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Background Antimesenteric cutback end‐to‐end isoperistaltic anastomosis (Sasaki‐Watanabe anastomosis; Sasaki‐W anastomosis), which was developed in our department, is a novel hand‐sewn anastomotic technique for Crohn's disease intended to prevent anastomotic stenosis and preserve the peripheral circulation. Aim The aim of the present study is to present the surgical technique of Sasaki‐W anastomosis and to assess the safety and the early results of the surgical anastomotic recurrence of Sasaki‐W anastomosis. Patients and Methods The present study was a single‐center retrospective cohort study. As an early‐period group, 13 patients with Crohn's disease, who were mainly selected from cases considered to be at high risk of recurrence, underwent 15 Sasaki‐W anastomoses from August 2009 to January 2012. As a late‐period group, 36 patients with Crohn's disease, who were selected regardless of risk factors, underwent 37 Sasaki‐W anastomoses from September 2016 to March 2020. The medical data including patient characteristics, surgical records, postoperative details, and surgical recurrences were assessed. Results There were no intraoperative complications. With a median follow‐up of 107 mo, surgical recurrence occurred in one patient at 106 mo after surgery in the early‐period group. The cumulative surgical recurrence‐free rate in the early‐period group was 100% at 5 y and 86% at 10 y after surgery. No patients required reoperation in the late‐period group. Conclusion Sasaki‐W anastomosis is safe and feasible. Although long‐term study is needed, this anastomotic technique can be a reasonable operative option for Crohn's disease., Antimesenteric cutback end‐to‐end isoperistaltic anastomosis (Sasaki‐Watanabe anastomosis; Sasaki‐W anastomosis) is a novel hand‐sewn anastomotic technique for Crohn’s disease intended to prevent anastomotic stenosis and preserve the peripheral circulation. Here we show the surgical technique and early results of surgical anastomotic recurrence.

Cancer of the intestinal tract (small and large intestine) associated with Crohn's disease has a low incidence but can be fatal if it develops. Thus, the key question is how to deal with this type of cancer. The current study surveyed major medical facilities that treat inflammatory bowel disease (IBD) surgically in Japan in order to examine the clinical features of cancer of the intestinal tract associated with Crohn's disease and explore ways to deal with this cancer in the future.Sixteen major medical facilities that treat IBD surgically were surveyed regarding cancer of the intestinal tract associated with Crohn's disease. The medical facilities had treated 3,454 patients with Crohn's disease, 122 of whom had developed intestinal cancer. The medical facilities were surveyed regarding those 122 patients.The incidence of intestinal cancer associated with Crohn's disease has increased yearly. Cancer most often developed in the left side of the colon and, particularly, in the rectum and anal canal. Seventy-six percent of cases were diagnosed preoperatively, 4% were diagnosed intraoperatively, while the remaining 20% were diagnosed pathologically after surgery. The most prevalent histological type of cancer was mucinous carcinoma (50%). Forty-two percent of cancers were differentiated, with 4% being poorly differentiated. The surgical procedure performed most often (67%) was abdominoperineal resection. The 5-year survival rate by stage was 88% for Stage I, 68% for Stage II, 71% for Stage IIIa, 25% for Stage IIIb and 0% for Stage IV. Overall, the 5-year survival rate was 52%.Gastrointestinal (GI) cancer associated with Crohn's disease had an incidence of 3.5%, but also involved a poor prognosis with a 5-year survival rate of 52%. Early detection through surveillance is crucial to improving the prognosis for patients. However, surveillance of the intestinal tract with endoscopy or contrast studies is technically and diagnostically hampered by Crohn's disease and intestinal strictures. A biopsy of the anal canal, a common site of cancer, can readily be performed and constitutes the first step in surveillance.

Interleukin-23 (IL-23) plays an essential role in the mucosal immune system. It has been suggested that IL-23 is able to induce carcinogenesis as well as inflammation and a recent study revealed that IL-23R is expressed in colorectal carcinoma cells. However, neither the differences in the IL-23R expression among the patients nor the concrete functions of IL-23 in colorectal carcinoma cells have been revealed. The aim of the present study was to examine the characteristics of IL-23R expression in colorectal carcinoma and the direct effects of IL-23 on colorectal cancer cells. We examined the IL-23R expression in human colorectal cancer tissue samples by immunohistochemistry. Cell proliferation and invasion assays under IL-23 stimulation were performed using cultured cells derived from colorectal cancer. ELISA and real-time PCR were used to evaluate the transforming growth factor (TGF)-β production due to IL-23 stimulation. All of the TNM stage IV patients were positive for IL-23R. IL-23R expression in the carcinoma tissue was also relatively high at the deepest point of invasion in certain cases. The proliferative and invasive activities and/or TGF-β production of DLD-1 cells increased by IL-23 stimulation, whereas no change was observed in the activities of MIP101 and KM12c cells. IL-23 directly enhanced the malignancy of the colon carcinoma cells. An autocrine mechanism via TGF-β production may underlie these effects. IL-23 is therefore a potential target for cancer immunotherapy. However, the homogeneity in IL-23R expression and the effects of IL-23 on colorectal carcinoma cells should be considered.

