Akira Tsuchiya

Transradial approach for transcatheter arterial chemoembolization in patients with hepatocellular carcinoma: comparison with conventional transfemoral approach.

We evaluated the clinical usefulness and safety of transradial approach for transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) compared with that of conventional transfemoral approach. The two groups (radial group, n = 177; femoral group, n = 150) of cases were retrospectively compared with regard to the successful rate of angiography or TACE, time required for catheterizaiton and complications. Hepatic angiography and TACE were completed in 174 (98.3%) of 177 cases in the radial group. There was no intergroup difference of time required for catheterization. Minor complications (dull pain, numbness) occurred in 8 (4.6%) patients in the radial group, and there were lower complications in the radial group compared to the femoral group. TACE by our new transradial approach was found to have therapeutic efficacy with lower complications comparable to that of the conventional transfemoral approach.

INVESTIGATION OF THE GALLBLADDER CARCINOMA ACCOMPANIED WITH ACUTE CHOLECYSTITIS

An investigation was made on the causes and diagnosis in 5 cases of gallbladder carcinoma ac-companied with acute cholecystitis which had different pathosis and causes each other. One case was of acute cholecystitis caused by calculus impaction accompanied with abiogenetic carcinoma without any relationship between the carcinoma and cholecystitis. Of the remaining 4 cases of cholecystitis caused by a gallbladder carcinoma, one case developed acute cholecystitis with an impacted calculus which was accompanied with edema in the neck due to wide-spreading invasion of carcinoma in the main gallbladder; another one case developed acute cholecystitis with occlusion of the cystic duct due to a gallbladder carcinoma arising in the duct; and two cases developed acute cholecystitis, because tumor necrosis tissue due to a gallbladder carcinoma fully occupied the lumen of the gallbladder. The pathosis and causes of cholecystitis were different from each other as mentioned above, and unclear images due to inflammation sometimes disturbed us in making the preoperative diagnosis. Accordingly, it is necessary to carry out careful observation and inspection always with attention to possible complication of carcinoma, even if the image diagnoses exhibit acute cholecystitis.

An Adult Case of Multiple Ileal Mucosal Diaphragms.

極めてまれな多発性回腸膜様狭窄症の1症例を報告した.患者は63歳の男性.1989年3月に当院で直腸癌の手術を受けるまでは, 腸閉塞の既往はなかった.術後のイレウスのため, 1989年9月に再入院し, 再開腹した.癒着剥離の際, 回腸の近位側に膜様狭窄部が多発していることが偶然に判明した.膜様部の中心にはpin-holeから径10mmの大きさの穴が1個あった.膜様物が集中していた回腸を50cm切除し, 端々吻合した.吻合前に空腸瘻と盲腸瘻のtubeを残存小腸内腔に挿入して抵抗なく通過できることを確認した.組織学的検査で膜様部には粘膜筋板が著明に肥厚している像が認められた.成人の先天性小腸狭窄症は極めてまれで, 我々が検索しえたかぎりでは, 報告例は世界で6例のみであった.