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1.
Rinsho Shinkeigaku ; 62(4): 298-300, 2022 Apr 27.
Artigo em Japonês | MEDLINE | ID: mdl-35354726

RESUMO

A 68-year-old woman with Parkinson's disease, who had previously undergone Roux-en-Y gastrojejunostomy for early gastric cancer, complained of wearing-off and troublesome dyskinesia that had progressed over 7-years. After the introduction of levodopa-carbidopa intestinal gel therapy (LCIG) by nasojejunal tube, she had a good clinical response. Percutaneous endoscopic gastrostomy with a jejunal extension tube was difficult in this case, due to lack of gastrostomy site and fibrous postoperative adhesion. We introduced LCIG by direct percutaneous endoscopic jejunostomy (D-PEJ) which offers a less invasive procedure to operative tube placement. The factors affecting the success of D-PEJ could interfere with transillumination, abdominal thickness and the location of other organs. We determined the optimum site of catheter insertion with the assistance of real-time 3D reconstruction CT-jejunography. She was discharged home on postoperative day 14 without any procedure-related complications. Real-time 3D reconstructive CT-jejunography guided D-PEJ is a useful method for a patient who benefit from LCIG with prior gastrojejunostomy.


Assuntos
Carbidopa , Derivação Gástrica , Idoso , Antiparkinsonianos , Combinação de Medicamentos , Feminino , Géis/uso terapêutico , Humanos , Imageamento Tridimensional , Jejunostomia , Levodopa , Tomografia Computadorizada por Raios X
2.
BMC Surg ; 22(1): 5, 2022 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-34996411

RESUMO

BACKGROUND: The frequency of gallstones is higher in patients who have undergone gastrectomy than in the general population. While there have been some studies of gallstone formation after open gastrectomy, there are few reports of gallstones after laparoscopic gastrectomy (LG). Therefore, this study aimed to evaluate the incidence of gallstones after LG. METHODS: We retrospectively reviewed the records of 184 patients who underwent LG between January 2011 and May 2016 at Saiseikai Utsunomiya Hospital. After gastrectomy, abdominal ultrasonography was generally performed every 6 months for 5 years. Patients who underwent cholecystectomy before LG, underwent simultaneous cholecystectomy, and did not undergo abdominal ultrasonography, with an observation period of < 24 months, were excluded from the study. Finally, 90 patients were analyzed. Laparoscopic cholecystectomy was performed whenever biliary complications occurred. Patient characteristics were compared using the two-tailed Fisher's exact test or Chi-square test. In addition, the risk factors for postoperative gallstones were analyzed using logistic regression analysis. RESULTS: Among the 90 patients included in this study, 60 were men (78%), and the mean age was 65.5 years. Laparoscopic total gastrectomy was performed for 15 patients and laparoscopic distal gastrectomy for 75 patients. D2 lymph node dissection was performed for 8 patients (9%), whereas 68 patients underwent LG with Roux-en-Y reconstruction (76%). Gallstones were detected after LG in 27 of the 90 (30%) patients. Multivariate analysis identified Roux-en-Y reconstruction and male sex as significant risk factors of gallstones after gastrectomy. The incidence of gallstones was significantly higher (53%) in male patients who underwent Roux-en-Y reconstruction. Symptomatic gallstones after laparoscopic cholecystectomy were found in 6 cases (6/27, 22%), and all patients underwent laparoscopic cholecystectomy. CONCLUSION: Roux-en-Y reconstruction and male sex were identified as significant risk factors for gallstones after LG.


Assuntos
Cálculos Biliares , Laparoscopia , Neoplasias Gástricas , Idoso , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/epidemiologia , Cálculos Biliares/etiologia , Gastrectomia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/cirurgia
3.
J Surg Case Rep ; 2021(9): rjab399, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34567517

RESUMO

Delayed deep mesh infection is a rare complication and the precise mechanism of its development is unknown. We report a case of delayed deep mesh infection after inguinal hernia repair. A 65-year-old man was admitted for treatment of colon cancer. He had a history of bilateral hernioplasty repaired with mesh-plugs 6 years previously. Fluorine-18 fluorodeoxyglucose positron emission tomographic scan showed positive findings in the right inguinal region similar to cancer. He had no complaints or findings to suspect mesh infection. Postoperative computed tomography scan over time revealed a fluid collection with inflammation. Eleven years after hernia repair, the patient presented with inflammation in the right inguinal region and emergency operation was performed. An abscess cavity was found and the mesh-plug covered with granulation tissue was removed. The patient remains free of recurrence of inguinal hernia or inflammatory changes after 3 years of follow-up.

