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Volume 40, Issue 12
Displaying 1-19 of 19 articles from this issue
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Kentaro Shirasaka, Kimihiko Funahashi, Junichi Koike, Naoyasu Saito, H ...2007 Volume 40 Issue 12 Pages 1881-1886
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSPurpose: Due to the lack of a consensus on postoperative follow-up of colorectal cancer with perforation, we retrospectively evaluated clinical cases of this type, including long-term prognosis. Patients and Methods: Subjects were 28 patients with peritonitis due to colorectal cancer occurring in the 2 decades from 1984 to 2004. We examined the clinicopathological background, postoperative recurrence, and prognosis. Results: The male-to-female ratio was 20: 8 and mean age was 61.5 years (45-82 years). In 56% of patients, perforation was due to sigmoid colon cancer. Perforation was observed at the oral end of the lesion in 13 patients and at the tumor in 15. Free perforation occurred in 64.3%(18/28). For histological staging, 17 patients were in stage II, 7 in stage III, 3 in stage IV, and 1 unknown. About 60% were in stageII. Of the 28, 22 underwent radical surgery, with 4 of these dying of DIC, while 7 (32%) developed recurrence in a mean 33.6 months (5 in stage II and 2 in stage IIIa). Recurrence involved liver metastasis (n=2), lung metastasis with local recurrence (n=1) peritoneal metastasis (n=2), anastomotic recurrence (n=1), and local recurrence (n=1). Survival was 63.5%, equivalent to that of stage III in a control group. Conclusion: Perforation thus influences the prognosis of colorectal cancer, suggesting that careful follow-up is needed for colorectal cancer with perforation.View full abstractDownload PDF (300K) -
Kazuhiro Nishikawa, Yasuhiro Tanaka, Makoto Fujii, Yoshikazu Morimoto, ...2007 Volume 40 Issue 12 Pages 1887-1892
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report an extremely rare case of gastric cancer metastasis to the skeletal muscles associated with dermatomyositis. A 65-year-old man admitted for muscle weakness and anorexia was found on physical examination to have generalized varied redness of the face and upper chest and erythema with desquamation on the dorsum of the hands. Serum CPK was abnormally elevated. Endoscopic examination showed a type 3 tumor in the upper third of the stomach, which we treated with predonisolone followed by total gastrectomy. Histologically, the tumor was poorly differentiated adenocarcinoma classified as Stage IV (pT2 (SS), pN1, pH1, pP0, CY0, pM0) based on the Japanese Classification of Gastric Carcinoma. The patient underwent chemotherapy using TS-1 for seven months postoperatively and serum CEA decreased to within normal values, and his muscular strength improved. He subsequently suffered painful swelling in the right femur and back. Magnetic resonance imaging showed tumors in the vastus lateralis muscle and infraspinatus muscle had ring enhanced intensity in T2-weighted images. Histopathological examination of aspiration needle biopsy specimen from the right vastus lateralis muscle confirmed that tumors had metastasized from gastric cancer. A second round of chemotherapy with paclitaxel was ineffective and the man died 11 months postoperatively due to multiple metastasis to the liver, abdominal lymph nodes, andand peritoneum.View full abstractDownload PDF (486K) -
Naoto Takahashi, Hideyuki Kashiwagi, Nobuo Omura, Kazuhito Tsuboi, Kat ...2007 Volume 40 Issue 12 Pages 1893-1897
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 43-year-old woman undergoning vagotomy and antrectomy for Zollinger-Ellison syndrome (ZES) 11 years earlier exhibited postoperative serum gastrin level exceeding 1, 000pg/ml, for which H2 receptor antagonist (H2RA) or proton pump inhibitor (PPI) was administered. In October 1995, endoscopic examination showed numerous tiny elevated lesions in the remnant stomach and around the anastomosis, for which endoscopic biopsy showed carcinoid cells. We suspected that hypergastrinemia triggered ECL-cells to hyperplasia or carcinoids of the remnant stomach. In May 1997, we conducted remnant gastorectomy. Histrological examination of the resected specimen showed carcinoids of the remnant stomach. The woman remains well 20 years after her first operation.View full abstractDownload PDF (392K) -
Sadanobu Izumi, Kunihiko Shiota2007 Volume 40 Issue 12 Pages 1898-1903
