Yuji Miyasaka

Adult Intussusception Due to Enteric Neoplasms

Adult intussusception is an infrequent disease and the cause of intussusception differs between children and adults [1–3]. Many of the cases in adults are secondary to an underlying lesion and adult intussusception of the colon is most often secondary to a malignant tumor. There are no typical complaints, signs, or symptoms often associated with the chronic process of bowel obstruction. The diagnosis of adult intussusception is usually made by preoperative radiological and endoscopic examinations, or during laparotomy. Surgical resection or operative reintegration is required. The aim of this study was to retrospectively evaluate the preoperative diagnoses and surgical treatments of patients with adult intussusception in our hospital.

Basaloid-Squamous Carcinoma of the Esophagus: Report of a Case

We report herein the case of a 69-year-old man with basaloid-squamous carcinoma (BSC) of the esophagus. To the best of our knowledge, this is the 60th case of BSC of the esophagus to be reported in Japan, and a review of the other 59 cases is presented after this case report. In our patient, endoscopic findings revealed a circumferential erosion in the middle intrathoracic esophagus (Im), and a protruding tumor with friable ulceration in the center of the erosion. A biopsy suggested that it was moderately differentiated squamous cell carcinoma (SCC), and a thoracoscopic total thoracic esophagectomy was performed. Histologically, the protruding-type lesion with ulceration was composed of BSC, and the circumferential 0 -I + IIc type lesion was composed of moderately differentiated SCC. The immunohistochemical findings of these resected specimens led us to suspect that the basal-layer-type SCC had transformed into BSC by undergoing differentiation and expansive proliferation.

Laparoscopic treatment of cholecystocolonic fistula: report of a case preoperatively diagnosed by barium enema.

The authors present a case of cholecystocolonic fistula with no specific symptoms, such as severe diarrhea or pneumobilia, preoperatively diagnosed and treated by the laparoscopic approach. A preoperative barium enema demonstrated a cholecystocolonic fistula. The fistula was divided by the laparoscopic stapling technique. Important features in the management of this case are (1) preoperative diagnosis of the fistula by barium enema carried out for screening colorectal cancer, (2) dissection of the gallbladder from its bed before division of the fistula, and (3) use of the laparoscopic stapling technique to divide the fistula while preventing fecal soilage.

Ischemic stricture of the small intestine associated with acute pancreatitis

SummaryA 37-yr-old man underwent an open drainage operation for severe acute pancreatitis and received respiratory ventilation support for 4 mo because of respiratory failure based on disseminated intravascular coagulation (DIC) and septic shock. Under intensive care, he sometimes had bloody diarrhea for about 6 wk. Colonoscopic findings suggested that the bleeding had derived from the small intestine. The patient then gradually recovered from acute pancreatitis and was discharged from the hospital. Thereafter, he suffered relapses of ileus and his symptoms progressively worsened. The patient underwent a second operation about 2 yr after the onset of acute pancreatitis. At celiotomy, multiple stenoses of the distal ileum measuring about 60 cm in length were found and the segment was resected. The resected specimen demonstrated six separate circumferential strictures and shallow ulcerations. Histologically, multiple ulcerations were restricted to the mucosa and were accompanied by marked submucosal edema and fibrosis. The mucosa between the ulcers revealed chronic regenerative changes: intimal thickening of small mesenteric arteries causing luminal narrowing and organized thrombosis in small mesenteric veins. Therefore, these were considered to be a series of segmental ischemic lesions. Note that delayed ischemic stricture of the small intestine may occur as a chronic complication of acute pancreatitis.

