Masaaki Shinoda

A new method of hernioplasty for adult groin hernias centering on repair of the transversalis fascia

A new method of hernioplasty for adult groin hernias centering on repair of the transversalis fascia was assessed by a questionnaire conducted every five years on adult patients who had received the above operation. The efficacy of this method was evaluated in terms of the postoperative quality of life and prevention of recurrence of groin hernias. Over the last 9 years, 834 adult patients with 921 groin hernias, including bilateral lesions, have undergone the above procedure and overall, favorable results were obtained, with only one case of recurrence (0.1 per cent) being reported. Contralateral herniation, which has been often reported following Bassinis or Hatakoshis method, was found in only one of our patients although the number of patients who complained of pain in the operated region was comparatively high, being 51 cases or 11.4 per cent.

An experimental study of the preparation of a substitute stomach following total gastrectomy in the rat.

In 38 rats, a substitute stomach was prepared through transplantation of the ileocaecal intestinal portion following total gastrectomy. 47% of rats tolerated the operation. The survival rate of the tolerated rats for 360 days after the surgery was 16%. Their body weight corresponded to 77% of that in the untreated control rats on the 360th day after the operation. Compared to other conventional methods of total gastrectomy and reconstruction, this method is quite outstanding. From this experimental fact, the preparation of a substitute stomach through transprataation of the ileocaecal intestinal segment seems possible to supplement a part of the defects in the agastric syndrome accompanying total gastrectomy for a prolonged period.

Comparison of granisetron and the combination of granisetron plus methylprednisolone in the prophylaxis of cisplatin-induced emesis

BackgroundThis trial investigated whether a combination of granisetron plus methylprednisolone was more effective than granisetron alone in controlling acute and delayed emesis associated with cisplatin chemotherapy.MethodsUsing a crossover study, an objective comparison was made between the combination therapy of granisetron and methylprednisolone (GM), and the monotherapy of granisetron (G), in patients receiving cancer chemotherapy containing cisplatin. Ten of 13 patients completed the randomized crossover trials. Three patients were withdrawn due to severe nausea and vomiting, and/or the patients refusal of chemotherapy.ResultsThe GM and G treatments were considered to be remarkably effective (10/10, 100%), or effective (8/10, 80%), in controlling acute emesis, respectively. Delayed emesis was controlled in 100% of the patients in the GM group and in 70% (7/10) of the patients in the G group. Eighty percent of the patients preferred the combination therapy because of the absence of nausea and vomiting. No clinical adverse effects were experienced with the combination use of granisetron and methylprednisolone.ConclusionOverall, the combination therapy of granisetron and methylprednisolone is more efficient and useful in preventing the acute and delayed emesis associated with intense chemotherapy in comparison to granisetron used as a monotherapy.

Intraoperative Peritoneal Hyperthemia to the Gastric Cancer with Serosal Invasion.

漿膜浸潤陽性胃癌21例を対象として, 腹膜再発の予防と予後の改善を目的として, Cisplatinをもちいた術中の腹腔内温熱化学療法 (IPH) を考案し施行した.その結果, 最長1年7か月経過中であるが, IPH施行群には腹膜再発による死亡はなく, Kaplan-Meier法による予後検定でも, 切除胃癌症例で深達度ssγ, se, seiをあわせたhistorical control群に比較し9か月の時点で, IPH施行群19例が生存率88.0%に対しcontrol群82例は66.1%と5%以下の危険率で有意の予後の改善をしめした.また, 最も腹膜再発をきたしやすいBorrmann 4型胃癌では, 1年7か月の時点において, IPH施行群6例の生存率100%に対しcontrol群22例の生存率は24.9%で0.1%以下の危険率で有意に予後が改善した.このような結果から, 本法は漿膜浸潤陽性胃癌において, 腹膜再発予防にきわめて有効な方法であると考えられた.

Diagnosis and surgical treatment of cholecystointestinal fistula.

昭和51年から61年までの11年間に当科で経験した胆嚢消化管瘻13例を対象に, 診断と外科的治療を中心に検討した.術前診断しえたのは13例中6例 (46%) で, 存在診断には腹部単純撮影と消化管造影が有用であった.直接胆道造影は有所見例では質的診断も可能であった.手術は胆嚢摘出術と瘻孔閉鎖術を基本とし, 根治術をしえたのは13例中9例で, 胆石イレウスの2例には腸切開結石摘出術のみを行った.瘻孔の開存により胆道の逆行性感染や肝機能異常等の合併症をきたすことは少く, また特に胆石イレウス症例では一期的根治術施行後にむしろ胆道系合併症が多いことから, 胆石残存の認められないときは必ずしも手術侵襲の強い瘻孔根治術を必要としないと考える.

Vagotomy and pyloroplasty for perforated duodenal ulcer.

十二指腸潰瘍穿孔に対する従来の広範囲胃切除 (以下広胃切) 法は小胃症状とそれによる体重減少などを招き, 社会復帰後の就労状況も必ずしも満足といえない成績である.このため, 胃全体の温存をはかれる迷走神経切離 (以下, 迷切) 兼幽門形成術を20症例に適用し, その遠隔成績を中心に62例の広胃切例と比較検討した.(1) 手術時間, 入院期間は迷切例で152±29 (±SD) 分, 24±7日, 胃切例で140±26分, 26±17日と大同小異であった.(2) 術後遠隔調査において体重増加例は広胃切の43%に対し迷切例は75%と著明に改善された.(3) 食後症状発現は胃切例42%に対し迷切例44%とほぼ同程度であったが, 迷切例は短期間に軽快する例が多かった.(4) 潰瘍再発率は胃切例1.6% (1/62), 迷切例5% (1/20) であった.