4.
Gan To Kagaku Ryoho ; 46(5): 953-955, 2019 May.
Artigo em Japonês | MEDLINE | ID: mdl-31189824

RESUMO

A 73-year-old man underwent laparoscopic sigmoidectomy for sigmoid colon cancer. Two years after the operation, multiple lung metastasis was diagnosed and chemotherapy with bevacizumab, irinotecan, and TS-1®was started in the patient. However, epigastric pain developed 73 days after the initial course of chemotherapy. Abdominal CT revealed duodenal perforation and generalized peritonitis. Emergency operation with omental patch closure was immediately performed. The patient was discharged 15 days after the emergency operation without any complication. This is an extremely rare case of bevacizu- mab-related duodenal perforation.


Assuntos
Bevacizumab/efeitos adversos , Úlcera Duodenal , Perfuração Intestinal , Neoplasias do Colo Sigmoide , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica , Colo Sigmoide , Humanos , Masculino , Neoplasias do Colo Sigmoide/terapia
5.
Clin Endosc ; 52(1): 59-64, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30300983

RESUMO

BACKGROUND/AIMS: The clinical impact of single-stage endoscopic stone extraction by endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy during the same hospitalization remains elusive. This study aimed to determine the efficacy and safety of single-stage ERCP and cholecystectomy during the same hospitalization in patients with cholangitis. METHODS: We retrospectively reviewed the medical records of 166 patients who underwent ERCP for mild to moderate cholangitis due to choledocholithiasis secondary to cholecystolithiasis from 2012 to 2016. RESULTS: Complete stone extraction was accomplished in 92% of patients (152/166) at the first ERCP. Among 152 patients who underwent complete stone extraction, cholecystectomy was scheduled for 119 patients (78%). Cholecystectomy was performed during the same hospitalization in 89% of patients (106/119). We compared two groups of patients: those who underwent cholecystectomy during the same hospitalization (n=106) and those who underwent cholecystectomy during a subsequent hospitalization (n=13). In the delayed group, cholecystectomy was performed about three months after the first ERCP. There were no significant differences between the groups in terms of operative time, rate of postoperative complications, and interval from cholecystectomy to discharge. CONCLUSION: Single-stage endoscopic stone extraction is recommended in patients with mild to moderate acute cholangitis due to choledocholithiasis. The combination of endoscopic stone extraction and cholecystectomy during the same hospitalization is safe and feasible.

6.
Asian J Endosc Surg ; 11(1): 43-46, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28664605

RESUMO

Simultaneous paraesophageal and Morgagni hernias are very rare. Here, we report a case involving a 91-year-old woman with simultaneous paraesophageal and Morgagni hernias. Both hernias were repaired laparoscopically. The postoperative course was uneventful. Laparoscopic repair for hernias seems to be feasible and minimally invasive, but only a few reports have described such repairs of hernial orifices.


Assuntos
Hérnia Hiatal/cirurgia , Hérnias Diafragmáticas Congênitas/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Idoso de 80 Anos ou mais , Feminino , Hérnia Hiatal/complicações , Hérnia Hiatal/diagnóstico por imagem , Hérnias Diafragmáticas Congênitas/complicações , Hérnias Diafragmáticas Congênitas/diagnóstico por imagem , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Segurança do Paciente , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
7.
Gan To Kagaku Ryoho ; 43(7): 909-11, 2016 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-27431640

RESUMO

A 51-year-old man underwent abdominoperineal resection for advanced rectal cancer at a hospital. He attended our outpatient clinic 58 months later with pain in the external genitalia, and was diagnosed with local pelvic recurrence and metastasis to the para-aortic lymph node and both adrenal glands. He received a total of 30 Gy of radiation for analgesia; subsequently, chemotherapy(mFOLFOX6 plus bevacizumab)was initiated. However, extreme left buttock and left femoral pain developed after the 6 courses of chemotherapy. Abdominal CT revealed Fournier's gangrene caused by small intestinal perforation. Emergency drainage under spinal anesthesia was immediately performed. Two additional drainage procedures were required thereafter and an ileostomy was constructed. The patient was discharged 100 days after the initial drainage. This is an extremely rare example of a bevacizumab-related small intestinal perforation that developed into Fournier's gan- grene.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bevacizumab/efeitos adversos , Gangrena de Fournier/etiologia , Perfuração Intestinal/induzido quimicamente , Intestino Delgado/diagnóstico por imagem , Neoplasias Retais/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Bevacizumab/administração & dosagem , Quimiorradioterapia , Drenagem , Evolução Fatal , Fluoruracila/administração & dosagem , Humanos , Leucovorina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Compostos Organoplatínicos/administração & dosagem , Neoplasias Retais/diagnóstico por imagem
8.
Asian J Endosc Surg ; 9(4): 270-274, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27349207

