To evaluate the immune reactivity of the patients with cancer, peripheral lymphocytes, lymphcyte subsets, and natural killer cell activity (NK activity) were determined in 97 cancer patients, and their stages, performance status (PS), and nutritional status were comparativery studied.
A significant low level of NK activity was noted in stage IV patients, NK activity was decreased with advanced PS. It was significantly low at PS 3 and 4. A good coorelation between nutritional status and NK activity was observed, and a significantly decreased NK activity was noted in oligotrophia.
Among lymphcyte subsets, OKT 3 and 4 were significantly higher in stage i and PS1, and OKT8 appeared to increase with more advanced stage and PS. The OKT 4/OKT8 did not show significant difference depending on stages, however, tended to decrease with advanced PS.
It was suggested that NK activity reflects the condition of a cancer patient. Especially the good coorelation with nutrition was impressive. Though a certain tendency has been noted in the ratio of lymphcyte subsets, it appears to lack as good a coorelation as that in NK activity.

View full abstract

The serum SLX level in patients with breast, gastric and colorectal cancers were studied in order to clarify its clinical significance. Sera from a total of 225 patients (75 breast cancers, 61 gastric cancers, 35 colorectal cancers, ……) were analyzed in this study. Cut off value was determined at 28.0U/ml on the basis of the mean SLX levels from 68 healthy subjects. As a result, positive rates of SLX in patients with primary breast, gastric and colorectal cancers were 10%, 24.5% and 13.6%, respectively. These results indicate that the serum SLX level has little diagnostic value for primary cancer. However, positive rates of SLX tended to increased with advanced of the stage. Positive rates of SLX in patients with recurrent breast, gastric and colorectal cancers were 46.7%, 83.3% and 53.8%, respectively. Serial determination revealed that serum SLX levels chronologically increased with a progress of cancer. From these findings, it is suggested that the determination of serum SLX levels might be a useful diagnostic aid of recurrent cancers. It might be also a favorable monitor to evaluate the effectiveness of the treatment against cancer.

View full abstract

Thirty-eight pure mucinous carcinomas of the breast were studied from the clinicopathological and prognostic aspects, and compared with so-called mixed type of mucinous carcinomas (n=21) and invasive ductal carcinomas (n=1266). The pure type accounted for 2.5% of all primary breast carcinomas. The patients with the mean age of 50 years were characterized by a high occurrence in stage I and low occurrence in stage III, however, included two (5.6%) in stage IV. The positive lymph node metastases and vascular invasions were significantly less frequent. The 10-year survival and disease-free rate were 70.2% and 81.0%, respectively, and there were no significant differences among the three groups.
All of six recurrent patients had distant metastases. Recurrence was commonly found in patients who had nodal metastases and vascular invasion at the time of surgery. The disease-free period was as long as the mean of 57.6 months, however, the survival period after recurrence was not so long as 26.1 months. The prognostic factors are discussed.

View full abstract

Twenty-two elderly (over 80 years old) gastric cancer patients undergone operations were subjected to a review of the preoperative examination results, types of operation, complication rate, and hosptial mortality.
Early gastric cancers of protruded type and advanced gastric cancers of Type Borrmann 3 in lower third (region A) were common. The resection rate was 95.5%; the curative resection rate, 55.6%; the complication rate, 45.5%; hospital mortality, 18.2%; and operative mortality, 4.5%. In the preoperative examinations, the highest incidence of abnormal data was shown at the lung (68.2%), followed by those at the liver and the heart. The pulmonary complications occupied 70% of the postoperative complications. In the group having four or more abnormal items in the preoperative examinations, the complication rate was 71.4%, and hospital mortality rate was 42.9%. There were no significant correlations between the resected area of R-number (extent of lymph node removal), and complication rate or hospital mortality. The five-year survival rate of curative resection cases was a favorable 77.8%.
For enhancement of the operative result, the determination of an adequate region for resection and selective dissection of associated lymph nodes are both necessary, depending on the general status and local findings. Temporary gastrostomy with fine calibre tube, as well as forbiding smoking, chest physiotherapy, and tracheal cleaning, was beneficial to prevent pulmonary complications.

