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Background Recently, the prevalence of venous thromboembolism (VTE) in Asian patients with inflammatory bowel disease (IBD) is gradually increasing. IBD surgery is a well-recognized risk factor for VTE. However, there are no prospective studies about VTE after surgery for ulcerative colitis (UC) in Asia. This multicenter prospective study aimed to clarify the prevalence and risk factors for perioperative VTE in UC surgery in Japan. Methods A total of 134 patients with UC were included from January 1, 2013 to December 31, 2014. Preoperative screening was performed in all patients. In the perioperative period, standard VTE prophylaxis based on risk assessment was administered. The prevalence of pre- and postoperative VTE, its risk factors, and mortality rates were investigated. Results Perioperative deep vein thrombosis and pulmonary embolism were diagnosed in 15 (11.1%) and 1 patient (0.7%), respectively. All patients were asymptomatic. No surgery-related deaths were found (mortality rate 0%). Seven patients (5.2%) were diagnosed, and 8 (6.4%) during postoperative follow-up by ultrasonography or computed tomography. Forty-seven percent of VTE cases was developed preoperatively. A preoperative hospital length stay of over 5 days was a significant risk factor [P = 0.04; odds ratio: 8.26 (1.06–64.60)] for preoperative VTE. Postoperative deep vein thrombosis occurred in 8 of the 127 patients (6.4%). Six out of these 8 (75.0%) occurred after postoperative day 14. Perioperative blood transfusion was a significant risk factor [P = 0.04; odds ratio: 8.26 (1.06–64.60)] for postoperative VTE. Conclusion A VTE-conscious perioperative management is as necessary in Asia as in Western countries.

Rapid advances in microelectromechanical systems have stimulated the development of compact devices, which require effective cooling technologies (e.g., microchannel cooling). However, the inconsistencies between experimental and classical theoretical predictions for the liquid flow in microchannel remain unclarified. Given the larger surface/volume ratio of microchannel, the surface effects increase as channel scale decreases. Here we show the scale effect of the boundary condition at the solid–liquid interface on single-phase convective heat transfer characteristics in microchannels. We demonstrate that the deviation from classical theory with a reduction in hydraulic diameters is due to the breakdown of the continuum solid–liquid boundary condition. The forced convective heat transfer characteristics of single-phase laminar flow in a parallel-plate microchannel are investigated. Using the theoretical Poiseuille and Nusselt numbers derived under the slip boundary condition at the solid–liquid interface, we estimate the slip length and thermal slip length at the interface.

Identification of new tetrodotoxin (TTX, 1) analogues would be significant in the elucidation of its biosynthetic pathway and a study of its structure-activity relationships. In this study, a new TTX analogue, 6-deoxyTTX (2), was isolated from the ovary of the pufferfish, Takifugu pardalis, and the structure was determined using spectroscopic methods. Compound 2 was also identified in other marine animals, Nassarius snail and blue-ringed octopuses, using LC-MS. Furthermore, we investigated the voltage-gated sodium channel blocking activity of 2 by examination of the inhibitory activities to cytotoxicity induced by ouabain and veratridine in mouse neuroblastoma cells (Neuro-2a). The activities were then compared with those of 1, 11-deoxyTTX (3), and 6,11-dideoxyTTX (4). The EC50 value for 2 was estimated to be 6.5±2.2 nM, approximately 3-fold larger than that of 1 (2.1±0.6 nM) and approximately 20-fold smaller than that of 3. These results suggested that contribution of the C-6 hydroxy group to the activity is less than that of the C-11 hydroxy group.

