The Japanese Journal of Gastroenterological Surgery
Online ISSN : 1348-9372
Print ISSN : 0386-9768
ISSN-L : 0386-9768
Volume 38, Issue 8
Displaying 1-24 of 24 articles from this issue
  • Matsuo Nagata, Takehide Asano, Hiroshi Yamamoto, Nobuhiro Takiguchi, O ...
    2005 Volume 38 Issue 8 Pages 1271-1279
    Published: 2005
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    Purpose: Autologous blood transfusion has been shown to be useful as a means of avoiding the problems associated with allogeneic transfusion, such as transmission of bacteria and viruses, and immunological reactions, such as allergy, graft-versus-host disease, and suppression of tumor immunity. This study retrospectively investigated the usefulness of autologous blood donation in esophageal cancer treated by chemoradiotherapy (CRT) followed by surgery. Patients and Methods: Between June 2000 and October 2003, 59 patientswith resectable esophageal cancer were treated by preoperative CRT, consisting of 5FU 700-800mg/m2 days1-5, Nedaplatin 80mg/m2 (or Cisplatin 70mg/m2) day 1, and 30Gy of radiation days 1-19. The criteria for autologous blood donation were: Hb value greater than 11g/dl, body weight greater than 40kg, and having obtained informed consent in writing. Autologous blood was collected 1 and 2 weeks before surgery, anderythropoietin was injected on the day of each blood donation. Esophagectomy was performed by right thoracotomy and laparotomy, and a cervical or intrathoracic anastomosis was created between the esophagus andgastric tube by the stapling technique. The autologous blood donor (ABD) group was compared with a nonautologous blood donor (NABD) group who were treated by the same preoperative CRT schedule and satisfied the criteria for autologous blood donation between Aug 1998 and May 2000. Results: The Hb value of 49 (83.1%) of the 59 patients treated by preoperative CRT was higher than 11g/dl, and 400-800ml (mean 662.2±158.5ml) of autologous blood was successfully collected from the 45 patients (76.3%) who weighed morethan 40kg. Allogeneic blood transfusion during the perioperative period was avoided in only 1 patient (9.1%) in the NABD group. In the ABD group, on the other hand, allogeneic blood products, including MAP, FFP and PPF, were avoided in 36 patients (83.7%). There were no significant differences between the twogroups in postoperative complications or Hb, serum total protein, and albumin values. Conclusion: These results indicate that autologous blood donation is useful as a means of avoiding allogeneic blood transfusion inesophageal cancer patients treated by preoperative CRT and surgery.
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  • Kumiko Kato, Tomoyuki Saeki, Youji Yamazaki
    2005 Volume 38 Issue 8 Pages 1280-1287
    Published: 2005
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    Purpose: Mda-7/IL-24 is a unique cytokine gene belonging to the IL-10 family. Adenoviral-mediated gene transfer of mda-7/IL-24 induces growth suppression and apoptosis selectively in a wide range of cancer cell lines without causing cytotoxity to normal cells. We studied the anti tumor effect and signaling pathways of mda-7/IL-24 in human hepatic cancer cell lines in vitro. Materials and Methods: Overexpression of MDA-7 by a replication-incompetent adenovirus (Ad-mda-7) in human hepatic cancer cell lines, i. e., HepG2 (p53-wild type) and Hep3B (p53-deleted type), was evaluated by immunochemistry and Western blot analysis. Cell proliferation was assayed by a dye exclusion test. Apoptosis signaling proteins (PARP, CASPASE, and BAX) and the JAK/STAT pathway were evaluated by Western blot analysis. Results: Ad-mda-7 inhibited growth in both cell lines 72 hours after transduction (p<0.05). MDA-7 and cleaved PARP expressions were up-regulated after 72 hours in both cell lines. Up-regulation of BAX expression was observed in HepG2 cells, while no difference was observed in Hep3B cells. Cleaved CASPASE-8 expression was detected in both cell lines, and pSTAT3 expressed in HepG2 cells. Conclusions: Mda-7/IL-24 effectively induced apoptosis in hepatic cell lines. The anti tumor effect was proved to occur in p53 and Bax independently and through the activation of caspase cascade pathways. Activation of STAT3 could be involved in the apoptosis pathway.
