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Volume 29, Issue 5
Displaying 1-24 of 24 articles from this issue
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Hajime Saitoh, Shichisaburo Abo, Michihiko Kitamura, Yoshihiro Minamiy ...1996 Volume 29 Issue 5 Pages 955-959
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSPostoperative respiratory dysfunction in esophageal cancer patients during the early period after surgery was freaquently encountered, but its causes were not clear. We investigated the causes of postoperative respiratory dysfunction from the point of view of respiratory muscle strength in 13 patients with esophageal cancer. Respiratory muscle function was evaluated with maximal inspiratory mouth pressure at the RV level (MIP) and maximal expiratory mouth pressure at TLC level (MEP). Skeletal muscle function was evaluated with grip strength (GS). Skeletal muscle function was evaluated with grip strength (GS), MIP, MEP and GS were measured on the before surgery, and on the 3rd, 4th, 5th, 6th, 7th, 14th, and 21st postoperative days (POD). On the 3rd POD, MIP and MEP had significantly decreased to 34.7 ± 15.4% and 43.1 ± 3.3% respectively of the preoperative value (p<0.05), and on the 21st POD, recovered to 86.4 ± 12.7% and 87.2 ± 9.0% respectively of the preoperative value. MIP and MEP were correlated significantly with forced vital capacity (FVC) and one-second forced expiratory volume (FEV1.0), but GS was weakly correlated with MIP and MEP. Our data suggest that MIP and MEP are a useful indexes of postoperative respiratory function and there was a possibility that respiratory muscle disorder could have contributed to postoperative respiratory dysfunction rather than skeletal muscle function.View full abstractDownload PDF (7954K) -
Takahiko Fukuchi, Atsuyoshi Onitsuka, Masatomo Hayashi, Shoshi Senga, ...1996 Volume 29 Issue 5 Pages 960-964
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIn order to determine the effectiveness and side effects of continous epidural morphine for postoperative pain management after gastric and colorectal surgery, a comparative study was made on 90 patients receiving continuous epidural morphine (Ep group) and 83 patients receiving a non-opioid intramuscularly or rectally when they required (non-Ep group). The Ep group was divided into two or three subgroups by age, dose and site of epidural catheter. The mean pain scores were 8.0 in the Ep group and 17.0 in the non-Ep group (p<0.001). Pruitus was present more frequently in the Ep group than in the non-Ep group (p<0.05). There was no significant difference in the side effects between patients grouped by the dose of morphine. In patients over 74-year-old, the period without flatus in the Ep group was significantly longer than that in the non-Ep group. Respiratory depression in the thoracic epidural group was significantly more frequent than in the lumbar epidural group (15.4% vs 2.0%, p<0.05). Continuous epidural morphine was effective for postoperative pain management, and had no severe side effects. But we have to pay careful attention to the lateness of flatus in elder patients and respiratory depression in patients during thoracic epidural administration.View full abstractDownload PDF (8773K) -
Taichi Kanamaru, Makoto Usami, Hiroshi Kasahara, Atsunori Iso, Joji Ko ...1996 Volume 29 Issue 5 Pages 965-970
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThirty-two cases after gastrectomy and 15 cases after cola-rectal resection were studied before and year after surgery to determine the changes in bone mineral density (BMD, g/cm2) by dual energy X-ray absorptiometry. BMD in 1 year after gastrectomy was significantly lower than oreoperative RMD (0.93 ± 0.17 vs. 0.89 ± 0.15 in males, 0.68 ± 0 A3 vs. 0.65 ± 0.13 in females) (p<0.01) and BMD in males after color-rectal resection was lower than preoperative BMD (0.97 ± 0.20 vs. 0.88 ± 0.16) (p<0.05). The rates of bone loss, expressed as the percent change in preoperative BMD was no difference between males and females, -4.1 ± 6.7 vs.-5.7 ± 5.3 after gastrectomy, and-2.3 ± 2.9 vs.-0.3 ± 4.0 after colo-rectal resection. The rates of bone loss in patients with after total gastrectomy, Billroth I, Billroth and color-rectal resection were-9.5 ± 5.7, -1.8 ± 5.5, -4.5 ± 4.8 and-1.7 ± 3.3, respectively. Only the rate of bone loss in patients with after total gastrectomy was greater than that in patients with other three operation methods (p<0.05). We suggest that bone mineral disorders occur in a year after gastro-intestinal surgery, especially after total gastrectomy and it is necessary to evaluate BMD longitudinally.View full abstractDownload PDF (10094K) -