Background: Previous studies have shown various risk factors for the initial and/or the second operation for Crohn's disease (CD). However, limited data are available with regard to the risk factors for a third operation. We aimed to clarify the risk factors for a third operation for CD. Methods: A total of 200 CD patients who underwent a second intestinal surgery at 13 institutions were examined. We performed univariate and multivariate analyses to examine the influence of independent variables on the cumulative rate of needing a third operation. Results: A total of 95 patients underwent a third operation. The overall 5-year and 10-year cumulative rates for the third operation were 42.2% and 71.0%, respectively. In univariate analysis, the interval between the initial and the second operation (P = 0.0069), postoperative administration of infliximab (P = 0.0030), and the anatomical site of the disease (P = 0.0132) were significant risk factors for the third operation. In multivariate analysis, the interval between the initial and the second operation (P = 0.0287) and postoperative administration of infliximab (P = 0.0297) remained significant risk factors for the third operation. The cumulative 5-year third operation rate was significantly higher in patients with an interval of less than 5 years between the first and second operations than for those with an interval of 5 years or more (47.8% versus 35.2%, P = 0.0232). Conclusions: An interval of less than 5 years between the first and the second operations is a significant risk factor for a third operation in patients with CD. (Inflamm Bowel Dis 2011;)

Crohn病に対する外科治療の原則は，健常部をできるだけ温存する病変部の切除である．また，線維性狭窄に対しては各種の狭窄形成術が行われ，病変に応じて消化管の可及的な温存が可能である．ストーマ造設はプアリスク症例や排便機能障害例において適応となる．術後の寛解維持療法については，6～12カ月ごとの内視鏡検査により軽度の病変では5-ASAを，中等度～高度病変に対しては免疫調節薬を加え，さらにInfliximabを用いるアルゴリズムが欧米では提唱されているが，本邦においては，これに成分栄養剤を加えたより丁寧な寛解維持療法が行われている．

To evaluate the efficacy of early diagnosis and early administration of corticosteroid for peristomal pyoderma gangrenosum, a prospective study was carried out.In April 1998, we began studying a new treatment regimen of peristomal pyoderma gangrenosum in which prednisone at a dose of 20 to 40 mg was administered systemically immediately after diagnosis. Early-stage peristomal pyoderma gangrenosum was treated concurrently with topical cadexomer iodine, and at the granulation stage, treatment with clobetasol ointment was started. Healing of peristomal pyoderma gangrenosum was determined by complete epithelialization of ulcer without pain or exudates. Patients were assigned to group A (n = 7) before April 1998 and group B (n = 10) after April 1998, and historical comparison was done between the 2 groups.In group A, all patients had ulcerative colitis, and in group B, 7 patients had ulcerative colitis, 2 had Crohn's disease, and one had indeterminate colitis. In group B, significantly earlier diagnosis (P = 0.0093), earlier start of treatment (P = 0.0057), higher initial dose of corticosteroid (P = 0.0052), and earlier healing of peristomal pyoderma gangrenosum (P = 0.0023) were observed.Early diagnosis and early corticosteroid administration appeared to be effective for promoting healing of peristomal pyoderma gangrenosum.

症例は54歳，女性．腹部CTで偶然発見された膵体部の内分泌腫瘍の診断で当科紹介．入院後精査にて，転移性肝腫瘍を伴っていたが，膵体部の腫瘍より尾側の膵に実質組織や主膵管を認めず，膵体尾部欠損合併膵内分泌腫瘍の診断．治療方針として，膵腫瘍は切除を行い，転移性肝腫瘍は肝動注療法を中心とした化学療法を行う方針とした．手術所見では，膵体部に腫瘍を認め，それより尾側は分厚い脂肪組織に置換し，膵実質・主膵管を認めなかった．膵中央切除術を行い，膵の消化管再建は行わなかった．組織学的には，高分化型神経内分泌癌であり，膵腫瘍の尾側は，ほぼ脂肪置換しており，ラ島を散在性に認めたが，膵外分泌細胞は認めなかった．術後の膵内分泌機能は良好で，耐糖能異常を認めなかった．膵体尾部脂肪置換を合併した膵内分泌腫瘍に対して膵中央切除術を行い，尾側膵の消化管への再建を行わなかった極めて稀な症例を経験したので報告する．

