岡山医学会Acta Medica Okayama0030-155812322011腹腔鏡下に摘出しえた上行結腸間膜発生のCastleman病の１例129132ENManabuNishieShinyaOtsukaJunTomodaKeishiFujiwaraWe report herein a case of mesenteric Castleman's disease which was confirmed on pathology. A 60-year-old man was admitted to our hospital complaining of abdominal pain. On the physical examination, there was no palpable mass. Computed tomography findings and magnetic resonance imaging revealed a well circumscribed, lobulated round mass on the right side of the superior mesenteric vein. Laparoscopic surgery for the mesenteric tumor was carried out to obtain a definite diagnosis and treatment. In the operative field, the mass was located on the ascending colic mesentery and measured about 3 cm in size. It was solid and surrounded by a thin fibrous capsule. The histological diagnosis of the mesenteric tumor was hyaline vascular type Castleman's disease. The postoperative course of the patient was uneventful, and he was discharged on the 10th postoperative day.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-15581065-61994腹腔動脈完全閉塞をきたした肝細胞癌合併高齢者糖尿病の興味ある一例663668ENTakahikoOkaJunTomodaHaruhikoKobashiNobuyukiSakaiKohsakuSakaguchiKazuhideYamamotoToshihiroHigashiToshioItoGotaroYamadaTakaoTsujiWe report a 75-year-old female with diabetes mellitus complicated with celiac arterial obliteration and hepatocellular cercinoma (HCC). She had been treated with diet therapy by her family doctor for essential hypertension and diabetes mellitus and was referred to our hospital because a space occupying lesion (SOL) was detected in the liver by abdominal CT examination. The SOL was confirmed as hepatocellular carcinoma by ultrasonography and magnetic resoance imaging. Celiac angiography revealed complete obliteration of the celiac artery probably due to diabetic macroangiopathy. Sine the deterioration of the liver function was not conspicuous, it was suggested that the development of HCC was affected by diabetes mellitus.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155812222010白線ヘルニアの1例：本邦手術症例85例の検討125127ENHideakiMiyasoManabuNishieHiromiIwagakiHirooIshiiIsaoFujitaJunTomodaA 78-year-old woman visited our hospital after developing severe abdominal pain and upper abdominal swelling. An emergency operation was performed following a diagnosis of linea alba hernia with impaction of the falciform ligament of the liver as observed on CT findings. A defect of about 30 mm in diameter was observed in the linea alba, and preperitoneal adipose tissue and the falciform ligament of the liver prolapsed from the location of the defect and were impacted. We resolved the impaction of the falciform ligament of the liver by dissecting it, and we resected the preperitoneal adipose tissue. Simple closure was performed to correct the hernia orifice because the surrounding tissue was relatively rigid and the tension was mild. The patient's condition improved, and she was discharged on the 5th postoperative day.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155812322011早期胃癌に対する内視鏡的粘膜下層剥離術後に 急性胃蜂窩織炎を併発した１例133136ENManabuNishieKazuhideIwakawaRyousukeHamanoNaoyukiTokunagaYousukeTunemitsuShinyaOotsukaMasaruInagakiHiromiIwagakiTomohiroGoubaruIsaoFujitaTakakoMurakamiJunTomodaPhlegmonous gastritis is a rare inflammatory lesion in which bacterial infection occurs in the gastric wall. A 92-year-old man was admitted to the medical ward due to early gastric cancer. The patient received endoscopic submucosal dissection (ESD), and he complained of sudden-onset upper abdominal pain the day after ESD. On physical examination he showed rebound tenderness in the upper abdomen. The white blood cell count was 16,100/μl, and an abdominal CT-SCAN showed diffuse and irregular thickening of the gastric wall. At emergency operation, a subtotal gastrectomy was performed, and the patient had an uneventful recovery.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155812232010手術時手洗いにおける従来法とツーステージ・サージカルスクラブ法，ウォーターレス法の比較について225229ENYukaKobayashiMisaYamadaHiromiFujiiYukikoKoIzumiUotaniMarikoTamotoMasakoNadaHiroyukiMuraiEiKadoHiromiIwagakiJunTomodaShinyaSaitoTo evaluate the usefulness of the waterless hand washing method for surgical anti-sepsis, we conducted a microbial sampling study, comparing it to a conventional surgical scrub method. A total of 18 operating-room nurses were undertaking the following three-hand washing protocols : scrubbing with blushes using 4w/v% chlorhexidine gluconate (CHG) and also rubbing with CHG, followed by application of a 0.2w/v% CHG with ethanol (HS) preparation. (conventional method); rubbing with CHG and application of HS (two-stage surgical scrub method; TSS); rubbing with anti-septic soap and application of HS (waterless method; WL). Microbial sampling was conducted after hand washing using the glove juice method. No statistically significant differences in bacterial numbers were found among these three methods. The number of bacterially positive subjects was significantly higher in the conventional method than the TSS method. These results indicate that there are adverse effects of blush-scrubbing, as the detected bacteria were related to normal skin flora. As such, the WL method for hand anti-sepsis appears to be equivalent to the conventional surgical scrubbing method in terms of microbial detection. The WL method should therefore be introduced as a standard hand anti-sepsis method at the time of surgery because it is cost-effective as well as time-efficient.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-1558891-21977内視鏡的に観察したMallory-Weiss症候群の1例5964ENTakehikoTsunashimaKimioOkaTatsuyaKawaiRokuroMatsumotoJunTomodaShunYamamotoJunjiYamadaYoshitoOhashiShoichiKitaTakashiTanigawaMasanobuImaiA case of Mallory-Weiss syndrome confirmed by endoscopic observation. A 46-year-old man was admitted by emergency because of hematemesis and melena. An endoscopic examination revealed a laceration and bleeding at the esophago-gastric junction. The patient was recovered by blood transfusion. The authors emphasized that endoscopic examination in emergency is useful for diagnosis of Mallory-Weiss syndrome.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155812512013メサラジン坐薬調製の工夫と臨床経験2933ENKeikoFunagakureSyuziHoritaTerutakaHamaokaTakeshiTasakaHiroshiTatibanaTakakoMurakamiTatuyaToyokawaEijiSatoJunTomodaUlcerative proctitis (UP) is a prevalent condition associated with increased morbidity, and topical mesalazine (5-aminosalicylic acid [5-ASA]) is known to inhibit the inflammatory processes in UP. We successfully devised mesalazine suppositories, in which 250mg mesalazine was equally distributed and remained stable for at least 2 weeks. We evaluated the effect of using mesalazine suppositories twice a day (BID) on two UP patients. The results demonstrated that mesalazine suppositories were efficacious, well tolerated and safe for the long-term maintenance of UP remission.No potential conflict of interest relevant to this article was reported.