The Japanese Journal of Gastroenterological Surgery
Online ISSN : 1348-9372
Print ISSN : 0386-9768
ISSN-L : 0386-9768
Volume 30, Issue 7
Displaying 1-26 of 26 articles from this issue
  • Keisuke Koeda, Nobuhiro Sato, Kenichiro Ikeda, Kouki Otsuka, Yusuke Ki ...
    1997 Volume 30 Issue 7 Pages 1691-1698
    Published: 1997
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    In order to clarify the usefullness of intensive infusion of extracellular fluid solution, we examined cardiopulmonary parameters, water and sodium metabolism and postoperative complications in 51 patients who underwent total thoracic esophagectomy. To maintain cardiac index significantly higher than the preoperative level, right ventricular end diastolic volume index were kept greater than 130ml/m2. The intraoperative water intake was 15.3ml/kg/h, and the water intake on the operation day was 5.2ml/kg/h. Total water balance was the lowest on postoperative day 2 (POD2). The respiratory functions were improved from POD2. The oxygen delivery index were maintained over 650ml/min/m2, and the oxygen extraction rate were maintained under 25%. The incidence of postoperative complications were 13.7% for pulmonary complications, 13.7% for hyperbilirubinemia, 11.8% for arrhythmia, 3.9% for minor leakage and 2.0% for acute renal failure. We conclude that our postoperative management could ameliorate perioperative organ oxygen matabolism and achieve early recovery from surgical stress.
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  • Tsuneaki Fujiya, Koujin Endoh, Jyunichi Mikuni, Yoichiro Kakugawa, Yas ...
    1997 Volume 30 Issue 7 Pages 1699-1705
    Published: 1997
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    From 1967 to 1990 a total of 2350 patients underwent gastrectomies for gastric cancer. These patients were divided into 3 groups (49 years or less: the younger group n=511, 50-69: the middle aged group n= 1476, 70 years or higher: the elder group n=363), and the elder group was compared with other groups in the terms of clinicopathological features and surgical outcome. The incidence of tumor localized upper third or lower third in the stomach or protruded from the surrounding mucosa was significantly hi gherin the elder group than in the others. There was no significant difference among those groups with regard to depth of invasion, extent of lymph node metastasis, peritoneal dissemination and liver metastasis. The differentiated type of tumor was more frequently seen in the elder group than in the others. The rates of double or multicentric cancer were higher in the elder group than in the others. Alghough 5-year survival rate of the elder group following curative resection was significantly lower than that of the middle-aged and younger groups, there was no difference of relative survival rates among 3 groups. Hazard ratio of the middle-aged and younger groups comparing with the elder group was 0.61 and 0.51 respectively. These results indicate that surgical outcome of the eldery was not different from that of others, operation should be aimed at relatively curative intent and the most important factor affecting the long-term survival in the elderly was the death caused by other diseases.
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  • Takeo Kosaka, Jun-ichi Sugaya, Shigeru Yoshida, Yasuharu Nakano, Shige ...
    1997 Volume 30 Issue 7 Pages 1706-1713
    Published: 1997
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    We investigated whether multiple modalities of therapy for advanced gastric cancer with peritonealmetastasis could lengthen the patient's survival time and outpatient interval. Between 1984 and 1995, 108patients undergoing surgery for gastric cancer at our department were found to have peritoneal metastasis. With generalized Wilcoxon test, gastrectomy, postoperative chemotherapy (POC), performance status (PS), age, operative peritoneal chemotherapy (OC), nodal status (N) and peritoneal status (P) showed significant differences. Multivariate analysis with Cox's proportional hazard model showed gastrectomy, POC, P, OC and sex are significantly potent prognostic factors. In the aspect of home care duration, age, PS, complications, preoperative chemotherapy, N, gastrectomy and OC showed significant differences. These results suggests that gastrectomy and chemotherapy in the perioperative period might be useful for gastric cancer with peritoneal metastasis.
