Tetsunobu Udaka

Familial Epidermoid Cysts of the Spleen : Report of Two Cases

The familial occurrence of epidermoid cysts of the spleen is rare, with only six cases having ever been reported, to our knowledge. We recently diagnosed epidermoid cysts of the spleen in a mother and son. First, a 15-year-old boy was admitted to our hospital for management of blunt abdominal trauma. Computed tomography (CT) showed a ruptured large splenic cyst with an intraabdominal hematoma. We performed a splenectomy, and histopathological examination confirmed the existence of an epidermoid cyst of the spleen. About 2 years and 6 months later, the family physician found that the patients 41-year-old mother had a large splenic cyst, and she was referred to our hospital for further investigation. CT showed a 10 × 8 cm cyst occupying most of the spleen. The patient underwent splenectomy, and a pathological diagnosis of an epidermoid cyst of the spleen was confirmed. Although the etiology of epidermoid cysts of the spleen is unclear, this familial occurrence may support the hypothesis of congenital malformation as a result of genetic change.

Perioperative supplementation with bifidobacteria improves postoperative nutritional recovery, inflammatory response, and fecal microbiota in patients undergoing colorectal surgery: a prospective, randomized clinical trial

The use of probiotics has been widely documented to benefit human health, but their clinical value in surgical patients remains unclear. The present study investigated the effect of perioperative oral administration of probiotic bifidobacteria to patients undergoing colorectal surgery. Sixty patients undergoing colorectal resection were randomized to two groups prior to resection. One group (n=31) received a probiotic supplement, Bifidobacterium longum BB536, preoperatively for 7–14 days and postoperatively for 14 days, while the other group (n=29) received no intervention as a control. The occurrences of postoperative infectious complications were recorded. Blood and fecal samples were collected before and after surgery. No significant difference was found in the incidence of postoperative infectious complications and duration of hospital stay between the two groups. In comparison to the control group, the probiotic group tended to have higher postoperative levels of erythrocytes, hemoglobin, lymphocytes, total protein, and albumin and lower levels of high sensitive C-reactive proteins. Postoperatively, the proportions of fecal bacteria changed significantly; Actinobacteria increased in the probiotic group, Bacteroidetes and Proteobacteria increased in the control group, and Firmicutes decreased in both groups. Significant correlations were found between the proportions of fecal bacteria and blood parameters; Actinobacteria correlated negatively with blood inflammatory parameters, while Bacteroidetes and Proteobacteria correlated positively with blood inflammatory parameters. In the subgroup of patients who received preoperative chemoradiotherapy treatment, the duration of hospital stay was significantly shortened upon probiotic intervention. These results suggest that perioperative oral administration of bifidobacteria may contribute to a balanced intestinal microbiota and attenuated postoperative inflammatory responses, which may subsequently promote a healthy recovery after colorectal resection.

A case of metachronous brain metastases from gastric cancer with no recurrence

症例は75歳の男性で, 急性骨髄性白血病のため当院血液内科で化学療法を受け, 完全寛解状態であった. 今回, 貧血の精査のため行った上部消化管内視鏡検査にて胃体上部に進行胃癌を指摘され, D2郭清を伴う胃全摘術を施行した. 術後1年5か月目に人格変化, 嘔吐がみられ, 頭部MRIを施行したところ, 大脳半球に3個の転移性脳腫瘍を認めた. 胸腹部CT, 腹部超音波検査では転移を認めず, 腫瘍マーカーも正常であった. 白血病再燃による病変も否定できず, 脳腫瘍生検を行った. 病理組織学的診断は中分化型腺癌で, 胃癌の病理組織学的検査所見とも一致しており, 胃癌脳転移と診断した. 脳転移に対し, サイバーナイフを行ったところ, 臨床症状の改善を認め, 通院治療が可能となった. 5か月後, 新たな2個の脳転移に対し, 再度サイバーナイフの施行を要したが, 脳転移発症後1年経過現在, 胸腹部を含め無再発生存中である.

A Case of Solitary Peutz-Jeghers Type Hamartoma of the Jejunum with Bloody Stool and Intussusception.

下血を主訴とし. 腸重積を呈した単発性Peutz-Jeghers (P-J) 型空腸過誤腫の1例を経験したので報告する.症例は47歳の男性.1996年10月2日頃より下血を認め入院となった. 小腸造影検査で空腸に腫瘍を認め, 1週間後の腹部超音波, CT検査で空腸に腸重積の所見を認めたが, 腹部症状は認めなかった. 小腸造影の再検査では腸重積を認めなかった. 腸重積を呈した空腸腫瘍と診断して11月26日手術を施行した. トライツ靱帯より50cmの空腸が三筒性の重積をきたしていた. 用手的に整復した後, 腫瘤を含め20cmの空腸を切除した. 摘出標本では, 腫瘍は有茎性のポリープで, 病理組織学的診断は, P-J型の過誤腫であった.自験例では, 過誤腫による無症状の腫重積を起こしては自然に軽快するという興味深い経過をたどっていた. また, 本疾患は良性腫瘍であるため腸切除よりは腸切開・ポリープ切除が適切な手術法であると思われた.