All issues
Volume 52 (2019)
- Issue 12 Pages 695-
- Issue 11 Pages 611-
- Issue 10 Pages 551-
- Issue 9 Pages 485-
- Issue 8 Pages 405-
- Issue 7 Pages 345-
- Issue 6 Pages 281-
- Issue 5 Pages 239-
- Issue 4 Pages 191-
- Issue 3 Pages 137-
- Issue 2 Pages 83-
- Issue 1 Pages 1-
- Issue Special_Issue P･･･
- Issue Supplement2 Pag･･･
- Issue Supplement1 Pag･･･
Volume 32, Issue 8
Displaying 1-25 of 25 articles from this issue
- |<
- <
- 1
- >
- >|
-
Harushi Osugi, Masayuki Higashino, Taigou Tokuhara, Susumu Kaseno, Nob ...1999 Volume 32 Issue 8 Pages 2051-2057
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTo evaluate the usefulness of ambulatory intraesophageal bilirubin monitoring in the diagnosis of gastroesophageal reflux, 24 patients with reflux symptoms and 5 controls without symptoms were studied, and the results were compared with that of pH monitoring. The bilirubin monitoring was performed by spectrophotometry using Bilitec 2000 (Synectics Medical AB, Stockholm, Sweden). Bilirubin reflux or acid reflux was judged when absorbance was 0.15 or more, or when pH was less than 4 in the esophagus at 5 cm oral to the pressure inversion point, respectively. The duration of each reflux compared to the total observed period was obtained to determine percentage of time. Twenty-four hour monitoring was completed in all of 29 subjects. Percentage of time of bilirubin and acid reflux was less than 5% in all controls. In 3 patients with symptoms and without any evidence of morphological abnormalities in the upper gastrointestinal tract or biliary tree, percentage of time of acid reflux was less than 5%, but percentage of time of bilirubin reflux was more than 8% in 2 patients. Reflux esophagitis was found in the other 21 patients. Acid reflux was found only in 1 of 4 patients who had a history of subtotal gastrectomy, but abnormal bilirubin reflux was found in all 4 patients. In the other 17 patients, a significant difference was found in the amount of percentage of time of bilirubin reflux by the severity of reflux esophagitis, whereas this difference was not found in that of acid reflux. Intraesophageal bilirubin monitoring using Bilitec 2000 can be performed safely with pH monitoring and is useful in the diagnosis and evaluation of the severity of gastroesophageal reflux. Furthemore, bilirubin monitoring could be essential in patients with hypochlorhydria or minimal reflux.View full abstractDownload PDF (63K) -
Masashi Takemura, Harushi Osugi, Taigo Tokuhara, Nobuyasu Takada, Hiro ...1999 Volume 32 Issue 8 Pages 2058-2063
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe capability of minithoracotomy assisted thoracoscopic esophagectomy as a curative procedure for esophageal cancer was compared with conventional esophagectomy through right thoracotomy by the quality of mediastinal lymph node dissection. Of the patients with esophageal cancer who were treated with minithoracotomy assisted thoracoscopic esophagectomy from July 1995 to July 1998, 39 patients, excluding the patients who were converted to conventional thoracotomy and ended in noncurative operation, were classified as T group. Fifty-three patients who underwent conventional esophagectomy through right thoracotomy and who were not resected of other extraesophageal organs from January 1993 to June 1995 were classified as C group. No hospital death were occurred in either group. No significant difference in the frequency of postoperative complications was found. Although the operative stage was different, the pathological stage was not different in two groups. The duration of thoracic procedure was significantly longer in T group than in the C group. No significant difference was observed in the mount of intrathoracic blood loss. The number of dissected nodes and metastatic nodes in the mediastinum was not different between two groups. Regarding location of lymph node including tracheobronchial nodes and nodes along the recurrent laryngeal nerves, no difference was found. These results suggests that minithoracotomy assisted thoracoscopic esophagectomy is efficacious as a curative procedure for esophageal cancer.View full abstractDownload PDF (48K) -
Takamasa Hiraoka, Takao Umemoto, Katuyuki Kunieda, Motohisa Kato, Iwao ...1999 Volume 32 Issue 8 Pages 2064-2071
