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Volume 47, Issue 9
Displaying 1-13 of 13 articles from this issue
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ORIGINAL ARTICLE
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Masayuki Okuno, Etsuro Hatano, Kojiro Nakamura, Yosuke Kasai, Takahiro ...Article type: ORIGINAL ARTICLE
2014 Volume 47 Issue 9 Pages 467-476
Published: September 01, 2014
Released on J-STAGE: September 19, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLPurpose: A nomogram was reported that predicts diseasefree survival (DFS) after hepatic resection for patients with colorectal liver metastasis (CRLM) between 2000 and 2004 at 11 institutions in Japan. We externally validated this nomogram from patients after 2005 at our hospital. Method: Fifty patients with colorectal liver metastasis who had undergone a primary hepatic resection at Kyoto University Hospital from January 2005 to November 2009 were studied. Results: Three year-disease free survival (DFS) rate was 48.0% and the median DFS time was 25.9 months. The nomogram C-index was 0.54. The nomogram score was similar in the recurrent group (n=27) and the non-recurrent group (n=23) (mean 6.96 vs. 5.26, P=0.25). The DFS time of the high risk group (score ≥5) was shorter than that of the low risk group (score ≤4) (19.5 M vs. 51.2 M), but not with statistically significance (P=0.28). Among the 24 patients who received FOLFOX/FOLFIRI as neoadjuvant chemotherapy for liver metastasis, patients were divided into responders (CR+PR) and non-responders (SD+PD). Although the mean nomogram score of each group was similar (7.40 vs. 7.92, P=0.84), the 3-year DFS rate was significantly higher in the responders than the non-responders (70.0% vs. 28.6%, P=0.02). Conclusion: This study suggests that we should be discreet in applying this nomogram to patients receiving perioperative chemotherapy. At present, perioperative chemotherapy with new drugs might affect the disease-free survival after hepatectomy, suggesting that a new nomogram needs to be established.View full abstractDownload PDF (1190K) Full view HTML
CASE REPORT
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Eiichi Eto, Yosuke Ueno, Katsuhiko Hidaka, Koichi Yano, Hiromasa Fujit ...Article type: CASE REPORT
2014 Volume 47 Issue 9 Pages 477-483
Published: September 01, 2014
Released on J-STAGE: September 19, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLA bedridden, 68-year-old man with a history of intracranial hemorrhage 8 years previously, and who received percutaneous endoscopic gastrostomy (PEG) at that time was admitted to our hospital with a complaint of tar-like bloody vomiting. A laceration at the esophagogastric junction (Mallory-Weiss syndrome) and gastric volvulus were found by emergency upper endoscopy. Since the gastric volvulus could not be endoscopically repaired, laparoscopic surgery was done to repair the gastric torsion. A fascicular band between the abdominal wall and the anterior gastric wall caused by PEG was observed. The transverse colon coiled itself around the band (internal hernia), and then the stomach was twisted by traction of the displaced transverse colon. After reducing the internal hernia of the transverse colon, the gastric volvulus was spontaneously repaired. After that, the fascicular band was transected. The postoperative course of the patient was good. Cases with gastric volvulus caused by PEG are rare. Our search of the Japanese literatures yielded only 3 previous ones.View full abstractDownload PDF (1557K) Full view HTML -
Yoshihiro Takahara, Naganori Hayashi, Yoshiaki Okamoto, Kensuke Suzuki ...Article type: CASE REPORT
2014 Volume 47 Issue 9 Pages 484-489
Published: September 01, 2014
Released on J-STAGE: September 19, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLAn aortoduodenal fistula is a rare, lethal cause of massive gastrointestinal tract bleedings. Primary aortoduodenal fistula (PADF) is an abdominal communication between the aorta and duodenum, whereas secondary aortoduodenal fistula is usually a result of previously implanted aortic prosthetic graft repairs. We report a patient who underwent partial duodenal resection for a PADF after stent-graft repair. An 87-year-old man was referred to our hospital because of hematemesis and pre-shock state. After diagnosis of PADF, the patient had undergone stent-graft repair. After stent-graft repair, we performed a partial resection of the duodenum for preservation of stent graft infection. He died of myocardial infarction after 5 months from stent-graft repair. Conventional treatment of PADF is based on debridement, repair of the duodenal fistula, and removal of inciting factors. Frequent extra-anatomic vascular bypass procedures are necessary. Recently, some studies have reported stent-grafting for aortoduodenal fistulas. However, since there was a risk of infection after stent-graft therapy, we performed a partial resection of the duodenum. We believe strict observation is necessary because the long-term prognosis of stent-graft infection is unclear.View full abstractDownload PDF (1133K) Full view HTML -
