Masatomo Yoshioka

Complete Cure of Malignant Lymphoma of the Stomach with a Huge Adrenal Lesion Achieved by Preoperative Chemotherapy and Surgery: Report of a Case

Abstract We report herein the case of a 53-year-old woman with malignant lymphoma of the stomach who was successfully treated by preoperative chemotherapy and surgery. The patient consulted our hospital with the chief complaint of upper abdominal pain. Endoscopy demonstrated a protruding lesion at the antral posterior wall of the stomach, and a post-biopsy pathological diagnosis of diffuse large cell type B-cell lymphoma was established. Moreover, abdominal ultrasonography, computed tomography, and magnetic resonance imaging demonstrated a tumor measuring approximately 10 cm in diameter in the left adrenal gland. A total of three courses of chemotherapy using the CHOP regimen were given preoperatively. The CHOP regimen consisted of 100 mg of prednisolone administered for 8 days together with 1.9 mg of vincristine, 1 000 mg of cyclophosphamide, and 60 mg of epirubicin administered intravenously on the first day. This resulted in tumor shrinkage, and a distal gastrectomy, lymph node dissection, and left adrenalectomy were subsequently performed. Since the pathological findings of the resected tissue specimen demonstrated complete elimination of the malignant lymphoma, this combination of procedures was defined as having resulted in a complete response. The postoperative course of this patient was uneventful. She is still alive without any sign of tumor recurrence 6 years after her operation, and is being followed up at the outpatient clinic.

Prolonged Hyperbilirubinemia After Living-Related Liver Transplantation: A Pediatric Case Report

CASE REPORTAn 11-year-old Japanese girl, who had undergone a Kasai opera-tion for biliary atresia at the age of 3 months, was admitted forLRLT with hepatopulmonary syndrome. Her blood type was Band preoperative total (T-) and direct (D-) bilirubin were 3.1 and2.8 mg/dL, respectively.LRLT was performed using her mother’s left lobe of the liver onJanuary 20, 2001. The donor blood type O was compatible withthat of the recipient. The recipient’s standard liver volume (SLV),which was calculated based upon the body surface, and the weightof the liver graft were 987 mL and 724 g, respectively. Ratio of thegraft to the SLV was 73.4%. The operative time was 19 hours 17minutes; the blood loss 1380 mL.Blood transfusion was started on the postoperative day (POD) 4due to progressive anemia after the operation. Because the abdom-inal drains showed increasing hemorrhage despite blood transfu-sions, laparotomy was performed on POD 10. It revealed aruptured hepatic artery causing massive abdominal bleeding. Afterelimination of blood, reanastomosis of the hepatic artery wasperformed. Marked hyperbilirubinemia (T- and D- bilirubin levelswere 15.3 and 10.2 mg/dL, respectively) that appeared after thesecond operation was prolonged. Plasma exchange (PE) for thehyperbilirubinemia was administered from the POD 17 to 21.Based on the possibility that the cholestasis was due to tacrolimus,she was converted to cyclosporine on POD 21. Hemolysis was alsoconsidered to be a possible cause of the hyperbilirubinemia,possibly due to anti B-blood type antibody induced by the trans-ferred donor lymphocytes. She underwent further transfusion withrinsed O blood type red blood cells. Prolonged and intractablehyperbilirubinemia was addressed by liver biopsies, which consis-tently showed ischemic hepatic cells (Fig 1a), intracytoplasmic, andextracytoplasmic cholestasis (Fig 1b). Hyperbilirubinemia did notimprove despite a second PE (from POD 30). The patient unfor-tunately died of hepatic failure on POD 42.DISCUSSION

A case of intestinal strangulation caused by transmesenteric hernia.

