A metastatic jejunal tumor from squamous cell carcinoma of the lung found in an intestinal perforation.

An 85-year-old male with advanced squamous cell carcinoma of the lung, who was diagnosed about 10 years prior to his current presentation, suddenly complained of abdominal pain and underwent an abdominal computed tomography scan, which revealed free air and massive ascites. He was admitted to our hospital for acute peritonitis and emergency surgery was performed. During the surgical procedure, a perforation of the jejunum was diagnosed and repaired.

Limited pancreatectomy for metastatic pancreatic tumors from renal cell carcinoma.

Background/aims: Metastasis of renal cell carcinoma (RCC) to distant organs occurs commonly, even after radical nephrectomy, but metastatic lesions are rarely detected in the pancreas. The present study aim was to improve the postoperative quality of life of a patient with pancreatic metastasis of RCC through limited resection of the pancreas.

Methodology: Since therapeutic modalities including chemotherapy or radiation are ineffective for metastatic tumors, surgical intervention is a treatment of choice in selected patients.

Inflammatory Polyp of the Gallbladder Mimicking Early Polypoid Carcinoma.

We treated a 69-year-old male with a 16-mm polyp of the gallbladder. Enhanced computed tomography demonstrated marked enhancement. With a tentative diagnosis of early polypoid cancer of the gallbladder, open cholecystectomy was performed.

Surgical management for stenosis of the pancreaticojejunostomy.

The management of the stenosis of the pancreaticojejunostomy is dictated by the state of the anastomosis and the residual pancreas, endocrine, and exocrine pancreatic function. We report a case of a 23-year-old woman who presented with recurrent attacks of acute pancreatitis. Four years ago, she was diagnosed with pancreatic injury with a transection of the body of the pancreas.

Inflammatory cytokines promote inducible nitric oxide synthase-mediated DNA damage in hamster gallbladder epithelial cells.

Aim: To investigate the link between chronic biliary inflammation and carcinogenesis using hamster gallbladder epithelial cells.

Methods: Gallbladder epithelial cells were isolated from hamsters and cultured with a mixture of inflammatory cytokines including interleukin-1beta, interferon-gamma, and tumor necrosis factor-alpha. Inducible nitric oxide synthase (iNOS) expression, nitric oxide (NO) generation, and DNA damage were evaluated.

Glomus tumor of the omentum: a case report.

Computed tomography revealed a well-enhanced omental mass. Magnetic resonance imaging demonstrated a mass with low signal intensity on T1-weighted images (WI) and high signal intensity on T2-WI. Resected specimens immunohistochemically showed positive results for alpha-smooth muscle actin, muscle-specific actin (HHF35) and vimentin, and negative results for S-100 protein, CD34, desmin, EMA, keratin, calretinin, HBME1, and c-kit.

Situs ambiguous with gastric cancer: report of a case.

Situs ambiguous is an unpredictable anomaly characterized by disorder of the organ arrangement in the chest and abdomen. We report a case of situs ambiguous found incidentally in a 73-year-old man with gastric cancer. Preoperative imaging showed polysplenia, a bridging liver, a midline gall bladder, and pancreatic divisum.

Gastric wall-covering method for the prevention of pancreatic fistula after pancreatic resection.

A pancreatic fistula is one of the most frequent complications and is still responsible for most mortality after pancreatic surgery. We propose a gastric wall-covering method, a new and novel surgical technique in pancreatic surgery for the prevention of pancreatic fistula, in which the pancreatic cutting surface is covered completely with the gastric wall. Ten patients underwent our new surgical technique, gastric wall-covering method, in 7 patients with distal pancreatectomy and in 3 with partial resection of the head of the pancreas.

Gastric wall-covering method for the prevention of pancreatic fistula after hand-assisted laparoscopic distal pancreatectomy for pancreatic tumor.

Laparoscopic pancreatic surgery has been a common surgical procedure for pancreatic tumors. However, the rate of the pancreatic fistula after laparoscopic pancreatic surgery is still high. Recently, we have reported a gastric wall-covering method, a new and novel surgical technique in pancreatic surgery for the prevention of pancreatic fistula, in which the pancreatic cutting surface is covered completely with the gastric wall.

Solitary recurrence of hilar cholangiocarcinoma in a mediastinal lymph node two years after curative resection.

