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Atypical carcinoid tumors of the uterine cervix represent rare neuroendocrine tumors and are highly aggressive, showing early lymphatic invasion and hematogenous distant metastases. Because of the small number of cases, there are currently no recommendations regarding treatment, and little is known about the response to chemotherapeutic agents. A 39-year-old woman was diagnosed with a primary atypical carcinoid of the uterine cervix with numerous metastases to the liver. After radical hysterectomy, she underwent hepatic arterial chemoembolization with streptozotocin and 5-fluorouracil. Complete response was achieved in numerous liver metastases. At the 2-year follow up of chemotherapy, the patient remains alive. Treatment for atypical carcinoid tumors remains elusive, however hepatic arterial chemoembolization with streptozotocin and 5-fluorouracil was effective in the present primary atypical carcinoid with liver metastases. A review of the previous reports is also presented.

大腸癌における再発巣の部位では腟転移は非常に稀である．今回，我々は直腸癌（Ra）術後2年に腟転移を認めた症例を経験したので，再発経路など文献的考察をふまえて報告する．症例は77歳女性．2007年7月直腸癌に対し当科で直腸低位前方切除術+リンパ節郭清（D3）を行った．術後フッ化ピリミジン経口抗がん剤内服にて補助療法を行った．術後経過良好であったが，術後2年のフォローアップCTにて傍大動脈リンパ節の腫脹を認めた．次いでFDG-PET検査を行ったところ，同部位と外陰部に強い集積を認めた．外陰部異常所見に対し，産婦人科にて精査を行ったところ腟に粘膜病変を認め，生検でAdenocarcinomaと診断された．直腸癌術後腟転移，傍大動脈リンパ節転移再発と診断し，中心静脈カテーテルポートを用いた化学療法（mFOLFOX6）と腟転移巣の切除を行った．現在転移再発治療開始後1年7カ月経過しており治療を継続している．

We report the case of a patient with colon cancer accompanied by multiple unresectable liver metastases who showed complete response (CR) to modified TEGAFIRI (mTEGAFIRI) (tegafur-uracil/leucovorin+irinotecan) chemotherapy. The patient was a 58-year-old Japanese male with cancer of the descending colon accompanied by multiple unresectable liver metastases. Following resection of the sigmoid colon cancer, mTEGAFIRI chemotherapy was administered. Abdominal computed tomography performed upon completion of 12 courses of chemotherapy showed that the unresectable liver metastatic lesions had disappeared, indicating CR. The only adverse drug reactions (ADRs) experienced to date have been stomatitis (grade 1) and neutropenia (grade 1). Anticancer therapy has thus been continued, and CR has been maintained for 15 months. The present patient achieved CR in response to mTEGAFIRI chemotherapy, a regimen that has not previously been reported, while experiencing only mild ADRs and maintaining a good quality of life. mTEGAFIRI chemotherapy is convenient to administer and is thought to be a potentially useful treatment option for patients with unresectable, recurrent colon cancer.

Background: Colorectal cancer most commonly metastasizes to the liver. However, in patients with liver metastases precluding radical resection, we still have no other choice but to

Mucinous cystic neoplasm (MCN) of the pancreas is characterized by mucin-producing columnar epithelium and an ovarian-type stroma. It occurs almost exclusively in women and is almost always located in the pancreatic body or tail. Here, we report a case of large MCN located in the pancreatic head but not in the body nor tail in a 32-year-old pregnant woman, which was thought to have grown rapidly during pregnancy. It was ruptured at 34 weeks of gestation and the patient was admitted to the emergency department of the University of Fukui Hospital with an acute abdomen. Emergency cesarean section followed by pancreaticoduodenectomy was performed. The tumor consisted of many small cysts lined by a single-layer of mucinous epithelium with papillary growth and partial solid parts showing invasive growth and sarcomatoid changes, indicating mucinous cystic neoplasm with an associated invasive carcinoma (previously referred as mucinous cystadenocarcinoma). Thickened septa revealed ovarian-type stroma strongly positive for α-inhibin and partly positive for progesterone receptor immunohistochemically. We also review and discuss previous reports of MCNs including those with an associated invasive carcinoma in pregnant patients.

