Mamoru Hiraki

Xanthogranulomatous Cholecystitis with a Liver Abscess and Metastatic Endophthalmitis: Report of a Case

Abstract There have been no reported cases of xanthogranulomatous cholecystitis with a liver abscess and metastatic endophthalmitis in the literature. There has been only one other case of xanthogranulomatous cholecystitis associated with a liver abscess in Japan prior to the present report. A 53-year-old man was admitted to a local hospital complaining of high fever. Abdominal ultrasonography and computed tomography showed a liver abscess. After percutaneous transhepatic abscess drainage, he complained of an abnormal sensation in his left eyeball and was diagnosed to have endophthalmitis. After being treated for the endophthalmitis, he was referred to our hospital to have the liver abscess evaluated. Endoscopic retrograde cholangiopancreatography showed a normal biliary system without any communication with the liver abscess. Two weeks after endoscopic retrograde cholangiopancreatography he complained of right hypochondralgia. Ultrasonography revealed the presence of sludge in the swollen gallbladder. Under a diagnosis of cholecystitis with a liver abscess, a cholecystectomy was performed. A histological examination indicated xanthogranulomatous cholecystitis based on the findings of a granulomatous lesion consisting of foamy cells in the gallbladder wall. We herein present the first known case of xanthogranulomatous cholecystitis with a liver abscess and metastatic endophthalmitis, while also making a review of the literature.

Direct observation of the portal vein interior by intra‐operative angioscopy in the dog and man

The purpose of this study was to develop the technique of intra‐operative portal angioscopy using a portal angioscope, and to demonstrate its potential use in the therapy for patients with hepatocellular carcinoma (HCC) bearing a portal thrombus. Portal angioscopes, Olympus BF3C10 and CHFP10 of a diameter of 3.5 mm and 4.8 mm, respectively, were used during operation in five dogs, two patients with hepatic metastasis from colon cancer and three patients with HCC having a portal tumour thrombus. The portal vein and hepatic artery were ligated simultaneously, and the angioscope was immediately introduced under direct vision through a small portal venotomy. Blood in the portal vein was almost fully diverted by infusion of heparinized saline through a channel of the angioscope at a rate of 3 mL/min in dogs and 5 mL/min in patients with hepatic metastasis. Rates of 6 mL/min and 10 mL/min in dogs and patients, respectively, were adequate to clear completely the portal vein of blood. In patients with HCC, portal tumour thrombectomy was performed with a Fogarty balloon catheter by suctioning thrombi through a channel of the fibrescope after visual study of the portal thrombus.

Clinicopathological studies on 47 protuberant advanced carcinoma of large intestine.

過去10年間に当教室で経験した腫瘤型大腸癌症例47例について臨床病理学的に検討し以下の結果を得た.1) 組織型は高分化腺癌が85% (40/47) を占め, 深達度ではpm, ss (a1) 症例が多く, リンパ節転移は少ないことが特徴的であったが, 肝転移率は全大腸癌症例と大差はなかった.2) 肉眼形態により4型に分類可能であり, この4型には癌の進行度に差があることが判明し, 小結節扁平隆起型は予後良好, 結節亀裂型はリンパ節転移, 肝転移ともに多く予後不良な傾向がみられた.3) 以上より腫瘤型大腸癌の肉眼分類は, 術中術後の治療および追跡に有用性が高いと考えられた.