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Volume 40, Issue 8
Displaying 1-17 of 17 articles from this issue
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Takashi Hiromatsu, Hiroshi Hasegawa, Eiji Sakamoto, Shunichiro Komatsu ...2007 Volume 40 Issue 8 Pages 1449-1455
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSPurpose: Laparoscopic cholecystectomy, although widely disseminated for treating benign gallbladder disease, involves complications such as biliary injury. This makes it very important to prevent complications. Materials and Methods: For the last 16 years, 1, 926 patients of cholecystolithiasis underwent laparoscopic cholecystectomy with preoperative cholangiography (ERCP etc). We evaluated operating duration as an indicator of the degree of difficulty using multivariate logistic regression analysis. Results: We found that three factors-(gallbladder wall thickening, incarcerated stones in the gallbladder neck, and the duration of elevated CRP) contributed most to extended operating time, showed as a linear function, Y=8.928×X+77.974. Risk was classified preoperatively into low, intermediate, and high. Anticipated operating time was 76 minutes in the lowrisk group, 96 minutes in the intermediate-risk group, and 132 minutes in the high-risk group respectively. Conclusions: We concluded that we could select appropriate surgeon based on risk degree to decrease operative complications.View full abstractDownload PDF (476K) -
Hironori Tsujimoto, Satoshi Ono, Hidetaka Mochizuki2007 Volume 40 Issue 8 Pages 1456-1465
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSImmunosuppression after surgical stress frequently kills critically ill patients, creating critical problem in improving mortality in such patients. Surgical stress induces the deactivation and systemic loss of leukocytes, including monocytes, lymphocytes, and dendritic cells. Surgical stress also produces proapoptotic factors that may induce systemic loss of leukocytes and parenchymal cells. Studies of septic rodents have shown that apoptosis is prevented by administering antiapoptotic agents, improving survival from sepsis. In short, surgical stress induces extensive loss of immunocompetent cells via apoptosis, which in turn, may lead to severe microbial infection, suggesting that the regulation of unfavorable apoptosis and adoptive transfer of lost cells is effective as a therapeutic approach to immunosuppression associated with surgical stress.View full abstractDownload PDF (480K) -
Anatomic Variant and Intraoperative PrecautionMakoto Yamasaki, Yuichiro Doki, Hiroshi Miyata, Takushi Yasuda, Shuji ...2007 Volume 40 Issue 8 Pages 1466-1472
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA nonrecurrent inferior laryngeal nerve (NRILN) is a rare anomaly. We report four cases of esophageal cancer with NRILN treated by transthoracic esophagectomy with three-field lymphadenectomy. All had been diagnosed as esophageal cancer. Under a diagnosis of concomitant NRILN based on preoperative computed tomography, we conducted transthoracic esophagectomy with three-field lymphadenectomy. The right subclavian artery on the right between the esophagus and vertebral column was recognizable perioperatively. The right recurrent nerve was not identified at the right subclavian artery during mediastinal dissection, but the NRILN was identified as going directly from the vagal nerve to the larynx during neck lymphadenectomy. The thoracic duct ran between the esophagus and the azygos vein, terminating at the right venous angle. Because the aberrant right subclavian artery is associated with the NRILN, right-sided terminating thoracic duct, etc., surgery must proceed under stringent controll with these abnormalities in mind. In patients with NRILN, cancer tends to metastasize to neck lymph nodes regardless of upper mediastinal lymph nodes, which is why esophagectomy with three-field lymphadenectomy is considered standard in treating thoracic esophageal cancer with NRILN.View full abstractDownload PDF (507K) -
Yasuhiko Midorikawa, Kumiko Suzuki, Takeshi Nakachi, Teruhiko Kasuga2007 Volume 40 Issue 8 Pages 1473-1478
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSCase 1. A 72-year-old man who had undergone distal gastrectomy for gastric cancer 1 year and 2 months earlier and suffered from jaundice was found in enhanced Computed Tomography (CT) of the abdomen to have lymph node swelling of the hepatic hilus and paraaorta. Treatment with low-dose FP chemotherapy and oral administration of TS-1 at 80mg/day proved ineffective. We then Paclitaxel administered at a dose of 60mg/ body intravenous infusion once a week for three weeks followed by a drug-free-one week period as a single course. Five months later, this therapy induced CR. We then administered Paclitaxel for 6 months, but he died due to rapid growth of multiple liver metastases appearing 4 months after Paclitaxel was stopped. Case 2. A 67-year-old man who had undergone total gamg/week was found in enstrectomy, distal pancreatectomy, and splenectomy and treated with 80mg/day of oral TS-1 and CDDP of 10hanced abdominal CT to have multiple liver metastases and paraaortic lymph node swelling. Paclitaxel was administered at a dose of 60mg/body intravenous infusion once a week for three weeks followed by a drug-free-one week period as a single course. Nine months later, this therapy had induced CR, which has continued for two years and seven months in biweekly administration, maintained for more than 3 years as of this writing. The result of case 1 suggested some break in immunological surveillance after Paclitaxel was stopped. Despite CR, we have concluded that it is better to use continuous chemotherapy against metastasis for at least one year.View full abstractDownload PDF (494K) -
