YAG laser excision was performed for the treatment of sixty-three patients with uterine myoma (portio myoma; 1, endcervical myoma; 37, submucosal myoma of the corpus; 25).
All patients except one (submucosal myoma) were treated at an outpatients basis. The local infiltration of 1% lidocaine was given to the cervix. The procedure was underwent with YAG laser attached to new ceramic rod (made of artificial sapphire) by using the contact method.
The output power was delivered from 15 to 20 watts. All cases except 5 were cured successfully by having only one treatment. A case with endocervical myoma was operated on having transabdominal hysterectomy because of successive hypermenorrhea, but there was no lesion in the cavity. Four cases with endocervical myoma were reirradiated because of residual lesions. The side effects during and after the procedure were minimum. In conclusion, transvaginal laser therapy is the conservative one beneficial for the uterine myoma.

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近年本邦でも肺血栓塞栓症例の報告は増加傾向にあるが,右房内可動性血栓を確認し得た症例は稀有である.今回我々は上大静脈にを有する特異な右房内紐状血栓による広範囲肺塞栓症の1例を経験したので報告する.症例は50歳,女性.高熱と呼吸困難のため某院に入院していたが,呼吸困難増強し心エコーにて右房内に異常エコーを認めたため当院に転院.心電図上第III誘導にQ波があり,胸部誘導で陰性T波,PaO2 43.2mmHg,PaCO2 35.2mmHgと著明な低酸素血症,FDP高値,心エコー上右房を充満し一部が右室へ流入する長い紐状の極めて可動性に富む異常エコー像を認めた.胸部X線で肺動脈陰影の拡大,肺血流シンチで両肺野に多発性の欠損像があり,右房内血栓による肺血栓塞栓症と診断した.外科的血栓除去術を予定したが,翌朝突然強い呼吸困難と共に意識消失した.意識消失後の経食道エコーでは右房右室内から血栓と思われたエコーは消失しており,入院7日目死亡した.剖検上,両側肺動脈の血栓による閉塞を確認した.右房右室内には血栓はなく,右房近傍の上大静脈背面に血栓様物の付着を見るのみであった.下肢および骨盤内の静脈には,血栓および炎症所見は認めなかった.また組織学的に子宮内膜組織の増殖を認めた.これよりエストロゲンの持続的分泌による血液凝固亢進状態が血栓形成に関与し,末梢静脈で形成された血栓が何らかの機序で上大静脈に付着した可能性が示唆された.

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The authors present here a case of congenital abdominal wall defect associated with vitelline vascular remnant. It suggests a hint to embryogenesis of gastroschisis. A new-born male, weiging 3,000g, was transferred to the authors' hospital because of abdominal wall defect (gastroschisis). On operation, the abdominal wall defect was 28mm in diameter. The umbilical cord attached normally on the left margin of the defect, and an abnormal string was found between eviscerated ileal mesentery and the right margin of the defect. The string was diagnosed as vitelline vascular remnant by its histological findings and its connecting position. The authors concluded that the abdominal wall defect occurred in the umbilical cord itself, because the vitelline artery and vein had to attach the umbilical cord. This suggests that gastroschisis is probably a result of umbilical cord rupture in the uterin.

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0生日女児.出生時,剣状突起より2cm尾側の正中に1×2cm大の腹壁の全層欠損があり,肝の表面が露出していた.また,左側腹壁の膨隆を認めた.臍帯とその周囲に異常なく,その他の合併奇形は認めなかった.4生日に腹壁の部分欠損を伴う上腹壁ヘルニアの診断で手術を施行した。肝と癒着した腹壁欠損縁を剥離後,腹壁を検索すると菲薄だが筋層を認め,左側筋層がより菲薄であった.筋層と皮膚の2層で縫合閉鎖した.腹壁の形成異常としては腹壁破裂,臍帯ヘルニア,脊柱などの多発奇形を伴うbody stalk anomalyや,腹壁筋低形成を呈するprune belly症候群が知られるが,他の非定型的な腹壁欠損症例の報告は少なく,検索しえた限りでは6例のみであった.自験例の病因については,器官形成時期における側方皺襞の伸展癒合障害と沿軸中胚葉由来の筋板の伸長・分化障害が左上腹部に相当する部分で起こったと考えられた.

