The Japanese Journal of Gastroenterological Surgery
Online ISSN : 1348-9372
Print ISSN : 0386-9768
ISSN-L : 0386-9768
Volume 25, Issue 9
Displaying 1-34 of 34 articles from this issue
  • Yoichi Saitoh
    1992 Volume 25 Issue 9 Pages 2259-2268
    Published: 1992
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    In our past experience with 251 cases of acute pancreatits, several problems have emerged. We have conducted basic analysis in hope of solving them. The results of our investigation are presented in this paper. First, the pathogenesis in initial stages of the disease is illustrated whereas disarray of pancreatic acinar microtubules is suggested to be involved in this process. In case of biliary pancreatitis, the promoting effect on pancreatic secretion by bile acids may trigger the disorder. In addition, intraductal hypertension within the pancreas in suggested to play an important role in its exacerbation. We have also studied possible pathogenesis involved in organ failures, and found the presence of hepatotoxic factor (s) in ascitic fluid as well as the involvement of macrophages in pulmonary dysfunction. In circulatory failure in both kidney and pancreas, there is an impairment of cytochrome oxydase system due to mitochondrail damage, for which perfluorocarbons may offer a useful treatment. Our results further indicate that immunosupression may play a role in excerbating the condition, which may effectively be prevented by transintestinal nourishment. It is also found that the serum level of trypsin protein eaterase activity is a useful indicator for both prognosis and severity of the disease. For the treatmnet of acute pancreatitis, significance of peritoneal lavage as well as of plasma excahnge is revealed. Hence, it is conducted that only aggressive approaches combining surgical resection of necrotic tissue with open drainage and the above modalities would be linked to better results, especially in severe cases.
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  • L. William Traverso
    1992 Volume 25 Issue 9 Pages 2269-2279
    Published: 1992
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
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  • Edward L. Bradley, William G. Whitaker
    1992 Volume 25 Issue 9 Pages 2280-2290
    Published: 1992
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
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  • Mitsuhiro Tomiyama, Hiroyuki Kato, Koichi Ono, Tomoo Okushiba, Masafum ...
    1992 Volume 25 Issue 9 Pages 2291-2300
    Published: 1992
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    One experimental arterio-portal shunt method was studied to make it clear whether it improves hepatic dysfunction after hepatic artery obstruction. Mongrel dogs were divided into two groups, those with ligated hepatic arteries (HAL) and those with arterio-portal shunts (APS) in which one end of the hepatic artery was anastomosed to the side of the portal vein following ligation of hepatic arteries. In the HAL group, mean total hepatic blood flow decreased to 53% and hepatic oxygen delivery to 43% of the control values, while portal vein resistance increased to 250% six hours after occlusion of the hepatic artery. On the other hand, in the APS group, total hepatic blood flow, hepatic oxygen delivery and portal vein resistance remained near their initial values at 124%, 108% and 70% respectively. Concentrations of total bile acid, GOT and GPT were lower in the APS group than in the HAL group. The arterial ketone body ratio was lower in the HAL group than in the APS group. In conclusion, this experiment made it clear that the arterio-portal shunt method had the beneficial effect of preserving hepatic blood flow and hepatic oxygen delivery during hepatic artery occlusion, and was useful in preventing liver failure.
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  • Norio Inoue, Seiji Endo, Rikiya Abe
    1992 Volume 25 Issue 9 Pages 2301-2307
    Published: 1992
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    We studied the role of Kupffer cells in the endotoxin-induced liver injury. Rat hepatocytes and Kupffer cells were primarily cultured, and viability of the hepatocytes were evaluated by MTT assay in vitro. Isolated hepatocytes were cultured in a medium containing different concentrations of lipopolysaccharide (LPS) (0, 25, 50, 100 μg/ml) for 24 hours. Viability of hepatocytes was not affected by LPS at any concentration. Isolated Kupffer cells were cultured for 24 hours in medium containing the same concentrations of LPS and no fetal bovine serum, and the medium was harvested. Isolated hepatocytes were added to these media replaced with these medium and cultured for 24 hours. Viability of the hepatocytes cultured in the medium in whick Kupffer cells had been cultured for 24 hours with LPS decreased significantly with increasing LPS concentration. We then performed the same experiment using Kupffer cells isolated from endotoxinemic rats which had been injected LPS (20μg) 24 hours earlier. The same Kupffer cell-mediated hepatotoxicity was obtained and the toxicity was much stronger than in the case of Kupffer cells isolated from normal rats. Hepatotoxicity of endotoxin in not a direct effect of endotoxin on hepatocytes, but is a Kupffer cell-mediated effect. It is suggested that Kupffer cells might be activated in endotoxinemia.