We recently encountered an unusual case of hilar cholangiocarcinoma in which a solitary recurrence in a mediastinal lymph node occurred two years after curative resection of the primary tumor. A 64-year old woman was admitted to our hospital with a complaint of right hypochondrial discomfort. After imaging studies demonstrated a hilar cholangiocarcinoma in the left hepatic duct, a curative resection of the tumor was performed, consisting of a left hepatic lobectomy along with caudate lobectomy, regional lymph node dissection, and resection of the extrahepatic bile duct.

Pancreatic carcinoma coexisting with chronic pancreatitis versus tumor-forming pancreatitis: diagnostic utility of the time-signal intensity curve from dynamic contrast-enhanced MR imaging.

Aim: To evaluate the ability of the time-signal intensity curve (TIC) of the pancreas obtained from dynamic contrast-enhanced magnetic resonance imaging (MRI) for differentiation of focal pancreatic masses, especially pancreatic carcinoma coexisting with chronic pancreatitis and tumor-forming pancreatitis.

Methods: Forty-eight consecutive patients who underwent surgery for a focal pancreatic mass, including pancreatic ductal carcinoma (n=33), tumor-forming pancreatitis (n=8), and islet cell tumor (n=7), were reviewed. Five pancreatic carcinomas coexisted with longstanding chronic pancreatitis.

Extrahepatic collaterals and liver damage in embolotherapy for ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery.

Aim: To evaluate the effects of extrahepatic collaterals to the liver on liver damage and patient outcome after embolotherapy for the ruptured hepatic artery pseudoaneurysm following hepatobiliary pancreatic surgery.

Methods: We reviewed 9 patients who underwent transcatheter arterial embolization (TAE) for the ruptured hepatic artery pseudoaneurysm following major hepatobiliary pancreatic surgery between June 1992 and April 2006. We paid special attention to the extrahepatic arterial collaterals to the liver which may affect post-TAE liver damage and patient outcome.

Endoscopic naso-pancreatic stent-guided single-branch resection of the pancreas for multiple intraductal papillary mucinous adenomas.

In benign or low-grade malignant pancreatic tumors, complete removal of the lesion is sufficient for a cure, and thus minimal resection techniques with preservation of the pancreatic functional reserve have advantages over more extended pancreatic resections. However, a high incidence of postoperative pancreatic fistula in such procedures has been reported. Moreover, branch-type intraductal papillary mucinous neoplasms of the pancreas tend to locate in the head of the pancreas, and show less malignant potential.

Evaluation and management of thoracopancreatic fistula.

Background: Thoracopancreatic fistula is a rare clinical entity but a serious complication of inflammatory pancreatic diseases, caused by a disruption of the pancreatic ductal system. Its diagnosis is frequently misleading, however, and thus is often delayed.

Methods: Seven patients with thoracopancreatic fistula who presented at our department between March 2002 and July 2005 were investigated, focusing on the diagnostic work-up as well as the treatment strategies, the response to therapy, and the outcome.

Mucosa-associated lymphoid tissue lymphoma of the transverse colon: a case report.

We herein present a case of a 75-year-old female with mucosa-associated lymphoid tissue (MALT) lymphoma of the transverse colon with the stage IE (Ann Arbor classification). Colonoscopy revealed the tumor's appearance as a IIa plus II c-like early colon cancer as defined according to the macroscopic classification of the Japanese Research Society for Cancer of Colon, Rectum and Anus, measuring less than 2 cm in diameter. Histologically, the tumor was diagnosed as MALT lymphoma because of the presence of lymphoepithelial lesions consisting of diffuse proliferation of atypical lymphocytes and glandular destruction.

Methyl-introduced A-ring analogues of 1alpha,25-dihydroxyvitamin D3: synthesis and biological evaluation.

The hormonally-active metabolite of vitamin D, 1alpha,25-dihydroxyvitamin D3 (1), has a wide variety of biological activities, which makes it a promising therapeutic agent for the treatment of cancer, psoriasis and osteoporosis. Insights into the structure-activity relationships of the A-ring of 1 are needed to assist the development of more potent and selective analogues, as well as to define the molecular mode of action. All possible A-ring stereoisomers of 2-methyl-1,25-dihydroxyvitamin D3 and 2,2-dimethyl-1,25-dihydroxyvitamin D3, which differ in stereochemistry at the C1-, C2- and C3-positions, were designed and efficiently synthesized by employing the convergent method.

