Suizo
Online ISSN : 1881-2805
Print ISSN : 0913-0071
ISSN-L : 0913-0071
Volume 20, Issue 2
Displaying 1-13 of 13 articles from this issue
  • Shuji SUZUKI, Nobuhiko HARADA, Mamoru SUZUKI, Fujio HANYU
    2005 Volume 20 Issue 2 Pages 73-78
    Published: 2005
    Released on J-STAGE: November 17, 2006
    JOURNAL FREE ACCESS
    Vascular and perfusion imaging by enhanced sonography with levovist has been advanced in recent years. We comparted the dynamic computed tomography (CT) images and perfusion images of enhanced sonography. Fourteen patients, who underwent dynamic CT and enhanced sonography, were diagnosed histopathologically with invasive ductal carcinoma of the pancreas between July 2001 and July 2004. Images of enhanced sonography were classified into three types : diffuse enhanced type (DE, n=1), partial enhanced type (PE, n=6), non-enhanced type (NE, n=7). The sensitivity and specificity of dynamic CT were similar to those of enhanced sonography, and the findings of enhanced sonography closely correlated with those of dynamic CT. Perfusion imaging of enhanced sonography could be more useful in cases with inflammation, fibrotic changes, and tumor blood flow than dynamic CT.
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  • Seiki KIRIYAMA, Takashi KUMADA, Makoto TANIKAWA, Yasuhiro SONE, Yasuhi ...
    2005 Volume 20 Issue 2 Pages 79-84
    Published: 2005
    Released on J-STAGE: November 17, 2006
    JOURNAL FREE ACCESS
    The clinical features of choledocholithiasis were studied in a consecutive series of 1,117 cases including 441 with stones passed spontaneously, treated at our department during the last 10 years. Serum pancreatic enzyme was elevated in 218 (19.5%) cases, and 216 (20.8%) of 1,036 patients had attacks of abdominal pain. However, severe pancreatitis was in only diagnosed in 24 patients, representing 11% of 218 patients with elevated pancreatic enzymes, 2.1% of total 1,117 cases. In 137 (62.8%) of 218 with elevated pancreatic enzymes, stones had passed spontaneously, and in 26 (11.9%) patients, the stone diameter was less than or equal to 5 mm. Elevation of pancreatic enzymes was seen in 31.1% of 441 cases with passed stones. These results suggest that acute pancreatitis as a complication of choledocholithiasis, in particular, with small stones, is not rare (about 20%), though it rarely present as severe pancreatitis.
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  • Makoto OTSUKI, Yasuyuki KIHARA
    2005 Volume 20 Issue 2 Pages 85-89
    Published: 2005
    Released on J-STAGE: November 17, 2006
    JOURNAL FREE ACCESS
    Severe acute pancreatitis was designated as an object disease (intractable disease) of the treatment-research project of intractable diseases in January 1991. This treatment-research project of intractable disease was amended in 1998 and severe acute pancreatitis was chosen as a serious disease that was exempted from medical bill at the expense of the government. At the same time, however, the validity of the document was shortened to 6 months from 1 year. We surveyed the application of severe acute pancreatitis to this system and investigated the problems associated with the treatment-research project system of intractable disease. New applicants for the treatment-research project system doubled in five years, from 718 patients in 1998 to 1,433 patients in 2003. However, it was less than 30% of the estimated number of patients with severe acute pancreatitis. The renewal of documents decreased from 456 in 1998 to 152 in 2002. In 2003, the document for renewal was adopted, but the renewed applicants increased again to 183. However, the increase of the renewal of documents was limited only to one year, and renewal for more than one year was decreased. The reduced applications for the renewal of documents for several years suggest that the newly adopted documents are effective in reducing unnecessary renewal.
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  • Kentaro YAMAGIWA, [in Japanese], [in Japanese], [in Japanese], [in Jap ...
    2005 Volume 20 Issue 2 Pages 90-96
    Published: 2005
    Released on J-STAGE: November 17, 2006
    JOURNAL FREE ACCESS
    A 65-year-old woman suffered from idiopathic severe acute pancreatitis complicated with an infected pancreatic pseudocyst, which developed into subphrenic abscess and resulted in lung abscess through the diaphragmatic hiatus into the pleural cavity at about 4 months after onset. She was referred to our hospital and treated by drainage. An enhanced study via the drainage tube under fluoroscopy revealed bronchial fistula. The endoscopic retrograde pancreatography did not reveal a bronchopancreatic fistula. She recovered from the pancreatic pseudocyst following conservative therapy, but not the subphrenic abscess and lung abscess with bronchial fistula by drainage. The patient underwent inferior lobectomy of the left lung and partial resection of the left diaphragm with reconstruction of the left diaphragm using a pedicled flap of the lateral dorsal muscle. At two years after the operation, the patient remains well with no recurrence. Successful surgical treatment of subphrenic and lung abscesses associated with bronchial fistula due to an infected pancreatic pseudocyst could be achieved through a thoracic approach alone, following conservative treatment of the intra-abdominal infection.
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  • Motoaki NAGANO, Kazuo CHIJIIWA, Jiro OHUCHIDA, Kazuhiro KONDO, Kohki N ...
