Nihon geka hokan. Archiv fur japanische Chirurgie最新文献

It is said that the prognosis is poor in cases with recurrent pulmonary metastasis after operation for gastric cancer. In this article, 2 cases with nodular type of pulmonary metastasis resected after operation for gastric cancer and surviving well are reported by the authors. Case 1: 57-year-old female. The patient underwent a total gastrectomy for the 3'type of cardiac cancer. As the serum levels of tumor markers increased and the chest X-ray examination revealed a mass lesion in the right lung (S10), the operation for the lesion under the diagnosis of metastatic lung cancer was performed 1 year and 2 months after gastrectomy. The patient died of pulmonal and pleural metastasis 4 years and 7 months after the first operation. Case 2: 65-year-old male. The patient underwent a subtotal gastrectomy for the 5' type of gastric cancer. Chest X-ray examination for follow-up study revealed a mass lesion in the left lung (S5). The patient underwent a left pulmonary superior lobe resection 2 years and 9 months after gastrectomy. The patient is still alive 6 years after the first operation. Surgical treatment must be actively considered for nodular type of metastatic lung cancer after operation for gastric cancer.

A simple procedure of right hepatic lobectomy for bulky liver tumors is proposed. The procedure is named "Anterior approach", which is characterized by transection of hepatic parenchyma without mobilization and rotation of the right hepatic lobe. The transection directly reaches the ventral surface of the retrohepatic inferior vena cava first at the portion of caudate process. The hepatic parenchymal transection proceeds from ventral to dorsal and from caudal to cranial. Several dorsal short hepatic veins are severed on the ventral surface of the IVC and the right hepatic vein is finally severed from inside. This method enables the minimization of operative stress and is especially useful for cases with a huge tumor in the right hepatic lobe which invades the diaphragm or thoraco-abdominal wall.

A case of an extremely rare aneurysm of the distal segment of the anterior inferior cerebellar artery (AICA) is presented. A 61-year-old woman who was admitted with subarachnoid hemorrhage associated with fourth ventricular hematoma had such an aneurysm, which was successfully clipped. The literature is reviewed.

We encountered and reported one such rare case of liposarcoma which originated in the chest wall. A 60-year-old man came to our hospital with the chief complaint of a phyma in the right anterior chest wall. On palpation, a hard and non-mobile phyma measuring 3 x 3 cm was felt in the chest wall. Chest CT showed a phyma measuring 2.2 x 1.5 cm in the right anterior chest. The periphery of the phyma was smooth, and had a well-defined boundary with the surrounding tissues. Ultrasonic examination revealed that the tumor existed between the major and minor pectoral muscles. The inside of the tumor was nearly uniform, and showed low echo. Punctured cytological examination revealed scattered atypical cells with spindle, foamy or vacuolar sporophores on the mucoid matrix. A fat staining examination revealed lipoblasts with oil red-positive granules. Based on these findings, the patient was diagnosed as having myxoid type liposarcoma. Operation consisted of resection of the skin, subcutaneous tissues, mammary gland, part of major and minor pectoral muscles, the fourth and fifth ribs and pleura. The Reconstruction of the chest wall was performed for defects in the ribs and pleura using Marlex Mesh. Histopathological findings revealed that the tumor was myxoid type liposarcoma.

We report here a 65-year old man with primary duodenal malignant lymphoma combined with gastric lymphoma and early gastric cancer. Malignant lymphoma in the bulbus of the duodenum was suspected of by endoscopic biopsy during follow up of duodenal ulcer. Preoperative examination revealed an extension of malignant lymphoma from the bulbus to the stomach in combination with early gastric cancer. We performed a pancreaticoduodenectomy because the tumor invaded to the second portion of the duodenum. The postoperative course was uneventful and he received adjuvant chemotherapy following surgery. To our knowledge, this case is the first report of primary duodenal malignant lymphoma combined with gastric lymphoma and early gastric cancer.

A case of adenocarcinoma developed in the reconstructed gastric tube after esophagectomy was reported. The patient was 66 years old man and he had received subtotal esophagectomy for the carcinoma of the esophagus 11 years previously. The follow-up examination of upper GI series revealed an ulcerative lesion in the lower part of the gastric tube and endoscopic biopsy showed adenocarcinoma. The partial resection of the lower gastric tube with mediansternotomy was performed because of limiting the invasion of the carcinoma. Pathological examination showed that poorly differentiated adenocarcinoma with signet ring cells had invaded muscularis propria. The postoperative course was uneventful and he is well without any recurrence 6 months after the operation. A double carcinoma, such as esophageal cancer concomitant gastric cancer is not rare, but a carcinoma of the gastric tube which was substituted for the esophagus is rare. Recently, the incidence of carcinoma of the gastric tube is increasing due to the increasingly long-term survival rate of patients who had esophageal carcinoma. In order to ensure the early detection of a second carcinoma which can minimalize damage from curative resections, follow up examinations should be conducted with the utmost diligence.

During the period from 1986 to 1993, a total gastrectomy was performed in 174 patients with gastric malignancy in Uwajima City Hospital. Among these patients, 160 patients required lymph node dissection around the splenic artery, 109 (68.1%) of whom received pancreas-preserving operation and 51 distal pancreatectomy. Although in the former group only 3 patients (2.8%) had complications relating to pancreatorrhea, 14 patients (27.5%) suffered this complication in the latter group. On the other hand, only about 11.5% were histologically proved to have metastatic involvement in the lymph nodes around the splenic artery. These findings suggest that pancreas-preserving operation should be positively evaluated in lymph node dissection around the splenic artery.