insufficiency under obstruction of hepatic arterial inflow was studied for a week in 21 mongrel dogs that were divided into three groups. The first group underwent only hepatic arterial ligation, and was observed for 48 hours (HAL). The second group underwent partial portal arterialization after ligation of the hepatic artery, and was observed for 48 hours (PPA-S). The third group treated like the second group, and was observed for a week (PPA-L). Each group consisted of 7 dogs. Total hepatic blood flow decreased to about 60% 48hours after hepatic arterial ligation in the HAL group, but was maintained above the preoperative value in both the PPA-S and PPA-L groups. Portal venous pressure did not change in any group. Hepatic oxygen delivery decreased to 49% in the HAL group after 48 hours, whereas it could be maintained in the PPA groups even after a week. Hepatic oxygen consumption did not change significantly in any group. In the PPA-L group, GOT and GPT were not elevated as in the HAL group, and they recovered to the preoperative level after a week. In light microscopy, a marked necrotic change was noted in the HAL group, but no change was noted in the PPA groups. In conclusion, this experimental study showed that partial portal arterialization has beneficial effects on liver under hepatic artrial obstruction for at least a week.View full abstractDownload PDF (18819K) -
Shigeki Takashima, Fujio Tomita, Takayoshi Akiyama, Harukimi Gotohda, ...1993 Volume 26 Issue 12 Pages 2784-2792
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe lymph node metastases of 109 cases with right colon cancer were studied, and the following results wereobtained. Nodal involvement was found in 49.5% of these cases. The number of lymph nodes isolated was 7664nodes, an average of 70.3 nodes per specimen. The incidence of the lymph node metastases was 3.4% of 7664 nodes.The classical pattern, three arteries branching separately from the superior mesenteric artery, was present in only47.7%. It was very difficult to determin nodal involvement macroscopically. The metastatic rate was the highest inthe epicolic and/or the paracolic nodes near the tumor, and second in the intermediate nodes along the main artery.This suggests that the lymph flow along the main artery is stronger than that along the marginal artery.Metastases to the epicolic and/or paracolic nodes were confined within 10 cm from the tumor margin. In caecal andproximal ascending colon cancer, the most of the central nodal involvement was present in the nodes along theileocolic artery, and in middle and distal ascending colon cancer, it was recognized in the nodes along the ileocolic, right colic and middle colic artery. In right transverse colon cancer, it was mainly recognized in the nodes along themiddle colic artery. Metastases to the nodes in front of the vena cava inferior and to the right external iliac nodeswere recognized in 3 cases of caecal and ascending colon cancer invading to the caecum.View full abstractDownload PDF (18807K) -
Yoshiyuki Kurosaka1993 Volume 26 Issue 12 Pages 2793-2802
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe small intestine is unique in its high resistance to tumor formation. To clarify the organ specificity of the carcinogenresistance of the small bowel, a segment of the ileum was interposed in the distal colon in male Wistar rats. The rats were administered MNNG at a dose of 2.5mg/day via the rectum for 2weeks from the second postoperative week. The rats were then intraperitoneally injected with IdU and BrdU at a 2-hour interval, and sacrificed 10, 20, 30, and 40 weeks after the operation. Control rats were given saline in a similar manner. Cell kinetic analysis of intestinal epithelium was performed by the double labeling method. The following carcinogenic rates were achieved: 0% for the saline group; 0% for the MNNG-treated group at 10weeks, 54.5% at 20weeks, 35.0% at 30 weeks, and 52.6% at 40 weeks. There was a significant difference in the site of cancer occurrence between the MNNG-treated groups. The carcinogenic rate in the interposed ileum was 3.3%, significantly lower than the 38.3% in the distal colon. Also the number of cancers per rat was 0.03 in the interposed ileum, significantly lower than 0.70 in the distal colon. The migration time of the MNNG-treated group was 91.4±21.1 hours in the distal colon and 40.6±8.2 hours in the interposed ileum. The epithelial cell migration time from the bottom of the crypt to the surface in the interposed ileum was significantly shorter than that in the distal colon. From these results, it was concluded that the rapid renewal rates of the small bowel epithelium cells was the principal carcinogenresistance mechanism of the small bowel.View full abstractDownload PDF (20691K) -
