Atsuyoshi Onitsuka

Malignant schwannoma of the esophagus with lymph node metastasis: literature review of schwannoma of the esophagus

An extremely rare case of malignant schwannoma of the esophagus with lymph node metastasis is reported. A 49-year-old woman was found to have an abnormal shadow on a chest X-ray film taken during an annual checkup. Upper gastrointestinal series showed extrinsic pressure on the middle thoracic esophagus, without a mucosal lesion. An exploratory operation was performed, with a tentative diagnosis of esophageal leiomyoma. The tumor was enucleated with part of the esophageal mucosa, and a few enlarged lymph nodes around the tumor were dissected. The resected tumor was an elastic firm mass, measuring 8.2 x 5.8 x 3.7 cm, and had a smooth surface. Histological examination of the tumor revealed the proliferation of spindle-shaped cells with chromatin-rich nuclei. The nuclei were variable in size and showed remarkable atypia. A paraesophageal lymph node had same findings as the main tumor. Immunohistochemically, the tumor cells were diffusely positive for S-100 protein and neuron-specific enolase. The pathological diagnosis of this tumor was malignant esophageal schwannoma with lymph node metastasis. Esophageal schwannoma is extremely rare. We reviewed the literature on 19 cases of esophageal schwannoma, including that in our patient. The majority of the tumors were benign. Only three cases of schwannoma were malignant, and this is the first reported case of malignant schwannoma with lymph node metastasis.

Current practices in adult groin hernias: a survey of Japanese general surgeons.

Abstract.The tendency to perform abdominal wall reinforcement using various types of mesh (tension-free repair) is increasing. A questionnaire to poll Japanese surgeons on their current surgical modalities for groin hernias was sent to 105 hospitals and was returned by 83 hospitals. The majority (83%) of responders to this survey supported the tension-free repair as a standard operation for adult groin hernias. Of these 69 tension-free repairs, the mesh-plug repair was the most frequent standard operation (n = 53, 64%) and was performed by all responders. Ten (12%) opted for the prolene hernia system (PHS) repair as a standard operation and 52% of responders had experience of the PHS repair. Laparoscopic repair was performed as a standard operation by only one responder and was performed by only 34% of responders.

Effect of Portal Hypertension Caused by Chronic High Venous Pressure on Small-Intestinal Sugar Absorption

The effect of portal hypertension and chronic high venous pressure on the absorption of the small intestine was examined by constricting the suprahepatic and subdiaphragmatic inferior vena cava in rats. A group of rats with the constricted suprahepatic and subdiaphragmatic inferior vena cava comprised group 1 (n = 9) and another group of rats with only laparotomy comprised group 2 (n = 9). Two months after the operation, sugar absorption and other parameters were measured. The blood pressures of the infrahepatic inferior vena cava and the portal vein 8 wk after the operation in group 1 were significantly higher than those in group 2. The results of D-xylose absorption tests showed that the amount of excreted D-xylose in urine in group 1 was significantly lower than that of group 2, but the D-xylose everted sac test showed no significant differences between the two groups. The glucose everted sac test showed that the amount of glucose absorption in group 1 was significantly lower than that in group 2. These findings suggest that chronic high venous pressure caused by constriction of suprahepatic inferior vena cava may lead to sugar malabsorption. We conclude that portal hypertension with high venous pressure below the diaphragm can lead to sugar malabsorption in the intestine.

Rapid growth of hepatocellular carcinoma after or during interferon treatment for chronic hepatitis C: Report of three cases

We report herein the cases of three patients in whom marked rapid growth of hepatocellular carcinoma (HCC) became evident after or during interferon (IFN) treatment for chronic hepatitis C. The HCC tumors were 10, 4.7, and 3.1 cm in size, and were found 7 months, 10 weeks, and 10 weeks after the initiation of IFN, respectively, in cases 1, 2, and 3. The clinical courses of these three patients suggest that the progression of HCC was more rapid during the IFN treatment period. Thus, we propose that abdominal ultrasonic (US) examination should be performed monthly in patients with chronic hepatitis who undergo IFN treatment.

Hepatoma with Growth in Right Atrium: Report of Successful Resection

A case of hepatocellular carcinoma (HCC) with growth in the right atrium is presented. Simultaneous removal of the left lobe of the liver and the intracardiac tumor was carried out using cardiopulmonary bypass. Although HCC was combined with liver cirrhosis, the patient tolerated left hemihepatectomy. The patient is doing well without signs of recurrence 7 months after operation.

Dielectric spectrogram for evaluating ischemic microstructural changes of the liver in simple cold preservation.

