Search

症例は53歳の男性で，2009年3月貧血の精査目的で下部消化管内視鏡検査を施行し，上行結腸に腫瘤を指摘された．内視鏡下生検の結果，gastrointestinal stromal tumor（以下，GISTと略記）が疑われた．腹部造影CTにて肝尾状葉に孤立性の腫瘤を認めており，大腸GISTおよび肝転移の術前診断で，4月に回盲部切除術，Spiegel葉切除術を施行した．摘出標本の病理組織学的検査，免疫組織化学染色および遺伝子解析にて，大腸平滑筋肉腫とその肝転移と診断した．近年GISTの疾患概念は大きく変化し，かつて消化管平滑筋肉腫と報告されてきた腫瘍の大部分はGISTに分類されるようになり，真の消化管平滑筋肉腫は大変まれとなった．本症例は，GISTとの鑑別診断，さらには治療方針決定のため，遺伝子解析が有用であった．

Objectives The potent antioxidant activity of Eriobotrya japonica seed extract (ESE) and its usefulness in the prevention and treatment of various disorders has been reported previously. Its antioxidant activity associated with β-sitosterol and polyphenols contained in the extract was also validated. In this study, anti-allergic activity of Eriobotrya japonica seed extract was investigated. Methods The inhibition of histamine release-mediated type 1 allergy by Eriobotrya japonica seed extract was used as an index. Key findings The administration of this extract inhibited histamine release from rat mast cells, suggesting its usefulness in allergic disease treatment. In an experiment using a guineapig allergic rhinitis model, this extract reduced the frequency of sneezing and nose-scratching. Conclusions These results suggest that Eriobotrya japonica seed extract may contribute to the relief of allergic disease-related symptoms.

To evaluate combination therapy with warfarin potassium (WF) and bucolome (BUC),we assigned patients on warfarin potassium (WF) at Kochi University Medical School Hospital to a group also receiving BUC (BUC-combination group) and a group not receiving BUC (non-combination group),and compared the WF doses and TT values.In each patient,we investigated the doses of WF before and after the start or discontinuation of combination therapy with BUC.There was no significant difference in TT values between the two groups.However,the WF dose in the BUC-combination group was significantly lower than that in the non-combination group.BUC was therefore useful for maintaining anticoagulation activity and decreasing the dose of WF.Furthermore,there was a correlation between the doses of WF before and after the start or discontinuation of combination therapy with BUC in each patient.Based on the regression line obtained using WF doses,in the presence and absence of BUC,the subsequent dose of WF could be predicted at the start or discontinuation of combination therapy with BUC,suggesting that it would be useful in anticoagulation control.

The effect of Eriobotrya japonica seed extract (ESE) prepared with 70% ethanol on gastric mucosal injury was investigated. Six experimental models with different action mechanisms were used for the evaluation. Three concentrations of ESE were prepared for each model. ESE administration was initiated 14 days before induction of gastric mucosal injury, and its effect was investigated. ESE inhibited formation of gastric mucosal injury.

We herein report the case of a patient with mucinous gastric carcinoma with peritoneal dissemination that disappeared after neoadjuvant chemotherapy with S-1 alone. The patient has survived for over 23 months after surgery, without recurrence. A 60-year old man was referred to our hospital because of an advanced gastric cancer, detected by upper gastrointestinal endoscopy at another hospital. Staging laparoscopy was performed on October 25, 2002, and revealed massive peritoneal dissemination. Two courses of neoadjuvant chemotherapy with S-1 were administered, at 120 mg/day for 28 days, as one course. Total gastrectomy, with D2 lymph node dissection, was performed on January 24, 2003. The peritoneal dissemination had macroscopically disappeared and the cytology of the peritoneal lavage fluid was class III. His final diagnosis was gastric carcinoma, MLU, type 3, T2(SS), P0, H0, M0, N3, CY0, stage IV.

骨盤内臓全摘術 (TPE) は一般的にはdouble stoma の造設を伴い, 術後QOLが問題視されてきた. しかし, 最近ではstomaless TPEの良好な経過も報告されている. 我々は術前画像診断で広範囲に膀胱浸潤を来した進行直腸癌に対しTPEを施行し, Studer変法による膀胱再建を施行した1例を経験した. 患者は61歳の男性で, 主訴は便秘. 平成14年4月12日近医で大腸内視鏡検査を受け, 肛門縁より約4.5～20cmに全周性の狭窄を指摘され, 生検で中分化型腺癌と診断された. 画像診断で腫瘍は広範囲の膀胱浸潤が疑われたが他臓器転移は見られず, TPEの適応とした. 同年7月9日患者の同意のもと, TPE後にStuder変法による代用膀胱を作成した. 9月30日に退院後, 昼間のcontinenceは十分えられ, 腹圧排尿後の残尿は50ml程度となった. 骨盤内臓全摘術後のStuder 変法による膀胱再建は症例を選べば有用な方法であると考えられた.

早期胃癌, 大腸癌同時性重複癌を合併した皮膚筋炎と診断された興味ある1例を経験した. 症例は72歳の男性. 平成11年6月頃より顔面～頸胸部を中心とする落屑を伴う紅斑が出現した. 同年9月検診目的の胃内視鏡検査にて胃体上部に1型胃癌を指摘された. CPK 394 IU/L, LDH 686 IU/Lであったが, 術前皮膚生検では皮膚筋炎の確診は得られなかった. 同年10月8日開腹術施行し, 術中腹腔内検索にて発見された横行結腸癌とともに切除した. 術後3日目には上半身の紅斑, 掻痒感ともに消失したが, 術後約1か月目より自力歩行困難となるほどの筋力低下を来した. ミオグロビン-S 454 ng/mlであり, 筋生検, 筋電図, 臨床経過から皮膚筋炎と診断した. 12月25日よりプレドニン50mg/dayで内服を開始したところ, 内服後3日目より自力歩行も容易となり筋力は著しく改善した.