Perioperative increase in oxidative activity in surgical patients reportedly prevents postoperative surgical site infection (SSI). Several clinical studies have shown that oxidative activity under sevoflurane anaesthesia was higher than that under propofol anaesthesia. Therefore, we hypothesised that sevoflurane anaesthesia would discourage SSI compared with propofol anaesthesia. To examine the effect of anaesthesia maintained with sevoflurane and propofol on SSI, a total of 265 consecutive adult patients, with American Society of Anesthesiologists physical status 1-3, who underwent elective open gastrointestinal surgery under general anaesthesia, were surveyed for SSI between January 2007 and December 2008. Sevoflurane or propofol was selected to maintain anaesthesia in 95 and 170 patients, respectively. A propensity score was used for pairwise matching of these patients to avoid selection biases between the two methods of anaesthesia. Propensity matching yielded 84 pairs of patients. We compared standardised infection ratios (SIRs), i.e. the quotient of the number of SSI cases observed and the number of SSI cases expected, calculated using data from the National Nosocomial Infection Surveillance, between sevoflurane and propofol anaesthesia. After propensity matching, SIR after sevoflurane anaesthesia was 1.89 [95% confidence interval (CI): 1.46-2.32], which was significantly lower than after propofol anaesthesia (4.78; 95% CI: 4.30-5.27) (P=0.02). This study suggests that sevoflurane tends to suppress SSI after elective open gastrointestinal surgery compared with propofol.

今回，子宮および両側付属器摘出術13年後に発症した虫垂子宮内膜症の1例を経験したので報告する．患者は60歳の女性で，既往歴は47歳時に子宮筋腫で子宮および両側付属器摘出術を施行されている．平成20年9月，右下腹部痛を主訴に受診し腹部CTを施行したところ虫垂穿孔を否定できず緊急手術をおこなった．虫垂は発赤し壁肥厚化しており虫垂を根部にて切除した．病理組織学的診断では虫垂は委縮しており，粘膜上皮はほとんど認められなかった．壁には慢性炎症と拡張した腺腔構造を呈する子宮内膜組織が内膜間質を伴って認められた．また免疫染色検査でエストロゲンレセプターが陽性，またプロゲステロンレセプターも一部陽性であり，虫垂子宮内膜症と診断した．虫垂子宮内膜症は通常性成熟期に多く，閉経後は報告例も少ない．さらに，子宮および両側付属器摘出10数年後に発見された報告もなく貴重な症例であると考えられた．

We describe an unusual case of biliopancreatic fistula, free perforation, and subsequent abscess formation within the lesser peritoneal sac associated with intraductal papillary mucinous carcinoma (IPMC). A 71-year-old man presented with general fatigue and loss of appetite that had persisted for 1 month. Abdominal computed tomography (CT) revealed findings consistent with an intraductal papillary mucinous neoplasm (IPMN) of the pancreas, accompanied by abscess formation in the bursa omentalis. Gastrointestinal fiberscopy revealed a swollen papilla of Vater expanded by sticky mucus, and a communication between the pancreatic duct and bile duct was demonstrated by the injection of indigo carmine solution into the pancreatic duct. Percutaneous transhepatic abscess drainage (PTAD) was performed on the day of admission. After this procedure, the patient was managed for 1 month and supported nutritionally with glycemic control for diabetes mellitus. After admission, the patient had an episode of obstructive jaundice that was treated by retrograde biliary drainage. Pancreaticoduodenectomy with lymph node dissection was then performed. Pathological examination revealed IPMN with patchy, scattered carcinoma of the pancreatic head and uncinate process with the formation of a biliopancreatic fistula. Bile duct epithelium in the area of the biliopancreatic fistula demonstrated atypical papillary epithelium suggestive of tumor invasion.

