Yoshihisa Goto

Diverticular disease of the colon at a regional general hospital in Japan

PURPOSE: X-ray film registry records were reviewed to better understand the changing nature of diverticular disease (DD) of the colon in Japan. RESULTS: Among 6,849 patients undergoing barium enema examination during a eight-year period from 1985 to 1992, this condition was found in 1,074 patients (15.7 percent), including 702 males (65.4 percent) and 372 females (34.6 percent). During this eight-year period there was an increase in frequency from 10.7 percent in 1985 to 17.8 percent in 1992. The proportion of patients with right-sided, bilateral, and left-sided DD was 69.2 percent, 17.5 percent, and 13.3 percent, respectively. The right-sided DD was more common in the younger age group and was predominant in male patients, whereas the left-sided DD increased with age, especially in female patients. Of the 1,074 patients, 11 (1.0 percent) underwent surgery in the same period. Regarding the rightsided DD, only 2 of 743 patients received surgery (0.3 percent). On the other hand, of the 143 patients with left-sided DD, 9 patients (6.3 percent) received some form of surgery. CONCLUSION: Right-sided diverticular disease of the colon is still common in Japan. It does not appear that this tendency will change in the future. Nearly all patients diagnosed as having diverticula had either no symptoms or only mild symptoms, and only about 1 percent required surgery. Right-sided diverticular disease of the colon seems to have had no serious clinical problems compared with left-sided DD.

Desmoplastic response in biopsy specimens of early colorectal carcinoma is predictive of deep submucosal invasion

PURPOSE: The aim of this study was to evaluate the role of histopathology of biopsy specimens in predicting depth of infiltration in early colorectal carcinomas before treatment. METHODS: Early colorectal carcinomas that had been resected surgically or endoscopically between 1984 and 1995 were analyzed. Histopathologic findings, including differentiation of adenocarcinoma and a desmoplastic response were investigated. RESULTS: One hundred nine early colorectal carcinomas consisted of 73 lesions of carcinomain situ, 13 submucosal carcinomas with minimum invasion, 8 lesions with moderate invasion, and 15 lesions with deep invasion. Of 73 carcinomain situ lesions, 72 (approximately 99 percent) showed well-differentiated adenocarcinomas and no desmoplastic response. Twelve (92 percent) of 13 submucosal carcinomas with minimum invasion also revealed well-differentiated adenocarcinoma without a desmoplastic response. Sixty-three percent (5/8)of lesions with moderate invasion revealed well-differentiated adenocarcinoma. None of the lesions had a desmoplastic response. Among lesions with deep invasion, 73 percent (11/15) demonstrated moderately differentiated adenocarcinoma, and 11 lesions had a prominent desmoplastic response (73 percent;P<0.01). CONCLUSIONS: These results suggest that if histopathologic findings of biopsy specimens taken from them before treatment demonstrated adenocarcinoma associated with a desmoplastic response, the lesions had at least deep invasion carcinomas. These lesions should be resected surgically. Submucosal carcinomas with minimum invasion, which have no desmoplastic response, could be treated endoscopically.

Prednisolone therapy for intra-abdominal desmoid tumors in a patient with familial adenomatous polyposis

The management of intra-abdominal desmoid tumors in patients with familial adenomatous polyposis (FAP) is very difficult. Non-steroidal anti-inflammatory drugs (NSAIDs), anti-estrogenic agents, and steroids are most commonly used, because surgical removal of these tumors may result in severe morbidity, with local recurrence being common. We report a patient with FAP and intra-abdominal desmoid tumors that regressed markedly after prednisolone therapy. The patient, a 38-year-old woman, had undergone total colectomy and ileorectal anastomosis with a diagnosis of FAP with colon cancer. Approximately 17 months after the surgery, she noticed an elastic firm lump in the abdominal wall. She also experienced lower abdominal distension. Computed tomography (CT) of the lower abdomen showed an invasive heterogenous low-density mass occupying the intra-abdominal space. She was treated with sulindac, NSAID, at 300 mg/day, the diagnosis being intra-abdominal desmoid tumors. She exhibited an intestinal obstruction about 9 months after the initiation of sulindac therapy. We changed the treatment and began prednisolone (initial dose, 40 mg/day). This treatment was continued for two years; subsequently the lesions regressed markedly. She is currently well, more than 3 years after the withdrawal of prednisolone.

