RETROPERITONEAL SCHWANNOMA : A CASE REPORT AND REVIEW OF THE LITERATURE

Reported herein is a rare case of retroperitoneal schwannoma in a patient without von Recklinghausen's disease. This patient was free of symptoms, and the tumor was found by chance during a periodical physical examination. Complete excision of the tumor was performed, and as of this writing, 36 months after the operation, the patient is free of the disease. In addition, a review was carried out on the 121 cases of retroperitoneal schwannoma reported in the Japanese literature from 1981 to 1992. In this series, malignant tumors were seen in 26.4% of all cases, and when this tumor was found in association with von Recklinghausen's disease, the malignancy rate increased to 52.9%. Thirty seven percent of the patients with malignant tumors had died at the time of writing of their case report, and their mean survival period was 18 months after the first surgical treatment. All the patients with benign tumors underwent complete resection and had a good prognosis

THE INCIDENCE OF PEPTIC ULCER SURGERY BEFORE AND AFTER THE INTRODUCTION OF H2-RECEPTOR ANTAGONISTS

Since the introduction of H2-receptor antagonists, the incidence of ulcer surgery has decreased markedly. Based on the number of patients who underwent ulcer surgery and upper gastrointestinal endoscopy in our hospital, the number of operations for peptic ulcer disease has decreased, although the number of peptic ulcer patients diagnosed by endoscopy has increased after the introduction of cimetidine (the first H2-receptor antagonist in Japan). The decreasing rate of surgical therapy before and after the administration of H2-receptor antagonists was 49.1%. The number of emergency operations has also decreased among ulcer patients diagnosed by endoscopy although the number of perforated and bleeding ulcer patients has increased. It is also reported that the most common operative procedure for both gastric and duodenal ulcer was distal gastrectomy reconstructed by gastroduodenostomy (Billroth Ⅰ)

A SCINTIGRAPHIC STUDY OF MASS PERISTALSIS IN HUMAN COLON

Although many attempts have been made to study human colonic motility, the colonic transit is still poorly understood. Both spontaneous and neostigmine-induced peristalsis of the colon were studied with scintigraphy. A polythene tube was inserted into the cecum through a colonofiberscope. 37 MBq of ⁹⁹ᵐTc-DTPA and 75 ml of saline were instilled and dynamic scan was begun. Eight healthy volunteers were examined by the method above mentioned. The sampling time was set at fifteen seconds in six persons and three seconds in the rest. 0.5 mg of neostigmine was injected intravenously to stimulate the paristalsis when no peristalsis occurred within thirty minutes after the study was begun. Dynamic scanning was performed for sixty to ninety minutes. This scintigraphic study revealed that the spontaneous and induced peristalsis were almost identical on colonogram. ⁹⁹ᵐTc-DTPA solution was propelled from the cecum and ascending colon to the sigmoid colon or the rectum for about fifteen seconds during mass peristalsis. Colonogram (time-activity curve) enables us to analyze mass peristalsis easily and more objectively than colonoscintigram. The spontaneous and neostigmine-induced peristalsis seemed to be almost identical in all but one of eight subjects

A NEW OPERATIVE TECHNIQUE FOR ESOPHAGEAL RECONSTRUCTION USING A LONG GASTRIC TUBE OF 3 CM DIAMETER

The anthors have successfully prepared a 3 cm diameter gastric tube with a more favorable blood supply than the conventional one by performing interrupted suture each of the mucosal layers and seromuscular layers of the stomach separately with pyloromyotomy as a drainage procedure. This gastric tube caused no clavicular pressure on the anastomotic portion through a retrosternal route, so that we could perform end-to-end anastomosis between the cervical esophagus and the gastric tube in a region higher than the clavicle. We report in this paper the clinical findings of our procedure : it was effective in preventing postoperative complications such as suture insufficiency and passage disturbance other than postoperative complaints due to dumping and reflux esophagitis, etc

SURGICAL TREATMENT OF PRIMARY GASTRIC LYMPHOMA : A RETROSPECTIVE STUDY OF 13 CASES

A retrospective study of 13 patients who were operated on primary gastric lymphoma was made to evaluate the influence of clinicopathologic features and method of treatment on survival. There was an association found between tumor size and depth of invasion, or lymph node involvement especially in the localized type. More specifically, when the tumor measured 10cm or more in diameter, the tumor stage advanced except for the infiltrative-flat type. The estimated 5-year survival rates were 75% for stage Ⅰ, 66.7% for stage Ⅱ and 50% for stage Ⅳ, respectively. We experienced a case of recurrence in the remnant stomach after resection for an early stage lymphoma of the infiltrative-flat type, and two cases of over 10-year survival after extended resection with adjuvant chemotherapy for advanced stage Ⅳ lymphoma. Therefore, we concluded that adequate resection should be performed even for early lymphoma, and also that adjuvant chemotherapy be given for advanced lymphoma

MESENTERIC LIPOSARCOMA : A CASE REPORT

We report a case of a large liposarcoma arising from the small bowel mesentery. A 63-year-old man was referred to our outpatient clinic with the chief com- plaint of abdominal disterision in September 1995. The sense of the abdomirial distension had progressed gradually over the previous six years. Computed tomography scan and magnetic resonance imaging showed the main component of the mass was fatty tissue. The clinical diagnosis was liposarcoma of unknown origin. Laparotomy showed that the yellow -white, encapsulated mass was found in the small bowel mesentery. The excised tumor was 7700g in weight. The histological diagnosis was well-differentiated liposarcoma. The flow cytometric DNA ploidy was aneuploidy. The patient received no adjuvant chemotherapy and has been followed up without local reccurrence or metastasis for one year

ANESTHESIA FOR RADICAL SURGERY OF NEONATAL CONGENITAL DIAPHRAGMATIC HERNIA USING CONTINUOUS ADMINISTRATION OF FENTANYL AND HIGH-FREQUENCY OSCILLATORY VENTILATION

Patients with congenital diaphragmatic hernia were managed using continu- ous administration of fentanyl and high-frequency oscillation during the perioperative period. Fentanyl was continuously administered at 0.076 μg/kg/min and initial settings for high-frequency oscillation were : fraction of inspired oxygen=0.75, frequency=15 Hz, stroke volume=6.7 ml/kg, mean airway pressure=19 cmH₂O. All the patients were administered dopamine and dobutamine for hemodynamic stability. Their operations were completed with no problem