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Volume 39, Issue 9
Displaying 1-17 of 17 articles from this issue
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Toshiaki Tanaka, Susumu Sueyoshi, Hiroko Sasahara, Yuichi Tanaka, Naok ...2006 Volume 39 Issue 9 Pages 1465-1471
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSMalignant strictures and fistula of the esophagus and tracheobronchus adversely affect the quality of life (QOL) and prognosis in patients with incurable esophageal carcinoma. Stenting is one of the best palliation modalities for improve QOL. We evaluated the effect of intraesophageal and intratracheal stenting in patients with stricture and/or fistula of esophagus and trachea due to thoracic esophageal carcinoma. Patients and Methods: Subjects were 61 with advanced esophageal carcinoma treated with stenting from 1995 through 2003, 36 with esophageal stent, 17 with tracheal stent, and 8 with both. They were evaluated based on the prognosis and QOL. An esophageal stent was placed as final treatment after chemoradiation therapy, and 7 out of those treated with the bronchial stent underwent chemoradiation therapy after stenting. Results: Median survival after stenting was 2.5 months in patients with an esophageal stent, 9.6 months in patients with a tracheal stent, and 3.4 months in patients treated with both stents. Food ingestion was improved in 80% of patients with the esophageal stent, and about half were discharged. Worsening of performance status (PS) was seen after stenting in 3 out of 17 patients with PS3.Tracheal stent placement improved the PS in 15 out of 17 patients, resulting in the improvement of the QOL. Responders for chemoradiation therapy after trachial stenting survived for a long time. Conclusions: Esophageal stenting improved food ingestion and QOL in patients with PS≤2. It did not always result in improved QOL in those patients with PS3.QOL improved in most of patients treated with the trachial stents, and long survival is expected in responders to chemoradiation therapy after stenting.View full abstractDownload PDF (467K) -
Kazuaki Nakanishi, Toshiya Kamiyama, Takahito Nakagawa, Kazuhito Uemur ...2006 Volume 39 Issue 9 Pages 1472-1479
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSPurpose: We evaluated the clinicopathological features of hepatocellular carcinoma (HCC) less than or equal to 2cm in diameter, and clarified which tumors should be resected anatomically to improve prognosis. Patients and methods: Of 508 HCC cases under going hepatectomy from 1990 to 2003, 63 less than or equal to 2 cm in maximum diameter were studied. We evaluated clinicopathological features, the effectiveness of anatomical resection, and recurrence-free survival, classified by gross appearance or tumor size. We also evaluated univariate and multivariate analysis of recurrence. Results: Small nodular type with indistinct margins (Type 0) accounted for 11. 1%, simple nodular type (Type 1) for 63. 5%, simple nodular type with extranodular growth (Type 2) for 19. 0%, and confluent multinodular type (Type 3) for 6. 3%. In cases of Type 2+3 or more than 1. 5cm, the number of portal vein invasions and intrahepatic metastasis increased, while the proportion of well-differentiated HCC in these cases decreased. Disease-free survival was significantly better in anatomical resection (n=24) than in nonanatomical resection (n=39). In cases of Type 2+3 or more than 1. 5cm, disease-free survival was also significantly better in anatomical resection. Anatomical resection, preoperative platelet counts of >120, 000/mm3, and nonportal vein invasion were significantly better prognostic factors in recurrence-free survival according to univariate analysis, and anatomical resection and nonportal vein invasion were also significant according to multivariate analysis. Conclusion Clinicopatholigic variation was wide even in HCC under 2cm. Biological malignant potential increased in cases of Type 2+3 or more than 1. 5cm, in which case anatomical resection is effective.View full abstractDownload PDF (744K) -
Masaya Uesato, Yasushi Shinohara, Naotake Akutu, Masashi Suzuki, Masay ...2006 Volume 39 Issue 9 Pages 1480-1486
