Surgery for Congenital Duodenal Atresia

Congenital duodenal atresia consists of extrinsic duodenal obstruction of annular pancreas and intrinsic obstruction of intestinal atresia. The aim of this study is to clarify clinical patterns of congenital duodenal atresia on the basis of surgical experiece and discuss major problems with respect to surgical treatment

Delayed Surgery for Congenital Diaphragmatic Hernia

Infants with congenital diaphragmatic hernia (CDH) operated on at 12 hours of age have poor prognosis. Development of severe hypoxemia due to hypoplastic lung and pulmonary vascular constriction is the major prognostic factor. Infants who show reasonable gas exchange at first but develop severe hypoxemia a few hours following surgery (honeymoon period) may have benefited from delayed radical surgery. During the waiting period, the patient should be kept on a minimal handling and stabilizing protocol. In our institute, 24 CDH patients were treated from 1970 to 1995. These patients were divided into two groups : group I (n = 11) was the first stage (1970-1984), group II (n = 13) was the second stage (1985-1995). The total survival rate of these two groups did not improve. However our experience with the last six cases using this stabilizing protocol between 1989 and 1995 suggests that delayed repair surgery for CDH improved the survival rate. The survival rate changed from 33.3% in group I to 44.4% in group II. We report our cases, including clinical status, surgical findings and treatments

Prognostic Value of Circulating CA 19-9 in Colorectal Cancer Patients

Aims: We examined the preoperative serum levels of sialyl Lewisa (CA19-9) and carcinoembryonic antigen (CEA) in 262 colorectal cancer patients, in order to clarify whether or not the prognostic value of CA19-9 after curative surgery is superior to that of CEA. Patients and Methods: The patients were divided into two groups: low or high antigen groups (higher or lower than a selected diagnostic-based cut-off value). For evaluation of the prognostic value of CA19-9 and CEA, the disease-free interval was studied. Results: The disease-free interval of patients with a high serum levels of CA19-9 or CEA was significantly shorter than for those patients with a low serum level of the particular antigen (P<0.0001 and P=0.0009, respectively). The disease-free interval of patients with stage I/II tumors who had a high CA19-9 level was significantly shorter than in those patients with stage I/II tumors with low CA19-9 levels (P=0.0020). In contrast, the disease-free interval of patients with stage I/II tumors who had a low or high CEA level did not differ. Cox s regression analysis revealed that a high serum level of CA19-9 or CEA was an independent predictor for short disease-free interval after curative surgery, separate from stage (Hazard ratio=2.65 or 1.68, respectively, versus a low serum level of each respective antigen) . Conclusions: These data suggest that the preoperative serum level of CA19-9 was a stronger prognostic factor after curative surgery than CEA. Furthermore, in contrast to CEA, CA19-9 provides more prognostic information than that obtained by conventional staging methods in patients with stage I/II tumors

Biological Differences Between. Polypoid and Nonpolypoid Growth Types of Colorectal Cancer

Background- Two distinct morphologic types of colorectal cancer have been described in recent studies: polypoid growth type (PG-type) and nonpolypoid growth type (NPG-type). Materials and Methods- We investigated possible biological and clinical differences between 37 PG-type and 156 NPGtype cancers using both univariate and multivariate analyses (logistic and Cox regression models). Results- Unlike NPG-type cancers, PG-type cancers had a high proportion of well-differentiated adenocarcinoma cells, a high likelihood of being early colorectal cancers (carcinoma in situ and cancer invades submucosa), and a low frequency of lymph node metastasis. On average, such PG-type cancers also carried a better prognosis than NPG-type cancers (P=0.01). In particular, PG-type cancer patients with stage IV tumors had a better prognosis than NPG-type cancer patients (P=0.02). In fact, after performing a Cox regression analysis, we found that colorectal cancer growth type is an independent prognostic variable, separate from histologic type or stage. Conclusions- PG-type colorectal cancer is less aggressive and has a favorable prognosis compared to NPG-type cancer

