A 59-year-old man was admitted to our hospital for a feeling of weakness and abdominal pain. He had a history of appendectomy and laparotomy for ileus 38 years ago. He was found to be anemic. ...Colonoscopy revealed multiple ulcerations with two fistulas, which ran in the longitudinal direction, in the transverse colon. Barium enema revealed dilation of the lumen of the transverse colon and fistulous openings from a dilated ileum and a contracted ileum. The patient was diagnosed with blind loop syndrome due to ileocolic side-to-side anastomosis, and laparotomy was performed. The ileocolic anastomosis was resected and the short circuit was released. Annular strictures of the proximal and the distal ileum were seen at the anastomotic site, and histological examination revealed erosion in the mucosa and acute peritonitis at the anastomotic site of the ileum. Endoscopic diagnosis, such as diagnosis of ileal strictures, was important because blind loop syndrome by short circuit of the small intestine and colon is an indication for surgical removal of the short circuit.
Purpose: To improve prognosis, we evaluated preoperative factors for treating colorectal perforation and potentially fatal factors and postoperative complications. Methods: Subjects were 35 persons ...undergoing emergency surgery for colorectal perforation between January 2004 and August 2008. We analyzed preoperative factors of age, complications, perforation cause and site, white blood cell count, creatinine, prothrombin time, base excess, body temperature, blood pressure, APACHE II score, time from perforation onset to surgical intervention, ascites, and surgical procedure. We then analyzed potentially fatal postoperative complications for mortality. Results: Overall mortality was 23% (N=8) for which significant predictive factors in univariate analysis were creatinine, prothrombin time, base excess, body temperature, blood pressure, APACHE II score, and ascites. Multivariate logistic regression analysis, however, showed only the APACHE II score to be significantly associated with mortality (relative risk 1.89, p=0.005). Mortality in those with an APACHE II score of ≥20 was 83%, compared to 10%, in those with an APACHE II score of <20 (p=0.001). Postoperative mortality increased significantly from zero in those without the postoperative infection such as intraperitoneal infection, bacteremia or pneumonia to 53% in those with the infections (p<0.001). Mortality increased significantly from 13% in those without disseminated intravascular coagulation (DIC) to 80% in those with it (p=0.006). Conclusions: The APACHE II score is significantly predictive in those with colorectal perforation. And, it indicated that successful management of the postoperative infections could reduce mortality.
A 73–year–old man with melena, fever and lower abdominal pain was found to have a palpable tumor and lower abdominal tendernes. Abdominal computed tomography (CT) showed a solid 14 cm tumor with ...bleeding, internal necrosis, and surrounded by air bubbles different from intestinal lumen. The tumor was fed from the jejunal artery. The size, location, and perforation suggested a gastrointestinal stromal tumor (GIST). Laparotomy confirmed a giant small intestine tumor adheding to the posterior bladder wall and retroperitoneum. Inflammatory change involved the appendix. We partially resected the small intestine including the tumor and part of the bladder wall, also conducting, appendectomy and drainage. Histopathological findings showed tumor cells positive for c–kit and confirming a definitive diagnosis of small intestinal GIST. Imatinib mesylate was started 8 months later as chemotherapy. No recurrence has been seen in the 21 months postoperatively.
This paper describes the development process for tension legs type Submerged Floating tunnels (SFT) in shallow water. SFT is a completely new type of tunnels, unlike anything ever seen before. SFTs ...have attacked attentions as a new access to solve the problems not adequately dealt with by conventional structures. But, there are still many unknown factors, as no such structures. Therefore, Hokkaido University, Hokkaido Development Bureau and the Society Submerged Floating Tunnel Technology Research have studied on SFT technology, such as, design methods, tunnel structure, mooring systems, foundations, its construction in this several years. So, we are able to develop the design and construction methods for tension legs type Submerged Floating tunnels in shallow water.
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