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  • Noritsugu Hagiwara, Ryoichi Tomita, Masahiro Fukuzawa
    2005 Volume 38 Issue 8 Pages 1288-1295
    Published: 2005
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    Purpose: We studied rectal motility in chronic constipation. Methods: Rectal manometric recordings using a transanal probe placed with manometric sensors in the rectum were made for 2 hours before meals and 2 hours after meal, in 10 slow-transit constipation patients (group A) and 10 healthy volunteers (group B). Results: Manometric waves recorded in group B were classified into 4 types: Type I was a low-amplitude continuous wave. Type II was a high-amplitude continuous wave or continuous wave with the base line ascending. Type III showed only the base line ascending. Type IV was a high-amplitude sharp wave. Before meals only type I waves appeared. After meals, the frequency of type I waves increased in group B (p<0.01). Types III and IV appeared only in group B. The incidents of type II waves was the same in both groups, but appearance in group B was ealier than that in group A (p<0.01). In group A, the higher frequency wave was delayed and no higher amplitude wave was observed. Conclusion: Our results suggest that slow-transit chronic constipation patients lack a rectal response to eating due to a gastro-rectal reflex disorder.
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  • Katsuhiro Okuda, Masaaki Sano, Hiroshi Narita, Tadashi Shibata, Katsum ...
    2005 Volume 38 Issue 8 Pages 1296-1300
    Published: 2005
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    We report a very rare case of double esophageal carcinoma along with so-called carcinosarcoma and squamous cell carcinoma. A 57-year-old man admitted for dysphagia was found in esophageal X-ray and an upper gastrointestinal series to have squamous cell carcinoma in the middle intrathoracic esophagus. The lesion was too narrow to examine from the anal side of esophagus. Metastasis surveys suggested multiple lung metastasis. After undergoing 1 course of chemotherapy and radiation therapy, the man experienced difficulty in swallowing his saliva, necessitating subtotal esophagectomy. Macroscopic and microscopic findings of resected specimens showed squamous cell carcinoma in the middle intrathoracic esophagus and so-called carcinosarcoma in the lower intrathoracic esophagus. So-called carcinosarcoma of the esophagus is a rare malignant neoplasm, hence our report.
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  • Masaki Azuma, Shohachi Suzuki, Takanori Sakaguchi, Shigeyasu Ota, Keis ...
    2005 Volume 38 Issue 8 Pages 1301-1305
    Published: 2005
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    We report a 67-year-old man with alpha-fetoprotein (AFP)-producing gastric cancer and synchronous liver metastasis with a portal tumor thrombus. After being followed up elsewhere for hepatitis C virus infection, he was admitted in August 1999 for a liver tumor found due to high serum AFP. Abdominal CT showed a 7.5cm - diameter tumor developing into a portal branch in the right hepatic lobe. Gastrointestinal fiberscopy showed a type 2 tumor in the remnant stomach, histologically diagnosed as poorly differentiated adenocarcinoma. We diagnosed lesions as hepatocellular carcinoma and gastric cancer in the remnant stomach. Three weeks after percutaneous transhepatic portal embolization, we conducted extended right hepatic lobectomy and partial gastric resection. Since both hepatic and gastric tumors were positive for AFP immunohistochemical staining, we diagnosed him histologically as having AFP-producing gastric cancer with liver metastasis. He underwent adjuvant chemotherapy with 5-FU and CDDP and is doing well without recurrence more than 5 years after surgery.
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  • Rie Nishikata, Masanori Terashima, Nobutoshi Soeta, Satoshi Ohtani, Sh ...
    2005 Volume 38 Issue 8 Pages 1306-1311
    Published: 2005
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    A 52-year-old man transferred to our hospital for suspected gastric cancer with epigastralgia, weight loss, and appetite loss was found in gastrointestinal fiber to have type 4 gastric cancer. Gastric biopsy showed signet ring cell carcinoma. When scheduled for neoajuvant chemotherapy, he reported exertional dyspnea and pre-sented with hypoxemia and hypocapnia. Chest CT showed diffuse granular shadows and thickened bron-covessel bundles. Lung perfusion study showed stringy defects indicating the presence of multiple microem-bolisms. On hospital day 8, dyspnea suddenly worsened, and chest CT showed increased macular shadows. He died of respiratory failure on hospital day 10. Necropsy of the lung showed fibrocellular intimal proliferation, organized thrombi, and recanalization in small pulmonary arteries compatible with pulmonary tumor throm-botic microangiopathy (PTTM).