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  • Kazuhito Misawa, Yoshie Une, Yasuaki Nakajima, Naoki Sato, Shinichi Ma ...
    1992 Volume 25 Issue 9 Pages 2308-2313
    Published: 1992
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    Correlation between serum levels of AFP or PIVKA-II and the prognostic factors were evaluated in 48 resected hepatocellular carcinoma. Positive rate was 68.8% in AFP, 58.3% in PIVKA-II and 85.4% in both combination. The AFP level was correlated with none of the pathological factors. But in cases of PTVKA-II, the higher was it level, the higher was the incidence of intrahepatic metastasis, the more advanced the stage, the higher the rate of recurrence and the poorer the prognosis. In the patients of positive tumor marker at the first diagnosis, the rate of positive tumor marker at recurrence again was 45% in AFP and 38% in PIVKA-II. And in the patients of negative tumor marker at first diagnosis, the rate of positive tumor marker at recurrence was 13% in AFP and 0% in PIVKA-I. Therefore both tumor markers are necessary for diagnosis of HCC and monitoring after hepatoctomy. Especially, PIVKA-II was useful for evaluation of the stage and the patients with high levels of PTVKA-II were thought to be advanced HCC.
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  • Comparison of Clinical and Histopathological Findings
    Nobuhiko Ueda, Nobuki Takahashi, Hideo Yamasaki, Kazunori Hirano
    1992 Volume 25 Issue 9 Pages 2314-2320
    Published: 1992
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    The present study examined the operative timing for acute cholecystitis and compared clinical findings with histopathological findings of the resected gallbladder in 26 cases of acute cholecystitis. They were divided into three phases by histopathological findings: congestion and edema phase (A phase), necrosis and abscess phase (B phase), and absorption phase (C phase). Cases in B or C phase were subdivided into Bl and Cl phase in which inflammation reached the muscular layer, and were subdivided into B2 or C2 phase in which inflammation reached the subserosal layer. Patients in B phase, especially in B2 phase, frequently had associated complications before or after the operation. So for patients in B2 phase it is necessary to perform an emergency operation. For patients in A or B1 phase an early operation is necessary to prevent later complications. Severe inflammatory changes, such as muscular defense, fever over 38°C, leukocytosis over 15, 000/mm3, or on imaging findings, pericholecystic panniculitis, ascites, right pleural effusion, or subphrenic abscess, in addition to pericholecystic fluid accumulation, are important clinical findings from which B2 phase is conjectured.
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  • Tsukasa Azuma
    1992 Volume 25 Issue 9 Pages 2321-2329
    Published: 1992
    Released on J-STAGE: August 23, 2011
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    This study was aimed to clarify prognosis-regulating factors in gallbladder cancer invading the subserosal layer (ss cancer). Thirty-three patients with ss cancer confirmed microscopically were studied. The relationship between the mode of tumor spread in the subserosal layer, pathologic factors, and postoperative survival rates was examined. In the mode of tumor spread, the degree of depth of cancer infiltration in the ss (degree of ss inf), the ratio of the cancer-infiltrating area in the ss to the whole mucosal area (ss%), and the growth pattern (INF) in the ss were examined. The degree of ss inf showed significant correlations with lymphatic or venous invasion, regional nodal metastasis, and hepatic infiltration (p<0.01). The ss% also showed significant correlations with regional nodal metastasis and hepatic metastasis (p<0.01). No significant correlation was found between INF and pathologic factors. In the postoperative survival rates, significant differences were found in the degree of ss inf (p<0.01) and ss% (p<0.05) respectively, whereas no difference was seen in INF. Therefore, it was concluded that the degree of ss inf and ss% are important prognosis-regulating factors in ss cancer.
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  • Gohichi Iwasaki, Masao Kobari, Makoto Sunamura, Kazunori Takeda, Kiyoa ...
    1992 Volume 25 Issue 9 Pages 2330-2336
    Published: 1992
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    Thirty-eight patients who underwent pancreaticoduodenectomy during the past 8 years were divided into 2 groups according to the pancreatic and biliary drainage method. One was the previous method of T-tube and tube jejunostomy (19 cases), and the other was the RTPBD tube method (retrograde transhepatic pancreatico-biliary drainage tube method) (19 cases), the postoperative course and complications in the 2 groups were compared. Drainage volume of pancreatic juice was 163.5±13.7 ml/day in the previous method, and 113.4±15.2 ml/day in the RTPBD tube method, and that of bile was 292.3±24.4 ml/day in the previous method, and 323.4 ± 65.2 ml/day in the RTPBD tube method. These differences were not significant. Postoperative increase in ALP was found in 50-60%, and postoperative icterus was found in 20-30% of both groups. Anastomotic leakage of the choledochojejunostomy was found 1 case (4.5%) by the previous method, and 1 case (6.6%) by the RTPBD tube method, that of pancreaticojejunostomy was found in 2 cases (9.5%) by the previous method, and 3 cases (18.7%) by the RTPBD tube method, and these differences were not significant. The RTPBD tube method was easy to perform and was as effective as pancreatic juice and bile drainage after pancreaticoduodenectomy.
