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Volume 32, Issue 12
Displaying 1-14 of 14 articles from this issue
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Satofumi Nakano1999 Volume 32 Issue 12 Pages 2621-2630
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSOne of the causes of anastomotic leakage following esophageal reconstruction is the disturbance of the local blood flow. To elucidate the effect of local perfusion of the reconstructed gastric tube, an experimental study was performed using dogs. The effects of administration of PGE1 to either the regional artery (the left gastroepiloic artery) or the sysemic vein were investigated. The dogs in which gastric tubes were made were divided into four groups which continuously recieved;(1) no perfusion (group C, control);(2) administra-tion of saline into the left gastroepiploic artery (group S);(3) administration of PGE1 into the vein (group Pv); and (4) administration of PGE1 into the left gastroepiploic artery (group Pa). In each group, the perfu-sion unit of blood flow (PU), index of O2 saturation (ISO2) and pH at the fundus of the gastric tube were monitored sequentially. Histological evaluation of the gastric tube was also performed. The values of PU, ISO2 and pH in group S showed no significant improvement compared with those in group C. PU, ISO2 and pH were significantly increased in both Pa and Pv groups compared to those in group C and were also significantly different between group Pa and group Pv. Histological findings of the gastric tube in group Pa at six hours and24 hours showed no interstitial edema or bleeding, which were markedly seen in group C. From this study, it is concluded that the microcirculation of the gastric tube is significantly improved by arterial administration of PGE1. It is suggestod that intraarterial infusion of PGE1 is effective for prevention of leakage at the anastomotic site of esophagogastrostomy.View full abstractDownload PDF (170K) -
Kikuo Koufuji, Jinryo Takeda, Keishirou Aoyagi, Shoujirou Yano, Naotak ...1999 Volume 32 Issue 12 Pages 2631-2636
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe studied the effect of gastrectomy on bone minerals and bone metabolism in 9 male patients with gastric carcinoma who underwent distal gastrectomy with curability A. Bone mineral density (BMD) and BMD Y%which were measured by the dual X-ray mineral absorptiometry measurement (DXA) method. Serum bone specific alkaline phosphatase (B-Alp), intact-osteocalcin (I-OC), intact-parathyroid hormone (I-PTH), 1α, 25 (OH)2D3, Ca, P and urinary pyridinoline (Pyd), and deoxy-pyridinoline (D-Pyd) were evaluated before surgery, 6 and 12 months after surgery. A statistically significant correlation between preoperative BMD, BMD Y%and body weight was recognized (p<0.05).
A statistically significant correlation between preoperative Pyd, D-pyd and patients' age was also recognized (p<0.05). Both BMD and BMD Y%reduced after surgery. On the other hand, I-OC and B-Alp significantly in- creased at both 6 and 12 months after surgery (p<0.05). Pyd also significantly increasel 6 and 12 months after surgery. These results suggested that both osteogenesis and bone resorption increased in the early phase of the postoperative course of gastrectomy, so we have to consider carefully the prevention of bone disorders after gastrectomy.View full abstractDownload PDF (77K) -
Masami Niki, Eiji Nomura, Hideaki Mabuchi, Motoyuki Nakamura, Kanji Ni ...1999 Volume 32 Issue 12 Pages 2637-2642
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe majority of studies examining the role of TGF-β in gastric carcinoma have focused on scirrhous carcinoma. We therefore undertook a retrospective immunohistochemical study of gastric carcinoma in order to characterize the TGF-β expression in malignant gastric lesions and to determine whether expression of TGF-β was related to disease progression. On immunohistochemical analysis. TGF-β expression in scirrhous gastric carcinomas was significantly higher than in non-scirrhous gastric carcinomas. In the patients with curative resection, TGF-β expression in scirrhous gastric carcinomas was significantly higher in patients who developed peritoneal recurrence after surgery than those who did not develop such recurrence, and TGF-β expression in non-scirrhous gastric carcinomas was significantly higher in patients who developed peritoneal recurrence than those who did not develop such recurrence. In an attempt to clarify the mechanism of the prevalence of the peritoneal dissemination of scirrhous gastric carcinoma, the present investigation examined not only the protein expression of TGF-β but also TGF-β1 mRNA expression in gastric carcinomas. The plasma TGF-β1 concentrations in scirrhous gastric carcinomas patients was significantly higher than in non-scirrhous gastric carcinomas patients. These data suggest that TGF-β may contribute in part to the mechanism of formation for scirrhous gastric carcinoma.View full abstractDownload PDF (83K) -
