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Volume 36, Issue 12
Displaying 1-12 of 12 articles from this issue
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Using Cox's proportional hazard modelNorio Yukawa, Makoto Akaike, Yukio Sugimasa, Shoji Takemiya, Toshio Im ...2003 Volume 36 Issue 12 Pages 1651-1658
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSPurpose: We compared the prognostic value of the number of lymph node metastases with lymph node factors in the Japanese Classification of Colorectal Carcinoma (JCCC).Methods: We examined the prognostic value in 815 patients who had undergone curative operations for colorectal cancer.Results: No significant difference in overall survival was seen n2, n3 and n4 in the JCCC by univariate analysis. In contrast, the difference in the number of lymph node metastases was significant by univariate and multivariate analysis in overall survival with a linear step-wise progression of the relative risk. In a similar manner to overall survival, no significant difference was seen in disease-free survival among n2, n3 and n4 in the JCCC by univariate analysis. The number of metastatic nodes was significant in disease-free survival by univariate analysis, with a linear step-wise progression of the relative risk shown by multivariate analysis.Discussion: The number of metastatic lymph nodes is an important prognostic factor in patients with colorectal carcinoma. If we examined them intra-operatively, the number of lymph node metastases may be as useful as the location of those for accurate lymph node dissection.View full abstractDownload PDF (71K) -
Junya Noguchi, Koutarou Kitahara, Kazutoshi Date, Kazuyuki Ono, Makoto ...2003 Volume 36 Issue 12 Pages 1659-1664
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 75-year old male was admitted to our hospital after being diagnosed as having gastric cancer. Tests upon hospitalization revealed high CEA (132 ng/ml) and AFP (75.3 ng/ml) values. In January 1997 pylorogastrectomy was performed. The case was classified as gastric cancer producing AFP tub1, SS, ly2, v1, N1, and Stage II. The patient began to develop a headache about 1 year 4 months after surgery, whereupon he was diagnosed as having brain metastasis from the same gastric cancer. Tumorectomy was performed. Metastatic gastric cancer and AFP production were also confirmed pathologically. About five years since surgery, the patient is still alive without recurrence. Both gastric cancer producing AFP and brain metastasis from gastric cancer generally have poor prognosis. In the present case it was possible to select surgical treatment and obtain a good prognosis. Surgical treatment could be one mode of treatment also for cases of brain metastasis from gastric cancer producing AFP. ATBF1, a transcription factor involved in AFP production inhibition, was not expressed at the tumor site where AFP production was seen also in the present case. This enabled confirmation of one of the features of gastric cancer producing AFP.View full abstractDownload PDF (162K) -
Kunihiro Yamasawa, Seiji Yano, Makoto Koike, Tomoko Itagaki, Yoshinori ...2003 Volume 36 Issue 12 Pages 1665-1670
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 69 year-old man underwent a gastrointestinal endoscopic examination (GIEE) one year ago from which the only abnormal finding was swelling of the duodenal papilla. However, a current GIEE showed swelling and redness of the duodenal papilla. A biopsy was performed, and the histological examination indicated a suspected well differentiated adenocarcinoma. Endoscopic ultrasonography showed that the tumor occupied only the mucosal layer. Endoscopic retrograde cholangiopancreatography revealed that the tumor had invaded neither the pancreatic duct nor the bile duct. Therefore, an operative papillectomy was undertaken and the tumor at the duodenal papilla was completely resected. The final histopathological diagnosis was myoepithelial hamartoma.