Runt-related transcription factor 2 (RUNX2) belongs to the RUNX family of heterodimeric transcription factors, and is mainly associated with osteogenesis. Previous in vitro studies demonstrated that RUNX2 increased the cell proliferation of mouse and rat colon carcinoma cells but the status of RUNX2 has remained unknown in human colon carcinoma. Therefore, we examined clinical significance and biological functions of RUNX2 in colon carcinoma. RUNX2 immunoreactivity was examined in 157 colon carcinoma tissues using immunohistochemistry. RUNX2 immunoreactivity was evaluated as percentage of positive carcinoma cells [i.e., labeling index (LI)]. We used SW480 and DLD-1 human colon carcinoma cells, expressing estrogen receptor-β (ER) in subsequent in vitro studies. RUNX2 immunoreactivity was detected in colon carcinoma cells, and the median value of RUNX2 LI was 67%. RUNX2 LI was significantly associated with Dukes' stage, liver metastasis and ERβ status. In addition, RUNX2 LI was significantly associated with adverse clinical outcome of the colon carcinoma patients, and turned out an independent prognostic factor following multivariate analysis. Results of in vitro studies demonstrated that both SW480 and DLD-1 cells transfected with small interfering RNA against RUNX2 significantly decreased their cell proliferation, migration and invasive properties. In addition, RUNX2 mRNA level was significantly decreased by ER antagonist in these two cells. These findings all suggest that RUNX2 is a potent prognostic factor in human colon carcinoma patients through the promotion of cell proliferation and invasion properties, and is at least partly upregulated by estrogen signals through ERβ of carcinoma cells.

今回，我々は家族性大腸腺腫症（familial adenomatous polyposis；以下，FAPと略記）術後に発生したストーマ部の回腸癌を2例経験した．1例目は58歳の男性で，FAPのため31歳時に大腸全摘術，永久回腸ストーマ造設術を施行した．50歳頃からのストーマ部のポリープが直径約5cm大にまで増大した．2例目は65歳の女性で，FAPのため41歳で大腸全摘術，永久回腸ストーマ造設術を施行した．63歳頃からのストーマ部のポリープが直径3～4cm大にまで増大した．いずれの症例に対しても，腫瘤を含む回腸部分切除，回腸ストーマ再造設を行った．病理組織学上はいずれも腺癌であった．癌発生の原因は不明であるが，FAPという遺伝要因に，ストーマ部における物理的・化学的刺激などの環境要因が加わって起こる可能性が推測され，ストーマ造設・ケアにおける注意と定期的なフォローが重要と考えられた．

症例は39歳の女性で，内科的治療に抵抗性の全大腸炎型潰瘍性大腸炎に対し大腸全摘・回腸嚢肛門吻合・回腸瘻造設術を施行した．術後経過は良好で，約4か月後，回腸瘻閉鎖術を行ったが，術後腸閉塞を発症し，術後第10病日よりイレウスチューブ挿入するも改善は乏しかった．第39病日多量の下血が出現，プレショック状態となり，第41病日緊急手術を施行した．術中内視鏡検査にて小腸粘膜に多発するびらんと血液の滲出を認めたが，活動性出血は認めず，びらん部からの生検を行い，手術を終了した．病理組織学的検査所見上，潰瘍性大腸炎類似の小腸病変が示唆され，プレドニゾロンの静注を開始した．また，血管造影検査にて血管外漏出を認めた第2空腸動脈領域に塞栓術を施行した．その後下血は治まり，再手術後第27病日に退院した．これまでの文献を踏まえ，本症例の病態に対する考察を加えて報告する．

症例は69歳の女性で，強皮症の治療中に腹部膨満が出現し，二次性慢性偽性腸閉塞症（chronic intestinal pseudo-obstruction；以下，CIPと略記）および腸管嚢腫様気腫症（pneumatosis cystoides intestinalis；以下，PCIと略記）と診断された．保存的治療により一度は改善したが，その後再増悪した．食事再開とともに発熱などの症状の増悪を繰り返す状態となったため，PCI部の空腸の切除術を施行した．術後経過は良好で，食事量は増加し栄養状態の改善も図れた．CIPに対する外科的治療には議論がある．CIPにPCIを伴い経口摂取が困難な場合，PCI部の切除を考慮する必要があるが，病変が限局的であれば，強皮症のような全身病に合併した場合であっても切除の有効性は高いと思われた．

症例は41歳の男性で，前医にて甲状腺癌，多発肺転移の診断で手術を行い，最終診断は濾胞癌の未分化転化であった．当院で頸部への放射線治療を行っていた．腹痛，全身倦怠感を主訴に来院した．左上腹部と臍右に鶏卵大の圧痛を伴う腫瘤を触知し，血液生化学検査では炎症反応の上昇，高度の貧血，凝固線溶系の亢進を認め精査加療目的で入院となった．腹部US，CTで小腸腫瘍による腸重積症の診断となり，腹腔鏡補助下で緊急手術を施行した．術後，経口摂取が一時期可能にはなったが，徐々に全身状態が悪化し，術後第20病日に永眠された．病理組織学的診断は甲状腺未分化癌による小腸転移であった．甲状腺未分化癌が小腸に転移することはまれで，国内外での報告は，自験例を含め5例である．若干の文献的考察を加え報告する．

