Thirty resected cases of parotid tumor were retrospectively investigated about the treatments and postoperative complications. Postoperative facial nerve palsy was found in 6 out of 27 cases of benign tumor and in 3 out of 3 cases of malignant tumor. In these cases, facial nerve palsy turned to be permanent in 2 cases of each benign and malignant tumor. In other cases, facial nerve palsy disappeared in one month to 2 years. In one of malignant cases, facial nerve was resected in combination with parotid tumor invading the nerve and reconstructed successfully. Considering the postoperative complications and the radicality, ennucleation of the tumor is thought to be the most preferable method for the benign parotid tumor. In addition the nerve stimulator is thought to be useful for the preservation of facial nerve.

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Xeroradiography (XR) was retrospectively compared with a newly developed computed radioagraphy (FCR) for diagnostic availavility for breast cancer. FCR provides with the image sprocessed by a computer. Subjects were 65 breast cancer patients for XR and 51 for FCR. Both methods were performed preoperatively. No significant difference was observed in distribution of age between the two groups but the average tumor size in XR group was lerger than that in FCR group. Tumor shadow appeared in 44 of 65 xeromammograms (67.7%) and in 34 of 51 computed radiograms (66.7%). Microcalcification was detected in 27 of 65 xeromammograms (41.5%) and 21 of 51 computed radiograms (41.2%). Consequently, diagnosis of breast cancer could be achieved in 47 of 65 patients (72.3%, establihed: 39, suspective: 8) through XR and in 41 of 51 (80.4%, established: 33, suspected: 8) through FCR. Thus FCR is thought to be more useful for breast cancer because it not only offers good diagnostic information as accurate as that of XR but also permits a patient smaller radiation exposure.

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During a period of 1975-85, isolated mitral valve replacement (MVR) with the bioprosthetic valve was performed in 102 patients. The late complications and long-term durability of the bioprostheis were evaluated in 93 of the 102 patients who had survived more than 1 month postoperatively. The cumulative follow-up duration was 888.9 patient-years with a maximum follow-up of 13 years. Late mortality was 1.01%/patient-years (9 patients), and actuarial survival rate was 87% at 5 years and 76% at 13 years. Thrombo-embolic envents occurred in 5 times (0.67%/patient-years) and the probability of freedom from thromboembolic events at 13 years was 92%. Prosthetic valve endocarditis occurred in 4 times (0.45%/patient-years). Prosthetic valve dysfunction occurred 33 times (3.71%/pt-yrs) in 32 patients. Of 33 prosthetic valve dysfunctions, 32 were due to primary tissue failure (PTF). PTF was first experienced at 3 years postoperatively and rapidly increased after 6 years of surgery. The probability of freedom from prosthetic valve dysfunction at 13 years was 35%.
Extended follow-up after MVR with the bioprosthesis confirms the satisfactory performance and lowthrombogenisity of this device up to 13 years after operation. PTF of the cusps remains the chief cause of valvedysfunction leading to reoperation and may represent a major problem.

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Sixty-eight gastric cancers were subjected to a study of the diagnosis of depth of invasion using endoscopic ultrasonography (EUS). In this study the correct diagnostic rate and misdiagnostic factors were analysed. The correct diagnostic rates of m-, sm-, pm-cancer groups and the invased cancers more than ss were 64.7%, 50.0%, 80.0% and 92.9%, respectively. These of early and advanced cancers were 82.9% and 97.0%, respectively. The misdiagnostic factors included ulcer scar (8 cases), microinvasion to submucosa (4 cases), scatter invasion (2 cases) and others (4 cases). The correct diagnostic rates were poor in depressed early type, signet ring cell type and cancers on the greater curvature of antrum or body of stomach.
It can be concluded that EUS is good at differentiating between early and advanced cancers, but is poor in differentiating between m- and sm-cancers, in which a necessity of further investigation is indicated.

