A case of a solitary metastatic diaphragmatic tumor--relation to the peritoneal stomata of the diaphragm.

We herein describe a metastatic diaphragmatic tumor, an entity that has rarely been reported radiologically. The primary lesion was advanced colon cancer, and the root of the metastasis was thought to be the peritoneal stoma(ta) of the diaphragm, which has previously been shown to absorb both intraperitoneal fluid and small particles.

A case of a primary hepatic tumor causing segmental changes on imaging and its relation to Zahn's infarct.

A 69-year-old female was admitted to our hospital for further examination of an intrahepatic mass which had been found while undergoing a complete physical examination. The mass measured 4 cm in size and was located in the medial segment (S4) of the liver. On computed tomography (CT), S4 was observed to be 'atrophied' and was well enhanced segmentally. A celiac angiogram showed segmental staining, and a transarterial portogram demonstrated portal stoppage of S4 from the left branch. However, no segmental intensity difference was seen on magnetic resonance imaging (MRI). An aspiration biopsy showed adenocarcinoma and thus an operation was performed under a tentative diagnosis of intrahepatic cholangiocarcinoma. The postoperative diagnosis of the tumor was combined hepatocellular and cholangiocellular carcinoma. However, no histological abnormality was seen in S4, contrary to the expectation of Zahn's infarct. In this study, we discuss the mechanism and imaging findings of Zahn's infarct, the possible reasons as to why no pathological change was seen in S4, as well as stress the rarity of reports on Zahn's infarct in cases of portal thrombus due to hepatocellular carcinoma.

Kumacone II: an adapter to aid in the placement of a purse-string suture in very low anterior rectal resection.

We have designed an adapter called the "Kumacone II", being a bottle-shaped rubber device which greatly aids in placing a purse-string suture, even at the lowest level near the anorectal junction of the rectum. When this adapter is used, performing the anastomosis is much less time-consuming and not as much training is needed as for low anterior resection using conventional manual suturing. In a clinical study, the incidence of leakage and incontinence was nil in five out of five patients.

Elastofibroma dorsi. Cytologic, histologic, immunohistochemical and ultrastructural studies.

Cytologic, light and electron microscopic, and immunohistochemical studies were conducted on a case of elastofibroma. Aspiration cytology showed a characteristic "braidlike" or "fern leaf-like" structure. Immunohistochemically the accumulate was shown to be elastin. Transmission electron microscopy indicated electron-dense, granular aggregates surrounded by microfilaments and collagen, while scanning electron microscopy revealed balls with a ball-of-yarn-like structure consisting of small fibrils, probably of elastin. These structures are unique to this disease and useful for diagnosis.

[Results of operative management of cancer of the pancreas].

All 269 patients underwent surgery as pancreatic cancer in our institute from 1965 to 1985. Resectability rate was 20.3% (32/158) in the head, 20.7% (19/92) in the body and tail and 0% in the combined lesion. Pancreaticoduodenectomy (PD) was performed for the head in 30 patients. Distal pancreatectomy was performed for the body and tail in 16 patients. There were three postoperative deaths in the case which underwent the resection. Operative survival rate in the head was 43.9% at the first year and 27.4% at the 5 th year. Two patients survived more than five years after PD. On the other hand, survival rate in the body and tail was 40% at the first year and 26.4% at the 5 th year. Only one patient is alive 5 years 10 months after distal pancreatectomy.