Sho-saiko-to extract, a Chinese herbal medicine, is widely used for treatment of chronic hepatitis in Japan. However, it is not clear what conditions Sho-saiko-to extract improves hepatic inflammation and fibrosis. We therefore induced various stages of liver injury in model rats and administered Sho-saiko-to extract. We then evaluated the liver inflammation and liver fibrosis-improving effects of Sho-saiko-to extract. The liver injury model rats were produced by administration of various doses of dimethylnitrosamine (DMN) and Sho-saiko-to extract was administered to these rats. Then the liver inflammation and fibrosis-improving effects of Sho-saiko-to extract were evaluated according to L-asparate aminotransferase (AST), L-alanine aminotransferase (ALT), liver retinoid levels, levels of hydroxyproline, Transforming Growth Factor-beta (TGF-beta), and the liver fibrosis area. These indicators depended on the total doses of DMN. The ability of Sho-saiko-to extract to improve liver inflammation and fibrosis was limited to the following levels of the respective parameters: AST levels (234-264 U/l), ALT levels (208-232 U/l), TGF-beta levels (1102-1265 pg/g liver tissue), hydroxyproline levels (633-719 nmol/g liver tissue), and liver fibrosis area (9.7-10.6 times for normal rat). These findings suggested that Sho-saiko-to extract is effective in the treatment of liver inflammation and fibrosis up to a certain degree of severity, but it produces no improvement in more severe cases.

Eriobotrya japonica is considered a medicinal plant, and its leaves (Eriobotrya folia) have been used to treat skin diseases, as well as to relieve inflammation, pain, coughing, and sputa. In our evaluation of the pharmacological efficacy of the seed extracts, constituents of the seeds were found to contain the unsaturated fatty acids linolenic and linoleic acids and the sterol β-sitosterol in the 70% EtOH and the MeOH extracts. The seed extracts were orally administered to rats with dimethylnitrosamine-induced hepatopathy, and blood L-asparate aminotransferase (AST) and L-alanine aminotransferase (ALT) levels, liver retinoid level, and hydroxyproline level were measured. Liver fibrosis rates calculated after Azan-Mallory staining and evaluation of the liver function-improving effects of extracts were showed that AST, ALT, and hydroxyproline levels and liver fibrosis rates were significantly lower, and retinoid levels were significantly higher in hepatopathic rats treated with 70% EtOH and MeOH extracts of the seed than in water-treated control rats. This suggests that the positive effect on liver function of the extracts varies depending on the extracting solvent used. 70% EtOH and MeOH extract of the seeds inhibited the development of liver fibrosis in hepatopathic rats, thus exhibiting potent improvement. The unsaturated linolenic and linoleic acids and the sterol β-sitosterol contained in these extracts may also contribute to the improvement of liver function.

肝門部胆管癌50切除例について,リンパ節転移状況を検索し,予後との関連性を検討し,適切なリンパ節郭清を模索した. リンパ節転移度別の予後では, n0症例の5年生存率は20.9%, n1の5年生存率は16.7%で,共に1例ずつ5年以上生存例を認めた. n2, n3症例では最長1年5カ月死亡と不良であった.部位別リンパ節転移率では, No.8 (a, p)が最も多く, No.12b, 12pが次いでおり,第2群リンパ節転移が多くを占めていた.第3群リンパ節転移は少なかった. No.5, 6リンパ節に転移の認められた症例があった. 以上より,リンパ節郭清は, D2を基本とし, No. 5, 6郭清を加え, n2, n3転移を明らかに認めるような症例では,拡大郭清や拡大切除は控える配慮が必要になってくるものと思われる.

To achieve a high-density integration of non-volatile memory, NbO x selector-cell prepared by a sputtering process is developed for cross-point 3D-ReRAM. By optimizing sputtering conditions, NbO x film with a threshold voltage of ±0.5V is obtained as a bidirectional selector. Furthermore, ReRAM with a stack of NbO x selector-cells is confirmed to have a good switching property at the threshold voltage of ±0.5V.

One-dose package dispensations of tablets and capsules were performed in all outpatients in order to improve the medication compliance and prevent any incorrect drug ingestion and the effect of this method was evaluated based on a questionnaire survey for outpatients. As a result, it became clear that the age of the patient, the interval of taking medicine, the kind of drugs in the one-dose packages, the number of prescriptions and the dosage days were judgment factors in the evaluation process. In other words, the outpatients who gave “good” answers were aged, had been taking the medicine for a long time, and had received many kinds of drugs in a one-dose package. On the other hand, the outpatients who gave “not good” answers had more types of medicine prescribed, and had been taking the medicine for longer periods of time. After being the one-dose package method the number of dispensing errors decreased from 6.0 cases to 3.5 cases per day on the average.