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe prognosis of 261 gastrectomized pasients (Stage I: 117, II: 31, III: 62, IV: 51) out of 411 gastric cancer pasients for 5 years starting from 1985 were statistically analyzed according to the prognostic factors of Japanese classification of gastric carcinoma and serum levels of pre-and postoperative tumor markers, by uni-and multivariated methods. From the above results, the personal prognosis was predicated using a neural network. This network was constructed with 9 neurons for the input layer information such as Stage, serum CEA and IAP levels at one month after operation, the difference of pre-and post-operative CEA value, curative and non-curative resection, number of metastatic lymph nodes, 9 neurons for the middle layer and 2 neurons for the output layer. After learning this neural network by the back propagation method, 94 out of 130 pasients (72. 3%) satisfactorily gave the correct answer. Also, using the learned neural network, the prognosis of 90 out of 131 unknown patients (68. 7%) was predicted correctly. In terms of the treatment effects, the neural network model may be useful for predicting the new personal prognosis of gastrectomized pasients.View full abstractDownload PDF (65K) -
Masanori Kobayashi, Shigekazu Ohyama, Keiichiro Ohta, Toshiki Matsubar ...1999 Volume 32 Issue 8 Pages 2072-2076
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe mapped the arterial areas of lymphatic drainage, by studying cases of single lymphonode metastasis of early gastric cancer. Arterial areas of lymphtic drainage are divided into four areas according to the arteries that supply the stomach (left gastric arterial area, right gastroepiplolic arterial area, splenic arterial area, and right gastric arterial area). The left gastric arterial area is the largest of the four. and extends to the whole stomach expcept for the greater curvature of the upper one-third of the stomach and pylorus. The right gastric arterial area is small and includes the lesser curvature of the antrum. The splenic arterial area is also small and extends to the greater curvature of the upper two-thirds of the stomach. From the lesser curvature of the lower body and the greater curvature of the middle body and the greater curvature of the middle body to the antrum, the left gastric arterial and right gastroepiploic arterial areas overlap. Tumors located in these overlapped areas have the possibility of metastasizing to the lymphonodes of either area. Therefore, it is necessary to dissect the lymphnodes of these overlapped areas. In conclusion, the map of arterial areas of lymphatic drainage should be used to discuss the extent of resection and dissection.View full abstractDownload PDF (114K) -
Takayuki Yamaki, Masanori Suzuki, Kenji Hukuhara, Michiaki Unno, Kogin ...1999 Volume 32 Issue 8 Pages 2077-2084
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe purpose of this study was to investigate the changes in the tissue and plasma lipid peroxides, and to determine their significance following hepatic ischemia and reperfusion. Using CL-HPLC assay, we quantified phosphatidylcholine hydroperoxide (PCOOH), which is a primary peroxidative product of the most important functional lipid in the hepatocellular membrane. This experimental study divided subjects into three groups according to the duration of hepatic ischemia induced as follows: 10, 20, and 30 minutes by occlusion of the hepatic inflow of the hepatic artery and portal vein. Hepatic energy charge and arterial ketone body ratio decreased significantly as the duration of ischemia increased, and recoverd after reperfusion. alanine aminotransferase and hepatic PCOOH levels showed marked increases, and hepatic glutathione levels showed decreases following reperfusion. Also, a close correlation between the PCOOH levels in peripheral vein and liver was observed as well as in peripheral vein and hepatic vein. These results suggest that membrane lipid peroxidation induced the production of oxidative radical formation and is involved in the pathogenesis of the reperfusion injury, and furthermore, that the plasma PCOOH levels are a useful index, which can indicate the reperfusion injury process directly and sensitively.View full abstractDownload PDF (115K) -
Naoki Sato, Yuichi Hatakeyama, Wataru Igarasi, Toshiyuki Ono, Yoshihis ...1999 Volume 32 Issue 8 Pages 2085-2094
