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Some patients with von Recklinghausen's disease are accompanied with skin neoplasms and varieties of other systemic lesions. We experienced a rare case of leiomoysarcoma of the duodenum complicated with von Recklinghausen's disease, and we reported it with the review of other reports.A-62-year-old female was admitted to the hospital because of general fatigue. Many cafe-lait spots and skin nodules were found, and abdominal tumor with severe anemia was also detected. After UGI, CT, and angiography were done the operation was performed under the diagnosis of leiomyosarcoma of the duodenum. The tumor was originated from the third portion of the duodenum and grew extramurally, so partial resection of the duodenum and the jejunum performed. This tumor was histologically diagnosed as leiomyosarcoma.Twelve cases of gastrointestinal leiomyosarcoma with von Recklinghausen's disease were reported in Japan. And this case was the third one having leiomyosarcoma originated from the duodenum. The possibility of having digestive disease must be taken into consideration when a patient of von Recklinghausen's disease complains of digestive dysfunction.

Undifferentiated sarcomas of the liver are very rare and have poor response to chemotherapy and radiation, with resultant poor prognosis. A case of undifferentiated sarcoma of the liver is reported. A 11-year-old woman complained of right hypochondial pain. A giant cystic tumor of the right lobe of the liver was detected by abdominal ultrasonography and CT, and this tumor was hypovascular by angiography. The resected specimen was surrounded by dense materials, with inside including necrotic materials, and no evidense of the tumor. But histological examination revealed immature tumor cells, so we diagnosed it as undifferentiated sarcoma of the liver. Postoperatively combination chemotherapy of VCR, ACD and CPA was performed, and the patient is disease free for 1 year and 5 months after surgery.

We experienced four cases of diffuse infiltrating carcinoma of the colon. In each case, curative resection was impossible because the carcinoma invaved beyond the wall of the colon and lymph node metastasis was far advanced. All the 4 patients died during 718 months after surgery. There was no ulceration or tumor in the resected specimens except one in which shallow erosion was observed. Histological examination revealed poorly differeantiated adenocarcinoma in two cases, signet ring cell carcinoma and mucinous carcnoma in each one case, highly invaded lymphatic vessels being observed in all cases.To our knowldege, 160 cases of diffuse infiltrating carcinoma of the colon have been already reported in Japan. When compared with other colon carcinomas diffuse infiltrating carcinoma is predominant in youngers, most commonly found in the lower colon, and often has shorter period of the disease. There are few curative resection cases, and most cases resist to chemotherapy and radiotherapy. The prognosis is extremely poor. Histopathologically these carcinomas are said to be comprised of signet ring cell carcinoma, poorly differentiated adenocarcinoma, and diffuse infilteating type due to invasion of lymph vessel and interstitial proliferation, however, we often encounter complicated features, in that further studies of its histologic genesis are probably needed.

Esophageal stricture concomitant with rheumatoid arthritis (RA) is rare, and besides, further concomitance of early esophageal cancer has not been reported. Here we describe a case of early esophageal cancer concomitant with RA which presented with esophageal stricture, together with a review of the literature.A 55-year-old female, who had been treated for RA for 14 years, visited our hospital due to dysphasia. Esophagography showed a funnel-shaped stricture of the thoracic inferior esophagus. Esophagoscopy with Lugol staining revealed an insular superficial elevation on the oral side of the stricture, and biopsy revealed an esophageal carcinoma. The thoracic lower esophagus and cardiac part of the stomach were resected.Macroscopically, an inflammatory stricture (3cm in major axis) was observed in the thoracic inferior esophagus, and in contact with its oral edge, a superficial elevated tumor (1.5×1.2cm) was present. Histological examination showed fibrosis involving mainly the submucosal layer and inflammatory cell infiltration at the site of the stricture. The tumor on the oral side of the stricture was moderately differentiated squamous cell carcinoma. The patient is alive without any symptom of recurrence 3 year and 5 months after the operation.

