Acetic acid spray in colonoscopy: an alternative to chromoendoscopy.
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Acetic Acid↗
Biomedical subjects
Y J Kawamura
Publications and source records attributed to Y J Kawamura.
Intussusception of appendiceal adenoma mimicking invasive carcinoma.
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Adenoma, Villous↗
Superficial depressed early carcinoma that developed into protuberant advanced carcinoma in the transverse colon.
A screening colonoscopic examination in a 70-year-old man revealed a nonpolypoid type superficial depressed early carcinoma, about 2cm in diameter, in the transverse colon. The lesion was not resected and was observed because of coexisting nonresectable hepatocellular carcinoma (HCC). Fifteen months later, follow-up examinations revealed a polypoid type protuberant advanced carcinoma, about 6 cm in diameter, at the same site. Because complete response of the HCC had been induced by transarterial embolization, the colon carcinoma was operatively resected. There is an indefinite concept that colorectal carcinomas develop without substantial morphological changes, and no superficial depressed carcinoma that developed into a protuberant type advanced carcinoma has been reported. The case reported here provides evidence that some polypoid carcinomas arise from superficial depressed precursors. There is some intermingling between the two postulated colorectal carcinogenic pathways, the conventional polypoid pathway named the "adenoma-carcinoma sequence", and the nonpolypoid pathway, including so-called "de-novo" carcinogenesis.
Aged↗
Early feeding after oncological colorectal surgery in Japanese patients.
We aimed to determine the safety and feasibility of an alternative postoperative oral intake protocol for Japanese patients who had had oncological colorectal surgery, with the goal of shortening the length of postoperative stay to the same level as that in Western countries. The subjects of the study were 42 consecutive patients who underwent elective oncological colorectal surgery. Two protocols., Japanese traditional management (TM: n = 20) and alternative management (AM; n = 22), were employed. The two protocols differed in their management of oral intake after surgery. Tolerance of the alternative protocol and the incidence of postoperative complications were determined. The mean length of postoperative stay in the AM and TM groups was 11.5 +/- 1.2 and 24.0 +/- 2.1 days, respectively (P < 0.0001; t-test). Analysis of the patients who underwent open operation also revealed that the length of postoperative stay was less in the AM group than in the TM group (12.3 +/- 1.7 and 24.7 +/- 2.2 days, respectively, P = 0.0003). One patient in the TM group developed small bowel obstruction during the introduction of oral intake. One patient in the AM group also developed small bowel obstruction, after discharge. and was readmitted. Other patients tolerated both the TM and AM protocols. Morbidity in the AM group was 20.0%, and that in the TM group was 30.0% (P = 0.72). The employment of an alternative postoperative oral intake protocol was safe and feasible for Japanese patients. Further investigation is needed to determine the possible benefits, both medical and socioeconomic, of this approach.
Adult↗
Effect of high ligation on the long-term result of patients with operable colon cancer, particularly those with limited nodal involvement.
OBJECTIVE: To find out what effect the extent of nodal dissection has on patients with operable colonic cancer. DESIGN: Retrospective study. SETTING: Teaching hospital, Japan. PATIENTS: 564 consecutive patients who had potentially curative operations for colon cancer. Patients treated by limited nodal dissection, in which only pericolonic nodes were dissected, were excluded. MAIN OUTCOME MEASURES: Disease free survival classified by extent of nodal dissection. RESULTS: High ligation gave no significant advantage when patients were subgrouped according to degree of nodal involvement. However, number of patients with aggressive involvement (including intermediate or central nodes) was small. 511 patients (91%) had limited nodal involvement (no nodal involvement or nodal involvement confined to pericolonic nodes). High ligation of the vessels gave no advantage even with meticulous subgrouping according to age, site, and depth of invasion. CONCLUSION: Most patients with colonic cancer had limited nodal involvement. High ligation did not affect the long term results in these patients, so, less invasive low ligation should be considered. A larger study will be necessary to clarify the indications for low and high ligation for patients with aggressive nodal involvement.
Aged↗
Sigmoid colon cancer associated with primary hyperparathyroidism: report of a case.