Abnormalities in humoral immunity are implicated in the pathogenesis of ulcerative colitis. However, the detailed mechanisms of B-cell activation in the locale remain unaccounted for. We analyzed ulcerative colitis from the standpoint of lymphocytic expansion in the loco. Intestinal specimens obtained at surgery from 30 patients with ulcerative colitis treated with corticosteroids and 15 with Crohn's disease were analyzed by immunohistochemistry and flow cytometry. Ulcerative colitis was characterized by a diffuse distribution of Ki-67(+) small round cells particularly in the ulcer base (that were CD19(+) and CD20(-)), with a significant number of them also CD138(+). Immunoelectron microscopy for CD19 revealed an abundance of rough endoplasmic reticulum in the cytoplasm. These indicated that they are of immature plasma lineage cells. By contrast, plasma cells in Crohn's disease were negative for CD19, and the labeling for Ki-67 was infrequent, showing mature phenotype. Flow cytometry revealed an occurrence of CD19(+) and CD20(-) cells in ulcerative colitis but not in Crohn's disease. The labeling index of Ki-67 among CD19(+) plasma cells was positively correlated with the clinical activity of ulcerative colitis. High labeling of Ki-67 in CD19(+) plasma cells is specific for active ulcerative colitis that was resistant to medical treatment by corticosteroids.

潰瘍性大腸炎(UC)とCrohn病(CD)の手術例における腸管外合併症の種類と頻度手術前後の経過について当科経験例を対象に検討を行った.UC233例中103例(44.2%),CD233例中99例(42.5%)に腸管外合併症が認められた.UC,CDともに胆石症が最多で,各々28例(12.0%),29例(12.4%)であった.その7割は術後に発症し,CDでは小腸型で有意に多かった.CDに特徴的な合併症としては微量元素・ビタミン欠乏症が20例(8.6%)に認められた.UCでは末梢関節炎,壊疽性膿皮症,ブドウ膜炎が各々20例(8.6%),16例(6.9%),7例(3%)に認められた.壊疽性膿皮症とブドウ膜炎は大腸全摘術後に改善することが多かったが,関節炎は逆に悪化または新たに発症することが多かった.UC,CDの外科治療では手術が各腸管外合併症に与える影響をよく理解することが重要である.

在宅中心静脈栄養療法(HPN)施行中の症例の問題点を検討した.対象は当科で経験したHPN症例19例(男:女=13:6,HPN導入時平均年齢38歳,平均施行期間3.3年)であり,その原疾患はクローン病が15例,非特異性多発性小腸潰瘍症が2例,慢性特発性偽性腸閉塞症が2例であった.HPNの適応は短腸症候群,難治性の肛門病変,経腸栄養不耐などであった.HPNの合併症ではカテーテル感染が最も多く,2年で約6割の症例がカテーテルの交換を必要とした.また代謝合併症として微量元素の過剰と欠乏,肝機能障害,骨軟化症などを認めた,HPNはメリットも多いが重篤な合併症も数多くあり,その施行に際しての経過観察と管理は慎重に行うべきであると考えられた.

240例のCrohn病手術例のうち,狭窄形成術は計151例に対して行い,2回目手術以降は狭窄形成術施行例の比率が増加していた.施行部位は,回腸,大腸,回盲弁などに行われ,回腸がもっとも多い適応部位であったが,2回目以降の手術では前回吻合部,前回狭窄形成部に対しても狭窄形成術が行われた.施行術式は,Heineke-Mikulicz法が最も多いが,病変の長さ,固さに応じて他の術式も行われた.狭窄形成術の長期成績を累積再手術についてみると,手術施行部位では狭窄形成部と吻合部とで差はなく,症例毎でも狭窄形成術併用群と,腸切除単独例とでも差はなかった,また,狭窄形成術併用群と腸切除単独群との比較では,病変長が長いにもかかわらず切除腸管の長さ,残存小腸長に差はなく狭窄形成術による腸管温存効果が認められた.狭窄形成術は,腸管温存効果も見られ,繰り返す狭窄性小腸病変には良い適応で切除に匹敵する成績が得られた.

