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Volume 36, Issue 8
Displaying 1-16 of 16 articles from this issue
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Junya Fujita, Yasuo Tsukahara, Kimimasa Ikeda, Kenzo Akagi, Kazuomi Ka ...2003 Volume 36 Issue 8 Pages 1151-1158
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe generally accepted standard surgery for advanced gastric cancer in Japan is gastrectomy with D2 lymph node dissection accompanied by omentobursectomy, but the significance of prophylactic omentobursectomy in survival after gastrectomy remains unproved. Since 1996, we have used gastrectomy preserving the omental bursa for both early and some advanced gastric cancers under a restricted criterion. We retrospectively studied whether surgical removal of the omental bursa improved survival from gastric cancer, and evaluated adverse complications caused by omentobursectomy. Methods: Subjects were 188 T2 or T3 gastric cancer patients undergoing curative gastrectomy-97 involving omental bursa preserving gastrectomy (OPG) and 91 gastrectomy with resection of omental bursa (OB). We compared surgical stress, postoperative complications, the incidence of surgically induced mechanical ileus, the incidence and pattern of cancer recurrence, and survival between OPG and OB. Results: Operation time, blood loss, and serum amylase on postoperative day (POD) 1 were significantly greater in OB than OPG. The incidence of early postoperative complications was 13.4% in OPG and 20.9% in OB. Among subjects, 11 (12.1%) suffered mechanical ileus in BG, compared to 3 (3.1%) in OPG. No significant difference was seen in the incidence of peritoneal recurrence between groups. Five-year survival in OPG vs OB was 81.3% vs 75.9% in stage IB, 77.8% vs 66.7% in stage II, and 40.0% vs 43.8% in stage IIIA, showing no significant difference between groups. Conclusion: OPG resulted in less surgical stress and fewer postoperative complications with survival similar to OB. These results suggest that omental bursa preserving gastrectomy may be applicable to T2 or T3 advanced gastric cancer patients. A prospective randomized controlled trial comparing these 2 procedures is recommended to clarify the clinical contribution of omentobursectomy.View full abstractDownload PDF (121K) -
Seigou Hoshina, Kazuo Takemura, Masaki Nagaya, Akio Yamada, Katsuya Ak ...2003 Volume 36 Issue 8 Pages 1159-1166
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWith older people now living longer, emergency surgery among the elderly is rising. Indications for surgery remain controversial, however, especially in the very ill. We retrospectively evaluated emergency abdominal surgical risk and outcome in the elderly using POSSUM and APACHE II scoring. Subjects and Methods: Subjects were consisted of 102, 384 patients treated at a university hospital emergency department between 1996 and 2000. Of these, 65 were elde-rly patients aged from 70 to 91 years old, undergoing emergency surgery for abdomen. Results: Preoperative Physiologyical POSSUM scores were significantly higher among nonsurvivors than survivors, i.e., 30.9+10.0 vs. 24.3+5.7 (p<0.01). Postoperative morbidity in patients developing complications was significantly higher than among those without complications, i.e., 0.73+0.22 vs. 0.55+0.22 (p<0.01). Preoperative APACHE II scores among survivors were 10.4+5.7 and postoperative scores 9.3+3.9, showing a statistically significant decrease (p<0.03). In nonsurvivors, however, APACHE II scores tended to increase. No significance was observed in preoperative APACHE II scores between survivors and nonsurvivors. Conclusion: POSSUM scoring is useful in determining the need for surgery in abdominal emergencies and predicting mortality and morbidity in the elderly.View full abstractDownload PDF (68K) -
Masahiro Kaneko, Harushi Osugi, Masashi Takemura, Shigeru Lee, Shinich ...2003 Volume 36 Issue 8 Pages 1167-1172
