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Volume 34, Issue 12
Displaying 1-17 of 17 articles from this issue
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Masashi Takemura, Harushi Osugi, Nobuyasu Takada, Satoru Kishida, Masa ...2001 Volume 34 Issue 12 Pages 1695-1701
Published: 2001
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe studied the therapeutic strategy in submucosal esophageal cancer using clinicopathological factors and metastasized node size.Patients and Methods:50 patients with pT1b esophageal cancer undergoing 3-field lymph node dissection were evaluated.Results:Of the 50 patients, lymph node metastasis was found in 18. Clinicopathologically, the incidence of well differentiated squamous cell carcinoma, negative lymphatic or blood vessel invasion was higher in the 32 patients without lymph node metastasis than the 18 with. In multivariant analysis, the negative lymphatic or blood vessel invasion was the most affecting factor for contributing to lymph node metastasis. Of the 2532 nodes dissected, the number of metastasized nodes was 63, including 41 with a mojor axis of 10mm or shorter and 19 with a major axis of 6mm or shorter in length. Macroscopic diagnosis of metastasis was difficult in nodes less than 9mm in diameter. Survival was 84%5 years after surgery and 5 patients died of cancer recurrence 3 hematogenous and 2 lymphatic. Those with lymphatic invasion showed significantly poorer prognosis than others.Conclusions:For the patients with pT1b esophageal cancer who can indicate endoscopic mucosal resection, the diagnostic mucosal resection was selected first. If the lesion was well differentiated squamous cell carcinoma and had no lymphatic or blood vessel invasion, the possibility of lymph node metastasis was low. But, the 3-field lymph node dissection was required in the other patientsView full abstractDownload PDF (56K) -
Daisuke Minabe2001 Volume 34 Issue 12 Pages 1702-1712
Published: 2001
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe clarified the mechanism of recurrence after pancreatic cancer resection through clinicopathlogical and moleculer studies were attempted. The clinocopathological profiles of 25 patients who undergoing pancreatectomy for pancreatic cancerwere evaluated, using multivariate analysis. A significant prognostic factor for liver metastasis was venous invasion (v factor) in the main tumor, and that for both local recurrence and peritoneal metastasis was lymph vessel invasion (1y factor). The polymerase chain reaction (PCR) targeting the mutant K-ras gene was applied to detect cancer cells in tissue specimens from liver, peritoneum, and marrow during surgery from 13 patients with pancreatic cancer. In only 1 (25.0%) patient with v3 among the 4 patients with more than v2 who developed postoperative liver metastasis, the mutant K-ras gene was detected in liver tissue specimen. In 4 of 5 (80.0%) patients with more than 1y2, the mutant K-ras gene was detected in peritoneal tissue specimens, and all developed peritoneal recurrence. In 2 of the 4 (50.0%) with more than v2 and 1y2, the mutant K-ras gene was detected in bone marrow tissue, and all suffered distant metastasis. In conclusion, the recurrence after pancreatic cancer resection is mainly caused by micrometastasis rapidly formed by venous or lymph vessel invasion.View full abstractDownload PDF (75K) -
Gen Sugawara, Akihiro Yamaguchi, Masatoshi Isogai, Tohru Harada, Yuji ...2001 Volume 34 Issue 12 Pages 1713-1717
Published: 2001
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe clinicopathologically studied 19 patients with nonocclusive mesenteric ischemia. 10 men and 9 women aged 48-88 years (mean: 74.6 years). The majority of patients had cardiovascular disease and 6 had colla- gen disease. Preoperative examination showed no specific findings. The necrotic bowel was resected in all pa- tients, and survival was 78. 9%. Histological examination of the straight arteries of the resected bowel re-vealed arteritis in 3 patients with a history of collagen disease. When intimal thickening was classified into 3 categories based on the intimal/media ratio, intimal thickening in 18 of 19 was mild in 3, moderate in 10, and severe in 5. Although organic vascular occlusion was not observed, intimal thickening in the straight arteries and arteritis may be factors responsible for the development of nonocclusive mesenteric ischemia.View full abstractDownload PDF (121K) -
Shiro Nakae, Katsunori Kawaguchi, Hidehiro Sawa, Ippei Matsumoto, Mana ...2001 Volume 34 Issue 12 Pages 1718-1726
Published: 2001