Chiaki Yasui, Naoki Yamanaka, Eizo Okamoto1996 Volume 29 Issue 5 Pages 971-976
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe importance of monitoring alkaline phosphatase as a parameter of the posthepatectomy course was studied in the 46 massively hepatectomized patients with normal (17 cases), cirrhotic (21 cases) or obstructive jaundiced (8 cases) livers. A total bilirubin level over 5.0 mg/dl in the postoperative course was defined as hepatic failure. The alkaline phosphatase level in uneventful cases reached the bottom just after the operation and subsequently increased with decreasing total bilirubin level. In the early postoperative period, the rate of increas in serum alkaline phsphatase was higher in normal liver than in the other groups. No correlation between the prothrombin time and the alkaline phosphatase level was found in the postoperative course. In contrast, in the patients with progressive hepatic failure, the alkaline phosphatase level decreased and remained lower level. These findings lead us to the conclusion that after massive hepatectomy, monitoring of serum alkaline phsphatase is useful in predicting bile secretion capacity and the regenerative process in the remnant liver.View full abstractDownload PDF (11241K) -
Masafumi Shiotani, Yonson Ku, Yoichi Saitoh1996 Volume 29 Issue 5 Pages 977-982
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThis study was undertaken to test the hypothesis that ischemia-reperfusion injury of the liver contributes to hepatic metastases of rat ascitic hepatoma (AH130). Sprague-Dawley rats underwent either a sham operation consisting of only a laparotomy (group I, n=8) or a laparotomy and 20-minute (group II, n=7) or 30-minute ischemia (group III, n=8) of the median and left hepatic lobes by clamping of the hepatic artery and portal branches. After a 10-minute stabilization period after laparotomy (group I) or the start of reperfusion (groups II and III), the animals received an intravenous injection of 1ml of a suspension of AH130 cells (1×106 cells/ml) via the dorsal penile vein. Ten days later, the animals were sacrificed and the macroscopic metastatic foci were counted. In addition, the metastatic index (MI), as defined by the number of tumor foci per gram of liver tissue, in the right lobe and in the median plus left lobes was compared. In group I, MIs were 0.6 ± 0.7 (mean ± SD) and 1.0 ±1.3 tumor foci/g of liver tissue, respectively, in the right and the median plus left lobes, showing similar values in the two regions. However, in group II, the MI of the median plus left lobes (3.4 ± 2.8) was significantly higher than that of the nonischemic right lobe (1.0 ± 1.1, p<0.05). In group III, MIs were 17.5 ± 15.2 and 6.7 ± 7.3, respectively, in the ischemic and nonischemic lobes, also showing a statistically significant difference between the two regions (p<0.05). Furthermore, in the median plus left lobes, the longer the duration of ischemia, the higher the MI (p<0.05). These results suggest that ischemia-reperfusion injury of the liver accelerates the risk of hematogenous metastasis to the liver.View full abstractDownload PDF (12550K) -
Hirokazu Matsutomo, Hajime Hirose, Shoshi Senga, Hideo Itoh, Masatoshi ...1996 Volume 29 Issue 5 Pages 983-989
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe studied the tolerance to ischemic injury of thioacetamide-induced cirrhotic liver and normal liver in rats. Wistar rats were divided into an LC group (n=30): thioacetamide-induced liver cirrhosis, and an N group (n=30): normal. Ischemic injury was inflicted for sixty minutes, and bile was collected to determine bile flow and its recovery rate after reperfusion. High energy phosphates were measured before ischemia, before reperfusion, and 15, 30 and 60 minutes after reperfusion. ATP and TAN levels in the liver tissue (unit: μmol/gdw) 60 minutes after reperfusion were significantly (p<0.05) lower in the LC group (2.40 and 