We describe the physiological examination of anorectal function in children with chronic constipation (CC), including Hirschsprung's (H) disease (aganglionosis) and its allied disorders [hypoganglionosis (Hypo) and intestinal neuronal dysplasia (IND)]. The assessments are summarized as follows: 1) Anorectal manometry: Enteric nervous system, especially non-adrenergic non-cholinergic excitatory and inhibitory nerves, controls the ano-rectal sphincter reflex. Therefore, patients with aganglionosis lack ano-rectal sphincter reflexes. Abnormalities of the enteric nervous system in Hypo and IND show atypical sphincter reflexes. In contrast, CC patients exhibit normal sphincter reflexes. 2) Terminal motor latency in the pudendal and sacral nerves: Patients with aganglionosis, Hypo, IND and CC exhibit conduction delay of these nerves. These findings may suggest damage to the pudendal and sacral motor nerves due to straining during defecation. 3) Anal canal sensation test (anal canal mucosal electrosensitivity and somatosensory evoked potential tests): Anal sensation is decreased in patients with H disease, Hypo, IND and CC. These findings may suggest damage to the pudendal sensory nerves due to straining during defecation. 4) Defecography: This examination easily detects an obstructive type in school-age patients with CC. 5) Gastrointestinal transit time: This examination easily detects the slow transit type in school-age patients with CC. Conclusions: It is easy for pediatric surgeons to evaluate physiological function in patients with CC, H disease and its allied diseases using physiological examinations.
During the course of 4 years and 8 months, from January 2009 to August 2013, 737 patients underwent surgery with general anesthesia at our department. Perioperative heparinization was required in 28 of these patients (3.8%) because they had been treated with antithrombotic therapy prior to the operation. Oral antithrombotic agents were discontinued as part of the perioperative management after the patients had been hospitalized for one week prior to surgery, and the activated partial thromboplastin time was controlled at around 55-70 seconds with continuous intravenous administration of unfractionated heparin. The intravenous heparin administration was discontinued 6 hours before surgery. In all patients, surgery was performed safely, and oral medications were resumed on postoperative day 1. There were no significant differences in the operative time or blood loss between the heparinization and control groups. Among 316 patients with resectable malignant tumors of the lung, 20 (6.3%) received antithrombotic therapy before surgery. In the heparinization group, a significantly prolonged operative time was observed, but there was no significant increase in blood loss or the postoperative hospitalization period. These observations suggest that surgery with perioperative heparinization in patients receiving antithrombotic therapy can be performed safely similar to routine surgery.
A 57-year-old man presented to a local clinic with gradually progressive wheezing and was referred to our hospital. Chest computed tomography revealed atelectasis in the lingular segment of the left lung and a polypoid lesion in the left main bronchus. Endoscopic resection of the endobronchial tumour was performed with a high-frequency electrosurgical snare under general anaesthesia. Based on histological examination of the resected specimen, an endobronchial cartilaginous hamartoma was diagnosed. This approach may be an alternative for resection of selected benign endobronchial tumours. After 2 years of follow up, the patient remains free of disease. While endobronchial hamartoma is relatively rare, this diagnosis should be considered in a patient with respiratory complaints, such as gradual progression of wheezing and persistent cough.
We present a case of a 73-year-old woman. After undergoing mastectomy for ductal carcinoma in situ (DCIS), CEA levels became normal. She exhibited elevated CEA levels, 19-years after colectomy for colon cancer. Despite the fact that she had undergone regular medical examinations, we could not determine the cause. Two years after the initial finding of elevated CEA, she noticed bloody discharge from the nipple. The cytology was class IIIb. We could not detect a tumor in her breast, by palpation or mammography, but were able to examine the intraductal region by ultrasound. CEA levels were elevated (17.6 ng/dl), but returned to normal after operation on the breast. There was no recurrence.
The prognosis of relapsed Ewing sarcoma family of tumor (ESFT) continues to be miserable. In such cases, the purpose of treatment should be palliative care. We report a case of a boy with relapsed EFST who was treated with irinotecan hydrochloride. This treatment was able to provide him with a transient improvement of quality of life. Irinotecan was administered at a dose of 40 mg/m2/day for three consecutive days. Thereafter, it was stopped for four days and was subsequently administered for an additional three days. This course was repeated in 21-28 days cycles. We were able to observe an improvement of images using technetium-99m-bone scans. We did not observe any signs of new tumor lesions for up to five months. The pain was relieved and no serious adverse effects were observed. While the efficacy of irinotecan remains to be confirmed, in many cases, irinotecan can be effective for relapsed ESFT.
An 80-year-old Japanese man was admitted to the hospital with abdominal pain. Blood examination showed the elevated level of CA19-9. Computed tomography showed a swollen lymph node near segment 1 of the liver and a 25 mm hepatic tumor in segment 5. With the diagnosis of hepatocellular carcinoma, we performed liver resection and lymph node dissection. The pathological diagnosis was consistent with combined hepatocellularcholangiocarcinoma, classical type. He is alive 11 months with no recurrence postoperatively.