Sakurao Hiraki

Mesenteric paraganglioma : Report of a case

We report a rare case of a solitary primary paraganglioma arising in the mesentery, found in a 72-year-old woman who presented with abdominal pain and a palpable abdominal mass. This extra-abdominal paraganglioma developed from paraganglionic cells that travelled by vertebral migration from the root of the superior mesenteric artery. Extra-adrenal paraganglia extend anywhere from the neck down to the base of the pelvis. Ultrasonography, computed tomography (CT), and angiography showed a solid and cystic heterogeneously enhanced mass, which was fed by the superior mesenteric artery, without distant metastasis. Exploratory laparotomy revealed a large, dark, brownish-red mass in the mesentery of the ileum, which was distinct from the ileum. The mass consisted of peripherally solid areas with central hemorrhage and cystic degeneration. It was diagnosed as a paraganglioma histologically. The patient is free from recurrence of paraganglioma after 1 year of follow up. To our knowledge, this represents only the seventh case of a paraganglioma arising in the mesentery.

Effect of Cautery with Irrigation Forceps on the Remnant Liver after Hepatectomy in Rats

Monopolar cautery with irrigation forceps (CIF) was devised for use in liver resection that does not require occlusion of inflow to the remnant liver. However, a high power output is required to divide the hepatic parenchyma which boils the irrigation water. This study was performed to investigate the effects of using CIF on the hepatic parenchyma. Histologic and biochemical examination was performed in rats which had undergone hepatectomy using the CIF, irrigating bipolar (IB), Pringle’s maneuver with blunt dissection (group P), or a sham operation. A greater cautery distance was obtained with the CIF than the IB. There was no significant difference in the remnant liver function after the 1st postoperative day in any of the groups. CIF is an effective instrument for anatomic or nonanatomic hepatic resection.

Interleukin-6 and granulocytic elastase levels following laparoscopic cholecystectomy

Interleukin-6 (IL-6) levels have been shown to correlate well with the magnitude of surgical stress. Serum IL-6 and plasma granulocytic elastase levels, 24 h after surgery, were determined in 12 patients who underwent open major surgery [MS group; esophageal carcinoma (n=5), gastric carcinoma (n=3), colorectal carcinoma (n=4) 5 patients who had open cholecystectomy [OC group] and 17 patients who had laparoscopic cholecystectomy [LC group]. IL-6 levels correlated significantly with the duration of surgery (r=0.685,P < 0.01) and with intraoperative blood loss (r=0.583,P < 0.02). However, there was no significant correlation between granulocytic elastase and the duration of surgery or blood loss. Plasma IL-6 levels in the LC group (21±3 pg/ml) were significantly lower than those in the OC group (47±5 pg/ml) and the MS group (186±36pg/ml) (P<0.05;P<0.01). However, there was no significant difference in granulocytic elastase levels between the LC group (318±8μg/l), the OC group (360±130 gmg/ml), and the MS group (701±344 μg/l). Increased IL-6 levels correlated well with increased duration of surgery. The lower IL-6 levels following laparoscopic cholecystectomy may therefore be indicative of lower surgical stress associated with laparoscopic cholecystectomy.

A Case of Simultaneous Presence of Malignant Lyniphoma and Adenocarcinoma of the Stomach

胃悪性リンパ腫と早期胃癌の共存例は非常にまれである. 病理組織学的に興味が持たれ, 文献的考察を加え報告する. 症例は63歳の男性, 慢性肝炎 (HCV+), 胃潰瘍で, 内科治療中であった. 胃内視鏡生検にて胃幽門部にIIc (adenocarcinoma), 胃体上部に悪性リンパ腫を診断され, 胃全摘術を施行した. 切除標本の全割病理組織学的検索では胃悪性リンパ腫は表層型で, 胃全体に散布しており6病変認められた. しかも, そのうちの2病変に相接してtubular adenomaの存在もみられた. 深達度はsmでLSG分類ではdiffuse lymphoma, medium sized cell type, B cellであった. 一方, 胃癌は幽門部後壁小彎側に存在しIIc, 深達度はm, 組織型は中分化腺癌 (tub2) であった. 胃粘膜よりHelicobacter pyloriが証明された. リンパ節転移はなく, 両者は全く別々に離れ存在していた.

Compensatory hepatic hypertrophy after occlusion of branches of the portal vein or bile duct

The effect on the liver of portal or bile duct branch occlusion was examined in rabbits by measuring hepatic tissue blood flow and cellular kinetics, using the bromodeoxyuridine labeling index. The portal branch bile duct branch, or both, to the main lobe and caudate lobe (80.4% of total liver weight) were ligated or embolized just above the right posterior lobe (19.6%), resulting in compensatory hypertrophy of the right posterior lobe and atrophy of the main and caudate lobes. Twenty-four days after ligation, the degree of compensatory hypertrophy in the different groups was comparable. There were significant differences in the pattern of the development of hypertrophy. Ligation of both a portal branch and the corresponding bile duct resulted in more rapid hypertrophy and atrophy than ligation of a portal branch alone. Ligation of a branch of the bile duct resulted in slow development of hypertrophy and atrophy. In the embolization group, the increase in the right posterior lobe stopped 6 days after the operation, resulting that it was about 40% thereafter. Histological findings showed that the fibrin clot had contracted and was floating in the portal branch to the main lobe. These results suggested that portal blood flow to the main lobe had resumed and was gradually increasing as the clot contracted. Portal branch ligation gave results superior to those with portal branch embolization with regard to application to preoperative procedure in extended hepatobiliary surgery.