Pseudomyxoma peritonei is derived mostly from the rupture of an appendiceal cystic tumor and produces a large quantity of mucinous substance. Though its malignancy level is low, radical resection is difficult and its prognosis is poor. In some institutes in European countries and the United States, multidisciplinary treatment with chemo-hyperthermia at a relatively low temperature is performed following subtotal peritonectomy. We carried out high-temperature chemo-hyperthermic peritoneal perfusion following incomplete resections of mucinous tumors in six patients.After resection of the main tumor and macroscopic gross tumor resection of dissemination, heated perfusate containing anticancer agents was poured into the peritoneal cavity and stirred and pumped into a circulation between the abdomen and a reservoir. The temperature of the surface of the peritoneum was maintained at around 43 degrees C.The intraperitoneal space was sufficiently heated without severe complications. The pathological diagnosis in four of the patients was peritoneal mucinous carcinomatosis, and in the other two patients, it was intermediate type between peritoneal mucinous carcinomatosis and disseminated peritoneal adenomucinosis. Two patients died, 15 and 26 months after the treatment. The other four patients have survived for 4, 24, 26, and 80 months now, and two of them, who have survived for 26 and 80 months, received a second treatment 18 and 32 months, respectively, after the initial treatment. These results seemed not to be inferior to those in the reports from institutes in Europe and the United States which performed subtotal peritonectomy and then used mild hyperthermia in chemo-hyperthermia.For treating pseudomyxoma peritonei, high-temperature chemo-hyperthermic peritoneal perfusion following incomplete tumor resection is effective even without peritonectomy.

The development of islet cultures is desirable for successful clinical islet transplantation. Fetal bovine serum (FBS) has been used as a supplement in islet culture medium, but it may be an unsuitable supplement due recent animal health problems. We have evaluated the use of the silk protein, sericin, derived from Bombyx mori as a replacement for FBS in islet culture medium. Twenty rat islets were cultured in medium containing either sericin or FBS, or no supplement, for 14 days, during which time viable islets were counted in order to evaluate islet survival. Insulin secretion was measured in vitro by static incubation on days 3 and 7. In vivo function of cultured islets was tested by syngeneic transplantation. The islets were evaluated histologically and immunohistochemically after culture and transplantation. Ninety-five percent of islets were viable after culture for 14 days in culture medium supplemented with either FBS or sericin, while no islets survived beyond 7 days in culture without supplement. No significant differences in stimulated insulin secretion were noted between two groups of islets grown on supplemented media. Following transplantation, islets cultured in FBS or sericin rapidly reversed hyperglycemia and maintained normal glycemic control. Histologically, islets cultured with sericin displayed a well-preserved structure and strong insulin staining before and after transplantation. Serum-free medium containing sericin appears to be useful for islet culture.

Purpose To clarify the components primarily responsible for diffusion abnormalities in pancreatic cancerous tissue. Materials and Methods Subjects comprised 10 patients with surgically confirmed pancreatic cancer. Diffusion-weighted (DW) echo-planar imaging (b value = 0, 500 s/mm2) was employed to calculate the apparent diffusion coefficient (ADC). ADC values of cancer and noncancerous tissue were calculated. Furthermore, ADC values of the cancer were compared with histopathological results. Results The mean (±standard deviation) ADC value was significantly lower for tumor (1.27 ± 0.52 × 10−3 mm2/s) than for noncancerous tissue (1.90 ± 0.41 × 10−3 mm2/s, P < 0.05). Histopathological examination showed similar proportions of fibrotic area, cellular component, necrosis, and mucin in each case. Regarding the density of fibrosis in cancer, three cases were classified in the loose fibrosis group and the remaining seven cases were classified in the dense fibrosis group. The mean ADC value was significantly higher in the loose fibrosis group (1.88 ± 0.39 × 10−3 mm2/s) than in the dense fibrosis group (1.01 ± 0.29 × 10−3 mm2/s, P < 0.05). In quantitative analysis, ADC correlated well with the proportion of collagenous fibers (r = −0.87, P < 0.05). Conclusion Collagenous fibers may be responsible for diffusion abnormalities in pancreatic cancer. J. Magn. Reson. Imaging 2008;27:1302–1308. © 2008 Wiley-Liss, Inc.

We have performed ultrasonic experiments on clathrate compounds ROs 4 Sb 12 and R 3 Pd 20 Ge 6 to explore rattling and tunneling of a guest rattler's motion. We have found frequency dependence of the elastic constants and ultrasonic attenuations, which is called as ultrasonic dispersion, due to thermally activated rattling. At low temperatures, Curie-type elastic softening obeying 1/ T with antiferro-type intersite interaction, which corresponds to quantum tunneling, appears and continues even to the lowest 20 mK in LaOs 4 Sb 12 and La 3 Pd 20 Ge 6 . The understanding of the local charge fluctuation, rattling and tunneling, being coupled to conduction electrons in metals is a basic issue in the aspect of electron–phonon interaction in strongly correlated phenomena such as heavy fermion state, superconductivity and multi-channel Kondo screening effect.