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  • Takemi Sugimoto, Yonson Ku, Yoichi Saitoh
    1997 Volume 30 Issue 7 Pages 1714-1719
    Published: 1997
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    The aim of this study was to investigate whether preoperative occlusion of the hepatic vein might obviate the need for hepatic vein reconstruction after hepatectomy combined with hepatic vein resection. In laparotomized beagles, the left and middle hepatic veins were exposed along the hepatic edge and theproximal portion was obstructed by ligations approximately 1.5cm in length to establish hepatic venous occlusion (HVO). Two experimental groups were studied: group I, controls sacrificed immediately after HVO (n=7); group II, dogs sacrificed two weeks after HVO (n=7). After sacrifice, retrograde hepatic venography was performed to compare collateral formation in the two groups. In group I, retrograde hepatic venograms showed complete lack of opacification of the left and middle hepatic venous trees without collateral formation. In contrast, in group II, the left and middle hepatic venous trees, distal to the obstructed portion, were clearly opacified through a number of collaterals. Portal venous pressure increased immediately after HVO. However, the level returned to baseline 40min after HVO. In group II, macroscopic findings of the liver including color and size at sacrifice were similar to those before HVE, and congestion was not demonstrated histopathologically. Although GOT showed a transient elevation after HVO, serum bilirubin levels were maintained within normal range throughout observation. These results suggest that preoperative HVO may obviate the need for hepatic vein reconstruction in patients with liver cancers requiring hepatectomy with hepatic vein resection.
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  • Toshiyuki Ono, Yuichi Hatakeyama, Kiyoshi Hara, Wataru Igarashi, Naoki ...
    1997 Volume 30 Issue 7 Pages 1720-1724
    Published: 1997
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    We had reported that it was useful to evaluate of the degree of fibrosis in liver for determining the method of hepatectomy. In this study we examined the significance of measurement of the hardness in liver using new tactile sensor. Using the livers of rats that had been administrated thioacetamide (200mg/ kg, 3 times/week, intraperitoneal), we measured hepatic fibrosis ratio (HFR) by computed color image analysis and measured Δf and stiffness by new tactile senor. We investigated correlation between HFR and Δf, stiffness. There was highly significant correlation between HFR and Δf (r=0.791, p<0.0001), stiffness (r=0.844, p<0.0001). Therefore new tactile sensor was very useful to appraise the hardness of liver simply and rapidly.
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  • Kyoshi Tsuji, Takashi Suhara, Motohisa Kato, Hiroshi Takao, Yasuyuki S ...
    1997 Volume 30 Issue 7 Pages 1725-1733
    Published: 1997
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    To obtain an early diagnosis of peritoneal dissemination of gastric cancer, the usefulness a novel method employing the release of carcinoembryonic antigen (CEA) from cancer cells via peritoneal irrigation with phosphatidylinositol phospholipase C (PI-PLC) was evaluated experimentally and clinically. Experimental study: 1) The CEA value was increased about 1.7 fold by PI-PLC against KATO-III CEA secreting cancer cells. 2) The CEA value increase depended on the duration of incubation with PI-PLC and the number of target cells. 3) The CEA value was increased by combination with trypsin. Clinical study: Three kinds of irrigation cytology were performed at laparotomy on 81 gastric cancer patients, that is irrigation cytology (IR), cell CEA stain (cCEA) and PI-PLC. 1) The positive rate for 12 patients with macroscopic peritoneal dissemination (P) was 91% for IR, 75% for cCEA and 83% for PI-PLC, while corresponding values were 2.9%, 4.3% and 7.2%, respectively, in 69 cases without P. 2) CEA sensitivity ranged from 1.8 times to 600 times, and the characteristic of showing positivity on PI-PLC suggested microscopic peritoneal dissemination reflected by clinico-pathological findings, From the above results, it is suggested that PI-PLC is a potentially useful method of objectively detecting early peritoneal dissemination.
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  • Takahiro Santo, Takashi Yokoyama, Takashi Kodama, Yoshio Takesue, Eizo ...
    1997 Volume 30 Issue 7 Pages 1734-1738
    Published: 1997
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    In order to study the characteristics of the strains causing Methicillin-resistant Staphylococcus aureus (MRSA) enterocolitis, we investigated the coagulase type and the production of staphylococcal enterotoxin (SE) of MRSA strains isolated in our ward for the past 13 years.Among the 28 strains causing MRSA enterocolitis, the first One Was a Coagulase type II and SE C and TSST-1-producing Strain (II CT type), and the remaining 27 strains were coagulase type II and SE C, SE A and TSST-1-producing strains (IIACT type)-Tumor necrosis factorα (TNFα) and interleukin-2 (IL2) production from human peripheral blood mononuclear cell sincubated with the culture supernatant of various types of MRSA was examined.TNFα and IL-2 production from human peripheral blood mononuclear cells incubated with the culture supernatant of the II ACT type of MRSA was the highest.Methylpredonisolone or human immunoglobulin SignifiCantly reduced the TNFαand IL-2 production in the cultures (p<0.05).These results suggest that methylpredonisolone or human immunoglobulin is effective in the treatment of MRSA enterocolitis.