症例は20歳の女性で，平成21年12月，乗用車運転中に対向車と正面衝突した．精査にて腹腔内出血，肝・膵・脾損傷と右大腿骨骨幹部骨折を認め当院へ入院した．来院時全身状態は安定しており，血管造影検査を行い明らかな造影剤の漏出がないことを確認し，保存的に経過観察とした．受傷後8日に上腹部に限局した腹膜刺激症状が出現しCTを行ったところ，網嚢内に限局した腹水貯留を認めた．胆道損傷を疑い受傷後9日目に緊急手術を行った．肝臓，脾臓からは出血を認めず膵臓は全体に腫大していた．肝十二指腸間膜の検索にて総胆管の完全断裂を認め，胆嚢摘出，術中胆道造影，総胆管空腸吻合術を行った．術後経過は良好で近医へ転院した．鈍的外傷による胆管損傷はまれな病態であり，損傷形態としては総胆管完全離断を来すことが多い．鈍的外傷による複数の臓器損傷から発症初期に胆管損傷を診断することは困難であり注意が必要である．

症例は64歳の男性で，約2年前より肛門部の腫瘍，肛門周囲からの排膿を自覚するも放置．腫瘍の増大，臀部痛のため，座位不能となり受診．精査にて，広範な臀部膿瘍をともなった肛門管癌の診断で，有茎腹直筋皮弁，植皮を付加した腹会陰式直腸切断術を施行した．病理組織学的には中分化型腺癌でAI，N1，H0，P0，Stage IIIaで根治度Aの手術であった．今回，広範な臀部膿瘍をともなった肛門管癌症例を経験したので，文献的考察を加え報告する.

消化管ストーマ造設の標準化を進める上で，適切な分類法に基づいたストーマ合併症の評価が重要である．発症時期別分類としては早期と晩期に分けるのが一般的であるが，早期の定義に関して，過去の報告はストーマ造設術後30日（1カ月）以内とするものと術直後の入院期間中とするものに大別される．術後の入院期間が短縮しつつある昨今，退院直後にストーマ合併症が問題となる症例もみられるので，入院中に限らず術後30日以内を早期と定義するのが良いと考えられる．またストーマ合併症には処置不要なものから緊急手術を要するものまで様々な重症度があるが，重症度別の検討を行った論文は少ない．重症度分類としては有害事象共通用語基準（CTCAE）のストーマ合併症に関するGrade分類が利用可能と考えられるが，用語がストーマケアの現場で使いにくいという問題がある．そこで本稿では用語の修正と追加を行い，ストーマ合併症の重症度分類案として使用可能か検討を行った．

症例は60歳の女性で，腹部膨満を主訴に近医を受診後，胸腹水を伴う卵巣癌の疑いで当院婦人科紹介となった．血液検査にてCA125の異常高値を認め，腹部超音波，腹部造影CT・MRIにて，子宮と接する巨大な多房性嚢胞性腫瘤で，嚢胞内に乳頭状に増殖する充実性部分を認め，卵巣癌（漿液性嚢胞腺癌）が疑われた．開腹所見は両側付属器に異常はなく，空腸から管外に発育する約20cm大の腫瘤を認め，一部は膀胱へ浸潤していたため，合併切除を行った．術後胸腹水の再出現は認めず，第15病日に退院となった．病理組織学的にはc-kit陽性で小腸gastrointestinal stromal tumor（GIST）と診断された．嚢胞性GISTは比較的まれで，CA125の上昇とPseudo-Meigs症候群と同様の機序を呈したきわめて特異な病態であったため術前診断が困難であった．Pseudo-Meigs症候群を来した小腸GISTは本邦では初めての症例である．

Alternative precursor messenger RNA (pre-mRNA) splicing plays an important role in the generation of functional diversity of the genome. The process of pre-mRNA splicing is regulated by cis- and trans-elements, and their deregulations result in aberrantly spliced individual variants and aberrant expression profiles. Accumulating evidence has revealed that aberrant splicing contributes to a number of diseases including human neoplasms. It is well known that germ line mutations in the cis-element of tumor suppressor genes such as mismatch repair (MMR) genes, the adenomatous polyposis coli (APC) gene and the E-cadherin (CDH1) gene are involved in Lynch syndrome, familial adenomatous polyposis and hereditary diffuse gastric cancer, respectively. In addition, somatic mutations in cis-elements also play a role in tumorigenesis. These genetic alterations including nonsense, missense or silent mutations in cis-elements led to aberrant transcripts by exon skipping, retention of the intron or introduction of a new splice site. The majority of erroneous transcripts with a premature termination codon are eliminated through nonsense-mediated mRNA decay. However, it is difficult to accurately predict the resulting transcripts with current in silico strategies. Correct interpretation of genetic alterations and the investigation of aberrant transcripts are crucial for genetic diagnosis of hereditary diseases and elucidation of the molecular characteristics of neoplasms from a clinical point of view. In this review we summarize the current knowledge of the regulatory mechanism underlying alternative pre-mRNA splicing and aberrant splicing, with particular focus on digestive tract malignancies.

