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症例は75歳，女性．心窩部不快感を主訴に上部消化管内視鏡検査を施行され，幽門狭窄を認めた．粘膜面に異常はなく幽門部に浮腫状狭窄を認めた．生検では，悪性像は認めなかった．腹部CT検査ではびまん性壁肥厚を認め，腫瘍マーカーはCA19-9値が735U/mlと高値であった．確定診断は得られなかったが，症状の改善を認めず，CA19-9が高値であり，胃壁の肥厚を認めることから，悪性の可能性を疑い手術を施行した．切除標本では壁の肥厚は認めず，狭窄部の硬化のみであった．病理診断では粘膜上皮に癌を認めず，粘膜下浸潤型の高分化型腺癌であった．免疫染色でCA19-9が陽性であり，術後に血清のCA19-9値は正常化したため，CA19-9産生胃癌と診断した．粘膜面に異常がなく，生検で悪性像が得られない幽門狭窄を認めた場合には癌の可能性も考慮すべきである．

Seventy-seven cases of rectal cancer undergoing low anterior resection of the rectum at the hospital from January 1985 to August 1993 were subjected to a study comparing for postoperative complication and the hight of anastomosed site by reconstruction procedures. There were 28 cases of manual suture and 49 cases of mechanical suture. The 49 cases included 15 cases of EEA method and 34 cases of double stapling technique (DST) in which EEA is inserted into the anus and is connected and anastomosed with the anvil of oral-side colon. No significant difference was noted in operative time among these procedures. Postoperative anastonotic leakage occurred in 10.7% of manual suture group; 13.3% of EEA group; and 5.9% in DST group. Wound and intraperitoneal infection developed in each one case from all groups. One EEA case and four DST cases had stricture at the anastomosed site, but none in manual suture cases. When the hight from the anal verge to anastomosed site was compared among three groups, DST was able to anastomose at a lower position than the others.

We experienced an extremely rare case of esophageal perforation due to a partial denture presenting with 3 perforations and bilateral pneumothorax, which was successfully managed by conservative treatments. This paper describes the case with a review of such perforated cases due to a partial denture seen in the Japanese literature for the past three decades. A 60-year-old man was seen at the hospital, because he accidentally swallowed a partial denture. It was impossible to take out under a hardscope, but was successfully taken out by using a balloon catheter for sclerotherapy under a fiberscope. Immediately after that remarkable bilateral pneumothorax, mediastinal emphysema, and subcutaneous emphysema developed. In addition esophagography revealed extramural leakages of contrast medium in the vicinity of the second physiologic stenosis of the esophagus and just above the diaphragm. A diagnosis of esophageal perforation was made. Conservative treatments including intermittent suction of the esophagus, intravenous hyperalimentation, and administration of antibiotics were performed. The clinical course was uneventful and the perforations were completely closed on the 15th hospital day. The patient was discharged from the hospital on the 19th day.

A 52-year-old woman was seen at the hospital for close examination, because she was pointed out having a splenoma at a nearby hospital when she visited there complaining of abdominal distention. There were no fever, anemia, and jaundice. No superficial lymph nodes were palpated. In the abdomen the spleen extending from an area under the left costal arch to the infraumbilical area was palpated. Abdominal CT and echography revealed a giant splenoma with homogenous internal structure. The liver had no morphological abnormalities nor tumor shadow. No lymph node swelling was also shown. There were no hepatitis nor abnormal findings in peripheral blood (white blood cell fraction), blood biochemical tests, tumor markers, neutrophilic Al-p value, and bone marrow picture. No causative disease for the splenoma was able to be determined preoperatively, and a possibility of lymphoma arising in the spleen or leukemia was not ruled out. So, splenectomy was performed in order to diagnose and to alleviated the symptoms. The excised spleen was 1, 860 g in weight and 24.3×14.7×5.8cm in size. Pathologically it was diagnosed as hairy cell leukemia. This disease is uncommonly encountered, but we should entertain it as a probable differential diagnosis for giant splenoma. This paper presents this case with a review of the literature.