Toshihiko Mikami

HEMOBILIA CAUSED BY A GIANT BENIGN HEMANGIOMA OF THE LIVER : REPORT OF A CASE

We report herein the extremely unusual case of a 39-year-old woman in whom a giant cavernous hemangioma caused hemobilia. Cavernous hemangioma is the most common benign neoplasm of the liver and rarely causes any clinical symptoms or signs, while hemobilia usually occurs secondary to accidental operative or iatrogenic trauma, vascular disease, inflammatory disorders, gallstones, or tumors of the liver. Although invasive or malignant hepatic tumors often result in a communication between the biliary tract and the blood vessels, only one case of hemobilia caused by a benign cavernous hemangioma has ever been reported, but with no details about the patient. Our patient presented to a local hospital with severe melena as the initial main symptom, where ligation of the right hepatic artery was performed. This failed to relieve her symptoms, and she was subsequently referred to our department where a right hepatectomy was performed. Histopathological examination revealed no malignancy combined with the tumor; however, the hemangioma was exposed to the bile duct in segment VIII, which was presumably the cause of the hemobilia. This patient remains in good health almost 6 years after her operation. To the best of our knowledge this is the first case report of hemobilia caused by a cavernous hemangioma, and is accompanied by a detailed analysis.

The anatomy of the parapancreaticoduodenal vessels and the introduction of a new pylorus‐preserving pancreatoduodenectomy with increased vessel preservation

Classical pancreaticoduodenectomy for malignant tumors of the pancreatoduodenal region or chronic pancreatitis has recently been discussed in terms of the quality of life, associated with long-term postoperative morbidity. Pylorus-preserving pancreatoduodenectomy (PPPD) for the patient with chronic pancreatitis was first reported by Traverso and Longmire. Since that time, PPPD has become an accepted surgical procedure that is being increasingly indicated for certain malignancies. Herein, we report a PPPD that also preserves the parapancreatoduodenal vessels. The reasons why PPPD with the preservation of these vessels is significant are related to the length of the preserved duodenum and the reactions of gastrointestinal hormones. However, it may appear that this new PPPD poses a little greater risk of cancer recurrence, since the surgery is less radical than the usual PD. If the indications listed below are strictly observed, this operation should enable. The indications are: (1) chronic pancreatitis with tumor formation in the pancreatic head, (2) ampullary carcinoma, (3) inferion biliary duct carcinoma, (4) early duodenal carcinoma (all without pancreatic invasion), and (5) certain benign cystic tumors. Whether this operation should also be recommended for patients with small carcinomas or islet cell tumors arising in the head of the pancreas is now being investigated.

An experimental study on the effects of selected drugs on pancreatic regeneration after partial pancreatectomy

This study was undertaken to determine the effect of the single and combined administration of caerulein, hydrocortisone, and FOY-305 (camostat) on the regeneration of the remnant pancreas after a 90% pancreatectomy in rats. After undergoing either a sham operation or a 90% pancreatectomy, the rats were administered the three drugs either singly or in combination. After the rats were killed, the pancreas was weighed and examined for tissue amylase activity, tissue protein content and total DNA content. The results were as follows: In the sham operation group, the caerulein among three drugs produced a significant trophic effect. The trophic effect in the combined administration group was greater than that in the single administration group. In the 90% pancreatectomy group, of the three drugs administered, hydrocortisone produced the most significant trophic effect. The trophic effect in the combined administration group was greater than that in the single administration group. These data suggest that the trophic effect of caerulein is significant in mature pancreatic cells while that of hydrocortisone is an immature one and that an additive effect of the three drugs was observed.

HETEROTOPIC CARCINOMA OF THE STOMACH, REPORT OF A CASE

A 55-year-old woman underwent a medical check-up. X-ray examination revealed an elevated lesion on the an-terior wall of the antrum (Figs., 1, 2). Endoscopic examination of the stomach showed an elevated lesion with bridging folds (Fig. 3). Gastric biopsy proved the lesion to be nonmalignant. Subtotal gastrectomy was performed because it seemed probable that the lesion might contain a submucosal tumor or carcinoma. We diagnosed adenocarcinoma of the stomach in the frozen section. Gross findings of the resected specimen showed an elevated lesion, 2.3×1.5cm in size (Fig. 5). The lesion was located in the muscular region of the stomach, well-defined and separated from the surrounding normal tissue. The tip of the lesion was slightly depressed and erosive. The histological diagnosis was well-differentiated tubular adenocarcinoma of the stomach-tub, , INFβ, ly1 v0, awθowθn1θ0/28, n2θ0/8. Histologically, it was proved that the adenocarcinoma was produced in heterotopic growth in the subumucosal layer of the stomach (Fig. 8a). This is a rarely seen lesion although a few reports concerning similar lesions have been made.