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Volume 33, Issue 1
Displaying 1-25 of 25 articles from this issue
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Tsuneaki Fujiya, Hideaki Yamanami, Junichi Mikuni, Yoichiro Kakugawa, ...2000 Volume 33 Issue 1 Pages 1-5
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTo evaluate the relationship between perioperative blood transfusion (PBT) and survival time over 10 years after curative gastrectomy for early gastric cancer (EGC), we reviewed 776 patients retrospectively treated surgically in Miyagi cancer center from 1967 to 1986. Of these 776, 140 (18.1%) patients received PBT. The percentage of elderly (70 years or older), submucosal invasion, lower hemoglobin content (<14g/dl), total gastrectomy, chemotherapy and earlier operative periods (1967-1976) in transfused patients were significantly higher than those in non-transfused patients. A total of 653 patients (84.1%) survived over 10 years after surgery, 91 patients (11.7%) died of causes related to gastric cancer (unrelated causes), and 29 patients (3.7%) died of causes related to gastric cancer (related causes). In comparison with transfused patients to non-transfused patients there is not significant difference in cause of death. Using only unrelated causes in Cox multivariate analysis, the independent prognostic factors were elderly, male, earlier operative period, total gastrectomy and PBT. In our current study, PBT inversely affects long-term survival of the patients with EGC by increasing the number of death by some causes unrelated to gastric cancer. In conclusion, it is important to avoid an unnecessary PBT for long-term survival of the patients with EGC.View full abstractDownload PDF (40K) -
Yoshiro Kubo, Akira Kurita, Shigemitsu Takashima2000 Volume 33 Issue 1 Pages 6-11
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe conducted a clinicopathologic study of ten cases of gastric cancer with a tumor thrombus in the perigantric vein during 12 years from 1986 through 1997. Gastric cancer with a tumor thrombus represented 0.7% of 1, 345 gastric cancer resected in this period. The tumor thrombus was found in the lt. gastric vein in two cases, rt. gastroepiploic vein in two, peri-esophageal vein in one, splenic vein in four and superior mesenteric vein in one. The tumor's characteristic features included a large size and a dominance of differentiated tubular adenocarcinoma and expanding growth modes. Nine cases were resected without residual tumors and four cases are alive without any evidence of recurrence 5 years after surgery. Extended excision of the lesions might be essential for improvement of prognosis in the case of gastric cancer with a tumor thrombus.View full abstractDownload PDF (126K) -
Takuo Inui, Kazuo Hatsuse, Tsukasa Aihara, Yasushi Okusa, Noritsugu Ku ...2000 Volume 33 Issue 1 Pages 12-17
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTelomerase activity is undetectable in adult human tissues, but in proliferating hepatocytes it can be present during liver regeneration. In this study we investigated the activation of telomerase in the rat hepatic remnant, the ratio of the cell cycle (G0/G1 phase, S phase, G2/M phase), the regeneration rate and the average regeneration rate per hour of the hepatic remnant at 12, 24, 36, 48, 72 hrs, 1 wk, and 4 wks after 70% partial hepatectomy in rats. Telomerase activity was assayed by the telomeric repeat amplification protocol which we modified (modified TRAP) and quantitated by using an internal standard. Telomerase activity was strongly detected at 12 and 24 hrs (p<0.001), and then decreased gradually to the normal level at 1 wk after hepatectomy, whereas the peak of the proportion of the S phase was at 24 and 36 hrs after the operation. The average regeneration rate per hour of the hepatic remnant correlated significantly with the telomerase activity (r=0.858, p<0.001). In conclusion, these findings may suggest that hepatectomy mediate the activation of telomerase and indicate that the activity is strongly increased before DNA synthesis.View full abstractDownload PDF (87K) -
Masanori Suzuki, Tetsuyuki Uchiyama, Masaya Oikawa, Shinichi Takemura, ...2000 Volume 33 Issue 1 Pages 18-24
