The advantages of a surgical tissue adhesive, n-butylcianoacrylate, Histoacryl®, in closure of inguinal hernia wound in children were discussed. Subjects were 229 children aged from 2 months to 11 years, with the average of 3 years and 3 months.
Potts operation was performed in all the cases. After high ligation of hernia sac, aponeurosis of external oblique muscle and superficial fascia were closed by interrupted sutures. The wound edges of the skin were approximated with forceps and small droplets of the tissue adhesive were placed directly over the skin. On the 6th postoperative day, the tissue adhesive was removed at out-patient-clinic. Although five cases, in which two layers of tissue adhesive were given, showed early detachment of the adhesive, all other cases, in which the adhesive was given in single layer, showed excellent wound healing.
Direct application of a few droplets of tissue adhesive without covering mesh over the wound is simple tecnique and gives excellent cosmetic results without any stich marks. Tissue adhesive is useful for the closure of small wounds with less tension such as hernia wounds in children.

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Reconstructive operation using instrumental anastomosis was performed on 44 of 101 cases of total gastgrectomy experienced during a period of recent 5 years up to Feburary 1989, and was compared with the contemporaneous hand-suture reconstruction mainly for operative contents, postoperative complications and the like.
In the instrumental anastomosis group, some shortening of the reconstructive time was obtained not only by p-Roux-Y method using 2 EEAs and Roux-Y method as standard reconstruction, but also by a use of purse-string instrument (PSI) and TA55 for purse-sting suture nd for stiump closure, respectively.
The instrumental anasotmosis group showed major and minor incomplete suture in 1 case, each, totalling 2 (4.5%) and stenosis in 3(6.8%), compared with major and minor incomplete suture in 2 and 3, respectively, totalling 5(8.8%) and no case of stenosis in the hand-suture group. Incomplete suture and stenosis more often occurred forthe latter and former groups, respectively. Postoperative hospitalization averaged to count 32.7 and 39.4 days, respectively, being shorter for the former group. Rate of dissected n3 and that of concomitantly-resected pancreatocaudal, spleen were 36% and 21%, and 66% and 42%, respectively. Thoracotomy was performed in 25% of the cases. Obviously, the instrumental anastomosis group more often received enlargement operaiton.

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Twenty-two cases of neck surgery in children less than 6 years old during past 17 years (1971-87) were subjected to a clinical study and a follow-up survey by questionnaire, where 17 responses could be collected. Subjected cases included each 4 cases of lymphangioma and nonspecific lymphadenitis, 3 of median cervical cyst (fistula), each 2 of tuberculous lymphadenitis, dermoid cyst, supprative lymphadenitis, and histiocytosis X, and each one of bronchial cyst, chondronevus and lateral cervical cyst. Correct diagnosis rate was 45% preoperatively. Of the 17 follow-up cases recurrence was noted in each one case of uncompletely resected lymphangioma, dermoid cyst, and histiocytosis X. Death occurred in the histiocytosis X case. In 4 (25%) cases the surgical wounds were judged as conspicuous by their parents, of which 2 were of giant lymphangioma and one of the 2 received reoperation. The remaining 2 cases appeared to have surgical problem when viewed plastic surgically. No postoperative bronchostenosis was caused. If the incision is carried out horizontally for child neck surgery, operation is allowed to apply to children even under 6 years of age.

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Reconstruction of the superior vena cava was performe on eight cases, including 5 of primary lung cancer, each one of metastatic mediastinal lymphnodes from uterus cancer and breast cancer, and one of invasive thymoma. Five cases showed the superior vena cava syndrome preoperatively and 3 revealed invasion to the superior vena cava at operation. In two cases of primary lung cancer and each one of lymphnode metastasis from breast cancer and invaive thymoma, reconstruction of the superior vena cava and resection of the main lesion were performed. The other 4 cases were underwent only bypass operation as a palliative procedure for the superior vena cava syndrome. Four of 5 cases with superior vena cava syndrome showed improvement in the symptome while the remaining died of thrombosis. The longest prognosis was 2 years and 9 months for the case in which the main was resected.
Palliative operation can not promise a good prognosis but offer symptomatic remission of the supperior vena cava syndrome. Even in a patient undergone reconstruction of the superior vena cava due to a malignant disease, should the main lesion be resected where the patient can have a favorable prognosis.

