Eiji Shimozawa

Chronic calcifying pancreatitis associated with primary hyperparathyroidism —Report of a case and review of the literature—

A 34 year old male was hospitalized because of severe abdominal pain and diarrhea. An abdominal X-ray revealed multiple calculi in the head of pancreas and blood tests showed his serum calcium level to be high. He underwent surgery of the parathyroid gland and a parathyroid tumor was removed. Two months later, resection of the head of the pancreas was also performed. Eighteen months after his operation there has been no recurrence of abdominal pain or diarrhea and his serum calcium level is within the normal range. We report this case herein and also discuss the possible cause and effect relationship between primary hyperparathyroidism and pancreatitis, and the appropriate management, in relation to a review of the literature.

A Case Report of Zollinger Ellison Syndrome and Review of the Literature

There is much controversy concerning the mode of therapy for patients in whom Zollinger-Ellison syndrome is strongly suspected but a tumor can not be located. We recently experienced a patient with Zollinger-Ellison syndrome presenting with melena in whom an attempt to stop the bleeding by H-2 antagonists failed and an emergency operation had to be carried out. At laparotomy, no tumor was found in the pancreas, duodenum or stomach wall and there was no specific swelling in any of the lymph nodes. A total gastrectomy was thus done with lymphadenectomy and a histopathological examination revealed two gastrinomas in the lymph nodes of the gastrinoma triangle. Postoperative secretin tests with 2 u/kg of secretin have been negative even 6.5 years later, and the patient is now well and working as a full time teacher. In this case, an emergency total gastrectomy was performed for uncontrolled bleeding, but we want to stress the importance of lymphadenectomy based on the findings of the frozen section and changes in gastrin levels.

A Case of Preoperatively Diagnosed Retroperitoneal Cavernous Lymphangioma.

後腹膜海綿状リンパ管腫の1例を経験した.症例は40歳男性で, 腹部圧迫感を主訴として来院し, 超音波検査にて蜂巣状構造を呈する巨大な腹部腫瘤を認めた.Computed tomographyでは左横隔膜下から膵後方を通り左腎下極に及ぶ内部構造均一な嚢胞状腫瘤としてとらえられ, 血管造影では血管成分の乏しい腫瘤と考えられた.超音波ガイド下穿刺にて乳康を吸引した.上記より後腹膜腫瘍 (リンパ管腫を強く疑う) の診断にて摘出術を施行した.大動脈周囲にて強固に癒着し腫瘍の辺縁は不明瞭となっていた.切除された腫瘤はスポンジ様の構造・弾性を呈し, 病理組織学的にリンパ管腫と診断された.後腹膜リンパ管腫の本邦報告例は約100例で, そのうち海綿状リンパ管腫は7例とまれな疾患であり, また浸潤性の発育・悪性化の問題点もあり文献的考察を加え報告した.