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A quasi-two-dimensional model has been developed to predict the performance of a crossflow jet singlet oxygen generator. The model takes into account HO2− depletion, gas temperature variation due to the pooling deactivation of O2(Δ1), and the stretch effect of gas/liquid interaction area due to the jet-induced pressure loss. The modeling results compare favorably with the test data measured over a wide range of geometries and operation conditions. The overall agreements between measured and calculated values in terms of root-mean-square errors for utilization, yield, and gas temperature are 0.030, 0.035, and 16.23K, respectively.

The present study compares the laser medium properties for subsonic and transonic iodine injection schemes of a multi-kW grid-nozzle supersonic chemical oxygen iodine laser (COIL). Two supersonic nozzles of similar geometry having subsonic or transonic iodine injectors were investigated in the present study. Small signal gain (SSG) and internal cavity temperature (ICT) were experimentally measured as a function of the iodine flow rate and coordinate in the direction of the gas flow. Dissociated fraction of iodine F and the number N of O2(1Δ) molecules consumed for the dissociation of one iodine molecule were estimated by an analytical method, utilizing SSG and ICT as input parameters. Both gain and temperature were measured by diode laser spectroscopy. Pressure broadening of the spectroscopic line of iodine atom was taken into account when calculating the gas temperature in the cavity.

[ F d h i 58-year-old woman was admitted to a local clinic with the omplaint of right subcostal and back pain in October 2002. all thickening and a polypoid lesion of the gallbladder were etected by abdominal ultrasonography. She was referred to his hospital for further evaluation of the wall thickening and allbladder lesion. Abdominal ultrasonography showed a twohamber gallbladder, the wall of which was thickened and ielded small strong echos, containing a broad-based polypoid esion 12 mm in diameter. Endoscopic retrograde cholangiogaphy was performed, and revealed a double hepatic duct and n anomalous pancreaticobiliary ductal junction (Fig. 1). The ight side hepatic duct joined with the cystic duct, draining into he common bile duct through a narrow segment. Preoperative omputed tomography revealed no elevated mucosal lesion in he gallbladder. We performed open cholecystectomy because f suspected gallbladder cancer and to prevent injury to the arrow segment of the biliary duct when performing cholecysectomy from the fundus [1]. Intraoperative cholangiography lso showed a double hepatic duct. The resected gallbladder howed hyperplasia with focal regenerative atypia of the muosa but no carcinoma. The polypoid lesion detected preopertively was a constriction of the gallbladder. The postoperative ourse was uneventful. The patient had no right subcostal pain fter discharge. A double common bile duct is a rare anomaly of the biliary ystem. Anomalous pancreaticobiliary ductal junction is also a ongenital anomaly of the pancreaticobiliary system. Various ancreaticobiliary duct anomalies associated with this anomaous pancreaticobiliary ductal junction have been reported in he literature. The first case of double common bile duct was

Though nasogastric intubation has been pointed out as a cause of benign acquired esophageal stenosis, no report of complete obstruction can be found. This is the first report of complete esophageal obstruction probably due to this intubation. A 19-year-old girl accidentally stabbed herself with chopsticks in the upper cervical esophagus. Two hours later, she was brought to a hospital for severe dyspnea caused by huge retropharyngeal emphysema. This ruptured into the right pleural cavity and she had an emergency drainage operation. The nasogastric tube was left indwelling for 6 days after the operation. The patient was then transferred to Toranomon Hospital, and her esophagus, which was found completely obstructed in the lower half, was successfully resected and reconstructed. Histological examination showed the cause of the esophageal obstruction to be circular detachment of the mucosa due to acute superficial inflammation and postinflammatory healing process. The constitutional factors were also suspected, because her incisional wounds became hypertrophic scar and she developed early postoperative bowel obstruction due to excessive adhesion. Though this case seems to be a very rare one in which several unfavorable factors coincided, each factor alone is not uncommon. From this point of view, precautions to take during nasogastric intubation are discussed.