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 64-yera-old man admitted with dysphagia in January 2002 was found after swallowing barium to have a localized elevated lesion 25 mm long in the cervico-thoracic esophagus. Endoscopy showed a wide-based polypoid lesion 20 cm from the incisor on the right side of the esophagus. The lesion was suspected to have invaded the muscular layer by endoscopic ultrasonography (EUS), however, metastatic lesion was not detected by computed tomography (CT) or ultrasonography (US). Thoracoscopic esophagectomy and extended lymph node dissection were done on May 8th, 2002, with staging of T2N0M0, Stage 2. The lesion was a wide-based 22×16mm polypoid, macroscopically. Histological study showed basaloid carcinoma invading the submucosal layer with mild blood vessel invasion, but lymphatic invasion and lymph node metastasis were not seen. Basaloid carcinoma is associated with a poor prognosis, and rarely found in the cervico-thoracic esophagus. A good prognosis can be expected when invasion is limited to the submucosal layer. The patient is under meticulous care for recurrence because of the high expression of Ki-67, which indicates high cell proliferation.View full abstractDownload PDF (147K) -
Shinsuke Satake, Youtai Ishado, Reiko Nakai, Yasuomi Mukaeyama, Sakan ...2003 Volume 36 Issue 8 Pages 1173-1177
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTwo cases of gastric carcinoid tumor associated with type A gastritis were treated by distal gastrectomy. Endoscopic examinations showed multiple small polypoid lesions in the body and fundus of the stomach, which arose against a background of body-fundus atrophic gastritis. All were diagnosed as carcinoid tumor based on the histology of the biopsy specimen and showed high serum gastrin concentration and positive antiparietal cell antibody. Distal gastrectomy was done to suppress excess gastrin secretion. Serum gastrin concentration normalized immediately after surgery. Postoperative periodic gastroscopy and biopsy examination showed complete regression of the carcinoid tumor.View full abstractDownload PDF (83K) -
Madoka Hamada, Junichi Ichikawa, Mitsuya Ito, Tatsuhiro Ishii, Tadanor ...2003 Volume 36 Issue 8 Pages 1178-1182
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of dermatomyositis combined with early gastric cancer synchronous with advanced colonic cancer. A 72-year-old man noting whole-body erythema with desquamation in June 1999 was found in gastroduodenoscopy during a physical check up to have macroscopic Type 1 adenocarcinoma of the stomach. Examination of the skin biopsy did not show specific dermatomyositis features. Surgical excision of the gastric cancer was done on December 8, 1999. A colonic tumor was pointed out during laparotomy, and both tumors were excised. Erythema disappeared by postoperative day (POD) 3, but the patient felt progressive muscle loss. Serum myoglobin-S, muscle biopsy, and electromyography supported a dermatomyositis diagnosis. Administration of predonisolone (50 mg/day) was started on December 25, 1999, to control myopathy. His feeling of muscle loss dramatically improved and he was able to walk freely.View full abstractDownload PDF (99K) -
Hidekazu Yamamoto, Satoshi Nara, Yoshito Tanaka, Kouya Hida, Eiji Yama ...2003 Volume 36 Issue 8 Pages 1183-1188
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 67-year-old man diagnosed with sigmoid colon cancer and liver metastasis had been treated with chemotherapy after sigmoidectomy and two partial hepatectomies via an implanted hepatic artery catheter system connected to a reservoir. As the reservoir was exposed by a subdermally spilled anticancer drug, it was removed although there was no apparent infection. Three monthes later, a giant hepatic pseudoaneurysm occurred, because the remained catether was infected. The splenic artery, functioning as a drainage artery, was obstructed interventionally, but the celiac artery, the aneurysm's main feeding artery, could not be obstructed and it remained patent, resulting in further development of the hepatic pseudoaneurysm, obstructive jaundice, and impending rupture. Surgical ligation of the celiac artery successfully halted blood supply to the aneurysm. Arterial catheter system should be treated carefully to avoid infection, but once infection occurs, adequate treatment should be implemented immediately, because serious complications may occur through the infected system. If pseudoaneurysm is a complication, surgical ligation of the aneurysmal feeding artery is considered an excellent alternative if other intervention fails.View full abstractDownload PDF (83K) -