Propriety of Switching to the Day-care SurgeryYasuki Unemura, Shuichi Fujioka, Takashi Imai, Katsumaro Suzuki, Takey ...1999 Volume 32 Issue 12 Pages 2643-2648
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe investigated the patients' opinion on laparoscopic cholecystectomy, which has the reputation of becoming one of the day-care surgical procedures of the future. The most desirable admission day in the day before the operation: 55%, 2-3 days prior to the operation: 43% and on the day of the operation: 2%. The request admission on the day of the operation was considered to be due to personal reasons. More than 83% of the patients did not mind the increase in the charge caused by a prolonged postoperative period. Eighty percent of patients had taken out some form of private sickness insurance and 86% of them applied to their insurance company for payment. The incremental daily charge that may well make patients want to shorten the hospital stay is 10, 000 yen as a standard. The average postoperative period is 4.5±1.9 days for all patients, and those classified by the patients'degree of work-load were: extremely busy: 3.7±0.8; busy: 4.3±1.9; relatively no work pressure; 4.5±1.9; and no pressure of work: 5.2±2.0 days respectively. The group without any work pressure had a statistically significant prolonged postoperative period compared with the extremely busy and busy groups. However, 87% of all patients were of the opinion that the same postoperative period as they experienced was suitable, and 8% of the patients desired a shorter stay. In addition, patients who positively desired a decrease in the postoperative stay without any change of the charge were about 3% of all patients. In conclusion, patients of this study still have not recognized laparoscopic cholecystectomy as a day-care surgical procedure in the present health care system.View full abstractDownload PDF (236K) -
Noriaki Kojima, Fumio Sakashita, Shuntaro Honda, Kouki Hayashi, Tomohi ...1999 Volume 32 Issue 12 Pages 2649-2653
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe were able to gather 54 reported cases of situs inversus totalis (SIT) associated with gastric cancer in Japan, and in 55 cases, including our case, we discuss the significance of SIT. A 66 year old man who was diagnosed as having situs inversus due to dextro-cardia while he was a student at school, was admitted to our hospital because of complaints of dizziness and general fatigue. After UGI, US and GIF examination, he was found to have an advanced stage IIIa cancer at the C portion of the stomach associated with SIT. On January 30, 1998 a total gastrectomy with D3 lymphadenectomy was performed, and was reconstructed by modified ρ-Graham method (pap>tub, se, INFβ, int, ly2, v2, ow (-), aw (-), n1, H0, P0, stage IIIa). SIT was also confirmed in the stomach, liver, pancreas, and other organs, including the main vessels, during the surgery.View full abstractDownload PDF (101K) -
Kazuo Hirose, Makoto Ishida, Kunihiro Fujita, Hiroyuki Maeda, Takanori ...1999 Volume 32 Issue 12 Pages 2654-2658
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 72-year-old man who exhibited Borrmann type 2 gastric cancer with metastases in the liver and paraaortic lymph nodes underwent total gastrectomy with D4 lymph node dissection, distal pancreaticosplenectomy, and partial resection of the two metastatic liver tumors. The para-aortic nodal metastases were not completely dissected, and resulted in noncurative resection. However, a catheter for hepatic arterial infusion was inserted. The resected cancer was histologically diagnosed as poorly differentiated adenocarcinoma, ssγ, ly3, v1, and n4. For early postoperative chemotherapy, the patient was treated with hepatic arterial infusion (750mg of 5-FU, 10mg of adriamycin, and 26mg of mitomycin C), oral doxifluridine (600mg/day), and intravenous infusion of cisplatin (100mg), mitomycin C (48mg), etoposide (150mg) and pirarubicin (60mg). Administrations of oral tegafur (600mg/day) and intravenous lentinan (2mg/2 weeks) were continued at an outpatient clinic. At 1 year and 6 months after the operation, residual metastases in the para-aortic lymph node were not detected by abdominal computed tomography, and complete response continued for 5 months. Therafter, the tegafur-lentinan therapy was continued, the patient remained in good general condition, and the values of both carcinoembryonic antigen and immunosuppressive acidic protein in the serum normal until 4 years and 6 months after the operation. He died of mediastinal lymph node recurrence 5 years and 2 months after the operation, but no hepatic recurrence was detected. Thus, the patient was successfully treated by the maintaining immunochemotherapy, as well as cytoreductive surgery and early postoperative induction chemotherapy, which resulted in long-term survival.View full abstractDownload PDF (111K) -
Keiji Uchide, Masaki Kashiwazaki, Youichi Makari, Sadayuki Doi, Nobuo ...1999 Volume 32 Issue 12 Pages 2659-2663
