Masazumi Terada

Intussusception of an appendiceal mucocele: Report of a case

A 66 year old Japanese female was admitted to our department for the examination and treatment of a mass in the cecum. She had experienced no symptoms or signs other than a positive test result for fecal occult blood. The mass in the cecum was confirmed by barium enema, colonofiberscopy and CT scanning. The presumptive diagnosis was a submucosal tumor of the cecum, however, a laparotomy subsequently revealed intussusception of an appendiceal mass. An ileocaecal resection with an ileocolic anastomosis was therefore performed and the mass was histologically diagnosed as a mucocele of the appendix. This patient is only the 24th case of intussusception of a mucocele of the appendix to be reported in Japan. A review of the available literature on this condition follows the case report.

An improved cryopreservation procedure for human fetal pancreas tissues

Improved viability and function of insulin-producing beta (B) cells of frozen-stored human fetal pancreatic tissue was obtained by a two-step method utilizing high concentrations of dimethyl sulfoxide (DMSO). Human fetal pancreata (14–23–week gestation) obtained from pathologic abortions were teased and cultured overnight. Prior to freezing the tissues were immersed in 0.9% saline containing 0.5 M DMSO for 30 min (room temperature) and then placed in 2.1M DMSO on ice for 5 min. The tissues were frozen by the method previously developed in our laboratory and stored at – 196°C. The frozen-stored tissues were subsequently thawed at 24°C and cultured overnight before viability testing. Viability and function of the B cells were assessed by several specific assay methods; glucose plus theophylline-induced insulin release during static incubation and perifusion, 3H-leucine incorporation into insulin, and insulin content of the tissue grown in athymic mice for 7 days. The response to glucose plus theophylline stimulation, measured on the frozen-thawed tissue one day after thawing, was 80% of the level measured in control tissue maintained in organ culture. Frozen-thawed tissues maintained in organ culture for 1 week responded comparably in the in vitro assay systems. The insulin content of frozen-thawed pancreatic tissue removed from athymic mice 1 week after transplantation was approximately 60% of the amount measured in the control grafts. These results demonstrate the utility of our procedure in the maintenance of the viability and function of frozen-stored human B cells both in culture and after transplantation.

Hashimoto's thyroiditis presenting with severe pressure symptoms--a case report.

A extremely rare case of Hashimotos thyroiditis presenting with pressure symptoms is described herein. A 50 year old Japanese woman was referred to our department with swelling of the anterior neck, facial edema and recent heavy snoring. Oto-rhinolaryngological examinations revealed no movement of the bilateral vocal cords, severe laryngeal edema and diffuse edema of the tongue and pharynx. These findings had apparently been induced by compression of the bilateral recurrent nerves and internal jugular veins by an enlarged thyroid gland. The results of thyroid function and autoimmune tests were compatible with a diagnosis of Hashimotos disease and thus, total thyroidectomy with a tracheostomy was performed uneventfully. The resected specimen weighed 168 grams and was confirmed histologically to be Hashimotos disease. Following her operation all the above symptoms disappeared and 4 months later, the patient is well and asymptomatic.

Prognosis of Resected Pancreatoduodenal Cancers.

1969年10月より1990年10月までに経験した膵頭領域癌 (十二指腸癌, 原発不明癌を除く) 切除例114例の予後および予後に関与する因子について検討した.症例の内訳は膵頭部癌55例, 乳頭部癌34例, 下部胆管癌25例であり, 平均年齢はそれぞれ64.0±11.7歳, 59.3±12.3歳, 62.1±11.5歳であった.このうち膵頭部癌の予後が最も悪く (p<0.01), 1年生存率は40%, 5年生存率は8%であった.乳頭部癌の予後は膵頭部癌に比べ比較的良好で1年生存率64%, 5年生存率31%であった.しかし進行したstage III以上の症例では予後不良で膵頭部癌とほとんど変わらない生存曲線を示した.下部胆管癌は最も予後良好であり, 1年生存率72%, 5年生存率44%であった.膵頭部癌では予後に最も関与したstage決定因子は膵後組織への浸潤 (Rp因子) であり, 術式では膵頭十二指腸切除術が膵全摘術より予後良好であった (p<0.05).乳頭部癌では膵臓浸潤 (Panc), 十二指腸浸潤 (D), リンパ節転移 (N) の各因子とも予後に関与したが, Panc因子が最も重要であった (p<0.001).下部胆管癌では各stage決定因子の有無で予後に有意差を認めなかったが, 組織学的リンパ節転移 (n) 1, 組織学的膵臓浸潤 (panc) 1, 組織学的十二指腸浸潤 (d) 1, 組織学的胆嚢浸潤 (ginf) 1にとどまっていれば比較的良好な予後が期待された.