Yasushi Iwatsuka

Closure of the Distal Pancreatic Stump with a Seromuscular Flap

We describe herein our new method for transecting the pancreas and closing its stump in distal pancreatectomy, devised to decrease the risk of pancreatic fistula formation. With this technique, the pancreas is transected in such a way that a convex stump is left, whereby the pancreatic secretions from the parenchyma near the pancreatic stump are fully drained into the main pancreatic duct. A pedicled seromuscular flap of the stomach or jejunum is then used to cover the cut surface of the pancreas. This new technique provides tight closure of the pancreatic stump after distal pancreatectomy.

Tuberculous pseudoaneurysm of the descending thoracic aorta: a case report and literature review of surgically treated cases.

Tuberculous aneurysm of the aorta is an extremely rare disease with a high mortality rate. Only 32 patients treated surgically have been reported in the literature. These reports indicate an 84.4% operative survival rate. We present a case of a tuberculous false aneurysm in the descending thoracic aorta that was successfully treated surgically with an extracorporeal circulation. The hole in the aorta within the false aneurysm was closed with a Dacron patch because the aortic wall appeared to be free of active infection as a result of long-term preoperative antituberculous chemotherapy.

Pedicled jejunal seromuscular flap for bronchocutaneous fistula

We report the successful closure of a complicated bronchocutaneous fistula using a pedicled jejunal flap. The fistula, secondary to tuberculosis and irradiation, previously had been closed with a latissimus dorsi musculocutaneous flap. This initial repair failed. The recurrent fistulas were closed again using a jejunal seromuscular flap, and the chest wall defect was reconstructed with a rectus abdominis musculocutaneous flap.

Upper extremity ischemia in athletes : Embolism from the injured posterior circumflex humeral artery

Upper extremity ischemia in athletes is caused by embolism from the proximal arterial compromise at the thoracic outlet or under the pectoralis minor. The posterior circumflex humeral artery (PCHA), a branch of the third part of the axillary artery, can also be injured by repetitive overhead activity including the tennis or volleyball game, resulting in aneurysm formation or thrombotic occlusion, and this lesion could be a source of distal embolism. We report two patients with complaints of hand and forearm ischemia due to distal embolism from the aneurysm in one patient and thrombotic occlusion of the PCHA in the other. The former was a 20-year-old amateur tennis player. Angiography revealed an aneurysm of the PCHA and multiple distal embolism. He was treated by resection of the aneurysm and thromboendarterectomy with vein patchplasty of the occluded ulnar artery. Five years after surgery now, he can enjoy playing tennis without new embolic events, although he still has mild ischemic symptoms during playing tennis. The latter was a 17-year-old volleyball player. Angiography showed thrombotic occlusion of the PCHA and embolic occlusion of the digital arteries. Surgical intervention was not required because he decided not to play volleyball. Two years later now, he has had no new episodes of embolism, although he has ischemic symptoms only when cold.

Case Report: Hepatic adenoma with bone marrow metaplasia in a patient with glycogen storage disease type 1a

A 34 year old man with glycogen storage disease type 1a had two hepatic tumours since 18 years of age. They had continued to grow until he was 24 years old, but showed no further growth since then. He underwent a right hepatic trisegmentectomy with caudate lobectomy under veno‐venous bypass. The tumour in the posterior segment showed nodule‐within‐nodule appearance. Histologically, the inner adenoma with dysplasia, bone marrow metaplasia and lymphocytic infiltration was separated by a fibrous band from the outer adenoma of usual histology.

Below-Elbow Joint Arterial Reconstruction for Chronic Ischaemia

Ten below-elbow joint arterial bypass grafts performed in nine patients for chronic upper extremity ischaemia are reviewed. The cause of the ischaemia was thromboangiitis obliterans in four patients, iatrogenic trauma in four and unknown aetiology in one. Graft revision was required in two patients with thromboangiitis obliterans who underwent axillary-brachial bypass. Eight grafts, including one reoperation, have remained patent from 1 to 10 years (mean 54.3 months). Graft failure after 5 months did not occur, at which time the primary patency rate was 80%. In general, the long-term patency rates of autogenous vein bypass graft to the forearm were satisfactory. Aggressive arterial reconstruction is especially indicated in significant chronic upper extremity ischaemia resulting from iatrogenic trauma, as chances of success are excellent. Clinical and technical problems of in situ vein bypass in the upper extremity are discussed.