View full abstract

Until now, 21 cases of Crohn's disease (78% of total cases of this disease) have been surgically treated at our department. Of thse cases, 14 received a curative surgery (complete resection of the lesion). We analyzed postoperative relapes of the disease in these 14 cases. Postoperative relapse was seen in 2 (50%) of the 4 patients with Crohn's disease of the small bowel and 3 (33%) of the 9 patients with Crohn's disease of the small and large bowels. Of these 5 cases of postoperative relapse, 4 had relapse at a site close to the anastomoses. The mean timespan from the surgery to the relapse was 3 years and 3 months in patients with Crohn's disease of the small bowel and 11 months in those with Crohn's disease of the small and large bowels. The relapse rate was 13% for the patients with a preoperative IOIBD (International Organization for the Study of Inflammatory Bowel Disease) score of 4 or less and 67% for those with a preoperative IOIBD score of 5 or more. Of the 9 cases in whom the unaffected intestine was resected for 10 cm more proximal (adoral) from the lesion, no one showed postoperative relaps. Of the 5 cases in whom the unaffected intestine was reseacted for less than 10 cm proximal from the lesion, all showed postoperative relapse. However, no correlation was found between the relapse rate and the length of the resected unaffected intestine distal (towards the anus) from the lesion. Reoperation was done in 2 cases because of fistulation.

View full abstract

Recently it has been recommended that radical operation of Hirschsprung's disease shall be performed without colostomy.
The indication of colostomy in the patients with Hirschsprung's disease was evaluated retrospectively. From our study colostomy should be indicated in the following circumstances: 1. Aganglionosis is extended to above the descending colon. 2. The patient in neonatal period is poor condition. 3. Bowel habit is not controlled by conservative therapy.
The conservative therapy before the radical operation includes enema or lavage of the colon using warmed saline and should be carried out carefully.

View full abstract

Colorectal cacinomas of 58 patients aged 75 years or over who recieved bowel resections, were clinicopathologically studied compared with those of 373 patients aged 40 to 74 during 22 years from 1965 to 1986. Cancers in older patients indicated following features: (1) higher frequency in right sided colon, localized carcinoma and pm invased cancer, (2) variety in histological classification, (3) lower frequency in degree of matastasis and advanced stages, (4) satisfactory resectability (90.6%), operative mortality (5.3%), and 5-years survival (74.9%). These data suggest that radical surgery for colorectal carcinoma in aged patients is justificable.

View full abstract

Accessory liver is a developmental anomaly of the liver first reported by Wagner in 1861, that is noted quite seldom. Since when Tasaki reported in 1904 in Japan, only 36 cases have been reported. In recent two years the authors experienced as many as five cases with accessory liver, which have been studied clinicopathologically. The patients were of 38 to 63 years old, including 4 males. They were asymptomatic, and it was found coincidentally during the surgical operations for other diseases. These accesory livers were located at the body and the bottom of the gallbladder in 2 cases each, and at hepatoduodenal ligament in 1 case, centring around gallbladder, the trend of which was same as reported. All of them had one accessory liver of 12×8mm maximum and 6×3mm minimum in size, and ovoid or oval in shape. Further, communication with the primary liver has not been made through parenchyma but through restiform tissue.
Histopathologically all of the patients showed Glisson's sheath and central veins, revealing a shape similar to heaptic lobule. In addition, in the part communicated with walls of the gallbladder, dilatated bile duct and blood vessels were noted, that are considered to communicated with the primary liver through the restiform part.

View full abstract

Twelve patients with nonparasitic hepatic cyst (NPHC) who were treated surgically have been studied. Thehepatic cysts were classified according to their morphologic features into three groups in clinical prctice; 1. solitary, 2. scattered, and 3. polycystic types. It was recommended in this study that surgical management of symptomatic NPHC was guided by the type of the cyst and its content. Fenestraton operation is recommended for polycystic liver, and deroofing operation, for solitary and the main cyst of scattered type as the first choice, when theses cysts contain colorless or yellow clear fluid. Small cysts of scattered type are treated with ethanol injection under ultrasonically guided puncture. If the content of the cyst is brownish, turbid or mucinous, complete extirpation of a cyst or hepatectomy should be considered case-by-case.