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  • Manabu Takata
    1997 Volume 30 Issue 7 Pages 1739-1746
    Published: 1997
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    The aim of the study is to demonstrate a tumoricidal effect of povidone-iodine (PVP-I) against intraluminal exfoliated carcinoma cells in specimens with colorectal malignancy. As a preliminary experiment, cultured human colon cancer cells added to PVP-I solution were centrifuged on a Nycodenz linear density gradient column. Viable tumor cells were revealed to be concentrated in a band at the top while nonviable tumor cells were at the bottom. Based on the results, the same technique was applied to the exforiated colorectal carcinoma cells in surgical specimens. Eight operative specimens of colorectal cancer were irrigated with tissue culture medium and the resulting cell specimens were centrifuged on the same column as the previous study. In all eight specimens, tumor cells were recovered with a median percentage viability of 86 for proximal lumen specimens and 67 for distal lumen specimens. Then, another 16 operative specimens were irrigated. Half of the cell specimens were added to PVP-I solution. The viability of tumor cells was not impaired in the 0.5% PVP-I group, whereas in the 5% PVP-I group, the median percentage viability was 0 in both lumen specimens. PVP-I had tumoricidal efficacy and bowel irrigation with this agent may reduce the local recurrence of colorectal cancer.
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  • Katsumi Iwase, Toru Tsujimura, Tsunekazu Hanai, Shin Jimbo, Kaoru Miur ...
    1997 Volume 30 Issue 7 Pages 1747-1751
    Published: 1997
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    The localizations of Cu/Zn and Mn superoxide dismutase (SOD), which catalyzes the dismutation of superoxide radicals (O2) to 02 and H2O2, were studied in 26 colo-rectal carcinomas by an immunohistochemical technique. We employed 10% formalin fixed paraffin embedded thin sections andused antihuman Cu/Zn-and Mn-SOD antibodies. The concentrations of both SODs in these tissues were also measured by a sandwich enzyme immunoassay technique. Both Cu/Zn and Mn SOD were more clearly immunohistochemi cally stained in cancer cells than in the normal mucosal layer of the large intestine. Among cancer tissues, both stained more clearly in rnany well-differentiated carcinomas. The concentration of Mn SOD was significantly elevated in cancer tissues, especially in well-differentiated malienancies. The ratio of the tissue concentration of Mn SOD to that of Cu/Zn SOD was also high in the well-differentiated carcinomas. Cu/Zn SOD changed its intra-cellular localization from a predominance in the basal portions of normal mucosal cells to a homogeneous distribution in the cytoplasm of cancer cells. In conclusion, both SODs appear to be related to tumor growth, and Mn SOD may play a role in the differentiation of colo-rectal carcinoma.
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  • Satoshi Yamamoto, Hiroshi Shingu, Takeshi Nagayasu, Tadayuki Oka, Hiro ...
    1997 Volume 30 Issue 7 Pages 1752-1755
    Published: 1997
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    We experienced two cases of esogateal-cutaneous fistula anterior fusion of the cervical spine. The first patient is a 35-year-old woman who had an esogageal-cutaneous fistula after four anterior fusions of the cervical spine. She was able to start eating 6 weeks after suture of the esophageal injury and wrapping with the sternohyoid muscle. The second patient is a 49-year-old man with an esogageal-cutaneous fistula after three anterior fusions of the cervical spine. He had a simple closure of the esophageal injury, and 5 months was needed for him to start eating after surgery. We wave able to close the fistula with fibrin glue. We think more reports of such cases have been appearing along with the development of orthopedic surgery.
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  • Akihisa Fukumoto, Akihiko Watanabe, Takatsugu Yamada, Hidetomo Sawada, ...