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSSeventy-one cases of gastrojejunocolic fistula, a rare and serious complication of marginal ulcers after surgery for gastric or duodenal ulcers, have been reported in the Japanese literature from 1931 to 1998. Recently, we experienced a case of gastrojejunocolic fistula which had developed 13 years after distal gastrectomy for duodenal ulcer perforation. Surgical procedures were successfully performed on this case. A 37-year-old man was admitted to our hospital with complaints of severe diarrhea, weight loss, and buttock pain. He had undergone distal partial gastrectomy with Billroth II and retrocolic anastomosis for duodenal ulcer perforation 13 years before. Radiologic and endoscopic examinations revealed a gastrojejunocolic fistula. Thus, subtotal gastrectomy with partial resection of the jejunum and transverse colon was successfully performed. There was a weight gain of 18 kg three months after surgery.View full abstractDownload PDF (79K) -
Hirochika Makino, Chikara Kunisaki, Hidenori Masui, Shinji Togo, Hiros ...1999 Volume 32 Issue 12 Pages 2664-2668
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 65-year-old male who was followed-up for liver cirrhosis by another hospital, was admitted to our hospital for melena and anemia. Upper gastrointestinal endoscopy revealed enlarged and tortuous varices in the descending portion of the duodenum. Hypotonic duodenogram demonstrated a filling defect with well-defined margins and smooth surfaces in the descending portion of the duodenum. A percutaneous transhepatic portogram revealed duodenal varices that were mainly supplied via the posterior inferior pancreaticoduodenal vein that drained to the testicular vein. Duodenal varices were treated by percutaneous transhepatic portal obliteration. His symptoms temporaily were relieved, but two months later, during a regular checkup at our outpatient the melena and anemia recurred. So, he was readmitted to our hospital. After readmission, a testiculovenogram revealed that the duodenal varices remained. Intraoperative injection sclerotherapy was selected as a safe treatment. We injected 5 ml of ethanolaminoleate intravariceally after ligation and resection of the varices. The postoperative course progressed favorably, even through a duodenal ulcer developed. No recurrence of the duodenal varices has been detected during the follow-up period of two years after intraoperative injection sclerotherapy. In conclusion, intraoperative ligation and injection sclerotherapy is a safe, sure, and useful method for treatment of duodenal varices.View full abstractDownload PDF (76K) -
Takafumi Machimoto, Hajime Nakamura, Yoshiharu Sakai, Kazuichi Okazaki ...1999 Volume 32 Issue 12 Pages 2669-2673
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of autoimmune-related chronic pancreatitis with narrowing of the major pancreatic duct. A 37-year-old man was admitted with complaints of epigastralgia. On admission, an abdominal CT showed diffuse swelling of the pancreas without any dilatation of the main pancreatic duct. Serum amylase level was elevated to 345IU/L and the diagnosis of acute pancreatitis was made. However, obstructive jaundice appeared thereafter and abdominal CT and US revealed dilatation of the common bile duct. ERCP showed no choledocolithiasis and smooth narrowing of the lower bile duct and the major pancreatic duct. A tentative diagnosis of chronic pancreatitis with narrowing of the major pancreatic duct was made, and we investigated the relation with autoimmune disease. Anti-Lactoferrin antibody was positive, and then glucocorticoid therapy was started. Two weeks later and six months later, ERCP showed improvement in the narrowing of the common bile duct and the major pancreatic duct. Recently, a new disease entity of “chronic pancreatitis with narrowing of the major pancreatic duct” was reported. This is a kind of autoimmune disease and treated effectively by glucocorticoids. We surgeons should be well aware of this kind of disease entity, and when we encounter such cases, we should consider the indication of surgery after examining the possibility of improvement by means of glucocorticoid therapyView full abstractDownload PDF (85K) -
Takuya Nakai, Osamu Shiraishi, Takashi Kawabe, Sadao Funai, Histoshi K ...1999 Volume 32 Issue 12 Pages 2674-2678
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe case study is a 56-year-old woman who had come to hospital complaining of fever and abdominal pain. She underwent pylorus-preserving pancreatoduodenectomy using Imanaga (Billroth I) reconstruction for the treatment of lower bile duct carcinoma. Because of postoperative recurrences of cholangitis and hepatophyma, abscess drainage was provided. There was nothing remarkable with the serum ALP levels nor with the upper gastrointestinal rentogenography; in addition, 99mTc-PMT hepatobiliary scintigraphy failed to demonstrate any stricture at the site of the choledocho-jejunostomy or bile stasis in the proximal jejunum loop. The patient began to take meals, only to manifest symptoms of cholangitis, for which intra-arterial infusion of antibiotics was ineffective. We assumed that the cholangitis was probably due to reflux of food into the biliary tract, and so the reconstruction was changed from Billroth I to Billroth II. No recurrences of cholangitis have occurred for the last six months after the re-operation.View full abstractDownload PDF (60K) -
