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Desmoid tumor commonly occurs in the extremities or abdominal wall in patients with adenomatous polyposis coli (APC) or those who have a previous history of undergoing abdominal operation. This time we experienced a case of mesenteric desmoid tumor in a 28-year-old man without such associated disease and the history. The patient was admitted to the hospital because of an abdominal tumor. A fist-sized and elastic hard tumor was palpated in the right lower abdominal region. Barium enema showed no abnormal findings. Abdominal CT and ultrasonographic examination suggested a mesenteric tumor. On laparotomy, the tumor, 11×7×6cm in size, was located at the ileocecal mesentery and an ileo-cecal resection was performed. Histological examination revealed desmoid tumor consisiting of uniform spindle cells with collagen fibers. The postoperative course of the patient was uneventful and he has had no sign of recurrence for more than 2 years after the surgery. In a review of the Japanese literature, the solitary appearance of mesenteric desmoid tumor like this patient who had no APC nor history of laparotomy has been reported in only ten cases so far.

We report three patiens who inserted an expandable metallic stent (EMS) to bronchial stenosis caused by cancer. Patient 1 who had undergone a subtotal esophagectomy for an esophageal cancer was admitted to the hospital because of dyspnea due to left main bronchial invasion of a reccurent cancer. Tracheal intubation was performed under general anesthesia and then EMS was placed at the site of bronchial stenosis via flexible bronchoscopy under fluoroscopic guidance. The procedure promptly relieved respiratory distress and improved arterial PO2 (51.0mmHg→93.7 mmHg), Hugh-Jones classification (V→III) and Performance Status (4→1). Patient 2 complained of dyspnea dur to left main bronchial invasion of a lung cancer. Insertion of EMS relieved respiratory distress and improved Hugh-Jones classification (V→IV) and Performance Status (4→3). Patient 3 complained of dyspnea due to bilateral main bronchial invasion of a reccurrent esophageal cancer. Insertion of EMS could not relieve respiratory distress. We were able to relieve respiratory distress in two out of three. It is thought that EMS treatment for neoplastic bronchial stenosis is useful for relieving respiratory distress and improving quality of life for the patient.

We report five cases of metastatic brain tumor preceded by neurological symptoms. All patients received removal of the brain tumors prior to resection of the primary lesions. The primary site of cancer was the lung in 3 patients, and esophagus and breast in one each. The number of brain tumor was one in four patients and 3 in one. The duration from the removal of the brain tumors to the resection of the primary lesions ranged from 0.5 to 6 months. Two patients with lung cancer, who did not undergo postoperative whole brain radiation therapy, died of recurrence of brain tumors 14 months and 15 months after the resection of the primary lesions, respectively. On the other hand, no recurrence of the brain tumor was found in 3 patients with postoperative whole brain radiation. One patient with breast cancer died 14 months, and two patients with esophageal and lung cancer are alive 30 months and 37 months after the resection of the primary lesions, respectively. Curative resection for both brain metastasis and primary lesions was performed in 2 patients surviving for more than two years. Resection of brain metastasis and primary lesions, and postoperative whole brain radiation therapy according to the progressive extent of the lesions would improve the prognosis.

Liver cysts have been treated by an operation under laparotomy or ultrasonography-guided alcohol sclerotherapy so far. With a recent wide-spread use of laparoscopic procedure, laparoscopic fenestration (LF) has been increasingly performed for liver cysts. In this paper four cases of liver cysts treated with LF were studied to elucidate LF's characteristics by comparing with other procedures. Two patients had a simple cyst and two had multiple cysts. The size of cysts ranged from 8 to 18cm. Two of the four patients underwent simultaneous laparoscopic cholecystectomy for coexisted cholecystolithiasis. LF was performed safely without postoperative complication. No recurrences were found during a follow-up period of 10-42 months. The duration of hospital stay of patients treated by LF was 7±2 days, which was shorter than that of patients treated by ultrasonography-guided alcohol sclerotherapy (22±10 days) and by fenestration with laparotomy (16±3 days). Drunkenness and abdominal pain occured to all patients treated by alcohol sclerotherapy. These results would indicate that LF appears to be a safe and useful method for liver cysts.

