Takeshi Kuyama

Intestinal involvement in Behçet's disease: Review of 136 surgical cases in the Japanese literature

A survey was prepared of 136 cases of laparotomy in patients with Behçets disease and intestinal ulcers in Japan. The incidence of the disease is highest in males in the fourth and fifth decades. The ulcers are frequently found in the terminal ileum and the cecum. The ulcers are liable to perforate into the abdominal cavity, so that many patients require emergency operation. Resection of the ileocecal region or right half of the colon is the usual operation in the treatment of this disease. However, it is necessary to search for skip lesions, because multiple ulcers may be present. The incidence of postoperative complications and postoperative recurrence of ulcers is so high that supplementary management is often required.

Gallstone ileus. Review of 112 patients in the Japanese literature.

A survey was made of 112 cases of gallstone ileus reported in the Japanese literature, including 3 of our cases. The ratio of males to females was 1 to 1.1, the age range was 13 to 87 years, and biliary-enteric fistulas were demonstrated in 81 percent of the patients. Although cholecystoduodenal fistula was most common, eight cases of choledochoduodenal fistula were reported. Sixteen patients passed obstructing gallstones through a patulous sphincter of Oddi. The ileum was occluded in 54 percent of the cases. Duodenal obstruction was seen in 10 percent. There was no operative mortality in seven patients treated with enterolithotomy, subsequent cholecystectomy and repair of the fistula, whereas a mortality rate of 19 percent followed the one-stage procedure.

Idiopathic perforation of the sigmoid colon in Japan

This is a report of a case of idiopathic perforation of the sigmoid colon, a rare condition, and a review of 65 cases collected from the Japanese literature including our own. The ratio of males to females was 42∶23, the ages ranged from 16 to 87 years, and 68% of the patients were in the sixth decade or older. The perforation sites were in the middle of the sigmoid colon in 43 cases, of which 79% were at the antimesenteric border, and in the rectosigmoid region in 2 cases. Several pathogenetic factors are considered to be responsible for this perforation, among which constipation and raised intra-abdominal or intraluminal pressure may be most important. In the cases associated with constipation, differential diagnosis must be made by histologic examination. Free air under the diaphragm was noted on x-ray in 46% of patients and leukopenia under 4000/mm3in 35% of the cases. Only 2 patients with confined perforation were diagnosed preoperatively by barium enema x-rays. The overall mortality rate was 35%. Exteriorization or resection of the perforated site resulted in the best prognosis among the various operative procedures. There were 5 instances of colocutaneous fistula in 13 patients who underwent simple closure of the perforation.

Pancreatic endocrine function after total gastrectomy and truncal vagotomy

Oral and intravenous glucose tolerance tests were performed in four groups: (1) preoperative patients, (2) patients with interposition reconstruction after total gastrectomy, (3) patients with Roux-Y reconstruction after total gastrectomy, and (4) patients with intrathoracic replacement after esophagectomy. We obtained the following results: (1) Hyperglucagonemia in response to orally administered glucose occurred after truncal vagotomy and occurred in the presence and absence of gastric tissue. (2) compared wtih the preoperative study, all postoperative groups demonstrated glucose intolerance. (3) The glucose intolerance was due to increased glucagon, insulinopenia, and possibly nutritional factors. (4) The insulin response to intravenous glucose suggests an impairment in the first phase of insulin secretion in the surgically treated group, demonstrating a role for the vagus in insulin secretion. (5) The glucose tolerance curve shows that the interposition operation is superior the the Roux-Y operation.

Acute diffuse phlegmonous gastritis

A case of acute diffuse phlegmonous gastritis in a 54 year old man with an abrupt onset of upper abdominal pain, high fever and complete anorexia was presented. The stomach wall was remarkably thickened and rigid. Histologically there was massive infiltration of polymorphonuclear leukocytes in the submucosa and muscularis of the stomach wall. The lamina muscularis mucosae was fragmented by the numerous small focal adscesses.

Effects of vagotomy and gastrectomy on pancreatic glucagon release.

The effects of gastrectomy and vagotomy on pancreatic glucagon release were investigated clinically. The study included 20 men and eight women, who ranged in age from 28 to 69 years, and who were divided into the following four groups: 1) patients with gastroduodenal ulcers treated with partial gastrectomy, by the Billroth I method, whose hepatic branch was preserved (n = 7). 2) Patients with gastroduodenal ulcers treated with partial gastrectomy, by the Billroth II method, whose hepatic branch was preserved (n = 7). 3) Patients with gastric carcinoma treated with subtotal gastrectomy, by the Billroth I method. In these cases lymphadenectomy required section of the hepatic branch (n = 7). 4) Patients with gastric carcinoma treated with subtotal gastrectomy, by the Billroth II method. In these cases lymphadenectomy required section of the hepatic branch (n = 7). Oral glucose tolerance tests were performed in 10 patients, before operation, and in 28 gastrectomized and vagotomized patients. In the preoperative patients and in the first group, oral glucose (50g) suppressed pancreatic glucagon release, but in the other groups pancreatic glucagon levels were markedly increased.

Hepatocellular carcinoma with extrahepatic growth: a case report and review of the Japanese literature

SummaryA case of extrahepatically growing hepatocellular carcinoma is reported, and the Japanese literature is reviewed. A 42-year-old man was admitted to our hospital on December 27,1985 complaining of epigastralgia and nausea. Ultrasonography and computerized tomography showed a large tumor in the right hepatic lobe. This Was removed surgically and examined histologically.

Extraosseous osteogenic sarcoma arising from the retroperitoneum: a case report.

A 44-year-old housewife with a mass in the left upper quadrant of the abdomen was admitted. The tentative diagnosis was cystadenocarcinoma arising from the pancreatic tail, as determined by CT and selective angiography. Excision of the mass with removal of the spleen, pancreatic tail, left renal capsule and surrounding lymphnodes was performed. Photomicroscopic sections revealed proliferation of malignant cells and malignant osteoids. The final diagnosis was osteogenic sarcoma arising from the retroperitoneum. among the extraosseous osteogenic sarcoma arising from the somatic soft tissue, involvement of the retroperitoneum is rare. Only 12 cases including our own case have been reported as being of retroperitoneal origin. No patient survived for five years and in our patient, there are signs of recurrence one year after the surgery.

Malignant Lymphoma in the Residual Stomach after Gastrectomy A Case Report

We surgically treated a 52 year old Japanese man with a malignant lymphoma in the residual stomach 16 years after a gastrectomy. Our findings and a discussion of related literature are reported herein.

Effect of endogenous secretin on plasma glucagon after total pancreatectomy

Normal dogs and totally pancreatectomized dogs with intact stomach and duodenum were given 0.1 N hydrochloric acid directly into the duodenum in a study of the effect of endogenous secretin on glucagon secretion. The glucagon responsive to 30K antibody first decreased after total pancreatectomy, but increased with time if no insulin was administered. Total pancreatectomy was followed by a gradual, statistically significant increase in the basal secretion of blood secretin. The endogenous secretin secreted in response to the infusion of 0.1 N hydrochloric acid into the duodenum in no way varied the blood glucagon level in normal dogs, but slightly decreased blood gut glucagon in totally pancreatectomized dogs. The secretion of blood secretin in response to the infusion of 0.1 N hydrochloric acid into the duodenum was maintained even after total pancreatectomy.