Hepatic portal venous gas is a rare complication observed in a case of bowel necrosis and the like, and regarded as a sign of poor prognosis. We report a case of non-occlusive bowel infarction accompanied by hepatic portal venous gas. The case was an 87-year-old woman who complained of lower abdominal pain. Hepatic portal venous gas was observed on a plain abdominal X-ray film and abdominal ultrasound examination, emergency laparotomy being performed under a diagnosis of panperitonitis. Ileum, from 140cm to 70cm oral from the Bauhin valve, fell into Iimited necrosis, and resection of this necrotic bowel was performed. Angiography carried out on the resected specimen revealed no arterial obstruction, and histologically there was only non-specific inflammation. Although it was not typical, we diagnoses as non-occlusive bowel infarction from these findings. Postoperatively the patient was doing relatively well, and discharged on the 47th day after surgery.

A 44-year-old woman has been followed with Crohn's disease was admitted with the complaint of acute abdominal pain. An emergency operation was performed with the diagnosis of GI tract perforation. A free perforation of the transverese colon was observed. Partial resection of transverse colon was carried out. Pathological examination revealed Crohn's disease of the colon. Postoperatively a fistula of the anastomosis and an abcess of the ascending colon occurred, so the parts of the colon with abnormal lesions were resected in a two-stepapproach. A free perforation of the colon in Crohn's disease is uncommon and 9 cases have been reported in Japan.

The syndrome of massive small intestinal infarction caused by mesenteric artery occlusion is known generally well. But little attention has been paid to a mild ischemic disease of the small bowel similar to ischemic colitis. Here we report a case of mild ischemic inflammation of the jejunum resulting from the obstruction of the superior mesenteric artery distal to the origin of the ileocolic artery. A 72 years old male visited our hospital with a history of abdominal fullness and vomiting lasting 6 days. His abdomen was distended but no tenderness or muscular defens were detected. Since a plain X-ray of the abdomen revealed remarkably little bowel gas, an emergency laparotomy was done and the preoperative diagnosis was small bowel obstruction. at operation, a 30cm segment of the distal ileum had turned reddish and thickened, so a resection of this segment was performed. And the superior mesenteric artery was palpated and found to have a hard induration. The resected jejunum was diagnosed histologically as having ischemic inflammation. The postoperative course was uneventful and postoperative arteriography revealed an obstruction of the superior mesenteric artery distal to the origin of the ileocolic artery. We concluded that the segmental lesion of the jejunum was a mild ischemic change caused by the distal obstruction of the superior mesenteric artery.

Nine hundred forty-five patients with colorectal cancer were operated on at Ogaki Muncipal Hospital during the 16 year period from 1970 to 1985. Thirty-four patients (3.6%) who died within 30 days of surgery were studied clinically and the risk factors associated with the operation for colorectal cancer are discussed. Peculiarly, many of the operative deaths occurred in the elderly, with tumor complications such as perforation, obstruction and so on, and their cancers were far advanced. So even whith light operations such as colostomy, we were seldom able to save them. The mortality rate in patients 75 or more years old was 8.5% (15/176). For those who had complications with their tumors the rate was 8.1% (24/279) and with far advanced cancers it was 7.1% (13/183). Each of those mortalities was significantly higher than of the control group. In conclusion, we suggest that most important risk factors associated with the operation for colorectal cancer are the elderly, and the patients who have complications with tumors and far advanced cancers.

We reviewed 21 patients with resected hepatic metastases from colorectal cancer and considered the significance of hepatic resection and hepatic artery infusion (HIA) for the colorectal hepatic metastases. The mean survival of the hepatic resection group was 23 months and the cumulative 3-year survival rate was 37.4%. The recurrences after hepatic resection were observed in nineteen cases (90.5%). The sites of the recurrences were liver, lung, and local recurrence in that order of frequency. The extent of liver metastases was divided into three groups (H1, H2, H3). Each group was analyzed with regard to three kinds of treatment: 21 cases with hepatic resection, 23 cases with arterial infusion via the hepatic artery (HAI(+)), and 51 cases without hepatic resection or arterial infusion (HAI(-)). The survival rate for the each therapy was compared in the H1, H2 and H3 groups. In the H1 group, the cumulative 3-year survival rate was 43.7% (hepatic resection), 0% (HAI(+)), 6.5% (HAI(-)). In the H2 group the cumulative 2-year survival rate was 0% (hepatic resection), 25.7% (HAI(+)), and 35.0% (HAI(-)). In the H3 group the 2-year survival rate was 0% (HAI(+)) and 14.2% (HAI(-)). There were no statistically significant differences among the therapeuetic methods in each group. But we considered that hepatic resection in H1 was somewhat effective.