We present herein a case of sigmoid colon cancer associated with primary hyperparathyroidism (PHP). PHP is known to be associated with malignancy, and decreased intracolonic calcium (Ca) resulting from increased vitamin D (VD) levels may play a role in colorectal carcinogenesis. PHP was diagnosed in this patient by preoperative screening blood chemistry examination. The blood level of intact parathyroid hormone (PTH) was elevated and a parathyroid gland scintigram demonstrated abnormal uptake near the right lower lobe of the thyroid. There was no evidence of bone metastasis, and a sigmoid colectomy was performed with curative intent. The patient had an uneventful postoperative course without a critical elevation of the serum Ca level. This case report suggests that a relationship exists between PHP and colon cancer, and the possible mechanisms of this association are presented in our discussion.
Adenocarcinoma↗
Endoscopic resection for submucosally invasive colorectal cancer: is it feasible?
BACKGROUND: Recent advances in colonoscopy have resulted in an increasing number of endoscopic resections of colorectal neoplasms. However, endoscopic resection of submucosal invasive cancer remains a controversial issue. METHODS: The subjects for this study were the surgically treated patients with submucosal invasive colorectal cancer. These patients were classified into two groups: those with versus those without preoperative endoscopic resection. Clinicopathologic features and prognosis were compared and analyzed. RESULTS: Fifty patients underwent surgery for submucosally invasive colorectal cancer. Numbers of patients with and without preoperative endoscopic resection were 22 and 28, respectively. In 36.4% of the patients, endoscopic resections were incomplete. Two patients in whom the preoperative endoscopic resections had revealed a positive cancer margin, had nodal metastasis. One of these patients also developed hepatic metastasis. Endoscopic findings such as diameter and shape were not indicative of either lymphatic or vascular invasion. There were no morbidities or mortalities associated with endoscopic resection or surgery. CONCLUSIONS: Preoperative endoscopic resection for colorectal submucosal cancer is feasible, provided the resection is complete. The indications for surgical treatment should be determined after pathologic examination.
Case-Control Studies↗
Bilateral inguinal hernia repaired by laparoscopic technique: a rare complication of femorofemoral bypass.
Femorofemoral bypass is an established procedure for limb salvage and disabling claudication. However, surgical exposure of the femoral artery may result in damage leading to development of an inguinal hernia. Herein we report the first case of laparoscopic repair of bilateral inguinal hernias that developed after femorofemoral bypass.
Femoral Artery↗
Severe complications of ulcerative colitis after high-dose prednisolone and azathioprine treatment.
We report a rare case of ulcerative colitis (UC) associated with methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa infections in multiple organs, and with compressive fracture from osteoporosis after the administration of high-dose prednisolone and azathioprine. A 25-year-old man had been treated with high-dose prednisolone for UC. He suddenly experienced severe lumbago, which prevented him from walking. Plain X-ray demonstrated compressive fractures of the thoracic and the lumbar vertebrae, which were thought to be due to osteoporosis as a side effect of the high-dose prednisolone. At this admission, in another hospital, he also had a bloody discharge from the rectum, and azathioprine was started; however, the patient's condition still did not show any improvement. The total doses of azathioprine and prednisolone he had received were 3150 mg and more than 15,000 mg, respectively. Considering the presence of the serious complications, surgical intervention was the treatment selected. Culture study revealed MRSA in the feces and nasal cavity, and P. aeruginosa in the feces and urine. Vancomycin hydrochloride and gentamicin were administered, and were effective, with a subsequent negative culture study. Subtotal colectomy with mucus fistula was performed. After the operation, culture studies remained negative. Major steroid side effects such as bone fracture and osteoporosis should be considered as an indication for surgery in UC patients. MRSA and P. aeruginosa are a menace, especially for UC immunosuppressed patients on steroid or immunosuppressive therapy. When these bacteria are detected, there should be prompt and adequate antimicrobial therapy against the organisms and the immunosuppressive therapy should be immediately discontinued. We conclude that surgical therapy should be considered in the earlier stage for patients with intractable UC, rather than continuing long-term administration of steroid or azathioprine, which may lead to serious complications.
Adult↗
Gasless laparoscopically assisted colonic surgery.