5-Fluorouracil (5-FU) is a key anticancer drug that for its broad antitumor activity, as well as for its synergism with other anticancer drugs, has been used to treat various types of malignancies. In chemotherapeutic regimens, 5-FU has been combined with oxaliplatin, irinotecan and other drugs as a continuous intravenous infusion. Recent clinical chemotherapy studies have shown that several of the regimens with oral 5-FU drugs are not inferior compared to those involving continuous 5-FU infusion chemotherapy, and it is probable that in some regimens continuous 5-FU infusion can be replaced by oral 5-FU drugs. Historically, both the pharmaceutical industry and academia in Japan have been involved in the development of oral 5-FU drugs, and this review will focus on the current knowledge of 5-FU anabolism and catabolism, and the available information about the various orally-administrable 5-FU drugs, including UFT, S-1 and capecitabine. Clinical studies comparing the efficacy and adverse events of S-1 and capecitabine have been reported, and the accumulated results should be utilized to optimize the treatment of cancer patients. On the other hand, it is essential to elucidate the pharmacokinetic mechanism of each of the newly-developed drugs, to correctly select the drugs for each patient in the clinical setting, and to further develop optimized drug derivatives.

Crohn病に対する外科治療の原則は，健常部をできるだけ温存する病変部の切除である．また，線維性狭窄に対しては各種の狭窄形成術が行われ，病変に応じて消化管の可及的な温存が可能である．ストーマ造設はプアリスク症例や排便機能障害例において適応となる．術後の寛解維持療法については，6～12カ月ごとの内視鏡検査により軽度の病変では5-ASAを，中等度～高度病変に対しては免疫調節薬を加え，さらにInfliximabを用いるアルゴリズムが欧米では提唱されているが，本邦においては，これに成分栄養剤を加えたより丁寧な寛解維持療法が行われている．

Currently 5-fluorouracil (5-FU) plays a central role in the chemotherapeutic regimens for colorectal cancers and thus it is important to understand the mechanisms that determine 5-FU sensitivity. The expression profiles of human colon cancer cell line DLD-1, its 5-FU-resistant subclone DLD-1/FU and a further 21 types of colon cancer cell lines were compared to identify the novel genes defining the sensitivity to 5-FU and to estimate which population of genes is responsible for 5-FU sensitivity. In the hierarchical clustering, DLD-1 and DLD-1/FU were most closely clustered despite over 100 times difference in their 50% inhibitory concentration of 5-FU. In DLD-1/FU, the population of genes differentially expressed compared to DLD-1 was limited to 3.3%, although it ranged from 4.8% to 24.0% in the other 21 cell lines, thus indicating that the difference of 5-FU sensitivity was defined by a limited number of genes. Next, the role of the cellular inhibitor of apoptosis 2 (cIAP2) gene, which was up-regulated in DLD-1/FU, was investigated for 5-FU resistance using RNA interference. The down-regulation of cIAP2 efficiently enhanced 5-FU sensitivity, the activation of caspase 3/7 and apoptosis under exposure to 5-FU. The immunohistochemistry of cIAP2 in cancer and corresponding normal tissues from colorectal cancer patients in stage III revealed that cIAP2 was more frequently expressed in cancer tissues than in normal tissues, and cIAP2-positive patients had a trend toward early recurrence after fluorouracil-based chemotherapy. Although the association between drug sensitivity and the IAP family in colorectal cancer has not yet been discussed, cIAP2 may therefore play an important role as a target therapy in colorectal cancer.

慢性膵炎の合併症として膵仮性嚢胞は手術適応のひとつとなりうる．仮性嚢胞内の消化酵素が血管を浸食し，破裂させることが稀にある．嚢胞内出血が腹腔内や消化管内に起こると，大量出血により致命的となる．今回嚢胞内出血が嚢胞外への穿破を逃れ，術前には確定診断がつかず，術中超音波で診断された膵仮性嚢胞内仮性動脈瘤の一例を経験した．症例は56歳の男性．2001年に急性膵炎を発症．保存的加療で軽快したが，大量飲酒を連日続けていた．2007年に上腹部痛出現し，精査したところ，CT上膵仮性嚢胞と慢性膵炎を指摘された．また嚢胞内はわずかに造影効果があったが，全身状態が安定していることと，血管造影が施行できなかったことで嚢胞内出血を断定できなかった．手術施行し，開腹後超音波検索で嚢胞内のジェット流が認められ，嚢胞内出血が確認された．脾動脈を結紮するとジェット流は消失し，脾動脈からの出血と考えられた．その後膵体尾部切除，DuVal式膵空腸吻合術を施行した．標本では嚢胞内に器質化した凝血塊が存在し，そのなかで仮性動脈瘤が形成されていたために腹腔内や消化管内への穿破出血を免れたと考えられた．膵仮性嚢胞内出血が疑われたときは，血管造影を含め慎重な術前評価を行い，術式の決定を行うべきである．

症例は44歳，女性．2008年7月頃より右腋窩に違和感を感じ外来受診した．可動性良好な腫大したリンパ節を触知し，超音波検査（US）で不整形で一部境界不明瞭な腫大したリンパ節を認めた．リンパ節生検にて低分化型腺癌の転移が疑われ，ER(+)，PgR(+)であったため，転移性乳癌が疑われた．PETにて右腋窩および右乳房の下に高集積を認めた．触診で右乳房下部に皮下腫瘤を触知し，USで11×15mm大の境界不整なlow echoic massを認め，生検にて浸潤性小葉癌の診断であった．右腋窩リンパ節郭清（Level-II）を含む乳房下部腫瘤摘出術を施行し，皮下腫瘤の切除標本内には，小葉と乳管が完備した副乳腺組織が存在するため，副乳腺原発癌と診断した．腋窩リンパ節Level-Iに9/21のリンパ節転移を認め，stageIIのため術後補助化学療法としてCEFを行っている．副乳小葉癌は稀であり，若干の文献的考察を加えて報告する．