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For biliary tract dieases, drip infusion cholangiography (DIC) offers available visualization and information relating to levels of impaired liver function. In this paper, serum total bilirubin, glutamine oxaloacetic transaminase (GOT), glutamine pyruvic transaminase (GPT) and alkaline phosphatase (ALP) were examined as the indexes of liver function in 268 cases of cholelithiasis mainly. On those cases, Meglumine iotroxate was drip-injected as a contrast medium of DIC, and the relation between the respective level and optimum time for the best visualization of the common hepatic duct and common bile duct was analysed. Furthermoer Meglumine adipiodon was also examined, and both succesful visualizations were comparied. As a result, it was proposed that the successful visualization of Meglumine iotroxate was shown earlier and clearer than that of Meglumine the successful visualization of Meglumine iotroxate was shown earlier and clearer than that of Meglumine iotroxate was more useful and more sensitive to get successful visualization of the extrahepatic duct as contrast media of DIC in liver function disorder cases in some extent.

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19 patients (14 men, 5 women) who had undergone surgery in our department for gallstones accompanied with liver cirrhosis (LC) during the 9 years between 1980 and 1988 were reviewed, and the following results were obtained.
1) Stones localized in the gallbladder were most frequent. Pigmented stones, particularly black stones, were the predominant type.
2) Among 11 patients in whom the surgery was aimed only at gallstones, the mean operation time was 159 min, and the mean bleeding volume was 597ml. These values were significantly higher than those in patients with gallstones not accompanied with LC.
3) The postoperative course was favorable in Child A cases, whereas postoperative jaundice occurred in 3 of 4 Child B cases, and one Child C case resulted in death from postoperative liver failure. Palliative surgery after improvement in the general condition and liver function is desirable in the treatment of patients with decreased hepatic reserve.

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Lithotripsy in 77 patients, and the therapeutic results were studied in reference to the results of pre-treatment examinations. The echo patterns after fragmentation could be classified into the floating type of microfragments, sediment type of small fragments and sediment type of large fragments. The floating type of microfragments showed a significantly higher rate of disappearance. The Ia type of gallstones in the echo pattern often presented the floating type of microfragments after fragmentation, showing a significantly higher disappearance rate compared with other types. The disappearance rate was significantly higher in gallstones with the diameters of 20 mm or less. In the features with CT scan, gallstones showing patterns of lower density tended to show higher disappearance rates.
There were some cases in which mild abdominal pain considered concomitant with excretion of fragments was noticed several hours after the treatment. This finding suggested that spontaneous excretion of fragments would occur relatively early. If a state of sufficient fragmentation is obtained, the disappearance of gallstones can be occur relatively early. If a state of sufficient fragmentation is obtained, the disappearance of gallstones can be fragmentation may cause complications such as cholecystitis. Therefore, a careful study of the results of pre treatment examinations is needed.

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Twelve adult patients with congenital dilatation of the biliary tract, who were diagnosed and treated in Nishinomiya Prefectural Hospital, were reviewed, and some associated problems in the cases were discussed.
Eleven of the 12 cases had choledochal dilatation, which included seven presenting cystic dilatation and four fusiform one. All of the former 7 cases were accompanied with anomalous arrangement of pancreatobiliary duct, which was not demonstrated in one of the latter 4 cases. Of the 7 cases, four were symptomatic and diagnosed during pregnancy, two had peritonitis due to the perforation of cysts, and one was associated with bile duct carcinoma. Even in the case where the anomalous arrangement of pancreatobiliary duct had not been disclosed, resection of cystic portion and hepatojejunostomy was performed. These procedures could be done with good results in 9 of 11 cases. So it is recommended that these procedures can be performed even for congenital choledochal dilatation, which is asymptomatic or suspected.
One of the twelve cases had intrahepatic biliary dilatation. It caused a localized cystic dilatation in the left segmental bile duct but histologically looked like that of Caroli's disease.

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It is a recent serious problem that fungal infection has been increasingly associated with gastrointestinal diseases in surgical patients that might be caused by lots of antibiotics with wide spectra. A large dose of oral Amphotericin B (AMPH) was given to 5 cases of fungal infections after or before surgery for Degos' disease, gastric, liver, colon and rectal cancers. In each one case of postoperative catheter sepsis and Degos' disease with multiple perforations of the gastrointestinal tract, C. albicans and C. glabrata were detected. Oral AMPH 900mg-4800mg for 5-10 days resulted in significant effects such as negative-conversion of the fungi, improvement in CRP, and normalization of WBC. In addition to the formerly reported results from bioavaility study determining tissue distributions, oral large dose of AMPH regimen appears to be safe and effective for fungal infection in surgery.

