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Laparoscopic surgery is less invasive and provides better cosmetic outcomes than conventional surgery. Laparoscopic liver resection has been covered by insurance since April 2010 and is increasingly performed in many hospitals. However, laparoscopic hepatectomy is sometimes difficult to perform safely in the case of HCC recurrence because adhesions restrict vision and manipulation of forceps. We report the results of laparoscopic hepatectomy for cases of HCC recurrence. From June 2010 through December 2014, 180 laparoscopic hepatectomy procedures for HCC were performed in our hospital; 33 were in patients with HCC recurrence. Of the 33 patients, 26 underwent pure laparoscopic partial hepatectomy. The median operative time was 242 min, the median bleeding amount was less than 5 g, and the median hospital stay after surgery was 12.0 days. In the group that underwent laparoscopic hepatectomy after open liver resection (12 patients), the median operative time was 303.5 min, the median bleeding amount was less than 5 g, and the median hospital stay after surgery was 9.0 days. Among the 21 patients that underwent laparoscopic hepatectomy after laparoscopic liver resection, the median operative time was 248 min (p=0.382), the median bleeding amount was less than 5 g (p=0.112), and the median hospital stay after surgery was 11.0 days (p=0.236). We could perform laparoscopic hepatectomy for cases of HCC recurrence. This procedure can be suitable for HCC recurrence, which sometimes requires poly-surgery.

An 81-year-old woman was admitted for leg edema. She was found to have membranous glomerulonephritis with advanced gastric cancer after renal biopsy and endoscopic examination. Serum albumin was 1.4 g/dL and total protein was 4 g/dL on admission. After albumin was administered, distal gastrectomy was performed. Albumin administration continued post-operatively. The post-operative course was unremarkable and she was discharged on post-operative day 19. Six months after the operation, serum albumin gradually increased and uric protein volume decreased. Possible remission of membranous glomerulonephritis with gastric cancer can be expected after gastrectomy but careful perioperative management is required.

A 58-year-old woman presented to our hospital with a huge hepatic mass. A CT scan showed an enhanced mass lesion on the fundus of the gallbladder and an enhanced mass ring on the gallbladder bed. Since FDG-PET showed no evidence of metastasis, we performed cholecystectomy, hepatectomy of S4a/5, and regional lymph node dissection. The immunohistochemical study of the specimen was positive for CK7, CK20, chromogranin A, and synaptophysin. The Ki-67 labeling index was 50%, and the SSTR2 score was 2+. The patient was diagnosed with neuroendocrine carcinoma. Since she was in poor condition and on hemodialysis, we started administration of somatostatin analog at the time of recurrence, and soon her diarrhea improved but the tumor increased in size.

Laparoscopic hepatectomy has been reported as a safe and effective approach for the treatment of hepatocellular carcinoma ( HCC). However, few studies have reported survival outcomes after laparoscopic hepatectomy in HCC patients with cirrhosis. In the present study, we evaluated the surgical outcomes and disease-free survival in these cases. Between June 2010 and March 2013, 35 HCC patients with cirrhosis underwent laparoscopic hepatectomy. Operative variables for laparoscopic vs open hepatectomy were as follows: operative times, 268.3 vs 183.3 minutes (p=0.0043); blood loss volume, 151.0 vs 1,106.1 g (p.001); 1-year disease-free survival rate, 73.1 vs 71.6%; and 2-year disease-free survival rate, 39.9% vs 28.6% (p=0.568), respectively. Laparoscopic hepatectomy is feasible and safe in selected patients with liver cirrhosis, with similar outcomes in disease-free survival when compared with open hepatectomy.