Hitoshi Inagaki, Tsuyoshi Kurokawa, Hiroshi Kojima, Junji Kato, Taiki ...2003 Volume 36 Issue 8 Pages 1189-1193
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of localized primary sclerosing cholangitis (PSC) mimicking hilar cholangiocarcinoma. A 57-year-old male with elevated serum bilirubin in blood biochemistry examinations who underwent percutaneus transhepatic cholangiodrainage to alleviate jaundice was hospitalized with a diagnosis of hilar cholangiocarcinoma. Cholangiography showed dilation of the left and right intrahepatic bile ducts and stenosis extending to the bifurcation of the left and right hepatic bile duct from the common hepatic duct. Angiography showed slight encasement of the right hepatic artery. We diagnosed hilar cholangiocarcioma in radioimaging and resected the right lobe and caudate lobe of the liver on 14 days after percutaneus intrahepatic right portal vein embolization. Pathologically, no malignant cells were detected and only a thickened fibrous layer around the bile duct and infiltration of inflammatory cells into hepatic tissue were found. The final diagnosis of PSC was determined based on the absence of biliary disease history. PSC is difficult to differentially diagnose from cholangiocacinoma, especially in patients who have localized biliary stenosis in the hepatic hilar region, as in our case. PSC is progressive and involves a high risk of complicating cholangiocarcinoma. It is, therefore, necessary to carefully use several modalities for diagnosis and treatment of such localized biliary stenosis.View full abstractDownload PDF (113K) -
Hiroki Akamatsu, Masaaki Nakahara, Shigeru Imabun, Nobutaka Hatanaka, ...2003 Volume 36 Issue 8 Pages 1194-1198
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of lower bile duct carcinoma associated with celiac axis compression syndrome (CACS). Pancreaticoduodenectomy was safely done monitoring hepatic arterial flow with electromagnetic flowmetry. A 77-year-old woman admitted for epigastralgia and jaundice was found in visceral arteriography to have extensive collateral blood flow to the hepatic artery via the dilated pancreatic arcade from the superior mesenteric artery. A lateral view of aortography showed compression of the celiac axis. A diagnosis of lower bile duct carcinoma associated with CACS was made. The median arcuate ligament was divided and pancreaticoduodenectomy done. After ligament division, clamping of the gastroduodenal artery did not decrease the hepatic arterial blood flow measured with electromagnetic flowmetry. The patient's postoperative course was uneventful. When pancreaticoduodenectomy is done on patients with CACS, monitoring and securing the hepatic arterial blood flow is important for preventing postoperative complications. Doppler ultrasonography was useful in diagnosis and postoperative follow-up.View full abstractDownload PDF (93K) -
Naohito Kanazumi, Yuichi Suzuki, Aya Motoyama, Daisuke Kobayashi, Koui ...2003 Volume 36 Issue 8 Pages 1199-1204
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a rare case of so-called carcinosarcoma of the pancreatic head. A 77-year-old man with a 5 cm low echoic tumor in the pancreatic head found in abdominal ultrasonography (US) for abdominal fullness was further found in abdominal computed tomography (CT) to have a tumor with central necrosis in the pancre- atic head and the 2nd portion of the duodenum, so we conducted pancreatoduodenectomy based on a diagnosis of malignant tumor either in the pancreatic head or at submucosa of the duodenum. The tumor was 6 × 7 × 4.5 cm and occupied the region between the pancreatic head and submucosa of the duodenum. Histopathological findings showed both moderately differentiated adenocarcinoma and pleomorphic sarcoma in the tumor. The definitive diagnosis was so-called carcinosarcoma of the pancreas. Despite curative resection, the patient died on postoperative day 65 due to multiple liver metastasis. Carcinosarcoma of the pancreas is rare, with our case being only the 10th reported in the Japanese literature.View full abstractDownload PDF (148K) -