7.54, respectively) than in the N group (4.72 and 9.88, respectively). The TAN level immediately before reperfusion was also significantly (p<0.01) lower in the LC group (6.36) than in the N group (10.77). The survival rate one week after ischemic injury and the recovery rate of bile flow 60 minutes after reperfusion were significantly (p<0.01) low in the LC group (0% and 5.9%, respectively), compared with those in the N group (100% and 51.4%, respectively). Tolerance to ischemic injury was much lower in the cirrhotic liver than in the normal liver. Furthermore, remarkable reduction in the adenine nucleotide pool occurred in the course of ischemia, suggesting low ATP synthesis after reperfusion.View full abstractDownload PDF (12778K) -
Kazuo Hatsuse, Hideki Aoki, Tsukasa Aihara, Michinori Murayama, Kenji ...1996 Volume 29 Issue 5 Pages 990-997
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSFifty candidates for liver resection, who underwent CT obtained during arterial portography (CTAP), CT during hepatic arteriography (CTHA), and combined use of both techniques, were studied. Histopathologic study confirmed 96 tumors, consisting of 69 malignant tumors (hepatocellular carcinoma: [HCC] 28, metatasis 41), 17 borderline lesions of HCC, and 10 benign tumors. There were 45 tumors 1.5 cm or smaller in diameter, consisting of 17 borderline lesions of HCC and 28 other lesions. Eighty-six tumors (89.6%) were detected with CTAP, 74 (77%) with CTHA, and 87 (90.6%) with combined scaning. The detection rates for borderline lesions were 76.5% with CTAP and 35.5% with CTHA. These findings suggested that small tumors in patients with viral hepatitis or liver cirrhosis, detected with CTAP but not with CTHA, might be borderline lesions of HCC. Of 28 small tumors 19 (69%), excluding borderline lesions of HCC, were detected with CTHA. Of these, 9 malignant tumors and only 1 benign tumor had rim enhancement. Use of rim enhancement as the criterion for malignancy of these small tumors gave an accuracy rate of 84%. The above data suggest that CTAP alone can be used to detect hepatic tumors and that CTHA is of value not only in diagnosing borderline lesions, but also in differentiating malignant small tumors from benign ones.View full abstractDownload PDF (15204K) -
Taichi Shuto, Hiroaki Kinoshita, Kazuhiro Hirohashi, Shoji Kubo, Tadas ...1996 Volume 29 Issue 5 Pages 998-1003
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIn our hospital, as of December 1993, radical hepatic resections had been performed in 82 patients with small hepatocellular carcinoma (HCC) 2cm or smaller. Bisegmentectomy was done in 8 patients, segmentectomy in 11, subsegmentectomy in 20, and partial resection in 43. When the results of preoperative liver function tests were satisfactory, a large-scale operation was generally possible, but in decisions about the scale of the operation, the intraoperative appearance and findings from palpation of the liver were more important than preopeartive findings. There were recurences in 39 patients. The survival rate and tumor-free survival rate were better after bisegmentectomy than after smaller scale operations. If the scale of surgery had been decided according to preoperative liver function, 12 patients of the 74 who did not in fact undergo bisegmentectomy could have been selected for bisegmentectomy. However, in these 12 patients, only two had recurrences. If bisegmentectomy had been done for all patients, then of the 37 cases of recurrence among the 74 patients who did not undergo bisegmentectomy, seven could have been prevented (the recurrence was within the part of the liver that would have been resected). However, because of liver dysfunction, six of these seven patients could not have withstood bisegmentectomy. Our selection of the scale for resection of small HCC on the basis of results of liver function tests, intraoperative inspection, and palpation of the liver was suitable except for one patient.View full abstractDownload PDF (9730K) -
Noboru Yokoyama1996 Volume 29 Issue 5 Pages 1004-1012
