Hajime Yonekawa

The hypertrophic uncinate process of the pancreas wrapping the superior mesenteric vein and artery —A case report—

The hypertrophic uncinate process of the pancreas wrapping the superior mesenteric vein and artery was discovered during surgery on a patient with nodular chronic pancreatitis. Such a rare anomaly has never been noted in the English literature so far as we have been able to find. This malformation of the pancreatic uncinate process was considered to be due to excess fusion between the ventral and dorsal pancreatic anlages during embryonic stage.

Obstructive jaundice caused by a huge liver cyst riding on the hilum: report of a case.

A 71-year-old man presented to our hospital with obstructive jaundice, found to be caused by a huge liver cyst which was centrally located and riding on the hilum. Percutaneous transhepatic cyst drainage was performed, following which obstruction of the bile duct was relieved and the jaundice subsided. As jaundice recurred after removal of the drainage tube, the patient underwent deroofing, since when he has remained well. Only 13 cases of liver cysts producing obstructive jaundice have been reported in the English literature, most of which were characteristically enormous, located centrally, and riding on the hilum. Liver cysts possessing such features are likely to cause obstructive jaundice by compressing the hepatic hilum. Cyst drainage is helpful for ameliorating the jaundice and making an accurate diagnosis; however, subsequent deroofing or injection therapy is necessary to prevent recurrence.

Surgical treatment of intra-thoracic esophageal carcinoma infiltrating to the neighboring organs.

他臓器浸潤胸部食道癌52例を対象としてその浸潤臓器別に外科的治療の成績を検討し, 他臓器合併切除の適応につき考察した.1) 大動脈浸潤を伴う13例の1年生存率は23, 1%であり, 気管浸潤を伴う13例の1年生存率は15.4%であった.大動脈・気管への浸潤例では他にも臓器浸潤を伴う症例やリンパ節転移 (n-number) が高い症例が多かった.2) 大動脈浸潤例では癌の浸潤が小範囲に限局し, リンパ節転移がN2以下である症例にかぎり大動脈外膜切除の適応があると考える.気管浸潤に対する気管の合併切除・再建術の適応と手技は今後の問題と思われた.3) 肺や心嚢などへの浸潤例では約半数においてリンパ節転移はn2以下であり, 積極的な合併切除により予後の改善が期待される.

Partial splenic embolization for hypersplenism with liver cirrhosis.

肝硬変に伴う脾機能亢進症10例に対して部分的脾動脈塞栓術 (Partial Splenic Embolization) を施行し, その効果, 肝機能に及ぼす影響, 合併症とその対策について検討した. 血小板数は本法施行後3日目より急激に増加し, 12ヵ月経過後においても9.1±2.7×104/mm3と施行前より有意な上昇が持続した (p<0.05).本法により血小板数の増加を持続的に得るためには脾の50～70%の梗塞範囲が必要であった. 本法は肝予備能の悪い症例やhigh riskの症例に対しても安全に施行することができ, 発熱などの副作用は保存的対処が可能であった. また肝機能に及ぼす影響は一過性であった. 本法の効果が不十分であった症例には反復する必要があると思われた.