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Male breast cancer is a reratively rare disease but in recent years the number of reported cases continues to increase. In this paper we report on a case of male breast cancer as well as some discussion of the disease. The patient was 67 years old and at about one year after onset he came to our hospital with the chief complaints of right subareolar tumor and right axillary lymph node swelling. After examination, he was diagnosed as having a right breast cancer T_2aN_1bM₀, stage II and standard radical mastectomy was performed. In preoperative hormone assay no abnormal levels obseved either in the blood or urine. In hormone reseptor assay of the tumor, estrogen reseptors (ER) were positive and along with postoperative radiation 50 G ray, chemotheraphy and endocrinotheraphy were conducted. A present three years later he is still healthy. A search of the literature has indicated that male breast cancer is most often observed in elderly patients and the disease period is protracted with good coincidence with this case. Moreover, since male breast cancer is said to be more commonly found in advanced stages and have poorer prognosis in comparison to female breast cancer, further enlightenment activities targeted for males are important.

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Spindle cell carcinoma of the mammary gland has been categorized into so-called "carcinosarcoma" in the former general rule for mammary cancer and rarely found in Japan. In addition to already reported domestic 13 cases, we report a case of the disease together with a review of the literature.
A 35-year-old woman had a large tumor approximately 10×9cm in size ranging her whole right breast. Right extended radical mastectomy was carried out uner a suspesion of nonepitherial tumor. Histological examination as well as findings from immunological tissue stain indicated a spindle cell carcinoma.
Although we can not draw any clear findings from a comparative review between Japan and European/American patients because of too small number of its reports, the common finding may be that mammary spindle cell carcinoma appears as a slightly larger tumor but has similar natures including prognosis to those of regular type breast carcinomas.

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Several operative procedures for funnel chest were adapted during recent 15 years. Before 1977, sternal elevation and simple sternal turnover were the standard procedures. Since 1978, sternal turnover procedure preserved with the abdominal rectal muscle were used for 125 cases. This procedure had several advantages, such as good wound healing and comestic superiority of the sternum. But postoperative follow up survey in 1986 revealed a moderate degree of sternal protrusion and costal excavation in 41% cases.
Then, the modified sternal plasty was deviced which was changed from the sternal turnover procefure with the abdominal rectal muscle but the sternum was not turned. This new procedure has the physiological cavature in shape and clinical application to 7 cases was resulted in satisfactory outcome.

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Most cases of acute suppurative mediastinitis are secondary to esophageal perforation. Nontraumatic mediastinitis is uncommon because of the development of antibiotic therapy.
Acute suppurative mediastinitis in a 53-year-old man is presented. The patient primarily infected with pharyngitis, which was extended into each origin of the submandibular, masticator and parapharyngeal space. Tracheostomy performed under this condition brought about severe suppurative mediastinitis, because the focal infection was extended to the mediastinum via peritracheal space. Emergency mediastinal drainage wtih thoracotomy was successful in this case.
In deep neck infections, there are no clear border between the compartment of muscle fascia and mediastinum. Extension of infection into the mediastinum may associate with severe complications such as empyema and endocarditis. In a case having focal infection in the peritracheal space, an indication of tracheotomy should be carefully considered.

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The upper and lower esophageal sphincter has been considered to prevent reflux of gastric contents to the pharynx. Surgery of the cervical esophagus or larynx may lead to pulmonary complication by deteriorating the antireflux function, more likely than gastric surgery. In this report, the function of the upper esophgeal sphincter (UES) was studied with microtransducers in 3 patients with esophageal cancer, who had different types of surgery respectively.
Total esophagectomy, laryngectomy and cervical lymph node dissection caused disfunction of the UES in case1. Total esophagectomy preserving the larynx and cervical lymph node dissection reduced the UES pressure, which was not disappeared in case 2. In case 3, the UES pressure was not altered by subtotal esophagectomy, however, laryngectomy preserving the cervical esophagus performed later on for laryngeal cancer reduced the UES pressure. So, it is concluded that esophagectomy and/or laryngectomy result in the UES disfunction in varying degree. Care must be taken to prevent aspiration pneumonia, if the cervical esophagus or pharynx is involved by surgical intervention.