RESUMO

INTRODUCTION: The aim of this study was to compare the clinical outcomes of single-incision transumbilical laparoscopy-assisted appendectomy performed by surgical residents and attending surgeons. METHODS: We reviewed the clinical outcomes of 131 transumbilical laparoscopy-assisted appendectomies performed from January 2011 to June 2014. During the study period, 13 residents and 6 board-certified attending surgeons performed the procedures. For all operations performed by residents and attending surgeons, we reviewed and compared gender, age, BMI, body temperature, white blood cell count, C-reactive protein serum level, and the presence of a fecalith or abscess. Clinical outcomes including operative time, estimated blood loss, need for additional ports, conversion to open surgery, intraoperative complications, postoperative complications, and postoperative hospital stay were compared between the two groups. RESULTS: The mean preoperative white blood cell count in the resident-operated group was significantly higher than in the attending-operated group (14.0 vs 10.8 ×103 /mm3 , P = 0.007). There were no other significant differences in clinical variables between the two groups. Outcomes show that estimated blood loss was significantly higher (23.4 vs 9.8 mL, P = 0.031) and operative time tended to be longer (86.0 vs 72.0 min, P = 0.056) in the resident-operated group. No other significant differences were observed. CONCLUSION: Transumbilical laparoscopy-assisted appendectomy performed by residents is feasible and safe. It is an acceptable as a part of routine surgical training.


Assuntos
Apendicectomia , Apendicite/cirurgia , Internato e Residência , Laparoscopia , Adolescente , Adulto , Criança , Competência Clínica , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Umbigo , Adulto Jovem
9.
Jpn J Clin Oncol ; 45(3): 286-90, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25489005

RESUMO

Recently, bevacizumab has become a key drug for treatment of metastatic colorectal cancer. Molecularly targeted agents such as bevacizumab can cause life-threatening adverse effects, though they are generally considered less toxic than cytotoxic drugs. Here, we review the case of a 76-year-old male rectal cancer patient with liver metastasis who suffered extensive bowel necrosis after administration of 5-fluorouracil-based chemotherapy with bevacizumab, and required a subtotal colectomy and end-ileostomy. Microscopic findings revealed extensive mucosal necrosis in the resected colon specimen and necrosis at the muscularis propria of the descending colon. Pathological findings suggested that the mucosal damage induced by chemotherapy may be exacerbated by treatment with bevacizumab, resulting in extensive necrosis.


Assuntos
Inibidores da Angiogênese/efeitos adversos , Anticorpos Monoclonais Humanizados/efeitos adversos , Colo/patologia , Neoplasias Retais/tratamento farmacológico , Idoso , Anticorpos Monoclonais Humanizados/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bevacizumab , Colectomia/métodos , Evolução Fatal , Fluoruracila/administração & dosagem , Humanos , Ileostomia/métodos , Leucovorina/administração & dosagem , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Masculino , Necrose/induzido quimicamente , Necrose/cirurgia , Compostos Organoplatínicos/administração & dosagem , Neoplasias Retais/patologia
10.
Int Surg ; 99(3): 230-4, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24833144

RESUMO

The ileosigmoid knot (ISK) is a rare cause of intestinal obstruction. ISK is a condition in which the ileum wraps around the base of the sigmoid colon and forms a knot, leading to high mortality with rapid progression to bowel gangrene. We herein report a rare case of ISK at week 13 of pregnancy. The ISK was diagnosed by computed tomography, and the patient underwent emergency surgery for acute abdomen. Laparotomy showed segmental gangrenous change in the sigmoid colon, which was twisted around the distal ileal loop. The gangrenous bowel was resected, and primary anastomosis was performed. To our knowledge, the present case involves the first and earliest pregnancy in which a preoperative diagnosis of ISK was made and successful treatment was performed with surgery. A radiologic approach should be undertaken for prompt diagnosis and optimal management, even in early pregnancy.