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSChronological changes in proliferation of colonic mucosal cells in dimethylhydrazine (DMH)-induced colon carcinogenesis were investigated by using biopsy specimens obtained by serial colonoscopy. The proliferating cell nuclear antigen (PCNA)-labeling index and the proliferation index (P.I.) of colonic mucosa in DMH-treated rats were significantly higher than those in control rats from 12 weeks after the beginning of carcinogen injection until the end of the experiment. PCNA-stained cells in the crypt of the mucosa in DMH-treated rats moved from the base of the surface with increasing incidence of colon tumors, compared with the control rats. At necropsy, aneuploidy of the mucosa was discovered only in rats with tumors. The PCNA-labeling index (55.3± 12.8%) and P.I.(31.2± 5.5%) in rats with tumors were significantly higher than those in rats without tumors. These proliferative changes in the mucosa, suggesting that it became a high risk mucosa, imply that these changes may become the parameters for detecting colon cancer.View full abstractDownload PDF (16198K) -
Kazuo Hase, Hidetaka Mochizuki, Katsuyuki Utsunomiya, Tsukasa Yoshizum ...1996 Volume 29 Issue 5 Pages 1013-1021
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSOne hundred and two patients underwent curative resection of submucosal invasive colorectal carcinomas in the first period, between 1971 and 1989. All patients were followed for at least 5 years (mean=88.5 months). Lymph node metastasis, found in 13 patients (12.7%) was associated with a worse outcome: 38.5% of node (+) patients developed recurrence, vs 5.6% of node (-) patients (p=0.002). The cumulative death curve from cancer was also worse in node (+) vs node (-) (p<0.001). Five histopathological characteristics were identified as risk factors for lymph node metastasis: 1) small clusters of undifferentiated cancer cells in the invasive front of the lesions; 2) a poorly demarcated invasive front; 3) moderately or poorly differentiated cancer cells in the invasive front; 4) extension of the tumor to the middle or deep submucosal layer; and 5) cancer cells in vessels. Whereas patients with ≤3 risk factors had no nodal spread, the rate of lymph node involvement in patients with 4 or 5 risk factors was 33.3% and 61.5%, respectively. In the second period, between 1990 and 1993, 30 patients underwent initial endoscopic polypectomy of submucosal invasive colorectal carcinomas. Eleven patients with 4 or 5 risk factors had open surgery, and lymph node metastasis was found in 4 of them. Nineteen patients with <3 risk factors were followed without open surgery and no recurrence appeared in the follow-up period of 21 to 68 months (mean=44.9 months). Therefore appropriate bowel resection with lymph node dissection is indicated if such a lesion exhibits 4 or 5 risk factors for metastasis. These findings may be helpful in this era of increasing endoscopic removal of colorectal tumors.View full abstractDownload PDF (17665K) -
Akira Tsunoda, Miki Shibusawa, Gouichi Kamiyama, Manabu Takada, Noboru ...1996 Volume 29 Issue 5 Pages 1022-1027
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSPapanicolau smear preparations of mucus from the lining surface of 19 colon specimens removed because of carcinoma were examiend. At a distance of 5cm or more from the tumor, 67-75% of the smears were positive, while 100% contained malignant cells if the smears were taken less than 5cm from the tumor. Then the viability of tumor cells shed into the intestinal lumen was determined in the patients with colorectal carcinoma. Fifteen operative specimens were irrigated. The resulting cell specimens were centrifuged on a Nycodenz linear density gradient column so that tumor cells were concentrated in a band at the top. In 13 of the 15 proximal lumen specimens a median of 0.66×105 tumor cells were recovered, with a median percentage viability of 79. In 5 specimens examined, the neoplastic cells showed fluorescence. In 12 of the 15 distal lumen specimens a median of 0.27×105 tumor cells were recovered with a median percentage viability of 83, and fluorescence was observed in 3 specimens examined. Thus viable exfoliated tumor cells were demonstrated. Their presence in large numbers at the site of an intestinal anastomosis supports their potential role in the etiology of suture line recurrenceView full abstractDownload PDF (11196K) -
Masanori Tada, Ichirou Matsukura, Eiich Yabata, Satoshi Okabe, Mitsuo ...1996 Volume 29 Issue 5 Pages 1028-1034