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A very rare case of synchronous double cancer including primary jejunal and early gastric cancer diagnosed preoperatively is reported.
A 70-year-old woman visited our hospital complaining of sensation of abdominal fullness and vomiting. Clinical and histological examination revealed a primary jejunal and early gastric cancer. The jejunal cancer was like Borrmnn 2 type, located just below the ligament of Treitz, and was histologically a well-differentiated adenocarcinoma. While the early gastric cancer was a II a type locating on the lesser curvature of the middle gastric body and also histologically a well differentiated adenocarcinoma. Distal partial gastrectomy and resection of small intestine including the jejunal cancer were performed.
A jejunal cancer is rare among all digestive tract, cancers, particularly that accompanied by a gastric cancer. Most of jejunal cancers are not diagnosed preoperatively, and already advanced at the time of operation. Every effort should be made to detect them in early stages.

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A case of endosopically polypectomised carcinoid tumor of the duodenum is reported. A 56-year-old woman without symptom visited our hospital for examiantion of the upper GI tract. Upper GI tract series and endoscopic examination showed a semipedunculated submucosal tumor in the descending portion of duodenum. Endoscopical polypectomy of this tumor was performed to make the accurate histological diagnosis. The polypectomised tumor meaured 2.7×2.5×2.1cm. Microscopic examination showed no tumor cells at the resected stumps and electron microscopic examination revealed the picture of carcinoid tumor. CT and ultrasound afer established diagnosis did not demonstrate any lymph node and distant metastases. The patient has been being observed carefully because she rejected the operation. Local recurrence or distant metastasis was not observed during the following 19 months.

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A 73-year-old woman was suspected to have gallstone ileus from abdominal simple X-ray film and ultrasonography. Preoperative alimentary examination revealed a cholecystoduodenal fistula, and freeing of the ilues was successfully performed.
Gallstone ileus commonly occurs in aged people and we often have difficulties in diagnosis because its ileus condition prevent from sufficient preoperative diagnosing. Abdominal simple X-ray film and ultrasonographic examination are simple methods to offer some convincing holds suspecting the disease. For this disease conservative treatment is first selected, however, the majority of cases demaned surgical operation. Radical treatment for internal biliary fistula is not always necessary if biliary residual stones are not found. In this case which had no residual stones but had high risks, no biliary radical operation was carried out.

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We report a case of rectal diverticulum resulted in severe stenosis of the rectum, in which the differntial diagnosis from a malignant tumor was difficult.
A 34-year-old man complainted of anal pain and dyschezia. Enema and endoscopic examination of the colon revealed severe stenosis of the rectum. Conservative treatments did not yield a remission, the disease progressed, and a possible malignancy was suspected, hence, laparotomy was performed. Perirectal tissues showed stone-like consistency because of chronic inflammatory change, for which tissue biopsy could not be applied. From some findings during surgery, the possible malignancy could not be denied, abdominoperineal excision of rectum being performed. Pathological examiantion revealed a structure of diverticulum in the rectal muscularis and a severe inflammatory feature ranging to the tunica externa. The lesion was diagnosed as inflammatory rectal stenosis resulted from expanded diverticulitis to the surrouding tunica tissues of the rectum.
Compared to other colic diverticulums, rectal one more rarely occurs and 7 cases were reported in Japan. Like the others rectal diverticulum is asymptomatic as far as it has no complication. Howerver, as shown in this case, differential diagnosis from a malignancy may be difficult when an inflammatory tumor is formed in the surrounding tissues and/or stenosis is caused by the tumor.

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Perianal Paget's disease has some unique aspects different from other malignant tumors in that it often associates with a malignant tumor and has a wide range of dermal infiltlation. These facts demand careful attentions in the treatment of the disease. We encountered a 68-year-old male patient with the disease associated with rectal cancer. In the preoperative mapping of biopsy, the anal lesion to be resected was determined and excision of rectum was carried out under consideration of postoperative better maintenanse of defecation function and surgical radicality. Moreover, a wide range of defected skin around the anal could be repaired with pediculated flap by one-step approach. As far as we could review, only 15 cases (indluding this) of perinal Paget's disease associated with rectal cancer have been reported in Japan. We present here several attentions for appropriate resection of this relatively rare disease.