Assuntos
Doenças do Íleo/cirurgia , Obstrução Intestinal/etiologia , Complicações na Gravidez/cirurgia , Doenças do Colo Sigmoide/cirurgia , Abdome Agudo/etiologia , Abdome Agudo/cirurgia , Adulto , Anastomose Cirúrgica , Feminino , Humanos , Doenças do Íleo/complicações , Doenças do Íleo/diagnóstico por imagem , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Gravidez , Complicações na Gravidez/diagnóstico por imagem , Doenças do Colo Sigmoide/complicações , Doenças do Colo Sigmoide/diagnóstico por imagem , Tomografia Computadorizada por Raios X
11.
World J Surg Oncol ; 11: 289, 2013 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-24209713

RESUMO

Metastatic pancreatic cancer is rare, accounting for approximately 2% of all pancreatic malignancies, and most cases arise from renal cell carcinoma. We report the case of a 63-year-old woman, who presented with a pancreatic tumor detected during her annual health examination. She had undergone left nephrectomy 13 years previously for renal cell carcinoma. Computed tomography (CT) revealed two tumors in the head and body of the pancreas, a hypervascular tumor and a hypovascular tumor with an enhanced rim, respectively. She underwent pylorus-preserving pancreaticoduodenectomy, and metastatic pancreatic tumors arising from the kidney with clustered clear cell carcinoma immunohistochemically positive for CD10 were diagnosed. This report presents the different enhancement features of different lesions on CT scans. Because the enhancement features of lesions have been reported to vary according to the size of the metastatic tumor, a knowledge of the history of renal cell carcinoma is crucial for diagnosis.


Assuntos
Carcinoma de Células Renais/patologia , Neoplasias Renais/patologia , Nefrectomia/efeitos adversos , Neoplasias Pancreáticas/secundário , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/cirurgia , Feminino , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Pessoa de Meia-Idade , Pancreatectomia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia , Complicações Pós-Operatórias , Prognóstico , Literatura de Revisão como Assunto , Tomografia Computadorizada por Raios X
12.
Arthritis Res Ther ; 14(3): R107, 2012 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-22569209

RESUMO

INTRODUCTION: We used DR1 transgenic mice and covalently linked DR1 multimers to characterize analog-specific inhibitory T cells in collagen-induced arthritis (CIA). Because of the low numbers of antigen-specific T cells in wild-type mice, functional T-cell studies in autoimmune arthritis have been challenging. The use of T-cell receptor (TCR) transgenic mice has provided useful information, but such T cells may not represent the heterogeneous T-cell response that occurs in natural settings. Our focus was to develop tools to identify and characterize the population of immunoregulatory T cells induced in wild-type mice by an analog peptide of CII259-273, which contains amino acid substitutions at positions 263 (N) and 266 (D) (analog peptide A12). METHODS: DR1 multimers, developed by loading empty class II molecules with exogenous peptide, provide a method for visualizing antigen-specific T cells with flow cytometry. However, the low binding avidity of A12 for the major histocompatibility complex (MHC) made this strategy untenable. To overcome this problem, we generated DR1 multimers in which the analog peptide A12 was covalently linked, hoping that the low-avidity analog would occupy enough binding clefts to allow detection of the responsive T cells. RESULTS: Staining with the tetramer revealed that A12-specific T cells were readily detectable at 10 days after immunization. These CD4(+) T cells are a highly selective subset of the TCR repertoire and have a limited clonality. Analysis of cytokine expression showed that cells detected by tetramer (A12) expressed primarily suppressive cytokines (interleukin-4 (IL-4) and IL-10) in response to collagen, compared with control cells. Although they did not express Fox-p3, they were extremely effective in preventing and suppressing inflammatory arthritis. CONCLUSIONS: In summary, our studies showed that the use of covalently linked multimers allows characterization of analog-specific T cells that are otherwise difficult to detect. The suppressive character of the analog-specific T-cell response suggests that these cells attenuate autoimmunity and differ significantly in phenotype from the inflammatory T cells predominantly found in arthritic joints. Such reagents will become powerful tools to study T-cell responses in RA patients in upcoming clinical trials.