View full abstract

Thirty nine cases of unresectable liver cancer (12 of primary and 27) of metastatic cases 0 were subjected to portal infusion chemotherapy, where intra-arterial injection was occasionally added, using a subcutaneously buried "reservoir" which was originally deviced. Antitumor effect was shown in 9 out of 12 cases of primary liver cancer, and in 13 out of 27 of metastatic liver cancer. When the subjects were divided into two groups, a long-term group treated for a month or more and a short-term group treated for less than a month, a significant life prolongation effect was noted in the long-term group, which was particularly remarkable in metastatic cancers (p<0.01). Moreover, the subcutaneously buried reservoir was available for cancer patients to grade up their quality of life.
In an attempt to demonstrate the availability of the portal regimen experimentally, 5-FU was given to adult dogs by intravenous or intraportal route and the blood and hepatic tissue levels were determined. Significantly higher levels were noted in dogs given 5-FU through the portal vein (p<0.01).
These findings have indicated an availability of the portal infusion chemotherapy using reservoir in unresectable liver cancers.

View full abstract

In order to prevent pancreatic fistula after distal pancreatctomy, we performed a new method, that is, partial occlusion of the main pancreatic duct and its smaller ductules with prolamine (Ethibloc®). This method was performed in 30 cases of gastric malignancies (Ethibloc-group). This Ethibloc-group was clinically compared with other 30 cases without Ethibloc injection (Non-Ethibloc-group). Regarding the incidence of postoperative pancreatic fistula, Ethbloc-group (10%) was significantly lower than that of Non-Ethibloc-group (36.7%). On the first day after operation, both serum and drain exudate amylase levels had been elevated extraordinary in Ethibloc-group. However, these elevations were recovered rapidly by seven days after operaiton. Localized and transient pancreatitis must have developed in accordance with the part of pancreatic duct occlusion. As to histological changes, several reports by some investigators suggest that progressive atrophic fibrosis of the pancreas would occur in the part of Ethibloc injection. This technique of Ethibloc-occlusion, which has advantages of safety and simplicity, is considered useful for the prevention of pancreatic fistula.

View full abstract

Three hundred and seventy three adult patients operated on for hernia in the last 21 years were reviewed.
Inguinal hernia lateralis and medialis were more common in males as shown in the male-to-female ratios of 201:57 and 18:1 respectively, while femoral and cicatrical hernia were more common in females as the ratios of 3:23 and 10:48, respectively. Yearly analysis of age distribution of male inguinal hernia lateralis revealed a two peaks pattern at ages of 30s and 60s in the former period (1967-73), and one-peak pattern at age of 60s or 70s in the middle (1974-80) or latter period (1981-87), respectively. On the other hand, no remarkable change was observed in females with a two-peaks pattern at ages of 20-30s and 60s, and a possible contribution of aging and pregnancy/delivery to occurrence of hernia was indicated. Furthermore, an increase of all types of hernia was observed in the latte period rather than other periods. These findings suggest that the positive attitude toward operation of physicians and aged people themselves, which was induced by their consideration of a progress of aged society, medical repletion, and the remainder of their lives, might result in an increase in number of operative cases for hernia.

View full abstract

A case of adenomatous goiter with hyperthyroidism, complicating thyroid carcinoma, is reported together with appropriate discussion. The patient was a 51-year-old woman, complaining of the recent expansion of a tumor of the cervical area which had first appeared one year before. On preoperative examination hyperthyroidism was evident, and hot nodules were noted in the upper sides of both thyroid lobes on thyroid scintigram using 123-1.
Ultrasonic examination disclosed multiple cysts of the entire thyroid gland. Papillary carcinoma (about 1cm) was noted in a part of the resected right lobe, and accordingly the diagnosis of adenomatous goiter withhyperthyroidism complicating thyroid carcinoma was made.