腹腔内デスモイド腫瘍に対して薬物療法で良好な経過をたどった1例を経験したので報告する．症例は72歳の男性で，直腸癌術後，異時性肺転移術後の経過観察中に腹腔内腫瘍が出現，直腸癌腹腔内再発と診断し開腹術を施行した．腫瘍は小腸間膜内にあり切除可能であったが，広範な小腸合併切除を要するため切除しなかった．病理組織学的検査でgastrointestinal stromal tumorと診断されメシル酸イマチニブを投与したが，治療抵抗性で有害事象も強かった．永久標本を再検討したところβ-カテニンの核内発現が認められデスモイド腫瘍と診断された．メシル酸イマチニブを中止し高用量タモキシフェン/スリンダク併用療法を開始したところ，2か月後のCTで腫瘍の縮小が認められたが，5か月後には腫瘍径に変化は見られなくなった．手術を勧めたが患者が拒否したため，開始後2年経過した現在も継続中であり，これまでのところデスモイド腫瘍の再増大を認めていない．

短期間で増悪した原発性アミロイドーシスに伴う続発性慢性偽性腸閉塞症（secondary chronic intestinal pseudo-obstruction；以下，Secondary CIP）を経験した．症例は56歳の男性で，2004年より腹部膨満感が出現し近医で特発性CIPと診断された．2005年初めより症状が増悪したため，イレウスチューブを5か月間以上留置するも改善せず，2006年に当科紹介・入院となった．イレウスチューブから連日2,000 ml以上の排液を認め，イレウスチューブの再挿入時に十二指腸穿孔が疑われ緊急手術となった．術中所見では十二指腸損傷は同定できなかったが，Treitz靭帯から回盲弁の口側100 cmまでの小腸の著明な拡張，腸管壁の脆弱化が認められたため，小腸を約300 cm切除し，空腸瘻を作成した．病理組織学的検査所見で原発性アミロイドーシスに続発するCIPの診断となったが，術後半年で原病死した．原発性アミロイドーシスに伴うCIPは予後不良であり，対処療法しかないのが現状である．

In colorectal cancer (CRC) patients, metastasis to the regional lymph node (LN) is an important first step in the dissemination of cancers. To identify the genes possibly involved in LN metastasis of CRC, we analyzed LN metastases in an orthotopic implantation mouse model with 22 CRC cell lines using Matrigel, an extracellular matrix protein derived from mice sarcoma, and combined the data with gene expression profiles of cDNA microarray of those cell lines. With this implantation analysis, the incidence of LN metastasis was 60% in 228 orthotopically implanted mice and varied from 100% to 0% among the cell lines. KM12c and Clone A showed LN metastasis in all orthotopically implanted mice, but DLD-1, HCT-8, and SW948 did not show LN metastases at all. In contrast, the incidence of liver and lung metastasis in 22 CRC cell lines was 13% and 1%, respectively. Combining those data with cDNA microarray in vitro, we isolated 636 genes that were differentially expressed depending on the incidence of LN metastasis. Among those genes, the expression level of ring finger protein 125 (RNF125), previously known as an E3 ubiquitin ligase in T cell activation, was significantly different between primary tumors in Stage III CRC patients with LN metastasis and Stage II patients without LN metastasis. In conclusion, the orthotopic implantation mice model with Matrigel was useful, and we isolated candidate genes such as RNF125 that possibly play an important role in LN metastasis of CRC cells.

潰瘍性大腸炎 (ulcerative colitis; 以下, UC) では小児期に手術を行うことが少なくないが, 学業への影響, 手術適応, 成長障害など小児特有の問題がある. 当科で1987～2004年の間に小児期 (15歳未満) に初回手術を施行したUC8例について検討した. 手術は全例2期あるいは3期分割で大腸全摘, 回腸肛門吻合 (ileo-anal anastomosis; 以下, IAA) 術を行った. 手術適応は重症4例, 難治3例, 出血1例で緊急手術となった例は5例であった. 術前平均総ステロイド投与量は9,855mgであった. 術後早期合併症は創感染3例のみで, 晩期合併症は腸閉塞2例, 重症pouchitis, 回腸瘻狭窄, 吻合部狭窄をそれぞれ1例ずつ (重複含む) 認めた. 重篤な合併症は認めなかった. 手術後の排便機能は良好であり, また成長障害は認めず, 現在頻回の通院を要している例は1例のみであり学業・就労への影響もほとんどないものと思われた. 小児UCに対するIAAは良好な結果であった.

症例は58歳, 男性. 4カ月間にわたり増悪と軽快を繰り返す右下腹部の腫瘤を主訴に近医を受診し, desmoidが疑われ当科紹介となった. 生検標本について免疫組織化学検査を追加したところ, 炎症性筋線維芽細胞性腫瘍 (inflammatory myofibroblastic tumor : 以下IMTと略記) が疑われ, 腫瘤摘出術を行った. 腫瘤は下腹部正中やや右寄りの皮下に認め, 腹直筋にも浸潤していたため, 周囲脂肪組織, 腹直筋と共に腫瘍を切除した. 腫瘍の大きさは50×55×30mmで, 切除標本では, 境界不明瞭で黄色調と白色調の部分が混在していた. 病理組織診断では, 紡錘形細胞の束状配列, 形質細胞やリンパ球などの炎症細胞や組織球が混在し, 免疫染色でHHF-35陽性, α-SMA陽性, β-catenin核染色性陰性であり, IMTと診断した. IMTは束状に増生する筋線維芽細胞にリンパ球, 形質細胞, 好酸球など種々の炎症細胞浸潤を伴い, 近年その発症機序が注目されている炎症性かつ腫瘍性の病変である.