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Spontaneous rupture of hepatocellular carcinoma dose not rarely occur in Japan.
However, we often have much difficulties in the diagnosis and treatment and its prognosis is generally poor as yet. We report a case of spontaneously ruptured hepatocellular carcinoma (HCC) in which surgical treatmen successfully saved the life.
A 56-year-old male was admitted with hypochondralgia and faintness.
Ultrasonography, Computed tomography, and abdominal puncture revealed abdominal bleeding from spontaneously ruptured HCC. Emergency angiography showed a tumor stein in the left robe of the liver and tumor thrombus was suggested in the left portal branch by portography.
The bleeding was successfully stopped by means of selective transarterial embolization (TAE) of the left hepatic artery. Subsequently left hepatic resection was performed safely after disappearance of ascites under good liver condition confirmed by liver function tests. Resected specimen revealed that the main tumor located in the segment IV sized about φ 4cm and left portal branch was filled with tumor thrombus.
Successful treatments of spontaneously ruptured HCC are considered to be achieved by early and optimal diagnosis, cessation of bleeding by TAE, and operation under good conditions.

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We describe two cases of cholelithiasis in children in our department, together with a review of 56 cases which have been documented for the recent one decade. The diagnosis and ethiology of cholelithiasis in children are also discussed in these 58 cases.

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A case of carcinoid tumor of the gallbladder which was accidentally found during surgery is reported.
The patient, a 35 year-old woman complaining of right hypochondrial pain underwent cholecystectomy because abdominal echogram and DIC indicated cholecystolithiasis. A small tumor with a size of 15×9mm was found at the neck of the gallbladder during operation. Histologic examination revealed a carcinoid tumor of the gallbladder infiltrating to the subserous layer but there was no evidence of adenocarcinoma. The patient has been doing well 13 month after surgery without recurrence.
To our knowledge, only 20 cases of carcinoid tumor of the gallbladder including this case have been reported in the Japanese literature. Clinicopathological investigation of these cases revealed that carcinoid tumors of the gallbladder under 20mm in size mostly remained within the ss layer and the prognoses were good, on the other hand, tumors with over 20mm in size or hinf (+) had very poor prognoses, for which therefore intensive follow up should be neccessary.

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We have treated a patient with adenosquamous cell carcinoma of the gallbladder. Most carcinomas of the gallbladder are adenocarcinomas, and few are adenosquamous cell carcinomas. The origins of squamous cell carcinomas in this location are not understood, because healthy mucosa of the gallbladder have no squamous cells. There are few reports of benign squamous metaplasia of the mucosa of the gallbladder in Japan. Benign squamous metaplasia and the interesting histology of the gallbladder in this case are discussed.

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A retrosepctive study was made of 6 cases of pancreatic pseudocyst for the past 3 years and 9 months. The patients with the avarage age of 43 (18-58 years old) included 4 males and 2 females. Their ethiologies were acute pancreatitis, chronic pancreatitis in acute aggravated state, and trauma in each 2 cases. Excepting one case of traumatic pancreatitis for which conservative treatment led to a spontaneous diminution of the cyst, remaining cases were subjected to punction and drainage, which resulted in a diminution and disappearance of the cyst in 2 cases. For one case presented inracystic hemorrhage on the first week after drainage, distal pancreatectomy associated with cyst and splenectomy were carried out; and for one case in which 3 times of needle aspiration failed in diminution or disappearance to cause intracystic inflammation, cystogastrostomy was done. Postoperative course was uneventful in the 5 cases. One case in which drainage was not done associated with septic shock soon after the onset of pancreatitis, and then developed intracystic hemorrhage. In spite of an emergency operation, the patient died of MOF.
After needling drainage, minute management taking surgical treatments into consideration is necessary. Surgical treatment may be appropriate for cases associated with intracystic hemorrhage and inflammation, or those in which the recurrence repeatedly occurs.

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We report two cases of panperitonitis presenting with interesting findings.
Case 1: Upon laparotomy for panperitonitis, a tumor with pusdischarge was found in the greater omentum but no focus causing peritonitis was known. This tumor was removed and a fish-bone was found in it. A possible suspicion that the fish-bone should have perforated the intestinal wall and the wound naturally healed was arisen.
Case 2: Upon laparotomy for panperitonitis, a massive intra-abdominal bleeding was found with no apparent origin except some adhesions of the omentum to an old duodenal ulcer. Minute histological examination of the ulcer after distal gastrectomy revealed a perforated focus which might be the origin for the intra-abdominal bleeding.