    1997 Volume 30 Issue 7 Pages 1756-1760
    Published: 1997
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    We report a very rare case of peptic ulcer occurring in the gastric tube and perforating the pericardium space resulting in cardiac tamponade. The patient is a 74-year-old man who received subtotal esophagectomy for esophageal cancer reconstructed by a gastric roll via the retrosternal route in 1986. In March 1991, five years after the primary surgery, endoscopy was performed because he felt a precordial pain. A peptic ulcer was revealed in the gastric tube. An antiacidic drug was orally administered and the peptic ulcer was cured. In May 1994, peptic ulceration recurred in the gastric tube and another antiacidic drug was administered. On 14th August 1994, severe precordial pain occurred suddenly and radiological examination revealed gas in the pericardial region. Soon he went into shock and cardiac tamponade was diagnosed. Immediately operative pericardial drainage was performed under left thoracotomy because esophageal replacement was reconstructed by a gastric roll via the retrosternal route. Then, his general condition improved gradually. He was discharged 60 days after surgery in a healthy condition. This is the first reported case of a patient who was rescued operatively from cardiac tamponade due to penetration of a peptic ulcer occurring in the gastric tube after esophagectomy for esophageal cancer.
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  • Akira Watanabe, Matsumi Umehara, Matsuomi Umehara, Koji Horiba, Koji S ...
    1997 Volume 30 Issue 7 Pages 1761-1765
    Published: 1997
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    A case report of primary squamous cell carcinoma of the atomach is presented. A 62-year-old man complaing of upper abdominal discomfort and tarry stool was referred to our hospital for severe anemia. Gastroscopy revealed a large ulcerative lesion on the lesser curvature of the upper gastric body. Biopsy of the lesion was performed and squamous cell carcinoma was suspected. The total gastrectomy with distal pancreaticosplenectomy was performed. Macroscopically, the tumor appeared to be a Borrmann 2 type cancer and was on the upper body of the resected stomach about 1cm from the esophageal mucosa. Histology indicated that the tumor was poorly differentiated squamous cell carcinoma proliferating as irregular solid nests and sharply demarcated from the esophagus. Postoperative follow-up was uneventful for 9 months, after which time however a brain metastasis was found. The metastatic lesion of the brain was extirpated. The patient is presently in a good condition, 2 years and 4 months after gastrectomy. Primary squamous cell carcinoma of the stomach is an extremely rare lesion and only 26 cases, including our case, have been reported in the Japanese literature.
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  • Masahiro Shinoda, Yoshifumi Takenaka, Takaaki Yamamoto, Toshio Mori
    1997 Volume 30 Issue 7 Pages 1766-1770
    Published: 1997
    Released on J-STAGE: August 23, 2011
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    A 30-year-old woman was admitted with tarry stools. Her HCGβ level was high; 140ng/ml in the serum and 1340 IU/l in the urine. Findings were as follows; a huge ulcerous lesion in the 2nd portion of the duodenum, multiple masses in the liver, and pneumothorax on the right side. The biopsy diagnosis of the duodenum and liver was choriocarcinoma. To control bleeding from the duodenum, gastrojejunostomy was performed. But her general condition did not take a favorable turn, and she died 50 days after the operation. Histological diagnosis by autopsy was pure choriocarcinoma. It had metastasized to the lung, liver, stomach, pancreas and left ovary, but no primary lesion was found in her genital tract. She had a history of labor one year earlier, and we diagnosed her condition as metastasis of gestational choriocarcinoma to the duodenum, probably originating in the uterus or placenta. Eight cases of choriocarcinoma in the duodenum were reported in the literature, but our case is the first one of metastasis of gestational choriocarcinoma to the duodenum.
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  • Hideo Matsumoto, Ryuji Hirai, Tetsuya Ohta, Ryuichiro Ohashi, Seiji Ka ...
    1997 Volume 30 Issue 7 Pages 1771-1775
    Published: 1997
    Released on J-STAGE: August 23, 2011
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    A 62-year-old man who developed a high fever and right hypochondralgia was referred to our hospital. Based on his laboratory data on admission, (WBC count of 16200/μl and CRP of 11.8mg/ml), the patient was presumed to have severe inflammation. A multiloculated hypoechoic lesion, 5cm in diameter, was detected ultrasonographically in the posteroinferior segment of the liver accompanying fluid pooling was noted in the right subphrenic space. Abdominal CT scan and MR imaging studies demonstrated the same lesion characteristics as the ultrasonographic findings. We diagnosed a liver abscess, then performed percutaneous US guided drainage. One month later, the features of the lesion had changed to those of a homogeneous hypoattenuating mass on CT scan. Partial hepatectomy of the posterior segment was performed because malignant disease was suspected based on the needle biopsy specimen. The excised liver specimen revealed a solid mass which was pathologically diagnosed as an inflammatory pseudotumor. We speculate that the liver abscess had developed into an inflammatory pseudotumor during the course of treatment.
