Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)
Online ISSN : 1882-5133
Print ISSN : 1345-2843
ISSN-L : 1345-2843
Volume 64, Issue 10
Displaying 1-50 of 59 articles from this issue
  • Toshihiko MIKAMI, Tousei OHMURA, Yasuyo SUZUKI, Koichi OKUYA, Kenji OK ...
    2003 Volume 64 Issue 10 Pages 2369-2374
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    Invasive micropapillary carcinoma (IMC) is a rare variant of invasive ductal carcinoma having a high frequency of lymphnode metastasis and a poor prognosis. We treated 7 such cases surgically in the last 2 years. We compared clinocopathological features in these cases, and evaluated the expression of ER, PgR, c-erbB2, E-cadherin and β-catenin immunohistochemically. A high incidence of axillar lymphnode metastasis was found. Aspiration biopsy cytology was done and in most cases Papanicolaoustained smears showed papillary structured cell clusters without a fibrovascular core. This may be a helpful feature for preoperatively diagnosing of IMC. The positive rates of ER and PgR were 71% and 57%, and 71% of cases were judged c-erbB2 positive (++/+++). All cases were E-cadherin and β-catenin positive, but these molecules were not expressed outside micropapillary clusters.
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  • Yasuaki KASHU, Shinsuke KAJIWARA, Hiromichi NAKAGAWA, Hitoshi TANAKA, ...
    2003 Volume 64 Issue 10 Pages 2375-2377
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    A total of 21 patients with thymoma operated on at the hospital was enrolled in this study. These were divided into two groups, one of 8 patients operated with open chest surgery (thoracotomy group) and the other of 13 with video-assisted thoracic surgery (VATS group). These two groups were compared with perioperative and postoperative invasion. Perioperative time and a hospital stay were not different. Mean insertion period of chest drain in thoracotomy group was 5.38 days longer than in VATS group 3.25 days. Mean amount of chest drain discharge was 585.1 ml in thoracotomy group more than in VATS group 110.5 ml. These showed significant differences in two groups. Retrospective evaluation of 21 patients, one patient (7.7%) of thoracotomy group should be operated by VATS because of final diagnosis ectopic lung tissus sized of 5.5 cm. And one patient (12.5%) of VATS group should be operated by open chest surgery while the tumor sized of 4.0 cm was diagnosed Type B3 by WHO classification of primary thymic epithelial tumor. Additional resection of mediastinal space was done later. VATS for thymoma was less invasive than open chest surgery for thymoma, however, the surgical indication using VATS is still deliberate.
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  • Gotaro KATSUNO, Makoto TSUMURA, Yasutaka KOKUDO, Atsushi MURAOKA, Masa ...
    2003 Volume 64 Issue 10 Pages 2378-2383
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    A total of 88 cases of 81patients with spontaneous pneumothorax treated at the hospital from March 1992 to August 2001 were subjected to a study of examining preoperative chest CT and thoracographic findings from the standpoint of postoperative recurrence. Preoperative chest CT and thoracography were conducted in 82 cases and 41cases (including 25 cases with continuous air leakage), respectively. Eight (9.1%) patients developed recurrence of pneumothorax, and three patients of them underwent reoperation. Considering the intraoperative findings, newly formed bullae appeared to be a cause of recurrence. Resulting from these examinations, we conclude that it is difficult to predict the risk factor for postoperative recurrence at this time, in addition, it is important that the area of air leakage can be confirmed by thoracoscopic findings.
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  • Koji DAIRAKU, Masahiko KISHIKAWA, Tadahiko ENOKI, Shinji NOSHIMA, Kimi ...
    2003 Volume 64 Issue 10 Pages 2384-2389
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    A total of 44 patients with cecum mobile treated at the hospital between April 1987 and April 2000 were enrolled in a retrospective analysis and a questionnaire survey. There were 3 men and 41 women, with an average age of 24.0±1.9 years. All 44 patients presented with right lower abdominal pain, and one patient also had vomiting. The average ailing time was 279.8±70.4 days. The preoperative white blood cell counts in all patients were normal. The average length of the ptosis with hepatic flexure was 10.4±0.4cm. Seventeen patients underwent a ten Horn's plication and 27 underwent a ten Horns' plication and an appendectomy. The average hospitalization was 10.6±1.1 days. According to the questionnaire survey, 32 (72%) patients responded that their symptoms improved after the procedure. In addition, 37 (84%) patients responded that this operation was well. Thus, we should consider this ten Horns' plication for patients with persistent and prolonged right lower abdominal pain and constipation.
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  • Shigeo SHIIKI
    2003 Volume 64 Issue 10 Pages 2390-2393
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    A 13-year-old girl was seen at the hospital because of rapidly enlarging mass of the right breast. The mass occupied the entire right breast and was well-defined, elastic, firm, and 15×15cm in size. Results of ultrasonography, computed tomography, and a core needle biopsy suggested juvenile fibroadenoma. The tumor was removed under endoscopic guidance through a small incision in the axilla. The histopathologic diagnosis was juvenile fibroadenoma. Both estrogen and progesteron receptors were positive. To avoid breast deformity, with its attendant psychological affects, and possible dysfunction of lactation, suspected juvenile fibroadenoma is best resected under endoscopic guidance.
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  • Makoto KOIKE, Yoshinori NIO, Masayuki ITAKURA, Seiji YANO, Riruke MARU ...
    2003 Volume 64 Issue 10 Pages 2394-2398
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    Diabetic mastopathy is a specific type mastopathy characterized by prominent fibrosis of the mammary gland and perivascular or periductal infiltration of lymphcytes. So far 19 cases have been reported in this country. In this paper, we report two patients with diabetic mastopathy. Case 1: A 65-year-old woman with NIDDM who had been treated with insulin was pointed out a tumor in the D-region of the left breast by a medical checkup. Ultrasonic examination showed an 18×10mm low echoic mass. Mammography showed a polygonal mass with isodensity as breast glandular issue. Case 2: A 37-year-old woman with IDDM who had been treated with insulin for 26 years noticed a tumor in the C-region of the left breast. Ultrasonic examination showed a 10×8mm low echoic mass. No mass was visualized on mammography. In the two cases, these tumors were suggestive of cancer on palpation and ultrasonic examination and excisional biopsies were performed. Intraoperative pathologic findings showed keloidal fibrosis and periductal and perilobular infiltration of lymphocytes. Diabetic mastopathy was diagnosed.
    Although the differentiation between this disease and breast cancer is difficult and requrires biopsy, it is a future subject whether needle biopsy or excisional biopsy is recommended.
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  • Hiromi KAWAI, Takayuki OSANAI, Masaki KAKIMOTO, Yoichi TORIYA, Naoya G ...
    2003 Volume 64 Issue 10 Pages 2399-2402
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    A case of mucocele-like tumor, which was resected by endoscopic surgery, is reported. A 51-year-old woman was seen at the hospital because of a lump of the right breast. Physical examination revealed an 1.5×2.0 cm elastic hard tumor with smooth surface and a well movable nodule in the lateral quadrant of the right breast. Mammography revealed a homogeneous mass lesion. Calcification and spiculation were not detected. Echography revealed cysts and duct-ectasia without papillary lesions. Magnetic resonance imaging (MRI) revealed enhancement of the wall, however, no papillary lesion was found. Time intensity curve of MRI revealed benign pattern.