Acute suppuration of the pancreatic duct associated with pancreatic ductal obstruction due to pancreas carcinoma.

Acute obstructive suppurative cholangitis is a well-known clinical entity; however, acute suppuration of the pancreatic duct in the setting of pancreatic ductal obstruction is an uncommon pancreatic disorder. We report a case of acute suppuration of the pancreatic duct without either a concomitant pancreatic abscess or an infected pseudocyst, presenting as acute relapsing pancreatitis. In this case, the underlying cause of suppuration of the pancreatic duct was pancreatic ductal obstruction and chronic pancreatitis secondary to pancreas head carcinoma along with infection of Escherichia coli.

Bile-reflux into the pancreatic ducts is associated with the development of intraductal papillary carcinoma in hamsters.

Background: Reflux of pancreatic juice into the biliary tract is a well-known risk factor for the development of biliary carcinoma. In this study, we investigated the significance of bile-reflux into the pancreatic ducts in pancreatic carcinogenesis, especially in the development of carcinoma in the main pancreatic duct in hamsters.

Materials And Methods: Syrian hamsters were subjected to three different surgical procedures: cholecystoduodenostomy with dissection of the extrahepatic bile duct on the distal end of the common duct (Model A); cholecystoduodenostomy along with a dissection of the common bile duct (Model B); or simple laparotomy (Model C).

Intraoperative pancreatography and gastric-wall-covering method for the prevention of pancreatic leakage after enucleation of insulinoma in the pancreas.

Pancreatic leakage is one of the most common complications following pancreatic surgery. Although several surgical techniques and several devices for the management of pancreatic ducts have been advocated to prevent pancreatic leakage, its incidence is still not acceptable. We report our new surgical technique, a gastric-wall-covering method, for the prevention of pancreatic leakage in the enucleation of insulinoma in the pancreas, along with intraoperative pancreatography for navigation surgery of the pancreatic duct.

Inferior branch-preserving superior head resection of the pancreas with gastric wall-covering method for intraductal papillary mucinous adenoma.

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas showed significantly less aggressive pathologic features compared with common pancreatic cancer. Therefore, several organ-preserving techniques, including duodenum-preserving pancreatic head resection, have been advocated in surgical procedures for IPMN. We describe a surgical technique of superior head resection of the pancreas with inferior branch preservation followed by a gastric wall-covering method for the prevention of pancreatic leakage in patients with IPMN of the pancreas head.

Demonstration of a biliobronchial fistula with a hepatoiminodiacetic acid scan.

Biliobronchial fistula (BBF) is a rare complication after hepatic resection. A 68-year-old woman who had undergone a right hepatic trisegmentectomy followed by a hepaticojejunostomy with a Roux-en-Y anastomosis for gallbladder cancer and liver metastasis from colon cancer was admitted to our hospital for further investigation of persistent bilioptysis. We could not detect the cause of the bilioptysis on computed tomography or magnetic resonance cholangiopancreatography, but a hepatoiminodiacetic scan clearly showed the BBF.

Risk factors for pancreatic anastomotic leakage: the significance of preoperative dynamic magnetic resonance imaging of the pancreas as a predictor of leakage.

Background: The histologic degree of pancreatic fibrosis can be assessed preoperatively by using the time-signal intensity curve (TIC) of the pancreas obtained from dynamic magnetic resonance imaging.

Study Design: To identify risk factors for postoperative pancreatic anastomotic leakage and to assess the impact of pancreatic TIC on this complication, 89 patients who underwent a pancreatic head resection with an end-to-side pancreaticojejunostomy between December 1998 and August 2005 were retrospectively reviewed. The pancreatic TIC profiles were classified into 3 types: type I, indicating a normal pancreas without fibrosis; and types II and III indicating fibrotic pancreas.

[A case of recurrent mediastinal pancreatic pseudocyst].

A 46-year-old man complaining right lateroabdominal pain and dysphagia was admitted our hospital. The CT examination revealed the low density area spreading through the mediastinum. The patient's condition improved with fast and antibiotics.