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症例は72歳，男性．嘔吐を主訴に当院救急外来を受診した．血液生化学検査では軽度の貧血を認めたほかは異常を認めず，CEA，CA19-9も正常範囲内であった．腹部超音波検査では脾臓の大部分を占める小嚢胞の集簇を伴う充実性の腫瘤を認め，脾動脈周囲にリンパ節の腫大を認めた．腹部CTでは膵尾部に接して脾臓に淡い造影効果を伴う腫瘍を認めた．腹部血管造影では，脾臓全体に広がる血管増生像を認めた．上下部消化管内視鏡検査では，胃粘膜下腫瘍と大腸ポリープを認めた．脾原発血管肉腫を第一に疑い，膵体尾部切除，脾摘出術，胃部分切除術を施行した．病理組織診断は脾浸潤，胃転移を伴う膵腺房細胞癌であった．術後1年経過した現在再発徴候なく経過観察中である．

Background While using an irrigation-suction instrument for laparoscopic surgery, irregular adsorption of fatty tissue may damage the tissue or obstruct continuous sucking. A new device made up of a divided silicone drain tip to prevent irregular adsorption was reported. Materials and methods A cigarette-type silicone drain was cut 4 cm in length. It was slipped over the instrument to cover the side holes, leaving 1.0 to 1.5 cm free from the end of the instrument. It was fixed by means of 1-0 silk above the side holes. Finally, the free tip was divided vertically into 4 even pieces like octopus arms. Results This device could prevent the irregular adsorption of fatty tissue (greater and lesser omentum, or epiploic appendices) and could suck saline, fresh, and coagulated blood almost continuously. Conclusions This simple and easy device facilitated the prevention of irregular adsorption of fatty tissue while using an irrigation-suction instrument for laparoscopic surgery.

Background. We recently developed a novel system of direct hemoperfusion under hepatic venous isolation in an attempt to achieve high-dose intraarterial chemotherapy for patients with malignant liver tumors. We report here the results of treatment of these patients with advanced hepatocellular carcinoma. Methods. Adriamycin (100 to 150 mg/m2) was administered into the hepatic artery of 15 patients, under conditions of extracorporeal drug elimination by direct hemoperfusion under hepatic venous isolation. Hepatic venous isolation was accomplished mainly by the double-balloon technique with an occlusion catheter and a balloon catheter. The isolated hepatic venous blood was filtered by direct hemoperfusion and pumped to the left axillary vein. Results. During 5 minutes of adriamycin infusion, the mean drug extraction ratios of the direct hemoperfusion filters were 91%±9% (mean±SD). The amount of drug removed by the system was 26.4%±16.0% of the amount of drug administered. Two patients died, one of necrotizing pancreatitis and the other of hepatic arterial thrombosis. Both deaths were related directly to the hepatic arterial catheter. Other side effects included hemolysis related to the system of hemoperfusion (87%), chemical hepatitis (80%), leukopenia less than 3000/mm3 (67%), alopecia (33%), and nausea and vomiting (20%). Nine (64%) of 14 evaluable patients had objective tumor responses, with a median duration of response of 6.2 months. Conclusions. This approach offers an effective therapeutic option for patients with advanced hepatocellular carcinoma.

The minimal graft volume still remains unclear in partial liver transplantation (PLT). The purpose of this study was to determine whether portal decompression with the aid of a portahepatic vein shunt (PHVS) could improve survival in the extremely reduced size liver transplantation in dogs. After donor hepatectomy, the liver was reduced to 27% of the recipient whole liver consisting of the right lateral and caudate lobes. The reducted grafts with PHVS (group A,n = 6) or without PHVS (group B,n = 6) were orthotopically transplanted. All group A animals survived more than 3 days (the longest: 7 days), whereas all group B animals died within 48 h (P

The efficacy of the femoro-hepatic arterial heated bypass in liver hyperthermia was evaluated using mongrel dogs (n = 4). Extracorporeal circuit contains a centrifugal pump and a heat exchanger consisting of warmer coils and a water bath kept at a temperature of 47C. Mean hepatic parenchymal temperature showed rapid and isolated elevation up to 42.8°C, while the mean rectal temperature remained less than 39.3°C. Therefore, we conclude that this method is simple and highly effective to perform regional liver hyperthermia.

