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The resection of the lower anterior portion of the rectum has become a popular surgical method for the treatment of cancer. This method allows for cancer resection while preserving the anal sphincter muscle. However, due to the risk of rupture of sutures at the anastomosis site, temporary ileostomy is often performed as a concomitant, preventative procedure. Ileostomy itself may be associated with certain complications and may have a negative impact on the quality of life of patients. In this study, we included 43 patients with rectal cancer who had undergone surgery at our hospital between 2011 and 2016. We collected data regarding patientsʼ age, sex, body mass index, rectal cancer sites, complication types, and other clinical variables. We also investigated surgery-related variables such as surgical method, medical history of diabetes mellitus, smoking history, and other relevant variables to identify the risk factors for complications. The most common complication was skin irritation (n＝12, 28%). We did not identify any statistically significant risk factors. Most complications resolved following appropriate medical treatment. However, one patient with outlet obstruction underwent reoperation because of mesentery inflammation. In conclusion, early prevention and treatment of complications is important, regardless of the patient background.

Transnasal ultrathin endoscopy (GIF-XP260N) was newly introduced into Nishizaki Hospital in May 2007. We herein report a transition of preparation method for transnasal ultrathin endoscopy and the present state of PEG (percutaneous endoscopic gastrostomy) using transnasal ultrathin endoscopy. At first, a Spray method was adopted for the preparation in transnasal ultrathin endoscopy. After that, its preparation has changed to a Stick method being thought the high acceptance procedure. We have done a questionnaire about two preparation methods for transnasal ultrathin endoscopy (N=50). In the Stick method, nasal painful rate of patients were decreased 28 patients (56%) to 19 patients (38%) comparing the Spray method. In addition, a person who transnasal ultrathin endoscopies at next time were increased 40 patients (80%) to 43 patients (86%) comparing the Spray method. We have thought that the Stick method was more comfortable preparation method than the Spray method. From July 2007 to April 2009, PEG was performed using transnasal ultrathin endoscopy (28 cases). All cases were done by Introducer method. Successful rate of PEG was 84.8 % (28/33). There was no complication during these procedures. In future, we have thought that pleasant preparation method for transnasal ultrathin endoscopy is the Stick method and PEG are promised by using the same endoscopy.

In our department, from April 2002 through August 2005, a percutaneous endoscopic gastrostomy (PEG) was performed on 29 patients ranging from 16 to 90 years of age. PEG is a simpler type of gastrostomy than a laparotomical gastrostomy. The purpose of this study was to evaluate the post PEG complications and prognosis. All 29 patients underwent the Introducer method for PEG. There was only one complicated patient with bleeding disorder that was associated with acquired hemophilia A. She had poor blood coagulation data as revealed by the prolonged of APTT without DIC (Disseminated intravascular coagulation). This patient finally died due to complications resulting from bilateral aspiration pneumonia, cerebral infarction and uncontrolled bleeding from the fistula following PEG. Regarding the prognosis of these patients, only three patients survived for 2 years, while no patient survived for more than 3 years. The coagulation functions, such as APTT and PT, were fully evaluated before PEG m all patients. If this step is performed, PEG is thus considered to be a safe and useful procedure

In our department, from April 2002 through August 2005, a percutaneous endoscopic gastrostomy (PEG) was performed on 29 patients ranging from 16 to 90 years of age. PEG is a simpler type of gastrostomy than a laparotomical gastrostomy. The purpose of this study was to evaluate the post PEG complications and prognosis. All 29 patients underwent the Introducer method for PEG. There was only one complicated patient with bleeding disorder that was associated with acquired hemophilia A. She had poor blood coagulation data as revealed by the prolonged of APTT without DIC (Disseminated intravascular coagulation). This patient finally died due to complications resulting from bilateral aspiration pneumonia, cerebral infarction and uncontrolled bleeding from the fistula following PEG. Regarding the prognosis of these patients, only three patients survived for 2 years, while no patient survived for more than 3 years. The coagulation functions, such as APTT and PT, were fully evaluated before PEG m all patients. If this step is performed, PEG is thus considered to be a safe and useful procedure, 論文

A 42-year-old man, who had been bedridden for a long time due to cerebral palsy from birth, was admitted to our department for abdominal pain and vomiting. He was diagnosed as having intestinal obstruction because plain abdominal radiography and abdominal computed tomography revealed marked dilatation of the ascending and transverse colon. On the 3rd day after admission, an emergency laparotomy was performed subsequent to the diagnosis of strangulated ileus secondary to colon obstruction. During the operation, the transverse colon was found to be twisted 180 degrees counterclockwise and necrotic. It was resected and a double-barrelled colostomy was made. In comparison with signoid colon volvulus, transverse colon volvulus is a very rare disease and is difficult to diagnose preoperatively. In treating patients with abdominal symptoms similar to that of our patient, it would be good to always bear the possibility of transverse colon volvulus in mind.