症例は11歳, 男子で突然の腹痛で発症し, 急性腹症の診断にて当科へ紹介された.緊急手術にて, 広範に壊死に陥っている小腸が認められ, 検索の結果小腸間膜裂孔に腸管が複雑に入りこんだために生じた絞扼性イレウスと診断された.腸間膜裂孔は4.0×3.0cmの大きさで回腸末端より約50cmの部位に位置しており, この部位を含め1/2以上の小腸を切除し手術を終了した.約6か月を経過した現在short bowel syndromeなどとくに異常もなく健康な日常生活を送っている.腸間膜裂孔ヘルニアはまれな疾患であるが, いったん発症すると絞扼性イレウスの形をとることが多く, 進行は急速でしばしば腸切除が必要とされる.本症例に若干の文献的考察を加え報告する.

Hyperbaric treatment for acute intestinal obstruction and peritonitis

From the results on the clinical and experimental studies on the relation between the cause of acute intestinal obstruction and peritonitis and the growth of intestinal microorganisms, the authors have the following conclusion; In the cases of acute intestinal obstruction and peritonitis, the intestinal microorganisms especially the number of E. coli group of bacilli remarkably increase and the endotoxin (lipopolysaccharide of the cellular component) might be liberated and increased in blood. These pathological process induce the liber, kidney and circulatory disturbance and the high grade of dropping or insufficience of the function in the various kinds of organs. By such bad circulation as the cause induce the result and the result induce the cause, the high grade of oxygen deficiency and at last the death may be induced. From the point of view on the cause of the acute intestinal obstruction and peritonitis, the active surgical t rea tment were carried out on 8 cases of severe acute intestinal obstruction and pertionitis who are in the high grade of poor risk and are unable to stand the operation by the hitherto method. The hyperbaric t reatment was carried out to the patients before and after the operation and 5 cases were rescued. In order to clarify the reason why the hyperbaric t reatment was effective to the shock by intestinal obstruction and peritonitis, the clinical and experimental results on the effect of the hyperbaric t rea tment to the pathophysiology of intestinal obstruction were carried out and the following results were obtained. 1. It was clearly observed that the decrease of oxygen pressure in arterial blood, increase of carbonic acid gas pressure and the remarkable drop of blood pH were clearly inhibited by the hyperbaric t rea tment and moreover it was clarified by the histological feature by the microscope and the cellular fine structure by electron microscope that the severe oxygen deficiency of the organs such as liber, kidney and adrenal gland became to better by the hyperbaric treatment. 2. The appearance and the increase of E. coli endotoxin (lipopolysaccharide of the components) in intestinal obstruction was clearly inhibited by the hyperbaric t rea tment and the survival time of the animal remarkably prolonged. 3. The inhibitory effect of the hyperbaric t rea tment against the lethal disturbing action of E. coli endotoxin (lipopolysaccharide of the component) was clearly observed. These results on the effect of hyperbaric t rea tment upon the pathophysiology of intestinal obstruction may clarify one of the reason why the patients suffering f rom severe acut intestinal obstruction and peritonitis who are unable to rescue by the hitherto concept were rescued by the active surgical and hyperbaric t rea tment and the survival time of the experimental ileus animal prolonged remarkably by the hyperbaric treatment.

Studies on gallstones by means of the x-ray diffractometer

Powder X-ray diffractometer char t s of 7 crit ical gal ls tones are shown in F igure 1, where some differences between cholesterol stone and calcium bi l i rubinate stone are confirmed at 20 in 14.9 ~ 15.5 ~ 17 ~ and 23.1 ~ Hydrous cholesterol stone associated by cholesterol shows a spli t t ing peak a t 20 in 14.6 ~ and 14.9, where the fo rmer peak is s t ronger than the la t te r of normal cholesterol stone. A calcium carbonate stone shows an indicant peak at 20 in 29.3 ~ and a fa t ty acid stone gives a dis t inct peak a t 20 in 13.8 ~ 419 206 diffraction charts of gallstone are shown in Table 1, where variations of peak in intensity ~re found. Figure 1. X-Ray Diffractometer Charts of Gallstones