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In our department, located in Awaji-island in the midst of an aging district, 760 patients operated on for gastric cancer during the recent 11 years included many aged people; i.e. over 70 years of age 31.4%, and over 80 years of age 5.5%. With an increase in age, patients tend to have more preoperative complications, as shown in the following figures: 12.1% in patients under 70; 65.3% in patients in their 70s; and 71.4% in those of 80 and over. There was a significant difference between the two age groups of under 70, and 70 and over. Postoperative complications developed in 19.8% of the age group under 70; in 20.9% of that of the 70s; and in 50.0% of that of 80 and over, showing a significant difference between the two groups bordering on the age of 80. Compared to the patient group under 80, aged patients of 80 and over had poorer surgical results in the mortality rate during hospitalization, and a significantly prolonged hospital stay. Moreover, from an analysis of data for the recent 3 years, our guideline to employ an active attitude for surgery of advanced gastric cancer in aged patients was highly successful in patients in their 70s but was clearly unsuccessful in those in their 80s and over, compared with former results prior to our guideline. These findings indicate that in operation for gastric cancer patients of 80 years of age and over, should be termed as "the aged".

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In terms of clinicopathological features of cases of gastric cancers as examined by age, the auther's investigations have confirmed that patients in their twenties and thirties hold biological properties in common. In this study, the authers examined the above patients as cases of juvenile gastric cancer and obtained the following results:
Cases of juvenile gastric cancer represented 76 (9.2%) of a total of 827 resected cases, with sex ratio of 1:1. Of these 76 cases, 33 were all depressed type early cancers and 43 were advanced cancers with predominant IV type (15 cases). Juvenile 5-year-survival rate was 60.2%, which was practically equal to 59.3% for patients aged over 40 years. Curative resection was performed in 88.2% of the cases, 5-year-survival rate for which was 71.6%. Recurrence was noted in 13 curatively resected cases. Death occurred in 22 cases, 21 of which showed ps (+) as depth of penetration, and the cause was peritoneal dissemination in 19 cases.

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Ten primary malignant lymphomas of the stomach resected for these 13 years were comparatively studied by dividing into 4 early and 6 advanced malignant lymphomas. These primary gastric lymphomas represented 1.5% of the 653 malignant neoplasms of the sotmach in the same period. Early lymphoma was more commonly occured in younger and female patients. The early tumors had a tendency of localization and only 25% of the tumors invaded two or three segments of the stomach, whereas 83.3% in the advanced cases. In gross pathologic appearance, however, 3 of the 4 early malignant lymphomas of the stomach showed superficial spread types, while half of the advanced ones showed the appearance of giant rugal. Even if the tumors invaded submucosal layer, half of them showed lymphnode involvement which extended and remained in n₂. Therefore we should have a radical operation with R2 lymphnode dissection for primary early malignant lymphomas of the stomach.

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Eleven patients with spontaneous duodenal fistula were subjected to a study of diangosis and surgical treatment. The 11 patients included 9 with cholecystoduodenal fistula and 2 with coloduodenal fistula. Preoperative diagnosis could be made in 7 (64%) out of the 11 based on pneumobilia in abdominal scout X-P and GI series. Direct cholangiography, which was performed in only a few cases, could yield the definite diagnosis with a high rate. The patients basically underwent surgical treatment for original disease and excision of fistula. In 9 patients the duodenal intestine was directly sutured after excision of fistula, where the depression treatment due to T tube to the billiary tract added to all the patients were very effective without anastomotic leakage. For 2 of 3 patients with gallstone ileus who manifested poor condition preoperatively, incision of small intestine and cholelithotomy were done, but the fistulae were left.
From these findings, it seems important to add some depression treatment to the billiary tract after excision of fistula. Moreover, in a case of gallstone ileus which have no residual stones, excision of fistula accompanied by inevitable large operative invasion is not always necessary.

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[in Japanese]

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Twenty two patients with gastrointestinal leiomyosarcoma treated at our institution from 1976 through to March 1989 were examined for the role of hepatectomy in treating its liver metastasis.
The 5-year survival rate was 77.1% for all patients and 80.3% for patients who received curative resection. Of 4 patients who died during the observational period, 2 died of hepatic insufficiency caused by massive liver metastasis. Liver metastasis was found in 7 patients, representing 31.8% for all patients and 87.5% for those with all sorts of metastases. Three of these 7 patients received hepatectomy to remove metastatic foci. There was no all sorts of metastases. Three of these 7 patients received hepatectomy to remove metastatic foci. There was no who received hepatectomy could enjoy the longest survival. Contrary to our expectation, all patients whose metastases were resected showed eventual recurrences in the residual liver. Though hepatectomy is effective in removing huge foci, the disease cannot be cured by this maneuver only.
Further more combined therapeutic strategies are required to control those cases of gastrointestinal leiomyosarcoma with its liver metastasis.