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  • Naoto Katagata, Mutsuo Yamada, Kenzi Gonda, Takeshi Sakuma, Fumiaki Wa ...
    2005 Volume 38 Issue 8 Pages 1312-1317
    Published: 2005
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    We report two cases of duodenal somatostatinoma associated with von Recklinghausen's disease. Case 1 involved a 45-year-old man and case 2 a 67-year-old man, in whom cafe-aulait skin macules and multiple neurofibromas were noted over the entire body. They underwent pancreatoduodenectomy based on a diagnosis of duodenal carcinoid in the oral side of the papilla of Vater. Histologically, the duodenal tumors in these cases infiltrated the pancreatic head. A high-power view showed tumors to consist of small round cells with a solid or trabecular pattern and conspicuous psammoma bodies. Regional lymph nodes contained metastases. Immunohistochemical examination showed that tumor cells stained for somatostatin and chromogranin. In case 1, ultrastractual study demonstrated neuroendocrine secretory granules (300-400 nm in diameter) in cytoplasm. It is noted that somatostatinoma should be considered on differential diagnosis in patient with von Recklinghausen's disease accompanied with periampullary neoplasm.
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  • Junko Izai, Hideyuki Kanemoto, Kazuya Matsunaga, Tomoki Ebata, Atsuyuk ...
    2005 Volume 38 Issue 8 Pages 1318-1323
    Published: 2005
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    A 71-year-old man with hepatocellular carcinoma (HCC) and chronic hepatitis C underwent percutaneous ra-diofrequency ablation therapy (RFA) for two HCC nodules 2cm in diameter, in the anterior inferior segment (S5) and posterior inferior segment (S6) in March 2003. A tumor thrombus was detected in the right posterior inferior portal branch (P6) by US 38 days after RFA, which rapidly progressed and reached the anterior-posterior portal bifurcation one month later. He underwent right hepatic lobectomy in June 2003. Pathological examination showed the tumor thrombus to be moderately differentiated hepatocellular carcioma, whereas primary tumors in S5 and S6 were completely necrotic. Necrotic HCC in the portal venule was also detected in the ablated area of S6. We concluded that microscopic portal vein tumor thrombus may have been pushed into P6 by RFA, meaning RFA should be closely followed up taking into account possible rapid recurrence.
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  • Shinsuke Matsuda, Masanobu Usui, Hideaki Suzuki, Yoshifumi Ogura, Taiz ...
    2005 Volume 38 Issue 8 Pages 1324-1329
    Published: 2005
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    We report a case of quadruple cancer of 3 organs in which mucinous cholangiocarcinoma and gastric remnant cancer developed pastoperatively for early gastric cancer and bile duct cancer. A 69-year-old man had undergone distal gastrectomy for early gastric cancer at age 54 (IIc tumor, moderately differentiated tubular adenocarcinoma, m), and hilar hepatectomy with caudate lobectomy for bile duct cancer at age 63 (papillary tumor, 2.0×2.0cm, well-differentiated tubular adenocarcinoma, ss, n0, stage II). He was admitted for anterior chest and upper abdominal discomfort and an increase in serum CA19-9. Early gastric cancer detected at the remnant stomach necessitated endoscopic mucosal resection (0-1 type, well-differentiated tubular adenocarcinoma, m). US, CT, and MRI showed a tumor from the lateral segment of the liver to the anterior mediastinum. Preoperative diagnosis was liver metastasis of bile duct cancer, necessiatating lateral segmentectomy with partial resection of the diaphragm, sternum, and pericardium. Macroscopic findings showed a tumor 7.0×5.0 cm with a yellowish-white lobular cut surface. The pathological diagnosis was mucinous cholangiocarcinoma (T2: diaphragm, sternum, pericardium, N0, M0, Stage III). He died 7 months after the last operation due to multiple bone metastases.
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  • Kenji Mimatsu, Hisao Kanou, Hide Kaneda, Youichi Kuboi, Yoshihisa Kats ...