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA biological adhesive, GRF glue, prepared by combining gelatin, resorcinol, and formaldehyde, was applied to the cut surface of a rat liver to determine the glue's effects histologically. The adhesive force of GRF glue was also compared to a fibrin glue in a tensile strength test. Male Sprague-Dawley rats, weighing 200 to 250g, were subjected to partial hepatectomy, and the GRF glue was applied to the cut surface of the liver. In this animal model, the process of GRF glue absorption was followed histologically. The surface of the eosinophilic glue was first covered by fibrous tissue that extended from the adjacent normal tissue. Then, macrophages appeared within the glue and the absorptive process continued. On day 28 following the glue application, tissue repair was generally completed with a thick fibrous layer replacing the cut region. On the intact liver surface, on the other hand, fibrosis or fatty degeneration was noted, and indicated direct hepatic toxicity of the formaldehyde. In an experiment using lumps of GRF glue placed in the peritoneal cavity, 100%survival was recorded at a dosage of 2.5 mg/g per body weight. When the dosage exceeded 10 mg, however, all animals succumbed within 5 days of exposure. The above experiments contribute to clarifying the efficacy and absorptive process of GRF glue when applied to the hepatectomized liver surface. The tissue toxicity of formaldehyde or substances that are generated during the reabsorption process was confirmed when the glue was applied inappropriately or at excessive dosages. It is essential to closely observe the method of application and the dosage of this agent to prevent its potential adverse effects.View full abstractDownload PDF (132K) -
Kazuyuki Takenami, Ken Takasaki, Masakazu Yamamoto, Masashi Tsugita, A ...2000 Volume 33 Issue 1 Pages 25-31
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe clinical significance of AFP and PIVKA-II measurement was studied in 444 resected hepatocellular carcinomas (HCC). The positive rate was 61.0% for AFP, 36.9% for PIVKA-II and 70.9% for the combination of the two, respectively. No significant correlation was found between serum AFP and plasma PIVKA-II levels; therefore these markers seemed to be complementary. In 130 patients with HCC smaller than 2cm in diameter, the positive rate was 57.7% for AFP and 10.0% for PIVKA-II, respectively, these findings indicate that elevation of plasma PIVKA-II was more rarely found than that of serum AFP in small HCC. Correlation between AFP, PIVKA-II and the clinicopathological factors was analyzed by Spearman's rank correlation test. Significant correlations were observed between AFP and vp, differentiation, and im, whereas there were significant correlations between PIVKA-II and stage, vp, im, fc-inf, maximal tumor diameter, and differentiation. The survival rate after the operation was significantly lowest in the highest plasma PIVKA-II group, as well as in the highest serum AFP group. The multivariate analysis by Cox's proportional hazard model, using stepwise regression analysis, suggested that plasma PIVKA-II levels, as well as vp and im, would be some of the most important prognostic factors.View full abstractDownload PDF (72K) -
Manabu Shiozawa, Toshio Imada, Ryuji Shiraishi, Takashi Oshima, Yasush ...2000 Volume 33 Issue 1 Pages 32-37
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThis study was conducted to evaluate the preventive effect of chinese medicine of Dai-saiko-to (CM-8), Sho-saiko-to (CM-9) and Inchin-go-rei-san (CM-117) on gallstone formation after truncal vagotomy in the hamster. Gallstone formation was observed in 100% of the control hamsters and 50% of those treated with CM-8, 55.6% with CM-9 and 62.5% with CM-117. Total bile acid concentration in the gallbladder bile was lower in the CM-8 group and higher in the CM-9 and TJ-117 groups. In the molecular forms of bile acids, the ratios of cholic acid to chenodeoxycholic acid (CA/CDCA) and secondary bile acid to primary bile acid (S/P) were improved in the CM-9 and CM-117 groups. However, it was not improved in the CM-8 group. The preventive effect of the extracts on gallbladder stone formation was closely related with biliary constituents and the melecular forms of bile acids in the CM-9 and CM-117 groups. In the CM-8 group, the preventive effect might be dependent upon other factors.View full abstractDownload PDF (59K) -
Yasuo Shima, Masanobu Mori, Norihisa Takakura, Masahiro Ohishi, Toshik ...2000 Volume 33 Issue 1 Pages 38-43
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThirty-seven cases (0.86%) of bile duct injuries during laparoscopic cholecystectomy performed at the 1st Department of Surgery, Okayama University Medical School and 13 other hospitals were evaluated. Sites of the injuries included 33 cases of common bile/hepatic duct, 2 of liver bed, 1 of posterior branch, and 1 of caudate branch. Eighteen cases (49%) occurred at hospitals performing less than 100 laparoscopic cholecystectomies, and 22 cases (59%) resulted from surgeons who performed less than 20 laparoscopic cholecystectomies. These results suggest that a lack of experience caused bile duct injuries. In cases with inflammation, evaluation of inflammatory degree by preoperative imaging may be important to avoid injuries due to misidentification. In these cases, it is essential to convert to open cholecystectomy without sticking on laparoscopic procedure. In order to avoid electrocautery injuries, the instrument should be used close to the wall of the gall bladder and should not be used near the bile duct. Futher, intraoperative cholangiography is useful to detect intraoperatively bile duct injuries.View full abstractDownload PDF (49K) -
