Nobuyoshi Morita

Laparoscopic repair of a diaphragmatic hernia through the foramen of Morgagni

AbstractA 78-year-old woman is described who presented with a diaphragmatic hernia through the foramen of Morgagni. A definitive diagnosis was confirmed by a sagittal view on magnetic resonance imaging prior to surgery. The hernia was repaired laparoscopically under an abdominal wall lifting technique without pneumoperitoneum, and her symptoms completely resolved postoperatively with no evidence of recurrence. The laparoscopic repair was considered a suitable and safe procedure for the treatment of a Morgagni hernia.

Pancreaticojejunostomy: Report of a 25 year experience☆

Surgical therapy for 88 patients operated on between 1958 and 1982 has been reviewed. Ninety-three operative procedures were performed including pancreaticojejunostomy in 56, pancreaticocystojejunostomy in 12, pancreaticojejunostomy with resection of less than 10 percent of the pancreas in 16, and pancreaticojejunostomy with resection of more than 50 percent of the pancreas in 9. Operative mortality was 7.5 percent and operative morbidity was 25 percent. Overall, 63 percent of the patients had an excellent or good result in the postoperative follow-up period which averaged 4 years. In the nonalcohol-induced pancreatitis group, ductal diameter was a good predictor of postoperative success, whereas in the alcoholic patient population, abstinence from further alcohol intake was a more accurate predictor of the success of pancreatic drainage.

Combined right hepatic and retrohepatic caval resection with reconstruction using a polytetrafluoroethylene graft for primary leiomyosarcoma of the liver: Report of case

We present herein the case of a 53-year-old woman who underwent successful surgical treatment for a leiomyosarcoma of the liver that originated from the posterior hepatic segment and involved the retrohepatic inferior vena cava (IVC). A computed tomographic scan and magnetic resonance imaging demonstrated a large tumor, with rich vascularity, in the liver. The IVC was found to be occluded on these scans, which was confirmed by venacavography. The patient underwent a combined right hepatic and caval resection with reconstruction using an expanded polytetra-fluoroethylene graft. The tumor consisted of spindle-shaped cells with cigar-shaped nuclei. It also had a moderate degree of cellularity and ten mitotic figures per ten high-power fields. Immunohistologically, desmin and alpha-smooth muscle actin were stained positive in the tumor cells, implying that the tumor was derived from smooth muscle cells. The patient is alive and well 15 months after her operation.

Surgical Stress and the Development of Complications in Relation to Polymorphonuclear Leukocyte Elastase (PMNE) Levels

This study was conducted to examine the effects of surgical stress on changes in polymorphonuclear leukocyte elastase (PMNE) levels, and to evaluate the relationship of these changes to the development of postoperative complication. A total of 69 patients who underwent alimentary surgery were subsequently divided into three groups: a complicated group, comprised of 25 patients; an uncomplicated group with a high blood loss (H) of more than 1 000 ml, comprised of 18 patients; and an uncomplicated group with a low blood loss (L) of less than 1 000 ml, comprised of 26 patients. The changes in the levels of PMNE, fibronectin (FN), and antithrombin III (AT III) were compared among these three groups. In the uncomplicated H and L groups the PMNE levels rose significantly on postoperative day (POD) 1. On POD 3, high levels of PMNE were still evident in the uncomplicated H group, but a decline was observed in the uncomplicated L group. From POD 7 onwards the levels decreased to the preoperative values in both uncomplicated groups; however, the complicated group continued to show high levels even on POD 14. Significantly decreased FN levels were observed for the first 3 PODs in each group. The uncomplicated H and L groups regained their preoperative levels on PODs 7 and 14, respectively, but no recovery was found in the complicated group. The AT III levels showed similar changes to the FN levels in all groups. These findings indicate that monitoring the PMNE levels could be a useful index for the early detection of postoperative complications following alimentary surgery.

Malignant duodenocolic fistula--a case report.

A 63 year-old woman with a malignant duodenocolic fistula of colonic origin was so diagnosed following radiological examination. She had symptoms of feculant vomitus, persistent diarrhea and emaciation. Following preoperative treatment of the nutritional and electrolyte disorders with intravenous hyperalimentation, a one-staged right hemicolectomy and pancreatoduodenectomy was performed successfully. We emphasized that an en-bloc removal of all the possibly involved structures is the most successful procedure for malignant duodenocolic fistula of colonic origin.

Expanded polytetrafluoroethylene grafts for small artery replacement.

Twenty vascular grafts of expanded polytetrafluoroethylene with a 1.5 mm. internal diameter and a 4.0 cm. length, were placed in the femoral arteries of dogs. The animals, divided into two groups, with and without pluronic F 68, were sacrificed two weeks after surgery. The patency rate was 33.3% (2/6) and 21.5% (3/14), which was not statistically significant. One factor contributing to the occlusion of the grafts were excessive proliferation of granulation tissue due to early formation of the thrombus. Histological findings showed that the pseudointima was almost complete, although it was only about 0.114 mm. thick at the anastomotic line.

The Reticuloendothelial System and Hepatocyte Function in Orthotopic Liver Transplantation

The reticuloendothelial system function, especially phagocytic activity, and hepatocyte function were investigated in dogs undergoing an orthotopic liver transplantation. The donors phagocytic index, measured by a lipid emulsion test, was higher in the Survivor group which survived more than 3 days after transplantation (0.063±0.008 vs 0.024±0.002; mean ± standard error of the mean (SEM),P<0.01). There was a statistically significant difference in the phagocytic index between the survivor and nonsurvivor groups. However, the hepatocyte function at an early phase after transplantation, indicated by the arterial ketone body ratio, hepaplastin test and lecithin cholesterol acyltransferase level, did not distinguish the Survivor group from the Nonsurvivor group at all. In the survivor group, the hepaplastin test and the lecithin cholesterol acyltransferase level were significantly decreased after liver transplantation, namely from 155±15% to 58±5% and from 57±12 unit/ml to 19±1 unit/ml on the 2nd day after transplantation (P<0.01,P<0.05), respectively. On the other hand, the reticuloendothelial system (RES) function, as estimated by the phagocytic index and serum complement activity (CH 50), demonstrated no change throughout the experimental period. The present study therefore demonstrated that the operative results might be affected by the phagocytic activity.