    2005 Volume 38 Issue 8 Pages 1330-1334
    Published: 2005
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    A 60-year-old man was admitted for occult fever and a liver tumor detected by ultrasonography. He has a his-tory of penile cancer five years previously. Computed tomography demonstrated a low-density tumor 5cm in diameter in the right lobe. Angiography showed that the tumor was hypovascular. An aspiration tumor bi-opsy was performed because of difficulty in diagnosing the tumor, and the pathological findings suggested squamous cell carcinoma, a metastasis of the penile cancer. At surgery the liver tumor was found to have in-vaded the transverse colon, and right hepatic lobectomy with hilar lymphadenectomy combined with right hemicolectomy was performed. The final pathological diagnosis of the liver tumor was poorly differentiated cholangiocarcinoma. The mechanism of tumor invasion to the colon may have been inflammatory adhesion and penetration of the adjacent transverse colon. Intrahepatic cholangiocarcinoma with invasion of other or-gans is reported to have a poor prognosis, and it requires strict follow-up.
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  • Koh Uyama, Hiroshi Okitsu, Hisashi Ishikura, Toshihiro Ichimori, Masas ...
    2005 Volume 38 Issue 8 Pages 1335-1339
    Published: 2005
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    A 55-year-old woman admitted for gallstones was found in ultrasonography and abdominal CT scan to have a cystic lesion 30mm in diameter in the body of the gallbladder, which divided the gallbladder into two parts, neck and fungus. Small gallstones were also seen at the neck of the gallbladder. We undertook laparoscopiccholecystectomy. Macroscopic examination found a large cyst in the body of the gallbladder and some gall-stones at the neck of the gallbladder. An incision showed to be filled with coagulated bile. Histologically, the cyst was an enlarged Rokitansky-Aschoff sinus whose inner surface was lined by a single layer of papillary hyperplasia and well differentiated adenocarcinoma. Gallbladder cysts are rare, with only 4 cases of cancerous gallbladder cyst reported worldwide in so far as we know. We report this extremely rare combination of gall-bladder cyst and cancer, together with a review of the literature.
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  • Kazuyo Tsuchiya, Kazuo Chijiiwa, Masahiro Kai, Jiro Ohuchida, Shuichir ...
    2005 Volume 38 Issue 8 Pages 1340-1345
    Published: 2005
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    Mucin-producing bile duct tumors are rare. More than 90% of bile duct tumors are adenocarcinomas, and only 7 cases of mucin-producing bile duct adenoma have been reported in the Japanese literature. We report a case of mucin-producing bile duct adenoma with a history of repeated abdominal pain and liver dysfunction. A 63- year-old woman was admitted to the hospital with abdominal pain and jaundice. ERCP revealed an irregular defect in the common bile duct and left hepatic duct. Although the lesion was not detected by per-oral cholangioscopy (POCS) because of the large amount of mucin, intraductal ultrasonography (IDUS) demonstrated a small polypoid lesion in the left hepatic duct. Extended left lobectomy of the liver was performed for a preoperative diagnosis of mucin-producing bile duct tumor, and the final pathological diagnosis was mucinproducing bile duct adenoma.
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  • Chihiro Ono, Kanji Yaegashi, Haruhiko Aoyagi, Yoshinobu Nishioka, Hisa ...
    2005 Volume 38 Issue 8 Pages 1346-1350
    Published: 2005
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    A 28-year-old man referred for examination of a pelvic mass found in an assessment of constipation and dysuria was found in pelvic CT and MRI to have a 14×9×10cm presacral calcified cystic mass. Barium enema and colonoscopic examination showed that the posterior wall of the rectum was notably displaced anteriorly. Biopsy during colonoscopy showed no atypical cells. The mass, excised transabdominally, was posterior to the rectum, anterior to the sacrum, and partially attached to the sacrum and firmly to the coccyx. Macroscopically, it had a thick wall containing hemorrhagic fluid and necrotic materials. Histological examination showed a thick fibrous wall free of epithelial cell lining and containing granulation tissue with cholesterin crystals. Therefore the mass was suspected to be a pseudocyst. His complaints were ameliorated clinically and he was discharged on post-operative day 26. Presacral pseudocysts are extremely rare and have not, to our knowledge, been reported previously in Japan.