Intra-abdominal bronchogenic cyst with gastric attachment: Report of a case

We report a rare case of an intra-abdominal bronchogenic cyst. An abnormal lesion was detected on an ultrasonogram, done as part of a physical checkup, in an 81-year-old woman. Computed tomography and magnetic resonance imaging showed a cystic mass attached to the lesser curvature of the stomach. Initially, we suspected a congenital cyst without malignant components; however, as the patient wished to have the lesion removed, we performed a minilaparotomy. The cystic lesion was firmly attached to the lesser curvature by fibrous tissue. Microscopic examination subsequently revealed the 26-mm mass to be a benign bronchogenic cyst with a bronchial element. We compared our findings with those of 50 previously reported cases of intraabdominal bronchogenic cysts. None of these patients was older than ours, and lesions attached to the esophagus or stomach were extremely unusual. Bronchogenic cysts are difficult to diagnose preoperatively based on imaging findings, but surgery may be indicated if malignant components are suspected, or if the lesion is enlarging or causing symptoms.

The Use of Autologous Fibrin Glue for the Treatment of Postoperative Fecal Fistula Following an Appendectomy: Report of a Case

We herein report a case of postoperative fecal fistula following an appendectomy which was successfully treated by the use of autologous fibrin glue. An 82-year-old man had acute appendicitis and underwent an appendectomy. Later, a fecal fistula developed and he underwent drainage treatment twice. After 4 weeks of drainage and during the third recurrence, the remaining fistula was successfully treated using autologous fibrin glue, instead of surgery, due to potential complications and the risks of associated with advanced age. No recurrence has been observed for 5 months. In conclusion, autologous fibrin gluing for fecal fistula was found to be a safe, economical, and effective treatment. A search of Medline from 1980 until 2002 revealed no other report of this treatment for postoperative fecal fistula following an appendectomy.

Inflammatory pseudotumor of the liver in a patient with rectal cancer: a case report

Abstract. An inflammatory pseudotumor of the liver was discovered during a metastatic examination of a patient with rectal adenocarcinoma. Magnetic resonance imaging showed a three-component lesion that infiltrated a large portal vein, and CT arteriography and CT during arterial portography showed a portal obstruction. A histopathological examination proved that necrosis was present in the central zone; infiltration by proliferating connective tissue with chronic inflammatory cells was prominent in the middle zone; and fibrous changes, including pseudo-bile duct proliferation, were present in the peripheral zone. Magnetic resonance imaging revealed both portal infiltration and histopathological features including the above-noted three components. Magnetic resonance imaging is perhaps the most useful diagnostic modality.

Significance of Preoperative Evaluations of Tumor Necrosis Factor-Alpha, the Granulocyte/Lymphocyte Ratio and Their Correlation with Regard to Outcome in Gastric Cancer Patients

Aim: In order to clarify the anti-cancer effects of tumor necrosis factor-α (TNFα), we examined the relationship between the preoperative evaluations of TNFα and the granulocyte/lymphocyte ratio (G/L ratio) in relation to outcome in gastric cancer patients. Materials and Methods: Peripheral blood samples were taken within 1 week before curative gastrectomy for measurement of TNFα and the G/L ratio. Five-year survival was determined in 71 operative gastric cancer cases. Results: The 5-year survival of the high TNFα group (≧8,000 pg/ml ) was 64.1%, 29.0% for the low TNFα group (<8,000 pg/ml) and 13.3 and 73.1% for those of the high (≧4.0) and low (<4.0) G/L ratio groups, respectively. The comparisons of these 5-year survival rates showed statistically significant differences. Moreover, there was a negative linear correlation between TNFα and the G/L ratio regarding outcome. Conclusions: Preoperative evaluations with TNFα and the G/L ratio may be important prognostic indicators, and their correlation may be a good indicator of the degree of effectiveness in activating anti-cancer immunity in gastric cancer patients.