目的・方法:潰瘍性大腸炎術後のpouchitisについて,診断,治療上の問題点を検討した.Pouchitisの診断にはPouchitis Disease Activity Index (PDAI) scoreと厚生省診断基準案を併用した.厚生省診断基準案の内視鏡所見で中等度以上に該当した症例に対して抗生剤を投与し,前後の臨床症状,内視鏡所見について検討した.結果:PDAI scoreと厚生省診断基準案は同様の結果であり,組織所見なしでも診断,重症度判定は可能であった.Pouchitis症例では排便回数は内視鏡所見とよく相関し,治療後有意に減少した.

症例は23歳女性.5年前にスプレー缶の蓋を膣内に留置してしまったが医療機関を受診せず放置し,次第に月経周期に類似した下血と腰痛が出現したため近医を受診した.大腸内視鏡検査で膣内異物と直腸膣瘻を指摘され経肛門的に異物除去術が施行されたが,2カ月後も瘻孔が閉鎖しないため当科を紹介された.初診時2横指大の直腸膣瘻と膣狭窄を認めた.回腸にループ式人工肛門が増設されたが6カ月後も瘻孔は閉鎖せず,根治目的に手術が施行された.瘻孔周辺の直腸と膣は高度の線維化により強固に癒着しており直腸・膣の修復は不可能であったため,再手術により子宮摘出・直腸切除,結腸肛門吻合術が施行された.3年2カ月の間にこれらの手術を含む計6回の手術が行われ直腸膣瘻は根治した.膣内異物による直腸膣瘻はまれな病態であるが,治療に難渋した自験例を若干の文献的考察を加え報告する.

The aim was to study the effect of intraduodenal capsaicin on interdigestive gastric contractions. Mongrel dogs were equipped with strain-gauge force transducers to measure gastroduodenal motility. The effects of intraduodenal capsaicin with or without pharmacological antagonists on spontaneous and motilin-induced interdigestive gastric contractions and on plasma motilin were studied in dogs with intact stomachs. The effect of intraduodenal capsaicin on gastric contractions was also studied in vagally denervated gastric (Heidenhain) pouch and vagally innervated antral pouch. Intraduodenal capsaicin inhibited spontaneous and motilin-induced gastric contractions. The spontaneous peak in plasma motilin was inhibited by intraduodenal capsaicin. The effect of intraduodenal capsaicin on motilin-induced gastric contractions was not affected by blockade of nitric oxide synthase, or by β-adrenoceptor antagonist. Administration of α-adrenergic blocker inhibited basal interdigestive gastric motility. Intraduodenal capsaicin had no effect on contractions in the Heidenhain pouch but inhibited those in vagally innervated antral pouch. Duodenal afferent fibres stimulated by capsaicin inhibit gastric contractions via a nitric oxide-independent extrinsic neural reflex.

We report here a case of granulocyte-colony stimulating factor (G-CSF)-producing esophageal carcinoma in a 66-year-old man. The International Union Against Cancer (UICC) staging was IV A, and a diagnosis of moderately differentiated squamous cell carcinoma was made, based on histopathology. The diagnosis was based on marked leukocytosis (41 500 leukocytes/mm3) and an elevated serum level of G-CSF (154 pg/ml). Immunofluorescent histochemistry and northern blot analysis confirmed the expression of G-CSF protein in cancer cells and its mRNA in cancer tissue. We paid special attention to any change in serum G-CSF levels during aggressive cancer treatment. Subtotal esophagectomy induced a significant decrease in G-CSF level. Adjuvant chemo-radiotherapy, targeting celiac lymph node metastasis, and radiotherapy, targeting solitary lung metastasis, together effectively maintained a low serum G-CSF level, despite a recurrence of the tumor in the lungs, in the form of multiple metastases, with an increase in serum G-CSF levels. The patient's clinical course suggested that serum G-CSF would be a useful marker for monitoring the effects of treatment on G-CSF-producing carcinoma.

