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Volume 39, Issue 11
Displaying 1-16 of 16 articles from this issue
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Takumi Sakakibara, Kenji Hibi, Masahiko Koike, Michitaka Fujiwara, Yas ...2006 Volume 39 Issue 11 Pages 1649-1657
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIntroduction: PAI-1 has been shown to be a clinical marker of a poor prognosis in several human cancers, and it has also been shown to promote tumor growth and invasion during angiogenesis. Methods: To assess PAI-1 as a marker for the malignancy of digestive tract cancer, we performed quantitative RT-PCR for the PAI-1 gene and evaluated the relationship between the PAI-1 gene expression levels and clinicopathological findings in digestive tract cancer. Results: A significant increase in PAI-1 expression scores was observed in lymphnode-metastasis-positive digestive tract cancers compared to negative cancers as well as in distantmetastasis-positive digestive tract cancers compared to negative cancers. The PAI-1 expression score increased markedly with tumor stage, and multivariate analysis revealed the PAI-1 expression score to be a strong and independent prognostic factor for digestive tract cancer. Conclusion: These results suggested that PAI-1 may serve as a new parameter for the predicting the outcome of digestive tract cancer.View full abstractDownload PDF (1470K) -
Tarou Higuchi, Kouki Otsuka, Kentarou Fujisawa, Tetsuya Itabashi, Yuic ...2006 Volume 39 Issue 11 Pages 1658-1665
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSPurpose: The aim of this study was to compare the oncologic outcomes of laparoscopy-assisted colectomy (LAC) and open colectomy (OC) for colorectal cancer. Subjects: This retrospective, non-randomized study examined 88 patients who were cured with no residual tumors after undergoing a colorectal resection with a D3-dissection between January 1996 and March 2005. The patients were divided into 2 groups, those receiving a LAC (n=43) and those receiving an OC (n=45). The groups were compared with regard to blood loss, duration of surgery, lymph node yield, postoperative hospital stay, complications, recurrence, and survival rates. Results: None of the patients in the LAC group required conversion to OC in this study. Intraoperative blood loss was significantly lower for the LAC group (18mL) than for the OC group (271mL, P<0.0001), and the postoperative hospital stay was significantly shorter for the LAC group (13 days) than for the OC group (25 days, P<0.0001). The duration of surgery and the number of dissected lymph nodes were very similar between the groups. No significant differences in the rate of complication (LAC, 9.3%;OC, 22.2%; P=0.0976), the recurrence rate (LAC, 2.3%;OC, 11.1%;P=0.1022), the overall 5-year survival rate (LAC, 100%;OC, 93.2%;P=0.1064) or the disease-free 5-year survival rate (LAC, 95.2%;OC, 86.6%;P=0.1793) were observed between the groups. No perioperative deaths occurred in either group. Conclusions: Our findings suggest that LAC offers not only the better short-term prognosis but also a very similar oncologic outcomes to that of OC with regard to the middle-to-long-term prognosis for sigmoid and rectosigmoid carcinoma. We therefore expect that LAC could be equally effective as traditional OC for sigmoid and rectosigoid resection with D3-dissection from an oncologic point of view.View full abstractDownload PDF (844K) -
Kimiyasu Yoneyama, Shigehiro Kikuyama, Renpei Oyama2006 Volume 39 Issue 11 Pages 1666-1671
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSMost gastrocolic fistulas have been reported in connection with malignant tumors or as a complication of stomal ulcers after a gastrojejunostomy. We report a case of gastrocolic fistula caused by a benign gastric ulcer. A 48-year-old man was admitted to our hospital complaining of abdominal pain and nausea. An upper GIexamination revealed a protrusion at the posterior wall of the stomach, and the barium leaked from the lesion to the colon. An endoscopic examination showed a gastric ulcer and fistula. A fiberscope could be inserted into the colon through the fistula. Barium enema examination showed the flow of barium from the transverse colon into the stomach. We concluded that the gastrocolic fistula had been created by the penetration of a gastric ulcer. The patient underwent surgery; the transverse colon had adhered to the posterior wall of the stomach, so a Billroth I distal gastrectomy and a partial resection of the transverse colon were performed. The resected specimen showed an ulcer in the posterior wall. Histology revealed that the gastrocolic fistula had originated from a peptic ulcer of the stomach, and no evidence of malignancy was found.View full abstractDownload PDF (1062K) -
Hiroaki Mieno, Taira Kinoshita, Masaru Konishi, Toshio Nakagouri, Shin ...2006 Volume 39 Issue 11 Pages 1672-1677
