Hitoshi Sewake

Anomalous arrangement of the pancreaticobiliary ductal system without dilatation of the biliary tract.

A rare case of anomalous arrangement of the pancreaticobiliary ductal system without dilatation of the biliary tract (AAPBDS without DBT) associated with mucosal dysplasia of the biliary duct is described herein. A 53 year old male with a long history of diarrhea and right upper abdominal pain was diagnosed as having AAPBDS without DBT by endoscopic retrograde cholangiopancreatography and other examinations. Excision of the gallbladder and biliary duct with a Roux-en-Y hepatico-jejunostomy was performed and subsequent pathological examination of the surgical specimens showed mucosal hyperplasia of the gall-bladder and mucosal dysplasia of the biliary duct. Considering the dysplastic changes of the biliary duct as seen in our case, and the high incidence of AAPBDS without DBT developing into carcinoma of the biliary duct, being 12.2 per cent, we suggest that pancreaticobiliary ductal diversion with excision of the gall-bladder and biliary duct should also be performed for AAPBDS without DBT. However, further pathological investigations concerning the excised biliary duct in AAPBDS without DBT will be need to be carried out.

The influence of clinical use of antibiotics on the sensitivity of strains isolated from postoperative infections —A comparison of nosocomial pathogens with strains isolated from the bacterial flora of patients—

In the present study, we investigated how the recent clinical use of antibiotics have altered the antibiotic susceptibility of strains isolated from postoperative infections, especially Gram-negative rods. ForPseudomonas aeruginosa, serogroup E strains acounted for about 20 per cent of postoperative infections, but were unable to the isolated from either the feces of patients on admission or from the appendix contents of patients with appendicitis. It therefore appeared that serogroup E strains were responsible for the nosocomial infections in our department. The strains of methicillin-resistantStaphylococcus aureus andPseudomonas aeruginosa serogroup E, which we assumed to be nosocomial pathogens, acquired a high level of resistance to antibiotics soon after third-generation cephems became widely used. On the other hand, the antibiotic susceptibility ofEnterobacter cloacae, Citrobacter freundii, and the serogroups ofPseudomonas aeruginosa other than E, which were considered to originate from the bacterial flora of patients, did not vary throughout the several years of the study period.

Hemorrhagic multiple ulcers of the intenstine associated with hematopoietic malignancy, Report of two cases.

最近われわれは血液悪性疾患に合併した腸管の出血性多発性潰瘍2例を経験し, 病理学的にも興味ある組織像を示したので報告する.症例1は悪性リンパ腫の白血病化に対し化学療法を施行した後に, 症例2は骨髄異形成症候群のステロイド療法中に発症した.いずれも持続する大量下血のため, 積極的な外科切除を行ったが, 2例とも再発, 増悪をきたし予後不良であった.病理組織学的検索にて症例1では小腸への悪性細胞浸潤に加えてcytomegalovirus感染が潰瘍病変部に強く認められた.症例2では非特異的潰瘍の像を呈しており, また手術侵襲に対する生体防御反応の1つである好中球機能の亢進は認められず, 術後重篤な感染症を合併した.本2例から本症の発生およびその進行には一般にいわれる悪性細胞の腸管への浸潤によるのみでなく, 原疾患の進行や化学療法, ステロイド剤投与などの医原性因子から生じる宿主の感染防御能の低下が大きな要因となるものと考えられた.