Hideo Koike

Primary Abscess of the Omentum : Report of a Case

We report a case of a primary abscess of the omentum without any obvious etiology. A 62-year-old man was referred to our clinic with lower abdominal pain, and computed tomography showed an intra-abdominal abscess in the left pelvic area. Laparotomy revealed that the abscess adhered to the urinary bladder and abdominal wall, but no perforation of the alimentary tract was identified and there was no foreign body in the abscess cavity. A culture of the abscess fluid grew Clostridium perfringens. The patient was discharged on the 16th hospital day after an uneventful postoperative course without any complications.

Exogastrically Developed Pedunculated Epithelioid Leiomyoma of the Stomach

Epithelioid leiomyomas of the gastrointestinal tract are difficult to diagnose before surgery and their malignancy is not readily evaluated. The tumor is of smooth muscle origin, arising from the muscularis propria, and frequently develops in the gastrium, occasionally extending into the gastrocolic ligament or greater omentum. Malignancy is evaluated from the numbers of mitotic cells per 50 high power fields. However, even a tumor with few mitoses may metastatize. Thus, we propose that the malignancy of the tumor should be decided in terms of location, size, pattern of growth, invasion of the mucosa, cellularity, mitotic rate, and anaplasia. We reported a case of epithelioid leiomyoma that was pedunculated, with exogastric expansion. The literature is reviewed.

RESULTS OF THE INTRODUCTION OF CLINICAL PATH TO SURGERY FOR BREAST CANCER

当院では医療の標準化・業務の効率化・医療の質の向上・入院日数の短縮を目的として全科的にクリニカルパスを導入し,その有効性について検討したので報告する.対象は乳癌症例で, 2000年4月から2001年3月までの導入前14症例と2001年4月から2002年3月までの導入後25症例とした.医療の標準化を徹底するため,従来の漫然とした医療行為は削除され,早期離床・早期退院を促すことが可能になった.入院オーダーを疾患毎に統一してオーダリングシステムからパス表を作成し,必要な医療行為をもれなく確実に行い,患者に対してはパス表を用いて入院後の治療内容と経過の説明を行いインフォームドコンセントの充実を計った.パス導入後は在院日数は短縮し,総医療費は減少したが1日あたり医療費は増加した.更に病床利用率は一時的に下がったものの回転率は上昇し全身麻酔手術件数も増加し収益にも有効であった.現在の厳しい医療業界においてパス導入は有効と考えられた.

Small Intestinal Evisceration through the Anus due to Spontaneous Rupture of the Rectosigmoid

A case of intestinal evisceration through the anus due to spontaneous rupture of the rectosigmoid is reported. The patient was a 76-year-old widow with habitual constipation. The episode of eviscerati