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 51-year-old man admitted for anorexia and weight loss was found in an endoscopic examination to have type 1 cancer in the upper body of the stomach. Abdominal angiography and CT showed a portal vein thrombus and No.8 and 12 lymph nodes. Since curative surgery was not deemed possible, we started neoadjuvant chemotherapy using TS-1 plus cisplatin (CDDP) for down staging. TS-1 (100mg/body/day) was orally administered for 2 weeks followed by a drug-free 2-week period, and CDDP (100mg/body) was administered intravenously on day 8 as 1 course. The only side effect was mild myelosupression. After 4 courses of chemotherapy, lymph nodes were reduced in size, and the portal vein thrombus disappeared. Curative distalgastrectomy was then done. Histological change in neoadjuvant chemotherapy was judged to be Grade 1a for the main tumor. No lymph node metastasis was detected. There was no recurrence on CT and TS-1 was continued in the 1 year after surgery. Neoadjuvant chemotherapy using TS-1 plus CDDP is thus effective in advanced gastric cancer with portal vein thrombus.View full abstractDownload PDF (712K) -
Tadaaki Noguchi, Masaki Ueno, Harushi Udagawa, Kazuhisa Ehara, Shinji ...2006 Volume 39 Issue 9 Pages 1487-1492
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 77-year-old man with no history of thoracic radiotherapy or interstitial pneumonitis was administered paclitaxel (PXL) for peritoneal dissemination of gastric cancer in August 2004. After PXL, he had dyspnea, and high resolution CT (HRCT) showed reticular infiltrations in both lung fields, yielding a diagnosis of paclitaxelinduced pneumonitis. Steroid pulse therapy and mechanical ventilatory support improved his condition temporarily, but general state got worse and he died. There have been 14 reports of PXL-induced pneumonitis for cancer patients. Only 5 cases, including ours, were fatal. There is no significant prognostic factor, but KL-6 seemed to be a good prognostic factor in our case. It is therefore important to check the patient. s condition when PXL is administered. Pneumonitis should be noted and, when it is suspected, chemotherapy must be stopped and treatment should be started immediately.View full abstractDownload PDF (717K) -
Hiroya Iida, Yasuhisa Tango, Yoshihiro Tsutamoto, Takanori Harimura, K ...2006 Volume 39 Issue 9 Pages 1493-1497
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 77-year-old woman with epigastric pain undergoing upper gastrointestinal (GI) tract endoscopy elsewhere was found to have a protruding extramural lesion in the anterior wall of the middle gastric body and She was referred for further evaluation. Abdominal ultrasonography showed a space-occupying lesion of the liver (SOL) measuring 39 by 30mm with an iso to high echo level. Abdominal computed tomography (CT) showed an enhanced heterogeneous SOL on the inside of the marginal portion of the tumor. Abdominal magnetic resonance imaging (MRI) showed a low signal SOL on a T1-weighted image and a high signal SOL on a T2-weighted image. A dynamic MRI study showed an internal heterogeneous image. No other GI tract examinations showed any abnormal findings. We first suspected the mass to be a cavernous hepatic hemangioma, but it was difficult to distinguish liver hemangioma accurately from intrahepatic bile duct carcinoma or metastatic liver tumor. In July 2004, we conducted laparoscopic-assisted partial hepatectomy. The tumor consisted of fibrous connective tissue and a cavernous hemangioma. Histopathological analysis yield a definitive diagnosis of liver-sclerosing hemangioma. Case reports of liver-sclerosing hemangioma are rare, and only 9 such cases have, to our knowledge, been described in the literature.View full abstractDownload PDF (711K) -
Takanori Kyokane, Shinsuke Iyomasa, Yutaka Kuroyanagi, Satoshi Kobayas ...2006 Volume 39 Issue 9 Pages 1498-1504
