maeda kotaro

BACKGROUND: Recurrence of Crohn's disease usually occurs at anastomotic sites. OBJECTIVE: A new anastomosis technique (Kono-S anastomosis) designed to minimize anastomotic restenosis was compared with conventional anastomoses. DESIGN AND SETTINGS: The Kono-S anastomosis technique was first used for Crohn's disease in 2003 at the Asahikawa Medical University Hospital. The resection is accomplished by transecting the bowel with a linear cutter so that the mesentery side is located in the center of the stump. Both stumps are sutured to create a supporting column to maintain the diameter and dimension of the anastomosis. Longitudinal enterotomies are made at the antimesenteric sides of the 2 segments of intestine. The side-to-side antimesenteric anastomosis is then performed in transverse fashion. The medical records and follow-up details of all patients undergoing this procedure were reviewed. PATIENTS: From 2003 to 2009, 69 patients with Crohn's disease who underwent Kono-S anastomosis (group S) were compared with 73 historical patients with Crohn's disease who underwent conventional anastomosis (group C) from 1993 to 2003. MAIN OUTCOME MEASURES: A Kaplan-Meier analysis of the follow-up data on surgical recurrence at the anastomosis was performed. The endoscopic recurrence score at the anastomosis was calculated. RESULTS: The median endoscopic recurrence score in group S was significantly lower than that in group C (2.6 vs 3.4; P = .008). The Kaplan-Meier analysis showed a lesser probability of anastomotic surgical recurrence in the S group at 5 years (0% vs 15%; P = .0013). The absence of postoperative infliximab did not affect the restenosis rate in group S. LIMITATIONS: This study was limited by its historical retrospective nature. CONCLUSION: The Kono-S anastomosis appears to be effective in preventing anastomotic surgical recurrence in Crohn's disease.

Because the rate of recurrence after curative resection for T1 colorectal cancer is low, the characteristics of recurrence remain obscure. This multicenter study attempted to clarify the characteristics of recurrence after curative resection for T1 colorectal cancer. We analyzed the associations between recurrence and various clinicopathological features in 798 patients who had undergone curative resection alone for T1 colorectal cancer at 14 hospitals between 1991 and 1996. The rate of lymph node metastasis (LNM) in patients with T1 colorectal cancer was 10.5% (84/798), and 18 (2.3%) of the 798 patients developed recurrence during the median follow-up of 7.8 years. The recurrence rates in patients with colon cancer with and without LNM were 3.6 and 1.3%, respectively (p = 0.19). These rates in patients with cancer of the rectum were 25.0 and 1.1% (p < 0.0001). Among various parameters, histological grade (p < 0.0001), location (p = 0.025), LNM (p < 0.0001), and venous invasion (p = 0.0013) were risk factors for recurrence. Among them, LNM (p = 0.0008) and histological grade (p = 0.041) were independent risk factors for recurrence after curative resection for T1 colorectal cancer. Time to recurrence was more likely to be shorter for patients with, than without nodal involvement. In patients with an unfavorable histological grade, all recurrences developed within 1 year. The recurrence rate after curative resection for node-negative T1 colorectal cancer was very low. The effectiveness of surveillance to detect recurrence after curative resection for T1 colorectal cancer should be validated in further studies.

Purpose: We identified appropriate colon cancer dissection area for muscularis propria (MP) invasion.<BR>Subjects and methods: Clinical outcomes were studied retrospectively in 84 MP cancer subjects based on tumor site. These were clinicopathologically compared to 180 subjects with subserosa invasion (SS cancer).<BR>Results: No difference was seen in left or right–side sites for curative surgery frequency, lymph node metastasis, or main or intermediate lymph node metastasis. Lymph node metastases were fewer at 23.8% in MP cancer with curative surgery than in SS cancer at 33.5% (p=0.08). No significant difference was seen in main or intermediate lymph node metastasis rates, recurrence in those with main or intermediate lymph node metastasis, or prognosis between MP and SS cancer.<BR>Conclusions: Main and intermediate lymph node dissection is recommended for MP cancer just as for SS cancer.