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  • Kazuo Hatsuse, Makoto Maemura, Satoshi Shouno, Michinori Murayama, Yos ...
    1992 Volume 25 Issue 9 Pages 2337-2341
    Published: 1992
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    We examined the efficacy of early intermittent hepatic arterial infusion chemotherapy(IHAIC)after resection of metastases from colorectal cancer for prevention of early recurrence in the remnant liver. Thirty-two patients were divided into 2 groups consisting of 20 patients with hepatectomy (group A), and 12 patients with hepatectomy followed by IHAIC(group B). Fluorouracil was given every 2 weeks in addition to mitomycin C every 4 weeks, and doxorubicin every 8 weeks in IHAIC. In group A, 17 patients had recurrences and in 10 of them, the site of recurrence was in the remnant liver. In group B, 5 patients had recurrences and in 4 of them, the site of recurrence was in the remnant liver. The cumulative disease-free survival rates with respect to remnant liver recurrence for group A and B, respectively, were 1 year, 28% and 79%; 2 years, 18% and 53%; 3 years, 0% and 53%. The differences in the disease-free survival rates between the 2 groups were statistically significant(p<0.001, 0.05).The cumulative survival rates, respectively, were 1 year, 82% and 100%; 2 years, 21% and 44%; 3 years, 10% and 44%. The differences were not statistically significant. We concluded that postoperative IHAIC was effective for prevention of early recurrence in the remnant liver. But more studies of chemotherapeutic agents and infusion routes are necessary to improve prognosis in view of the survival rate.
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  • Kazuyoshi Hoshino, Toshihisa Kijima, Seiji Moriwaki, Masao Yonekawa, K ...
    1992 Volume 25 Issue 9 Pages 2342-2346
    Published: 1992
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    We examined the relationship between the number of metastatic lymph nodes and prognosis of patients with colorectal cancer. One hundred patients with histologically proven lymph node metastasis and depth of wall invasion of ss (a1) or s (a2) underwent curative surgery for colorectal cancer in our department between 1977 and 1989. The 5-year survival rates for patients with 1, 2, 3 and 4 or more metastatic nodes were 56%, 63%, 34%, 35% respectively. Based on the above result, the patients were divided into 2 groups, those with 1 or 2 metastatic lymph nodes and those with 3 or more nodes, and the 5-year survival rates of the two groups were compared. The rate was 59% in the first group and 35% in the second, the difference being statistically significant. When the 5-year survival rate was calculated for patients with 1-3 metastatic lymph nodes and those with 4 or more nodes according to the TNM classification by the UICC, it was 54% in the first group and 35% in the second, but the difference was not significant. It appears likely that the classification of cases by 1 or 2 metastatic lymph nodes and 3 or more nodes is more useful for predicting the prognosis for patients with colorectal cancer.
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  • Shinji Yamamoto, Hidetaka Mochizuki, Kazuo Hase, Sachio Yokoyama, Yosh ...
    1992 Volume 25 Issue 9 Pages 2347-2353
    Published: 1992
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    rectum was evaluated by intraoperative laser doppler flowmetry in 38 patients with rectal cancer. With the probe sutured to the colonic wall, blood flow was measured at the serosal side of the sigmoid colon, 1cm anal to which anastomosis was planned. The average blood flow was 24.7ml/min/100g tissue, which was measured soon after laparotomy. On clamping both the IMA and the left colic artery the blood flow reduction rate was 16%, which was significantly greater than 9% on clamping the superior rectal artery only (p<0.05). In patients with Riolan arcade (RA), blood flow remained almost unchanged by clamping the involved arteries, while in patients without RA the reduction rate was 25% with a significant difference (p<0.001). Although blood flow was reduced both in the high ligation group and the low ligation group after the anastomosis was performed with involved arteries ligated and divided, no significant difference in the reduction rate was noticed irrespective of the ligation site and the presence or absence of Riolan arcade. On the ground that no anastomotic dehiscence was observed in any of patients with high ligation of the IMA, high ligation of IMA may safely be performed on the basis of appropriately preserved blood flow at the oral side of the anastomosed colon, regardless of the presence of RA.
