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Volume 36, Issue 6
Displaying 1-13 of 13 articles from this issue
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Kazuhiko Yamada, Shigekazu Ohyama, Keiichiro Ohta, Toshiki Matsubara, ...2003 Volume 36 Issue 6 Pages 443-450
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSPurpose: We clarified the difference between surgical and cadaveric views of paraaortic dissection around the aortic hiatus in gastric cancer patients. Material and Methods: The pathway of the lymphatic trunk and its relationship to the thoracic duct and the cisterna chyli was studied in 38 postmortem cadaver specimens and 16 intraoperative specimens. Results: In cadaver specimens, most of the lymphatic trunk passed through the aortic hiatus. The average number of lymphatic trunks was 2.07 on the left and 1.16 on the right. In 4 specimens (11%), however, there were some thin lymphatic vessels that did not pass through the aortic hiatus. The incidence of the cisterna chyli is 2 specimens (5%). In surgical specimens, most thick lymphatic trunks passed through the aortic hiatus. In 4 specimens (25%), however, the thick lymphatic trunk did not pass through the aortic hiatus. Conclusion: We conclude that the main lymphatic pathway passes into the thoracic duct through the aortic hiatus. In paraaortic dissection during gastric cancer surgery, it is important to note that the aortic hiatus is behind the bilateral renal artery. Another thin lymphatic vessel is located between the median and internal bundle of the diaphragmatic crus that does not pass through the aortic hiatus. Care is thus needed in noting the difference in the number and pathway of lymphatics between surgical and cadaveric views of paraaortic dissection around the aortic hiatus.View full abstractDownload PDF (161K) -
Taro Ikeda, Ryouichi Tomita, Masahiro Fukuzawa2003 Volume 36 Issue 6 Pages 451-457
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIntroduction: No previous reports have, to our knowledge, been made on anal mucosal electric sensation (AMES) in postoperative patients with anorectal malformation. We studied AEMS in comparison with clinical manifestation.Subjects: Subjects were 24 patients with anorectal malformation (ARM group) who underwent anorectoplasty (19 males and 5 females aged 5-48 years; mean age: 18.3 years) and 11 in a control group (4 males and 7 females aged 9-52 years; mean age: 30.7 years). Based on the type of anorectal malformation, patients were divided into 3 groups: high, 13; intermediate, 6; low, 5.Methods: AMES was measured at 3 positions, at the anal skin margin and 1 cm and 2 cm from the anal skin margin. AEMS was analyzed compared to the type of anorectal malformation and clinical manifestation.Results: AMES clearly increased at the 3 sites in ARM, especially high and intermediate, compared to the control group. The sensitivity threshold in the lower anal canal in low types was about the same as in the control group. An analysis of clinical manifestations showed significantly increased thresholds in the upper and middle anal canal in the group of patients with difficulty in distinguishing between gas and defecation, and with fecal incontinence (p<0.01 and p<0.05).Discussion: AMES for high and intermediate types in the ARM group was worse than that in the low types and normal groups. Anal canal mucosal electric sensitivity in the upper and middle anal canal was important for gas and defecation distinction and fecal maintenance.View full abstractDownload PDF (58K) -
Kazuyuki Nagai, Ken Yanagibashi, Tokiharu Miyahara, Noriyuki Okada, Mi ...2003 Volume 36 Issue 6 Pages 458-463
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 63-year-old man with a long history of coughing, particularly when drinking beer, was admitted when esophagography showed an esophagobronchial fistula. He also had frequent episodes of pneumonia. Esophagography, esophagoscopy, and bronchoscopy showed a fistula between the anterior wall of the middle thoracic esophagus and the left main bronchus and an esophageal tumor (0-Ip) facing the fistula. Biopsy of the esophageal tumor showed poorly differentiated squamous cell carcinoma necessitating endoscopic resection. The depth of the cancer was sm2, necessitating open esophagectomy with lymph node dissection and fistula resection. Histologically, the lumen of the fistula was covered with squamous epithelium and surrounded by muscularis mucosa. We diagnosed congenital esophagobronchial fistula (Braimbridge II) based on the patient's history, operative and histological findings. Occurrence of esophageal cancer may be related to the fistula due to their location facing each other.View full abstractDownload PDF (136K) -
Koji Asai, Seiji Igarashi, Hideaki Shimizu, Hiroshi Miyata, Jun Horigu ...2003 Volume 36 Issue 6 Pages 464-469
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 60-year-old man with dysphagia diagnosed via gastrointestinal endoscopy at a clinic as esophageal cancer aand admitted to our hospital, had a white blood cell count of 12, 400/mm3. Despite preoperative chemotherapy, leukocytes rose to 22, 200/mm3 and blood granulocyte colony-stimulating factor (G-CSF) to 120 pg/ml. In only 1 month, the tumor quadrupled in size, chemotherapy was to be ended after 1 course, and subtotal esophagectomy conducted. Histopathologically, the lesion was so-called carcinosacoma at the tumor mass, adenocarcinoma at the pedicle, and basaloid carcinoma at the basilar portion. Postoperatively, the leukocyte count gradually decreased and G-CSF dropped to 25 pg/ml. Due to immunohistochemical studies showing positive staining for G-CSF in tumor cells, the man was diagnosed with a G-CSF-producing tumor. Although only 5 cases of G-CSF-producing esophageal carcinosacoma cases have been reported, none showed such a variable histological findings of our case, which appears to be very rare.View full abstractDownload PDF (136K) -