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 61-year-old woman was treated by partial hepatectomy to multiple hepatic tumors in January 2006. After the operation, it was diagnosed as carcinoid. Therefore we searched a whole body by blood analysis, CT, GIF and CF, but no abnormal findings were revealed. In June 2006, PET/CT to detect the primary site revealed a positive accumulation at the inferior pole of the left kidney level and the left side of the aorta. So we diagnosed a lymph node metastasis or an intestinal tumor, and performed laparotomy. Intra abdominal findings revealed a duodenal tumor 1cm in diameter of the 3 rd portion near the lymph node metastasis 2cm in diameter detected by PET/CT. After distal duodenectomy, microscopic findings showed a duodenal carcinoid and lymph node metastases. And findings of liver carcinoid were likewise; so final diagnosis was metastatic liver carcinoid. This time we experienced an interesting case that the site of the primary lesion became clear with discovery of the isolated lymph node metastasis after hepatectomy of liver metastases, so reported.View full abstractDownload PDF (542K) -
Masaya Inoue, Tsuyoshi Sano, Kazuaki Shimada, Yoshihiro Sakamoto, Sato ...2007 Volume 40 Issue 12 Pages 1904-1909
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of gastrinoma presented with Zollinger-Ellison syndrome associated with skip metastasis to the paraaortic lymph nodes. A 56-year-old woman with a two-year history of medical treatment for multiple duodenal ulcer and presented with watery diarrhea. Computed tomography (CT) revealed a mass 20mm in diameter in the head of the pancreas. Hormonal examination showed elevation of serum gastrin level, suggesting gastrinoma. She underwent subtotal stomach-preserving pancreatoduodenectomy with retroperitoneal lymph node clearance due to the paraaortic lymph nodes metastasis confirmed by intraoperative frozen section.A pathological diagnosis for primary pancreatic gastrinoma was made using a positive immunohistochemical staining for gastrin, and showed not regional but skip metastasis to the paraaortic lymph nodes. This case is highlighted a gastrinoma with skip metastasis to the paraaortic lymph nodes that is an extremely rare situation and, to our knowledge, no such previous case has been reported.View full abstractDownload PDF (445K) -
Masaharu Tada, Ryuichiro Doi, Kohei Ogawa, Yoshiya Kawaguchi, Hiroto E ...2007 Volume 40 Issue 12 Pages 1910-1914
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 62-year-old woman suffering a high sudden-onset fever on postoperative day (POD) 35 after pancreatoduodenectomy was found elsewhere in computed tomography to have a hepatic abscess and systemic antibiotics were initiated. Her condition worsened rapidly over the next 12 hours, so she was transferred to our hospital. Due to the rapid progression of the liver abscess, the large amount of portal gas, and free air in the abdominal cavity, we conducted laparotomy, which showed no gastrointestinal perforation or failure of the previous sutures, but the liver abscess had ruptured and this was considered to be the source of free abdominal air. The presence of Clostridium perfringens was histopathologically confirmed in liver tissues and ascites. After surgery, severe hemolysis progressed rapidly, causing circulatory disorder and killing the patient 22 hours after admission. Clostridium infection is very rare, but opportunistic infection may occur in a host compromised by major surgery similar to this current case. When rapid progression of jaundice and gas generation on imaging is encountered, the possibility of Clostridium infection should be considered. Because the systemic condition worsens rapidly, early diagnosis and early initiation of active treatment are vital in preserving life in such cases.View full abstractDownload PDF (449K) -
Hiroyoshi Matsukawa, Takahito Yagi, Hiroshi Sadamori, Hiroaki Matsuda, ...2007 Volume 40 Issue 12 Pages 1915-1920
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe clinical treatment of situs inversus is difficult due to the inverted mirror-imaged anatomy and accompanying anomalies. A 55-year-old woman with total situs inversus and Kartagener's syndrome (bronchoectasia, chronic sinusitis and dextrocardia) was found to have a large-sized hepatic angiogenic tumor in the posterior sector and underwent successful hepatectomy. Concomitant anomalous anatomy included interruption of the inferior vena cava at the liver and azygous continuation, hepatic veins flowing into the right atrium polysplenia, agenesis of the dorsal pancreas, and malrotation of the intestine. In hepatic resection for situs inversus, it is thus important to be aware of this inverted mirror imaging and to confirm organic and vascular anatomical anomalies.View full abstractDownload PDF (533K) -
