Sclerosing encapsulating peritonitis combined with peritoneal encapsulation.

The combined occurrence of idiopathic sclerosing encapsulating peritonitis and peritoneal encapsulation is described. A 52-year-old man presented with intestinal obstruction. The results of preoperative examinations were suggestive of sclerosing encapsulating peritonitis. Laparotomy revealed the concurrence of peritoneal encapsulation and sclerosing encapsulating peritonitis. The thick membrane of sclerosing encapsulating peritonitis was freed with multiple incisions. After operation, the patient reverted to the preoperative state. The condition, however, was alleviated with conservative therapy consisting of intravenous hyperalimentation and nasogastric suction. To our knowledge, the combined occurrence of sclerosing encapsulating peritonitis and peritoneal encapsulation has never before been reported.

Colorectal cancer incidence among atomic bomb survivors, 1950-80.

Colorectal cancer incidence in the LSS sample during 1950-80 was investigated. A total of 730 incidence cases of colorectal cancer were confirmed from a variety of sources. Sixty-two percent of the cancers were microscopically verified and 12% were ascertained through death certificate only. The risk of colon cancer increased significantly with intestinal dose, but no definite increase of risk was observed for rectal cancer. Relative risk at 1 Sv and excess risk per 10(4) PY-Sv for colon cancer are 1.80 (90% confidence internal 1.37-2.36) and 0.36 (90% confidence interval 0.06-0.77) respectively. City and sex did not significantly modify the dose-response of colon cancer, but the risk decreased with age at the time of bombings (ATB). The relative risk of colon cancer does not vary substantially over time following exposure. A non-linear dose response did not significantly improve the fit. Further, the anatomic location of the tumors indicate that the cecum and ascending, transverse and descending, and sigmoid colon seem equally sensitive to radiation. No difference in the distribution of tumor histological types could be observed by radiation dose.

Pulmonary mycobacteriosis caused by rifampicin-resistant Mycobacterium szulgai.

We describe a rare case of pulmonary mycobacteriosis infected with rifampicin (RFP)-resistant Mycobacterium szulgai that was successfully eradicated with clarithromycin (CAM) treatment. An 80-year-old man was admitted to our hospital with a 4-week history of high fever, productive cough and malaise. Chest roentgenogram showed an infiltrative shadow in the left lower lung field. Isolated bacteria from sputum were acid-fast bacilli and identified as M. szulgai by the DNA-DNA hybridization method. Drug susceptibility tests showed resistance to RFP (MIC>100 microg/ml). Combined treatment with ethionamide, streptomycin and isoniazid based on the results of drug susceptibility tests resulted in clinical and radiologic improvement within two years. Additional treatment with CAM for another year resulted in complete eradication of the mycobacterium.

[5-Fluorouracil level and pyrimidine nucleoside phosphorylase activity in cancer patients after oral administration of doxifluridine (5'-DFUR)].

For the purpose to evaluate the distribution of 5'-DFUR in the cancerous tissues and non-cancerous tissues of 64 cancer patients (21 gastric, 25 colo-rectal and 18 breast cancers), pyrimidine nucleoside phosphorylase (PyNPase) activity and 5-FU level were determined by bioassay and GC-MS method. 5-FU levels in the plasma were also measured in all patients. Four hundred mg of 5'-DFUR was orally administrated three times a day for 3 to 7 days and just 3 hours before surgical operations. PyNPase activity and 5-FU level were significantly higher in the cancerous tissues than non-cancerous ones. 5-FU levels in the plasma were significantly lower than those in both cancerous and non-cancerous tissues. In conclusion, 5'-DFUR is expected to be an useful anticancer drug because of the selective accumulation of converted 5-FU in cancerous tissues.

[A case of superior lumbar hernia].

A 64-year-old man was admitted to our hospital on July 1, 1992, complaining of right flank mass. Physical examination revealed a 7 x 8 cm soft, non-tender, smooth-surfaced mass which protruded under abdominal pressure. A CT scan of the abdomen demonstrated a defect of the aponeurosis of the transverse abdominis muscle and a protrusion of the retroperitoneal fat through the defect. Under the diagnosis of right superior lumbar hernia, surgery was done. The defect about 2 cm in diameter in the center of the superior lumbar triangle was closed by several interrupted sutures. The patient had an uneventful recovery.

[Evaluation of the lipid and glucose metabolism on the apancreatic status with insulin supplement and with pancreatic autotransplantation].