Endoscopic surgery has been widely applied with the view of minimizing tissue trauma and improving the cosmetic outcome of surgery by avoiding large operative scars. Endoscopic surgery for thyroid disease has been reported in recent literature. Our report is on two patients with autonomously functioning thyroid nodules, on whom we performed endoscopic thyroidectomy. These patients had unilateral thyroid nodules. ^Tc scintigram showed increased uptake in areas where the nodules were. We performed endoscopic thyroidectomy using an anterior chest approach. C0_2 was insufflated at 4mmHg of intraspace pressure to create the working space. Three trocars were inserted from the subclavian area, and the thyroid dissection and the resection of vessels were performed with a harmonic scalpel. The operation time of these two patient were 120 and 118 minutes respectively. The two patients were discharged from hospital on the 2 nd and 3 rd post operative days respectively and were fully satisfied with the cosmetic result., 論文

Pulmonary embolism (PE) is a disease with a poor prognosis and common in western people. We experienced a case of PE after an operation for umbilical hernia. A 72-yearold woman whose height was 146 cm and weight was 78 kg, was referred to our hospital because of a soft mass (15×12×8 cm^3) in the umbilical region. Umbilical hernia was diagnosed with both physical examination and abdominal computed tomography. A radical operation was performed. On the 2nd postoperative day when she moved, she suddenly had dyspnea and fell into unconsciousness with hypoxemia. Multiple perfusional defects were revealed by a pulmonary blood flow scintigram, and the case was diagnosed as PE. We started thrombolytic and anticoagulant therapy with heparin and urokinase immediately. She was discharged from the hospital without sequelae on the 33rd postoperative day. It is thought that PE occurred due to deep vein thrombosis, increased intraabdominal pressure caused by the bowel returning into the abdominal cavity, tightening of the abdominal wall and obesity. If postoperative sudden onsets of dyspnea and unconsciousness with hypoxemia of unknown origin are encountered, examination and treatments should immediately be done keeping the presence of PE in mind.

We herein report a case of malignant mesothelioma from onset which developed as pleural effusion related to metastasis and later presented as an omental tumor over a 2.5 year period. A 49-year-old man developed right pleural effusion in August 1995, which was cured by thoracocentasis. One year later, his chest X-ray showed diffuse pleural thickening in August 1996, and two nodules were found in his right lung in September 1996. He was referred to the University Hospital in January 1997 because of right chest and right upper abdominal pain. The X-ray and CT of the chest revealed diffuse, irregular thickening of the right chest wall with many nodules in the lung. A CT scan of the abdomen showed three tumors in the upper abdomen. There was no history of asbestos exposure. At laparotomy, the tumors were confined to the omentum with no widespread tumor deposits. Histologically, this tumor was a malignant mesothehoma with a fibrous form mimicking fibrosarcoma. On immunohistochemical staining, the tumor cells were positive for cytokeratin and vimentin. Electron microscopy showed rare desmosomes and sparse microvilli. The patients was still undergoing chemotherapy at the time of writing.

A case of ruptured pseudoaneurysm of the stump of the gastroduodenal artery with treatment by transcatheter arterial embolization (TAE) in a 66-year-old man is reported. The patient underwent pancreatoduodenectomy for carcinoma of the bile duct. He developed anastomotic leakage of pancreatoienunostomy on the 7th postoperative day, and then intra-abdominal bleeding on the 25th postoperative day. Following stabilization of his general condition, emergency angiography demonstrated a rupture of pseudoaneurysm of the stump of the gastroduodenal artery which was succesfully treated by TAE., 論文

