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Fiber optic transmission systems have been applied over a variety of areas, but fiber optic video signal transmission systems are not so spread as fiber optic data transmission systems.

Two cases of intrahepatic gallstones with stenosis of the common hepatic duct caused by overriding of the right hepatic artery are described. The probable diagnosis of the compression of the bile duct by the artery was obtained by superimposing a direct cholangiogram on an angiogram. The final diagnosis was made at operation. The first patient was successfully treated by resection of the compressed common hepatic duct with Roux-en-Y hepaticojejunostomy anterior to the right hepatic artery. In the second patient, lateral segmentectomy and cholangiojejunostomy were performed.

肝細胞癌に対する術前肝動脈塞栓術施行例25例と非施行例23例の病理学的検索を行った.スポンゼル単独使用群8例と, 抗癌剤併用群17例とは壊死率に差はなく, 手術を前提として肝動脈塞栓術を行う場合塞栓物質のみにて肝動脈塞栓術を行い早期に腫瘍を含む硬塞病変の切除を行うべきものと考えられた.壊死組織の診断には鍍銀染色が有用であり, 完全壊死例を含め肝細胞癌として特徴を示すものが多く診断価値があるものと考えられた, また肝動脈塞栓術から手術までの期間による組織修復過程は, 形態学的に経時的なパターンを示さなかった.これは結節の大きいものは修復過程の遅延が起るものと考えられた.

To determine problems involved in the treatment and diagnosis of pancreatic cancer, a collective study of small carcinoma of the pancreas (2 cm or less in diameter) was performed. One hundred six cases were collected and analyzed. The results were as follows: In small carcinoma of the pancreas, the resectability rate was 99.0% and the operative mortality rate was 4%. Only 44% of the patients belonged to Stage I, and 14% belonged to Stage III or IV. Lymph node involvement, capsular invasion, retroperitoneal invasion, and vascular invasion were found in 30, 20, 12, and 9% of the patients, respectively. The postoperative cumulative 5-year survival rate was 30.3%, and that of Stage I was 37.0%. A small-sized tumor of the pancreas is not always an early carcinoma, but a tumor in Stage I may be regarded as an early carcinoma. Percutaneous transhepatic cholangiography and endoscopic retrograde cholangiopancreatography were the main diagnostic indicators in cases with and without jaundice, respectively. There was no specific single serum test for detecting small pancreatic cancer.

The patient was a 59-year-old man without any particular complaint. Upon examination, he was found to have a high serum CEA level, and a subsequent detailed examination revealed a hepatic tumor in the medial segment of the left hepatic lobe (S4). The tumor was suspected of being metastatic because his serum AFP level was within normal range. Detailed examination of other intra-abdominal organs, however, revealed no abnormalities. Therefore, after diagnosis of a primary hepatic carcinoma producing CEA, the S4 subsegment was excised using the microwave coagulator. The tumor size was 2.6×1.8cm. Histopathologically, it was found to be a hepatocellular carcinoma of Edmondson type II with a capsule. The postoperative course has been favorable; the serum CEA level returned to normal, thereby confirming the production of CEA by the tumor. Increased CEA levels are rare in primary hepatocellular carcinomas, but very common in metastatic liver cancers. Therefore, detailed examination of other intra-adbominal organs is necessary in the diagnosis of such cases.

From 1965 to 1980, reoperations for residual or recurrent stones were performed on 78 out of 962 Japanese patients with cholelithiasis. The majority of patients who required reoperation had intrahepatic stones. Most of the causes of reoperation were residual stones due to incomplete removal or the non-detection of intrahepatic stones at the previous surgery. Very careful examination of the intrahepatic biliary trees should be done in patients with biliary tract diseases, because in many, the first operation was done during their youth. To remove the intrahepatic calculi completely, hepatic lobectomy should be considered as a final procedure. The causes of reoperation of common duct stones were residual in 60 per cent and recurrent in 40 per cent. Definitive surgery should be done at the first or at least the second operation to avoid irreversible hepatic disorders which have untoward effects on the prognosis. It is important not only to remove the stones but also to relieve the bile stasis in the biliary tract.

One hundred and nineteen patients with intrahepatic stones treated surgically in Nagasaki University Hospital from 1969 to 1984 were reviewed. The patients were divided into four types according to location of the stones and the presence or absence of stenotic lesions and/or localized dilatation of the intrahepatic bile ducts. Types I and II patients were treated with choledocholithotomy or choledochojejunostomy, while type III patients underwent hepatic resection and type IV patients were treated by partial hepatic resection with bilioenteric anastomosis, including extended hepatico-choledochojejunostomy. The majority of operative or early deaths belonged to type IV and residual stones were present in almost all patients. The long-term results for the 88 patients revealed that the rate of improvement was 100 per cent for type I, 87 per cent for type II, 83 per cent for type III and 84 per cent for type IV. In type IV, the most excellent results (92 per cent) were obtained by extended hepaticocholedochojejunostomy, especially with hepatectomy. It is suggested that extended hepaticocholedochojejunostomy with partial hepatic resection is a reasonable procedure for treating patients with type IV intrahepatic stones.

Eighty-six patients with primary extrahepatic bile duct carcinoma operated on in the Second Department of Surgery at Nagasaki University Hospital during a recent 13.5-year period were reviewed. The patients were divided into five groups depending upon the site of the tumor. The operative mortality, resectability, postoperative survival period, and five-year survival rate in each group were studied. The lower third group had the highest resectability, lowest operative mortality and longest post operative survival period. The hepatic duct, the upper third and the extended groups, however, showed extremely poor results. The pathological features of these three groups are discussed here and an operative procedure for resection of the tumor is proposed. We emphasize that the development of methods of early diagnosis is necessary, and recommend aggressive surgical treatment for tumors of the hepatic duct, upper third, and extended groups.