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During a period of 1969-88, 30 patients (14 males and 16-females) with primary varicose veins suffered from incurable leg ulcer were operated on in our institution.
The average duration lasting lower extremity symptoms was 9.8 years in males or 10 years in females. While the average duration suffered from incurable leg ulcer was 14.6 months in males or 5.5 months in females. Solitary leg ulcers were seen in 23 cases and multiple ulcers in 7. Small ulcers measuring less than 2cm in diameter were completely cured by extensive whole saphenous vein stripping and excision of varices. For larger ulcers extrafascial or subfascial ligation of perforator branches with valve incompetence were performed. Furthermore, middle layer skin grafting was necessary for extensive ulcers measuring more than 3cm in diameter. Among 30 patients 9 needed skin grafting, and we have no experience of recurrence of treated ulcers. Thus incurable leg ulcer could be healed completely by operation within the average of 2.3 months.

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Graft-versus-host disease (GVHD) is a well known severe complication occurring after bone marrow transplantation but reports on GVHD after blood transfusion are not so frequent. We report the occurrence of GVHD after blood transfusion in 2 patients. We were obliged to give massive transfusions due to rupture of a hepatic aneurysm after an operation for biliary tract cancer in one at the 2 patients. Subsequently, the patient developed GVHD with dermal symptoms, which remained at the Grade I level and resolved without any treatments. The other patient had a gastric cancer, underwent surgery and was receiving immunotherapy. After intermittent transfusion the patient developed GVHD and died after presenting the symptoms progressed to Grade IV. It was presumed that GVHD in these 2 cases resulted from the blood transfusion though the host immunodeficiency was not obvious. It may be interpreted that a crisis occurs if some similarities in HLA typing are present.

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A case of primary hyperparathyrodism (PHP) associted with advanced thyroid cancer in a 67-year-old woman is reported. In this case the differential diagnosis before operation was very difficult. It is not rare that the patient with PHP has a thyroid cancer, however, the thyroid cancer is commonly occult or small, and rarely large and advanced seen in this case. In the operative treatment of PHP, the thyroid gland must be explored carefully. If a thyroid cancer accidentally found is smal, lobectomy of the thyroid gland may be a proper treatment. However if it is advanced, subtotal thryoidectomy and modified neck dissection or more extensive operation must be chosen.

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A 72-year-old woman, who was pointed out for a left thyroid tumor during her ambulatory treatment by ORL for dyspnea and cervical swelling, was referred to our departmetn. The patient underwent tracheotomy because of a rapid enlargement of the tumor and worsened dyspnea after admission, and at the same time a part of the tumor was resected for pathological examination. The H.E. stain suggested an anaplastic carcinoma, however, from findings in additional immunohistological stain, the nature of the tumor cells was finally confirmed as leiomyosarcoma. The patient died without any surgical treatment. Leiomyosarcoma of the thyroid gland is difficult to be differentiated from anaplastic carcinoma, especially spindle cell type, making immunohistological staining examinations indispensable.

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Adenolipoma of the breast is a rare benign tumor. Three cases of adenolipoma of the breast are presented, with a review of the literature.
Case 1 was a 57-year-old woman who had a soft, well-circumscribed mass in the right breast, measuring 13×12cm in diameter. Mammography showed an oval radiolucent shadow with well defined low or iso-echogenic lesion with strong internal echoes and smooth margin. The tumor was encapsulated, and 14×12×3.5cm (390g) in size. It consisted of fatty tissues containing focal areas of grayish-white breast tissues. Histological findings indicated an adenolipoma. Case 2 was a 44-year-old woman (2.0×1.2×1.0cm), and case 4, a 52-year-old woman (4.5×2.5×1.3cm). These cases showed the same pathological features as case 1. Only 13 cases including these 3 cases have been reported in Japan. The adenolipoma of the breast were reviewed and discussed the clinicopathologic aspects and the histogenesis.