Hamartoma of duodenal papilla is a very rare case, which has been reported in 2 cases including ours in the Japanese literature. It is considered that tumors of the duodenal papilla will rarely include hamartoma.View full abstractDownload PDF (121K) -
Toshio Nakamura, Makoto Yagi, Takeshi Kuhara, Emiko Kojima, Toshikatsu ...2003 Volume 36 Issue 12 Pages 1671-1676
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 76-year-old female was referred and admitted to our hospital with the complaint of abdominal and back pain. Multiple visceral artery aneurysms and dissecting aortic aneurysm were detected by abdominal CT and angiography. Suddenly, she developed massive gastrointestinal bleeding with shock at 35 hospital days. Emergency operation was performed to her. Aneurysm of the pancreaticoduodenal artery ruptured into the duodenum. Hemostasis accomplished with ligation and suturing of the anterior pancreaticoduodenal arteries, closure of the duodenal wall, and filling up the cavity of aneurysm by the major omentum. Postoperative courses were uneventful.View full abstractDownload PDF (135K) -
Tomoyoshi Mohri, Yasuhiro Sumi, Katsutoshi Murase, Tsuyoshi Shimamoto, ...2003 Volume 36 Issue 12 Pages 1677-1681
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of rectal cancer with synchronous multiple liver metastases invading to the inferior vena cava (IVC). The patient was a 61-year-old man. Abdominal CT showed multiple liver metastases in segments 1, 6, 7 and 8. Invasion of the IVC from the liver metastases was suspected from the caval venography findings. Extended right hepatic lobectomy and caudate lobectomy with resection and replacement of the IVC using Dacron with rings under the Biopump by total hepatic vascular exclusion (THVE) for the multiple liver metastases from the rectal cancer was conducted as the first operation. About one month later the second operation, a low anterior resection of the rectum, was performed. The patient is alive 2 years after surgery without any recurrence of rectal cancer. This case suggests the possibility and utility of the aggressive surgical method for the liver metastases from rectal cancer invading IVC, therefore we recommend the operation for such a case because of the improved quality of life (QOL) and prolonged survival of the patient.View full abstractDownload PDF (117K) -
Tsutomu Fujii, Tetsuya Kaneko, Hiroyuki Sugimoto, Soichiro Inoue, Shin ...2003 Volume 36 Issue 12 Pages 1682-1687
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report herein a case of non-icteric hilar cholangiocarcinoma after acute cholecystitis, in which radical excision was possible. A 67-year-old man was examined at an affiliated hospital because of abdominal pain and vomiting, and underwent a cholecystectomy based on a diagnosis of acute cholecystitis in September 2001. Postoperative magnetic resonance cholangiopancreatography (MRCP) showed a filling defect in the common hepatic duct, and he was referred to our hospital. On admission, the serum total bilirubin value was normal at 1.0mg/dl, and the serum level of biliary enzymes was not elevated. Abdominal ultrasonography visualized no dilation of the intrahepatic bile duct. In December of the same year, a right hepatectomy with caudate lobectomy and resection of the extrahepatic bile duct were performed based on a diagnosis from close examinations of hilar cholangiocarcinoma with few sites of stenosis, thought to have progressed from the superior bile duct to the right hepatic duct. Although several cases of non-icteric hilar cholangiocarcinoma have been reported, most are accompanied by an elevation in the serum level of biliary enzymes or dilation of the intrahepatic bile duct. In this case, we considered that the correct diagnosis could only have been obtained only with MRCP, and the usefulness of this examination method is suggested.View full abstractDownload PDF (105K) -
Masahiko Sugano, Motomi Nasu, Kenji Tsukada, Toshio Takayama, Masayuki ...2003 Volume 36 Issue 12 Pages 1688-1693
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSPrimary splenic angiosarcoma is extremely rare. Seventy cases of primary splenic angiosarcoma have been reported in Japan. We experienced a case of spontaneously ruptured splenic angiosarcoma. A 50-year-old woman with abdominal pain and hemorrhagic shock was transported by ambulance to our hospital. Abdominal CT showed splenomegaly with multiple nodules, and hepatomegaly with small nodules. Bloody ascites was recognized by abdominal needle aspiration. An emergency operation was performed to her who was diagnosed massive intraperitoneal hemorrhage. On entering the abdominal cavity, about 3, 000 ml of bloody ascites and multiple nodules in the spleen were recognized. Splenectomy was performed because of bleeding from the ruptured spleen. A liver biopsy was also done. The immunohistochemical and the molecularbiological examinations revealed angiosarcoma of the spleen associated with liver metastasis. The patient succumbed 80 days after the operation due to disseminated intravascular coagulation. A probable differential diagnois of angiosarcoma must be kept in mind for splenomegaly.View full abstractDownload PDF (126K) -
Hidemitsu Sugai, Koji Kono, Hideki Fujii2003 Volume 36 Issue 12 Pages 1694-1697
