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Volume 41, Issue 4
Displaying 1-17 of 17 articles from this issue
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Masaaki Iwatsuki, Yoshio Haga, Shigeru Katafuchi, Satoshi Ikei, Hideo ...2008 Volume 41 Issue 4 Pages 373-379
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSBackground: We evaluated the accuracy of surgical auditing systems, POSSUM and P-POSSUM, developed in the United Kingdom, in emergency digestive surgery. Patients and Methods: Using POSSUM and PPOSSUM, we calculated expected mortality in 294 patients who underwent emergency digestive surgery from January 2001 to December 2003.In the original literature, the endpoint for POSSUM was defined as 30-day mortality and that for P-POSSUM as the in-hospital mortality. The ratio of observed to expected mortality rates (OE ratio) was defined as a measure of accuracy. Results: Overall morbidity was 20.7%, 30-day mortality 6.5%, and in-hospital mortality 7.1%. POSSUM overpredicted mortality rates at a low-risk band where expected rates were 0 to 49%-observed-rate 2/249, 0.80%, vs. expected rate 33/249, 13.3%: OE ratio 0.061 with 95% confidence intervals (CI) of 0.015-0.25. Expected rates were comparable to observed rates at a high-risk band where expected rates were 50 to 100%-observed-rate 17/45, 37.7% vs. expected rate 23/45, 51.1%; the OE ratio 0.74 with 95% CI of 0.46-1.12.Similarly, P-POSSUM overpredicted mortality rates at a low-risk band where expected rates were 0 to 59%-observed rate 6/267, 2.2% vs. expected rate 24/267, 9.0%: OE ratio 0.23 with 95% CI of 0.094-0.58. In contrast, expected rates were closer to the observed rates at a high-risk band where the expected rates were 60 to 100%-observed rate 15/27, 55.6% vs. expected rate 22/27, 81.5%: OE ratio 0.68 with 95% CI of 0.47-1.00.Conclusion: Current single-center data suggests that both POSSUM and P-POSSUM may overpredict mortality rates in low-risk patients who undergo emergency digestive surgery.View full abstractDownload PDF (318K) -
Eiji Takeuchi, Yoichirou Kobayashi, Kanji Miyata, Norihiro Yuasa, Yasu ...2008 Volume 41 Issue 4 Pages 380-387
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSPurpose: We analyzed short-term endpoints of minilaparotomy using the moving window method for radical surgery in the treatment of colorectal cancer. Methods: Between December 2002 and March 2007, 175 patients were scheduled to undergo resection for colorectal cancer via a 7cm minilaparotomy using the moving window method at our institution. The ratio of the all radical surgery (606 cases) for colorectal cancer during the same period at our institution was 29%. Stapled anastomosis-functional end-to-end anastomosis or double stapling-was used. Result: Of 21 surgeons conducting the operation, 12 with 3-9 years of postgraduate experience undertook 69 cases (39%). The wound length was elongated to 10cm in 39 cases (22%). Mean operating time was 127 minutes and mean bleeding volume was 97ml. One patient (0.6%) had an intraoperative complication involving a bowel injury caused by the stapler, necessitating reoperation on postoperative day (POD) 1. Some 27 patients (15%) had postoperative complications, common by intestinal obstruction (11 cases, 6%), surgical site infection (4 cases, 2%), and retrograde infection of the drainage tube (3 cases). No anastomoticleakage occurred. Two patients died while hospitalized-one peritonitis due to cancer and one fron pneumonia due to Alzheimer.s disease. Seventy-five (91%) of 82 patients for whom a clinical pathway was used were discharged in line with the pathway. The mean postoperative hospital stay was 14 days. Conclusions: Minilaparotomy using the moving window method is a procedure under direct vision similar to ordinary three-dimensional laparotomy, and is safe and minimally invasive suitable for general surgeons.View full abstractDownload PDF (667K) -
Takamasa Takahashi, Kanji Miyata, Norihiro Yuasa, Eiji Takeuchi, Yasut ...2008 Volume 41 Issue 4 Pages 388-392
