Maxillary Advancement for Unilateral Crossbite in a Patient with Sleep Apnea Syndrome

This article reports the case of a 44-year-old male with skeletal Class III, Angle Class III malocclusion and unilateral crossbite with concerns about obstructive sleep apnea syndrome (OSAS), esthetics and functional problems. To correct the skeletal deformities, the maxilla was anteriorly repositioned by employing LeFort I osteotomy following pre-surgical orthodontic treatment, because a mandibular setback might induce disordered breathing and cause OSAS. After active treatment for 13 months, satisfactory occlusion was achieved and an acceptable facial and oral profile was obtained. In addition, the apnea hypopnea index (AHI) decreased from 18.8 preoperatively to 10.6 postoperatively. Furthermore, after a follow-up period of 7 months, the AHI again significantly decreased from 10.6 to 6.2. In conclusion, surgical advancement of the maxilla using LeFort I osteotomy has proven to be useful in patients with this kind of skeletal malocclusion, while preventing a worsening of the OSAS

Pathologic stage I non–small cell lung cancer with high levels of preoperative serum carcinoembryonic antigen: Clinicopathologic characteristics and prognosis

ObjectiveSurgery alone remains the standard therapy for patients with stage I non–small cell lung cancer. Although the preoperative serum level of carcinoembryonic antigen has been shown to be an independent prognostic factor, it has not yet been included in the staging system and does not alter the treatment strategy, especially in the selection of patients for adjuvant chemotherapy.MethodsFrom 1986 to 2003, preoperative and postoperative serum carcinoembryonic antigen levels were measured in 455 patients with completely resected pathologic stage I non–small cell lung cancer. We compared the clinicopathologic characteristics and outcomes among patients who had preoperative serum carcinoembryonic antigen levels within the normal range (N group, n = 323), patients who had high carcinoembryonic antigen levels before surgery but normal levels after surgery (HN group, n = 112), and patients who had high carcinoembryonic antigen levels before and after surgery (HH group, n = 20).ResultsThe significant characteristics of the HN group included the male sex, greater age, smoking, squamous cell histology, T2 status, lymphatic invasion, vascular invasion, and pleural invasion. Adenocarcinomas in patients of the HN group were more likely to be moderately to poorly differentiated. The 5-year survivals in the HN and HH groups were significantly lower (56.2% and 43.1%, respectively) than those in the N group (85.9%). Multivariate analysis revealed that greater age, non-adenocarcinoma histology, pleural invasion, and the carcinoembryonic antigen in the HN and HH groups were independent prognostic factors.ConclusionPatients with resected pathologic stage I non–small cell lung cancer and high preoperative serum carcinoembryonic antigen levels are a subgroup with a distinctly poor prognosis who display smoking-related clinicopathologic characteristics

LOCAL RECURRENCE OF RECTAL CANCER

One hundred twenty-six rectal cancers were operated upon in the First Department of Surgery, Nagasaki University School of Medicine. Local recurrence occurred in thirty-three (26.2%). In this study, contributing factors in causing local recurrence were local excision of the surgical approach, advanced stage, depth of cancer invasion, location of carcinoma of the rectum below the peritoneal reflection (Rb) or above (Rba) and nodal involvement of n2 or more. As far as advanced rectal cancer and cancer location of Rb are concerned, it is suggested on the basis of this study that the incidence of local recurrence should be high

Vascular Patterns of Villous Tumors of the Colorectum

In order to more fully understand the morphological characteristics of villous tumors of the colorectum, the vascular patterns of six colorectal resection specimens were microangiographically studied. Grossly, villous adenomas were of two main types: pedunculated polyps and carpet-like lesions. Pedunculated villous adenomas had many large stalk vessels in a broad short pedicle, representing a large blood supply to the tumor. The carpet-like lesions were composed of continuous clusters of polyps with stalk vessels and the flat elevated lesions among polyps and at the periphery showed similar vascular patterns to the mucosa of normal colon. In lesions with cancer invasive to the proper muscle layer, scattered ulcerations due to the destruction of polyps were also observed, corresponding to at least a Dukes B lesion. The above findings could represent very important additional information for endoscopic treatment or local excision for the prevention of hemorrhagic complicatios or incomplete removal of tumor

