Masahiko Nonaka

The outcome of postoperative hemorrhaging following a hemorrhoidectomy

PurposePostoperative hemorrhage (PH) is rare, but it is widely recognized as a postoperative complication of a hemorrhoidectomy. The assessment of this complication may provide information which can be used to improve the clinical outcome of a patient who has undergone a hemorrhoidectomy.MethodsBetween January 2006 and December 2007, a total of 1294 patients with symptomatic hemorrhoids underwent a hemorrhoidectomy at our hospital. The patient records were retrospectively analyzed.ResultsIn this study, 23 patients had suffered from PH and had undergone a second operation (1.7%). The bleeding points were located as follows: 14 anterior,7 right laterally, 8 left laterally, and 2 posteriorly. Of these patients with early hemorrhage, 1 case was at the anterior, 1 was left lateral, and 2 were posterior. A significant correlation was observed between the period and the location of postoperative hemorrhage (P = 0.0023). From one to four piles were excised (1 in 264 patients, 2 in 240 patients, 3 in 702 patients, 4 in 88 patients). A significant correlation was also observed between the number of piles and the occurrence of PH (P = 0.032).ConclusionsAt the posterior wall, a late period hemorrhage is less likely to be found than an early period hemorrhage. It was found that the more piles that were excised, the greater the occurrence of PH.

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.

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.