We report a case of rapidly growing pulmonary carcinosarcoma admixed with osteosarcomatous component. A 66-year-old male was admitted to our hospital because of hemosputum. A chest X-ray film and CT showed a tumor mesured 9×8cm in the middle field of the left lung. Squamous cell carcinoma was suspected by cytological examination of sputum. Left upper lobectomy and partial resection of the left lower lobe were performed. Histologically, the tumor was composed of carcinomatous (squamous cell carcinoma and adenocarcinoma) and sarcomatous (fibrosarcoma and osteosarcoma) elements, and there was an apparent transition of the squamous cell carcinoma into the fibrosarcoma, so the patient was diagnosed as so-called carcinosarcoma of the lung. Postoperative chemotherapy was performed, but the patient died seven months after the operation. In a review of 25 Japanse cases of pulmonary carcinosarcoma described in the literature since 1974, only 4 cases including our case had both the transposition between two elements and sarcomatous component with obvious differentiation. We thought that these cases occupied an intermediate position, between the so-called carcinosarcoma and true carcinosarcoma. Because some cases could not be classified according to the conventional pathological classification, we think that pulmonary carcinosarcoma might be classified by some other different method.

We report a 46-year-old female with Budd-Chiari syndrome associated with intractable ascites. Ultrasonography (US), hepatic venography and cavography showed an obstruction of the confluence of hepatic veins (HV) and severe stenosis of the hepatic portion of the inferior vena cava (IVC). An operation was performed by the suprahepatic approach under partial cardiopulmonary bypass. The severe stenosis of IVC was reopened by finger fracture, and the scar was resected. The obstructed HV was reopened by using forceps. Ringed Gore-Tex patch graft was secured over the incision of IVC. The blood flows by pulsed Doppler US before the operation were 0.73l/min in hepatic veins, 1.59l/min in IVC and 0.70l/min in potal vein. Postoperatively, these values were increased to 1.75l/min, 2.38l/min and 1.26l/min, respectively. Doppler waveform in the hepatic veins and the IVC changed from continuous flow to triphasic one. In this case, pulsed Doppler US was quite useful in evaluating the hepatic hemodynamics before and after the operation, as well as in assessing the therapeutic effects.

A 46-year-old woman had suffered from occasional attacks of upper abdominal pain and mild jaundice for 6 years, and had been diagnosed as hepatolithiasis with computed tomography and abdominal echography at elsewhere. On admission to the hospital endoscopic retrograde cholangiography (ERC) and percutaneous transhepatic cholangiography (PTC) revealed the double gallbladder associated with gallstones in the accessory gallbladder and with choledochal stones. It was diagnosed as double gallbladder with biliary stones (H-shaped type, Gross' classification type B). Both gallbladders were removed and a T-tube was placed in the common bile duct. The postoperative course was uneventful. The double gallbladder is a rare anomaly. Fifty-two Japanese cases of double gallbladder including this case have been seen. Correct preoperative diagnosis has been achieved in 28 (58%) of the 52 cases. The correct diagnosis rate has been increasingly improved with the progression of imaging techniques, such as 11% before 1980 to 48% after 1981. The association of gallstone was reported in 28 (61%) out of 46 cases. Except 9 cases in which no description was found about whether the stones existed in both gallbladders or not, 11 out of 19 cases had gallstones in the both gallbladder, and of the remaining 8 cases 5 had gallstone only in the accessory gallbladder like this case. Gallbladder carcinoma was found in 3 cases. These results indicate that both gallbladders should be removed.

Obturator hernia, first reported by Ronsil in 1724, is a relatively rare disease. Recent experience with 2 cases of this disease which were definitely diagnosed before surgery is described. Case 1: A 77-year-old woman was referred to the hospital, because she was suspected having an obstruction of the ileum at other hospital. There was a 3-year history of suffering from abdominal pain, vomiting, and right medial femoral pain which were not treated. On admission to the hospital. Howship Romberg sign and ileogram indicated obturator hernia. Laparotomy was performed and it revealed an incarcerated ileum into the right obturator foramen about 1m from the end of ileum. The ileum by about 6cm was resected. Case 2: A 76-year-old woman was admitted to the hospital because of poor appetite, nausea, vomiting, and abdominal distension. Various examination indicated obstruction of the ileum due to obturator hernia. Abdominal CT revealed the incarcerated intestine, 22mm in diameter, between the obturator and pectineal muscles. Laparotomy was carried out and it was found that the ileum incarcerated into the left obturator foramen 60cm from the ileum end, causing ileus. After treeing of the ileus was performed, the hernia hilum was closed with direct suture. Postoperative course was uneventful in both cases. Prompt image studies are helpful for the early diagnosis of obturator bernia in old thin women.