Vascular injuries, bowel injuries and organ injuries are often encountered in laparoscopic colectomy as accidental complications. Such injuries still sometimes occur even at present. We have performed 446 laparoscopic colectomy so far, among whom 14 cases of vascular injuries, 9 cases of bowel injuries and 1 case of organ injury have occurred. Though 12 cases of laparoscopic colectomy had to be converted to open surgery, conversion was not required in any of the vascular injury cases. In order to avoid these accidental situations, there are some significant steps that have to be followed in laparoscopic colectomy. Surgeons need to follow standard operative procedure, learn about the principle and characteristic of surgical devices, and acquire the skill of using those devices. Furthermore, the operator, his/her assistant and endoscopist should have sound anatomical knowledge concerning the membrane structure and proper dissection layer. The collaboration between clinicians can also lead to obtain a better surgical field of view. The surgeon, the assistant and endoscopist become the triunity. A coordinated operation should be carried out, and the visual field is ensured after the anatomical membrane structure and stratum disjunction are understood. However, we should not hesitate to convert to open laparotomy in those cases where the laparoscopic field of view is limited, or bleeding is poorly controlled.

Anorectal manometory is the principal technique used to evaluate anorectal function. We describe our experience with 2 patients in whom rectal perforation was caused by anorectal manometory. Informed consent for this report was obtained from the patients and their families. Case 1 was a man in his 40's who underwent super low anterior resection with a transverse colostomy. In the third month after surgery, anorectal manometory was performed before colostomy closure. During the sensory test, abdominal pain developed. Emergency surgery was performed for a diagnosis of perforated peritonitis. Case 2 was a woman in her 70's who underwent transanal resection to treat a prolapse (using an automatic suture device). In the sixth month after surgery, anorectal manometory (included a sensory test) was performed. The patient had melena after the examination and was given conservative therapy for about 3 weeks for a diagnosis of rectal perforation. Sensory test with an Obatametoro balloon catheter is a useful diagnostic procedure that is very simple to perform, with no individual difference in instrumentation. However, post operative examinations should be carefully performed because excessive pressure can be applied to anastomotic sites.

This article aims to idenfify the characteristics of surgical treatment for fecal incontinence as a standardized modality. While randomized controlled trials are rare, various quantitative measures are used to evaluate the outcomes and the criteria for successful results are often arbitrarily defined, various surgical modalities have recently been developed, improved and established, especially in the western world. Therefore, there is an urgent need to create a guideline for surgical treatment for fecal incontinence in Japan. As of today, overlapping sphincteroplasty is the most commonly accepted technique. Sacral nerve stimulation is a novel, less invasive and promising modality for patients with fecal incontinence, who do not respond to conservative therapies. Although colostomy is often regarded as a failure of treatment, it might be an effective technique to improve quality of life in society. A better understanding among Japanese colorectal surgeons of the surgical algorithm and modalities as well as their pros and cons for fecal incontinence is needed.<br>

This article aims to idenfify the characteristics of surgical treatment for fecal incontinence as a standardized modality. While randomized controlled trials are rare, various quantitative measures are used to evaluate the outcomes and the criteria for successful results are often arbitrarily defined, various surgical modalities have recently been developed, improved and established, especially in the western world. Therefore, there is an urgent need to create a guideline for surgical treatment for fecal incontinence in Japan. As of today, overlapping sphincteroplasty is the most commonly accepted technique. Sacral nerve stimulation is a novel, less invasive and promising modality for patients with fecal incontinence, who do not respond to conservative therapies. Although colostomy is often regarded as a failure of treatment, it might be an effective technique to improve quality of life in society. A better understanding among Japanese colorectal surgeons of the surgical algorithm and modalities as well as their pros and cons for fecal incontinence is needed.<br>

