Laparoscopic repair of acute small bowel obstruction due to left paraduodenal hernia: A case report.

INTRODUCTION: Paraduodenal hernia is a rare disease but the most common internal hernia. Laparoscopic repair of paraduodenal hernia is feasible and effective because of its minimal invasiveness and aesthetic advantage. PRESENTATION OF CASE: We report a case of a 79 year-old-man who was admitted with a complaint of recurrent left abdominal pain. Computed tomography revealed an encapsulated cluster of jejunum loops in the left upper quadrant, near the ligament of Treitz and at the dorsal side of the inferior mesenteric vein. Emergency laparoscopic surgery was performed. The jejunum loops incarcerated in the hernia sac was reduced. The hernia orifice was closed with interrupted suture. Postoperative period was uneventful and the patient was discharged home on the 7th postoperative day. There has been no recurrence during a follow-up. DISCUSSION: If there is a working space in the abdominal cavity, laparoscopic surgery for paraduodenal hernia leads to patient's early recovery with cosmetic satisfaction. CONCLUSION: Left paraduodenal hernia is a rare cause of small bowel obstruction that should be thought about patient with a history of recurrent abdominal pain. Computed tomography is the standard for a correct diagnosis. Laparoscopic repair as the first surgical option for paraduodenal hernia is feasible despite of technical difficulties.

A hepatocellular neoplasm accompanied with massive histiocyte infiltration.

This report presents the case of a unique hepatocellular nodule occurring in a 73-year-old Japanese male with diabetes mellitus and mild obesity. The nodule consisted of hepatocyte-like tumor cells and abundant foam cell type histiocytes that filled up a sinusoid-like space and formed central loose fibrosis. The superficial area did not contain as many histiocytes and showed hepatocellular adenoma character, but there was a focal hepatocellular carcinoma-like lesion, thus suggesting hepatocellular adenoma with malignant transformation. The background liver showed an almost normal histology except for mild steatosis with no specific infiltration of macrophages. These macrophages contained abundant fat droplets, whereas the tumor cells had no fat droplets. The expressions of monocyte chemoattractant protein-1 and macrophage colony-stimulating factor were significantly higher in the tumor than in the background liver. These findings suggested such macrophage infiltration induced by the tumor cells and these macrophages probably phagocytosed surplus fat at the intercellular space of this unique tumor.

Infectious complications after gastric cancer surgery accelerate a rapid hepatic recurrence.

BACKGROUND/AIMS: Rapid hepatic recurrence is sometimes experienced after gastric or pancreatobiliary cancer surgery. The aim of this study was to investigate the risk factors for the timing of hepatic recurrence. METHODOLOGY: The medical records of 20 patients who had hepatic recurrence after either a gastrectomy for gastric cancer (11 patients) or a pancreatoduodenectomy for pancreatobiliary cancer (9 patients) between 2002 and 2007 were retrospectively reviewed. The cumulative recurrence rate of liver metastasis was calculated using the Kaplan-Meier method, and 14 possible factors affecting the rapid hepatic recurrence were analyzed by univariate and multivariate analyses. RESULTS: The median time for the hepatic recurrence after the operation was 4.9 months (range 1 to 20.4 months). Among 14 factors, only postoperative infectious complications significantly accelerated the hepatic recurrence based on a univariate analysis (p = 0.049). Two more factors, gastric cancer and preoperative tumor marker elevation, had a tendency to affect the rapid recurrence, but did not show statistical significance (both p = 0.06). A multivariate analysis revealed that postoperative infectious complications (p = 0.005) and gastric cancer (p = 0.04) were significant and independent factors. Five of 11 patients with gastric cancer suffered from postoperative infectious complications, 4 of which were associated with pancreatic leakage after a pancreatosplenectomy, and all 5 patients had hepatic recurrence within 3 months after the operation. CONCLUSIONS: Postoperative infectious complications are thus considered to accelerate a rapid hepatic recurrence after a gastrectomy for gastric cancer.

Efficacy of major hepatectomy for large hepatocellular carcinoma.