BACKGROUND: Laparoscopic technique has been applied to a variety of colonic and rectal operations, generally using carbon dioxide insufflation (CDI). However, CDI is inevitably associated with cardiopulmonary loading and can cause complications. The objective of this study was to determine the feasibility of gasless laparoscopic colonic surgery. METHODS: The abdominal wall was lifted up using an originally designed retractor. A small incision, 3 to 5 cm in length, was made at the start of the operation. The surgeon operated through this incision using both conventional and laparoscopic instruments. RESULTS: Operations were undertaken in 67 patients. In 6 patients (9%), conversion to open surgery was necessitated. In the remaining 61 patients, operations were completed with gasless laparoscopically assisted technique. Four reoperations (7%) were performed because of postoperative bleeding, anastomotic rotation, anastomotic stricture, and transmesenteric hernia. Fifty-three patients with colonic cancer were operated on with potentially curative intent. Of these, 1 (2%) developed hepatic recurrence during the mean follow-up period of 23.8 months. There was no port site recurrence. CONCLUSIONS: Gasless laparoscopic colonic surgery is technically feasible. CDI is not necessary to perform minimal access surgery.
Carbon Dioxide↗
Contribution of computed tomography to decision making in the management of adhesive small bowel obstruction.
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Decision Making↗
Appendico-ileo-vesical fistula.
Appendico-vesical fistula is a rare condition. In total, 109 cases, most secondary to appendicitis, have been reported in the English-language literature. We report the first case, to our knowledge, of appendico-ileo-vesical fistula secondary to appendiceal diverticulitis. An enterovesical fistula was diagnosed by urine culture, cystoscopy, and computed tomography. The locations of enteric opening sites were demonstrated by barium enema and colonoscopy. Ileocecal resection and fistulectomy with primary reconstruction were performed. We believe that accurate pre- and intra-operative diagnosis is essential for cure. This case demonstrates the importance of barium enema and colonoscopic examinations in the diagnosis and treatment of complicated enterovesical fistula.
Adult↗
[Carbohydrate chains and hematogenous metastasis: a review].
It is well known that the expression of carbohydrate chains on cell changes during the development and progression of carcinoma. Some carbohydrate chains have been used in clinical practice as tumor markers. Some, such as sialyl Lewis a (CA 19.9), sialyl Lewis X, and Tn, are known to function as adhesion molecules. However, their role in the development of hematogenous metastasis is still controversial. In this paper, many investigations concerning this issue are reviewed. Clinical trials for treatment of patients with advanced cancer using carbohydrate chains are also mentioned.
Animals↗
Interleukin-6 and stress hormone responses after uncomplicated gasless laparoscopic-assisted and open sigmoid colectomy.
PURPOSE: Laparoscopic colectomy has increasingly been advocated as an option for treatment of colonic disease. The purpose of this study was to compare effects of laparoscopic-assisted sigmoid colectomy (LAS) and conventional open colectomy (OPEN) on postoperative cytokine and stress hormone responses. METHODS: Fourteen patients with sigmoid colon cancer, apparently free of preoperative complications, were analyzed. Patients in both groups underwent sigmoid colectomy with lymphadenectomy. LAS was performed by the gasless abdominal wall-lifting method. A 5 cm incision was placed at the beginning of the operation. Blood samples were taken preoperatively and postoperatively for measurement of interleukin-6, glucagon and C-reactive protein. Urinary catecholamine excretions were also determined postoperatively. RESULTS: The two groups of patients were similar with respect to age (61 +/- 7 for LAS vs. 64 +/- 9 for OPEN) and sex. Intraoperative blood loss did not differ significantly between groups (112 +/- 97 ml for LAS vs. 366 +/- 380 ml for OPEN). Operative times for LAS tended to be longer than those for OPEN (231 +/- 67 vs. 169 +/- 45 minutes; P = 0.08). Similar time courses of postoperative interleukin-6, C-reactive protein, and stress hormone responses were observed in both groups. No significant differences were observed in the magnitude of changes except that the serum interleukin-6 level on day of surgery (postoperative day 0) was significantly higher in LAS patients than in those receiving OPEN. In addition, interleukin-6 levels showed a significant positive correlation with operative duration (r = 0.582; P < 0.05). CONCLUSIONS: Data suggest that stress responses after sigmoid colectomy, in patients undergoing LAS, are comparable with those of patients receiving OPEN and that the early interleukin-6 response after surgery appears to be associated with operative time.
Aged↗
[Carbohydrate antigens in carcinoma invasion and metastasis].
