Akio Ashida

Successful treatment of multiple small-bowel perforations caused by cytomegalovirus in a patient with malignant lymphoma : Report of a case

We report the successful management of multiple small-bowel perforations caused by cytomegalovirus (CMV) infection in a 60-year-old man, 1 day after CHOP (cyclophosphamide/doxorubicin/vincristine/prednisone) therapy induction for malignant lymphoma. Emergency laparotomy was performed for perforative peritonitis, but we did not resect the lesions at this time. Instead, we exteriorized the small bowel and then irrigated the peritoneal cavity and intestinal tract. His white blood cell count was low, at 200 cells/µl, so this therapy was continued until it recovered. The intestine was highly edematous, but it improved after irrigation with peritoneal dialysis solution. In the second-stage procedure, we resected the small bowel with the perforations, and constructed a jejunostomy and colostomy, then closed the abdominal cavity. Although the patient needed central venous hyperalimentation, he had a favorable postoperative course and started treatment again for the malignant lymphoma.

Technique and assessment of sentinel lymph node biopsy usefulness in laparoscopy-assisted distal gastrectomy

BackgroundRecently, some studies have suggested that sentinel node biopsy also can be applied to gastric cancer. The authors apply sentinel lymph node biopsy in laparoscopy assisted distal gastrectomy to perform it as safe limited surgery. Limited surgery is a procedure in which the extent of lesion resection and lymph node dissection is reduced. The authors demonstrate that intraoperative diagnosis of lymph node metastasis is useful in this respect.MethodsThe study was conducted with 38 patients (29 men and 9 women) who had a preoperative diagnosis of T1 tumor invasion. The patients had a mean age of 66.2 years. Patent blue (1%) was injected submucosally into four or five different sites around the primary tumor at 1 ml per site. Blue-stained lymphatics and lymph nodes could be seen by turning over the greater omentum and the lesser omentum extraperitoneally. If blue nodes were found, biopsy was performed.ResultsThe mean number of blue nodes dissected was 2.5 ± 1.9. Intraoperative identification and biopsy of blue nodes could be performed for 35 (92.1%) of the 38 patients. Of the 35 patients in whom blue nodes were identified, 4 (9.7%) had metastases in blue nodes confirmed by intraoperative frozen-section diagnosis. Intraoperative frozen-section diagnosis was negative for blue node metastasis in 31 patients. Postoperative permanent section diagnosis also showed no evidence of lymph node metastasis in these 31 patients (100% accuracy, 0% false-negative rates).ConclusionsThe reported method allows observation of blue-stained lymphatics up to 2 h after patent blue injection. Sentinel node biopsy was performed in laparoscopy assisted distal gastrectomy, making it technically equivalent to open gastrectomy. Sentinel node biopsy can serve as a method to determine the appropriate use of laparoscopy assisted distal gastrectomy for management of T1 gastric cancer.

MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY FOR AFFERENT LOOP SYNDROME

In April 2006, a 70-year-old man who had undergone a subtotal gastrectomy with Billroth II reconstruction for a benign peptic ulcer in 1955 and cholecystectomy for gallstones in 2005 was admitted to our hospital complaining of abdominal pain, distention and vomiting. Physical examination showed a large cystic abdominal mass with tenderness in the epigastrium. The results of laboratory tests showed serum amylase (AMY) of 518 IU/L, alanine aminotransferase of 641 IU/L, aspartate aminotransferase of 1198 IU/L, lactate dehydrogenas (LDH) of 378 IU/L and white blood cell of 5100/lL. Computed tomography (CT) examination showed fluid-filled loops of bowel (Fig. 1a). The superior mesenteric vessels were displaced anteriorly (Fig. 1a). These findings strongly suggested the diagnosis of afferent loop syndrome.1,2 MRCP clearly showed a long complex afferent loop course with an abrupt cut-off at the site of the gastrojejunostomy anastomosis (Fig. 2).

An Improved Technique for Esophagojejunostomy after Total Gastrectomy with a Novel Anvil Grasping Forceps

D T i t c e t t n t c c a F i ircular stapler anastomosis has been widely used in esophgojejunostomy after total gastrectomy. Because tearing f an esophagojejunostomy can result in lethal complicaions, this anastomosis occupies an important step during he reconstruction procedure of total gastrectomy. But echnical problems associated with the procedure of the nastomosis remain because of the anatomic features round the abdominal esophagus, which is located in a eep and narrow region at the bottom of the upper abdomnal cavity. We present a new technique for esophagojejuostomy using a novel anvil grasping forceps, which has a orn head (Fig. 1).

Liver Infarction due to Liver Abscess

nosed segment III infarction due to liver abscess, because CT scan showed the cluster sign characteristic of a liver abscess [1, 2] . We performed an operation for lavage and drainage ( fig. 2 ). Nine days later, CT examination revealed that the abscess cavity had become smaller and the infarction area had a transformed abscess ( fig. 1 b). Five months later, CT examination revealed that the lateral segment of the liver was entirely reduced ( fig. 1 c). Case

Platelet Activation in Patients After Splenectomy with Total Gastrectomy for Gastric Cancer

OBJECTIVE We investigated change in platelet activation using flow cytometry in patients before and after splenectomy with total gastrectomy for gastric cancer. METHODS Six patients who underwent splenectomy for lymphadenectomy with total gastrectomy for gastric cancer were the subjects in this study. In the patients, platelet count and platelet activation were evaluated before the operation, 1 week after the operation, and 1 month after the operation. Expression of CD62P (P-selectin) was analysed as a marker of platelet activation using flow cytometry. RESULTS Although platelet count significantly increased 1 week after the operation, the platelet count 1 month after the operation did not increase significantly. Expression of CD62P (P-selectin) significantly decreased at 1 week and 1 month after the operation, compared with the level before the operation. No postoperative complications occurred in any patient. CONCLUSION In the present study, platelet activation did not progress after the operation. The results mean that the risk of thrombosis after splenectomy does not increase.

A CASE OF OBSTRUCTIVE ILEUS CAUSED BY ENDOMETORIOSIS IN THE ILEUM

A 45-year-old woman seen at the department because of a right lower quadrant abdominal pain at menstruation which started about 3 years before. Abdominal X-ray film revealed intestinal obstruction. Obstructive ileus following appendectomy was suspected and the patient was operated on. During surgery, adhesive ileus at the terminal ileum was detected. Ileocecal resection was performed. Pathological diagnosis was made with endometriosis in the ileum, Bowel endometriosis causing intestinal obstruction is rare. It presents difficulty in pre-and intra-operative diagnosis. In a review of the literature, 28 cases including this case have been reported in Japan. It was characteristic of this disease that seven cases (25%) had a previous history of endometriosis, and 14 cases (50%) developed symptoms at menstruations. Those symptoms included abdominal pain, consti-pation, melena, diarrhea, and vomitting. In this case, the patient also complained of abdominal pain and constipation at menstruations. Entertaining of these characteristics, careful attitude for history taking is very important to get the correct diagnosis.