術前診断に多列検出器CT（MDCT）が有用であった虫垂S状結腸瘻の1例を報告するとともに，虫垂S状結腸瘻の本邦報告例と自験例を含めた19例について検討した．症例は57歳，男性．1カ月来の右下腹部痛と受診当日の下血を主訴に受診．MDCTおよび大腸内視鏡検査を施行し，虫垂S状結腸瘻の術前診断を得られ，同日緊急に回盲部切除，S状結腸切除にて膿瘍腔とともに一塊に切除した．これまでの報告ではほとんどの症例で術前に注腸造影検査がなされていたが，本症例ではMDCTにて確定診断を得られた．さらに，緊急手術を考慮する際には腸管切除の前処置に影響することもなく，有用であると考えられた．

症例は64歳，男性．右下腹部痛，嘔吐にて来院した．腹部CT検査にて上行結腸内に多重構造を示す重積腸管を認めた．回腸悪性腫瘍を先進部とする腸重積を疑い，重積腸管を整復せず，回結腸動脈根部までの郭清を伴う回盲部切除術を施行した．腫瘍は回盲弁から30cmの回腸に存在しIIa型高分化腺癌であった．深達度はmでリンパ節転移は認めなかった．早期小腸癌は稀な疾患であり，文献的考察を加え報告する．

Background and Objectives: Vascular endothelial growth factor (VEGF) is known as an important factor in the growth and metastasis of cancer cells. In 2001, a novel angiogenesis factor, endocrine gland-derived vascular endothelial growth factor (EG-VEGF), was cloned. In this study, we investigated the expression of EG-VEGF in colorectal cancer, the relationship between its expression and clinicopathological factors, and the in vitro activity of EG-VEGF transfectants. Methods: We determined expression levels of EG-VEGF in 113 advanced colorectal cancers resected in our hospital by quantitative PCR, and compared the expression levels and clinicopathological findings by multivariate analyses. Results: The expression of EG-VEGF mRNA was positive in 31 cancers and negative in 82 cancers. We found that compared with the negative expression of the EG-VEGF gene, its positive expression was more frequently associated with hematogenous metastasis, and was associated with a poorer survival rate. In addition, EG-VEGF transfectants showed a higher degree of in vitro tubular formation than control cells. Conclusions: We speculate that, in colorectal cancers, the EG-VEGF gene functions as an important factor in angiogenesis in primary and metastatic lesions, and consider that it is useful as a novel prognostic factor. EG-VEGF molecule-targeted therapy has the potential for improving survival rates. J. Surg. Oncol. 2007;96:605–610. © 2007 Wiley-Liss, Inc.

症例は79歳, 男性. 脳梗塞による嚥下障害のため空腸瘻を造設し, ラコール®1,200kcal/24hr, 食塩3g/分3の投与にて管理されていた. 経腸栄養開始2カ月後, 腹痛が出現し, CTにて空腸瘻カテーテル周囲の腸管の壁肥厚と壁内ガス像, 多量の腹水を認めた. 腹腔穿刺を施行すると, 腹水は混濁しグラム陰性桿菌を認めたため緊急手術となった. 空腸瘻カテーテル周囲の腸管に限局性の腸炎を認めるも穿孔は認められなかった. 腸炎の原因として, 空腸瘻のカテーテル自体による影響は考えにくく, 食塩の投与方法が疑われた. 食塩1gを20mlに溶解すると浸透圧は1540mOsm/mlであり, 腸管内が高浸透圧となり腸炎を引き起こしたのではないかと考えられた. 空腸瘻より食塩を投与する際は, 食塩を多くの水分で希釈し浸透圧を下げて投与するか, あるいは経静脈的に投与するような工夫が必要であると考えられた.

