Hideyuki Ichikawa

Churg-Strauss syndrome (allergic granulomatous angitis) presenting with ileus caused by ischemic ileal ulcer

Abstract: We report a rare case of Churg-Strauss syndrome (CSS) in a 41-year-old Japanese man with a history of middle-age onset of bronchial asthma who had severe abdominal pain. He presented with ileus caused by an annular ulcer of the ileum, attributable to mucosal ischemia resulting from necrotizing vasculitis of the mesenteric artery. He also had marked hypereosinophilia (51.5%), elevated serum IgE levels (34040 IU/ml), and generalized enlargement of the superficial cervical lymph nodes, containing eosinophilic granulomas. A stenotic lesion caused by an annular ulcer in the ileum was found and resected by laparotomy. Microscopic examination of the resected specimen revealed luminal narrowing or occlusion of small arteries in the ulcer base, subserosa, and mesenterium resulting from marked fibrotic intimal thickening with fragmentation or lack of the internal elastic lamina. These findings were diagnosed as vasculitis, scar stage. The postoperative course was uneventful, with the patient receiving a maintenance dose of prednisolone (10–15 mg/day) for 7 years subsequently. We must carefully diagnose and treat patients with middle-age onset asthma, because the symptom may be a lung manifestation of CSS, in which various organs including gastrointestinal tract are involved as a result of systemic necrotizing vasculitis.

Esophageal intramural pseudodiverticulosis associated with esophageal perforation

Abstract: We report a rare case of esophageal intramural pseudodiverticulosis with lower esophageal stricture which perforated into the peritoneal cavity after the patient vomited. A 61-year-old man was admitted with severe chest and epigastric pain after dysphagia and vomiting. Under a diagnosis of upper gastrointestinal perforation, laparotomy was performed. The anterior wall of the abdominal esophagus was found to have ruptured, and proximal gastrectomy with abdominal esophagectomy was performed. His-tological examination revealed esophageal intramural pseudodiverticulosis with esophageal stricture distal to the site of rupture, and postoperative endoscopy showed diffuse pseudodiverticulosis in the remaining esophagus. The patient is free of symptoms 5 years after the surgery. This case suggests that careful treatment may be indicated in patients with esophageal intramural pseudodiverticulosis with stricture and elevated intraluminal pressure, to minimize the possibility of severe complications such as esophageal perforation.

Abdominal surgery in patients 90 years of age and older at a provincial general hospital

Background:  It has been commonly accepted that age itself is never an absolute contraindication for surgical treatment in the elderly. Some of the many problems with the oldest old could be solved by surgical intervention. However, there are quite a few issues to be resolved for the surgical treatment of patients aged in their nineties. We therefore investigated cases of abdominal operations performed during the past decade, and wish to give our point of view on the indication, significance, merits and demerits of conducting surgical operations in this age‐group of patients.

Abdominal surgery in patients aged over 90 years old at a provincial general hospital

It has been commonly accepted that age itself is never an absolute contraindication for surgical treatment. Some many problems could be solved through surgical intervention, we studied perioperative status, postoperative morbidity and mortality, and short-and-long-term outcomes after abdominal surgery in a series of patients 90 year old or older, operated at a provincial General Hospital. Seven patients were treated using elective surgical procedures, while 6 had emergency surgery. The incidence of postoperative morbidity was fairly high after both elective and emergency operations. Major complications occurred in one patient who died on the 20th postoperative day, due to multiple organ failure. One case of hospital death occurred when a patient died on the 240th day after a gastrectomy. There was long-term survival of over five years occurred among the patients in the study who had reviewed elective operations for malignant lesions. No definite relation was revealed between the risk score and post-operative morbidity or mortality. No evident change in performance status was found even aged patient who underwent abdominal surgical procedures. These results indicate the need for more meticulous consideration, including more precise decisions regarding the indication for surgical intervention, and more intensive perioperative management, in order to secure more favorable therapeutic outcomes and quality of life for high-risk patients over 90 year of age.

Solitary Splenic Metastasis from Cecal Cancer

Solitary splenic metastasis of a malignant tumor is very rare. The patient reported here had cecal cancer metastasizing only to the spleen 6 years after colectomy. The patient underwent splenectomy, a

Proceedings Of The 21St Autumn Meeting From October 15th-17th, 1979-Maebashi, Japan

When the peripheral blood lymphocytes from patients with various types of hepatitis were stimulated in vitro with liver specific protein, lymphocyte transformation and MIF production were detectable in many cases, especially in chronic active hepatitis. The macrophage activating factor (MAF), a kind of lymphokines, was also detected in the culture medium of activated lymphocytes from patients who showed positive blastogenesis. The activated macrophages by MAF were shown to be cytotoxic to the separated liver cells causing the marked inhibition of albumin synthesis. MAF-containing culture supernatants of these active lymphocytes activated guinea pig macrophages which inhibited the albumin biosynthesis of the isolated liver cells. These observations suggest that the macrophagemediated cytotoxicity may play and role in pathogenesis of chronic active hepatitis.

SIGNIFICANCE OF GASTRIC MUCO-SUBSTANCE RELATED TO THE PATHOGENESIS AND TREATMENT OF GASTRIC ULCER

十二指腸潰瘍の成因として, 酸分泌亢進が第一にあげられるのに対して, 胃潰瘍の場合にはこの酸分泌の亢進が顕著でなく, 低酸, 無酸状態下でも発生しているために, いろいろな発生要因があげられてきた.ことにF, Hollanderが強調した2層からなる粘液による粘膜関門の障害と潰瘍発生との関係は胃潰瘍の発生をかなり解明させる, 興味深い見解であり, この考えに立ち, 胃粘液分泌に焦点を向けた研究成果も少なからず発表されてきたが, なお解明を要する点が数多く残されている.筆者らは胃潰瘍病巣組織内のムコ物質の消長, 胃液検査上, 酸量と粘液成分量との相関, 各種病態下におけるこの相関の変化, 手例前後における胃液中の粘液成分の消長, 実験的胃粘膜創部, および急性潰瘍病巣における胃壁組織内および胃液内のムコ物質の態度などを検討し, 十二指腸潰瘍例におけるような顕者な機能異常ではないが, 胃潰瘍の成因あるいは慢性化の要因として, 他の局所性因子とともに粘液による粘膜防禦機構の弱体化をも考慮すべきことを述べた.