Nihon geka hokan. Archiv fur japanische Chirurgie最新文献

A case of visual disturbance by embolization through the external carotid artery (ECA) after internal carotid artery (ICA) occlusion is reported. A 65-year-old female presented left ICA occlusion 14 years ago. She was admitted with acute deterioration of left visual acuity. Ophthalmologically, the retinal central artery was occluded. Cerebral angiography disclosed an irregular wall at the left ICA stump and stenosis of the maxillary artery. Carotid endarterectomy of the common carotid artery, ECA and residual ICA was performed and atheromatous plaque with ulceration was removed. The postoperative course was uneventful. We discuss cases of ICA occlusion in relation to visual impairment.

Unlabelled: In recent years, an increase in average life expectancy has led to a rapid rise in the number of elderly patients undergoing surgery for acute cholecystitis. We studied the clinical characteristics of elderly patients (aged 75 years of more) undergoing surgery for acute cholecystitis, as compared with those of non-elderly patients (aged less than 75 years) undergoing similar procedures. Twenty-four of the patients were elderly, and 44 were non-elderly.

Results: Echography and abdominal computed tomography (CT) revealed no characteristic findings specific to elderly patients, but a smaller proportion of elderly patients showed a three-layered structure of the gallbladder wall. The leukocyte count on admission was significantly lower in elderly patients than in non-elderly patients. As for therapy, a significantly higher proportion of elderly patients underwent percutaneous transhepatic gallbladder drainage (PTGBD) + cholecystectomy + choledochotomy/choledocholithotomy, as compared with non-elderly patients. In contrast, cholecystectomy alone was performed more frequently in non-elderly patients than in elderly patients. The main postoperative complications were psychic symptoms and respiratory tract infections. The postoperative hospital stay was significantly longer for elderly patients, in part because they requested to remain in the hospital until they were able to perform activities of daily living.

An 87-year-old man diagnosed as having advanced gastric carcinoma was admitted to our hospital. In a barium X-ray examination of the stomach taken at another hospital, filling defects were obseved in the greater and lesser curvatures of the antrum, while the entire pyloric region was rigid and stenotic. The gastroscopic findings showed pronounced curvature and stenosis of the pylorus and the pyloric mucosa was edematous and sclerotic. Histopathological examination of a biopsy specimen from the pylorus indicated a group V. The gastroscopic findings subsequent to admission displayed pronounced improvement with only sporadic shallow ulceration and erosion. The histopathological findings of the excised specimen showed that several depressed lesions in the antrum were active ulcers or their scars and the depressed lesions extending from the antrum to the pyloric ring were early gastric carcinoma. The findings of filling defects of the antrum and stenosis with ridigity of the pyloric region in the radiographic examination, and pronounced curvature and stenosis of the pylorus and sclerosis with edema of the pyloric mucosa in the gastroscopic examination were very similar to typical findings of advanced gastric carcinoma with pyloric stenosis. In addition, histopathological examination of a biopsy specimen from the pylorus indicating a group V made differentiation from advanced gastric carcinoma extremely difficult.