Hisashi Onodera, Tae Bun Park, Masato Hasegawa, Yoshihiro Yamazoe, Tad ...1993 Volume 26 Issue 12 Pages 2803-2808
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe analyzed 23 patients (5 males and 18 females, mean age 60) who had been operated on in our department for radiation enteritis. 1) These patients were divided into two types according to the time of surgery. Sixteen of 23 (70%) patients were operated on a median of 12 months after radiotherapy, while 7 (30%) underwent surgery more than 10 years later. 2) They were also divided according to the dominant symptoms. Fourteen of 23 (60%) complained of nausea and abdominal distension suggestive of small bowel injury, whereas 7 (30%) had tenesmus and anal bleeding indicating proctitis. Two patients developed perforative peritonitis. 3) The operations performed were as follows: extensive intestinal resection and anastomosis (13), pull-through procedure (3), rectal excision (2), ileostomy (3), by-pass operation (2). Two patients with peritonitis died despite open drainage. Nineteen intestinal anasotmoses were all successfully performed. Patients who underwent extensive small bowel resection could resume ordinary daily life without symptoms. Our analysis showed that small bowel injury should be treated by generous resection of the affected bowels followed by anastomosis of the disease-free ends, while rectal lesions are best dealt with by restorative proctectomy. This may provide a good quality of life and minimize major postoperative complications such as leakage.View full abstractDownload PDF (12542K) -
Haruhiko Inufusa, Toshiyuki Adachi, Masato Nakamura, Katsuhisa Shindo, ...1993 Volume 26 Issue 12 Pages 2809-2815
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe cancer specific antigen coagulant cancer antigen 1 (CCA-1) is a novel serine protease that has a strong potential to activate Factor X directly. The monoclonal antibody AI18, which recognizes CCA-1 and has a specific inhibitory effect on CCA-1 coagulant activity, was used for the immunohistological detection of CCA-1 on colorectal cancer tissues, and for comparison to CEA expression. CCA-1 expression on colorectal cancers was detected in 92% of the patients, while CEA was found in 98% of patients. Expression of CCA-1 on normal colorectal tissues was not observed, hence CEA was expressed in 72% of patients. Half the cases of colorectal adenoma and cancer'in-adenoma showed positive CCA-1 expression. CCA-1 expression was observed partially on squamous epithelial cells, gastric glands and bronchial mucoglands of normal adults and fetuses. CCA-1 is a novel cancer-specific antigen with well-characterized biological activity.View full abstractDownload PDF (14960K) -
Yoshinori Shirai, Masao Nunomura, Hiromi Sarashina, Norio Saitoh, Shin ...1993 Volume 26 Issue 12 Pages 2816-2821
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSUrinary function was evaluated after personal interview in 34 patients and after examination of the results of a urodynamic study in 15 of these, in whom resection for carcinoma of the rectum with preoperative irradiation therapy was performed. From the results of the personal interview, urinary urgency was found to have occurred in 19.2% when preoperative radiation was over. Urinary function after surgery was preserved in the group of patients who had undergone bilateral and unilateral pelvic plexus nerve preserving operations, whereas urinary dysfunction occurred in 66.7% of the group of patients who had undergone operations without pelvic plexus nerve preservation. Urinary dysfunction was recognized in 53.9% of the group of patients who had undergone abdominoperineal resection, but in none of the group of patients who had undergone low anterior resection. The urodynamic study showed that 21.4% had residual urinary output of more than 40ml, 23.1% had the first desire to void at less than 100ml, 15.4% had the maximum desire to void at less than 200ml, 28.6% had compliance of the bladder at less than 20ml/cmH2O when preoperative irradiation was over, and these data became worse 1 month after surgery. However these phenomena were improved 1 year after surgery.View full abstractDownload PDF (12313K) -
Kazuomi Iwasaki, Takuo Shinozaki, Satoshi Yamaguchi, Takafumi Urakawa, ...1993 Volume 26 Issue 12 Pages 2822-2826
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe report a case of gastric cancer limited to the mucosa that metastasized to the paraaortic lymph node. A 40-year-old man was admitted to our hospital complaining of epigastralgia and nausea. Radiologic and endoscopic examination of the upper gastrointestinal tract showed superficial spreading IIc type cancer in the antrum. Distal gastrectomy with R4 lymphadenectomy was performed. Pathological examination revealed poorly differentiated adenocarcinoma limited to the mucosa, 5.4×4.5cm in size, and marked lymph vessel invasion in the submucosa, muscularis propria and subserosa. The tumor metastasized to the paraaortic lymph node. The patient is alive with no recurrence1year and 4 months after surgery.View full abstractDownload PDF (8946K) -