A new simple technique consisting of direct hemoperfusion under infrahepatic inferior vena caval isolation for intraarterial chemotherapy of pelvic tumors is herein described. The inferior vena cava is occluded at the infrahepatic level by means of balloon inflation using a balloon-tipped catheter (16F), which is placed through the right greater saphenous vein. The isolated infrahepatic vena caval blood is withdrawn by a centrifugal pump through a catheter (16F) in the contralateral greater saphenous vein and is filtered by direct hemoperfusion during intraarterial infusion of anticancer drugs. Venous reentry is provided by the central lumen of the balloon-tipped catheter. This procedure was used sequentially on two different occasions to treat a patient with an extensive pelvic tumor. Good hemodynamic stability and a reduction of the systemic drug toxicities were confirmed in both trials. Therefore, we believe that this technique is technically feasible and highly effective in reducing systemic toxicities during high-dose intraarterial chemotherapy for pelvic tumors.

The minimum graft volume still remains unclear in reduced-size liver transplantation (RLT). This study reports the improved survival of canine RLT using a quarter graft with the aid of a portahepatic vein shunt (PHVS). In beagles, the donor liver was reduced to the right lateral and caudate lobes (quarter graft) with or without provision of PHVS, and transplanted orthotopically in the recipient. The PHVS was established by an end-to-end anastomosis of the portal vein branch and the hepatic vein in the resected left lateral lobe. Liver chemistries including arterial blood ketone body ratio (AKBR) were serially measured during and after surgery. All seven animals with PHVS survived more than 3 days (mean +/- SD; 5.3 +/- 1.7 days), whereas all six without PHVS died within 3 days (1.8 +/- 0.8 days, P < 0.01). Portal vein pressures immediately after recirculation in animals with and without PHVS were 8.5 +/- 1.2 mmHg and 16.9 +/- 3.1 mmHg, respectively (P < 0.01). Regardless of the presence or absence of PHVS, AKBR dropped to a level lower than 0.7 during the anhepatic period and returned promptly to above 1.0 as early as 30 min after recirculation. Thereafter, the AKBR values in animals with PHVS remained higher than 1.0, whereas those in animals without PHVS showed a progressive decrease, showing a statistically significant difference between the two groups after 12 hr (P < 0.05). Graft function, as assessed by AKBR, was well correlated with survival and other liver chemistries. These results indicate that, in an extreme RLT, portal hypertension is a risk factor predisposing to graft failure, most likely by increasing microvascular injury after recirculation.

We report herein the case of a 26-year-old man who suffered a spontaneous splenic rupture during the course of a rubella infection. Initially, he presented with a high fever accompanied by a skin rash extending from the body trunk to the extremities and was admitted to hospital 3 days after onset for sudden upper abdominal pain radiating to both shoulders. On admission, he was pale and sweating with hypotension. An abdominal ultrasonographic study revealed a collection of fluid in the perisplenic space and exploratory laparotomy confirmed an intraabdominal hemorrhage from a ruptured spleen. The patient was treated by splenectomy and recovered uneventfully. The excised spleen was found to be moderately enlarged with a denuded capsule. Because the patient had no history of any external trauma and a positive serological test for rubella, we concluded that rubella contributed to the spontaneous splenic rupture in this case.

We investigated the effect of oxygen supply on hepatic cellular viability during cold perfusion storage of rat livers. A perfluoro-N-methyldecahydroisoquinoline (FMIQ) emulsion is used as an oxygen carrier. The composition of the perfusate containing 20 w/v% FMIQ is essentially the same as the University of Wisconsin (UW) solution except for the exclusion of hydroxyethyl starch. Rat livers were perfused at 4 degrees C for up to 24 h with either UW solution (group I, oxygenated; group II, unoxygenated) or FMIQ solution (group III, oxygenated; group IV, unoxygenated). After perfusion storage, the livers were reperfused with warm (37 degrees C) oxygenated or cold (4 degrees C) unoxygenated Krebs-Henseleit bicarbonate buffer, and nuclear trypan blue uptake was measured as the index of cell death. With warm oxygenated reperfusion, there remained less than 2% noviable parenchymal cells up to 24 h, regardless of perfusate or oxygenation. In UW-perfused livers, the proportion of nonviable nonprenchymal cells (NPC) increased progressively regardless of oxygenation, the values in groups I and II in the periportal field at 24 h being 39.9 +/- 4.7% (mean +/- SD) and 36.5 +/- 4.2%, respectively. By contrast, in FMIQ-perfused livers, dye uptake by NPC was significantly reduced with oxygenation (16.9 +/- 5.7% and 39.4% +/- 9.1% at 24 h in groups III and IV; P < 0.001). With cold unoxygenated reperfusion, livers in groups I, II, and IV showed a significant decrease of nonviable NPC, while those in group III showed no significant changes. These data indicate that oxygen supply during perfusion storage of the liver may ameliorate lethal injury to NPC precipitated during reperfusion.