This study looks into methods to improve bonding strength between UFC panel and grout that is very important to ensure good performance of Ultra-thin White Topping with High Strength Concrete (HSC-WT). For that, several methods with combinations of forming macro textures on the panel surface and special surface treatment with chemical ingredients on the interface were examined by shear tests and direct tension tests in a laboratory. After the examinations, some of candidate methods were selected and applied to full scale pavement loading tests and their effects on the pavement behavior were investigated. Positive effects of the methods were confirmed from the test. Also, possibility of early opening to traffic of the pavement was examined by increasing early age of strength of grout.

Water-related damage is one of the major problems for the durability of the bituminous pavement and concrete slabs of concrete deck bridges. In particular, damage can be drastically accelerated by the intervention of water and some chemicals such as surfactants and salts. Therefore, the mass transfer mechanism of water and the mechanism of chemical absorption in pavement materials are important to study. The authors previously pointed out that water storage in bituminous pavement layers is caused by moisture vapor in the air, and developed a new moisture permeation test apparatus to analyze the mass transfer. Based on this test method, the present study showed experimentally that water and surfactant accumulate in the bridge deck pavement and concrete slabs. Water accumulation in the pavement and deck slabs increases according to the daily climatic fluctuation. The repetitive moisture permeation test showed that alkylphenol-ethoxylate type surfactant applied on the top surface permeates through water-impermeable pavement layers and accumulates in the concrete slab.

Although heart rate (HR) responses to hyperventilation (HV) have been used as a cardiovascular autonomic function test, autonomic involvement during HV remains uncertain. To clarify the relationship between autonomic activity and cardiovascular changes during HV, we compared cardiovascular responses during HV among subjects with different autonomic function, namely 16 patients with probable multiple system atrophy (MSA), 16 with possible MSA, 28 with Parkinson's disease (PD) and 28 healthy controls. Abnormalities of cardiovascular responses to head-up postural change and the Valsalva maneuver were definitely present in the order of probable MSA, possible MSA and PD, and abnormal HR and blood pressure (BP) responses during HV were observed in probable MSA and possible MSA, but not in PD. Unlike the significant difference in standard cardiovascular autonomic function tests, the HR and BP responses during HV were equivalent between probable and possible MSA. These findings suggest that cardiovascular control during HV may be affected not only by autonomic activity but also by other factors.

his paper deals with dynamic behaviors of a whitetopping pavement structure with a surface layer of high strength fiber reinforced concrete panel (HSC-WT) under traffic road. A test pavement of HSC-WT was constructed on an accelerated loading facility and was subjected to moving axle loads. After five hundred thousand axle passes, small gaps developed between HSC panel and grout near joint, but any crack didn't develop. Analysis of the loading test with dynamic 3DFEM and comparison of the result with the measured data revealed that visco-elastic effect of the asphalt layer was relatively small. Stress analysis using the identified visco-elastic parameters confirmed that the stresses in the panel due to axle load are much less than the strength of the HSC panel.

Research Note, Water-related damage to bituminous pavement is considered to result from penetration of liquid water from the surface and/or subsurface. However, surface courses made of bituminous material such as runway pavements are usually not permeable for liquid water. Therefore, such phenomena may be caused by moisture vapor in the air. A new moisture permeation test apparatus was developed to analyze the mass transfer. Moisture permeation tests under typical hot summer conditions suggested that atmospheric moisture permeates and accumulates in bituminous mixtures through mass transfer by vapor diffusion despite the water impermeability of bituminous surface mixtures. The moisture permeation test provides an effective approach to analyze water storage mechanisms and moisture-related phenomena such as blistering in bituminous mixtures, although the test apparatus and condition settings require some improvement., 水分による歴青系舗装の損傷は，表面や路床から液状浸入した水が原因であると考えられてきた。しかし，滑走路等のアスファルト舗装表層は実質的に不透水であることが多い。したがって，著者らは大気中の水蒸気（湿気）がこれらの要因であると考え，この検証のために新しい透湿試験装置を開発した。透湿試験から，たとえ表層材料が実質的に不透水性であっても，典型的な夏の暑い日の気象条件においては水蒸気透過による物質移動により大気中の水分が透過し，凝縮した水分が混合物中に多量に蓄積しうることが明らかとなった。試験装置や試験条件に関してさらなる改良を加えることが必要であるものの，透湿試験は水分蓄積メカニズムの解明とブリスタリング現象等の水分に関連する損傷を評価する有効な試験方法である。

潰瘍性大腸炎(UC)とCrohn病(CD)の手術例における腸管外合併症の種類と頻度手術前後の経過について当科経験例を対象に検討を行った.UC233例中103例(44.2%),CD233例中99例(42.5%)に腸管外合併症が認められた.UC,CDともに胆石症が最多で,各々28例(12.0%),29例(12.4%)であった.その7割は術後に発症し,CDでは小腸型で有意に多かった.CDに特徴的な合併症としては微量元素・ビタミン欠乏症が20例(8.6%)に認められた.UCでは末梢関節炎,壊疽性膿皮症,ブドウ膜炎が各々20例(8.6%),16例(6.9%),7例(3%)に認められた.壊疽性膿皮症とブドウ膜炎は大腸全摘術後に改善することが多かったが,関節炎は逆に悪化または新たに発症することが多かった.UC,CDの外科治療では手術が各腸管外合併症に与える影響をよく理解することが重要である.

