Hisanobu Sakata

Laparoscope-assisted distal gastrectomy for early gastric cancer in a 76-year-old man with situs inversus totalis.

We report a case of a 76-year-old man with situs inversus totalis (SIT) who developed early gastric cancer. He was successfully treated by laparoscope-assisted distal gastrectomy for the gastric cancer. This case suggests that patients with SIT with malignancy could also undergo laparoscopic surgery. To the best of our knowledge, no case of laparoscopic surgery for malignant neoplasms associated with SIT has been reported in the English literature. We therefore believe this is the first case report.

Ileal varices associated with recurrent bleeding in a patient with liver cirrhosis

Abstract: We report a rare case of massive and recurrent bleeding from ileal varices in a patient with hepatitis C virus-positive liver cirrhosis. A 66-year old woman, who had undergone laparotomy and blood transfusion 36 years before (because of an extrauterine pregnancy) and endoscopic sclerotherapy for esophageal varices 1 year previously, was admitted to our hospital with loss of bright red blood per rectum. The bleeding was massive and recurrent, and frequent blood transfusions were required. Endoscopic studies failed to find the bleeding site. In the venous phase of selective superior mesenteric angiography, mesenteric varices in the lower part of the abdominal cavity were observed. Laparotomy was performed to control the repeated bleeding which had lasted for more than 1 month. Varices communicating with the right ovarian vein were found on the ileal wall and segmental resection of the ileum was performed. Histological examination demonstrated a massive varicose vein and several dilated veins in the submucosa. The patients postoperative course was favorable, with no hemorrhagic events during a follow-up of more than 6 months after surgery. Ileal varices should be considered in the diagnosis of a patient who presents with lower gastrointestinal bleeding and portal hypertension.

LDL apheresis for arteriosclerosis obliterans with occluded bypass graft: change in prostacyclin and effect on ischemic symptoms.

To study the mechanism of efficacy of low-density lipoprotein (LDL) adsorption for arte riosclerosis obliterans (ASO), eight ASO patients without indication for bypass surgery underwent LDL apheresis twice a week for 5 weeks and the change in prostaglandin I2 (PGI 2) and thromboxane A2 (TXA2) due to LDL apheresis was measured. The concentra tion of 6-keto-PGFI,, a metabolite of PGI2, in systemic venous blood significantly increased from 10.4 ± 1.8 to 42.0 ± 10.6 pg/mL (P < 0.05) after one session of LDL apheresis, while no significant change of TXB2, a metabolite of TXA2, was encountered. The ratio of 6-keto-PGF,,,/TXB2 also rose dramatically from 0.213 ±0.044 to 0.522 ±0.128 (P < 0.05) . In five patients, the ischemic clinical symptoms improved and both the concentration of 6-keto-PGF1α and the ratio of 6-keto-PGF1α/TXB2 increased significantly, whereas in three patients there was no effect on clinical symptoms and neither parameter changed. These results suggest that elevated production of PGI 2 from vascular cells due to LDL apheresis might contribute to improvement of ischemic symptoms.

A traumatic pseudoaneurysm of the dorsalis pedis artery: Report of a case

Abstract.A 63-year old woman underwent a resection of a pseudoaneurysm in the dorsalis pedis artery. The aneurysm was suggested to have formed because of a bruise on the dorsal aspect of the foot 5 years previously. This is a rare case of a traumatic aneurysm in the peripheral artery.

Intermittent claudication associated with persistent sciatic artery: Report of two cases

Two elderly women complaining of intermittent claudication complicated with persistent sciatic artery are herein reported. A direct femoral arteriogram showed hypoplasty of the superficial femoral artery and an unnatural anatomical relationship between the distal superficial femoral artery and the proximal popliteal artery, thus suggesting the presence of persistent sciatic artery. The diagnosis of persistent sciatic artery was finally made based on the aortography findings including the iliac arterial system and computed tomography (CT) scan. Magnetic resonance imaging (MRI) was helpful to demonstrate the entire image of this anomaly in cases with non-thrombolized sciatic artery. These diagnostic methods were useful in designing the optimal surgical strategy. The first case with a gluteal pulsating mass underwent exclusion of the persistent sciatic artery including the aneurysm through a retroperitoneal approach with a combination of femorotibial bypass, while the second case with thrombosed persistent sciatic artery only underwent femoropopliteal bypass. To recognize such a rare lesion, awareness of the differential diagnosis is important, and to provide appropriate treatment, an accurate whole image including adequate angiography, a CT scan, and magnetic resonance imaging is necessary.