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 75-year-old woman undergoing laparoscopic cholecystectomy for cholelithiasis developed a sudden high fever on postoperative day (POD) 4. Abdominal computed tomography (CT) showed intraabdominal fluid collection due to bile leakage, which was drained immediately with a 10Fr drainage tube. Fistulography showed leakage from the anterior segmental bile duct occluded by the hemostasis clip. We attempted percutaneous biliary ablation with absolute ethanol for the biliary fistula. A 5Fr balloon catheter was inserted through the fistula into the anterior segmental bile duct. After the balloon was inflated, contrast material was infused to determine the optimal dose of ethanol, then 2.5mL of absolute ethanol was infused and washed out after 5 minutes. We repeated this 3 or 4 times a day. During each procedure, the patient reported pain and flushing, then serum transaminase and serum alkaline phosphatase rose after the procedure. After 4 sessions of biliary ablation over 12 days, biliary drainage was eliminated. Abdominal CT showed no liver abscess. The drainage tube was removed 19 days after the first biliary ablation with no serious complications. One year after biliary ablation, the patient is doing well without signs of cholangitis or bile leakage. Biliary ablation is thus a safe, effective intervention for treating major bile leakage, especially in biliary fistulas that do not communicate with the remainder of the biliary tree.View full abstractDownload PDF (648K) -
Yukiyasu Okamura, Kiyoshi Ishigure, Tadao Ishikawa, Yoshikuni Inokawa, ...2006 Volume 39 Issue 9 Pages 1505-1510
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 60-year-old woman was admitted to hospital after complaining of a right upper quadrant pain and vomiting. Abdominal ultrasonography and computed tomography revealed an irregular tumor in the gallbladder. We diagnosed the patient as having carcinoma of the gallbladder with subserosal invasion and performed an extended cholecystectomy. Histologically, the tumor consisted of adenocarcinoma and sarcomatous tumor cells with a spindle shape and partial chondroid differentiation. Immunohistochemically, the sarcomatous element was negative for an epithelial marker and positive for an interstitial marker; thus, the lesion was diagnosed as a true carcinosarcoma. Carcinosarcoma of the gallbladder is rare, and few cases with long-term survival have been reported. We report a patient with a carinosarcoma of the gallbladder who is alive with no signs of recurrence 54 months after surgery.View full abstractDownload PDF (738K) -
Motohira Yoshida, Yuji Watanabe, Atsushi Horiuchi, Takashi Doi, Hiromi ...2006 Volume 39 Issue 9 Pages 1511-1516
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of aberrant pancreatic prolapse into the duodenum treated with minimally invasive surgery. A 51-year-old man admitted on a diagnosis of an asymptomatic gastric submucosal tumor showed no laboratory data abnormalities. Gastroduodenal endoscopy and fluoroscopy showed a spherical submucosal tumor apparently arising from the antral mucosa and prolapsing into the duodenal bulbus. Histological examination of the tumor showed no specific results. Enhanced computed tomography showed a cystic tumor with peripheral contrast enhancement in the duodenum. Preoperative diagnosis was a gastrointestinal stromal tumor with central degeneration. To prevent intraoperative tumor cells seeding, we conducted a laparoscopeassisted intragastric en-bloc lumpectomy. The tumor was diagnosed histologically as an aberrant pancreas containing nonatypic pancreatic juice. Recovery and discharge were uneventful.View full abstractDownload PDF (484K) -
Manabu Emi, Kazuto Jinushi, Ryou Sumimoto2006 Volume 39 Issue 9 Pages 1517-1522
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 54-year-woman, with elevated CEA and undergoing gastrointestinal endoscopy was found to have a type 5 tumor on the lesser curvature of the lower stomach. Abdominal computed tomography (CT) showed continuous small cystic tumors in the lower abdominal cavity. We conducted laparotomy on suspicion of dissemination of gastric cancer or pseudomyxoma peritonei, but could not definitively diagnose the case during sugery. We then conducted distal gastrectomy and B-II reconstruction. Pathological diagnosis showed disseminated gastric cancer, but clinical findings showed a strong possibility of pseudomyxoma peritonei, leading to resection of the cystic tumor plus appendectomy, omentectomy, and partial resection of the transverse colon. We situated a subcutaneous implant-reservoir was sited intraperitoneally for postoperative chemotherapy. The resected specimen showed pseudomyxoma peritonei arising in the appendix. Intraperitoneal chemotherapy involved CDDP and MMC was performed for three times. Daily oral administration of 1, 200mg of 5.DFUR was started 11 months after surgery because of slightly elevated CEA, but the patient is doing well without signs of recurrence as of 30 months after the initial laparotomy.View full abstractDownload PDF (498K) -