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIntroduction:The present study was carried out to clarify the clinical characteristics of multiple colorectal carcinomas and to consider the recommended postoperative follow up.Method:We examined the clinical backgrounds of patients with multiple colorectal cancers and compared them with those of patients with solitary cancer. 828 patients underwent surgery for colorectal carcinoma at our institute in the last 16 years.Result:Among them, 64 patients (7.7%) had multiple lesions, including 47 (5.7%) synchronous and 17 (2.1%) metachronous, ones. Tumor distribution did not differ significantly between single and synchronous multiple cases. In metachronous cases, primary carcinomas were predominantly located in the left colon. Time interval of metachronous occurrence ranged to 18 years, averaging 7.25 years. Association of adenomatous polyps was found to be high at 93.3% in multiple colorectal cancers, compared to 73.1% in solitary cases. The frequency of gastric cancer was 12.8% in synchronous multiple colorectal cancers, but only 4.8% in solitary colorectal cancer. In cases where proximal colon could not be examined, or adenomatous polyps were detected preoperatively and regular postoperative follow-up with total colon fiberscopy was lacking, the diagnosis of a secondary metachronous colorectal cancer tended to be late.Discussion:The patients with a history of surgery for colorectal cancer, especially having adenomatous polyps, a history of gastric cancer, and/or a family history of colorectal cancer were considered to have higher risk of developing multiple colorectal cancers. Taking those factors into consideration, surveillance by total colon fiberscopy should be performed for early detection of a secondary metachronous cancer.View full abstractDownload PDF (79K) -
Kenji Hasegawa, Tsunehide Osawa, Naoko Kamano, Yoshiro Masuya, Masashi ...2001 Volume 34 Issue 12 Pages 1727-1731
Published: 2001
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSNecrotic fascitis by Aeromonas hydrophila is quite rare. We report a severe case of this complication after surgery for gastric malignancy. A 74-year-old woman with malignant lymphoma of the whole stomach under-went total gastrectomy. Postoperatively, she showed septic symptoms by the evening of the day of operation. By the next day, subcutaneous hemorrhage had appeared in her abdominal wall, and necrotic fascitis devel-oped several hours afterward. Necrotic skin and subcutaneous tissues were aggressively excised and antibi-otic therapy changed to cover all suspected bacteria. Gram-negative bacillus was noted in smear Gram stain- ing incised necrotic tissue, ascites, and blood. The patient died about 50 hours after operation, despite at-tempts at resuscitation. The colonization of Aeromonas hydrophila was obtained some days later. To our knowl-edge, this is the first case reported of postoperative necrotic fascitis and sepsis by Aeromonas hydrophila. We suggest that since infection by Aeromonas hydrophila can be very serious for the compromised host, prophylac-tic antibiotics covering Gramnegative bacillus should be used for such patients.View full abstractDownload PDF (85K) -
Kazuo Hirose, Masato Tamaki, Katsunori Senda, Yasuo Hirono, Atsushi Ii ...2001 Volume 34 Issue 12 Pages 1732-1736
Published: 2001
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 57-year-old man with anorexia, right lumbar and hip pain, and weight loss was admitted and diagnosed with type 4 gastric cancer with multiple bone metastasis. Bone scintigraphy disclosed multiple areas of abnor-mal radioisotope (RI) uptake in the pelvis, lumbar vertebra, and ribs. Plain bone X-ray examination showed multiple osteolytic shadows in the pelvis. Total gastrectomy with D1 lymph node dissection was done. Histo-logical examination of resected specimens showed poorly differentiated adenocarcinoma, intermediate type, se, INFβ, ly1, v2, n1, H0, P0, cy0, M1 (oss). We speculated that all cancer lesions except bone metastases had been resected. Pain was relieved and disappeared after early postoperative systemic chemotherapy with 5- FU and mitomycin C (MMC). Combined systemic chemotherapy with 5-FU, adriamycin, and MMC (modified FAM), and radiotherapy (Linac, 3Gy×12) for the pelvis resulted in the disappearance of abnormal RI uptake in bone scintigraphy and change of the metastatic lesions to osteosclerotic shadows on plain X-ray film. The patient continued to undergo immunochemotherapy with oral UFT and intravenous lentinan as an outpatient, and remained in good general condition with neither symptoms nor findings on X-ray or bone scintigraphy ex- amination. He died of heart failure 9 years and 8 months postoperatively. Multidisciplinary therapy including gastrectomy and postoperative combined chemoradiotherapy, thus, resulted in long-term survivalView full abstractDownload PDF (103K) -
