Ryouhei Izumi

Detection by CT during arterial portography of colorectal cancer metastases to liver.

A prospective evaluation of the accuracy of real-time ultrasonography (US), computed tomography (CT), infusion hepatic angiography (IHA), and computed tomography during arterial portography (CT-AP) was performed on 65 resected liver metastases of colorectal cancers. The total detection rate was 58.5 percent for US, 56.3 percent for CT, 554 percent for IHA, and 86.2 percent for CT-AP. The sensitivity of 29 lesions with diameters of smaller than 1 cm was 65.5 percent for CT-AP, CT found only two, and both US and IHA localized no more than three. The smallest lesions detectable by CT-AP were as small as 0.4 cm in diameter. CT-AP proved most useful in detecting the liver metastases, and the use of this techique is recommended for preoperative planning of hepatectomy on patients with liver metastases.

Clinical experience of biliary tract carcinoma associated with anomalous union of the pancreaticobiliary ductal system

Between 1978 and 1988, 15 patients with gallbladder cancer and 2 patients with bile duct cancer were seen among 49 patients with anomalous union of the pancreaticobiliary ductal system. Radiographic findings revealed two types of this anomalous condition: one in which the pancreatic duct entered the common bile duct(type 1) and one in which the common bile duct entered the pancreatic duct (type 2). In gallbladder cancer, the common bile duct presented no dilatation, or in some patients, mild dilatation, and type-1 anomalous union was frequently found among these patients. In contrast, the two patients with bile duct cancer had cystic dilatation of the common bile duct and type-2 anomalous union. The bile amylase level, which was determined in seven patients, was extremely high in all the patients. Histopathologically, the tumors in most patients showed papillary to papillo-tubular proliferation in the mucosal layer while atypical epithelial hyperplasia was noted in the vicinity of the tumor area. These findings suggest that this congenital anomaly in both ducts results in a loss of the normal sphincteric mechanism of the doudenal papilla, and that chronic relapsing cholecystitis or cholangitis, caused by the reflux of pancreatic juice into the biliary tract, can induced progressive changes to atypical epithelial hyperplasia which may develop into carcinoma.

Acute pancreatitis associated with anomalous union of the pancreaticobiliary ductal system

Between 1978 and 1989, 13 of 48 patients with anomalous union of the pancreaticobiliary ductal system (AUPBD) were diagnosed as having acute pancreatitis. We have studied the clinical, radiologic, and surgical features of these 13 patients. A transient rise in the intraductal pressure of the pancreatic duct during an episode of abdominal pain is responsible for pancreatitis in patients with AUPBD. This rise in the intraductal pressure must be due to bile reflux into the pancreatic duct when an abnormally long common channel is blocked by cholelithiasis, protein plug, or dysfunction of the sphincter of Oddi. The pancreatitis resolves when the common channel obstruction is removed, and bile and pancreatic juice flow easily into the duodenum. We believe that this phenomenon is responsible for acute relapsing pancreatitis. It is our belief that the pancreas appears almost normal during symptom-free intervals.

Pancreatitis and anomalous union of the pancreaticobiliary ductal system in childhood.

From January 1978 to December 1989, 48 patients were diagnosed as having anomalous union of the pancreaticobiliary ductal system (AUPBD) at the Second Department of Surgery, Kanazawa University Hospital and its affiliated hospitals. Among these 48 patients, 13 (28.1%) were children under 13 years of age. Four of these patients had acute pancreatitis. The clinical, radiological, and surgical features of these patients are presented. The chief presenting complaint was epigastric pain in all cases; three patients had recurrent episodes of epigastric pain and had been diagnosed as having autotoxicosis. AUPBD was clearly demonstrated in all patients, three by endoscopic retrograde cholangiopancreatography (ERCP) and one by operative cholangiography. At operation, macroscopic evidence of pancreatitis was recognized in all cases. In one case, roentogenolucent pancreaticolithiases were seen on ERCP. We consider AUPBD as an important cause of pancreatitis in children and advocate ERCP in children who are suspected having biliary tract or pancreatic disease. The diagnosis of AUPBD should be considered when children with abdominal pain and elevated serum or urinary amylase levels are evaluated.

The immunosuppressive effect of 5-lipoxygenase inhibitor on liver allotransplantation in rats

This study was performed to examine the immunosuppressive effect of a 5-lipoxygenase inhibitor, AA-861, on liver transplantation in rodents, and also to examine the production of eicosanoids during rejection of liver allograft in these animals. Rats were divided into three groups: group I (syngenic orthotopic liver transplantation from LEW to LEW), group II (allogenic OLT from ACI to LEW with dimethyl sulfoxide), and group III (allogenic OLT from ACI to LEW with AA-861 [20 mg/kg/day] s.c. dissolved in DMSO). Histological examinations were performed, survival time was monitored, and eicosanoid levels at 3, 5, and 7 days after transplantation were measured. Mean survival time in group III was significantly longer than that in group II (36.0 +/- 6.8 vs. 11.1 +/- 0.7 days, mean +/- SEM; P < 0.01). Histologically, the degree of rejection in group III was moderate compared with that in group II. On day 3, the LTB4 level in group II was significantly higher than that in group I (3361 +/- 985 vs. 407 +/- 70 pg/ml, P < 0.05), and the PGE2 level in group III was significantly higher than that in group 1 (50.3 +/- 4.8 vs. 23.5 +/- 4.7 pg/ml, P < 0.01) and in group II (32.9 +/- 4.2 pg/ml, P < 0.05). These findings suggest that AA-861 reduced liver allograft rejection by suppressing the elevation of 5-lipoxygenase products and increasing PGE2 production in the early stage of rejection.

