Satoshi Taniwaki

Multiple ulcers of the ileum due to Cytomegalovirus infection in a patient who showed no evidence of an immunocompromised state.

Abstract68-year-old woman presented with abdominal pain and vomiting. After initial conservative therapy, laparotomy showed multiple ulcers of the ileum, one of which had perforated and adhered to the uterus. The affected segment of the ileum was resected. Numerous cytomegalic cells, corresponding to endothelia and macrophages, with intranuclear inclusion bodies, were found in microscopic sections of the ulcerated lesions. These findings were consistent with cytomegalic vasculitis and enteritis.Cytomegalovirus infections of the alimentary tract have been, reported mainly in severely immunocompromised patients or those with predisposing disorders such as ulcerative colitis; their prognosis is usually poor. In our patient, there was no obvious immunocompromised state or other gastrointestinal disorders. The postoperative course has been uneventful for 2 years after surgery. The prognosis ofCytomegalovirus-associated lesions in the alimentary tract may be quite good in the immunocompetent patient.

Improving the side-to-side stapled anastomosis: comparison of staplers for robust crotch formation

BACKGROUND Few studies have investigated the burst pressure of side-to-side anastomoses comparing different stapling devices that are commercially available. OBJECTIVES We conducted side-to-side anastomoses with a variety of staplers and compared burst pressure in the crotch of the anastomoses. SETTING Nagoya City East Medical Center. METHODS We conducted side-to-side anastomoses with 9 staplers with different shapes and forms. Fresh pig small intestines were used. A side-to-side anastomosis was performed between 2 intestine specimens using a linear stapler. The burst pressure of the anastomosis was recorded. RESULTS In total, 45 staplers were used for this experiment. The site of leakage in all cases was the crotch. Regarding the influence of the number of staple rows, the burst pressure in 3-row staplers was significantly higher than in 2-row staplers. With regard to the relationship between staple height and burst pressure, staples with a height slightly shorter than the intestinal thickness showed the highest burst pressure. In a comparison of staplers with uniform staple heights and stamplers with staples of 3 different heights, the latter had significantly lower burst pressures. Neoveil significantly increased the burst pressure in the crotch and contributed to the highest burst pressure of all the staplers used in this experiment. CONCLUSIONS In this experiment, we defined the important factors that influence burst pressure at the crotch of a stapled, side-to-side anastomosis. These factors include the number of staple rows, the height of the staple compared with the thickness of the tissue, uniformity of staple height, and reinforcement of the staple line. In any surgical case requiring intestinal anastomosis, selection of a stapler is a critical step.

Evaluation of a New Stapler with Unique Surface Gripping Technology

Background: Staplers make it possible to create a gastrointestinal anastomosis quickly, easily, and securely. Staplers have undergone several improvements. We herein evaluate the effect of a new stapler with unique surface gripping technology that provides a superior tissue grip without trauma during firing. Methods: Porcine small bowel was used. The stapling devices compared were the ECHELON FLEX with White (E) and GST System White (G). The number of total malformed staples, severely malformed staples, staples malformed to the cutting side, and the absolute value of the degree of malformation were evaluated. Results: The number of malformed staples and the absolute value of the degree of malformation were significantly lower in group G. The number of occurrences of total malformations <0 was greater in group G. Comparing the inner, middle, and outer staple rows, the number of occurrences Original Research Article of malformations were lower on the outer row in group E. Comparing the front, middle, and back parts malformation was lower in the front. Conclusions: We found that a new stapler is superior to a standard stapler with regard to a reliable “B” shape formation of sta staple malformation and the strength of the suture line.

Eversion stripping of the esophagus with intraesophageal insufflation—A case report

Highlights • The indications for stripping of the esophagus have decreased due to the widespread of endoscopic mucosal resection and thoracoscopic surgery.• Even if indications for this procedure have decreased, this is an important option in the armamentarium of the esophageal surgeon.

Resection of the Gastric Tube Reconstructed through the Retrosternal Route without Sternotomy

With advances of combined modality therapy, prognoses in esophageal cancer have been improving. After resection of esophageal cancer, the development of gastric tube cancer is a risk. While such cancer in an early stage can be cured endoscopically, total gastric tube resection is indicated in advanced stages. A 68-year-old man underwent subtotal esophagectomy reconstructed with a gastric tube through the retrosternal route. Gastric cancer was found one and a half years postoperatively. The gastric tube was resected without sternotomy. This is the first report of a patient undergoing resection of the gastric tube reconstructed through the retrosternal route without sternotomy.

A Case of Leiomyoblastoma Originated in the Duodenum.

平滑筋芽細胞腫は胃に発生する場合がほとんどで, 十二指腸原発例は少ない.今回, 我々は72歳の女性の十二指腸下行脚に発生した平滑筋芽細胞腫の1例を経験した.十二指腸原発平滑筋芽細胞腫の本邦報告例は過去に22例しかなく, このうち悪性症例は4例で, 1例のみ腫瘍死が確認されている.本症例は, 膵頭十二指腸切除術を施行し, 手術所見や組織学的検索で浸潤傾向やリンパ節転移など悪性所見を認めなかったが, 術後約4年で, 肝転移, 腹水貯留をきたし死亡した.また, 本腫瘍は通常, 類上皮性平滑筋腫瘍と同義語として取り扱われている.しかし, HE染色を中心とした通常観察では, 神経原性腫瘍との鑑別が困難な症例もあり, 本症例でも, 免疫染色によりこの鑑別が可能であった.本腫瘍の組織学的診断に際しては, 通常観察で典型例と判断されても, 免疫染色や電顕を使用した多角的検索により, 平滑筋由来であることを確認する必要があると考えられた.