Penetration by a huge abdominal aortic aneurysm into the lumbar vertebrae: Report of a case

We report herein the case of a 64-year-old man who underwent urgent surgery for a huge abdominal aortic aneurysm (AAA) with severe lumbago. At surgery, a defect in the posterior wall of the AAA, through which the adjacent lumbar vertebrae was seen after removal of intraluminal thrombi, was encountered with no evidence of blood leakage. This is a rare case of AAA that eroded the posterior wall and exposed the vertebrae.

Role of Femorofemoral Crossover Bypass Grafting for Unilateral Iliac Atherosclerotic Disease: A Comparative Evaluation with Anatomic Bypass

PurposeTo assess the role of femorofemoral or iliofemoral crossover bypass grafting, the early and late results of crossover bypasses were reviewed and compared with those of anatomic bypasses.MethodsThe clinical records of 164 patients with arteriosclerosis obliterans who underwent 99 crossover bypasses and 65 anatomic ones from 1982 to 2002 were retrospectively evaluated. The early and late results including operative mortality and morbidity, graft patency rate, limb salvage rate, and survival rate of the patients as well as backgrounds of the patients were compared between the two kinds of bypass procedures. In addition, perioperative factors including bypass procedures affecting graft patency were evaluated by a multivariate analysis.ResultsThe percentage of high-risk patients was higher in the crossover bypass group than in the anatomic bypass group. The operative mortality and morbidity were similar between both bypass groups. The primary and secondary patency rates of crossover bypass grafts (93% and 97%, 83% and 92%, and 65% and 63% at 2, 5, and 10 years, respectively) were lower than those of anatomic ones (95% and 98%, 93% and 98%, and 90% and 98% at 2, 5, and 10 years, respectively). The late survival of the patients in the crossover bypass group was significantly lower than that in the anatomic bypass group. A multivariate analysis revealed the operative method, namely the crossover bypass, to be the only significant risk factor of late graft failure.ConclusionA crossover bypass was thus determined to be an acceptable procedure only in high-risk patients with a limited life expectancy.

Fifteen-year experience in axillofemoral bypass with externally supported knitted Dacron prosthesis in a Japanese hospital.

BACKGROUND Recently, several reports in the United States have demonstrated remarkable improvement in the patency of axillofemoral (AXF) bypass with an externally supported prosthesis. The purpose of this study was to review the prognoses regarding graft patency, limb salvage, and survival of patients who underwent AXF bypass grafting with an externally supported, knitted Dacron prosthesis (EXS) in a Japanese hospital and to analyze what factors affected the graft patency. METHODS The clinical records of 81 patients with arteriosclerosis obliterans (ASO) who underwent 47 axillounifemoral bypasses and 34 axillobifemoral bypasses with EXS were retrospectively checked and, by uni- and multivariate analysis, perioperative factors were evaluated. RESULTS The cumulative primary and secondary patency rates of AXF bypass grafts were 81% and 88%, 73% and 80%, and 70% and 77% at 3, 5, and 7 years, respectively, with no change thereafter. Limb salvage rate was 100%. The operative mortality was 3.7% and the survival rate was 63%, 41%, and 35% at 3, 5, and 7 years, respectively. The risk factors adversely affecting the patency were age (younger than 75 years), poor distal runoff, and preoperative leukocyte count (more than 8,000/microL) by univariate analysis, none of which were significant by stepwise multivariate analysis. CONCLUSIONS AXF bypass using EXS was an acceptable procedure in ASO patients at high risk for conventional anatomic bypass or with limited life expectancy, and there was no significant risk factor that independently affected the patency.

Intrahepatic pseudoaneurysm after surgical hemostasis for a delayed hemorrhage due to blunt liver injury: report of a case.

Abstract We report herein a case of delayed hemor-rhage occurring after blunt hepatic trauma which was further complicated by an intrahepatic pseudo-aneurysm. The delayed hemorrhage with free rupture occurred 2 weeks after the injury and the pseudoaneurysm developed 8 weeks after surgical hemostatic intervention for the delayed hemorrhage. The pseudoaneurysm was successfully treated by transcatheter arterial embolization. This rare case is reported to demonstrate the possibility of delayed catastrophic complications occurring after blunt liver injury and to point out the necessity of continued surveillance until the liver has completely healed.

Laparoscopic surgery for the diagnosis and treatment of a paracecal hernia repair: Report of a case

Internal hernias are relatively rare viscous protrusions through a defect in the peritoneal cavity. Paracecal hernia is one of the least common types, and only a few cases have been reported to date. We herein present the case of a 43-year-old woman, who was preoperatively diagnosed to have a small bowel obstruction caused by a paracecal hernia resulting from intestinal protrusion and invagination into a paracecal pouch. Laparoscopic surgery was performed for definitive diagnosis and treatment. The surgery achieved a good outcome and the patient experienced an uneventful perioperative course.