View full abstract

Primary hemangiopericytoma of the breast is a rare disease, especially the malignant one is.
Preoperative examinations of a 48-year-old woman had indicated an advanced breast cancer. According to the General Rule for Clinical and Pathological Record of Mammary Cancer, it was diagnosed as T4bN1bMO Stage IIIb. Radical mastectomy was carried out. The resected specimen revealed that yellowish and grayish white tumor was arising in the mammary gland, accompanied by hemorrhagic necrosis, and had not invaded the greater pectoral muscle. Histologically, it was poor in connective fibers; the tumor cells seemed to fill up between numerous vessels;and mitosis was frequently found. From these findings, she was diagnosed to have a malignant hemangiopericytoma which was keratin-negative and epitherial membrane antigen-negative. Furthermore, the diagnosis was immunologically confirmed, because factor 8 was not stained with the tumor cells but did with some area of the vascular endotherium. Electron microscopy also showed the characteristic features.
In Japan, only few cases of primary hemangiopericytoma of the breast have been reported, particularly fewer cases of malignant hemangiopericytoma having been found.

View full abstract

In the Western Countries, lobular carcinomas of the breast are found in about 5-10% of all breast cancers, and they are characterized by frequent occurrence of bilaterality and multicentricity. In Japan, however, lobular carcinomas have been considered not only to be rare, but also to be devoid of such clinical characteristics. We report a 35-year-old female patient with bilateral and unilaterally-multicentric (4 primary lesions in the right breast) lobular carcinomas. Recently, the incidence of the breast cancer has been increasing in Japan along with the westernization in life style. This case may be an example indicating a westernization of clinical features of breast cancer in Japan.

View full abstract

The clinical and pathologic feature of two cases of squamous breast cancer are presented, togerther with a review of 56 cases appeared in the domestic literature. Case 1 is a 57-year-old woman, histopathologically who had scirrhus carcinoma and squamous cell carcinoma (SCC), and the case 2, a 61-year-old woman, having papillotubular carcinoma and SCC. Axillary nodal metastasis was positive in both cases, which were of SCC pattern in case 1 and of papillotubular carcinoma pattern in case 2. Estrogen and progesterone receptor assaies were both negative in case 1 but both positive in case 2.
A review of the literature shows that squamous breast cancer seems to be more common in elder patients, with the average of 50.3 years in Japan. A patient population of SCC mixed with invasive ductal carcinoma (adeno-SCC) has more frequent nodal involvement than that of pure SCC; and the positive lymph nodes involve SCC rather than invasive ductal carcinoma. Hence, a possible difference has been suggested in biological behavior of SCC cells between pure SCC and metaplastic carcinoma including adeno-SCC.

View full abstract

A 65-year-old female with atypical coarctation of the aorta associated with bilateral occlusions of the subclavian arteries, showing marked pressure gradient and calcification of the aorta, was successfully operated by the method of extra-anatomic bypass grafting using a PTFE tube 19mm in diameter from the ascending aorta to the abdominal aorta above the bifurcation. The operative procedure consisted of a bypass graft from the ascending aorta to the abdominal aorta is considered the first choice of surgical management in the cases of atypical coarctation of the aorta associated with a marked calcificaiton of the descending aorta.

View full abstract

Seven patients undergone intra-aortic balloon pumping (IABP) after cardiovascular surgery could survive without vascular complication and/or ischemia of the limb which might be caused by IABP. For prevention of vascular troubles of the lower limbs, some active therapeutic attempts were employed as follows:
1) Balloon insertion through the femoral artery and continuous injection of heparin (3 cases).
2) Balloon insertion through the femoral artery and femoro-femoral arterial bypass 91 case).
3) Balloon insertion throught the left common iliac artery and axillo-femoral arterial bypass (2 cases).
No cases developed femoral arterial thrombosis nor ones demanded arterial dissection were experienced. Surgical insertion of IABP appears to be safer than the percutaneous route. In addition, active prophilactic surgery is effective in such cases as to have possible factors to develop limb ischemia including atherosclerosis.