Intersphincteric resection (IRS) is a surgical technique used to preserve sphincter function, mainly cases of low rectal cancer located less than 5 cm from the anal verge [1, 2]. There have been reports of laparoscopic ISR [3, 4], but discussion of the specific techniques used in this laparoscopic surgical procedure have not been sufficient. For better outcomes of this sophisticated procedure, extreme care must taken to prevent perforation of the rectal wall and to preserve the external sphincter muscle. The most difficult steps for ISR are the circular dissection and separation of the internal sphincter muscle from the external sphincter and puborectalis using the perineal approach. The authors' techniques and the advantages of laparoscopic ISR are shown by a video presentation of three rectal tumor cases. Also, the perioperative outcomes for the patients who underwent laparoscopic ISR with this technique are described.From January 2006 to September 2009, laparoscopic ISR with total mesorectal excision was performed for 15 patients (10 men and 5 women). The median age of the patients was 60.5 years. The T categories of the tumor node metastasis (TNM) classification for the rectal cancers were Tis for two patients, T1 for one patient, T2 for four patients, and T3 for eight patients. The median distance from the anal verge to the tumor in this series was 3.7 cm. The Tis cases had large laterally spreading tumors that could not be removed by endoscopic submucosal dissection. The T1 case presented in the video had a small tumor just above the dentate line that had developed in the presence of chronic ulcerative colitis. Because this case required total proctocolectomy and ileal pouch anal anastomosis, local resection was not used (Table 1). Table 1 Patients' clinical characteristics (2006.1-2009.8) No. of patients: 15 Gender (M/F):10/5 Age: years (range): 60.5 (31-75) pT*: Tis (n=2), T1 (n=1), T2 (n=4), T3 (n=8) Distance from anal verge: cm (range): 3.7 (2-5) * Pathological T categories of the tumor node metastagis (TNM) classificationThe 68-year-old man in case 1 had a large, laterally spreading rectal tumor. The 61-year-old man in case 2 had rectal cancer, with a tumor located 4 cm from the anal verge. Laparoscopic surgery was performed after neoadjuvant chemoradiotherapy. The 71-year-old woman in case 3 had T1 rectal cancer, with a tumor located just above the dentate line. After dissection of the intersphincteric space, the prolapsing technique was used.In the male patients, the rectum with the mesorectum was first dissected to the anal hiatus, initially on the posterior side along the avascular plane. Second, Denonvilliers' fascia was dissected, and the seminal vesicle was exposed. The third step was dissection of the lateral tissues followed by incision of Denonvilliers' fascia with the rectal wall exposure and care taken not to injure the neurovascular bundle (Fig. 1). Along this dissection plane, the puborectalis could be reached and intersphincteric space entered from the lateral side of the rectal wall (Fig. 2). The final step was dissection of the hiatal ligament at the posterior side of the rectum. Nearly circular dissection of the intersphincteric space could be completed. The difficulties associated with the perineal approach were reduced by this abdominal approach, and the tumor could be exteriorized easily. Fig. 1 After incission of the Denonvilliers' fascia at the lateral side of the seminal vesicle puborectalis muscle can be reached at the lateral side of the rectum. Fig. 2 Adhesion line between the puborectalis muscle and rectal wall is enposed. Intersphinecteric space can be entered along this dissection plane at the lateral side of the rectum.The mean duration of surgery was 386 min, and the mean blood loss was 108 ml. The mean postoperative hospital stay was 18 days. The diverting ileostomy was closed at a mean of 7.3 postoperative months. No remarkable perioperative complication was encountered (Table 2). Table 2 Perioperative outcomes (n=15) Duration of surgery: min (range) 386 (319-510) Blood loss: ml (range) 108 (0-180) Postoperative hospital stay: days (range) 18 (11-31) COMPLICATIONS: n (range) Anastomotic leakage 1 Stricture of the anastomosis 1 Pelvic abscess 1 Postoperative period until the stoma closure (months) 7.3 (3-16) CONCLUSION: Laparoscopic ISR enabled reduction of the difficulties associated with the perineal approach. An advantage of laparoscopic ISR is the ability clearly to visualize anatomic structures in the deep pelvic cavity.

患者は71歳女性,主訴は右乳頭部びらん. 2年前の左乳癌術後からtamoxifen (TAM)の内服治療を行い通院中であった. 1998年8月頃より右乳頭部びらんを認め,皮膚生検にてPaget病と診断し乳房切除術施行.また婦人科検診にて最大径4.0cmの大きな子宮内膜ポリープが発見され子宮内容除去術施行した.乳癌術後の補助療法として広く使用されているTAMの長期投与によるエストロゲン作用が子宮内膜の増殖状態を持続させ,内膜ポリープや子宮内膜癌などの発生を高めることが知られている.一方対側乳癌の発生頻度を有意に低下させるとの報告もある.今回経験した症例は初回乳癌術後2年間TAMを投与中に,対側乳房のPaget病,および子宮内膜ポリープの発生をみた.本症例のPaget細胞のER免疫染色は陰性であった. TAM投与中は投与期間や量にかかわらず対側乳房の観察や,婦人科的検査は行われるべきである.

To examine the effects of Sho-saiko-to extract on liver fibrosis, the drug was administered to rats with dimethylnitrosamine-induced liver-injury at various doses. Hydroxyproline and retinoid levels in the liver were measured as indicators of liver function. In liver-injured rats, the hydroxyproline level in the liver (957 ± 154nmol g−1) was about 4.16-times that found in normal liver (230 ± 11 nmol g−1), but administration of Sho-saiko-to extract (0.75%, 1.5% or 3%) reduced the hydroxyproline level significantly (554 ± 58, 356 ± 51, 374 ± 66 nmol g−1, P < 0.01). Single administration of the active constituents of Sho-saiko-to extract, glycyrrhizin, baicalin or baicalein, decreased the hydroxyproline level significantly compared with the ordinary food group (P < 0.05), but the decrease was smaller compared with the Sho-saiko-to extract group. The liver retinoid level was higher in the Sho-saiko-to extract group than the ordinary food group and the value increased dose-dependently. A significant negative correlation, r = −814 (P < 0.001) was detected between the hydroxyproline level and retinoid level in the liver of liver-injured rats. Significant negative correlations, r = 0.728 (P < 0.001) and r = −0.873 (P < 0.001), were also detected between the liver hydroxyproline level and the liver concentrations of the active constituents (glycyrretic acid, baicalin and baicalein) in the liver-injured rats. From these findings, it was considered that the liver concentrations of hydroxyproline and retinoid as well as the active constituents were involved in the improvement of liver fibrosis in the liver-injured rats administered Sho-saiko-to extract. Administration of Sho-saiko-to extract inhibited collagen production while an increase in retinoid level inhibited activation of Ito cells leading to inhibition and prevention of liver fibrosis.