Kazuya Matsunaga, Katsuhiko Uesaka, Atsuyuki Maeda, Hideyuki Kanemoto, ...2007 Volume 40 Issue 12 Pages 1921-1926
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 71-year-old woman treated for hepatitis C liver cirrhosis was diagnosed with hepatocellular carcinoma (HCC) 11cm in size in the lateral hepatic segment showing extrahepatic growth with a peritoneal disseminated nodule. Following trancatheter arterial embolization elsewhere, she was referred to us and underwent partial resection of the left lateral segment with combined resection of the spleen, stomach wall, and left diaphragm, and resection of the right subphrenic disseminated nodule under a preoperative diagnosis of ruptured HCC. The pathological diagnosis was sarcomatous HCC. Two months after complete resection, recurrent disseminated peritoneal nodules were detected in CT, which showed spontaneous regression without anticancer therapy in CT four months after surgery. This phenomenon continued for four months and the patient died of gastric bleeding due to direct invasion to the stomach. Sarcomatous HCC generally grows very rapidly and spontaneous regression such as in this dismal case is considered quite rare.View full abstractDownload PDF (506K) -
Takeo Nomi, Masayuki Sho, Ryo Nishinuma, Yoshiyuki Nakajima2007 Volume 40 Issue 12 Pages 1927-1932
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of thrombotic thrombocytopenic purpura related to late-onset pancreatic fistula. A man in his sixties admitted for fever and abdominal pain 50 days after pancreaticoduodenectomy for intraductal papillary mucinous carcinoma was diagnosed with pancreatic fistula in computed tomography, necessitating abdominal drainage. Fever and disturbed consciousness occurred 30 days after abdominal drainage. Blood examination showed thrombocytopenia, anemia, renal dysfunction, and low ADAMTS13 activity. Based on these clinical symptoms and blood examination, we diagnosed his condition as TTP. We conducted intensive care including plasma exchange. Ninety days after TTP onset, he was cured and discharged. Although the pathogenesis of TTP after surgery is largely unknown, rapid diagnosis and proper therapy are critical to recovery.View full abstractDownload PDF (383K) -
Koji Shibata, Masaya Shiomi, Yuichiro Tojima, Katsutaka Watanabe, Hide ...2007 Volume 40 Issue 12 Pages 1933-1937
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSThe patient is a 58-year-old man underwent radical nephrectomy for left renal cell carcinoma at age 56 to remove a 72mm tumor negative for lymph node metastasis. He underwent adjuvant interferon therapy. Although preoperative imaging diagnosis 2 months after the operation showed no splenic tumor, computed tomography (CT) showed a 14×10mm splenic tumor 6 months postoperatively. After the tumor grew to 20×16mm, we conducted a splenectomy based on a diagnosis of renal cell carcinoma metastasis. The histopathological diagnosis was a cavernous lymphangioma of the spleen. In our survey of the Japanese literature on splenic lymphangioma for the last 24 years showed only 4 reports of rapidly growing splenic lymphangioma. We have found no reports of newly developed splenic lymphangioma. This tumor may thus be rare rapidly growing splenic lymphangioma.View full abstractDownload PDF (419K) -
Tatsuya Shonaka, Kazuhito Misawa, Kazutomo Kikuchi, Keisa Takeda, Yumi ...2007 Volume 40 Issue 12 Pages 1938-1943
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of a fairly rare mesenchymal gastrointestinal mesenchymal tumor (GIMT) of the colon. A 46 year-old man with a history of sudden epigastric pain was found in Computed Tomography (CT) to have 6-cm diameter mass in the transverse colon complicated by peritoneal free air and massive fluid accumulation. Emergency surgery showed the mass to be a perforated submucosal tumor leading to peritonitis. Histologically, the resected tumor showed increased spindle cells with neutrophilic proliferation at the perforation. Immunofluorescence microscopy showed positive findings for vimentin but negative for c-kit, CD34, S-100, and SMA all compatible with GIMT.View full abstractDownload PDF (565K) -
Kenichiro Saito, Kazushige Shibahara, Masaru Kurokawa, Hideki Moriyama ...2007 Volume 40 Issue 12 Pages 1944-1949