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Breast cancer has various risk factors including a hereditary factor. We have experienced a case of metachronous bilateral breast cancer in a 59-year-old women from a cancer family which had breast cancers over 4 generations.
Standard radical mastectomy and oophorectomy were performed for her left breast 14 years ago, which was diagnosed as T2aN1aMO in stage II according to General Rules for Cancer of the Breast by Japan Breast Society. In 1986, the patient had another cancer at the C area of the right breast, which was diangosed as T1aN0M0 in stage I.
Modified radical mastectomy (Auchincloss method) was performed for her right breast. Histological diagnosis of both the 1st and 2nd cancer was solid-tubular adenocarcinoma. The family history of this patient is very interesting. There could be seen breast cancers in her grandmoter, mother, herself and two daughters. Her mother also had metachronous breast cancer. Added to this her father died of rectal cancer. So it is strongly suspisious that development of her cancer was concerned with the hereditary factor.
The patient was so carefully followed up due to the high risk of cancer arising after the first operation that the second breast cancer in the opposite side could be diagnosed in an early stage.

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We have performed the thoracic aortic-abdominal aortic bypass and the right renal-right common iliac bypass on a case of middle aortic syndrome, which is an aortostenotic disease involving the bifurcation of the renal arteries and having severe hypertention as the chief symptom. Blood pressure in upper extremities improved well from 170mmHg before operation to 140mmHg thereafter.
In Japan, the present disease has not been regarded as an independent entity, but is often classified as atypical coarctation of the arota, which is subtype of aortitis syndrome. On the contrary, in Europa and the United States, the concept of middle aortic syndrome is becoming general because of its specific clinical symptom due to anatomical specificity although its diverse pathogenesis. The stenotic region of this disease commonly involves the bifurcations of the major aortic branches. The concept of middle aortic syndrome is, therefore, of great value for planning the reconstruction of the vesseles and the therapeautics.

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We experienced a case of esophageal perforation due to a fish bone, in which the fish bone was removed by endoscopic examination immediately after admission and conservative treatments resulted in a successful cure.
A 46-year-old man complained of severe epigastric pain immediately after he ate a fish (Tai: sea bream) dish and the pain increased and he came to our hospital. Severe upper gastric pain and inflammatory findings indicated a suspicion of perforation of the gastrointestinal tract, however, abdominal X-ray films revealed no abnormality. Endoscopic examination revealed that both ends of a fish bone were sticked into the esophageal wall at 38 cm distant from the incisor, and then it was removed by the biopsy clamp. Immediately after the removal of it, the epigastric pain completely disappeared. Esophageal ulcer around the sticked part accompanied by mediastinitis was successfully managed by conservative treatments such as chemotherapy, fasting and TPN.
There are few reports of esophageal perforations due to a fish bone. Some of them reported that delayed detection caused severe complications. In this case the remarkable value of early detection by endoscopy should be emphasized.

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A 48-year-old woman injured in an automobile accident sustained posterior fracture-dislocation of the third thoracic vertebra with no spinal paralysis and multiple rib fractures. Dyspnea witout apparent cause necessitated tracheostomy. Contrast study was done because of purulent pleural effusion on the 8th day. Diagnosis of esophageal rupture at the fracture site of the vertebra was made. Chest drainage tubes were inserted into the both pleural cavities and parenteral antibiotics were started. This drainage seemed effective judging from the findings of contrast studies and chest-CTs, but the direct communication between the fracture portion of the vertebra and the esophageal rupture remained as a fistula.
The patient developed pneumonia following by DIC and she eventually died. Although the so-called "golden time" had passed when the exact diagnosis was made in this patient, an early surgical intervention might have been better than the conservative treatment. Esophageal rupture following the vertebral fracture is very rare and this seems to be the first reported case in Japan.

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Granular cell tumor (GCT), first reported in 1926 by Abrikossoff, is frequently found in the tongue and skin but rarely in the gastrointestinal tract, especially in the esophagus. Although GCT had been thought to originate from striated muscle cells, recently it is considered that GCT is derived from Schwann cells which are relatively benign.
In 46-year-old male complaining of occasional epigastralgia, esophagogram and endoscopy demonstrated an elevated lesion in the lower esophagus as well as gastric ulcer. Lower esophageal and total gastric resection was performed on June 1, 1988. Most of GCT_s are occasionally detected in a mass-screening and most patients are asymptomatic. GCT_s are commonly as small as around 10mm in diamater, and tend to be located in the lower esophagus.
When GCT_s were classified into a slightly elevated, sweet corn, and ture molar shapes, the true molar shape was most commonly seen. In the treatment of GCTs, endoscopic follow-up or polypectomy is recommended for those as small as about 10mm in diameter, but for larger GCT_s over 30mm surgical treatment is indicatable.

