Shunsuke Niki

Tokushima Municipal Hospital

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Masayuki Sumitomo

Tokushima Prefectural Central Hospital

Yasumasa Monden

Tokushima University

Tadashi Uyama

Kagawa Prefectural Central Hospital

Masaru Tsuyuguchi

Tokushima Municipal Hospital

Shoji Sakiyama

National Hospital Organization Kochi National Hospital

Taizo Fukumoto

Urasoe General Hospital

Nobuyuki Tanida

Japanese Red Cross Kochi Hospital

Shigetoshi Morimoto

Tokyo Metropolitan Geriatric Hospital

Yoshihito Furukita

Tokushima University

Tomofumi MINAMIMOTO

Tokushima University

Cooperative Institutions

Tokushima University

Tokushima Prefectural Central Hospital

Tokushima Municipal Hospital

Tokushima University Hospital

National Hospital Organization

Tokushima Hospital

Red Cross Hospital

Tsuda University

Second Hospital of Nanchang

University Health Network

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A case report of pelvic lipomatosis with severe rectal stenosis.

The Japanese Journal of Gastroenterological Surgery (1990)

Katsuhiro Tanaka Toshikatsu Taniki Shunsuke Niki Taizou Fukumoto Daisaku Harauchi

Pelvic lipomatosisの1例を経験した. 症例: 32歳, 女性. 主訴: 便秘. 肛門縁より10cm口側に狭窄部下端を触知し狭窄部より口側への直腸鏡の挿入は不可能であった. 粘膜面に不整はなく, 生検では正常の直腸粘膜であった. 膀胱鏡検査では異常を認めなかった. 注腸造影でRa, Rsに長さ約10cmの全周性の高度狭窄を認めたが明かな偏位は認めなかった. Computed tomographyとmagneticresonaunce imageでは腫大した子宮と左卵巣に低吸収域を認め, 直腸周囲に厚さ約2cmの低吸収域を認めた. 腹部エコーにて子宮筋腫と両側卵巣嚢胞を認めたが直腸狭窄と関係ないと判断した. 手術所見: 直腸, 子宮, 卵巣は強く癒着しており直腸低位前方切除, 単純子宮全摘, 両側付属器摘除術を行った. 病理所見: 直腸粘膜に著変なく直腸周囲には厚い脂肪が認められた. この脂肪は正常の脂肪組織であり, 悪性所見はなく線維化や炎症所見は乏しかった.

Lipomatosis

10.5833/jjgs.23.938

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[A case of intrapulmonary lymph node simulating small carcinoma of the lung].

PubMed (1990)

Yoshihiro Hashimoto Yoshihiro Takishita Hiroyasu Bando Takahiro Sano Takashi Nagano

A 48-year-old male was admitted for further examination of a coin lesion with a diameter of 8 mm seen on chest X-ray. The patient was a heavy smoker and his serum level of CEA was elevated to 29.8 ng/ml. Since the broncho-fiberscopic examination was not able to yield a definitive diagnosis, an operation was performed as lung cancer was suspected. According to the histological examination, the small nodule was diagnosed as an intrapulmonary lymph node with anthracosis and silicotic nodules. A review of the limited number of case reports shows that men are more prone to intrapulmonary lymph nodes, and that the patients were all smokers but not necessarily with occupational experience of exposure to silica.

Nodule (geology)

Histopathological examination

Solitary pulmonary nodule

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A CASE OF INTUSSUSCEPTION OF THE GASTROJEJUNOSTOMY OCCURRED IN A PERIOPERATIVE PERIOD AFTER GASTRECTOMY

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) (2011)