Shuji Kawai, Hiroyuki Kawasaki, Hisashi Iseki, Akira Nishiyama, Michiy ...2001 Volume 34 Issue 12 Pages 1737-1741
Published: 2001
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 69-year-old man presented the hospital because of appetite loss. He was found the mass lesion around the stomach, pancreas, and spleen, and found the low density area of the liver by abdominal CT. He would be taken farther examination, but he had severe abdominal pain next day, and made an emergency admission. We diagnosed his illness as peritonitis and liver abscess due to pancreatitis, and had done cnservative therapy. But after several days, it was cleared that the mass lesion of the pancreas was the malignant tumor by percutaneous aspirated biopsy. We performed operation and diagnosed it as gastrointestinal stromal tumor (GIST) of the stomach. In the Japanese literature, no case of GIST of the stomach with liver abscess and peritonitis was reported. So we assume this case to be very rare.View full abstractDownload PDF (126K) -
Hidenori Takahashi, Takeshi Tono, Toshiyuki Kano, Takashi Iwazawa, Shi ...2001 Volume 34 Issue 12 Pages 1742-1746
Published: 2001
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of hepatocellular carcinoma with intrabileduct growth, presenting atypical imaging similar to cholelithiasis. A 57-year old man with chronic hepatitis C was admitted for right hypochondralgia and jaundice. Endoscopic retrograde cholangiography (ERC) showed a filling defect in the left hepatic duct. No space-occupying lesion (SOL) of the liver was seen in radiological examination, and he was diagnosed with hepatolithiasis. Symptoms disappeared after conservative treatment and he was discharged. Serum alphafetoprotein (AFP) gradually elevated, however, and he was readmitted for further examination. Radiological examination showed an intrabileduct tumor from the hepatic umbolical portion to the common bile duct (CBD) without SOL of the liver. ERC showed filling defect floating in the CBD. The diagnosis of hepatocellular carcinoma with intrabileduct growth was made and a hepatic left lobectomy conducted. The medial segment of the resected specimen showed a tumor 15mm in diameter. Histopathological diagnosis was poorly differentiated hepatocellular carcinoma with bileduct and portal venous invasion. Recurrence occurred about 2 years after surgery. Despite transcathether arterial embolization and percutaneous ethanol injection therapy, he died about 6 years after surgery.View full abstractDownload PDF (92K) -
Hiroshi Nakamura, Kenichi Teramoto, Susumu Takamatsu, Hiroyuki Baba, I ...2001 Volume 34 Issue 12 Pages 1747-1750
Published: 2001
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 69 year-old woman had a laparoscopic cholecystectomy for cholecystolithiasis without complication. On the 1 st postoperative day (1 POD), she deveropped severe dyspnea and cardiac arrest caused by a pulmonary embolism. We started cardiopulmonary resuscitation and anticoagulant therapy as soon as possible, but mechanical ventilation and a high dose of catecholamin were ineffective. Percutaneous cardiopulmonary support (PCPS) was applied for 3 days and her cardiopulmonary function gradually recovered. She discharged on 50 POD without further complication. These findings indicate that PCPS and anticoagulant therapy were effective for her pulmonary embolism.View full abstractDownload PDF (67K) -
Naoki Igarashi, Munehisa Kaneda, Yasumasa Koyama, Makoto Katagiri2001 Volume 34 Issue 12 Pages 1751-1755
Published: 2001
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIn this paper, a very rare case of a collison tumor of carcinoid and adenocarcinoma in the common bile duct is reported. A58-year-old male was admitted to our clinic because of jaundice. An abdominal ultrasonography, computed tomography and percutaneus transhepatic cholangiography detected a tumor, 25mm in size, in the lower part of the common bile duct. A pancreaticoduodenectomy was performed under a diagnosis of carcinoma. The resected specimen was white yellow tumor, 22×25mm in size, mulberry growing and a papillary growing tumor with a different color in the lower part of the common bile duct. A histological study demonstrated the presense of a collison tumor between a carcinoid tumor that stained positively with chromogranin and a papillary adenocarcinoma. Carcinoid of the common bile duct is a very rare disease and only 36 cases have been reported. None of these cases were preoperatively diagnosed as carcinoid tumors. Furthermore, the co-existance of carcinoid and adenocarcinoma in the common bile duct has been reported in only 6 cases. The treatment for the carcinoids of the common bile duct is the same as that for carcinomas of the common bile duct.View full abstractDownload PDF (95K) -
