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1.
Gan To Kagaku Ryoho ; 49(13): 1625-1627, 2022 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-36733156

RESUMO

This case involved an 82-year-old man with a history of diabetes mellitus and myocardial infarction. He was undergoing treatment with 2 oral antiplatelet agents. The patient presented to our hospital for carcinomatous pyloric stenosis caused by type 4 advanced gastric cancer. Although distal gastrectomy was planned, preoperative coronary angiography revealed triple- vessel coronary artery disease. Therefore, surgery was performed under management of intra-aortic balloon pumping (IABP)therapy. The patient's hemodynamics at the time of the operation were stable, and no perioperative cardiovascular complications occurred. However, the patient was not able to start an oral diet because of impaired swallowing function. Although he underwent daily swallowing rehabilitation, he died of aspiration pneumonia 40 days postoperatively. There are many reports of cancer resection under IABP management for patients with severe heart disease. Because the perioperative hemodynamics were stable in all 21 reported cases of digestive malignant tumor resections in Japan, an IABP is suggested to be very effective for patients with severe heart disease. However, early death has also occurred, as in the present case. Close attention to the indications for IABP therapy is needed, especially in elderly patients, in consideration of not only cancer and heart disease but also preoperative activities of daily living.


Assuntos
Doença da Artéria Coronariana , Estenose Coronária , Cardiopatias , Estenose Pilórica , Neoplasias Gástricas , Masculino , Humanos , Idoso , Idoso de 80 Anos ou mais , Balão Intra-Aórtico , Atividades Cotidianas , Neoplasias Gástricas/complicações , Neoplasias Gástricas/cirurgia , Estenose Pilórica/etiologia , Estenose Pilórica/cirurgia , Gastrectomia
2.
J Surg Educ ; 69(5): 605-10, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22910157

RESUMO

OBJECTIVE: The Lichtenstein inguinal hernia repair is commonly performed and suitable for teaching basic surgical skills. The objective of this study is to evaluate the feasibility of this procedure for surgical training, particularly in regard to patient outcomes. DESIGN: Retrospective case review after introduction of an integrated teaching program. SETTING: University teaching hospital. PARTICIPANTS: The Lichtenstein inguinal hernia repair is the standard procedure for adult primary unilateral inguinal hernia since 2003 at Jichi Medical University. We introduced an integrated teaching system of lectures, skill training. and videos to teach the skills for Lichtenstein inguinal hernia repair to residents and junior faculty in 2003. Cases were retrospectively divided into 4 groups based on the experience of the operating surgeon; junior residents (PGY 1-2, group A), senior residents (PGY 3-5, group B), junior faculty (PGY 6-10, group C), and senior faculty (PGY 11 or more, group D). Background, perioperative factors, and outcomes were evaluated among the groups. RESULTS: A total of 246 elective inguinal hernia repairs (group A: 136, group B: 49, group C: 42, group D: 19) were performed. There was a significant difference in the frequency of concomitant diseases (p = 0.012) and anticoagulant therapy (p = 0.031). Average operating time was 80.7 ± 24.9, 72.6 ± 20.8, 63.5 ± 22.0, and 54.7 ± 27.9 (min ± SD) in groups A, B, C, and D, respectively, with a significant difference between groups A and D (p < 0.001). No significant differences were observed in estimated blood loss (p = 0.216) or morbidity (p = 0.294). CONCLUSIONS: The Lichtenstein inguinal hernia repair can be safely performed by residents and junior faculty with the appropriate supervision of senior faculty without any disadvantage to patients. This integrated teaching program for Lichtenstein inguinal hernia repair is effective and feasible for training residents and junior faculty.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/educação , Internato e Residência , Idoso , Currículo , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
3.
Clin J Gastroenterol ; 4(6): 412-7, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26189746