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe conducted an experimental study investigating the significance of the quantitive analysis of extracellular matrix (ECM) that accumulates in the liver as hepatic fibrosis after partial hepatectomy for liver cirrhosis. Two groups of 5-wk-old male Wistar rats (10 to 40/group) were treated for 10 wks by weekly intraperitoneal administration of thioacetamide (200 mg/kg, 3 times/wk) or saline. All rats then underwent 70%hepatectomy under pentobarbital anesthesia. The expression of laminin, fibronectin, types I, III and IV collagen were detected by immunohistochemical staining using the resected liver tissue, and were quantitated using automatic image analysis. Hepatic regeneration activity was determined at 24 and 48 hours after partial hepatectomy by means of 5-bromodeoxyuridine incorporated into the DNA. In laminin, type III collagen and type IV collagen, a significant inverse correlation was found between the measured result and the DNA synthesis in all rats: r=-0. 497, r=-0. 511, r=-0. 481 respectively (p<0. 05) at 24 hours after partial hepatectomy, and r=-0. 559, r=-0. 444, r=-0. 375 respectively (p<0. 05) at 48 hours after partial hepatectomy. Accordingly, we conclude that preoperative quantitation of laminin, type III collagen, and type IV collagen is useful as an index to the hepatic regeneration activity after partial hepatectomy for liver cirrhosis.View full abstractDownload PDF (190K) -
Yoshihiko Sakurai, Makoto Miyakita, Koichi Yamataka, Noritaka Hayashi, ...1999 Volume 32 Issue 8 Pages 2095-2099
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThis paper describes a case of a resected submucosal tumor arising in the cervical esophagus, diagnosed as a cyst forming choristoma by histological findings. A 53-year-old man was seen at the hospital because of disturbance in swallowing and discomfort in the pharynx. A Submucosal tumor was detected by roentogenography, fiberscopic examination, and computed tomography. An operation was performed, and a pedunculated tumor was resected from the cervical esophagus. Histological findings revealed that the tumor was located in the esophageal submucosal layer and the muscularis mucosae was absent between the esophageal epithelium and the tumor. Macroscopically, the tumor consisted of cyst and lipoma-like adipose tissue. Seromucinous glands and cartilage were observed in the adipose tissue, and some of the excretory ducts dilated in various size. The cyst was lined by two-layered cuboidal epithelium which was histologically similar to that of the excretory ducts. The cyst was, therefore, considered to be formed by the dilatation of the excretory duct. The tumor was histologically diagnosed as cyst forming choristoma, which was formed by incomplete separation of the respiratory tract organ.View full abstractDownload PDF (94K) -
Hiroshi Manaka, Chikara Kunisaki, Yasushi Ichikawa, Hiroshi Kanaya, Na ...1999 Volume 32 Issue 8 Pages 2100-2104
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 77-year-old female with a chief complaint of anorexia was admitted to our hospital with a diagnosis of type 4 gastric cancer. Gastroenterologic evaluations revealed giant folds with ulcers in the upper and middle third of the stomach, and histologic study revealed diffuse medium-sized cell type malignant lymphoma, Tcell type. Chemotherapy with CHOP was administered two times prior to surgery with a diagnosis of Stage III (Naqvi). The patient underwent total gastrectomy, and pancreatosplenectomy with D2 lymph node dissection, which resulted in curability C. She died of lymph node metastasis 10 months later. T-cell type malignant lymphoma of the stomach is rare and complete remission is difficult to achieve. Establishment of an effective chemotherapy protocol is urgently needed for Tcell type malignant lymphoma of the stomach.View full abstractDownload PDF (94K) -
Kazuo Yasumoto, Kouichi Hirano, Atsuhiro Kawashima1999 Volume 32 Issue 8 Pages 2105-2109