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A very rare case of esophageal leiomyoma associated with esophageal cancer in a 57-year-old woman was reported. The patient was found to have a small intramural tumor in the middle intrathoracic esophagus by upper gastrointestinal series. Endoscopic biopsies, revealed a moderate dysplasia of esophageal epithelium on the top of the same elevated region. The patient underwent partial resection of the esophagus by right lateral thoracotomy. Microscopically, the resected tumor measuring 0.7×1.2cm was composed of interlacing bundes of smooth muscle Microscopically, the resected tumor measuring 0.7×1.2cm was composed of interlacing bundes of smooth muscle Microscopically, the resected tumor measuring 0.7×1.2cm was composed of interlacing bundes of smooth muscle correlation between the esophageal leiomyoma and cancer. We speculate that not only chronic mechanical stimulation to the epithelium covering the leiomyoma by usual swallowing but also some other common factors might cause the esophageal cancer.

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A rare case of gastric cancer showing an exogastric growth is repoted, together with a revie of the literature in reference to the common characteristic features to the disease.
A 76-year-old man visited our hospital with the chief complaints of a rapid enlargement of left upper abdominal mass, poor appetite, upper abdominal pain, and anemia. Abdominal ultrasonography, X-ray film of the stomach, CT, and angiography revealed an exogastric groth type of tumor. Operation was carried out and disclosed that the tumor growing from the pyloric antrum with a lumen was a giant exogastric growth type as large as 10×13×13 cm weighed 1, 000g. Macroscopically pylorectomy and excision of lesion of transverse colon could lead to a curative resection. Histologic examinations revealed undifferentiated carcinoma (solid carcinoma). On 11th month after surgery the patient experienced the recurrence and died.
Common characteristic features to the disease are: that the tumor rapidly increase; commonly occupies the greater cuvature of pyloric antrum; invades the other organ, especially the transverse colon; and is enough resectable for its large mass. In addition, the tumors are histologically determined as undifferentiated carcinoma in more than half of the cases; and frequently classified into medullary type of framework. The prognosis is as poor asthat almost patients die within one year.

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We experienced 6 cases of malignant gastric lymphoma during the 5 years from January 1984 to December 1988. In 2 of the 6 patients gastric excision and chemotherapy regimen were performed prolonged their lives for long periods, but the remaining 4 merely underwent chemotherapy. Unexpectedly, favorable result of a long survival could be obtained for the latter cases, as well as for the fomers of the said gastric excision, except for one case which died of other illness.

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Primary cancer arised in the duodenum is rare, especially an adenosquamous cell carcinoma extremely rare.
In a 45-year-old male complaining of epigastralgia, hypotonic duodenography revealed a definite stricture in the 2nd portion of the duodenum. Endoscopic biopsy showed a well differentiated adenoarcinoma. Therefore, standard pancreaticoduodenectomy was performed. Metastasis was found in the para pancreatic lymphnode. The postoperative histological examination revealed that the lesion was not related with the Vater's papilla and there was aberrant pancreas at the adjacent area. These findings suggest that the lesion might arise in the aberrant pancreas rather than in the duodenal mucosa. The patient has been well without any evidence of recurrence for 5years since the surgery.

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cute aflunet loop obstruction is a rather rare complication after gastrectomy (Billroth-II, Roux-Y). It is characterized by acute abdominal pain and high blood level of amylase and may take a serious course if delayed surgical treatment result in the rupture of the affluent loop. It is diangosable by demonstrating a dilated affluent loop by abdominal ultrasonography and CT. We describe here two cases of ruptured affluent loop following acute affluent loop obstruction after Billroth-II, as well as a study of te references with regard to its diagnosis and treatment.
Case 1 was a 21-year-old man who spasmodically drank about 2 liters of water to develop the symptom 10 days after gastrectomy (Billroth-II) for perforated duodenal ulcer. Case 2 was a 18-years-old man who developed the symptom after immoderate eating and drinking on the previous day. He had a history of gastrectomy. Efficient diagnosis of te symptom could be yielded from laboratory findings such as leukocytosis and hig blood amylase level, and by measns of imaging procedures of CT and abdominal ultrasonography. Above all, it seems necessary that in the case of acute abdomen after gastrectomy (B-II, Rous-V), we bear the symptom in mind in diagnosing and treating witin a short time.

