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ABSTRACT: PURPOSE: The aim of this study was to evaluate the chronological changes in the amount of drainage fluid after thyroidectomy, and to establish standard indications for the drain to be removed. METHODS: We examined a cohort of 249 patients undergoing thyroid surgery. The patients were divided into four groups: a Graves' group, a non-dissection group, a central-dissection group and a lateral-dissection group. The amount of drainage was measured every 6 h, and the drain was removed postoperatively when the drainage decreased in amount and contained serous fluid after a meal. RESULTS: In all four groups, the most drainage occurred in the first 6 h after surgery. The total amount of drainage from the operation to the time of drain removal was significantly higher in Graves' group and in the lateral-dissection group than in the other two groups. The median wound drainage significantly decreased from 12 to 18 h after surgery in all four groups. In the lateral-dissection group, the wound drainage significantly decreased again in the first 24-30 h. CONCLUSION: The findings of this study suggest that drains can be removed postoperatively if the drainage was less than 15 mL during a 6-h period and contain serous fluid.
Surgery Today 02/2013; · 1.22 Impact Factor
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ABSTRACT: An 85-year-old male with advanced squamous cell carcinoma of the lung, who was diagnosed about 10 years prior to his current presentation, suddenly complained of abdominal pain and underwent an abdominal computed tomography scan, which revealed free air and massive ascites. He was admitted to our hospital for acute peritonitis and emergency surgery was performed. During the surgical procedure, a perforation of the jejunum was diagnosed and repaired. He was diagnosed to have a metastatic tumor originating from a squamous cell carcinoma of the lung. He improved and was transferred to the former hospital on the 27th postoperative day. Jejunal metastasis from squamous cell carcinoma of the lung is rare, and the prognosis of peritonitis due to a perforated intestinal metastasis from lung cancer is poor. There have been 10 reports of jejunal metastasis of squamous cell carcinoma of the lung reported in Japan between 2000 and 2011. Therefore, when patients with advanced lung cancer present with acute abdomen, it is necessary to keep in mind the possibility of a gastrointestinal metastatic tumor.
Case Reports in Gastroenterology 09/2011; 5(3):636-41.
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ABSTRACT: Parenchymal leiomyomas of the breast are extremely rare, with only 25 cases reported in the literature. We report the 26th case of parenchymal leiomyoma of the breast in a 63-year-old woman who presented to us with a right breast tumor detected on her screening mammography. This tumor was evaluated by mammography, ultrasonography, and MR imaging. To the best of our knowledge, this is the first case of a parenchymal leiomyoma of the breast examined by MR imaging. MR imaging revealed an oval mass with circumscribed margins that appeared as a high-intensity lesion in both T1 and T2. A dynamic MRI study showed a gradual increase pattern on the mass. Excisional biopsy revealed a growth pattern of interlacing fascicles of spindle cells without atypia or mitoses, consistent with parenchymal leiomyoma of the breast. Here we report a case of parenchymal leiomyoma of the breast, and describe the clinical, pathological, and immunohistochemical findings. In addition, we review the literature on parenchymal leiomyoma of the breast with regard to clinical characteristics and pathological features of this entity.
Breast Cancer 03/2011; 18(3):231-6. · 1.36 Impact Factor
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ABSTRACT: Although stomal varices are a rare complication, bleeding stomal varices often need to be treated owing to symptoms of hypovolemic shock, recurrence of stomal bleeding, or deterioration in the quality of life. Various treatment strategies for the management of bleeding stomal varices have thus far been reported. We report the case of a 60-year-old woman with refractory recurrent bleeding from varices in a sigmoid stoma, along with nonalcoholic steatohepatitis and marked splenomegaly. A physical examination revealed that the skin was discolored and bluish around the circumference of the sigmoid stoma. The venous phase of a celiac arteriogram revealed an afferent vein from the splenic vein and another from the inferior mesenteric vein, and veins draining into the left superficial epigastric vein. A balloon-occluded retrograde transvenous obliteration (BRTO) procedure was performed. The skin around the stoma, initially discolored bluish, improved markedly. After 10 months of follow-up, the patient has remained well without further episodes of stomal bleeding. To our knowledge, this is the first case of recurrent hemorrhage from stomal varices that was successfully treated by BRTO in a patient with portal hypertension.
Journal of Gastroenterology 02/2007; 42(1):91-5. · 4.16 Impact Factor
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Shigeto Maeda,
Kazuo Shimizu, Shigeki Minami,
Naomi Hayashida,
Tamotsu Kuroki,
Akira Furuichi,
Nozomu Sugiyama,
Katsu Ishigaki,
Ryuichiro Suto,
Junichiro Furui,
Takashi Kanematsu
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ABSTRACT: Endoscopic surgery has now become a well-established modality for the treatment of various organ diseases. In the present study, we analyzed the surgical results achieved by video-assisted neck surgery (VANS) in thyroid and parathyroid diseases.
From January 2000 to April 2002, 87 patients (eight males and 79 females) with a mean age of 49 years underwent VANS. The preoperative diagnoses of these patients included 37 benign thyroid tumors, 30 Graves' diseases, 17 parathyroid adenomas and three thyroid cancers.