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Introduction: Ovarian auto-amputation is extremely rare and is most commonly attributed to chronic adnexal torsion and subsequent devascularization that precipitate infarction and necrosis. We describe a woman (Jehovah's witness) who presented with an inflamed abdominal cyst, which was diagnosed as an auto-amputated endometrial ovarian cyst, following laparoscopic surgery.

Case presentation: A 45-year-old Jehovah's witness was referred to our hospital with acute abdominal pain. She had complained of dysmenorrhea prior to referral. Laboratory data revealed evidence of severe inflammation (white blood cell count 12400 cells/μL, C-reactive protein 17.4 mg/dL).

  MRI revealed a cystic pelvic tumor with features of a benign ovarian cyst. She received intravenous antibiotics with resolution of inflammation following this conservative therapy after which we performed laparoscopic surgery for removal of the pelvic mass. Intraoperatively, we performed careful adhesiolysis followed by meticulous exploration of the pelvic cavity. We performed cystectomy and left adnexectomy with insertion of multiple drains into the peritoneal cavity.

Discussion: Based on the laparoscopic and histopathological findings, the patient was diagnosed with chemical panperitonitis associated with a wandering ovarian endometrial cyst.

Conclusion: We report successful but significantly challenging laparoscopic intervention for a wandering ovarian endometrial cyst in a woman with chemical peritonitis.

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Shrubby rheophytes are characterized by sympodial branching as well as the general characters of rheophytes. Paedorheophytes are woody rheophytes that are rheophytic in juvenile stages and resemble land plants at maturity. Although their leaf shape is believed to change gradually from narrow-lanceolate juvenile leaves to broadly lanceolate adult leaves, our field observations show that in Saraca declinata and Tristania whitiana, tropical paedorheophytes, have two and three classes of leaf shape, respectively, which change abruptly from one class to the other during the growth.

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心臓血管肉腫は極めて稀な疾患ではあるが, 悪性心臓腫瘍の中では最も頻度が高く, 報告例の大部分は右房原発である. また, 何らかの治療はおろか生前診断さえ困難であるとまでいわれている. 今回, 左房原発の悪性腫瘍を術前に疑い, 結果的には失ったが手術を施行し得た貴重な症例を経験したので報告する.

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We report findings in eight cases of omphalocele encountered at Kyoto University Hospital during the period from January 1983 to January 1991. The average maternal age was 26 years (range, 18-38years), 2 were nulliparous, and 6 women were multiparous. The gestational age at time of delivery averaged 37 weeks (range, 35-39 weeks). The average infant weight at birth was 2636g (range, 1934-3380g). There were 5 cesarean sections and 3 vaginal deliveries. Associated congenital anomalies were recognized in 4 cases. Six of the neonate are still alive, one has died, and one died in uterus. The two infants who died also had severe congenital anomalies. The poor prognosis for neonates with omphalocele appears to be related to the severity of associated congenital anomalies and chromosomal anomalies. On the other hand, neither whether the sac is ruptured nor the diameter of the defect is a useful prognostic indicator. Bowel-wall thikening with ruptured omphalocele requires careful attention.

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32歳男性で不明熱を主訴に来院した患者に,胸部単純X線写真上,心臓内石灰化腫瘤を確認し,精査のうえ右心室内孤立性の石灰化腫瘤として,手術的にこれを摘除した症例を報告する.その成因は摘除標本の病理学的な検索でも確定不可能であったが,われわれはこれを,腫瘍の石灰化,変性心筋組織の石灰化などでなく,壁在血栓の石灰化であろうと考えた.
心臓内石灰化腫瘤に対する手術適応は,(1)成因不明で,発熱,不定胸痛などの症状の原因となっている可能性があること,(2)肺梗塞の危険があること,(3)手術手技の容易なことなどから,かなり広く考えてよいと思われる.
なお本症の診断における胸部単純X線写真の重要性を改めて強調する.

