[Show abstract][Hide abstract] ABSTRACT: Pyogenic liver abscess (PLA) complicated by inferior vena caval (IVC) thrombosis is rare but life-threatening. We experienced a case of PLA complicated by an IVC thrombus close to the right atrium after pancreatoduodenectomy. A 75-year-old man had undergone pancreatoduodenectomy with modified-Child reconstruction for pancreatic cancer 3 years prior, and no recurrence was noted on follow-up. He was admitted to our hospital owing to fever and general fatigue. PLA and septic shock were diagnosed, and conservative therapy with antibiotics was initiated. His general condition gradually improved, but a thrombus in the middle hepatic vein and IVC was noted on follow-up computed tomography on hospital day 8. Although anticoagulant therapy using heparin was started, the thrombus size increase and extended to the right atrium. Considering the risk of pulmonary embolism, we planned a surgical intervention with a cardiovascular surgeon to remove the thrombus. During surgery, we made an incision in the right atrium and removed the thrombus using extracorporeal circulation. After removal, we dissected the middle hepatic vein using an automated suturing device to prevent the thrombus from extending into the IVC. The patient was discharged 10 weeks after surgery. Eighteen months post-intervention, there was no recurrence of either PLA or thrombi. Our experience suggests that physicians should consider the existence of a middle hepatic vein and IVC thrombi when examining PLA patients and that surgical intervention can be applied successfully in such cases.
[Show abstract][Hide abstract] ABSTRACT: Localization of colorectal inflammation is a characteristic of ulcerative colitis (UC). However, in certain cases, due to the “backwash” of cecal contents, the inflammation spreads to the terminal ileum, causing ileitis. This condition is known as backwash ileitis (BWI). Here, we describe a case of ileal perforation due to UC with BWI. An 82-year-old woman, who had undergone a Hartmann operation for perforation of the rectum after colonoscopy 2 years previously, was admitted to our hospital because of bloody stool. UC was diagnosed, and she underwent emergency subtotal colectomy and construction of an ileostomy due to continuous bloody stool, anemia, and decreasing blood pressure. During the surgery, we detected inflammation in the terminal ileum; however, we did not sufficiently resect the ileum. On postoperative day 8, a re-operation was needed due to an ileal perforation. During laparotomy, we observed an ileal perforation at 5 cm and 20 cm proximal from the ileostomy site; therefore, we resected the small intestine up to the normal mucosa. Although we continued to treat the patient in the intensive care unit, she died 14 days after the second surgery. BWI is often diagnosed for the first time during surgery. No effective therapeutic method is currently available for BWI. Therefore, in such cases, the involved ileum should be sufficiently resected up to the normal mucosa during the first operation.
[Show abstract][Hide abstract] ABSTRACT: A 70-year-old woman with unresectable advanced gastric cancer accompanied by peritoneal dissemination underwent jejunostomy, and was treated with S-1 and low-dose CDDP. One course consisted of S-1 (80 mg/day) via an intestinal fistula tube from days 1 to 14. This was followed by 7 days rest, and CDDP (20 mg/day) was administered by 1-hour continuous intravenous infusion on day 1 and 8. She continued to receive this chemotherapy for a total of 14 courses, followed by 3 courses of a weekly paclitaxel regimen. She died 14 months after surgery. All chemotherapy had been conducted in an outpatient setting. We concluded that the administration of S-1, combined with low-dose CDDP (div) through a jejunostomy, can improve the quality of life (QOL) of a patient who has unresectable advanced gastric and is incapable of oral intake. We report this rare case with a review of the literature.
No preview · Article · Jul 2011 · Gan to kagaku ryoho. Cancer & chemotherapy
[Show abstract][Hide abstract] ABSTRACT: A 57-year-old woman admitted for an abdominal tumor was found in abdominal computed tomography (CT), magnetic resonance image (MRI), angiography, and upper gastrointestinal endoscopy to have a gastrointestinal stromal tumor (GIST) of the duodenum with an extra pedunculated gastrointestinal growth. In the operative findings, a 10cm tumor outside the duodenum and an independent 4cm tumor in the pancreas head were diagnosed as pancreatic tumors with lymph node metastasis, necessitating pancreaticoduodenectomy. Histological examination showed these tumors to be extra-GIST of the pancreas with lymph node metastasis or peritoneal dissemination. We report this rare case together with a review of the literature.