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSAn extremely rare case of gastric carcinoma with metastasis to the tongue is reported. A 65-year-old man had undergone total gastrectomy for a type 3 gastric carcinoma, which was located in the upper portion of the stomach (P0H0t2n1, Stage II, D2), about one year before. Histopathologically, the resected specimen contained moderately differentiated tubular adenocarcinoma (ss, ly0, v2). Following gastrectomy, he was admitted to our hospital complaining of one subcutaneous tumor over the right middle abdomen. Serum CA19-9 was also elevated. Two months after the admission, physical examination showed a swollen tumor in the left side of the tongue. A biopsy of the tongue tumor indicated adenocarcinoma which was strikingly similar to the primary gastric cancer. In addition, all specimens of these tumors were positive for CA19-9 staining. Therefore, these two tumors of the tongue and the skin were diagnosed as metastases of the gastric carcinoma. Interestingly, he had developed no metastases other than the tongue, the skin and the lymph node. Furthermore, histochemical analysis showed that overexpression of mutant p53 protein was detected in both tissue from the most progressive site of the primary and from the metastatic tumors, suggesting that alteration of the p53 gene may be involved in the progression of gastric cancer.View full abstractDownload PDF (121K) -
Yoshinori Yagi, Akiyoshi Seshimo, Maki Mitsuhashi, Kazuki Aratake, Mas ...1999 Volume 32 Issue 8 Pages 2110-2114
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 74-year-old male was admitted to our hospital with a chief complaint of melena. The gastroendoscopy revealed an early gastric cancer (IIa+IIc) at the posterior wall of the antrum, and an advanced duodenal cancer (Borrmann type-2). Furthermore, the colonoscopy revealed advanced colon cancer of the ascending colon. The diagnosis was synchronous triple cancer of the stomach, duodenum and ascending colon. We performed a distal gastrectomy with wide resection of the duodenal bulb and partial resection of the ascending colon. Pathological examination of the resected specimen revealed papillary adenocarcinoma of the stomach, and moderately differentiated adenocarcinoma of the duodenum and ascending colon. The duodenal cancer showed lymphoid stroma and was LMP-1 and EBER positive. Thus, we suspected the cancer was associated with Epstein-Barr virus (EBV). Although primary gastric cancer associated with EBV has been described in the literature, primary duodenal cancer has never been reported. Moreover, this is the 11th case reported in Japan of synchronous triple cancer which concluded the primary duodenal cancer.View full abstractDownload PDF (98K) -
Nobuhiro Shibata, Takasi Shibata, Takahiro Niinobu, Kimimasa Ikeda, Ma ...1999 Volume 32 Issue 8 Pages 2115-2118
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe herein report a case of colon cancer metastatic to the liver which has underwent four hepatic resections and survived eight years. A 56-year-old man with abdominal distension was admitted to our hospital in May 1990 and underwent emergency laparotomy because of obstructive ileus. At laparotomy, transverse colon cancer and metastatic hepatic tumor were found. He underwent right colectomy and partial hepatectomy. Histological examination of the resected specimens showed moderately differenciated adenocarcinomas and the hepatic tumor was diagnosed as a metastasis from the colon. One year and seven months after the first operation, the patient was noted to have one nodule in the lateral segment on a routine follow-up CT scan. The patient underwent a second hepatic resection (lateral segmentectomy). Four years later, he had a CT scan that revealed two new nodules in segments 4 and 8. The patient underwent a third resection. Three years later, a follow-up CT scan reveals a new 4cm nodule in segment 5. The patient underwent fourth hepatic resection. Histologically, the resected specimen revealed evidence of moderately differenciated adenocarcinoma. The patient remains alive and well at 8 years after the first operation. There are few reports regarding the value of repeat hepatic resections in patients who have a recurrence in their liver following initial resection of hepatic metastases. This case illustrates that repeat hepatectomy for recurrent hepatic metastases is a viable option for the well selected patient.View full abstractDownload PDF (75K) -
Kazuki Yokoi, Akio Harada, Takumi Sakakibara, Yoshinao Komatu, Sigeru ...1999 Volume 32 Issue 8 Pages 2119-2123
