Sphincter of Oddi motility was measured in 55 gallstone patients either through the sinus tract of percutaneous transhepatic biliary drainage or through the T tube. The influence of cholecystectomy and gastrectomy on the sphincter of Oddi was analyzed by comparing responses in patients with or without surgery to the administration of cerulein and the ingestion of dry egg yolk. When comparing cholecystectomized patients to nonsurgical subjects, cholecystectomy revealed no influence on the response to cerulein and feeding. Both groups showed relaxation of contraction waves after provocations. On the other hand, two thirds of the postgastrectomy patients showed an acceleration in the contractions of the sphincter of Oddi after provocations (one third showed no change), while all of the nongastrectomy group saw the disappearance of the wave after cerulein administration and 83% revealed complete suppression of the wave after feeding. It is suspected that this paradoxical response to CCK on the sphincter of Oddi is a lithogenic factor after gastrectomy.

No abstract

A 48-year-old woman complaining of weakness and numbness of the upper limbs was diagnosed as having left breast cancer cT2N1M1 (liver and meninx) ER+, PR+, and HER2-after close examinations. Within succeeding about two weeks, her symptoms were rapidly aggravated, and she also developed general pain, dysbasia due to muscle weakness of both upper and lower limbs, decreased left visual acuity, impaired adduction of the left eyeball, and aspiration pneumonia. The patient was considered not to be a candidate for radiation therapy because the whole spinal cord might be involved in the irradiation area, and drug regimen was started. Administration of tamoxifen LH-RH analogue and large i.v. doses of methotrexate (MTX) resulted in gradual improvement of her symptoms. She was discharged from our hospital in a wheelchair after a 1.5-months hospital stay. Following a total of four courses of large doses of MTX and five courses of CMF (cyclophosphamide, methotrexate, and 5-FU) therapy, she was able to walk by herself. Her clinical course had been observed while she was on endocrine therapy alone. Four months after the completion of the chemotherapy, the CMF regimen resumed because a mild degree of aggravation in weakness of the right lower limb was identified. The patient who is under stable condition has been followed in the clinic, as of one year and 7 months after the onset of the symptoms.

A 22-year-old man was admitted to our hospital because of the sudden onset of upper abdominal pain of unknown cause in the morning. An abdominal CT scan showed ascites in the abdominal cavity and a mass in the left omentum, which was not enhanced by contrast CT, without extravasation of contrast medium. Angiographic examination of the abdomen did not indicate extravasation. From these findings intraabdominal hemorrhage caused by bleeding from the greater omentum was suspected. Vital sighs were stable, but laparoscopic operation was carried out to search the cause of the omental hemorrhage and to avoid possible risk of rebleeding. We found hematoma inside the greater omentum. Partial resection of the omentum including the left gastroepiploic vessel was done. His postoperative course was uneventful. Pathologic examination of the omentum presented no abnormal findings. Thus idiopathic omental hemorrhage was diagnosed. We present the case with a review of the literature.

No abstract