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  • Hajime Yonekawa, Shingo Shima, Yutaka Yoshizumi, Yoshiaki Sugiura, Sus ...
    1992 Volume 25 Issue 9 Pages 2354-2358
    Published: 1992
    Released on J-STAGE: August 23, 2011
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    A case of esophageal carcinoma associated with dermatomyositis is presented. The patient was a 66 year-old man who had suffered from dermatomyositis since 1986. Because of mild pain on swallowing, esophagography and esophagoscopy were performed in May 1988, and carcinoma of the upper third of the esophagus was disclosed. He refused surgical treatment at that time, and no treatment was given for his carcinoma. His dermatomyositis had improved despite progression of his carcinoma, and he needed only a non-steroidal anti-inflammatory drug. He agreed to receive an esophagectomy in November 1989. Pathological examination of the resected specimen revealed well differentiated squamous cell carcinoma spreading from the lower to the upper esophagus and invading the adventitia. Metastases were found in the para-esophageal and subcarinal lymph nodes. The post-operative course was uneventful, and his dermatomyositis seemed to be in complete remission without medication. He survived for 14 months, and died of recurrence of the carcinoma.
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  • Yasuhiro Sakurai, Yasuhisa Fujimoto, Tetsuya Nanba, Tamahiro Nishihara ...
    1992 Volume 25 Issue 9 Pages 2359-2363
    Published: 1992
    Released on J-STAGE: August 23, 2011
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    A relatively rare case of gastric lipoma, in which computed tomography (CT) was proved useful for diagnosis is reported, with a review of 180 cases of gastric lipoma in Japan. The patients was 47-year-old man. A gastric submucosal tumor had been detected in an upper gastrointestinal series and endoscopic examination about 3 years before he was admitted to our hospital for further examination of the tumor, which was increasing in size. An upper gastrointestinal series and endoscopic examination revealed a submucosal tumor in the posterior wall of the stomach body. Diagnosis from the biopsy of the submucosal tumor was not possible, however a low CT number suggested that the tumor was a lipoma. The tumor was surgically extirpated. Histological examination showed that the tumor was a gastric lipoma composed of mature adipose cells. The results of this case suggest that a CT scan can help diagnose gastric lipoma.
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  • Kenji Dohden, Yukimitsu Kawaura, Yumiko Otake
    1992 Volume 25 Issue 9 Pages 2364-2367
    Published: 1992
    Released on J-STAGE: August 23, 2011
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    We experienced a case of gastric villous adenoma containing carcinoma. The patient, a 74-year-old woman, underwent subtotal gastrectomy for Borrmann 2 type advanced gastric carcinoma. Resected specimens showed another tumor measuring 25×30 mm near the Borrmann 2 type carcinoma. The tumor was diagnosed histopathologically as gastric villous adenoma, coexisting with Borrmann 2 type advanced carcinoma. Part of this villous adenoma was well-differentiated adenocarcinoma Gastric Villous adenoma is rare compared with large bowel villous adenoma. On the other hand, all gastric villous adenomas reported to date, including that in our case, contained carcinoma. Though gastric villous adenoma is rare, its treatment should be the same as treatment of cancer.
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  • Satoshi Hashimoto, Masayuki Uchimura, Shinji Waki, Hideo Kida, Kazuhir ...
    1992 Volume 25 Issue 9 Pages 2368-2372
    Published: 1992
    Released on J-STAGE: August 23, 2011
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    Injury to the proper hepatic artery occurs accidentally in abdominal trauma, lymph node resection of upper abdominal organs and so on. We describe three cases of injury to the proper hepatic artery. These injuries caused by trauma or intraoperative procedures. Postoperative angiographies revealed collaterals mainly from the hepaticoduodenal ligament. No patient had hepatic failure, but one of them had postoperative cholecystitis and an other had liver cirrhosis 10 years later. We conclude that ligation of the proper hepatic artery is permitted as long as a collateral circulation pathway is maintained. But after ligation, efforts to prevent liver failure and gall bladder necrosis and a long term follow-up are needed.
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  • Toshihiko Kobayashi, Yoshihiko Sano, Tadatoshi Okubo, Hiroshi Ogawa, H ...