About 50% of patients who have a permanent stoma experience some degree of parastomal hernia formation. To prevent this complication, the extraperitoneal route is considered to be more effective than the transperitoneal route in the case of open colorectal surgery. This technique also has superiority in avoiding postoperative intestinal obstruction. Although laparoscopic surgery for rectal cancer has not been proved to be as safe as open surgery by a randomized-controlled trial, some studies have shown the equality of long-term results with laparoscopic low anterior resection and laparoscopic abdominoperineal resection. It is anticipated that cases of laparoscopic abdominoperineal resection will increase in the near future. However, a laparoscopic technique for creation of a permanent stoma has hardly been discussed. Most operative procedures for laparoscopic stoma creation have been performed with transperitoneal route, which may cause parastomal hernia and/or intestinal obstruction. This report describes a laparoscopic technique for permanent sigmoid stoma creation through the extraperitoneal approach.

The reactive ion etching (RIE) of the binary transition-metal oxides (TMOs) NiO, CuO and CoO, which are expected to be key materials of resistance random access memory (RRAMTM), was investigated. We found that inductively coupled plasma using CHF3-based discharge, which is highly compatible with conventional semiconductor RIE, is effective for the TMOs studied here. Furthermore, device fabrication using Pt/CoO/Pt trilayers is carried out, and a large change in resistance, which is an essential functionality of RRAM, was successfully observed. This should be definite evidence of a successful RIE realized in the present device fabrication.

Xanthogranulomatous changes in the pancreas are extremely rare. A 66-year-old man presented with a 2-year history of epigastralgia. Computed tomography scan revealed a 4-cm low-density area around the body of the pancreas. Magnetic resonance imaging demonstrated that the mass appeared hyperintense on a T2-weighted image and isointense on a T1-weighted image. Based on a diagnosis of invasive ductal carcinoma of the pancreas, distal pancreatectomy and splenectomy were performed. Sections examined from the mass showed an aggregation of many foamy histiocytes, lymphocytes, and plasma cells. The surrounding pancreatic tissue showed fibrosis and chronic inflammation. These findings suggested a xanthogranulomatous inflammation, and resulted in a diagnosis of xanthogranulomatous pancreatitis.

Primary carcinoma of the vermiform appendix is a rare disease. It presents difficulty in diagnosis preoperatively and postoperative histopathologic examination ofen offers the definite diagnosis for the first time. We have experienced four cases of primary carcinoma of the vermiform appendix. Preoperative diagnoses were ileocecal tumor in case 1 and 3, ovarian cancer in case 2, and pseudomyxoma peritonei arising from the appendix in case 4. We performed an appendectomy in case 1, ileocecal resection and extirpation of the uterus and ovary in case 2, ileocecal resection in case 3, and appendectomy and peritoneal levage (with 2, 500ml of 5% dextorose water) in case 4. At laparotomy, case 2 and 4 showed psuedomyxoma peritonei. Pathological diagnoses were mucinous cystadenocarcinoma in case 1, 2 and 4, and adenocarcinoma in case 3. After the surgical resection of the tumor, intraperitoneal administration of cisplatin and intravenous injection of pirarubicin and cyclophosphamide were executed in case 2, and peritoneal lavage and intraperitoneal administration of 5-FU were executed in case 4. All patients are still alive.

Renal cell carcinoma (RCC) easily metastasizes on blood. So, metastases from RCC to the lung, liver and bone are common, but the pancreas in a rare site. We report a resected case of multiple pancreatic and hepatic metastases of RCC occurred 8 years after operation in a 61-year-old man. The patient had undergone a right nephrectomy for a primary RCC 8 years before, and a sigmoidectomy for a metastatic tumor of the sigmoid colon 5 years before admission. And this time, abdominal CT and magnetic resonance imaging (MRI) demonstrated multiple tumors at the pancreatic head and tail and a solitary tumor at the posterior segment of the liver. A Pylorus-preserving pancreatoduodenectomy, a distal pancreatectomy, a partial resection of the pancretic body and a partial resection of the posterior segment of the liver were performed under the diagnosis of the multiple pancreatic and hepatic metastases of RCC. Histopathological findings of the resected material showed metastases of RCC to the pancreas and liver. There have been 57 resected cases of pancreatic metastasis of RCC in the Japanese literature. In about 78% of them, pancreatic metastasis occurred metachronously and after elasping for a relatively long time. Long-term follow up is necessary for the patient after nephrectomy for RCC.

Twenty-four cases of intrahepatic cholangiocarcinoma resected in our hospital in the 12 years from 1986 to 1997 were studied with respect to macroscopic classification and prognostic factors. 20.8% of the patients had stones of the intrahepatic or common bile duct. The serum level of carcinoembryonic antigen and of carbohydrate antigen 19-9 was positive in 38.1% and in 86.4% of the patients, respectively. The outcome were poor: one-and five-year survival rates were 55.3% and 22.1%, respectively. Macroscopic classification was made into mass-forming, periductal infiltrating, and intraductal growth types, following a report of The Liver Cancer Study Group of Japan (1994). The outcomes of the mass-forming type (n=9) and the periductal infiltrating type (n=11) were very poor and showed no significant difference. But the patients of the intraductal growth type (n=4) were all living with good prognoses. Prognostic factors were examined according to the Classification of Primary Liver Cancer (Third Edition, 1992). Lymph node involvement, serosa invasion, and portal invasion were significant indicators of a poor prognosis.