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Body stalk anomaly (以下,本症) は,臍帯ヘルニア,腹壁破裂などの腹壁異常に,強度の側弯症,頭蓋異常,四肢異常,短臍帯などを伴う極めて予後不良の先天異常である. 今回,我々は出生前診断2例を含めた本症を3例経験した. 症例1及び症例2は,胎児超音波検査にて臍帯ヘルニア,高度の脊椎異常,単一臍帯動脈,短臍帯などの所見を認め本症と診断された. 各々切迫早産,胎児仮死のため緊急帝王切開となり出生し,呼吸不全のため生直後死亡した. また,症例3は,出生前に臍帯ヘルニアと診断され,帝王切開により出生したが,呼吸不全のため生後2.5時間で死亡した. 症例3は,臍帯ヘルニア以外に,右側弯,単一臍帯動脈,短臍帯が認められ,retrospective にみて本症と考えられた. 3例ともに高度の肺低形成 (肺体重比:症例1;0.23%,症例2;0.42%,症例3;0.56%) を認め,治療抵抗性の呼吸不全の原因と考えられた.

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A unicornate uterus with a rudimentary horn is a rare Müllerian duct abnormality. This uterine anomaly may cause variable gynecologic complications, including hematometra, endometriosis leading to acute pelvic pain, infertility, and obstetric complications, including miscarriage, preterm delivery, and rupture of the uterus, especially when the pregnancy implants in the rudimentary horn. To date, the standard treatment for the latter condition has been laparotomy, as patients usually experience massive abdominal hemorrhage or pregnancies too large to attempt laparoscopic removal. We report a case of a non-communicating rudimentary uterine horn pregnancy which was preoperatively diagnosed by ultrasonography, hysterofiberscopy, and magnetic resonance imaging, and then subsequently resected laparoscopically.

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31歳の1回経産婦より出生した児に以下の複合奇形を認め, inferior celosomiaと考えられる症例を経験したので報告する. 臍帯は臍下型臍帯ヘルニアの形態を呈し, その下方に腹壁欠損があり, 恥骨は欠如していた. その欠損腹壁より臍帯と一塊となった8cm×10cm×6cmの嚢状突出組織を認め, 組織学的に中央部が結腸粘膜, 両外側部が膀胱粘膜よりなり, vesicointcstinal fissureであった. また, 剖検上, 両側尿管および小腸はこの嚢状組織に開口していた. 十二指腸は腹膜腔内にあり, 結腸は痕跡的に認めるのみで, S状結腸および直腸は欠損し, 鎖肛であった. 外陰部は欠損し, 性別不能で, 剖検上も小骨盤腔に卵巣および精巣を認めなかった. 右下肢少趾症の合併を認めた.

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On 27 May 1982, an egg-laying site of Onychodactylus japonicus was found on Mt. Hodatsu, Ishikawa Prefecture. Many pairs of stalked rod-shaped egg sacs were attached to stones in the inmost recesses of a small underground cavity where cold springs emerge from under stones to form the headwaters of a mountain stream. Each egg sac contained 6-13 (mean=11.0) eggs, and the number of eggs laid by a single female was 17-25 (mean=22.0).

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There were sixteen cases of neurilemmoma in the head and neck, which were observed at Kanazawa University Hospital from 1973 to 1985. In ou r series, the tumor was distributed as follows: nasal cavity, 4 cases; pharynx, 4 cases; pnrotid gland, 2 cases; oral cavity, 2 cases; mastoid, 1 case; auditory canal, 1 case; upper neck, 1 case and epiglottis, 1 case. All cases were treated with surgical excision. In a case of pharynx, part of the tumor remained because the capsule was indistinguishable, and has recurred after 5 years. In the histological findings, uncapsulated tumors were found in the cases of the nasal cavity and epiglottis. Some cases of the nasal cavity have lacked the capsule on the surface of the tumor facing to open space. Two tumors of the pharynx and upper neck had their origin from sympathetic nerve in the parapharyngeal space. According to CT scan, tumors arising from the sympathetic nerve had appeared in the anterior part of parapharyngeal space or posterior part (carotid sheath) of it. Thus we supposed that neurilemmoma arised from the sympathetic nerve would be classified into three groups; pharyngeal type which corresponds to pharyngeal tumor, carotid sheath type which corresponds to upper neck tumor and mixed type which extends to both region. It is significant to foreknow the relation of carotid and jugular vein to tumor, especially in the carotid sheath type, preoperatively. For this reason, CT scan with contrast enhancement would be prefered.