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 76-year-old woman admitted for upper abdominal pain, nausea, and vomiting was found in enhanced abdominal computed tomography (CT) to have mesenteric and portal vein thrombosis. Small-intestine necrosis was not suspected. Her syptoms were relieved by continuous transvenous injection of heparin sodium solution. Four months later, she suffered bowel-obstructive ileus following nausea and vomiting. Enterography showed severe stenosis at the upper jejunum and duodenum-transeverse colon fistula. Laparotomy showed severe 4cm stenosis in the jejunum about 40cm distal from Treitz. s ligament, necessitating partial jejunal resection. The patient was discharged as healthy. Patients should thus be followed up even in the late phase of superior mesenteric and portal vein thrombosis, which occasionally causes ileus.View full abstractDownload PDF (582K) -
Katsuhisa Ohashi, Satomi Furukawa, Kenichi Komura, Tetsuro Yamana, Kin ...2007 Volume 40 Issue 12 Pages 1950-1954
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 25-year-old man diagnosed with uncontrollable perianal abcess was admitted. At first, we strongly suspected of heaving Crohn. s disease, which was eventually. Later, we confirmed Crohn. s disease pahologically from perinial tissue. The perineum was inveterate, and developed into a huge defect. After medication by infliximab, intractable pain under morphine and the defect immediately improved. No case has been reported, to our knowledge, that infliximab being effective for a huge perineal defect and uncontrollable pain in Japan.View full abstractDownload PDF (908K) -
Junya Oguma, Hikaru Tamura, Masahiko Aoki, Kei Hosoda, Hiromu Kido, Ki ...2007 Volume 40 Issue 12 Pages 1955-1959
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 46-year-old woman was admitted to our hospital complaining for postevacuative tumor prolapse from the anus and left lower abdominal pain. The tumor, about 5cm from the anus, was manually reduced, and abdominal computed tomography (CT) showed intussusception in the sigmoid colon, which was reduced using a barium enema. After careful examination, we diagnosed colonic intussusception resulting from lipoma and conducted segmental sigmoidcolectomy assisted by laparoscopy. Pathological examination showed an atypical lipomatous tumor growing from the submucosal layer. The postoperative course was uneventful. Laparoscopic-assisted surgery a preferable in repeated colonic intussusception such as this case.View full abstractDownload PDF (556K) -
Junya Yamamoto, Yasuhide Fuchino, Jun Ohishi, Takanori Harimura, Shini ...2007 Volume 40 Issue 12 Pages 1960-1965
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSMultidetector-row computed tomography (CT) is minimally-invasive inspection and can offer a lot of information in an abdominal cavity by a short time, and it is effective for preoperative diagnosis of various diseases. A 63-year-old woman with ascending colon cancer accompanied by adult intestinal malrotation examined using Multidetector-row CT, underwent laparoscopic-assisted right hemicolectomy with D3 lymph node dissection. By unifying the inspection that used the radiographic contrast enema and Multidetector row CT (multiplanar reconstruction, volume rendering, 3D-CT Angiography), we could grasp the abnormal anatomy, the site ofthe tumor, and the run of the feeding artery, and were able to perform an operation more safely. Multidetector-row CT is very useful for preoperative diagnosis, in surgery of diseases with abnormal anatomy, and in laparoscope-assisted surgery.View full abstractDownload PDF (568K) -
Ryutaro Sakabe, Yukio Sato, Naoki Hirabayashi, Wataru Takiyama, Yoshie ...2007 Volume 40 Issue 12 Pages 1966-1971
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSMetastatic umbilical tumor from internal malignancy, called Sister Mary Joseph.s Nodule (SMJN), is known as a poor prognostic sign. SMJN from colorectal cancer is comparatively rare with only 37 cases reported, to our knowledge, in Japan. We report a case of sigmoid colon cancer with SMJN and review the clinical and pathological features of SMJN from colorectal cancer in the Japanese literature. A 54-year-old man admitted for abdominal pain and constipation was found in colonoscopy to have a sigmoid colon tumor with severe stenosis. Microscopic findings of the biopsy specimen showed well differentiated adenocarcinoma. Physical examination showed a hard red umbilical tumor 2cm in diameter, and aspiration biopsy cytology showed metastatic adenocarcinoma. Abdominal computed tomography showed an enhanced mass at the umbilicus, with ascites and peritoneal dissemination. Operative findings showed sigmoid colon cancer with panperitonitis carcinomatosa and multiple liver metastases. The man underwent colostomy and systemic chemotherapy, but died of cancer 4 months after surgery. It is important to choose treatments for SMJN from colorectal cancer in consideration of the other organ metastases.View full abstractDownload PDF (446K) -
