A Case of Funnel Chest Performed Sternal Turnover with Rectus Abdominis Muscle Pedicle

There are two types of surgical procedures for funnel chest: sternal turnover and sternocostal elevation. Both procedures have some merits and some demerits respectively,so the uniformed operative techniques for funnel chest are not concluded. However, it is most important that correction of excavation and prevention of postoperative repiratory dysfunction have completely performed. A 12- year-old boy with severe excavation in the anterior thorax admitted to our hospital was diagnosed as funnel chest.We underwent sternal turnover with rectus abdominis muscle pedicle.Some of reports ordinarily recommended overlap of only sternum to firm plastron and prevent postoperative flail chest. However, we respectively performed conjugation and overlap of both sternum and costal cartilages for more firm fixation of plastron (so-called Ravitch\u27s method),because the overlap of only sternum is not enough to fix plastron firmly.The patient was successfully treated without flail chest postoperative course.The postoperative appearance was satisfactory and respiratory symptom has improved

Spontaneous Closure of a Rectovaginal Fistula that Developed after Double-stapled Anastomosis in Low Anterior Resection

Management of a rectovaginal fistula (RVF) following low circular-stapled colorectal anastomosis is difficult and often unsatisfactory. We report herein the case of a 66- year-old woman who developed a RVF following low anterior resection using the double-stapling technique for rectal cancer. The RVF spontaneously closed with nonoperative treatment that included simple observation without dietary restrictions. The spontaneous closure occurred within approximately 25 days. Minimally symptomatic patients may be candidates for nonoperative treatment

Type of Operation does not Affect Survival after Non-curative Resection for Adenocarcinoma of the Rectum at or below the Peritoneal Reflection: a Multivariate Analysis

Purpose. The purpose of this study was to determine whether the type of operation [sphincter-saving resection (SSR) or abdominoperineal resection (APR)] for primary adenocarcinoma of the rectum at or below the peritoneal reflection affects survival after non-curative surgery. Methods. This retrospective study included 42 patients who underwent non-curative surgery by the following two types of operation between 1989 and 1998: (1) SSR (n=19 patients) included low anterior resection with either double-stapling technique (n=16) or transanal coloanal anastomosis (n=3); (2) APR (n=23). \u27Non-curative\u27 resection implied \u27Curability B\u27 and \u27Curability C\u27 defined by the Japanese Classification of Colorectal Carcinoma. Outcome measure was diseasespecific survival. Univariate and multivariate Cox\u27s regression analyses were used to evaluate data. Median follow-up was 17.2 months at study conclusion. Results. Disease-specific survival after non-curative surgery did not differ between the two types of operations. Multivariate analyses showed that the type of operation was not a significant independent variable in predicting disease-specific survival after surgery. One variable - \u27Curability\u27 - was significant predictor of outcome after surgery. Conclusions. The type of operation (SSR or APR) did not affect survival after non-curative resection for adenocarcinoma of the rectum at or below the peritoneal reflection

Spontaneous Closure of a Rectovaginal Fistula that Developed after Double-stapled Anastomosis in Low Anterior Resection

Management of a rectovaginal fistula (RVF) following low circular-stapled colorectal anastomosis is difficult and often unsatisfactory. We report herein the case of a 66- year-old woman who developed a RVF following low anterior resection using the double-stapling technique for rectal cancer. The RVF spontaneously closed with nonoperative treatment that included simple observation without dietary restrictions. The spontaneous closure occurred within approximately 25 days. Minimally symptomatic patients may be candidates for nonoperative treatment

Factors Influencing Proper Clinical Evaluation of Depth of Tumor Invasion in Gastric Cancer

The purpose of this study was to elucidate the factors that influence the clinical evaluation of the depth of tumor invasion in patients with T1 (tumor invasion of mucosa or submucosa) gastric cancer. The depth of tumor invasion was determined in 593 patients with gastric cancer. Patients were divided into two groups based on the agreement between clinical and pathological evaluation of depth of tumor invasion. Of 320 patients with clinical T1 gastric cancer, consistent diagnoses were made in 308 (96.2%) patients (consistent diagnosis group) while inconsistent diagnoses were made in 12 (3.8%) patients (inconsistent diagnosis group). In the clinical T1 gastric cancer, multivariate logistic regression analysis revealed that the disagreement between the clinical and pathological evaluation of the depth of tumor invasion was independently related to two variables; tumor location (upper stomach) and maximum tumor diameter (?30 mm). For clinical T1 gastric cancer with ?30 mm in maximum tumor diameter located in the upper stomach, caution should be exercised when selecting therapy