The mean operative time of VANS was 165 min for a hemithyroidectomy, 287 min for a subtotal thyroidectomy, and 157 min for a parathyroidectomy. The mean intraoperative blood loss was 60, 183 and 23 g for a hemithyroidectomy, subtotal thyroidectomy and parathyroidectomy, respectively. No conversion from VANS to conventional surgery was experienced. Three patients (3.4%) had temporary palsy of the recurrent laryngeal nerve. Otherwise, the postoperative courses were uneventful.
VANS for thyroid and parathyroid diseases was found to be safe and effective. From a cosmetic point of view, a high degree of patient satisfaction was obtained. VANS is thus considered to be an excellent option for selected patients with thyroid and parathyroid diseases.
Biomedecine [?] Pharmacotherapy 02/2002; 56 Suppl 1:92s-95s. · 2.00 Impact Factor
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Journal of Gastrointestinal Surgery 9(7):1006-8. · 2.83 Impact Factor
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ABSTRACT: We investigated whether the serum Thymidine phosphorylase (TP) levels in venous blood drainage specimens were associated with the prognosis and risk of liver metastasis in patients with resectable colorectal cancer.
From 88 patients with colorectal cancer, specimens of venous blood drainage were obtained during operation. The serum TP levels were measured by a highly sensitive Enzyme-Linked Immunosorbent Assay (ELISA) method.
Subsequently, 88 patients were divided into two groups based on the levels of TP. The dividing line was determined to be 55ng/mL. The TP-high group (> 55ng/mL) had a significantly shorter overall survival than the TP-low group (< 55ng/mL). A multivariate analysis indicated that the serum TP level in venous blood drainage specimens to be a better prognostic factor independent of the traditional pathologic parameters. The serum TP levels of 3 patients with metachronous liver metastasis were high (> 55ng/mL).
These findings suggest that the serum TP levels in venous blood drainage specimens reflect the prognosis of patients with colorectal cancer undergoing curative resection, particularly the risk of liver metastasis.
Hepato-gastroenterology 55(82-83):418-21. · 0.66 Impact Factor
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ABSTRACT: An 80-year-old male was admitted to our hospital on February 16, 2009, complaining of having suffered right lower quadrant pain for a period of 4 days. Abdominal computed tomography (CT) showed amesenterial abscess adjacent to the terminal ileum, and the possibility of acute appendicitis was excluded from the preoperative diagnosis by this imaging. Upon surgery, the appendix and cecum revealed normal appearance, without the presence of ascites. However, ileocecal resectionwas performed because of abscess formation that appeared to originate from the terminal ileum or the cecum. Resected specimens showed ileal diverticula, including one that was perforated. Perforation of ileal diverticula should be a candidate for the differential diagnosis of an inflammatory process near the ileocecal region
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ABSTRACT: Seven cases with intestinal perforation by ingested foreign bodies (IFBs) were surgically treated in our hospital between January 2000 and August 2009. We reviewed the preoperative mental conditions, awareness of ingestion, preoperative diagnosis, the type of foreign bodies, perforation site, treatment and morbidity for these patients. The ratio of males to females was 4 : 3, and patient age ranged from 27 years to 85 years. Three of 7 patients had an abnormal mental condition, including neurosis with medication in 1, severe mental retardation in 1 and dementia in 1. Six patients were not aware they had IFBs. Preoperative diagnoses were perforative peritonitis in 6 cases and ileus in 1 case. The ingested objects consisted of fish bones in 4 cases, toothpicks in 2 cases and a press-through package in 1 case. Computed tomography (CT) showed the ingested fish bones in all 4 cases, while plain abdominal radiography demonstrated fish bone in only one of these cases. Toothpicks and a press-through package were not detected on CT or by plain abdominal radiography. The perforation sites were the small intestine in 5 cases and the large intestine (transverse colon) in 2 cases. Treatments were intestinal resection with or without omentectomy in 5 cases, suture alone in 1 case and omentectomy alone in 1 case. Postoperative complications were seen in 2 patients, including hepatic failure and bleeding from gastroesophageal reflux disease in 1 case, and removal and reinsertion of a V-P shunt tube in 1 case. The mortality rate was 0%
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ABSTRACT: The effects of early feeding for postoperative ileus remain unclear. We evaluated whether the early feeding is safe and feasible in Japanese patients after open bowel resection, and whether early feeding can enhance the resolution of postoperative ileus. An early feeding protocol was applied to 23 patients (Group 1). As a control, we reviewed the charts of 25 consecutive patients who were operated on just before the protocol and whose diet was started by traditional methods (Group 2). Daily examination and interviews of patients were performed. The majority of the patients in Group 1 (87.0%) tolerated the early feeding. There were no major complications or mortality that was related to early postoperative feeding. There was a significant difference between Group 1 and Group 2 in the distributions of the time to passage of flatus (median?2 vs. 3 days, p=0.002), the time of the first bowel movement (median?3 vs. 5 days, p=0.001), and the length of postoperative hospital stay (median?15 vs. 22 days, p<0.0001). There was no significant difference in the frequency of postoperative complications between the groups (p=0.44). Early postoperative feeding protocol is safe and feasible for patients who are required colorectal surgery. Early feeding may promote the early resolution of postoperative ileus