No preview · Article · Jan 2011 · Nippon Shokaki Geka Gakkai zasshi
[Show abstract][Hide abstract] ABSTRACT: The patient was a 74-year-old man whose chief complaint was epigastralgia. A detailed examination revealed a gastric cancer located from antrum to duodenal bulb with multiple liver metastases. Because of a difficulty with oral intake, we performed a distal gastrectomy at first. After the operation, a combination chemotherapy with S-1 and weekly paclitaxel was performed, and liver metastases were successfully disappeared after 4 courses of the regimen. A subsequent CT evaluation after 6 courses of the regimen revealed that liver metastases maintained the clinical complete response (cCR), but a right adrenal tumor was detected. We performed a right adrenalectomy after 13 months from gastrectomy, and a histopathological examination revealed that the adrenal tumor was a recurrent gastric cancer. After the second operation, only one course treatment of S-1 alone was performed because the patient rejected the chemotherapy. The patient is alive without a chemotherapy and maintained cCR for 75 months after the second operation.
No preview · Article · Nov 2010 · Gan to kagaku ryoho. Cancer & chemotherapy
[Show abstract][Hide abstract] ABSTRACT: A 64-year-old man was admitted to our hospital with anal pain on evacuation. MRI revealed a large rectal submucosal tumor, more than 6 cm in diameter. Fine needle histological diagnosis indicated GIST with moderate risk. The patient was treated with imatinib mesylate in order to preserve the anus. The anal pain and tumor size decreased. Trans-anal local excision was performed. This case suggests that imatinib mesylate can make it possible to treat large rectal GIST cases by preserving anus, if neoadjuvant chemotherapy can be effective.
No preview · Article · Dec 2009 · Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology
[Show abstract][Hide abstract] ABSTRACT: We describe here two cases of locally advanced rectal cancer treated with neoadjuvant chemotherapy prior to surgery. The first patient was a 54-year-old man whose chief complaint was bloody stool. A detailed examination revealed a rectal cancer with direct invasion of the primary rectal carcinoma into the prostate. Four courses of FOLFOX4 were administered as neoadjuvant chemotherapy. Because the invasion to the prostate was difficult to determine by subsequent CT evaluation, we performed a radical resection. The pathological examination revealed that all surgical margins were negative for malignancy and no metastasis to lymph nodes was found, therefore a surgical evaluation of curability was classified as A. The second patient was a 49-year-old woman whose chief complaint was irregular menstruation. A detailed examination revealed a rectal cancer with metastasis to an ovary and paraaortic lymph node. One course of FOLFOX4 and six courses of mFOLFOX6 (combined with bevacizumab in the first five courses) were administered as neoadjuvant chemotherapy. Subsequent examinations revealed significantly reduced primary tumor and the size of metastatic lesion. Given that metastasis to the paraaortic lymph node was difficult to determine, we performed a radical resection. The pathological examination revealed that all surgical margins were negative for malignancy, and the postoperative FDG-PET evaluation did not find FDG accumulation to paraaortic lymph node. We determined that there was no residual cancer and evaluated the surgery as curability B. We conclude that neoadjuvant chemotherapy against locally advanced rectal cancer may improve the curability of the surgery and save the surrounding organs.
No preview · Article · Nov 2009 · Gan to kagaku ryoho. Cancer & chemotherapy
[Show abstract][Hide abstract] ABSTRACT: A 25-year-old woman seen for abdominal pain that decreased after taking medicine was sent home but returned the next day when pain recurred and intensified. After admission, pain intensified with peritoneal irritation. Abdominal computed tomography (CT) showed swollen small intestines, and laboratory studies showed a severe pancytopenia. Emergency laparotomy showed an omphalomesenteric duct remnant between the peritoneal umbilicus and the ileum. The small intestine was twisted around the duct and the other part of the small intestine was entrapped. An internal hernia caused an intestinal obstruction. Few such reports have been made in adults, but this possibility should be considered as a possible cause of intestinal obstruction in patients not having undergone previous abdominal surgery.
[Show abstract][Hide abstract] ABSTRACT: Although extended lymphadenectomy for thoracic esophageal cancer is widely practiced in Japan, solitary supraclavicular lymph node recurrence (SCLR) has often become a problem. This study was designed to evaluate the survival and clinical benefit of salvage cervical lymphadenectomy.
Between 1989 and 2001, 153 patients underwent esophagectomy for esophageal cancers. SCLR was identified in 5 (3.7%) patients and these five patients were examined retrospectively.
Surgical treatment was performed intensively for all patients. Two patients showed longterm survival for 7 years 3 months and 4 years, respectively. Four patients belonged to the good prognostic group but the other patient had poor prognosis from the viewpoint of both the pathological metastatic lymph node number and disease-free interval (DFI). There were no local recurrences but were a recurrent laryngeal nerve palsy in three patients associated with treatment.