Yoshinari Hashimoto, Hiroshi Fukuda, Syoji Matsui, Tsutomu Fujimoto, T ...1993 Volume 26 Issue 12 Pages 2827-2831
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe report a case of gastric leiomyoblastoma in a child. An 11-year-old boy was admitted because of vomiting and melena. Laboratory data showed severe anemia (RBC 184×104/mm3, Hb 5.2g/dl, Ht 16.6%) and hypoproteinemia (4.7 g/dl). Upper gastrointestinal series and gastroendoscopy showed a sub-mucosal tumor with central erosion in the anterior wall of the stomach body, about 3 cm in diameter. Distal partial gastrectomy combined with dissection of perigastric lymph nodes was performed. The resected specimen showed a submucosal tumor on the stomach body, measuring 4×2.5×1.7cm in size, with a central ulcer. Histological examination revealed leiomyoblastoma of the stomach (atypical oval cells each with a clear space near the nucleus), and no metastasis to lymph nodes. The postoperative course was uneventful. Ultrasonography of the abdomen showed no remarkable findings, and gallium scintigraphy showed no hot lesion in the chest or abdomen. We finally diagnosed leiomyoblastoma of stomach in a child. Four cases of gastric leiomyoblastoma in childhood have been reported in Japan, with 13 cases (11 female) in the world literature. Seven cases had Carney's triad: gastric leiomyoblastoma, functioning extraadenal paraganglioma and lung chondroma. Our case did not have this triad. In following the clinical course of children with gastric leiomyoblastoma, special attention must be paid to the possibility of Carney's triad.View full abstractDownload PDF (8476K) -
Nobuharu Yanabu, Keiichiro Mori, Yasuo Wada, Hajime Nakamura, Yoshio Y ...1993 Volume 26 Issue 12 Pages 2832-2835
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe performed a successful right lobectomy of the liver in a hemophilia A patient with hepatocellular carcinoma under supplementation of factor VIII concentrate. We administered 2500 units of factor VIII concentrate one hour prior to surgery. The intraoperative course was uneventful except for oozing from the abdominal wall near the end of the operation. This was controlled by an additiona12500 units of factor VIII concentrate. Since blood coagulation factorts including factor VIII are consumed more extensively in major hepatic resection than other kinds of abdominal surgery, supplementation of a lager amount of factor VIII concentrate may be necessary in the intra-and postoperative management of hepatic surgery in hemophilia patients.View full abstractDownload PDF (7235K) -
Yuichi Machiki, Yuji Nimura, Naokazu Hayakawa, Junnichi Kamiya, Satosh ...1993 Volume 26 Issue 12 Pages 2836-2840
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe report a 45-year-old asymptomatic female patient in whom abdominal CT revealed a hepatic tumor. Plain CT scan showed a low absorptive lesion in the right posterior segment of the liver with a density of+56 Hounsfield units. Dynamic CT scan showed homogeneous enhancement 10 seconds after the intravenous injection of contrast medium, which was washed out after 60 seconds. Ultrasonography demonstrated a hyperechoic mass, inside which was an inhomogenous oval. The Tl-weighted MR image showed an area of low intensity, which the T2-weighted image showed high intensity. Hepatic arteriography showed a hypervascular mass. Hepatic focal nodular hyperplasia was suspected preoperatively, and partial hepatic resection of the right posterior segment was performed. The cut surface of the tumor was dark reddish with a well-defined margin without capsule. The pathological diagnosis was hepatic angiomyolipoma. This case presented a non-specific hypervascular tumor, because of the very small fat component, which made preoperative diagnosis difficult.View full abstractDownload PDF (9656K) -
Shigeki Murakami, Nobushi Ishiga, Tatsuo Sho, Kiyohiro Inhihara, Kunih ...1993 Volume 26 Issue 12 Pages 2841-2845
