Mucinous cystadenocarcinoma of the retroperitoneum: report of a case.

Retroperitoneal mucinous cystadenocarcinomas are extremely rare. A 40-year-old Japanese woman was found to have a retroperitoneal mucinous cystadenocarcinoma of ovarian type. Both ovaries were normal. Concentrations of carcinoembryonic antigen and carbohydrate antigen 19-9 in the cyst fluid were extremely high (810,000 ng/ml and 8,082,000 IU/l, respectively). The tumor varied from benign to borderline and malignant in microscopic appearance, and the lesion was composed of mesothelium-like cells. The histologic and immunohistochemical findings suggested that the tumor developed from mucinous metaplasia of the coelomic mesothelium.

Colorectal carcinoma liver metastases: clinical significance of preoperative measurement of serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels.

The clinical significance of preoperative levels of serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9) was evaluated in patients with colorectal carcinoma liver metastases. Preoperative serum CEA and CA 19-9 levels, the number and size of liver metastases, and survival data were analyzed retrospectively in 73 patients. Using the cutoff level of 5 ng/ml for CEA and 37 U/ml for CA 19-9, the positivity of these for detecting metastatic deposits were 81% and 56%, respectively. CEA level was correlated with the number (P = 0.0081) and size (P = 0.013) of liver metastases among patients with positive CEA level, while CA 19-9 level was correlated only with the number of liver metastases (P = 0.0072) among those with positive CA 19-9 level. In the overall series, preoperative CEA and CA 19-9 levels were correlated significantly with survival only at higher cutoff levels. In 46 patients undergoing curative hepatectomy, however, these levels were not correlated with survival, even at higher cutoff levels. In conclusion, the CEA level is closely associated with the extent of liver metastases, while the CA 19-9 level may reflect multiplicity of hepatic deposits. Preoperative measurement of serum CEA and CA 19-9 levels appears to be of some prognostic value.

Orally administered ginseng extract reduces serum total cholesterol and triglycerides that induce fatty liver in 66% hepatectomized rats.

The effects of ginseng extract (from the root of Panax ginseng) on factors inducing fatty liver were examined in 66% hepatectomized rats. Oral administration of ginseng extract at 125 or 250 mg/kg/day produced statistically significant reductions in total cholesterol and triglyceride concentrations in the blood 3 days after hepatectomy (P<0.05); the total cholesterol response appeared to be dose-related. Administration of ginseng extract at both doses also reduced total cholesterol and triglyceride concentrations in the liver 3 days after hepatectomy. Food intake and serum chemistry parameters indicating liver and kidney function were unchanged after ginseng administration except for the lipid metabolic parameters. These observations suggest that orally administered ginseng extract can suppress the formation of fatty liver after hepatic resection.

Gallbladder cancer with intratumoral anechoic foci: a mimic of adenomyomatosis.

We report a case of advanced gallbladder cancer in a 58-year-old man. On ultrasonography, there were anechoic foci within the tumor. Although anechoic foci within a thickened gallbladder wall usually represent intramural diverticula (dilated Rokitansky-Aschoff sinuses) of adenomyomatosis, cystically dilated cancerous glands were the etiology of these foci in this case. Thus, gallbladder cancer may also have anechoic foci within the tumor.

Ischemic biliary stricture due to lymph node dissection in the hepatoduodenal ligament.

We report on 2 cases of ischemic biliary stricture after radical lymphadenectomy in the hepatoduodenal ligament with skeletonization of the extrahepatic bile ducts for malignant diseases. In both cases, histologic examination of the subsequently resected biliary strictures revealed evidence of ischemia. Skeletonization of the bile ducts may result in ischemia and stricture formation. In patients who require thorough dissection of the hepatoduodenal lymph nodes, bile duct resection should be considered.

Intraluminal duodenal diverticulum with malposition of the ampulla of Vater.

Intraluminal duodenal diverticulum is a rare congenital anomaly, sometimes associated with malposition of the ampulla of Vater. When the diverticulum is excised, the position of the ampulla should be determined carefully to avoid injury to pancreaticobiliary ducts. We report two patients with symptomatic intraluminal duodenal diverticulum and malposition of the ampulla. The ampulla was located on the rim of the diverticulum in one patient; in the others, the ampullary site was the posterior wall of the duodenum. Both patients underwent successful excision of the diverticulum without ductal injuries. As we have been unable to find any case with an ampullary location on the anterior wall of the duodenum, anterior duodenotomy followed by identification of the ampulla must precede excision of the diverticulum in order to avoid pancreaticobiliary ductal injuries.

Indocyanine green disappearance enhanced by prostaglandin E1 in patients with hepatic resection.

Indocyanine green (ICG) is a reliable indicator reflecting hepatocyte function and hepatic blood flow. Prostaglandin E1 (PGE) has been indicated to increase hepatic blood flow and protect the hepatocyte. The purpose of this study is to investigate whether PGE influences the ICG disappearance rate in patients with hepatic resection. Eleven patients with hepatic resection were divided into two groups according to the presence of liver cirrhosis (LC, n = 4) and chronic hepatitis (CH, n = 7). ICG 0.1 mg/kg was given as an intravenous bolus into the cubital vein 5 min after PGE administration, then the disappearance rate of ICG (ICG-K) was determined by a finger monitoring method. PGE administration increased ICG-K in the LC and CH groups with normal liver function, and the ICG-K response was dose dependent when the dosage of PGE ranged from 0.01 to 0.05 microg/kg/min. When ICG-K relative to the ICG-K of the control was defined as the ICG-K ratio, the daily course of the ratio in the LC group was higher than in the CH group. PGE increases the ICG-K of patients with normal liver function before and after hepatic resection, and this is evident in the case of liver cirrhosis.

Suppression of hepatic portal blood flow caused by carbon dioxide pneumoperitoneum can be restored after dopamine administration in pigs.

Portal venous blood flow (PVF), hepatic arterial blood flow (HAF) and systemic arterial pressure (SAP) were examined after dopamine (DA) injection into the jugular vein under carbon dioxide pneumoperitoneum in pigs. When intraabdominal pressure (IAP) was increased by 12 mmHg, PVF and HAF were reduced, but SAP was unchanged. When IAP was kept at 12 mmHg, the injection of DA at 10 micrograms/kg/min for 2 min produced an increase in PVF without causing any change in HAF or SAP. The response in PVF was dose-dependent. When IAP was increased to 16 mmHg, PVF response was diminished, and no change in HAF or SAP was seen at the same dose of DA. These observations suggest that DA is effective in increasing PVF under enhanced IAP conditions, but such circulatory improvement due to the agent would be prominent when IAP is below 12 mmHg.

[A concomitant operation of aorto-coronary bypass graft and lung cancer: report of a case].

A case of a 66-year-old man with ischemic heart disease and lung cancer is reported. Chest roentgenogram revealed an irregular 2.8 x 2.0 cm mass in the right upper lobe. Coronary angiography showed 75-90% stenosis of the left anterior descending artery, and these lesions was suspected to cause perioperative myocardial infarction. A concomitant operation of aorto-coronary bypass graft and right upper lobectomy was performed through median sternotomy. A concomitant operation must be considered to be definitive and ideally preferable in selected cases.