A 63-year-old woman underwent breast-conserving resection and axillary lymph node dissection for bilateral breast cancer in December 2008. Histopathological diagnosis for the right breast cancer was t=1.3 cm, n=1/29, estrogen receptor (ER) (+), progesterone receptor (PgR) (+), human epidermal growth factor receptor 2(HER2) (-), and that for the left breast cancer was t=1.8 cm, n=9/28, ER (+), PgR (+), and HER2 (-). She was administered adjuvant chemotherapy (4 courses of fluorouracil, epirubicin, and cyclophosphamide [FEC 100] and 4 courses of docetaxel[DTX], 75 mg/m²), letrozole, and bilateral radiation therapy for the remaining breast tissue. She noticed a mass in the left breast in December 2013. Fine-needle aspiration cytology and core-needle biopsy indicated a malignant phyllodes tumor or stromal sarcoma. Positron emission tomography-computed tomography (PET-CT) revealed the accumulation of fluorodeoxyglucose (FDG) only in the mass. The tumor enlarged rapidly to more than 5 cm during the pre-operative period. In January 2014, the patient underwent left mastectomy. The histopathological diagnosis was malignant phyllodes tumor in the left breast, with a tumor diameter of 7 cm, and negative margins. Presently, 6 months after the operation, the patient is alive without recurrence.

A 26-year-old man was admitted to hospital because of lower quadrant pain. Colonoscopy showed a polypoid lesion (0- Ip: protruded, pedunculated)in the cecum. Endoscopic biopsy revealed a tubular adenoma with severe atypia. Laparoscopy- assisted ileocecal resection was performed, as the diameter of the tumor made colonoscopic treatment difficult. Appendiceal intussusceptions were found in the excised specimen. The tumor was mucosal in origin. The patient remained cancer-free after the surgery.

A 94-year-old woman with a distended abdomen was transferred to our hospital.Based on the enhanced abdominal computed tomographic (CT) finding, she was diagnosed with colonic obstruction due to sigmoid cancer. Colonoscopy was performed to make definitive and qualitative diagnoses, and to release the stenosis using a self-expanding metallic stent (SEMS). The SEMS was inserted without complication.On the fifth day after the decompression, the patient underwent laparoscope-assisted sigmoidectomy with lymph node resection.Despite the colon obstruction, a primary anastomosis was performed.The operation time was 163 min, and 3 mL of blood was lost.The patient was discharged without complications. We describe the case of a bridge to surgery in a very elderly patient. A bridge to surgery can be an effective option for the treatment of colon obstruction in non-elderly and very elderly patients.

A 69-year-old woman had undergone breast conserving surgery and axillary lymph node dissection for left breast cancer 10 years previously. The tumor was positive for estrogen receptor (ER) and progesterone receptor (PgR), and negative for human epidermal growth factor receptor-2 (HER2). Adjuvant tamoxifen and radiation therapy were administered to the conserved breast for 5 years. The patient detected a painless neck mass 1 year previously. Computed tomography (CT) revealed a hyoid bone mass, and fine needle aspiration cytology indicated a diagnosis of adenocarcinoma. Positron emission tomography combined with CT (PET-CT) revealed masses in the pelvis, spine, hyoid bone, and cervical lymph node. For definitive diagnosis, excisional biopsy of the hyoid bone was performed. Immunohistostaining revealed that the cells were CK7 (+), CK20(-), mammaglobin (+), GCDFP-15 (+), ER (+), PgR (+), and HER2 (-). The final diagnosis was multiple bone metastasis(hyoid, pelvis, spine)as well as cervical lymph node metastasis from breast cancer. After diagnosis, the patient was treated with anastrozole and denosumab, and she achieved a partial response. She has experienced progression free survival for 12 months. Metastasis to the hyoid bone is uncommon for breast cancer. We report a case in which hormone therapy was effective after it was selected based on the results of excisional biopsy.

In recent years, breast reconstruction is being increasingly performed. Axillary resection is the standard treatment for axillary recurrence after a negative sentinel node (SN) biopsy. Appropriate treatment in the event of a negative SN artifact poses a problem. Case 1: A3 9-year-old woman with right breast cancer underwent Bt+SN (negative)+TE, IMP. Approximately 8 years postoperatively, axillary lymph node recurrence was diagnosed. Axillary resection was performed, and the reconstructed breast was preserved. Case 2: A4 0-year-old woman with right breast cancer underwent Bt+SN (negative)+TE, IMP. Approximately 8 years postoperatively, axillary lymph node recurrence was diagnosed. Axillary resection was performed, and the reconstructed breast was preserved. Case 3: A5 7-year-old woman with right breast cancer underwent Bt+SN (negative)+ TE, IMP. Because the metastatic lymph node was near the reconstructed breast, axillary resection and removal of the reconstructed breast was performed. It is expected that the incidence of axillary lymph node recurrence after breast reconstruction will increase in the future. For axillary lymph node recurrence, surgical resection needs to be performed to achieve a complete recovery. Therefore, it may be necessary to perform surgery without preserving the reconstructed breast.

