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Evaluation of prognostic factors and scoring system in colonic perforation

World Journal of Gastroenterology 2007年第23期13卷 3228-3231页

作者： Atsushi Horiuchi Yuji Watanabe Takashi Doi kouichi sato Syungo Yukumi Motohira Yoshida Yuji Yamamoto Hiroki Sugishita Kanji Kawachi Department of Surgery 2 Ehime University School of Medicine

AIM: To study the significance of scoring systems assessing severity and prognostic factors in patients with colonic perforation. METHODS: A total of 26 patients (9 men, 17 women; mean age 72.7 ± 11.6 years) underwent emergency operation for colorectal perforation in our institution between 1993 and 2005. Several clinical factors were measured preoperatively and 24 h postoperatively. Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), Mannheim peritonitis index (MPI) and peritonitis index of Altona (PIA Ⅱ) scores were calculated preoperatively. RESULTS: Overall postoperative mortality rate was 23.1% (6 patients). Compared with survivors, non- survivors displayed low blood pressure, low serum protein and high serum creatinine preoperatively, and low blood pressure, low white blood cell count, low pH, low PaO2/FiO2, and high serum creatinine postoperatively. APACHE Ⅱ score was significantly lower in survivors than in non-survivors (10.4 ± 3.84 vs 19.3 ± 2.87, P = 0.00003). Non-survivors tended to display high MPI score and low PIA Ⅱ score, but no signif icant difference was identif ied. CONCLUSION: Pre- and postoperative blood pressure and serum creatinine level appear related to prognosis of colonic perforation. APACHE Ⅱ score is most associated with prognosis and scores ≥ 20 are associated with signif icantly increased mortality rate.

关键词： Scoring system Colonic perforation Prognostic factor

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Huge mucinous borderline ovarian cystadenoma in a premenarchal girl

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Open Journal of Pediatrics 2012年第1期2卷 82-86页

作者： Atsushi Horiuchi Kazuhiro Kameoka kouichi sato Yuji Yamamoto Yuji Watanabe Department of Surgery Division of Gastrointestinal Surgery and Surgical Oncology School of Medicine Ehime University Toon City Japan

Epithelial ovarian tumors are common in adult women, but rare in children. Especially mucinous ovarian cystadenoma is extremely rare, with only 16 cases in premenarchal girls reported to date. We present a case of 12-year-old premenarchal girl with symptoms of lower abdominal distension. CT showed a large multilocular tumor spreading throughout the entire abdominal cavity from the right upper quadrant to the pelvic cavity. The tumor was brought out little by little with aspiration of the fluid contents with a small incision. The tumor was found to originate from the left ovary, and oophorectomy was performed. The tumor measured 26 × 18 cm and weighed 5860 g. Histological diagnosis was mucinous ovarian cystadenoma with borderline malignancy. No evidence of recurrence had been seen as of 2 years postoperatively. In the review of premenarchal mucinous borderline ovarian cystadenoma, all cases were stage I and underwent salpingo-oophorectomy or oophorectomy. Those patients were alive without recurrence. Al-though mucinous borderline ovarian cystadenoma was characterized as malignancy, premenarchal cases showed favorable outcomes and salpingo-oohprectomy or oophorectomy appears appropriate.

关键词： Ovary Mucinous Cystadenoma Borderline Tumor Premenarchal

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Skull metastasis from hepatocellular carcinoma with chronic hepatitis B

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World Journal of Gastrointestinal Oncology 2010年第3期2卷 165-168页

作者： Takashi Goto Takahiro Dohmen kouichi Miura Shigetoshi Ohshima Kazuo Yoneyama Tomomi Shibuya Ei Kataoka Daisuke Segawa Wataru sato Yumiko Anezaki Hajime Ishii Daigo Kon Ikuhiro Yamada Kentaro Kamada Hirohide Ohnishi Department of Gastroenterology Akita University School of Medicine

A 56-year-old male visited our hospital for evaluation of an occipital *** computed tomography showed hypervascular enhancement with osteolytic change in the skull and a huge enhanced mass in the *** resonance imaging showed bone metastasis in the thoracic *** for hepatitis B surface antigen and hepatitis B core antibody were positive and his liver condition was Child-Pugh grade *** diagnosis was hepatocellular carcinoma(HCC) with skull and vertebrae metastases on chronic hepatitis *** was treated with radiation therapy for bone metastases and transcatheter arterial chemoembolization for *** he developed acute respiratory failure because of aspiration pneumonia,congestion and oedema with haemorrhage of the lungs and *** showed HCC with multiple bone *** liver tumor was categorized as well-differentiated HCC,Edmondson classification Ⅰ,trabecular type and pseudoglandular *** the liver mild infiltration of lymphocytes was seen in Glisson's capsules which were signif icantly enlarged with well preserved limiting *** necrosis was not *** fibrosis was *** 8 cm × 7 cm × 3 cm metastatic lesion had formed in the left occipitotemporal part of the cranial *** lesion was osteolytic and showed invasion into the dura *** the subdural cavity nor the brain showed involvement from the metastatic ***,skull metastasis from HCC is very rare and it affects the patient's prognosis and the quality of ***,it is very important to make an early diagnosis and carry out proper management of skull metastasis from HCC.

关键词： Hepatocellular carcinoma Skull metastasis Bone metastasis Osteolytic change Chronic hepatitis B

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