Yoshifumi Katagiri

Current practices in adult groin hernias: a survey of Japanese general surgeons.

Abstract.The tendency to perform abdominal wall reinforcement using various types of mesh (tension-free repair) is increasing. A questionnaire to poll Japanese surgeons on their current surgical modalities for groin hernias was sent to 105 hospitals and was returned by 83 hospitals. The majority (83%) of responders to this survey supported the tension-free repair as a standard operation for adult groin hernias. Of these 69 tension-free repairs, the mesh-plug repair was the most frequent standard operation (n = 53, 64%) and was performed by all responders. Ten (12%) opted for the prolene hernia system (PHS) repair as a standard operation and 52% of responders had experience of the PHS repair. Laparoscopic repair was performed as a standard operation by only one responder and was performed by only 34% of responders.

Immunoglobulin G4-related sclerosing cholangitis without pancreatic involvement.

tography (MRCP) demonstrated that the biliary stricture did not spread to the root of the left medial branch ( fig. 2 ). Right hepatic lobectomy, caudate lobectomy and resection of the extrahepatic bile duct with D2 lymph node dissection were performed. A resected specimen showed an irregular but smooth surface of hepatic hilar mucosa and A 62-year-old man with a past history of retroperitoneal fibrosis was admitted with obstructive jaundice. CT demonstrated dilated intrahepatic bile ducts and a nonswollen pancreas. Endoscopic retrograde cholangiography (ERC) disclosed an irregular stricture of the hepatic hilar bile ducts ( fig. 1 ). Magnetic resonance cholangiopancreaPublished online: March 5, 2009

A Simultaneous Operative Case of Hepatocellular Carcinoma Combined with Ischemic Heart Disease.

症例は68歳の男性で, 手術適応のある冠動脈狭窄を伴った肝細胞癌症例に対し, 1期的に冠動脈再建術と肝切除術を施行した.冠動脈病変は右冠動脈の完全閉塞, 左主幹動脈, 左回旋枝のいずれもで75%狭窄が存在し, 肝臓の病変は後下区域に径30mm大の肝細胞癌が認められた.術前の心機能は駆出率0.65と良好で, かつ臨床病期1と肝予備能も十分であった.まず体外循環下に3枝に大動脈-冠動脈バイパス術を行い, 術中の心係数も3.21/kg/m2と良好で, activatedcoagulationtime (ACT) も144秒と血液凝固能も安定していた.よって体外循環離脱後, 引き続き肝後下亜区域切除術を施行した.術中術後経過は良好で, 管理困難な出血, 創感染などはなく, 術後10か月の現在, 肝細胞癌の再発なく健在である.このことは今後増加するであろう虚血性心疾患を合併した肝細胞癌に対する積極的な治療法の1選択肢を示唆するものである.