Manabu Tsukada, Takuro Saito, Takao Tsuchiya, Yoshihiro Satoh, Akira K ...2003 Volume 36 Issue 8 Pages 1205-1209
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA acute traumatic abdominal hernia is rare and a Spigelian hernia is uncommon in the anterior abdominal wall. We report a case of Spigelian hernia caused by a traffic accident. A 20-year-old man, in a motor vehicle crash, was hemodynamically stable on arrival at the emergency department. Physical examination showed a fractured left femur, an irreducible 5.0×3.0 cm bulge in the left lower abdominal quadrant, and an avulsion of the musculature in the right lower abdominal quadrant with oppressive pain. Abdominal computed tomogra- phy (CT) showed a central rupture of the liver, fracture of the lumbar bone, and ruptures of the left and right lower abdominal wall with a herniated small intestine. We diagnosed the abdominal wall bulge as a traumatic Spigelian hernia and reduced the incarcerated hernia. Because of the hemodynamically stable condition, observation was elected to treat the central liver rupture. The man required 3 months of the bed rest for the fractures of the lumbar bone and left femur. During this time, the abdominal hernia shrank, finally healing after 3 month. Physical examination showed no bulge and no avulsion in the upright and standing positon, and no herniation was confirmed by abdominal CT or ultrasonography. He did well in follow-up without recurrence of hernia at 9 month after the trauma.View full abstractDownload PDF (63K) -
Kazunori Shimada, Noritsugu Ogawa, Shin Mizutani, Yasushi Tanaka2003 Volume 36 Issue 8 Pages 1210-1215
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 78-year-old man noting an abdominal mass about 6 months earlier was admitted for abdominal distention and dyspnea with a giant abdominal mass and necrotic umbilicus on August 31, 2001. Contrast-enhanced abdominal computed tomography (CT) showed a 30×25 cm mass occupying the whole abdomen, consisting of heterogeneously enhanced solid and giant cystic lesions. The origin of the tumor was unclear. Distant metastasis was not found, so laparotomy was done and the noninvasive tumor found to have arisen in the greater omentum. The resected tumor was 30×25×10 cm in diameter and weighed 3, 854 g. Histologically, the tumor was consisted of proliferated spindle cells or epithelioid cells with irregular and fascicular patterns and mitotic figures in a 4-5/10 high power field. Immunohistochemically, tumor cells were positive for c-kit and partially positive for CD34, indicating gastrointestinal stromal tumor (GIST) of the greater omentum. The man remains alive and recurrence-free 11 months after resection.View full abstractDownload PDF (126K) -
Yoshimi Hirohashi, Yorikazu Ohtsuka, Katsuhiko Hidaka2003 Volume 36 Issue 8 Pages 1216-1220
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 79-year-old woman admitted with suspected bowel obstruction had a past history of oral aphta 2 months earlier. After temporary remission, symptoms recurred, necessitating surgery. Operative findings showed marked wall thickness and redness of the terminal ileum, necessitating ileocecal resection. The resected specimen showed a large punched-out ulcer on the ileocecal valve and 3 small ulcers on the terminal ileum. Histologically, the ulcer was nonspecific and reached the subserosal layer. In this case, it was very difficult to differentiate between Beheet's disease and simple ulcer due to the presence of oral aphta and positive HLA B51. Finally, a diagnosis of simple ulcer was made bared on the absence of other specific signs of Beheet's disease except for oral aphta and positive HLA B51. Simple ulcer should thus be kept in mind as a differential diagnosis, even in an elderly patient.View full abstractDownload PDF (63K) -
Masakazu Fujii, Kazuya Nishida2003 Volume 36 Issue 8 Pages 1221-1226
