Yasutomo Ojima

Primary anorectal malignant melanoma: report of a case.

Primary anorectal malignant melanoma is a fairly uncommon but highly malignant disease. This disease is sometimes mistaken for such benign conditions as either a hemorrhoid or rectal polyp. We herein describe a case of early primary malignant melanoma of the anal canal. In this case, magnetic resonance (MR) imaging was found to be useful for diagnosing the melanotic melanoma. We especially emphasize the usefulness of a fat-saturation MR image in distinguishing melanotic melanoma from other rectal tumors.

A tailgut cyst found accompanying rectal cancer: Report of a case

Tailgut cysts are rare congenital lesions. To date, only four cases have been reported in Japan, and the occurrence of a tailgut cyst with rectal cancer has never been documented. We describe here the case of a patient in whom a tailgut cyst in the retrorectal space was associated with rectal cancer. Preoperative computed tomography scans and endorectal ultrasonography failed to identify the lesion as cystic, instead suggesting an involved lymph node. This case emphasizes the necessity for careful diagnosis of masses in the retrorectal space in patients with rectal cancer.

Long-term outcome of S-1 and cisplatin combination therapy in patients with advanced or recurrent gastric cancer.

BackgroundAlthough combination therapy of S-1 and cisplatin (CDDP) has excellent efficacy against gastric cancer, the effect of the treatment on survival has been unclear. The aim of this study was to evaluate the long-term outcome of this combination therapy.MethodsSixty-three patients with advanced or recurrent gastric cancer were treated with S-1, with or without CDDP, as first-line chemotherapy, and the clinical results were compared retrospectively. S-1 was administered orally at a standard dose of 80 mg/m2. In the treatment of the S-1 group, S-1 was given for 28 consecutive days, followed by a 14-day rest. In the treatment of the S-1/CDDP group, S-1 was given for 21 consecutive days, followed by a 14-day rest, and CDDP, at 60 mg/m2, was infused on day 8.ResultsThe incidence of adverse reactions of more than grade 3 was 22.5% in the S-1 group and 43.5% in the S-1/CDDP group, and the treatment compliance was better in the S-1 group. The overall response rate was 25.9% in the S-1 group, and 36.8% in the S-1/CDDP group. The combination of S-1 with CDDP had better effects on the primary lesion and on differentiated-type carcinoma than S-1 alone. However, there was no difference in survival between the two patient groups. The median survival time after the initiation of treatment in the S-1 group was 322 days, and that in the S-1/CDDP group was 319 days.ConclusionsOur results suggest that the combination of CDDP with S-1 does not improve the long-term outcome of S-1 therapy.

Inflammatory fibroid polyp of the ileum with the appearance of a borrmann type II lesion, caused by colostomy irrigation: Report of a case

Inflammatory fibroid polyps (IFPs) are rarely found in the gastrointestinal tract. The majority of IFPs are sessile-pedunculated or pedunculated polypoid lesions, whereas a polyp presenting like a Borrmann type II lesion is extremely unusual. This report describes the case of a 74-year-old man with a history of intussusception, in whom a preoperative diagnosis of a cecal tumor of the ileocecal valve was made. A laparotomy subsequently revealed a lesion similar to a Borrmann type II tumor located 15 cm above the ileocecal valve, but not at the valve. The lesion was diagnosed as an IFP which had been caused by repeated colostomy irrigation. The aim of the present report is to draw attention to this entity, which should be included in the differential diagnosis of intussusception and small bowel obstruction.

Survival of patients treated by an autonomic nerve-preserving gastrectomy for early gastric cancer

PurposeAutonomic nerve preservation in a gastrectomy for gastric cancer improves the postoperative quality of life. We retrospectively examined the survival of patients treated by an autonomic nerve-preserving gastrectomy in comparison to the survival of the patients treated by a conventional gastrectomy.MethodsThe survival of 385 patients treated by an autonomic nerve-preserving gastrectomy for clinical early gastric cancer (the ANP group) was compared with that of 285 patients treated by a conventional gastrectomy (non-ANP group).ResultsAmong the ANP group, the numbers of patients with tumor invasion to the mucosa, submucosa, and muscularis propria were 210, 166, and 9, respectively, whereas the numbers of patients with lymph node metastasis grades of N0, N1, and N2 were 360, 21, and 4, respectively. The overall 5-year survival rate of the ANP group was 94.7%, which was superior to that of the non-ANP group (90.4%; P = 0.003). The 5-year survival rates of patients with lymph node metastasis were 94.9% and 91.8% in the ANP and non-ANP groups, respectively (P = 0.733). Only 3 patients in the ANP group died from gastric cancer.ConclusionsThe survival of patients treated by an autonomic nerve-preserving gastrectomy was equivalent to that of patients treated by a conventional gastrectomy, thus suggesting that an autonomic nervepreserving gastrectomy could be a useful procedure for the treatment of early gastric cancer.

A new method for laparoscopic percutaneous tube gastrostomy with a single 1-Cm-long incision for patients with esophageal obstruction

Since the introduction of percutaneous endoscopic gastrostomy (PEG) by Gauderer and Ponsky in 1981, this method of gastrostomy has been widely used because of its small degree of invasiveness. In the original technique, the gastrostomy tube was delivered from the mouth into the stomach by withdrawing the guidewire connected to the tube. Russel and colleagues modified this method and inserted the gastrostomy tube into the stomach directly from the skin over the guidewire. Both methods require the use of a gastrofiberscope, which cannot be used in patients with esophageal obstruction. Esophageal obstruction is a common symptom of a malignant tumor in the neck, and even a metallic stent cannot maintain patency of the esophagus throughout the patient’s life. For this reason, patients with advanced esophageal cancer require prophylactic PEG before complete esophageal obstruction or else they must undergo open gastrostomy, which usually requires an incision of 5 to 8 cm in length. Laparoscopic tube gastrostomy was first reported in 1990 as a method that can be used in patients with esophageal obstruction, but this method has not become popular because it is complicated and requires multiple wounds. We describe here a new method for laparoscopic percutaneous tube gastrostomy (LPTG) with a single 1-cmlong incision for patients with esophageal obstruction. METHODS Patients LPTG was performed in seven patients with esophageal obstruction caused by malignant neck tumors, such as laryngeal, thyroid, and esophageal tumors.