Sadao Kashihara

Pancreatectomy for carcinoma of the head of the pancreas associated with multiple anomalies including the preduodenal portal vein

Total pancreatectomy was performed for carcinoma of the head of the pancreas associated with multiple anomalies in the peripancreatic region and of the pancreas. The anomalies were preduodenal portal vein, annular pancreas with agenesis of the dorsal pancreas, left-sided gallbladder, polysplenia and high mobile right colon. The surgical implications of pancreatectomy for such anatomical abnormalities, especially preduodenal portal vein, and the usefulness of ultrasonography for the preoperative evaluation are given attention.

Size of breast cancer on ultrasonography, cut-surface of resected specimen, and palpation

In the period from January 1985 to May 1987, 68 patients with palpable breast cancers were studied to compare the size on ultrasonography with the size of the cut-surface of the resected specimen. Both the width (mediolateral size) and height (size in depth) were delineated as smaller on ultrasonography than on the cut-surface of resected specimens. The difference in size between ultrasonography and resected specimen was greater for the width than for the height. These results can explain why breast cancer has a greater ratio of height to width on ultrasonography. The ratio of the width on palpation to that on ultrasonography was also evaluated. These ratios proved to be useful in differentiating breast cancer from benign lesions.

Three cases of afferent loop obstruction —The role of ultrasonography in the diagnosis

Three cases of obstruction of the afferent loop following a Billroth II type gastrectomy were preoperatively detected by ultrasonography. The obstructions in the 3 patients were caused by volvulus, internal herniation and recurrence of gastric cancer, respectively. The important US findings which helped diagnose this condition were a dilated intestinal loop without gas echo in the upper abdominal cavity and echo lucent swelling of the pancreas. Ultrasonography is very useful for the early and easy detection of this life-threatening condition which requires immediate surgery.

Architectural distortion of subcutaneous fascial layer in breast tumors: ultrasonographic evaluation.

To develop a criterion to evaluate architectural changes of the subcutaneous tissue layer around the breast, 120 patients with histologically proven tumors were studied as to ultrasonographical delineation of the superficial layer (SL) of the superficial fascia. Breast ultrasonography was performed using an electronic-linear scanner with a 5.0 MHz probe. When SL was identified over the tumor, it was classified into 3 types: flat, disrupted, and convergent types. SL was identified in 106 patients (88%). Forty-six were evaluated to be flat type, and 41 (89%) of them had benign tumors. The remaining 60 were subdivided into either disrupted (n = 44) or convergent type (n = 16); 53 (88%) of these 60 cases had cancerous lesions. Histologically, inward retraction of SL was the most common pattern in breast cancer. Thus, the ultrasonographic pattern of SL reflects the histological findings and can be a useful clue to differentiate benign lesions from cancerous ones.

A case of ischemic stenosis of the small intestine.

腸管膜動脈の循環障害に起因する小腸狭窄の1例を経験した.症例は61歳男, 腹部大動脈再建術後に下痢, 腹痛, 嘔吐を呈し, 腹腔内膿瘍と診断されて当科に入院した.排膿術を施行するも症状の改善を得ず, 腸閉塞症状が出現した.高カロリー輸液下に諸検査を行い, 血管造影で上腸管膜動脈根部の狭窄を認めた.虚血が関与する腸閉塞の診断で開腹すると, 回腸の一部が索状に狭窄し, これに沿う腸管膜は萎縮していた.狭窄部を切除し, 端々吻合して症状の消失をみた.病変部は肉眼的に瘢痕状で, 組織学的には腸管全層にわたる線維化と腸管膜動脈の閉塞性変化を認めた.本症は予後不良と言われるが, その改善のためには診断から治療にわたる栄養管理をはじめ, 適切な全身管理が肝要である.

EVALUATION OF BILIARY DIVERSION

過去10年間に当科で施行された胆・膵系手術例で, 総ビリルビン10mg/dl以上の閉塞性黄疸を有する54例 (根治術施行例, 胆石症によるものは除外) の術後ビリルビン値の推移を解析し, 半減期 (T1/2) を算出し, 黄疸軽減効果の判定を行った. 内瘻より外瘻の方が, 有効例の割合, T1/2とも不良で, 内瘻間では肝腸吻合が効果不良であった. log T1/2と GPT, LAPとは逆相関を示したが, 術前T.B.値とは相関なく, 肝転移は黄疸軽減には余り影響が無かった.30日以内死亡 (10例) 原因は, 黄疸持続が6例と最高であった.閉塞性黄疸の治療には肝再生能力の十分な早期に手術を行う必要のある事を述べる.