To clarify the changes in vascular resistance in Crohn's disease, we studied changes in the thickness of arterial media histometrically. The resected specimens of mesenterium and intestine from 18 patients with Crohn's disease were used. Each intestinal lesion was classified into three grades: no inflammation, exudative change, and fibrosing change. In the ileum, significant atrophy in the media of the submucosal peripheral arteries was noted during exudative and fibrosing changes, while in the submucosal larger vessels or in the mesenterium, the thickness of the arterial media did not change. In the colon, atrophy in the media of the submucosal arteries was noted in all stages except in the larger vessel during exudative change, while no significant changes were noted in the mesenterium. In conclusion, it is suggested that circulatory disturbance occurs even in the early stage in Crohn's disease, and there seems to be increased vascular resistance in the area between the deep submucosal and the distal mesenteric arteries.

症例 : 症例は23歳, 女性.14歳時に下痢にてCrohn病発症後内科的治療を行ったが, 16歳時に腸管狭窄のため結腸亜全摘, 小腸部分切除, 回腸直腸吻合術を施行した.23歳時に直腸膣瘻 (RVF) 形成, 腸管病変再燃および胆嚢結石症を認めた.術後3ヵ月後に結婚を予定して外科を受診, 術式は患者の希望を考慮して吻合部切除, 回腸直腸吻合, 胆嚢摘出およびループ式回腸瘻造設術を施行した.結婚後妊娠希望で薬物治療は行わずに病変の再燃は認めなかったが不妊が続いた.産婦人科で25歳時に排卵誘発剤投与を受けて妊娠, 26歳時に帝王切開にて正常男児 (2550g) を無事出産した.妊娠期および周産期での病変再燃, 回腸人工肛門トラブル, RVF増悪などは認めず, 出生男児は順調に成長している.結語 : RVF合併したCrohn病症例で回腸瘻造設を行い妊娠, 出産が可能であった.

症例1:42歳,女.再燃緩解型,難治例として大腸全摘・直腸粘膜切除・回腸肛門吻合兼ループ式回腸瘻造設術を行ったが,術後約2カ月後よりストーマ周囲に疼痛を伴う潰瘍性病変と筋筒内膿瘍を認め入院した.一時prednisolone 20mgにて改善をみたが,さらに2カ月後より大動脈炎症候群を合併し潰瘍は再び増悪拡大した. dexamethazone 6mgの全身投与を開始したところすべての症状は消褪し2カ月後瘢痕治癒した.症例2:54歳,女.再燃緩解型であったが,重症発作のため大腸亜全摘兼回腸瘻・直腸粘液瘻造設を行った.3カ月後ストーマ周囲に疼痛を伴う潰瘍形成を認め来院した.prednisolone 30mgの経口投与を開始したところ3カ月半後に潰瘍は治癒した.炎症性腸疾患術後のストーマ周囲の病変には,壊疽性膿皮症の存在を念頭に置き治療に当たることが必要である.本報告例ではステロイド剤の全身投与が有効であった.

We aimed to evaluate time changes in reoperation rate after initial surgery in Crohn's disease (CD) over the last five decades in Japan and to assess the risk factors for reoperation, given that a decrease in the reoperation rate for CD remains controversial.CD patients (n-476) who underwent initial intestinal surgery were examined. Case records were collected from 13 institutions and scrutinized retrospectively. The primary outcome measure was the reoperation rate needing intestinal surgery. To evaluate the time changes, we compared medical treatment and reoperation rate in patients from two different periods of time; before and after 2002 when infliximab became available in Japan (1963-2002 and 2003-2008 groups). Univariate and multivariate analyses were performed to examine the influence of independent variables on the cumulative reoperation rate.A total of 201 patients underwent reoperation. Overall 5-year and 10-year cumulative reoperation rates were 31.4% and 61.2%, respectively. In multivariate analysis, an onset of the disease between 1963-2002 (p=0.0199) and postoperative administration of infliximab (p=0.0003) and immunosuppressants (p0.0001) were significant risk factors for reoperation. The cumulative 5-year reoperation rate decreased significantly in the 2003-2008 group compared to the 1963-2002 group (6.3% vs. 32.9%, p0.05).The reoperation rate for CD has decreased significantly in recent years in Japan. However, to further confirm this time trend, we need to evaluate CD patients with a longer follow-up period.