View full abstract

A case of traffic accident who could be successfully diagnosed as acute traumatic diaphragmatic hernia shortly after the accident is reported.
The case showed typical shock signs such as hypotension, and respiratory disturbance in early stage, despite of the absence of any other traumatic lesion in the thraco-abdominal region.
Loose retroperitoneal fixation of the ascending colon was considered to be the explanation for the atypical course of the case.
Close observation on physical findings and radiological check up are thought to be very important and would make early diagnosis possible.

View full abstract

A case of inflammatory fibroid polyp of the ileum which played a role of the presentation to cause intussusception is reported.
A 38-year-old woman complained of hypogastric pain. Ultrasonography and X-ray examination of the lower gatrointestinal tract offered suspicion of an intussusception and a mass at the ileum. Endoscopic examination of the lower GI tract revealed a tumor mass, about the size of tip of the thumb, not at the ileocecum but at the leson distant from the end of the ileum by 50cm to the oral-side. From these, a behavior of the tumor as the presentation to cause intussusception and to be restored during examinaitons was inferred. The small intestinal lesion of about 20cm including the tumor was excised. Histopathologically, a proliferation of collagen fiber mainly in the submucous layer and an inflammatory cellular infiltration were shown. She was diagnosed to have inflammatory fibroid polyp.
This disease having no characteristic symptoms is difficult to be diagnosed definitively and preoperatively. But it is really necessary to carry out active examinatons, bearing in mind that the disease is one of the possible causative factors to induce intussusception.

View full abstract

Peritonitis chronica fibrosa incapsulata is a relatively rare disease, and no ethiologic theory has not been established as yet. We experienced a case which appered to be of the disease.
A 36-year-old woman was referred to our hospital, whose treatments under the diagnosis of postoperative ileus had failed, and laparotomy was performed. Operative findings revealed that whole the small intestine formed nearly a lump, and an area, locating from the ligament of Treitz by 40cm to oral-side of the ileocecum by about 15 cm, was covered with white capsula. The surgery included the excision of the capsula and adhesiotomy. Pathological findings of the capsula indicated a membranate structure made of chollagen.
This case is considered to be of peritonitis chronica fibrosa incapsulata. Various causes such as tuberculois and nonspecific inflammation have been discussed for the disease, but in this case anamnestic peritonitis might cause the disease.

View full abstract

During recent 5 years, we have experienced 2 cases of intussusception in adults, which is common in cheldren but relatively rare in adults. Case 1) was a 20-year-old male with the chief complaint of abdominal pain. He was diagnosed as appendecitis, but his appendix was normal at laparotomy. Ileo-cecal resection was carried out, because an intussusception was found that was caused by inflammatory tumor in the cecum. Case 2) was a 74-year-old male with the chief complaints of abdominal pain and a mass at the left upper abdomen. Preoperative CT scan revealed intussusception. Left hemicolectomy was carried out. A polyp, 1.5cm in diameter, was found in the sigmoid colon which was a typical adenoma histologically.
CT scan is a useful diagnostic means for intussusception.

View full abstract

We experienced an unusual case of amoebic dysentery with lange intestinal perforation that was developed after surgery under first diagnosis of acute appendicitis.
The patient was a 30-year-old Pakistani male, complaining of diarrhea and right side low abdominal pain. Except an increase of leukocyte and accelerated erythrocyte sedimentation, neither blood biochemical examination non ultrasonography revealed any remarkable abnormalities. Because of his increasing revere ileocecal pain appendectomy was made under diagnosis of appendicitis. After an one-week favorable potoperative course, he suddenly suffered from high fever with shoking chill at night time. A suspicion of malearia was risen from his anamnesis, adequate treatment were added, but the symptom of peritonitis appeared. Emergent laparotomy revealed a perforation in the ascending colon and also rupture of heaptic obscess. So he was diognoed as amoebic dysentery. Nourishing amoeba worm was found in the mucus of resected colon and also in the destroyed material of hepatic obscess. After that, he had complications of re-perforation at the residual infectious intestine and failure of utures, leading to reoperation.
Fortunately the patient was gradually getting well and his life could be saved. We think this is a very interesting case to study the fulminant change in amoebic dysentery.