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA case of staphylococcal scalded skin syndrome (SSSS) after hepatectomy is reported. The patient was a 63-year-old male with liver cirrhosis, who was found to have a tumor in the liver by ultrasonography. Computed tomography and angiography showed hepatocellular carcinoma and partial hepatectomy was performed under thoracotomy and laparotomy. After the operation he had sepsis from a thoracic empyema, and showed peeling of the skin of all over the body. Nikolsky's sign was positive. MRSA was cultured from the pleural effusion, ascites and blood. He was diagnosed as SSSS and we performed thoracic drainage and gave intravenous antibiotics, which led to recovery. Almost all cases of SSSS in adults have some concomitant diseases. Liver cirrhosis, diabetes mellitus and extensive blood loss during hepatectomy was the cause of SSSS in our case. SSSS is rare in adults, and to our knowledge this is the first reported case after hepatectomy.View full abstractDownload PDF (104K) -
Masaya Tamura, Humihiko Kimoto, Osamu Murobayashi, Shin Nagao, Shigeit ...1999 Volume 32 Issue 8 Pages 2124-2128
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case initially identified as acute cholecystitis, found to have a skin metastasis 11 months after surgery. A 75-year-old woman was diagnosed as acute cholecystitis and underwent cholecystectomy. A resected specimen showed an elvated lesion with an irregular margin at the fundus. Histological examination of the gallbladder revealed small cell carcinoma, which did not invade to the serosa. A liver metastasis developed 5 months after surgery. Follow-up computed tomography 11 months after surgery showed cutaneous metastasis from the gallbladder. Dissemination via a percutaneous trans-hepatic gallbladder drainage tube is most probable.View full abstractDownload PDF (117K) -
Kengo Kanetaka, Norihiro Kohara, Hiroyuki Yuzawa, Takayuki Hamada, Sat ...1999 Volume 32 Issue 8 Pages 2129-2133
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe present a case of islet cell tumor which recurred as multiple liver metastases, 9 years after the initial surgery in 1991. The patient was a 65 year-old Japanese man who underwent the resection of a nunfunctioning islet cell tunor at the age of 56, which we reported previously. He had had no symptoms or significant abnormalities in regular checkups until 1996, when abdominal ultrasonography revealed multiple nodules in the right lobe of the liver. Abdonimal computed tomography demonstrated that the rims of each nodule were well-enhanced after injection of contrast medium. The nodule centers were not enhanced, implying nocrosis. Other radiological examinations did not reveal any abnormal findings in the left lobe of the liver or in the gastrointestinaltract. With a diagnosis of recurrent islet cell tumor right lobectomy of the liver was performed. The histological examination obtained from the second operation showed that each of the nodules consisted of polygonal tumor cells arranged in solid and trabecular pattern, occasionally appearing in a ribbon-like pattern. These cells were Grimelius-stain positive. The histological findings were similar to those of the primary islet cell tumor resected 9 year before. The patient remains well without any evidence of the recurrence one year later. This fact suggests to us that surgical resection might provide a favorable prognosis in a patient with metastatic islet cell tumor, because of its slow-growing behavior.View full abstractDownload PDF (98K) -
Kouji Koinuma, Tetsu Amemiya, Shouichi Oka, Hiroshi Yamaguchi, Hiroaki ...1999 Volume 32 Issue 8 Pages 2134-2138
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 58-year old woman was admitted to our hospital complaining of abdominal distension, leg edema and 10 kg weight increase for a month. Abdominal ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI) revealed a heterogeneous giant tumor in the abdomen. Angiography showed some hypervascular lesions supplied by the gastroepiploic arteries. An operation was performed under the diagnosis of an omental malignant tumor. The tumor, which originated from the greater omentum, was resected with a block of the greater omentum. The resected tumor measured 32×26×13cm and weighed about 6, 900g. The histopathological diagnosis was mixed type liposarcoma (myxoid type and round cell type). Three months after the operation, local recurrence was detected. We performed a second operation, but found extensive peritoneal dissemination. About one month later the patient dead.View full abstractDownload PDF (108K) -