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe present three cases featuring a very late and unusual recurrence of gastric cancer. As for the three cases, bone and bone marrow metastasis was observed 5.6 years and 6.8 years and 7.3 years after the initial curative surgery, respectively. In the three cases, common characteristics were a relatively younger age, the diffuse type adenocarcinoma and prominent lymphatic metastaseis. Gastric cancer recurs usually within 5 years after initial surgery. Even though metastasis to the bone/bone marrow is uncommon in patient with gastric carcinoma, the possibility of late recurrence of this type should be recognized.View full abstractDownload PDF (1094K) -
Masaomi Ichinokawa, Kazuhiro Iwai, Yoshiyuki Matsumura, Seiji Mega, Ry ...2006 Volume 39 Issue 11 Pages 1678-1682
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSAneurysms of the pancreaticoduodenal arteries are rare and account for only 2% of aneurysms in the splanchnic circulation. We report a case of anterior superior pancreaticoduodenal artery aneurysm with complete occlusion of the superior mesenteric artery at its origin. A 76-year-old woman was admitted to our hospital, because an asymptomatic splanchnic aneurysm had been detected by abdominal ultrasonography during a screening examination. Selective angiography showed that the aneurysm was 30mm in diameter and located in the anterior superior pancreaticoduodenal artery, and an aortogram showed complete occlusion of the superior mesenteric artery at its origin. Since it seemed very difficult to perform the complete coil embolization of the aneurysm and we were concerned about ischemia of the superior mesenteric artery, we performed aneurysectomy by open surgery. Pathological examination showed degeneration of the smooth muscle tissue in tunica media. The aneurysm was probably caused by hemodynamic stress produced by the increased flow in compensation for the complete occlusion of the superior mesenteric artery at its origin. The patient is doing well as of 5 months postoperatively.View full abstractDownload PDF (639K) -
Yoshikazu Yagi, Yasuaki Nishimura, Shigekazu Nakatsugawa, Tomoki Fukuo ...2006 Volume 39 Issue 11 Pages 1683-1688
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 64-year-old man treated for diabetes mellitus came to our hospital in January 2004 complaining of left hypochondriac pain of about one month.s duration. Abdominal US revealed a tumor in the body of the pancreas over 4cm in size. The serum CEA and CA19-9 levels were elevated. ERP revealed the occlusion of the main pancreatic duct in the region of the pancreatic body. Abdominal CT and abdominal angiography showed that the pancreatic tumor involved the celiac artery, splenic artery, common hepatic artery, superior mesenteric artery, superior mesenteric vein, splenic vein, and portal vein. We therefore made diagnosis of unresectable cancer of the pancreatic body, and gemcitabine chemotherapy was started in February. In April, the tumor marker levels had become normal and the clinical course was favorable. However, fever, vomiting, and headache suddenly developed, and he was admitted the next day. We diagnosed meningeal carcinomatosis based on the cerebral CT and MRI findings, and radiotherapy was selected to treat the meningeal carcinomatosis, because there was no evidence of metastasis to other organs. The gemicitabine dose was reduced during radiotherapy.As of December 2005, the patient is alive and has continued on gemcitabine chemotherapy.View full abstractDownload PDF (614K) -
Isamu Kagawa, Koichi Nishiwaki, Yoshiro Matsumoto, Bunsei Nobukawa, Ko ...2006 Volume 39 Issue 11 Pages 1689-1694
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 68-year-old woman admitted for epigastralgia and jaundice, diagnosed with a 7×6cm mass in the head of the pancreas and a right hypernephroma, necessitating pylorus- preserving pancreatoduodenectomy and right adrenectomy. Surgical specimens showed adenosquamous carcinoma in the head of the pancreas and cavernous hemangioma in the retroperitoneal space. The mass in the pancreatic head consisted of 60% squamous carcinoma, 20% adenocarcinoma, and 20% mixtures of adeno and squamous carcinoma. Carcinoma in situ was seen in the main tumor and the main and peripheral pancreatic ducts on the resected pancreas. Carcinoma in situ apparently progressed to adenocarcinoma and/or squamous carcinoma. The woman died of metastases to the liver on 4 months after the operation.View full abstractDownload PDF (654K) -
Hidetaka Yamanaka, Kaname Ono, Tatsuro Satoh, Yuuji Iida, Satoshi Kami ...2006 Volume 39 Issue 11 Pages 1695-1700
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSInflammatory myofibroblastic tumor (IMT) is defined as a mass lesion consisting of proliferating of myofibroblasts and inflammatory cell infiltration, discovered for study of pulmonary inflammatory pseudotumor, and it occurs at many sites in the body, and it discussed essence as inflammation or neoplasm. We repot a case of splenic IMT. A 32-year-old woman was admitted to our hospital for abdominal pain. Blood examination showed leukocytosis and anemia, and she operated splenectomy as diagnosed splenic tumor by abdominal US and CT and MRI and angiography. Histological examination of the resected specimen revealed splenic IMT with amyloid deposition. After operation, leukocytosis and anemia were improved and no reccurence detected for 22 months. This is the second case of splenic IMT reported in Japan and the first case of IMT with amyloid deposition reported all over the world. Negative for ALK-1 and positive for deposition of AA-type amyloid, our patient. s tumor was suggesting an inflammatory lesion.View full abstractDownload PDF (737K) -