The blistering phenomenon is one of the major damages in bituminous pavement during a hot summer. The phenomenon was believed to be caused by water permeating from outside via channels of connected pores in bituminous mixtures. However, the surface course in bituminous pavement is not permeable to water, particularly near the blistering area. Therefore, permeation of liquid water is unlikely to be responsible for the water accumulation that causes the blistering phenomenon. Moisture vapor in the air is important in water intrusion into bituminous mixtures. This study examined moisture transfer mechanisms in bituminous pavements, focusing on the coefficient of permeability of pavement mixtures of both liquid water and humid air (i.e. air containing water vapor)., ブリスタリング現象は，夏季の特に暑い時期に生じるアスファルト舗装の主要な損傷の一つである。この現象は，アスファルト混合物中の連続空隙を通して外部から浸入した雨水が原因であるとされてきた。しかしながら，アスファルト舗装の表層，特にブリスタリング等の損傷が生じる箇所周辺は不透水である。つまり，ブリスタリング現象を引き起こす滞留水の要因として，液体状態での水の浸透は考えにくい。著者らは，大気中の湿気が水蒸気として透過し結露することが舗装体内への水分浸入の鍵を握る現象であることを既報で指摘した。本研究では，アスファルト舗装混合物中の水分移動機構の検討として，水および湿潤空気の透過係数に注目することにより，ブリスタリング現象において鍵となる水分浸入の要因を実験検討した研究成果を報告する。

The photodegradation behavior of a straight asphalt was investigated using a new method "photodegradation test of asphalt binder using pressed thin film samples". Although the photodegradation caused by outdoor exposure is limited to the near surface, the results confirmed that the degree of degradation during 1 to 2 months is more severe than that by the pressure aging vessel (PAV) test, which is designed to simulate the degradation that will occur in the asphalt pavement over 5 to 10 service years., Le comportement à la photodégradation d'un asphalte sans additif a été étudié en utilisant une nouvelle méthode, « essai de photodégradation d'échantillons de minces couches pressées de liant routier ». Bien que la photodégradation engendrée par l'exposition aux éléments soit peu profonde, les résultats ont confirmé que le niveau de dégradation durant 1 à 2 mois est plus élevé que celui indiqué par l’essai de vieillissement PAV (pressure aging vessel) qui est conçu pour simuler la dégradation du revêtement en asphalte durant une période de 5 à 10 ans.

Aggregate pop-out is one of the major damages of porous asphalt pavement. As for the causes of pop-out damage, initial performance of modified binders such as shear strength and brittleness at low temperature must be an important factor, but the author focus on the deterioration of modified binders due to ultra-violet rays (UV) in this study. The results of Cantabro-loss after UV irradiation showed that accelerated UV aging induced the aggregate pop-out damage of porous asphalt mixtures. Binder properties after UV irradiation also showed the increase of Fraas Breaking Point and oxygen containing functional group. Furthermore, it was confirmed that there is a good correlation between the increase of oxygen containing functional group and Fraas Breaking Point.

在宅中心静脈栄養療法(HPN)施行中の症例の問題点を検討した.対象は当科で経験したHPN症例19例(男:女=13:6,HPN導入時平均年齢38歳,平均施行期間3.3年)であり,その原疾患はクローン病が15例,非特異性多発性小腸潰瘍症が2例,慢性特発性偽性腸閉塞症が2例であった.HPNの適応は短腸症候群,難治性の肛門病変,経腸栄養不耐などであった.HPNの合併症ではカテーテル感染が最も多く,2年で約6割の症例がカテーテルの交換を必要とした.また代謝合併症として微量元素の過剰と欠乏,肝機能障害,骨軟化症などを認めた,HPNはメリットも多いが重篤な合併症も数多くあり,その施行に際しての経過観察と管理は慎重に行うべきであると考えられた.

Focusing on sunlight that has severe effects on the degradation of asphalt pavement during service, this study examined the relationships between the film thickness of asphalt and the states of photodegradation. The results confirmed that thinner films had a higher modulus of elasticity, lower viscosity, and increased production of carbonyl groups, which is an indicator of oxidative degradation. The degree of degradation rapidly increased especially at thicknesses below 200 μm. The wavelength dependence of spectral photodegradation was also examined. Visual observations and the carbonyl index confirmed that ultraviolet irradiation in the range of 300 to 400 nm caused severe photodegradation of asphalt. Carbon black blocked light near the surface of the asphalt layer, where the damage caused by light is most severe. Addition of carbon black helps to prevent photodegradation by ultraviolet irradiation in the wavelength range of 300 to 400 nm., アスファルト舗装の供用中の劣化現象に影響の大きい光に注目し，この劣化におけるアスファルト単体の膜厚の影響を調査した。その結果，膜厚が薄くなるにつれて，特に200 μm以下の領域で，弾性率の増大や粘性の喪失，また酸化劣化を示すカルボニル基生成の増大など，劣化の程度が急激に著しくなることが確認された。また，分光劣化試験による波長依存性を調査した結果，外観変化やカルボニル指数の挙動より，アスファルトの光による劣化には波長範囲300～400 nmの紫外線の影響が大きいことを明らかにした。さらに，遮光性フィラーとして知られるカーボンブラックは，光による劣化の著しいアスファルト層の表面付近で機能し，波長300～400 nmの紫外線による劣化を抑える効果のあることが見出された。