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  • Chifumi Maruyama, Masakazu Yamamoto, Masashi Tsugita, Takehito Otsubo, ...
    1997 Volume 30 Issue 7 Pages 1776-1779
    Published: 1997
    Released on J-STAGE: August 23, 2011
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    In a 62-year-old man with known abdominal distension and lower extrernity edema, abdominal computed tomographic scan confirmed the dianosis of hepatocellularcarcinoma in the right lobe with tumor thrombus extending into the right atrium and intrahepatic metastasis to the left lobe. We administered chemotherapy, consisting of CDDP 100mg by means of hepatic arterial infusion. After chemotherapy, the tumor thrombus in the right atrium receded such that the distal portion was no longer in the right atrium, but rather in the inferior vena cava. The intrahepatic metastasis disappeared. Right hepatectomy extirpatlon ot the inferior vena caval tumor thrombus was performed. Simultaneously, we identified cecal cancer necessitating ileocecal resection. The patient died of dissemination due to recurrence of the cecal cancer, without evidence of hepatocellularcarcinoma recurrence, 19 months after the operation.
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  • Yuichi Nakasato, Nobuyoshi Hanyu, Masaru Naruse, Yoichi Ohira, Kazuhik ...
    1997 Volume 30 Issue 7 Pages 1780-1784
    Published: 1997
    Released on J-STAGE: August 23, 2011
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    A 58-year-old woman was admitted to the hospital because of abdominal pain and vomiting. Abdominal ultrasonography revealed acute cholecystitis and a protruding lesion. Percutaneous transhepatic gallbladder drainage was undergone. Endoscopic retrograde cholangiopancreatography showed a maximum 20-mm wide diffused type dilatation of the common bile duct, and a 20-mm long cystic dilatation of the common channel, therefore an anomalous arrangement of the pancreaticobiliary duct, IVB type by Todani's classification, was suspected. Cytological findings in bile juice in the gallbladder were class V. Cholecystectomy followed by en bloc wedge resection of the gallbladder bed and lymphadenectomy, resection of the extrahepatic common bile duce and hepato-jejunostomy were performed. The level of amylase in the bile juice in the extrahepatic common bile duct was 86, 923 IU/L. Macroscopic examination of resected specimens showed a papillary cancer with an irregular surface mucosa around the mass. Histological findings revealed a papillary adenocarcinoma (ly0, v0) spreading on the Rokitansky-Aschoff sinus (m). In a review of the Japanese literature, only 30 cases of early gallbladder cancer associated with an anomalous arrangement of the pancreaticobiliary duct could be found.
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  • Yukio Sonoda, Koji Yamaguchi, Shuji Saeki, Seiji Naito, Masaki Takashi ...
    1997 Volume 30 Issue 7 Pages 1785-1788
    Published: 1997
    Released on J-STAGE: August 23, 2011
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    Pancreatic metastasis from renal cell carcinoma is rare. We report a case of resection of such a metastasis. A 67-year-old man had a left nephrectomy for renal cell carcinoma four years prior to the present admission. Follow-up CT showed a metastatic nodule in the tail of the pancreas. Distal pancreatectomy and splenectomy was performed. Long and careful follow-up including examination of the pancreas is mandatory after nephrectomy for renal cell carcinoma.
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  • Hiroki Nakamura, Shoji Kubo, Kunihiro Katsuragi, Hiroaki Kinoshita, Ta ...
    1997 Volume 30 Issue 7 Pages 1789-1793
    Published: 1997
    Released on J-STAGE: August 23, 2011
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    We report the case of 62-year-old man with secondary torsion of the greater omentum caused by a right inguinal hernia. His chief complaints were lower abdominal pain and vomiting. On admission, hispulse was 114 beats/min, and his temperature was 37.1°C. He had tenderness and peritoneal rebound pain in the right lower abdomen, and bulging in the right groin region. On blood analysis, the white blood cell count was elevated to 16, 300/μl, and C-reactive protein was 38.5mg/dl. The abdominal X-ray film revealed absence of intestinal gas in the right lower quadrant. Computed tomography of the lower abdomen demonstrated concentric folds or an arrow pattern. Ultrasonography of right groin region revealed a hyperechoic structure in the bulging region. Emergency surgery was performed under the diagnosis of intussusception of the small intestine; however, the definitive diagnosis was made intraoperatively as a secondary torsion of the greater omentum caused by a right inguinal hernia. Torsion of the greater omentum is a rare acute abdominal disease and generally is difficult to diagnose preoperatively.In our case, if we had had knowledge and experience of this rare disease, preoperative diagnosis bycomputed tomography and ultrasonography would have been possible. The combination of computedtomography and ultrasonography seems important for differential diagnosis of acute abdominal diseases.
