Obstructive jaundice secondary to pancreatic pseudocyst

A case of obstructive jaundice resulting from the compression of the common bile duct by a pancreatic pseudocyst is reported, which is of rare occurrence. Total excision of the cyst and choledochojejunostomy were performed. Postoperative course was uneventful with rapid disappearance of jaundice. Nine out of ten cases of pancreatic pseudocyst were treated by total excision with one death during 1951 through 1974.     

Chronotropic and inotropic effects of 3 kinds of alpha-adrenergic blockers on the isolated dog atria

Using the isolated and blood-perfused dog atrial preparation, chronotropic and inotropic responses to 3 kinds of alpha-adrenergic blockers, phentolamine, phenoxybenzamine, and E-643, were compared. When phenoxybenzamine was administered into the cannulated sinus node artery, positive chronotropic and inotropic responses were induced in doses of 10-300 microgram. Phentolamine also produced positive responses, but at larger doses such as 100 and 300 microgram, accompanying initial negative responses. E-643 usually produced only negative chronotropic and inotropic effects. Positive responses to phenoxybenzamine and phentolamine were significantly suppressed by propranolol, and negative responses to E-643 and phentolamine were not modified by atropine treatment. From these results and previous reports, it is assumed that sinus tachycardia induced by alpha-blockers in situ may be due to 3 different mechanisms, i.e., 1) reflex tachycardia induced by the hypotension, 2) augmented catecholamine release mediated by the block of the presynaptic alpha-adrenoceptors, and 3) direct catecholamine release from locally innervated sympathetic nerve terminals.     

Clinico-pathological study on the appropriate range of pancreatic resection to obtain operative curability of pancreatic head cancer

We studied the mode of spread on the pancreatic head carcinoma histologically in association with the patient survival period and the mode of cancer recurrence. The histological materials were 41 surgically resected specimens and 12 autopsied specimens. The mode of cancer spread were classified into 5 factors: continuous spreading along the caudal pancreatic duct wall; dysplastic lesion; multicentric cancer lesion; lymphatic infiltration; lymph node metastasis and direct invasion toward the retroperitoneal space. As a result, total pancreatectomy is considered as rationale only when continuous ductal infiltration spreads into the duct in pancreatic tail, but the cut margin of the pancreas should be 2 cm distant, at least, by the macroscopical observation. Additionally, frozen section of the cut line, cytological examinations of the pancreatic juice and duct epithelium in remaining pancreas should be negative. It was remarkable that the patient's prognosis depended upon the lymph-node involvement and retroperitoneal invasion at the surgical resection. Therefore, it is most important to do prophylactic resection of a soft tissue behind the pancreas including lymph nodes in the retroperitoneal space.