Masanori Tokunaga, Shigekazu Ohyama, Soya Nunobe, Naoki Hiki, Tetsu Fu ...2007 Volume 40 Issue 8 Pages 1479-1484
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 69-year-old Japanese woman with gastric cancer was referred to our hospital for further management. Gastrointestinal fiberscopy revealed type 2 advanced gastric cancer in the posterior wall of the gastric cardia (cT4panc, cN2, cH0, cP0, cM0, cStage IV). In cases of advanced gastric cancer, neoadjuvant chemotherapy (NAC) with S-1/CDDP is usually admitted for tumor down-staging at our hospital. Since the patient agreed to undergo NAC, S-1 (80mg/m2) was administered orally for 21 consecutive days, followed by intravenous CDDP0 (cisplatin, 60mg/m2) on Day 8. Radiological examinations after NAC showed partial response of the primary and lymph node lesions. Subsequently total gastrectomy with extended lymph node dissection was performed. Histological examination of the resected specimen showed no cancer cells in either the stomach or any of the dissected lymph nodes. It was assumed that histological CR had been achieved by the NAC with S1/CDDP. Although there are numerous reports of advanced gastric cancer cases, in which histological CR was achieved after two or more courses of NAC, histological CR was achieved after one course of NAC in the present case. Herein we report this very rare case in this paper with a review of the literature.View full abstractDownload PDF (406K) -
Hidekazu Takahashi, Shin Mizutani, Toshirou Nishida, Tsukasa Ooyama, F ...2007 Volume 40 Issue 8 Pages 1485-1489
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 74-year-old man admitted our hospital for general fatigue and anemia was found in endoscopic examination to have type 2 cancer in the gastric body. While most biopsy specimens were diagnosed as adenocarcinoma, some were squamous cell carcinoma. Computed tomography (CT) showed direct invasion of the tumor to the pancreas and lymph node metastases. We conducted 3 courses of S-1/CDDP to downstage the tumor before surgery. Pre-operative chemotherapy was evaluated NC in follow-up CT. We conducted total gastrectomy with distal pancreatectomy and splenectomy. Post operative pathological examination showed that the tumor remaining consisted of squamous cell carcinoma free of any adenocarcinoma component. The fact that chemotherapy eliminated the adenocarcinoma component but not the squamous compornent suggests that sensitivity to combined S-1 and CDDP chemotherapy may differ between adenocarcinoma and squamous cell carcinoma.View full abstractDownload PDF (448K) -
Yuji Masaki, Takashi Ueno, Hirotaka Hamada, Takashi Akiyama2007 Volume 40 Issue 8 Pages 1490-1495
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a very rare case of hepatocellular carcinoma with sarcomatous change occurring as a liver abscess. A 68-year-old male who was diagnosed with a liver abscess in ultrasonography and seen for high fever and right chest pain. Abdominal computed tomography (CT) revealed a solitary liver tumor 6cm in diameter with ring enhancement at the posterior lobe. For the liver abscess, we conducted percutaneous drainage and recognized a little grayish pus. We decided to operate when the inflammatory reaction lasted more than 10 days. Pathohistological examination showed diffuse tumor cell growth with mitosis and necrosis. In immunohistochemical staining, tumor cells were strongly positive for vimentin and MIB-1, and were arranged trabecularly in silver staining. Hepatocellular carcinoma with sarcomatous change grows invasively, features a high incidence of extrahepatic metastasis, and follows a rapid clinical course.View full abstractDownload PDF (550K) -
Tatsuya Orimo, Toshiya Kamiyama, Takahito Nakagawa, Kazuaki Nakanishi, ...2007 Volume 40 Issue 8 Pages 1496-1501
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 61-year-old woman was admitted to our hospital because of pain in her back on the right side. Abdominal CT revealed a cystic tumor in S8-7 of the liver measuring about 6cm in diameter and an intraperitoneal fluid collection. TAE was performed because of intraperitoneal bleeding from the tumor. Preoperative colonoscopy revealed a sigmoid colon tumor, and sigmoidectomy and S8-7 hepatectomy were performed for a diagnosis of sigmoid colon cancer and bile duct cystadenocarcinoma or liver metastasis by the sigmoid colon cancer. The histological diagnosis was sigmoid colon cancer and bile duct cystadenocarcinoma. Bile duct cystadenocarcinoma is rare, and the treatment of choice is a complete resection of the tumor.View full abstractDownload PDF (571K) -
Kazuhiro Suzumura, Nobukazu Kuroda, Jiro Fujimoto2007 Volume 40 Issue 8 Pages 1502-1507