蛋白漏出性胃腸症はアルブミンが消化管壁から管腔へ過剰に漏出することで低蛋白血症をきたす疾患で, 栄養管理に難渋することが多い. 今回われわれは蛋白漏出胃腸症を合併した虚血性小腸炎を経験したので報告する. 症例は72歳, 男性. 脳硬塞, 心房細動で入院. 入院中に嘔吐・腹痛を認め腸閉塞と診断, イレウス管挿入にて減圧をはかり, イレウス症状は軽快したが食事開始と共に激しい下痢・下血および低アルブミン血症が持続した. 消化管からの蛋白漏出が疑われ, 蛋白漏出シンチグラフィー施行. 左下腹部に異常集積を認め, 虚血性小腸炎による蛋白漏出胃腸症を疑い, 回盲部を含む小腸部分切除術を施行した. 術後から経腸栄養を開始. 術前管理に難渋した下痢の回数・量ともに術後は軽快し, 低アルブミン血症も軽快した. 蛋白漏出性胃腸症を合併した虚血性小腸炎の報告例はなく, 原因・治療法を考える上で大変興味深い症例であった.

Approximately half of the transplantable pancreatic islet tissue is lost during isolation, including the digestion and purification steps. Modifying the isolation method could increase the yield. This would enable the one donor-one recipient concept and improve the therapeutic effects of islet transplantation. This study aims to improve islet transplantation by increasing the yield of islets from the pancreas, both the number of islets and their size. Therefore, we used a sericin-containing isolating solution. Rat pancreatic islets were isolated by collagenase digestion and hand picking. We refer to islets isolated with or without sericin in the isolation solution as the sericin and control group, respectively. Volume yield, endocrine function, and islet morphology were compared between the groups. Histological distribution of sericin was evaluated by immunofluorescence staining to examine its mechanism of action in pancreatic islets. The pancreatic islet yield in the sericin group was significantly higher than that in the control group. The endocrine function of islets in the sericin group was comparable to that of islets isolated by conventional methods. Sericin adhered to the surface of isolated pancreatic islets and colocalized with E-cadherin, a cell membrane protein, which might explain the cytoprotective effects of sericin. The islet morphology tended to be better preserved in the sericin group. Sericin could prevent cytoarchitectural damage during the isolation and purification process, resulting in increased pancreatic islet yield. This suggests that sericin could contribute to islet therapy by enhancing the stability of islets.

The angiogenic proteins vascular endothelial growth factor (VEGF) and prokineticin1 (PROK1) proteins are considered important in colorectal cancer, the relationship between their simultaneous expression and prognosis was investigated in the present study. VEGF and PROK1 expression in 620 primary human colorectal cancer lesions was confirmed via immunohistochemical staining with anti-VEGF and anti-PROK1 antibodies, and the correlation between the expression of these 2 proteins and recurrence/prognosis were investigated. VEGF protein was expressed in 329 (53.1%) and PROK1 protein was expressed in 223 (36.0%). PROK1 and VEGF were simultaneously expressed in 116 (18.7%) of the 620 cases. The correlation coefficient between VEGF expression and PROK1 expression was r = 0.11, and therefore correlation was not observed. Clinical pathology revealed that substantially lymphnode matastasis, hematogenous metastasis, or TMN advanced-stage IV was significantly more prevalent in cases that expressed both VEGF and PROK1 than in the cases negative for both proteins or those positive for only 1 of the proteins. Also the cases positive for both proteins exhibited the worst recurrence and prognosis. In the Cox proportional hazards model, VEGF and PROK1 expression was an independent prognostic factor. The prognosis was poorer in colorectal cancers that expressed both PROK1 and VEGF relative to the cases that expressed only 1 protein, and the expression of both proteins was found to be an independent prognostic factor.

The expression of the CD44 variant exon 9 (CD44v9) was investigated in order to elucidate its significance for cancer stem cells in circulating human colorectal cancer cells (CTCs).After peripheral blood was drawn from patients with colorectal cancer, CTCs were collected. Using the reverse transcription-polymerase chain reaction method, we examined the relationship between expression of CD44v9 mRNA and prognosis.In 60 out of 150 patients with colorectal cancer, expression of CD44v9 mRNA was positive in CTCs. In patients with stage III disease, the 5-year survival rate was 89% for patients with negative CD44v9 expression, whereas it was 52.4% in patients with positive expression (p0.05). In patients with stage IV unresectable cancer, the 2-year survival rate was 70.1% in cases with CD44v9-negative expression and 33.3% in cases of positive expression (p0.05).CD44v9 mRNA in the CTCs of colorectal cancer is useful as a factor predicting recurrence, prognosis, and treatment efficacy.

