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Volume 28, Issue 9
Displaying 1-12 of 12 articles from this issue
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Toshio Mitomi1995 Volume 28 Issue 9 Pages 1901-1910
Published: 1995
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIn this paper, treatments of esophageal cancer was described, in which our department has been involved for twenty years. Since radiotherapy was first introduced to treat it, it has been gradually recognized that surgery is more effective than radiotherapy. Shortly after the introduction of surgery, main issue was to improve its resectability. Then, a wide lymph node dissection of cervical, thoracic, and abdominal lymph nodes has been often performed. Now, most suitable treatment can be chosen among a variety of treatment modality for a patient of a certain disease state, since early esophageal cancer has increased in number. According to the reports of superficial esophageal cancer by Nabeya, Mitomi and Endo, mucosal cancer has gradually increased. In our institution, superficial cancer was 25% of all esophageal cancer. tremendous amounts of serial endoscopic findings of ENNG-induced canine esophageal cancer were clinically useful in early detection of esophageal cancer. Furthermore, screening examination on the esophagus was worthy in patients with head and neck cancer or alcohol dependency. As endoscopic mucosal resection for early esophageal cancer was developed, indication of extensive lymph node dissection was determined, results of immunotherapy and chemotherapy were improved, and more accurate diagnosis of a main lesion and lymph node metastasis was developed, new development in treatments of esophageal cancer would be expected in the near future.View full abstractDownload PDF (18531K) -
Surgery Using Univariate and Multiplelogistic Regression AnalysisKazusada Shirao1995 Volume 28 Issue 9 Pages 1911-1918
Published: 1995
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIn order to predict postoperative pulmonary complications, I studied 47 patients with esophageal cancer who underwent esophagectomy between October 1987 and March 1991, using univariate analysis and multiple logistic regression analysis. Pulmonary complications occurred in 15 patients. Age, vital capacity, forced expiratory volume and serum transferrin were significantly different between the cases with and without pulmonary complications. As a result of multiple logistic regression analysis, vital capacity, percentage of ideal body weight and serum prealbumin were selected as factors of predicting postoperative pulmonary complications. When the decision level was fixed at 0.3, I had an overall prediction rate of 83% (39/47 cases) between October 1987 and March 1991 by retrospective study, and 73% (30/41 cases) between April 1991 and October 1993 by prospective study. It is concluded that predicting pulmonary complications is useful for perioperative management of esophageal cancer surgery.View full abstractDownload PDF (14743K) -
Satoru Motoyama, Shichisaburo Abo, Michihiko Kitamura, Reijiro Saito, ...1995 Volume 28 Issue 9 Pages 1919-1925
Published: 1995
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSFrom 1989 to 1993, 129 patients with thoracic and abdominal esophageal cancer underwent esophagectomy at the Second Department of Surgery, Akita University Hospital. In this study, in order to analyze the mechanism of occurrence of postoperative hyper bilirubinemia (PHB), 93 patients who underwent total or subtotal thoracic and abdominal esophagectomy without any complications were selected. They were reconstructed by cervical or upper thoracic esophagogastrostomy through the posterior mediastinal route using a right thoraco-abdominal approach. Of the 93 patients, 41 experienced PHB within 2 weeks after surgery (group H) and 52 did not (group N). We examined the preoperative residual rate of indocianine green, the preoperative creatinine clearance value, intraoperative blood loss, total volume of blood transfusion, total operation time, the duration of open chest exploration, the duration of systolic blood pressure below 100mmHg or 80mmHg, the urine amount during operation, and the routine laboratory tests on liver function including serum levels of bilirubin, the number of leucocyte and it's fractions from the day before surgery to the 14th postoperative day (POD). In group H, the mean value of total serum bilirubin increased to more than 2mg/dl on the 4th POD, peaked on the 5th POD (3.6±2.0mg/dl), then dropped gradually. Intraoperative blood loss and total volume of blood transfusion were greater significant (p<0.05) in group H. The rate of occurrence of PHB was lower in patients who had been treated with prostaglandin E1 than those who had not. That suggests that intraoperative hemodynamic factors may contribute to the pathogenesis of PHB and prostaglandin E1 can protect the liver from sever stress.View full abstractDownload PDF (13135K) -
Masataka Ikeda, Mitsukazu Gotoh, Hiroaki Nagano, Masato Sakon, Toshio ...1995 Volume 28 Issue 9 Pages 1926-1932
Published: 1995