Infliximab is effective in the treatment of steroid-resistant Crohn disease. However, there is clinical concern about a possible correlation between an increased risk of anorectal cancer and infliximab treatment. We report a case of anorectal cancer in long-standing perianal Crohn disease. A 34-year-old patient with a long-standing perianal lesion of Crohn disease underwent 3 sessions of infliximab therapy. After therapy, the concentration of plasma CEA was 36.5ng/ml and rose to 91.4ng/ml. We suspected anorectal cancer, so abdominoperineal resection was performed. The histological findings indicated mucinous adenocarcinoma. Monitoring of patients with long-standing perianal Crohn disease is considered essential for early diagnosis of anal cancer after obtaining biopsy samples from perianal lesions. Additionally, when infliximab is started for perianal Crohn disease, thorough examination for perianal lesion should be performed.

Crohn病7例の狭窄性小腸病変に対する,strictureplasty(SXPL)の手術成績を検討した.症例は男4例,女3例,SXPL施行時の平均年齢は32.7歳であった,術後平均経過期間は17.1カ月(3～34カ月)であり,初回手術時の病型は,小腸大腸型5例,小腸型2例で,4例は同時に腸切除を行った.施行したSXPLの内容はHeineke-Mikulicz型22カ所,Finney型5カ所,Jaboulay型3カ所の計30カ所であった.術後,重篤な合併症はなく,全例症状とIOIBD scoreの改善を認め,良好な経過を示した.SXPLは安全な術式であり,積極的に施行すべき術式であると考えられた.

A 72-year-old man was given a diagnosis of Crohn's disease in 1976 at age 44, and partial resection of is ileum was performed. In November 1982, barium enema examination revealed on ileorectal fistula. As he had no complaint, conservative therapy was chosen. In August 2003, he had high fever and CT scan revealed presacral abscess. Ileocecal resection, partial resection of is small intestine and loop sigmoid colostomy were performed. In December 2004, the serum level of CEA was gradually elevated and he complained of anal mucus discharge. Endoscopic examination showed a fistula orifice in the rectum and biopsy of the fistula revealed mucinous adenocarcinoma. We performed abdominoperineal resection of the rectum with partial resection of the sacrum. We thought that careful observation helped the detection of such a rare case of carcinoma arising from a fistula tract.

In the pathogenesis of intestinal ischemia-reperfusion injury, the measurement of lipid peroxides needs to be established. Sprague-Dawley rat intestines were assessed after 30 minutes of occlusion of the superior mesenteric artery followed by reperfusion at 30, 60, 120, 180, 360 minutes. Grade of the mucosal injury, accumulation of the activated neutrophils and ICAM-1 expression were transiently increased after reperfusion. Two measuring methods of mucosal lipid peroxides using thiobarbituric acid reacting substance (TBARS) and phosphatidylcholine hydroperoxide (PCOOH) were compared. PCOOH level was significantly increased after reperfusion, while the mucosal TBARS level showed no significant change. In conclusion, lipid peroxidation could be detected with high specificity and sensitivity by measuring the mucosal phosphatidylcholine hydroperoxide level. lipid peroxide; intestine; ischemia

We previously reported that inhibition of gastric motility and hypertrophy of the small intestinal mucosa were observed after ileo-jejunal transposition which induced hypersecretion of enteroglucagon. Our aim was to study the effect of four enteroglucagon-related peptides (glucagon, glucagon-like peptide (GLP)-1, -2 and glicentin) on gastroduodenal motility and their mechanisms of action.The effect of these four peptides on motilin-induced interdigestive contractions was studied in dogs with vagally denervated gastric pouches equipped with four strain gauge force transducers on the pouch, gastric body, antrum and duodenum. Whether or not nitric oxide synthase inhibitor or phentolamine and propranolol reverses the inhibitory effect of those peptides was also studied.Glucagon inhibited contractions in the pouch and stomach but had no effect on duodenal contractility. GLP-1 inhibited contractions at all sites. GLP-2 inhibited contractions in the pouch but did not affect motility in the neurally intact gastroduodenum. Glicentin had no effect on contractions at any site. Pretreatment with either a nitric oxide synthase inhibitor or phentolamine and propranolol reversed the inhibitory effect of glucagon, GLP-1 and GLP-2 on contractions in the pouch, but did not alter the inhibitory effect of glucagon and GLP-1 on motility in the neurally intact stomach and duodenum.These results suggest that the effects of four peptides on gastroduodenal motility differ, and changes occur in the enteric neural modulation of motor activity after chronic surgical extrinsic denervation.