In this randomized multicenter Phase III study, patients with curatively resected Stage II/IIIA gastric cancer were assigned to postoperative adjuvant therapy with an oral fluoropyrimidine S-1 alone (2 weeks of treatment and 1 week of rest for 6 months, followed by 2 weeks of treatment and 2 weeks of rest for 6 months) or S-1 combined with an oral biological response modifier PSK (the same regimen of S-1 plus daily PSK for 12 months). The main objective was to evaluate the survival benefit and quality of life (QOL) of combined therapy. The primary end points were the time to relapse and the duration of survival after surgery, i.e. the rates of disease-free survival and overall survival at 3 and 5 years. The secondary end points were the relations of survival rates to drug compliance, QOL, adverse events, postoperative complications, relapse status, and the preoperative expression of immune or tumor markers. The sample size was 140 per treatment arm.

It has been known that the thermosensitivity of tumour cells can be increased by lowering intra-cellular pH (pHi) by inhibiting pHi control mechanisms. The pHi is partially controlled by transport of H+ from cytoplasm into endocytic and secretary systems in the cells mediated by vacuolar type H+ATPase and also by transport of H+ through plasma membrane.This study investigated the effects the bafilomycine A1, an inhibitor of the vacuolar type H+ATPase and the EIPA, an inhibitor of the Na+/H+ exchanger in plasma membrane, on thermosensitivity of AsPC-1 cells, a human pancreatic cancer cell line. It also investigated the effects of combination of bafilomycine A1 and EIPA.The treatment of cancer cells with bafilomycine A1 or EIPA individually slightly lowered pHi of the cells in vitro and increased the thermosensitivity of the cells.The combination of these two drugs significantly lowered pHi and increased thermosensitivity of cancer cells in vitro and enhanced the heat-induced the growth delay of AsPC-1 tumours grown s.c in the legs of BALB/cA nude mice.

// Takanori Goi 1,* , Toshiyuki Nakazawa 1,* , Yasuo Hirono 1 and Akio Yamaguchi 1 1 First Department of Surgery, University of Fukui, Japan * These authors contributed equally to this work Correspondence to: Takanori Goi, email: // Keywords : Colorectal cancer, Prokineticin1(PROK1), Vascular endothelial growth factor (VEGF) Received : December 21, 2014 Accepted : January 20, 2015 Published : February 28, 2015 Abstract Hematogenous metastasis, mainly hepatic metastasis, is a frequent metastatic mode in colorectal cancer involving angiogenic growth factors. Two angiogenic growth factors, in particular, Vascular endothelial growth factor (VEGF) and Prokineticin1(PROK1), are considered to have an important role in hematogenous metastasis of colorectal cancer. Accordingly, we report our findings on the importance of the anti-tumor efffect by inhibiting these two factors in human colorectal cancer. When the culture fluid of Colorectal cancer cell lines(DLD-1, HCT116, and LoVo) with high levels of VEGF/PROK1 expression was injected subcutaneously into mice, the culture fluid increased subcutaneous angiogenesis. But when both anti-PROK1 and anti-VEGF antibodies were present in the culture fluid, the length and size of the blood vessels were reduced compared with those seen in the fluid-only, anti-PROK1, and anti-VEGF controls. Also, tumor masses were produced in mice by subcutaneously embedding colorectal cancer cells with high levels VEGF/PROK1 expression. When both anti-PROK1 and anti-VEGF antibodies were simultaneously applied, tumor formation and peritumoral angiogenesis were strongly suppressed, compared with when either anti-PROK1 antibody or anti-VEGF antibody was applied alone. Simultaneous targeting of both angiogenic growth factors(VEGF/PROK1) may prove more useful in colorectal cancer.

