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Background Non-occlusive mesenteric ischaemia (NOMI) is a condition in which intestinal ischaemia arises due to spasms of peripheral blood vessels; however, there is no obstruction of the main arteries. Risk factors include hypertension, diabetes, and increasing age, but the traumatic injury triggering NOMI onset is rarely reported. We report a case of NOMI caused by a pelvic fracture due to a fall injury. Case presentation A 77-year-old man was transported to the hospital due to a fall injury. CT revealed a pelvic fracture and a haematoma in the pelvic extraperitoneal space. The next day, the patient developed shock, and CT revealed an increase in haematoma size. Both internal iliac arteries were embolized by transcatheter arterial embolization (TAE). The next day’s CT revealed intestinal necrosis of the ascending colon, and emergency surgery was planned. During surgery, necrosis was identified in the serosa of the ascending, transverse, and sigmoid colon. We performed subtotal excision from the ascending colon to the sigmoid colon. On postoperative day 10, melena was observed, and CT revealed partial thickening of the small intestine and a decrease in the contrast effect. Considering the post-total colectomy and general condition, we proceeded with conservative treatment. Over time, the patient developed liver and renal dysfunction and died 16 days after surgery. Conclusions We experienced a case of NOMI caused by bleeding from a pelvic fracture. It is important to keep in mind the risk of developing NOMI in traumatic bleeding to avoid missing this diagnosis.

乳腺アポクリン癌からの化生を示唆する紡錘細胞癌の1例を経験した.症例は78歳の女性で,左乳房腫瘤を主訴に来院した.術前はアポクリン癌を疑い術中迅速病理診断にて癌を確認し胸筋温存乳房切除術(Bt+Ax+Ic)を施行した.組織学的には紡錘型細胞よりなる肉腫様部分とアポクリン化生を示す癌腫部分がほぼ半分の領域を占め,さらに両者の漸次移行部も認められた.アポクリン化生癌からさらに紡錘細胞癌が発生したものと思われた.リンパ節転移なし,ホルモン・リセプター(ER・PgR)はいずれも陰性であった.術後8年1カ月経過するが再発兆候は認めない.

今回われわれは, S状結腸腹膜垂が索状となった絞扼性イレウスの1例を経験したので報告する.症例は71歳,女性.下腹部痛にて近医を受診,入院のうえ保存的に経過をみていたが,症状軽快せず, CTで右下腹部腸管の膨隆を認め,腹水もみられたため,絞扼性イレウスの診断にて当科紹介され,転院となった.当科入院後の腹部超音波検査でも右下腹部の腸管が限局して緊満しており腹水も認め,腸管の絞扼が疑われたため,同日緊急手術を施行した.開腹したところ, S状結腸腹膜垂が膀胱前壁と癒着して索状となり,回腸末端より40cmから130cmの腸管が絞扼されていたため,同部回腸を切除した.術後経過は順調であった.腹膜垂が原因となってイレウスをきたした症例は極めて稀と考えられ,本邦報告例を集計し文献的考察を加えたので報告する.

症例は64歳の男性. 幽門狭窄を伴う進行胃癌に対し開腹手術を行ったが膵臓への浸潤が高度で非切除, 胃空腸吻合術のみとなった. TS-1を用いた化学療法を開始し, 1サイクル後のCTでは胃前庭部の腫瘤, 周囲リンパ節とも縮小し, PRと判定した. 3サイクル後はCT上, 胃の腫瘤および周囲リンパ節とも指摘できずCRとなった. 1年間CRを持続した後, 再度の開腹手術で幽門側胃切除術を行った. 病理組織学的検索では切除標本に癌細胞の遺残はみられなかった. TS-1は経口であるため外来投与可能であり, 患者のQOLを損なわない化学療法である. 今回, 初回手術時には非切除となった高度進行胃癌に対して経口化学療法剤であるTS-1を投与してCT上, CRとなり, 再手術を行い病変部を切除しえた. 病理組織学的検索では切除標本に癌細胞の遺残はみられず, 今後切除不能例を含めた高度進行胃癌に対してTS-1が有用となる可能性が示唆された.