Takayuki Ogino, Masayuki Ohue, Shingo Noura, Terumasa Yamada, Isao Miy ...2007 Volume 40 Issue 12 Pages 1972-1976
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report two cases of venous thromboembolism caused by pelvic lymphocele after rectal cancer surgery with lateral node dissection. Case1: A 44-year-old man hospitalized for anorectal cancer 7cm from the anal verge arising from an anal fistula was found in biopsy specimens to have signet-ring cell carcinoma. After preoperative chemoradiation, he underwent abdominoperineal resection with lateral node dissection. On postoperative day (POD) 20, he suffered acute pain and edema of the right lower extremity. CT showed deep vein thrombosis due to compression of the right external iliac vein by a 10.8cm wide pelvic lymphocele. After lymphocele drainage and anticoagulation therapy, he recovered. Case2: A 54-year-old woman hospitalized for rectal cancer and massive lateral node metastases, developed pulmonary embolism with bilateral deep vein thrombosis caused by pelvic lymphoceles on POD 42 after abdominoperineal resection with lateral node dissection following preoperative chemoradiation. After lymphocele drainage and anticoagulation therapy following inferior vena cava filter placement, she recovered. These two patients remain alive and disease-free 1 year after surgery.View full abstractDownload PDF (411K) -
Ryo Oono, Yoshihiro Ueda, Ken Yoshida, Kazuki Taniguchi, Makoto Nagaha ...2007 Volume 40 Issue 12 Pages 1977-1981
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSAdjuvant chemotherapy with cyclophosphamide, vincristine, adriamycin, prednisolon (CHOP) was administered to a 79-year-old woman following ileocecal resection diagnosed as terminal primary malignant ileal lymphoma.After 2 cycles of CHOP, she was admitted for a severe nonproductive cough and high fever. X-ray imaging and computed tomography (CT) of the chest showed diffuse ground-glass bilateral opacities diagnosed as pneumocystis pneumonia (PCP) as deduced from markedly elevated serum beta-D-glucan. Following treatment with trimethoprim-sulfamethoxazole and corticosteroids, she recovered and her chest radiography became normal. PCP occurs most commonly in patients undergoing immunosuppressive therapy for cancer or organ transplantation and people with AIDS. These treatments should be started early in the course of the illness as side effects of adjuvant chemotherapy for cancer.View full abstractDownload PDF (539K) -
Kazuhiro Narita, Akira Tsunoda, Kentaro Nakao, Goichi Kamiyama, Katsuo ...2007 Volume 40 Issue 12 Pages 1982-1986
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSTemporary loop stoma has been used in sphincter-preserving rectal cancer surgery and the stoma closed in regular surgery. Few reports have, however, been on the clinical pathway for loop ileostomy closure. We assessed the feasibility of a clinical pathway for this. Subjects were 26 patients undergoing ileostomy closuresince April 2004. Clinical results for 12 managed based on the pathway (CP group) were compared to those for 14 treated by introduction of the pathway (NCP group). The CP group was hospitalized the day before surgery and discharged on postoperative day (POD) 4. Postoperative gastric ileus was examined with radiopaque markers. After having introduced the pathway, execution was 100%. Postoperative time to intake in the CP group (median, 1day) was significantly shorter than that in NCP group (median, 2days). Hospitalization in the CP group (median, 6.5days) was significantly shorter than that in NCP group (median, 15days). The postoperative hospital stay in the CP group (median, 4 days) was shorter than that in the NCP group (median, 10days). More than 70% of markers had been emptied from the stomach in 83% of patients by POD 1. Gastric ileus may be mostly resolved on POD 1. Nine of the 12 patients (75.0%) in the CP group were discharged on POD 4. A 4-day hospital stay following ileostomy closure as the clinical path is feasible.View full abstractDownload PDF (397K)
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