Although we had speculated that infrahepatic IVC clamping would reduce blood loss during hepatectomy, we failed to demonstrate any beneficial effects in this clinical setting with low CVP.

A 56-year-old man was found to have a pancreatic tail tumor. His blood chemistry showed no infection with hepatitis B or C virus and no elevations of tumor markers or pancreatic hormones. Abdominal ultrasound showed an encapsulated, rather heterogeneous, hypoechoic tumor, 6.5 cm in maximum diameter, with a beak sign. Helical dynamic CT revealed an irregularly enhanced tumor with pooling of contrast medium in the delayed phase. Abdominal angiography showed a hypervascular tumor. With a tentative diagnosis of non-functional islet-cell tumor, the patient underwent resection of the pancreatic body and tail with splenectomy. The contour of the liver and its surface were normal. In microscopic examination, tumor cells arranged in a trabecular pattern with focal bile pigment resembling hepatocellular carcinoma (HCC). Immunohistochemically, these tumor cells were positivefor HEPPAR-1, CAM5.2, cytokeratin 18 and COX-2, but negative for MUC-1, and cytokeratins 7, 20 and 8. These results supported a diagnosis of HCC without any adenocarcinoma component. The patient is currently doing well without any signs of recurrence in either the remaining pancreas or liver three years after surgery. We report the rare case with ectopic HCC in the pancreas with a review of the literature.

A 33-year-old woman, gravida 2, para 1, was found to have a huge intra-abdominal cyst (2619 ml) in the 15th week. The cyst increased in volume to 3660 ml during the next 31 days. A tentative diagnosis of ovarian or pancreatic mucinous cystadenoma was made. Since the cyst was considered to cause fetal intra-uterine growth restriction, the patient underwent surgery in the 23rd week of pregnancy. The cyst was found to originate from the pancreas, and distal pancreatectomy with splenectomy was performed. The specimen weighed 5500 gm, which is the largest so far reported. Her postoperative course was uneventful, and she had a healthy full-term infant. Histological diagnosis was a benign mucinous cystadenoma. Up to the present, there have been three reported cases of pancreatic mucinous cystadenoma, including our case, and two cases of pancreatic mucinous cystadenocarcinoma, in association with pregnancy. Our case is the third reported of successful resection of the tumor during pregnancy resulting in a healthy infant.

Endovascular total arch repair with the use of in situ fenestration can be performed with commercially available devices with acceptable interim results.

An 81-year-old female patient was admitted to the emergency room of our hospital with complaints of respiratory distress, abdominal ache, nausea, and intermittent vomiting. A plain X-ray of the abdomen and chest revealed air-fluid levels on the abdomen and the right side of the chest. Laboratory tests showed severe acidemia with a blood base excess level of -24.9 mmol/L. Since the patient was considered to have acute intestinal obstruction due to transverse colon herniation into the thorax through a foramen of Morgagni, emergency surgery was performed. Operative findings revealed that the retrosternal diaphragm had a defect of 5 cm in diameter and 20 cm in length with the transverse colon herniated into the thorax. The diaphragm defect was sutured first, and partial resection of the transverse colon was performed. After the operation, the patient had no symptoms and no recurrence has been observed during the 1-year follow-up. There have been 263 reported cases of Morgagani hernia in Japan. The case of the Morgagni hernia is reported here with some bibliographical comments.