Treatment of a giant inguinal hernia using transabdominal pre-peritoneal repair.

We present the case of a male Japanese patient with a giant inguinal hernia that extended to his knees while standing. A transabdominal pre-peritoneal (TAPP) repair was performed under general anesthesia. Complete reduction of the contents of the hernia was achieved within 2 h 50 min.

Ultrasonographic findings and the clinical results of treatment for lymphedema.

We undertook this study using ultrasonography to examine structural changes occurring in the subcutaneous tissue with lymphedema. Ultrasonographic images were taken in 178 outpatients and 29 inpatients, with the images of the subcutis fluid accumulation, which was categorized into three types ( grade 0: absent, grade 1: a minimal amount of water, grade 2: stone-paved image due to excess water). Initial percentage of excess volume was correlated with the tissue fluid (grade 0: 7.

Effect of gaiters on muscle pump activity in healthy volunteers.

Objectives: Exercise of the leg with external limb compression has been reported to be useful for preventing and reducing leg oedema. The aim of this study was to investigate the effects of leg gaiters on calf muscle pump activity.

Methods: Continuous measurements of the interface pressure at the leg during exercise and determination of the femoral venous velocity at the groin during exercise were carried out in healthy volunteers with elastic stockings alone, leg gaiters alone and gaiters over the elastic stockings.

Laparoscopic cholecystectomy in patients with a previous history of gastrectomy.

Background/aims: Laparoscopic cholecystectomy (LC) in patients with a previous history of upper abdominal surgery is a difficult procedure with a high conversion rate.

Methodology: Forty-two patients with a previous history of gastrectomy (gastrectomy group) were compared to patients without previous abdominal surgery (no surgery group, n=1375). Patients in the gastrectomy group were divided into two groups for comparison: first, an umbilicus-group (n=12, at the umbilicus) and a side-group (n=23, right of the umbilicus) by the location of the primary port insertion, second, a benign group (n=31) and a malignant group (n=11).

Development of separated elastic stockings.

Objectives: To investigate the acceptability of newly developed separated elastic stockings, which are divided into two portions at the ankle.

Methods: The difficulty in putting on and taking off stockings was compared between the original or modified separated stockings with various techniques in order to reduce the shift of the stockings and current non-separated stockings in healthy volunteers and patients with lymphoedema by applying both stockings alternately. In the modified model, the shift during daily activities was measured in healthy volunteers and patients with lymphoedema.

Interface pressure and stiffness in different combinations of compression material.

Objectives: To compare the interface pressure and stiffness between various combinations of compression material.

Methods: Using a stiffness-determining device, the interface pressure and stiffness were determined in several combinations of five elastic stockings and two elastic bandages.

Results: In the double stockings system, the interface pressure increased significantly and the highest stiffness was observed in double short-stretch stockings.

Development of a device to determine the stiffness of elastic garments and bandages.

Objective: To evaluate the reliability of a newly developed stiffness-determining device, composed of a leg mannequin and air-pack type analyser, for measuring the interface pressure.

Method: The correlation of stiffness values obtained employing the Hohenstein method and this new method was investigated using 17 different brands of medical elastic compression stocking.

Results: A significant correlation in stiffness values using the two methods was obtained (P < 0.

Improvement of a three-dimensional measurement system for the evaluation of foot edema.

Background/aims: This study investigated the accuracy and usefulness of a newly improved three-dimensional measurement system for measuring the volume and circumference at the foot as well as at the calf and ankle.

Methods: Regarding the newly improved device, halogen light was projected from four directions instead of the conventional two directions. The circumference and volume were measured in the morning and evening with and without elastic stockings in 23 healthy subjects.

Comparison of stiffness and interface pressure during rest and exercise among various arm sleeves.

Objectives: To compare the interface pressure during rest and exercise among various kinds of arm sleeves.

Methods: The interface pressure underneath nine different arm sleeves was measured during 10 maximal opening and closing movements of fingers using a pressure transducer (Air Pack Type Analyser) in 16 healthy volunteers. Furthermore, in order to evaluate the characteristics of each arm sleeve, the extensibility, stiffness and thickness were determined in vitro by several apparatuses.

A comparison of interface pressure and stiffness between elastic stockings and bandages.

Objectives: To compare the interface pressure during posture changes and exercise between elastic stockings and bandages.

Methods: Using a pressure transducer (air pack-type analyzer), the interface pressures associated with three different elastic stockings and three different elastic bandages were measured during supine resting, standing and exercise in 15 healthy volunteers.

Results: Short-stretch bandages showed a significantly higher static stiffness index value, which is defined as the pressure difference between lying and standing, than long-stretch bandages and short-stretch stockings (P < 0.

Unsuspected gallbladder carcinoma after laparoscopic cholecystectomy.

Background/purpose: Many cases have been reported of disastrous port-site recurrence after laparoscopic cholecystectomy (LC) revealed unsuspected gallbladder carcinoma (GBC). Some investigators have reported that the prognosis of patients after LC showed unsuspected GBC is not worsened by laparoscopic procedures. We retrospectively reviewed our cases and the literature to reconfirm the intrinsic risks of LC for unsuspected GBC.

Surgical treatment for colorectal liver metastases involving the paracaval portion of the caudate lobe.

Background: Hepatic neoplasms in the paracaval portion of the caudate lobe (S1r) are usually difficult to treat surgically because such neoplasms often invade the hepatic veins and/or inferior vena cava (IVC). We reevaluated resected cases of colorectal liver metastases involving S1r to confirm the significance of aggressive surgical treatments.