To evaluate the effect of pancreatic fragments transplantation on glucose and lipid metabolism in the apancreatic status, 22 healthy mongrel dogs were totally pancreatectomized and then divided into three groups, (1) 5 dogs without any supplement , (2) 5 dogs with insulin replacement, and (3) 12 dogs with additional pancreatic fragments transplantation. In these three groups, changes in fasting plasma sugar, triglyceride, total cholesterol, phospholipid and lipoprotein fractions were studied. Stability of serum glucose levels were compared between the dogs with insulin replacement and those with transplantation by using glucose infusion and insulin test. Without insulin replacement or transplantation, apancreatic dogs showed high serum glucose levels immediately after total pancreatectomy. With pancreatic transplantation, serum glucose levels and lipids were well controlled within normal limits for a long time period after the operation. However, in the dogs with insulin replacement, serum glucose levels and lipids were remarkably unstable in fasting period and also showed easily tendencies to become hypoglycemic status by insulin test and diabetic ketoacidosis by glucose infusion test as compared with those in the transplanted dogs.

Lipid metabolism in partially hepatectomized dogs and effect of hepatic periarterial neurectomy.

Lipid metabolism in partially hepatectomized dogs was studied, by observing changes in serum lipids after hepatectomy and biosynthesis of lipids in the slices of the regenerating liver tissue. In addition, the effect of hepatic periarterial neurectomy was evaluated. Serum lipids decreased after partial hepatectomy and did not return to the postoperative level until the first postoperative week, whereas biosynthesis of lipids in the slices of the regenerating liver tissue was considerably augmented in the early postoperative period. This augmentation of lipid synthesis appears to be requirement for regeneration of the liver. When hepatic periarterial neurectomy plus partial hepatectomy was carried out, each lipid and lipoprotein fraction, except for FFA, showed a tendency to recovery earlier from the immediate postoperative decrease and did not show a late postoperative excessive increase. The decrease of alpha-lipoprotein in the immediate postoperative period was augmented and the time of the peak of concentration of pre-beta-lipoprotein was hastened. Therefore, hepatic periarterial neurectomy seems to act in such a manner so as to maintain the homeostasis in lipid metabolism after partial hepatectomy and to activate the regenerative property of the residual liver in the early postoperative period.

Hyperparathyroidism following the atomic bombing in Nagasaki.

Forty-three patients with hyperparathyroidism (HPT), including 20 atomic bomb survivors (46.5 per cent) were treated surgically in our institute during the last 19 years. The mean age of the patients at the time of atomic bomb exposure (AB*E) was 17.6 +/- 1.5 years. The mean latent interval between atomic bomb exposure and detection of HPT was 39.1 +/- 1.1 years. We compared the 20 AB*E patients with 23 patients who had a history of neither atomic bomb exposure nor therapeutic irradiation to the neck region (non-AB*E patients). It was determined that females were more prominently affected by HPT than males among AB*E patients. The parathyroid lesions in AB*E patients consisted of adenoma in 16 patients and hyperplasia in 4. A similar proportion of pathological lesions was also observed in non-AB*E patients. Thyroid lesions accompanied by HPT, however, were more often revealed in AB*E patients than in non-AB*E patients. The two most common lesions in AB*E patients were papillary carcinoma in 3 patients (15 per cent) and adenoma in 3 (15 per cent). These findings suggest that atomic bomb survivors may be at a greater risk of developing HPT with a high incidence of accompanying thyroid disease.

Successful preoperative preparation for thyroidectomy in Graves' disease using lithium alone: report of two cases.

To elucidate the effect of lithium carbonate in the preoperative preparation of patients with Graves' disease, it was given without any other antithyroid medication to two patients as an alternative to thionamide, which had caused adverse effects. The initial dose of lithium carbonate was 600 mg/day, and the final doses were 1200 and 900 mg/day, while the periods of administration were 67 and 27 days, respectively. The highest serum concentrations of lithium during the administration period were 0.83 and 0.43 mEq/l, respectively. This preoperative preparation lowered serum thyroid hormone levels and clinical improvement. A subtotal thyroidectomy was performed uneventfully in both patients, after which the serum lithium levels decreased rapidly and the thyroid hormone levels increased only slightly for a few days. No adverse effects of lithium carbonate were observed. Thus, we conclude that the administration of lithium carbonate alone is an effective and safe method for the preoperative management of Graves' disease when conventional antithyroid drugs show adverse effects.