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症例1は1カ月の男児, 主訴は臍腫瘤と臍湿潤.臍帯脱落後から湿潤が続き, 臍に径約5mm, 鮮紅色の腫瘤と皮膚のびらんがみられた.6カ月時に腫瘤を核出し, 病理検査で小腸粘膜を認めた.しかし湿潤は改善せず, 9カ月時に再手術を行った.開腹し, 臍を腹腔面も含めて切除したところ, 異所性膵組織が証明された.症例2は1歳1カ月の女児, 主訴は臍湿潤.臍帯脱落後から臍の腫瘤と湿潤が続いた.他院で腫瘤のみ切除されたが, 湿潤は改善しなかった.1歳5カ月時に開腹, 臍を腹腔面も含めて切除したところ, 異所性膵組織を認めた.2例とも開腹時には小腸に異常を認めず, 湿潤とびらんは軽快した.卵黄腸管遺残による臍ポリープは本邦で22例の報告しかみられず, 異所性膵組織をともなった症例は8例のみである.本症に対しては, 開腹し合併奇形を検索するとともに, 腫瘤を完全に摘出する必要があると考える.

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左室内血栓は,急性心筋梗塞(AMI)後の合併症であり,全身の塞栓症の原因となりうる.とくに小さなで左室壁に付着し可動性のある球形を呈したball-like thrombusは脆弱で全身の塞栓症を惹起しやすい.左室内血栓除去術の適応,時期,方法について検討した.対象は2000年1月～2005年8月の間に左室内ball-like thrombusで,左室内血栓除去術を施行した4例である.全例男性で,年齢は42～61歳(平均年齢53.5歳),基礎疾患は,2例が小範囲の心筋梗塞,1例が急性期広範囲心筋梗塞,1例がたこつぼ型心筋症であった.血栓の最大短径は8～25mm(平均15.8mm)であった.同時手術は,3例に冠動脈バイパス術(CABG),2例にMaze手術,1例に僧帽弁輪形成術であった.左室の切開部に対して,3例にフェルト補強を加えた直接閉鎖,1例にinfarction exclusion technique (Komeda-David法)による修復を行った.全例生存し,在院日数は19～84日(平均46日)であった.AMI超急性期症例の左室切開部には,出血のコントロールと左室リモデリング予防という意味で,infarction exclusion technique (Komeda David法)が有用であった.

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  Rudimentary horn pregnancy (RHP) is a rare disease, the frequency of which is reported as 1/76,000 to 1/150,000 of pregnancies. The preoperative diagnosis is reportedly difficult, and the diagnostic yield is 16%. Some RHP cases are determined during the operation for ectopic pregnancy diagnosed, preoperatively, as tubal pregnancy. We present a case of RHP diagnosed by ultrasound and treated with laparoscopic surgery. A 35-year-old woman (gravida: 2, para: 1) presented to our department with suspected ectopic pregnancy at 6-weeks gestation.

  Vaginal ultrasound revealed a gestational sac covered with a thick myometrium on the left side of the uterus and a fetal heart beat within. Communication between the endometrium of the uterus and the gestational sac was undetected. Magnetic resonance imaging (MRI) showed the same findings as those of ultrasonography and a diagnosis of pregnancy with non-communicating rudimentary horn was established. On laparoscopy, we resected the rudimentary uterine horn including the fetus. This case demonstrates that laparoscopic resection of pregnant rudimentary horn is safe and feasible in the surgical management of unruptured RHP.

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