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症例は62歳の男性で, 心窩部痛を主訴に近医を受診し左肝内胆管拡張を指摘され当院紹介入院となった. 入院前後検査所見で動揺性の胆汁うっ滞を示し, 腹部CTでは左肝内胆管は著明に拡張し総胆管も拡張していたが明らかな腫瘍像は認められなかった. ERCPでは粘液と考えられる淡い陰影欠損像が三管合流部および左肝管分岐部に多く存在し, B2, B3胆管枝分岐部に不定形の透亮像を認めた. 胆管内超音波検査では腫瘍の同定はできなかったが, 左肝内胆管原発の粘液産生肝内胆管腫瘍を疑い肝左葉, 左尾状葉切除を施行した. 摘出標本上B3胆管枝根部近くに2.5×1cm大の乳頭状腫瘍を認め, 病理組織所見は腺腫成分を含む乳頭腺癌, 深達度mで膵管内乳頭粘液性腫瘍 (intraductal papillary mucinous tumor of the pancreas; 以下, 膵IPMT) 類似の腫瘍であった. 臨床病理学的に膵IPMT類似の粘液産生肝内胆管癌の1例を経験したので最近の疾患概念についても言及し報告する.

Apparent 14C ages of human and faunal remains from the Kitakogane shell midden assigned to the Early Jomon period were measured to estimate the reservoir effect on different species. In previous studies, northern fur seal and Japanese deer had showed significant age differences of 860 14C yr, in concordance with the large reservoir ages observed in pre-bomb shells from the western North Pacific. However, the present study suggests that other sedentary marine organisms, including porpoise, Japanese sea lion and scallop, show a smaller reservoir age-offset at 720 14C yr at the same site. The ethology of northern fur seal was probably responsible for this discrepancy because of a larger reservoir age in the Sea of Okhotsk into which they migrated. This suggests the reservoir effect on humans was more complicated than a simple linear mixing between marine and terrestrial reservoirs in the case of the NW Pacific coast. It was suggested that an interspecies comparison of 14C age-offsets could produce more precise estimation of the marine reservoir effect in the past.

今回, 経皮的ラジオ波焼灼術後にseedingをきたした肝細胞癌の1例を経験した. 症例は56歳の女性で, 肝S7被膜下の28×20mm径の肝細胞癌に対し, Cool-tip型電極を使用し2回の穿刺で経皮的ラジオ波焼灼術を施行した. 約9か月後の腹部CTにて前回焼灼部の低吸収域から肝外に突出する形で, 動脈相で淡く濃染される小結節病変を認めた. 肝細胞癌再発の術前診断にて肝部分切除術を施行した. 摘出標本では前回焼灼部に近接し7×6mm大と3×3mm大の腫瘍を2個認めた. 病理組織検査では焼灼部は凝固壊死に陥った肝細胞で, 脂肪組織を介在して2個の高分化型肝細胞癌を認めた. 2回の穿刺, 焼灼に一致し腫瘍を2個認めたこと, 焼灼部と腫瘍との連続性がみられなかったことなどからseeding と診断した. 経皮的ラジオ波焼灼術後のseeding の対策も含め検討し報告する.

There has been a number of investigations for the correlation between the Asia monsoon and the North Atlantic climate for the last glacial; however, little research has been done for the present interglacial, the Holocene. Here we present for the first time a high-resolution composite proxy record for the Indian Ocean summer monsoon spanning around 12 000 years based on the δ13C time series of both a single plant species (Carex mulieensis) remains cellulose and the total plant assemblage cellulose in the Hongyuan peat bog from the Tibet Plateau. The records show that the strength of the Indian Ocean summer monsoon had abrupt variations during the last 12 000 years. The weakest monsoon occurred in the Younger Dryas period. Following rapid strengthening from around 11 200 to 10 800 a BP the monsoon kept a generally strong level for around 5300 years. From around 5500 a BP onwards the monsoon strength tended to gradual decrease. In addition, there are a series of abrupt variation events of the monsoon strength on centennial to millennial time scales, which superimpose the general tendency of the monsoon variation. In every case when the ice-rafted debris events in the North Atlantic occurred, the summer monsoon strength decreased correspondingly. These evidences show that teleconnection between the Indian Ocean summer monsoon and the North Atlantic climate is present not only in the last glacial but also in the Holocene, which may be linked to abrupt reorganizations of the ocean thermohaline circulation, leading to redistribution of energy, changing temperature and moisture gradient over the southern subtropical Indian Ocean, and eventually controlling the variability of the Indian Ocean summer monsoon.

