Hiroko Aruga

Additional microvascular anastomosis in reconstruction after total esophagectomy for cervical esophageal carcinoma.

BACKGROUND Maintaining sufficient blood flow to the substitute organ after total esophagectomy is essential for decreasing the risk of anastomotic leakage. Additional venous, or arterial and venous, anastomoses between the vessels of the gastric tube and the vessels in the neck after total esophagectomy are described for 11 patients with cervical esophageal carcinoma. METHODS The tissue blood flow was measured by laser Doppler flowmetry before and after anastomosis. Venous anastomosis was performed for all 11 patients, and arterial anastomosis was added for 7 patients. RESULTS A significant increase in tissue blood flow was observed after venous anastomosis alone (mean, 19%; P < 0.05) and after arterial and venous anastomoses (mean 43%; P < 0.01). There was no anastomotic leakage or hospital death. CONCLUSIONS This procedure may reduce the risk of anastomotic leakage especially in the case of pharyngogastrostomy following total esophagectomy.

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.

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.