The influence of 16,16-dimethyl prostaglandin E2 (16,16-dm PGE2; an agent used for the prevention of stress ulcer after hepatectomy of the cirrhotic liver) on liver regeneration after hepatectomy was studied in rats. The following results were obtained. Ulceration after the stress of 6 h of water immersion was markedly suppressed in rats treated with 30 r/kg of 16,16-dmPGE2 as compared with the untreated controls. In animals that received hepatectomy alone, the gastric pH and gastric mucosal blood flow showed significant reduction from the preoperative levels. In animals that received hepatectomy plus 16,16-dmPGE2 treatment the postoperative reduction in the gastric pH and gastric mucosal blood flow was suppressed, suggesting the effectiveness of 16,16-dmPGE2 treatment in the prevention of stress ulcer after hepatectomy of the cirrhotic liver. The 3H-thymidine uptake percentage and thymidine activity 24 h after hepatectomy and the DNA content 30 h after hepatectomy were significantly higher in animals treated with 16,16-dmPGE2 than in the untreated controls. In animals that were treated intraperitoneally with 50 mg/kg of indomethacin 6 h before hepatectomy the mitotic index 30 h after hepatectomy was markedly lower than that in untreated controls. This indomethacin-induced reduction in the mitotic index tended to be normalized by treatment with 16,16-dmPGE2. These results suggest that 16,16-dmPGE2 treatment effectively prevents stress ulcer and favorably affects hepatic regeneration after hepatectomy of the cirrhotic liver.

We have experienced 56 cases of advanced and recurrent colorectal carcinoma treated with 5-Fluorouracil (5-FU)/l-Leucovorin (LV) therapy from January 2000 to March 2005. The RPMI regimen was employed, but 5-FU was administered at the dose of 500 mg/body for the first cycle and 750 mg/body for subsequent cycles, thanks to its safety, economy, and simplicity. l-LV was administered at 375 mg/body for all cycles. An average of 3.6 cycles were given, and the average 5-FU dose was 427.7 mg/m(2). The probability of the toxicities (Grade 3 or 4) tended to be less frequent compared with that observed in multi-center cooperative studies in Japan, although the frequency of nausea and vomiting was similar. Responses were CR 0/56, PR 16/56, NC 23/56, and PD 17/56, and the overall response rate was 28.6%. The median progression-free survival time was 6.0 months, and the median overall survival time was 14.0 months, which was longer than that achieved in multi-center studies in Japan. These data suggest that new regimens such as FOLFOX 4 and infusional 5-FU/l-LV therapy can be administered at lower doses of anti-cancer drugs with less toxicity and possible longer survival time.

We investigated the response of gastric vessels to prostaglandin (PG) E2 after intra-duodenal release of bile in rats with obstructive jaundice. The animals were divided into four groups according to duration of bile duct obstruction (BDO): control and 1 week (W), 2W, and 3W groups. Prolonged BDO decreased gastric mucosal blood flow (BF) significantly. The BF recovered after the release of BDO in the 1W and 2W groups, but not in the 3W group. BDO decreased PGE2 content in gastric mucosa in the 1W, 2W, and 3W groups. PGE2 decreased vascular perfusion pressure of the isolated stomach in the control and 2W groups, but not in the 3W group. The response of gastric vessels to PGE2 was poor in the 3W group compared with the control and 2W groups. Decreased PGE2 in the gastric mucosa and decreased response of gastric vessels to PGE2 may affect gastric blood flow in obstructive jaundice.

Patients with peptic ulcers admitted to the First Department of Surgery, Kobe University School of Medicine, during the past ten years were divided into a first half group and a second half group, corresponding to the development of cimetidine, and changes in the pattern of intractable ulcers were studied retrospectively.In the second half group, both the number of admissions and the number of operations decreased by 50%, but the rate of surgery, about 70%, was unchanged. In the second half, the rate of surgery for hemorrhage was reduced slightly, but the rate of surgery for intractability increased slightly.The backgrounds and morphological features of intractable ulcer patients were investigated, and the age, the rate of complications and gastric analysis were not different in the two groups but the percentage of women increased in the second half and the past history of ulcer dropped from 87% to 55%. Morphologically the rates of giant ulcers, 2 cm or larger, linear ulcers 3 cm or longer, and ulcers with deep UI IV increased, while multiple ulcers decreased from 57.5% to 25%.