Hiroshi Sugiura, Hiroshi Takahashi, Eiji Shimozawa, Akira Fukunaga, Ry ...2001 Volume 34 Issue 12 Pages 1756-1760
Published: 2001
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report herein four patients with primary carcinoma of the cystic duct. Case 1: A 70-year-old male underwent a cholecystectomy under the diagnosis of cholecystolithiasis. A histopathological examination revealed a tubular adenocarcinoma infiltrating the fibromuscular layer of the cystic duct. Resection of the bile duct was therefore performed. Nine years after the operation, he died as a result of a cerebral infarction. The carcinoma did not recur. Case 2: A 61-year-old male presented with jaundice. ERCP demonstrated the stenosis of the middle bile duct and an obstruction of the cystic duct. He underwent an extended cholecystectomy and resection of the bile duct. A histopathological examination revealed an adenocarcinoma of the cystic duct, with ductal spread to the bile duct. He is alive and shows no signs of recurrence 112 months after the operation. Case 3: A 54-year-old male was admitted with acute cholecystitis. Percutaneous transhepatic cholangiography showed an obstruction of the cystic duct. An ERCP-assisted biopsy revealed a tubular adenocarcinoma. He underwent an extended cholecystectomy and resection of the bile duct. Microscopically, the carcinoma infiltrated the subserosal layer of the cystic duct, with perineural invasion and ductal spread to the bile duct. Sixteen months after the operation, he died of pleuritis carcinomatosis. Case 4: A 70-year-old female presented with abdominal pain. CT demonstrated a tumor of the cystic duct. An ERCP-assisted biopsy revealed a tubular adenocarcinoma. She underwent an extended cholecystectomy and resection of the bile duct and is alive with no signs of recurrence one year after the operation.View full abstractDownload PDF (96K) -
Atsushi Kudo, Tuneo Kawasaki, Masatoshi Jibiki, Seitaku Hayashi, Touki ...2001 Volume 34 Issue 12 Pages 1761-1764
Published: 2001
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIdiopathic torsion of the omentum is relatively rare, with only 59cases reported in the Japanese literature. We treated a very rare idiopatic torsion of the omentum with transepiploic hernia in a 27-year-old man who was seen for lower abdominal pain. He had tenderness with Blumberg sign in the left lower abdomen. Computed tomography (CT) showed a large fat density mass with concentric linear strands in the right lower abdomen. Laparotomy under a diagnosis of omental tumor, revealed a dark-red omental mass with triple clockwise torsion and bloody ascites. The omentum contained many interstices and circulatory disturbance of the intestine was observed due to omental torsion. The necrotic omentum, including interstices, was resected. Although preoperative diagnosis of this disease is usually difficult, comfirmative diagnosis is possible when CT shows concentric linear strands.View full abstractDownload PDF (70K) -
Nobuhiko Ueda, Hideaki Nezuka, Seiichi Yamamoto, Yoshiaki Isobe2001 Volume 34 Issue 12 Pages 1765-1769
Published: 2001
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA patient with ileal carcinoids associated with radiating soft tissue strands in the mesenterium is reported. A 54-year-old man complained of intermmittent abdominal pain. A mass of about 10cm in diameter was palpated in the right lower abdomen on physical examination. Abdominal computed tomography findings revealed a mass 4×2.5×7cm in diameter, enhanced at an early phase in the mesenterium at the terminal ileum with radiating soft tissue strands to the surrounding small bowel loops. Two lesions inside and in the small bowel wall with enhancement and many small lymph nodes in the mesenterium were also seen. Surgery showed a solid mass 8×5×3cm in diameter and many enlarged lymph nodes in the mesenterium at the terminal ileum. The terminal ileum gathered around the mass was resected with enlarged lymph nodes. At the mucosal side of the small bowel of the resected specimen, 1 tumor with a wide stalk about 25mm in diameter and 7 submucosal tumors 3 to 8mm in diameter were also seen. Pathologically, all tumors were carcinoid, and that with the wide stalk invaded the subserosal layer. The mass in the mesenterium consisted of the same tumor cells and was judged to be lymph node metastasis. The patient has been followed up for 1 year with no evidence of recurrence.View full abstractDownload PDF (96K) -