Background. Although the number of patients with early gastric cancer (EGC) treated by endoscopic mucosal resection (EMR) has increased, the appropriate strategy for treating those with incomplete resection has not been established. Methods. This study analyzed 726 cases of EGC in patients treated by EMR between 1991 and 2000, in order to clarify the en-bloc and complete resection rates. We classified patients with incomplete resection into four groups according to the estimated risk of residual cancer or lymph node (LN) metastasis, determined from pathological findings of EMR specimens. We then analyzed 45 patients with EGC treated surgically after incomplete EMR, with the aim of eliciting the risk of residual cancer and LN metastasis. Results. Of the 726 patients, 529 (72.9%) had an en-bloc resection, while 378 (52.1%) had a complete resection. Three hundred and nine patients were found to have mucosal cancer and lateral cut-end-positive status with no LN metastasis (group A). In this group, 18 patients (5.8%) had residual cancer, with the lesions in the majority of patients being limited to the mucosal layer. Group B consisted of 14 patients with differentiated and submucosal (sm1) depth cancers, with 1 patient having residual cancer and 2 patients having LN metastasis. Fifteen patients were classified as group C, with sm2 or greater and vertical cut end-negative status, with 2 showing residual cancer and 1 showing LN metastasis. Group D included 10 patients with vertical cut end-positive status. Four of these patients had residual cancer while 1 had LN metastasis. Conclusion. We recommend that patients in group A should have close follow-up or endoscopic treatment, while those in groups B, C, or D should be treated by gastrectomy associated with LN dissection.

Encapsulated islet cells have potential for use in cellular therapy for type I diabetes, but cell survival under hypoxia during revascularization is a serious problem lessening the effect of cellular therapy. To overcome the difficulty in cell survival under hypoxia, we have introduced the anti-apoptotic genes, crmA and bcl-2 , into a RIN-5F cell line derived from rat islet of Langerhans cells, named RIN-5F-CrmA and RIN-5F-Bcl-2, respectively. RT-PCR and immunoblotting showed that RIN-5F-CrmA cells stably expressed crmA transcripts and that RIN-5F-Bcl-2 cells stably expressed Bcl-2, respectively. Over-expression of these anti-apoptotic genes prolonged the culture period under hypoxic conditions ( p O 2 2%). In hypoxia, Rin-5F cell lines produced less insulin, but over-expression of crmA significantly reduced the decrease of insulin synthesis in hypoxic culture. These results indicate that both CrmA and Bcl-2 are effective for inhibiting cell death under hypoxia, and suggest that CrmA would be superior to Bcl-2 because of the improved insulin production in hypoxia. This anti-apoptotic approach would have important therapeutic implications for successful transplantation of encapsulated islet cells.

目的: 胃癌術後の食事制限がBMI変化に及ぼす影響を検討する. 対象: 2001年8月から2002年6月までに根治度AあるいはBの手術を受け, 術後栄養指導の後, アンケート調査に回答された胃癌症例63例. 方法: 術後3か月目にアンケート調査を行った. 胃癌術後早期には好ましくないと思われる食品20品目について, 1. 術前より食べる習慣がない, 2. 食べていない, 3. 控えめに食べる, 4. 気にせず食べる, のいずれかを回答してもらった. 1. を除いた品目数中, 2. の割合が50%以上の患者さんをA群, 4. の割合が50%以上をC群, いずれにも該当しないものをB群と分類し, 術後3か月の時点で, 術前のBMI との変化を検討した. 結果: A群30例, B群20例, C群13例であった. BMIの変化では, A群が-2.46kg/m2, B 群が-2.77kg/m2, C群が-1.65kg/m2で, C群はA群, B群に比べて有意に術後BMIの減少が少なく抑えられていた. 胃局所切除術, 胃分節切除術, D2郭清を伴う幽門側胃切除術について術式ごとに解析しても, この傾向は保たれていた. 考察: 胃癌術後のBMI 変化からみると, 食事制限については愁訴なく術前同様に摂取できる患者さんについては, 医療者の方から制限を設けず, 自由に摂取してもらった方がBMIの減少は少なく抑えられると考えられた. しかし, 食事に起因する愁訴のある症例や, 術前から術後の栄養障害が危惧されるような症例については, 積極的な栄養指導が必要であると考えられた.