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report surgical treatment of Chilaiditi syndrome. An 81-year-old woman admitted for chest discomfort and appetite loss was found in chest and abdominal X-ray to have colonic gas in the right lower lung field. Chest and abdominal CT showed colonic gas in the right subphrenic space. Chilaiditi syndrome was diagnosed, and with her own and her family's approval, underwent surgery to ameliorate the symptoms. We fixed the right colonic flexure to the peritoneum on the right side after dissecting adhesion between the ascending and transverse colon. The postoperative course was uneventful, and the patient was discharged 21 days after surgery. Colonic Chilaiditi syndrome is generally asymptomatic, so most cases are simply followed up. The small intestinal type is often associated with intestinal strangulation, indicating surgery for symptomatic colonic Chilaiditi syndrome. Such surgery may not be difficult, but is often difficult to determine whether indicated.View full abstractDownload PDF (100K) -
Hiroaki Ito, Shuji Tanaka, Hajime Kihara, Masaki Hirota, Yoichiro Baba ...2003 Volume 36 Issue 8 Pages 1227-1231
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 57-year-old woman reporting right lower abdominal pain was palpated with a mobile fine tumor in the right lower abdomen. Abdominal ultrasonography showed a multiple concentric ring sign, and abdominal computed tomography showed a target sign. Chest radiography showed the cave of the right lung. In emergency surgery, we treated the ileum-ascending colon intussusception by Hutchinson's method. We found a soft nodule 3 cm in diameter at the head of the intussusception elevated toward the lumen and having poor mobility, suggesting that the lesion extended from the mucosa to muscularis propria or deeper. We also found 5 similar nodules and many enlarged lymph nodes and small white nodules near the intestine with intussusception. Pathologically, lymph nodes had agglutinated glanuloma, epithelioid cells, and Langhans giant cells. A sputum test and gastric juice were positive tuberculous germs. Deoxyribonucleic acid and favorite acid bacteria cultivation of lymph nodes were positivity. We reported this as an example of intestinal tuberculosis discovered after intussusception that is an extremely rare complication.View full abstractDownload PDF (86K) -
Masatoshi Kajiwara, Yutaka Konishi, Tatehiro Kajiwara2003 Volume 36 Issue 8 Pages 1232-1236
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 65-year-old woman treated with corticosteroid for scleroderma reported abdominal pain after corticosteroid-pulse therapy. Abdominal radiography showed free air below the diaphragm, necessitating emergency surgery for a diagnosis of gastrointestinal perforation. At laparotomy, we found a perforation with a deep ulcer on the opposite side of sigmoid colon attachment. Since radiography showed no pulmonary lesions, we confirmed the diagnosis of colonic tuberculosis by histological findings of the resected sigmoid colon, which showed typical granuloma with Langhans giant cells and acid-fast bacilli. She was prescribed 4 types of antituberculous drugs-INH, RFP, EB, and SM- and discharged. Postoperative colonoscopy showed circular ulcers that gradually improved. Cases of tuberculous perforation of intestine and colon have been reported, and this possibility should be considered when differentially diagnosing gastrointestinal perforation.View full abstractDownload PDF (78K) -
Norihiro Okamoto, Morito Maruta, Koutarou Maeda, Harunobu Sato, Koji M ...2003 Volume 36 Issue 8 Pages 1237-1241
Published: 2003
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of gastrointestinal pacemaker cell tumor (GIPACT) with special reference to the usefulness of multiplaner reconstruction (MPR) and three-dimensional imaging (3D) by multislice computed tomography (MSCT) for selecting the surgical procedure and approach. A 36-year-old man with constipation was admitted for further examination was found in diagnostic imaging studies to have a submucosal tumor in the lower rectum. MPR and 3D were used to select the tumor approach and surgical procedure, resulting in a successful ultralow anterior resection with transanal anastmosis. Histological examination of the resected specimen showed the tumor consisted of spindle-shaped cells. Immunohistochemical testing was negative for s-100 and muscle-actin, and positive for CD34 and c-kit and the tumor was diagnosed as GIPACT. The postoperative course was uneventful except for temporary urinary dysfunction.View full abstractDownload PDF (104K)
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