Nobuhisa Nakajima, Masato Nakayama, Tomoyuki Takagi, Eisuke Nagabuchi2001 Volume 34 Issue 12 Pages 1770-1774
Published: 2001
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe number of Dieulafoy-erosion gastric ulcers reported has recently increased, although this ulcer of the small intestine is very rare. We treated a patient of bleeding from a Dieulafoy-erosion ileal ulcer. A 87-year-old man was admitted to our hospital with melena. Scintigraphy (99mTc-RBC) showed an accumulation in the right lower quadrant. Emergency surgery was conducted, and intraoperative endoscopy identified the bleeding point, and we undertook spindle resection of the ileum. Pathologic examination revealed charactaristic features of a Dieulafoy-erosion. Only 8 such cases in the small intestine have been reported worldwide, to ourknowledge.View full abstractDownload PDF (67K) -
Tsuyoshi Igami, Hiroshi Hasegawa, Seiji Ogiso, Eiji Sakamoto, Hiroaki ...2001 Volume 34 Issue 12 Pages 1775-1779
Published: 2001
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 51-year-old man with anacatesthesia was diagnosed as having acute myelocytic leukemia (M5a). After 3 weeks of leukemia treatment, an abdominal CT showed an intrailiopsoas abscess, with right leg pain and fervescence. Conservative therapy using antibiotics was adopted, and a second. CT showed the improvement of the abscess. After another 2 weeks of leukemia treatment, a CT examination showed the relapse of the abscess. The same therapy was performed, and the abscess improved once again. A colography revealed a gastrographin exudate from the intrailipsoas abscess. After the remission of the bone marrow inhibition, we performed an appendectomy and drainage. The histological findings of the appendix showed the inflammation but no leukemic cells were found. Only 13 cases of acute appendicitis complicated by leukemia in adults have been reported in the Japanese literature.View full abstractDownload PDF (84K) -
Yuki Sekine, Ryogo Ichinose, Tatsuya Fukumori, Yu Suzuki, Yoshihiro En ...2001 Volume 34 Issue 12 Pages 1780-1784
Published: 2001
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 63-year-old man reporting sudden onset of severe abdominal pain was found on physical examination to show boardy stiffness, severe tenderness, and muscular defense in the lower abdomen. A diagnosis of peritonitis led to emergency surgery. Exploration showed extensive coagulation, stool covered with mesenterium, and a 10-cm fissure at the middle and lower rectal wall, so we conducted Hartmann's operation. Postoperatively, the man suffered from decreased white blood cell and platelet counts and increased heart rate and oliguria. Intensive care including endotoxin absorption therapy, mechanical ventilation support, and blood transfusion, improved his condition. An idiopathic perforation of the colon was defined as the occurrence in the absence of carcinoma, diverticulum, foreign bodies, inflammatory bowel disease, and iatrogenic agents. The most common site of idiopathic perforation of the large intestine is sigmoid colon (70-80%). Idiopathic perforation of the rectum is rare (5-10%). The site of such a perforation is typically the anterior wall just proximal to the peritoneal reflection, so closure of the anal site of the rectum is difficult. It is difficult to correctly preoperatively diagnose colon perforation. Due to the systemic inflammatory response, the postoperative course of this disease is eventful and intensive care is mandatory.View full abstractDownload PDF (90K) -
Kenichiro Uemura, Yoshiaki Murakami, Takashi Yokoyama, Yoshio Takesue, ...2001 Volume 34 Issue 12 Pages 1785-1788
Published: 2001
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a successful in situ right gastroepiploic artery (RGEA) bypass graft for ischemia of the superior mesenteric artery. A47-year-old man admitted to another clinic for acute abdominal pain underwent exploratory laparotomy that revealed severe ischemia of the ileum with marginal arterial flow preserved. Following conservative therapy, the man was transferred to our hospital diagnosed with superior mesenteric artery (SMA) occlusion. Mesenteric angiography showed the SMA to be totally occluded distally from the middle colic artery and collateral vessels from the middle colic artery and the first jejunum artery to the ileum. In situ RGEA-SMA bypass was successful and recovery uneventful. Angiography 1 month later showed good RGEA bypass graft patency. This is to our knowledge the first documented case of successful RGEA used as an in situ arterial bypass graft for superior mesenteric ischemia.View full abstractDownload PDF (74K)
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