Daisuke Kubota

Predictive factors for surgical indication in adhesive small bowel obstruction

BACKGROUND Small bowel obstruction (SBO) after abdominal surgery is usually treated successfully with intestinal decompression using a long nasointestinal tube (LT), but some cases fail to respond. METHODS Clinical background and laboratory data on admission were evaluated retrospectively for 53 patients with adhesive SBO to determine predictive factors for failure of LT decompression, and the appropriate timing of laparotomy was investigated. RESULTS Complete SBO (no evidence of air within the large bowel) and increased serum creatine phosphokinase (>or=130 IU/L) were independent predictive factors for LT decompression failure. Laparotomy was indicated in 14 patients (9 and 5 with complete and partial SBO, respectively), whereas successful LT decompression occurred in 39 patients (9 and 30, respectively). Resolution of SBO took significantly longer for complete SBO (6.3 days) than for partial SBO (2.6 days). CONCLUSIONS Patients with complete SBO or high serum creatine phosphokinase (CPK) may not respond to LT decompression. Laparotomy is appropriate after non-response for 7 and 3 days for complete and partial SBO, respectively.

Delayed hepatic resection for ruptured hepatocellular carcinoma

BACKGROUND Although transcatheter arterial embolization is advocated as initial therapy for ruptured hepatocellular carcinoma (HCC), hepatic resection is necessary for cure. The effectiveness of delayed hepatic resection for ruptured HCC was determined. METHODS The records of 10 patients who underwent delayed hepatic resection for ruptured HCC were reviewed. RESULTS All patients were men, and the mean age was 63 years. For hemostasis, transcatheter arterial embolization was performed in three patients, whereas in the other patients bleeding stopped without special procedures. Mean interval from rupture to hepatic resection was 74 days. Liver function test results before hepatic resection were almost normal. Trisegmentectomy in one and bisegmentectomy in four patients were performed, whereas minor hepatic resection was performed for four extrahepatic HCCs. There were no operative or hospital deaths. Four patients had cirrhosis. The mean tumor diameter was 7.5 cm. Of seven patients with recurrence, two with dissemination had tumors that ruptured on the inferior aspect of the liver. The 1- and 3-year survival rates were 77% and 48%, respectively. CONCLUSIONS Because delayed hepatic resection for ruptured HCC was safe and compared similarly with that for other patients who underwent resection for HCC, it should be used. However, when HCC ruptures in an inferior location, recurrence of tumor as dissemination is likely.

Latent Gallbladder Carcinoma in a Young Adult Patient with Acute Cholecystitis: Report of a Case

Acute cholecystitis associated with gallbladder carcinoma is very rare in young patients (younger than 30 years of age). Moreover, a definitive preoperative diagnosis is difficult. A 26-year-old man was referred to our hospital with a 5-day history of right upper quadrant pain. Computed tomography and ultrasonography demonstrated an enlarged gallbladder with a diffuse thick wall and a 2-cm gallstone obstructing the cystic duct. Magnetic resonance cholangiopancreatography showed no evidence of an anomalous pancreaticobiliary junction. The patient showed an elevation in the white blood cell count, serum C-reactive protein, and alkaline phosphate; however, total bilirubin, alanine aminotransferase, and tumor markers including carcinoembryonic antigen and carbohydrate antigen 19–9 were all within the normal ranges. The preoperative diagnosis of gallstone-induced acute cholecystitis was made and an open cholecystectomy was thus performed 2 days after admission. The macroscopic findings showed a necrotic enlarged gallbladder with a thick wall and a gallstone, but no intraluminal nodular lesion. Histologic examinations revealed well-differentiated focal adenocarcinoma in the gallbladder mucosa, but no venous, lymphatic, or perineural invasion. The postoperative course has been uneventful with no recurrence 18 months postoperatively.

Clinicopathological analysis of nodules in cirrhotic liver after resection for hepatocellular carcinoma.

肝癌切除後の残肝再発には,転移再発ならびに多中心性再発の2種類の様式が考えられている.これら残肝再発の機序を解明する一助として,最近5年間に取り扱った切除肝癌161症例の非癌部肝内結節性病変を再検索した.その結果,161症例中31症例(19%)に術前術中に診断し得なかった結節性病変48結節が検出された.これらを病理組織学的に検討したところ,large regenerative noduleは19結節(40%),adenomatous hyperplasiaは10結節(21%), early HCCは8結節(17%), intrahepatic metas-tasisは8結節(17%)であった.したがって,最近精度の著しく向上した術前画像診断法によっても検出しえない結節性病変が残肝にかなり存在することが推測された.

Biphasic clinical characteristics of mild to moderate chest trauma according to age

PurposeMild to moderate chest trauma is a common disease, although its clinical characteristics are not well known. We investigated the clinical profiles and the early and long-term outcome of hospitalized patients with chest trauma, focusing particularly on elderly patients.MethodsThe clinical records of patients who were hospitalized in Higashisumiyoshi Morimoto Hospital for chest trauma between January 2001 and December 2004 were retrospectively reviewed. The clinical profiles, treatment methods, and outcomes were investigated. The primary endpoint was a repeat visit to the hospital for another traumatic condition after discharge, and the secondary endpoint was death. The patients were divided into two groups with respect to the age of 60 years, and differences were compared statistically.ResultsIn all, 53 patients (34 men) were hospitalized for chest trauma in our hospital between January 2001 and December 2004. The mean age was 54.9 years (17–85 years). The distribution of age showed biphasic peaks—in the tens to twenties, and sixties to seventies. Injuries were significantly more likely to be caused by a fall in elderly patients than in younger patients (P < 0.05). The elderly patients revisited our hospital with another trauma more frequently than did the younger patients (P < 0.05).ConclusionElderly patients were likely to suffer both falls and a further traumatic condition. This probably reflects the general deterioration of physical abilities, such as lowered cognitive and somatic performances.