Hiroyoshi Yoh, Sonshin Takao, Hiroyuki Shinchi, Keiichirou Uchikura, M ...2000 Volume 33 Issue 1 Pages 44-52
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSHilar cholangiocarcinoma with obstructive jaundice is an indication to be performed major hepatectomy as a curative treatment. However, hepatic failure in most of major hepatectomized patients still remains to a serious problem and causes of poor prognosis. We investigated the factors of hepatic failure in 28 hepatectomized patients for hilar cholangiocarcinoma. The higher rate of hepatectomy and poor management of preoperative cholangitis signigicantly correlated to postoperative liver failure (p=0.01 and p<0.001, respectively.) Moreover, preoperative cholangitis is significantly correlated to hospital death (p=0.01). Therefore, percutaneous transhepatic biliary drainage (PTBD) for management of preoperative cholangitis improves postoperative morbidity and postoperative hepatic failure. PTBD should be performed for not only reduction of jaundice but also management of preoperative cholangitis.View full abstractDownload PDF (82K) -
Naoya Murase, Satoshi Okabe, Hiroshi Kuwabara, Masaru Udagawa, Shunrou ...2000 Volume 33 Issue 1 Pages 53-61
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe reviewed 58 patients with colorectal cancer invasion of muscularis propria (mp cancer) for the purpose of determining proper surgical treatment. In this study, we subclassified mp cancer into three grades (mp1-mp3) according to the degree of vertical invasion, compared mp cancer with cancer invasion of submucosa (sm cancer), and contrasted rectal and colonic mp cancer clinicopathologically. In addition, thorough investigation of patients who died due to cancer and who had node involvement was conducted. The results obtained were as follows: 1) Macroscopically, the frequency of elevated type in mp1 cases was significantly higher in contrast to mp2 or mp3 cases. 2) In comparison with sm cancer, mp cancer showed marked venous invasion. But there was no difference between Grade-III sm cancer (deep invasion) and mp1 cancer. 3) In Comparison with colonic mp cancer, rectal mp cancer showed ulcerated type appearance with clear margin more frequently, higher degree of venous invasion and lower five-year survival rate. 4) Seven patients died due to cancer. All had rectal cancer with invasion of mp2 or mp3 and had larger tumors than other patients. 5) Seven of 34 patients with rectal cancer had lymph node metastasis, and all lesions were located in Ra-P. Only one patient had lateral lymph node metastasis. We conclude that proper surgery for mp1 could be similar to the operation for sm cancer, and that for mp2 or mp3 we should add D3 lymph node dissection suitable especially in case of Ra-P.View full abstractDownload PDF (64K) -
Kenichiro Fukuhara, Harushi Osugi, Kiyotoshi Inoue, Nobuyasu Takada, M ...2000 Volume 33 Issue 1 Pages 62-65
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSAn adult case of congenital esophagobronchial fistula is reported. A 56-year-old man known to have diverticulum in the midesophagus, was refurred to us for evaluation of pneumonia of the left lower lobe which developed after open cholecystectomy. Careful endoscopic observation revealed tiny orifices in the bottom of the diverticulum, and fistulography showed connection between the orifices and the left lower lobe bronchus. On the 115 th day after cholecystectomy, the esophageal diverticulum and the fistula were removed together with the carnified left lower lobe through a left thoracotomy. Recovery has been uneventful with no respiratory infection. The condition was diagnosed as congenital esophagobronchial fistula because the direct communication between the esophageal epithelium with muscular mucosa and the bronchial epithelium was confirmed histologically and was classified as Braimbridge type I since the fistula orifice was in the esophageal diverticulum. Congenital esophagobronchial fistula manifesting in adulthood is rare, and 45% are Braimbridge type I. Careful endoscopic observation of the esophageal diverticulum and consideration of congenital esophagobronchial fistula may avoid unnecessary aspiration pneumonia.View full abstractDownload PDF (59K) -