Hashimoto's thyroiditis presenting with severe pressure symptoms--a case report.

A extremely rare case of Hashimoto's thyroiditis presenting with pressure symptoms is described herein. A 50 year old Japanese woman was referred to our department with swelling of the anterior neck, facial edema and recent heavy snoring. Oto-rhinolaryngological examinations revealed no movement of the bilateral vocal cords, severe laryngeal edema and diffuse edema of the tongue and pharynx. These findings had apparently been induced by compression of the bilateral recurrent nerves and internal jugular veins by an enlarged thyroid gland. The results of thyroid function and autoimmune tests were compatible with a diagnosis of Hashimoto's disease and thus, total thyroidectomy with a tracheostomy was performed uneventfully. The resected specimen weighed 168 grams and was confirmed histologically to be Hashimoto's disease. Following her operation, all the above symptoms disappeared and 4 months later, the patient is well and asymptomatic.

Gastroduodenal regulation of common duct bile flow in the dog.

We investigated the relationship between the entry of individual drops of bile into the duodenum and gastroduodenal motor activity in the fasted state in 10 conscious dogs. The common bile duct was transected and a catheter was inserted through each end. The exteriorized catheters were connected to a photometric drop-flow meter. During phase III activity, bile entered the duodenum in single drops, only in between two consecutive contractions, or as a series of drops during transient inhibition of duodenal contractions by antral phase III contractions. During phase II activity bile also entered the duodenum, usually in between contractions or when the duodenum was intermittently quiescent. Bile entered the duodenum during a duodenal contraction only when the contraction amplitude was less than 15% +/- 1% (mean +/- SE) of the maximal amplitude during phase III contractions. Bile flow into the duodenum showed a cyclic pattern with a peak during late duodenal phase II activity and a trough during duodenal phase I activity only when phase III activity originated in the duodenum and migrated caudad. There was no cyclic pattern of bile flow when phase III activity originated in the proximal jejunum and migrated caudad. The total volume of bile flow in a migrating motor complex cycle and bile flow rate were greater when phase III activity started in the proximal jejunum than when it started in the duodenum. We conclude that gastroduodenal contractions play an important role in the regulation of bile flow into the duodenum. The cyclic pattern of bile flow is altered when phase III activity starts ectopically in the jejunum.

Mucus-secreting presacral cyst--a case report.

A mucus-secreting presacral cyst was found in a 49-year-old woman who complained of dysuria. A routine rectal digital examination revealed a retrorectal mass. Diagnostic imaging demonstrated a large presacral cystic tumor. The cyst was removed through a transsacral approach. Histologically, the cyst membrane consisted of squamous and columnar mucus-secreting epithelium, and was diagnosed as a mucus-secreting presacral cyst.

Canine gallbladder cyclic motor activity.

We investigated whether the gallbladder has cyclic motor activity similar to that of the stomach, lower esophageal sphincter, and sphincter of Oddi in the fasted state. We found that the canine gallbladder infundibulum exhibited a cyclic burst of short duration (69 +/- 3 s) contractions that were closely associated with phase III activity of the antrum. The cyclic motor activity was sometimes less prominent or absent in the body and the fundus of the gallbladder. The mean period of gallbladder cyclic motor activity was not significantly different from the mean period of phase III activity in the stomach and the duodenum. The cyclic bursts of gallbladder contractions lasted for 21 +/- 2 min. The gallbladder cyclic motor activity started at about the same time as the antral phase III activity, and both of these activities started approximately 12 min earlier than the duodenal phase III activity. In addition to the aforementioned cyclic bursts of contractions, the gallbladder sometimes exhibited long duration (6.4 +/- 0.6 min) contractions that occurred irregularly and unpredictably during the duodenal migrating motor complex cycle. We conclude that during fasting the canine gallbladder has a cyclic motor activity that is temporally related to phase III activity of the stomach and the duodenum. The role of short duration phasic contractions during cyclic motor activity may be to periodically stir gallbladder contents, whereas the long duration contractions may partially empty the gallbladder in the fasted state.

Lithium carbonate in the preoperative preparation of Graves' disease.