Yoshinori Sugenoya, Hiroshi Saiki1999 Volume 32 Issue 12 Pages 2679-2683
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA rare case of splenic injury was caused by colonoscopy. A 72-year-old man was admitted with a smallbowel obstruction. Distal gastorectomy had been performed due to a gastric ulcer twenty years ago. The small-bowel obstruction was improved with conservative therapy. A few days later, colonoscopy was performed because he had been suffering from constipation. The procedure was uncomplicated and endoscopic findings were normal. Approximately 4 hours after colonoscopy, the patient complained of left upper quadrant pain without peritoneal signs. Hypotension, and decreases in red blood cell count and in hemoglobin were also noted. A CT scan was obtained, which demonstrated a laceration of the spleen, and splenectomy was performed. Splenic injury following colonoscopy is very rare. But if left upper quadrant pain or shock are observed after colonoscopy, physicians should be aware of this unusual colonoscopic complication.View full abstractDownload PDF (65K) -
Hiroshige Sasaki, Masatomo Hayashi, Atsuyoshi Onitsuka1999 Volume 32 Issue 12 Pages 2684-2688
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of the Villous Adenoma of the rectum and sigmoid colon with electrolyte depletion syndrome and carcinoma confining to the mucosa. A 55-year-old man was admitted with severe diarrhea and vomiting. He had suffered from diarrhea since the age of 40.
Physical and laboratory examinations on admission showed a shock state, moderately decreased serum electrolytes (Na 127 mEq/l, K 3.1 mEq/l, Cl72mEq/l) and hyperazotemia (BUN85.1 mg/dl) due to dehydration. Double contrast barium enema examination showed a huge tumor which presented a shaggy appearance in the rectum and sigmoid colon. Endoscopic finding showed the villous tumor in the rectum and slgmoid colon. Histological examination of the biopsy specimen revealed a villous adenoma with adenocarcinoma. He underwent abdominoperineal resection of the rectum with regional lymphadenectomy after fluid and electrolyte adjustment. The tumor was 26×13 cm in size and occupied the circumference of the bowel. Histological findings revealed a villous adenoma with well-differentiated adenocarcinoma confined to the mucosa. His postoperative course was uneventful and he has shown no recurrence for 4 years after the operation.View full abstractDownload PDF (85K) -
Tatsunori Hamasaki, Naohide Mori, Kenji Wadamori, Masaaki Oka1999 Volume 32 Issue 12 Pages 2689-2693
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe experienced a case of superior mesenteric artery syndrome (SMAS) as a post-operative complication after abdominoperineal excision for rectal cancer in 65-year-old man. Duodenal compression by the overlying superior mesenteric artery may be caused by strong traction of the mesenterium to the pelvic floor which was made by postoperative adhesion. Although the mobilization of the third part of the duodenum was performed, the symptoms reappeared 3 months after surgery. Therefore, we performed side-to-side duodenoje-junostomy. The patient has continued to make satisfactory progress 8 years after the reoperation. SMAS should be considered as a postoperative ompliation after abdominal surgery, although it may be rare. Side-to-side duodenojejunostomy may be recommended.View full abstractDownload PDF (91K) -
Yu Takahashi, Hiroshi Hasegawa, Seiji Ogiso, Masaya Shiomi, Masato Mom ...1999 Volume 32 Issue 12 Pages 2694-2698
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSGastrointestinal stromal tumor is a relatively new concept. We experienced a GIST case and had experienced four leiomyosarcomas of the rectum by histological findngs. Immunohistochemical re-examination was peformed in all cases, anew, and all four were GIST. A 57-year-old woman complaining of abdominal fullness, constipation, dysuria was referred to the hospital with a diagnosis of pelvic tumor. Various imaging examinations were carried out, and an operation was perfomed under a diagnosis of pelvic tumor. At operation, we found the primary tumor of the rectum and abdominoperineal resection was perfomed. Histologically, the tumor was composed of spindle-shaped cells with an interweaving bundle patters. Immunohistochemically, the tumor was diagnosed as a gastrointestinal stromal tumor (GIST), uncommitted type, malignant. A concept of GIST is spreading, so we need to carry out a further examination of this desease from now.View full abstractDownload PDF (129K)
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