Sumiharu Yamamoto, Hiroki Satou, Izuru Endou, Masatoshi Kubo, Tetsunob ...Article type: CASE REPORT
2014 Volume 47 Issue 9 Pages 490-498
Published: September 01, 2014
Released on J-STAGE: September 19, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLWe report a case of a 64-year-old woman who presented with abdominal pain and a palpable tumor in the right abdomen. Blood analysis revealed an increased level of CEA, and endoscopic examination detected a Type 2 mucinous adenocarcinoma of the duodenal descending limb opposite from the hepatopancreatic ampulla of Vater. CT showed a 10 cm right abdominal cavitary tumor perforating into the duodenum and ascending colon, invading the transverse colon with lymph node metastasis, and possibly invading the inferior vena cava. The tumor was considered unresectable and S-1 chemotherapy was initiated. Initial chemotherapy generated a reduction in the level of CEA by half. Abscess formation in the tumor cavity induced severe fever and anemia, making it impossible to continue S-1 chemotherapy. Pancreatoduodenectomy and right hemicolectomy were performed. Tumor pathology showed duodenal mucinous adenocarcinoma with invasion to the colon and metastasis to one lymph node next to the inferior vena cava. Adjuvant S-1 chemotherapy was continued postoperatively and there were no signs of recurrence at 18 months postoperatively. Thirteen Japanese cases of primary duodenal mucinous adenocarcinoma that included chemotherapy were analyzed, and the present case may provide a therapeutic strategy for similar cases in the future.View full abstractDownload PDF (1522K) Full view HTML -
Hiroshi Sakai, Akira Kobayashi, Akira Shimizu, Takahide Yokoyama, Hiro ...Article type: CASE REPORT
2014 Volume 47 Issue 9 Pages 499-507
Published: September 01, 2014
Released on J-STAGE: September 19, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLDifferentiation of hemorrhagic hepatic cysts from mucinous cystic neoplasms (MCN) is often difficult on the basis of imaging studies, particularly when the mural nodule is abnormally enhanced after the intravenous injection of contrast medium. We report 3 cases of hemorrhagic hepatic cyst with a characteristic contrast pattern observed during preoperative dynamic CT and MRI studies. In all 3 cases, the following imaging findings suggested the presence of a hemorrhagic hepatic cyst: hyperintense cystic contents on T1-weighted MRI, extreme hypointense area in mural nodules on T2 star-weighted MRI, and a discordance in mural nodule characteristics between US or MRI and CT findings. However, dynamic studies demonstrated focal enhancement during the early phase coupled with progressive centrifugal enhancement during the delayed phase in the mural nodules. The enhancement of the mural nodule did not exclude the possibility of MCN; therefore, we performed a hepatectomy in all 3 cases. Histological examinations showed that the mural nodules were blood clots with organized granulation and vascularization. No malignant cells were observed in either the mural nodules or the cyst walls. The lesions were diagnosed as hemorrhagic hepatic cysts in all 3 cases. Based on these results, the presently described contrast patterns of the dynamic studies performed in these cases, that is, focal enhancement in the mural nodules during the early phase coupled with progressive centrifugal enhancement during the delayed phase, were suggested to be useful imaging features for the accurate diagnosis of hemorrhagic hepatic cysts.View full abstractDownload PDF (1956K) Full view HTML -
Hiroshi Kawase, Kazuto Otaka, Satoshi Hayama, Tatsunosuke Ichimura, Na ...Article type: CASE REPORT
2014 Volume 47 Issue 9 Pages 508-515
Published: September 01, 2014