    2005 Volume 20 Issue 2 Pages 97-102
    Published: 2005
    Released on J-STAGE: November 17, 2006
    JOURNAL FREE ACCESS
    A 70-year-old man presented with upper abdominal fullness. Gastroendoscopy showed a bulging tumor suspicious of a submucosal tumor. CT showed the presence of tumor, 8 cm in diameter, originating from the tale of the pancreas and invading the stomach. Balloon ERP showed irregular and dilated main pancreatic duct and defect, suggesting mucin or mural nodule in the main pancreatic duct. Endoscopic boring biopsy from the stomach confirmed the presence of carcinoma. The patient underwent total gastrectomy, distal pancreatectomy, splenectomy, partial resection of the transverse colon, and regional lymph nodes dissection. Final pathological diagnosis was adenosquamous carcinoma derived from intraductal papillary mucinous neoplasm (IPMN) and transition from IPMN to adenosquamous carcinoma was clearly observed. Since no case of adenosquamous carcinoma derived from IPMN has been reported in the English and Japanese literature, we report the case and discuss the malignant potential of IPMN.
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  • Soon-Myoung KANG, Atsunori NITTA, Hajime TANAKA, Akihiro MURATA, Yuhik ...
    2005 Volume 20 Issue 2 Pages 103-109
    Published: 2005
    Released on J-STAGE: November 17, 2006
    JOURNAL FREE ACCESS
    A 66-year-old male presented with general fatigue and jaundice. Laboratory findings showed cholestatic liver dysfunction and high levels of serum gamma-globulin and IgG. Computed tomography and magnetic resonance imaging revealed enlargement of the head of the pancreas with irregular narrowing of the main pancreatic duct and stenosis of the lower bile duct. It also demonstrated fibrosis surrounding the pancreatic tail. The findings of biopsy specimens from the head of the pancreas were consistent with autoimmune pancreatitis. Steroid therapy resulted in improvement of the pancreatic head lesion. Three years later, follow up imaging tests showed the appearance of new fibrotic tissue involving the abdominal aorta without significant changes in the pancreas. We describe an interesting case of autoimmune pancreatitis with retroperitoneal fibrosis after steroid therapy.
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  • Kenji YAMAO, Yasuhiro SHIMIZU, Nobumasa MIZUNO, Kuniyuki TAKAHASHI, Ak ...
    2005 Volume 20 Issue 2 Pages 110-113
    Published: 2005
    Released on J-STAGE: November 17, 2006
    JOURNAL FREE ACCESS
    A 78-year-old man was admitted to our hospital with the chief complaint of abdominal pain. Various imaging studies demonstrated multiple cystic lesions throughout the whole pancreas, and a mural nodule 5 mm in diameter in the body. Distal pancreatectomy was performed. Although histopathological examination revealed IPMN with mild atypia, the patient died because of poorly differentiated adenocarcinoma of the pancreatic stump that grew rapidly two years after distal pancreatectomy. We report a case of extremely aggressive IPMN that developed in the pancreatic remnant tissue.
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  • Junko IZAI, Hideyuki KANEMOTO, Kazuya MATSUNAGA, Atsuyuki MAEDA, Katsu ...
    2005 Volume 20 Issue 2 Pages 114-118
    Published: 2005
    Released on J-STAGE: November 17, 2006
    JOURNAL FREE ACCESS
    A 63-year-old man with a wandering abdominal tumor was admitted to a nearby hospital. CT and MRI demonstrated a 4-cm diameter tumor adjacent to the head of the pancreas. Laparotomy revealed that the tumor originated in the lower part of the pancreatic head and protruded into the transverse mesocolon. Frozen section of the tumor revealed adenocarcinoma of the pancreas. The patient was treated with chemoradiotherapy and was referred to our hospital 3 months later. He underwent pancreaticoduodenectomy combined with colectomy. Histopathological examination revealed mucinous carcinoma of the pancreas. Few similar cases have been reported. We attribute the “wandering tumor” of our case to acquired insufficient fixation of the pancreas head and duodenum caused by rapid weight loss.
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  • Koji NONOGAKI, Takashi KUMADA, Seiki KIRIYAMA, Makoto TANIKAWA
    2005 Volume 20 Issue 2 Pages 119-125
    Published: 2005
    Released on J-STAGE: November 17, 2006
    JOURNAL FREE ACCESS
    Severe acute pancreatitis can cause various complications. Intestinal necrosis following severe acute pancreatitis is uncommon but fatal complication. We report three patients who developed intestinal necrosis. Case 1 : An 88-year-old man. Autopsy revealed broad necrosis of the small intestine. Case 2 : A 35-year-old man with hematochezia after one month of hospitalization. He was diagnosed as ischemic colitis by colonoscopy. Because conservative treatment did not improve the condition, left hemicolectomy was performed on the 20 th day after manifestation, which revealed broad necrosis of the left colon. Case 3 : A 66-year-old woman. Broad necrosis of the small intestine and pancreatic necrosis were confirmed at autopsy. Physicians should take utmost care of patients with severe acute pancreatitis who develop complications including those affecting gut.
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  • Toyoma KAKU, Tetsuhide ITO, Naoko INOUE, Ken KAWABE, Takamasa OONO, [i ...
    2005 Volume 20 Issue 2 Pages 126-132
    Published: 2005
    Released on J-STAGE: November 17, 2006
    JOURNAL FREE ACCESS
    The reported incidence of pancreatic carcinoma in CCP varies from 2.9 to 25%. The pathogenetic relationship between these two conditions has been debated, but it is still not necessarily clear. Here, we report a case of pancreatic carcinoma associated with CCP. A 78-year-old man suffered from alcohol-related CCP for 28 years. Follow-up computed tomography showed a pancreatic tumor in the head of the pancreas with liver and abdominal lymph node metastases. Histopathological studies of a biopsy specimen from the liver metastasis revealed adenocarcinoma. Subsequently, chemotherapy with gemcitabine was undertaken. In this case, the patient had a long history of CCP, and thus a strong association of these two diseases is suspected. We emphasize the need for close follow-up of patients with CCP to detect possible coexisting pancreatic carcinoma.
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