Continuous Measurement of Tissue Oxygen and Carbon Dioxide Gas Tensions in Dog Liver in Ischemia/Reperfusion

An experiment was conducted to determine whether the oxygen and carbon dioxide gas tensions in liver tissue (PtO2 and PtCO2, respectively) reflect the state of microcirculation and/or metabolism in the ischemic liver. Subjects were divided into three groups: group 1, 30 min ischemia; group 2, 60 min ischemia; group 3, four times of intermittent 15 min ischemia after every 10 min of reperfusion. PtO2, PtCO2 and tissue blood flow (TBF) were measured by mass spectrometry, comparatively studied with the serum GOT level as an indicator of liver tissue damage. Furthermore, the time point at which the PtCO2 increase for 1 min initially became less than 1/2 of the maximum value was located on the transit curve of PtCO2, referred to as the critically anaerobic (CA) point, with which new indices of critically anaerobic score (CAS) and time (CAT) (see details in text) were developed. The profiles of PtO2 and PtCO2 during ischemia and reperfusion were clearly demonstrated, and the CA point was observed 12.7 +/- 2.9 min after induction of ischemia. PtO2 was positively correlated with TBF and negatively with the serum GOT level. Furthermore, not only CAS but also CAT were significantly correlated with PtO2, TBF, and the serum GOT level. It was concluded that PtCO2 reflects the state of anaerobic tissue metabolism during ischemia and PtO2 reflects the magnitude of microcirculatory disturbance and tissue injury caused by ischemia/reperfusion. Therefore, continuous monitoring of not only PtO2 but also PtCO2 is beneficial for patients undergoing hepatic surgery with ischemia

Advanced gastrointestinal stromal tumor with intracerebral hemorrhage during sunitinib treatment\n

　Herein, a 70-year-old female was initially treated with sunitinib 50 mg/day to treat an imatinib-resistant gastrointestinal stromal tumor. After sunitinib initiation, nausea, hypertension, hepatic dysfunction, anorexia, fatigue, thrombocytopenia, epistaxis, and palmoplantar erythrodysesthesia syndrome developed; the dose was reduced to 25 mg/day.　Subsequently, adverse events improved, and from the fifth course onward, sunitinib 37.5 mg/day was continued. Approximately 11 months after initiating sunitinib therapy, the patient developed disturbance of consciousness, aphasia, and left hemiplegia. Computed tomography of the head revealed intracerebral hemorrhage, and the patient was hospitalized. No brain metastases, cerebral aneurysms, or cerebral arteriovenous malformations were observed. Sunitinib-induced hypertensive cerebral hemorrhage was suspected as the cause of intracerebral hemorrhage. Conservative treatments, such as antihypertensive drugs, were administered without surgical treatment. The symptoms and intracerebral hemorrhage gradually improved, and the patient was discharged from the hospital. Intracerebral hemorrhage with sunitinib is extremely rare, but has a high mortality rate. During sunitinib treatment, controlling blood pressure and thrombocytopenia is important to prevent bleeding

Disappearance of the spleen as a rare complication of infected pancreatic pseudocyst following acute relapsing phase of chronic pancreatitis.

Splenic involvement of an infected pseudocyst is known to be a rare complication of infected pancreatic necrosis following pancreatitis. We present herein a case of chronic alcoholic pancreatitis complicated by a major infected pseudocyst formation involving the spleen, with subsequent rupture and complete disappearance of the entire spleen. A 60-year-old Japanese man with a history of chronic alcoholic pancreatitis with a pancreatic tail pseudocyst was referred to us because of severe epigastralgia. CT revealed spontaneous rupture of the pseudocyst into the stomach and free air in the pseudocyst. The body and tail of the pancreas were disrupted due to pancreatic necrosis, and the splenic parenchyma was also partially ruptured and disrupted with large tears of the splenic surface. One month later, CT showed almost complete disruption of the splenic parenchyma. Three months later, CT showed remarkable regression of the pseudocyst and complete disappearance of the entire spleen. Although splenic involvement of pancreatic pseudocysts should be considered to be a potentially lethal complication because of hemorrhage or infection, it can possibly be treated conservatively. In the present case, complete obstruction of both the splenic artery and vein due to chronic inflammation, and spontaneous drainage into the stomach were the most probable causes for the spontaneous regression without surgical treatment. This is the first report of splenic disappearance after splenic rupture demonstrated by CT