A case of primary hyperparathyroidism with four enlarged glands is presented in which a few mitotic figures were observed. The patient was a 37-year-old male. He had a past history of primary pyperparathyroidism. An operation had been carried out in 1970, and two enlarged glands had been removed. In 1986, recurrence of the hyperparathyroidism was confirmed and the remaining two glands were subtotally extirpated leaving 1/2 of the smallest one. Histological feature of the four glands were all the same. Hyperplasia of the chief cells were observed. They formed cords, nests, acini, or follicules. A few giant cells and mitotic figures were also observed. In primary hyperparathyroidism, it is sometime difficult to diagnose the cause histologically. Especially, the differential diagnosis between adenoma and hyperplasia is almost impossible. Clinically, if only one enlarged gland is observed, the lesion is though to be adenoma, and in the cases with four enlarged glands, the diagnosis of hyperplasia is followed. Although a few authers have reported that mitosis can be observed even in primary hyperplasia of the parathyroid glands, it has been thought that mitosis is a common finding not for primary hyperplasia but for parathyroid cancer. From the viewpoint of this, our case with four enlarged lgands is intersting in clinical expression of hyperplasia but histological featurte of mitosis.

Clinicopathologic findings in 51 patients below 40 years of age with carcinoma of the colon and rectum were reviewed and compared with those of a control group containing 812 patients ranging from 40 to 74 years of age.There were no significant differences between the two groups with regard to sex distribution, lesion distribution, tumor size, tumor differentiation, depth of invasion, and peritoneal dissemination. Liver metastasis and lymph node metastasis were more frequent in the younger group than in the control group, and therefore we considered that the colorectal cancer in the younger group had more malignant potential.Forty-nine patients (96.1%) of the younger group underwent resection, but curative resection was performed in only half of the cases, which was lower than the figure of 70.9% in the control group. The reasons for non-curative resection were mainly peritoneal dissemination and liver metastasis. The cumulative five-year survival rates were 43.0% (all cases) and 86.7% (curative resection), and these figures were not significantly different from those of the control group.Therefore it is important to perform curative resection in the young as well as aged patients.

For the past 20 years, we experienced 6 cases of ruptured abdominal visceral aneurysms. These included 3 cases of middle colic, 1 of splenic, 1 of right hepatic and 1 of submucosal gastric aneurysm. The 3 cases of middle colic aneurysms had abdominal pain with shock caused by intra-abdominal bleeding, and underwent emergency operation. The other 3 cases had gastrointestinal bleeding. Of the 3 cases, splenic aneurysm ruptured into the pancreatic duct, right hepatic aneurysm ruptured into the bile duct and submucosal gastric aneurysm ruptured into the stomach, their bleeding points being detected by arteriography preoperatively. All 6 cases were treated surgically without significant postoperatie complications. In our country, there were 117 caes of ruptured abdominal visceral aneurysms for past 20 years. They included 37 cases of splenic, 29 of hepatic, 15 of submucosal small intestinal, 10 of pancreaticoduodenal, 8 of superior mesenteric, 7 of gastric, 7 of colic, 2 of celiac and 2 of interior mesenteric aneurysms. Of the 117 cases, 50 cases had intra-abdominal bleeding and 63 cases had gastrointestinal bleeding. Mortality rate of them was 28.3%.

Benign tumors of the extrahepatic bile duct are rare. The present paper describes a case of multiple benign polyp of the extrahepatic bile duct, together with a review of 26 cases reported in the Japanese literature.A 74-year-old woman visited our hospital with epigastralgia. She was operated on for choledocholithiasis, and multiple polyps were found in the common bile duct during surgery.The extrahepatic bile duct was resected and choledocho-jejunal Roux-en-Y anastomosis was done. Histological findings of the polyps revealed inflammatory hyperplasia.Benign tumors of the extrahepatic bile duct frequently occur in middle-aged and elderly patients, and icterus is the most common complaint. A precise preoperative diagnosis is difficult. If a filling defect or an abnormal shadow is found upon operative cholangiography, the common bile duct should be opened and cholangioscopy should be performed. The standard surgical treatment of the disease is resection of the bile duct, but hepatectomy or pancreaticoduodenectomy is sometimes necessary. However, excessive treatment should be avoided as for as possible, sine this disease is benign.