Daisuke Wada

The successful application of jejunal interposition for severe dumping syndrome: Report of a case

We report herein the case of a 76-year-old man with intractable dumping syndrome which had manifested itself 3 years after he underwent a gastric resection and Billroth I reconstruction for a gastric ulcer. Despite aggressive medical therapy by the time of admission, he had suffered from disabling dumping symptoms for 9 years. In an attempt to relieve these symptoms, a 15-cm segment of the jejunum was placed isoperistaltically between the lesser curvature of the remnant stomach and the duodenum, and a selective vagotomy was performed. The dumping symptoms that he had experienced preoperatively completely disappeared after the revisory surgery. Postoperatively, an upper gastrointestinal series demonstrated a larger gastric pouch and slower gastric passage into the small intestine than what was seen preoperatively, while gastric emptying studies using the acetaminophen method also showed normal patterns in both the early and late postoperative phases. Thus, we consider that this surgical procedure is a simple and effective way to inhibit rapid gastric emptying and to slow intestinal transit in the treatment of dumping syndrome.

Efficacy of erlotinib and imatinib in a patient with a rectal gastrointestinal stromal tumor and synchronous pulmonary adenocarcinoma: A case report

The synchronous existence of lung cancer and gastrointestinal stromal tumors (GIST) is considered to be extremely rare. To the best of our knowledge, this is the first report about the treatment of lung cancer and GIST with two kinds of molecular targeting drugs. An 83-year-old woman with a rectal GIST, which carried a c-kit mutation, and pulmonary adenocarcinoma, which exhibited an epidermal growth factor receptor (EGFR) mutation, was treated alternately with imatinib and erlotinib. Good control over both diseases was achieved for two years. The present case is not only of interest due to the rare co-occurrence of GIST and lung cancer, but also because it involved two tumors carrying different gene mutations, and both tumors were brought under control using different molecular targeting drugs.

Case report of an anomalous arrangement of the pancreaticobiliary ducts and nuclear DNA ploidy analysis

Two cases with an anomalous arrangement of the pancreaticobiliary ducts (APBD) are reported in order to investigate the mechanism of carcinogenesis of the extrahepatic biliary tract from the aspect of DNA ploidy analysis. Highly elevated biliary enzymes were found in both cases. Although inflammatory changes without any metaplasia or neoplasia were observed histologically, a cytofluorometric nuclear DNA ploidy analysis showed an aneuploid low ploidy pattern in a histogram of the gall bladder, an aneuploid high ploidy pattern in a histogram of the common bile duct in one patient, and a diploidy pattern in the gall bladder, an aneuploid low pattern in the common bile duct in another case. These results may show that APBD may play a role in the development in DNA ploidy abnormality with refluxed pancreatic juice which may induce repeated irritation and inflammation. Radical surgery including a complete excision of the extrahepatic biliary tract followed by reconstruction may achieve better results with regard to undesirable consequences with an abnormal nuclear DNA ploidy pattern and decrease the likelihood of developing carcinoma.

An unusual case of gastric outlet obstruction

An unusual case of gastric outlet obstruction due to hypertrophic pyloric stenosis associated with prepyloric ulceration is described. An upper gastrointestinal series showed a tumorous filling defect at the pylorus. Hypertrophy of the muscle layer and tumorous, elevated mucosa were found in the pylorus, and an ulceration was present in the elevated mucosa at surgery. The clinical course was uneventful after selective vagotomy and gastric antrectomy.

Propensity score‐matched study of laparoscopic and open surgery for colorectal cancer in rural hospitals

Various randomized clinical studies have suggested that short‐ and long‐term outcomes of laparoscopic surgery (LAP) for colorectal cancer are comparable with those of open surgery (OP). However, these studies were performed in high‐volume hospitals. The aim of the present study was to compare the outcomes of LAP versus OP for colorectal cancer in rural hospitals.

Successful resection of cholangiocellular carcinoma with tumor thrombus in the main trunk of the portal vein

A space-occupying lesion in the right hepatic lobe, with dilated peripheral bile ducts, was observed by ultrasonography and computed tomography in a 50-year-old man with right upper quadrant abdominal pain. One month later, this lesion evidenced rapid growth and a tumor thrombus, which completely occluded the main trunk and the left primary branch of the portal vein, had developed. The tumor was diagnosed as a cholangiocellular carcinoma with an unusual pattern of intravascular extension. The primary tumor and the portal tumor thrombus were resected via a right hepatic trisegmentectomy combined with resection of the portal vein and extrahepatic bile duct, using a superior mesenteric vein—left femoral vein catheter bypass (SMV—FV bypass). The SMV—FV bypass was found to effectively reduce intraoperative hemorrhage.

An Experimental Study on Gastric Secretion Following Proximal Massive Small Bowel Resection.

小腸近位側2/3切除術後の胃酸分泌動態を分泌促進系因子面から検討するため, 実験犬を用い酸分泌能, 右胃大網静脈 (RGEV) 血漿ガストリン値とヒスタミン値, 幽門洞G細胞数, 壁細胞数を経時的に測定した.1) 術後3～4週: BAO, MAO (mEq/h), 壁細胞数 (個/0.2mm幅垂直切片柱) はそれぞれ48.5%, 28.2%, 16.4%増加し, RGEV血漿ガストリン値 (pg/ml), ヒスタミン値 (nM), G細胞数 (個/mm幅垂直切片柱) はそれぞれ57.8%, 32.2%, 10.9%減少した.2) 術後11～12週: BAOは術前値にほぼ回復したが, MAOは減少傾向を示すものの高値を持続した.RGEV血漿ガストリン値とヒスタミン値は増加し術前値に回復する傾向を示した.壁細胞数はやや減少したのに対しG細胞数は増加した.以上から, 術後の胃酸分泌能の亢進は壁細胞数の増加と機能亢進が直接関与しており, RGEV血漿ガストリンおよびヒスタミンの変動は,酸分泌量の増減に伴うfeedback作用の結果であると考えられた.

An Experimental Study of the Effects of Bile in the Stomach on Hypergastrinemia Following Selective Proximal Vagotomy.

選択的近位迷走神経切離術(SPV)後の高ガストリン血症に及ぼす胃内胆汁の影響を実験的に検討した.術後12週では胆汁を胃内に流入させた群(胆汁群)は試験食投与後の末梢血漿ガストリン値(IRG),ソマトスタチン値(SRIF)が対照群に比較し低値で,integrated IRG,SRIF responseは胆汁群(8.98±2.27,7.14±1,62ng・120min/ml)が対照群(15.26±2.97,11.87±2.71ng・120min/ml)に比較し有意に低かった.免疫組織化学法で染色した幽門洞粘膜内G,D細胞数(30.5±3.9個/mm,22.2±1.9個/mm)は対照群(47.4±6.6個/mm,26.9±2.1個/mm)に比較し有意に少数であった.以上からSPV後に胃内に流入した胆汁はG細胞数を減らし,血中ガストリン値を低下させることが示唆された.また胆汁群の幽門洞粘膜には点状出血,発赤や表層性胃炎がみられ,胃内流入胆汁がSPV後の胃潰瘍発生の一因である可能性が示唆された.