Ken Yamanaka

Diaphragmatic hernia resulting from injury during microwave-assisted laparoscopic hepatectomy.

A 31-year-old woman underwent microwave-assisted laparoscopic hepatectomy of the left lateral segment for focal nodular hyperplasia on January 14, 1998. On September 9, 1998, she felt continuous left abdominal pain and was admitted to our hospital for further examination. An upper gastrointestinal series showed converging folds of the greater curvature of the upper third of the stomach and craniad displacement of this portion. Thoracic magnetic resonance imaging showed herniation of the stomach into the pleural cavity. The patient was referred to our department, where she underwent surgery for a diaphragmatic hernia. The fundus of the stomach had escaped into the left pleural cavity through a defect in the diaphragm near where laparoscopic hepatectomy had been performed. The stomach was returned to the peritoneal cavity and the defect sutured. The patient’s postoperative course was uneventful. Although diaphragmatic hernia after laparoscopic surgery is a rare complication, with the performance of more advanced laparoscopic procedures and the use of higher-technology tissue-destruction/hemostatic devices such as the microwave coagulator, more caution should be observed to prevent injury to adjacent organs such as the diaphragm.

CASE REPORT: Malignant Fibrous Histiocytoma in the Ileum Associated with Intussusception

Malignant fibrous histiocytoma (MFH) is a rare neoplasm, initially described in 1964 by O’Brien and Stout, who considered it to be of histiocytic origin. It has been increasingly recognized to be a discrete entity. MFH usually occurs as a mass on an extremity or the retroperitoneum, but it rarely occurs in the digestive system. In addition to our case, 11 cases of primary small intestine MFH have been reported in the English literature (1–11). We report here a rare case of MFH in the ileum associated with intussusception and review the 12 cases documented in the literature.

A morphologic study of the behavior of biogenic amines in experimental acetic acid gastric ulcer.

SummaryMorphological observations were made of the behavior of biogenic amines in the gastric wall of rats with acetic acid-induced ulcer. In the normal rat stomach, abundant adrenergic fibers were seen in the adventitia of arteries and arterioles, with frequently distributed mast cells in their environs, in all gastric wall layers. Mast cells had a more frequent distribution in the antral region than in the corpus ventriculi while enterochromaffin-like cells (EC-like cells) were found with greater frequencies in the latter region of gastric wall. Adrenergic fibers were abundant around blood vessels in perilesional area of the gastric wall of rats with acetic acid ulcer. Mast cells, seen more frequently in the antral region as in the normal rats, showed degranulation in these rats. The population of PAS-positive mucous cells reached its peak in 10 days after injection of acetic acid and subsequently declined with healing of the ulcer, thus remarkably concordant with the ulcer index. Local administration of serotonin produced angiospasm in the greater omentum. The finding indicates a possible participation of arteriospasm by adrenergic nerve fibers in the pathogenesis of gastric ulcer. The results of the present study strongly suggest that biogenic amines have bearing as an aggressive factor upon the angiospasm theory of ulcerogenesis.

A Clinical Study on Intraoperative Additional Resection for Gastric Cancer with Residual Cancer Cell in the Surgical Margin.

過去10年間の治癒切除胃癌317例のうち, 初回切除時に組織学的に切除断端陽性で, 同手術中に追加切除を行った14例 (追加切除群) について臨床的検討を行った.対照には, 追加切除群と同様の浸潤型で, 初回切除断端陰性であったか, 切除断端陽性と判断し追加切除を行ったが組織学的には陰性であった197例 (対照群) を用いた.追加切除群の予後的漿膜因子 (PS) 陰性例4例では, 再発例や癌死例はなかった.追加切除群PS陽性例10例の5年生存率, 5年無症候率 (無症候期間から生存率に準じて算出) は33.3%, 13.0%で対照群PS陽性例の30.6%, 23.2%と差は認められず, リンパ節転移別にみても両群間で差は認められなかった.ステージ別に生存率, 無症候率を比較しても差は認められなかった.初回切除断端陽性となりen bloc切除がなしえず, 同手術中に追加切除を行っても生存率の低下や再発率の増加はなく, 術中追加切除は根治性からみて, 意義のある手技であることを確認した.