    An aspiration cytology revealed a jelly like substance and epithelial cells which showed malignant cells and mucinous carcinoma was suspected. However, a possibility of benign tumor could not be ruled out, and a lumpectomy was performed using endoscopic technique for cosmetic benefit. Histopathological study of the resected material disclosed that no lining epithelial cells were present in the cystic wall, and that atypical ductal hyperplasia and mastopathy such as sclerosing adenosis were observed but no prominent cancer cells were seen. Mucocele-like tumor was definitely diagnosed.
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  • Hideki TAKADA, Masaji YAMAUCHI, Tatsuaki NAKASHIO, Eisaku SATO, Yoshio ...
    2003 Volume 64 Issue 10 Pages 2403-2405
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    Gastric cancer metastasizing from a malignant phyllodes tumor is rare. A 53-year-old woman underwent simple mastectomy for a malignant phyllodes tumor in October 1996, then partial lobectomy 3 times for metastatic lung tumors 47 months after breast mastectomy. She was readmitted for anemia and melena, and stomach showed metastatis from the malignant phyllodes tumor pathologically. The patient died 51 months after mastectomy. We consider the most effective management of this tumor after mastectomy is early detection of metastasis and aggressive surgical approach if it is resectable.
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  • Motoaki YASUKAWA, Masaaki NAKAHARA, Shigeru IMABUN, Nobutaka HATANAKA, ...
    2003 Volume 64 Issue 10 Pages 2406-2409
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    A 61-year-old woman underwent Bt+Ax+Ic+Mj for right breast cancer in May 1989. The pathological diagnosis was scirrhous carcinoma, n1β (4/9), ER (+), PgR (-), and she was placed on oral UFT and TAM for three years postoperatively. In May 1999, bone metastasis was detected in the left ilium. Four courses of CEF chemotherapy and radiation therapy (42 Gy) followed by weekly docetaxel therapy were administered, and the serum CEA level decreased from 9.0 ng/ml to 2.3 ng/ml. In September 2001, a compression fracture caused by bone metastasis in the right femoral neck was diagnosed, and an artificial femoral head replacement operation was performed. Trastuzumab 90 mg and paclitaxel 60 mg were concomitantly administered for two weeks because the primary and metastatic site were Herceptest 2+, and the CEA value decreased from 13.5 ng/ml to within the normal range, 2.2 ng/ml. Bone scintigraphy did not show complete resolution of the metastatic sites, but no new lesions appeared for 20 months. The combination of trastuzumab and paclitaxel was effective against postoperative multiple bone metastasis in this case.
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  • Soujin SAI, Makoto KATOU, Hiromichi ISHII, Yoshimasa EBIHARA, Mamoru M ...
    2003 Volume 64 Issue 10 Pages 2410-2413
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    A 36-year-old woman was admitted to the hospital because of skin erythema and a tumor of the left breast. Clinical examinations showed highly suspicious inflammatory breast cancer. We performed a modified radical mastectomy after down stage due to neo-adjuvant chemotherapy. Histopathologically, it was diagnosed as comedo intraductal carcinoma at the whole gland without evidence of inflammatory breast cancer.
    Inflammatory breast cancer has clinical characteristics of diffuse skin erythema, edema, and induration. Pathologically, it is diagnosed based on cancer cell embolism and invasion of cutaneous lymph vessel. While intraductal carcinoma rarely appears with inflammation at the skin, and so far only one case has been reported in Japan as far as we could review. We report this rare case of ductal carcinoma in situ presenting an appearance of inflammatory breast cancer, with a review of the literature.
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  • Ken-ichi SUTO, Wataru ICHIKAWA, Yoshitaka TSUJI, Eiichi ARAI, Michio S ...
    2003 Volume 64 Issue 10 Pages 2414-2417
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    We report two cases of pericardial metastasis from gastric cancer with cardiac tamponade. Although pericardial metastasis from gastric cancer is rare, cardiac tamponade induces serious condition. Patient 1, a 52-year-old woman, developed cardiac tamponade 4 months after intraadominal metastasis which had occurred 22 months after surgery for gastric cancer. Patient 2, a 68-year-old man, developed cardiac tamponade 2 months after metastasis to the neck, mediastinal, and abdominal lymph nodes which had occurred 30 months after surgery for gastric cancer. We performed pericardial puncture and/or production of subxiphoid pericardial window after the devolopment of cardiac tamponade. However, they died 4 and one month after the onset of tamponade, respectively. There have been no patients who recovered from the condition by pericardial puncture and production of subxiphoid pericardial window, and local infusion of antineoplastic agents and symptomatic treatments should favor the importance of QOL in these patients. The development of new antineoplastic agents and new other treatments are expected in the future.
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  • Kazuyuki MIZUNUMA, Naoki HARUTA, Ryo SHINHARA, Manabu KURAYOSHI, Yuich ...
    2003 Volume 64 Issue 10 Pages 2418-2421
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    A 27-year-old woman was admitted to our hospital because of pain and swelling of unknown cause in the left lower extremity. She was diagnosed as having deep venous thrombosis complicated with pulmonary embolism on imaging methods. We inserted a temporary vena cava filter to prevent aggravation of pulmonary embolism with anticoagulant therapy. No complications occurred during insertion of the filter and it was removed 13 days after insertion. Thereafter no severe complications occurred and the patient was discharged very much improved. This is thought to be a case of deep venous thrombosis due to protein S deficiency. In this case there were no probable causes of deep venous thrombosis other than a significant decrease in protein S activity. Protein S deficiency caused abnormal coagulation might originate these pathologic conditions in this case. In the treatment of young women of childbearing age, we must carefully indicate a temporary vena cava filter and select the type of the filter. Further we must follow them for a long time considering the time of withdrawing anticoagulation therapy and establish contact with their gynecologists closely.
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  • Yoshihiro MORIWAKI, Sigeru YAMAGISHI, Hiroshi TOYODA, Takayuki KOSUGE, ...
    2003 Volume 64 Issue 10 Pages 2422-2425
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    We experienced a case of traumatic pneumothorax which was mimicking intraperitoneal free air. The patient injured in a traffic accident underwent on emergency craniectomy due to acute subdural hemorrhage, cerebral contusion, and traumatic subarachnoidal hemorrhage. Chest X-ray examination after the operation showed abnormal air under the right diaphragma and an abdominal CT scan also showed abnormal air anterior the liver surface and lateral to the duodenum. An emergency laparotomy was performed, but, we could not find intraperitoneal free air or gastrointestinal injury. We must notice the risk that CT images for patients with severe shock often show virtual images and easily lead to misunderstanding, because of the restricted time for evaluation of the CT image, difficulty of discussion with other physicians. We can differentiate pneumothorax from intraperitoneal free air by examining whether hepatic round ligament and farciform ligament can be confirmed in the normal position.
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  • Kazuhito YAJIMA, Shuntaro KOYAMA, Akihiro TSUKAHARA, Norio TANAKA, Nob ...