Regorafenib is a novel, orally administered multi-kinase inhibitor that has recently been approved for the treatment of recurrent gastrointestinal stromal tumor (GIST). We report a case of successful treatment of recurrent duodenal GIST, which was found to be resistant to imatinib and sunitinib, with regorafenib. A 62-year-old woman underwent a pancreatoduodenectomy for duodenal GIST; after 2 years, a computed tomography (CT) scan detected liver metastases. The patient received imatinib for 6 years, and underwent 2 hepatectomies. Subsequently, she received sunitinib for 10 months; however, CT scans revealed the presence of multiple vertebral metastases. She underwent a laminectomy for the palliative treatment of the vertebral metastases. Upon immunohistochemical examination, the recurrent tumor stained positive for c-kit, confirming the diagnosis for GIST. Consequently, the patient received regorafenib; although the treatment controlled the liver metastases, the vertebral metastases were found to have progressed. She survived for 9 years and 5 months after the initial surgical resection. Regorafenib might be beneficial in the treatment of recurrent GISTs that prove to be resistant to imatinib and sunitinib.

Malignant bowel obstruction often causes oral intake difficulties and decreases quality of life. In Japan, gastroduodenal stenting for malignant gastric outlet obstruction has been covered by health insurance since 2010, while colon stenting has been covered since 2012. Both approaches are useful treatments for malignant bowel obstruction. Here we report the case of a woman with gastric outlet obstruction and rectal obstruction due to breast cancer metastases who was able to eat solid food after duodenal and colon stenting. When choosing whether to perform endoscopic stenting or surgical intervention such as gastrojejunostomy, ileostomy, and colostomy for treating malignant bowel obstruction, it is important to assess the patient's general condition and prognosis as well as the obstruction position.

We performed endoscopic gastroduodenal stenting for gastric outlet obstruction (GOO) caused by unresectable gastric cancer in 15 patients. We compared the clinical outcomes of the stent placement procedure with those of a gastrojejunostomy performed in 32 patients.Stent placement was performed safely without complications, and the median number of days until oral food intake could be resumed and the median number of days spent in the hospital was 2 and 15 days, respectively. The GOO score improved in 13 patients (87%); however, re-interventions were necessary for 7 patients due to stent obstruction caused by tumor growth. No differences between the stenting and gastrojejunostomy groups were found for the rate of improvement in GOO score, the duration until oral food intake could be resumed, or the overall survival rate. Patients in the stenting group had significantly fewer complications and shorter hospital stay. However, more re-interventions were required for patients of the stenting group compared to patients of the gastrojejunostomy group.Endoscopic gastroduodenal stenting can be performed safely and is beneficial for the improvement of oral food intake.

A 60-year-old woman presented to our hospital with a pelvic tumor detected by using computed tomography at the Department of Urology of another hospital. Her medical history indicated that she had undergone left nephrectomy and left hemicolectomy for a tumor of the left kidney 7 years previously. Leiomyosarcoma of the left kidney was diagnosed on the basis of the histopathological examination at the previous hospital. Recurrence of leiomyosarcoma was suspected, and a second operation was performed. A mesenteric tumor was detected. Leiomyosarcoma recurrence was diagnosed on the basis of another histopathological examination. The patient remains free of disease and recurrence 3 years after the second operation. Primary leiomyosarcoma of the kidney is a rare disease, even among renal tumors. The prognosis of leiomyosarcoma of the kidney is poor because of frequent metastasis and recurrence. Radical resection is the preferred first choice for treatment, but recurrence still occurs frequently. In our case, the mesenteric recurrence was detected 7 years after the first operation. There have been no previous reports of mesenteric recurrence of leiomyosarcoma of the kidney. Although histopathological and immunohistochemical examinations indicated a poor prognosis, the patient is alive and there are no signs of recurrence 3 years after the second operation.