Interaction of CA19-9 with E-selectin is involved in initiation of hematogenous metastases. We investigated whether serum concentrations of E-selectin and CA19-9 are good predictors of hematogenous metastases and prognosis in colorectal cancer. Pre-operative serum samples were obtained from 152 patients with colorectal cancer, and from 28 healthy volunteers. Correlation between serum E-selectin and CA19-9 was studied in terms of clinically detected hematogenous metastases and prognosis of patients. Low serum concentration of E-selectin was defined as &lt; 50 U/ml in healthy volunteers, and on that basis, 20.4% of all patients belonged to the high E-selectin group. Several distinctive characteristics were observed in the clinical course of patients with high serum concentrations of both CA19-9 and E-selectin. The rate of Dukes&apos; D cancer was significantly higher, and curative surgery was performed less frequently in patients with high serum concentrations of both CA19-9 and E-selectin (60 and 40%) than in others. However, there was no significant difference in the frequency of recurrence after curative surgery between patients with high serum concentrations of both CA19-9 and E-selectin (25.0%) and others. Overall the 5-year survival rate was significantly lower in patients with high serum concentrations of both CA19-9 and E-selectin (34.3%) than in other patients. Even if the serum concentration of CA19-9 was high, prognosis was not poor in patients with low serum concentration of E-selectin. These results suggested that it was useful to measure both CA19-9 and E-selectin as markers of hematogenous metastases and as predictors of prognosis in colorectal cancer.

The aim of this paper is to share our first experience of a novel procedure with da Vinci surgical system® for colorectal cancer here in Japan and provide the current status of robot surgery. A 77-year-old male was transferred to our department for curative surgery of sigmoid colon cancer (T1N0M0). The patient was placed in Trendelenburg position and 5 ports were inserted into the abdominal cavity. After that, patient cart with 4 arms was docked on the left caudal side. Superior rectal artery and vein were divided, sigmoid colon was mobilized and rectum was dissected in robotic surgery. The outcomes of this case were comparable to those in the literature in terms of blood loss, morbidity and length of hospital stay, apart from operative duration due to being unfamiliar with robot. Robotic surgery might be feasible and safe procedure for colorectal cancer. © 2010 The Japanese Society of Gastroenterological Surgery.

We aimed to evaluate the rapid pull-through technique and the rectal stimulation test in anorectal manometry. Seventy-one patients underwent the examination from September 2007 to August 2008. The examination was carried out in the left lateral decubitus position with water perfusion catheter according to the pull-through technique to measure the high-pressure zone (HPZ) and maximum resting pressure (MRP) 3 times each. An Obatametro balloon catheter of 7mm in diameter was used for the rectal stimulation test. As a result of evaluating the correlates most closely with age, gender and Wexner&#039;s incontinence score, the first sensation (FS) and maximum tolerable volume (MTV) did not reveal a correlation with those factors in the rectal stimulation test, while the tolerable volume (TV) defined in the manuscript as MTV-FS was related to them. In conclusion, TV could be a valuable indicator for fecal incontinence in the near future.&lt;br&gt;

The aim of this paper is to share our first experience of a novel procedure with da Vinci surgical system® for colorectal cancer here in Japan and provide the current status of robot surgery. A 77-year-old male was transferred to our department for curative surgery of sigmoid colon cancer (T1N0M0). The patient was placed in Trendelenburg position and 5 ports were inserted into the abdominal cavity. After that, patient cart with 4 arms was docked on the left caudal side. Superior rectal artery and vein were divided, sigmoid colon was mobilized and rectum was dissected in robotic surgery. The outcomes of this case were comparable to those in the literature in terms of blood loss, morbidity and length of hospital stay, apart from operative duration due to being unfamiliar with robot. Robotic surgery might be feasible and safe procedure for colorectal cancer. © 2010 The Japanese Society of Gastroenterological Surgery.

We have used a femtosecond pump-probe impulsive Raman technique to explore the ultrafast dynamics of micelle suspended single-walled carbon nanotubes (SWNTs) in various pH environments. The structures of coherent phonon spectra of the radial breathing modes exhibit significant pH dependence, to which we attribute the effect of the protonation at the surface of SWNTs, resulting in the modification of electronic properties of semiconductor SWNTs. Analysis of the time-domain data using a time-frequency transformation uncovers also a second transient longitudinal breathing mode, which vanishes after 1 ps of the photoexcitation. © 2009 The American Physical Society.