Yuji Masaki, Toshimasa Okada2000 Volume 33 Issue 1 Pages 66-69
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 54-year-old man was admitted to our hospital for further examination of a left upper abdominal mass, which was found incidentally by abdominal CT following acute pancreatitis. He had a past history of undergoing a distal partial gastrectomy for perforation of a gastric ulcer in Brazil 24 years ago. Upper gastrointestinal endoscopic examination showed a typical submucosal tumor of the residual stomach. In abdominal CT, MRI, and angiography, it was difficult to distinguish between submucosal tumor and other nonepithelial tumors. The resected specimen revealed foreign body which was derived from gauze left from the previous gastrectomy. Foreign body should be suspected in case of unknown mass with a history of laparotomy.View full abstractDownload PDF (80K) -
Yuichi Kasakura, Masashi Fujii, Fumirou Mochizuki, Takerou Mazaki, Shi ...2000 Volume 33 Issue 1 Pages 70-74
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe experienced two patients with malignant peritoneal mesothelioma. Both patients had a history of ex-posure to asbestos; one had been given a diagnosis of asbestosis. Both patients showed ascites retention; they complained of abdominal flatulence and abdominalgia, and the ascitic fluids appeared bright yellow and viscous in nature. Cytological examination, suggested mesothelioma. The preoperative diagnosis was consid-ered difficult because of the importance of differentiating from the diseases which cause ascites, particularly cancerous peritonitis. Accordingly, exclusion diagnosis by dissection of the celiac viscera was necessary. In both cases, mesothelioma was classified as diffuse clinically and as epithelial histologically, and special stain-ings exhibited positive for malignant peritoneal mesothelioma by hyaluronidase digestion method. One pa-tient had constriction in the ileum. Another showed no response to thermotherapy; therefore celiotomy was performed to administer the antitumor drugs, but the treatment was palliative. The antitumor drugs cis-platine and etoposide were used and they were effective in reducing the volume of ascites. However, at pre-sent, no effective therapy is available to treat mesothelioma. As its prognosis is significantly poor, a new multi-disciplinary therapy were including gene therapy and immunotherapy should be searched for.View full abstractDownload PDF (113K) -
Hideo Tohira, Ken-ichiro Tateyama, Yutaka Ozeki2000 Volume 33 Issue 1 Pages 75-79
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 72-year-old female were admitted to a clinic with complaint of epigastric pain, and suspected as acute cholecystitis, then transferred to our hospital. On the first day after admission the symptom was deteriorated and we performed percutaneous transhepatic gallbladder drainage to prevent exacerbation of the symptom and aspirated suppurative bile. On the next day biochemistry tests revealed that total bilirubin was 15.9mg dl and Pentalogy of Raynolds was observed, then we diagnosed acute obstructive suppurative cholangitis with GB stone. On the same day a CT was taken and it demonstrated retroperitoneal emphysema with alveolar pattern at just cranial side of the pancreas. On the 7thday after admission, we performed a laparotomy to eliminate the cause of the cholangitis, a gallbladder and gallstones. We also investigated the retroperitoneal emphysema, and as a result we found the retroperitoneum filled with necrotic tissue without abscess. We decided the cause of the retroperitoneal emphysema was infection due to the cholangitis. The patient was discharged on the 77thday after admission. The retroperitoneal emphysema due to acute obstructive suppurative cholangitis has not been reported in this country yet, and we herein reported such a rare case.View full abstractDownload PDF (111K) -
Motoki Hiroyoshi, Yutaka Nagata, Kazunori Ogino, Keizou Kikkawa, Hitos ...2000 Volume 33 Issue 1 Pages 80-84
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 56-year-old man was admitted to our hospital because of epigastric pain. Percutaneous transhepatic cholangiography showed a narrowing of the choledochus, and peroral transpapillary cholangioscopy demonstrated an irregular lesion at the entry site of the cystic duct. Cholecystectomy and resection of the bile duct were performed with cleaning of the regional lymph nodes. Tumor measuring 15 mm was found in the cystic duct. Microscopic examination demonstrated moderately differentiated tubular adenocarcinoma without metastasis to the regional lymph nodes. The depth of tumor invasion was limited to the subserosal layer. Out of fifty-seven cases in the Japanese literature, including the present case, only seventeen cases were diagnosed as primary carcinoma of the cystic duct preoperatively.View full abstractDownload PDF (85K) -