Photosynthetic pigments and other indicators of phytoplankton were analyzed in a dated undisturbed sediment core obtained from the southern basin of Lake Baikal to reveal temporal changes in the phytoplankton community in the lake through the last glacial/post-glacial transition. The sedimentation age of the core spans the last 24 14C ka. Chlorophyll a, its derivatives, carotenoids and total organic carbon (TOC) started to increase after 15 14C ka, and the onset of biogenic silica occurred at 10 14C ka. This indicated that the post-glacial growth of diatoms was preceded by that of other phytoplankton groups. In the record of the pigments and TOC, a temporary decrease was observed in the period 11.5–10.5 14C ka, corresponding to the Younger Dryas cold period. The similarity found between the depth profiles of pyropheophytin a and steryl chlorin esters formed through predation of phytoplankton by zooplankton and that of TOC suggested the important contribution of fecal pellets to sedimentary organic matter in the lake.

Non-invasive diagnosis of cirrhosis by transit-time analysis of an ultrasound contrast agent has been reported, even though the mechanism by which contrast arrives to the hepatic vein earlier in cirrhosis than in normal controls is unknown. The aim of this study is to assess whether the earlier appearance of contrast in the hepatic vein depends on intrahepatic or extrahepatic causes.There were 15 participants: six volunteers, three patients with hepatitis, and six with cirrhosis. The contrast agent was given intravenously, and transit-time analysis of the hepatic artery, portal vein and hepatic vein was performed. The time-acoustic intensity curves in the three vessels were analyzed by an image and cineloop display and quantification software package.The hepatic artery and portal vein arrival times were not significantly different among the three groups. On the other hand, hepatic vein arrival times were significantly earlier in cirrhosis (median 18 seconds) compared with arrival times in hepatitis patients (median 30 seconds, P0.001) and in healthy volunteers (median 31 seconds, P0.001). These results give support to a previous pilot study and indicate that most of the time delay in hepatic vein arrival time between cirrhosis and the other groups originated from intrahepatic circulation abnormalities.This study confirms that the earlier appearance of contrast in the hepatic vein observed in cirrhosis is due to intrahepatic, and not extrahepatic, hemodynamic changes.

Accelerator mass spectrometry (AMS) was used to measure radiocarbon ( 14 C) in bones excavated from the Late Jomon shell midden at the Kitakogane site, Hokkaido, Japan. Comparison between 14 C ages of terrestrial and marine mammals from the same site showed systematic age differences which could be attributed to the 14 C marine reservoir effect in the western North Pacific Ocean. Furthermore, this effect was clearly observed in human remains from this site, indicating a heavy dependence on seafood. Dietary habit was estimated from δ 13 C and δ 15 N measured in the same human remains. Apparent 14 C ages indicated 79% of protein originated from marine sources.

This study presents the results of carbon and nitrogen isotopic analyses of six human skeletons excavated from the Tochibara rockshelter (Nagano, Japan). The human skeletons were reported to be accompanied by “Oshigata-mon” type pottery dating to the Earliest Jomon period (8900 BP ≃ 6600 BP). A radiocarbon determination from charcoal associated with the human remains was reported to be 8650 ± 180 BP (GaK-1056). However, the depositional context of human skeletons was uncertain because they were recovered by excavations that were dug by prescribed levels. Our results indicated that these skeletons date to the Earliest Jomon period; the 14C determinations place these remains between 8260 ± 100 BP (TERRA-b030799ab38) and 8580 ± 100 BP (TERRA-b011300a35). This coincides with the archaeological evidence that these specimens are some of the oldest Jomon skeletal materials. Furthermore, δ13C and δ15N values provide evidence for the first reconstruction of the diet of an inland Earliest Jomon population. Although the distribution of data indicated a possibility that they had exploited small amounts of seafood, the isotopic data point to this group having relied heavily on a terrestrial ecosystem based on C3 plants.

