Hidetoshi Fujiwara

PANCREATIC SECRETORY TRYPSIN INHIBITOR AS A MARKER FOR EARLY DETECTION OF REJECTION IN CANINE PANCREAS ALLOTRANSPLANTATION

Serum pancreatic secretory trypsin inhibitor (PSTI)* was measured in the course of canine segmental pancreas allotransplantation without immunosuppression. Serum PSTI concentrations showed two distinct elevations: the first elevation was on the first day and the onset of the second elevation was the sixth day after operation. The first postoperative elevation of the serum PSTI level is thought to be related to the operative procedures, because the first elevation was observed after both autotransplantation and allotransplantation, and biopsies of the autograft and allograft at the first day after the operations showed nonspecific neutrophilic infiltration and no perivascular lymphoid infiltrates. The second postoperative elevation of the serum PSTI level is thought to reflect a rejection process because this elevation was not seen after autotransplantation, and biopsies of allografts at the sixth day after the operation showed typical perivascular lymphoid infiltrates and cellular rejection of the exocrine tissue. In addition, the onset of the second elevation of serum PSTI level preceded by about three days the onset of the elevation of blood sugar at the ninth day after the operation. The results suggest that serum PSTI can be used as a marker for diagnosis of early pancreatic allograft rejection.

Spontaneous rupture of an intrahepatic bile duct with biloma treated by percutaneous drainage and endoscopic sphincterotomy

A case of spontaneous rupture of an intrahepatic bile duct with biloma formation treated by percutaneous drainage and endoscopic sphincterotomy is reported. A 73-yr-old woman was admitted with fever and abdominal pain. There was no past history of abdominal surgery, instrumentation, or trauma. Ultrasound and computed tomography revealed a massive fluid collection in the abdominal cavity. Endoscopic retrograde cholangiography demonstrated extravasation of contrast medium from a distal biliary radicle in the left lobe of the liver. After successful treatment by percutaneous drainage and endoscopic sphincterotomy, the patient did well. Ultrasound and computed tomography showed resolution of the biloma. Nontraumatic bilomas are very rare: in fact, only 24 cases of spontaneous biloma have been reported. Endoscopic treatment for patients with spontaneous bilomas can be safe and effective, and should be considered.

Reconstruction of a large duodenal defect created by resection of a duodenal tubulovillous adenoma using a double-tract anastomosis to a retrocolic roux-en-y loop: report of a case.

Abstract.Adenomas arising in the duodenum are uncommon. The surgical approach to adenoma of the duodenum remains controversial. We herein report the successful closure of a large defect after a partial duodenectomy for an adenoma. A 60-year-old man developed duodenal adenoma. An upper gastrointestinal roentgenographic series and endoscopy revealed a 2.5-cm tumor located adjacent to the duodenal papilla. The tumor was too large to be removed endoscopically, and therefore it was resected en bloc by a partial duodenectomy. Histology confirmed the diagnosis of benign tubulovillous adenoma. The large duodenal defect created by resection of the tumor was closed with double-tract anastomosis to a retrocolic Roux-en-Y loop. Large duodenal defects represent difficult surgical problems. Closure by direct anastomosis to a Roux-en-Y loop side-to-side is thus considered to be the procedure of choice.

A CASE OF A GIGANTIC PLANTBEZOAR ACCOMPANIED WITH PERFORATED GASTRIC ULCER

巨大植物胃石による胃壁の圧迫が原因と考えられる潰瘍形成から穿孔に至った稀な症例を経験したので報告する.症例は67歳男性,市販の干し柿を数個摂取した翌日から嘔吐,翌々日から食欲不振が出現し,摂食から1週間後に胃透視および胃内視鏡にて巨大な胃石を指摘された.保存的治療中,穿孔をきたしたため緊急手術にて胃切除術を施行し軽快した.胃石が胃に停滞した場合は潰瘍を併存することが多く,稀に穿孔をきたす場合があり,胃石の大きさにもよるが内科的治療に抵抗性の場合はすみやかに外科的処置をとる必要があると思われた.

The long-term function and histology of segmental pancreatic autografts with pancreatic exocrine diversion to the esophagus in dogs

The endocrine function and histology of segmental pancreatic autografts with pancreatic exocrine diversion to the esophagus were assessed in nine dogs which survived longer than three years. An original twelve dogs underwent total pancreatectomy followed by a segmental pancreatic graft autotransplanted with pancreatic duct to esophagus anastomosis in the neck. All twelve dogs immediately had normal fasting glucose, nine of which sustained it for more than three years. One of the twelve dogs died on the tenth day from a thrombosis and two others died of causes unrelated to the graft; one of pneumonia and the other of an unknown cause, within the first year of transplantation. An intravenous glucose tolerance test performed three years after the transplantation revealed K values (1.90±0.37) which were not significantly different from those tested before the transplantation (1.92±0.42). The patency of the anastomosis between the pancreatic duct and the esophagus was clearly identified in the specimen of a dog sacrificed three years after the transplantation. The mucosa of the esophagus was macroscopically and microscopically almost normal. Histological studies of the autografts done three years after the transplantation showed almost normal pancreatic architecture in the islets and exocrine tissues, while histochemical analysis with immunoperoxidase stains confirmed the presence of insulin, glucagon and somatostatin. It is therefore possible that this new technique could be used for clinical segmental pancreatic transplantation.