To assess the advantages of a laparoscope-assisted proctocolectomy with ileal J-pouch anal anastomosis compared with conventional procedures, we retrospectively analyzed the results of the two procedures as follows: Eleven patients including five patients with familial adenomatous polyposis (FAP) and six with ulcerative colitis (UC) underwent a laparoscope-assisted proctocolectomy and hand-sewn ileal J-pouch anal anastomosis at our department from June 1997 to November 1999. This laparoscope-assisted colectomy (LAC) group was then compared with a group of 13 patients who had undergone conventional ileal pouch anal anastomosis using a standard laparotomy from 1986 to 1997. The median operative time of the LAC group was 8 h 23 min, which was 81 min longer than that of the standard colectomy (SC) group. The number of days during which eating was prohibited were similar in the two groups but the median postoperative hospital stay was significantly shorter in the LAC group (24.1 days). In the LAC group, the small incisions showed better cosmetic results and there was also a remarkable reduction in the degree of postoperative pain. In conclusion, a laparoscope-assisted proctocolectomy with ileal J-pouch anal anastomosis can be employed widely in patients with FAP and also in selected patients with UC.

PURPOSE: Bacterial overgrowth sometimes complicates the clinical course of Crohn's disease and may lead to inappropriate treatment. To clarify the effect of antibiotic therapy, we monitored the hydrogen concentration in expiratory breath after fasting. METHODS: We evaluated 18 patients (15 males; median age, 32.7; range, 22.3–60 years) for postoperative bacterial overgrowth symptoms and for intestinal dilation by plain abdominal x-ray. Five patients had ileitis and 13 patients had ileocolitis. Various intestinal resections were performed in all, and strictureplasties were done at the same time in 13 patients. The median postoperative period was 10.2 (range, 1.2–102) months. Nine patients, who had symptoms such as bloating, nausea, vomiting, or pain, were classified as the symptomatic group, whereas nine other patients, who had no symptoms, were classified as the symptom-free group. Sixteen patients who had undergone intestinal resections for noninflammatory bowel disease served as the control group. After overnight fasting, hydrogen concentration in end-expiratory breath was measured with gas chromatography. At the same time clinical examinations of white blood cell count, hemoglobin, total protein, serum albumin, iron, sialic acid, and C-reactive protein in the peripheral blood were performed. To assess the effect of antibacterial treatment, changes in symptoms were assessed in eight patients who received antibacterial treatment. Hydrogen concentration was measured repeatedly before and after treatment in six patients. RESULTS: The symptomatic group had an expiratory hydrogen concentration level significantly higher (median, 40; range, 20–139 ppm) than the control group (median, 3; range, 1–6 ppm) and the symptom-free group (median, 4; range, 1–10 ppm). After the antibiotic treatment the symptoms were improved in all of the patients, and the hydrogen concentration level was significantly reduced (median, 4.5; range, 2–13 ppm). CONCLUSIONS: Antibacterial treatment was useful in the postoperative patients whose assessments were complicated by bacterial overgrowth. Using a hydrogen breath test, bacterial overgrowth was effectively monitored and managed, effecting a change in clinical symptoms.