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A 32-year-old woman was introduced to our hospital with a tumor of the left lateral abdomen.
Abdominal ultrasonography, CT, barium enema and abdominal angiograhy revealed a round and cystic tumor 5×6cm in the left lateral abdomen. An aspiration biopsy of the content of the tumor using ultrasonography disclosed a white-yellowish serous fluid.
The patient underwent surgery with a diagnosis of intra-abdominal cyst. The tumor located in the retroperitoneal space was resected easily. The operative diagnosis was retroperitoneal serous cyst. Pathologically, the malignancy was not detected.
Though this disease is defined as a tumor originating in the retroperitoneal space except the kidney, adrenal gland, ureter and pancreas, the origins of the most cases were unknown. Since 1911, 28 cases have been reported in Japan, and this case might be the 29th.

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We report a case of lipoma of the retroperitoneum, which is so rare that only about 60 cases have been reported in Japan so far. A 22-years-old woman was seen with the complaint of right hypochondral discomfort. Since the graphic studies including computed tomography and ultrasonography made a diagnosis of lipoma of the retroperitoneum, the tumor was resected. Histopathologically it was a lipoma. Lipoma of the retroperitoneum is easily diagnosed by echography or CT, but has difficulties in treating, because it is possibly accompanied by recurrence and a morphorogical change to sarcoma. On resection of lipomas, surgeons should pay attentions for these possibilities.

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We have recently encountered a case of schwannoma of the mesenterium.
A 22-year-old woman was admitted with the complaint of an abdominal mass. Ultrasonography and CT scan and CT scan showed a solid mass measuring 10×7cm. Superior mesenterial angiography revealed that the tumor was fed by the jejunal arteries and stained in late phase. It was diagnosed as a solid tumor of the mesenterium of the small intestine. At laparotomy, the tumor was found to be a benign schwannoma of the mesenterium and tumor excision was performed. Histologically, the greater part of the tumor showed Antoni type A, but some part showed Antoni type B.
The benign schwannoma of the mesenterium is a rare disease and in Japan only 4 reports have been available including this case. Age, sex, symptoms, diagnosis and treatment were discussed.

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Mesentric lymphangioma is a rare disease, particularlly in adults. Recently we have encountered an adult case. The case wa a 36-year-old female with the complaints of abdominal mass and oppressed sensation. Palpation of the abdomen revealed an approximately pherical, smooth surface, elastic hard, and movable tumor 6cm in surface, elastic hard, and movable tumor 6cm in diameter. Ultrasonography showed a multilocular cystic under the umbilicus on standing position. From the result as well as various examinations, it was diagnosed as intraperitoneal parenteral cystoma. On laparotomy under general anesthesia, a dark-red multilocular cystoma in the transverese mesocolon was found and excised as "en-bloc". Histopathologic findings indicated mesenteric lymphangioma. Postoperative course was uneventful.
In addition, the ethiologic investiagion of the disease in adults and its characteristics were disccussed in domestic 32 cases collected, and the significant diagnostic value of ultrasonography is emphasized.

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A 51 year old woman was admitted with the chief complaints of left upper arm and left anterior chest pains. The clinical X-rays revealed a mediastinal tumor. The computed tomography of the chest showed an hourglassshaped tumor developing in the vertebral canal and the vertebral foramen of Th3.
The patient was operated on with transthoracicapproach. By enlarging the vertebral foramen of Th3, the Th3, the tumor was dissected totally. The pathological diagnosis was neurinoma. It is clinically important to select the apropriate approach for treatment of spinal hourglass tumor. The computed tomography of the spine provided the exact location and the mode of development of the tumor, and was the mot useful diagnostic tool.

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The frequency of obturator hernia is as rare as about 0.4-1.5% of that of strangulated hernia. However, a fact that the onset of the disease concentrates on an aged people may bring us more opportunities to encounter the disease routinely with a progression of aged society. We describe 3 cases of obturator hernia.
Case 1 (70-year-old male), 2 (80, female), and 3(78, female) had right obturator hernias. Two cases were positive to Howsip-Romberg sign, an oppressed symptom of the obturator nerve, but the rest one was negative in which preoperative diagnosis was difficult. Postoperative complication was observed in case 1 which was a formation of abscess on the femur and delayed the treatment period. The reason might be that we had overlooked residual hernia sac to which the necrotized intestinal tract was intussuscepted. Hence, extirpation of hernia sac is necessary for a case of obturator hernia, in which the intestinal tract was necrotized with inflamed hernia sac.