Kazuya Sakata, Yoshikazu Ikeda, Tadasu Mori, Kimiko Okamoto, Kan Idegu ...2003 Volume 36 Issue 6 Pages 470-475
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 72-year-old woman undergoing total gastrectomy for gastric cancer became acutely ill with septic shock and adult respiratory distress syndrome, on post operative day (POD) 1, but the focus of infection was not detected. She developed abdominal distension, diarrhea, necrotic change in the abdominal skin, and subcutaneous emphysema in the chest wall. She died on POD 3 despite intensive care. Aeromonas hydrophila was cultured from the specimen on POD 2. An inspection of the hospital environment found no strain matching the patient's, so the origin of Aeromonas hydrophila remains unknown. Aeromonas sometimes causes food poisoning, and 31 reports during the past 15 years in Japan state that Aeromonas infection is highly progressive and fatal, as our case. Postoperative Aeromonas infection is rare but very serious, and requires particularly vigilant monitoring.View full abstractDownload PDF (84K) -
Hitoshi Yamaie, Toshiya Ito, Fumio Kitaoka, Kaname Ishizu, Koichi Aoki ...2003 Volume 36 Issue 6 Pages 476-481
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 70-year-old woman underwent partial duodenectomy for duodenal gastrointestinal stromal tumor (GIST). Two solitary metastatic lesions detected in the transverse mesocolon and liver 2.2 years and 6 years after surgery were removed. Since similar pathohistological and immunohistochemical findings were obtained from these 3 tumors, the patient was diagnosed as having c-kit-, CD34-and vimentine-positive GIST. Malignancy tended to be higher in metastatic tumors than in the primary tumor. Duodenal GIST was supplied by the superior mesenteric artery and the left colica. The metastatic lesion in the mesocolon doubled in size in about 85 days. Since the patient survived 7 years after surgery, we recommed active tumor resection when metastatic lesions are detected in regular follow-up at 6-month intervals postoperatively for 10 years or more.View full abstractDownload PDF (121K) -
Motoi Kondo, Keizo Dono, Masato Sakon, Hiroaki Nagano, Taro Hayashi, K ...2003 Volume 36 Issue 6 Pages 482-487
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSHepatocellular carcinoma (HCC) with tumor invasion into the bile duct but without a detectable tumor in the liver is rare, being observed in only 2 (0.4%) of 484 patients undergoing hepatectomy for HCC in our department. The first patient, who had a tumor thrombus in the anterior branch of the bile duct, underwent anterior segmentectomy and removal of the bile duct tumor. The second patient, who had a tumor thrombus in the left bile duct and a solitary nodule at subsegment 8 (S8), underwent left lobectomy, removal of the bile duct tumor, and percutaneous ethanol injection therapy (PEIT) for the tumor at S8. Histopathological examination of resected specimens could not identify the tumor in the liver, but poorly differentiated HCC was diagnosed in both cases. A biopsy sample of the S8 tumor showed well-differentiated HCC. The first patient died of intrahepatic recurrence 5 months after surgery. The second patient also developed intrahepatic recurrence and died 3 years after surgery. The prognosis of these patients was poor because the tumor was poorly differentiated. In addition to surgery, development of the effective neoadjuvant therapy is mandatory for this type of HCC.View full abstractDownload PDF (90K) -
Kou Shiraishi, Shunji Mori, Kiyoshi Isobe, Takamori Nakayama2003 Volume 36 Issue 6 Pages 488-492
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a very rare case of gastric rupture and complicated IIIa pattern pancreatic injury in which mortality was avoided by gastrectomy and distal-pancreas-preserving pancreatogastrostomy. A 64-year-old man seen in an emergency for abdominal blunt trauma and hematemesis after a traffic accident was found to have suspected gastric rupture due to free air and bleeding in the abdominal cavity seen in abdominal computed tomography (CT). Emergency surgery showed a gastric laceration at the lower body to the antrum and a bleeding open ulcer at the lower body near the lesser curvature, necessitating complete pancreatic transection for injury to the main pancreatic duct on the right border of the superior mesenteric vein. We condu cted gastrectomy to control bleeding and pancreatogastrostomy at the distal pancreas to preserve pancreatic function. The acute-phase postoperative course was good but a slight pancreatic fistula occurred. Blood glucose and pancreas external secretion were acceptable after discharge. We found that pancreatogastrostomy was suitable in preserving the pancreas in combined gastrointestinal injury and/or massive bleeding.View full abstractDownload PDF (100K) -
Haruhiko Naito, Tatuya Orimo, Nozomi Minagawa, Tomonori Hamada, Hirofu ...2003 Volume 36 Issue 6 Pages 493-496
