カラードップラー超音波が有効であった外傷後に生じた動脈性持続勃起症の1例

19歳男.仕事中に会陰部を強打, その後より持続する陰茎勃起が出現するため受診.カラードップラーにて右陰茎海綿体脚部に血液のleakと思われるcavityを認め, high-flow typeの外傷性priapismと診断した.両側内陰部動脈造影を施行したところ, 右海綿体動脈の一部に造影剤の溢流像を認めたため, 自己血凝血塊を用いた動脈塞栓術を施行した.しかし治療2週間後より再び持続性勃起を認めるようになり, カラードップラーで前回と同じ部位にcavityの再発を認めたため, 自己血凝血塊よりも更に吸収時間の長いgelatin spongeを用いて再度, 動脈塞栓術を施行した.その後は再発を認めることなく経過している.本症の診断と治療後の経過観察において, カラードップラーは侵襲もなく容易に行うことができるため, 有用であるThe patient was a 19-year-old man who was examined due to persistent penile erection, which appeared following a blow to the perineal region during work. Color Doppler ultrasonography of the corpora cavernosa revealed a cavity in one part of the cavernous artery that suggested a blood leak, and a diagnosis of high flow type priapism due to trauma was made. Bilateral internal pudendal arteriography demonstrated dilation and extravasation in one part of the right cavernous artery, then transarterial embolization was performed superselectively in the right cavernous artery using an autologous clot. However, 2 weeks after treatment, slight penile erection reoccurred. Color Doppler ultrasonography revealed reformation of the cavity at the treated lesion, and embolization was again performed using a gelatin sponge. Following embolization, the course proceeded satisfactorily without any relapse. Color Doppler ultrasonography, which is non-invasive and can be easily performed, is considered to be an effective means for diagnosis and follow up of arterial high flow priapism

Successful management of locally advanced hilar cholangiocarcinoma : Surgical procedure for extended left hepatic lobectomy coupled by resection/ reconstruction of the right hepatic artery

Recently, the methods for hepatic lobectomy, which require highly qualified and experienced surgeons and include difficult post-operative management, have improved markedly, and, moreover, there are very few patient deaths resulting from hepatic artery reconstruction. Now, as an overall trend, the focus of discussion has shifted to whether there is any positive value in radical resection. A few reports have described success in such operations.Extended left hepatectomy with right hepatic artery resection in a case of advanced hilar cholangiocarcinoma with suspected right hepatic artery invasion is reported. The surgery absolutely required reconstruction of the hepatic artery. During the postoperative course, in which the patient was at high risk for complications, temporary bleeding was observed from a pseudo aneurysm in the anastomotic site. Fortunately, no severe problems were caused by transarterial embolization in the right hepatic artery. The patient completed the planned chemotherapy regimen and was discharged