Assuntos
Artrite Experimental/imunologia , Colágeno Tipo II/imunologia , Antígeno HLA-DR1 , Linfócitos T/imunologia , Animais , Artrite Experimental/genética , Artrite Reumatoide/imunologia , Citometria de Fluxo , Antígeno HLA-DR1/genética , Antígeno HLA-DR1/imunologia , Humanos , Camundongos , Camundongos Knockout , Camundongos Transgênicos
13.
Clin Exp Metastasis ; 20(5): 431-5, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-14524532

RESUMO

Marimastat is a broad-spectrum matrix metalloproteinase (MMP) inhibitor that inhibits almost all major MMPs, key enzymes in gastric cancer invasion and metastasis. We investigated the ability of marimastat to inhibit tumor angiogenesis in the severe combined immuno-deficient (SCID) mouse/human gastric cancer model of peritoneal dissemination. A human stomach adenocarcinoma cell line, TMK-1, was injected intraperitoneally into SCID mice. On the 7th day after tumor inoculation, the administration of marimastat (27 mg/kg/day) was initiated and the treatment was continued for 2 weeks using subcutaneously-inoculating mini-osmotic pumps. On the 21st day, the mice were killed and the disseminated nodules were evaluated. Total weights, numbers, and the microvascular density of the disseminating nodules were significantly lower in mice treated with marimastat compared to the control group. Film in situ zymography demonstrated that net gelatinolytic activity in the tissues was weaker in treated-group nodules than in control-group nodules. Thus, our results suggested that marimastat inhibited peritoneal dissemination of human gastric cancer cells through inhibition of tumor angiogenesis, possibly involving the down-regulation of gelatinases, in SCID mice injected with human gastric cancer cells.


Assuntos
Inibidores Enzimáticos/farmacologia , Gelatinases/antagonistas & inibidores , Ácidos Hidroxâmicos/farmacologia , Neovascularização Patológica , Peritônio/enzimologia , Neoplasias Gástricas/patologia , Animais , Humanos , Imuno-Histoquímica , Camundongos , Camundongos SCID , Microcirculação , Osmose , Molécula-1 de Adesão Celular Endotelial a Plaquetas/biossíntese , Fatores de Tempo , Células Tumorais Cultivadas
14.
Jpn J Cancer Res ; 93(7): 834-41, 2002 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-12149150

RESUMO

Marimastat, a matrix metalloproteinese inhibitor, was examined for the ability to prevent peritoneal dissemination of a human gastric cancer xenograft, TMK-1. Even with novel approaches such as molecular targeting of cancer chemotherapy, peritoneal dissemination of gastric cancer has little sensitivity to anticancer drugs, and it is impossible to inhibit its growth completely. Intraperitoneal injection of TMK-1 into nude mice at 5 x 10( 5) cells / body resulted in carcinomatous peritonitis that mimicked clinical cases. Continuous administration of marimastat (18 mg / kg / day) from 24 h after the tumor inoculation successfully inhibited the growth of peritoneal dissemination nodules. Combined administration of marimastat (18 mg / kg / day) and mitomycin C (MMC, 2 mg / kg) showed synergistic inhibition of growth of peritoneal dissemination, being superior to MMC alone (2 mg / kg). Although marimastat alone could not increase survival time with statistical significance, combined administration of marimastat and MMC had a survival benefit with statistical significance. The combination of marimastat and MMC increased the preventive effect on peritoneal dissemination. Marimastat seems to be a candidate for the prevention of peritoneal spread of gastric carcinoma.


Assuntos
Ácidos Hidroxâmicos/uso terapêutico , Inibidores de Metaloproteinases de Matriz , Neoplasias Gástricas/patologia , Animais , Antibióticos Antineoplásicos/uso terapêutico , Antineoplásicos/uso terapêutico , Peso Corporal/efeitos dos fármacos , Sobrevivência Celular , Corantes/farmacologia , Relação Dose-Resposta a Droga , Inibidores Enzimáticos/uso terapêutico , Humanos , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Nus , Mitomicina/uso terapêutico , Modelos Químicos , Metástase Neoplásica , Transplante de Neoplasias , Peritônio/metabolismo , Neoplasias Gástricas/terapia , Sais de Tetrazólio/farmacologia , Tiazóis/farmacologia , Fatores de Tempo , Células Tumorais Cultivadas
15.
Gastric Cancer ; 3(3): 156-160, 2000 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-11984730

RESUMO

Cronkhite-Canada syndrome is generally accepted to be a benign disorder, with 374 reported cases to the present. Worldwide, there have been 18 previously reported cases of Cronkhite-Canada syndrome associated with gastric cancer. In this report we describe a case of a 52-year-old man with the clinical features of Cronkhite-Canada syndrome combined with gastric cancer. Although the gastric tumor was located at the antrum of the stomach, we performed a total gastrectomy because of the edematous swelling and high risk of malignancy in the remnant stomach. As Cronkhite-Canada syndrome may be a premalignant condition for gastric cancer, as well as for colorectal cancer, we suggest periodic examination of the stomach, colon, and rectum for patients with Cronkhite-Canada syndrome.

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