A 43 -year-old woman with a palpable mass in the right breast consulted a neighborhood doctor. She was diagnosed with right breast cancer after core needle biopsy, and she was referred to our hospital. Mammography revealed an indistinct mass with calcification in the lower outer quadrant of the right breast. Ultrasonography revealed a hypoechoic mass with a high echo spot. Magnetic resonance imaging (MRI) revealed a high intensity tumor with peripheral enhancement. The patient underwent mastectomy with sentinel lymph node(SN) biopsy and axillary lymph node dissection. Histologically, the tumor was composed of a solid-tubular carcinoma with a centrally located metaplastic cartilaginous element. There was an abrupt transition between these components, without intervening spindle cells or osteoclastic cells. Subtyping via immunohistochemical analysis for estrogen receptor (ER), progesterone receptor (PgR), and human epidermal growth factor receptor 2 (HER2) demonstrated that the tumor was triple negative (TN). The histological diagnosis was matrix-producing carcinoma (MPC). Adjuvant chemotherapy was administered, and she has been recurrence-free. MPC has unique features, such as emphasis of the peripheral zone of the tumor by using contrast enhanced-computed tomography (CT) and gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA) MRI. Most cases of MPC that have been reported were TN. The 5 year survival rate for MPC is poorer than that for breast cancer. In Japan, 7 cases of MPC recurrence have been reported within 2.5 years, suggesting that careful follow-up is necessary for 2-3 years after surgery.

A 60-year-old man with unresectable colon cancer required treatment for hydronephrosis, acute cholecystitis, and obstructive jaundice before chemotherapy. His performance status (PS) gradually deteriorated to PS 4. Cetuximab monotherapy was initiated instead of intensive chemotherapy. His general condition improved and mFOLFOX7 therapy was then continued in addition to cetuximab. A computed tomography (CT) scan after 6 months of chemotherapy revealed a partial response (PR). Cetuximab monotherapy may contribute to the treatment of patients with a poor PS.

An 80-year-old man was admitted to our hospital with fever and dizziness. He was diagnosed with splenic abscess and invasion of descending colon cancer by enhanced abdominal computed tomography. A type 2 colon cancer was also observed in the descending colon by colonoscopy. There was no distant metastasis. Therefore, he underwent left hemicolectomy with splenectomy. A histological diagnosis of mucinous adenocarcinoma was made. The pathological findings were pT4b, pN1, cM0, fStage IIIa. The patient was discharged on the ninth post-operative day without any complications. We herein report a rare case of splenic abscess due to invasion of colon cancer and review 8 previous case reports. An en block resection including lymph node resection is recommended in such cases for curative resection.

A-64-years-old woman with locally advanced rectal cancer, which had invaded the vagina, was referred to our hospital. She was administered neoadjuvant chemotherapy to reduce the tumor size. After 4 courses of chemotherapy consisting of folinic acid, fluorouracil, and oxaliplatin (mFOLFOX6), an enhanced computed tomography (CT) scan and magnetic resonance imaging (MRI) indicated marked tumor shrinkage. We performed a laparoscopically assisted low anterior resection, which included total mesorectal resection, resection of the vaginal posterior wall, and right lateral lymph node resection. The chemotherapy prevented us from having to create a permanent colostomy. The efficacy of the neoadjuvant chemotherapy was Grade 1b. We experienced a case of neoadjuvant chemotherapy followed by curative resection.