Plexiform schwannoma is a benign peripheral nerve sheath tumor composed exclusively of schwann cells arranged in a plexiform pattern. Most plexiform schwannomas are skin tumors and there has been only one case report of this tumor originating in the colon. We describe herein the first known case of plexiform schwannoma of the small intestine occurring without any relationship to schwannomatosis or neurofibromatosis. A 57-year-old man presented with a short history of abdominal pain, vomiting, and bloody stool after each meal. Jejunography demonstrated multiple nodular tumors in the small intestine. We resected the small intestine laparoscopically. The tumors consisted of multiple white nodules in the submucosal and subserosal layers. Microscopic examination revealed that each tumor was composed mainly of Antony A tissue, compatible with conventional schwannoma. Immunohistochemically, the tumors were positive for S-100, vimentin, and neuron-specific enolase, and negative for HHF35, Alpha-SMA, and c-kit. No evidence of recurrence has been found in 38 months of follow-up.

症例は51歳,男性. 2002年4月3日,虫垂穿孔性汎発性腹膜炎にて,虫垂切除術・腹腔内ドレナージを施行した.ドレーンは下腹壁より筋膜を貫いて,右腸骨窩およびダグラス窩に挿入した.術後6病日より陰嚢の発赤・腫大を認め,腹部CTでは鼠径部から陰嚢内にガスを伴う広範な膿瘍を認めた.術後8病日にFournier's gangreneの診断にて,壊死組織のデブリードメントを施行した.膿瘍は筋膜に沿って広がり筋膜の広範囲な壊死を認めたが,皮下脂肪には浮腫性変化を認めるのみであった.細菌培養では, BacteroidesとStreptococcusの混合感染であった.Fournier's gangreneは下腹部から会陰部に急速に拡大する重症壊死性筋膜炎の特殊型である.急性虫垂炎に合併する事は極めて稀であり,本邦報告例は自験例を含め3例のみであった.感染経路として,腹壁から筋膜を貫いて挿入したドレーンにより,腹腔内感染が筋膜にそって拡大した可能性が示唆された.

Introduction and aims Porcine pancreatic islets have been difficult to preserve because isolated porcine islets tend to disaggregate to single cells and lose function under culture conditions. In the current study, the influence of agarose microencapsulation on the maintenance of the number and function of islets in culture preservations and the effect of culture preconditioning of microencapsulated porcine islets on xenogenic transplantation were investigated. Methodology Porcine islets were isolated and then microencapsulated in 5% agarose membrane. The percentage of naked and microencapsulated islets remaining in the culture preservations was assessed. The effect of microencapsulation and culture on secretory function was investigated in vitro. The survival of overnight-cultured and 7-days-cultured microencapsulated islets in xenogenic transplantations was examined. Results A good percentage of microencapsulated islets remained in the culture preservations. They could maintain good secretory functions in vitro after 7 days of culture. In addition, we observed a significant prolongation of mean islet survival by culture preconditioning. Conclusions The present findings suggest that microencapsulation is one of the useful preserving methods for maintenance of the number and function of cultured isolated porcine islets. Moreover, culture preconditioning is effective for improving islet survival and might be a good option leading to clinical success.

A p-type thermoelectric film of (Bi2Te3)0.25(Sb2Te3)0.75 was fabricated by radio frequency sputtering. The target for the sputtering was prepared by mechanical alloying (MA) and pulsed current sintering (PCS) process. The single phase of Bi0.5Sb1.5Te3 was obtained by planetary ball milling Bi powder, Te powder and Sb powder for 36ks. The obtained powder was consolidated by PCS into the cylindrical target of 50 mm in diameter and 4mm in thickness at 643 K under a pressure of 13 MPa. The sintered body consisted of Bi0.5Sb1.5Te3 without cracks. The sintered Bi0.5Sb1.5Te3 was joined to Cu backing plate with In for an insertion by PCS process. The thin film of (Bi2Te3)0.25(Sb2Te3)0.75 was fabricated on a polyimide substrate by RF sputtering. The thickness of this thin film was about 15-20μm. This film was amorphous state and crystallized at about 520 K. The performance of this p-type thermoelectric film after the crystallization were 2.0mV in voltage and 2.9μA in current at 20 K of the difference between heating side temperature 353 K and cooling side temperature 333 K.