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe purpose of this study was to determine the effect of the condition of the oral side of the anastomosis on the anorectal function after a sphincter-saving operation for rectal cancer. We used a four-channel microtip pressure transducer catheter producted by Miller Corp. The sensors were placed at 0, 5, 10 and 15 cm from the tip. The catheter was inserted and the sensors were placed at 5, 10, 15 and 20 cm from the anal verge. The pressure of each location was recorded for 90 minutes. Conventional anorectal manometry and clinical questionnaires were also used. We divided the patients into 2 groups according to the clinical score obtained by the questionnaire, a good function group and a poor one. To analyze these data, we changed each pressure into scores of 5 degrees. When the control group, the good group and the poor group were compared with each other, significant differences were found in the length of the stump, the number of postoperative months, compliance and the pressure score. A significant correlation was found between the total pressure score and clinical score. anorectal function was mainly affected by the number of postoperative months, the length of the stump, rectal compliance and anal sensation. In addition to those factors, a stable condition of luminal pressure and movement in the oral side of the anastomosis is important for good anorectal function after surgery.View full abstractDownload PDF (11391K) -
Shin-ichiro Aoki, Atsushi Kimura, Yasushi Adachi, Hiroshi Adachi, Shig ...1996 Volume 29 Issue 5 Pages 1035-1039
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe report the first case in Japan of an unusual arterial malformation, congenital agenesis of the celiac artery and superior mesenteric artery. The diagnosis in this case was made preoperatively by abdominal angiography and confirmed surgically. A 45-year-old male with a history of Moyamoya disease underwent distal partial gastrectomy for a penetrating gastric ulcer. Angiographic and operative findings showed that the inferior mesenteric artery fed the greater curvature of the stomach, the entire small intestine and colon, and probably the pancreas and spleen. The liver was fedonly by several arteris around the ligament teres hepatis. We concluded that in this case the celiac artery and superior mesenteric artery were somehow closed at the base in utero, and collateral pathways developed from the inferior mesenteric artery.View full abstractDownload PDF (9019K) -
Gastric Cancer Complicated with Virchow MetastasiKeisuke Matsusaki, Tomohiro Toda, Katsutoshi Yoshida, Toyokazu Kawano, ...1996 Volume 29 Issue 5 Pages 1040-1044
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe had a patient with early gastric cancer who died of carcinomatous peritonitis 5 months after surgical resection. Metastasis of the cancer to virchow's lymphnode had already occurred at the time of detection, and the resected sample was examined for cancer-related genes and nuclear DNA ploidy. In Japan, only 5 cases of Virchow metastasis of early gastric cancer have been reported so far and this might be the first one examined for the cancer-related genes. The patient was a 50-year-old woman who was diagnosed as having early gastric cancer by gastroscopy and an operation was performed. At the time of hospitalization, small lymph nodes were palpable in the epi-clavicular cavity from the left jugular portion, and were pathologically diagnosed metastasis of the cancer during the operation. In this particular case, while a IIa lesion of 35×28 mm in size was found with the cancer itself remainingin the mucosal layer, there was marked tumor involvement in the lymphatic vesels in the submucosal layer. The DNA ploidy pattern was aneuploid, and the expression of nm23, a candidate metastasis-suppressor gene, was reduced. Overexpression of c-erbB-2 was detected in both the primary and the metastatic tumors. Cancer cells in the lymphatics and the metastatic focus showed stronger expression than in the primary focus, suggesting involvement of the lymph node metastaView full abstractDownload PDF (10745K) -
Makoto Kammori, Kaoru Kobayashi, Takuro Nakamura, Ichiro Konagaya, Hir ...1996 Volume 29 Issue 5 Pages 1045-1049