Takami Fukui, Naoki Yokoo, Takahiro Yoshida, Chihiro Tanaka, Tatsushi ...1999 Volume 32 Issue 8 Pages 2139-2143
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe experienced a rare case of ileal duplication with multiple fistula and heterotopic gastric mucosa in the small intestine which was detected because of an ileus. A 71-year-old woman was admitted to our hospital with nausea, vomiting and abdominal distention. On admission physical examination revealed tenderness and muscle guarding at the lower abdomen. Plain abdominal X-ray and abdominal CT showed dilated loops of the small intestine. An emergency laparotomy was carried out. During the laparotomy, one fistula which was at the jejunum 130 cm from the ligament of Treitz were found. Adhesions of the dilated small intestine and an ileal duplication 100cm from the ileum end were found. In addition, three fistulas which were in the dilatedsmall intestine were found. The dilated small intestine including the ileal duplication and the fistula at the jejunum were resected. Histological examination revealed some gastric-pyloric glands in the small intestine specimen. These findings suggest that the fistula, due to heterotopic gastric mucosa, caused the ileus.View full abstractDownload PDF (110K) -
Takafumi Oshiro, Tsuneo Tanaka, Toshiyuki Itamoto, Daisuke Tokita, Hir ...1999 Volume 32 Issue 8 Pages 2144-2148
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 63-year-old man who complained of melena was admitted to our hospital. The patient was diagnosed with a malignant mesenteric tumor by CT and garium scintigraphy, the rise in CA19-9, and so on. A tumor obvious to the naked eye and thought to be malignant was found during laparotomy for Meckel's diverticulum which was located on the oral side 80 cm from the end of the ileum. The mesenteric tumor, discoverd before the operation, resulted from a swollen lymph node due to metastasis. A partial resection and lymph node dissection were done. Histologically, the tumor was a moderately differentiated adenocarcinoma which developed from the Meckel's diverticulum without ectopic tissues. A serum CA19-9 value decreased rapidly after the operation, and CA19-9 was proved in the tumor cell by immunohistological staining. The adenocarcinoma which developed from the Meckel's diverticulum is very rare, and only 21 cases have been reported in Japan until now. Although reports indicate poor prognosis for this tumor, postoperative recurrence has not been detected in this case for 18 months, and the patient continues to improve. In this patient, the measurement of serum CA19-9 was useful as an indicator of recurrence and as a predictor of metastasis.View full abstractDownload PDF (97K) -
Rika Ishibashi, Masahiro Kamati, Toshihiko Kurohiji, Keita Kobayashi, ...1999 Volume 32 Issue 8 Pages 2149-2152
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA-60-year old female visited our hospital because of abdominal pain. Her abdomen was distended without muscular defense. A abdominal X-ray and CT showed marked distention in the colon. An emergency laparotomy was performed due to septic shock. Obstructive colitis associated with sigmoid colon cancer was intraoperatively diagnosed and left hemicolectomy was performed. After the operation, PMX and CHDF were immediately started for endotoxicemia and acute renal failure. She recovered gradually from septic shock after 2 sessions of PMX, and drank clear water perorally for 2 weeks after the operation. HDF support for acute renal failure was stopped on the 38th postoperative day, and she was discharged on the 76th postoperative day.View full abstractDownload PDF (73K) -
Kunio Takeuchi, Yasushi Tsuzuki, Tetsu Ando, Masanori Kobayashi, Ryoku ...1999 Volume 32 Issue 8 Pages 2153-2157
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of HNPCC associated with leiomyosarcoma of the trapezius muscle. A 55-year-old man had ascending colon cancer at 24 years of age, transverse colon cancer at 35 years and sigmoid colon cancer at 54 years. His mother had colon cancer, his father had gastric cancer, two of his brothers had colon cancer, one brother had liver cancer, and his uncle and his cousin on his mother's side had colon cancer. He visited a clinic due to a swelling of his right shoulder. Aspiration cytology was performed and a diagnosis of class V was made. Thereafter, he consulted and was admitted to our department. After detailed examination, he was diagnosed as having a malignant tumor of the trapezius muscle, and the tumor was surgically removed. Histopathological diagnosis of the excised specimen was leiomyosarcoma originating from the trapezius muscle. He died of local recurrence and lung metastases 4 months after surgery. One of the clinical features of HNPCC is a high incidence of multiple primary neoplasms although a few cases have been associated with malignant neoplasms of the soft tissues as in our case.View full abstractDownload PDF (127K) -
