[Expandable metallic stent for the treatment of left-sided colonic obstruction with malignant disease].

Recently, it was reported that an EMS (expandable metallic stent) was useful for treatment of colorectal obstruction. In our department, EMSs were used for seven patients with left-sided colonic obstruction with unresectable malignant disease. After these treatments with EMS, their symptoms were improved and they were able to intake food. Stomal formation was avoided except in one patient with severe soiling. In conclusion, EMS is thought to be useful for the improvement of quality of life in the patients with unresectable malignant colonic obstruction.

[Hepatoblastoma: clinico-radiological study of fifteen cases].

From January 1976 to October 1989, 15 patients with hepatoblastoma who underwent surgery at the National Cancer Center Hospital were evaluated by clinico-radiological techniques. Eight patients were boys and seven were girls; their average age was 3 years and 5 months. Abdominal mass or distention was initially noted in 12 patients. Alpha-fetoprotein level was extremely high (average, 327 micrograms/ml) in all cases but one. Hepatitis B surface antigen was negative in all cases. Tumors occupied mainly the right lobe of the liver in 67% of patients, and the mean tumor diameter was 11.1 cm. Of 15 hepatoblastomas, 10 were grossly classified as massive type and five as multinodular. Histopathological diagnosis was well differentiated (fetal type) hepatoblastoma in 10 patients and poorly differentiated (embryonal type) hepatoblastoma in five. Fibrous capsule was also recognized in eight. The noncancerous liver was normal in all cases. Ultrasonography (US) (n = 7 patients) demonstrated an inhomogeneous internal echo with well demarcated margin in five cases and without such margin in two. Nonenhanced CT (n = 6) showed an isodense or low density mass in all cases. Drip infusion CT (n = 5) revealed isodensity in the early phase. Dynamic CT performed in one patient showed a well enhanced mass that appeared hypervascular on angiography. Preoperative chemotherapy and radiation therapy provoked histological changes such as necrosis, fibrosis and calcifications. These changes were reflected on CT images. Both US and CT demonstrated the characteristic internal structure and gross appearance of hepatoblastoma.

[Effect of the lateral hypothalamic area-lesions on the development of gastric mucosal damages by water immersion restraint stress in rats].

The role of the lateral hypothalamic area (LHA) in the development of gastric mucosal damages induced by water immersion restraint stress was evaluated in bilateral LHA-lesioned rats. The ulcer index of lesions (M +/- SEM, mm) was significantly higher in LHA-lesioned rats (21.6 +/- 2.8) than in both thalamus-lesioned rats (9.8 +/- 2.0) and non-treated rats (10.2 +/- 1.5). The gastric acid and pepsin outputs during water immersion for 5 hours were significantly lower in the LHA-lesioned rats than in both the control rats. In the LHA-lesioned rats, PAS-positive mucus content of gastric corpus without lesions was significantly decreased after water immersion restraint stress for 5 hours. All these results suggest that lateral hypothalamic area plays an important role in the process of stress ulcer formation mainly through the disturbance of mucosal defensive mechanism such as changes in gastric mucus contents.

[Complete occlusion both left main coronary artery and right coronary artery].

A 67-year-old man, who had complete occlusion both of left main coronary artery (LMCA) and right coronary artery (RCA), underwent coronary revascularization. He had been suffering from severe angina pectoris preoperatively. Exercise electrocardiogram (single Master) showed myocardial ischemia. On cardiac catheterization, he showed extensive collaterals from right main coronary artery, and well-preserved left ventricular function. At operation, coronary arteries revealed severe sclerosis, especially in RCA, but there was no evidence of old myocardial infarction. Three saphenous vein grafts were bypassed to LAD, LCX, and RCA. Postoperatively, he remained free of angina pectoris at 6 months after uneventful surgery.