The radical operation initiated with Caldwell-Luc is generally adopted for operation of chronic sinusitis. The method, however, leaves the point that it occasionally develops hyperplasia of granulation and changes the operative cavity due to re-infection in the postoperative course. Then the route to the proper nasal cavity is closed to induce occasional onsets of postoperative maxillary cyst. The operation method established in an attempt to improve this point is Akaike's sinoplasty. The author has conducted the sinoplasty for patients with chronic sinusitis. The postoperative course was investigated on subjective symptoms, endoscopy, roentgenography, and histopathological tests for comparison with that in the cases of radical operation. No appreciable difference was seen in the postoperative symptoms between the two groups of sinoplasty and radical operation. Endoscopy of the patency of the intranasal ethmoid sinus and naso-antral openings revealed no specifically appreciable difference between the two groups, but the patency of the inferior nasal meatus was more favorable in sinoplasty than the radical operation. The X-ray contract radiography and laminagraphy of the patency of naso-antral openings and ethmoid sinus revealed almost the same results. Histopathology of the postoperative maxillary sinus revealed that the mucosa was less edema and the cell infiltration and growth of connective tissues were prominent in about half of the treated cases of the 10th postoperative month. On the other hand, the antral tissues from radically treated cases of the end of the first postoperative month consisted of granulation with only hyperplasia of connective tissues. The emergence of squamous cells and regenerated mucosa of the columnar epithelium were noted around the 3rd or 4th postoperative month. The examination of the cases treated separately with sinoplasty and radical operation revealed that naso-antral openings created with sinoplasty were less susceptible to closure than those with radical operation and the resistivity of mucosa to infection in sinoplasty seemed to be stronger than that of the so-called regenerated mucosa following radical operation.

A family of multiple endocrine neoplasia type I with five confirmed cases in three generations is described. All of them have primary hyperparathyroidism in common. The propositus is 51 year-old male. After a year of symptoms of gastroduodenal ulcer, he was found to have elevated levels of serum gastrin and PTH. The serial imaging studies revealed a tumor in pancreatic head, and Zollinger-Ellison syndrome was diagnosed. The gastrin level was reduced into normal range after extirpation of the tumor, but post surgical elevation of Calcium put the patient under parathyroidectomy, which normalized serum PTH and Calcium levels. His two sisters (I and II), the mother of them, and the daughter of sister I, had neither signs nor symptoms until family study showed hypercalcemia in all. Sister I is a 54 year-old female with enlarged parathyroid. The hyperparathyroidism is of chemical type, but no other endocrinological abnormality is found. The Calcium level decreased after parathyroidectomy. Sister II is a 56 year-old female. The only sign was galactorrhea. Serum PTH and Calcium decreased after parathyroidectomy. The prolactinoma was diagnosed by the increased prolactin levels and enhanced mass lesion in sella turcica. Her serum prolactin levels is now within normal range since she is on bromocryptine. The mother of the above three siblings and the daughter of the sister I are now under further study.

The method of differentiating between the portal vein and the bile ducts by means of their intrahepatic portions was studied. The left branch of the portal vein courses horizontally as the transverse portion, then veers anteriorly at an acute angle to make the umbilical portion. This characteristic form was demonstrated in all normal controls and 95% of the jaundiced patients studied. The left hepatic duct does not curve anteriorly at an acute angle, but branches off to the lateral segment running superior to the umbilical portion. This anatomic relationship and characteristic form of the umbilical portion were useful in differentiating the portal vein and the bile ducts.

下咽頭癌を含めた食道癌70症例に対して術前に頸部超音波検査を施行し, その頸部, 上縦隔リンパ節転移診断を手術郭清リンパ節の病理診断と対比検討した.描出されたリンパ節の側からみるとtrue positive rate=76%, true negative rate=94%であった.病理組織学的に転移のあったリンパ節の側からみると超音波診断率は60%と低いが, 径5mmを越えるリンパ節転移を対象とすると診断率は88%であった.頸部超音波検査は食道癌頸部転移のみならず上縦隔リンパ節転移に対しても有用性の高い診断法であり, 特に胸部食道癌において重要な腕頭動脈周囲から頸部右傍食道傍気管領域に連なるリンパ節転移経路の検索には欠くことのできない検査である.

