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.
This paper evaluates the effects of treatment with a pumping technique and arthroscopic lysis and lavage, followed by rehabilitative training, on condylar head mobility of the temporomandibular joint ...(TMJ). We studied 32 TMJs in 19 patients suffering from chronic closed lock with severe adhesion. The results were compared between cases with adhesions concentrated in two areas : mostly in the posterior and/or the anterior synovial portion of the upper TMJ compartment (11 joints) and mostly around the eminence (21 joints). The results showed a statistically significant improvement in condylar head movement for both groups between the initial and final stages of treatment. However, the results also suggested that patients with adhesion concentrated around the eminence are less likely to recover condylar head mobility to the same extent as those in the other group. (J. Oral Sci. 41, 61-66, 1999)
A 52-year-old man presented with a pulsatile mass in the right groin. He had undergone lumbar sympathectomy and aorto-right femoral artery bypass using an 8mm Microvel double velour graft, 14 years ...previously, for aortoiliac occlusive disease caused by thromboangiitis obliterans. Based on a clinical diagnosis of an anastomotic aneurysm, an operation was performed. When the aneurysm was incised, it was found that the anastomosis of the graft to the femoral artery was intact and that the graft itself had a defect, 3cm in size on the anterior wall, 1.5cm proximal to the distal anastomosis. The final diagnosis was a nonanastomotic false aneurysm due to prosthetic graft failure. The failed portion of the graft was resected, and a 10mm Hemashield Gold woven double velour graft was interposed between the old graft and the right femoral artery. Generally, arterial grafts below the groin are subject to high levels of mechanical stress, and graft failure is not uncommon. Vascular surgeons should keep in mind that graft failure is not rare in patients with long-standing prosthetic grafts.
A 58-year-old male patient who had a huge false aneurysm as a late sequela of division of patent ductus arteriosus was surgically managed with success. It is noteworthy that 24 years had elapsed from ...the initial operation until recognition of the aneurysm. The pathogenesis and method of the surgical treatment are discussed.
Delayed manifestation of aortic stenosis caused by abdominal blunt trauma is rare. We report herein the case of a 67-year-old man who was taken to a nearby hospital after being crushed between a ...heavy truck and a wall. An emergency laparotomy was performed, revealing only a mesenteric tear which was repaired. He was discharged after an uneventful postoperative course; however, 1 month later he began to experience intermittent claudication, and presented to our hospital in December 1994, 1 year after the first operation. Angiography and enhanced computed tomography (CT) demonstrated infrarenal abdominal aortic dilatation with distal stenosis. Both the dilated and stenotic lesions were resected and bypass surgery ws performed. Pathologic examination demonstrated that the intima had been lacerated circumferentially and everted distally, causing the aortic stenosis. To our knowledge, this is the first case of the delayed manifestation of traumatic aortic stenosis to be documented in Japan. The etiology of this rare complication of blunt trauma is described in this report.
Background: Pulmonary angiosarcoma is a rare tumor that usually grows rapidly and has a highly malignant clinical course. There have been only a few reports of this tumor, which was diagnosed ...preoperatively. We report a case of pulmonary angiosarcoma diagnosed preoperatively. Case: A 70-year-old man presented with symptoms suggesting chronic pulmonary thromboembolism. The CT scan and MRI revealed a mass obliterating the right pulmonary artery invading its wall. A primary tumor of the pulmonary artery was suspected and a transcatheter aspiration biopsy confirmed it to be angiosarcoma. The tumor was completely resected by right pneumonectomy with mediastinal lymph node dissection. The histological diagnosis of the resected specimen was an intimal sarcoma. Ten months after the operation, the patient is alive without any evidence of recurrence. Conclusion: A rare case of preoperatively diagnosed pulmonary intimal sarcoma with successful surgical resection was reported.
In diagnosis and treatment of colorectal cancer, PET/CT has high sensitivity and specificity in comparison to other modalities, and in the near future is expected to play important roles in these ...areas. However, because of the high cost, PET/CT must be used cost-effectively. In the diagnosis of colorectal cancer with PET/CT, evaluation of cancer growth is possible, but evaluation of tumor invasion is inadequate. In the diagnosis of lymph node metastases, PET/CT provides higher sensitivity of evaluation in distant lymph nodes. The reason for difficulty in proximal lymph node evaluation is due to the close proximity of the main cancer tumor. In the diagnosis of liver metastases, meta-analysis indicates the need for higher sensitivity and specificity compared to CT and MRI. In the diagnosis of pulmonary metastases, chest CT should be obtained in very early pulmonary metastases because of the tiny tumor size in the early stage. In the diagnosis of local recurrence, discrimination between postoperative change and recurrence is difficult, but PET/CT is very useful as a qualitative diagnostic tool. Recent reports have also indicated the usefulness of PET/CT in the evaluation of treatment efficacy in chemotherapy or radiotherapy.
Celiac artery aneurysm (CAA) is very rare. We report a case of CAA with type IIIb aortic dissection (DA) which was treated surgically. A 60-year-old man who had an abnormal enlargement of the aorta ...on abdominal ultrasonography was admitted to our hospital. Angiography and CT scan revealed CAA with type IIIb DA. His general condition was stable and surgery was performed electively. The CAA was exposed through a median laparotomy. It was found to be about 3cm in diameter. As vascular reconstruction seemed difficult and the proper hepatic artery showed good pulsation after clamping the common hepatic artery, we decided to perform celiac artery aneurysmectomy without vascular reconstruction. Except for transient liver dysfunction, there was no other complication and he was discharged on the 24th postoperative day. During surgery for CAA, when collateral perfusion from the SMA to the liver is adequate, it seems that vascular reconstruction is not always necessary as shown by this case.
The right half of the colon was resected in a 70-year-old woman in August 2002 for ascending colon cancer. The peritoneum was also resected because of metastasis (Stage IV). Since tumor markers ...gradually increased, positron emission tomography (PET)/ computed tomography (CT) revealed peritoneal dissemination. Abdominal pain appeared 40 months after surgery. Barium enema findings revealed an ileal constriction approximately 25 cm from the anastomosed site toward the anus. Repeat PET/CT revealed peritoneal dissemination coinciding with ileal constriction. CT did not reveal well-defined tumor shadows. The patient was diagnosed with constriction associated with peritoneal metastasis and underwent surgery. Surgical findings revealed a roughly 2-cm peritoneal metastatic focus and ileal constriction. The site was resected and anastomosed. Postoperative progress was favorable; the patient was discharged and enjoys a favorable quality of life through outpatient adjuvant chemotherapy. PET/CT is suggested to be useful in observing the progress of peritoneal dissemination and may be of assistance in determining the course of treatment.
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