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe case of a 27-year-old woman who complained of epigastralgia with giant hepatic angiomyolipoma is reported. This tumor occupied her whole right lobe. The typical medical findings of hepatic angiomyolipoma were a marked hyperechoic mass on US, a low density mass on plain CT, and a hypervascular mass on contrastenhanced CT and angiography. But the findings varied with the ratio of adipose tissue to muscle. This case has the upper typical medical findings, but it was necessary to diagnose from the giant hemangioma. It was especially difficult to differentiate hepatic angiomyolipoma from small hepatocellular carcinoma (≤2 cm) undergoing fatty degeneration. Histologically they were characterrized by an admixture of blood vessels, adipose tissue and smooth muscle, but in addition to these components, extramedullary hematopoiesis was seen especially in hepatic angiomyolipoma. This finding was seen in this one. No case of malignant hepatic angiomyolipoma has been reported, however malignant transformation of renal angiomyolipoma was recently reported, so it is necessary to provide careful follow-up.View full abstractDownload PDF (9990K) -
Isao Kobayashi, Susumi Ohwada, Yasuo Morishita1993 Volume 26 Issue 12 Pages 2846-2849
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 43-year-old woman with ehpatocellular carcinoma following complete remission ofmalignant lymphoma is reported. After three years of complete remission of malignant lymphoma, her a fetoprotein level increased to 1448 ng/ml. Ultrasonograms and computed tomograms revealed a tumor in the posterior superior segment of the liver. Radical right hepatectomy was performed. Histologically, the tumor was Edmondson III, hepatocellular carcinoma. Follow-up examination of secondary malignant disease is important for cancer patients, and can contribute to in the quality of life.View full abstractDownload PDF (7670K) -
Toshihiro Tsubono, Fujio Sugimoto, Kazuhiro Tsukada, Katsuyoshi Hatake ...1993 Volume 26 Issue 12 Pages 2850-2853
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA case of parapapillary choledochoduodenal fistula complicated by active hemorrhage is reported herein. A 68-year-old man underwent percutaneous transhepatic gallbladder drainage for acute cholecystitis. Cholangiography through the biliary drain disclosed a bile duct stone. Choledochoduodenal fistula developed one week after biliary drainage. He underwent cholecystectomy and exploration of the common bile duct. A T-tube was placed in the common duct. On postoperative day 13, three weeks after developing the fistula, he suffered hemobilia and massive rectal bleeding with shock. Endoscopic hemostasis or arterial embolization was impossible. Exploration of the duodenum demonstrated active bleeding from the fistula. Hemostasis was obtained by placing a suture ligature into the fistula. No further bleeding or cholangitis occurred. Active hemorrhage from choledochoduodenal fistula is a rare but possible complication in the early period after developing the fistula. It is necessary to keep hemorrhagic complication in mind in the management of choledochoduodenal fistula.View full abstractDownload PDF (8491K) -
Mikio Yasumura, Yutaka Ozeki, Nagaki Matsubara, Hideki Ishida, Tomihik ...1993 Volume 26 Issue 12 Pages 2854-2858
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA55-year-old man was admitted to our hospital because of icterus. Ultrasonography revealed a markedly dilatated intrahepatic bileduct and an irregular tumor of the hepatic hilus. Computed tomqgraphy showed a low densityarea, 30×20mm in size, with central calcification. Under a diagnosis of bile duct carcinoma of thehepatic hilus occurring from the right intrahepatic bile duct, right trisegmentectomy withcaudate lobectomy was carried out. The tumor specimen was 30×25mm in size, and was histologically found to be well differentiated tubular adenocarcinoma. Microscopically, there were many psamoma body-like calcifications in the duct. The mechanism of calcification in this case was beiieved to be dystrophic calcification. Calcification is a rare finding bile duct carclnoma.View full abstractDownload PDF (9366K) -
Satoru Motoyama, Hideo Terashima, Tomio Matsuoka, Masahiro Saito, Shic ...1993 Volume 26 Issue 12 Pages 2859-2863
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA case of renal cell carcinoma, that metastasized to the pancreas and skin is reported. The patient was a 67-year-old woman who relapsed 19 years after surgical treatment of the primary lesion and was diagnosed to have two metastatic pancreatic tumors and a solitary subctaneous nodule. As dissemination of this malignancy to the pancreas occurs infrequently after radical surgery, only 17 cases of this type of recurrence have been documented in the literature. Surgical resection of the metastatic pancreatic tumor as well as the skin lesion was successfully carried out in this case.View full abstractDownload PDF (10177K) -
A Clinicopathological Studies on 126 Operated Patients Including Our 2 CasesTadashi Katsuramaki, Masami Kimura, Toshihiko Mikami, Kazuhiro Yamashi ...1993 Volume 26 Issue 12 Pages 2864-2868
