Curative two-stage resection for synchronous triple cancers of the esophagus, colon, and liver: Report of a case

AbstractIntroductionCases of synchronous triple cancers of the esophagus and other organs curatively resected are rare.Presentation of caseA 73-year-old man was admitted to our hospital with bloody feces. He was diagnosed with synchronous triple cancers of the esophagus, colon, and liver. We selected a two-stage operation to safely achieve curative resection for all three cancers. The first stage of the operation comprised a laparoscopy-assisted sigmoidectomy and partial liver resection via open surgery. The patient was discharged without complications. Thirty days later, he was readmitted and thoracoscopic esophagectomy was performed. Although pneumonia-induced pulmonary aspiration occurred as a postoperative complication, it was treated conservatively. The patient was discharged on postoperative day 24.DiscussionEsophagectomy is a highly invasive procedure; thus, simultaneous surgery for plural organs, including the esophagus, may induce life-threatening, severe complications. Two-stage surgery is useful in reducing surgical stress in high-risk patients. For synchronous multiple cancers, the planning of two-stage surgery should be considered for each cancer to maintain organ function and reduce the stress and difficulty of each stage.ConclusionWe successfully treated synchronous triple cancers, including esophageal cancer, by a two-stage operation

シンタイ ショウガイシャ フクシホウ ショウガイ ニンテイ センモンイ チョウサ ニ オケル ショウガイ ニンテイ ノ カダイ 1 シカク ショウガイ

身体障害者福祉法の障害の範囲は、成立当時の視覚障害、聴覚障害、肢体不自由等の障害から、現在は内部機能障害にまで障害の範囲が拡大されてきている。そのために、疾患との区別がわかりにくくなり障害の概念が複雑になった。そこで、著者らは、平成15年度から、身体障害者福祉法が本来目的としている更生援護を適切に達成し、かつ、真に必要な人に、必要なサービスを、適切な時期に提供するための障害認定のありかたについて検討してきた。本研究は、研究の基礎的資料を得るために平成17年2月から3月にかけて各都道府県の障害認定専門医に対して行った調査の結果の一部であり、視覚障害の認定に関する調査結果をまとめている。研究の結果、視覚障害の認定に関して、視力障害の測定を両眼視で行うこと、視野障害の測定方法を再検討すること、高次脳機能障害や言葉でのやりとりの出来ない幼児などの視覚機能の測定方法についての基礎的研究を行うこと、再認定の方法について基礎的研究を行うことなどの課題が明らかになった。The range of the disabilities of the Law for Persons with Physical Disabilities has been expanded to internal disabilities from formation. As the distinction between disability and disease has been confused, the definition of disability has been complicated. The authors have been discussing an adequate definition of disability to offer the sufficient service to those who really need when they need since 2003. An survey of medical evaluation experts of each prefecture was carried out to investigate the reality of disability determination in order to get a basic information. This article is one part of result of the survey and reports the problems of the disability determination of visual impairment. The measurement of visual acuity with both eyes, reexamining the measurement method of the visual field, the need of study about the measurement method of visual functions such as the infants who cannot speak and cognitive functional disorder, and the study about the method of reassessment of impairment are found as the problems

Totally laparoscopic total gastrectomy for gastric cancer: Literature review and comparison of the procedure of esophagojejunostomy

There has been a recent increase in the use of totally laparoscopic total gastrectomy (TLTG) for gastric cancer. However, there is no scientific evidence to determine which esophagojejunostomy (EJS) technique is the best. In addition, both short- and long-term oncological results of TLTG are inconsistent. We reviewed 25 articles about TLTG for gastric cancer in which at least 10 cases were included. We analyzed the short-term results, relationships between EJS techniques and complications, long-term oncological results, and comparative study results of TLTG. TLTG was performed in a total of 1170 patients. The mortality rate was 0.7%, and the short-term results were satisfactory. Regarding EJS techniques and complications, circular staplers (CSs) methods were significantly associated with leakage (4.7% vs. 1.1%, p < 0.001) and stenosis (8.3% vs. 1.8%, p < 0.001) of the EJS as compared with the linear stapler method. The long-term oncological prognosis was acceptable in patients with early gastric cancers and without metastases to lymph nodes. Although TLTG tended to increase surgical time compared with open total gastrectomy and laparoscopy-assisted total gastrectomy, it reduced intraoperative blood loss and was expected to shorten postoperative hospital stay. TLTG is found to be safer and more feasible than open total gastrectomy and laparoscopy-assisted total gastrectomy. At present, there is no evidence to encourage performing TLTG for patients with advanced gastric cancer from the viewpoint of long-term oncological prognosis. Although the current major EJS techniques are CS and linear stapler methods, in this review, CS methods are significantly associated with leakage and stenosis of the EJS