Abstract.Purpose: Monitoring ischemic liver injury is important in liver transplantation. We previously reported that dielectric properties were correlated with tissue adenosine triphosphate during liver preservation; however, it is unknown what the changes in dielectric properties are based on. Using rats, we studied the relationship between dielectric parameters and microstructural changes in liver tissues during preservation. Methods: We serially measured the percent decrease in conductivity and the percent increase in relative permittivity in rat livers, and determined the areas of cellular and extracellular components using a charge-coupled device microscope and an NIH image. Thereafter, we evaluated the relationship between dielectric parameters and microstructural changes in the liver tissues. Results: A positive linear and exponential correlation was found between the percent decrease in conductivity and the percent decrease in extracellular components (P < 0.01). A positive linear and exponential correlation was also found between the percent increase in relative permittivity and the percent increase in cellular components (P < 0.01). Conclusions: Our results suggest that the serial changes in tissue conductivity and the relative permittivity reflect changes in liver tissue microstructures during cold preservation.

Cruveilhier-baumgarten Disease: A Case Report Emphasizing the Diagnostic Value of Ct Scanning and Angiography

A 64-year-old woman with Cruveilhier-Baumgarten disease (C-B) had symptoms of hepatic encephalopathy and signs of portal hypertension. The diagnosis was made by CT scanning, angiography, and liver biopsy, which revealed minimal fibrosis. The distinctive features of C-B disease are the absence of the hepatic round ligament and the absence of significant liver disease.

Analysis of the T Cell Receptor Vβ Repertoire in 2,4,6-Trinitrobenzenesulfonic Acid Induced Colitis in Mice

The aim of this study was to analyze which types of T cells are at work and the specific nature of their response, using a mouse 2,4,6-trinitrobenzenesulfonic acid (TNBS) induced colitis model. The response of T cells to TNBS was analyzed by anti-TNBS mixed-lymphocyte reaction. T cell clones were established by limiting dilution. Phenotypes and T cell receptor (TCR) Vβ of T cells were analyzed by flow cytometry. Colitis was induced by administration of TNBS enemas, and lamina propria lymphocytes were isolated and analyzed. The proliferative responses to TNBS of spleen T cells were partially inhibited by the addition of antimouse CD4 or CD8 antibodies to the mixed-lymphocyte culture. Conversely, these were inhibited by the addition of both antibodies. Flow cytometric analysis showed that TCR Vβ14 T cells specifically increased in the CD8+ T cell population. We established CD8+ TCR Vβ14 T cell clones which were TNBS reactive and self-restricted. Investigation using lamina propria lymphocytes in TNBS-induced colitis revealed that the rate of CD8+ TCR Vβ14 T cells changed with histological inflammatory activity which also attained a peak on day 5 following enema administration. Both CD4+ and CD8+ T cell subsets responded to TNBS, and the rate of CD8+ TCR Vβ14 T cells changed with histological inflammatory activity in TNBS-induced colitis.

Immunoglobulin G4-related sclerosing cholangitis without pancreatic involvement.

tography (MRCP) demonstrated that the biliary stricture did not spread to the root of the left medial branch ( fig. 2 ). Right hepatic lobectomy, caudate lobectomy and resection of the extrahepatic bile duct with D2 lymph node dissection were performed. A resected specimen showed an irregular but smooth surface of hepatic hilar mucosa and A 62-year-old man with a past history of retroperitoneal fibrosis was admitted with obstructive jaundice. CT demonstrated dilated intrahepatic bile ducts and a nonswollen pancreas. Endoscopic retrograde cholangiography (ERC) disclosed an irregular stricture of the hepatic hilar bile ducts ( fig. 1 ). Magnetic resonance cholangiopancreaPublished online: March 5, 2009

A Case Report of the Traumatic Rupture of the Gallbladder.

腹部鈍的外傷による胆嚢破裂の1例を経験した.患者は49歳の男性.飲酒運転中の交通事故で受傷し来院した.来院時には軽度の腹痛を認めるのみであった.自覚症状に乏しかったが, 受傷6日後に総ビリルビン値が5.0mg/dlまで上昇した.点滴静注胆道造影併用CT, ERCPを施行し, 胆嚢破裂と診断し受傷後16日目に手術を施行した.開腹すると, 腹腔内に胆汁性の腹水を認めた.胆嚢底部から体部にかけて肝床より剥がれており, 体部前壁に直径8mmの破裂孔を認めた.合併損傷を認めず胆嚢摘出術と腹腔ドレナージを施行した.受傷直後より腹部所見に乏しく, 食事摂取, 歩行も可能で結果的に受傷から手術に至るまで時間を要した.胆嚢破裂の診断にはDIC-CT, ERCが有用であった.