RESUMO

Carcinoma of the minor duodenal papilla is extremely rare. We present the case of a 69-year-old man diagnosed with a tumor of the second portion of the duodenum by upper gastrointestinal endoscopy, which revealed a 1.5-cm elevated tumor with slight ulceration at the minor duodenal papilla. Biopsy revealed adenocarcinoma, and a computed tomography scan showed an enhanced tumor in the duodenum, with no abnormality in the pancreatic head. A pancreas-sparing segmental duodenectomy was performed, and the duodenum reconstructed with an end-to-end anastomosis. Microscopically, the tumor was a well-differentiated adenocarcinoma, with no infiltration at the cut end of the accessory pancreatic duct. The postoperative course was uneventful and the patient discharged on postoperative day 11. We reviewed previously reported cases of carcinoma of the minor duodenal papilla. Early and exact preoperative diagnosis of duodenal neoplasms makes it possible to select a less invasive treatment, which also maintains curability.

4.
JOP ; 10(1): 59-63, 2009 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-19129618

RESUMO

CONTEXT: Although rare, a pancreatic arteriovenous malformation can have serious consequences. A diagnosis of arteriovenous malformation requires evidence of aberrant communication between the arterial and the venous systems. This report describes a case where the use of multi-detector row CT and specific post-processing methods provided a diagnosis of arteriovenous malformation. This minimally invasive diagnostic approach resulted in a clear, precise and comprehensive visual representation of the pancreatic arteriovenous malformation. CASE REPORT: A 60-year-old man with right hypochondriac pain presented with a mass in the head of the pancreas. The hypochondriac pain resolved spontaneously and physical examination revealed no abnormal findings. A multi-detector row CT study was performed. The data obtained in the arterial phase demonstrated a high-contrast mass in the head of the pancreas and early enhancement of the portal vein. A maximum intensity projection method clarified the aberrant vascular communication. Changes in Hounsfield numbers were observed using a multi-planar reformation method. A volume-rendering method was used to create a 3D model which demonstrated the spatial relationship between the aberrant vascular communication and the surrounding tissue. An annual follow-up study using this technique showed no significant alteration. CONCLUSIONS: Multi-detector row CT with specific post-processing methods is a useful diagnostic tool for pancreatic arteriovenous malformation.


Assuntos
Malformações Arteriovenosas/diagnóstico por imagem , Hemodinâmica , Imageamento Tridimensional/métodos , Pâncreas/irrigação sanguínea , Veia Porta/anormalidades , Tomografia Computadorizada por Raios X/métodos , Simulação por Computador , Humanos , Imageamento Tridimensional/instrumentação , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Pâncreas/anormalidades , Pâncreas/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Portografia/instrumentação , Portografia/métodos , Intensificação de Imagem Radiográfica/métodos , Tomografia Computadorizada por Raios X/instrumentação
5.
Dis Colon Rectum ; 51(2): 196-201, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18176829

RESUMO

PURPOSE: This study was designed to confirm the safety of not removing small adenoma in patients who undergo colorectal cancer surgery. METHODS: Patients who underwent surveillance colonoscopy after surgery were enrolled. The study was approved by our institutional review board. Colonoscopy was performed with magnification chromocolonoscopy. Benign adenomas of 6 mm or less in size, diagnosed based on both nonmagnified and magnified observation, were left unresected with a maximum of three polyps per patient. The sites of the polyps were marked by tattooing. Interval colonoscopy was performed predominantly yearly or biennially. Increase in size by 2 mm or larger was defined as significant. In follow-up, polyps were removed if they grew larger than 6 mm, were suspicious for high-grade dysplasia, or the patients requested to have polyps removal. RESULTS: Five hundred polyps in 284 patients met the above criteria and were not resected, and 412 polyps were followed by repeat colonoscopy. The mean observation period was 3.6+/-2.2 years and the mean number of repeat colonoscopy was 3.6+/-1.6. At the final colonoscopy, 71 percent of 412 polyps showed no change in size, 15 percent increased, 3 percent decreased, and 11 percent could not be identified. Eighty-eight polyps were resected endoscopically, and histology showed neither cancer nor adenomas with high-grade dysplasia. Two hundred fifty-five polyps detected in the same patient cohort during index/repeat colonoscopy were removed, including four adenomas with high-grade dysplasia and two T1 cancers. CONCLUSIONS: Leaving small polyps is safe even in patients who have undergone colorectal cancer surgery, provided that careful observation is guaranteed.