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe patient was a 70-year-old female. Early gastric cancer IIc was detected in the gastric pylorus vestibular apparatus department by upper gastrointestinal endoscopy and she was admitted to our hospital for an operation. Before the operation, we detected a 3 cm cyst in the S2, 3 area of the liver by abdominal CT and ultrasonography besides the early gstric cancer found in the pylorus vestibular apparatus department. CA19-9 was present at the high level of 106.2 U/ml in the serum. We believed that the high serum level of CA19-9 was derived from the benign liver cyst, because we could not find any other forcus, for example a pancreatic or ovarian lesion. We performed distal gastrectomy and D2 lymphectomy. Liver cyst aspiration was performed simultaneously then, and 7 ml of uncolored, clear, serousliver cyst fluid was removed. The liver cyst fluid had an abnormaly high level of CA19-9, 21, 280 U/ml. Histological examination of the cyst revealed a large amount of well-differentiated adenocarcinoma and in part a cribriform pattern (moderately differentiated adenocarcinoma) in the gastrectomy preparation. Three months after the operation, serum CA19-9 nomalized to 26.7 U/ml. But it was at a high level of 43.5 U/ml in 6 months and is maintaining a high level, 37 U/ml, at present. This is a case of quite rare liver cyst withan abnormally high level of CA19-9 in the serum, complicating early gastric cancer.View full abstractDownload PDF (9410K) -
Toru Beppu, Yoshihiro Masuda, Shigeru Katafuchi, Hiroshi Egami, Kazuko ...1996 Volume 29 Issue 5 Pages 1050-1054
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSWe performed laparoscopic splenectomy in combination with cholecystectomy in a 16-year-old girl with hereditary spherocytosis and cholecystolithiasis. The levels of hemoglogin and serum total bilirubin returned to normal immediately after surgery. The laparoscopic procedure is less invasive than open cholecystectomy or splenectomy in terms of the changes in serum interleukin 6 levels after surgery. This approach can be used in the treatment of spherocytosis with cholecystolithiasis, and it offers both functional and cosmetic advantages.View full abstractDownload PDF (7840K) -
Ryo Yoshida, Yoshinori Hamada, Hideho Takada, Yasunori Katou, Tsuyoshi ...1996 Volume 29 Issue 5 Pages 1055-1058
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSNeurofibroma was first described by von Recklinghause, and this disease usually involves the skin, subcutaneous tissue and bone. We report an extremely rare case of pancreatitis due to neurofibroma of the duodnum caused by von Recklinghausen's disease. The patient was a 59-year-old man who had a past history of von Recklinghausen's disease. He was referred to our hospital with a diagnosis of pancreatitis. CT, MRI, ERCP and angiography suggested a benign tumor of the head of the pancreas. Pancreaticoduodenectomy with preservation of the pylorus was performed. The tumor measured 1 cm in diamter, and was diagnosed as neurofibroma of the duodenum. The tumor cells showed immunoreactivity with anti-s-100 antibody.View full abstractDownload PDF (8191K) -
Manabu Nishiwaki, Hiroshi Ashida, Hitoshi Tada, Akihiko Nishioka, Joji ...1996 Volume 29 Issue 5 Pages 1059-1063
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSPancreatic fistula i:, a severe postoperative complication, and it may be fatal. We experienced a casein which administratior of factor XIII and a somatostatin analogue (Sandostatin®) was very effectiveagainst the pancreatic fistula after distal gastrectomy for gastric cancer. A 48-year-old man received distal gastrectomy with Billroth-II reconstruction under a diagnosis of early gastric cancer at another hospital. Pancreatic fistula due to the intraoperative pancreatic injury developed postoperatively. The pancreatic fistula persisted with an amylase-rich effluent of 450-1800 ml/day. moreover, a duodenal fistula caused by rupture of the duodenal stump and hemorrhagic shock due to itraabdominal bleeding were secondary caused by the pancreatic fistula. He was admitted to our hospital with hemorrhagic shock. a surgical hemostatic procedure was performed, in which an injured portion of the pancreas was not detected. Postoperatively, combined therapy with intravenous administration of factor XIII (6 V/day) and subcutaneous administration of Sandostatin® (200μg/day) was attempted. Fistula outputs was markedly reduced. The pancreatic fistula closed on the 21st day, and the duodenal fistula closed on the 26th day after administration of Sandstatin® was started. Combined therapy with factor XIII and somatostatin analogue is a reasonable and effective therapeutic method.View full abstractDownload PDF (10162K) -