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Deep vein thrombosis of the lower extremities is the cause of pulmonary embolism in nearly all cases. There are few reports of pulmonary embolism resulted from the thrombi of superficial varices of the lower extremities. We encountered such a case due to the thrombi of superficial varices.
A 61-year-old woman has been suffering from varices of the lower extremities since around the age of 25 when she conceived her first child, and the symptoms she conceived her first child, and the symptoms were getting worse afterward. Sometimes she had experienced superficial phlebitis without definitive treatment. This time the patient suddently presented with a malaise in the presented with a malaise in the chest and faint. Scintigraphy of pulmonary blood flow and pulmonary angiography revealed flow and pulmonary angiography revealed to pulmonary embolism. No findings suspecting of deep vein thrombosis were found, namely. Homan sign was negative and either swelling nor pain was noted. Bilateral venography of the lower extremities showed the good patency of the deep veins without any thrombi. Pulmonary embolism could be alleviated by thrombolytic and thrombolytic and anticoagulant regimen. Stripping operation succeeded in the treatment of varices of the bilateral lower extremities. Though the frequnecy of pulmonary embolism caused by varices of the lower extremities is as low as less than 1%, its mortality is high if once it actually occurs and hence careful attention is needed.

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Although arteriosclerotic femoral artery aneurysm is a common disease. Localized aneurysm on the deep femoral artery is extremely rare. A case of solitary arteriosclerotic aneurysms of the bilateral deep femoral arteries is described. A man, aged 84, first underwent resection of an aneurysm of the left deep femoral artery and the gap was bridged with PTFE graft. Nineteen months later, rupture of an aneurysm of the right deep femoral artery occurred, as a surgical emergency, the inflow and outflow arteries of the aneurysm were simply ligated and the aneurysmal sac was partially excised. Postoperative course was uneventful. Deep femoral aneurysm was usually ligated or excised without any reconstructive procedure, however, in recent years, the surgical importance of the deep femoral artery in occulusive arterial disease has been recognized. Patients with superficial femoral aretery occlusion should depend on the patency of the deep femoral artery for collateral flow to the distal limb. It is our policy therefore the restore the continuity of the deep femoral artery whenever possible. We prefer to use synthetic graft, because this allows us to save the graft, because this allows us to save the which needs distal bypass subsequently.

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Femoral aneurysm commonly has no clinical symptoms but once it appears severe symptoms such as rapture of the aneurysm and necrosis of the lower extremity due to obliteration of the artery are induced. We describe a case of bilateral femoral aneurysms which showed a rapid growing. A 71-year-old male, who has been admitted to our hospital with a diagnosis of early gastric cancer, was accidentally detected to have bilateral femoral aneurysms. The aneurysms rapidly increased in size to 6.5×4.5cm in the right and 10.0×4.5cm in the left side without any symptom during his hospitalization. They were successfully reseced and replaced by Cooley's double velour grafts (8mm in diameter)and his saphenous vein graft. Histological examination of the aneurysmal wall revealed an atherosclerotic change extended to the tunica adventitia and partially destroyed internal elastic lamina. Now four months after the vascular reconstruction, the patient is up and well without complaints.

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First Department of Surgery, Department of Clinical Laboratory Medicine*, Gifu University School of Medicine female, who had a history of cholecystectomy 12 years before, was diagnosed to have a hepatic tumor by abdominal US. The tumor revealed solid pattern and not homogenous by abdominal CT and US. Aspiration cytology guided by US, selective celiac angiography, and tumor markers suggested no malignancy.
Since the patient had a residual stone in the common bile duct and liver dysfunction, choledocholithotomy was carried out. Small hen's egg-sized tumor was found in the left lateral segment of the liver, which was prominent to the abdominal cavity. It was resected with liver tissue. The resected specimen revealed thickly encapsulated granuloma, which consisted of fibrous foreign bodies and central necrosis. Pathologically, fiber fragment surrounded by foreign body giant cells were seen.
Retained sponges usually detected as a cystic tumor, and such granuloma formation is relatively rare. Granuloma caused by retained sponges should be remembered to have a difficulty in diagnosing.

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