フククウキョウカ ニ セツジョ シタ フククウナイ シュッケツ オ キタシタ イ gastrointestinal stromal tumor ノ 1レイ

A 67 year-old man was admitted for sudden epigastralgia. At that time, although conscious, thepatient was in shock and was found on physical examination to have tenderness and reboundtenderness of the upper abdomen. Abdominal computed tomography（CT）showed hemoperitoneumand gallbladder stone. He was found in gastroendoscopic examination to have a submucosaltumor. After admission analgesics decreased abdominal pain and the patient was sent forlaparoscopic surgery. We found 500 g of blood in the intra-abdominal cavity and a bleeding tumorgrowing from the antrum of the stomach. The tumor was excised by wedge resection of thegastric wall. Histopathological diagnosis was gastrointestinal stomal tumor of the stomach（GIST）.12 cases of hemoperitoneum caused by GIST have been reported, but only in our case lapaloscopictreatment was performed

A New Candidate Supporting Drug, Rikkunshito, for the QOL in Advanced Esophageal Cancer Patients with Chemotherapy Using Docetaxel/5-FU/CDDP

Purpose. Docetaxel/5-FU/CDDP (DFP) therapy is a useful treatment for advanced esophageal cancer. However, adverse reactions such as chemotherapy-induced nausea and vomiting (CINV) interfere often with continuation of the chemotherapy. We investigated the efficacy of rikkunshito (TJ-43) on CINV. Methods. Nineteen patients who were going to undergo DFP therapy were enrolled. They were assigned to the following two groups: a TJ-43-treated group and -nontreated group. The following parameters were compared between the 2 groups: (1) the frequency of symptoms occurred, (2) vomiting, nausea, and anorexia score, and (3) QOL score. Results. The incidence of symptoms was lower in the TJ-43-treated group than that in the control group. The nausea score of the TJ-43-treated group was significantly lower than that of the control group. In the QOL score, the mood score and the ADL score decreased significantly in the control group. Conclusion. We recommend TJ-43 administration in patients undergoing DFP chemotherapy

ジュウニシチョウ カコウキャク ニ ハッセイシタ タハツセイ シュッケツセイ ジュウニシチョウ カイヨウ ノ 1レイ

We report a case of multiple hemorrhagic ulcers of the descending duodenum treated successfullysurgical suture and endoscopic clipping after transcatheter arterial embolization（TAE）. A50 level year-old man was treated in intensive care unit because of multiple organ failure by MRSAinfection after operation of ulcerative colitis. Massive intermittent melena from ileostomy wasoccurred and an endoscopic examination revealed mucosal erosion with massive bleeding from theVater’s papilla. Emergency abdominal angiography was performed because the condition of thepatients was poor. Angiography of common hepatic artery and gastroduodenal artery didn’tshow extravasation. An extravasation of the inferior pancreaticoduodenal artery was revealedand a hemostasis was performed with metal coil embolization. But the hemorrhage occurred repeatedlythree days after TAE. We embolized the gastroduodenal artery and the pancreaticoduonenalartery. We performed surgery after three times TAE. We identified the duodenalulcer with an exposed blood vessel beside the Vater’s papilla and complete hemostasis wasachieved by suturing ulcer through the incision of the anterior wall of the duodenum. The otherhemorrhagic duodenal ulcer of the 2nd portion occurred 25 days after the operation, and this hemorrhagecould be treated by the endoscopic hemostasis using clip

ゴウセイ キュウシュウセイ ユチャク ボウシザイ オ シヨウシタ イ ゼンテキ ジュツゴ ニ ハッショウシタ コウヤクセイ イレウス ノ イチレイ

The patient was a 50-year-old male. He underwent total gastrectomy with complication ablationof the greater omentum for gastric cancer. We used composition absorbent materials toprevent adhesion（seprafilm_）at closing of the abdominal wall. When he consulted our hospital forabdominal pain after 7 months later, we diagnosed the patient as having adhesive ileus. Severalhours later, he demonstrated abdominal swelling and fell into shock. Therefore, we performedurgent abdominal surgery. There were large quantities of cacosmia ascites and no adhesion exceptat only one point between the bottom of the previous wound and the small intestine. Weconfirmed strangulation ileus that had turned the small intestine with 360°dextroversion centeringon the adhesion point and the superior mesenteric artery root. Because most of small intestinehad become swollen and necrotized, we performed wide small intestinal resection with about 60cmsmall intestines survived. Currently we are following the patient with at-home intravenous hyperalimentationafter two further reoperations. At the time of the first operation, we had applied　seprafilm. This patient had a very late case of strangulation ileus, because there was almost noadhesion. This case represents a rare r side effect reports, involving shock, infection developingafter the use of seprafilm

ショウチョウカンマク デスモイド シュヨウ ノ 1レイ

A 51-year-old man was referred to our hospital in 2005, because of an abdominal mass in thehypogastrium. There was no tenderness, and the tumor moved to epigastric resion easily. Therewere no important findings in a physical examination, except the mass. Enhanced CT showed themass with clear boundaries of 8cm size that the inside was contrasted heterogeneously in pelviccavity, and the internal was able to confirm tessellated mass by a supersonic wave. We doubtedintestinal GIST and performed an operation. We showed mass of mesoileum origin, in 15cm oralside from terminal ileum, there was no adhesion and invasion to circumference, so we underwent apartial resection of the terminal ileum. It was diagnosed as desmoid of a mesoileum origin by apostoperative histopathology diagnosis. There has been no recurrence for postoperative threeyears. Intraabdominal desmoid is relatively rare, and often noted a history of the laparotomy orestrogenic intervention, and combined with Gardner’s syndrome. In addition, it is assumed that itusually grows infiltrative, and easy to develop local recurrence. We experienced a rare case fallingunder neither, so we report it