Yukikiyo Kawakami Shunsuke Niki

症例は50歳台女性.検診の胃透視で異常を指摘され胃内視鏡検査を行ったところ,前庭部にIIc病変が認められた.早期胃癌の診断で幽門側胃切除術施行.再建は自動縫合器によるRoux-Y法を行った.第4病日の夜に嘔吐があり,翌日の腹部レントゲンで残胃の著明な拡張が見られたため胃管を挿入.第6病日に透視検査を行ったが造影剤は残胃に停滞し吻合部を通過しなかった.吻合部狭窄と判断し胃管留置にて経過をみたが連日多量の排液が続いた.第12病日に再度透視検査を行ったところ,吻合部で腸重積と思われる所見を認め,第14病日に再手術施行.吻合部の空腸盲端が残胃内に入り込んでいた.周囲の胃および小腸壁は炎症性に硬化しており,腸重積は全く解除できなかったため,吻合部全体を切除の上,再建をやり直した.胃切除後の腸重積は非常に稀であり,これまでの報告例とともに考察を加えて報告する.

10.3919/jjsa.72.686

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A Case of Intractable Esophageal Fistula Repaired by a Patch of the Iliotibial Tract and Pectoralis Major Muscle Prombage

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) (2014)

Yota Yamamoto Shunsuke Niki Yoshihito Furukita Akira Tangoku

症例は70歳台，男性．12年前食道癌で食道亜全摘，頸部食道胃管吻合術を施行された．7年前，吻合部近傍の頸部リンパ節再発に対して行われた化学放射線療法により，吻合部難治性瘢痕狭窄をきたした．8カ月前に再吻合術を行ったが，縫合不全から難治性食道皮膚瘻を形成した．全身状態から遊離空腸移植より大胸筋被覆充填術を選択した．瘻孔の縫合閉鎖は不可能であったため，左大腿から採取した腸脛靱帯を瘻孔に縫着し，有茎大胸筋弁で被覆充填した．術後は縫合不全や狭窄なく経過し，第38病日に他院転院した．難治性食道瘻に対する筋弁充填術においては，唾液漏出の阻止が充填組織の生着に重要である．瘻孔の直接縫合が不可能な場合は，皮島によるパッチ法があるが，手技が煩雑で植皮が必要となることも多い．腸脛靱帯を用いた遊離筋膜パッチは手技が容易であり，食道瘻閉鎖に非常に有用であった．

Pectoralis major muscle

10.3919/jjsa.75.369

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Pleural changes in rat lung allografts.

The Journal of the Japanese Association for Chest Surgery (1993)

Tadashi Uyama Shoji Sakiyama Nobuyuki Tanida Masayuki Sumitomo Shunsuke Niki

正常肺の胸膜下にはMHCクラスII抗原陽性の樹状細胞 (DC) が分布しておりDCをターゲットとして, 胸膜にも拒絶反応が強くおこりうると考えられる.胸膜における拒絶反応様式をラット肺移植モデルで検討した.レシピエコトのクラスII抗原に対するモノクローナル抗体による免疫組織学的検討では, latentphaseにすでに胸膜下にレシピエント細胞の浸潤が認められ, 細胞浸潤は拒絶反応の進行とともに強くなる.Vascular phaseでは浸潤細胞は単核球, マクロファージが主体であるが, alveolar phaseには線維芽細胞の出現が観察され, 線維化が始まりdestructive phaseには線維化はさらに高度となる.不適当な免疫抑制や繰り返す拒絶反応により胸膜線維化の原因となり移植肺のコンプライアンスの低下を引き起こす可能性がある.

10.2995/jacsurg.7.448

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A CLINICAL STUDY OF BLEEDING AFTER THYROID OPERATION

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) (1999)