Background Steady pressure automatically controlled endoscopy is a new insufflation concept, achieving a laparoscopy-like steady environment in the upper GI tract, recently reported in the esophagus. Objective The purpose of this work was to validate the feasibility and safety of steady pressure automatically controlled endoscopy in the lower GI tract and to identify major factors that enable it. Design This was a nonsurvival animal study using canine models. Settings The study was conducted in an academic center. Patients Canine models were used in this study. Interventions In experiment 1, steady pressure automatically controlled endoscopy was attempted in the cecum with insufflation pressures of 4, 8, and 12 mm Hg. We assessed performance by video review and continuous intracecal pressure monitoring. Next, steady pressure automatically controlled endoscopy was performed for 20 minutes under optimal pressure, 8 mm Hg (n = 10). In experiment 2, steady pressure automatically controlled endoscopy was attempted in the rectum with or without artificial colonic flexure and with either low (8 mm Hg) or high (16 mm Hg) insufflation pressure to assess the effects of anatomic flexure and insufflation pressure on the establishment of steady pressure automatically controlled endoscopy (n = 6). Main outcome measures We measured multipoint intraluminal pressure monitoring in the upstream bowel, as well as cardiopulmonary parameters. Results For experiment 1, steady pressure automatically controlled endoscopy in cecum was successful at all of the tested insufflation pressures; 8 mm Hg provided the optimal result. Steady pressure automatically controlled endoscopy was safely performed for 20 minutes at 8 mm Hg without any cardiopulmonary parameter changes or intraluminal pressure elevation in the upstream bowel. For experiment 2, confinement of the steady pressure environment to the rectum was achieved only with the assistance of colonic flexure and at 8 mm Hg insufflation pressure. In other conditions, the insufflated gas extended throughout the entire colon. Limitations This study was limited by being an animal study. Conclusions Steady pressure automatically controlled endoscopy is feasible and safe in the lower GI tract under the optimized insufflation pressure and in the presence of anatomical flexure (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A150).

Laparoscopic partial gastrectomy has become a common procedure for gastric submucosal tumors because of its accepted feasibility, safety, and oncologic outcomes. However, long-term postoperative outcomes have not been determined, especially based on the location of submucosal tumors.We reviewed 52 consecutive gastric submucosal tumor patients who underwent laparoscopic partial gastrectomy between 1999 and 2009. They were divided into a lesser curvature group (LC group, n = 23) and a greater curvature group (GC group, n = 26) according to tumor location. We compared the following postoperative data about gastric function between the two groups: (i) body weight change during the first postoperative year; (ii) gastrointestinal symptoms (e.g. abdominal pain/discomfort, bloating, heartburn, and dyspepsia); (iii) the amount of food residue at endoscopy; and (iv) the need for medications such as histamine H2 -receptor antagonists, proton pump inhibitors, and prokinetic drugs.Only a few patients - one in the LC group and two in the GC group - showed body weight loss (over 10%). Compared to the GC group (n = 0 in all three categories), the LC group showed significantly higher frequency of prolonged postoperative abdominal symptoms (n = 4, P = 0.042), food residue at endoscopic follow-up (n = 4, P = 0.036), and postoperative medication use (n = 5, P = 0.016).Patients who received laparoscopic partial gastrectomy did not have severe body weight loss, which suggests dysfunction of the gastric remnant. However, patients in the LC group should receive special attention, as they have a higher risk of developing postoperative gastrointestinal symptoms.