SrBi2Ta2O9 (SBT) thin films were deposited on 6-inch Pt/Ti/SiO2/Si substrates by rf magnetron sputtering using a 12-inch ceramic SBT single target. It is found that several sputtering parameters such as argon (Ar) pressure and rf power were very effective to control the Bi content of SBT thin films which is essential for obtaining good ferroelectric properties.

Sho-saiko-to, one of the most widely used Chinese herbal preparations, has long been used for the treatment of chronic liver diseases. We have investigated its effect in retarding the process of liver fibrosis and accelerating liver regeneration, especially its effect on Ito cells that are thought to be deeply involved with liver fibrosis. Sho-saiko-to extract and its active constituents were orally administered to rats with dimethy lnitrosamine-induced liver-injury. After treatment with sho-saiko-to extract hepatic function improved, histopathological results confirmed repair of liver tissue, and retinoid levels increased. On the other hand, when active constituents of sho-saiko-to extract were administered alone, liver retinoid levels remained low, implying that interaction among active constituents of the extract was suppressing Ito cell activation. When sho-saiko-to extract was administered to 70% hepatectomized normal and liver-injured rats, liver weight, the number of S-phase-cells and retinoid levels increased with time. However, these changes were different for normal and liver-injured rats, suggesting that the site of action of sho-saiko-to extract in regenerating liver is different for normal and liver-injured rats. These results show that sho-saiko-to extract was useful for suppressing the activation of Ito cells.

We report a case of gastric leiomyosarcoma showing a pedunculated extragastric development that is very rare. A 75-year-old woman was admitted to the hospital because of an abdominal tumor and epigastralgia. gastric transillumination, gastric camera and abdominal CT offered a suspicion of extramucosal tumor of the stomach. Endoscopic ultrasonography was performed and extragastric leiomyosarcoma was diagnosed. Upon laparotomy a tumor with the size of 17×12×9cm and pedunculated from the posterior wall of the body of the stomach was present and it was excised by a wedge resection. Cross section showed yellowish white solid tumor with necrosis. The pathological diagnosis of the excised tumor was extragastric leiomyosarcoma. There was no distant metastasis and direct invasion of adjacent structure, but microscopically mitosis was found 8/10 High Power Field, and the tumor was 17cm in diameter, so that her prognosis might be very poor. There have been no signs of recurrence, and the patient is in good health to date.

Tubular adenomas of the breast are rare benign tumors that commonly occur in younger women. The authers describe a case of rapidly enlarging tubular adenoma occurred in a pregnant woman. A 17-year-old woman was sent to the hospital because of a breast tumor. She had a baby girl 4 days before. The tumor had grown rapidly during pregnancy. The tumor, measuring 9.0 cm×8.0 cm was palpable in the CD area of the left breast. Ultrasonography and mammography showed no apparent signs of malignancy. Under the diagnosis of fibroadenoma or phyllodes tumor, the tumor was extripated. Pathohistologically, the tumor was diagnosed as tubular adenoma. Tubular adenomas are so rare that only 32 cases have been reported in the Japanese literature. Among of them, this case is thought to be clinically rare in such a longer diameter of the tumor and a rapid growth during pregnancy.

For the purpose of treating intractable decubitus and skin ulcer, streptokinase (SK) jellies containing different types of thickening agents were prepared. Adhesion to the affected sites, the spreading ability of the jelly preparation, and the properties of the SK in the jelly, which are all considered to greatly affect the clinical efficacy, were examined pharmaceutically using the viscosity, spreading area, and release and stability of SK as indexes. Regarding the viscosity and spreading area which are thought to affect both adhesion and spreading greatly, when sodium polyacrylate (PANa) was used as a thickener, higher viscosity and smaller spreading area were obtained in comparison with carboxymethylcellulose sodium (CMCNa) and sodium alginate (Alg Na). In addition, the viscosity and the spreading area obtained with PANa were also slightly more affected by temperature than with CMCNa and AlgNa. Regarding the release of SK from the jelly preparations, with PANa no initial burst was observed and SK was continuously released at a constant rate in contrast with CMCNa and AlgNa, thus obviously showing the superiority of PANa in the retention of SK. Although no loss of the potency of SK was found in the jellies containing PANa, CMCNa or AlgNa at 5°C, for 30 days, the remaining potency was greatly decreased to 49-62% at 25°C after 30 days and 33-42% at 37°C after 30 days. These results showed that the adhesion, spreading ability and SK-release were greatly different among the tested thickening agents, and the properties of PANa were found to be clearly superior to those of the other agents. According to these results, SK jelly containing 2% PANa was used for the treatment of intractable decubitus and skin ulcer, and an excellent therapeutic effect was obtained.

This paper deals with development of sputtering technology of Ta2O5/TaOx stacked film for ReRAM mass-production. Thickness of TaOx film deposited by sputtering process is possible to obtain with good uniformity. However, if a high deposition rate is required for mass production, it is very difficult to obtain good controllability and uniformity of TaOx film. These problems affect the switching characteristics of the ReRAM. In order to solve these problems, sputtering tool and process for ReRAM mass-production are developed. We report the result of TaOx film with good resistance uniformity and controllability and deposition stability without low deposition rate. Moreover, switching characteristics of Pt/Ta2O5/TaOx/Pt-ReRAM-cells are evaluated.