血漿フィプロネクチン (pFN) と血液凝固第XIII因子 (XIII因子) が潰瘍性大腸炎 (UC) の病態の質やstageの指標になりうるか否かについて検討した.対象はUC32例で, 延べ46回 (活動期19例, 緩解期27例) 両指標と血小板数, フィブリノーゲン (Fbg) を測定した、pFNはパルチゲンプレート法で, XIII因子はモノダンシルカダベリン法にて測定した.活動期のpFN, XIII因子は緩解期に比べ低下し (P

Until now, 21 cases of Crohn's disease (78% of total cases of this disease) have been surgically treated at our department. Of thse cases, 14 received a curative surgery (complete resection of the lesion). We analyzed postoperative relapes of the disease in these 14 cases. Postoperative relapse was seen in 2 (50%) of the 4 patients with Crohn's disease of the small bowel and 3 (33%) of the 9 patients with Crohn's disease of the small and large bowels. Of these 5 cases of postoperative relapse, 4 had relapse at a site close to the anastomoses. The mean timespan from the surgery to the relapse was 3 years and 3 months in patients with Crohn's disease of the small bowel and 11 months in those with Crohn's disease of the small and large bowels. The relapse rate was 13% for the patients with a preoperative IOIBD (International Organization for the Study of Inflammatory Bowel Disease) score of 4 or less and 67% for those with a preoperative IOIBD score of 5 or more. Of the 9 cases in whom the unaffected intestine was resected for 10 cm more proximal (adoral) from the lesion, no one showed postoperative relaps. Of the 5 cases in whom the unaffected intestine was reseacted for less than 10 cm proximal from the lesion, all showed postoperative relapse. However, no correlation was found between the relapse rate and the length of the resected unaffected intestine distal (towards the anus) from the lesion. Reoperation was done in 2 cases because of fistulation.

Changes in gastric mucosal blood flow were investigated for their relationship to gastric mucosal prostaglandin E2 (PGE2) and noradrenaline (NA) in rats with hemorrhagic shock. The results were as follows: 1) Gastric mucosal blood flow and NA decreased after hemorrhage. Gastric mucosal PGE2 initially increased after exsanguination and then markedly decreased. 2) Administration of NA before hemorrhage resulted in an increase of PGE2. However, the PGE2 value for animals receiving NA after hemorrhage was not different from that of non-NA-treated group. 3) Pre-treatment with PGE2 suppressed the reduction in both gastric mucosal blood flow and NA and the development of ulcer. These results suggest that the increase in gastric mucosal PGE2 in the early stage of shock might represent a phenomenon of adaptation by the adrenergic activation, and the decrease in PGE2 in the late stage might result from impaired synthesis of PGE2 due to persistent hypoxia and might be one of the possible factors in ulcer formation.

Possible changes in surgical treatment of peptic ulcers at the Kobe University Hospital (First Dept. of Surgery) over the past ten years were explored, dividing the 10 years into the first (1978-1982) and second (1983-1987) periods. The number of hospitalized peptic ulcer cases and the number of surgically treated peptic ulcer cases fel by 50% from the first to the second period. The decrease was particularly marked in duodenal ulcer cases (in comparison with ulcers of the other sites) and intractable ulcer cases (in comparison with ulcers of the other features). The percentage of patients who underwent urgent operation was 37.3% in the first period, which fell to 28.6% in the second period. The number of surgically treated intractable ulcer cases showed a 69.2% reduction in the second period compared to the first period. However, the percentage of cases whose excised specimen was rated as representing giant ulcer, linear ulcer, or U1 IV was higher in the second period than in the first period. Stenosis was found in 7 cases in the first period and 3 cases in the second period. The percentage of hemorrhagic ulcer cases who received conservative treatment or pallilative operation became higher in the second period than in the first period, while the percentage of hemorrhagic ulcer cases who underwent urgent operation decreased from 65.2% in the first period to 33.3% in the second period. In hemorrhagic ulcer cases, the death rate during or after uregent operation rose from 28.7% (first period) to 40.0% (second period). Perforated ulcer was found in 7 cases in the first period and 1 case in the second period. Of these 8 cases, 4 died (3 in the first period and 1 in the second period). Death rate was particularly high in elderly patients who had no history of ulcer and in patients who received surgery 12 hours or more after perforation.

The administration of peptide YY (PYY: 0.8, 1.6 and 3.2 nmol/kg/h, i.v.) to fasting rats inhibited not only baclofen (2 mg/kg, s.c.)-stimulated gastric acid output and gastric mucosal blood flow, but also pentagastrin (8 micrograms/kg/h, i.v.)-stimulated gastric acid output. PYY (3.2 nmol/kg/h) reduced baclofen-induced acid output more than pentagastrin-induced acid output, i.e., by 61.8 +/- 11.5% compared to 35.3 +/- 8.2%. PYY inhibited acetylcholine (ACh) release from cholinergic nerve endings of gastric body evoked by electrical transmural stimulation (ETS: 1 msec, 10 V, 3 Hz, 30 sec) by 47.2 +/- 3.5%. The mechanism of the inhibitory effect of PYY on gastric acid output seems to involve decreased gastric mucosal blood flow and reduced ACh release from cholinergic nerves.