Perineal laceration treated with negative pressure wound therapy following colostomy.

A male in his early 30s was transported to the emergency room after being hit by a vehicle while inebriated and lying in the street. His general condition was stable; however, he had a perineal laceration that extended to the coccyx. Due to the proximity of the wound margin to the anus, we were concerned regarding the potential contamination and opted not to suture it. Therefore, we refrained from suturing the wound and kept the wound open after irrigation and debridement. Additionally, we performed a transverse colostomy. On day 4, we initiated negative pressure wound therapy for 40 days, during which sufficient wound granulation occurred. The patient was discharged, and the colostomy was closed approximately 4 months after the injury. Our case illustrates the effectiveness of negative pressure wound therapy in managing perineal lacerations.

[A Case of Resected Lymph Node Recurrence of Cancer of the Papilla of Vater].

We report the successful resection of lymph node recurrence of cancer of the papilla of Vater after pancreatoduodenectomy (PD). A 67-year-old man had undergone PD for adenocarcinoma of the papilla of Vater, and histopathological examination revealed well differentiated papillotubular adenocarcinoma, ly1, v0, T1, n (0), pStage ⅠB. One year after surgery, abdominal computed tomography revealed a mass at the left side of the residual inferior pancreaticoduodenal artery (IPDA). We resected the mass, which was diagnosed as lymph node recurrence of cancer of the papilla of Vater. The patient remains alive without any evidence of recurrence 5 years since the second operation. We suggest that complete resection of lymph node surrounding the IPDA is an important surgical procedure for cancer of the papilla of Vater. There still is only limited experience with resection for recurrence of cancer of the papilla of Vater, but our case shows that it may provide for long-term survival from recurrence of cancer of the papilla of Vater.

A device for ensuring the neochordae replacement in mitral valve repair.

We have developed a new device for maintaining artificial chordae at the appropriate length during the tying of Gore-Tex sutures (W. L. Gore and Assoc, Flagstaff, AZ). This double-armed, double-hooked device is inserted through the loop formed by the neochordae, which is anchored in the papillary muscle and passed through the prolapsing segment. The device pulls up both leaflets and maintains the neochordae at the same length as that of the opposing normal chordae. The prolapsed leaflet is suspended at the same height as the facing leaflet, enabling the accurate and reproducible placement of neochordae.

[A case of liver metastatic recurrence of bile duct cancer completely responding to single-drug S-1 chemotherapy].

A 65-year-old man with common bile duct cancer was treated by pylorus-preserving pancreaticoduodenectomy with D2 lymph node dissection. Three months after surgery, tumor marker was increasing, and CT demonstrated multiple liver metastatic tumors. Single drug chemotherapy with S-1(100 mg/body/day)was administered. After 6 months, the liver metastatic tumors could not be visualized by CT. S-1 may be the chemotherapy of choice for recurrence of bile duct cancer.