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A male patient in his 80s underwent colonic stenting for obstructive sigmoid colon cancer with multiple liver metastases. With systemic chemotherapy for approximately 1 year, the liver metastasis disappeared, so laparoscopic sigmoid colectomy was performed for the primary lesion. No recurrence was observed for a while, although CT revealed liver metastasis in the liver S4, and radiofrequency ablation was performed. Radiation therapy was performed for the liver metastasis of liver S2 that subsequently appeared. After a recurrence-free period of approximately 2 years, a rapid regrowth of liver metastasis in liver S2 was observed. Thus, 4 years and 3 months after the initial diagnosis, lateral segmentectomy of the liver was performed. Five years have passed since the first visit, and he is alive without recurrence. The patient had obstructive colorectal cancer with unresectable liver metastasis, and as the obstruction was released by a colonic stent, systemic chemotherapy was prioritized. Hence, liver metastasis was controlled, and the primary lesion was resected. Furthermore, for the liver metastasis that appeared later, various loco-regional cancer therapies were provided to achieve a cancer-free state.

The authors present the postoperative complications of skull base surgery based on a 10-year experience with 26 patients operated on via the supraorbital trans-basal or orbitozygomatic approach. The lesions included 19 malignant tumors and seven benign tumors. Postoperative cerebrospinal (CSF) leak occurred in one of the two patients in whom the dural defects were repaired with a fascia lata graft. None of the remaining 24 patients who were repaired with a musculopericranial flap suffered postoperative CSF leak. Three patients developed epidural abscess, but no infection was seen in the patients who had been reconstructed with a vascularized musculo-cutaneous flap to occlude the dead space. Preoperative radiation therapy correlated with a high incidence of postoperative infection. Cranial nerve deterioration or palsy occurred in four patients. Intraoperative injury of the internal carotid artery occurred in one patient who developed severe neurological deterioration. After an average follow-up period of 40 months (range 12 to 109 months), 68% of patients with malignant tumors and 100% of patients with benign tumors were alive with no evidence of recurrence.

A total of seven patients with head and neck tumors underwent a surgery of the anterior skull base in combination with an extracranial approach. Two patients had squamous cell carcinoma of the frontal sinus; one, undifferentiated carcinoma of the ethmoid sinus; two, squamous cell carcinoma of the ethmoid sinus; one, olfactory neuroblastoma; and one, recurrent squamous cell carcinoma of the nasopharynx. Two patients, one with frontal sinus carcinoma and one with undifferentiated carcinoma, developed recurrence. The former was treated with a salvage operation and the latter, with radiotherapy and chemotherapy. Six patients are alive disease free (4, 5, 6, 8, 27 and 73 months) whereas the other is alive with disease (8 months). One patient developed partial necrosis of the reconstructed bony skull base and another developed enophthalmus and temporary diplopia postoperatively. No serious complications, however, were noted in any cases.

The complications and swallowing functions were studied in eleven patients who had undergone free jejunal autograft reconstruction after total pharyngolaryngectomy and cervical esophagotomy. All patients have had advanced cancers of the hypopharynx or cervical esophagus. Fistula was complicated in three patients (27%), including one (9%) who died of pneumonia. Death or graft necrosis was not complicated in perioperative period. There was no patient with stenosis. Radiation necrosis of the graft and skin occurred six months after post-operative 60 Gy irradiation in one patient. Ten patients of 11 regained swallowing function. An oral diet was started between 9 and 50 post-operative days, with an average of 19 days. The duration of a diet was from 20 to 60 minutes (mean: 37 to 40 minutes). Five patients could take a normal diet, while the another five ate gluel or liquid food. The free jejunal graft reconstruction of pharyngoesophagus was highly safe reliability and an advantage in an early recovery of swallowing function, but it had some problems with regard to post-operative irradiation and swallowing.

Endometrial cancer is more frequent in patients at a postmenopausal age, when the ovarian secretion of androgens instead of estrogens seems to be relatively increased. In clinical or experimental medicine, progesterones are widely used for the treatment of endometrial cancer, probably because they have an antiestrogenic action and cause differentiation of cancer cells from the proliferative phase. The effects of testosterone(T), progesterone(P), and/or 17 beta-estradiol(E) on the incorporation of 3H-thymidine in autoradiograms were investigated in immature rats. The autoradiogram revealed many grains due to 3H-thymidine in the endometrial epithelium, stroma, and the myometrium in the immature rat 30 hours after E-injection. T alone markedly induced the DNA synthesis in the stroma and the myometrium, but not in the epithelium. T displayed a synergistic interaction with E in both the stroma and the myometrium with a slight increase in thymidine incorporation into the epithelium. P alone induced DNA synthesis in the stroma and the myometrium. Simultaneous injection of E and P also produced the same result as that when P alone was injected. P markedly inhibited DNA synthesis due to E in the epithelium. Autoradiograms of the immature rat uterus provide basic support for the rationality of P therapy for cancer or adenomatous hyperplasia of the endometrium.

Isolation of progesterone secreting cells from the ovaries of immature rats pretreated with pregnant mare serum gonadotropin (PMS) was conducted by a simple procedure which combined the collagenase digestion with a density gradient method. After digestion of the ovarian tissue slices by the enzyme, the residue was gently pressed and placed on a sucrose density gradient. Three bands appearing in the tube after centrifugation were designated as S-1, S-2 and S-3 from the top to the bottom, respectively. The S-1 cells from the ovaries at 6 days after PMS secreted the greatest amount progesterone, i.e. approximately 430 ng per 10(5) cells during the 18th incubation. Progesterone secretion from the S-2 cells was less than 48% of that from the S-1 cells. A physiological interrelation between the S-1 and S-2 cells remains unexplained by the present experiment. The luteal cells were yellow, spheroidal and 15 to 40 mus in diameter. Many vesicle-like particles were found on the cell surfaces. Progesterone secretion from the prepared cells was stimulated significantly by hCG in vitro. This result indicates that progesterone secreting cells isolated by the collagenase-sucrose density gradient preserve their native function as luteal cells. The procedure for preparation of luteal cells in the present report may provide a suitable model for in vitro studies on the corpus luteum.