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A 67-year-old female was referred to Yokohama City University Hospital because of reccurent intestinal bleeding for two months. Upper gastrointestinal series, endoscopic examination, and abdominal CT failed to demonstrate the bleeding CT failed to demonstrate the bleeding site. Selective superior mesenteric arteriography demonstrate the bleeding CT failed to demonstrate the bleeding site. Selective superior mesenteric arteriography malformation was recongnized in the terminal portion of the ileum at laparotomy, and wedge resection was performed. The pathologic study showed a proliferation of the convoluted arteries and veins ranging from mucosal to subserosal layer of the intestine. A rare case of ileal arteriovenous malformation, which was diagnosed by selective arteriographgy, was reported.

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Intestinal dulplication is a rare entity of congenital disease and occurs at any region of the gastrointestinal tract. A variety of clinical signs and symptoms in some cases of this disease often make it difficult for us to make correct diagnosis and treatment. In this paper, 6 cases (5 male infants and 1 female infant) who have been operated on for this disease in our department are reported. These 6 cases were 2 months old to 2 years old, 5 of them being under 1 year. Symptoms were intestinal obstruction in 4 cases and melena and perineal mass in one case each. These duplications occurred at the jejunal, ileal, terminoileal and rectal regions in 1, 1, 3 and 1 cases, respectively. One case had both tubullar and spherical dulplications and others had single spherical duplication each. Histologically, these duplications had both mucosal with cubic epithelium and muscular layer with smooth muscle. In 4 cases, diagnosis was made during emergency operation. Prognosis was good in all cases. In almost all cases, before a veriety of clinical findings, emergency operation was inevitably carried out without preoperative diagnosis. Accurate diagnosis based upon appropriate judgement is required preoperatively.

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We reported a case of inflammatory fibroid polyp (IFP) developed in the jejunum. The case is a 21-year-old woman who visited our hospital with nausea, vomiting and bloody stool as cc. Small intestine barium roentogenography revealed a polypoid lesion with irregular barium spots. Superior mesenteric angiography revealed irregular pooling of the contrast medium changing phase-dependently. Partial jejunectomy was performed under a diagnosis as submucosal tumor. Histopathological examination confirmed the tumor to be in submucosal layer, consisting of connective tissue accompanying remarkable hyperplasia of capillary vessels. Erosion was noted in mucous membrane covering the tumor. These results gave us diagnosis as IFP developed in the jejunum. Small intestine IFP is comparatively rare. As far as we know, only 41 cases have been reported in Japan most of which occurred with intussusceptive ileus compared with the present case occurring with bleeding from the tumor, a result apparently reflecting the pathological findings. Pre-operative imaging diagnosis also reflected the pathological findings small intestine roentogenography and superior mesenteric angiography were suggested to be effective.

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A case of total resection of jejunum and ileum is reported, together with a review of 19 cases of extremely massive resection of small intestine living.
The patient was a 58-year-old man who had undergone esophageal operation 6 months previously, and total resection of jejunum and ileum was perfomed because of SMA embolism. He was treated with TPN, but died 8 months after operation because of heaptic failure with cholangitis.
Review of the 19 cases indicate that, the patients whose residual jejunum and ileum lengthen into 50cm and less with intact ileocecal valve can possibly live without TPN and ED, and a long term nutritional treatment considering of the compensatory function of residual intestine is necessary. Furthermore, in a patinet whose residual jejunum and ileum lengthen into 50cm and less without ileocecal valve or already undergone gastrectomy, cholecystectomy should be considered.

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Primary small intestinal cancer is a comparatively rare malignant tumor of the digestive tract and can often be diagnosable upon laparotomy for ileus, acute abdomen and the like. The auther recently experienced a case of primary small intestinal cancer presenting aneurysmoid growth pattern without causing luminal stenosis.
The case was a 57-year-old man, who came to the hospital with fever and anemia. Abdominal US and CT revealed a tumor of 7cm in diameter in the right hypogastric lesion.
The patient was operated on under the diagnosis of intraperitoneal tumor. The tumor was found adorally about 20cm from the terminal ileum; it infiltrated into and proliferated all over the intestinal canal wall, but with dilated intestinal canal lumen and aneurysmoid growth causing no canal obstruction. Pathohistologically, it was papillary adenocarcinoma.

