A case of postoperative recurrent cholangitis after pancreaticoduodenectomy successfully treated by tract conversion surgery.

A 69-year-old man, who had undergone pylorus-preserving pancreaticoduodenectomy (PD) (Imanaga procedure) for duodenum papilla cancer 13 years prior, had a history of repeated hospitalization due to cholangitis since the third year after surgery and liver abscess at the 10th year after surgery. Gastrointestinal series indicated no stenosis after the cholangiojejunostomy. However, reflux of contrast media into the bile duct and persistence of food residues were observed. We considered the cholangitis to be caused by reflux and persistence of food residues into the bile duct. So, we performed the tract conversion surgery, Imanaga procedure to Child method. The postoperative course was good even after re-initiating dietary intake. He was discharged on the 19th day after surgery. He has not experienced recurrent cholangitis for 18 months. For patients with post-PD recurrent cholangitis caused by reflux of food residues like ours, surgical treatment should be considered because tract conversion may be an effective solution.

Improving accuracy in period measurement of gratings with multiple diffraction orders.

Determining the period of a grating generating multiple diffraction orders from the data of diffraction angle measurement is not an easy task, mainly because of positioning error. We propose a novel technique, i.e., numerically adjusting the specimen position, to solve the problem. The procedure alone would reduce the amount of uncertainty by two orders of magnitude.

[Case of gastric cancer with recurrence of carcinomatous lymphangiosis of the lung 7.6 years after surgery and successfully treated with S-1/low-dose CDDP/Lentinan combination therapy].

A 78-year-old woman underwent gastrectomy for type 3 gastric cancer with pyloric stenosis, which was detected in November 1997. Thoracic and abdominal CT and other diagnostic procedures were conducted regularly for 5 years after surgery. The patient was recurrence-free and her clinical course was satisfactory. Starting in early May 2005, however, she began to experience respiratory difficulty at exertion, which exacerbated rapidly thereafter. Examination at a department of respiratory physiology led to a diagnosis of a recurrence of stomach cancer and carcinomatous lymphangiosis+lymphatic metastasis to the peritoneal cavity. She was referred to us for palliative care. The accentuated respiratory difficulty was eased with oxygen inhalation and opioid administration. With improvement in her respiratory condition, a combination of S-1 80 mg/day, CDDP 10 mg x once/week and Lentinan 1 mg x twice/week, was initiated. Within about 2 weeks, her respiratory difficulty was eliminated and after 4 weeks x 2 courses, the tumor images were no longer recognized in the thoracic and abdominal CTs. The combination therapy of S-1/low-dose CDDP/Lentinan is free of evident adverse effects and may be a potent therapeutic alternative as a palliative therapy for malignant stomach cancers in elderly patients or those in a poor systemic condition.

En bloc resection for primary non-Hodgkin's lymphoma of the descending colon with massive extension into the neighboring organs.

A 79-year-old female who was surgically treated and received adjuvant chemotherapy for primary non-Hodgkin's lymphoma of the descending colon with massive extension into the pancreatic tail, spleen, and left kidney is herein reported. The patient had acute colonic obstruction and an urgent laparotomy was performed because endoscopic decompression using a transnasal ileus tube could not be done. We performed a left colectomy with an en bloc resection of the neighboring organs, followed by the creation of an end colostomy. The patient had no major postoperative complications and is well without any recurrence of lymphomas 6 months after surgery.

Cutaneous metastasis from pancreatic adenocarcinoma: a case report and a review of the literature.

We treated a 77-year-old Japanese man with cutaneous metastases from pancreatic adenocarcinoma. Physical examinations revealed reddish, non-tender and firm nodules in left axilla. Laboratory examination showed a remarkable elevation in the tumor markers of CA 19-9, DUPAN-2 and SPAN-1. Abdominal computed tomography showed a low-density mass in the tail of the pancreas, and histological examination of nodule in the axilla revealed a metastatic adenocarcinoma. The immunohistochemistry of CA 19-9 in the excised nodule was positive. Cutaneous metastasis from pancreatic adenocarcinoma is usually rare, and the prognosis is poor, as the disease is usually advanced.