Kazushige Arai

Endoscopic membranectomy for congenital duodenal stenosis in an infant

A 60-day-old baby boy (body weight, 3,100 g) with congenital membranous stenosis in the third portion of the duodenum was successfully treated with endoscopic membranectomy by means of a high-frequency wave cutter.

The Efficacy and Diagnostic Significance of Sodium Thiosulphate Solution Spraying After Iodine Dyeing of the Esophagus

Abstract: Spraying with Sodium Thiosulphate Solution (STSS, Detoxol®) is reported to be useful in reducing the side effects of Iodine dyeing on the esophagus. In order to determine the optimal concentration of STSS and its efficacy, STSS was administered in the following concentrations. Group A: 10% (Original Solution), Group: B 5%. Group C, 2.5%. Group D: 1.7% and Group E: saline with no STSS, and a questionnaire was conducted to assess the side effects. The results showed that the higher the concentration, the less frequent and short lasting the side effects were. The effects of STSS on diagnostic efficacy was also evaluated. After spraying with STSS, the 2.5% solution removed iodine gradually but there were differences in discoloration among the various degrees of inflammation. When iodine dyeing was repeated, clear images with a good contrast were obtained. Excess iodine was neutralized and details of the surface and vascular pattern were more readily observed. Spraying with STSS seemed to increase the diagnostic ability of the procedure.

The Indications of Proximal Gastrectomy for Gastric Cancer in the Upper Third of the Stomach.

過去44年間に当教室で切除された上部胃癌 (C, CM, CE) 318例を対象とし, 噴門側胃切除術の適応について検討した. 各深達度別のリンパ節転移の割合はm: 0% (0/23), sm: 6.1% (2/33), mp: 25% (4/16), ss: 74.1% (43/58), se: 81.3% (104/128), si: 91.7% (55/60) で, ss以上でリンパ節転移が高率であったが, mp以深ではリンパ節転移112までであった. またsm, mp癌の転移リンパ節の詳細はsmがNo1, 7, mpがNo1, 2, 3, 11で, No4d, 5, 6, 10に転移を認めなかった. 治癒切除後の再発形式でも深達度mpまでの癌でリンパ節再発を認めたものはなく, 深達度mpまでの5年生存率でも噴切群86.7%に対し全摘群74%と両群間に差を認めなかった. 以上よりC領域の早期胃癌においてはD1+No7, mp癌においてもD1+No7, 11の郭清を加えることにより噴切は適応となる. 深達度ss以深ではn2以上の転移が高率であり噴切の適応とはならず, 拡大郭清が適応となろう.

A case of ruptured aneurysm of the left gastric artery with early gastric cancer.

症例は70歳男性.言語・構音障害を主訴に当院入院.左側頭葉に血腫を認め, 保存的治療を行っていたが, 突然, 出血性ショックに陥り, 厳重な全身管理下に出血源精査を行った.上部消化管内視鏡検査では胃体上部にIIc型早期胃癌を認めたが, 出血源とは断定できず, 腹部超音波検査および腹部computed tomography検査を行った.肝下面を中心とする腹腔内血腫が認められ, 腹部血管造影検査を行い左胃動脈瘤の存在を認めたため, 早期胃癌を併存した左胃動脈瘤破裂と診断し, 胃全摘術を施行して救命しえた.本症は, 調べえた本邦報告例では10例とまれであり, かつ破裂例は6例のみであった.画像診断, 全身管理の進歩により, 近年予後の改善をみているが, いまだ診断に難渋している症例が多かった.原因不明の腹痛, 急激なショックを呈した症例に遭遇した際には本症も念頭に置くべきと思われた.