    2003 Volume 64 Issue 10 Pages 2426-2430
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    We report two successful cases of perioperative respiratory management using Bi-level positive airway pressure (BiPAP) system in patients with chronic respiratory failure. Case 1: An 83-year-old man was admitted to the hospital with a diagnosed of cholangitis. He had a considerably decreased value of 530ml (21%) of FEV1.0 due to pulmonary emphysema and bronchial asthma. Diagnosed as having choledocholithiasis following a cholecystectomy, a choledocholithotomy and a choledochoduodenostomy were performed. Case 2: A 32-year-old woman, diagnosed as having cholecystocholedocholithiasis, had a considerably decreased value of 850ml (31%) of vital capacity due to muscular dystrophy. She underwent a cholecystectomy and a choledocholithotomy with minor laparotomy. In both cases, operation was performed under epidural and venous anesthesia without using a muscle relaxant and tracheal intubation. During operation, respiratory management was performed using BiPAP, and the two patients successfully weaned from ventilation without pulmonary complications. BiPAP is a noninvasive ventilation system of continuous positive airway pressure (CPAP). To our knowledge, there have been few reported cases of its use for perioperative management in gastrointestinal surgery. On the basis of the present experience, BiPAP system can be a useful application for treating a patient with chronic respiratory failure.
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  • Jae Sun PARK, Kichizo KAGA, Masayuki IWASAKI, Hiroshi INOUE
    2003 Volume 64 Issue 10 Pages 2431-2434
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    A 68-year-old man complaining of fever and cough was referred to the department of internal medicine in our hospital for close examination because chest plain X-ray film showed right thoracic pleural effusion at another hospital in January 1997. There was a previous history of undergoing a laparoscopic cholecystectomy elsewhere in 1993. After admission to the hospital, the pleural effusion was exudative, and a culture of the effusion yielded E. coli. Further exploration was conducted for pyothorax of unknown origin, and CT, magnetic resonance imaging, abdominal ultrasonography showed a cystic tumor shadow in the extrahepatic diaphragm. With a diagnosis of acute pyothorax and diaphragmatic tumor, administration of antibiotics was started and surgery for pyothorax was performed. At surgery, we performed a thoracotomy-aided scarification of empyema cavity with Two Windows Method. After the surgery irrigation was carried out and the subdiaphragmatic tumor removed after inflammatory reaction subsided. The lesion was presented in the subphrenic space, and was an abscess surrounded by hypertrophied cicatrical tissue, including a calcium bilirubin calculus.
    We sometimes encounter cases of subphrenic abscess caused by lost stone at laparoscopic cholecystectomy in the literature, however, rarely see such cases presented with pyothorax as this case. This paper reports the case together with some bibliographical comments.
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  • Toshiyuki NATSUME, Yoshiji WATANABE, Takashi MARUYAMA, Hajime TANAKA, ...
    2003 Volume 64 Issue 10 Pages 2435-2439
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    We report five cases of spontaneous esophageal rupture treated at the hospital from 1995 to 2002. Primary closure was carried out in all five cases including one case added fundic patch. Surgery was carried out within 6 hours after rupture in two cases, in which leakage did not occur. Leakage of the sutured site was seen in another two cases, in which operation was performed over 15 hours after the perforation. One patient died of serious mediastinitis. One patient who was added fundic patch to primary closure to prevent anastomotic leakage was discharged well despite a delayed surgical treatment, 15 hours after the onset, and corrosion of the mediastinum due to repeated vomiting. We think that some means to prevent anastomotic leakage must be considered to patients at a high risk of developing leakage. The paper also presents an analysis of a total of 98 cases of spontaneous esophageal rupture reported in the Japanese literature from 1990 till 2002.
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  • Yoshimi IWANUMA, Natsumi TOMITA, Takayuki AMANO, Yoshiaki KAJIYAMA, Bu ...
    2003 Volume 64 Issue 10 Pages 2440-2443
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    A 42-year-old man was admitted to the hospital because of epigastralgia in March 2000. Endoscopic examination revealed a 0-IIa+IIc lesion, 15mm in diameter, in a short segment Barrett's esophagus which was extended 2.5cm from the esophago-gastric junction. A histological examination of a biopsy specimen revealed adenocarcinoma. For making the definitive diagnosis, an endoscopic mucosal resection was performed. Pathological findings of the resected specimen were tubular adenocarcinoma, sm2 invasion, with the positive external margins. An extended mediastinal lymph node dissection and an esophagectomy with a reconstruction of the gastric tube were performed. There was no residual tumor in the esophagus, but two lymph node metastases were present in the mediastinum and abdomen. The status of the lymph node metastasis of superficial adenocarcinoma and the depth of tumor invasion have not been clarified as yet. In this case, D2 lymphadenectomy was required as curative operation for superficial esophageal adenocarcinoma.
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  • Michihiro ORIHATA, Hiroyoshi MIURA, Yoshifumi RI, Minoru MORIWAKI, Ter ...
    2003 Volume 64 Issue 10 Pages 2444-2449
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    A 65-year-old woman was seen at the hospital because of discomfort of the chest lasting from late October 1999. Endoscopical examination showed 2-type shaped, poorly differentiated squamous cell carcinoma of the middle intrathoracic esophagus. She underwent a surgical resection of the esophagus by right thoracotomy and laparotomy on January 13, 2000 (Mt, 2-type, 2.5×2.0×1.0 cm). This tumor was present within the submucosal layer of the esophagus (pT1b), and its pathological finding was small cell type undifferentiated carcinoma. Histopathological stage of esophageal cancer was pStage 1.
    From April 1, 2000, she felt a decrease of urination, edema and general fatigue, and was admitted again on April 11. The blood potassium level was low (2.1mEq/l), and blood ACTH and cortizol levels were high (1, 203.9pg/ml and 112.5 μg/dl, respectively). Abdominal CT scan showed multiple liver metastasis and bilateral hypertrophy of the adrenal glands. And immunohistochemical stain to detect ACTH on her esophageal cancer was positive. Ectopic ACTH syndrome induced by liver metastasis of esophageal cancer was diagnosed. She was treated with a blocker of adreno-cortizol synthesis, op'-DDD, and combined chemotherapy with CDDP and CPT-11, but she died on May 31, 2000.
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  • Tatsuo UMEOKA, Shigeki MURAKAMI, Kunihiko SAKAI, Takehiro TAKAMA, Yasu ...
    2003 Volume 64 Issue 10 Pages 2450-2453
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    A 41-year-old man seen elsewhere for hematemesis, was found is gastrointestinal endoscope to have a hemorrhagic ulcer in the upper posterior wall of the stomach. Bleeding was stopped using a endoscopic clip. Two days later, he was sent our hospital and treated conservatively, but his ulcer bled again. We stopped bleeding endoscopically. We had conducted gastrointestinal endscopy 6 years ago in this man and pointed out a submucosal tumor at the same site. We consider tumor resection necessary for stopping bleeding permanently, and conducted partial gastrectomy. The tumor was diagnosed pathologically as myoepithelial hamartoma.
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  • Yoichi KIKUCHI, Hiroshi MIZUNUMA
    2003 Volume 64 Issue 10 Pages 2454-2458
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
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    Gastric duplication, a congenital malformation, is one of duplication of the intestine. It is rare and so far less than 100 cases have been reported in Japan. We report a case of gastric duplication with gastric cancer which invaded the wall of the duplication stomach.
