Makoto Nakamuro

Budd-Chiari syndrome combined with antiphospholipid syndrome: case report and literature review

A forty-three-year-old woman with Budd-Chiari syndrome, who had had transcardiac membranotomy nearly three years earlier, was admitted to hospital with symptoms of abdominal discomfort and subfever for possible recurrence of the condition. Obstructions of the inferior vena cava (IVC) and hepatic veins (HVs) were thought to have recurred, and the obstructive lesions of the HVs were of the long and multiple type. Additionally, she had a high titer for antiphospholipid antibodies. To relieve abdominal discomfort, percutaneous transluminal angioplasty and medical treatment were instituted. Subsequent relief of symptoms was accompanied by an improvement in the date from laboratory investigations. The authors review 14 cases of Budd-Chiari syndrome associated with antiphospholipid syndrome previously reported in the literature and discuss the therapeutic approaches to the characteristic obstruction lesions of the IVC and HVs.

Aggressive resection for advanced pancreatic carcinoma

An aggressive pancreatectomy was performed on a 53 year old Japanese man with advanced cancer of the pancreas. The tumor originated from the body of the pancreas and invaded the stomach, duodenum, left kidney, transverse colon and common hepatic artery. An unexpected cancer was also found in the head of the pancreas during the operation. Therefore, total pancreatectomy, total gastrectomy, left adrenonephrectomy, resection of the left transverse colon and dissection of the regional lymph nodes were performed. Resection of the common hepatic artery was also performed, followed by an end-to-end anastomosis between the common hepatic artery and celiac trunk. The postoperative course was uneventful and the patient was doing well until nine months after the operation when multiple metastatic lesions were noted in the liver. He died 391 days after the operation from hepatic failure.

The development of a small bowel volvulus in the early postoperative period following a distal gastrectomy: Report of a case

A 51-year-old Japanese man who underwent a standard distal gastrectomy for cancer of the stomach developed abdominal pain when oral intake was commenced on the 6th postoperative day after an uneventful postoperative course. Complete obstruction of the jejunum led to a sudden deterioration in his general condition and a laparotomy was performed, revealing counterclockwise rotation of the mesenterium. The necrotic portion of the small intestine was removed, while 10 cm of the upper jejunum and 100 cm of the terminal ileum were preserved. His second postoperative course was uneventful apart from the development of “intestinal hurry,” which is now under medical control 9 months after his second laparotomy.

Papillary cystic neoplasm (PCN) of the pancreas with lymph node metastasis: Case report of a 77-year-ood woman and a review of 198 reported cases

A case of papillary cystic neoplasm (PCN) of the pancreas in a 77-year-old woman, the oldest patient in the English literature, is reported. Distal pancreatectomy with regional lymphadenectomy was performed for the tumor in the pancreatic tail. Postoperative pathology examination revealed a metastatic lesion in one of the regional lymph nodes. This patient is well doing without recurrence 5 years after surgery.

Usefulness of Secretin Injection during Enucleation of Insulinoma

A benign insulinoma, arising in the body of the pancreas, was successfully enucleated without injury to the main pancreatic duct. Preoperative diagnostic imaging procedures could not clarify the relat