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a very rare case of osteoclastoid giant cell carcinoma of the pancreas. A 66-year-old man admitted for general itching and jaundice was found in computed tomography (CT) and abdominal ultrasonography (US) to have a pancreatic tumor. Although serum CA19-9 was high at 82U/ml, other tumor markers were within normal range. CT and US showed an unevenly enhanced mass with cystic lesion about 6cm in diameter in the pancreatic head. Magnetic resonance imaging (MRI) T2 study showed a iso-high intensity mass. The pancreatic duct had been relocated by the tumor, but no obstruction was found by MRCP. The patient underwent pylorus-preserving pancreatoduodenectomy. Pathological examination showed osteoclastoid giant cell carcinoma of the pancreas. The patient's postoperative course was uneventful, but local recurrence was observed 1 year after surgery. We resected the recurrent tumor and part of the pancreas, and conducted distal gastrectomy. Liver metastasis progressed rapidly, however, postoperatively and he died four months after the second surgery.View full abstractDownload PDF (438K) -
Shigeru Kiyama, Naoki Imai, Senji Kasahara, Tuyoshi Takami, Masanao Sa ...2007 Volume 40 Issue 8 Pages 1508-1513
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 48-year-old woman reporting left hypochondriac pain, together with anemia and thrombocytopenia identified elsewhere, was found on palpation to have hard elastic masses in the left upper quadrant. Blood tests confirmed anemia and thrombocytopenia. Computed tomography (CT) showed partially contrasting nonuniform internal tumors corresponding to the spleen. FDG-PET indicated an accumulation from the left upper quadrant to the flank. Because thrombocytopenia had been worsened by blood transfusion and platelet transfusions, we initially diagnosed as pancytopenia due to hypersplenism, necessitating splenectomy. The extracted 15×12×12cm specimen weighted, 990g, had a smooth surface, and was hard and elastic. The cut surface was solid. Histopathological examination indicated hemangiosarcoma. After surgery, she was treated with supermass chemotherapy and peripheral blood stem cell transplantation. As of this writing 3 years after surgery, she continues to do well with no signs of recurrence.View full abstractDownload PDF (436K) -
Hayato Kan, Kiyonori Furukawa, Hideyuki Suzuki, Hiroyuki Tsuruta, Sato ...2007 Volume 40 Issue 8 Pages 1514-1519
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of stenotic ischemic enteritis, found during double balloon enteroscopy (DBE), resected in laparoscopy-assisted surgery. A 61-year-old woman diagnosed with hypertension, atrial fibrillation, and phlebothrombosis with abdominal pain and diarrhea one month earlier had been hospitalized for acute enteritis. Three weeks later, symptoms subsided and she was discharged. A few days later, she was diagnosed with an intestinal obstruction and rehospitalized. Computed tomography (CT) showed a lesion with thickening of the intestinal wall in the lower abdomen and dilation on the oral side of the intestine. After decompression of the intestine by a long tube, we checked for a stricture lesion by intestinal radiography. The lesion was observed and a biopsy conducted by DBE. A histological study showed inflammatory cell infiltration suggesting ischemic enteritis. Surgery a few days later yielded a definitive diagnosis of ischemic enteritis based on histological examination of the resected specimen.View full abstractDownload PDF (454K) -
Takao Ohtsuka, Akira Nakagawachi, Tomonori Shimonishi, Kiyokazu Koga, ...2007 Volume 40 Issue 8 Pages 1520-1524
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 69-year-old man with untreated atrial fibrillation admitted for intermittent abdominal pain and bloody stool was found in computed tomography (CT) to have occlusion of the superior mesenteric artery (SMA). Laboratory data suggested intestinal necrosis necessitating emergency laparotomy. The jejunum and ileum were found to be ischemic but not necrotic. Intraoperative angiography showed the SMA to be occluded just distal to the first jejunal branch. Subsequent SMA exploration led to thrombectomy. The ischemic color of the small intestine recovered immediately after thrombectomy, as did pulsation of the blood supply to the small intestine. The postoperative clinical course of the patient was good. Our case demonstrates that intraoperative angiography is useful in evaluating the occlusion site in the SMA when the patient undergoes laparotomy with a diagnosis of intestinal necrosis and ischemic change is found to be reversible.View full abstractDownload PDF (439K) -
Noriyuki Hirahara, Takeshi Nishi, Yasunari Kawabata, Toko Inao, Seiji ...2007 Volume 40 Issue 8 Pages 1525-1530