    1992 Volume 25 Issue 9 Pages 2373-2377
    Published: 1992
    Released on J-STAGE: August 23, 2011
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    A case of liver tumor in a 54-year-old woman is presented. She has no history of use of oral contraceptives. She was admitted because of a space-occupying lesion of the liver. Anemia and jaundice were not found on physical examination. Alphafetoprotein was within normal limits. A tumor mass 3 cm in diameter was detected in the right lobe of the liver by ultrasonography and computed tomography (CT). Angiographic hypervascularity suggested a diagnosis of hepatocellular carcinoma, but the absence of accumulation in the lipiodol CT and slight tumor stain in the trans SMA (supra-mesentric artery) portal CT did not support it. Partial hepatectomy and cholecystectomy were performed. The tumor was soft and greenish brown measured 3.2 × 2.2 × 3.7 cm and was sharply demarcated. Histologically, proliferation of enlarged hepatocytes rich in glycogen and with abundant lipochrome was seen. Tumor cells were arranged slightly irregularly. Bile duct tissues were not found in the tumor and the final diagnosis was liver cell adenoma. Chronic hepatitis without liver cirrhosis was found in her background.
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  • Kenichiro Kaneko, Takahiro Ito, Hisami Ando, Haruhisa Hara
    1992 Volume 25 Issue 9 Pages 2378-2382
    Published: 1992
    Released on J-STAGE: August 23, 2011
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    Lymph node dissection of the hepatoduodenal ligament interrupts the main lymphatic drainage of the liver. This interruption usually causes no trouble clinically, but we report a rare case of dilatation of the lymphatic vessels at the porta hepatis following gastrectomy for gastric cancer. The patient was a 58-year-old man who had undergone distal gastrectomy with R2 + No12 lymph node dissection and cholecystectomy for gastric cancer. A large amount of ascitic fluid developed after the operation, but the ascites was treated successfully with conservative treatment. Six months after the operation he was readmitted because of epigastric fullness. Ultrasonography showed anechoic areas around the left branch of the portal vein. Fluid aspirated from the anechoic areas was clear, serous and yellowish. It had a high protein content and almost the same electrolyte concentration as the serum. The retention fluid consisted of the lymph of the liver. Introduction of contrast material into the retention cavity revealed vessel-like structures with constriction. The patient recovered after percutaneous transhepatic lymphatic drainage.
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  • Takanori Shimura, Masaru Suzuki, Tsuyoshi Tsukamoto, Masao Sanada, Ken ...
    1992 Volume 25 Issue 9 Pages 2383-2387
    Published: 1992
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    We experienced a case of hepatocellular carcinoma (HCC) presenting as obstructive jaundice as a result of its growth into the bile duct, and it was difficult to distinguish HCC from cholangiocellular carcinoma (CCC). The patient is a 43-year-old man complaining of back pain. Abdominal echography and CT revealed a 6 cm diameter tumor with localized bile duct dilatation in the left lobe of the liver. After admission, he gradually presented a clinical picture of obstructive jaundice, and percutaneous transhepatic cholangiography (PTC) was carried out. On the PTC, a soft radiolucent shadow from the left hepatic duct to the common bile duct was seen. A celiotomy was carried out under the suspected diagnosis of CCC, and left lobectomy with resection of the caudate lobe and the bile duct was performed. Macroscopic examination of the surgical specimen showed a tumor in the lateral segment, and from the tumor a thrombus was serially growing into the left hepatic duct and common bile duct. Histologically, all lesions were HCC of Edmondson's grade II without any component of CCC. The patient has been followed up with no evidence of recurrence.
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  • Youichi Sakamoto, Shinichi Matsuge, Yasuyuki Takahashi
    1992 Volume 25 Issue 9 Pages 2388-2392
    Published: 1992
    Released on J-STAGE: August 23, 2011
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    A case of hemobilia in a 72-year-old woman is reported. The patient was admitted to our hospital with acute cholecystitis caused by cholelithiasis in October 1990. Three days after admission the patient vomited large amount of blood. A diagnosis of hemobilia was made at emergency gastroendoscopy when blood was seen spurting from the papilla of Vater. Ultrasonography and computed tomography of the abdomen showed a large and expansive gallbladder. On the celiac arteriogram, active bleeding was not demonstrated. Seven days after admission sudden hematemesis recurred. Percutaneous transhepatic gallbladder drainage was performed, and massive old and fresh blood flowed out through the drain. Under the diagnosis of hemorrhage of the gallbladder, surgical exploration was performed. The gallbladder was very large and tense, and it measured 15 cm in length by 7 cm in diameter. The gallbladder was removed. The common bile duct was explored and endoscopic examination of the biliary tract was carried out. There was no evidence of bleeding arising from parts of the other biliary tract. There were four mixed gallstones in the gallbladder. The mucosa of the gallbladder was necrotic and denuted, but was not ulcerated. Microscopic examination showed a gallbladder thickened wall with severe inflammation, edema and hemorrhage. There was no evidence of neoplasm or arteriosclerotic changes. Hemorrhage of the gallbladder is rare. We found sixty one cases in the Japanese literature. If hematemesis or melena are found, hemobilia should be considered a possible cause.