Kazuhito Minami, Yoshiyuki Yamaguchi, Yasuhiro Tutani, Takahisa Suzuki ...2006 Volume 39 Issue 9 Pages 1523-1528
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 74-year-old female was admitted because of nausea and vomiting due to obstraction of the proximal jejunum. She was diagnosed as having a malignant tumor in the small bowel with an upper gastro-intestinal series and a computerized tomography (CT) examination. Intra-operative findings showed that the primary tumor located in the proximal jejunum 2cm to the anal side from Treitz. s ligament, was 8cm in size, had invaded the transverse colon, transverse mesocolon, and stomach, had had no liver metastasis, but had spread into the peritoneal cavity (T4NxM1, AJCC Stage IV). Pathological examination of the peritoneal seeding samples confirmed this lesion as a tubular adenocarcinoma. A bypass operation with gastro-jejunostomy and transversesigmoid colostomy was performed. She received palliative chemotherapy with 2 courses of low-dose 5-fluorouracil and cisplatin (low-dose FP) treatment followed by oral TS-1 therapy. A partial response in the primary tumor was acquired after the first course of low-dose FP treatment and maintained with TS-1 therapy, as assessed by CT examination. The progression-free survival was 25 months. Adverse effects for low-dose FP treatment were grade 3 stomatitis, dermatitis, nausea, vomiting, and anorexia and grade 2 neutropenia, but for TS-1 therapy were no adverse effects except for grade 1 neutropenia and pigmentation, indicating a good quality of life. This case may be important for developing a standard chemotherapy against advanced and recurrent adenocarcinoma of the small bowel.View full abstractDownload PDF (482K) -
A Case of Metastatic Tumor of Small Intestine after 9 years of Operation for Uterine Cervical CancerJunji Okayama, Naoyuki Nakatsuji, Masato Horikawa, Mitsutoshi Tatsumi, ...2006 Volume 39 Issue 9 Pages 1529-1533
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe present a case of ileus considered due to small intestinal metastasis from uterine cervical cancer. A 56-year-old woman admitted for abdominal pain and vomiting was found in abdominal x-ray to have a fluid accumulation. Based on a diagnosis of ileus, we conducted intestinal drainage, but to no avail. Laparotomy showed stenosis of the small intestine 30cm from the terminal ileum. We partially resected the ileum, including the tumor. Pathological findings indicated uterine cervical cancer metastasis. The postoperative course was uneventful and she is being followed up as an outpatient. Metastasis from primary uterine cervical cancer to the small intestine is very rare and, to our knowledge, ours is only the second case reported in Japan.View full abstractDownload PDF (696K) -
Gaku Ohira, Yoshifumi Matsui, Tetsurou Urashima, Akihiro Usui, Tetsush ...2006 Volume 39 Issue 9 Pages 1534-1539
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 38-year-old man who ate raw ray liver reported right lower abdominal pain 2 days later, evidencing tenderness and rebound tenderness in the right lower quadrant of the abdomen. Laboratory data indicated elevated WBC (15, 200/mm3) and CRP (9.48mg/dl), and marked acidosis (base excess -7.4mmol/L). Abdominal computed tomography showed thickening of the ascending colon and small intestinal wall, and fluid collection around the ascending colon. Under a diagnosis of idiopathic peritonitis, we conducted emergency surgery, finding induration about 5cm in diameter in the ascending colon and in the ileum, necessitating partial resection of the ileum and colon. Pathological findings confirmed transmural infiltration of inflammatory cells mainly composed of eosinophilic leukocytosis at both colon and ileum induration. Because no paracites was found in the specimen and postoperative laboratory data indicated eosinophilia (9.0%), the definitive diagnosis was eosinophilic enteritis.View full abstractDownload PDF (1208K) -