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  • Takashi Akiyoshi, Masanori Tokunaga, Toshitatsu Ogino, Makoto Morita, ...
    2005 Volume 38 Issue 8 Pages 1351-1356
    Published: 2005
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
    A 75-year-old man undergoing emergency laparotomy for a ruptured abdominal aortic aneurysm in January 2001was found incidentally to have a solid tumor of the jejunum 3cm in diameter, necessitating Y graft replacement and partial jejunal resection. Microscopically, the tumor consisted of fascicles of spindle cells and stained positive for CD34 and KIT, leading to a histological diagnosis of gastrointestinal stromal tumor (GIST). Low mitotic figures (150 high-power field) and a low MIB-1labeling index (3%) evidenced no malignancy. Abdominal computed tomography showed an intrabdominal mass 8cm in diameter in September 2003, so we conducted laparotomy in October 2003, resecting the main omental tumor and 2 small nearby lesions. Microscopically, the tumor morphologically resembled the previous intestinal GIST, but mitotic figures were frequent (16·50 high-power field). C-kit mutation analysis showed both tumors to have the same mutation at exon 11of the c-kit gene (deletion of codon 564-576).The omental tumor was diagnosed as recurrent intestinal GIST. The patient is doing well 8 months postoperatively without any sign of recurrence.
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  • Teruo Iwata, Masaru Morita, Shoji Nakata, Masakazu Sugaya, Kenji Ono, ...
    2005 Volume 38 Issue 8 Pages 1357-1362
    Published: 2005
    Released on J-STAGE: June 08, 2011
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    A 50-year-old woman came to our hospital with chief complaints of constipation and abdominal pain in the right lower quadrant 7 years after bilateral mastectomy for invasive lobular carcinoma. Both radiological and endoscopic examinations revealed multiple stenotic lesions in the colon and erosive lesions in the stomach. Poorly differentiated adenocarcinoma with signet-ring cells was detected in the biopsy specimens of the gastric lesions, and the biopsy of the colon tumor showed similar features. Since immunohistochemical studies for hormone receptors (estrogen receptor, Hercep test) were positive, the lesions were diagnosed as metastases of the breast cancer, and right hemicolectomy was performed. Histological examination revealed that the tumor cells in the colon had spread into the submucosal layer and serosa and were histologically similar to the breast cancer cells. Invasive lobular carcinoma of the breast tends to metastasize to the gastrointestinal tract. It is important to pay special attention to gastrointestinal tract metastases in patients with invasive lobular carcinoma of the breast. It is also important to consider the possibility of metastasis by invasive lobular carcinoma of the breast whenever signet-ring cell carcinoma of the gastrointestinal tract is encountered.
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  • Shinjiro Kobayashi, Masaki Oohashi, Hidetoshi Oguma, Nobuo Tenma, Chik ...
    2005 Volume 38 Issue 8 Pages 1363-1368
    Published: 2005
    Released on J-STAGE: June 08, 2011
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    We report a case of an adenocarcinoma of the small intestine metastasizing to the abdominal wall 3 years after surgical resection. A 64-year-old man undergoing a segmental jejunal resection in October 2000 was confirmed histopathologically to have well-differentiated adenocarcinoma. A 4cm length lump was noted in the patient's right lower abdomen in October 2003 and imaging confirmed an abdominal wall tumor, which we Resected was performed in January 2004. The tumor was in the abdominal wall muscle, and no nodules or tumors were found in the abdominal wall cavity. Histopathology confirmed well-differentiated adenocarcinoma of the soft tissue. The patient was definitively diagnosed with recurrent small bowel cancer of the abdominal wall. This is, to our knowledge, the first such case reported and extremely rare, i.e., recurrent small bowel cancer in the abdominal muscle without metastasis to any other site.
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  • Satoshi Suzuki, Takeshi Mishina, Koei Nihei, Ken-ichiro Hirano, Mami W ...
