Tsunetake Hata

A Sodium Hyaluronate Carboxymethylcellulose Bioresorbable Membrane Prevents Postoperative Small-Bowel Adhesive Obstruction After Distal Gastrectomy

PurposeIt is predictable that since distal gastrectomy (DG) with Billroth I anastomosis involves no procedures caudal to transverse colon, the effects of the surgical wound are the main cause of adhesive obstruction. Thus, it is an appropriate operation to test the efficiency of a synthetic absorbable adhesion barrier (Seprafilm).MethodsThe subjects were 282 patients diagnosed with gastric cancer who underwent open DG with Billroth I anastomosis between 2001 and August, 2005. Seprafilm was not used in any patients operated on before April, 2003 (n = 169), but it was used in all patients operated on from May 2003 onward (n = 113). We retrospectively compared the incidences of adhesive obstruction in the Seprafilm group and the non-Seprafilm group.ResultsThe cumulative incidence of adhesive obstruction was significantly lower in the Seprafilm group than in the non-Seprafilm group (P = 0.021). The respective incidences of adhesive obstruction 2 years after surgery were 0.9% and 6.5%. Multivariate analysis of the occurrence of adhesive obstruction revealed no significant differences in sex, age, body mass index, operation time, blood loss, or degree of lymph-node dissection; however, it revealed a significant difference in relation to the use of Seprafilm (P = 0.049).ConclusionIn this series, Seprafilm reduced the incidence of adhesive obstruction after DG significantly; however, a prospective randomized study will be necessary to confirm this result.

Distant peritoneal metastasis to a mesh-plug prosthesis in a gastrointestinal cancer patient: report of a case.

A case of distant metastasis to mesh-plug prosthesis in gastrointestinal cancer is presented herein. An 88-year-old man had received mesh-plug repair with high ligation for a recurrence of a right inguinal hernia. Six months later, advanced gastric cancer and advanced transverse colon cancer were detected, and therefore a distal gastrectomy and partial colectomy were performed. Two weeks after the operation, the patient complained of right groin tenderness, and the mesh-plug prosthesis was removed to control any infection. A histopathological investigation demonstrated adenocarcinoma in the plug prosthesis. The patient died of carcinomatosis peritonei 45 days after the last operation.

Molecular Markers of Blood Coagulation and Fibrinolysis in Patients with Hepatocellular Carcinoma.

肝細胞癌 (HCC) 患者において凝固線溶系とthrombin-antithrombin III complex (以下, TATと略記), plasmin-α2-plasmin inhibitor complex (以下, PICと略記), D-dimerとの関連を, 臨床所見および病理組織学的因子から検討した.最近3年間に教室で肝切除術を施行した75症例を対象とした.TAT, PIC, D-dimerの平均値 (mean±S.E.) はそれぞれ4.49±0.58μg/l, 1.36±0.07μg/ml, 1.325±0.270μg/mlであり, いずれも高値であった.非癌部肝組織像, 腫瘍細胞の分化度, 被膜形成の有無, 門脈侵撃の有無と相関はなかった.StageとTATは正の相関がみられ (p=0.064), 肝内転移とDdimerは有意な正の相関をみとめた (p=0.005), HCCの肝内転移の進展と凝固線溶亢進との関連が示唆された.