Hiroshi Itoh, Naotaka Kadoya, Katsunobu Oyama, Masafumi Inokuchi, Wata ...2000 Volume 33 Issue 1 Pages 85-89
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 78-year-old woman who complained of left lower abdominal pain was admitted to our hospital. Physical examination showed a surgical operation scar for left nephrectomy which had been performed for a retroperi-toneal xanthogranuloma 12 years before, and revealed an elastic hard mass, approximately 10 cm in diameter, in the left lower abdominal region. Biochemical investigations showed elevations of carcinoembryonic antigen and carbohydrate antigen 19-9. Computed tomography revealed a retroperitoneal tumor around the descend-ing colon containing focal calcification with abundant fat. Barium enema examination demonstrated the op-pression of the descending colon to the inner part by the retroperitoneal tumor, and a cecal tumor. Under a di-agnosis of recurrent xanthogranuloma of the retroperitoneal region and cecal carcinoma, left colectomy in-cluding the retroperitoneal tumor was performed because of an intraoperative diagnosis of myxoid sarcoma, therefore, ileocecal resection with a D2 lymphadenectomy were also performed. Macroscopic findings of the resected specimen showed normal mucosa of the descending colon, and the tumor from the subserosa to retroperitoneum, which was composed of tan-yellow or gray-white various fibrous or myxomatous tumors with focal osteogenic change. Histologically, the tumor consisted of chondrosarcoma, osteosarcoma, leiomyo-sarcoma, liposarcoma, which was compatible with malignant mesenchymoma. Histopathological findings of ce-cal carcinoma were as follows: macroscopically type 2, well differentiated adenocarcinoma, ss, ly2, v0, n1 (+). As far as the Japanese literature is concerned, our case seems to be the 22 nd case of retroperitoneal malig-nant mesenchymoma, and the first case that describes the malignant mesenchymoma involving carcinoma. Here, we report a rare case of interest in histogenesis with a review of the literature.View full abstractDownload PDF (91K) -
Masaya Tamura, Humihiko Kimoto, Katsumi Kiyosaki, Rinichirou Wakasa2000 Volume 33 Issue 1 Pages 90-93
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 66-year-old male who had developed intestinal obstruction repeatedly was admitted to our hospital because of abdominal fullness and constipation. Gastrointestinal X-ray examination and angiography revealed intestinal malrotation similar to a mesenterium commune. Abdominal computed tomography and barium enema examination suggested a tumor of the small intestine. An emergency operation was performed 18 days after admission, and revealed a partially dilated small intestine attached to the splenic flexure and twisted in a 360° clockwise rotation. An intestinal tumor was found at the center of the twisted intestine. The ascending colon and cecum were not fixed to the recessus retroperitoneum, and there was mesocolon ascendens. The intestinal tumor was located about 50cm on the oral side from the terminal ileum. Cancer of the ileum was doubtful, so a right hemicolectomy with regional lymph nodes dissection (D2) was performed. The resected material revealed that the tumor was 5×4cm in size, type 2, and well differentiated adenocarcinoma of se, ly1, v0, n (+). This case had the possibility to reveal unusual course, because the mesenterium commune could have led to a mistaken diagnosis of an associated lesion.View full abstractDownload PDF (85K) -
Naoto Saito, Isamu Koyama, Haruyuki Anzai, Nozomu Shinozuka, Yoshitaka ...2000 Volume 33 Issue 1 Pages 94-97
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA case of nonspecific simple ulcer of the small intestine causing massive hemorrhage is reported here. A 60-year-old man was admitted to our hospital because of melena and lower abdominal pain. After admission he fell into hypovolemic shock due to massive melena. Celiac and superior mesenteric arteriograms demonstrated no abnormalities, however, 99mTc-RBC scintigraphy suggested bleeding from the distal ileum, and an emergency operation was performed. A small induration was palpated in the ileum 40cm proximal to the iliocecal valve, and wedge resection of the lesion was performed. A small ulcer was included in the specimen, and histopathological examination revealed a non-specific simple ulcer. In this case, a non-specific ulcer in the small intestine developed massive bleeding, and 99mTc-RBC scintigraphy was useful for the localization of the lesion.View full abstractDownload PDF (56K) -
