Naoharu Mori

Successful treatment of Fournier's gangrene with the assistance of preoperative computed tomography in an elderly man: report of a case.

An 87-year-old man presented with inguinal pain and swelling, and was later diagnosed as having Fournier’s gangrene. The information gained from preoperative computed tomography (CT) proved very useful for defining the extent of necrosis, and emergency surgery saved his life. Thus, CT should be performed prior to treatment of Fournier’s gangrene, even in an emergency situation.

A small, incidentally detected pancreatic somatostatinoma: Report of a case

Abstract.We report an asymptomatic 72-year-old woman with a small, incidentally detected, pancreatic somatostatinoma. The tumor, measuring 1 cm in diameter, showed a hypervascular pattern of contrast enhancement on computed tomography, and was found angiographically to receive a blood supply from the posterior superior pancreaticoduodenal artery. The results of preoperative hormonal assays all were normal. No assay for somatostatin was performed. No abnormality in either the pituitary or parathyroid was found. We thus considered the tumor to be a sporadic, nonfunctioning endocrine cell tumor, and enucleation was carried out. As some tumor cells in the resected specimen showed immunoreactivity for somatostatin, a diagnosis of somatostatinoma was made. Therefore, the possibility of somatostatinoma should be kept in mind when making a differential diagnosis of pancreatic endocrine tumors in cases where even a small hypervascular tumor is detected on enhanced computed tomography.

Carcinoma of the head of the pancreas with complete situs inversus and polycystic liver: Case report

A case of carcinoma of the pancreatic head associated with situs inversus (SI) and polycystic liver (PCL) is presented. The patient was a 71-year-old male with complaints of jaundice and general fatigue. Percutaneous transhepatic biliary drainage (PTBD) revealed complete obstruction of the lower end of the common bile duct (CBD). Endoscopic retrograde cholangiopancreatography (ERCP) revealed stenosis of the main pancreatic duct (MPD) in the head of the pancreas. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated multiple cysts in the liver as well as SI. Pylorus-preserving-pancreatoduodenectomy (PPPD) was performed by an operator who took his usual position on the patients right side. We had no particular difficulty during surgery, although we had to charge several procedures. We consider it reliable to take the usual positions during surgery, even in cases of SI.

Clinicopathological Study of Gastric Smooth Muscle Tumors.

当科で過去19年間に経験した胃平滑筋腫瘍37例についてとくに腫瘍悪性度について検討を加えた.対象の内訳は平滑筋腫14例, 平滑筋肉腫20例, 平滑筋芽細胞腫3例で, これらをA群 (平滑筋腫14例), B群 (平滑筋肉腫, 平滑筋芽細胞腫症例中無再発13例), C群 (平滑筋肉腫, 平滑筋芽細胞腫症例中非治癒切除または再発6例) に分けて, 腫瘍径, 核分裂像, 細胞密度, 核面積, 核形態, 腫瘍線維束形成について比較検討を行ったところ, 腫瘍径, 核分裂像, 核形態, 腫瘍線維束形成が腫瘍悪性度判定に重要な因子と考えられた.腫瘍径が5cm以下のものは予後良好であり, 10cmを越えるものは予後不良であり, 核分裂像では400倍視野10視野中の平均で3.0/HPFを越えるものの予後は不良であった.核形態, 腫瘍線維束形成は相関があり, 核形態がspindleshapeで線維束形成が明らかなものは予後良好であり, round shapeな核を持ち線維束形成の不明瞭なものは予後不良であった.