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79歳，男性．心窩部痛を主訴に近医を受診し，上部消化管内視鏡検査にて前庭部胃癌と十二指腸乳頭部癌を認め当院に紹介された．術前生検ではいずれも腺癌と診断され，標準膵頭十二指腸切除術により両者を一期的に切除した．病理組織学的検索では胃は腺癌（por2>tub2，pT2（MP），pN1，fStage II）で，十二指腸乳頭部病変は免疫組織学的検索にてsynaptophysin，chromogranin A陽性の内分泌細胞癌（pT3，pN1，fStage III）と診断された．また，複数のリンパ節に内分泌細胞癌および腺癌の起源の異なる転移を認めた．術後6カ月目で内分泌細胞癌が肝転移再発をきたし，13カ月目に癌死した．十二指腸乳頭部内分泌細胞癌の報告は複数あるが，胃癌との重複例はこれまで皆無であった．また，自験例は膵頭十二指腸切除術により両者の切除が一期的に可能であった興味ある症例と考え報告する．

69歳，女性．黄疸を主訴に近医受診し肝門部胆管癌と診断され，精査加療目的にて当科紹介入院となったが，肝転移を認めたため手術適応外と判断し，gemcitabine（GEM）を投与開始し外来継続投与を行った．投与開始後148日目に下肢脱力感を訴え，両側下肢近位筋の軽度筋力低下を認めたが，血液検査で異常なく経過観察となった．しかし，両下肢疼痛・筋力低下が進み，投与開始後162日目に両下肢疼痛・近位筋筋力低下，発熱，乏尿を主訴に当院救急外来受診となった．血液検査で炎症反応，筋原性逸脱酵素の上昇を認め，急性腎不全の所見で入院となったが，安静，輸液にてcreatine kinase（CK）は低下を示し，利尿を得た．疼痛，筋力低下は徐々に改善し入院後13日目からリハビリテーションを開始し，症状発現後約2カ月で症状消失した．原因精査の結果，GEMによる横紋筋融解症が最も強く推測された．

A 62-year-old woman was admitted to the hospital because of a right breast tumor. Previous history disclosed that she underwent a mastectomy for a malignant lymphoma of the left breast with 3courses of VEMP regimen 6years before. Thereafter she was doing well without any sign of recurrence until the contralateral breast mass occurred. Based on the result of an aspiration biopsy cytology (ABC) and a rapid progress of the tumor, it was diagnosed as malignant lymphoma of the breast. Further, an exploration of the wholebody revealed a tumor in the uterus. As no other lesions were detected, a mastectomy and hysterectomy were performed. Histological study of the resected materials revealed diffuse large cell type that was more malignant than the former lesion, but it was obscure whether these lesions were recurrence from the malignant lymphoma of the left breast or metachronous occurrence. In the treatment of malignant lymphoma, the patient should be strictly followed for a long time by entertaining a probable relapse.

Intestinal intussusption is primarily a disease of infants and occurs in adult in a relatively low frequency. Recently we experienced an adult case of idiopatic intussusption of the intestine. A 20-year-old man was seen at the hospital because of right lower quadlant pain. There was tenderness in the same region and a most probable diagnosis was appendicitis. With abdominal ultrasonography a diagnosis of iliocecal intussusption was made. During operation it was found that the cecum and terminal ileum was investigated into the ascending colon, but it was sponteniously released. We were not able to rule out a possible organic disease as a cause of the condition, and performed an ileocecal excision. No any lesion was detected in the excised intestine histopathologically. In a recent 11-year-old period a total of nine adult patient have been treated at the hospital, and two patients of them had an unknown cause. Eight out of nine patients underwent laparotomy, all of whom were definitely diagnosed as having an intestinal intussusption by preoperative abdominal ultrasonography. The importance of abdominal ultrasonography as a diagnotic tool should be emphasized.

We experienced an operated case of gastric cancer with an abnormally high level of serum α-fetoprotein (AFP). A 66-year-old man was admitted to the hospital because of black stool. Close examination indicated that the patient has a gastric cancer. Subtotal gastrectomy was carried out. Preoperative imagings and intraoperative findings disclosed no hepatic metastasis. AFT level once decreased to 41ng/ml on the 60th postoperative day from preoperative level of 6901ng/ml, but thereafter the AFT level rapidly increased. The patient died of liver failure due to hepatic metastasis 4 months after the operation. Immunohistochemical examination confirmed the localization of AFP in moderately differentiated ductal adenocarcinoma cells. In addition the Concanavalin A-reactive rate was as high as 87%, indicating the correlation with hepatic metastasis and revurrence.

We experienced three cases of acute gangrenous cholecystitis following a lower gastrointestinal operation. Case 1: A 76-year-old man developed acute gangrenous cholecystitis after left hemicolectomy for a cancer of the descending colon. Case 2: A 51-year-old man had intractable fistula due to perforation of the small intestine after appendectomy for acute appendicitis, and then developed this disease during a long fasting period. Case 3: A 77-year-old man manifested this disease 5 days after sigmoidectomy for perforation of diverticulum in the sigmoid colon. In all 3 cases laparotomy was carried out within several days after the onset and acalculous gangrenous gallbladder was confirmed. It is supposed that fasting due to lower intestinal operation and following initiation of ingestion can be a probable trigger for this disease.

We investigated postoperative complications including pneumonitis, pleural effusion, intraabdominal abscess, and bile leakage in 134 patients treated with hepatectomy with special references to the method of hepatic transection, the extent and the site of resection. Patients were categorized into three groups according to the methods used for hepatic transection: microwave tissue coagulator (MTC) group (n=25); cavitron ultrasonic surgical aspiration system (CUSA) group (n=52); and the other group (n=57). Comparisons were also made among patients having limited hepatic resection (_??_HrS:n=70), intermediate resection (Hr1:n=20), and extensive resection (Hr2_??_;n=44). Furthermore, the limited resections of S7 and S8 were distinguished from those of other sites. Each postoperative complication in the MTC group tended to be higher than those in the other two groups. The rate of pneumonitis reached to as high as 32% in the MTC group, which was significantly higher than that (5.8%) of the CUSA group (p

Fifteen patients who were admitted to our department with hepatocellular carcinoma (HCC) and under 40 years of age were reviewed. The rate of HBs antigen positive patients was 78.6%, whereas that of association of cirrhotics was only 20.0% and most patients showed relatively good liver function. Periodic follow-up for liver dysfunction had been performed in only 3 of 8 patients. Twelve patients (80%) had abdominal pain directly caused by advanced tumors and 3 of these patients were admitted to the hospital in a state of acute abdomen due to ruptured tumor. Most patients had highly advanced HCC; 53.3% had tumors larger than 10cm in diameter and 80% had multiple intrahepatic tumor spreads. Survivals of these patients were extremely short and only 3 patients survived over one year. However, 2 patients undergoing extended hepatectomy showed relatively long-term survivals more than a year. These results indicated that younger patients with HCC were rarely admitted to the hospital because of their relatively good liver function despite higher positive rate for HBs antigen. Therefore, close follow-up in such younger patients is of particular importance for the early detection of HCC.