    A 66-year-old woman diagnosed as having gastric cancer on the greater curvature of the lower part of the stomach in August 2001 was found to have a cystic tumor 11×6cm in diameter in the right upper quadrant of the abdomen on upper abdominal CT scan and echogram. A distal gastrectomy including the cystic tumor adherent to the stomach was performed. Histopathological study disclosed that smooth muscle continued to the proper muscle layer of the stomach was present in the cyst wall and mucosal epithelium of the stomach was seen in part of the inner aspect. Gastric duplication was consequently diagnosed. The gastric cancer had gone beyond the muscle layer and continuously invaded the duplicated stomach.
    So far four domestic cases and three foreign cases of gastric duplication with malignant tumor have been reported as far as we could review. This is the first case in tumor around the stomach, we must make diagnosis by keeping the possibility of gastric duplication in mind, and remove it considering a possible association of malignancy.
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  • Takashi MASUDA, Shouzou ISHIBASHI, Tetsuo HISADOME, Hirotaka MIYAZONO
    2003 Volume 64 Issue 10 Pages 2459-2462
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    A 34-year-old man was brought into the hospital by ambulance because of a 3-day history of frequent vomiting, general fatigue and dyspnea. He had been treated for duodenal ulcer at another hospital 6 years before admission. On admission, the patient showed a sign of acute pre-renal failure due to dehydration with high BUN and serum creatinine levels of 68.5mg/dl and 6.8mg/dl, respectively.
    Arterial blood gas analysis showed the presence of metabolic alkalosis, which was attributed to the loss of gastric juice by frequent vomiting. Continuous hemo-filtration was instituted with effects for his acute renal failure with oliguria. Gastrointestinal endoscopy confirmed the presence of post-bulbar duodenal ulcer causing sever stenosis. No evidence of malignancy was noted. Distal gastrectomy with Billroth II method was performed on 34th hospital day with a smooth postoperative recovery.
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  • Wataru SAKAMOTO, Koji SEKIKAWA, Kumiko WATANABE, Yoshihisa KOYAMA, Nor ...
    2003 Volume 64 Issue 10 Pages 2463-2467
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    Many cases of duodenal carcinoid reported previously have involved solitary and single lesions, and duodenal carcinoid accounts for only 4.5% of all duodenal tumors. Multicentric duodenal carcinoid lesions are very rare. We report the case of a 65-year-old man who underwent partial duodenectomy and distal gastrectomy for multiple duodenal carcinoids. An upper gastroduodenal series in a general screening examination at an affiliated hospital revealed a slight abnormality in the stomach. Endoscopic examination detected a polypoid lesion (Yamada-I type) in the bulb of the duodenum, and the histological diagnosis of the biopsy specimen was duodenal carcinoid. Endoscopic mucosal resection (EMR) was performed in our hospital, and the specimen was histologically diagnosed as primary duodenal carcinoid. A week later, another lesion was found close to the EMR scar during a follow-up endoscopic examination, and partial duodenectomy and distal gastrectomy were performed a month later. Pathological examination of the whole resected specimen revealed scattered multicentric duodenal carcinoid lesions, and immunohistochemical analysis showed that each lesion had quite different characteristics. Our experience in this case shows the importance of careful endoscopic analysis for multicentricity in case of duodenal carcinoid.
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  • Michiyasu NONAKA, Koji YOSHIDA, Koji IKEJIRI, Hideki SAITSU, Motonori ...
    2003 Volume 64 Issue 10 Pages 2468-2473
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    Two cases of gastrointestinal stromal tumor (GIST) of the duodenum are reported.
    Patient 1, a 75-year-old woman referred to the hospital because of right lateral abdominal oppressive sensation, was found having a segmental torous lesion without mucosal change in the trasitional area from descending to horizontal portion of the duodenum on duodenography and upper gastrointestinal endoscopy. After considering findings of CT, magnetic resonance imaging, and angiography, surgery was performed with a diagnosis of non-epithelial tumor (questionable GIST). During surgery there was no hepatic metastasis, peritoneal dissemination, or lymph node involvement. The removed tumor was 11×11×8cm in dimension.
    Patient 2, a 58-year-old man, was referred to the hospital because of an abnormality on upper gastrointestinal series at a medical checkup. Close exploration disclosed an about 3-cm sized protruding tumor with smooth margin in the duodenal lumen at the horizontal portion of the duldenum. With a diagnosis of non-epithelial tumor (questionable GIST), the patient was operated on.
    In the two cases, a local excision of the duodenum was carried out. Pathological diagnosis was duodenal GIST, uncommitted type. Case lwas diagnosed as malignant and Case 2 was diagnosed as benign GIST of the duodenum.
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  • Ataru NAKAYAMA, Kazuo TSUJIMOTO, Norio ITO, Nobumichi TAKEUCHI
    2003 Volume 64 Issue 10 Pages 2474-2477
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    An 84-year-old man was seen at the hospital because of lower abdominal pain and vomiting. The patient was diagnosed with having intestinal obstruction by abdominal X-ray examination, and was admitted on the same day. Since conservative treatment was ineffective, an emergency laparotomy was performed on the 3rd hospital day. During surgery, a large diverticulum (8×7cm in diameter) was located in the ileum about 40cm proximal from the terminal ileum. The diverticulum was twisted clockwise by about 180 degrees, and the ileum was obstructed by flexion at the attachment of the diverticulum. The ileum was wedge-resected. Histologically, Meckel's diverticulum was diagnosed because the diverticulum contained normal ileal mucosa and serosa. No findings of ectopic gastric mucosa nor malignancy were seen. We rarely encounter reports of Meckel's diverticulum in elderly patients, but these patients are often associated with serious complications such as strangulated ileus and intussusception. Meckel's diverticulum must be kept in mind in elderly patients with intestinal obstruction of unknown origin.
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  • Kazuto KANETAKE, Akitsugu HINO
    2003 Volume 64 Issue 10 Pages 2478-2481
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    A 23-year-old man was admitted to the hospital because of increasing lower abdominal pain and vomiting. He had been treated for repeated bouts of lower abdominal pain from his childhood elsewhere. His body temperature was 37.8°C. His abdomen was distended and there were muscle guarding, severe tenderness, and Blumberg's sign. Abdominal CT scan revealed multiple dilated, fluid-filled loops of the small bowel and the collapsed distal ileum. Abdominal free air was not seen. Laboratory tests showed the white cell count of 15, 400/μl and CRP of 0.1 mg/dl. From these findings, an emergency laparotomy was performed under a diagnosis of peritonitis with obstruction of the small bowel, and Meckel's diverticulum was found about 70 cm proximal to the ileocecal valve. The ileum was stenosed with an adhesional band and the diverticulum was volvulated about 180 degrees. The diverticulum lay on the stenosed part of the ileum and resultantly the ileum was obstructed. A partial resection of the ileum including Meckel's diverticulum was performed. We suggest that CT may be helpful for diagnosis when Meckel's diverticulitis is suspected.
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  • Yoshin ADACHI, Kengo NISHIMURA, Toru HIROE, Eiichi HAYASHI, Shunsuke F ...
