Narutoshi Nagao

Large solitary fibrous tumor of the retroperitoneum: report of a case.

We report an unusual case of a large solitary fibrous tumor (SFT) in the retroperitoneum. A 53-year-old man was referred to our hospital for surgical treatment of a swelling in the right flank with dull pain. Abdominal computed tomography (CT) and echograms showed a large encapsulated tumor compressing the right kidney and liver. At laparotomy, the tumor was found to be encapsulated but fixed to the capsule of the right kidney within a small area. Therefore, complete removal was achieved. The resected specimen was an encapsulated elastic hard tumor, 14 × 13 × 10 cm in size. Immunohistochemical studies revealed reactivity for CD34 and vimentin, but no staining for keratin, S-100, or Α-smooth muscle actin, confirming a diagnosis of SFT. Although SFT is usually associated with a favorable prognosis, close follow-up is recommended because of the limited information on its long-term behavior.

Evaluation of Treatment for Synchronous Hepatic Metastases from Gastric Cancer with Special Reference to Long-Term Survivors

Abstract.Abstract.Purpose: The purpose of this study was to determine the most effective means of treating liver metastases from gastric cancer.Methods: We retrospectively examined 43 patients with liver metastases, but without peritoneal dissemination, who had received different forms of treatment.Results: The crude 5-year survival rates of patients who underwent gastrectomy with complete hepatectomy (curative gastrectomy), noncurative gastrectomy, and no gastrectomy were 33.3%, 3.7%, and 0%, respectively. The curative gastrectomy group showed the highest survival rate (not significant). The median survival of patients given hepatic artery infusion (HAI), systemic chemotherapy, and no chemotherapy were 353, 189, and 61 days, respectively. The patients given chemotherapy survived significantly longer than those not given chemotherapy. Three patients survived for more than 5 years without any signs of recurrence. The long-term survivors all had primary lesions without serosal invasion (T2) and no other noncurative factors. Two patients underwent curative gastrectomy and one underwent noncurative gastrectomy. All were given postoperative chemotherapy; as HAI in two cases, and as systemic chemotherapy in one case.Conclusion: These findings suggest that curative gastrectomy combined with HAI or systemic chemotherapy should be attempted for patients with primary tumors without serosal invasion or any other noncurative factors.

A case of esophageal adenocarcinoma arising from the ectopic gastric mucosa in the thoracic esophagus.

A 75-year old man was detected with a pediculate tumor in the upper esophagus. A biopsy determined that it was an adenocarcinoma. A subtotal esophagectomy with dissection of three-fields of lymph nodes was selected. The pathological study revealed it to be an esophageal adenocarcinoma arising from ectopic gastric mucosa of the fundus of the stomach. His post-operative course was uneventful and without sign of recurrence for 3.5 years.

Giant left-sided inguinoscrotal hernia containing the cecum and appendix (giant left-sided Amyand's hernia)

The present case involved a 62‐year‐old male with a large left‐sided inguinoscrotal hernia. A CT scan and a clinical examination led to a diagnosis of a giant left‐sided Amyands hernia. The hernia was repaired using the ULTRAPRO Hernia System (UHS), and the patient exhibited an uneventful postoperative course.

V-shaped lymph node dissection in laparoscopic distal gastrectomy; new technique of intra-abdominal dissection and surgical outcomes

BackgroundRecently, laparoscopic-assisted distal gastrectomy (LADG) has become popular for the treatment of early gastric cancer. Furthermore, the use of totally laparoscopic gastrectomy (TLG), a more difficult procedure than LADG, has been increasing in Japan. Laparoscopic-assisted distal gastrectomy is currently performed more frequently than laparoscopic distal gastrectomy (LDG) in hospitals in Japan.MethodReconstruction after LDG is commonly performed extra-abdominally and lymph node dissection of the lesser curvature is performed at the same time. We have developed a new method of intra-abdominal lymph node dissection for the lesser curvature.ResultsOur technique showed positive results, is easy to perform, and is reasonable in terms of general oncology theory.ConclusionIn oncological therapy, this technique could be a valuable surgical option for totally laparoscopic surgery.

A patient with spontaneous rupture of the esophagus and concomitant gastric cancer whose life was saved: case of report and review of the literature in Japan

A 71-year-old man suddenly developed abdominal pain and vomiting on drinking soda after a meal, and visited a physician. Cervical subcutaneous and mediastinal emphysemas were observed on CT, and the patient was transferred to the emergency medical center of our hospital on the same day. Esophagography was performed at our department. A ruptured region was identified on the left side of the lower thoracic esophagus, and surgery was emergently performed employing sequential left thoracoabdominal incision. The chest wall was adhered due to inflammation, and large amounts of residual food and sloughing were present in the thoracic cavity and mediastinum. Moreover, necrotic changes were noted in the superior through inferior mediastinum. An about 2-cm rupture site was confirmed on the left side of the lower thoracic esophagus and closed by suture and filling with pediculate omentum. The presence of a tumorous lesion located mainly in the body of the stomach and lymph node enlargement were also diagnosed before surgery, for which gastric and intestinal fistulae were inserted to prepare for the second-stage surgery. The patient was admitted to an ICU after surgery. ARDS and MRSA-induced pneumonia and enteritis concomitantly developed but remitted. Curative surgery for gastric cancer was performed at 40 POD. Spontaneous rupture of the esophagus is relatively rare and that complicated by gastric caner is very rare, with only six cases being reported in Japan. Herein, we report the case.

A CASE OF CECAL VOLVULUS COMPLICATED BY PERFORATED PERITONITIS

症例は51歳，男性．主訴は腹痛にて当院救命救急センターを受診した．腹部単純レントゲンにてfree airを認め穿孔性腹膜炎と診断され当科に紹介された．腹部CT検査にてfree air，小腸および大腸の著明な拡張像，大量腹水を認めた．また来院時脈拍180/分，呼吸数36/分，体温38.3℃とSIRS状態であり，緊急手術施行となった．術中所見では十二指腸球部にピンホール状の穿孔と約1,500mlの膿性腹水を認め，さらに盲腸を中心に同部が時計回りに360度回転した上に拡張しており，盲腸軸捻転症と診断した．術式は大網充填術および捻転部を解除し，盲腸固定術を施行した．術後ARDSおよびDICを併発したが，集中治療管理を行い，術後40日目に退院した．結語:穿孔性腹膜炎（十二指腸穿孔）に合併した盲腸軸捻転症は極めて稀であり，また術前診断にMDCTが有用であった．

Maternal small-bowel volvulus hindered by prodromal labor

Small-bowel volvulus is a rare but accounts for 25% of the intestinal obstruction in pregnant women. Pregnancy and labor mask early signs and symptoms, leading to delay in diagnosis and increased morbidity. This report describes a case with bowel volvulus masked by early labor that underwent 330-cm resection of small intestine and gave a live infant.