Hiroshi Katamura

A CASE OF ABDOMINAL ACTINOMYCOSIS ORGINATED IN THE GREATER OMENTUM

An extremely rare case of abdominal Actinomycosis originated in the greater omentum was experienced. The case involved a 68-year-old woman with diabetes mellitus. She was seen at the hospital because of a palpable abdominal mass preceded by abdominal pain. Characteristic features of the mass included hardness, tenderness, and poor movability. The white blood cell count was within normal range. After admission abdominal CT revealed a mass 6cm in diameter just under the abdominal wall of the right lower abdomen which was poorly-defined at the wall-side; and visualized a thickened abdominal wall, from which direct invasion was suspected. On the other hand the deepest portion was smooth, and there was a cavity in the mass with a protrusion mimicking an intramural tumor. Abdominal ultrasonography showed a hypoechoic and intrenally heterogenous tumor with cystic structure partially. It was difficult to rule out a possibility of malignant tumor, because abdominal findings were slight, leukocytosis was lacked, no response was attained by administration of antibiotics, the tumor tended to increase, and CT findings indicated an invasive growth into the abdominal wall. Operation was carried out. The removed specimen was a 7×7 ×5cm solid tumor comprizing of the greater omentum and rectus abdominis muscle including a tumorous tissue. It was granuloma with yellow-green pus. Actinomycosis was determined pathologically by the findings of sulfur granule. The patient was diagnosed as abdominal Actinomycosis originated in the greater ometum.

Clinical Evaluation for Acute Gastric Mucosal Lesion.

急性胃粘膜病変の年代的推移を考察し, 発症の予防, 治療法を検討する目的で臨床的に統計評価した. 1979年8月から1991年12月までに横浜市立大学医学部第2外科, 同救命救急部において経験した急性胃粘膜病変72症例について年代別に前半6年と後半6年の2群に分け, その背景疾患, 治療, 予後について検討した. 前半の症例数は周術期38例, 非周術期18例の計56例であり, 後半の症例数は周術期7例, 非周術期9例の計16例と減少した. また, 死亡率は前半の43.1%から後半の14.3%と著しく減少した. 両期間において肝疾患, 呼吸器疾患, 脳血管障害などの合併症を有する症例において急性胃粘膜病変の発症が多く認められた. 周術期管理の向上に加え, H2-receptor antagonistを初めとする薬剤の普及に伴い急性胃粘膜病変の発生率が減少し, 手術症例, 死亡症例も減少した. 急性胃粘膜病変の発症予防, 治療にはH2-receptor antagonist, 防御因子増強剤の投与が有用と考えられた.