トウイン ニオケル ダイタイ ヘルニア シュジュツ 26ショウレイ ノ リンショウテキ ケントウ

We performed this study to investigate the differences in clinical features between incarcerated femoral hernias and non-incarcerated cases. We operated on 26 patients with a femoral hernia from April 1989 to December 1998. Twenty-four patients were female and two were male. Thir mean age at the time of operation was 68.2±15.4 years, and those older than 60 years were remarkably high. All females had a history of abortion more than twice. Eighteen of 26 (69.2%) hemoral hernias occurred on the right side, 7 on the left, and 1 on both sides. Those with an incarcerated hernia were 46.2% (12/26). Almost all patients without incarceration had only femoral tumors or swelling. On the contrary, a large number of the patients with an incarcerated hernia complained of abdominal or femoral pain, suggesting a hernial strangulation. Significant increases in white blood cell counts were recognized in the incarcerated cases compared to those without incarceration (9158.3± 2155.3 vs 6602.9±1049.5/mm3, respectively;P=0.0001). Additionally, the postoperative hospitalization periods of the patients with incarcerations were remarkably prolonged compared to those without an incarceration. According to the contents of the hernia in the 12 patients with incarcerations, we detected the small bowel in 9 and the grater omentum in 3. Six of 9 patients with an incarcerated small bowel had necrotic complications of strangulated small bowel. However, there was no clinical difference compared to the other 6 patients without a necrotic small bowel. In conculusion, we should recognize the possibility of femoral hernias in the treatment of patients complaining of a tumor or pain in the femoral triangle

Clinical study of strangulation obstruction of the small bowel

Early diagnosis of strangulation obstruction is very important for surgeons because delayed diagnosis often leads to severe complications. Thirty patients underwent an operation because of small bowel obstruction between April, 1993 and December, 1999. In the present study, we examined the differences in clinical findings between simple obstruction and strangulation obstruction. In addition, we examined the manifestation of systemic inflammatory response syndrome (SIRS) and whether it is useful for early diagnosis of strangulation obstruction, and whether it is correlated with the severity of ischemia due to strangulation. Tenderness was examined in all patients and signs such as abdominal irritation were detected more often in patients with strangulation obstruction than in the patients with simple obstruction. According to SIRS, the large number of the patients with strangulation obstruction showed SIRS before operation and the manifestation of SIRS correlated well with the length of the necrosis in the strangulated small bowel. We recognized the importance of anamnesis and clinical findings in examinations of small bowel obstruction, furthermore, it was suggested that SIRS should be the warning sign for strangulation obstruction

トウカ ニオケル ダイチョウ センコウ 83レイ ノ リンショウテキ ケントウ

Introduction : Colon perforation easily causes septic shock and multiple organ failure, mortality rate is high. We studied prognostic factors with colon perforation. From January１９９９to December ２００８, ８３ patients with colon perforation underwent emergency surgery in this department. Methods : Subjects were retrospectively divided into survivors（n＝６７）and nonsurvivors（n＝１６）. We studied their clinical factors and compared mortality for each factors. Results : Overall mortality was１９％ １６／８３）. The mean age was７４years, and significantly higher mortality over ８０years. The cause perforation was idiopathic in２５cases, cancer in２１cases, diverticulitis in１９ cases, iatrogenic in８cases, trauma in２cases, others in８cases. The perforation site was the most sigmoid colon. Patients with SOFA score at least five points before surgery and preoperative shock and leucopenia and older than２４hours before surgery was significantly higher mortality. Each was no difference in complications before surgery. PMX-DHP was performed in ３９ cases １３％ mortality. Discussion : In patients with colon perforation, preoperative assessment SOFA score was trusted to reflect the outcome

Coexistent poorly-differentiated neuroendocrine cell carcinoma and non-invasive well- differentiated adenocarcinoma in tubulovillous adenoma of the rectum : report of a casel

A 74-years old man was referred to our hospital for treatment of a rectal mass. Colonoscopy revealed villous tumor covering all the lower rectal lumen. Biopsy yielded a diagnosis of adenoma. CT examination showed tumor shadows of the rectum and the liver. Pelvic MRI examination showed a 10.5 8 7 cm tumor with high signal intensity on the T2 weighted images in the rectum. Rectosigmoidectomy with lymph node dissection was performed with the diagnosis of rectal cancer that metastasized to the liver. Histological and immuno- histochemical features showed coexistent poorly-differentiated small cell neuroendocrine cell (NEC) carcinoma and non-invasive well-differentiated adenocarcinoma in tubulovillous adenoma. However the chemotherapy with FOLFOX and Bevacizumab was performed postoperatively, the patient died in cancer 3 months after surgery. Rectal poorly-differentiated NEC carcinomas are thought to be a tumor with a high malignant potential. Recently, the UICC TNM classifications of malignant tumors, 7th edition and the Guidelines for colorectal NEC tumors of European Neuroendocrine Tumor Society have been published. They would be evaluated, and effective multimodal therapy for NEC carcinomas should be established

