Yoshifumi Kajiwara

An autopsy case of klippel-Feil syndrome with cardiovascular anomalies and upper limb anomaly

Abstract An autopsy case of Klippel‐Feil syndrome with the classical triad of short neck, low posterior hairline and limitation of neck movement is reported. The patient died of cardiac failure resulting from complicated serious cardiovascular anomalies such as double outlet right ventricle, congenital mitral valve stenosis and coarctation of aorta. The condition was also complicated by radial ray deficiency of the left arm and asymmetry of the thyroid gland. Narrowing of the left subclavian and axillary arteries was detected by angiography while the patient was alive, a finding which may suggest the etiology of this congenital anomaly complex.

The surgical technique of retroperitoneal lavage for the treatment of extended necrotizing pancreatitis

For cases of extended necrotizing pancreatitis which involve the spread of infectious or hemorrhagic necrotic lesions to the retroperitoneal tissue, we recommend sequestrectomy and subsequent retroperitoneal lavage via the retroperitoneal access. For successful retroperitoneal lavage, as much liquefactive infectious necrotic tissue as possible should be removed from the retroperitoneal cavity during the operation. In addition, the necrotic cavity should be opened, adequately washed out, and catheters placed in the retroperitoneal cavity by retroperitoneal access. Although we have only applied this ideal technique in two patients so far, the details are presented herein. The significance of retroperitoneal lavage lies in the fact that it cleans the retroperitoneal foci of infection and necrosis, and that it eliminates the necrotic material, bacterial deposits, and biologically active substances produced after surgery. Ultimately, wound healing is markedly promoted, leading to improvement in the systemic condition.

Two Cases of Rectal Cancer Prolapsing through the Anus.

肛門外脱出を来した直腸癌を2例経験した. 症例1は51歳の男性で, 直径4cm大で腫瘍が肛門縁から5cmの部位に存在した. 直上にBorrmann 1型の腫瘍を併発しており, 2群リンパ節郭清を伴う超低位前方切除を施行した. 病理組織検査ではm癌であった. 症例2は68歳の女性で, 直径約6cm大の腫瘍が肛門縁から3cmの部位に存在した. 超音波内視鏡でsm癌と診断し経肛門的に切除した. 病理組織検査でもsm癌であった. 切除断端には癌組織を認めなかった.大腸癌が肛門脱出を来す機序としては有茎性腫瘍が脱出する場合と直腸脱に伴う腫瘍脱出があるが, 前者の場合は腫瘍の大きさにかかわらず早期癌である可能性が非常に高い. 自験例では2例とも前者の機序と考えられた.

Pulmonary cytopathology of a thymic carcinoma.

悪性胸腺腫の約1/3は気管や肺に浸潤するが, 肺細胞診で腫瘍細胞を認めた報告はきわめて少ない. われわれは胸腺癌と思われる症例で, 気管支ブラッシングと喀痰の細胞診に腫瘍細胞を認めた.症例は47歳, 女性. 胸部X線写真と胸部CTにて右前上縦隔に腫瘤と肺野の小円形腫瘤がみつかり入院. テレコバルト療法にて一時縦隔腫瘤は縮小したが肺野の腫瘤の増大と血疾の出現にて再入院. 気管支ブラッシングと喀痰の細胞診が陽性となった. 肝転移も発見され死亡, 剖検された.気管支ブラッシング細胞診で腫瘍細胞は緩い結合性を示し, 紡錘形でN/C比大・核は不整形で核質は粗網状. 喀痰細胞診では高度の壊死と多核白血球を背景として, 大型多角形の腫瘍細胞が散在性にみられ, N/C比大. 核は大小不同で不整. 核質は粗顆粒状で1, 2個の核小体がみられた. 剖検病理所見では異型性の著しい腫瘍細胞が大小不整の胞巣に分けられ, 胞巣中心部に壊死がみられた. 電顕所見も合わせ胸腺癌と診断された. 本例では肺大細胞癌との鑑別が難しいが臨床的所見や放射線診断が確定診断の重要な助けとなった.