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a resected case of metachronous splenic metastasis from remnant gastric cancer in 63-year-old man who had undergone distal gastrectomy reconstructed with the Billroth-II method for a gastric ulcer in 1970. In October 1998, he suffered from advanced gastric cancer (B-30-A, Type 3, T3 (SE), N3 (NoJ2) H0, P0, MO) in the remnant stomach, necessitating total resection of the remnant stomach followed by Roux-en-Y reconstruction and partial resection of the transverse colon. He was followed up and treated by systemic chemotherapy. After 26 months, computed tomography showed a solitary splenic tumor 3cm in diameter with increased CEA tumor marker. Under a diagnosis of splenic metastasis from the remnant gastric cancer, we conducted a splenectomy. Histopathological examination showed well and moderately differentiated adenocarcinoma in the spleen, histologically compatible with the metastasis from remnant gastric cancer. He remains recurrence free 15 months later.View full abstractDownload PDF (102K) -
Takuya Ando, Masahiko Yamazaki, Shun-ichi Fukao, Koichiro Nakano, Hiro ...2003 Volume 36 Issue 12 Pages 1698-1702
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report two cases of nonspecific multiple ulcers of the small intestine causing ileus. Case 1: A 26-year-old man admitted for repeated symptoms of ileus was found x-ray examination of the small intestine to have multiple ulcers with fold convergency and circular stenoses in the ileum. Ilectomy and stricturoplasty were done based on a diagnosis of ileus due to ulcers of the small intestine. Case 2: A 31-year-old man admitted for repeated symptoms of ileus and anemia was found retrograde enterography to have irregular ulcers and stenoses in the terminal ileum. Ilectomy was done based on a diagnosis of ileus due to ulcers of the small intestine. In both cases, resected specimens showed circular ulcers and ulcer scars forming stenoses. Histological findings showed most ulcers were Ul-II, and fibrosis was prominent in stenoses. Both cases were diagnosised as nonspecific multiple ulcers of the small intestine causing ileus.View full abstractDownload PDF (87K) -
Kazuhiro Tsuji, Hirokuni Ikeda, Hidenobu Mitani, Makoto Saito, Masayuk ...2003 Volume 36 Issue 12 Pages 1703-1707
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe describe a case of heterotopic pancreas of the ileum causing ileus. A 76-year-old woman operated on for p-StageIB adenocarcinoma of the left lung and admitted with abdominal pain and vomiting was found in abdominal US, CT, and a small intestinal series to have ileal obstruction whose etiology was obscure. Intubation with an intestinal tube resolved symptoms, but the ileus recurred after extubation. Exploratory surgery found the ileum 150 cm orally from the ileocecal valve to be stenotic cicatricially, and the lesion was resected segmentally. Histopathological examination of the lesion showed heterotopic pancreatic tissue, Heinrich type I. It was difficult to obtain a definite diagnosis of heterotopic pancreas, and it was necessary to consider the lung cancer metastasis to the small intestine. This rare abnormality of the ileum is thus difficult to diagnose.View full abstractDownload PDF (72K) -
Riki Okita, Shuji Saeki, Hidenori Mukaida, Kazushi Hisamatsu, Naoki Hi ...2003 Volume 36 Issue 12 Pages 1708-1712
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 45-year-old man was admitted to hospital after undergoing a medical checkup. An abdominal US examination had shown a tumor in his upper abdominal cavity. On physical examination, the tumor was not palpable, but an abdominal CT scan and a MRI examination revealed a giant tumor in his upper abdominal cavity with the same density and intensity as fatty tissue. These findings suggested a lipoma or a liposarcoma of the retroperitoneum or mesenterium. After examination, the tumor was surgically removed. The tumor was located in the transverse mesocolon, and no invasion to the surrounding tissue was seen. Histology findings confirmed a diagnosis of lipoma. Mesenteric lipomas are rare, and only 16 cases have been reported in Japan. Some cases of diagnosed retroperitoneal lipoma recurred or metastasized. We plan to closely follow-up this case.View full abstractDownload PDF (77K) -
A Case of Operation for Synchronous Triple CancerKeiju Aokage, Hisashi Tsuji, Shuji Ichihara, Masatoshi Kubo, Shoji Tak ...2003 Volume 36 Issue 12 Pages 1713-1718
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe increase in the number of patients with multiple cancers is considered due to improved diagnotic techniques. We present a case in which a man underwent surgery for triple cancers of quadruple cancers, synchronous stomach, duodenal, and renal cancers and metachronous colon cancer. He underwent endoscopic polypectomy for a colon polyp in January 1995. The histological finding of this polyp was cancerous adenoma. In September 2000, he underwent omental implantation for gastric ulcer perforation. After this operation we found gastric and duodenal cancers in upper gastrointestinal endoscopic examination and right renal cancer in abdominal CT. He underwent total gastrectomy, pancreatoduodenectomy, and right nephrectomy in September 2000. Reports of quadruple cancers are increasing year by, as are reports of synchronous cancers. Cancers having the same risk factor easily accompany others, so we must be careful not to miss such cancers.View full abstractDownload PDF (154K)
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