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThis report presents two cases of solid and cytic tumor (SCT) of the pancreas, and discusses the indications for surgical treatment on the basis of 126 cases discribed about macro-and microscopical observations among SCT cases reported in Japan. Case 1 was a 23-year-old woman who complained of abdominal mass. An encapsulated cystic tumor (11×7cm in size) was detected at the pancreatic tail, and distal pancreatectomy was performed. Case 2 was a 44-year-old woman in whom a cystic tumor (5×4cm in size) with calcification in the capsule was detected at the pancreatic body. This patient also underwent distal pancreatectomy. Histologically, both tumors were confirmed to be SCT. In the review of 126 cases of SCT including our 2 cases, metastasis to a regional lymphonode was observed in only one case, and post operative metastasis or recurrence were found in 3 cases. The characteristic patterns of metastasis and/or recurrence were hepatic metastasis, but there was no metastasis to a lymphonode. There were 2 dead cases, all over 60 years of age, and the causes of death were related to hepatic metastasis. Therefore, it was suggested that the early detection of hepatic metastasis is most important in order to obtain better results. Further analysis will be necessary to assess the significance of the relationship between surgical treatment and metastasis to lymph node.View full abstractDownload PDF (9005K) -
Masafumi Shiotani, Yonson Ku, Yoshi Nagahata1993 Volume 26 Issue 12 Pages 2869-2873
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe experienced a case of lymphangioma of the lesser omentum. The patient was a 56-year-old woman who visited the hospital with a complaint of upper abdominal discomfort. Based on the preoperative diagnosis of cyst in the bursa omentalis obtained by imaging techniques including abdominal ultrasonography, CT and MRI, surgery was performed. since a multilocular tumor was found mainly in the lesser omentum, we considered the tumor was of lesser omentum origin. The tumor was 12.0×5.0×3.4cm in size, 150g in weight, and had a smooth, dark red surface. Histopathological examination confirmed a diagnosis of lymphangioma. Lymphangioma of the lesser omentum is a relatively rare disease, and to date only 25 cases have been reported, in the Japanese literature, excluding the present case. In this paper, we reviewed the reported cases of lymphangioma of the lesser omentum in Japan, with special reference to the diagnostic and therapeutic aspects.View full abstractDownload PDF (8885K) -
Sumitomo Kato, Hitoya Kobayashi, Tsukasa Nakagawa1993 Volume 26 Issue 12 Pages 2874-2878
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA case of carcinoma of the vermiform appendix forming a colonic and vesical fistula is presented along with a review of the literature previously reported in Japan. A 48-year-old woman was admitted to our hospital because of abdominal distension with pain. Colonoscopy revealed a fistula in the sigmoid colon and a tumor at the orifice of the appendix. A CT scan of the abdomen disclosed a distended appendix filled with high density substance, suggesting the accumulation of mucus. On exploration, a distended, thickened, enlarged tumor of the vermiform appendix that invaded to the sigmoid colon and urinary bladder with peritoneal dissemination was found. Ileocecal resection and removal of the colonic and vesical fistula were performed. Gross examination of the specimen revealed a distended vermiform appendix, inside which was a mucinous tumor connecting to the sigmoid colon and urinary bladder through the fistula. Histological evaluation revealed mucinous cystadenocarcinoma. Review of the 15 cases with fistula formation reported in the Japanese literature indicated that the histological type was mostly mucinous cystadenocarcinoma. Fistula formation was presumably due to the biological behavior of mucinous cancer, which was likely to invade outward. Although fistula formation in appendiceal cancer in itself may imply a more advanced stage and result in poorer prognosis, 4 of 15 reviewed resections were evaluated as curative, suggesting that an extirpative procedure with curative intent should be attempted for invasion to the adjacent organ or metastatic lymph nodes in the management of carcinoma of the appendix with fistula.View full abstractDownload PDF (9191K) -
Kenji Omura, Eiji Kanehira, Fumio Ishida, Iwao Adachi, Yutaka Mochiki, ...1993 Volume 26 Issue 12 Pages 2879-2882