The juvenile development of four Japanese flatheads (Platycephalidae),Onigocia macrolepis. O. spinosa, Inegocia japonica andRogadius asper, is described and illustrated from specimens trawled in Tosa Bay, southern Japan. Juveniles of twoOnigocia species are diagnosed by an ocular flap and absence (O. macrolepis) or presence (O. spinosa) of distinct dark bars on the body.Inegocia japonica juveniles are distinctive in having a heavily pigmented body and 12 dorsal and anal fin soft rays.Rogadius asper has a unique antrorse preopercular spine prior to 15 mm SL. During the early juvenile stage, strongly negative allometric growth occurs in the interorbital region, accompanied by migration of the eyes from the lateral to dorsal surface of the head.

Restless legs syndrome is generally treated with benzodiazepines, dopamine agonists or opioids; however, it is often resistant to these drugs. Here we report a case of restless legs syndrome that was successfully treated with quetiapine. The patient was a 17-year-old woman. Although her symptoms were not improved by treatment with clonazepam or cabergoline, the additional administration of quetiapine, one of the second-generation antipsychotic drugs, induced remarkable improvement in her symptoms. Although antipsyochotic drugs sometimes induce or complicate restless legs syndrome, this case seems to suggest that quetiapine can be effective on restless legs syndrome.

Stability of a laminar boundary layer having a mean velocity of Pohlhausen type was studied by numerically solving the perturbation equations when the boundary layer is subject to curvature and Coriolis force. When the channel rotates so that the Coriolis force acts toward the concave wall, the Taylor-Gortler vortices are generated on a concave surface with a weaker curvature than that in the stationary condition because of the instability effects of the Coriolis force. Vortices are suppressed and the critical Gortler number is increased when the Coriolis force acts opposite to the centrifugal force due to the wall curvature. Over a wide range of rotation rates, vortices with scales as large as the boundary layer thickness are easily generated.

A 5-cm gastric submucosal tumor was incidentally found through abdominal CT as a preoperative work-up for hysterectomy in a 62-year-old woman with uterine prolapse. NOTES using a flexible gastrointestinal endoscope via the transvaginal route was indicated to accomplish concomitant partial gastrectomy and hysterectomy. Perigastric dissection was performed, followed by stapled partial gastrectomy using transvaginal NOTES technique with two transabdominal ports. The specimen was delivered transvaginally by enlarging the initial vaginal entry site. Vaginal hysterectomy was then accomplished by utilizing the enlarged vaginal wound. The patient showed rapid and uneventful postoperative recovery without any narcotic need. No complication was noted, her cosmetic result was satisfactory, and there was complete resolution of preoperative gynecological symptoms. Female patients with concomitant gastrointestinal and gynecological conditions requiring large specimen retrieval would potentially be suitable candidates for the transvaginal NOTES approach.

A 69-year-old man complaining of odynophagia visited a nearby hospital, and was referred to our hospital with endoscopic findings showing a flat-elevated lesion 35 cm from the incisors. Biopsy in our hospital revealed small cell carcinoma with a squamous cell carcinoma component. Thoracoabdominal enhanced CT detected neither lymph node metastases, nor distant organ metastases. We selected subtotal esophagectomy and retrosternal reconstruction of gastric tube. Since small cell carcinoma of the esophagus has a dismal prognosis, we conducted a minimally invasive operation with two-field lymph node dissection from the standpoint of local treatment, then shifted early to postoperative chemotherapy. The pathological diagnosis was an undifferentiated carcinoma, small cell type, inf beta, pT1b (pSM), ie (-), ly0, v1, pIM0, pN0. Postoperatively, he underwent chemotherapy with CDDP+CPT-11 following small cell carcinoma of the lung. Here mains alive without evidence of recurrence in the two years three months since the operation.