    2003 Volume 64 Issue 10 Pages 2482-2485
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    This paper presents a patient who was diagnosed as having intestinal tuberculosis involving the terminal ileum and ascending colon after close exploration for repeated episodes of abdominal pain and was operated on.
    A 58-year-old woman with an about 3-year history of repeated episodes of abdominal pain was admitted to the department of internal medicine in our hospital for close exploration on November 21, 2001. Barium enema study, radiography of the small intestine, and colonofiberscopy offered a suspicion of intestinal tuberculosis.
    Biopsy yielded Langhans'huge cells, and hence intestinal tuberculosis was diagnosed. Medical treatment with tuberculostats was conducted, but 11 months later, the patient had repeated bouts of intestinal obstruction. The patient was referred to the department for surgery on October 18, 2002. A right hemicolectomy including the ileum by about 1m in length was carried out on October 22. The postoperative course was uneventful and the patient was discharged from the hospital on the 24th postoperative day. No recurrence has occurred up to now.
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  • Yoshitaka UJI, Akira NAKAE, Suguru MATSUI, Yoshikazu SHIMODE, Toshikaz ...
    2003 Volume 64 Issue 10 Pages 2486-2489
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    An 89-year-old man was admitted to the hospital because of abdominal pain and fever. Physical examination revealed the strong rebound tenderness and muscular guarding in the entire abdomen. CT scan of the abdomen revealed increased density throughout the mesenteric fat. A diagnosis of diffuse peritonitis was made and he was operated on. On exploration, a large amount of serous ascites was found and the mesenterium of the small intestine was reddish and swollen. Biopsy of the mesenterium and abdominal drainage were performed with a suspicion of mesenteric panniculitis. The pathological diagnosis of the mesenteric biopsy was mesenteric panniculitis, showing that inflammatory cells had infiltrated into the mesenteric fat. The operation improved the patient's systemic condition. But CT scans of the abdomen revealed an ischemic enteritis of the small intestine in the 13th day after the operation. Blood vessel's dilator and prednisone were reduced the blood level of C-reactive protein (CRP). Mesenteric panniculitis is a rather rare disease of unknown etiology, characterized by nonspecific inflammation. Mesenteric panniculitis is prone to require surgery because it manifests symptoms of diffuse peritonitis. But the conservative treatment is commonly employed. Mesenteric panniculitis must be kept in mind in the diagnosis of acute abdomen of unknown etiology.
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  • Takamitsu KOMAKI, Kiyoshi YOSHIKAWA, Riichiro NEZU, Masahiro FUJIKAWA, ...
    2003 Volume 64 Issue 10 Pages 2490-2494
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    A 69-year-old woman who had been followed for anemia and a hepatic angioma since June 1997 was admitted to the hospital because of an enlargement of the hepatic angioma and a recently appeared hepatic tumor in June 2000. On admission stool guaiac test was positive, but upper and lower gastrointestinal endoscopies revealed no abnormalities. A needle biopsy of the hepatic tumor offered a suspicion of hepatocellular carcinoma, and surgery was performed on September 12. During surgery a 2 cm-sized tumor was present in the ileum, so that a partial excision of the ileum and a hepatectomy were performed. The pathological diagnosis was carcinoid of the small intestine and its hepatic metastasis. As of 2 years 6 months after the operation, she has not experienced recurrence and is followed in the outpatient clinic.
    Carcinoid of the small intestine is accidentally detected and often associated with metastasis in many cases, and accordingly the prognosis is poor. However, there are some reports describing that the patients undergone direct therapy such as surgical excision or intrahepatic arterial infusion therapy are expected to have improved prognosis. In this paper, we present a case of small bowel carcinoid presented with hepatic metastasis in which the primary and metastatic foci could be resected, together with some bibliographical comments.
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  • Yasuyuki FUKAMI, Hiroshi HASEGAWA, Seiji OGISO, Eiji SAKAMOTO, Tsuyosh ...
    2003 Volume 64 Issue 10 Pages 2495-2499
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    Patient 1, a 45-year-old man was transferred to the hospital for left abdominal gunshot wound. Blood pressure was 60mmHg, a gunshot wound found in the left lateral region of abdomen. The bullet was palpated in the right lateral region. Upon laparotomy, the sigmoid mesocolon and jejunum ligament were damaged and the jejunum and an ascending colon were perforated.
    A partial jejunectomy and an ileocecal excision were performed.
    He was discharged from the hospital on the 28th hospital day.
    Patient 2, a 41-year-old man was admitted to the hospital because of several abdominal gunshot wounds. Transfix wounds were found in the right armpit, lumbar part to left abdomen, and left thigh. Blindness wounds were found in the right abdomen and left crus.
    A partial jejunectomy and an ileocecal excision were performed under laparotomy. We removed the bullets in the abdominal wall and left crus. He was discharged from the hospital on the 45th hospital day. The gunshot wound seems to increase in the near future, though it is still rare in Japan. We think that quick decision-making of operation is required patients who are suspected to have intraabdominal injuries due to abdominal gunshot wounds.
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  • Keiichi SATO, Kenshi WATANABE
    2003 Volume 64 Issue 10 Pages 2500-2503
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    The case is a 49-year-old female with a history of depression. She underwent a checkup at this hospital for the chief complaint of abdominal pain and a total of seven pointed foreign bodies were noted in an abdominal X-ray exam, so the patient was diagnosed with foreign bodies in the digestive tract and admitted on the same day. During admittance, findings of digestive perforation were not noted and several days were thought to have lapsed since swallowing, so the patient was first given nothing by mouth and the course observed. Afterwards, the policy was to at leisure endoscopically and surgically remove the foreign bodies. Lower and upper gastrointestinal tract endoscopy was performed on the fourth day of admittance and lower gastrointestinal tract endoscopy was performed on the eleventh day of admittance; a total of four foreign bodies were removed. One body was naturally eliminated on the fourth day of admittance. However, the remaining two lodged in the intestinal tract, so they were removed surgically on the seventeenth day of admittance. In the current case, a laparotomy could not be avoided, although when cases of foreign bodies in the digestive tract are encountered, the site of foreign bodies should be accurately essessed upon first examination. When even sharp foreign bodies can be removed endoscopically, endoscopic removal should be actively attempted.
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  • Toshiyuki TAKIKAWA, Kiyoshi TAKAISHI
    2003 Volume 64 Issue 10 Pages 2504-2507
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    This paper deals with a 64-year-old man who was found having an ectopic pancreas in the ileum when he was operated on with a diagnosis of rectal cancer.
    Ectopic pancreas appears commonly in the gastrointestinal tract in the vicinity of the duodenum, but rarely in the ileum. Almost all surgical cases of ectopic pancreas in the ileum present with intussusception, and few cases are found accidentally during surgery for other disease. In order to detect the ectopic pancreas associated with other disease, it is very important to carry out routine exploration of the peritoneal cavity at the surgery and to be faithful to the fundamental maneuvers such as so-called ‘chonarabe’.
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  • Hideaki KATOH, Nozomu MURAKAMI, Iwao ADACHI, Katsuya MORITA, Hiroshi Y ...