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 72-year-old man undergoing total gastrectomy followed by Roux-en-Y reconstruction for gastric cancer (pT1, pN0) and subsequently admitted for severe heartburn and appetite and weight loss was found in endoscopy to have severe reflux esophagitis (Grade D based on the Los Angels. classification). 24 hour Bile reflux was 33.4% in predominantly supine with 24-hour bilirubin monitoring. Upper gastrointestinal radiography showed the distance between the esophagojejunostomy and jejunojejunostomy to be short (30cm), considered to cause severe reflux esophagitis, necessitating reoperation in which the jejunojejunostomy was divided and the oral jejunum anastomosed to the jejunum 1m distal to the previous jejunojejunostomy. After reoperation, heartburn subsided and 24-hour bilirubin monitoring disclosed no bile reflux. Endoscopy 3 months later showed no reflux esophagitis. Esophageal 24-hour bilirubin monitoring in the esophagus enable to objectively analyze duodenal fluid reflux and initiate appropriate treatment.View full abstractDownload PDF (479K) -
Yoshio Oka, Junichi Nishijima, Masaaki Izukura, Satoru Miyazaki, Hiros ...2008 Volume 41 Issue 4 Pages 393-398
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 60-year-old man seen for vertigo and tarry stool was found in blood tests to have anemia and high serum CEA. Gastrointestinal endoscopy and computed tomography showed type II gastric cancer with lymph node and multiple hepatic metastases, necessitating chemotherapy using low-dose 5-FU/cisplatin. After metastatic liver lesions and lymph nodes shrank dramatically, we conducted distal gastrectomy with D2 lymph node dissection and partial hepatic resection. Despite postoperative hepatic arterial infusion of 5-FU (5-FU HAI), a recurrent hepatic lesion appeared 1 year and 8 months postoperatively. Treatment with 5-FU HAI failed to shrink the lesion, necessitating partial hepatic resection. He remains alive with normal serum CEA and recurrence-free 7 and a half years after initial surgery. In cases of gastric cancer with hepatic metastases, long-term survival may be attained through aggressive, effective multimodal treatment. We therefore favor such multimodal treatment for gastric cancer with hepatic metastases.View full abstractDownload PDF (849K) -
Jun Kimura, Masahide Kaji, Sei-ichi Yamamoto, Ki-ichi Maeda, Kazuhisa ...2008 Volume 41 Issue 4 Pages 399-405
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 31-year-old woman with epigastralgia was found in gastrointestinal series and gastrointestinal fiberscopy studies to have severe stenosis of the pyloric ring, although histopathological examination showed no malignancy. Blood tumor markers were elevated-(CA19-9: 660U/ml; CA125: 40.8U/ml). CEA 0.5ng/ml was normal. Abdominal computed tomography showed wall thickening of the pyloric ring and moderate ascites, necessitating diagnostic surgery. Surgery showed 5.0×2.0cm submucosal tumor of the pyloric ring and carcinomatous peritonitis. To treat stenosis, we conducted distal partial gastrectomy. Postoperative histopathological findings showed adenocarcinoma arising from an ectopic gastric pancreas (Heinlich type II). Postoperative abdominal magnetic resonance imaging (MRI) showed the pancreatic duct of ectopic gastric pancreas in the pyloric ring. This case suggested MRI is effective for diagnosis of ectopic pancreas.View full abstractDownload PDF (928K) -
Makoto Yoshida, Motoya Kashiyama, Setsuji Takanashi, Takumi Takagi, Sh ...2008 Volume 41 Issue 4 Pages 406-411
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSIntrahepatic bile duct cystadenoma is a rare cystic tumor of the liver. That with histopathologically ovarianlike stroma termed cystadenoma with mesenchymal stroma. All patients are female. The right-sided round ligament is a rare anomaly mostly accompanied by abnormal intrahepatic portal venous branching-something to be noted in hepatectomy. A 72-year old woman admitted for detailed checking of a liver tumor was found in abdominal CT to have a multilocular 6.0×5.5cm cystic tumor at segments 5 and 8 of the liver. Part of the tumor wall had calcified, and no intracystic nodules were seen. Serum CA19-9 was elevated. Under the diagno- sis of hepatobiliary cystic tumor, we performed conducted right hepatic lobectomy. The round ligament ran near the tumor into the liver, with the gallbladder to its left. Intraoperative ultrasound sonography showed the left umbilical portion to be nonexistent and the round ligament running to the right anterior banch of the portal vein. We diagnosed intrahepatic bile duct cystadenoma with mesenchymal stroma histopatholigically. Postoperative serum CA19-9 became normal and the man remains well without recurrence.View full abstractDownload PDF (789K) -