A 39-year-old woman was referred to our hospital with a history of fecal occult blood.She was diagnosed with advanced sigmoid colon cancer.A colonoscopy indicated a stenosis, and an enhanced abdominal computed tomography (CT) scan revealed liver metastasis.The patient was operated on for a total of 337 minutes, and an estimated 35 mL of blood was lost. This is the shortest operating time and lowest amount of blood loss of which we are aware.Although an intra-abdominal abscess occurred, the patient recovered well and was discharged on postoperative day 25.Herein, we describe the case of a patient who underwent simultaneous laparoscopic resection of sigmoid colon cancer and a synchronous liver metastasis.We also review the efficacy of simultaneous laparoscopic resection of colorectal cancer and synchronous liver metastasis in this report.

A 53-year-old woman with recurrent abdominal pain was referred to our hospital. Based on the enhanced abdominal computed tomographic (CT) finding, she was diagnosed with intussusception of the sigmoid colon. Colonoscopy was performed to release the intussusception, and a lead point lesion was detected. An advanced cancer was found in the rectum, which could be pushed back into the sigmoid colon easily using pressurized air. A more-advanced colon cancer was also detected on the oral side of the lesion. The patient was diagnosed with double cancer of the sigmoid colon and was treated with laparoscopic sigmoidectomy with lymph node resection (D3). Preliminary reduction by colonoscopy prior to surgery is an effective option in cases of adult intussusception. Colonoscopy can be used to perform definitive and qualitative diagnoses.

A 60-year-old man presenting with dysphagia was referred to our hospital with a diagnosis of esophageal cancer and gastric cancer. Upper gastrointestinal endoscopy revealed type 2 tumors in the upper thoracic esophagus and in the lesser curvature of the angular incisure, and elevated lesions in the duodenum and in the transverse colon. Laryngoscopy revealed erosion of the right vocal cord. Computed tomography (CT) of the chest revealed a nodule in the middle lobe of the right lung. Laryngomicro surgery was performed for the right vocal cord erosion, and it was diagnosed as carcinoma in situ. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) were performed for the lesions in the duodenum and in the transverse colon, respectively; the lesions were diagnosed as adenocarcinoma in adenoma. After 2 courses of neoadjuvant chemotherapy with the 5-fluorouracil (5-FU), cisplatin, and Adriamycin (FAP) regimen, subtotal esophagectomy with reconstruction of the pedunculated jejunum through the antethoracic route, total gastrectomy, and resection were performed on the right middle lobe of lung. Pathological examination revealed esophageal cancer (fT4N0M0, fStageIII), gastric cancer (ypT3N0M0, pStageIIA), and primary pulmonary adenocarcinoma (pT1bN1M0, pStageIIA). After surgery, the patient was treated with chemoradiotherapy (60 Gy, with 2 courses of 5-FU plus cisplatin [FP]), and 6 months after the operation, he was in good health without recurrence.

A 55-year-old man with melena was referred to our hospital with suspicion of pancreatic cancer. Upper gastrointestinal endoscopy revealed a type 3 tumor in the greater curvature of the pylorus invading the duodenum. Examination of biopsy specimens showed poorly differentiated adenocarcinoma. Abdominal computed tomography (CT) and positron emission tomography (PET)-CT revealed a gastric tumor in the antrum and regional lymph node metastases invading the pancreas, indicating clinical stage IIIB (cT3, N2, H0, P0, M0) disease. Following 2 courses of neoadjuvant chemotherapy with S-1 plus cisplatin( CDDP), distal gastrectomy with D2 lymphadenectomy was performed. Histological examination revealed no residual cancer cells in the surgically obtained stomach and lymph node specimens, suggesting a complete pathological response( Grade 3). The patient was treated with S-1 for 1 year after surgery. Currently, at 54 months after surgery, the patient is in good health without recurrence.

An update of the progress of inherently low-temperature poly-Si (LTPS) technologies, such as ELA, ion doping, and activation in conjunction with chemical vapor deposition (CVD) and pho. tolithography will be given. We will also discuss whether LTPS LCDs will be applied to a large-scale production line using a large motherglass substrate. It was found that a more-powerful excimer laser as well as photolithography with higher-resolution and a more-precise overlaid arrangement woulc enable a large-scale production line handling motherglass of 4th generation size to be constructed ir the very near future with reasonable investment and productivity costs.