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 55-year-old man admitted for fever, right lower abdominal pain and skin redness was found in laboratory data examination to have marked leukocytosis (13, 900/μl) and high C-reactive protein (27.7mg/dl). Abdominal computed tomography (CT) showed a 10×6×5cm cystic lesion in the right lower abdominal cavity. The abdominal abscess ruptured the day after hospitalization, and the man was treated with antibiotics and drainage. The drainage wound was closed and he was discharged 8 days after admission. The abscess ruptured again, however, and fistelography showed an enterocutaneous fisutula. Intraabdominal findings during laparotomy showed mucious ascites and multiple small size white indurations in the abdominal cavity. Histological examination of the small indurations showed epitheloid granuloma with caseous necrosis, suggesting tubercular peritonitis. Colonoscopy showed ileocecal erosion leading to a diagnosis of histologically tuberculous peritonitis. Antituberculous agents were administered and abdominal symptoms disappeared. Tuberculous peritonitis should thus be taken into consideration in differentitial diagnosis.View full abstractDownload PDF (441K) -
Ataru Onozato, Takatoshi Nakamura, Kazuhiko Hatate, Heita Ozawa, Takeo ...2007 Volume 40 Issue 8 Pages 1531-1535
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 55-year-old woman. Experiencing abdominal pain and vomiting after lunch and initially diagnosed with bowel obstruction and treated conservatively elsewhere by intestinal tube insertion had worsening abdominal pain 5 days after onset. Extreme overall abdominal tenderness and rebound tenderness were accompanied by a fist-sized mass palpated in the right lower quadrant. Enhanced abdominal Computed Tomography (CT) indicated target signs in the ileocecum suggesting peritonitis due to intussusception and necessitating emergency surgery. Perioperative findings confirmed ileal-ileal-colonic intussusception. The large dark red sausage-like mass found in the ileocecum could not be manual by repositioned, necessitating ileocecal resection. The resected specimen was a submucosal tumor 2.7cm long located 54cm from the distal ileum. Meckel's diverticulum was noted 20cm from the distal ileum. Histopathology confirmed lymphangioma of the ileum. Lymphangioma of the small intestine is so rare that only 36 cases have been reported in Japan. Given that only 6 such cases involved intussusception, our case is extremely rare. Lymphangioma of the small intestine should thus be considered in cases of intussusception in adoults.View full abstractDownload PDF (446K) -
Naoki Tani, Akinori Noguchi, Hiroki Takeshita, Yusuke Yamamoto, Tadao ...2007 Volume 40 Issue 8 Pages 1536-1541
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 78-year-old man who had undergone radical surgery for rectal cancer with liver metastasis 11 years earlier exhibited an elevated serum carcinoembryonic antigen level in November 2004. An abdominal CT examination demonstrated a mass in the pancreatic body and S4 of the liver. The main pancreatic duct was shown as sudden obstruction in ERCP, the pancreatic cancer with liver metastasis was suspected. A distal pancreatectomy and splenectomy, along with a partial resection of the liver, was performed. The pathologic diagnosis was moderately differentiated adenocarcinoma, compatible with metastases from the rectal carcinoma. Cases of pancreatic metastasis from colorectal cancer are rare, though several cases have shown that multi organ metastasis during the course of disease usually indicates a poor prognosis. Whether this disease is curable should be carefully determined, particularly when surgical treatment is considered. According to the literature, the prognosis of the resected pancreatic metastasis after the long period from primary operation may be relatively good.View full abstractDownload PDF (386K) -
Toru Saito, Ikuo Udagawa, Ram Dhoj Shrestha, Shigeki Watanabe, Kazuyas ...2007 Volume 40 Issue 8 Pages 1542-1547
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSAnorectal malignant melanoma (MM) is a rare disease with a poor prognosis and early-phase metastasis. We report our successful treatment with local excision and chemotherapy that has enabled our patient to survive for 10 years. A 70-year-old man suffering from rectal polyps underwent local transanal excision. A pedunculated olyp about 20mm long was resected. The cutting plane was black. The pathological diagnosis was MM. Some papers have reported that no difference exists in survival between abdominoperineal resection (APR) and local excision, with the patient followed up by chemotherapy alone. We have conducted CDV chemotherapy n our patient two or three times a year for 10 years. Anorectal MM has not been established despite the poor prognosis. Most cases of APR over these ten years have involved only local excision in this case. Lung metastasis detected in the ninth year has not progressed. In the tenth year, local recurrence was detected and local transanal excision was done, CDV chemotherapy was continued, and our patient remains free from disease and maintains high quality of life. This successfully case of ongoing anorectal MM provides valuable nformation on establishing an effective therapeutic regimen for this disease.View full abstractDownload PDF (465K) -
Mitsuo Miyazawa, Masayasu Aikawa, Takahiro Torii, Katsuya Okada, Yoshi ...2007 Volume 40 Issue 8 Pages 1548
Published: 2007
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSDownload PDF (175K)
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