Nobuyoshi Itoh

Percutaneous Transhepatic Drainage: Experience in 100 Cases

A two-step procedure for percutaneous transhepatic drainage (PTD) of the biliary tract was attempted on 101 patients with obstructive jaundice, 29 with benign and 71 with malignant lesions, and was successful in 100. With this procedure, marked clinical improvement, with reduction in levels of serum bilirubin, SGOT, SGPT and alkaline phosphatase, was achieved after 1-2 weeks as a preoperative step or for continuous drainage in inoperable cases. In one patient 8 dys after PTD, however, a complicating large intrahepatic hematoma proved fatal. Emergency operation was necessary in three of the four patients who developed bile peritonitis due to dislocation of the catheter and in one with intra-abdominal bleeding. Our results suggest that this procedure is very useful in the diagnosis and management of certain obstructive diseases of the biliary tract.

CT demonstration of annular pancreas: Case report

A patient with annular pancreas is described. CT succeeded in visualization of a peninsular protrusion of the parenchyma from the pancreatic head. In the diagnosis of annular pancreas, CT provided unequivocal evidence before operation.

Availability of plasma pancreatic polypeptide measurement in diagnosis of chronic pancreatitis.

Plasma pancreatic polypeptide (PP), a newly recognized pancreatic hormone, was studied in healthy subjects and patients with chronic pancreatitis. After an oral load of 50 g of meat extract, the plasma concentration of PP showed a rapid fourfold rise at 20 min in healthy controls. In contrast, the plasma PP level rose only 1.8-fold in patients with chronic pancreatitis. This difference was statistically significant (P less than 0.05). The increase rate of the PP level during the test in each subject correlated significantly (P less than 0.01) with total amylase output and maximal amylase concentration measured by the pancreozymin-secretin test. Thus, it is suggested that the measurement of the plasma PP level may be a useful tool to diagnose chronic pancreatitis.

Bilioportal Fistula as a Sequela to Choledocholithiasis: A Case Report

We describe a rare event, the diagnosis of bilioportal fistula preoperatively. A 68-year-old woman who developed progressive anemia and acute cholangitis was examined by percutaneous transhepatic cholangiography (PTC), which demonstrated a stone lodged in a dilated biliary tract and entry of contrast medium into the portal vein. Improvement of her general condition followed percutaneous transhepatic drainage (PTD), and radical operation was performed with success.