Masaki Ohi, Hiroyuki Fujikawa, Tohru Ohsawa, Takaaki Azuma, Hiroshi Ko ...2006 Volume 39 Issue 11 Pages 1701-1706
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 59-year-old woman with a history of operation and chemotherapy for ovarian cancer 9 years earlier was admitted for upper abdominal distension and appetiteloss in July 2001. Abdominal CT and MRI showed a tumor of the spleen. Serum CA125 had increased. Based on a diagnosis of solitary metastasis to the spleen from ovary or primary splenic tumor, we conducted surgery in August 2001. We found a tumor of the hilum of the spleen but no recurrence of ovarian cancer, and conducted splenectomy with resection of the diaphragm. The pathological diagnosis of the tumor was poorly differentiated adenocarcinoma metastatic from ovarian cancer. The patient remains alive 3 years and 10 months after splenectomy. Reports of solitary splenic metastasis from ovarian cancer are relatively rare. In some such cases, a good prognosis was obtained by chemotherapy following splenectomy, so splenectomy should be indicated in treating patients with solitary splenic metastasis from ovarian cancer.View full abstractDownload PDF (864K) -
Tatsuo Ikeno, Mizuho Machida, Kazunori Ozaki, Toshiyuki Sato, Kazuhiro ...2006 Volume 39 Issue 11 Pages 1707-1711
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 48-year-old man admitted for massive melena whose bleeding origin was not found clearly by esophagogastroduodenoscopy and total colonoscopy was found in colonoscopic findings to have fresh blood flowing from the terminal ileum. Computed tomography with enhanced contrast showed hemorrhage of the terminal ileum. Angiography identified bleeding from the branch of the ileocolic artery, so we conducted embolectomy with sponzel powder for this artery. Two weeks later, the patient recovered and was discharged without complaint. Five days later, however, he was readmitted for melena. We suspected strongly repeating hemorrhage from the ileum. Laparoscopic findings showed diverticulum of the ileum with hemorrhage, necessitating laparoscopic-assisted resection of the diverticulum. The postoperative course was smooth without complications. He was discharged 11 days after surgery and continues to do well.View full abstractDownload PDF (464K) -
Tomoharu Sugie, Yumi Matsushima, Toshihiro Nagai, Kazuhisa Ohgaki2006 Volume 39 Issue 11 Pages 1712-1717
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 70-year-old male was admitted for gastrointestinal bleeding. Endoscopic examinations failed to detect the site of the bleeding, and a CT scan disclosed a single liver mass and several intra-abdominal tumors. The preoperative diagnosis was metastatic GIST with intestinal bleeding, and the segment of small intestine involved 70cm distal to the ligament of Treitz and some peritoneal disseminated masses were resected. The resected tumors were microscopically examined and classified as CD34+, c-kit-, SMA-, S100- GISTs. Treatment with 400mg of imatinib started 24 days later and positron emission tomography (PET) 7 days later showed a marked decrease in abdominal uptake compared with PET before treatment. Adverse effects were minimal and the patient. s disease has been stable during fifteen months since imatinib was started.View full abstractDownload PDF (684K) -
Junji Akagi, Noriaki Takahashi, Shinji Okazaki, Eiji Takai, Takahiro T ...2006 Volume 39 Issue 11 Pages 1718-1724
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 76-year-old man complained of a right lower abdominal pain beginning in January 2005. A colonoscopy showed an elevated lesion in the cecum (30mm). and a blood analysis suggested inflammation (WBC, 13, 320/μl., CRP, 12.6mg/dL). Although the pathological findings for a biopsy of the elevated lesion suggested a Group I lesion, the possibility of malignancy could not be ruled out. Therefore, an ileocecal resection was performed on February 2005. Phlegmonous appendicitis and an elevated lesion of the cecum extending from the entrance of the appendix to the upper part of the appendix were observed during the operation. Pathological examination of the resected specimen showed a strong, fibrous connective tissue growing on the elevated lesion but no atypical cells or tumorous growth on the epithelial cells. These findings strongly suggested that the elevated lesion was an inflammatory pseudotumor (IPT) caused by the phlegmonous appendicitis. IPT of the colon and rectum is very rare, and, to our knowledge, only 23 reports (including ours) on IPT of the colon or rectum have been made, of which six cases arose from the appendix. In this case, IPT made inflammation of the appendix worse by growing and obstructing the entrance of appendix, which suggest that IPT should be resected as soon as possible.View full abstractDownload PDF (981K) -