Totally laparoscopic total gastrectomy for gastric cancer: Literature review and comparison of the procedure of esophagojejunostomy

There has been a recent increase in the use of totally laparoscopic total gastrectomy (TLTG) for gastric cancer. However, there is no scientific evidence to determine which esophagojejunostomy (EJS) technique is the best. In addition, both short- and long-term oncological results of TLTG are inconsistent. We reviewed 25 articles about TLTG for gastric cancer in which at least 10 cases were included. We analyzed the short-term results, relationships between EJS techniques and complications, long-term oncological results, and comparative study results of TLTG. TLTG was performed in a total of 1170 patients. The mortality rate was 0.7%, and the short-term results were satisfactory. Regarding EJS techniques and complications, circular staplers (CSs) methods were significantly associated with leakage (4.7% vs. 1.1%, p < 0.001) and stenosis (8.3% vs. 1.8%, p < 0.001) of the EJS as compared with the linear stapler method. The long-term oncological prognosis was acceptable in patients with early gastric cancers and without metastases to lymph nodes. Although TLTG tended to increase surgical time compared with open total gastrectomy and laparoscopy-assisted total gastrectomy, it reduced intraoperative blood loss and was expected to shorten postoperative hospital stay. TLTG is found to be safer and more feasible than open total gastrectomy and laparoscopy-assisted total gastrectomy. At present, there is no evidence to encourage performing TLTG for patients with advanced gastric cancer from the viewpoint of long-term oncological prognosis. Although the current major EJS techniques are CS and linear stapler methods, in this review, CS methods are significantly associated with leakage and stenosis of the EJS

Effects of Carbon Dioxide Enrichment during Different Growth Periods on Flowering, Pod Set and Seed Yield in Soybean

The objective of this study is to elucidate the effects of CO2 enrichment during different growth periods on flowering, pod set and seed yield in soybean (Glycine max (L.) Merr.). Soybean cultivar‘Fukuyutaka’was grown in a growth chamber of the Institute of Bioresources Research Center of Kyushu Electric Power Co., Inc. at Saga, Japan (33°17’-N, 130°18’-E) under natural light. The CO2 concentrations were maintained at 350 µmol mol−1 for ambient CO2 and at 700 µmol mol−1 for CO2 enrichment. CO2 concentration was elevated during the whole growth period (WP), vegetative growth period (VP) or reproductive period (RP). Seed yield was increased by CO2 enrichment during RP or WP due to the increase of pod number, but not by CO2 enrichment during VP.Although CO2 enrichment had no effect on the number of flowers, CO2 enrichment during RP increased the pod number on all raceme orders and that during WP increased the pod number in the secondary and tertiary racemes. It is suggested that an increase of seed yield by CO2 enrichment is mostly brought by the improvement of pod set, mainly on the high-order racemes that opened later during flowering period, and that the response of seed yield to CO2 enrichment is mainly attributed to the response during RP

Bile duct stone formation around a nylon suture after gastrectomy: A case report

BACKGROUND: Many cases of choledocholiths formed around sutures and clips used during cholecystectomy have been reported. We describe a case of gallstone formation around a nylon suture after non-biliary surgery. To the best of our knowledge, this is the first report of such a case. CASE PRESENTATION: A 75-year-old Japanese man, who had undergone distal gastrectomy for gastric cancer and reconstruction with the Billroth II method 8 years earlier, presented with gastric discomfort. Abdominal ultrasonography was conducted and we diagnosed cholecysto-choledocholithiasis with dilatation of the intrahepatic bile duct. He underwent cholecystectomy and cholangioduodenostomy for choledocholith removal. Gallstones, which had formed around a nylon suture used during the previous gastrectomy, were found in the bile duct. Sutures of the same material had also been placed on the duodenum. Chemical analysis revealed that the stones were composed of calcium bilirubinate. The patient was discharged on postoperative day 19, and choledocholithiasis has not recurred thus far. CONCLUSION: The findings from this case suggest that standard, non-resorbable sutures used in gastrectomy may be associated with the formation of bile duct stones; therefore, absorbable suture material may be required to avert gallstone formation even in the case of gastrectomy