Publications (8)14.21 Total impact
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Article: Gastric carcinoma presenting with extensive extraluminal growth: Report of a case
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ABSTRACT: We report a 48-year-old-man with gastric carcinoma presenting with an unusual extraluminal growth. The patient underwent a barium meal examination and gastrofiberscopy because of progressive anemia over 6 months. These examinations revealed a Borrmann type 3 advanced gastric carcinoma of the greater curvature of the antrum. Biopsies showed moderately differentiated tubular adenocarcinoma. The intraoperative findings showed gastric carcinoma associated with extensive extraluminal invasion into the adjacent organs, i.e., the transverse colon and mesocolon. A palliative distal gastrectomy with a partial resection of the transverse colon was performed because of peritoneal dissemination found in the mesocolon and rectovesical pouch. A histological examination of the specimen confirmed adenocarcinoma which had massively infiltrated the transverse colon and mesocolon. His postoperative course was uneventful. However, he died of peritonitis carcinomatosa 9 months later. Key Wordsgastric adenocarcinoma–extragastric growth–infiltration of transverse colonSurgery Today 04/2012; 30(5):432-434. · 1.22 Impact Factor -
Article: Intestinal evisceration through the anus caused by fragile rectal wall.
International Journal of Colorectal Disease 08/2008; 23(7):721-2. · 2.38 Impact Factor -
Article: Role of ganglion cells in sigmoid volvulus.
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ABSTRACT: The aim of this study was to clarify the role of ganglion cells in the development and recurrence of sigmoid volvulus. We analyzed 9 samples obtained from 9 patients who had undergone sigmoidectomy for sigmoid volvulus, and, for comparison, 18 samples from 18 patients who had undergone sigmoidectomy or low anterior resection for rectal cancer. Neuron-specific enolase was used for immunohistochemical staining to detect ganglion cells, and the number of ganglion cells in 20 contiguous fields was counted at 200? magnification. The average number of ganglion cells per 1000 cm(3) was corrected using the ratio of the circumference of the resected sigmoid colon to the average circumference in the control group. The raw numbers of ganglion cells in the Meissner's and Auerbach's plexuses in the volvulus group were significantly lower than those in the non-volvulus group (Meissner: p = 0.017, Auerbach: p = 0.007). The circumference of the resected sigmoid colons with volvulus was greater than that of those without volvulus (p = 0.00013). There was no significant difference in the corrected numbers of ganglion cells in the Meissner's plexus or Auerbach's plexus per 1000 cm(3) between the volvulus and non-volvulus groups (Meissner: p = 0.410, Auerbach: p = 0.890).Furthermore, there was no significant difference in the corrected numbers of ganglion cells between the revolvulus and non-revolvulus groups. These findings led us to conclude that functional disorder of bowel movement or elongation of the bowel in sigmoid volvulus or revolvulus is not related to the number of ganglion cells in Auerbach's or Meissner's plexus.World Journal of Surgery 02/2005; 29(1):88-91. · 2.36 Impact Factor -
Article: Characteristic features of abdominal organ injuries associated with gastric rupture in blunt abdominal trauma.
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ABSTRACT: Previous studies have investigated the mechanisms of gastric rupture based only on the findings in gastric rupture and excluding gastric lacerations. We investigated 14 cases of gastric injury (five with rupture and nine with laceration) from blunt abdominal trauma with or without thoracic trauma. Gastric injuries were caused by a traffic accident in 12 and by a fall in two patients. All of the patients with gastric rupture had had a full stomach at the time of impact. The patients had associated injuries of adjacent solid organs, the thoracic cage, and extremities. The frequency of injury of the hepatoduodenal or gastrohepatic ligament was higher in patients with gastric laceration than in patients with gastric rupture. Eight of nine patients with a gastric laceration had hepatic or pancreatic injury, whereas none of the patients with gastric rupture had such injury. The results of our study showed that the distended stomach tends to rupture by absorbing the impact from blunt abdominal trauma (i.e., it works like an airbag to protecting adjacent organs such as the liver and pancreas).The American Journal of Surgery 04/2004; 187(3):394-7. · 2.78 Impact Factor -
Article: Factors affecting the early mortality of patients with nontraumatic colorectal perforation.