    2005 Volume 38 Issue 8 Pages 1369-1373
    Published: 2005
    Released on J-STAGE: June 08, 2011
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    We report a case of peritoneal dissemination due to gastrointestinal stromal tumor (GIST) recurring almost 2 years postoperatively. The condition responded very favorably to treatment involving imatinib mesylate, after other therapy including 2 resections of peritoneally disseminated tumors, conventional immunochemotherapy, and continuous hyperthermic peritoneal perfusion (CHPP), proved ineffective. A 55-year-old man undergoing resection of the small intestine due to a 13cm giant ileal tumor 6 years earlier found histologically to consist of a fascicular proliferation of spindle-shaped cells with marked mitosis immunohistochemically positive for c-kit and the finally diagnosed with malignant GIST, was hospitalized 2 years later for lower abdominal pain and slight fever. Abdominal computed tomography (CT) showed multiple intraabdominal abscesses which finally diagnosed as peritoneal dissemination of GIST, necessitating 2 tumor resections. CHPP and intraabdominal infusion of CDDP at the second reduction surgery, conventional ADIC chemotherapy, and Krestin immunotherapy proved ineffective against the recurrent tumor. In Feb. 2002, oral administration of imatinib mesylate at 400mg/day was started. An abdominal CT showed rapid tumor disappearance. Response to treatment has continued up to the 30 months as of this writing. Drug toxicity resulting in facial edema and appetite loss were mild and tolerable. Our results strongly suggest that imatinib mesylate is potentially very effective and safe in treating recurrence of malignant GIST.
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  • Tsuyoshi Enomoto, Tsunehiko Maruyama, Sakae Horiuchi, Nobuhiro Ohkohch ...
    2005 Volume 38 Issue 8 Pages 1374-1378
    Published: 2005
    Released on J-STAGE: June 08, 2011
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    We report postoperative intussusception caused by the head portion of a linear stapler used in partial excision of the cecum. A 56-year-old man admitted for ileus due to sigmoid colon cancer underwent tube cecostomy to reduce intestinal pressure, followed by sigmoidectomy and closure of cecostomy. The cecum was partially ex-cised by a linear stapler and the cecostomy was closed. The patient experienced intermittent abdominal pain on 4th post operative day (POD), and a fist-sized mass was palpated in the upper right abdomen. The linear stapler used for stumps of the partial excision of the cecum was found to be incarcerated into middle trans-verse colon and the emergency operation was carried out. At laparotomy, the head portion showed cicatrized stumps with the linear stapler forming a 7cm mass, therefore we performed ileocecal resection under the con-sideration of the recurrence. In this case, dilatation of caliber difference of the ileocecal area which formed by ileus, oversewing cecal stump and mobility of cecum which induced by manipulation of closure of cecostomy likely caused the intussusception.
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  • Koji Uno, Takashi Kita, Yuichi Ogoshi, Masashi Ishikawa
    2005 Volume 38 Issue 8 Pages 1379-1383
    Published: 2005
    Released on J-STAGE: June 08, 2011
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    We report a case of humoral hypercalcemia of malignancy (HHM) associated with undifferentiated colon can-cer. A 41-year-old man admitted for acute abdomen and undergoing right colectomy was found to have a hard mass in the ascending colon diagnosed immunohistochemically as undifferentiated carcinoma. Postoperative CT findings showed multiple liver metastases. Hypercalcemia was observed on postoperative day (POD) 80 and diagnosed as HHM associated with undifferentiated colon cancer. Bisphosphonate treatment normalized serum calcium but the patient died on POD 105 due to multiple liver metastases. HHM associated with colon cancer is very rare. To our knowledge only 20 cases have been reported worldwide. Histopathologic studies revealed that there were seven cases of adenosquamous carcinoma, three cases of poorly differentiated carci-noma and three cases of adenocarcinoma which differentiation was not described. There was only one case of undifferentiated carcinoma, and this is the second case.
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  • Hiroshi Takahashi, Tetsuya Yamaguchi, Ryoji Takeda, Shingo Sakata, Mic ...
