Nobuo Mochinaga

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.

A case of a rare anomaly of the common bile duct associated with an abnormal arrangement of the pancreaticobiliary ductal union

A 39 year-old Japanese female patient with a duplication of the distal portion of the common bile duct is presented herein. Moreover, an abnormal arrangement of the pancreaticobiliary ductal union, congenital biliary dilatation and carcinoma of the gallbladder were all demonstrated by cholangiographic and endoscopical studies. The patient underwent radical surgery for advanced adenosquamous carcinoma of the gallbladder, and her postoperative course was satisfactory. A reflux of pancreatic juice into the bile duct was demonstrated, but it was eliminated and considered to be a contributory etiologic factor of the gallbladder carcinoma.

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.

Mucus-secreting presacral cyst--a case report.

A mucus-secreting presarcal cyst was found in a 49-year-old woman who complained of dysuria. A routine rectal digital examination revealed a retrorectal mass. Diagnostic imaging demonstrated a large presacral cystic tumor. The cyst was removed through a transsacral approach. Histologically, the cyst membrane consisted of squamous and columnar mucus-secreting epithelium, and was diagnosed as a mucus-secreting presacral cyst.

Hyperparathyroidism following the atomic bombing in Nagasaki

Forty-three patients with hyperparathyroidism (HPT) including 20 atomic bomb survivors (46.5 per cent) were treated surgically in our institute during the last 19 years. The mean age of the patients at the time of atomic bomb exposure (AB*E) was 17.6±1.5 years. The mean latent interval between atomic bomb exposure and detection of HPT was 39.1±1.1 years. We compared the 20 AB*E patients with 23 patients who had a history of neither atomic bomb exposure nor therapeutic irradiation to the neck region (non-AB*E patients). It was determined that females were more prominently affected by HPT than males among AB*E patients. The parathyroid lesions in AB*E patients consisted of adenoma in 16 patients and hyperplasia in 4. A similar proportion of pathological lesions was also observed in non-AB*E patients. Thyroid lesions accompanied by HPT, however, were more often revealed in AB*E patients than in non-AB*E patients. The two most common lesions in AB*E patients were papillary carcinoma in 3 patients (15 per cent) and adenoma in 3 (15 per cent). These findings suggest that atomic bomb survivors may be at a greater risk of developing HPT with a high incidence of accompanying thyroid disease.

Lipid metabolism in partially hepatectomized dogs and effect of hepatic periarterial neurectomy

Lipid metabolism in partially hepatectomized dogs was studied, by observing changes in serum lipids after hepatectomy and biosynthesis of lipids in the slices of the regenerating liver tissue. In addition, the effect of hepatic periarterial neurectomy was evaluated. Serum lipids decreased after partial hepatectomy and did not return to the preoperative level until the first postoperative week, whereas biosynthesis of lipids in the slices of the regenerating liver tissue was considerably augmented in the early postoperative period. This augmentation of lipid synthesis appears to be requirement for regeneration of the liver. When hepatic periarterial neurectomy plus partial hepatectomy was carried out, each lipid and lipoprotein fraction, except for FFA, showed a tendency to recover earlier from the immediate postoperative decrease and did not not show a late postoperative excessive increase. The decrease of α-lipoprotein in the immediate postoperative period was augmented and the time of the peak of concentration of pre-β-lipoprotein was hastened. Therefore, hepatic periarterial neurectomy seems to act in such a manner so as to maintain the homeostasis in lipid metabolism after partial hepatectomy and to activate the regenerative property of the residual liver in the early postoperative period.

Lymph node metastasis within the pectoralis major muscle in breast cancer--a case report.

We report herein, a case of a 75 year old woman with breast cancer in whom lymph node metastasis within the pectoralis major muscle was found. The breast mass measured 10×6 cm, and its overlying skin was red and edematous, suggesting inflammatory carcinoma. An extended radical mastectomy was performed and the lesion was histologically confirmed to be solid-tubular carcinoma with regional lymph node involvement. In the pectoralis major muscle, where lymph nodes do not usually exist, one positive metastatic lymph node and another metastatic lymph node-like nodule were histopathologically confirmed. To our knowledge, no other such case has ever been reported, yet the possibility of lymph nodes existing in the pectoralis major muscle, albeit rare, should nevertheless be considered in the treatment of breast cancer.