We measured postoperative amylase-creatinine clearance ratio (ACCR) and amylase isoenzymes, and evaluated their clinical significance in the early diagnosis of postoperative pancreatitis. It was shown that in cases with perforated duodenal ulcer, serum amylase was not always elevated. Thus, the leakage of pancreatic juice into the peritoneal cavity alone cannot be held responsible for an elevated level of serum pancreatic amylase, i.e., damage of the pancreatic exocrine glands should be considered. Similarly, postoperative patients with elevated serum pancreatic amylase, although suspected of stomal insufficiency, may suffer from acute pancreatitis. We report here two interesting cases with normal serum amylase but abnormal ACCR postoperatively. Acute pancreatitis was found to develop subsequently in these two patients. As a result, it is suggested that prolonged ab-normal ACCR may predict the possibility of postoperative pancreatitis. As ACCR is associated with renal tubular function, increased ACCR is not specific to pancreatitis. However, ACCR is sensitive to pancreatitis. We concluded that serial measurements of ACCR and amylase isoenzymes are helpful in the early diagnosis of postoperative pancreatitis.

During the period from October 1972 to January 1983, 462 patients with squamous cell carcinoma of the esophagus were admitted to Toranomon Hospital. Those patients with carcinoma of the hypopharynx, cervical esophagus, or cardia extending to the esophagus were excluded from the study. Resection and reconstruction were carried out in 295 patients with a resectability rate of 63.9 percent and an operative mortality rate of 1.7 percent. The 5 year survival rate for 101 patients who had resection with minimum 5 year follow-up was 34.7 percent. Although the ultimate outcome is largely influenced by the tumor type representing malignancy, it is worthwhile to make all efforts to resect the tumor with a negative surgical margin and to resect concomitant lesions if there are any. Surgeons should not be discouraged by the length or size of a tumor. The extent of positive lymph node is closely related to long-term results. However, systemic lymph node dissection should be carried out because 5 year survival can then be expected, even when positive nodes are dissected from various areas.

Ultrasonically guided percutaneous transhepatic cholangiography (UG-PTC), bile drainage (UG-PTBD) and gallbladder drainage procedure (UG-PTGBD), developed by us, were performed in 47, 183 and 36 patients, respectively. In 47 patients UG-PTC was successfully performed 51 times without complications. By UG-PTBD 220 intubations were carried out successfully and four attempts failed (1.8%). The main complication was that the catheter slipped out from the bile duct. It was experienced 27 times (12.3%) in 23 patients (12.4%) from two to 47 days after intubation. UG-PTGBD was successfully performed 36 times. Bleeding from the catheter was experienced in four patients. However, other complications such as cholascos were not experienced. Due to the development of ultrasonic diagnosis and the UG-PTBD procedure, the indications for percutaneous transhepatic cholangiography (PTC) are now limited. For differentiation of jaundice, ultrasonic examination takes over from PTC. For preparation of PTBD, thin needle cholangiography is no longer necessary because UG-PTBD is a single-step procedure without the need for cholangiography. Therefore, the indication for PTC is limited to patients with partial dilatation of intrahepatic bile ducts without jaundice, for example when only the left hepatic duct is dilated due to hepatolithiasis.

Two thousand four hundred and fifty-four autopsy cases of various mycoses were reported during the twelve-year period from 1958 to 1969. These account for 1.203 % of all cases reported in the Annual of the Pathological Autopsy Cascs in Japan during the said period. The results of a statistical survey of deep mycoses in Japan as viewed from findings in a long series of autopsy cases are briefly described. It is noteworthy that (1) there is a nation-wide distribution of mycoses throughout the country, where the most frequently affected organ was noted to be the esophagus for Candida and the lungs for Aspergillus and Cryptococcus, respectively; (2) common mycoses show a trend toward progressive increase in incidence whereas mucormycosis displays a tendency to decrease; and (3) frequently coexistent conditions which underlie secondary deep mycoses, especially leukemia, malignant lymphoma and aplastic anemia, were observed to show a conspicuous trend to diminish in incidence when viewed from ratios to total numbers of autopsy cases of respective diseases.