    2003 Volume 64 Issue 10 Pages 2508-2511
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    Recently, it has been reported that STI571 (imatinib) is effective to c-kit positive gastrointestinal stromal tumors (GIST). We experienced a good response of STI571 to GIST of the small intestine with peritoneal dissemination. A 76-year-old man was admitted to the hospital because of melena and anemia. Abdominal CT scan and small intestinal fluoroscopy demonstrated a mass 3cm in diameter on the jejunum. During surgery, we recognized an elastic hard mass at 60cm from the Treitz ligament and multiple elastic masses 5-10mm in diameter in the almost entire peritoneum. Intraoperative pathologic diagnosis was small intestinal GIST with peritoneal metastasis. We excised the jejunal mass which was the source of bleeding. The mass was smooth muscle type of GIST with c-kit positive and high grade of malignancy. After discharge, we talked with the patient and prescribed STI571 from 17th postoperative week. The ascites decreased and a complete remission of peritoneal dissemination was attained.
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  • Yuka FUJISHIMA, Toshimasa IZUMI, Hidetoshi ONCHI, Hirofumi AWATA, Kazu ...
    2003 Volume 64 Issue 10 Pages 2512-2515
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    A 51-year-old man was diagnosed as having panperitonitis due to perforation of acute appendicitis, and an appendectomy and peritoneal drainage were carried out. Six days later, redness and swelling covering from the lower abdomen to scrotum appeared. Computed tomography of the abdomen revealed subcutaneous gas and abscess formation. Eight days after the operation, debridement of necrosed tissue was performed. Although the abscess extended forward along the necrosed fascia, subcutaneous fat tissue only had an edematous change. Bacteriologic cultures showed a mix of aerobic and anaerobic organisms, including Bacteroides and Streptococcus.
    Fournier's gangrene is a specific type of necrotic fasciitis. It is a fulminating infection characterized by a rapid progress of necrosis of subcutaneous tissue covering from the lower abdomen to scrotum. This is the 3rd case report of Fournier's gangrene resulting from perforated appendicitis in Japan. We etiologically think that fournier's gangrene is associated with a drain through the abdominal wall and fascia in an appendectomy.
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  • Akihiko HIRAKAWA, Takaya TANAKA, Shintaro KAJIMOTO, Hiroyasu ISHIKURA, ...
    2003 Volume 64 Issue 10 Pages 2516-2519
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    A 53-year-old man with bloody mucous diarrhea and anal pain was found to have an abscess around the anus and underwent incision and drainage. Since bloody mucous diarrhea continued after surgery and ileus developed, the patient was transferred to our hospital, at which time he had a high fever, abdominal tenderness, and induration of the anal region. Abdominal X-P and CT detected ileus. Since abdominal pain was aggravated the next day, laparotomy was conducted and most of the colon found to be necrotic. Resection of the total colon and ileostomy were done, but the patient developed postoperative multiple organ failure and died. A diagnosis of amebic colitis was made based on histopathological examination. Patients with bloody mucous diarrhea should be diagnosed early based on this possibility. For surgery in fuluminant cases, the procedure should be selected based on the patient's general condition.
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  • Hiromichi ISHII, Soujin SAI, Yoshihiro KITAGAWA, Yoshimasa EBIHARA, Ma ...
    2003 Volume 64 Issue 10 Pages 2520-2524
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    We experienced a case of fulminant amebic colitis associated with multiple colon perforations. A 31-year-old man was admitted to the hospital because of abdominal pain, fever and diarrhea. He was diagnosed as having an intraabdominal abscess due to perforation of the bowel based on abdominal computed tomography (CT), and an emergency operation was performed. During the surgery, necrotic changes and multiple perforations were noted at the cecum, ascending, transverse and discending colons. These colons were resected. Intraoperatively, we suspected of amebic colitis. Cytological examination by periodic acid Schiff staining of ascites showed Entamoeba histolytica. He attained remission without mortal complications. In Japan, amoebiasis has been increasing recently, especialy, in patients who have returned from abroad and have practiced homosexual behavior. The mortality rate of fulminant amebic colitis is very high. Prompt diagnosis and treatment are important to save the patient's life. Cytological examination by PAS staining of ascites is useful for making prompt diagnosis.
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  • Satoru KAGAMI, Natsuki TOKURA, Tomohiko GOTO, Shigeyasu KAMATA, Kazuo ...
    2003 Volume 64 Issue 10 Pages 2525-2528
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    Mucosa-associated lymphoid tissue (MALT) lymphoma of the colon and rectum is extremely rare. We present a case of MALT lymphoma of the rectum that regressed after eradiation of Helicobacter pyloli (H.P.). A 52-year-old woman complaining of anal bleeding was admitted to the hospital with a suspicion of MALT lymphoma. Colonoscopic examination revealed an ulcerative lesion with bleeding in the dentate line and rectum (Rb). Pathological examination showed diffuse infiltration of atypical lymphocytes, which were positive for CD79 α immunostaining and also formed lymphoepithelial lesions, and confirmed the diagnosis of B-cell type MALT lymphoma. Under the enough informed consent, eradication therapy for H.P. was successfully carried out. Colonoscopic examination showed marked regression of the rectal tumor. Almost complete regression was further confirmed by a colonoscopy 6-months after the treatment.
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  • Noriharu MIKATA
    2003 Volume 64 Issue 10 Pages 2529-2533
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    Three cases of colon tumors occurring after treatment of renal cancer with interferon are reported. Patient 1, a 68-year-old woman, was found to have sigmoid colon cancer due to chronic anemia at the fourth year after receiving injections of interferon for 6 years following a nephrectomy for renal cancer. She underwent a sigmoid colectomy and histopathologic study revealed moderately differrentiated adenocarcinoma. Patient 2, a 68-year-old man, was found to have tumors in the ascending and transverse colons on colonoscopy after injections of interferon for 3 years 6 month following a nephrectomy for renal cancer. He underwent a hemicolectomy and histopathological examination showed well differrentiated and moderately differrentiated adenocarcinomas. Patient 3, a 54-year-old man, developed bloody stool when interferon had been administered for 2 years after a nephrectomy for renal cancer. Colonoscopy showed four tumors in the sigmoid colon and the tumors were removed by electrocautery. Colonic adenomas were observed histopathologically.
    In addition to these three case reports, the development of secondary tumors after interferon therapy is discussed with reference to the literature.
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  • Naoki KOSHIISHI, Takenao IDEZAWA, Ayako INOUE, Shuugo SHIBA, Mamoru OK ...
    2003 Volume 64 Issue 10 Pages 2534-2538
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    A 64-year-old woman was admitted to the hospital because of diarrhea. Colonoscopic examination showed a sessile yellow lesion of the lower rectum. Histological examination of a biopsied specimen was diagnosed as rectal carcinoid tumor. We recommended endoscopic resection to the patient but she disapproved the therapy. We performed a low anterior resection. The resected specimen contained a small elevated lesion measuring 7×5mm. The tumor was limited within the submucosal layer, having submucosal vascular invasion and regional lymph node involvement. The small carcinoid tumor of the rectum with the diameter of less than 10mm and submucosal invasion associated with lymph node metastasis is rare. To the best of our knowledge, this is the 13th case reported in Japan. We consider that local resection is indicated for rectal carcinoid tumor less than 10mm in diameter, and radical operation with lymph node dissection is indicated if vascular invasion is present, even though muscle invasion is absent on histological examination.