Yoshiaki Ebisawa, Toru Kono, Naoyuki Chisato, Noriaki Mamiya, Yoshihik ...2006 Volume 39 Issue 9 Pages 1540-1546
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a pediatric case of ulcerative colitis (UC) requiring emergency operation because of massive hemorrhaging per arterial rhexis from an ulcer of the ascending colon. The patient, a 12-year-old boy, presented with abdominal pain and bloody bowel discharge in September 2003. He was diagnosed as having UC and treated medically by his family doctor with predonisolone (PSL) and 5-acetylsalicylic acid (5-ASA). While his symptoms were temporarily alleviated, his condition deteriorated in October of the same year and he was referred and admitted to the pediatric department of our hospital. His condition was stabilized temporarily by medical intervention but worsened in May 2004, with more bloody discharge. On June 2, excessive bloody discharge was noted, and the medical treatment he had been receiving was deemed ineffective. The next day, an emergency colonoscopic examination was performed and an arterial hemorrhage from a deep isolated ulcer (intrinsic muscle layer denudation) in the ascending colon was diagnosed. Since endoscopic hemostasis was difficult, the patient was referred to our department for emergency surgery. Arterial hemorrhaging from an ulcer is extremely rare in patients with UC and is beyond medical treatment. Therefore, in such situations, early diagnosis and surgery are required. Particularly in pediatric UC, the incidence of which is increasing, many severe and fulminant cases have been reported, and the eruption rate when the whole of the colon is affected is high. Consequently, surgery should be performed immediately when necessary for the treatment of pediatric UC.View full abstractDownload PDF (766K) -
Kenji Okumura, Chol Joo Lee, Yoshihiro Endo, Hideaki Kurioka, Yasuyuki ...2006 Volume 39 Issue 9 Pages 1547-1552
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of amoebic colitis presenting as acute appendicitis in a 25-year-old Japanese woman. The patient visited our hospital complaining of lower abdominal pain, vomiting, and fever after returning to Japan from a one-month trip to India. She had severe lower abdominal pain and a slight rebound tenderness, and her abdomen was slightly distended. A swollen appendix extending to her umbilicus was detected on an abdominal enhanced CT scan and ultrasonography. She was diagnosed as having appendicitis and underwent an appendectomy. The resected appendix was 8.5×2.5cm in diameter, red, and swollen like a large sausage. Because her abdominal pain, diarrhea, white stools, and high fever persisted after the appendectomy, we performed further examiniations. Evident thickening of the ascending colon wall was seen on a CT scan, and disseminated round erosions with a white coat and deep ulcers on her rectum and ascending and sigmoid colon were detected during a colonoscopy. Trophozite amoeba was found in a biopsy of the mucosae from her colon and appendix. The patient was diagnosed as having colitis caused by amoebasis and was treated with metronidazole (2g/day for 10 days). Her symptoms rapidly disappeared, and no further complications occurred. Appendicitis was first suspected in this case, and only after an appendectomy was completed did futher examiniation reveal amoebic colitis. Since the disease was caught at an early stage, the metronidazole treatment was successful and the patient had a good outcome. Amoebiasis should be considered when treating patients with symptoms resembling acute appendicitis or gastroenterocolitis if the patient has been abroad, especially those who have visited amebiasis-endemic areas.View full abstractDownload PDF (576K) -
Kazuhiro Narita, Kazuhide Kumagai, Koji Shimizu, Takayuki Tanaka, Nobo ...2006 Volume 39 Issue 9 Pages 1553-1558