Methods: Between July 1977 and December 2002, 95 consecutive patients with colorectal liver metastases underwent hepatic resection.

Biliary stricture with hepatolithiasis as a late complication of retrograde transhepatic biliary drainage.

A 63-year-old man was admitted to a community hospital complaining of fever and epigastric pain. He had undergone cholecystectomy and choledocholithotomy with retrograde transhepatic biliary drainage 7 years previously. Referred to our hospital after demonstration of hepatolithiasis by computed tomography, he underwent further imaging that showed a dilated left lateral anterior segmental bile duct (B3) with hepatolithiasis.

Advanced gallbladder carcinoma with biliobiliary fistula, resected by hepatopancreatoduodenectomy, in an aged patient.

We report a 78-year-old man with a gallbladder carcinoma and biliobiliary fistula, diagnosed by percutaneous transhepatic cholangioscopic biopsy through the fistula. The impacted stones in the common hepatic duct were crushed, and then selective cholangiography under percutaneous transhepatic cholangioscopy (PTCS) revealed a biliobiliary fistula. Cholangioscopic biopsy tissues taken from the gallbladder revealed adenocarcinoma, but biopsies taken from the fistula revealed no evidence of malignancy.

Resection of a hilar cholangiocarcinoma in a patient with absent portal bifurcation.

Absence of the bifurcation of the portal vein is an extremely rare anomaly and the misled ligation of the portal vein would result in the lethal hepatic failure. In this paper, a resected case of hilar cholangiocarcinoma with this anomalous portal venous system is first presented. Preoperative percutaneous transhepatic portography disclosed an absence of portal bifurcation and a transversely running portal vessel from the right anterior segment to the left lateral segment.

Percutaneous transheptic cholangioscopic ethanol injection for intrabiliary tumor thrombi due to hepatocellular carcinoma.

Interventional treatments such as transcatheter arterial embolization and placement of a biliary endoprosthesis have been carried out in cases of inoperable hepatobiliary malignancy. We report here a case of recurrent intrabiliary tumor thrombi due to hepatocellular carcinoma, successfully treated by cholangioscopic ethanol injection in which the intrabiliary tumor thrombi were completely eliminated.

Mucosal bile duct carcinoma with superficial spread.

We describe a case of mucosal bile duct carcinoma with superficial spread in a 69-year-old man with gallstone pancreatitis. The patient was seen at the hospital because of abdominal pain, fever, and jaundice. Endoscopic retrograde cholangiography (ERC) demonstrated a protruding lesion in the lower third of the common bile duct (CBD) showing wall irregularity suggestive of malignancy.

Right hepatic lobectomy and subsegmental resection of the left caudate lobe for gallbladder carcinoma involving the hepatic hilus: preservation of the ventral portion of the left caudate lobe.

A case of gallbladder carcinoma in a 75-year-old woman with familial hyperbilirubinemia and preoperative hepatic dysfunction is presented. Tube cholangiography through a percutaneous transhepatic biliary drainage (PTBD) catheter demonstrated a stricture and the hepatic confluence without filling of the gallbladder and showed two bile duct branches arising from the left caudate lobe. Cholangiography also disclosed that the left dorsal branch, which joined the right hepatic bile duct, was involved with tumor, while the left ventral branch, which joined the left hepatic duct, was not.

A case of intrahepatic stones with an anomalous intrahepatic portal venous system.

A 64-year-old woman who had undergone surgery for gallstones twice was admitted with epigastric pain and fever. Ultrasonography revealed gallstones in the dilated left lateral intrahepatic bile ducts. Abdominal computed tomography disclosed atrophy of the left lateral segment and the right lobe of the liver, and hypertrophy of the left medial segment and the caudate lobe.

Congenital absence of portal venous system associated with a large inferior mesenteric-caval shunt: a case report.

We encountered a 30-year-old man with congenital absence of the portal venous system associated with a large inferior mesenteric-caval shunt via the internal iliac veins, which was revealed by angiography and liver biopsy. He had experienced refractory hemorrhoidal bleeding and occasional dyspneic attacks, but no episode of portal encephalopathy. The serum ammonia level in peripheral blood was within normal limits, which suggests the presence of a homeostatic control mechanism.

Right anterior hepatic artery arising from the superior mesenteric artery: a case report.

An unusual case of right anterior hepatic artery arising from the superior mesenteric artery is presented in a patient with hepatocellular carcinoma. This variation was demonstrated by angiography and computed tomography after transcatheter arterial embolization (TAE). It has not previously been identified in the medical literature.

Percutaneous transhepatic biliary drainage in patients with malignant biliary obstruction of the hepatic confluence.

Despite many studies on percutaneous transhepatic biliary drainage (PTBD), there are no satisfactory reports of PTBD for malignant obstruction of the hepatic confluence. In this study, the results of PTBD using the direct anterior approach under fluoroscopic guidance are described in 16 patients with malignant biliary obstruction of the hepatic confluence. A total of forty-two drainage catheters were placed in the 16 patients: one catheter was placed in three patients; two catheters in six; three catheters in four; four catheters in two; seven catheters in one.

Interventional embolization with fibrin glue for a large inferior mesenteric-caval shunt.

We report an unusual case of a large inferior mesenteric-caval shunt in a 25-year-old man without cirrhosis with hypoproteinemia and hypochromic anemia. In this large shunt the direct communication was between the inferior mesenteric vein and the internal iliac vein. Hemodynamic change as a result of the shunt was thought to cause his present clinical problems and future portosystemic encephalopathy.