Haruaki Ogawa

Efficacy of endoprosthesis for internal biliary drainage in patients with nonresectable carcinoma of the proximal bile duct

Surgical endoprosthesis as an internal biliary drainage was performed as a palliative treatment for 12 patients with a nonresectable carcinoma of the proximal bile ducts. In most of these patients jaundice was relieved, they were able to return to their homes, and their survival was substantially prolonged. The efficacy of this procedure was more favorable, compared to the results in patients in whom external drainage or cholangiojejunostomy was performed.

Congenital choledochal dilatation associated with carcinoma after choledochocystoduodenostomy —Case report and a review of the literature—

A 24-year old Japanese woman with congenital choledochal dilatation associated with carcinoma, cholelithiasis and pancreatolithiasis was treated. She had undergone choledochocystoduodenostomy at the age of 5 years. At the present admission, a dilated choledochus was excised and hepaticojejunostomy (Roux-en-Y anastomosis) and pancreatic ductojejunostomy were performed. Adenocarcinoma involved the entire mucosal surface of the resected specimen. We also present a review of the literature on the treatment and prognosis of patients with congenital biliary dilatation associated with carcinoma after bypass operation in childhood. We emphasize that in patients with congenital choledochal dilatation, the dilated choledochus should be excised, even in young children.

Vertical Banded Gastroplasty for Pickwick Syndrome. A Report of Two Cases.

睡眠時無呼吸症候群 (sleep apnea syndrome: SAS) あるいはobesity hypoventilation syndrome (OHS) を伴う重症肥満患者2例にvertical banded gastroplasty (VBG) を施行した.術後合併症はみられなかった.術後の良好な体重減少により睡眠時無呼吸発作の消失とOHSの改善が得られた.覚醒時のperformance activityの向上と精神的なirritabilityの消失によって患者のquality of lifeは著しく向上した.減量によって咽頭部, 胸壁, あるいは腹腔内などに過剰に蓄積した体脂肪が著明に減少したことがSASやOHSの改善に寄与したものと思われた.VBGは術後合併症が少なく, 減量効果の高い術式であり, SASあるいはOHSを伴う重症肥満に対する有用な治療法と考えられた.