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of two resections for liver metastasis and pancreatic metastasis 5years after colectomy. A 74-year-old man underwent sigmoidectomy for carcinoma of the sigmoid colon in October 1966, followed by adjuvant chemotherapy, partial lobectomy, and cholecystectomy for hepatic metastasis (S4) in September 1997, and partial lobectomy for hepatic metastasis (S6) in November 1998, again followed by adjuvant chemotherapy. After jaundice appeared in November 2000, the lower bile duct suffered a 1.5cm stricture, and bile cytology became Class V, he underwent pancreatoduodenectomy under a diagnosis of lower cancer of the bile duct. A tumor about 25mm in diameter was observed in the pancreas had invaded the submucosal layer of the bile duct. Metastatic lymph nodes the size of a finger tip were finger was present in the infrapylorus and around the abdominal aorta. The histological diagnosis was well to moderately differentiated carcinoma, compatible with a colon cancer metastasis.View full abstractDownload PDF (847K) -
Takehiro Sakai, Koichi Sato, Yoshie Hasegawa, Yuka Kimura, Yasuhiro Su ...2006 Volume 39 Issue 9 Pages 1559-1564
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA-79-year-old Japanese man with a history of atrial fibrillation and congestive heart failure was admitted for abdominal pain. Ultrasonography showed pelvic ascites and peritoneal irritation, or inflammatory change was seen in laboratory studies. After conservative therapy was begun, he was sent to us with peritoneal irritation and marked inflammatory deterioration. We suspected generalized peritonitis due to a perforated appendix, and conducted to emergency laparotomy. We found a swollen appendix and purulent ascites in the pelvis, and conducted an appendectomy. Bacteroides thetaiotaomicron was detected from ascites. Microscopic findings for the resected appendix showed severe serositis without mucosal inflammation. Because of elevated serum CEA and anemia, we conducted a gastrointestinal examination. Barium enema and colonoscopy showed advanced ascending colon cancer, necessitating right hemicolectomy with node dissection on postoperative day (POD) 23 after the appendectomy. The tumor showed neither perforation nor abscess. Histologically, the tumor was well-differentiated adenocarcinoma. The histological stage was ss, n (-), P0, H0, M (-), stage II. The postoperative course was uneventful and he was discharged on POD17 after the second surgery. We propose the mechanism of spontaneous bacterial peritonitis as follows. Ascites due to congestive heart failure was fol-lowed by bacterial translocation of Bacteroides in the necrotic tumor or edematous intestinal mucosa on the oral side of the colonic tumor, resulting in spontaneous bacterial peritonitis.View full abstractDownload PDF (560K) -
Tomonori Miyazawa, Haruhiko Makino, Hiroshi Tomita, Katsuyoshi Hatakey ...2006 Volume 39 Issue 9 Pages 1565-1570
Published: 2006
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of metastasis from rectal carcinoma to the thyroid gland in which fluorodeoxyglucose-positron emission tomography was useful in diagnosis. A 60-year-old woman who had undergone abdominoperineal resection of the rectum for rectal cancer in September 2001 was subsequently found to have lung metastasis necessitating wedge resection of the left lung in January 2002.She then underwent 7 courses of l-LV/5FU chemotherapy, but CEA gradually increased. We examined the patient for metastasis using systemic computed tomography and scintigraphy, but found no definite metastatic focus or local recurrence. In December 2003, FDG-PET indicated FDG accumulation in the left neck and the patient was diagnosed with metastasis to the thyroid gland from rectal carcinoma, undergoing left hemithyroidectomy in January 2004. Pathological finding showed adenocarcinoma metastasis to the thyroid gland-a very rare metastasis, with 5 cases, in-cluding ours reported in Japan. We found FDG-PET useful for detecting metastasis in patients with rectal cancer whose tumor markers increased after surgery despite normal results from conventional examination modalitiesView full abstractDownload PDF (671K)
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