Application of Different Anastomotic Methods for a Patient with Crohn\u27n Disease : Long-term Endoscopic Appearances of Hand-sewn Versus Biofragmentable Anastomosis Ring Method

After resection for ileocecal or ileocolonic Crohn\u27s disease (CD), anastomotic recurrence is common, and roughly one half of the cases who undergo hand-sewn anastomoses require further surgery for suture line recurrence. The other anastomoses methods, stapled anastomoses, had been compared with that of patients having hand-sewn anastomoses. But the type of anastomosis, whether stapled or hend-sewn, did not affect the rates of symptomatic or operative recurrence. A compression anastomosis device consisting of a biofragmentable anastomosis ring (VALTRAC^[○!R]) is used with new anastomosis methods, and no fragments remain in the anastomosis unlike with other anastomotic materials. There have been few reports regarding the employment of VALTRAC^[○!R] methods for anastomoses of patients with CD. We reported a 30-year-old male with a 14-year history of CD. In 1991, he was referred to our hospital for surgery because of stenoses of the ileum and terminal ileum, and underwent ileocecal resection. Ileocolic anastomosis was performed with a hand-sewn method. In 1996, the patient was referred to our hospital again for surgery because of an ileoileal fistula and multiple stenoses in the ileum and the anastomosis. Resection of the previous anastomosis was performed. Next, ileocolic anastomosis was performed using a VALTRAC^[○!R] method. Comparisons of the long-term appearance of two different anastomoses (one hand-sewn and the other done by VALTRAC^[○!R] methods) of the same portion of the intestine in the patient were reported herein

Resection of Hepatic Metastasis from Colorectal Cancer : Survival, Factors Influencing Prognosis, and Follow-up

The purpose of this retrospective study was to analyze the surgical results of hepatic resection in our patients with colorectal hepatic metastasis. During a 26-year period, 223 patients among 1,484 patients with colorectal cancer suffered liver metastasis. In 44 curatively resected patients, the one-, three- and five-year cumulative survival rates were 85.9%, 44.9% and 23.0%, respectively. The prognostic importance of seven factors was evaluated. Synchronous or metachronous resection, the type of liver resection, and histologic differentiation did not influence the prognosis, whereas the number and size of metastases, and lymph node involvement did significantly affect prognosis as single factors. The mean diameter of metastatic lesions in the liver was 2.5 cm in the synchronous group and 4.5 cm in the metachronous group, the difference being significant (p = 0.0005). The presence of tumors with large diameters in the metachronous group might mean our failure of early detection of the recurrence of hepatic metastases. It is necessary to make steady efforts such as introducing regular follow-up imaging of colorectal cancer. The median interval between the primary operation and liver metastasis resection was 15.7 months in the lymph node involvement group and 37.7 months in the no lymph node involvement group. In 19 patients among 21 metachronously resected patients, the hepatic resection was done within three years. In conclusion, it was considered that hepatectomy could be done safely, that detection of an earlier lesion could improve the surgical results, and that follow-up for liver metastasis should be done intensively between 12 and 36 months after colorectal cancer surgery

Genetic and Phenotypic Landscape of PRPH2-Associated Retinal Dystrophy in Japan

Peripherin-2 (PRPH2) is one of the causative genes of inherited retinal dystrophy. While the gene is relatively common in Caucasians, reports from Asian ethnicities are limited. In the present study, we report 40 Japanese patients from 30 families with PRPH2-associated retinal dystrophy. We identified 17 distinct pathogenic or likely pathogenic variants using next-generation sequencing. Variants p.R142W and p.V200E were relatively common in the cohort. The age of onset was generally in the 40’s; however, some patients had earlier onset (age: 5 years). Visual acuity of the patients ranged from hand motion to 1.5 (Snellen equivalent 20/13). The patients showed variable phenotypes such as retinitis pigmentosa, cone-rod dystrophy, and macular dystrophy. Additionally, intrafamilial phenotypic variability was observed. Choroidal neovascularization was observed in three eyes of two patients with retinitis pigmentosa. The results demonstrate the genotypic and phenotypic variations of the disease in the Asian cohort

宿便性結腸穿孔の1例

宿便成結腸穿孔は比較的稀な疾患である.今回我々は本症例の1例を経験した.症例は66歳,女性.腹痛を主訴に来院した.来院時腹部所見は板上硬で左下腹部に強度の圧通を認め,腸音は減弱していた.単純X線写真にて両側横隔膜下に遊離ガス像を認め,下部消化器管穿孔,汎発生腹膜炎の診断にて緊急手術を施行した.手術所見では下行結腸から直腸内に硬便が充満していた.S字結腸に穿孔部を認め,その近傍に腸管内から脱出した便塊を認めた.手術はハルトマン手術を施行した.切除標本では穿孔部は楕円形であり,手術所見,病理組織学的所見とあわせて宿便性結腸穿孔と診断した.術後は経過良好であった.手術から12ヶ月後,人工肛門閉鎖,下行結腸直腸吻合術を施行した.Stercoral colonic perforation is a relatively rare entity. This paper presents such a case in a 66-year-old woman. The patient was visited the hospital because of abdominal pain. Her abdomen was board-like, there was severe tenderness in the left lower quadrant, and bowel sounds were hypoactive. The abdominal x-ray film showed free air beneath the bilateral diaphragm. Lower gastrointestinal perforation and generalized peritonitis were diagnosed and an emergency operation performed. At laparotomy, the intestine from the descending colon to the rectum was filled with hard stool. A perforation was present in the sigmoid colon and, in the vicinity of the perforation, the stool mass had fallen away from the inside of the intestine. A Hartmann procedure was employed. On the resected material, the perforation was oval in shape. From operative and histopathological findings, a definite diagnosis of stercoral colonic perforation was made. The postoperative course was uneventiful. Twelve months after the operation, closure of an artificial anus and an anastomosis between the descending colon and the rectum were performed