1.Effectiveness of Hospital Cooperation in the JA Hokkaido Kousei-Ren Organization for Medical Examination and Treatment of Pancreaticobiliary Diseases
Nobuyuki YANAGAWA ; Mizue MUTO ; Kazuhiko ICHIKI ; Chisato ISHIKAWA ; Momotaro MUTO ; Mitsutaka INOUE
Journal of the Japanese Association of Rural Medicine 2016;65(4):809-815
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
2.A Case of Sigmoid Colon Cancer Detected in Process of Virchow Lymph Node Metastasis
Momotaro MUTO ; Mizue SHIMODA ; Chisato ISHIKAWA ; Mitsutaka INOUE ; Hiroyuki TAKAHASHI ; Masahiro HAGIWARA ; Takanori AOKI ; Michinori HASHIMOTO ; Satoshi INABA ; Hidehiko YABUKI
Journal of the Japanese Association of Rural Medicine 2013;62(2):140-145
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.
3.Two Cases of Mucinous Cystadenoma of the Appendix Incidentally Found in Patients with Elevated Serum CEA Level
Momotaro MUTO ; Mizue MUTO ; Chisato ISHIKAWA ; Mitsutaka INOUE ; Akio MASUDA ; Hiroyuki TAKAHASHI ; Masahiro HAGIWARA ; Takanori AOKI ; Michinori HASHIMOTO ; Satoshi INABA ; Hidehiko YABUKI
Journal of the Japanese Association of Rural Medicine 2014;63(1):49-56
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.
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