Toyokazu Furumoto

Bone disorder following partial and total gastrectomy with reference to bone mineral content

To study post-gastrectomy metabolic bone disorders, we measured the radial bone mineral content (BMC), serum levels of calcium, inorganic phosphorus, alkaline phosphatase, and 25-hydroxyvitamin D(25-OH-D) in 59 patients with partial- and 39 patients with total gastrectomy. Total gastrectomy patients manifested a higher incidence of decreased BMC levels than did partial gastrectomy patients (56 per centvs. 25 per cent). Patients subjected to the Billroth II procedure, especially females, manifested abnormally low BMC values. The decline in BMC was age-related; it was pronounced in females. At 10 years postoperatively, many of the partial gastrectomy patients manifested markedly low BMC levels; in totally gastrectomized patients this finding was made at less than 5 years postoperatively. Approximately 30 per cent of our patients showed abnormalities in serum minerals, alkaline phosphatase or 25-OH-D.

Serum zinc and copper changes after gastrectomy in aged patients with gastric cancer

Serum zinc and copper levels were evaluated in patients with gastric cancer who had undergone gastrectomy. These patients were divided into two age categories; namely, the aged group, comprising 39 patients over the age of 70 years, and the younger group, comprising 23 patients younger than 50 years. The data before and after surgery were compared between the two groups. Serum zinc levels in the aged group were significantly lower than those in the younger group, both before and after surgery. Serum copper levels, however, did not differ significantly between the two groups. The serum Cu/Zn ratio was also analyzed according to the histological stages of cancer (stages I to IV), and compared between the two ageclassified groups. The aged group showed a higher Cu/Zn ratio at all stages, whereas in the younger group, the ratio was significantly higher at stage IV than in the earlier stages. Preoperative serum zinc, copper, and the Cu/Zn ratio were studied in relation to the complication of anastomotic leak after surgery. The Cu/Zn ratio in the aged patients with this complication was significantly higher than that in the aged patients without it. These results suggest that the Cu/Zn ratio may be an important factor in determining nutritional parameters in the aged.

Vertical Banded Gastroplasty for Sleep Apnea Syndrome Associated with Morbid Obesity

We report a case of morbid obesity accompanied by obstructive sleep apnea syndrome (SAS) and obesity hypoventilation syndrome (OHS). Satisfactory weight control was obtained without significant surgical complications after vertical banded gastroplasty. With the reduction in weight, the symptoms of SAS and OHS, as well as several other complications caused by the severe obesity, disappeared. Quality of life also improved remarkably, as exhibited by improved activity performance and disappearance of irritability at waking. Thus, it appears that vertical banded gastroplasty is efficacious in the treatment of morbid obesity with sleep apnea and hypoventilation.

A cavernous hemangioma of the rectum treated as a hemorrhoid for 1 year prior to its diagnosis: report of a case.

We report herein the case of a 28-year-old woman with a rectal cavernous hemangioma in whom recurrent rectal bleeding and marked anemia were interpreted as being caused by her coexisting internal hemorrhoids, resulting in a delay in the correct diagnosis for 1 year. Digital examination revealed a walnut-sized, wide-based, and elastic soft mass, 3 cm proximal from the anal verge, in addition to the internal hemorrhoids. Colonofiberscopy revealed a bluish submucosal lesion with superficial capillary dilatation at the same site. A transanal local resection was performed and the histological diagnosis of the tumor was cavernous hemangioma. The patient has been well without any recurrence of rectal bleeding for 2 years and 6 months since her operation. Thus, although rectal cavernous hemangioma is rare, a lack of awareness of this condition could lead to misdiagnosis as hemorrhoids and subsequent inappropriate therapy.

An experimental study on cell dynamic alteration in digestive organs following total parenteral nutrition in dogs

SummaryTo investigate the effects of total parenteral nutrition (TPN) on the alimentary tract, liver and pancreas, dogs were kept under TPN for 3 weeks, and changes in the cell dynamics of those organs and gastrointestinal hormones were evaluated. DNA synthesis activity in the mucosa of the stomach, jejunum and ileum decreased after TPN, and these changes recovered after oral refeeding. However, in the non-mucosal structures of the gastrointestinal wall, liver and pancreas, no corresponding changes were observed. Serum gastrin concentration was lowered after TPN, and it recovered after oral refeeding. A positive correlation was observed between serum gastrin level and DNA synthesis activity in the mucosa of the stomach, jejunum and ileum at all periods. However, enteroglucagon and pancreatic glucagon in the blood did not show any changes after TPN. In conclusion, TPN-induced changes in cell dynamics in the mucosa of the alimentary tract are reversible after resumption of oral feeding, and the serum gastrin release may be a regulating factor in these changes.