Yoshihiro Moriwaki, Noriyuki Kamiya, Mitsunobu Kikuchi, Yukihiro Ozawa ...1999 Volume 32 Issue 8 Pages 2158-2162
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe reptort the usefulness and the safety of simultaneous mechanical anastomosis by metallic stapler at massive small bowel resection for senile acute mesenteric arterial occlusion in elderly patients. Three female patients, aged 83, 78, and 75 years old. were diagnosed as acute mesenteric arterial occlusion and underwent massive small bowel resection. Bowel necrosis and bloody peritoneal fluid was noted without bowel perforation. Simultaneous anastomosis by metallic stapler was performed without any strong intention to preserve small bowel as long as possible because of their age. In the two first cases side-to-end anastomosis was performed and the other case end-to-side. Remnant small bowel was 30 cm from the ligament of Treitz. 50 cm from the pyloric ring and 30 cm from the ligament of Treitz, respectively. Postoperative oral feeding was started at postoperative days 16, 17 and 10, respectively. The frequency of defectation was 3-4, 0-1 and 15 times a day, respectively. The patient undergoing end-to-side anastomosis had a high frequency of defecation. The volume of infusion required was 2, 000ml, 1, 000ml and 1, 000-2, 000ml a day, respectively. No signs of anastomotic leakage or progressive ischemia in the remnant small bowel were seen in the postoperative course of all 3 cases. The disadvantages with provximal jejunostomy were avoided by simultaneous reconstruction. Postoperative jejunography showed the benefit of side-to-end anastomosis in regard to absorption.View full abstractDownload PDF (62K) -
Masato Makino, Tetsuya Taniguchi, Nariyuki Yamane, Kazuo Kurayoshi, Os ...1999 Volume 32 Issue 8 Pages 2163-2166
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe examined 71 cases with 74 intestinal anastomoses using a biofragmentable anastomosis ring (BAR). Fragmentation of BAR occurred on the 18th postoperative day (POD) in entero-colonic (rectal) anastomoses and on the 20th POD in colo-colic (rectal) anastomosis on average. The mean time required for the anastomosis was 21 min. Anastomotic leakage was identified in two cases (3%) and wound infection occurred in 5 cases (7%). Intestinal obstruction (abdominal pain or vomiting) was a specific complication of BAR anastomosis that occurred between the 10th and 14th POD in 20 cases (28%), although it could be prevented by administration of laxatives. BAR provides a fast, standardized, safe anastomosis and defecation should be controlled in about 3 postoperative weeks in cases with colonic anastomosis using a 25-mm BAR.View full abstractDownload PDF (31K) -
Takashi Akaishi1999 Volume 32 Issue 8 Pages 2167-2171
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIn the surgical treatment for the esophageal cancer, thoracoscopic mobilization of the esophagus has been indicated for patients who had the primary lesion invading the mucosal musclelayer or deeper but up to the adventitia. The patients who were presumed not to tolerate with one-lung ventilation during the period of the mediastinal portion of the surgery has been excluded. The lung was kept away from the surgical field, using “thoracoweb” maneuver, and four hands, the surgeon's two and the assistant's two, participated in the mediastinal procedure, facillitating meticulous lymphadenectomy. It made no difference of the patients' survival whether the thoracoscopy was adapted or not. The thoracoscopic esophagectomy marked a better recovery in the patients' vital capacity than the conventional thoracotomy did. Laparoscopic mobilization of the stomach came to be demanded because the decline of the vital capacity was still observed during the early postoperative period even by thoracoscopy. No standard procedures have been established, and many technical proposals have been tried out for practice. The author has proposed to use a spacer balloon which is placed in the omental sac and is inflated to lift the stomach. The balloon is utilized for retracting the stomach in a less invasive manner that avoides retracting the stomach directly.View full abstractDownload PDF (140K) -
