Yuichi Machiki

A Case of Somatostatinoma of the Pancreas, Accompanied with Pancreas Divisum, that was Found at a Time of Acute Pancreatitis

Somatostatinomaは膵臓あるいは十二指腸に好発するまれな内分泌腫瘍である, 今回, 我々は膵癒合不全のため膵液の主排出路となっていた副膵管がsomatostatinomaにより閉塞し急性膵炎を発症した症例を経験した. 症例は65歳の男性で, 上腹部痛を主訴に来院し, 急性膵炎と診断された. 膵炎軽快後の内視鏡的逆行性膵管造影検査で背側膵管と腹側膵管が分枝のみで交通する膵管非癒合の所見を認め, また, 副膵管の途絶とその上流側膵管の拡張を認めた. 内視鏡所見では十二指腸下行脚副乳頭に一致する部位に潰瘍性腫瘍病変を認めた. 腫瘍により副膵管が閉塞し, その結果急性膵炎が発症したと考えられた. 急性膵炎の軽快した後に膵頭部癌の診断で膵頭十二指腸切除術を施行した. 病理組織学的に膵内分泌腫瘍と診断され, 免疫組織学的にsomatostatinで濃染された. 膵somatostatinomaと診断された.

A CASE OF DEATH DUE TO SNAKE (RHABDOPHIS TIGRINUS) BITE AND A REVIEW OF SIMILAR CASE REPORTS IN JAPAN

A patient, who died of cerebral hemorrhage resulting from a marked hemorrhagic tendency caused by a snake (Rhabdophis tigrinus, which has previously been considered to be atoxic) bite, was experienced. The patient, a 14-year-old boy, was bitten on the back of the left hand by the snake, and developed a headache some ten minutes later, with subsequent swelling of the region of the lesion. A hemorrhagic tendency occurred about 16 hours after the snake bite, and the patient fell into a coma after about 19 hours, resulting in respiratory arrest some hours after that. CT scan of the head revealed cerebral hemorrhage in the left lobe and occipital lobe. No remission occurred in spite of exchange transfusion, and the patient died on the tenth day after the snake bite. With regard to Rhabdophis tigrinus bite, when the toxic liquid secreted from the Duvernoy gland in the posterior part of the maxilla is injected into the human body, a hemorrhagic tendency is induced. In Japan, eight case including this case have been reported since the case of Sakamoto, all of them involving a hemorrhagic tendency. It is therefore necessary to guard against the occurrence of a hemorrhagic tendency in patients bitten by animals and to perform early exchange transfusion or antitoxic serm injection.