240例のCrohn病手術例のうち,狭窄形成術は計151例に対して行い,2回目手術以降は狭窄形成術施行例の比率が増加していた.施行部位は,回腸,大腸,回盲弁などに行われ,回腸がもっとも多い適応部位であったが,2回目以降の手術では前回吻合部,前回狭窄形成部に対しても狭窄形成術が行われた.施行術式は,Heineke-Mikulicz法が最も多いが,病変の長さ,固さに応じて他の術式も行われた.狭窄形成術の長期成績を累積再手術についてみると,手術施行部位では狭窄形成部と吻合部とで差はなく,症例毎でも狭窄形成術併用群と,腸切除単独例とでも差はなかった,また,狭窄形成術併用群と腸切除単独群との比較では,病変長が長いにもかかわらず切除腸管の長さ,残存小腸長に差はなく狭窄形成術による腸管温存効果が認められた.狭窄形成術は,腸管温存効果も見られ,繰り返す狭窄性小腸病変には良い適応で切除に匹敵する成績が得られた.

潰瘍性大腸炎では種々の合併症が報告されているが, 同じ炎症性腸疾患であるCrohn病と異なり瘻孔を形成することはまれであり, Crohn病との鑑別診断や, 治療上の問題となる. 今回, 我々は直腸肛門周囲に瘻孔を形成し, 外科治療を要した症例を3例経験したので報告する. 3症例はいずれも30～40 歳代の女性で, 病悩期間はそれぞれ約25年, 9年, 12年であった. 病型は症例1, 2が全大腸炎, 再燃緩解型, 症例3は左側大腸炎, 再燃緩解型であり, 重症例はなかった. 手術は症例1は全結腸直腸切除・回腸ストーマ造設術, 症例2は3期分割大腸全摘・回腸肛門吻合術, 症例3では直腸膣瘻修復・一時的回腸瘻造設術を行った. 3症例とも手術後1～3年経過しているが瘻孔の再発は認めず, 有効な術式であったと思われた.

Carbon black, used as a reinforcing filler for rubber materials, was evaluated for asphalt binders in pavements. Carbon black added to straight asphalt within 20 wt% caused an increase in the elastic modulus and a decrease in the viscosity of the asphalt, especially at temperatures higher than room temperature. Addition of carbon black raised the maximum service temperature of asphalt in the category of the binder performance grade according to the SHRP (Strategic Highway Research Program) specifications. On the other hand, addition of carbon black also increased the failure strain at low temperatures. Furthermore, addition of carbon black reduced the coefficient of thermal expansion (CTE) of asphalt to closer to that of aggregates. In asphalt mixtures, tensile stress occurs at the boundary between asphalt and aggregate with decreasing temperature due to the CTE difference. Addition of carbon black reduced this stress. Carbon black addition to asphalt has the potential to improve both deformation resistance in the high temperature region and crack resistance in the low temperature region, which were empirically considered to be contradictory. Therefore, carbon black is an effective filler for improving the durability of asphalt pavements.

症例は23歳女性.5年前にスプレー缶の蓋を膣内に留置してしまったが医療機関を受診せず放置し,次第に月経周期に類似した下血と腰痛が出現したため近医を受診した.大腸内視鏡検査で膣内異物と直腸膣瘻を指摘され経肛門的に異物除去術が施行されたが,2カ月後も瘻孔が閉鎖しないため当科を紹介された.初診時2横指大の直腸膣瘻と膣狭窄を認めた.回腸にループ式人工肛門が増設されたが6カ月後も瘻孔は閉鎖せず,根治目的に手術が施行された.瘻孔周辺の直腸と膣は高度の線維化により強固に癒着しており直腸・膣の修復は不可能であったため,再手術により子宮摘出・直腸切除,結腸肛門吻合術が施行された.3年2カ月の間にこれらの手術を含む計6回の手術が行われ直腸膣瘻は根治した.膣内異物による直腸膣瘻はまれな病態であるが,治療に難渋した自験例を若干の文献的考察を加え報告する.

下部直腸の全周性結節集簇様病変の1例について手術治療に関しての文献的考察を加え報告する.症例は60歳,女性.2001年9月の職:場検診にて直腸病変を指摘された.11月20日,手術目的で当科入院.精査の結果,下部直腸全体を占拠する結節集簇様腺管絨毛腺腫と診断した.2001年11月28日,直腸部分切除をともなう下部直腸粘膜筒状切除術を施行し,transverse coloplasty pouchを作製して直腸肛門吻合を行った.回腸瘻も造設したが6カ月後に閉鎖し,その後の経過は良好である.大きな結節集簇様病変では,内視鏡的切除が困難で,悪性成分の混在もあり得るため外科的切除の適応になる.下部直腸の全周性病変に対しては括約筋機能を温存するため粘膜筒状切除術の適応があるが,腫瘍の遺残や術後便失禁等の機能障害も報告されている.自験例では腫瘍の完全切除に加えて,良好な排便機能を保つことができた.