Hiromichi Yamai, Takahiro Yoshida, Jyuniti Seike, Jyunko Honda, Takano ...2008 Volume 41 Issue 4 Pages 412-417
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe report a case of the which was treated with TAE, RFA and surgery. In 2003, a 60-year-old man followed up for chronic hepatitis C and admitted for examination of intrahepatic lesions detected in urtrasonography was found in abdominal computed tomography (CT) to have two intrahepatic masses of about 4cm and 4.5cm and a solitary swollen 2.8cm lymph node to the right of the aorta. We diagnosed the intrahepatic lesions as he-patocellular carcinoma (HCC), but we could not diagnose the paraaortic lesion as a metastatic lymph node. We treated the hepatic lesion with TAE and RFA, and followed up the paraaortic mass, which became enlarged two months later. We resected the lymph node. The postoperative course was uneventful and the patient was discharged. Serum AFP decreased from a preoperative 2, 685ng/ml to a postoperative 3ng/ml. Two years later, neither intrahepatic recurrence nor the presence of the metastatic lymph node was seen.View full abstractDownload PDF (714K) -
Kazutoyo Morita, Akinobu Taketomi, Yo-ichi Yamashita, Takasuke Fukuhar ...2008 Volume 41 Issue 4 Pages 418-423
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSHepatocellular carcinoma with liver cirrhosis is often unresectable due to liver dysfunction. A 82-year-old man had two hepatocellular carcinomas measuring 2.5cm at S6 and 1cm at S8 of the liver. Despite transcatheter arterial chemoembolization (TACE) for these carcinomas, local recurrence was seen at S6, TACE repeated, and local recurrence seen again. He had severe liver dysfunction (Child-Pugh 8; Grade B, and liver damage C) and a huge gastro-renal shunt. Balloon-occluded retrograde transvenous obliteration (B-RTO)was conducted to increase portal flow to the liver and improve liver function. After B-RTO, liver function improved to Child-Pugh 6; Grade A, and liver damage B. Partial hepatic resection (S6) was successful and the man was discharged on postoperative day 14 without postoperative complications. The obliteration of portosystemic shunt using BRTO makes it possible to conduct hepatic resection for hepatocellular carcinoma in patients with severe liver dysfunction. This strategy is especially useful in the treatment of TACE resistant carcinoma.View full abstractDownload PDF (740K) -
Seiji Mega, Ryousuke Kawasaki, Kazuhiro Iwai, Toshimichi Asano, Kazuak ...2008 Volume 41 Issue 4 Pages 424-429
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 24-year-old man admitted for sudden abdominal pain was found in abdominal computed tomography (CT) to have a fluid collection in the subphrenic space and laboratory data and abdominal signs suggestive of diffuse peritonitis necessitating emergency surgery. We found massive biliary ascites in the peritoneal cavity and bile leakage from the gallbladder and a 3mm defect in the body of the gallbladder near Hartmann. s pouch. Duodenal serosa were normal. We conducted cholecystectomy and abdominal drainage. No gallbladder stones or thickening of the gallbladder wall were seen and culture of biliary ascites yielded no bacterial growth. The postoperative course was good and the man was discharged 10 days after surgery. Histologically, small thrombi occurred in the gallbladder wall near the perforation, but other parts of the gallbladder wall showed less inflammation. The definitive diagnosis was idiopathic perforation of the gallbladder.View full abstractDownload PDF (661K) -
Masaoki Hattori, Hideaki Suzuki, Hiroaki Shibahara, Shingo Kuze, Jyuni ...2008 Volume 41 Issue 4 Pages 430-434