Aeromonas sobriaによる電撃的経過をたどった敗血症の1例を報告した. 患者は82歳の女性.残胃癌にて根治術施行.術後第1日目後半より, 低血圧, 頻脈となり輸液負荷, 塩酸ドパミン投与により経過をみたが, 術後2日目に敗血症ショックによる末梢循環不全およびDICをきたした. 強度の代謝性アシドーシス, 血小板減少をきたし, 胸部, 腹部の皮下出血斑, 皮下気腫を呈した. ICUに入室し呼吸循環管理を行ったが, ショック状態から離脱できず同日死亡した. 動脈血培養にてAeromonas sobriaが検出された.Aeromonas sobriaの術後感染症としての報告はわれわれが調べえた範囲では本症例が第1例目であるが, 急激な経過をたどることや, ペニシリン系抗生物質に感受性が乏しいなど診断治療において特に注意すべきと考えられる.

A longitudinal characteristic curve of chronic liver disease (LCC-LD) is derived for the first time by a new method of time series data analysis, where a hospital information system is utilized as a clinical research application of the database. It describes a typical pattern of development of disease from the beginning of chronic hepatitis to the final stage of cirrhosis. The LCC-LD is obtained by effectively using patient data with various stages of developments of liver disease and the present method is applicable to derive the LCC of other diseases. The obtained LCC-LD may be useful for a clinical decision making support such as the prospective assessment (for example, the onset time of cirrhosis) of liver disease in individual patients, an evaluation of drug effect, etc.

The prevalence of a paracolostomy hernia has been reported to be from 10% to 50%, with serious impairment of the quality of life and sometimes life-threatening morbidity in some cases. Most essential in avoiding the need for further treatment of an end-sigmoid colostomy is prevention of a parastomal hernia.We examined the effects of the extraperitoneal route for stoma creation to prevent parastomal hernia after laparoscopic abdominoperineal resection for rectal neoplasms.This is a study of a retrospective cohort.Data on a total 37 consecutive patients who underwent abdominoperineal resection from March 2005 to December 2010 in Kochi Health Sciences Center were examined retrospectively in this study. Group A included 22 patients whose stoma was created through the extraperitoneal route, and group B included 15 patients whose stoma was created through the transperitoneal route.The main outcome measures were the rate of parastomal hernia determined through CT and clinical examinations in the 2 groups.In Group A, 1 case was diagnosed as having a parastomal hernia, whereas, in Group B, 5 cases were diagnosed by CT examination as having a parastomal hernia; the difference in incidence between the 2 groups was significant (p = 0.0305). Furthermore, median duration of the follow-up period between the latest CT examination and the primary operation was 722 days in group A, which was significantly longer than that in group B (442 days) (p = 0.001).: This study was limited by its nonrandomized retrospective design.Group B developed parastomal hernia more frequently within a significantly shorter period. A permanent sigmoid colostomy created through the extraperitoneal route can prevent the incidence of parastomal hernia after laparoscopic abdominoperineal resection.

Recently the sclerotherapy for esophageal Varices is rapidly spreading and becomes a first choice therapy in many hospitals. We experienced a case of advanced esophageal cancer 20 months following sclerotherapy using polidocanol for esophageal varices with alcoholic cirrhosis. It is well-known that erosive or chemical esophagitis can be the structural origin for esophageal cancer. There have been 8 cases of esophageal cancer following selerotherapy for esophageal varices in the Japanese literature, in that we discussed whether there was some etiologic correlation between sclerotherapy and esophageal cancer.

cis-Diamminedichloroplatinum (II) (cisplatin: CDDP) suppositories containing NaCl at different concentrations were prepared as a local chemotherapeutic agent for the treatment of uterine endometrial carcinoma and were administered to rabbits implanted with uterine VX2 tumor. The intrauterine CDDP histological level, as well as the antitumor effects and side effects of the suppositories to the liver and kidney were studied. The results showed high intrauterine tissue CDDP level in all suppository administrations. In particular, the NaCl-added suppositories enhanced the intrauterine CDDP level. As for antitumor effects, while the tumor growth rate of the NaCl-added suppository group was likely to be suppressed, the suppositories could not suppress tumor growth completely. The plasma platinum (Pt) level was 1.5 micrograms/ml or less and that of the liver and kidney was as low as 0.31 to 0.48 micrograms/g. No difference in levels depending on NaCl concentration was observed, nor was any abnormality found in the biochemical analysis including glutamate oxaloacetate transaminase (GOT) and blood urea nitrogen (BUN). Histopathological study revealed the degeneration of tumor cells in the NaCl-added suppository group. Minimal congestion and hemorrhage were observed in the endometria, possibly resulting from CDDP. By adding NaCl to CDDP suppositories, the uterine CDDP level and antitumor effects increased while no serious renal dysfunction was noted. Therefore, we conclude that NaCl-added CDDP suppositories are a useful local chemotherapy for endometrial carcinoma.

Recently the Flash Memory is scaling limit, Thus the Memory of various types is now under study for the next generation large capacity nonvolatile memory. Resistance random access memory (ReRAM) is attracts much attention due to its advantage for integration in the next generation nonvolatile memory, because it is depend on scaling by lithography compared with the Flash Memory of capacity type. The material for ReRAM is classified roughly into binary oxides and perovskite oxides. Several binary oxides such as a TaOx have the advantage for low-temperature process and low-cost materials compared with perovskite oxides such as a (Pr,Ca)MnO3 (PCMO). In this study, TaOx film with the thickness of 10nm were prepared by reactive RF magnetron sputtering on 8inch-Pt/Si substrate using a Ta metal target in oxygen ambient. The sputtering system was the multi chamber type mass production tool. The TaOx thin film was amorphous phase as a result of measurement by X-ray diffraction meter. Ta top electrodes with 50 um diameters were deposited on the surface of TaOx layer by the DC sputtering method using a shadow mask. The “Forming” voltage of TaOx-ReRAM was 5.0V. After “Forming” process, the “Set” and “Reset” voltage were 3.0V and –3.0V respectively. It has good switching properties with large on/off resistance ratio above 1,000.