Chihiro Tanaka, Naoki Yokoo, Katsuaki Ura, Kouichirou Hata, Tatsushi K ...2000 Volume 33 Issue 1 Pages 98-101
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 18-year-old was admitted to our hospital because of abdominal pain and high fever. Abdominal ultrasonography and computed tomography showed a cystic mass about 6 cm in diameter, lying near the peritoneum at the midline of the lower abdomen. Following the diagnosis of an infected urachal cyst, resection of the cystic tumor was performed. Adhesions were observed between the rectus abdominis muscle and the peritoneum, and some urachal remnant tissue was found between them. The tumor was an abscess localized by the omentum and adhering tightly to the peritoneum just behind the urachal remnant tissue, which did not have any pathway to the surrounding organs incliding the transverse colon. Because the tumor existed near the dorsal region of the urachal tissue, it was supposed that the infection of the urachal remnant tissue developed into the peritoneal cavity and formed an abscess localized by the omentum, which was confermed by histological examination. It is very seldom, if even, seen that an infected urachal cyst penetrates the abdominal wall and reaches the peritoneal cavity. A localized abscess formation by the omentum caused by an infected urachal remnant tissue has never been reported so far.View full abstractDownload PDF (93K) -
Manabu Okuyama, Hiroyuki Suzuki, Reijiro Saito, Satoru Motoyama, Sin-i ...2000 Volume 33 Issue 1 Pages 102-106
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe patient was a 72-year-old male who underwent total thoracic esophagectomy with reconstruction of the gastric tube through the posterior mediastinal route for esophageal cancer, on March 6, 1996. He received irradiation before and after the operation with a total dose of 73.1 Gy. On February 17, 1998, he suddenly suffered from dyspnea. He was diagnosed at another hospital as having an ulcer of the reconstructed gastric tube with a bronchial fistula, and was transferred to our hospital. Tracheostomy and mechanical ventilation were performed and we planned on waiting until the patient's general condition improved to tolerate an operation. The fistula, however, gradually enlarged, and the patient developed severe respiratory failure refractory to maximal conventional ventilation on the 10 th day. After cannulation with veno-venous extracorporea membrane oxygenation (ECMO), he was operated on to close the fistula using the pedicled pectoralis major muscle flap. The ECMO system was removed after 150 hours and he was able to be weaned off mechanical ventilation on the 64 th postoperative day. ECMO may be useful for patients who have to undergo surgical treatment under severe respiratory failure.View full abstractDownload PDF (74K) -
Iwao Sasaki, Yuji Funayama, Hiroo Naito, Kouhei Fukushima, Kenichi Shi ...2000 Volume 33 Issue 1 Pages 107-112
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe cause of Crohn's disease is still unknown and the disease is inherently refractory. Recently the number of cases with Crohn's disease has been increasing in our country, and we have begun to encounter the various complications associated with the disease. The purpose of surgical management for Crhon's disease is to maintain patient's quality of life as good condition by improving treatment of conplications such as bowel obstruction, intraabdominal abscess, internal or external fistula, and so on. Surgical indication is classified into absolute and relative one. Intestinal stenosis is a major complication of the disease. Minimal operative procedures, such as resection of a small part of the intestine or strictureplasty for skipped stenotic lesions of the small intestine, are ercommended. Laparoscopically assisted operations are applicable in selected patients. Selection of operative procedures is often difficult even for GI tract surgeons. We classified the operative findings of Crohn's lesions and developed a finding-based criteria to guide selection of the proper procedures. We recommended new strictureplasties, double Heineke-Mikulicz and side-to-side anastomosis (Michelassi), for multiple skipped lesions. Proper surgical procedures together with pre-and postoperative management lead to good results.View full abstractDownload PDF (61K) -
Takehira Yamamura, Yasutsugu Shoji, Masao Kusunoki2000 Volume 33 Issue 1 Pages 113-118