View full abstract

For recent 14 years we have encountered seven cases of diffuse infiltrative carcinoma of the large bowel, in which the male-to-female ratio was 4:3 with the mean age of 49.1 years. The lesions located at the rectum and/or sigmoid colon in all cases. Those pathological types included signet-ring cell carcinoma in 2, poorly differentiated adenocarcinoma in 2, moderately differentiated adenocarcinoma in 2, and well differentiated one in one case. Markedly fibrous proliferation was seen in 5 cases. All of them were resectable but in 5 cases the operations were palliative. Except the one case which has been free of malignancy after 22 months, the patients died within 12 months.
125 cases of diffuse infiltrative carcinoma of the colon have been reported in Japan. Most of the patients were found at advanced stages and about 80% of them died within one year.
Diffuse infiltrative colorectal carcinoma is a highly lethal neoplasma, and early detection of such a special cancer is really expected.

View full abstract

Anal carcinoma associated with perianal Pagetoid lesion is extremely rare, and only five cases of the disease, including ours, have been reported in Japan. We describe here our case and a review of the domestic literature.
On July 3, 1986, a 65-year-old man came to our hospital with chief complaints of perianal erythema and a left inguinal mass. Biopsy of perianal skin and the inguinal mass revealed perianal Pagetoid lesion and a metastasis to lymph node, respectively. On July 21 the patient was admitted, and underwent operation of August 4. Abdomen perineal rectectomy involving the skin distant from the lesion by 4cm, and dissection of left inguinal lymph nodes (Byron) were performed. Histological findigns of specimens revealed that it was a mucinous cell carcinoma originated in the anal canal which might develop subepidermally to form the perianal lesion. Histochemical characteristics of the cancer cells at both sites inclulded PAS-and Alcian blue-positive. On day 49 after surgery the patient was discharged, but after 9 months he died of respiratory insufficiency due to bilateral lung metastasis.

View full abstract

Three cases of bile duct tone, including one of intrahepatic bile duct stone and two of choledochal residual stone, were treated with laer irradiation under fiberscope, uing Molectron Nd-YAG Laer Model 800. The laser regimen was carried out by inserting choledochofiberscope through postoperative T-tube fistula or PTCD fitula. In all three cases the bile duct stones were successfully removed.
This laser technique is effective for incarcerated stones or those having diameters lager than that of fistula.

View full abstract

Pseudocyst of the pancreas that is not improved by conservative treatment has conventionally been treated by surgery, but percutaneous cystic drainage is coming to be used as emergency treatment for some cases in which the cyt rapidly becomes enlarged or which show severe inflammatory symptoms. We carried out percutaneous cystic drainage under ultrasonic guide with favorable results in the following 3 patients with pseudocyst of the pancreas; Patient 1: a 55-year-old man with giant pseudo cyst of the pancreas developing after trauma of the pancreas; Patient 2: a 35-year-old woman with pseudocyst of the pancreas developing after operation for pancreatic adenoma; Patient 3: a 55-year-old man with pseudocyst of the pancreas due to chronic pancreatitis. Percutaneous cystic drainage could provide symptomatic remission in these three patients, and the former 2 showed healing as a result of the drainage alone. Patient 3 underwent caudal pancreatectomy after improvement in systemic symptoms resulting from communication with the major pancreatic duct. Then the condition became healed. The percutaneous cystic drainage is, therefore, considered to be useful as an emergency treatment for pseudocyst of the pancreas and it has been proved to be a possible radical therapy.

View full abstract

Splenic metastasis from colon carcinoma is quite rare. Especially the localized plenic metatasis, which is the indication for splenectomy, is extremely rare since most splenic metastases are found as a part of wide-spreaded metastases. A case of resected splenic metastasis from colon carcinoma is reported.
A 51-years-old woman developed ascending colon carcinoma with high serum level of CEA (77.0ng/ml). Although srum CEA level have been nrmalized after the resection of primary lesion, it elevated again afterwards. Exploratory laparotomy was performed as the second operation and it revealed three peritoneally disseminated metastatic lesions. After the resection of those lesions, serum CEA decreased once, but it elevated again in a little while. Since a solitary space occupying lesion was detected in the spleen by ultrasonography, the third laparotomy was performed. It revealed a splenic metastasis and splenectomy was performed. After the third operation, the serum CEA was decreased. In this case, serum CEA was very useful for detecting recurrent metastatic lesions.

