Masahisa Nakagawa

Gastrin release from gastrinoma cells stimulated with secretin

SummaryThe secretin injection test has been proved to be useful in the diagnosis of gastrinomain vivo. Fresh gastrinoma cells were cultured for a short timein vitro and then stimulated with secretin. A rise in the gastrin concentration in the culture medium was observed within 10 min after the addition of secretin. This fact may be evidence that gastrinoma cells have receptors which bind with secretin resulting in the release of gastrin.

Primary Bilateral Adrenal Lymphoma Associated with Idiopathic Thrombocytopenic Purpura

Autoimmune disorders are occasionally associated with malignant lymphoma. To date only one case of primary adrenal lymphoma associated with idiopathic thrombocytopenic purpura (ITP) has ever been reported. This paper reports the case of a 63-year-old man with bilateral adrenal masses whose laboratory data showed decreased platelet count. Despite normal blood pressure, the adrenal tumors endocrinologically appeared to be pheochromocytoma. Core needle biopsy was not done due to thrombocytopenia attributed to concurrent ITP. After intravenous immunoglobulin treatment, splenectomy and bilateral adrenalectomy were performed since the first pathological findings of the frozen specimen suggested the possibility of a poorly-differentiated carcinoma. Immunohistochemical study finally showed the tumors to be diffuse large B-cell lymphoma. The patient underwent a subsequent course of combination chemotherapy and survived 6 years recurrence-free without any need for further treatment other than steroid replacement. The coincidence of adrenal lymphoma and ITP should be considered even if another kind of tumor is suspected, and core needle biopsy should be performed prior to operation, since the specific kind of tumor found alters the therapeutical strategy adopted.

Heterotopic autotransplantation of a pancreas segment with enteric drainage after total or subtotal pancreatectomy for chronic pancreatitis

SummaryFour patients with chronic alcoholic pancreatitis and one patient with idiopathic chronic pancreatitis, who had total or subtotal distal pancreatectomies for persistent pain, underwent simultaneous autotransplantation of a pancreas segment to preserve the pancreatic function. The segment was autotransplanted heterotopically to the iliac fossa with anastomosis of the splenic vessels to the iliac vessels to prevent reinnervation, and the pancreatic duct was anastomosed to the intestine to preserve exocrine function. Postoperatively, the patency of the graft vessels was confirmed by angiography in every patients. Complete pain relief has been obtained in all patients with a followup duration of 4–89 mo. Except for one patient who had been treated preoperatively with insulin injections for diabetes, the patients remained normoglycemic without exogenous insulin administration and demonstrated satisfactory insulin secretion during a 75-g oral glucose tolerance test. An exocrine pancreatic diagnostant test usingp-aminobenzoic acid yielded nearly similar levels to the preoperative value for all patients. Heterotopic autotransplantation of the pancreas segment appears to be effective for preserving pancreatic function, as well as providing permanent pain relief for patients with chronic pancreatitis who require extensive resection of the pancreas.

Heterotopic autotransplantation of the distal pancreas segment after total pancreatectomy for cancer of the head of the pancreas.

Autotransplantation of the distal pancreas segment with pancreaticojejunostomy was performed in four patients with cancer of the head of the pancreas to preserve endocrine pancreatic function after extended total pancreatectomy. All patients had tumor involvement of both the celiac axis and the portal vein. The pancreatic graft was determined to be cancer-free by frozen section histologic and pancreatic juice cytologic examinations. The distal pancreas segment was autotransplanted to the iliac vessels heterotopically and placed in the extraperitoneal pocket to avoid untoward effects of any local recurrence or pancreatic leakage. This procedure, in the form of reconstruction, might be called modified subtotal pancreatoduodenectomy. Postoperatively, all patients remained normoglycemic without exogenous insulin administration, and their quality of life was considered satisfactory.

Current status of benign biliary disorders in Japan and accuracy rates of preoperative diagnoses: Collective review of 14,654 patients

Data on 14,654 patients preoperatively diagnosed for benign lesions who had undergone surgical treatment during a 2 year period (April 1979 to March 1981) were obtained from 145 institutions. A total of 18,891 biliary disorders were confirmed and classified into 18 groups: stones in the gallbladder, 12,272 patients (83.7 percent of all patients); stones in the extrahepatic bile duct, 3,605 patients (24.6 percent); stones in the intrahepatic bile duct, 570 patients (3.9 percent); acalculous cholecystitis, 463 patients (3.2 percent); idiopathic dilatation of bile ducts, 375 patients (2.6 percent); stenosing papillitis, 274 patients (1.9 percent); benign stricture of bile ducts, 133 patients (0.9 percent); and others. Malignant tumors were found in 243 patients, of whom 132 (54.3 percent) were not expected to have gallbladder cancer. Accuracy rates for preoperative diagnoses in the patients with gallstones of the intrahepatic or extrahepatic bile ducts or the gallbladder, idiopathic dilatation of the bile ducts, benign stricture of the bile ducts, or benign stenosis of the papilla of Vater were higher than 90 percent. However, the false-negative rates for these six disorders, except gallstones of the gallbladder, were higher than 16 percent. Therefore, despite advances in diagnostic procedures before surgery, intraoperative examinations remain indispensable for determining the most effective approach to surgical repair.

