[in Japanese]

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[in Japanese]

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We did retrospective assessment on the strategy of treatments for 19 mothers screened group B streptococcus［GBS］positive, antibiotics prophylaxis for 19 infants, the ratio of carrier of GBS in 19 infants, and the results of blood examination after birth from April 1, 2006 to January 31, 2008.　We had 594 deliveries during this period. The strategy of treatment for mothers screened GBS positive was done according to the protocol of Centers for Disease Control and Prevention［CDC］. We made our original protocol of antibiotics prophylaxis for infants, considering of numbers of times of antibiotics prophylaxis for mothers, whether mothers had preterm rupture of membrane［PROM］or not. The mean number of times of antibiotics prophylaxis was 1.68（ 1～4 times）, 8 cases out of 19 mothers had PROM, the mean time from PROM to delivery was 13.1 hours （1～29 hours）, the mean gestational age was 39 weeks （37～41 weeks）, the mean birth weight was 2964g （2084～3284g）. We did antibiotics prophylaxis for 12 infants （63%）, 2 out of 12 were detected GBS colonization, none of them suffered from GBS infection. We did unnecessary antibiotics prophylaxis for 10 infants. So we realized that we should exchange information about mothers more closely with obstetricians and we should avoid unnecessary antibiotics prophylaxis for infants.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Recently the entity of penetrating atherosclerotic ulcer (PAU) had been apparent. We had encountered a very rare case with periaortic multi-nodular lesions caused by repeated rupture due to PAU. A 61 year-old female patient visited us because of her back pain. Routine computed tomography demonstrated a giant abdominal aneurysm and many tumor-like lesions at periaortic area that were considered for metastatic lymphnodes before surgery. Although preoperative diagnosis was not so accurate, surgical treatment was performed 16 June 2000 because of the high risk of rupture. Laparotomy revealed the giant abdominal aneurysm, 9 cm in diameter, with thicken, uneven wall adhering to adjacent tissue such as retroperitoneal membrane and soft tissues.Surgical process is not so smooth but successful. There were many diverse ulcers and intramural hematomas in abdominal aortic aneurysm. Ulcers made several pseudoaneurysms looking like bunch of grapes.The patient underwent successfully extended polytetarafuroroethylene grafting and postoperative course was uneventful. Eight years later computed tomograhy depicted no sign of recurrence. We concluded that aggressive surgical treatment for PAU of infrarenal abdominal aneurysm should be performed because of avoiding a life-threatening rupture of aneurysm.

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　A 30-year-old woman was admitted to our hospital with complaints of abdominal fullness and vomiting. She was diagnosed as mechanical ileus diagnosed by various modalities. Therapeutic long intestinal tube was inserted soon after admission. But after that symptoms had not been improved, She was consulted to our department. By the review of CT images, abnormal findings, so called “Whirl sign”, was detected and diagnosed as volvulus of the small intestine. Emergency operation was performed about 7 hours after admission. The small intestine was found to be twisted clock wise by 360 degrees at the root of the superior mesenteric artery. Manual canceration was performed to preserve twisted small intestine. Postoperative course was uneventful and transferred 22days after operation. Ordinally volvulus of the small intestine was diagnosed in infants under 1 year old and rarely in adult like this case. For early detection of this desease, review of various modalities is so important. Especially abdominal CT scan provide useful information for successful diagnosis of this disease.

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　We have recently experienced three cases of colonic cancer with ischemic colitis. In all cases,colonoscopy revealed erosive change, mucosal edema , and longitudinal ulcer in the colon. According to the endoscopic findings , a diagnosis of ischemic colitis was made. Additionary, colonoscopy revealed advanced colonic cancer in the distal colon. The colonic cancers of all cases were treated surgically.Ischemic colitis occurs acutely with abdominal pain, diarrhea, and, hematochezia. Although relatively uncommon, we can find case reports of colonic cancer with ischemic colitis. In the case of ischemic colitis, we need to determine whether a colonic cancer exists.

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A 78-year-old man was found to have a 2-cm mass at the 1.2cm oral side of the papilla of Vater in upper gastrointestinal endoscopy. A biopsy specimen was diagnosed as a moderately differentiated adenocarcinoma. He showed no endocrinological nor gastrointestinal symptoms clinically except for glucose intolerance. The Serum somatostatin was elevated to 140pg/ml （normal: 1.0-12） preoperatively. Under a diagnosis of duodenal cancer, we conducted pylorus-preserving pancreaticoduodenectomy. The tumor invade the head of the pancreas. No metastasis to the liver, but the surrounding lymph nodes of the pancreatic head contained metastasis. The tumor cells were arranged in trabecular and glandular structures, but psammoma body was not observed. The tumor lacked mitotic activity. Immunohistochemically, the tumor was intensely positive for somatostatin, and positive for chromogranin, but negative for insulin, gastrin, pancreatic polypeptide, serotonin, and glucagons. The patient remains alive without recurrence 16 months after the surgery.

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A 38-year-old man was referred to us about headache. Acute hydrocephalus and round tumor showing high signal on T1 and low signal on T2 weighted signal at the anterior third ventricle was identified on MR images. The tumor was resected via transventricular approach with a guidance of stereotaxic tool. The tumor was diagnosed histologically colloid cyst, however the mass consisted of firm granules principally. These unusual signals on MR images of colloid cyst may predict the existence of mucin clump inside.

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[in Japanese]

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[in Japanese]

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