We present a case of giant mucinous cyst adenoma which occurred in the sacrococcygeal region and developed evacuational disturbance. A 41-year-old woman, who underwent sacral tumor resection on her birth, noticed a slowly growing mass in the perianal region and developed evacuational disturbance. She was referred to our hospital for the evaluation of tumor. Image studies suggested a recurred sacrococcygeal teratoma.The well-defined tumor was 1070 gm in weight and contained large amount of mucinous fluid. Histologically, it was mucinous cyst adenoma without any malignancy. There is no previous report of mucinous cyst adenoma occurred in the sacrococcygeal region, although it is common in the ovary and a few in the retroperitoneum. Histogenesis of sacrococcygeal cyst adenoma is unclear. We applied a technique of posterior gluteal thigh faciocutaneus flap because of a large amount of tissue and skin defect. This was proved to be useful from cosmetic and functional standpoint to cover the tissue defect as well as to reinforce the vulnerability of the pelvic floor after the resection of the tumor and some part of the levator ani muscle.

We report a case of asymptomatic duodenal carcinoid in a 50-year-old male patient. A filling defect was detected on routine upper gastrointestinal X-ray examination, and serious and a sessile polyp of 5 mm in diameter was endoscopically observed. Biopsy revealed typical features of carcinoid. Partial resection of the duodenal was performed. The tumor was confirmed in the mucosa which was type B by Soga's classification. Immunohisto-chemically, numerous secretary granules of gastrin-positive and somatostatin-negative were observed. This patient is doing well with no signs of recurrence 12 months after surgery.

Sigmoid volvulus has often been treated by operative procedures. More recently, however, there has been an increasing number of case reports in which nonoperative reposition has been successfully conducted through the use of an endoscope, especially the colon fiberscope. In this report we present one case of sigmoid volvulus in which nonoperative reposition was achieved using a colon fiberscope. In Japan, to our knowledge, nine studies have so far described endoscopic reposition for this disturbance, including 21 cases in all. This paper presents a discussion of some of those cases for which a detailed description is available together with our case. Compared to four patients who received emergency operation for this disturbance in our clinic, there was no difference with regard to age or duration of affliction; however, the leucocyte count at the time of presentation tended to be higher in the operated group. In addition to evidence of intestinal necrosis and peritoneal irritation, this seems to suggest that evidence of inflammatory signs such as an increased leucocyte count may be helpful in deciding whether to apply nonoperative reposition.

Although many cases of traumatic intramural hematoma in the duodenum in children have been reported, nontraumatic intramural hematoma in the large intestine is extremely rare. Recently, we experienced a case of intramural hamatoma in the sigmoid colon associated with Marfan's syndrome of the incomplete type (forme fruste). This case is described with some comments based on the literature. The patient lacked ophthalmic symptoms and hereditary signs, but had skeletal anomalies. The complication of rupture of a dissecting aortic aneurysm due to median cystic necrosis accompanied by mucoid degeneration occurred after surgery. The patient's condition was thus considered to be Marfan's syndrome of the incomplete type. It is said that lesions in the cardiovascular system in Marfan's syndrome are attributable to abnormalities in the proteins composing the connective tissue or of the system for controlling protein production. The presence of a degenerative condition, Marfan's syndrome, may also have been involved in the formation of the intramural hematoma in the sigmoid colon of this patient.

Small-bowel obstruciton due to gastric bezoar is rare. This case was a 73-year-old gastrectomized woman who was admitted with nausea and abdominal pain and was suspected of having acute pancreatitis. She ate a lot of persimmons several days before the onset of her symptoms and was diagnosed as having gastric bezoar by gastrofiberscopy. Three weeks later severe abdominal pain and distension appeared abruptly. An upper gastrointestinal contrast series demonstrated small-bowel obstruction with a bezoar and emergent operation was performed. A hen-egg-sized bezoar was impacted in the jejunum 30 cm distal from Treitz's ligament. It was removed through enterotomy.Fifteen cases of small-bowel obstruction due to gastric bezoars including this case have been reported during the last 10 years. In all cases conservative treatment failed and laparotomy was necessary. In gastrectomized patients like this case, it is probable that dislodgement of gastric bezoars caused small-bowel obstruction. Therefore, prophylactic measures such as dietary to prevent bezoar formation are important.

Out of breast cancer patients treaked over the past 11 years, clinical investigations were performed on 12 patients with breast cancers complicated by antecedent or concomitant cancers of other organs. The stages of the second cancers (other organ cancers) were relatively more advanced than the accompanying breast cancer and deaths were mostly attributed to these second cancers. A comparative study on the significance of adjunct therapies breast cancer surgery demonstrated that the stages of the second cancers in patients concomitantly given radiation therapy or chemotherapy were more advanced and that the prognosis was aggravated.