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  • Hiroshi Miyata, Shigeyuki Tamura, Kazuhiro Okagawa, Kentarou Kishi, Ki ...
    1997 Volume 30 Issue 7 Pages 1794-1798
    Published: 1997
    Released on J-STAGE: August 23, 2011
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    A rare case of appendicitis perforativa with a fecal stone complicated by right hydronephrosis is reported. A 25-year-old man visited the Department of Medicine in, our hospital with lower abdominal pain. Computed tomography and intravenous pyelography revealed a stone in the right lower abdomen and right hydronephrosis, and a small-intestine series revealed deformity of the terminal ileum and the cecum. He was referred to the Department of Surgery suspected of a right ureter stone or Crohn's disease. Retrograde pyelography and Ba-enema suggested a diagnosis of right hydronephrosis associated with a fecal stone in the appendix, and surgery was performed. The appendix contained a fecal stone 1.5cm in diameter in the base, which had penetrated to the retroperitoneum in the peripheral side, and the right ureter was constricted by inflammatory granulation. Retrograde appendectomy and separation of the right ureter from granulation were performed. Intravenous pyelography and ultrasonography revealed that hydronephrosis was improved on the 16th postoperative day. We concluded that the right hydronephrosis was caused by stenosis of the right ureter due to granulation induced by perityphlitis which followed perforation of the appendix because of a fecal stone.
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  • Yutaka Hoshino, Kouichi Yanai, Tomohisa Ono, Tohru Tezuka, Akira Kenjo ...
    1997 Volume 30 Issue 7 Pages 1799-1803
    Published: 1997
    Released on J-STAGE: August 23, 2011
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    A 11-year-old boy with three colorectal cancers; rectal adenosquamous carcinoma, intramucosal sigmoid colon cancer, and poorly differentiated adenocarcinoma of the transverse colon, entered our hospital. We report this case because both multiple colorectal cancer in people under 20 years old, and rectal adenosquamous carcinoma are rare. Chief complaint of this boy was melena. The first operation was Hartmann's procedure for rectal adenosquamous carcinoma (first cancer). But there was mucinous lymph-node metastasis. A polyp was present on the sigmoid colon which was well differentiated adenocar-cinoma (second cancer). The second operation was drainage for a peri-stomal abscess, and poorly differentiated adenocarcinoma with signet ring cells appeared from the abscess wall. The third operation was resection of the stoma, left hemicolectomy for transverse colon cancer and construction of a transverse colostomy. The transverse colon cancer was poorly differentiated adenocarcinoma with moderate differentiation and mucinous carcinoma (third cancer). Peri-stomal carcinoma was present mainly on the proper muscle layer, and had no connection with the stomal mucosa. The patients is alive now, three years after the first operation, without recurrence. This patient had three colorectal cancers. Peri-stomal cancer seemed to be caused by dissemination from the first cancer during first operation.Synchronous multiple cancers are suspected for these three cancers because of various histologies. Incidentally, adenosquamous carcinoma is thought to result from squamous changes in adenocarcinoma. So we think our patient had cancers of various origins.
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  • Tetsuo Ishikawa, Kouichi Ohishi, Takafumi Ohshiro, Mari Kimura, Takayu ...