Assuntos
Adenoma/diagnóstico , Pólipos do Colo/cirurgia , Colonoscopia/métodos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Segunda Neoplasia Primária/diagnóstico , Cuidados Pós-Operatórios/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Pólipos do Colo/diagnóstico , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Prospectivos , Reoperação
6.
JOP ; 8(1): 44-9, 2007 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-17228133

RESUMO

CONTEXT: Primary pancreatic lymphoma is a rare form of extranodal lymphoma originating in the pancreas. The present report describes a case of follicular lymphoma of the pancreas with unique CT and MRI findings. CASE REPORT: A 58-year-old male complained of sudden abdominal pain, and routine ultrasonography detected an 8 cm hypoechoic tumor in the head of the pancreas. The 3D image generated using multi-cholangiography and virtual duodenography provided the information necessary for a laparotomy. The tumor was enucleated for diagnosis. Follicular lymphoma is quite rare in the pancreas and gastrointestinal tract. A considerable number of pancreatic lymphoma subtypes have been reported. The expression "pancreatic lymphoma" has been used to describe both primary lymphoid neoplasms originating in the pancreatic parenchyma and tumors invading from a peri-pancreatic lymphadenopathy. The present case belongs to the latter, which might explain the unique imaging findings and histological type. These subtypes display different imaging findings and different clinical characteristics. In the future, primary pancreatic lymphoma should be discussed separately depending on the subtype. CONCLUSION: We propose a new subtype of primary pancreatic lymphoma. Multi-cholangiography and virtual duodenography provided the information necessary for a laparotomy in the present case. Enucleation is indicated for benign and low-grade malignant tumors of the pancreas, even if the tumor is located in the head of the pancreas.


Assuntos
Linfoma Folicular/diagnóstico , Pâncreas/patologia , Neoplasias Pancreáticas/diagnóstico , Colangiografia/métodos , Humanos , Linfoma Folicular/patologia , Linfoma Folicular/cirurgia , Masculino , Pessoa de Meia-Idade , Pâncreas/cirurgia , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Tomografia Computadorizada por Raios X/métodos
7.
Gan To Kagaku Ryoho ; 32(13): 2133-6, 2005 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-16352944

RESUMO

A 76-year-old man developed jaundice and was hospitalized in January 2002. A 3 cm tumor was found in the head of the pancreas by abdominal CT, and the patient underwent laparotomy. The tumor was histologically diagnosed as a well-differentiated adenocarcinoma, and showed extensive invasion to the portal vein (T4NXM 0 Stage IV a). Incisional biopsy and hepaticojejunostomy were performed. On the basis of a drug sensitivity test, chemotherapy with 800 mg/m2/week gemcitabine was administered. The patient showed prolonged NC without any symptoms for 22 months, although the CEA and DUPAN-2 levels gradually increased during this time and massive ascites were detected in a routine abdominal CT at 22 months postsurgery. The patient died after 25 months of chemotherapy. Here we report a case of unresectable pancreatic cancer treated with gemcitabine on the basis of a drug sensitivity test.


Assuntos
Adenocarcinoma/tratamento farmacológico , Assistência Ambulatorial , Antimetabólitos Antineoplásicos/uso terapêutico , Desoxicitidina/análogos & derivados , Neoplasias Pancreáticas/tratamento farmacológico , Adenocarcinoma/patologia , Idoso , Desoxicitidina/uso terapêutico , Esquema de Medicação , Ensaios de Seleção de Medicamentos Antitumorais , Humanos , Masculino , Invasividade Neoplásica , Neoplasias Pancreáticas/patologia , Gencitabina
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