We evaluated the efficacy of chemotherapy using S-1 after gastrojejunostomy for unresectable gastric cancer with pyloric stenosis. We performed gastrojejunostomy to relieve obstruction in 40 patients from 1993 to 2007. After gastrojejunostomy, 15 patients were treated with S-1(S-1 group), 12 patients were treated with another anticancer drug(non S-1 group)and the other 13 patients received no chemotherapy. After informed consent was obtained, S-1(80 mg/m(2)day)and another anticancer drug was administered. The mean period of administered was 16(range 2-56)weeks in the S-1 group. In the non S-1 group, 5-FU was used in 1 patient, 5'-DFUR in 2, UFT in 3, FP chemotherapy in 3, CPT- 11/CDDP chemotherapy in 1, and 5-FU/PTX chemotherapy was conducted in 2 patients. The one-year survival rate was 63% and the median survival time was 394 days in the S-1 group, against 33% and 169 days, respectively, in the non S-1 group. Appetite loss of grade 3 was observed in one(7%)patient with nonhematological toxicity, but no patient suffered grade 3 hematological toxicity. We observed the course of all patients on an outpatient basis. In conclusion, S- 1 administration after gastrojejunostomy appears to be an effective treatment modality for far advanced gastric cancer patients with pyloric stenosis in view of toxicities, antitumor effects and QOL of the patients.

A 64-year-old man complaining of left hypochondriac pain visited our hospital. He was diagnosed as locally advanced unresectable cancer of the pancreatic body over 4 cm in size, because the pancreatic cancer involved the main artery and portal vein. Although chemotherapy of gemcitabine(GEM)(1.2 g/body/week)was started, he developed meningeal carcinomatosis after 2 courses of GEM. The size of the primary lesion decreased at this period, and total brain irradiation was selected to treat the meningeal carcinomatosis. He sequentially received GEM alone afterward until radiotherapy was performed for the progression of the primary lesion 24 months after the diagnosis. Although GEM alone was continued thereafter, vertebral metastases were detected 30 months following the diagnosis. He was treated with combined chemotherapy of GEM and S-1 that was effective. Finally, he died of peritoneal dissemination 42 months after diagnosis. The dose of GEM was reduced during the radiotherapy, and the total dose was 113.2 g.

FOLFOX/FOLFIRI chemotherapy is usually applied through central venous catheters because of possible occurrence of phlebitis during application of these regimen via peripheral vein. However, the exact frequency and degree of the problems at peripheral venous access site during FOLFOX/FOLFIRI chemotherapy via peripheral vein in the clinical setting has not been reported previously. We investigated the frequency of infusion failure and phlebitis in 43 patients with advanced or recurrent colorectal cancer who received FOLFOX4, mFOLFOX6 or FOLFIRI chemotherapy in our institution. After informed consent, FOLFOX/FOLFIRI chemotherapy was applied via peripheral vein in 29 cases; all courses (13.1+/-8.1 (Mean+/-SD)courses, 5-FU: 3,510+/-743 mg/body/course) were completed via peripheral vein in the 20 cases (70%). In the other 9 cases, the access site was converted to the central vein because of the problems of access site following completion of 5.9+/-2.0 courses via peripheral vein. Fifty eight times of phlebitis were recognized during total of 301 courses; severe phlebitis requiring medical treatment was not recognized in any case. Seventy seven times of the change of venous access site were required during total of 301 courses. These data would be essential for the exact informed consent for choosing the access site for FOLFOX/FOLFIRI chemotherapy.

We report a patient with unresectable gastric cancer who was effectively treated with S-1 after gastrojejunostomy. A 64-year-old man was referred to our hospital for anorexia and epigastric palpable mass. Upper gastrointestinal endoscopy revealed an ulcerous tumor in the antrum of the stomach, and gastric roentgenography showed pyloric stenosis. CT showed simultaneous multiple liver metastases. We performed gastrojejunostomy to allow oral intake. He was treated with daily oral administration of 120-80 mg S-1 for two weeks followed by one week rest as one course. The treatment was repeated for 19 courses until remission was observed. Weekly paclitaxel therapy (80 mg/m(2)/week) was then chosen as second-line chemotherapy. Administration was continued for three weeks with one-week rest. The treatment course was repeated for 6 courses. Bi-weekly administration of CPT-11 (80 mg) and CDDP (30 mg) was chosen as third-line chemotherapy. He died of progressive disease 2 years and 2 months after surgery. During chemotherapy, he maintained a performance status of 0 to 1, and maintained quality of life. This case suggested that the gastrojejunostomy was a useful method for treating unresectable gastric cancer, allowing the possibility of oral intake, and the use of S-1.

