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今回,われわれは腹膜垂によりイレウスとなった症例を2例経験したので報告する。症例1は26歳,男性.腹痛を主訴に前医より紹介となった.イレウス,消化管穿孔,汎発性腹膜炎の診断で緊急手術を施行した. S状結腸腹膜垂が膀胱と癒着し索状物となっていた.この腹膜垂により小腸は絞扼され穿孔していた.穿孔小腸を切除した.症例2は67歳,女性.嘔吐,腹痛を主訴に来院し原因不明のイレウスによる汎発性腹膜炎の診断で緊急手術を施行した. S状結腸腹膜垂がS状結腸間膜に癒着しループ状の索状物となっており小腸が嵌入し壊死に陥っていた.壊死小腸を切除した. 2例ともに術後経過は良好であった.腹膜垂によるイレウスの報告は,本邦において自験例2例を含め12例であり,世界的にも33例である.若干の文献的考察を加えて報告する.

It has been reported that caffeine (CA) metabolism in humans is catalyzed by cytochrome P450(CYP)1A2. Recently, we reported that human CYP3A4 and 2C, but not 1A2, contribute to trimethadione (TMO) N-demethylation in the human liver. In this study we simultaneously administered two indicators, CA (2 mg/kg) and TMO (4 mg/kg), which have different patterns of metabolism, to patients with cholelithiasis (control) or cirrhosis. The serum levels of CA and TMO, and their individual metabolites, were determined by high-performance liquid chromatography and gas chromatography, respectively. The metabolism of CA and TMO was significantly inhibited in patients with cirrhosis as compared with controls. The ratios of serum paraxanthine (PX)/CA and DMO/TMO at 4 h after administration of the two probe drugs were also significantly decreased in patients with cirrhosis. The PX/CA ratios of the smoking patients with cirrhosis were higher than those of non-smokers. No differences in serum DMO/TMO ratios were observed between the smokers and non-smokers. These results suggest that different estimations of hepatic oxidizing capacity, catalysed mainly by CYP2C and 3A4, are possible in humans.

肝硬変併存肝癌例の耐術評価に用いられている肝機能検査が, いかなる肝の形態的所見を反映しているか, 画像解析装置を用いて検討した. 肝硬変併存肝癌16例の肝実質の数か所から得た組織切片から単位体積あたりの肝細胞数と肝実質比を測定した. それにCT像から求めた肝容積とを組み合わせて肝細胞量や肝実質量および肝細胞総量を算出して形態的所見の定量化を試みた. さらに, これらの指標とICG負荷試験値 (ICGR15) や一般肝機能検査値とを比較検討した. ICGR15と, 実質比や単位体積あたりの細胞数および細胞量とは, r=-0.506 (p

The trimethadione (TMO) tolerance test, an estimation based on serum dimethadione (DMO)/TMO ratio (DMO is the only metabolite of TMO) was used to quantitatively confirm the functional hepatic parenchyma after hepatectomy. Hepatic functional reserve was confirmed to be improved when measured by TMO tolerance test after transarterial embolization(TAE)for ruptured case of hepatocellular carcinoma. The patient well tolerated hepatectomy. Accordingly, activation of hepatic functional reserve with TAE was tried on 3 patients who were diagnosed inoperable because of decreased hepatic functional reserve. In these patients, DMO/TMO ratios also increased after TAE and were considered operable. Hepatectomies were carried out and all 3 patients well tolerated the surgery. Histological examination of resected hepatic specimens revealed the regenerative nests at the sites where TAE did not affected. TMO tolerance test was able to evaluate the improvement in hepatic functional reserve, based on the hepatic parenchyma lregeneration. Thus, this test can be applied to evaluate the hepatic functional reserve in cases with decreased hepatic functional reserve.

肝細胞癌手術の術前と術後に, リピオドール-抗癌剤懸濁液動注療法 (L-TAI) をおこなった, 絶対的非治癒切除例を除く肝切除耐術例34例の予後規定因子を検討した.そのうち11例 (32%) に再発を認めた.その無再発生存率は, 1年, 91%, 3年, 68%, 5年, 45%であった.L-TAIによる80%以上の腫瘍内壊死, 腫瘍径5cm以下, 組織学的被膜浸潤なし (fc-inf (-)) そして組織学的門脈侵襲なし (vp (-)) などの各因子は, 有意に予後に良い影響を与えた.被膜浸潤の有無にかかわらず, 3cm以下の腫瘍の5年無再発生存率は100%であった, さらにfc-inf (-) 例やfc-inf (+) 例のそれぞれにおいて, 壊死率の高いほど, また腫瘍径が小さいほど, 再発までの期間は延長した.

Pre-operative evaluation of the quantity of functional remnant hepatic parenchyma after hepatectomy was carried out to predict the optimal amount of hepatic resection using the trimethadione (TMO) tolerance test. This test is an estimate based on serum diamethadione (DMO)/TMO ratio (DMO is the only metabolite of TMO) 4 h after oral administration of TMO, and computed tomography (CT) scans of the liver in patients with hepatocellular carcinoma (HCC). The percentage of remnant hepatic parenchyma was calculated pre-operatively from the remaining non-cancerous portion and the whole hepatic parenchyma, excluding the HCC portion, using the CT scans. Presumptive remnant DMO/TMO ratio was calculated by multiplying the percentage of remnant hepatic parenchyma and pre-operative serum DMO/TMO ratio in 45 patients with HCC undergoing resection. The presumptive remnant DMO/TMO ratios were 0.31 +/- 0.10 (mean +/- s.d.) in 42 patients who survived hepatectomy and 0.13 +/- 0.02 (below 0.15) in the three patients who died from postoperative hepatic failure. Of these surviving patients, two patients who had the presumptive remnant DMO/TMO ratios under 0.15 developed postoperative severe complications. Thus, hepatectomy may not be indicated in patients where presumptive remnant DMO/TMO ratio is 0.15 and lower. These findings suggest that pre-operative measurement of presumptive remnant DMO/TMO ratio, when obtained with the CT of the liver and TMO tolerance test, is useful for prediction of the quantity of functional remnant hepatic parenchyma after hepatectomy in patients with chronic liver disease.