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 77-year-old woman admitted for lower right lower abdominal pain and with no history of laparotomy was diagnosed with ileus and underwent long-tube decompression, multidetector-row computed tomography (CT) after small bowel contrast examination showed a loop in the small intestine on the ventral caudal side of the cecum, and she was diagnosed with a paracecal hernia. Under laparoscopy, the hernia sac on the lateral side of the cecum was dissected and opened. The postoperative course was uneventful and she was discharged on postoperative day 5. This lateral paracecal hernia is outside of the usual classification -ileocecal superior, ileocecal inferior, ileocecal infima, and retrocecal type- usually cited in Japan. Multidetector-row CT after small bowel contrast examination thus proved useful in diagnosing and the treating this case minimally invasively.View full abstractDownload PDF (630K) -
Koji Kubota, Michihiko Harada, Shigeyoshi Kumeda, Masako Otani2008 Volume 41 Issue 4 Pages 435-440
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA-66-year-old woman admitted for abdominal distension and an intraabdominal mass was found in abdominal computed tomography (CT) and magnetic resonance imaging (MRI) to have 14.5×14×6.5cm mass between the transverse colon and left kidney. Angiography and upper gastrointestinal endoscopy suggested gastrointestinal stromal tumor (GIST) of the stomach or transverse colon with an extra gastrointestinal pedunculated growth or sarcomatous lesion in the abdominal cavity. We completely resected the tumor together with the spleen, pancreatic tail, and splenic flexure colon. Histologically, the tumor consisted of interlacing bundles of spindle-shaped cells. Immunohistochemical examination showed it to be positive for c-kit and CD34. The tumor, kept intact from the colon, spleen, and pancreas, was diagnosed as mesentery GIST. We report this rare case together with a review of the literatures.View full abstractDownload PDF (608K) -
Ryo Takahashi, Takeshi Kaneko, Noboru Nakayama, Yoshiki Kataoka, Masan ...2008 Volume 41 Issue 4 Pages 441-445
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 82-year-old woman seen for lower abdominal pain was found in computed tomography to have a grape-like cystic mass with increased fat density below the ileocecal region. We conducted appendectomy under a diagnosis of acute appendicitis or appendiceal tumor. Resected specimen showed diverticulosis. Pathological examination indicated acute inflammation only at the tip of the appendix, and chronic inflammation at the true diverticulosis. True diverticulosis is rare, with only 6 cases reported in the Japanese literature. Some investigators recommend prophylactic appendectomy for asymptomatic appendiceal diverticulosis because it is highly prone to perforate in the presence of acute inflammation. This opinion has been based on inaccurate citation from outdated literature, acute appendicitis has equivalent risk of perforation among aged patients 65 years and older. We hold that no reason exists for prophylactic appendectomy in asymptomatic appendiceal diverticulosis.View full abstractDownload PDF (628K) -
Takahisa Hirokawa, Minoru Yamamoto, Masaki Sakamoto, Hirozumi Sawai, H ...2008 Volume 41 Issue 4 Pages 446-451
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSColorectal inflammatory myofibroblastic tumors (IMT) are rare, and most commonly occur in the lung. We report a case of IMT of the appendix, involving a malignant tumor in the differential diagnosis based on the speed of tumor growth. A 58-year-old man admitted for alcoholic cirrhosis had a growing tumor palpable in the lower right quadrant. Enhanced abdominal CT showed a slightly contrasted mass around the cecum. No tumor was found by colonoscopy without external compression. Barium enema findings indicated diverticuli of the ascending colon and deformation of the cecum, suggesting an inflammatory tumor whose malignancy could not be excluded, necessitating so laparoscopy-assisted ileocecal resection. The postoperative pathological diagnosis was IMT.View full abstractDownload PDF (697K) -
Hidefumi Kubo, Shinsuke Kanekiyo, Kousuke Tada, Hiroyasu Hasegawa2008 Volume 41 Issue 4 Pages 452-457