The effects of the herbal medicine Daikenchuto (TJ-100) after esophageal cancer resection, open-label, randomized controlled trial

Background Daikenchuto (TJ-100), a traditional Japanese herbal medicine, is widely used in Japan. Its effects on gastrointestinal motility and microcirculation and its anti-inflammatory effect are known. The purpose of this prospective randomized controlled trial was to investigate the effect of TJ-100 after esophagectomy in esophageal cancer patients. Methods Forty patients for whom subtotal esophageal resection for esophageal cancer was planned at our institute from March 2011 to August 2013 were enrolled and divided into two groups at the point of determination of the operation schedule after informed consent was obtained: a TJ-100 (15 g/day)-treated group (n = 20) and a control group (n = 20). The primary efficacy end-points were maintenance of the nutrition condition and the recovery of gastrointestinal function. The secondary efficacy end-points were the serum C-reactive protein (CRP) level and adrenomedullin level during the postoperative course, the incidence of postoperative complications, and the length of hospital stay after surgery. Results We examined 39 patients because one patient in the TJ-100 group was judged as having unresectable cancer after surgery. The mean age of the TJ-100 group patients was significantly older than that of the control group patients.The rate of body weight decrease at postoperative day 21 was significantly suppressed in the TJ-100 group (3.6% vs. the control group: 7.0%, p = 0.014), but the serum albumin level was not significantly different between the groups. The recovery of gastrointestinal function regarding flatus, defecation, and oral intake showed no significant between-group differences, but postoperative bowel symptoms tended to be rare in the TJ-100 group. There was no significant between-group difference in the length of hospital stay after surgery. The serum CRP level at postoperative day 3 was 4.9 mg/dl in the TJ-100 group and 6.9 mg/dl in the control group, showing a tendency of a suppressed serum CRP level in the TJ-100 group (p = 0.126). The rate of increase in adrenomedullin tended to be high postoperatively, but there was no significant difference between the two groups. Conclusions TJ-100 treatment after esophageal cancer resection has the effects of prompting the recovery of gastrointestinal motility and minimizing body weight loss, and it might suppress the excess inflammatory reaction related to surgery

Current status of sentinel lymph node navigation surgery in breast and gastrointestinal tract

Sentinel lymph node biopsy (SLNB) has been developed as a new diagnostic and therapeutic modality in melanoma and breast cancer surgery. The purpose of the SLNB include preventing the operative morbidity and improving the pathologic stage by focusing on fewer lymph nodes using immunocytochemic and molecular technology has almost achieved in breast cancer surgery. The prognostic meaning of immunocytochemically detected micrometastases is also evaluating in the SLN and bone marrow aspirates of women with early-stage breast cancer. SLNB using available techniques have suggested that the lymphatic drainage of the gastrointestinal tract is much more complicated than other sites, skip metastasis being rather frequent because of an aberrant lymphatic drainage outside of the basin exist. At the moment, the available data does not justify reduced extent of lymphadenectomy, but provides strong evidence for an improvement in tumor staging on the basis of SLNB. Two large scale prospective multi-center trials concerning feasibility of gamma-probe and dye detection for gastric cancer are ongoing in Japan. Recent studies have shown favorable results for identification of SLN in esophageal cancer. CT lymphography with endoscopic mucosal injection of iopamidol was applicable for SLN navigation of superficial esophageal cancer. The aim of surgical treatment is complete resection of the tumor-infiltrated organ including the regional lymph nodes. Accurate detection of SLN can achieve a selection of a more sophisticated tailor made approach. The patient can make a individualized choice from a broader spectrum of therapeutic options including endoscopic, laparoscopic or laparoscopy-assisted surgery, modified radical surgery, and typical radical surgery with lymph node dissection. Ultrastaging by detecting micrometastasis at the molecular level and the choice of an adequate treatment improve the postoperative quality of life and survival. However these issues require further investigation

Glutamine protects small intestinal mucosa

Supportive therapy during chemotherapy has become essential, but effective preventive therapies to gastrointestinal mucosal injury are few. We investigated the efficacy of glutamine in rat anticancer drug-induced enteritis model. In this study, we used twenty male SD rats. They were divided into control, 5-fluorouracil (5-FU) (orally administered at 20mg/kg day), 5-FU+glutamine (1000 mg/kg/day) and 5-FU+glutamine+fiber and oligosaccharide (GFO[○R]) (1000 mg/kg/day) groups. All groups were sacrificed on day 6 and upper jejunums were excised. The jejunal villous height was measured in specimens. IgA level in jejunal washing solution, and serum diamine oxidase activity were also measured. The jejunal villous height was recognized as shorter in the specimen from 5-FU treated rats compared with 5-FU+glutamine treated rats (p<0.001). Serum diamine oxidase activity in 5-FU+glutamine group were significantly superior to that in 5-FU group (p=0.028). IgA level in jejunal washing solution tended to be higher in 5-FU+glutamine group than that in 5-FU group (p=0.076). On the other hand, serum diamine oxidase activity and IgA level in jejunal washing solution showed no significant difference between 5-FU+GFO and 5-FU treatment group. Our results suggest that glutamine showed protective effects on mucosal injury of small intestine in rat anticancer drug-induced enteritis model