Katsuhiko Ishizaka

Platysma musculocutaneous flap for reconstruction of trachea in esophageal cancer

In 2 patients with advanced cervical esophageal cancer invading the trachea, total laryngoesophagectomy with resection of the posterior portion of the trachea and lymph node dissection of the bilateral neck and superior mediastinum was carried out. The partial defect in the trachea was repaired with a platysma musculocutaneous flap. A permanent tracheostoma, composed of the tracheal remnant anteriorly and the platysma musculocutaneous flap posteriorly, was made just over the manubrium sterni.

Endoscopic and manometric study of the cardia in post-gastrectomy patients

This study was undertaken to clarify the incidence of hiatus hernia and the functional changes in the cardia of post-gastrectomy patients. One hundred and four post-gastrectomy patients and 399 non-gastrectomy patients were selected for endoscopic study, and the diagnosis of hiatus hernia was made by observing the shape of the cardia inside the stomach. A manometric study was also done on 12 patients with gastric carcinoma and 14 patients with gallstones. Hiatus hernia was observed in 37.5 per cent of the post-gastrectomy patients, this incidence being significantly higher than the 19.3 per cent of the non-gastrectomy patients (p<0.01). In the latter group alone the incidence of hernia steadily increased with advancing age. In the post-gastrectomy patients, reflux esophagitis and heartburn were observed in 20.2 per cent and 27.9 per cent, respectively. These incidences tended to be higher in the patients with hernia but there were no significant differences. The manometric study revealed that lower esophageal sphincter pressure was significantly decreased after gastrectomy, but not after cholecystectomy.

Total pancreas divisum caused by ventral pancreas malrotation showing biliary pancreatitis

A 52-year-old man was admitted to our hospital complaining of abdominal pain. A blood test showed high serum levels of biliary enzymes and amylase. Surprisingly, a computed tomography scan revealed complete separation of the ventral and dorsal pancreas and swelling of the ventral pancreas with choledocholithiasis. Surgical cholecystectomy was performed to remove the bile duct stones after endoscopic removal was unsuccessful. The complete separation of the pancreatic parenchyma caused by ventral pancreas malrotation seen in this case is extremely rare, and may provide important information regarding embryologic development, deformity, and malfunction of the pancreas.