Kenichi Sakamoto, Takahiko Fukuchi1996 Volume 29 Issue 5 Pages 1064-1068
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSIt is difficult to determine whether to perform surgical treatment or not in the patient with acute celiopathy complicating ahematopoietic organ tumor in the bone marrow inhibition stage. We performed surgical treatment in 2 leukemia cases during the bone marrow inhibition stage. Diverticulitis of the large intestine occurred in one patient and acute appendicitis in the other. We present these two cases. Case 1 was that of a 46-year-old female. The blood data of this patient were WBC 2, 000/mm3 (neutrophils 1%) and right hemi-colectomy was performed. Perforating pseudodiverticula of the ascending colon were observed. Case 2 was that of a 68-year-old female. The blood data were WBC 400/mm3 (neutrophils 0%) and appendectomy was performed. It was acute appendicitis accompained by marked degenerative inflammation. In both cases the surgery and post-surgical controls were carried out in a clean room. After surgry without hemorrhage and wound infection it was possible to resume the treatment for leukemia, so the surgery was considered effective. Regardless of the stage of the underlying disease and even in the bone marrow inhibition stage, it was suggested that the positive indications for surgery could improve the therapeutic effect on the underlying disease if performed under careful control during and after the surgeryView full abstractDownload PDF (9089K) -
Naoki Ishiwa, Yoshikazu Noguchi, Kuniyasu Fukuzawa, Yasushi Rino, Tats ...1996 Volume 29 Issue 5 Pages 1069-1073
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 44-year-old woman was referred to our hospital for further evaluation of a gastric deformity detected in an annual physical examination. Abdominal sonography revealed a large cystic mass in the abdomen. Computed tomography and angiographic findings strongly suggested an omental cyst with a feeder from the right gastroepiploic artery. The mass was successfully excised by the routine abdominal laparoscopic technique and was diagnosed as cystic lymphangioma by histopathologic examination. Considering its benign nature, serous content and identification of a feeder, an omental cyst would be anothre good indication for laparoscopic surgery. In other cases, laparoscopy is a useful skill for direct diagnosis.View full abstractDownload PDF (8271K) -
Hiroyuki Kobayashi, Akitake Ide, Norihito Onishi, Kouzou Kubota, Hidet ...1996 Volume 29 Issue 5 Pages 1074-1078
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA case of adenocarcinoma of Meckel's diverticulum is reported. A 58-year-old male was admitted to our hospital because of abdominal pain and vomiting. A plain X-ray film showed bowel obstruction. Its location, however, was not revealed by contrast X-ray studies of an upper gastrointestinal series and the large bowel. Shortly after a transient remission, his bowel obstruction relapsed and laparotomy was done. A hen-egg sized tumor was found on the anti-mesenteric side of the ileum, 80 cm oral from Bauhin's valve and obstructing the intestinal lumen. Peritoneal dissemination was obserbed. Partial resection of the ileum including the main tumor was performed. Pathological examination of the resected specimen revealed that the tumor, showing poorly differentiated adenocarcinoma, arose from a genuine diverticulum, presumed to be Meckel's and occupied its entire cavity. There was neither ectopic gastric mucosa nor pancreatic tissue.View full abstractDownload PDF (9410K) -
Hajime Hikino, Masahisa Nakagawa1996 Volume 29 Issue 5 Pages 1079-1083
