Takeshi Mishina

Mucinous Cystadenocarcinoma of the Retroperitoneum: Report of a Case

Abstract Retroperitoneal mucinous cystadenocarcinomas are extremely rare. A 40-year-old Japanese woman was found to have a retroperitoneal mucinous cystadenocarcinoma of ovarian type. Both ovaries were normal. Concentrations of carcinoembryonic antigen and carbohydrate antigen 19-9 in the cyst fluid were extremely high (810 000 ng/ml and 8 082 000 IU/l, respectively). The tumor varied from benign to borderline and malignant in microscopic appearance, and the lesion was composed of mesothelium-like cells. The histologic and immunohistochemical findings suggested that the tumor developed from mucinous metaplasia of the coelomic mesothelium.

A case of Currarino triad with familial sacral bony deformities.

Abstract We describe a male patient presenting with Currarino triad: a recto-urethral fistula, sacral bony deformity, and a presacral teratoma. Clinical screening of his family revealed three additional cases with incomplete forms of this association. Cytogenetic findings in the patient and his mother were normal. This case suggests that the occurrence of an anorectal malformation together with a sacral bony deformity should raise a physicians index of suspicion for associated presacral tumors, and that screening of the patients family members with sacral radiographs is necessary.

SUCCESSFUL TREATMENT OF BLUNT TRAUMA INVOLVING COMPLETE LACERATION OF THE PANCREAS AND DUODENUM IN A 7-YEAR-OLD CHILD : REPORT OF A CASE

The acute onset of peritoneal signs and shock in a 7year-old boy who had been hit in the epigastrium by a log-seesaw mandated surgical treatment. Enhanced computed tomography (CT) demonstrated complete laceration of the pancreas as well as duodenal injury, and a duodenoduodenostomy with distal pancreaticogastrostomy was subsequently performed. Temporary external drainage of the stomach and distal pancreas led to an uneventful recovery in the early postoperative period. Although the patients postoperative development was appropriate for his age, the orifice of the distal pancreas spontaneously closed 2.5 years following surgery. We present this report to stress the fact that every effort should be made to preserve the pancreas following abdominal injury in children.

Hepatic gluconeogenesis from alanine following surgery

To clarify alanine metabolism in the liver with special reference to gluconeogenesis, catheters were placed in hepatic, portal, femoral, and external jugular veins of six male mongrel dogs. A trace amount of14C-alanine was administered as a single pulse into the external jugular vein on the first postoperative day, and the blood samples were taken from each vein for the subsequent two hours to measure14C-glucose radioactivity. Cumulative radioactivity after14C-alanine injection showed that 74 per cent of the radioactivity in whole protein-free serum was that of14C-glucose. Therefore, it is considered that the metabolic pathway of alanine in the liver after surgery is mainly through gluconeogenesis to glucose. Ourin vivo experiment clearly showed that hepatic gluconeogenesis from alanine is one of the important factors related to hyperglycemia after surgery.

A Case of Descending Colon Cancer with Submucosal Invasion with Paraaortic Lymph Node Metastasis

4群リンパ節転移を伴う下行結腸sm癌の1例を経験した. 症例は55歳の男性で, スクリーニング目的の下部消化管内視鏡検査にて下行結腸に径10mmのIs型ポリープを認めたため内視鏡的摘除術を施行した. 切除標本は深達度sm1であったが, 水平断端が陽性の可能性があったため, 追加切除の適応と考え根治手術を施行した. 術中所見で1群から大動脈周囲リンパ節までの広範な転移を迅速組織診断にて確認したため, 治癒切除は不可能と考え下行結腸部分切除術 (1群リンパ節郭清) を施行した. 病理組織学的診断では内視鏡的摘除術を施行した部位に癌の遺残はなかった. 術後14病日より5FU, アイソボリンによる化学療法を開始し, 計4クール施行後の腹部CTでは, 大動脈周囲リンパ節転移が消失し著効した. 大腸sm癌の中でも本例のように深達度sm1での4群リンパ節転移陽性例は極めてまれであり, 若干の文献的考察を加えて報告する.

Experimental study on gluconeogenesis from alanine in totally pancreatectomized dogs.

膵全摘術後早期の糖代謝について検討した.雑種成犬に膵胃全摘術を行い, 術後インスリン非投与群: I群 (n=3), 投与群: II群 (n=3) に分け, sham手術 (脾摘術) 群: III群 (n=6) を対照とした.術後1日目に14C-アラニン10μCi/kgを投与し経時的に肝静脈より採血.血漿ブドウ糖の放射能を測定した.血糖値はI, II, III群でそれぞれ370±64, 59±34, 105±21mg/dlとI群で高値となった (p<0.05).肝静脈14C-ブドウ糖放射能の最高値はそれぞれ24,311±1,327, 8,231±2,118, 27,394±11,994dpm/mlとII群で低値であった (p<0.05).膵全摘術後早期ではアラニンからの糖新生は他の一般手術と同程度であるが, インスリンで容易に抑制されること, インスリン単独投与では糖・アミノ酸代謝が正常に営まれていないことが示唆された.