Nihon geka hokan. Archiv fur japanische Chirurgie最新文献

A woman aged 62 with long history of chronic relapsing pancreatitis presented with swelling and ulcer in the lower limbs and occasional gastrointestinal bleeding. The radiological imaging showed complete obstruction of Inferior Vena Cava (IVC) at the level of the pancreas and well developed collateral vessels. Portal vein and splenic vein were also obstructed and superior mesenteric venous blood drained into the liver via coronary vein. She was originally found to have pancreas head tumor, which was not resectable. A palliative operation was performed, but histological examination of pancreatic specimen suggested only chronic inflammation and no evidence of malignancy. She was diagnosed as tumor-forming type chronic pancreatitis. Although SPV or SMV-PV obstruction has been recognized as a complication of chronic pancreatitis, IVC obstruction can occur by the same mechanism. This is the only case but one ever reported. Not only splenoportography but IVC-graphy will contribute to more precise understanding of patient's condition with chronic pancreatitis.

Neurogenic tumors of the liver are very rare, irrespective of associated neurofibromatosis. We report here a well-documented case of benign schwannoma in a 56-year-old woman without neurofibromatosis, including imaging and pathological examinations.

To assess the current status of extracorporeal shock wave lithotripsy (ESWL) for the treatment of gall-stones in Japan, we conducted a nationwide survey by sending a questionnaire to 251 institutions using this therapy. Replies were obtained from 50 institutions. The use of ESWL was investigated over the period from its introduction up to October 1992. ESWL was performed on 2,760 of 10,058 patients with gallstones (27.4%). The stones were completely pulverized in 1,021 of these 2,760 patients (37.0%). Complete disappearance was limited to single gallstones less than 20 mm in maximum diameter. A comparison in the number of ESWL sessions revealed no significant difference between the patients with and without a good response. Choledocholithiasis was resolved completely in 44.0% of 157 patients who underwent ESWL for this condition and intrahepatic stones were cured in 18.7% of 32 patients. Therefore, ESWL may be a useful form of conservative therapy for biliary calculi.

A case of a recurrent dislocation of the elbow joint in a 13-year-old female is described. The patient sustained a medial epicondylar fracture of the humerus and consulted us four months later. There was no deformity but marked lateral instability of the elbow was recognized. It could be fully flexed and hyperextended ca 20 degrees. The elbow joint could be easily dislocated by pronation of the hyperextended elbow. Roentgenogram demonstrated an apparent non-union of the medial epicondylar fracture. The fragment was repositioned so that the medial collateral ligament became taut. There was no recurrence of the dislocation ten months postoperatively.

We reported a new method of restorative proctocolectomy using posterior approach and pull-through reconstruction. This method obviated transanal manipulation, a major factor causing damage to the internal sphincter, thus preventing fecal incontinence due to sphincter dysfunction. Also, temporary ileostomy was not necessary because the spout of an S-pouch was pulled down below the anal verge and its distal free end acted as a diverting stoma while the more proximal, healing zone (future anastomotic line) was kept from fecal contamination. This method was applied to a 32-year-old woman with familial polyposis coli and a 50-year-old woman with ulcerative colitis. Their bowel movements steadily decreased to three times and five times a day, respectively. There was no fecal leakage or perianal excoriation. The advantages as well as disadvantages of this method compared with the conventional techniques were discussed.

Laparoscopic cholecystectomy is now becoming a safe procedure for the benign cholecystic diseases. But the differences, for example in the method of access to peritoneal cavity, visual field, and tools, between laparoscopic surgery and open surgery results in different complications. The purpose of this paper is to discuss how to avoid complications during laparoscopic cholecystectomy. A hundred consecutive patients were expected to receive an elective laparoscopic cholecystectomy from April 1991 to November 1992 in our clinic. Two patients were converted to open cholecystectomy. The reasons for conversion were uncontrollable bleeding from cystic artery and common-bile duct injury. Two other patients were obliged to undergo laparotomy due to post-operative bile leakage. Arterial bleeding from abdominal wall caused by inserting trocar was experienced in one case. Improvement of the equipment and surgical technique have got rid of these complications. We think it is still necessary to do intra-operative examinations such as cholangiography or ultrasonography. The previous two cases with complication of biliary injury underwent laparoscopic cholecystectomy without intraoperative examinations. We could have avoided these complications if intraoperative examinations were used. To prevent the complication of bleeding from abdominal wall, we have been carrying out a unique method. After the introduction of these procedures, we have never experienced any of these complications.

A patient, a 63 year-old-man, was admitted suffering from discomfort in the left abdominal area; this proved to be a case of leiomyosarcoma of the mesentery. An upper gastrointestinal series revealed stenosis in the 3rd portion of the duodenum, and shift of the entire intestine to the right side. Computed tomography showed a giant mass lesion with a central necrosis. Selective arterial angiography showed a heterogeneous tumor stain with several feeders and drainage veins. A partial resection of the intestine around the Treitz's ligament and left hemicolectomy was required due to the tumor's invasion of the intestinal wall and transverse colon. The operation was successfully performed supported by the angiographic findings. The resected tumor was 23 cm in diameter, 2330 g in weight, and was filled with blood. The histological diagnosis was leiomyosarcoma of the mesentery. The patient has been doing well during the 6 months postoperative period.

We report a case of cerebellar infarctions which occurred in the territories of the bilateral posterior inferior cerebellar arteries. This case was complicated with cranio-cervical anomalies composed of assimilation of the atlas, atlanto-axial dislocation, and basilar impression. The 40-year-old male patient had no detectable risk factors predisposing to atherosclerotic arterial occlusion or cardiogenic embolism, and there were no angiographic findings of atherosclerosis. It was, therefore, postulated that the cerebellar infarctions were secondary to those cranio-cervical anomalies. The developing mechanism is discussed.