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIn order to clarify the role of intraabdominal drains after hepatic resection, 54 patients who underwent hepatectomy were analyzed based on drainage-tube-related complications and duration of hospital stay. The patients were divided into two groups. In group A (n=29), drains were shortened with the decrease in drainage, and kept in place until the drainage became serous. In group B (n=25), drains were removed immediately when complications such as biliary leakage, bleeding and intractable ascites were not demonstrated. The duration of drainage and the postoperative hospital stay of the patients who were free of complications were significantly shorter in group B (n=19) than in group A (n=17) (8.7±2.5 vs 14.8±6.7 p <0.001, 15.6±2.8 vs 24.8±10.4 p <0.001, respectively), although none of the parameters was significantly different between the patients who had complications in group A (n=12) and group B (n=6). Early removal of abdominal drains in group B patients, when performed according to the criteria described above, did not cause any adverse effect on the patient's clinical course. These results indicate that early removal of abdominal drains significantly reduces the postoperative hospital stay of patients undergoing hepatectomy without causing any adverse effect, when the patients are secured from the complications of biliary leakage, bleeding and intractable ascites.View full abstractDownload PDF (13505K) -
Daisuke Kuroda, Michio Kato, Satoru Okumoto, Chikao Yasuda, Michizo Ha ...1995 Volume 28 Issue 9 Pages 1933-1937
Published: 1995
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe have devised a technique of thoracoscopy-assisted esophagectomy with minithoracotomy, which is safe and able to reduce surgical stress.We report here the clinical use of this method.The patient was a 76-year-old man who had advanced esophageal cancer of type 3, 8cm in length at Im.He also had severe obstructive pulmonary disorder.The spirometric examination showed that his FEV 1.0% was 39.3%, In the operation, the patient was placed in the supine position, and laparotomy was performed.Following reconstruction with the stomach through the retro-sternal route, a right mini-thoracotomy, which was approximately 10cm in length, was made through the 5th intercostal space with the patient in a left lateral position. Two 12mm trocars were placed in the 4th and 6th intercostal spaces.The thoracic esophagus could be removed safely under the thoracosopic guidance.His respiratory state in the postoperative period was stable, and there was no deterioration of postoperative blood gas findings in comparison with preoperative ones.We consider that it may be possible to extend the applications of this method to patients with preoperative pulmonary complications, the aged, or those with superficial cancer because of the magnified operative view and better manipulation permitted by thoracoscopic observation.View full abstractDownload PDF (9712K) -
Katsuki Muneoka, Atsushi Nashimoto, Juei Sasaki1995 Volume 28 Issue 9 Pages 1938-1942
Published: 1995
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 54-year-old woman with advanced gastric cancer underwent total gastrectomy, splenectomy, and resection of the caudal pancreas with para-aortic lymph node dissection. Microscopic examination showed the tumor to be a poorly differentiated adenocarcinoma that invaded to the subserosal layer. There were many lymph node metastases, and the number of positive para-aortic nodes was 26. Postoperative adjuvant chemotherapy consisted of sequential 5 FU and MTX therapy. As of 6years and 2months, there have been no signs of recurrece and she is alive and healthy. Several institutions in Japan have employed extended dissection of para-aortic lymph nodes. In this case, the number of metastatic para-aortic lymph nodes was 26, the largest number in the world. There have been no reports of a 5-year survivor with more than 20 positive para-aortic nodes. Para-aortic lymph node dissection is indicated for patients with HO, PO, T3 and/or N2 except for absolutely non-curative cases. The significance of para-aoritc lymph node dissection should be confirmed by a large-scale prospective randomized control study.View full abstractDownload PDF (9098K) -
Hideo Matsumoto, Shuichi Nomura, Shinichirou Tanaka, Isamu Nagahiro, R ...1995 Volume 28 Issue 9 Pages 1943-1947
Published: 1995
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA case of watery diarrhea, hypokalemia and achlorhydria (WDHA) syndrome, associated with primary hyperparathyroidism, is reported. A 71-year-old man was introduced to our department of surgery because of watery diarrhea. A mass in the head of the pancreas was detected with ultrasonography and magnetic resonance imaging (MRI). Moreover, swelling of the parathyroids was observed, although abnormal findings of pituitary gland were not remarkable. From laboratory data, hyperglycemia and hypokalemia were diagnosed and also the levels of vasoactive intestinal polipeptide (VIP) and parathyroid hormone (PTH) were very high in the serum, 1450 ng/ml and 8300 pg/ml, resp ctively. First, pancreaticoduodenectomy and later total parathyroidectomy in combination with autotransplantation of the parathyroid were performed. The procedure ameliorated the watery diarrhea and normalized the serum levels of VIPA and PTH. This is a case of multiple endocrine neoplasms (MEN) Type 1, consisting of the pancreatic VIP oma and hyperplasia of the parathyroid.View full abstractDownload PDF (9470K) -
Takahisa Kyogoku, Norihiko Yamada1995 Volume 28 Issue 9 Pages 1948-1952
Published: 1995
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTwo cases of postoperative intussusception secondary to long intestinal tubes are reported. A 80-year-old male and a 46-year-old female were admitted to our hospital because of adhesive small-bowel obstruction. Long intestinal tubes were inserted, but copious drainage continued, and so laparotomy were performed. After lysis of adhesions, intestinal tubes were remained in the jejunum in both patients. After withdrawal of the tubes, the patients began vomiting, and ultrasonography and CT scan of the abdomen demonstrated intussuscepted bowel. At the second surgery, antegrade jejunojejunal intussusceptions were found and reduced in both patients. It is supposed that the small bowel was telescoped over a long intestinal tube, and pleats were formed, fixed by adhesions and may have acted as a lead point for intussusception. In using a long intestinal tube, the possibility of intussusception must be considered, even after tube withdrawal.View full abstractDownload PDF (8542K) -