A case of perinephric liposarcoma which recurred ten years later from the initial operation

A 58-year old man was referred to our hospital for treatment of an abdominal mass. As for him, tumor resection with right nephrectomy had been performed ten years ago for a giant well-differentiated perinephric liposarcoma. CT examination showed a huge tumor shadow in the abdominal cavity. Abdominal MRI examination showed a 15 8 cm tumor with almost high signal intensity on the T2 weighted images. At lapalotomy, a large bulky retroperitoneal tumor pointed out before an operation was found. Surgical extirpation of the tumor was performed. Besides, several tumors of the thumb head size were detected into right retroperitoneal fatty tissue. The right side mesocolon and the tumors were not able to exfoliate, therefore right hemicolectomy was performed. Histological features showed dedifferentiated liposarcoma. The postoperative course was uneventful. But eight months after surgery, he was admitted again for treatment of a 4 3 cm retroperitoneal tumor. Extirpation of the tumor was performed. Histological finding of this tumor also showed dedifferentiated liposarcoma. Dedifferentiation, occurring in 15% of the well-differentiated liposarcomas, sometimes may develop later. Long-term detailed follow-up is necessary for well-differentiated liposarcoma

フクブ ドンテキ ガイショウゴ チハツセイ ニ ショウジタ オウコウ ケッチョウ カンマク レッコウ ヘルニア ノ 1レイ

A ７７-year-old woman presented to the emergency department with complains of abdominal pain and frequent vomiting. In the past, she has never been on surgery but she suffered blunt liver injury after motor vehicle accident nine months ago. She was performed trans-catheter arterial embolization to the left hepatic lobe at that time and had been seeing a doctor regularly for post traumatic biloma. The contrast-enhanced abdominal CT scan revealed a closed loop and a dilatation of a small intestine. She was diagnosed a small bowel obstruction due to a internal hernia. She was operated urgently. The surgical exploration showed that the congested jejunum incarcerated into an omental bursa, and an adhesion of the jejunum mesentery and a greater omentum. We found a mesentery hiatus of the transverse colon, through which a higher jejunum had incarcerated into the omental bursa. The jejunum was reduced manually and the hiatus was closed by suture. The patient followed a favorable postoperative course and was discharged on postoperative day６. We report a extremely rare transverse colon hiatal hernia that occurred in the late onset after blunt abdominal injury with the review of the literature

A study of transileocolic vein obliteration (TIO) for gastric varices

Seven cases of giant gastric varices were treated using TIO combined with balloon occlusion of the gastro-renal shunt, for the purpose of reviewing the significance of TIO in the treatment of gastric varices. In 6 of the 7 cases, giant varices were cured completely. In the unsuccessful case, it was a giant varix (the minimum diameter was 25 mm or more) which had been failed to be treated by the TIO. In 3 of the 7 cases, the varices on the gastric fornix had ruptured ; therefore, emergency TIO was undertaken and resulted in successful hemostasis and disappearance of the varices. After treatment using this technique, one case developed esophageal varices, and two patients showed a reduction in esophageal varices. In case where gastric varices had been accompanied by RC sign-positive esophageal varices, favorable results were obtained with obliteration of the gastro-renal shunt was combined with compression of the esophagus which had served as another shunt in these cases. After TIO, hepatic function remained unchanged or improved slightly. No case showed exacerbation of hepatic function. For massive gastric varices with an inside diameter of up to 2 cm, transileocolic vein obliteration (TIO) combined with balloon occlusion of the gastro-renal shunt, which occludes the shunt in an anterograde manner, secures the occlusion of the shunt with no complications. This technique seems to be an effective therapy for gastric varices

Successful cricothyrotomy for emergency airway management : a case report

A ６０ year-old male was brought to our emergency department by ambulance due to sudden onset of dyspnea. On examination, he was in coma since his level of consciousness decreased during transport, blood pressure was １９９／１１１mmHg, heart rate was１００ beats per minute, respirations were １０ per minute, blood oxygen saturation level（SpO２）was１００％ via assisted ventilation with Bag-Valve-Mask, and stridor was heard on auscultation. Those findings indicated airway emergency and endotracheal intubation was required. However, attempts at intubation were unsuccessful due to restriction of mouth opening. Muscle relaxant was then given to perform rapid sequence intubation, which caused vomiting. Failure to ventilation and intubation resulted in cardiopulmonary arrest. Chest compression was started immediately and decision for cricothyrotomy was made. １０ minute after cricothyrotomy, he revived. Subsequently, systemic management including therapeutic normothermia was performed at intensive care unit, then he regained consciousness. He was discharged １ month after admission