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  • Tetsuhisa YAMAMOTO, Koichi TAKEI, Takayoshi SEKIKAWA, Jun-ichi OKUDA, ...
    2003 Volume 64 Issue 10 Pages 2539-2542
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    Primary appendiceal cancer is rare, especially that with fistula formation to the abdominal wall and invasion into the colon. A 67-year-old woman was referred to the hospital because of a right lower abdominal skin fistula. A fistulography revealed a fistula formation to a tumor of the ascending colon, and a colonoscopy suggested the extra-colonic origin of the tumor. Abdominal CT and magnetic resonance imaging scans demonstrated an ileocecal tumor invading the abdominal wall. A biopsy of the ascending tumor showed mucinous adenocarcinoma. We diagnosed the case as primary appendiceal cancer with fistula formation to the skin and ascending colon. Right colectomy with lymph node dissection and a fistulectomy were performed.
    Histological evaluation confirmed mucinous appendiceal cancer with invasion to the ascending colon and fistula formation to the skin. The patient has been healthy for 20 months postoperatively.
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  • Yasuhiro TOYODA, Takashi KOYAMA, Shigeru KURISU, Hiromi MAEDA, Masahik ...
    2003 Volume 64 Issue 10 Pages 2543-2546
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    With the aging of the Japanese population year by year, the number of laparotomies performed on patients of an extremely advanced age will go on increasing. This report is concerned with an 101-year-old woman who underwent a curative operation for cancer of the transverse colon. After her initial complaint of hematochezia was diagnosed as transverse colon cancer at another clinic, she was admitted to the hospital. A right hemicolectomy combined with a resection of the small intestine was performed. Invasion of the ileum was noted, but there was no lymph node metastasis, liver metastasis, or peritoneal dissemination, so that surgery with curability A was considered feasible. The postoperative course was uneventful, and the patient was discharged on the 15th postoperative day. So far, 14 cases, including our patient, of laparotomy in patients over 100 years old have been reported in Japan. Of these 14 cases, elective surgery was performed in three case, included our case. All three cases were of colorectal cancer and no death were noted among them. We think that elective laparotomy with the same degree of surgical invasiveness as a colectomy can be safely performed without severe complications even for patients of an extremely advanced age, that is, over 100 years old.
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  • Ei HAKU, Ryo UYAMA, Nobuyuki SAKAMOTO, Kiyoshi HATAYA, Takemasa MIDORI ...
    2003 Volume 64 Issue 10 Pages 2547-2553
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    A 68-year-old woman was admitted to the hospital for the purpose of surgery after diagnosed as having gastric cancer (Borr 3). Colonofiberscopy performed for perioperative screening disclosed IIc type early cancer of the ascending colon. We diagnosed the case as synchronous double cancer involving the stomach and colon and performed a total gastrectomy (D2) and an ileocecal excision (D2). Histopathologically the colonic lesion was poorly differentiated adenocarcinoma (por2) associated with the same prominent fibrosis of the stroma as the gastric cancer had; it mainly situated in the submucosa and diffusely extended to the proper muscle layer. Accordingly gastric cancer with synchronous metastasis to the colon was diagnosed.
    It is very rare that IIc type metastasis of gastric cancer is found in the ascending colon in which both the primary and metastatic lesions are simultaneously detected and successfully resected. Although preoperative examination of the colonic lesion revealed the same poorly differentiated adenocarcinoma as gastric cancer, we could not diagnose it as colonic metastasis before surgery and had a great difficulty in differentiation from primary colonic cancer. The reasons were because the colonic lesion had not diffuse invasive type in morphology which is characteristic of metastatic colorectal cancer, and it situated in the uncommon site for metastasis from gastric cancer.
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  • Kenji TANIGUCHI, Kozo KIRIYAMA, Masaki WADA, Atsushi HIRAI, Hiroyuki S ...
    2003 Volume 64 Issue 10 Pages 2554-2558
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    A 52-year-old woman was referred to the hospital because of a cystic lesion in the liver detected by ultrasonography at another hospital. Computed tomography, magnetic resonance imaging and ultrasonography of the abdomen revealed a multilobular cystic tumor 14cm in maximum diameter in the left lobe of the liver. The cystic wall was smooth and thin with partially thickened septum. The serum level of CA19-9 was notably high, 4, 056U/ml. Hepatobiliary cystadenoma or cystadenocarcinoma was diagnosed, and a left lobectomy was performed. In the resected specimen, and encapsulated multilobular cystic mass was measured 14×10×9cm in dimension. Microscopically, the inner layer of the cyst with papillary projections in places was lined by a single layer of mucin secreting columnar epithelium, and the intermediate layer was composed of dense mesenchymal stroma, so-called ovarian-like stroma, interposed between an inner epithelial lining and an outer connective tissue layer. Mucinous biliary cystadenoma with mesenchymal stroma of the liver was diagnosed. The high serum CA19-9 level was normalized. No signs of recurrence have occurred, as of 2years 2months after the operation. Hepatobiliary cystadenoma with ovarian-like stroma is a rare neoplasm with possible malignant transformation. Total excision of the tumor is recommended for hepatobiliary cystadenoma.
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  • Masayuki TORI, Masaaki NAKAHARA, Kazushi KUROZUMI, Shigeru IMABUN, Kaz ...
    2003 Volume 64 Issue 10 Pages 2559-2563
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    A 63-year-old man was admitted to the hospital because of upper abdominal pain, back pain, and slight fever. On imaging methods, diffuse dilatation of the intrahepatic bile ducts in the left lobe was confirmed, and among them, abdominal ultrasonography demonstrated a tumor-like lesion at the proximal side of the dilated bile duct in the left lobe. Choledochography disclosed strictures of the bile ducts and dispersed dilatations of them. With a suspected diagnosis of cholangiocellular carcinoma, a left lobectomy was performed. Histopathological examination of the resected specimen, however, showed primary sclerosing cholangitis (PSC) and no malignant lesion. It is sometimes extremaly difficult to differentiate localized PSC from bile duct cancer, but it is desirable to treat localized PSC by surgical resection because it would provide good prognosis and association of bile duct cancer is probable.
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  • THE USEFULLNESS OF THE GUIDANCE WITH ERBD TUBE DURING CHOLECYSTECTOMY
    Hideo SHIGEMATSU, Hiroyuki KAWAMI, Tetsuya TOUGE
    2003 Volume 64 Issue 10 Pages 2564-2568
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    A 54-year-old woman with an one-month history of abdominal full sensation was admitted to the hospital under a diagnosis of gallstone. At first, she was suspected to have common bile duct (CBD) stone because she showed icterus. Endoscopic retrograde cholangiopancreatography (ERCP) showed stenosis of the CBD. However, no stone was found, and then, naso-biliary drainage (NBD) tube was inserted. The findings of the cholangiography through the NBD tube after the improvement of her icterus suggested Mirizzi syndrome. After the exchange of the NBD tube with an endoscopic retrograde biliary drainage (ERBD) tube, a laparotomy was performed. The operative findings showed a 20mm sized pure cholesterol stone fixed in the cystic duct and severe inflammatory adhesions around the cystic duct, reconfirming Mirizzi syndrome. A cholecystectomy and a removal of the fixed stone in the cystic duct were safely performed without injuries to hepatic duct. The ERBD tube was very useful to differentiate these cystic and hepatic ducts in this procesure.
