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We experienced two cases of aneurysm arised in the dorsal pancreatic artery which is a relatively rare entity. Casel involved a 53-year-old man who was informed to be a HCV-antibody carrier from blood donor test. Ultrasonography ad celiac angiography revealed an aneurysm of the dorsal pancreatic artery. So, he underwent excision of the aneurysm. Histopathologically, atherosclerotic change and aberrant pancreatic tissue were found in the wall of the aneurysm. Case 2 involved a 50-year-old woman who was suspected of having a splenic artery aneurysm with ultrasonography on regular medical checkup. Angiography revealed a dorsal pancreatic aneurysm. Histologically atherosclerotic ahgnge in the aneurysm wall. Aneurysms ofinternal organ arteries represent 4_??_5% of all aneurysms, Dorsal pancreatic artery aneurysms amount to 3% or less among all internal organ artery aneurysms. There have been another three cases of dorsal pancreatic artery aneurysm in the Japanese literature so far. The pathogenesis of the disease is still unknown. Of our he disease is still unknown. Of our two cases, one case had aberrant pancreatic tissue in the arterial wall. It is a unique finding that has not seen in such cases as long as we could review.

This report describes a case of submucosal small cell gastric cancer which was difficult to distinguish from a tumor of the head of the pancreas. A 50-year-old man complained of epigastric pain and underwent investigations which led to the discovery of a mass in the head of the pancreas. A submucosal tumor of the stomach or a tumor of the head of the pancreas were both considered possible, but no definite diagnosis could be made. The patient underwent laparotomy and pancreaticoduodenectomy because the mass proved difficult to resect. Perioperative gross findings provided no reliable evidence to establish a diagnosis. Histological examination of the resected specimen revealed a tumor, 8×7×6cm, extending outwards from the pyloric region on the lesser curvature of the stomach and infiltrating into the uncinate process of the pancreas. The histological diagnosis was primary small cell gastric cancer with partial differentiation to squamous cell carcinoma and adenocarcinoma. The tumor showed positive staining with Grimelius stain. Thirty cases of small cell gastric cancer, including this case, have been reported in Japan. Less than 0.2% of all gastric cancers are thought to be of this histological type. Gastric samll cell cancer often develops as a submucosal tumor and over 5cm in diameter at first detection; generally has a poor prognosis; and is often associated with distant metastasis. This patient had lymph node metastasis 8 months, and died 14 months following surgery.

The incidence of non-recurrent laryngeal nerve is claimed to be 0.3-0.9%, and this anatomical anomaly is important in thyroidectomy and parathyroidectomy. We encountered a right non-recurrent inferior laryngeal nerve, arising from the cervical trunk of the vagus and passing directly to the larynx in a 65-year-old female patient who underwent total parathyroidectomy. The anomaly of the recurrent nerve is explained by the process of nerve and blood vessel development from the embryologic branchial arches, and since it is known to be associated with anomalous origin of the right subclavian artery from the aortic arch, it is only observed on the right side. In this case, postoperative IV-DSA confirmed the right subclavian artery arising from near the peripheral site compared to the left subclavian artery. Recurrent nerve injury is one of the most important complications of thyroidectomy and parathyroidectomy, and the neural anatomy must be borne in mind especially at the right side.

Although for cases undergoing palliative surgery of abdominal aortic aneurysms (below: AAA), surgical replacement with a Y-shaped artificial blood vessel is an operation with a relatively high degree of safety, in recent years with the expansion of indications the elderly and high risk patients have tended to increase. Forty-six patients who underwent AAA palliative surgery at our faculty from 1978 through 1989 were classified them according to termination into 3 groups, namely, early death, late death and survival, and compared for age, maximum diameter of aneurysm, operating time, amount of blood loss and preoperative risk factors. In evaluating preoperative risk factors, we used a risk index score (below: RIS) by assigning points to 7 items (I. cardiac function, II. renal function, III. respiratory function, IV. cerebral vascular disorder, V. hypertension, VI. diabetes and VII. hyperlipidemia). Based on the results of this study on the propriety of this RIS, the following conclusions, could be obtained, (1) Among the 3 groups, a statistically significant difference was observed only in regard to RIS. (2) In comparing the survival rate of the 3 groups according to high (H), moderate (M) or low (L) RIS total scores, a significant difference after 3 years was observed between the H group and the other 2 groups, L and M. (3) All cases of early death had high RIS scores. (4) This RIS is considered to be appropriate as an objective evaluation method of high risk.

Two cases of popliteal artery aneurysm presenting with symptoms of acute arterial occlusion are reported. Case 1: A 79-year-old female was diagnosed as having bilateral popliteal artery aneurysms with thrombosis of the right aneurysm by conventional angiography and CT. This patient was treated with expanded PTFE bypass grafting with resection of the bilateral aneurysms. Case 2: A 60-year-old male was diagnosed as having a right popliteal artery aneurysm by conventional angiography and MRI. This patient was treated with autovein bypass grafting with ligation of the aneurysm for exclusion. Popliteal aneurysms semetimes complicate by thrombosis, embolism, and amputation, therefore elective replacement of the aneurysms at the time of diagnosis are really recommended.

Various symptoms in obstructive arterial disease seem to be derived from ischemia due to a decreased blood flow in the peripheral tissues. Diagnostic imaging is usually used to determine the pathological condition of the disease. Determination of tissue blood flow, however, is a more accurate diagnostic method. By using the electrochemical hydrogen clearance method, which is less invasive, tissue blood flow was determined at the ischemic gastrocnemius muscle during rest and exercise, before and after revascularization. With regard to the site of obstruction, tissue blood flow was found to be lower in the peripheral region than in the central. The degree of increase in tissue blood flow during exercise was also lower in cases of obstruction in the peripheral region. Comparison of blood flow before and after revascularization demonstrated the usefulness of determining local tissue blood flow. In addition in cases of diabetic angiopathy, the degree of increase in tissue blood flow during exercise was low, even though there was no obvious obstruction on arteriography, suggesting a pathological nature different from that of arteriosclerosis.