Heterotopic autotransplantation of the pancreas segment after pylorus-preserving total pancreatectomy: A case report of successful surgical treatment for chronic pancreatitis

A 38-year-old man who had suffered for 5 years from persistent abdominal pain caused by alcoholic chronic pancreatitis, presented with diffuse calcification of the entire pancreas with cystic formation of the pancreatic head. After a pylorus-preserving total pancreatectomy, the pancreatic head, including the cyst, was removed extracorporeally by bench surgery, and the remaining segment of the body and tail autotransplanted heterotopically to the iliac vessels with a pancreaticojejunostomy. Total resolution of the pain was achieved postoperatively, and dietary intake has been satisfactory. Both endocrine and exocrine pancreatic functions have been well preserved, and no insulin has been needed. Three months after his operation, the patient has returned to leading a normal life.

SURVIVAL RATE OF GASTRIC CANCER ACCORDING TO THE NEW AND FORMER “THE GENERAL RULES FOR GASTRIC CANCER”

“The General Rules for the Gastric cancer”were newly revised in July, 1993. In order to know the differences from the former Rules, 989 patients with gastric cancer, who underwent gastric resection in the department in the past 11 years, were statistically reanalized and corrected survival rates were calculated in this study. In the former stage classification, stage I and II cases accounted for 50.9% and 11.5%, respectively. The disproportion of the percentage in both stages resulted from the imbalance of the percentages of ps(-) and ssγ cases, which were 65.3% and 4.3%, respectively. Five-years survival rates in stage I, II, III and IV cases were 97.8, 89.3, 51.8% and 13.9%, respectively, and the there were significant differences among stage II, III and IV (p<0.01). In the new stage classification, percentage of each stage appeared to be distributed more appropriately, and the distribution was corrected. Five-year survival rates in stage Ia, Ib, II, IIIa, IIIb, IVa, and IVb cases was 98.2, 97.1, 78.1, 64.5, 23.0, 20.5, and 7.3%, respectively. In these values, stage Ia and IIIb almost equal to Ib and IVa, respectively, and significant differences were recognized between stage Ib and II, IIIa and IIIb (p<0.01), and IVa and IVb (p<0.05).

A Case Report of Extracorporeal Hepatectomy of the Medial and Anterior Segments for Liver Tumor.

中肝静脈を巻き込み, 左右肝静脈と大きな肝内門脈枝にはさまれた内側区域から前区域にまたがる腫瘍に対し, 比較的出血の少なくてすむ右3区域切除を行い, 摘出した右3区域を冷却臓器保存液中に浸漬して体外手術により内側および前区域を切除し, 後区域を同所性に自家移植した.本法は前・後区域間の広範囲な肝実質切離を無血下に行うので通常の中央2区域切除より出血は少なく, 無肝期はないので安全に行える術式である.本症例では術中術後の総輸血量3,600mlであった.自家移植肝の血流再開直後より動脈血中ケトン体比は危険域を脱し術翌日からは安全域に入った.肝細胞障害は術後4日目に正常化したがそれ以後も高ビリルビン血症は数日間遷延した.移植肝の胆管ドレナージの胆汁排出や胆汁中直接型ビリルビン濃度はその生着機能の確認に有用であった.術後3か月の現在, 肝機能のすべての指標は正常値を保っている.

A Case of Early Cancer of Gallbladder Accompanied with Adenomyomatosis.

今回, 私たちはadenomyomatosis (ADM) によって形成された二房性胆嚢に胆石症と早期胆嚢癌を合併した症例を経験した.症例は72歳, 女性で術前endoscopic retrograde chotangiography (ERC) にて二房性胆嚢に合併した胆石症と診断し, 胆嚢摘出術を施行した.摘出胆嚢底部には径2.5cm大の結石を認め, また切除標本の病理組織学的検索にて胆嚢底部には慢性胆嚢炎像を, 胆嚢体部にはRokitansky Aschoff sinus (RAS) の増殖によるsegmental ADMを認め, さらにADM部より頸部側では約4.7cm×4.0cm大の範囲に拡がる早期胆嚢癌巣 (well differentiated adenocarcinoma: m RAS ss) を認めた.文献的にはADMと胆嚢癌の合併報告例は本邦では自験例も含めて6例の報告があるのみで, 自験例を除く5例はいずれも癌巣がADMより底部側に存在しているのに対し, 自験例のみADMより頸部側に存在しておりADMの癌化説を示唆する症例である.

Effect of exogenously administered glucagon on plasma glucose levels in totally depancreatized dogs

SummaryGlucagon was administered exogenously via a subcutaneous route to totally depancreatized adult mongrel dogs and studies were made with major emphasis on glucagon effect on the plasma glucose levels.1.In the totally depancreatized dogs, the plasma glucose levels determined 90 minutes after glucagon injection (40µg/kg s.c.) were compared with the pretreatment fasting plasma glucose levels. The rate of increase in the plasma glucose levels was 5.13±0.48 times (M±SEM) in dogs with low pretreatment levels (lower than 100 mg/dl). In dogs with higher pretreatment levels (100–400mg/dl), the increase was 1.62±0.40 times. And in dogs with the pretreatment levels higher than 400mg/dl, the value was 0.90±.07 times.2.Ninety minutes after regular insulin injection (0.25U/kg i.v.), glucagon was administered (40/smg/kg s.c), and the changes in the plasma glucose levels were determined.3.In totally depancreatized dogs, a transient increase in the plasma insulin level was noted when glucagon was administered (40/smg/kg s.c.) under infusion of a mixture of glucose and insulin.4.There was no significant difference in the rate of disappearance of glucagon from the blood between normal and totally depancreatized dogs.5.It is considered that glucagon would be useful for the treatment of hypoglycemia encountered after total pancreatectomy.