The influence of grain boundaries and intragrain defects on poly-Si thin-film transistors (TFTS) was investigated by examining the crystallinity of poly-Si films formed by solid phase crystallization (SPC) and excimer laser annealing (ELA), and the electrical characteristics of transistors fabricated on the poly-Si films were examined. The increase in grain size by SPC improves field effect mobility (μ Fe ) due to the increase in the emission current over the potential barrier height at the grain boundary. The decrease in intragrain defect densities by an oxide thinning process improves the threshold voltage (V h ) and subthreshold voltage swing (S). On the contrary, in spite of the small grain size of 800 A, polv-Si TFTs fabricated by ELA exhibit good characteristics with a high μ FE low V th and low S, and good uniformity. It is found that since the realization of excellent performance and good uniformity in poly-Si TFTs depends on a low trap state density at the grain boundaries and a low intragrain defect density, poly-Si films formed by ELA are well suited for the application to poly-Si TFT liquid crystal display with peripheral integrated circuits.

The polymerizability of micelle-forming quaternary ammonium monomers, which were derived from a methacrylic ester and styrene, carrying a polymerizable double bond close to the head group (Type H) or at the alkyl chain end (Type T) including a new monomer, 5-(p-vinylphenyl)pentyltrimethylammonium bromide, has been investigated above their critical micelle concentrations in water. The results are explained on the basis of the structure of the obtained polymers as well as the micelle structure of the monomers in water. The Type H monomers were able to thermally polymerize, while the Type T monomers could not.

A sliding planar motion table system that can be used for the lens driving actuator of a laser cutting machine was developed. The system uses magnetic fluid as the lubricant to avoid the leakage of lubricating oil under the table and reduce environmental pollution. The motion table is suspended from the guide surface by an attractive force generated by electromagnets to reduce the contact and frictional forces between the table and the guide surface. The table is capable of movement in one rotational and two translational directions over the guide surface using six electromagnets and three non-contact displacement sensors. Experimental results showed that the magnetic suspension of the table reduced the friction by 82.1% compared to the friction that would otherwise be generated by the dead weight of the table. Circular motion within a diameter of 2 mm was achieved with resolutions of 5 μm and 20 μrad in the translational and rotational directions, respectively. A bandwidth of higher than 100 Hz was also achieved in the three movement directions.

The influence of the existence of an underlying SiO 2 layer on the lateral solid-phase epitaxy (L-SPE) of amorphous Si was investigated by comparing the characteristics of L-SPE with and without an underlying SiO 2 layer. For the L-SPE with an underlying SiO 2 layer which had a change from {110} to {111} facet growth, high density crystal defects, most of which were dislocations, were detected especially in the {111} facet growth region. The formation of {111} facets is caused primarily by high density dislocations incorporated by relaxation of the stress which originates from the retardation of Si atom rearrangement

The structure of cumulene bearing bulky substituents, 1,1,4,4-tetrakis(trimethylsilyl)butatriene, has been determined by an X-ray diffraction method. The molecule is centrosymmetric, and the variation in carbon–carbon double bonds has been observed. The distance of the central C=C bond is 1.276(8) A, whereas that of the terminal C=C bond is 1.319(6) A. These bond lengths are very similar to the unsubstituted butatrienes and the influence of bulky trimethylsilyl groups is not recognized in this context. Some distortions have been observed in the bond angles concerning the trimethylsilyl groups; the overcrowded environment of the central C=C bond seems to make this less reactive.

We report the first study on improvement in surface morphology and crystal quality of as—grown epitaxial CaF2 film on a (100) Si substrate grown through two MBE growth stages without any post-growth treatment. The degree of improvement in surfacemorphology and crystal quality depends not only on the thickness of an initial thin CaF2 film grown at the early growth stage of 550ºC but also on both the subsrate temperature and thickness of a sequential grown CaF2 film used for thesecond growth stage. Under optimum conditions, the CaF2 films exhibited high quality with an RBS/channeling minimum yield of 4%, together with a very smooth surface morphology without any other nuclel or cracks.