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We report a case of smoldering adult T-cell leukemia which was found from the excised lymphnode for a colon cancer.
The patient was a 57-year-old female, hospitalized for the purpose of undergoing surgery for sigmoid colon cancer of which she complained of abnormal laxation. Preoperative examination showed some abnormalities such as gallstones, and slight increases in GOT (43), GPT (43), and CA 19-9 (56U/ml), but the white blood cell count was normal (6500), no clinical manifestation being noted.
On January 12, 1989, R3 colectomy was carried out, and the lesion was found to be a 5×5cm, circular, type 2, and moderately differentiated adenocarcinoma which was s, ly0, v1, P0, H0, n (-) in stage II. Disappearance of lymphnode structure and an infiltration by deformed lympocytes with irregular nuclei were recognized in several of 253 and 242-1 of 36 purified lymphnodes.
The diagnosis of smoldering adult T-cell leukemia (ATL) was established due to a detection of the monoclonal integration of HTLV-I proviral DNA, with abnormal cells in peripheral blood. Biopsy of a 1cm lymphnode in an armpit did not demonstrate any abnormal condition. Other superficial lymphnodes were not palpated without any findings indicating lymphoma by imaging methods. The postoperative course of the patient, which has not shown worsening of ATL, yet, is under monitoring.

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We report 2 cases of synchronous metastases of colorectal carcinoma to the liver and lung in which the metastatic lesions could be radically resected. Case 1 A 59-year-old man underwent adominoperineal excision of rectum for lower rectal carcinoma (well-defferentiated adenocarcinoma in stage III; absolute curative resection). After 2 years and 3 months postoperatively, synchronous metastases to the liver and lung were found. Right lobectomy folloed by partial penumonectomy were carried out, each metastatic lesions being radically resected. As of 5 years and 3 months after the initial operation or one year and 11 months after resection of metastatic lesions, the patient is in health without recurrence. Case 2 A 57-year-old woman had a carcinoma of the ascending colon with synchronous metastatic lesions in the liver and lung. In the first step operation, right hemicolectomy (well-differentiated adenocarcinoma; absolute curative resection for the primary lesion) and catheter intubation into thehepatic artery were done, and postoperative chemotherapy by artrial injection was added. After 7 months, the metastasized lesions in the liver and lung were radically resected. At present as of 4 months after the resection no recurrence occurs.
From these experiences, surgical appropriateness for synchronous metastases to the liver and lung was considered.

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We present a case of incomplete torsion of the gallbladder in a 72-year-old woman which was preoperativery diagnosed with US, CT, and ERCP.
The patient admitted to the hospital complaining of right upper abdominal pain, fever and vomiting. Cholecystitis was suspected and conservative treatments led to alleviation on the 5th hospital day. However, US and CT revealed the enlarged gallbuladder and locating at the mid-area of upper adbdmen. The wall was thikend at the neck of gall bladder and it looked like a tumor, especially in contrast-enhanced CT. The gallbladder could not be seen on ERCP, and peak-shaped cystic duct was observed in the common bile duct side. It suggested that the malrotaion and obstruction of cystic duct caused torsion of the gallbladder.
Cholecystectomy was performed and we confirmed the values of US, CT, and ERCP for torsion of the gallbladder.

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A case of aplasia of the pancreatic body and tail associated with cholecystolithiasis is presented. A 57-year-old woman was admitted to our hospital complaining of epigastric pain. Ultrasonography and CT showed calculi in the atrophic gallbladder with no visualization of the pancreatic body and tail. ERCP revealed the short main pancreatic duct showing a smooth tapering and the accessory pancreatic duct. The patient underwent an operation for cholecystolithiasis. The operation revealed that the pancreatic head as almost normal in color and consistency and the body and tail appeared to be absent.

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Minute non-functioning islet cell tumor accompanied by large lymph node metastasis in a 61-year-old male is reported. The patient was reffered to us because of upper abdominal pain and high CEA level in blood. Physical examination revealed abdominal tumor but close evaluation including abdominal CT and angiography failed to establish the definite diagnosis. Operation showed a fist-sized lymph node swelling beneath the pancreas suggesting metastasis. But it was impossible to identify the primary focus and only lymph node biopsy was performed. He died on 31-post-operative-day. Autopsy revealed the minute non-functining islet cell carcinoma with a 2mm diameter as the primary origin.
In general, the non-functioning islet cell tumor exerts relatively low malignancy, and even in a malignant case, the primary focus grows expansively and forms a large tumor. This case seems to be a rare one developing mainly to the lymph node.

