Search

Our aim is to evaluate whether outcomes differ by admission day of the week in patients with spontaneous pneumothorax. One hundred twenty five patients undergoing video-assisted thoracic surgery(VATS) in Fukuoka Tokusyukai Hospital from 2007 through 2011 for spontaneous pneumothorax were reviewed. The clinical characteristics and outcomes were compared between patients in weekend admission and weekday admission groups. Patients were divided in 2 groups based on admission between Monday thru Friday vs on Saturday or Sunday. Another 2 groups by admission between Sunday thru Thursday vs on Friday or Saturday were also examined. Time to operation was significantly shorter for admission on period between Sunday thru Thursday compared to admission on Friday or Saturday. But there was no difference in the other clinical factors and postoperative outcomes between 2 groups. Patients admitted on the weekend proved to experience delayed operation, but did not have increased adverse outcomes or longer length of hospital stay compared to those admitted on a weekday. No significant "weekend effect" for spontaneous pneumothorax was demonstrated by the present study.

We encountered a case of delayed subcutaneous metastases of gastric carcinoma. The patient underwent distal gastrectomy for advanced gastric carcinoma 11 years ago. Postoperative pathological diagnosis indicated stage IIIB disease, poorly differentiated adenocarcinoma (scirrhous, T4a, ly2, v2, N2, H0, P0). Three courses of adjuvant chemotherapy with 5-fluorouracil (5-FU)+cisplatin (CDDP) were administered; however, the patient discontinued the treatment. No signs of recurrence were observed for 11 years after the treatment. However, subcutaneous metastases in the front portion of the head and the back and an ovarian tumor were detected after the remission period. The specimen from the resected subcutaneous tumor from the back indicated signet-ring cell carcinoma, and delayed subcutaneous and ovarian metastases of the gastric carcinoma was diagnosed. Therefore, 8 courses of the S-1+CDDP combination therapy were administered. The cutaneous metastases disappeared, but the ovarian tumor progressed and was therefore resected. Analysis of the resected ovarian tumor also indicated signet-ring cell carcinoma. We report a case of delayed recurrence of gastric carcinoma that was effectively treated with chemotherapy.

A 72-year-old man was admitted to our hospital complaining of upper abdominal pain and back pain. Advanced gastric cancer was found at the fundus of the stomach, and severe dysplasia was found at the lower esophagus. We proceeded with neoadjuvant chemotherapy (S-1+CDDP) because the lymph nodes in the lesser curvature of the stomach were metastasized and invasion of the pancreas and some vessels was suspected by computed tomography. The tumor size was reduced remarkably, the esophageal dysplasia disappeared after preoperative chemotherapy, and we were able to perform total gastrectomy.

A 59-year-old man realized a left lower abdominal pain and palpable mass about a month ago. He was admitted to our hospital because of the pain and high fever. Blood examinations revealed high levels of white blood cell count and CRP. Ultrasonography showed a wall thickness of the descending colon and 7 cm cystic mass with air around. Moreover, a 6 cm cystic mass was found an outside of the ascending colon. We first treated with antibiotics under the diagnosis of abscesses because of perforation of diverticulum. Colonoscopy revealed an obstructing tumor in descending colon and biopsy specimens of the tumor showed adenocarcinoma. The preoperative diagnosis of the right side tumor was unclear. We performed a partial resection of the descending colon, and the tumor outside of the ascending colon was resected. The pathological diagnosis of the tumors was both mucinous carcinoma of the colon. Mucinous carcinoma tends to be more found in the right side of the colon than in the left side. The rate of lymph node metastasis and dissemination is higher than that in differentiated adenocarcinoma. We report a rare case of mucinous carcinoma originated from the left side of the colon with a solitary dissemination in opposite side of the abdomen.

A bloodless surgery was required in the case of simultaneous liver metastases of colon cancer, one of which invaded at the confluence of left hepatic vein and inferior vena cava. In order to assure the safety and curability, hepatic arterial infusion chemotherapy aiming to size reduction was preceded to synchronous liver resection for a 53-year-old Jehovah's witness male. After gaining the reduction of tumor, synchronous liver resection was safely performed under a hemodilutional autotransfusion. The patient has been alive for 6 years under the withdrawal from chemotherapy.

A 71-year-old man began feeling a lower abdominal pain at bowel movement about one year ago. He was found to have a pelvic tumor during a health examination and referred to our hospital for further evaluation. CT and MRI scans demonstrated a giant pelvic tumor, 10 cm in size, which compressed the rectum. The likely preoperative diagnosis was leiomyosarcoma from the rectum or neurilemoma. To regulate intraoperative hemorrhaging and to reduce the tumor size, angiography was performed at two days before the operation and embolization of the tumor vessels was done. He had a tumor resection and a low anterior resection of the rectum and a transient colostomy of the ascending colon without blood transfusion. The resected tumor was covered with thin yellowish-white capsule with smooth surface, elastic hard on palpation, and was measured 10.5 × 9 × 10.5 cm, and weighted 320 g. The pathological diagnosis was neurilemoma (schwannoma) consisting both Antoni type A and Antoni type B sections.

A 66-year-old woman, complaining of anal bleeding with anemia, was examined and diagnosed as advanced rectal cancer. Hemoglobin level at admission was 8.8 g/dL. Abdominal CT and MRI revealed a solid tumor of 43x45 mm in diameter. Colostomy was preceded for the purpose of bleeding control under the blood-augmented treatment on the 7th day of hospitalization. Preoperative chemoradiation was performed (a total of 40 Gy radiation+FOLFOX4 for 1 cycle) and obtained a significant size reduction of the tumor (reduction rate 75%). Abdomino-perineal resection of rectum was performed with 550 mL of hemodilutional autotransfusion 3 months after the initiation of treatment. Pathological findings showed moderately differentiated adenocarcinoma with Stage III a. Vaginal fistula as an irradiation associated with complication was healed by duly performed debridement. The patient has survived for 31 months with no recurrence, which indicates that preceded colostomy and preoperative chemoradiation enabled a curative resection safely for the Jehovah's Witness patient with bleeding advanced rectal cancer.