Takatoshi Shimoyama, Kiyoomi Nishikawa, Khoji Azuma, Hiroshi Hisano, S ...1995 Volume 28 Issue 9 Pages 1953-1956
Published: 1995
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSDuplication of the colon and rectum in the adult is a rare anomaly. A 26-year-old man with recurrent episodes of pneumatouria and lower abdominal pain visited our hospital. Barium enema showed a duplicated colon at the sigmoid colon which ended blindly in the pelvis. Cystoscopy revealed incomplete duplication of the urinary bladder, but the communication between the urinary bladder and the duplicated colon was not detectable on cystography. X-ray of the vertebral column showed spina bifida of the sacrum. Resection of the duplicated colon on the mesenteric side of the sigmoid colon and the partial resection of the urinary bladder were performed. The resected specimen showed a tubular duplicated colon measuring 30cm in length which had histologically normal structure of he colonic wall.View full abstractDownload PDF (8961K) -
Katsuyuki Kunieda, Shigetoyo Saji, Syuntaro Honda, Akihiko Yoshida, Ky ...1995 Volume 28 Issue 9 Pages 1957-1961
Published: 1995
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe reported a very rare case of villous tumor of the rectum with adenoacanthoma invaded to the submucosal layer. The patient showed a fuluminant course with liver metastasis. A 75-year-old woman consulted a doctor with the chief complaint of anal bleeding, and a rectal tumor was pointed out. She was diagnosed as having rectal villous tumor with cancer invaded to the submucosal layer, and underwent local resection of the tumor by sacral approach after informed consent had been obtained. The tumor was flat in shape and 95×88mm in size. In histological study, the tumor was mainly well differentiated adenocarcinoma with invasion to the mucosal layer, and showed adenoacanthoma and poorly differentiated adenocarcinoma with invasion to the submucosal layer to the extent of 7mm. It also showed regional lymphnode metastasis of poorly differentiated adenocarcinoma. After her refusal to undergo re-operation, local recurrence with severe pain and liver metastasis were found 7 months following the first operation, and she underwent posterior pelvic exenteration. The histology of the recurrent foci showed adenoacanthoma. Her condition deteriorated with progressive cancer enlargement, and she died one year after the first operation. It should be taken into consideration that some of rectal villous tumors show fuluminant course, though local resection is thought to be polular treatment for them.View full abstractDownload PDF (9751K) -
Tetsuya Kaneko, Keisuke Terabe, Koichi Itoh, Koichi Fujita1995 Volume 28 Issue 9 Pages 1962-1966
Published: 1995
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 50-year-old woman was referred to our hospital for rectal cancer. Abdominal CT showed swelling of the para-aortic lymph nodes, suggesting possible metastasis. Preoperative laboratory findings indicated a slightly high Ievel of CEA (3.9ng/ml) and a very high level of CA19-9 (2090ng/ml). An operation was performed on December 17, 1989. Operative findings confirmed severe para-aortic lymph node metastasis. Abdominoperitoneal resection was performed with extended lymph node dissection including the paraaortic lymph nodes from the level of the left renal vein to the aortic bifurcation. Pathological examination revealed that all dissected para-aortic lymph nodes were metastatic. DNA histogram of the rectal cancer showed an aneuploid DNA pattern. Continuous intravenous administration of 5-fluorouracil (500mg/day) was performed for 30 days. After that, tegafur was administered perorally by a local doctor. CA19-9 was normalized after the operation. At six years and 1 month after the operation, the patient is well without any sign of recurrence. Long-term survival after rectal cancer surgery in a patient with a high level of CA19-9, metastatic para-aortic lymph nodes and DNA aneuploid pattern is considered rare.View full abstractDownload PDF (10391K) -
Yoshichika Okamoto, Kazuo Suzuki, Haruhiko Chigira, Takehito Katoh, Yo ...1995 Volume 28 Issue 9 Pages 1967-1971
Published: 1995
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSFrom November 1988 through January 1994, six patients with seven lesions of obturator hernia underwent surgery in Toyohashi Municipal Hospital. All the patients, ranging from 77 to 90 years old, were women, and all showed ileus symptoms. As concerns Howship-Romberg sign (H-R sign), patients had complaints in their lower extremities in six cases (86%), and objective findings were observed preoperatively in two of them. The period between the initial symptom and the operation ragned from 2 to 19 days (mean 8.1 days). Preoperative diagnosis of obturatory hernia was made in four cases (57%), where H-R sign and clinical images such as CT scan, ultrasonography and X-ray contrast examination of the intestine through a long tube were useful. The incarcerated bowel was the ileum in all cases: four lesions in the left obturator foramen and three in the right. Resection of the bowel was done for four cases, and the remaining cases without bowel resection were treated with surgery relatively soon after the initial symptom. In the treatment of aged women presenting ileus, it is important to take obturator hernia into consideration. H-R sign, CT scan and ultrasonography are useful for early diagnosis of obturator hernia.View full abstractDownload PDF (8979K)
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