Released on J-STAGE: September 19, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLWe report a case of concurrent existence of cholangiolocellular carcinoma (CoCC) and focal nodular hyperplasia (FNH), which, to the best of our knowledge, is the first case reported in Japan. A 64-year-old woman presented with heart failure and CT revealed an S2-liver tumor. Contrast-enhanced CT showed enhancement in the early phase and hypointense nodules in the late phase. CT angiography revealed another tumor in addition to the S2-tumor, which yielded images of defects on CT during arterial portography (CTAP), enhanced on CT during hepatic arteriography (CTHA) and prolonged enhancement in the delay phase. Both tumors were detected as high-intensity masses on enhanced MRI. When the diagnosis of multiple-hepatocellular carcinoma (HCC) was confirmed, laparoscopic lateral segmentectomy of the liver was performed. Although the nodule in S3 was difficult to identify on ultrasonography, it was visible beside the ligamentum teres on minilaparotomy. Histologically, the S2-tumor showed FNH and the S3-tumor showed CoCC. FNH is a non-tumorous lesion caused by hyperplastic changes and CoCC is a rare hepatic primary malignant tumor. Although it is sometimes difficult to differentiate FNH and CoCC from HCC, it is important to enable differential diagnosis of liver tumors.View full abstractDownload PDF (2023K) Full view HTML -
Takayoshi Nakajima, Tadashi Tsukamoto, Tomoyuki Wakahara, Akihiro Toyo ...Article type: CASE REPORT
2014 Volume 47 Issue 9 Pages 516-523
Published: September 01, 2014
Released on J-STAGE: September 19, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLA 76-year-old man was admitted to our hospital with a chief complaint of hypochondralgia and fever. Choledocholithiasis, acute cholecystitis and cholangitis were diagnosed. Three months after endoscopic retrograde biliary drainage (ERBD) and percutaneuous transhepatic gallbladder drainage (PTGBD), laparotomy was performed. Operative findings showed the gallbladder fundus was isolated and embedded into the liver. The cystic duct existed and connected to the common bile duct, but continuity between the cystic duct and the gallbladder fundus was disrupted. The cystic duct was resected just before the confluence of the bile duct, and the gallbladder fundus in the liver was resected after ligatation of the internal biliary fistula flowing into the posterior bile duct. The resected gallbladder included purulent bile juice and was pathologically diagnosed as chronic cholecystitis and continuity between the gallbladder and the cystic duct was not found. We report a rare case of isolated gallbladder fundus with a review of the literature.View full abstractDownload PDF (2832K) Full view HTML -
Susumu Miura, Koji Fujimoto, Yujiro Kokado, Kengo Asari, Hiro Hasegawa ...Article type: CASE REPORT
2014 Volume 47 Issue 9 Pages 524-530
Published: September 01, 2014
Released on J-STAGE: September 19, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLA 76-year-old woman was admitted to our hospital, because of sudden severe epigastralgia. Enhanced CT revealed 9.7×6.2 cm cystic tumor in the tail of the pancreas and massive ascites. The cystic lesion had been noted in the same location of the pancreas on US 2 year spreviously, though its size then was 4.4×4.1 cm in diameter. Emergency laparotomy was performed under a diagnosis of peritonitis caused by rupture of the cystic tumor of the pancreas. Ascites was dark red, and a ruptured mucinous cystic neoplasm in the tail of the pancreas was seen. Distal pancreatectomy with splenectomy was performed. The pathological diagnosis was mucinous cystadenoma of the pancreas with ovarian-like stroma. Rupture of mucinous cystadenoma of the pancreas is extremely rare, because of the firm capsule of the mucinous cystadenoma.View full abstractDownload PDF (1355K) Full view HTML -
Hiromasa Yamashita, Norihiro Yuasa, Eiji Takeuchi, Yasutomo Goto, Hide ...Article type: CASE REPORT
2014 Volume 47 Issue 9 Pages 531-537
Published: September 01, 2014
Released on J-STAGE: September 19, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLA 56-year-old man came to our hospital with abdominal distension and pain. A swollen spleen was palpable in the left upper abdomen. Blood examination showed leukocytosis, thrombocytopenia and elevation of serum IL2 receptor, IgM and IgA. Peripheral blood smear revealed atypical lymphocytes with irregular villi on the cell surface corresponding to villous lymphocyte. CT showed a remarkably swollen spleen. FDG-PET CT showed diffuse high FDG uptake in the spleen. Bone marrow smear showed nodular proliferation of atypical lymphocytes with irregular villi on the marginal cytoplasm. Tartrate-resistant acid phosphatase staining of the bone marrow was negative. Flow cytometry of peripheral blood lymphocytes indicated positive findings for CD20 and CD11c, but negative for CD5 CD10, CD25, and CD103. From these findings, we diagnosed this case as splenic marginal zone lymphoma. Because the patient had abdominal pain and thrombocytopenia, splenectomy was performed. Histopathological finding of the resected spleen showed diffuse proliferation of small to moderate size atypical lymphocytes invading the red pulp by replacing marginal zones. SMZL is one of the low grade non-Hodgkin lymphomas; however, there have been only 9 reported cases in Japan, including the present case , which was the first case with accurate preoperative diagnosis.View full abstractDownload PDF (1589K) Full view HTML -