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSA 74-year-old woman with right lateral abdominal pain and a breast tumor in April 2007 was found to have a right perinephric lesion and admitted for further examination and treatment. Abdominal CT disclosed a right perinephric lesion with an unclear margin. Barium enema suggested tumor invasion to the descending colon. Mammography and ultrasonography showed a tumor with a partial unclear margin at C in right breast. Needle biopsy of the breast tumor suggested low-grade malignant potential. Although no definitive diagnosis was made, we conducted laparotomy and found a mesenchymal tumors, necessitating right nephrectomy, partial excision of the descending colon including the tumor, and partial resection of the right breast in May 2007. Histopathological diagnosis was Pleomorphic cell liposarcoma. Histological study showed that the tumor cell had invaded to the submucosal layer of the colon and the resected breast tumor consisted of the same liposarcoma cells suggesting a metastatic tumor.View full abstractDownload PDF (947K) -
Takeshi Matsutani, Koji Sasajima, Hiroshi Maruyama, Ryohei Futami, Yos ...2008 Volume 41 Issue 4 Pages 458-463
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe evaluated the efficacy and safety of combination chemotherapy consisting of docetaxel (TXT), 5-fluorouracil (5-FU), and cisplatin (CDDP) as a second-line treatment for unresectable or recurrent esophageal squamous cell carcinoma. Ten patients who developed recurrence after surgery and three inoperable patients were enrolled in the combination of TXT 40mg/m2 (day 1), CDDP 10mg/body weight (days 1-5), and 5-FU 500mg/body weight (days 1-5) at intervals of 2 weeks. Evaluated responses in all patients were partial in 6, stable in 6, and progressive in 1.Overall response was 46%. Myelosuppressions with Grade 3 and 4 leucopenia occurred in 5 (38%). Combination chemotherapy of TXT, 5-FU, and CDDP is effective and tolerable as secondline treatment for patients with unresectable or recurrent squamous cell carcinoma of the esophagus.View full abstractDownload PDF (330K) -
Yuichiro Miyaki, Akihiro Yamaguchi, Masatoshi Isogai, Toru Harada, Yuj ...2008 Volume 41 Issue 4 Pages 464-468
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe studied the efficacy of CT measurement (Hounsfield Unit) of fluid accumulating in the expanded intestinal lumen in a case of strangulated small bowel obstruction. Subjects were 34 patients with small bowel obstruction whose fluid accumulated in the expanded intestinal lumen and ascites were measured by CT. Based on the clinical course and/or operative findings, subjects were divided into 2 groups of 11 with strangulated small bowel obstruction and 23 without, and CT measurement of fluid accumulated in the expanded intestinal lumen and those of ascites compared, CT measurement of fluid accumulated in the expanded intestinal lumen was 28.5±8.5 HU in the strangulated group and 18.3±6.5 HU in the non strangulated group, showing significant statistical difference (p<0.01). We regard the cutoff point of the strangulated group to be 22 HU by CT measurement of fluid accumulated in the expanded intestinal lumen is considered useful in the diagnosis of strangulated small bowel obstruction.View full abstractDownload PDF (583K) -
Rumiko Tashima, Sachio Yokoyama, Nobuyuki Arima, Kenichirou Baba, Masa ...2008 Volume 41 Issue 4 Pages 469-473
Published: 2008
Released on J-STAGE: June 08, 2011
JOURNAL FREE ACCESSWe analyzed the clinicopathologic features and treatment outcome of 7 patients with carcinoma associated with anal fistula (CAF) from 1989 to 2005 in our hospital. The male to female ratio was 5: 2, and the mean age 67 years (48-82). The average number of years of CAF arising from anal fistula was 26.4 years. Perianal pain was present in all patients. The mean tumor diameter was 55mm. Histologically, 71% of patients had mucinous adenocarcinoma and 86% stage II/III. Half of stage II/III disease had invaded adjacent viscera. All patients underwent abdominoperineal resection, and three underwent postoperative radiation and/or chemotherapy. Local recurrence developed in 4 and distant metastasis in 3. The four with local recurrence died, surviving a mean 2.3 years. Two patients have remained disease free for 56 to 61 months. Early diagnosis and aggressive excision with clear margins are required for cure. Chemoradiation followed by surgery may improve outcome of the disease invading to adjacent viscera.View full abstractDownload PDF (435K)
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