The patient was a 54-year-old female who was diagnosed as a Borrmann 4 type gastric cancer with invasion to the descending part of the duodenum and hepatic flexure of the colon. Curative resection was considered to be impossible from the clinical findings, so low-dose CDDP + 5-FU therapy and MTX/5-FU sequential therapy were given. After the chemotherapy, the primary lesion was decreased remarkably and the invasive foci disappeared. Therefore total gastrectomy with perigastric lymphadenectomy and splenic preservation was performed. The histological findings revealed that viable cancer cells remained only in the mucosal layer of the primary lesion. The patient has been alive without recurrence for 66 months after the curative resection. This case report suggests that patients who have good response to neoadjuvant chemotherapy with curative resection appear to have prolonged disease-free and overall survival.

The molecular structure of ethyl chloride has been determined by a joint analysis of the electron-diffraction data and the moments of inertia obtained by Schwendeman and Jacobs by means of microwave spectroscopy. In the analysis, a staggered conformation with Cs symmetry for the molecule and a local C3v symmetry about the C–C axis for the methyl group were assumed. Under the further assumptions that \varphiav(HCH)CH2 is 109.2±2° and \varphiav(CCH)CH2 is in the range of 113.6–109.6°, the following parameter values were determined: rg(C–C) 1.528(4) A; rg(C–Cl), 1.802(3) A; rg(C–CI), 2.746(5) A; rg; rg(C–H)CH2, 1.103(4) A; \varphiav(HCH)CH2, 110.0(1.6)°; and \varphiav(CCCl), 110.7(0.3) °. The rg and rs distances for the C–Cl and C-C bonds of various chlorinated alkanes were plotted against the difference between the numbers of methyl groups and chlorine atoms, Δn=n(CH3)–n(Cl). In general, as the number of chlorine atoms increases, both distances become shorter, though the rg distances are longer than the rs ...

Compound-specific radiocarbon analysis of five fatty-acid biomarkers was conducted for marine sediments collected from the western North Pacific. The fatty acids (C12 to C34) showed a typical bimodal distribution pattern with two maxima at C16 and C26. Their carbon isotopic compositions ranged from −25.1‰ (C16) to −31.8‰ (C28), suggesting that they derived from terrestrial higher plants and marine organisms. A large variations of 14C ages were found among the fatty acids detected in the same sedimentary horizon of the core, ranging from 530 BP (C18) to 3250 BP (C28). The results of 14C analysis of fatty acids could be divided into two groups, i.e., lower molecular weight (LMW) fatty acids (C16, C18) derived from marine organisms and higher molecular weight (HMW) fatty acids (C24, C26, C28) derived from terrestrial higher plants. The HMW fatty acids showed older ages, ranging from 2550 BP (C24) to 3250 BP (C28), than LMW fatty acids (530 BP [C18] to 1,820 years BP [C16]). On the other hand, bulk-phase total organic matter (TOM) showed the age of 2260 BP that is between those two groups, suggesting that it was likely a mixture of organic matter derived from marine and terrestrial sources. The compound specific 14C ages and δ13C data of sedimentary fatty acids presented here could provide useful information to decipher the fate and transport process of terrestrial organic matter to marine sediments.

Faunal remains originating from terrestrial and marine mammals, and belonging to the same archaeological deposits were compared to evaluate the marine radiocarbon reservoir ages around the Hokkaido island, Japan. From five shell middens of different ages from the Jomon period (4900 BP) to the Ainu cultural period (800 BP), 107 animal bone samples were selected for radiocarbon measurements. The apparent age differences between Japanese deer and northern fur seal showed the clear effect of deep-water upwelling in this region. Our data showed relatively stable age differences from 4500 BP to 800 BP, with an estimated ΔR values around 380 14C yr. Results are consistent with previous estimation based on simulation models and oceanographic properties.