Yoshiaki Nishida

The usefulness of postoperative continuous epidural morphine in abdominal surgery.

The influence of continuous epidural morphine on the recovery course of intestinal activity, urinary function, and ambulation after surgery was studied in 40 patients who underwent either gastrectomy for gastric cancer or cholecystectomy for cholelithiasis. Compared with a control group of patients whose postoperative pain was managed by pentazocine or hydroxyzine as before, the length of time before passing flatus or faeces was significantly shortened in the morphine groups (P<0.05). Following gastrectomy, the urinary catheter was able to be removed significantly earlier in the morphine group (P<0.05) although there was no statistical difference between both cholecystectomy groups. The morphine group experienced no difficulty with postoperative ambulation and exercise, although the difference in time before ambulation between the two groups was not considered significant. The results of this study led us to conclude that the postoperative continuous epidural infusion of morphine would be more beneficial following major abdominal surgery than the conventionally used methods of administering postoperative analgesia.

Physiological Age as an Outcome Predictor for Abdominal Surgery in Elderly Patients

It would seem that a large discrepancy exists between the “chronological” age and “apparent” age of elderly patients, and we often observe that the latter reflects the results of surgical procedures very well. In the present study, we reviewed 258 patients aged 70 years or older who underwent elective abdominal operations under general anesthesia, to evaluate an outcome predictor representing their “physiological” age. A total of 24 preoperative variables were compared between patients who left the hospital in a satisfactory condition, being survivors, and those who died in hospital despite the operative procedure performed, being nonsurvivors. In the group of patients aged between 70 and 79 years, there was no significant difference between the survivor and nonsurvivor groups for any of the variables examined; however, in the group of patients aged over 80 years old, the oldest of whom was 93 years, there were significant differences in the total lymphocyte count (TLC) and the performance status (PS), as well as in age, between the survivor and nonsurvivor groups. Utilizing the three variables of age, PS, and TLC, a computer-generated discriminant function analysis yielded an equation which discriminated survival with 97% accuracy, and mortality with 83% accuracy. These findings indicate that the PS and TLC scores added to the chronological age should be considered when deciding whether a surgical procedure is appropriate for an elderly patient.

The significance of preoperative chemotherapy for early gastric carcinoma

In order to achieve a complete prognosis for early gastric carcinoma, a greater effort must be made to improve its present treatment, considering the small percentage of patients who still die from recurrence despite the prompt initiation of surgery. Over the past 9 years, 26 patients with early gastric carcinoma have undergone surgical resection after receiving preoperative chemotherapy in the form of oral 5-FU or 5′-DFUR in our institute. The effectiveness of preoperative chemotherapy was evaluated by histopathological examination of the resected stomachs. Of a total of 24 patients with depressed type gastric cancer, 19 were histologically found to have a cancerless area within the cancerous lesion, 8 of whom were classified as being over Grade 1b. Gross changes were observed in 13 of these 24 patients. The frequency of multiple early gastric cancer occurring in patients who had not received chemotherapy was 11.6%, whereas in those who had received chemotherapy it was 3.8%. The findings of this study thus indicate that preoperative chemotherapy is useful for reducing minute cancer foci and microscopic metastatic lesions.

A case of Crohn's disease limited to the appendix, showing a portentous ultrasonographic finding

A case of Crohns disease limited to the appendix is reported. A preoperative ultrasonic study of the lower right abdomen revealed an interesting appearance that we named the “milky way sign.” Microscopic findings in the resected specimen confirmed that the sign represented adipose tissue of the mesoappendix that had become involved by transmural inflammation. This seems to be highly suggestive of Crohns disease.

Anti-Cancer Effects of Preoperative Chemotherapy for Gastric Carcinoma — The Relationship Between Histopathological Effects and Thymidilate Synthetase Inhibition Rate (TSIR)

In a previous study, the prognosis of positive histopathological effect cases with preoperative chemotherapy was significantly better than negative histopathological effect cases in advanced gastric cancer. This time, we investigated the relationship between the histopathological effects and Thymidilate Synthetase Inhibition Rate (TSIR). Object were 14 resected gastric cancer with preoperative chemotherapy of 5-Fu 300 mg/day for 14 days by oral administration. FdUMP, TS-free and TS-total were measured by the tumor sample and TSIR value was calculated. TSIR value were distributed from 0% to 90.7%, averaged 46.9%. TSIR value of the cases with positive histopathological effect indicated 70.5%, TSIR value without histopathological effect was 23.5%.

What is a Dieulafoy Ulcer—Relationship between Dieulafoy Ulcer and Ul-II Ulcer

Abstract: A Dieulafoy ulcer is defined as a gastric ulcer with a massive hemorrhage from a shallow circular depression with an eroded artery in the center. The disease entity has been variously described as Dieulafoy ulcer, exulceratio simplex, gastric aneurysm or submucosal vascular malformation. In this study, the relationship between Dieulafoy ulcers and hemorrhagic Ul‐II shallow solitary ulceration was investigated according to the macroscopic and histologic findings of the resected stomach. The hemorrhagic Ul‐II solitary ulcers resected were located on the upper or middle gastric body. Most of them were small sized (under 10 mm) ovoid ulcers, and had exposed (eroded) arteries on the ulcer floor. Histologically, the Ul‐II ulcers showed ulceration in the acute phase without fibrosis. We concluded that a Dieulafoy ulcer and hemorrhagic solitary Ul‐II ulcer are the same. In fact, a Dieulafoy ulcer has no special pathogenesis such as congenital abnormal vessels, aneurysm, etc.