Kazutoshi Date

Limited vertical skin incision for median sternotomy

The cosmetic deformity of the vertical skin incision for median sternotomy was decreased by using a mechanical traction system to increase exposure at the superior margin of a shorter wound. The limited vertical skin incision did not impede technical surgical maneuvers and produced a scar that was more acceptable than submammary incision or right anterior thoracotomy. The limited skin incision is especially useful in young women with congenital heart disease.

Successful resection of metachronous liver metastasis from α-fetoprotein-producing gastric cancer: Report of a case

We present herein the case of a 68-year-old man in whom metachronous liver metastasis from an α-fetoprotein (AFP)-producing gastric cancer was successfully treated. The patient initially underwent a distal gastrectomy for an AFPproducing gastric cancer on January 30, 1997, following which the serum AFP level which had been 228 ng/ml prior to surgery decreased to 30 ng/ml. However, 7 months after surgery, follow-up examination revealed an abnormal elevation of the serum AFP level up to 301 ng/ml, and a liver tumor was subsequently detected at segment 8 (S8) by abdominal ultrasonography. There was no evidence of hepatitis B or C virus infections. After various investigations, he was diagnosed to have liver metastases in S6 and S8, from the AFP-producing gastric cancer, and a partial hepatectomy of S6 and S8 was performed. His postoperative course was uneventful and he was discharged on postoperative day 26. Thereafter, his serum AFP levels decreased and have remained within normal limits for 12 months since his operation. To the best of our knowledge, this is the first case of successful resection of metachronous liver metastasis from an AFP-producing gastric cancer.

Eosinophilic colitis accompanied by Tolosa–Hunt syndrome: report of a case

presented in this case has been documented only rarely.1–3 With regard to laboratory findings, peripheral hypereosinophilia and elevation of serum IgE levels occur variably and are not reliable prerequisites for diagnosis.1,2 Because definite diagnosis requires microscopic evidence, multiple biopsies by endoscopy or fullthickness biopsies by minimal invasive surgery such as laparoscopy should be considered.2,4 The most interesting symptom seen in this case was painful ophthalmoplegia, which is produced by involvement of the cranial nerves passing through the cavernous sinus. This case was thought to be THS from his clinical course, the diagnosis of which is made only after other possible diseases, such as tumors and aneurysm, have been excluded. The etiology of THS is poorly understood, although the pathology is considered to be a non-specific granulomatous inflammation in the region of the cavernous sinus.5 Corticosteroids are the mainstay of treatment for EGE1,3,4 as well as for THS,5 and surgery is reserved for medically refractory EGE, usually either obstructive or perforated cases.1,4 In this case, it is possible that initial administration of corticosteroids could have prevented surgical intervention and provided relief from all symptoms. To the best of our knowledge, this is the first case of eosinophilic colitis and THS coexisting, probably merging accidentally.

SUCCESSFUL TREATMENT OF BLUNT TRAUMA INVOLVING COMPLETE LACERATION OF THE PANCREAS AND DUODENUM IN A 7-YEAR-OLD CHILD : REPORT OF A CASE

The acute onset of peritoneal signs and shock in a 7year-old boy who had been hit in the epigastrium by a log-seesaw mandated surgical treatment. Enhanced computed tomography (CT) demonstrated complete laceration of the pancreas as well as duodenal injury, and a duodenoduodenostomy with distal pancreaticogastrostomy was subsequently performed. Temporary external drainage of the stomach and distal pancreas led to an uneventful recovery in the early postoperative period. Although the patients postoperative development was appropriate for his age, the orifice of the distal pancreas spontaneously closed 2.5 years following surgery. We present this report to stress the fact that every effort should be made to preserve the pancreas following abdominal injury in children.

Gallbladder carcinoma presenting as exfoliative dermatitis (erythroderma).

Although exfoliative dermatitis (erythroderma) secondary to malignancy is commonly associated with lymphomas or leukemias, coincident gastrointestinal (GI) malignancy and erythroderma is rare. The authors recently encountered a patient with gallbladder carcinoma presenting as erythroderma. A 77-yr-old Japanese man presented with a 3-mo history of erythematous eruptions with pruritus over almost the entire body. After confirming the diagnosis of erythroderma, asymptomatic gallbladder carcinoma was found. Further investigations detected no malignancies in other organs. An extended cholecystectomy was performed. Histologic examination of resected specimens revealed poorly differentiated adenocarcinoma with negative resection margins. The eruptions with pruritus resolved within 1 wk after the operation. This is the first report, to our knowledge, of coincident biliary malignancy and erythroderma. The experience of the current patient suggests that erythroderma secondary to GI malignancy may resolve spontaneously after curative resection of the tumor.