Hiroyuki Nakaba

Giant Adrenal Myelolipoma: Report of a Case

Adrenal myelolipomas are rare benign tumors composed of mature adipose tissue and hematopoietic elements that resemble bone marrow. They are usually asymptomatic, and most cases are incidentally found at radiological examination or autopsy. Symptoms such as abdominal pain and increasing girth occur only when the tumor grows large. We report the case of a giant adrenal myelolipoma in a 51-year old man who presented with a huge abdominal mass and abdominal pain. The resected tumor weighed 6 000 g and could represent the largest such tumor ever documented in the literature. We discuss the diagnosis and treatment of this unusual tumor.

Gastric varices formation due to pancreatic tumor: a case of successful resection of cystadenocarcinoma.

We report a 70-year-old woman with gastric varices due to splenic vein obstruction by a cystadenocarcinoma of the caudal pancreas. Most of the pancreatic cancer had already extensively progressed and was unresectable when an obstruction of the splenic vein was also discovered. Two contributing factors are thought to have enabled us to perform a curative resection in this cases: (1) the gastric varices were detected by chance in a mass survey, (2) the cancer was not so advanced as to be unresectable.

Colon liver metastasis complicated with tumor thrombus in the bile duct: A case report

Highlights • Colorectal liver metastasis with bile duct tumor thrombus is rare in clinical.• Hepatectomy is a common therapeutic procedure for colorectal liver metastasis.• Colorectal liver metastasis with bile duct tumor thrombus might be a bad prognosis.

Serial changes in plasma levels of pancreatic elastase 1 after pancreatic surgeries

The alterations of the plasma level of elastase 1 (Ela) were investigated in 15 patients undergoing total pancreatectomy (TP), 18 patients undergoing pancreatoduodenectomy (PD), 8 patients undergoing distal pancreatectomy (DP) and 10 patients undergoing gastrectomy for gastric cancer (GR). The Ela level decreased rapidly below the normal level after TP. The plasma half-life of Ela was 4.6±1.2 h (Mean±SEM). The Ela levels after PD were abnormally elevated until the 7th postoperative day. The Ela levels after DP and GR were elevated gradually until the 7th postoperative day. From 1 to 6 months after PD, DP and GR, the Ela levels were normal. An additional release of Ela from the remaining pancreas following direct surgical interventions to the pancreas resulted in the elevated of the plasma level of Ela in the early postoperative period. The plasma level of Ela was normalized within 2 weeks after pancreatic surgery.

Impaired adrenal vascular response to hemorrhagic hypotension by an adreno-femoral venous shunt

We studied the influence of an adreno-femoral venous shunt on the regional blood flow in the dog adrenal gland during hemorrhagic hypotension. An adreno-femoral venous shunt was placed transperitoneally in the left adrenal gland while the animal was under pentobarbital anesthesia. The right adrenal gland was left intact. Hemorrhagic hypotension was induced at 50 mm Hg mean arterial blood pressure for 1 hr in six dogs and the other six dogs served as normotensive controls. Nonradioactive microspheres (2 X 10(6), 15 +/- 2 micron) were injected into the ventricle. The adrenal cortical and medullary blood flows were estimated by microscopic counting of the microspheres in the serially sectioned adrenal gland. The total adrenal blood flow (sum of the cortical and medullary blood flows) of two methods was compared; the microsphere method vs timed venous sampling through the shunt. In the intact right adrenal gland, the cortical blood flow was significantly decreased, but the medullary blood flow remained unchanged during hemorrhagic hypotension. Subsequently the total adrenal blood flow was not significantly decreased. In the cannulated left adrenal gland, both the cortical and medullary blood flows were significantly decreased and adrenal vascular autoregulation was inhibited. The total adrenal blood flow calculated by the microsphere method showed a significant correlation with that by timed venous sampling through the shunt. These results indicate that the adrenal medullary vasculature autoregulates during hemorrhagic hypotension and that an adreno-femoral venous shunt abolishes this vascular response.