Historically, malignant gastrointestinal obstruction has been treated with surgical gastrostomy, percutaneous endoscopic gastrostomy (PEG), or nasogastric decompression. Of these treatments, nasogastric tubes are effective and the least invasive, but they are not feasible for long-term use. Surgical gastrostomy is invasive and may be poorly tolerated by debilitated patients, and PEG may also be contraindicated in these patients; Critically ill patients with advanced gastric carcinoma or abdominal recurrence require palliative treatment with best supportive care. Decompression of the malignant obstruction arising from gastric juice, bile, intestinal discharge, or unabsorbed beverages drunk for personal satisfaction is important to quality of life. Recently, a novel technique, percutaneous transesophageal gastro-tubing (PTEG), has been introduced for decompression of malignant obstruction. PTEG was developed as an esophagostomy method to drain gastrointestinal contents, especially in patients who have undergone total or subtotal gastrectomy but cannot undergo PEG or drainage with gastrointestinal tube for peritonitis carcinomatosis. Indications for PTEG include status after gastrectomy, peritonitis carcinomatosis with intestinal obstruction, excessive ascites in the abdominal cavity, and status on long-term drainage by nasogastric tube. Benefits of PTEG include better quality of life; prevention of respiratory complications; long-term decompression, especially for ileus status using PTEG long tubing; and the possibility of drinking or eating water-soluble substances during continuous aspiration of gastrointestinal contents. Here, we describe the successful placement of PTEGs in 29 patients, including 19 with gastric cancer, 5 with ovarian cancer, 3 with colorectal cancer, and 2 with pancreatic cancer. PTEG alleviated the symptoms of obstruction in all 29 patients. Almost all patients were able to drink beverages. Eight of the 29 patients were temporarily discharged with no subsequent complications, 2 of whom were treated with outpatient hyperalimentation over 6 months. PTEG is a safe and effective technique for decompression of malignant gastrointestinal obstruction and is also useful for the management of tube feeding, which is contraindicated in patients receiving PEG procedures, including patients who have undergone gastrectomy and those with massive ascites.
Right hemicolectomy has been recognized as a basic surgical procedure in gastrointestinal surgery. Guidelines for the treatment of colorectal cancer were first published in 2005 and defined D3 as a standard lymph node dissection in patients with advanced colorectal cancer. However, strict D3 dissection is not an easy procedure and has technical differences between institutions and instructors. In this article we introduce detailed procedures for right hemicolectomy with antegrade D3 dissection by means of the inside approach which is routinely performed at our institution. We hope this article will be helpful for surgeons who perform operations for right-sided colon cancer.
Patients with malignant tumors are four times more likely to experience systemic amyloidosis, especially AA amyloidosis, and a quarter of these malignant tumors are renal clear cell carcinomas. However, reports of malignancies with AL amyloidosis are extremely rare. We report on a 66-year-old female with AL systemic amyloidosis and renal chromophobe cell carcinoma. We also survey the mechanism of the association by reviewing previous case reports.
We present a case of pregnancy complicated by sacroiliitis. The patient complained of lumbar pain, dysbasia, and fever of 37.8°C at 14 weeks' gestation. Sacroiliitis was diagnosed on the basis of magnetic resonance imaging. Treatment included bed rest, antibiotics, and analgesic medications. Complete recovery required 2 months.
Japanese writers of academic papers need to make effective use of as many English dictionaries as possible in order to select appropriate and idiomatic expressions for their writings. The increase in the number of dictionaries available in electronic form allows quicker and easier reference to example sentences, which in turn provides writers with increased opportunities to familiarize themselves with natural English.