Fumitaka Asahara, Junichi Matsui, Jun Miyauchi, Nobutoshi AndoArticle type: CASE REPORT
2014 Volume 47 Issue 9 Pages 538-544
Published: September 01, 2014
Released on J-STAGE: September 19, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLMalignant fibrous histiocytoma (MFH) is a tumor that most commonly appearing in the soft tissues of the limbs. It frequently shows bone and tissue metastases and recurrences, but rarely metastasizes to the gastrointestinal tract. We present a case of colonic intussusceptions caused by MFH due to a metastatic tumor arising from the ascending colon. A 68-year-old man underwent a curative operation following a diagnosis of a soft tissue sarcoma in the left chest wall. The tumor was diagnosed definitively as MFH pathologically seven months postoperatively, a thoracic vertebral metastasis was found, and decompression and fusion procedure were performed. Two months later, the patient referred to our hospital suffering from lower abdominal pain. CT showed a large soft mass with intussusceptions in the ascending colon. The histopathological diagnosis following an ileocecal resection was relapse of MFH, 53 months after the resection, but no recurrence in the abdominal cavity was observed. Although lung metastases was recognized, no remarkable changes in bone were observed.View full abstractDownload PDF (2907K) Full view HTML -
Takahiro Yoshikawa, Tomohide Mukougawa, Kouhei Ishioka, Satoshi Nishiw ...Article type: CASE REPORT
2014 Volume 47 Issue 9 Pages 545-550
Published: September 01, 2014
Released on J-STAGE: September 19, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLWe report a rare case of pseudomembranous colitis in a diverted rectum after Hartmann’s operation. A 73-year-old man underwent Hartmann’s operation under a diagnosis of occlusive ileus and perforation of the sigmoid colon due to rectosigmoid cancer. He had severe back pain and anal pain on postoperative day 8. Abdominal CT showed remarkable edema of the diverted rectum and endoscopy showed a lot of pseudomembranes in the diverted rectum, and we diagnosed pseudomembranous colitis. We immediately started oral administration of vancomycin and enema administration of vancomycin into the diverted rectum, and he quickly recovered after treatment. Enema administration of vancomycin was very useful for pseudomembranous colitis of the diverted rectum after Hartmann’s operation.View full abstractDownload PDF (1418K) Full view HTML -
Yuji Kimura, Shinya Ohtsuka, Kazuhide Iwakawa, Manabu Nishie, Ryousuke ...Article type: CASE REPORT
2014 Volume 47 Issue 9 Pages 551-557
Published: September 01, 2014
Released on J-STAGE: September 19, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLA 58-year-old woman was admitted for abdominal pain and colonoscopy revealed a mass at the ascending colon. The tumor was hard, irregularly surfaced and strangulated the lumen of the intestine. We performed right colectomy and lymph node dissection under a diagnosis of suspected poorly differentiated adenocarcinoma of the ascending colon. The resected specimen demonstrated a type 2 tumor measuring 40×30 mm. Pathological studies showed moderately differentiated squamous cell carcinoma without components of adenocarcinoma. Pathologic metastasis was found in the dissected lymph nodes. Postoperative adjuvant chemotherapy with tegafur·uracil/leucovorin was administered. The patient is alive without recurrence at 16 months after the operation.View full abstractDownload PDF (1730K) Full view HTML
SPECIAL CONTRIBUTION
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Effective Methods in Writing Results, Discussions, Acknowledgements, References, Tables, and FiguresTakako Kojima, Edward BarrogaArticle type: SPECIAL CONTRIBUTION
2014 Volume 47 Issue 9 Pages 558-560
Published: September 01, 2014
Released on J-STAGE: September 19, 2014
JOURNAL FREE ACCESS FULL-TEXT HTMLDownload PDF (528K) Full view HTML
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