Hiroki Shinkawa

Factors Affecting the Early Mortality of Patients with Nontraumatic Colorectal Perforation

Abstract.Purpose: We attempted to identify the factors associated with the early mortality of patients with nontraumatic colorectal perforation. Methods: Eighty patients who underwent surgery for nontraumatic colorectal perforation between May 1986 and December 1999 were retrospectively reviewed. Age, sex, cause of perforation, duration of symptoms, associated preoperative septic shock, concomitant disorders (including cardiac disease, chronic obstructive pulmonary disease, hemodialysis, and steroid treatment), operative findings (such as the site of perforation and the degree of peritonitis), and results of preoperative laboratory blood tests (such as the white blood cell count and platelet count) were analyzed for their association with early outcome using univariate and multivariate analyses. Results: Fourteen of the 80 patients died during hospitalization. According to the univariate analysis, advanced age, preoperative septic shock, concomitant disabling cardiac disease, hemodialysis, diffuse peritonitis, and a low preoperative platelet count were more frequent in the patients who died during hospitalization. According to the logistic regression analysis, preoperative septic shock (odds ratio 8.443, 95% confidence interval (CI) 1.625–43.873), concomitant end-stage renal failure (odds ratio 13.641, 95% CI 1.643–113.244), and diffuse peritonitis (odds ratio 13.212, 95% CI 1.441–121.102) were the most significant factors related to in-hospital mortality. Conclusion: Early diagnosis before the patients general condition deteriorates is a key to improving the early mortality associated with nontraumatic colorectal perforation, especially in patients with concomitant end-stage renal failure.

Expression of transcription factor E2F-1 in pancreatic ductal carcinoma: an immunohistochemical study.

E2F-1 is a transcriptional factor that mediates cell cycle progression from G1 to S phase, thereby influencing tumor progression. However, only a few clinicopathologic studies have been carried out using surgically removed specimens for defining its role in tumor biology. Therefore, we studied the expression of this cell cycle regulator on surgical specimens at the immunohistochemical level, and examined its possible relationship with proliferative index, assessed by analysis of MIB-1 expression, and clinicopathologic factors in pancreatic ductal carcinomas. E2F-1 and MIB-1 were immunostained on 54 surgically removed specimens, and nuclear reactivity was evaluated. The percentage of E2F-1 positive cells (E2F-1 PI) ranged from 3.8% to 71.4%. We found a statistically significant correlation between E2F-1 PI and the histologic grade of tumor differentiation (p = 0.0133), i.e. E2F-1 PI was higher in less-differentiated carcinomas. Furthermore, there was a positive correlation between E2F-1 PI and the percentage of MIB-1 PI (r = 0.763; p < 0.0001). The patients with higher E2F-1 PI (E2F-1 PI > or = 38.0 = median) showed a significantly shorter disease-associated survival time in R0 resection cases (n = 49, p = 0.015). The present analysis seems to support the theory that E2F-1 is upregulated in cell cycle, and its expression reflects the effector function of G1/S progression as far as pancreatic ductal carcinoma is concerned.

Hepatic Portal Venous Gas Caused by Blunt Abdominal Trauma : Is It a True Ominous Sign of Bowel Necrosis? : Report of a Case

Abstract.A case of transient portal venous gas in the liver following blunt abdominal trauma is described. Computed tomography (CT) demonstrated hepatic portal venous gas 4 h after the injury. An exploratory laparotomy revealed segmental necrosis of the small intestine with a rupture of the bladder. Pneumatosis intestinalis was evident on the resected bowel. A histopathologic study revealed congestion and bleeding in the bowel wall and a great deal of the mucosa had been lost because of necrosis. However, neither thrombus nor atherosclerotic changes were observed in the vessels. A bacteriological examination demonstrated anaerobic bacteria from the bowel mucosa, which was most likely to produce portal venous gas. Although the present case was associated with bowel necrosis, a review of literature demonstrated that portal venous gas does not necessarily indicate bowel necrosis in trauma patients. There is another possibility that the portal venous gas was caused by a sudden increase in the intra-abdominal pressure with concomitant mucosal disruption, which thus forced intraluminal gas into the portal circulation in the blunt trauma patients.

Role of Ganglion Cells in Sigmoid Volvulus

The aim of this study was to clarify the role of ganglion cells in the development and recurrence of sigmoid volvulus. We analyzed 9 samples obtained from 9 patients who had undergone sigmoidectomy for sigmoid volvulus, and, for comparison, 18 samples from 18 patients who had undergone sigmoidectomy or low anterior resection for rectal cancer. Neuron-specific enolase was used for immunohistochemical staining to detect ganglion cells, and the number of ganglion cells in 20 contiguous fields was counted at 200? magnification. The average number of ganglion cells per 1000 cm3 was corrected using the ratio of the circumference of the resected sigmoid colon to the average circumference in the control group.The raw numbers of ganglion cells in the Meissner’s and Auerbach’s plexuses in the volvulus group were significantly lower than those in the non-volvulus group (Meissner: p = 0.017, Auerbach: p = 0.007). The circumference of the resected sigmoid colons with volvulus was greater than that of those without volvulus (p = 0.00013). There was no significant difference in the corrected numbers of ganglion cells in the Meissner’s plexus or Auerbach’s plexus per 1000 cm3 between the volvulus and non-volvulus groups (Meissner: p = 0.410, Auerbach: p = 0.890).Furthermore, there was no significant difference in the corrected numbers of ganglion cells between the revolvulus and non-revolvulus groups. These findings led us to conclude that functional disorder of bowel movement or elongation of the bowel in sigmoid volvulus or revolvulus is not related to the number of ganglion cells in Auerbach’s or Meissner’s plexus.

Gastric carcinoma presenting with extensive extraluminal growth: Report of a case

We report a 48-year-old-man with gastric carcinoma presenting with an unusual extraluminal growth. The patient underwent a barium meal examination and gastrofiberscopy because of progressive anemia over 6 months. These examinations revealed a Borrmann type 3 advanced gastric carcinoma of the greater curvature of the antrum. Biopsies showed moderately differentiated tubular adenocarcinoma. The intraoperative findings showed gastric carcinoma associated with extensive extraluminal invasion into the adjacent organs, i.e., the transverse colon and mesocolon. A palliative distal gastrectomy with a partial resection of the transverse colon was performed because of peritoneal dissemination found in the mesocolon and rectovesical pouch. A histological examination of the specimen confirmed adenocarcinoma which had massively infiltrated the transverse colon and mesocolon. His postoperative course was uneventful. However, he died of peritonitis carcinomatosa 9 months later.