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  • Kenji Kakizaki, Yasunori Kikuchi, Hidemi Yamauchi
    1992 Volume 25 Issue 9 Pages 2393-2396
    Published: 1992
    Released on J-STAGE: August 23, 2011
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    Amputation neuromas of the biliary tract are rare benign lesions, most of them follow cholecystectomy. A case of amputation neuroma of the common bile duct following gastrectomy is presented. A 52-year-old man was hospitalized because of obstructive jaundice, which had been noticed one and half year earlier and transient. He had had gastrectomy for duodenal ulcer six months before the first onset of jaundice. A percutaneous transhepatic cholangiogram had first shown narrowing of the common bile duct, which had developed to complete obstruction in the course of one and half year. No malignant findings were obtained by cytological examination of the bile, preoperatively, On laparotomy, a 4×2 cm mass was found in the choledochal area. However, no maligant change was seen in frozen sections. Cholecystectomy and resection of the common bile duct with reconstruction by Roux-en-Y hepaticojejunostomy were performed. A permanent section confirmed that the lesional tissue was amputation neuroma. He is well and free of jaundice 30 months later.
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  • Toshiya Ito, Kenya Chiba, Keiji Inoue, Kouichi Motoshima, Takashi Yama ...
    1992 Volume 25 Issue 9 Pages 2397-2401
    Published: 1992
    Released on J-STAGE: August 23, 2011
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    The patient was a 50-year-old man who visited our hospital with abdominal pain and fever as the primary complaints. A diagnosis of severe acute pancreatitis was made by various examinations, and infusion therapy, chemotherapy and hyperbaric oxygen therapy were administered in the ICU. As a result, the general condition and clinical laboratory findings improved rapidly. However, as abdominal pain and high fever recurred about three weeks after admission, with a WBC of 15, 500, strongly positive CRP, and aggravation of CT findings, a diagnosis of infectious pancreatic necrosis was made, and laparotomy was carried out. The operation consisted of removal with the fingers of lysed infected necrotic tissues in the retroperitoneum including the pancreas by the retroperitoneal route, followed postoperatively by continuous retroperitoneal lavage, which was maintained for eight weeks. Staphylococcus aureus was detected in the necrotic foci. This operation was a new procedure. Its objective was elimination of infectious necrotic materials and biologically active materials that may be produced after an operation as well as debridement of infectious necrotic foci in the retroperitoneum. The procedure therefore promotes wound healing and improved the general condition.
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  • Yuichi Tomiki, Yoshifumi Ri, Hitoshi Funabiki, Toshio Morimoto, Ryoich ...
    1992 Volume 25 Issue 9 Pages 2402-2406
    Published: 1992
    Released on J-STAGE: August 23, 2011
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    We recently resected a serous cystadenoma of the pancreas with obstructive jaundice in our department and the case report is presented in this article. A 56-year-old man visited our hospital with a main complaint of jaundice. An abdominal ultrasonogram and CT scan revealed a cystic lesion corresponding with the head of the pancreas, and angiography showed the tumor to be hypovascular. Serous cystadenoma was then diagnosed after laparotomy. Up to the end to 1988 a total of 69 patients, including ours, with serous cystadenoma of the pancreas were reported in Japan and are reviewed in this study. This disease is routinely diagnosed by imaging, description of the internal structure of the mass, and analysis of its contents. However, because some cases show image findings similar to those of mucinous type which tend to be malignant, it is desirable to confirm the diagnosis surgically.
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  • Tetsuro Sasada, Arimichi Takabayashi, Tomonobu Sato, Tetsuro Miyaoka, ...
    1992 Volume 25 Issue 9 Pages 2407-2411
    Published: 1992
    Released on J-STAGE: August 23, 2011
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    Fatty infiltration of the pancreas is a very common histological change which is distributed evenly in the different parts of the organ. It is very rare, however, that the same change is observed in a localized area in the pancreas. Only three cases of this change have been reported previously. A case of focal fatty replacement of the pancreas is presented here. A 39-year-old woman was admitted to our hospital complaining of back pain. Abdominal ultrasonography showed a round hyperechoic mass, 0.7 cm in diameter, in the body of the pancreas. Computed tomographic scanning revealed a low density area in the same site, which was not enhanced after intravenous administration of contrast medium. The lesion was enucleated. The resected specimen was spherical (0.6 cm in diameter), elastic-soft and yellowish. Histopathological examination showed that it was mainly composed of adipose cells without any malignant changes, in which small clusters of pancreatic acinar cells remained intact. A diagnosis of focal fatty replacement of the pancreas was made. When the tumors in the pancreas are detected in radiological examinations, the possibility of this pathological change should be borne in mind.