Dear Editor: Familial adenomatous polyposis (FAP) is an autosomal dominant inherited disorder of the adenomatous polyposis coli (APC) gene. The APC gene is a tumor suppressor gene that is inactivated as the initial step in the formation of an adenomatous polyp as the gatekeeper of colonic neoplasia. Therefore, FAP is a colon cancer predisposition syndrome in precancerous colonic polyps. Thirty to 50% of new patients are solitary cases that perhaps represent new mutations of the APC gene. Symptoms such as bleeding and diarrhea appear gradually in early adulthood, and the mean age of cancer occurrence is approximately 40 years. Colorectal cancer will develop in virtually all affected patients unless the entire colon is removed. Total proctocolectomy followed by ileoanal (canal) anastomosis has been established as a standard surgical procedure for FAP. Patients who undergo this procedure are cured of the diseases by the removal of the entire colon. Continence and transanal defecation are preserved; however, the risk of cancer after this surgery is unknown. Crohn’s disease is an inflammatory bowel disease with unknown etiology. The geographic distribution of Crohn’s disease varies. While the terminal ileum is most often affected, the disease develops throughout the gastrointestinal tract, in the esophagus, stomach, duodenum, jejunum, ileum, colon, rectum, and anus. Crohn’s disease is an inflammation and ulceration process that occurs in the deep layers of the intestinal wall. The typical symptoms include abdominal pain, fever, weight loss, and diarrhea. The incidence of Crohn’s disease is now increasing in Japan and is estimated to be 2 to 3 patients per 10,000 people. In the present case, the patient with FAP initially intended to undergo total proctocolectomy and ileal Jpouch anal anastomosis. However, Crohn’s disease was intraoperatively found to be complicated with FAP, and a conventional Brooke’s ileostomy was constructed. A 40-year-old man was referred to our hospital with the diagnosis of FAP. He had no familial history such as FAP or colorectal cancer. His medical history started at 39 years when bloody stool was noted for the first time. At that time, he did not experience any other clinical symptoms to suggest the presence of inflammatory bowel disease. Total colonoscopy was performed to determine the diagnosis. A lot of small polyps, 2–5 mm in diameter, were noticed throughout the entire colon. A polyp, 10 mm in diameter, was also detected in the rectum 4 cm away from the anal verge. Advanced cancer was undetectable in any site of the colon and the rectum. Biopsies were taken, and histological examination revealed that the rectal lesion contained adenocarcinoma. He suddenly complained of abdominal fullness and pain. Abdominal radiograph suggested the presence of intestinal obstruction with unknown etiology. The symptoms spontaneously improved only by prohibition Int J Colorectal Dis (2006) 21:730–731 DOI 10.1007/s00384-006-0161-2

An X-ray intravital microscopy technique was developed to enable in vivo visualization of the coronary, cerebral, and pulmonary arteries in rats without exposure of organs and with spatial resolution in the micrometer range and temporal resolution in the millisecond range. We have refined the system continually in terms of the spatial resolution and exposure time. X-rays transmitted through an object are detected by an X-ray direct-conversion type detector, which incorporates an X-ray SATICON pickup tube. The spatial resolution has been improved to 6 μm, yielding sharp images of small arteries. The exposure time has been shortened to around 2 ms using a new rotating-disk X-ray shutter, enabling imaging of beating rat hearts. Quantitative evaluations of the X-ray intravital microscopy technique were extracted from measurements of the smallest-detectable vessel size and detection of the vessel function. The smallest-diameter vessel viewed for measurements is determined primarily by the concentration of iodinated contrast material. The iodine concentration depends on the injection technique. We used ex vivo rat hearts under Langendorff perfusion for accurate evaluation. After the contrast agent is injected into the origin of the aorta in an isolated perfused rat heart, the contrast agent is delivered directly into the coronary arteries with minimum dilution. The vascular internal diameter response of coronary arterial circulation is analyzed to evaluate the vessel function. Small blood vessels of more than about 50 μm diameters were visualized clearly at heart rates of around 300 beats/min. Vasodilation compared to the control was observed quantitatively using drug manipulation. Furthermore, the apparent increase in the number of small vessels with diameters of less than about 50 μm was observed after the vasoactive agents increased the diameters of invisible small blood vessels to visible sizes. This technique is expected to offer the potential for direct investigation of mechanisms of vascular dysfunctions.