Management of Blunt Hepatic Trauma

One hundred and twelve consecutive cases with blunt hepatic trauma between January 1, 1965 and December 31, 1988 at the First Dpartment of Surgery, Nagasaki University were reviewed. Fifty-seven patients had minor injuries, 33 moderate injuries and 22 severe injuries. Sixty-five patients (58%) sustained also one of more associated injuries. Out of 43 patients over the last ten years 30 were diagnosed by US or CT. Eighty-eight patients (78.3%) underwent laparotomy ; laparotomy and drainage alone in 13, suture and packs in 57, debridement and minor liver resection in 11 and right lobectomy in 9. The results of treated patients were assessed according to the grading of liver injury and assocated injury. The overall mortality was 13.4% (15 of 112). True liver-related mortality due to hemorrhage was 26.7% (4 of 5), and the other 11 patients who died were due to refractory shock and the development of multiple organ failure (MOF). Twenty-one patients were conservatively managed with only one death, and the other 20 survivors had no complications and healed completely from 6 to 12 months after trauma. Although lobectomy or resectional debridement are advocated as an operative procedure for massive injury, a conservative management for mild or moderate ruptures is still recommended as far as possible

Postoperative Course of Crohn\u27s Disease -In regard to Recurrence and Residual Disease at Anastomosis -

Twenty-seven patients with Crohn\u27s disease who were operated on at the First Department of Surgery, Nagasaki University School of Medicine and followed-up after surgery were reviewed. Involved portion of intestinal tract were 10 in small bowel only, 14 in both small and large bowels, and 3 in large bowel. Major indication for surgery were obstruction, fistula, peritonitis and intractability of medical therapy. Twenty-two patients underwent radical resection and the other 5 patients had the disease left behind at anastomosis. The recurrence rate was 25.9% (7 out of 22), and early recurrence was found in small bowel diseases with longitudinal ulcerations or multiple aphthoid ulcers. Initial recurrence occured near the suture line, which showed no wide spreading in subsequent periods. Two cases with both small and large bowel disease required reoperation over 5 years after initial surgery because of stenosis. Three out of five cases with residual disease at the intestinal resection margin had a good condition, but the other three cases with skip sigmoid disease were intractable for medical therapy. Most suture line recurrence and residual disease at anastomosis were sufficiently managed by postoperative medication for long periods of time. Long-term follow-up study showed a good quality of life in about 75% of these cases. In conclusion, conservative resection rather than the sacrifice of normal bowel should be recommended for an extended disease of small bowel

The Validily of Tracheal Surgery for the Aged

Surgery for tracheal stenotic lesions in older patients over age 70 was evaluated in comparison with younger patients under age 69 on the basis of our clinical experience. The causes of tracheal lesions were mainly malignant diseases in spite of varying variety of etiology in the younger patients. The outcome of surgical treatment in the older ones was not inferior to that in the younger ones as far as postoperative complications were prevented. In conclusion, it is emphasized that the surgical treatment of choice is essential for palliation of symptoms and expectance of high quality of life

加齢に伴うマウス骨格筋中L-carnosine含有量の変化

哺乳類の骨格筋や脳に多く含まれ,食肉中の機能性成分として注目されているヒスチジン含有ペプチド(カルノシン,アンセリン)の加齢に伴う筋肉含有量の変化を把握する目的で,2,8,18,40,50,60週令のマウスを用いて検討を行った。また,カルノシンを経口投与した影響も検討した。本研究により,マウス骨格筋中カルノシン量は,8週令のマウスに比較し50週令まで増加を示し,60週令では減少する傾向が観察された。また,40週令マウスの骨格筋におけるカルノシン経口投与の影響は観察されなかった。今後さらに週令の高い動物での検討やカルノシン投与量の検討が必要である。Carnosine is a β-alanyl-L-histidine dipeptide and is found in skeletal muscle and nervous tissue at concentrations ranging from 1 to 25mM. The muscle food that has been postulated to be a bioactive food component contains this dipeptide. Some anti-aging effects of carnosine have also been demonstrated at the whole animal level. There is evidence that carnosine concentrations may decline with age in rodents and humans and the carnosine concentration in the muscles of short-lived species appears to be much lower than that in long-lived species. While carnosine has been detected in mouse muscle, very little is known about the changes of carnosine concentration with, age in detail and after intake of carnosine. Therefore, we investigated the age-related change of carnosine concentration in mouse muscle and the effects of carnosine intake. In this study, carnosine concentration in muscle was increased after birth and carnosine concentration in 60-week-old mice was slightly decreased. While the effects after intake of carnosine was not observed. Further studies should be performed to investigate the changes of carnosine concentration in more aged-mice and the effects after intake of carnosine