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  • Takayuki Aimoto, Masahiko Onda, Eiji Uchida, Yasuo Arima, Syinya Iida, ...
    1992 Volume 25 Issue 9 Pages 2412-2416
    Published: 1992
    Released on J-STAGE: August 23, 2011
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    We experienced a patient with a nonfunctioning islet cell tumor in the papilla of Vater. A 61-year-old woman, complaining of jaundice, was admitted to our hospital for close examination. Preoperatively, either cholangioma of the lower common bile duct or carcinoma of the papilla of Vater was suspected. At laparatory, a tumor mass was found in the papilla of Vater and a frozen section of the tumor showed evidence of malignancy, so pancreatoduodenectomy was performed. Microscopically, the tumor was composed of cells resembling the cells of the islet tissue in the adjacent pancreas. They were arranged in ribbon-like, winding cords interspersed with capillary spaces. With immunohistochemical staining, this tumor was negative for insulin, glucagon, somatostatin and pancreatic polypeptide. This patient was diagnosed clinicopathologically as having a nonfunctioning islet cell tumor in the papilla of Vater. She made a good recovery from the operation. Because nonfunctioning islet cell tumors in the papilla of Vater are uncommon and their clinical manifestations are nonspecific, the preoperative diagnosis of these tumors may be very difficult.
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  • Toshio Nakagori, Hirohumi Miyoshi, Yozo Tsunoda, Hideyo Takeuchi, Riki ...
    1992 Volume 25 Issue 9 Pages 2417-2420
    Published: 1992
    Released on J-STAGE: August 23, 2011
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    A case of carcinoma of the body and tail of the pancreas treated by gastric-preserving distal pancreatectomy with dissection of the celiac artery is reported. A 75-year-old woman was admitted to our hospital complaining of loss of appetite and weight loss. Computed tomography and abdominal angiography revealed invasion of both the splenic artery and the splenic vein by carcinoma of the body and tail of the pancreas, so we performed gastricpreserving distal pancreatectomy with dissection of the celiac trunk. The right gastric artery was divided at its origin from the common hepatic artery. The right gastroepiploic artery was preserved only for supplying blood to the stomach. The post-operative course was uneventful. At the time of discharge from the hospital on the 21st postoperative day, she was eating a regular diet. An upper gastrointestinal series showed normal gastric activity. We believe gastric-preserving distal pancreatectomy with dissection of the celiac artery has a significant role to play in the management of patients with pancreatic carcinoma.
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  • Ryohei Ishibe, Koki Tanaka, Kazuhiko Yamada, Naoki Ishizaki, Akihiro N ...
    1992 Volume 25 Issue 9 Pages 2421-2425
    Published: 1992
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    Two cases of pancreatic pseudocyst found in the splenic parenchyma are reported. Both patients had alcoholic pancreatitis. Both cysts supposedly extended from the pancreas towards the spleen with communications. The contents of the cysts showed high amylase concentration. The condition in which a pancreatic pseudocyst extends into the spleen is rare. To our knowledge, 27 cases have been reported in the Japanese literature. Males were predominant and almost all patients were habitual alcohol drinkers. Only three cases including one in this report were diagnosed preoperatively by percutaneous puncture which disclosed a high amylase level. Accurate preoperative diagnosis is useful for prevention of fatal complications. Removal of the entire pseudocyst according to its pathogenesis is important.
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  • Makoto Mitsusada, Kimiyoshi Shimanuki, Hiroshi Yamamoto, Kouichi Shino ...
    1992 Volume 25 Issue 9 Pages 2426-2430
    Published: 1992
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    We report a case of goblet cell carcinoid tumor of the appendix. An 80-year-old man was diagnosed as having peritonitis due to acute appendicitis and an appendectomy was performed. The postoperative histologic investigation revealed a goblet cell carcinoid tumor of the proximal part of the appendix and a gangrenous change in its tip. Although there was no tumor cell infiltration at the surgical margin, we considered performing a right hemicolectomy, because of adhesion of the appendix to the cecum and the microscopic finding of intralymphatic invasion. However, taking the patient's age and his bad cardiac state into acount, we did not perform subsequent operation. No evidence of metastasis was seen on post-operative diagnostic imagings. We also reviewed 23 cases of this rare tumor with histologic features of both carcinoid and adenocarcinoma in Japan. Our conclusion was that, if possible, a subsequent operation should be carried out, because of the rather malignant clinical behavior of this tumor.
