Tadahiro Kimura

A patient with early gallbladder cancer derived from a Rokitanski-Aschoff sinus

We present herein a case of a 40-year-old male with early gallbladder cancer derived from a Rokitanski-Aschoff sinus (RAS). The patient originally presented at our hospital with epigastric discomfort, following which a diagnosis of adenomyomatosis (ADM) of the gallbladder was made, and a cholecystectomy performed. Histopathological examination of the resected specimen revealed a 7-mm well-differentiated papillo-tubular adenocarcinoma in the RAS epithelium in the body of the gallbladder. The RAS extended to the “pm” layer but the adenocarcinoma was an in situ lesion localized within the RAS epithelium. Considering the difficulties in making an early diagnosis of gallbladder cancer, active surgery should be performed for patients in whom ADM is seen in the gallbladder.

Study on Reaction of Subpapillary Venous Plexus in Patients with Arterial Occlusive Diseases of Lower Extremity by Reflective Spectrophotometry

The reactions of the subpapillary venous plexus were observed by analyzed fractional blood volume of tissue (Vb) in patients with arterial occlusive dis eases, Fontaines stage I-II, using the reflective spectrophotometer. The sole skin of 11 normal subjects, 17 patients with arteriosclerosis obli terans (ASO), and 14 patients with thromboangiitis obliterans (TAO) were scanned by the light reflectance of four specially selected wavelengths, including isobestic points (586 and 569 nm) and peaks in the spectra of oxyhemoglobin and deoxyhemoglobin (577 and 560 nm) in referring to time. Sampling area was the subpapillary venous plexus histologically because the depth for receiving reflectance is about 1.0 mm from the sole skin surface. One series observations was divided into five steps depending on the modes of combination of the ap plied pressure to ankle cuff and tilting. The Kubelka-Munk equation was uti lized to calculate blood volume (Vb). It is concluded that the patients with ASO might have a dysfunction, not of the subpapillary venous plexus, but of the venular valve, whereas patients with TAO might have a dysfunction of both the subpapillary venous plexus and venu lar valve.

Arteriovenous Communications in Patients with Primary Varicose Veins: An Investigation Using Thermography, Blood Oxygen Tension, and Operative Microscopy

The presence of arteriovenous communications (AVCs) in the lower extremi ties of patients with primary varicose veins with or without ulcerations was inves tigated by use of thermography, analysis of the blood oxygen tension, and observation under operative microscopy. Fifty-six subjects, including 20 normal subjects and 26 patients with primary varicose veins, were studied. Subjects maintained a standing position in a quiet room while thermography was performed both before and after exercise. The exercise was performed tiptoeing at a rate of twenty times per minute. After exer cise, hot spots on the lower extremities of the patients with varicose veins were localized by thermography. In the normal subjects, blood samples were aspi rated percutaneously from the femoral artery and vein before and after lumbar anesthesia. In the patients with primary varicose veins, an incision was made in the inguinal region following lumbar anesthesia and samples of blood were aspirated from the femoral artery and vein, the saphenous vein, and the ther mographic hot spots. The venous and arterial blood oxygen tensions were deter mined immediately in the hospital laboratory by means of a blood gas analyzer. After lumbar anesthesia, there were significant differences between the oxy gen tensions of the hot spots and those of the femoral or saphenous veins in the patients with varicose veins (p < 0.01, p < 0.05). At operation, the hot spots were investigated by operative dissection and microscopy. Small, pulsating arteries were observed at the sites that corresponded to the hot spots. These results strongly suggest that AVCs open up in the dermal capillary bed as the result of a persis tently high venous pressure, and these shunts, by diverting oxygenated blood away from the overlying skin, produce skin ischemia and ulceration.