Human colorectal carcinomas with increased metastatic potential and with poor prognosis are characterized by high content of sialyl-Lewis X carbohydrate antigen as detected by monoclonal antibody (mAb) FH6. The levels of these carbohydrate antigens apparently increase during colorectal carcinoma progression from nonmetastatic to metastatic tumors and inversely correlate with post operative survival of colon carcinoma patients. Cell lines have been selected for high and low levels of cell surface sialyl-Lewis X antigen using mAb FH6. The high expresser cells adhere strongly to cytokine-activated endothelial cells apparently through E-selectin. The high expresser cells are also adhesive to sections of human livers, although involvement of selectins in this process is unknown. Increased expression of sialyl-Lewis X antigens on the surface of these high expresser variant cells is apparently due to increased alpha 1,3-fucosyltransferase, a biosynthetic enzyme presumable responsible for the final step of the production of sialyl-Lewis X antigens. Human fucosyltransferase VI cDNA has been stably transfected into the low expresser variant cells. alpha 1,3-Fucosyltransferase activity, cell surface sialyl-Lewis X carbohydrate antigen, and adhesion to activated endothelial cells have been showed to increase in these transfectant cells. Furthermore, these cells show dramatic increase in their liver metastatic potential when it is tested by the intrasplenic injection into nude mice. We propose that carbohydrate antigens with unique peripheral epitopes serve as unique molecular phenotypes that determine colorectal cancer metastasis.
Animals↗
Totally extracorporeal laparoscopy-assisted colon resection without pneumoperitoneum.
We describe a new totally extracorporeal laparoscopy-assisted technique without insufflation of the peritoneum in the treatment of benign and malignant ascending and sigmoid colon lesions. Colon resection is performed using specially designed instruments that allow the surgeon to avoid insufflation of the peritoneum and, in case of cancer, allow for conventional lymph-adenectomy. With this new technique, the restrictions associated with the laparoscopic technique are nullified, and the surgeon can directly examine intra-abdominal contents. Our preliminary results are encouraging and demonstrate the feasibility of this technique as well as its positive results in terms of curability in selected cases of colon cancer. Additional experience will delineate the real clinical value of this technique in the treatment of malignant disease.
Adult↗
Laparoscopic-assisted colectomy and lymphadenectomy without peritoneal insufflation for sigmoid colon cancer patients.
PURPOSE: A new method for laparoscopic-assisted sigmoid colectomy and lymphadenectomy is presented. The purpose of this method is to avoid complications and restrictions associated with pneumoperitoneum. METHODS: Abdominal wall is lifted up with Kirschner wires, which are placed in the middle and left lower abdomen; then a minilaparotomy, which can be created because air-tightness is not necessary, is extended at the beginning of the operation to later remove the resected specimen. Two laparoscopic instruments are inserted through the right lower abdomen. Through the minilaparotomy, the surgeon can operate with conventional instruments. RESULTS: Operative time can be shortened, and surgical manipulations such as ligations and sutures are far easier than and cosmetic results are similar to those of laparoscopic surgery under pneumoperitoneum. CONCLUSION: We believe that this technique is a safe, time-saving, and cost-beneficial technique for sigmoid colectomy, and by changing the location of the minilaparotomy, this method can also be applied to other types of gastrointestinal surgery.
Abdominal Muscles↗
Transmesenteric hernia after laparoscopic-assisted sigmoid colectomy.
BACKGROUND AND OBJECTIVES: Laparoscopic-assisted surgery has been applied for a variety of colonic surgery. The objective of this paper is to demonstrate a possible and avoidable complication of laparoscopic colonic surgery. CASE PRESENTATION: A 47-year-old woman underwent gasless laparoscopic-assisted sigmoid colectomy. On the 20th postoperative day, she developed bowel obstruction. Decompression with a long tube failed to resolve the bowel obstruction. Open laparotomy was performed. Abdominal exploration revealed a loop of the small bowel incarcerated in the mesenteric defect caused by the previous operation. Adhesiolysis was performed, and the postoperative course was uneventful. DISCUSSION: Despite technical difficulty, complete closure of the mesentery after bowel resection is strongly recommended for prevention of transmesenteric incarcerated hernia after laparoscopic surgery.
Adenocarcinoma↗