Since lipid oxidation is involved in the deterioration of hypercholesterolemia-related atherosclerosis, ingestion of drinks and foods with antioxidant actions is useful for preventing lipid oxidation. Goishi-tea is a post-fermented-tea manufactured by a unique method in Japan, and may be useful for preventing various disorders. However, there is no scientific evidence. In this study, we compared the radical scavenging activity of goishi-tea with that of other teas, and administered this tea to a rabbit model of hypercholesteremia to evaluate its usefulness in the inhibition of hypercholesteremia and atherosclerosis. The radical scavenging activity of goishi-tea was similar to that of green-tea, and was higher than that of other types of fermented-teas. On the other hand, some difference of components was found between goishi-tea and green-tea. In cholesterol-fed rabbits, low-density lipoprotein (LDL)-cholesterol level in the goishi-tea-group was lower than that in the green-tea-group. Plasma lipidperoxide value was also lower in the goishi-tea-group than in the green-tea and tap-water-groups. On aortic endothelial staining, fat area in the goishi-tea-group was lower than that in the tap-water-group. Furthermore, fat accumulation in the aortic intima in the goishi-tea-group was very low. Goishi-tea has higher antioxidant activities than the other fermented-teas tested, which were generally low, and decreased serum lipid levels, suggesting that goishitea is a very peculiar fermented-tea with usefulness in the prevention of hypercholesterolemia and atherosclerosis.

In this study, we investigated the effects of an Eriobotrya japonica seed extract (ESE) on mucositis using a 5-fluorouracil (5-FU)-induced mucositis hamster model. This model was prepared by intraperitoneally administering 90 mg/kg of 5-FU to hamsters on Day 1, scratching 1 cm(2) of the left cheek pouch of hamsters with a wire brush on Days 2, 3, and 4, and intraperitoneally administering 60 mg/kg of 5-FU on Day 5. Mucositis was evaluated based on the mucositis score at the mucositis site, left cheek pouch thickness, histological findings on HE staining, and plasma lipid peroxide levels. On Day 10, the mucositis score and left cheek pouch thickness in the ESE group were significantly lower than those in the tap water group. Histologically, the two groups showed a defect of the cheek pouch epithelium on Day 6. On Day 10, epithelial injury and bacterial infection were noted in the tap water group. However, in the ESE group, similar findings were not observed. On Day 6, the plasma lipid peroxide level in the tap water group was significantly higher than that in the normal group. In the ESE group, the plasma lipid peroxide level was significantly lower than that in the tap water group. These results suggest that ESE is useful for treating chemotherapy-induced mucositis.

The anti-allergic activity of Eriobotrya japonica seeds extract (ESE) was investigated. Oral administration of ESE dramatically inhibited ear swelling due to allergic contact dermatitis caused by repeated application of two antigens, 4-ethoxymethylene-2-phenyl-2-oxazolin-5-one (oxazolone) and dinitrofluorobenzene (DNFB), respectively. The increase of histamine content in inflamed ear tissue induced by oxazolone and DNFB was significantly antagonized by orally administered ESE. Eosinophil peroxidase and myeloperoxidase activity in both models was suppressed by orally administered ESE. Tumour necrosis factor-α in the inflamed region caused by repeated application of DNFB was also significantly suppressed. The findings suggest that ESE may be effective for treating allergic contact dermatitis.

Laparoscopic surgery for colon cancer has been shown by several randomized, controlled trials to be an acceptable alternative to open surgery; however, laparoscopic rectal surgery has not been evaluated in a randomized trial. One of the most serious problems associated with laparoscopic rectal surgery are bowel clamping, irrigation, and transection of the rectum, and laparoscopic rectal surgery has not been as reliable as open rectal surgery. We present our new technique, the laparoscopic double-stapling technique, which eliminates these problems. This technique uses curved Doyen forceps introduced through the wound just above pubis symphysis for clamping the rectal wall at the anal side of the tumor. An endolinear stapler (length 60 mm) is inserted through the same wound, applied at the rectal wall parallel and caudal to the Doyen forceps, and transects the rectum under pneumoperitoneum. We used this technique for eight cases of rectal surgery. The laparoscopic double-stapling technique provided secure bowel clamping and rectal irrigation. The number of cartridges used in laparoscopic double-stapling technique cases was not more than 2, with an average of 1.6 per patient. None of the laparoscopic double-stapling technique cases experienced major complications. We consider that many cases of rectal cancer that are suitable for laparoscopic low anterior resection can undergo laparoscopic surgery by using this technique, which will improve the quality of rectal surgery.

Phase Change Random Access Memory [PRAM] is one of the candidates for next generation memory due to its non-volatility, high speed, high density and compatibility with Si-based semiconductor process. Ge2Sb2Te5 [GST] thin film, an active layer in this device, is utilized because it has the well-known property of rapid crystallization without phase separation in erasable compact discs industry.In order to integrate PRAM to beyond 512Mbit, a high writing current and degradation of cell transition at small cell size become a problem. To resolve these problem, Confined Cell structure PRAM was suggested. However, it was difficult to fill GST layer in a small hole with a conventional sputtering tool because a big overhang occurred.In this work, we prepared GST films on the small hole patterned wafer by a new concept sputtering tool which designed developed a new concept sputtering tool. The structure of GST film was observed with cross section SEM and the film composition was measured with XRF.It was observed an overhang was suppressed and a GST film was filled in a small hole with a new concept tool. In addition, the uniformity of the GST film composition was good at less than 1% in 200mm φ substrate.