    1997 Volume 30 Issue 7 Pages 1804-1808
    Published: 1997
    Released on J-STAGE: August 23, 2011
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    We report a case of rectal diverticulosis accompanied by severe rectal stenosis. A 65-year-old male patient complained of a sensation of abdominal fullness. Upon proctoscopic examination, a tumorous lesion and severe stenosis were recognized in the rectum. Although pathological examination of the tissue biopsy specimen showed no malignancy, the condition of this lesion was recognized as being consistent with a rectal carcinoma. Thus abdominoperineal resection of the rectum (Miles' operation) was performed. The elastic hard tumor was approximately 8 cm in length, producing remarkable stenosis and extensive attachment to other pelvic structures. Pathological examination of the specimen revealed acute and chronic diverticulitis of the rectum with no malignancy. The post-operative course was uneventful and the patient was discharged 24 days after the operation. Compared to other forms of colonic diverticulosis, there are few reports in the literature regarding rectal involvement and only 15 cases, including our case, with pertinent clinical symptoms have been reported in Japan. Among these 15, 9 cases underwent relatively aggressive surgical treatment against the rectal lesions, as follows: 3 cases of Miles' operation, 3 of single barrelled colostomy (Hartmann's operation), 1 of low anterior resection, 1 using the pull-through method and 1 of total pelvic exenteration. Concerning rectal diverticulosis, accurate preoperative diagnosis may be difficult when an inflammatory mass in the lower pelvic cavity and severe rectal stenosis have developed, especially in the terms of the differential diagnosis from rectal carcinoma.
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  • Hiroshi Yoshida, Kaku Egami, Masayo Wada, Shotaroh Maeda, Noritake Tan ...
    1997 Volume 30 Issue 7 Pages 1809-1813
    Published: 1997
    Released on J-STAGE: August 23, 2011
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    We report a patient with a huge malignant schwannoma of the rectum, who had persistently refused surgery for 40 months. A 58-year-old woman presented to Nippon Medical School Hospital of Tama-nagayama for first the time in June, 1990, with a complaint of anal pain. Investigations revealed a submucosal tumor of the rectum, 4cm in diameter. Subsequently, the patient presented to the hospital several times complaining of anaI pain, because of the rapid disappearnace of the pain, however, the patient refused surgery. In October, 1993, the patient was again admitted to the Tama-nagayama Hospital complaining of recurrent severe anal pain, mass, fever, weight loss and inability to walk and sit. Pus wasdi scharged from a huge hip tumor, 15×15×10cm in size. Laboratory investigation revealed high IAP values of 736μg/ml (normal 500≥). Abdominoperineal excision of the rectum was performed. Microscopic examination revealed the tumor to be a malignant schwannoma. The postoperative course was uneventful and the patient discharged from the hospital. Investigations revealed growth of the tumor. Thet umor was thus calculated to be 14 months from 4cm to 5cm in size, and 26 months from 5cm to 10cmin size.
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  • Yoshihiko Arano, Makoto Hirano, Nozomu Murakami, Shin Nagao, Tsutomu K ...
    1997 Volume 30 Issue 7 Pages 1814-1818
    Published: 1997
    Released on J-STAGE: August 23, 2011
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    A 75-year-old woman was admitted to our hospital because of occult blood in the stool. She had undergone resection of Isp type polyp (diameter 2.0 cm) in the rectum under colonoscopy. Histopathological diagnosis of the resected polyp was mucosa-associated lymphoid tissue lymphoma (MALT). Nine months after the initial resection, the tumor recurred in the same area. So the tumor was resected again. Because the tumor had remained, transsacral sleeve resection of the rectum was performed. It is suggested that partial resection of the rectum is required for MALT lymphoma.
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  • Kazuma Yano, Yoshio Okazaki, Ryuichi Etoh, Takayoshi Nagata
    1997 Volume 30 Issue 7 Pages 1819-1822
    Published: 1997
    Released on J-STAGE: August 23, 2011
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    The coincidence of malignant disease with tuberculosis in the digestive organ has been recently rare. We encountered a case of the anal carcinoma coexisting with tuberculotic anal fistula. A 63-year-old woman who complained anal bleeding during neurological therapy after cerebral bleeding and was diagnosed the anal carcinoma, underwent abdominoperineal excision of the rectum with inguinal lymph nodes dissection. Histological examination revealed tuberculoma in the anal fistula around the adenocar cinoma and in the inguinal lymph nodes. The patient was discharged after uneventful recovery, and is currently alive and well 3 years and 9 months after surgery, with neither recurrence of the cancer nor tuberculosis. It appears to be important that anal fistula with protracted course should be taken into consideration of concomitant cancer and tuberculosis.
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  • Yoshifumi Kobayashi, Norio Yoshimura, Hisakazu Yamagisi, Takahiro Oka
    1997 Volume 30 Issue 7 Pages 1823
    Published: 1997
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
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  • Kotaro Iwanami, Izumi Takeyoshi, Susumu Ohwada, Tetsushi Ogawa, Junya ...
    1997 Volume 30 Issue 7 Pages 1824
    Published: 1997
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
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