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  • Miwa KATAGIRI, Yoshinobu SUMIYAMA, Hirohisa KAJIWARA, Mitsuhiko NAKAMU ...
    2003 Volume 64 Issue 10 Pages 2569-2573
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    A 33-year-old man who was born suffering from von Recklinghausen's disease was admitted to the hospital because of general fatigue and jaundice. On examinations, dilatation of intrahepatic bile ducts in the both lobes and a tumor mainly situating at the portal umbilicus were confirmed. To relieve obstructive jaundice, endoscopic naso biliary duct (ENBD) and percutaneous trash hepatic colangio drainage (PTCD) were conducted. However, it was impossible to insert PTCD into the right intrahepatic bile duct due to multiple neurofibromas on the skin. After close exploration, cholangio cellular carcinoma in stage IV was diagnosed. Although we could not expect to perform a radical operation, a left lobectomy of the liver with associated excision of the portal vein was performed for the purpose of improvement of the patient's QOL, tube free and volume reduction.
    It is thought that volume reduction for bile duct cancer must be considered in cases in which extracorporeal drainage is impossible like in this case.
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  • Noriaki MOROFUJI, Shuuhei KOMATSU, Tetsuro YAMASHITA, Fumitaka MUTO, H ...
    2003 Volume 64 Issue 10 Pages 2574-2578
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    Endocrine cell carcinoma of the gallbladder is a very uncommon disease with a poor prognosis and no effective therapy for the disease has not been established as yet. We report here a rare case of endocrine cell carcinoma of the gallbladder. A 40-year-old woman admitted to another hospital because of right hypochondriac pain was refered to the hospital for a tumor in the neck of the gallbladder which remained after successful treatment of cholecystitis. After admission to the hospital, computed tomogra-phy and endoscopic retrograde cholangiopancreatography revealed a tumor in the neck of the gallbladder and anomalous arrangement of pancreaticobiliary duct. We diagnosed it as a gallbladder carcinoma and performed surgery. The intraoperative pathological diagnosis was neuroendocrine cell carcinoma. A pancreatoduodenectomy and resection of the liver S4a and S5 were performed, because lymphnode involvement around the pancreas head was evident. The tumor showed nodular protruded type. Histological findings demonstrated that the tumor consisted of endocrine cell carcinoma. Positive chromogranin A, EMA and NSE stainings were observed in these cells. Postoperative course was uneventful. The treatment strategy for patients with endocrine cell carcinoma is to detect the origin and metastases in an early stage and to observe carefully after the operation because of its malignant potential.
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  • Hiroshi KUSANAGI, Nobuyasu KANO, Shigetoshi YAMADA, Kazunori OHARA, Ma ...
    2003 Volume 64 Issue 10 Pages 2579-2582
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    A 48-year-old woman who underwent laparoscopic mastectomy for right breast cancer was admitted to for further examination of a cystic lesion in the pancreas. Abdominal ultrasonography revealed cystic lesions 5-10 mm in diameter in the pancreas tail. CT showed oligolocular lesions with calcification. Endoscopic retrograde cholangiopancreatography demonstrated a compression and slight dilation of the main pancreatic duct in the region of the pancreas tail. No communication between the main pancreatic duct and cyst was recognized. The preoperative diagnosis was mucinous cyst tumor. We performed laparoscopic assisted distal pancreatectomy and splenectomy. The patient was rotated laterally 45 degrees so that the left side was up. The distal pancreas and spleen were mobilized under laparoscopic procedure. A 7 cm incision was made on the upper abdomen and the lymph nodes dissected. The distal pancreas and spleen were extracted through this incision and the distal pancreas was resected.
    Histopathological findings revealed macrocystic serous cystoadenoma.
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  • Moritaka NAGAI, Koji MURABAYASHI, Yoshikazu AKASAKA, Tsukasa KUSUTA, S ...
    2003 Volume 64 Issue 10 Pages 2583-2587
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    This paper presents a case of huge non-functional adrenal cortical carcinoma.
    A 29-year-old man with a 10-month history of general fatigue was referred to the hospital after an increase in white blood cell (WBC) count was pointed out at a medical checkup. On physical examination, an infant's head sized and elastic hard tumor with tenderness was palpated in the left upper abdomen. The WBC count was as high as 16100/mm3. Abdominal CT scan revealed an enhanced tumor 20 cm in diameter with calcification which had heterogeneous center. Magnetic resonance imaging scan visualized concomitant presence of low and high intensities on both T1- and T2-weighted images. Abdominal angiogram showed accumulation of contrast material from the left superior, middle, and inferior adrenal arteries. Adrenal hormone levels were in normal ranges. With a diagnosis of a non-functional adrenal cortical tumor, the left adrenal tumor was removed with associated resection of the left kidney, spleen, and pancreatic body and tail with periaortic lymph node dissection. The resected specimen showed a tumor 24×16×10 cm in dimension with a capsule and an extensively necrotic inner part. The histopathological diagnosis was adrenal cortical carcinoma.
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  • Kentaro TASAKI, Hiroshi YAMAMOTO, Takehide ASANO, Matsuo NAGATA, Akina ...
    2003 Volume 64 Issue 10 Pages 2588-2590
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    11 cases of abdominal liposarcoma were resected at our surgical division. Their average age was 48. 2 years and male-to-female ratio was 5 to 6. Abdominal recurrece was observed in eight cases. The tumor sizes depended on the length of disease free intervals. The operations were performed by various methods. Histopathology revealed well differentiated type in two (18%), myxoid type in four (37%), round cell type in two (18%) and mixed type in three (37%) cases. Some cases changed their cell proliferation type when found as abdominal recurrence. Overall 5-year survival rate was 90%. Six of 11 cases received radiation and/or chemotherapy. Strict observation and aggressive surgical treatment seemed to lead to long survival for patients with abdominal liposarcoma.
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  • Kazuhiro HIRAMATSU, Takamasa NAGASHIMA, Yasunobu MIZUKAMI, Masahiko HA ...
    2003 Volume 64 Issue 10 Pages 2591-2593
    Published: October 25, 2003
    Released on J-STAGE: March 31, 2009
    JOURNAL FREE ACCESS
    A 57-year-old man was seen at our hospital because of abdominal pain and low grade fever. There was a previous history of undergoing an appendectomy. When he was seen, a tumor about 5cm in diameter was palpable just beneath the previous appendectomy scar. Careful scrutiny was started to find relationships with the previous operation. Abdominal computed tomography revealed an abdominal wall abscess and a linear calcification about 5cm in length surrounding the tumor. Although he denied accidental ingestion of any fish bone, granuloma derived from fish bone was highly suspected in its shape and an emergency operation was performed. The tumor was firmly adherent to the greater omentum but free from the intestine. There was no evident perforated site in the intestine. Then, a fish bone about 5cm in length was found inside of the tumor, which was chronic granuloma penetrating the abdominal wall to form the abscess.
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