Characteristics of the Serum Pepsinogen (PG) Test, and the Relationship between PG Test Results and Gastric Cancer Outcomes

Background and Aims: The serum pepsinogen (Pg) test is considered to be a high-risk marker for gastric cancer, so that it is intended that it will be gradually adopted for mass surveys in Japan. This manuscript examines the characteristics of the preoperative Pg test and the relationship between its results and the postoperative outcomes of gastric cancer cases in relation to the neutrophil/lymphocyte ratio (NLR) as a prognostic marker. Materials and Methods: Peripheral blood samples were taken within 1 week before gastrectomy for the Pg test and NLR. Results: The Pg test identified 128 (+) cases (59.0%) and 89 (–) cases (41.0%). In three of all cases, cancer had not been detected by an upper gastrointestinal series (UGI) in the previous year (every case showed Pg (+)). Five-year survival was 80.5% in the Pg (+) group, 60.7% in the Pg (–) group, 85.6% in the NLR (< 5.0) group, and 29.9% in the NLR (≥ 5.0) group, but 14.3% in the NLR (≥ 5.0) plus Pg (–) group, and 89.5% in the NLR (< 5.0) plus Pg (+) group. The differences in the 5-year survivals were statistically significant. Conclusions: A mass survey using the Pg test alone is inadequate, but the Pg test may be an important adjunct to the conventional methods. Gastric cancer with Pg (–) may have a higher potential for malignancy than cancer with Pg (+).

Transperitoneal drainage for a large cystic degeneration after regression of an intra-abdominal desmoid tumor.

A new technique is described for treating a large cystic degeneration after regression of an intra-abdominal desmoid tumors in patients with familial adenomatous polyposis. A cysto-peritoneal shunt is made for the relief of large cystic degeneration by creating a channel between the mesenteric cyst and the peritoneal cavity by means of a silicone tube to facilitate transperitoneal drainage.

Surgical Management for Villous Tumors of the Rectum

We describe 10 patients with villous tumors of the rectum. Seven tumors showed severe dysplasia but only one invasion of the muscularis propria of the bowel wall. All patients underwent a sphincter-conserving operation. There was one local recurrence which was treated by further local excision. One patient died of other causes, but the remainders recovered.Villous tumors of the rectum, even those showing severe dysplasia, can be adequately treated by local excision because they are adenomas. However, anterior resection is indicated when the tumor is too large for local excision, is located in the upper rectum, or when invasive cancer cannot be ruled out.ZusammenfassungEs werden zehn Patienten mit villösen Rektutumoren beschrieben. Sieben Tumoren zeigten eine schwere Dysplasie, aber nur einer eine Invasion in die Lamina muscularis propria der Darmwand. Alle Patienten wurden einer sphinktererhaltenden Operation unterzogen. Es trat ein Lokalrezidiv auf, das mit einer weiteren lokalen Exzision behandelt wurde. Ein Patient starb aus anderen Gründen, die übrigen erholten sich.Villöse Tumoren des Rektums, auch solche mit schweren Dysplasien, können angemessen mit lokalen Exzisionen behandelt werden, weil es sich bei ihnen um Adenome handelt. Trotzdem ist die vordere Resektion indiziert, wenn der Tumor zu groß für eine lokale Exzision ist, wenn er im oberen Rektum lokalisiert ist oder wenn ein invasiv wachsendes Karzimon nicht ausgeschlossen werden kann.