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A recent progress in various image diagnostic techniques had made us increasingly easy to diagnose splenic cysts; however, the primary organ is sometimes difficult to be determined in a case of giant cysts. This paper describes a case of splenic cyst, in which a preoperative diagnosis was successfully carried out by percutaneous puncture with the guidance of ultrasonic image. The patient was a 45-year-old female who suffered from bruising on the abdomen one year before admission and began to complain of epigastric pain some six months previously. Gastric rediography revealed a pressure image. Ultrasonic examination was then conducted; a cyst with a child's head in size was discovered in the left upper abdomen. A gastric, hepatic, or pancreatic cyst was suspected, but a splenic cyst was most likely. So the cyst was punctured with the guidance of ultrasonic image. Post-puncture ultrasonic examination and CT scanning revealed that the cyst was present in the spleen and diagnosed as a splenic cyst. Splenectomy was carried out. On pathologic findings the cyst was diagnosed as a splenic pseudocyst. Either ultrasonic examination or CT scanning after cyst puncture is considered useful in diagnosing an abdominal giant cyst in a case where the primary organ is unidentified.

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For the last 19 years between 1970 and 1988, 10 therapeutic splenectomies for hematologic diseases were performed in our institution.
The diseases indicated for splenecotmy were hereditary spherocytosis (HS) in 4 patients, idiopathic thrombocytopenic purpura (ITP) in 4, coombs test negative hemolytic anemia in one, and chronic myeloid leukemia in one.
All of the 4 patients with HS and 3 of the 4 with ITP had an exellent response, one with ITP had a partial response, and two with other diseases had no responses.
From domestic and overseas papers reported between 1984 and 1988, the effects of splenectomy for autoimmune diseases including ITP, autoimmune hemolytic anemia, and systemic lupus erythematosus were assessed. Fifty-eight percent of patients with ITP and 60% of those with other autoimmune diseases excellently responded to splenectomy where the blood counts were maintained in the normal range. These results may indicate further therapeutic availability of splenectomy for various autoimmune diseases.

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A case of primary leiomyoma of the greater comentum is reported. Case: A 73-year-old woman. Present History: The patient has had a pain in the left upper quadrant since about April 1989. She went to her local practitioner and was referred to our hospital because of a tumor indicated. Past History: in 1964 she had a left oophorectomy because of left ovarian cyst. In 1965 had an appendectomy. Present State: A fist sized tumor was palpable in the left upper quadrant. It as well movalbe and accompanied by tenderness. Laboratory Findings: A selective abdominal angiography revealed the right greater omentum artery separated from the gastric wall and a deep stained tumor feeded by the artery. Therefore the case was diagnosed to have a greater omentum tumor and extracion of the tumor was performed on June 12. The pathological examination revealed greater omentum leiomyoma.
We rarely encounter solid tumors primarily arising in the greater ometum, especially benign ones. The diagnostic significance of palpation and selective abdominal angiography is emphasized.

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Anterior sacral tumors are rare. Recently, we experienced quite a rare case of malignant neurilemmoma.
The case is a 51-year-old man, who came to our hospital for defectation pain. Digital examination of the rectum revealed a tumor, which was confirmed by CT and MRI, and a chordoma was suspected of the anterior aspect of the sarcum. The huge tumor filled almost the entire pelvic cavity. It was removed by a transabdominal-transsacral method. It was a solid encapsulated tumor 16×10×8cm in size. Pathological diangosis was a malignant neurilemmoma, and the patient has been closely followed on ambulant basis. It is seldom to encounter a tumor in this region, but the types of tumors are diverse. CT and MRI are most useful but these diagnostic methods are not yet perfect in quality. The importance of digital examination of the rectum should be emphasized for an early detection of such diseases.

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Desmoid tumor is a benign lesion with a high incidence of local recurrence after surgical exision, but rarely accompanied by the malignant change. A case of desmoid tumor with malignant change after twice surgical excisons was presented.
A 61-year-old man underwent excision of a mass measured 14.0×7.5×4.0cm in the right buttock. It was pelvic fibromatosis histologically. After one year and one month, a recurrent mass was shown in the pelvic cavity and removed. However, after 7 months another tumor recurred again and grew to cause dyschezia. Abdominoperineal resection of the tumor was carried out. Histological examination showed a malignant transformation to fibrosarcoma in a part of the removed specimen.
The patient, who underwent radiation and chemotherapy following the third operation, is alive and free from

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