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  • Yoshihiro Moriwaki, Koichiro Shinmyo, Hideo Hosoi, Masaaki Kitagawa, K ...
    1992 Volume 25 Issue 9 Pages 2431-2435
    Published: 1992
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    We report a case of mesenteric cyst. The patient, a 59-year-old woman, was admitted with a palpable abdominal mass. By using ultrasonography, computed tomography, magnetic resonance imaging, angiography etc., she was diagnosed as having an intraperitoneal cyst and an operation was performed. The tumor was found in the radix mesentery close to the third portion of the duodenum. The tumor involved the jejunal vessels, but they were able to be separated and the tumor was resected. The tumor was a unilocular cystic mass with a thick wall and the content was a dull yellow fluid. The tumor was histopathologically a pseudocyst with a chronic inflammatory cell infiltration. Adult cases of mesenteric cyst are rare and we discussed the clinical features of mesenteric cysts in adults as compared with those in children.
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  • Masanobu Komatsu, Takeshi Miyake, Naoki Miyazaki, Masaru Kawamura, Hir ...
    1992 Volume 25 Issue 9 Pages 2436-2440
    Published: 1992
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    54-year-old man underwent a wide resection of the right chest wall because of a tumor which was diagnosed histologically as a malignant fibrous histiocytoma. Five months later, during chemotherapy for lung metastasis, he developed a symptom of upper alimentary tract obstruction. A CT scan showed an intussusception caused by a small intestinal tumor as a leading mass. An operation revealed a jejuno-jejunal intussusception 10 cm in length, 15 cm distal to the duodenojejunal flexure. A round, brittle tumor measuring 5.0×6.7×3.5 cm was found in the resected jejunum. Its cut surface was necrotic and hemorrhagic. Pathological study revealed jejunal metastasis of the malignant fibrous histiocytoma. A metastatic intestinal tumor of malignant fibrous histiocytoma is very rare. This is the 6th case in the Japanese literature. CT scanning is effective for diagnosis of intestinal intussusception.
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  • Tetsunobu Udaka, Shigeharu Moriyama, Toshihito Hanaoka, Takahiro Kinos ...
    1992 Volume 25 Issue 9 Pages 2441-2445
    Published: 1992
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    Primary malignant lymphoma of the gastro-intestinal tract largely originates in the stomach or in the small intestine. We report a rare case of primary malignant lymphoma of the rectum. A 70-year-old woman came to our hospital with the chief complaint of anal bleeding. A rectal mass, which occupied the anterior wall of the rectum and extended 4 cm from the anal verge, was detected by digital examination. The tumor revealed an elevated lesion about 6 cm long by barium enema examination. Endoscopy showed that the surface of the mass was covered with rectal mucosa, and that it was multinodular and had an ulceration in the center. Histological diagnosis of the biopsy specimen was suspicion of malignant lymphoma. Abdomino-perineal resection with R3 lymph node dissection and partial resection of the posterior wall of the vagina were performed. The clinical stage was A1N1 (+) P0H0M (-), stage III. Histological and imunohistological diagnosis of the resected specimen was diffuse lymphoma, medium-sized cell, B-cell type (IgA, κ). The patient had multiple organ failure on the 10th postoperative day. Although she recovered from that, she unfortunately died of aspiration pneumonia 8 months after surgery. In this paper, we clinico-pathologically reviewed 65 cases of malignant lymphoma of the rectum reported in Japan from 1981 to 1992.
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  • Yoshiaki Kajiyama, Masahiko Tsurumaru, Yoshimasa Ono, Harushi Udagawa, ...
    1992 Volume 25 Issue 9 Pages 2446
    Published: 1992
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
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  • Genzan Shirohzu, Hideaki Yamana, Toshiaki Matsumura, Teruhiko Fujii, U ...
    1992 Volume 25 Issue 9 Pages 2447
    Published: 1992
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    Download PDF (2294K)
  • Yasuyuki Nonaka, Hiromi Iwagaki, Nagahide Matsubara, Toshikazu Kimura, ...
    1992 Volume 25 Issue 9 Pages 2448
    Published: 1992
    Released on J-STAGE: August 23, 2011
    JOURNAL FREE ACCESS
    Download PDF (2131K)
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