Fumio Konishi, Hideo Nagai, Kyotaro Kanazawa1999 Volume 32 Issue 8 Pages 2172-2176
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSLaparoscopic assisted colectomy is considered to be less invasive, and patients have less pain and fast postoperative recovery. This operation is usually indicated for large sessile adenomas or for early invasive carcinomas, which are not suitable for colonoscopic removal. The indication of this procedure for more advanced colorectal carcinomas is controvertial. However, according to our experience of more than 100 cases, laparoscopic assisted colectomy is thought to be as curative as open colectomy provided the patients are properly selected. D3 lymphnode dissection for advanced colorectal carcinomas in the right colon or in the sigmoid colon is technically feasible under laparosocpic procedure, provided there are no significant obesity or wide spread adhesion due to the previous abdominal surgeries. There are reports on “port site recurrences”, and the results of the long-term follow up should be analyzed. In this review, the methods of laparoscopicassited right colectomy and sigmoidectomy are also presented.View full abstractDownload PDF (74K) -
Seigo Kitano, Toshio Bandoh1999 Volume 32 Issue 8 Pages 2177-2181
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSLaparoscopic cholecystectomy (LC) has been recognized as the standard procedure of choice of cholelithiasis. Because of the limited operative field of vision and the technical diffieculty to manipulate the long forceps, bile duct injury during LC may occur more frequently than open cholecystectomy. For prevention of this complication, good orientation of the bile duct anatomy and to try careful dissection of Calot's triangle are essencial. Since 1993, 268 LCs have been carried out in our institution. Convertion to open surgery due to the peroperative complications was noted in 2 of the patients (0.7%); a bleeding from the cirrhotic liver bed and a CBD injury. In 34 cases of CBD exploration, we have applied the transcystic bile drainage (C-tube drainage), instead of T-tube drainage. C-tube is used not only for postoperative bile drainage but also for the diagnosis and management of possible remnant stones. With this drainage, hospital stay is greatly shortened and pain is minimum.View full abstractDownload PDF (40K) -
Its Problems and FutureTatsuo Yamakawa1999 Volume 32 Issue 8 Pages 2182-2186
Published: 1999
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWith development of new instruments and technologies, endoscopic surgery has become one of the surgeon's armamentarium in benign or malignant diseases of gastrointestinal tract, because of its advantages including less postoperative pain, rapid recovery and short hospital stay. In this paper, new development of instruments including Endo-GIA (linear cutter), instrument for automatic anastomosis as well as ultrasonic aspirator and ultrasonic coagulation shears were introduced. Moreover an advent of technologies including laparoscopically assisted surgery and hand assisted laparoscopic surgery tremendously overcome the surgeon's handicaps involved in endoscopic surgery and makes advanced surgery possible. On the other hand, discussion was mainly focussed on the problems inherent to laparoscopic surgery indicated for the cases with cancerous diseases, especially port site recurrence. Port site recurrence seems to be secondary to multiple factors including the gas used, local trauma, tumor manipulation, bilologic properties of the tumor, and individual surgeon's skills. Therefore the most important thing is that laparoscopic surgery should be indicated for the cases in which radical cure can be expected. Moreover we surgeon should be versed in fundamental technique of cancer surgery that is so-called “no-touch” technique advocated by Turnbull and a tumor should be delivered through a plastic bag.View full abstractDownload PDF (72K)
- |<
- <
- 1
- >
- >|