Pancreatic Pseudocysts - Proposal for Diagnosis and Surgical Management -

To determine the clinical features and problems presented by a pancreatic pseudocyst, eighteen patients managed at our hospitals since 1980 were reviewed. Males predominated with a ratio of 16: 2, and the average age was 36.2 years. Pseudocyst was located in the pancreatic head in 6, in the body in 6, in the tail in 5 and multiple pseudocysts in one case. The cause of pancreatic pseudocyst was chronic pancreatitis in 9 (including 8 patients with histories of alcoholism), acute pancreatitis in 2 and trauma in 7 patients, respectively. Three patients were associated with pancreatic calculi. Rupture of pseudocyst occurred in one patient with multiple cysts. Autopsy showed acute pancreatic necrosis and penetration to the stomach and duodenum. The indications for surgery were principally cyst-related symptoms(infection, hemorrhage, enlargement and compression of adjacent organs) and differential diagnosis from malignancy. Most of the patients underwent internal drainage ; 9 cystojejunostomy, 2 cystogastrostomy). Three patients underwent cystojejunostomy with longitudinal pancreaticojejunostomy for chronic pancreatitis. Massive hemorrhage after cystogastrostomy occurred in one patient with infected pseudocysts, which required removal of the cysts. Postoperative outcome of the 17 surgical patients was excellent in 16 patients. Only one patient died of pancreatitis associated with alcohol abuse, resulting in a 5.9% mortality. This study suggests that adequate internal drainage by pancreaticojejunostomy to treat the underlying pancreatic disease is most important to obtain an excellent prognosis in patients with pseudocysts

Surgery for Ulcerative Colitis - A Comparative Retrospective Study -

The records of patients with ulcerative colitis (UC) who underwent operation at our hospitals between 1973 and 1995 were reviewed. The clinical course of the disease was the chronic relapsing-remitting type in seven, chronic continuous type in four, acute attack of the relapsing-remitting type in six, and fulminant colitis (toxic megacolon) in two patients. The most common indication for surgery was a condition refractory to conservative therapy. Four patients with massive bleeding, perforation and toxic megacolon underwent emergency operation. The surgical procedures performed were ileoanal anastomosis (IAA) in four, ileoanal canal anastomosis (IACA) in one, ileorectal anastomosis (IRA) in five, proctocolectomy and permanent ileostomy (PCI) in four, and colectomy in five patients. The mortality rate was 5.2%. During follow-up, drug therapy with sulfasalazine (salazosulfapyridine) in colectomy or IRA patients was necessary to control inflammation in the remaining rectal mucosa. One patient with segmental colectomy for severe colitis required removal of the remaining colon 1 year later. Three out of four patients undergoing total proctocolectomy and IAA had a good postoperative course with an average of six bowel movements in 24 hours, but one patient with a long rectal cuff was returned to a PCI because of a cuff abscess. The PCEEA instrument was sufficient to perform IAA and IACA. Carcinoma in the remnant rectum occurred in one patient 20 years after Hartmann\u27s procedure. In conclusion, total proctocolectomy, which has the advantage of removing all diseased mucosa with its potential for inflammation, dysplasia, and carcinoma, may be preferable for extensive long-standing UC

Biliary Cystadenocarcinoma - Report of 2 Cases -

The clinical and pathologic features of two patients with biliary cystadenocarcinoma were presented and the previous literatures were reviewed. Case 1 : A 52-year-old man complained of heart burn and weight loss. Abdominal ultrasound and CT offered suspicions of biliary cystadenocarcinoma of the left hepatic lobe. Left hepatic lobectomy was performed, but the tumor invaded to adjacent viscera. The resected tumor (26×21×5.5 cm) was multilocular cystadenocarcinoma with mucin production. He survived for one year and 8 months after surgery. Case 2: A 60-year-old man suffering from sudden-onset frost and high fever underwent left lateral segmentectomy of the liver with a diagnosis of cystadenocarcinoma defined by biopsy specimen in previous operation. The tumor (6.0×4.5×3.5 cm) was multilocular cyst with mucin-producing papillary adenocarcinoma. He died of recurrent cancer 2 years and one month after surgery. The histogenesis of cystadenocarcinoma is still unclear because of its rare disease. The presence of benign epithelium in our cases may support their origin from cystadenoma