Two brothers with multiple visceral artery aneurysms or dilatations and diffuse connective tissue fragility who did not have clinical features of Marfan syndrome are reported. One presented with retroperitoneal hemorrhage during angiography, and idiopathic medionecrosis was proved by resection of the aneurysms. These cases belong to the heterogeneous group of Marfan syndrome. The angiographical features (multiple dilation of visceral arteries) suggests fragility of connective tissue and is predictive of hazards during and after a catheterization and operation.

Adult↗

PubMedDate not supplied

A new method of duodenum-preserving subtotal resection of the head of the pancreas based on the surgical anatomy.

BACKGROUND/AIMS: Duodenum-preserving resection of the head of the pancreas has been performed for benign and, sometimes, malignant diseases of the pancreas. We propose a new procedure of duodenum-preserving subtotal pancreatectomy of the pancreas according to the precise anatomy of the pancreatoduodenal region, especially of the pancreaticoduodenal arteries which provide blood to the duodenum. MATERIAL AND METHODS: After a complete Kocher's maneuver is performed, the pancreas is cut above the portal vein and removed from the third portion of the duodenum, followed by the removal of the posterior surface of the pancreas head from a connective tissue membrane. The main pancreatic duct is identified at its junction with the terminal portion of the bile duct from the posterior surface of the head of the pancreas and is cut at the junction. The pancreas is cut in the line of the ASPD. This line is almost the same as the left side of the common bile duct. The ASPD and the common bile duct should be preserved in this procedure. RESULTS: The reason for leaving part of the pancreas between the duodenum and the anterior superior pancreaticoduodenal artery and the common bile duct is that the artery toward the papilla of Vater runs along the right side of the common bile duct and would be difficult to be preserved with the removal of this part of the pancreas. The most important technique of this procedure is in keeping the connective tissue membrane of the posterior surface of the pancreas intact so as to preserve pancreaticoduodenal arteries and veins, because all the pancreaticoduodenal arteries and veins are situated on this membrane. Complete Kocher's maneuver should cause no problem in this procedure. CONCLUSIONS: Benign lesions as well as low-grade malignancy of the head of the pancreas may possibly be the indication of this procedure.

Adenocarcinoma, Mucinous↗

PubMedDate not supplied

A case of gallbladder cancer with para-aortic lymph node metastasis who has survived more than seven years after the primary extended radical operation.

A 55-year-old man with gallbladder cancer was surgically treated in our hospital in July 1988. The tumor was about 8 cm in diameter, replaced the entire gallbladder, and invaded the liver and the hepatoduodenal ligament. In addition, extensive tumor metastasis to lymph nodes, including those of the para-aortic area was noted (Stage IV). Extended cholecystectomy with resection of the liver and lymph node dissection were performed. Although all of the macroscopic tumors were removed surgically, we believed that the tumor would recur in the near future, since all of the excised para-aortic lymph nodes were involved by carcinoma histologically. After surgery, the patient received 5'-deoxy-5-fluorouridine (5'-DFUR) orally at a dose of 600 mg per day. In December 1993, more than 5 years after the primary operation, cancer recurrence in para-aortic lymph nodes was demonstrated by computed tomography (CT). In June 1994, the patient underwent a second operation for treatment of recurrent tumor. The lymph nodes firmly adhered to both the aorta and left renal vein, and could not be removed. Since August 1994, he has received external radiation therapy, and there has been no further enlargement of the nodes. This is the first reported case of gallbladder cancer with para-aortic lymph node metastasis who survived more than seven years after the primary extended radical operation with cholecystectomy, resection of the liver, and extended lymph node dissection.

Adenocarcinoma↗

PubMedDate not supplied

Appleby operation for carcinoma of the body and tail of the pancreas.

Long-term survival of carcinomas in the body and tail of the pancreas after surgery is still rare. One of the major reasons for unresectability is cancerous invasion to major vessels, such as the common hepatic and splenic arteries. Resection of the involved arteries can increase resectability and thus might increase post-operative survival. The aim of this study was to clarify the importance of the Appleby operation for carcinoma of the body and tail of the pancreas. A Case Report was carried out with a 54 year-old man, had suffered back pain and loss of body weight for six months. Imaging procedures such as US, CT or angiography showed a carcinoma in the body of the pancreas, about 3 cm in size, and both the common hepatic and splenic arteries were invaded by the tumor. The Appleby operation was used for this patient, since firstly there was no invasion to the head of the pancreas, secondly neither the proper hepatic artery nor the SMA was involved, thirdly the root of the CA was free of carcinoma, and finally because clear pulsation of the proper hepatic artery could be felt one or two minutes after occlusion of the CHA, which indicated that resection of the CHA would not lead to hepatic ischemia. The postoperative course was uneventful. His appetite recovered well and his body weight increased to the level before the disease. The patient was relieved from back pain and has returned to work 18 months after the operation, although he had a local recurrence eight months after the operation. In addition, eleven cases with carcinoma of the body and tail of the pancreas were used for a literature review. The average survival time after the Appleby operation is 6.6 months, and four patients are still alive. One patient has survived 13 years after the operation. It was concluded that although the prognosis after Appleby procedure is still not satisfactory that this operation can at least offer patients a better quality of life.

Back Pain↗