View full abstract

A 57-year-old man with a history of left adrenalectomy for pheochromocytoma 23 years ago was admitted to our hospital. Examinations revealed a hypervascular tumor in the left renal hilar regin. With the diagnosis of recurrent pheochromocytoma, after the blood pressure was stabilized, a tumor weighing 16g and measuring 5×3.5×3.5cm was resected. The blood catecholamine did not decrease postoperatively. An abdominal CT scan and an aortography showed a remaining tumor adjacent to the arta. The patient was reoperated and a tumor located dorsal to the left renal vein was removed. This tomor weighed 7g and measured 3×2.3×2cm. Hitologically the two tumors were benign pheochromocytoma. Around the same time the patient's eldest son underwent surgery for the same disease.
This reported case is the 19th case as familial pheochromocytoma and the 10th case as recurrent pheochromocytoma in Japan as far as the authors confirm. It should be emphasized multiple lesions could be suspected in treating recurrent pheochromocytoma.

View full abstract

Recently, we have experienced a successfully resected case of huge liposarcoma arising in the left perinephrium.
The case was a 70-year-old man who complained of abdominal distention and wa diagnoed to have an abdominal tumor by a near practitioner. In November 1986, he was admitted to our hospital to undergo operation. Simple X-ray examination of the abdomen, urography, ultrasonography of the abdomen, and CT indicated a retroperitoneal tumor arising in adipoe tissues. Operation revealed that a tumor was located in the left retroperitoneal cavity and invaded the left kidney, left adrenal, and left renal arteries and veins. Hitopathologically, the tumor was a well-differenciated liposarcoma of the mixture involving lipoma-like type and sclerosing one.

View full abstract

A 25-year-old man came to the hospital because he could not take a supine position due to an enlarging girth of the abdomen that was noticed 5 months ago. Preoperative ultrasonography, CT, and angiography offered a diagnois of intraperitoneal cytoma, and the resection was performed. The tumor ariing in the lesser omentum occupied the cavum cul-de-sac, passed through between the stomach and pancreas, was held between inferior and posterior lobes of the great omentum, and spreded the entire abdominal cavity. No adhesion with the surrounding tissues wa noted, and the tumor approximately 7kg in wight was excised. The tumor was partitioned with thin wall into several large and small cavities which were transferable each other and filled with blood liquid. Pathologically it was cystic lymphangioma. He was diagnced as cystic lymphangioma at the lesser omentum.

View full abstract

A case of internal hernia difficult for diagnosis has been reported with discussion of literature. A 62-year-old male was admitted with complaints of abdominal pain and body weight loss. Physical examination revealed epigastric tenderness but intestinal movement was not so increaed. Roentogenograms of the upper gastrointestinal tract, ultrasonography, and computed tomography of the abdomen were all within normal limits. After admission, he repeated to have paroxymal abdominal pain and vomiting. The roentogenographic findings of the abdomen suggested an obstraction of upper gastrointestinal tract. Roentogenogram of the upper gastrointestinal tract when he felt abdominal pain demonstrated the proximal portion of the Jujunum was located in abnormal portion. Then we suspected internal hernia and performed operation. At operation, the proximal Jujunum was enclosed in a hernial sac which was formed by the part of transverse mesocolon. The neck of the sac was located laterally of the inferior mesenteric vein. After surgery, the patient has remained asymptomatic and been able to eat.

View full abstract

A case of an obturator hernia preoperatively diagnosed by computed tomography (CT) is reported. The key CT findings for the diagnosis are a bowel loop located posterior to the pectineus muscle, deformed muscular bands of external obturater muscle and dilated bowel loop proximal to the obturator foramen. We believe that CT can be a very useful tool for the diagnosis of obturator hernia.

View full abstract