A study of the assessment of axillary lymph nodes before surgery for breast cancer using multidetector-row computed tomography

PurposeSentinel lymph node biopsy (SLNB) is widely used in the detection of breast cancer metastasis, and a retrospective study was conducted to determine whether the preoperative assessment of axillary lymph node metastasis using multidetector-row computed tomography (MDCT) images would contribute to the selection of patients who require SLNB.MethodsSeventy of the 164 patients who underwent surgery of the breast during the period of April 2006 to December 2008 were selected as subjects who: (1) did not undergo preoperative chemotherapy; (2) had undergone MDCT before the surgery; (3) had undergone either SLNB or axillary lymph node removal during the operation; and (4) whose T factor was pathologically T2 or less. The diameter and shape of the largest lymph node that was identified on an MDCT image of the axilla on the affected side were measured and compared with permanent pathological specimens.ResultsSize: The group with lymph node metastasis included 21 subjects with an average diameter of the largest lymph node of 10.3 mm (range, 6–23 mm), and the nonmetastasis group included 49 subjects with that of 7.1 mm (5–13 mm). Shape: Round lymph nodes that internally contained no fat concentration in 24 subjects, and cuneate or round lymph nodes that internally contained a fat concentration in 46 subjects. The observable lymph nodes that were round had a diameter of at least 10 mm, and internally contained no fat concentration (A) were regarded as positive, whereas the cuneate or round lymph nodes that measured less than 8 mm in diameter and internally contained fat concentration (B) were regarded as negative, and both positive predictive value and negative predictive value was 100%.ConclusionsAxilla removal was performed from the beginning in the case of (A) by assessing the size and shape for the presence or absence of axillary lymph node metastasis before surgery using MDCT.

A case of pseudosarcoma associated with type 3 squamous cell carcinoma of the esophagus: report of a case.

A case of a primary esophageal pseudosarcoma associated with an independent type 3 tumor is described herein. A 60-year-old male presented with dysphagia and chest discomfort. A clinical evaluation revealed a type 3 tumor in the middle of the esophagus, which was diagnosed after a biopsy to be squamous cell carcinoma (SCC). A subsequent gross examination of the subtotally removed esophagus revealed a polypoid tumor adjacent to the type 3 tumor. Histologically, the polypoid mass was composed of SCC and mesenchymal components without a transitional zone. The tumor was thus classified as a pseudosarcoma of the esophagus, and was unique in that this appeared to have developed independently from the SCC.

Erratum to: Liquid-injection for preperitoneal dissection of transabdominal preperitoneal (TAPP) inguinal hernia repair

In the title the word ‘‘inguial’’ is correctly spelled ‘‘inguinal’’. On the first page, in the Abstract, 8th line, ‘‘preperitonal’’ should be ‘‘preperitoneal’’. At the bottom of the left column, first page, T. Mizota, N. Takemoto, H. Yamada, Y. Miyasaka NTT East Sapporo Hospital, Sapporo, Hokkaido, Japan e-mail: nori-take@pop16.odn.ne.jp should be changed to T. Mizota N. Takemoto H. Yamada Y. Miyasaka NTT East Sapporo Hospital, Sapporo, Hokkaido, Japan e-mail: tmizota@huhp.hokudai.ac.jp N. Takemoto e-mail: nori-take@pop16.odn.ne.jp On the second page, left column, 4th paragraph, first line, delete ‘‘to’’. On the fifth page, left column, first paragraph, 9 line, change ‘‘safely’’ to ‘‘safety’’. In Reference 8, change ‘‘Naoki M’’ to ‘‘Matsumura N’’. The online version of the original article can be found under doi:10. 1007/s00464-014-3703-7.

Long-term Survival after Local Recurrence from Gastric Cancer: Report of a Case

症例は63歳の男性で, 1994年8月3日胃癌に対して幽門側胃切除術を施行した. 総合所見は中分化型腺癌, fT1 (SM), N1, H0, P0, M0, fStage IBであった. 1996年7 月の腹部CT で胃十二指腸吻合部から膵頭部前面にかけて腫瘤を認め, その後徐々に増大傾向を示したが他部位に再発巣を認めず1997年11月6日膵頭十二指腸切除術を施行した. 腫瘤は胃十二指腸吻合部から膵頭部にかけて一塊となっており膵との境界は不明瞭で剥離困難であった. 病理学的検査で胃癌の局所再発と判定された. 再発切除後6年6か月経過した現在, 再発徴候なく健在である. 本例は再発胃癌に対して膵頭十二指腸切除術を施行し長期生存が得られたまれな症例と考え若干の文献的考察を加え報告した.