Hiromu Tsuge

A Case of Crohn's Disease of the Appendix.

Yasuyuki Nonaka, Hiromu Tsuge, Masahito Yumura

虫垂Crohn病はきわめてまれで, 本邦では14例が報告されているにすぎない. 今回, われわれは虫垂Crohn病の1例を経験したので報告する. 症例は42歳の男性. 腹痛を主訴に来院. 右下腹部に強い圧痛と筋性防御, Blumberg徴候を認め, 急性虫垂炎の診断にて緊急手術を行った. 虫垂は炎症性に著しく腫大しており, 後腹膜に癒着し大網に被われていた. 盲腸および終末回腸には異常はみられず, 虫垂切除術を施行した. 切除標本では, 虫垂壁は著しく肥厚しており, 粘膜面は顆粒状を呈していた. 病理組織学的には全層にわたりリンパ球集簇巣と非乾酪性類上皮細胞肉芽腫を認め, 虫垂Crohn病と診断された. 術後内視鏡検査にて虫垂開口部周囲盲腸粘膜に結節状隆起病変の集簇が認められた. 同部の生検ではCrohn病を示唆する所見はみられなかった. 術後6か月現在, 慎重に経過観察中である.

A Case of Free Perforation of the Ileum in Crohn's Disease.

Yasuyuki Nonaka, Hiromu Tsuge, Masahito Yumura

症例は23歳,男性.激しい腹痛を主訴に来院.右中下腹部に筋性防御を伴う圧痛を認め,急性虫垂炎による腹膜炎の診断にて緊急手術を行った.虫垂はほぼ正常.癒着し狭窄を伴った終末回腸と,これに続く口側回腸の拡張あり,拡張腸管の腸間膜側には穿孔を認めた.穿孔部を含め回盲部より約1mの回腸を回盲部とともに切除し,一期的吻合再建を行った.切除標本では,終末回腸に縦走潰瘍と痩孔形成がみられ,回盲部より約50cmの潰瘍内に穿孔部が認められた.組織学的にはリンパ球浸潤と非乾酪性類上皮細胞肉芽腫を認め, Crohn病と診断された.穿孔原因として,遠位腸管の癒着・狭窄による腸管内圧の上昇と潰瘍性病変の急性増悪が考えられた. Crohn病は穿孔による腹膜炎で急性発症する例も少なからず認められるため,穿孔性腹膜炎の鑑別疾患の一つとして考慮すべきと考えられた.

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A case report of triple cancer of the esophagus, stomach, and rectum.

Yasuyuki Nonaka, Hiromu Tsuge, Masahito Yumura

今回,われわれは稀な食道・胃・直腸3重複癌の1例を経験した.症例は55歳,男性.腹痛と下痢を主訴に来院.大腸内視鏡検査にて上部直腸に全周性高度狭窄を伴う進行癌を認めた.また術前に上部消化管内視鏡検査を行ったところ,胃体上部にIIc型早期癌を認めたため,低位前方切除術に続いて噴門側胃切除術を行った.直腸癌術後1年5カ月の上部消化管内視鏡検査にて胸部食道に0-IIc型食道癌を認め,粘膜切除術を施行した.その組織学的深達度はsm2であったため根治手術を薦めたが,手術同意を得られず,放射線療法を追加施行した.粘膜切除術後9カ月現在再発の徴候はみられず,外来にて慎重に経過観察中である.

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Vacuolar Hepatocyte Degeneration Induced by Infusion of 20% Glucose Solution with Insulin after Hepatopancreatectomy in Rats

Noriyuki Kawata, Hiromu Tsuge, Akira Gouchi, R Nakagou et autres

To investigate the causes of hepatic dysfunction after extensive resection of the liver together with pancreatectomy, rats were subjected to sham operation, to 68% hepatectomy alone, to 90% pancreatectomy alone, or to 68% hepatectomy combined with 90% pancreatectomy (hepatopancreatectomy). Solutions of 5% …

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Hyperammonemia induced by administration of glucose and insulin after hepatopancreatectomy in rats.

Mutsuo Harano, Hiromu Tsuge, NOBUKO KAWADA, N Ryozo et autres

Massive resection of both the liver and pancreas is performed as a radical procedure in some cases of advanced biliary cancer, but it has been reported that this disease is frequently complicated by hyperbilirubinemia or hepatic insufficiency postoperatively, which is a serious …

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Nitric Oxide Mediates Cerulein-Induced Relaxation of Canine Sphincter of Oddi

Yasuo Shima, Masanobu Mori, Masao Harano, Hiromu Tsuge et autres

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A case of living related liver transplantation for an adult recipient with primary biliary cirrhosis

Takahito Yagi, Naoto Urushihara, Masahiro Oishi, Hiroyoshi Matsukawa et autres

A 49-year-old female received a living related liver transplantation from her son. She had a 13-years history of primary biliary cirrhosis (PBC). The preoperative 1-year survival rate and mortality after 6 months were calculated to be 6.5% and 99.3%, respectively. The graft …

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The Long-Term Survival of Patients with Ductal Carcinoma of the Pancreatic Head and Body

Hisashi MIMURA, Masanobu Mori, Takuji Mimura, Keisuke Hamazaki et autres

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Interruption of hepatic arterial blood flow after resection of pancreaticobiliary carcinoma.

Hiromu Tsuge, HIROAKI MIMURA, Kei Hamazaki, Masaya Mori et autres

BACKGROUND/AIMS: We reviewed 17 cases of patients with interrupted hepatic arterial blood flow to determine the effect of such an interruption. MATERIALS AND METHODS: In 17 patients undergoing radical resection of pancreaticobiliary carcinoma with simultaneous hepatic artery excision (n=15) or intraoperative hepatic …

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Laparoscopic cholecystectomy: a multicenter study of 17 hospitals.

Hiromu Tsuge, K Orita, Kei Hamazaki, Masatomo Mori et autres

A study of 1,254 laparoscopic cholecystectomies performed at 17 hospitals affiliated with the Liver, Gallbladder, and Pancreas Research Group of the First Department of Surgery at Okayama University was undertaken to assess the current status and safety of this procedure. The data …

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Right portal embolization before extended right hepatectomy using laparoscopic catheterization of the ileocolic vein: a prospective study.

Hiromu Tsuge, HIROAKI MIMURA, Noboru Kawata, Kunzou ORITA

Preoperative embolization of the right portal vein branch before extended right hepatectomy for hepatocellular carcinoma or hilar cholangiocarcinoma has been recommended for the prevention of postoperative liver failure. Percutaneous transhepatic insertion into the intrahepatic portal vein and insertion into the ileocolic vein …

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Effects of Gastrectomy on Motility, Perfusion Pressure, and Caerulein-Induced Relaxation of Sphincter of Oddi in Dogs.

Takakazu Kobayashi, Toshio HOSOBA, Masataka Mori, HIROAKI MIMURA et autres

The effects of subtotal-gastrectomy (gastrectomy) on the spontaneous motility and caerulein-induced relaxation of the sphincter of Oddi (SO) were investigated in the dog. The spontaneous motility and the response to caerulein of the SO were recorded using perfusion method. The basal perfusion …

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