ABSTRACT
Clear differences in the medical environment exist between core and local cities in Japan. In particular, there are marked differences in medical examination and treatment of pancreaticobiliary diseases. Therefore, we investigated whether the requirement for medical examination and treatment of pancreaticobiliary diseases is increasing and whether patient care can be improved by dispatching a pancreaticobiliary specialist to a hospital that does not have a pancreaticobiliary division. From August 2013 to March 2015, we retrospectively reviewed data of 68 patients (38 men, 30 women; median age 68 years) who underwent endoscopic ultrasonography (EUS) or transpapillary treatment at the Engaru Kosei General Hospital (Engaru Hospital) either by a visiting specialist from the pancreaticobiliary division of Asahikawa Kosei General Hospital (Asahikawa Hospital) or by doctors at Engaru Hospital. Of the 68 patients, 25 underwent EUS by the visiting specialist, and the accuracy rate based on observation and operative cases was 92.5% (23/25). Furthermore, 43 patients underwent transpapillary treatment by the visiting specialist, which was successful in 88.4% (38/43) of patients. However, the success rate of cases treated by doctors at Engaru Hospital was 75% (3/4). During this period, 14 patients from Engaru Hospital were sent to the Asahikawa Hospital: 2 had failed treatment by doctors at Engaru Hospital and the rest were patients who either preferred to be examined at Asahikawa Hospital or required more extensive examination. Therefore, dispatching pancreaticobiliary specialists to institutions without a pancreaticobiliary division is an effective means of distribution of medical resources. Furthermore, this reduces the patient<s burden of illness. We consider the concept of “hospital cooperation” to be an extremely useful system.
ABSTRACT
Case I was a 85-year-old woman. She was referred to us as her serum CEA level was found as high as 9.2ng/ml at a clinic in her neighborhood. CT and ultrasound scans revealed a cystic tumor in the appendix area. A barium enema examination showed a tubercular lesion in the subcecal area. The surface of the lesion was flat and smooth. The vermiform appendix was not scanned with the contrast medium. She was diagnosed with mucinous cystadenoma of the appendix. Partial cecotomy was performed. The postoperative serum CEA fell to a normal level of 4.7ng/ml. Case II was also a woman . The 74- year-old inpatient was being treated for high blood pressure and hyperlipemia when her serum CEA level was found elevated to 12.3ng/ml. CT and ultrasonograph examinations revealed a cystic tumor in the appendix area. A barium enema examination showed a mucocele-like tubercle in the appendix. The patient was diagnosed with mucinous cystadenoma of the appendix and partial cecotomy was performed. The CEA level was normalized postoperatively with 1.5ng/ml. The pathologic tests confirmed either of these two cases was mucinous cystadenoma of the appendix. Immunohistochemical staining showed a CEA positive.
ABSTRACT
This report takes up a 65-year-old woman. Suspecting a tumorous superior fovea in the left clavicle, she consulted with our hospital’s Department of Otolaryngology. As a result of the lymph node biopsy performed at the department, she was diagnosed as having moderately differentiated tubular carcinoma. CT scanning revealed a number of swollen lymph nodes and parietal tylosis in the sigmoid colon. Endoscopy produced no abnormalities in the upper digestive tract, but an endoscopic check of the lower digestive tract revealed an all-around Type II tumor. The ailment was pathohistologically identified as tubular carcinoma. That said, the patient was diagnosed as suffering from sigmoid colon accompanying Virchow lymph node metastasis. Then, sigmoidostomy and the dissection of the D3 lymph node were performed. Pathohistological diagnosis revealed moderately differentiated tubular carcinoma, SE, N3, HO, PO, M1 (Virchow lymph node metastasis), Stage IV. Chemotherapy was postoperatively initiated with mFOLFOX6.
ABSTRACT
A 86-year-old woman visited us, complaining about sharp abdominal pain she had very morning when she got up. Ultrasound and computer tomography scans of the abdomen revealed notable parietal hypertrophy and swelling of the gallbladder. The old woman was diagnosed with acute cholecystitis and immediately admitted to the hospital. Her condition did not improve on conservative management. Percutaneous transhepatic gallbladder drainage (PTGBD) was performed. The bile thus aspirated was bloody, which led us to suspect necrotizing cholecystitis. Emergency cholecystectomy was done. The abdominal operation found the gallbladder wandering with a torsion of 360 degrees around the gallbladder neck as the axis and the leakage of bile in the abdominal cavity from what could be presumed to be the area where the PTGBD was placed. After the torsion was corrected, the gallbladder was surgically removed. Neither gallstones nor tumors were found in it. There were signs of hemorrhagic necrosis in the mucus membrane. The patient made good progress after the operation and was discharged on the 15th hospital day. Torsion of the gallbladder is a comparatively rare entity and its symptoms are not always specific. Therefore, it defies preoperative diagnosis. In this paper, we report our experience with a case of this disease which presented characteristic radiographic images and discuss the treatment strategies including PTGBD.