BACKGROUND/AIMS: Large hepatocellular carcinomas (HCC) with diameter >10 cm reportedly displays poor prognosis. The role of hepatic resection in the treatment of large HCC remains controversial. We evaluated the efficacy of hepatic resection, particularly major hepatectomy, for large HCC. METHODOLOGY: From January 1987 to December 2004, a total of 252 patients with primary HCC underwent hepatic resection in our institution. The 22 patients with HCC > or =10 cm (Group A) were compared with the 230 patients with HCC <10 cm (Group B) in terms of clinicopathological factors and prognosis. RESULTS: Serum alpha-fetoprotein level was significantly higher in Group A than in Group B (p=0.004) and populations of patients with portal vein invasion, hepatic vein invasion and satellite nodules were significantly higher in Group A than in Group B (p<0.001; p<0.001; p=0.034. The 5-year survival rate was worse for Group A (45.2%; median survival, 25 months) than for Group B (67.8%; median survival, 48.2 months). Major hepatic resection (>2 segments) was the only prognostic factor for overall survival in patients with large HCC (p=0.024). Five-year survival rate was significantly better for patients with major hepatectomy (58.3%; median survival, 30.0 months) than for patients with minor hepatic resection (16.7%; median survival, 7.1 months). Liver cirrhosis and early recurrence were significantly less frequent in the major hepatectomy group than in the minor hepatectomy group (p=0.026; p=0.005). Hepatic resection for large HCC could be performed with zero mortality. CONCLUSIONS: Major hepatectomy can improve prognosis while preserving liver function for patients with large HCC.

Percutaneous transhepatic portal embolization for persistent bile leakage after hepatic resection: report of a case.

Bile leakage is a relatively common complication after hepatic resection. We report a case of intractable bile leakage after hepatectomy, which was successfully treated by percutaneous transhepatic portal embolization (PTPE). A 58-year-old Japanese man underwent anterior resection of the rectum followed by central bisegmentectomy of the liver (S4 + S5 + S8) for rectal cancer with liver metastasis. Bile leakage from the cut surface of the posterior segment developed on postoperative day 2. Conservative management with simple drainage and ethanol injections into the fistula proved ineffective. Thus, we performed PTPE in the posterior portal branch to eliminate the production of bile from the posterior segment and to block the enterohepatic circulation to that segment. His post-treatment course was uneventful and the bile leakage resolved immediately.

Intrahepatic multicystic biliary hamartoma: report of a case.

Multicystic biliary hamartoma is a very rare hamartomatous nodule in the liver, which has recently been described as a new category of hepatic nodular lesion. We herein report the case of a 55-year-old man histopathologically diagnosed with this entity following surgery. A solitary multilocular lesion in the liver was pointed out by ultrasonography during a systemic examination for a positive HBs antigen. This nodule could not be definitively diagnosed by radiologic modalities, including computed tomography, magnetic resonance imaging and arteriography. The patient underwent a partial resection of the posterior segment of the liver. The nodule was a localized lesion which measured 5 x 3 cm at the widest point and displayed a honeycomb appearance. Histologically, it consisted of ductal structures, periductal glands, fibrous connective tissues containing blood vessels, and bile-like materials and xanthogranulomatous inflammation within some ducts. Liver parenchyma was not present in the nodule and the bile ducts were not dilated in the background liver. The ductal epithelium expressed biliary type cytokeratins (CK7 and 19) in immunohistochemical studies. These histopathological features were consistent with multicystic biliary hamartoma, and we discuss this rare case in detail in this report.

Structural relationship of child behavior and its evaluation during dental treatment.

The present study uses structural equation modeling to explore the structural relationship of child behavior type and its evaluation during dental treatment. The study population consisted of 33 children at their first visit to a pediatric dentist at the Dental Hospital of Tsurumi University. Child behavior was evaluated by the Frankl Behavior Rating Scale and the behavior evaluation scale developed by Kurosu. Factor analysis extracted 3 behavior types: escape, self-defense, and facial expression. The path diagram of structural relationships between child behavior and the Frankl Behavior Rating Scale indicated that facial expression had the strongest correlation to the Frankl Behavior Rating Scale.

Vine-twining polymerization: amylose twines around polyethers to form amylose-polyether inclusion complexes.

In this paper, we describe a new polymerization manner termed as "vine-twining polymerization" to produce amylose-polymer inclusion complexes. The polymerization was achieved by an enzymatic polymerization of alpha-D-glucose-1-phosphate monomer catalyzed by phosphorylase in the presence of polyTHF as a guest polymer. The structure of the product was determined by X-ray powder diffraction and (1)H NMR measurements to be the inclusion complex. The formation process of the inclusion complexes during the polymerization was also evaluated. Furthermore, the formation of the inclusion complexes by this polymerization method by using polyTHFs with various M(n)s and end groups, as well as other polyethers as the guest polymers, was examined.