    2005 Volume 38 Issue 8 Pages 1384-1389
    Published: 2005
    Released on J-STAGE: June 08, 2011
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    We reported a case of von Recklinghausen's disease (VRD) associated with sigmoid colon cancer. A 35-year-old man diagnosed with VRD since childhood the same as his mother was seen for left lower abdominal pain. Colon fiberscopy showed advanced sigmoid colon cancer, necessitating laparoscopy-assisted sigmoidectomy. Although nonepithelial tumors such as neurofibrosarcoma are known to occur frequently in patients with VRD, epithelial tumors are thought to be rare. It has been pointed out that VRD patients may possibly inherit cancers of the colon and rectum. We clinically considered this possibility by examining cases in Japan from 1983 to 2004. The result showed that the average age (57.6 y. o.) of VRD patients (28 cases including ours) with colonic and rectal cancers was significantly low compared with the average age (68.4 y. o.) of non-VRD patients with the cancers operated in our hospital these 2 years. However, the incidence of VRD patients with colonic and rectal cancers was low against recent increases of these cancers in Japan. We confirmed that there was no increase of colon and rectal cancers with VRD patients.
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  • Toshio Iino, Katsuhito Suwa, Eiichirou Miura, Yoshiyuki Furukawa, Yosh ...
    2005 Volume 38 Issue 8 Pages 1390-1394
    Published: 2005
    Released on J-STAGE: June 08, 2011
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    A 42-year-old man with bloody stool was found in barium enema and colonoscopy to have a polypoid lesion 20 mm with an irregular surface and fold convergence in the rectum. Biopsies were consistent with poorly differ-entiated adenocarcinoma. Given the patient's disability, we conducted Hartmann's operation. Histological ex-amination showed poorly differentiated adenocarcinoma invading the submucosal layer with lymphnode meta-stasis. The poorly differentiated adenocarcinoma was encircled by tubulovillous adenoma. No point mutation of the K-ras gene was observed in the poorly differentiated adenocarcinoma or tubulovillous adenoma. Immunohistochemically, only the poorly differentiated adenocarcinoma showed diffuse positive staining for p53 protein. Based on the pathological figure and molecular biological analysis, this case was definitively diag-nosed as poorly differentiated adenocarcinoma following a pathway included in the adenoma-carcinoma se-quence.
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  • Nobuhiro Shibata, Masayuki Hotokezaka, Sei-ichiro Jimi, Masayasu Shima ...
    2005 Volume 38 Issue 8 Pages 1395-1399
    Published: 2005
    Released on J-STAGE: June 08, 2011
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    We report a very rare case of pyometral peritonitis due to uterine perforation an uterorectal fistula. A 61-year-old woman admitted for abdominal pain and fever was found in physical examination to present muscular de-fense in the lower abdomen. Abdominal pain resolved spontaneously, however, several hours after admission. Computed tomography showed an enlarged uterine cavity and an uterorectal fistula subsequently treated conservatively. Gastrografin enema study showed the fistula had shrunken, and computed tomography study showed air and fluid accumulation in the uterus. Trans-vaginal drainage of the uterus closed the uterorectal fistula and no pyometral or uterorectal fistula was observed thereafter indicating the effectiveness of proper drainage. Careful follow-up is necessary, however, because of possible pyometral recurrence.
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  • Noriyuki Yasutomo, You Kurashima, Satoshi Kondo
    2005 Volume 38 Issue 8 Pages 1400-1404
    Published: 2005
    Released on J-STAGE: June 08, 2011
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    A case of tubulo-villous adenoma of the rectum is reported. The patient was a 76 year-old woman who complained of general fatigue and dehydration. Electrolyte disturbances and renal dysfunction (Na 125mEq/l, K2.1mEq/l, Cl 88mg/l, BUN 57.9U/l, CREA 1.36mg/dl) were found, but they improved after admission. At the same time, an incarcerated tumor that had arisen from internal hemorrhoids that had repeatedly prolapsed over the past 2 years, was observed in the form of a fist-sized, soft, easy-bleeding velvet-like mass with a large quantity of mucus on its surface. A detailed examination revealed a villous tumor occupying 3/4 of the circumference of the lumen that was approximately 10cm in diameter and 8mm proximal to the dentate line. Superlow anterior resection was performed. The histopathological diagnosis was tubullo-villous adenoma with no malignancy and a negative cut-end. There have been no recurrences of the dehydration or electrolyte disturbances.
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  • 1CTP in Patients with Pancreatic Cancer
    Michihiko Wada, Ryo Hosotani, Hiroaki Terajima, Takashi Hashimoto, Tok ...
    2005 Volume 38 Issue 8 Pages 1405
    Published: 2005
    Released on J-STAGE: June 08, 2011
    JOURNAL FREE ACCESS
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