Seishi Aoki, Michio Sato, Shinji Ogawa, Hirohisa Harada, Ryouhei Miyat ...2006 Volume 39 Issue 11 Pages 1725-1729
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of neuroendocrine cell carcinoma of the appendix vermiformis found in bowel obstruction. A 62-year-old woman with symptoms of bowel obstruction was found in computed tomography (CT) and endoscopy to have a mass in the cecum and ascending colon that cmpressed the terminal ieum. CT also showed swollen lymph nodes at the mesentrium and paraaorta. Pathological examination of an endoscopic biopsy specimen in showed the tumor to be poorly differentiated colon adenocarcinoma. After recovering the obstruction in treatment by ileus tube, we conducted right colectomy with paracolic lymph node dissection. Histo logical examination showed that the tumor was originated from the appendix vermiformis, expanded to the subserosal layer, and developed to ileocolic valve in the submucosal layer causing the bowel obstruction. The tumor consisted mainly of neuroendocrine cell carcinoma positive for Grimelius staining and immunohistochemically positive for chromogranin A and NSE. Minor areas of the tumor showed mucinous carcinoma. She died of cancer 10 months after surgery. Neuroendocrine cell carcinoma of the appendix vermiformis is rare and only 3 cases, including ours, have been reported in the literature.View full abstractDownload PDF (652K) -
Kazuhide Ozaki, Madoka Hamada, Yuichi Saisaka, Yuichi Shibuya, Yasuo S ...2006 Volume 39 Issue 11 Pages 1730-1734
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 32-year-old woman undergoing Hartmann.s operation due to advanced rectal cancer and diagnosed pathologically with signet-ring cell carcinoma, Rs, Type 3, se, n4 (+), underwent adjuvant chemotherapy with 5FU, CDDP, and CPT-11. Four months later, she found in abdominal computed tomography (CT) to have a pelvic mass and simultaneously a right-side breast tumor. In abdominal CT at 50 days later, the pelvic mass had grown to 20×15×15cm, requiring resection to remove her abdominal pain. The resected specimen was pathologically diagnosed as signet-ring cell carcinoma, the same as the rectal lesion. Needle biopsy also showed the breast tumor to be signet-ring cell carcinoma. The definitive diagnosis was metachronous breast and ovarian metastases from rectal signet-ring cell carcinoma, clinically a very rare case.View full abstractDownload PDF (825K) -
Kentaro Kawasaki, Hirokazu Ohno, Daisuke Tsugawa, Shiro Takase, Takash ...2006 Volume 39 Issue 11 Pages 1735-1740
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of perianal Paget's disease with preoperative SNB, resected curatively, reconstructed with a V-Y skin flap, and preserved anal function. A 82-year-old woman reporting perianal itching and redness was referred with a diagnosis of Paget's disease. The lesion was 16×15cm. Preoperative pelvic computed tomography (CT) showed bilateral inguinal lymph node swelling, necessitating sentinel lymph node biopsy (SNB) using 99m-Tc. The result of the biopsy was negative. We determined the resection line by preoperative mapping, conducting a wide excision while maintaining a 2cm safety margin around the main lesion, and constructing a temporary stoma. We then conducted V-Y skin flap reconstruction using bilateral posterior femoral skin. Six months later, we closed the colostomy. Anal function has been preserved.View full abstractDownload PDF (605K) -
Kaoru Mizusaki, Eiichi Saito2006 Volume 39 Issue 11 Pages 1741-1746
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 75-year-old man was admitted to hospital complaining of a right femoral swelling, Physical examination revealed a hard tumor in the femoral region, but pain and tenderness were not recognized, A plane abdominal xray showed no sign of ileus, Abdominal computed tomography revealed a tumor in the right femoral region, Laboratory data revealed the absence of leucocytosis, with a white blood cell count of 8, 880/mm3, and an elevated CRP level of 6, 5mg/dL, We suspected a femoral hernia with incarceration of the greater omentum, but the patiant did not consent to the operation, We thought that can observe a progress from the abdominal examination, the examination of the femoral region and the laboratory data, and we gave an antibiotic and performed the operation on the next day, A hernia sac with a cross section of 6×3cm was observed in the right femoral region during the operation, When we incised the hernia sac, we presume that the hernia content is the hypertrophic greater omentum, and resected the hernia content, But the hernia contet was the phlegmonous appendix, Upon study of the abdominal cavity from the same wound, we recognized redness and hypertrophy of the cecum, and remaind a part of appendix, An additional resection of the remained appendix was performed, and the McVay repair procedure was used to repair the femoral hernia, Here, we discuss the 17 cases including ours, report in Japanese medical literature.View full abstractDownload PDF (891K)
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