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSA 62-year-old man received total gastrectomy and cholecystectomy for early remnant gastric cancer and cholecystolithiasis on February 6, 1995. On the 2nd postoperative day, he had a sudden attack of loss of consciousness and general convulsion during bed rest. Despite marked arterial hypoxemia (PaO2 20 mmHg), chest radiography and ECG showed no apparent abnormalities. But chest-enhanced CT and pulmonary angiography revealed a large thrombus in the main trunk of the right pulmonary artery, and lung perfusion scintigraphy revealed multiple wedge-shaped defects especially in the right lung. Therefore we diagnosed this case as acute massive pulmonary embolism. Continuous infusion of urokinase and heparin through an indwelling catheter in the right pulmonary artery was instituted, followed by insertion of an inferior vena caval filter (IVC) 2nd day after the onset, for the purpose of early ambulation and prevention of a recurrent pulmonary embolism. He had a good clinical course without complications, and was discharged on May 13. For postoperative pulmonary embolism, insertion of an IVCf in the early stage is considered to be beneficial for effective therapy and the prevention of a recurrent embolism, in addition to the conventional anticoagulant and thrombolytic therapy.View full abstractDownload PDF (8277K) -
Masato Kayahara, Takukazu Nagakawa, Hajime Arakawa, Haruo Yagi, Fumio ...1996 Volume 29 Issue 5 Pages 1084-1088
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSThe pattern of tumor spread and mode of recurrence of carcinoma of the pancreatic head area were investigated by clinicopathologic analysis for the preservation of superior mesenteric pleuxus. One hundred and thirty three patients with carcinoma of the pancreatic head area were examined histopath-ologically. These patients consisted of 70 with carcinoma of the head of the pancreas (Ph), 31 with distal bile duct cancer (Bi), and 32 with carcinoma of the papilla of Vater (A). Fifty-five (79%) of the patients with “Ph” disease, 21 (67%) of those with “Bi” disease, and 14 (44%) of those with “A” disease had nodal involvement. Frequencies of No.14 lymph node metastasis were 34%. 32%, and 16% respectively Extrapancreatic plexus invasion by these three carcinomas was observed in 60% of “Ph”, 26% of “Bi”, and 3% of “A” patients. Retroperitoneal recurrence including paraaortic lymph nodes was discovered in 88% of the patients with “Ph” who had undergone macroscopically curative resection. All six “Bi” patients with recurrence among patients who underwent curative resection had retroperitoneal recurrence. These results indicate that complete dissection including paraaortic lymph nodes and the extrapan-creatic plexus is necessary for carcinoma of the head of the pancreas. It is possible to perform nodal dissection around the supperior mesenteric artery while preserving the nerve plexus for patients without far advanced distal bile duct cancer or carcinoma of the papilla of Vater.View full abstractDownload PDF (10776K) -
Harutsugu Sodeyama, Susumu Asato, Kazuhiro Hanazaki, Masao Wakabayashi ...1996 Volume 29 Issue 5 Pages 1089-1093
Published: 1996
Released on J-STAGE: August 23, 2011
JOURNAL FREE ACCESSLaparoscopic splenectomy was performed on five patients with the idiopathic thrombocytopenic purpura, and was compared with open splenectomy. During the operation, the patients were placed in a right oblique lateral and head-up position, abdominal wall-lift methods were used in addition to pneumoperitoneum, and ultrasonic dissector and Harmonic Scalpel (LCS) were useful. The operation time for laparoscopic splenectomy ranged from 164 to 298 minutes (average: 220±54 minutes), which was significantly longer than that for open splenectomy (average: 97±25 minutes). The average blood loss in laparoscopic and open splenectomy was 170±180g (ranged from 20 to 400g) and 204±212g, respectively. There were no significant differences in the dose of analgesia used within three days after the operation and in the period of analgesia requirement between the two groups. Because in the patients receiving laparoscopic splenectomy, oral intake was begun 2.4±0.6 days after the operation and postoperative hospitalization was 11.4±2.1 days, the patients recovered significantly more rapidly than those who received open splenectomy. There were no fatal complications. Laparoscopic splenectomy may be the preferable treatment for the idiopathic thrombocytopenic purpura.View full abstractDownload PDF (9912K)
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