[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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[in Japanese]

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[in Japanese]

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[in Japanese]

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Since the first laparoscopic cholecystectomy (LC) was reported in 1990, it has met with widespread acceptance as a standard procedure using four ports. In the meantime, single incision laparoscopic cholecystectomy (SILC) was performed by Romanelli in 2008, thereafter SILC has become popular gradually.Twenty-five cases undergoing SILC and twenty-five cases undergoing LC within same period were subjected to a clinical study on safety and advantage. The review included operative time, blood loss, length of hospital stay (LOS), postoperative pain, existence of complication. Postoperative pain was evaluated using postoperative analgesic use as primary outcome measures.Patients in the SILC group had shorter mean operative time (100.2 min. vs 123.5 min.) for the LC group and less blood loss (2.72 ml vs 10.88 ml). Overall LOS, analgesia requirements, and existence of complication were similar between the 2 groups.SILC resulted in less operative time, less blood loss and similar other clinical outcomes. Thus, it can be recommended as a safe alternative procedure in elective laparoscopic cholecystectomy.

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[in Japanese]

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[in Japanese]

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A 56-year-old man was referred to our hospital because of multiple subcutaneous nodules and left upper abdominal pain. CT scan showed an irregular mass in his pancreatic body and tail, and a number of nodules scattered throughout his subcutaneous adipose tissue. The histopathological examination of a subcutaneous nodule on his chest revealed poorly differentiated adenocarcinoma. Therefore, we diagnosed his nodules as cutaneous metastases originating from pancreatic cancer. Following chemotherapy with Gemcitabine, the subcutaneous tumors were markedly reduced in both size and number. After that, however, they began to grow again, and he died about seven months after initial treatment.

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　The advent of radiosurgery has recently changed the trend in the treatment of vestibular schwannoma (VS).Large (>or=3 cm) VSs often still need surgery. Hearing preservation is not easy when total resection is attempted.Subtotal resection of VS seldom leads to recurrence. Radiosurgery can be applied even if the residual VS recurs.We report two patients with large VS treated by intentional subtotal resection with hearing preservation. We recommend subtotal resection for large VS of the patient with serviceable hearing.

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A 64-year-old woman was introduced to our division because she was pointed out her big goiter by computed tomography (CT) in the close hospital. Her chief complain was slight swallowing disorder at the first visit. The nodule, about 5 cm in size, could be palpable at the left lobe of the thyroid. The isoechoic mass that the size was 4.1 cm in length was confirmed ultrasongraphically. Because of no information of the mediastinum, the enhanced CT had been done. As the result of this examination, the solitary tumor with lobular shape was found out. The operation was planned because she had a symptom due to goiter. The small incision of anterior neck was adopted to approach to the tumor of the left anterior mediastinum. After the partial resection of the nodule in the left thyroid gland, the nodule could be watched just like preoperated images according to enhanced CT and be extirpated. There are no signs of invasion, adhesion and special feeding vessels. The specimen consisted of two pieces (the tumor of left lobe: 5.5 by 3.0 cm in size, 26.9 g in weight; the mediastinal tumor: 3.9 by 2.8 cm in size, 10.9 g in weight).In conclusion, the enhanced CT was very useful for the doubtful case of intrathoracic goiter.

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We reported a case of appendiceal intussusception related to endometriosis. Few cases have been reported in Japan,According to literature, only 10 cases of appendiceal intussusception associated with endometriosis, including our case, have been reported.A 46-year-old woman developed bloody stool. Colonoscopy showed tumor in the cecum. Ba enema and enhanced abdominal CT scan revealed appendiceal intussusception with cystic mass. Therefore, the diagnosis of appendiceal intussusception related to appendiceal mucocele, and laparoscopy-assisted ileocecal resection with lymph node dissection was performed. The postoperative pathological findings were consistent with appendiceal endometriosis. Laparoscopic procedure is very useful to the treatment of the appendiceal intussusception, in respect of the curability and invasiveness.

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A 66-year old woman presented to our hospital with jaundice, hepatic dysfunction and hyperglycemia. Although we initially suspected pancreatic cancer, the patient was diagnosed with autoimmune pancreatitis (AIP). She was started on a daily dose of 35 mg of Prednisolone (PSL) after endoscopic biliary drainage. Although clear improvement was observed in the pancreatic and bile duct strictures, she began to suffer from shortness of breath and hypoxemia while tapering PSL and was again hospitalized with suspected interstitial pneumonia. Failing to respond to steroid pulse therapy, ventilation management was initiated but exacerbated interstitial shadows combined with bilateral pneumothorax and 110 days after admission, she died of exacerbation of respiratory failure. Although a pathological investigation was not performed and many points remain unclear, we strongly suspect IgG4-related interstitial pneumonia.

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