Phase Change Random Access Memory [PRAM] is one of the candidate for next generation memory due to its non-volitality, high speed, high density and compatibility with Si-based semiconductor process. Ge2Sb2Te5 [GST] thin film , an active layer in this device, is utilized because it has the well-known property of rapid crystallization without phase separation in erasable compact discs industry.We investigated the difference of the character of the GST thin film with various sputtering methods. 100nm thick GST films were prepared with DC magnetron sputtering and RF magnetron sputtering for this experiment. XRF, XRD,SEM and four point probe measurement are used to analyze the electrical properties of these films.As for the composition of the DC sputtered GST films, Te was insufficient from target composition, while the composition of RF sputtered GST films were almost same as target composition. The RF sputtered GST films were composed of hcp by 400°C annealing. On the other hand, the DC sputtered films were mixed-phase of fcc and hcp. The resistivity of DC Sputtered GST films was higher than RF sputtered film cause of poor crystallinity. The uniformity of RF sputtered film was better than DC sputtered film.

We herein report a case of rectosigmoid cancer metastasizing to a fistula in ano. A 53-year-old man complaining of anal bleeding consulted another hospital. He had been suffering from an anal fistula since 7 years. On the left upper side of the skin surface around the anus a fistula end was seen as a hole that tunneled down into the back passage, although no hard tumor was palpable on the hole. Complete colonoscopy revealed an ulcerative tumor in the rectosigmoid colon. On 5 February 2004, anterior resection and lymphadenectomy was performed. The post-operative pathological diagnosis was rectosigmoid cancer, Type 2, T2, N0, M0, stage II. The anal fistula was a simple type and mucinous discharge was not observed. On 23 February 2004, coring out the anal fistula was performed by the former hospital. Pathological diagnosis of the excised fistula revealed well-differentiated adenocarcinoma; identical to the colon tumor. Immunohistochemical staining of these two lesions were negative for (CK) 7 but staining with CK20 revealed some stained tumor cells in two lesions. We diagnosed this tumor as metastatic adenocarcinoma from a rectosigmoid cancer. Recurrent lesions were not seen during the first year after the first operation.

A large number of studies have demonstrated that the presence of eosinophils in the lungs of patients with pulmonary fibrosis correlates with poor prognosis or resistance to therapy. However, direct evidence of the relationship between the influx of eosinophil and pulmonary fibrosis has not yet been described experimentally. In this article, pulmonary fibrosis was induced by different doses of bleomycin (BLM) and using different aged rats. On selected days afterwards, the lungs were lavaged and harvested for analyzing fibrosis, eosinophil influx and cytokine expression. There was a significant relationship between eosinophilia and the pulmonary fibrosis (r=0.98, p

Background/Purpose. The utility of hepatectomy for patients with metastatic liver tumors from gastrointestinal stromal tumors (GISTs) was evaluated in the present study. Methods. Between 1989 and 2001, ten patients with liver metastases from GIST (four men and six women; age, 34‐77 years) underwent hepatectomy at our hospital. All patients underwent complete resection of the primary tumor and hepatectomy with or without microwave coagulation therapy (MCT) for all detectable hepatic tumors. Results. The median survival time after hepatectomy was 39 months (range, 1 to 96 months). There was one postoperative death. One patient is still alive with relapse of hepatic tumors, and the remaining eight patients died of disease (liver in six, peritoneum in one, and bone in one). Relapse of hepatic tumors occurred in seven patients. The disease-free rate after hepatectomy was 22% at 2 years and 11% at 5 years. The survival times of the four patients who received hepatic arterial chemoembolization for recurrent hepatic metastases were 7 months (still alive), 17, 23, and 28 months (average, 19 months). Conclusions. Our data suggest that aggressive surgery (hepatectomy and MCT) for all detectable hepatic tumors and hepatic arterial chemoembolization for recurrent hepatic metastases improve survival.

(Ba,Sr)TiO3 (BST) films were deposited by RF magnetron sputtering using BST sintered ceramic targets and an approach to deposit BST films with higher permittivity by sputtering deposition was explored aiming to the application of thin film capacitor, RF tunable components and so on.Basic sputtering conditions such as RF power, deposition temperature and so on were varied in this study. BST films and Pt/BST/Pt capacitors were investigated by electrical properties, XRD analysis and SEM observation. It became clear that deposition temperature, deposition rate, and BST film thickness were important parameters for optimization of the dielectric constant. From the non-linearly relationship between dielectric constant and BST film thickness, we could also find that the interfacial layer between BST and Pt bottom electrode was important for controlling the BST film properties. Furthermore, an approach to enhance the crystalline quality has to be explored for further improvement of BST film properties. Dielectric constant could be raised up to 10% by just changing the gas flow sequence of BST sputtering process.

Thin Pb(Zr, Ti)O3 films were grown on a 8-inch Ir(111)/SiO2/Si substrate by a liquid-source MOCVD system. These films showed dependency of ferroelectric properties on several deposition parameters. PZT single phase was obtained at a substrate temperature of 620°C. The film showed (111) preferred orientation and the Pt/Pb1.16(Zr0.45, Ti0.55)Ox(115nm)/Ir capacitors had excellent ferroelectric properties. The switching charge (Qsw) value (at 2V), saturation voltage (V90) and leakage current density (at 1.5V) were 47.4uC/cm2, 1.7V and 7.5E-8A/cm2 respectively. The capacitor made by using an IrOx top electrode had excellent fatigue-free property.