Naoki Takabayashi

Giant Intrahepatic Biliary Cystadenoma in a Male: A Case Report, Immunohistopathological Analysis, and Review of the Literature

Clinical features of biliary cystadenoma, due to its rarity, have been gradually investigated, mostly from both surgical and radiological aspects. There have been fewer than 150 case reports of biliary cystadenoma and fewer than 50 cases of biliary cystadenocarcinoma in the literature so far (1–33). Biliary cystadenoma is most often found in middle-aged women, and no more than 10 cases in men have been reported to date (3, 8, 16, 19, 33). Here we report a case of male giant intrahepatic biliary cystadenoma, mainly from the immunohistopathological point of view, to add to some information about its etiology.

Coagulation disorder as a prognostic factor for patients with colorectal perforation

BackgroundAlthough sepsis after surgery for colorectal perforation frequently results in severe coagulation disorders and consequent death of the patient, the correlation between coagulation abnormalities and postoperative mortality of colorectal perforation has not been clarified.MethodsThe medical records of 101 consecutive patients receiving surgery for colorectal perforations between January 1994 and July 2006 were retrospectively reviewed. The abnormalities of preoperative laboratory data reflecting coagulation disorders and other possible risk factors were analyzed by univariate and multivariate analysis.ResultsProlonged prothrombin time and activated partial thromboplastin time significantly correlated with a poor prognosis (both P < 0.001). Among the several risk factors analyzed, only the presence of coagulation disorders was an independent predictive factor of postoperative mortality.ConclusionsProlonged prothrombin time and activated partial thromboplastin time are useful prognostic factors for predicting the surgical outcome for patients with colorectal perforation.

Cancer in the anal canal, and in an anal fistula, that developed during a longstanding course of Crohn's disease.

1. Hakim RM, Levin N. Malnutrition in hemodialysis patients. Am J Kidney Dis 1993;21:125–37. 2. Avram MM, Mittman N, Bonomini L, Chattopadhyay J, Fein P. Markers for survival in dialysis: a seven-year prospective study. Am J Kidney Dis 1995;26:209–29. 3. Ross EA, Koo LC. Improved nutrition after the detection and treatment of occult gastroparesis in nondiabetic dialysis patients. Am J Kidney Dis 1998;31:62–6. 4. Silang R, Regalad M, Cheng IH, Wesson DE. Prokinetic agents increase plasma albumin in hypoalbuminemic chronic dialysis patients with delayed gastric emptying. Am J Kidney Dis 2001;37:287–93. 5. Schoenmakere GD, Vanholder R, Rottey S, Duym P, Lameire N. Relationship between gastric emptying and clinical and biochemical factors in chronic haemodialysis patients. Nephrol Dial Transplant 2001;16:1850–5. 6. Schwartz JG, McMahan CA, Green GM, Phillips WT. Gastric emptying in Mexican Americans compared to non-Hispanic whites. Dig Dis Sci 1995;40:624–30. 7. Camborova P, Hubka P, Sulkova I, Hulin I. The pacemaker activity of interstitial cells of Cajal and gastric electrical activity. Physiol Res 2003;52:275–84. 8. Makino H. Electrogastrography and gastric electrical activity in patients with chronic renal failure (in Japanese with English abstract). Nippon Rinsho Seiri Gakkai Zasshi (Jpn J Clin Physiol) 2002;32:15–22.

Villous Adenoma with Advanced Cancer of the Rectum, Clinically Accompanied with Hypopotassemia.

大腸のvillous adenomaにおいて, 腫瘍からの大量の粘液排泄が原因で血清電解質などに異常をきたすことは極めてまれである. 今回われわれは, 臨床的に低カリウム血症を呈した進行癌を伴う直腸villous adenomaの2例を経験したので報告する.症例1は89歳の女性. 多量の粘液便排泄を主訴に入院した. 直腸に大きさ15×7cmの進行癌を伴う巨大villous adenomaを認め, 腫瘍からの粘液排泄が原因と考えられる低カリウム血症 (K3.1mEq/l) と低蛋白血症 (TP5.5g/dl) を呈していた. なお, 排泄液の電解質組成はNa140mEq/l, K56mEq/l, Cl 141mEq/lと, カリウムの著しい高値を示した.症例2は68歳の女性. 多量の粘液性下痢と全身倦怠感を主訴に入院した. 直腸に大きさ16×6cmの進行癌を伴う巨大villous adenomaを認め, 血清カリウム値は2.5mEq/lであった. 2症例とも直腸切断術が行われ, 術後低カリウム血症は改善した.