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe present here four case of adult intussusception following harvesting of a free jejunal graft. The four patients were diagnosed as having hypopharyngeal or cervical esophageal carcinoma, and a pharyngolaryngoesophagectomy was performed. To restore the esophageal continuity, a piece of free jejunal graft was harvested from the upper portion of the jejunum in each patient. The two jejunal stumps were anastomosed in an end-to-end fashion using an Albert-Lembert stitch. The patients complained of abdominal pain, nausea and vomiting during the postoperative course. At first, they were treated as having an adhesive ileus. In spite of conservative therapy, each patient required repeated surgery. Only one patient was diagnosed as having intussusception preoperatively, the rest were diagnosed as having adhesive ileus. All of them showed intussusception at surgery, and three required resection of the morbid intestine, including the leading point that was the anastomotic site. The postoperative course was uneventful in each patient, and no recurrent intussusception has occurred. After harvesting a free jejunal graft, it is necessary to remember the possibility of this rare complication.View full abstractDownload PDF (8583K) -
Atsuro Niwa, Shingi Sasaki, Takamori Mitsui, Takehiro Kato, Hiroshi Ko ...1993 Volume 26 Issue 12 Pages 2883-2887
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSNecrotizing fasciitis caused by bowel disease is a rare but life-threatening infection. A 46-year-old male schizophrenic was trasferred from a local mental hospital to our hospital with abdominal pain and distention. Clinical examination revealed swelling and redness of the right flank and lower abdominal wall with tenderness, and anal fistula. Laboratory data showed leucocytosis, hypoproteinemia and hyperglycemia. CT scan demonstrated extensive gas and inflammatory exudate in the paravesical space, retroperitoneal space and abdominal wall. A diagnosis of necrotizing fasciitis involving the pararectal space, retroperitoneal space and abdominal wall caused by an anal fistula was made. Urgent aggressive surgery was performed. The retroperitoneal space was opened and drained by the extraperitoneal incision. The affected abdominal wall was incised and necrotic tissue debrided as thoroughly as possible. Systemic administration of antibiotics and gamma-globulin was started after surgery. In addition to the initial surgery, repeated daily irrigation of the retroperitoneal space, perirectal space and abdominal wall was performed under general anesthesia. The patient made a full recovery and was transferred to the mental ward on the 55th day after admission. Early diagnosis, rapid initial aggressive surgery and repeated daily surgery are important to save the patient's life.View full abstractDownload PDF (10673K) -
Akira Kusuyama, Kimikazu Iwamoto, Naoya Watanabe, Satoshi Murata, Keiz ...1993 Volume 26 Issue 12 Pages 2888-2892
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 38-year-old woman underwent an operation for panperitonitis approximately 3.5 years ago, due to perforation of rectal cancer, characterized as Borrmann type 3 well differentiated adenocarcinoma. She was admitted to our hospital with abdominal mass and highly positive carcinoembryonic antigen (CEA) levels on October 1992, and diagnosed as having paraaortic lymph node metastases on the basis of abdominal ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI) findings. At our second-look operation, however, inferior vena cava thrombus was found as a recurrence. It was histologically proved to be well differentiated adenocarcinoma. We believe this is the first report of metastatic inferior vena cava thrombus and lymph node metastases in pelvic cavity caused not direct invasion but hematogenous infiltrative growth without any other metastatic tumors after surgery for panperitonitis due to the perforation of rectal cancer.View full abstractDownload PDF (8863K) -
Yoshiaki Nakano, Katsuhiro Kawasaki, Yuichi Kawabata, Yoshihiko Ota, T ...1993 Volume 26 Issue 12 Pages 2893-2896
Published: 1993
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 59-year-old woman was admitted to our hospital because of right upper abdominal tumor. She had a history of cafe-au-lait spots and skin tumors on her entire body from infancy. Abdominal CT and ultrasonographic findings indicated that the tumor was 4.0×4.0 cm in size on the right kidney and that the wall was partially calcified. We diagnosed the tumor as a retroperitoneal teratoma, and performed excision. There was viscous yellow liquid and hair within the tumor. Histological diagnosis was mature teratoma. Retroperitoneal teratoma in an adult is very rare, and has been reported in 31 cases in Japan. Computed tomography is useful for the diagnosis. Whether it is malignant or benign cannot be verified except by histological findings. However 31% of cases were malignant, so we should emphasize the importance of surgical removal and the early diagnosis.View full abstractDownload PDF (8492K)
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