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSUlcerative colitis (UC) is defined as idiopathic, nonspecific inflammatory disorder of the large intestine involving primarily the mucous membrane, often with ulceration. UC requires the removal of all disease bearing mucosa of the colon and rectum. Since 1983, we have performed ileal J pouch-anal anastomosis (IAA) using a forceps coagulation technique. It has taken a ling time to finish the surgical strategy. Since 1997, we have introduced an ultrasonically activated scalpel (Harmonic Scalpel® (HS)) and Bipolar Scissors (Power Star ® (PS)) to simplify the techniques of anorectal mucosectomy and total colectomy. HS and PS shortened the operative time and decreased blood loss compared with the forceps coagulation technique. We recommend the use of HS and PS for restorative proctocolectomy.View full abstractDownload PDF (83K) -
Sphincter-Saving Operation for Lower Rectal CancerTakayuki Morita2000 Volume 33 Issue 1 Pages 119-122
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSMany attention has been focused on sphincter-saving operation for the patients with lower rectal cancer, and has led to renewed interest of indication and functional outcome of postoperative bowel movement. Most of the patients with curative resection were found to have no distal intramural spread, which did not appear to have great significance for operative indication. The results of analysis of another clinicopathological factors suggested that sphincter-preserving operation did not carry an increase risk of recurrence compared with abdominoperineal resection, unless the cancer had low grade differentiation and extension beyond the proper muscle infiltrating deeper. Radical lymph node dissection have been applied in both patients having sphinctersaving operation and abdominoperineal resection. Organ and or nerve preserving operation can be consistent with radical lymph node dissection for lower rectal cancer. Postoperative care following sphincter-saving operation is essential. Our experiences indicate that inadequate blood supply and damage of bowel itself on suture line are important risk factors of anastomotic leak. On the other hand, some patients having sphinctersaving operation have often experienced bowel dysfunction. To improve these problems, reconstruction with colonic J-pouch have been performed. The patients who received colonic J-pouch anastomosis had fewer defection symptoms. Colorectal surgeons should be challenge to balance both curability and functional preservation for better postoperative quality of life.View full abstractDownload PDF (56K) -
Shigeo Ohki, Hideyuki Ike, Akira Sugita, Shigeki Yamaguchi, Yasushi Ic ...2000 Volume 33 Issue 1 Pages 123-127
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIn the recent treatment of rectal cancer, both radicality and postoperative funtion are required according to the cancer stage. We are performing two types of autonomic nerve preserving operation. One is total autonomic nerve preserving operation (TANPO) in order to maintain both male sexual function and urinary function, and the other is partial pelvic piexus perserving operation (PPPPO) in oder to maintain urinary function at the least. TANPO means that automonic nerves such as lumbar sympathetic nerves, pelvic splanchnic nerves and pelvic plexus are completely preserved. PPPPO means that a part of pelvic splanchnic nerves from sacral foramen S2, S3 or S4 and a part of pelvic plexus are preserved. TANPO is suitable for the rectal cancer whose finding is up to A1N0 (upper rectum) or MPN0 (lower rectum). PPPPO is suitable for the rectal ancer whose finding is SE or N (+)(upper rectum), or A1N0 (lower rectum). Five year survival rates of total preservation, Preservation of S234 and preservation of S34, S4 are 87.0%(n=33), 93.6%(n=15), and 92.3%(n=56), respectively.View full abstractDownload PDF (92K) -
Kenichi Sugihara2000 Volume 33 Issue 1 Pages 128-133
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIn order to improve the prognosis of patients with colorectal cancer, it is important to improve the outcome of liver metastases from colorectal cancer which is complicat in 25% of colorectal cancer patients. Liver resection is the most effective treatment and is indicated either when there is no extrahepatic metastases, or wnen complete removal of all metastatic tumors are confirmed. The 5-year survival rate after liver resection is from 35% to 40%, but recurrent tumors in the liver remnant develope in 40%. The advantage of adjuvant intra-arterial chemotherapy to control recurrence in the liver remnant has not been confirmed. Repeated liver resection shows the same outcome as that of the initial liver resection.View full abstractDownload PDF (56K) -
[in Japanese], [in Japanese]2000 Volume 33 Issue 1 Pages 134-136
Published: 2000
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSDownload PDF (41K)
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