Lithium carbonate was given in the preoperative preparation of 12 patients with Graves' disease, the reasons for its use being side effects of thionamide in 9 patients, insufficient control by thionamide in 1 and psychic symptoms in 2. Lithium carbonate was often used in combination with other drugs, namely; thionamide in 4 patients, beta-adrenergic blockades in 5, reserpine in 5 and glucocorticoid in 1. This preoperative control significantly decreased the mean serum T2 and T4 levels from 656 +/- 55 ng/dl to 180 +/- 16 ng/dl and from 25.9 +/- 2.1 micrograms/dl to 9.7 +/- 1.5 micrograms/dl, respectively. The only adverse effect of lithium carbonate was pollakisuria observed in one patient. All patients underwent subtotal thyroidectomy uneventfully. It is concluded that the administration of lithium carbonate alone or in combination with other drugs is an effective method of preoperatively controlling hyperthyroidism when conventional antithyroid drugs show adverse effects.

Lymph node metastasis within the pectoralis major muscle in breast cancer--a case report.

We report herein, a case of a 75 year old woman with breast cancer in whom lymph node metastasis within the pectoralis major muscle was found. The breast mass measured 10 X 6 cm, and its overlying skin was red and edematous, suggesting inflammatory carcinoma. An extended radical mastectomy was performed and the lesion was histologically confirmed to be solid-tubular carcinoma with regional lymph node involvement. In the pectoralis major muscle, where lymph nodes do not usually exist, one positive metastatic lymph node and another metastatic lymph node-like nodule were histopathologically confirmed. To our knowledge, no other such case has ever been reported, yet the possibility of lymph nodes existing in the pectoralis major muscle, albeit rare, should nevertheless be considered in the treatment of breast cancer.

Pleomorphic adenoma of the breast: report of a case.

We present herein the case of a 74-year-old woman found to have a pleomorphic adenoma, or so-called mixed tumor, of the breast. The patient presented with a hard mass, 3 cm in diameter, located just beneath the left areola. Physical examination suggested a diagnosis of breast carcinoma; however, the findings of both ultrasonography and mammography indicated a benign neoplasm. Aspiration biopsy cytology was evaluated as class III and the diagnosis of pleomorphic adenoma was finally confirmed by examination of an excisional biopsy specimen. As it is a rare benign tumor, pleomorphic adenoma of the breast has been mistaken for a malignant tumor clinically, mammographically, cytologically, and even by frozen section. Thus, an awareness of this disease in the breast will help to prevent misdiagnosis and overaggressive surgery.

A case of a rare anomaly of the common bile duct associated with an abnormal arrangement of the pancreaticobiliary ductal union.

A 39 year-old Japanese female patient with a duplication of the distal portion of the common bile duct is presented herein. Moreover, an abnormal arrangement of the pancreaticobiliary ductal union, congenital biliary dilatation and carcinoma of the gallbladder were all demonstrated by cholangiographic and endoscopical studies. The patient underwent radical surgery for advanced adenosquamous carcinoma of the gallbladder, and her postoperative course was satisfactory. A reflux of pancreatic juice into the bile duct was demonstrated, but it was eliminated and considered to be a contributory etiologic factor of the gallbladder carcinoma.

Intussusception of an appendiceal mucocele: report of a case.

A 66 year old Japanese female was admitted to our department for the examination and treatment of a mass in the cecum. She had experienced no symptoms or signs other than a positive test result for fecal occult blood. The mass in the cecum was confirmed by barium enema, colonofiberscopy and CT scanning. The presumptive diagnosis was a submucosal tumor of the cecum, however, a laparotomy subsequently revealed intussusception of an appendiceal mass. An ileocaecal resection with an ileocolic anastomosis was therefore performed and the mass was histologically diagnosed as a mucocele of the appendix. This patient is only the 24th case of intussusception of a mucocele of the appendix to be reported in Japan. A review of the available literature on this condition follows the case report.

Granular Cell Tumor of the Breast: A Case Report Describing Dynamic MR Mammography.

A case of granular cell tumor of the breast in a 36-year-old woman is reported. The patient presented with a hard mass,1.5 cm in diameter in the upper-outer quadrant of the left breast. Physical examination and ultrasonography suggested the presence of breast carcinoma. An aspiration biopsy cytology(ABC)specimen wasevaluated as class II, and dynamic magnetic resonance(MR)mammography indicated a benign tumor. Granular cell tumor was finally diagnosed on examination of an excisional biopsy specimen. Granular cell tumor of the breast can mimic breast carcinoma on physical examination, mammography, ultrasonography, and even gross inspection. Dynamic MR mammography has the potential distinguish this condition from carcinoma. Awareness of this disease and prudent use of diagnostic procedures, including MR mammography, will help prevent misdiagnosis and unnecessary surgery.