Synchronous Cancer of the Biliary Tract and Pancreas Associated with Anomalous Arrangement of the Pancreaticobiliary Ductal System

A 58-year-old man on abdominal ultrasonography and CT had an irregularly elevated lesion at the neck of the gallbladder and a cyst of approximately 6.5 cm in diameter at the pancreatic tail. Percutaneous transhepatic cholangiography revealed a 2-cm shadow defect at the neck of the gallbladder and an irregular, translucent 30 x 12 mm lesion in the intrapancreatic bile duct. Total pancreatectomy and extended cholecystectomy with regional lymph node dissection was performed. An anomalous arrangement of the pancreaticobiliary ductal system (AAPBD) was demonstrated by postoperative contrast radiography of resected specimen. The lesions of the gallbladder and common bile duct were papillary adenocarcinoma. In addition, papillary adenocarcinoma was limited almost entirely to the mucosal layer of the main pancreatic duct and its branches, from the junction of the common bile duct and pancreatic duct to the pancreatic tail. The three tumors were not continuous. The cyst at the pancreatic tail was a pseudocyst. This case represents synchronous cancer of the gallbladder, common bile duct, and pancreas associated with AAPBD.

Increased Graft Survival by Utilization of 15-Deoxyspergualin in a Canine Pancreatic Allotransplantation Model

The purpose of this study was to evaluate the effectiveness of 15-deoxyspergualin (DSG) administration against acute rejection of canine pancreatic allografts. Subsequent to partial pancreatic allotransplantation and total extirpation of the pancreas, 20 adult mongrel dogs were divided into four groups and treated with saline (group 1, controls, n = 5), DSG at 1.0 mg/kg/day (group 2, n = 5), DSG at 3.0 mg/kg/day (group 3, n = 5), or DSG at 5.0 mg/kg/day (group 4, n = 5) on postoperative days 4-7. The graft survival, defined by a fasting serum glucose level < 150 mg/dl, was significantly prolonged from 6.2 +/- 1.2 days in group 1 to 12.4 +/- 2.7 days in group 3 (p < 0.05) and to 16.8 +/- 3.2 days in group 4 (p < 0.05). Graft survival was not significantly prolonged in group 2, however. Two normoglycemic dogs in group 4 died due to gastrointestinal toxicity, one of the most serious side effects of DSG. The observation that the serum insulin levels increased in dogs treated with DSG was compatible with dose-dependent graft survival and suggested that DSG had no toxic effects on pancreatic endocrine function. In group 1 significantly increased thromboxane B2 (TXB2) levels and TXB2/6-keto-prostaglandin F1 alpha (PGF1 alpha) ratios were observed on postoperative days 3-5 which was thought to reflect acute rejection. Following administration of DSG, both TXB2 levels and TXB2/PGF1 alpha ratios were decreased on the 5th postoperative day in groups 2-4.(ABSTRACT TRUNCATED AT 250 WORDS)

Malignant Mesenchymoma of the Retroperitoneum Involving Cecal Carcinoma. A Case Report.

患者は78歳の女性.後腹膜の黄色肉芽腫で左腎摘出術を施行された既往がある.主訴は左下腹部痛で, 同部に一致して径10cmの腫瘤を触知し, 血液検査ではCEA とCA19-9が高値を示した. CTでは左後腹膜に石灰化を有し周囲に脂肪成分を伴う腫瘤を認めた.注腸造影では下行結腸は内側に圧排され, また盲腸に腫瘤陰影を認めた.2型盲腸癌と黄色肉芽腫の再発との診断で手術を施行した.下行結腸周囲の後腹膜腔に複数の腫瘤を認め, 迅速病理にてmyxoid sarcomaと診断されたため結腸左半切除術を施行し, また盲腸癌にて回盲部切除術を併施した.切除標本では漿膜下から後腹膜に黄褐色または灰白色な弾性硬の腫瘤を認めた. 組織学的には分化型の軟骨肉腫や骨肉腫, 平滑筋肉腫および脂肪肉腫の成分を認め悪性間葉腫と診断された.盲腸癌は2型の高分化腺癌でss, ly2, v0, n1 (+) であった. 本疾患はまれであり組織発生を検討する上で興味ある症例と考えられたので報告する

Surgical Treatment for Esophageal Cancer After Gastrectomy

Gastroesophageal reflux is associated with a high incidence of complications such as ulcer or cancer of the esophagus [1]. Gastrectomy results in regurgitation of bile into the esophagus. However, the etiologic role of gastrectomy in esophageal cancer is still controversial [2]. Surgical treatment of postgastrectomy esophageal cancer is also investigational, because esophageal reconstruction with vascularized graft in the patient who has undergone gastrectomy is sometimes difficult due to the presence of adhesion. In this connection, we reviewed 14 cases of postgastrectomy esophageal cancer among our series.

A case report of the liver hyperplasia developed by taking estrogen drugs.

本邦では極めてまれな,女性ホルモン剤による肝の腫瘍類似病変の1例を報告した.症例は64歳,男性.54歳時に前立腺癌で前立腺および睾丸除去術を受け,内分泌療法として合成女性ホルモン剤のdiethylstilbestrol phosphateを300mg/day,術後10年間にわたって内服していた.食欲不振を主訴に来院し,精査の結果腹部超音波でS8に径2cmのhypo echoic lesionを認め,血管造影でも同部位の濃染像を認めたため,肝細胞癌を強く疑い,S8部分切除術を施行した.切除標本は径15mmの黄色の結節で,組織学的には肝細胞の過形成性病変であり,周囲肝実質を圧排する様に増生していたが,被膜はみられなかった.同部の小葉構築は乱れ,中心静脈の増生を認めたが,核には異型性は認めなかった.FNHなどの既存の疾患の範疇には属さず,肝細胞過形成病変と診断した.