Salvage cervical lymphadenectomy for SCLR should be performed positively by selecting each case carefully. Indication must be weighed against increased morbidity considering such indicators as the extent of metastatic lymph node numbers and DFI.
No preview · Article · May 2005 · Hepato-gastroenterology
[Show abstract][Hide abstract] ABSTRACT: Little is known about the clinicopathological features of intermediate-stage T2 gastric cancer, defined as tumors invading the muscularis propria or subserosa.
Of 808 patients with gastric cancer, 210 patients (25.9%) who underwent gastrectomy for T2 gastric cancer were selected for this retrospective study. The clinicopathologic findings of these patients were analyzed retrospectively from their hospital records.
Of all 808 patients with gastric cancer, 73 patients (9.0%) had tumors invading the muscularis propria (mp). The remaining 137 patients (16.9%) had tumors invading the subserosa (ss). Compared with ss gastric cancer, mp gastric cancer was associated with smaller tumor size, an absence of lymphatic spreading, and hematogenous and late recurrence [disease-free interval: 654.5 days (mp) vs. 365.5 days (ss)]. Univariate analysis of cases with curative operations showed that lymphatic invasion, and lymph node metastasis were significant prognostic factors in patients with T2 gastric cancer. Further examination by multivariate analysis demonstrated that pN2 or higher as classified by both the JCGC (Japanese Classification of Gastric Cancer) and the TNM lymph node staging systems was a predictor of poor prognosis.
JCGC and TNM lymph node staging systems were the most reliable prognostic factors for T2 gastric cancer. Close follow-up should be required for patients with stage pN2 or higher gastric cancer. Long-term follow-up should be required for mp cancers, in particular.
No preview · Article · May 2005 · Hepato-gastroenterology
[Show abstract][Hide abstract] ABSTRACT: A 64-year-old man undergoing Miles' operation for rectal cancer with multiple liver metastasis (a2, ly2, v3, n1, H3, P0, M0) in August 2001 underwent postoperative hepatic artery infusion (HAI) at 5 FU (1,500mg/body/ 5 hr) weekly as an outpatient. HAI was done 46 times, with total 5 FU administered of 64g . Metastatic tumors at S3, S4 and S6 disappeared but those at S5,8 remained. The left hepatic artery narrowed and he hoped for hepatectomy. Neither distant metastasis nor local recurrence was detected, so he enderwent hepatectomy in July 2003. He continues to undergo HAI of 5 FU once a month as an outpatient. Hepatic resection after HAI chemotherapy is thus effective as a strategy in treating multiple liver metastasis from rectal cancer.
[Show abstract][Hide abstract] ABSTRACT: A 53-year-old man presented with massive right hydrothorax just after introduction of continuous ambulatory peritoneal dialysis (CAPD). Because the glucose concentration of pleural fluid was markedly high compared with that of serum, we diagnosed pleuroperitoneal communication. Thoracoscopic surgery was performed and thinning of the diaphragm was found. We sutured the diaphragm to repair the thin portion and performed pleurodesis with 50% glucose solution. He restarted CAPD 1 month post-operatively and continued at home without pleural effusion. Eight months post-operatively, he experienced dyspnea again and chest X-ray showed right hydrothorax. Although the cause of recurrent hydrothorax is unknown, it may be that not only surgical repair but also more intense pleurodesis is needed.
No preview · Article · Oct 2004 · Kyobu geka. The Japanese journal of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: Small cell carcinoma arising in the esophagus is a relatively rare diagnose. We present a case of superficial small cell carcinoma of the esophagus with liver metastasis treated by operation and chemotherapy. The patient was a 75-year-old woman. She complained of constipation and had the occult blood of stool pointed out by her home doctor. Endoscopic examination revealed a tumor in the abdominal esophagus, and biopsy demonstrated carcinoma. She underwent operation under the diagnosis of squamous cell carcinoma of the esophagus. During the operation, one of multiple liver metastases was diagnosed as small cell carcinoma by analysis of freshly prepared frozen sections. An abdominal esophagectomy with proximal gastrectomy was performed without any lymph node dissection. A plateau esophageal tumor, 1cm in diameter, was histologically composed of small cell carcinoma with the invasion depth of sm3. These small cells were positive for synaptophysin and ACTH, and electoron microscopical examination demonstrated intracytoplasmic neurosecretory glanules. The patient recieved post-operative chemotherapy consisting of Carboplatin and etoposide. Liver metastasis was once disappeared by computed tomography. But the patient died of rapid progress of the liver metastasis, 10 months after the surgery.
No preview · Article · Jul 2004 · Gastroenterological Endoscopy