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ABSTRACT: We attempted to identify the factors associated with the early mortality of patients with nontraumatic colorectal perforation. Eighty patients who underwent surgery for nontraumatic colorectal perforation between May 1986 and December 1999 were retrospectively reviewed. Age, sex, cause of perforation, duration of symptoms, associated preoperative septic shock, concomitant disorders (including cardiac disease, chronic obstructive pulmonary disease, hemodialysis, and steroid treatment), operative findings (such as the site of perforation and the degree of peritonitis), and results of preoperative laboratory blood tests (such as the white blood cell count and platelet count) were analyzed for their association with early outcome using univariate and multivariate analyses. Fourteen of the 80 patients died during hospitalization. According to the univariate analysis, advanced age, preoperative septic shock, concomitant disabling cardiac disease, hemodialysis, diffuse peritonitis, and a low preoperative platelet count were more frequent in the patients who died during hospitalization. According to the logistic regression analysis, preoperative septic shock (odds ratio 8.443, 95% confidence interval (CI) 1.625-43.873), concomitant end-stage renal failure (odds ratio 13.641, 95% CI 1.643-113.244), and diffuse peritonitis (odds ratio 13.212, 95% CI 1.441-121.102) were the most significant factors related to in-hospital mortality. Early diagnosis before the patient's general condition deteriorates is a key to improving the early mortality associated with nontraumatic colorectal perforation, especially in patients with concomitant end-stage renal failure.Surgery Today 02/2003; 33(1):13-7. · 1.22 Impact Factor -
Article: Influence of diabetes on persistent nonhealing ischemic foot ulcer in end-stage renal disease.
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ABSTRACT: The aim of this study was to identify important atherosclerotic risk factors for characteristic nonhealing ischemic foot ulcers in patients with end-stage renal failure. We retrospectively studied 534 consecutive hemodialysis patients in five dialysis units of the Tokyo metropolitan area between 1980 and 1999. The influence of risk factors for ischemic foot ulcers in hemodialysis patients was determined using a multivariate logistic model. The characteristic features were also evaluated with further comparison of the prevalence of risk factors between hemodialyzed diabetic patients with ischemic foot ulcers and another 61 age- and gender-matched nonhemodialyzed diabetic patients with ischemic foot ulcers. In the logistic model, two factors emerged as important risk factors for ischemic foot ulcers: renal failure due to diabetes [odds ratio 21.580 (95% CI 4.838-96.251); p = 0.0001] and a history of cerebrovascular disease [odds ratio 2.782 (1.015-7.624); p = 0.0467]. On the basis of a comparison of age- and gender-matched control patients, associated diabetic triopathy, a history of cerebrovascular disease, and hypertension were more frequent in the hemodialysis patients. The development of ischemic foot ulcers in those with end-stage renal failure is strongly influenced by underlying advanced diabetic microangiopathy and such other factors as sequelae of cerebrovascular disease and patient debilitation.World Journal of Surgery 12/2002; 26(11):1360-4. · 2.36 Impact Factor -
Article: Hepatic portal venous gas caused by blunt abdominal trauma: is it a true ominous sign of bowel necrosis? Report of a case.
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ABSTRACT: A case of transient portal venous gas in the liver following blunt abdominal trauma is described. Computed tomography (CT) demonstrated hepatic portal venous gas 4 h after the injury. An exploratory laparotomy revealed segmental necrosis of the small intestine with a rupture of the bladder. Pneumatosis intestinalis was evident on the resected bowel. A histopathologic study revealed congestion and bleeding in the bowel wall and a great deal of the mucosa had been lost because of necrosis. However, neither thrombus nor atherosclerotic changes were observed in the vessels. A bacteriological examination demonstrated anaerobic bacteria from the bowel mucosa, which was most likely to produce portal venous gas. Although the present case was associated with bowel necrosis, a review of literature demonstrated that portal venous gas does not necessarily indicate bowel necrosis in trauma patients. There is another possibility that the portal venous gas was caused by a sudden increase in the intra-abdominal pressure with concomitant mucosal disruption, which thus forced intraluminal gas into the portal circulation in the blunt trauma patients.Surgery Today 02/2002; 32(7):655-8. · 1.22 Impact Factor -
Article: Factors influencing mortality of acute intestinal infarction associated with SIRS.
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ABSTRACT: In patients with acute mesenteric ischemia, early diagnosis is considered to improve the prognosis by preventing the occurrence of systemic inflammatory response syndrome (SIRS). However, it remains unclear which factors affect the mortality once advanced ischemia and SIRS develop in cases of delayed diagnosis. The aim of this study was to investigate the predictors of in-hospital mortality in the late stage of acute mesenteric ischemia. We retrospectively studied 66 consecutive patients who had acute intestinal infarction associated with SIRS between 1986 and 2002. They included 19 of acute mesenteric thromboembolism and 47 cases of postoperative adhesions or an incarcerated hernia. A multivariate logistic model was used to identify important factors for in-hospital death among the background data. Two models were constructed with/without the cause of intestinal obstruction as a variable, since it might affect the prognosis. The results suggested that concomitant cardiac morbidity, high serum amylase level, and thrombocythemia are important factors for in-hospital mortality of acute intestinal infarction, regardless of the cause of intestinal infarction. Our results indicated that the prognosis is strongly influenced by associated cardiac morbidity and abnormal coagulopathy in the advanced stage of mesenteric ischemia.Hepato-gastroenterology 52(65):1474-8. · 0.66 Impact Factor