Shin‐ichi Yamasaki Masaru Tsuyuguchi Shunsuke Niki Daisuke Wada Tsuneo FUKUMOTO

A retrospective analysis of 10 patients with thyroid disease who underwent reoperation for postoperative bleeding was performed to know the prevention and strategies for this complication. There were five patients with Graves disease (subtotoal thyroidectomy), three with benign thyroid tumors (extirpation of thyroid tumors), and two with thyroid carcinoma. Eight of 10 patients were reoperated within 6 hours after initial operation. All patients had a complaint of pulsion of the anterior neck. Four patients complained of dyspnea. Removal of hematoma, hemostasis and closed drainage under general anesthesia were done in 9 and under local ansthesia in one patient. The origins of bleeding were twig of artery in anterior neck muscles in four, twig of the superior thyroid artery in two, inferior thyroid vein in one, subcutaneus vein in one and indistinctness in two patients. No complication occurred after reoperation and they were discharged from the hospital 10.7 days on an average after initial operation. Postoperative bleeding often occur from twigs of artery in the surrounding tissues in a short time after operation. A sure hemostasis by ligation of fine vessels and careful observation after operation are important. Prompt surgical treatment brings about favorable outcome if postoperative bleeding has occurred.

10.3919/jjsa.60.1165

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A case of poorly differentiated ("insular") thyroid carcinoma

Endocrine Surgery (2001)

Yasushi Kiyohisa Masaru Tsuyuguchi Shunsuke Niki Shigetoshi Morimoto Shuji Yonehara

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A CASE OF IDIOPATHIC CHYLOPNEUMOTHORAX ASSOCIATED WITH A MALIGNANT LYMPHOMA

The journal of the Japanese Practical Surgeon Society (1990)

Suguru Kimura Tadashi Uyama Tomofumi MINAMIMOTO Masayuki Sumitomo Shunsuke Niki

Chylopneumothorax is a pathologic condition in which chyle is deviated from the thoracic duct and pools in the thoracic cavity. Idiopathic chylopnenmothorax with unknown cause is extremely rare. We encountered such a rare case, in which recurred chylopneumothorax after a temporal cure of the disease by surgery was successfully treated by anastomosis of pleura, however, in the observation period after the second surgery, a malignant lymphoma was found in the pharynx. Lymphography showed a back current to the Hilus of the lung, which suggested a possible participation of the vulve dysfunction of lymph node in the mechanisms of the onset of chylopneumothorax. In addition, lymphocytes subpopulation in the thoracic fluid of recurred chylopneumothorax involved predominantly an immature T cell OKT10, accompanied by an increase in 4/8 due to a decrease in OKT8 compared to peripheral blood. OKT series in the thoracic fluid in chylopneumothorax in infants were well coincided with blood OKT3, 4, and 8 values in this case. The reason why lymphokine-activated killer (LAK) activity of periopheral mononuclear cells was higher than that of the mononuclear cells in the thoracic fluid appeared that OKT8 might decrease in the thoracic fluid, which meaned that the antitumor activity of the mononuclear cells in the fluid might be declined.

Chyle

Thoracic cavity

10.3919/ringe1963.51.1748

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Bronchial changes in rat lung allografts in the process of acute rejection.

The Journal of the Japanese Association for Chest Surgery (1994)

Shoji Sakiyama Tadashi Uyama Taizo Fukumoto Masafumi Tamaki Nobuyuki Tanida

ラット同所性左肺移植 (BN to LEW, LEW to LEW) を行ない, 急性拒絶反応による移植肺の気管支病変につき病理組織学的検討を行った.これまでの報告以外の所見として, 異系移植肺においては杯細胞の割合の増加, 気管支上皮の鋸歯状の変化, 上皮細胞での核分裂像, 基底細胞の配列の乱れ, 基底細胞の核異型, 水泡様変性等の変化が認められた.杯細胞数の割合は中等大気管支 (直径500-999μm) において移植後3日目 (おもにvascular phase) をピークとして有意な増加が認められた。5日目 (alveolar phase) 以降は上皮細胞の障害により急速にその数が減少した.急性拒絶反応の過程において, 移植肺の気管支上皮は粘膜下の炎症に対して増殖反応を示す時期, その反応性に異常を来たす時期を経て, 最終的に細胞死, 壊死へと到るものと思われる.

10.2995/jacsurg.8.110

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