Prolapse of Intussusception through the Anus as a Result of Sigmoid Colon Cancer

Adult intussusception is rare and most often associated with cancer. We report a case of intussuscepted sigmoid colon into the rectum protruding from the anus of a 47-year-old woman. The cause of the intussusception was sigmoid colon cancer. We removed the intussuscepted part of the sigmoid colon as well as the rectum and regional lymph nodes. The patient recovered uneventfully and there has been no evidence of recurrence of the cancer

Resection of Hepatic Metastasis from Colorectal Cancer : Survival, Factors Influencing Prognosis, and Follow-up

The purpose of this retrospective study was to analyze the surgical results of hepatic resection in our patients with colorectal hepatic metastasis. During a 26-year period, 223 patients among 1,484 patients with colorectal cancer suffered liver metastasis. In 44 curatively resected patients, the one-, three- and five-year cumulative survival rates were 85.9%, 44.9% and 23.0%, respectively. The prognostic importance of seven factors was evaluated. Synchronous or metachronous resection, the type of liver resection, and histologic differentiation did not influence the prognosis, whereas the number and size of metastases, and lymph node involvement did significantly affect prognosis as single factors. The mean diameter of metastatic lesions in the liver was 2.5 cm in the synchronous group and 4.5 cm in the metachronous group, the difference being significant (p = 0.0005). The presence of tumors with large diameters in the metachronous group might mean our failure of early detection of the recurrence of hepatic metastases. It is necessary to make steady efforts such as introducing regular follow-up imaging of colorectal cancer. The median interval between the primary operation and liver metastasis resection was 15.7 months in the lymph node involvement group and 37.7 months in the no lymph node involvement group. In 19 patients among 21 metachronously resected patients, the hepatic resection was done within three years. In conclusion, it was considered that hepatectomy could be done safely, that detection of an earlier lesion could improve the surgical results, and that follow-up for liver metastasis should be done intensively between 12 and 36 months after colorectal cancer surgery

解体新書に描かれた図譜の現代解釈 : 肝胆膵編

　解体新書は当時の日本において最先端の医学書であったが，改めて観察すると，現代医学との相違点がいくつか存在する。そこで解体新書の図譜を現代医学の視点から考察し，原図に沿って現代医学の要素をメディカルイラストレーションの手法を用いて加筆修正した。また江戸時代と現代において各臓器の見せ方の違いを考察した。本論文では解体新書の「肝臓篇」「膵臓，脾臓篇」の２章の中の，肝臓，胆嚢，膵臓の３臓器の図譜について現代医学の視点から考察して相違点を抽出した。それを基に，原図に沿って現代医学の要素を加筆修正した。加筆修正するポイントとして，臓器の構造や機能を，強調や省略を駆使して的確に表現した。また，臓器は生体的構図で描画し，関連する周囲組織も含めた構図を作成した。肝臓前面の図譜では，形状を整理し，間膜と肝円索を加筆した。肝門の図譜では，脈管を修正し，間膜と圧痕を加筆した。胆嚢の図譜では，形状と層の表現を修正し，胆嚢管の表現を修正した。膵臓の図譜では，前面と背面の２枚の図を作成した。また，肝門部を加筆，胆管と膵管を修正，胃と膵臓の前後関係を修正，脾臓の脈管を修正したうえで，腎臓を削除し，横行結腸を加筆した。Kaitai-Shinsho was one of the state-of-the-art medical books in Japan during the Edo period.However, on closer observation, there are several differences between the illustrations and modern medicine. Therefore, we nvestigated the illustrations in the Kaitai-Shinsho from a modern medical point of view, and retouched them using medical illustration techniques in accordance with the original figures. We also discussed the differences in how to show each organ in the Edo and modernperiods. Regarding the three organs of the liver, gallbladder, and pancreas, we extracted the differences and discussed from a modern medical point of view. The structures and functions of these organs that have been scientifically proven were adequately drawn through the use of emphasis and omission techniques. These organs were drawn with anatomical composition, which can be easily understood, including the relevant surrounding tissues. For the figure of “Liver: front", we 1) organized the shape of the entire liver, 2) retouched the surrounding membrane, and 3) retouched the round ligament. For the figure of “Liver: hilum", we 1) modified the vessels flowing into the liver, 2) retouched the surrounding membrane, and 3) retouched the impressions on the surface. For the figure of “Gallbladder", we 1) modified the layers of the wall, 2) retouched the shape, and 3) retouched the cystic duct. For the figure of “Pancreas", we drew two views of the pancreas front and pancreas back. In addition, we 1) retouched the hepatic hilum, 2) modified the bile duct and pancreatic duct, 3) modified the position of stomach and pancreas, 4) modified the vessels of the spleen, 5) removed the kidney, and 6) retouched the transverse colon