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 63 year-old woman operated on for cecal cancer associated with regional lymph node metastasis and peritoneal dissemination along the sigmoid colon had elevated CEA 1 year and 3 months later. Computed tomography (CT), magnetic resonance imaging (MRI) and fiberscopic examination showed no abnormal findings, so exploratory laparotomy was conducted 2 years and 3 months later after informed consent was obtained. The five metastatic nodules found and were extirpated from the surgical site, abdominal wall, intestinal anastomosis, and the pouch of Douglas. Splenic metastasis found in CT 4 years and 3 months after the primary operation were resected associated with group V cells in the irrigated fluid. She has taken 5'DFUR 800 mg/day orally for 6 years since the last operation and remains healthy without disease recurrence 13 years and 6 months after the primary operation.View full abstractDownload PDF (68K) -
Tatsuo Ikeno, Atsushi Sugiyama, Kunihiko Shimura, Hideyuki Ichikawa, K ...2003 Volume 36 Issue 6 Pages 497-502
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSMesenteric panniculitis is a rare inflammatory process of the mesenteric fat tissue with unknown etiology. We report 2 cases of mesenteric panniculitis of the large intestine successfully treated by surgery and review the relevant literature. A 65-year-old man admitted for ileus symptoms was found in double contrast radiography of the large intestine to have segment narrowing in the descending colon. Computed tomography showed of the descending colon wall thickened and surrounded by fatty tissue. Treatment with TPN and antibiotics provided no relief, so we conducted left colectomy. Histologically, degeneration and necrosis of fat cells were seen and mesenteric panniculitis confirmed. Postoperatively, ileus symptoms disappeared and he is doing well. A 61-year-old man admitted to a local clinic for low abdominal pain and diarrhea, was treated conservatively under a diagnosis of ulcerative colitis, but symptoms did not disappear and he was referred to our hospital. Colonoscopy showed reddish, swollen, tumor-free edema from the rectum to the sigmoid colon. Computed tomography showed findings similar to the first case, necessitating sigmoid colectomy. Postoperatively, the man is doing well.View full abstractDownload PDF (124K) -
Yasuhiro Kouchi, Mitsutaka Jimbou, Masatoshi Shigeta, Tomohiro Inokuch ...2003 Volume 36 Issue 6 Pages 503-508
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSNeuroendocrine carcinomas were diagnosed in 3 of 1, 021 patients who had colon cancers removed from October 1997 to September 2002 for an incidence of 0.29%. Patients were 2 men and 1 woman, 59 to 70 years of age (median, 65.3 years). Treatment involved: 2 right hemicolectomies and 1 sigmoidectomy. Colonic carcinoma is more likely to be malignant in lymphatic, vascular and liver metastases and the prognosis is dismal. These tumors showed light microscopic and immunohistochemical evidence of adenocarcinomatous areas, and neuroendocrine differentiation demonstrated by positive neuronspecific enolase (NSE), synaptophysin, and chromogranin-A staining. Neuroendocrine carcinoma has the least favorable prognosis and surgical treatment alone cannot provide a cure. When undifferentiated carcinoma or poorly differentiated adenocarcinoma is indicated for colorectal lesions at biopsy, aggressive exploration entertaining a possible existence of the disease is essential. Effective multimodal therapy should include operation and chemotherapy.View full abstractDownload PDF (167K) -
Shusaku Ohira, Hiroshi Hasegawa, Seiji Ogiso, Eiji Sakamoto, Tsuyoshi ...2003 Volume 36 Issue 6 Pages 509-513
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTraumatic delayed intestinal tract perforation is very rare, and may be caused by intestinal tract ischemia when blood circulation is obstructed in the mesenteric artery. We report a case in which the descending colon penetrated the body surface on the patient's side 13 days following an injury. The injury responded to medical treatment by drainage. A 31-year-old man who was burned in the abdomen in a traffic accident underwent dermatoplasty. On day 13 of hospitalization, a feces-like liquid exuded from the skingraft site on the left side of his abdomen. Imaging suggested that the descending colon was perforated. Since the burn site involved the entire abdomen, making laparotomy difficult, we inserted a drain and performed continuous suction. On day 109 of hospitalization, closing of the fistula was confirmed. This case is, to the best of our knowledge, the first report of its kind in Japan.View full abstractDownload PDF (89K) -
Yukitake Hasebe, Yasusige Nagasawa, Jyunichi Koike, Yousuke Shiokawa, ...2003 Volume 36 Issue 6 Pages 514-518
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIncisional hernia is an important complication of abdominal surgery, with primary incisional hernia occurring in 2-11% of patients undergoing laparotomy. It requiring surgical repair. Surgical repair using prosthetic material features low postoperative recurrence. We attempted to surgically repair incisional hernia using overlapped anterior fascia of the rectus muscle of the abdomen and onlay dual mesh, which is tensionfree repair and dose not require opening the peritoneum, in five cases. Mean patient age was 64.5 years, BMI was 27.5, maximum hernia diameter was 82.5 mm, and mean followup was 18.0 months. A complication of seroma occurred in 1 case. No postoperative recurrence was seen. We therefore recommend this technique for incisional hernia.View full abstractDownload PDF (81K)
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