Pulmonary embolism (PE) is a disease with a poor prognosis and common in western people. We experienced a case of PE after an operation for umbilical hernia. A 72-yearold woman whose height was 146 cm and weight was 78 kg, was referred to our hospital because of a soft mass (15×12×8 cm^3) in the umbilical region. Umbilical hernia was diagnosed with both physical examination and abdominal computed tomography. A radical operation was performed. On the 2nd postoperative day when she moved, she suddenly had dyspnea and fell into unconsciousness with hypoxemia. Multiple perfusional defects were revealed by a pulmonary blood flow scintigram, and the case was diagnosed as PE. We started thrombolytic and anticoagulant therapy with heparin and urokinase immediately. She was discharged from the hospital without sequelae on the 33rd postoperative day. It is thought that PE occurred due to deep vein thrombosis, increased intraabdominal pressure caused by the bowel returning into the abdominal cavity, tightening of the abdominal wall and obesity. If postoperative sudden onsets of dyspnea and unconsciousness with hypoxemia of unknown origin are encountered, examination and treatments should immediately be done keeping the presence of PE in mind., 論文

A 42-year-old man, who had been bedridden for a long time due to cerebral palsy from birth, was admitted to our department for abdominal pain and vomiting. He was diagnosed as having intestinal obstruction because plain abdominal radiography and abdominal computed tomography revealed marked dilatation of the ascending and transverse colon. On the 3rd day after admission, an emergency laparotomy was performed subsequent to the diagnosis of strangulated ileus secondary to colon obstruction. During the operation, the transverse colon was found to be twisted 180 degrees counterclockwise and necrotic. It was resected and a double-barrelled colostomy was made. In comparison with signoid colon volvulus, transverse colon volvulus is a very rare disease and is difficult to diagnose preoperatively. In treating patients with abdominal symptoms similar to that of our patient, it would be good to always bear the possibility of transverse colon volvulus in mind., 論文

We report three cases of primary small intestinal cancer, seen from 2002 to 2010. Two cases were male, and the other case was female. The median age at diagnosis was 64.6 years old. Tumor invasion was SI in 2 cases, and SE in one case. On initial presentation they were all advanced cancer cases. One case with peritoneal recurrence has died. Another one case with peritoneum recurrence underwent tumor resection. After this operation, no recurrence has been found. All these cases had been discovered as advanced cancer, and an earlier diagnosis was not possible. A routine screening system to detect early stage primary small intestinal cancer should be established as soon as possible., 論文

The resection of the lower anterior portion of the rectum has become a popular surgical method for the treatment of cancer. This method allows for cancer resection while preserving the anal sphincter muscle. However, due to the risk of rupture of sutures at the anastomosis site, temporary ileostomy is often performed as a concomitant, preventative procedure. Ileostomy itself may be associated with certain complications and may have a negative impact on the quality of life of patients. In this study, we included 43 patients with rectal cancer who had undergone surgery at our hospital between 2011 and 2016. We collected data regarding patientsʼ age, sex, body mass index, rectal cancer sites, complication types, and other clinical variables. We also investigated surgery-related variables such as surgical method, medical history of diabetes mellitus, smoking history, and other relevant variables to identify the risk factors for complications. The most common complication was skin irritation (n＝12, 28%). We did not identify any statistically significant risk factors. Most complications resolved following appropriate medical treatment. However, one patient with outlet obstruction underwent reoperation because of mesentery inflammation. In conclusion, early prevention and treatment of complications is important, regardless of the patient background., 論文

Transnasal ultrathin endoscopy (GIF-XP260N) was newly introduced into Nishizaki Hospital in May 2007. We herein report a transition of preparation method for transnasal ultrathin endoscopy and the present state of PEG (percutaneous endoscopic gastrostomy) using transnasal ultrathin endoscopy. At first, a Spray method was adopted for the preparation in transnasal ultrathin endoscopy. After that, its preparation has changed to a Stick method being thought the high acceptance procedure. We have done a questionnaire about two preparation methods for transnasal ultrathin endoscopy (N=50). In the Stick method, nasal painful rate of patients were decreased 28 patients (56%) to 19 patients (38%) comparing the Spray method. In addition, a person who transnasal ultrathin endoscopies at next time were increased 40 patients (80%) to 43 patients (86%) comparing the Spray method. We have thought that the Stick method was more comfortable preparation method than the Spray method. From July 2007 to April 2009, PEG was performed using transnasal ultrathin endoscopy (28 cases). All cases were done by Introducer method. Successful rate of PEG was 84.8 % (28/33). There was no complication during these procedures. In future, we have thought that pleasant preparation method for transnasal ultrathin endoscopy is the Stick method and PEG are promised by using the same endoscopy., 論文