Background We investigated the patterns and predictors of recurrence and survival in cryptogenic non-B, non-C, non-alcoholic hepatocellular carcinoma (CR-HCC). We compared the findings with those hepatitis virus B (B) and hepatitis virus C (C)-HCC. CR-HCC does not include HCC developed on NASH. Methods From 1990 to 2011, of 676 patients who underwent primary curative liver resection as initial therapy for HCC at our institution, 167 had B-HCC, 401 had C-HCC, and 62 had CR-HCC. Differences between three groups were analyzed using the Chi-squared test. Cumulative overall survival (OS) and disease-free survival (DFS) were determined by the Kaplan-Meier method, prognostic factors involved in OS/DFS were evaluated by univariate analysis using the log-rank test, and stepwise Cox regression analysis. Results Liver function was better in CR-HCC than in B/C-HCC, and mean tumor size was larger in CR-HCC than in B/C-HCC. In CR-HCC, OS was equivalent to that of B/C-HCC, and DFS was equivalent to that of B-HCC. Both tumor-related factors and background liver function appeared to be prognostic factors for three groups. Conclusion Our findings indicate that the probability of survival of advanced CR-HCC was not longer than that of B/C-HCC. Given our findings, a postoperative follow-up protocol for CR-HCC should be established alongside that for B/C-HCC.

Background Pancreatic cancer accompanied by a moderate-sized pseudocyst with extrapancreatic growth is extremely rare. Diagnosis of pancreatic cancer on preoperative imaging is difficult when the pancreatic parenchyma is compressed by a pseudocyst and becomes unclear. Despite advances in imaging techniques, accurate preoperative diagnosis of cystic lesions of the pancreas remains difficult. In this case, it was challenging to diagnose pancreatic cancer preoperatively as we could not accurately assess the pancreatic parenchyma, which had been compressed by a moderate-sized cystic lesion with extrapancreatic growth. Case presentation A 63-year-old woman underwent investigations for epigastric abdominal pain. She had no history of pancreatitis. Although we suspected pancreatic ductal carcinoma with a pancreatic cyst, there was no mass lesion or low-density area suggestive of pancreatic cancer. We did not immediately suspect pancreatic cancer, as development of a moderate-sized cyst with extrapancreatic growth is extremely rare and known tumor markers were not elevated. Therefore, we initially suspected that a massive benign cyst (mucinous cyst neoplasm, serous cyst neoplasm, or intraductal papillary mucinous neoplasm) resulted in stenosis of the main pancreatic duct. We were unable to reach a definitive diagnosis prior to the operation. We had planned a pancreaticoduodenectomy to reach a definitive diagnosis. However, we could not remove the tumor because of significant invasion of the surrounding tissue (portal vein, superior mesenteric vein, etc.). The fluid content of the cyst was serous, and aspiration cytology from the pancreatic cyst was Class III (no malignancy), but the surrounding white connective tissue samples were positive for pancreatic adenocarcinoma on pathological examination during surgery. We repeated imaging (CT, MRI, endoscopic ultrasound, etc.) postoperatively, but there were neither mass lesions nor a low-density area suggestive of pancreatic cancer. In retrospect, we think that the slight pancreatic duct dilation was the only finding suggestive of pancreatic cancer. Conclusions It is difficult to diagnose pancreatic cancer with pseudocyst preoperatively. If a pancreatic cyst is found in patients who had normal tumor marker levels or no history of pancreatitis, we should always consider the possibility of pancreatic cancer. In such cases, slight pancreatic duct dilation may be a diagnostic clue.

Background Although gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, they are very rare. This study evaluated clinical and histopathological characteristics of duodenal GISTs to identify factors useful in predicting prognosis for patients with these tumors. Methods A retrospective study was performed on 20 patients who had undergone surgery between 1987 and 2009 for duodenal GISTs. Clinical, histopathological, and immunohistochemical data were evaluated. Survival analyses were conducted using Kaplan-Meier estimates. Results In 12 patients (60%), duodenal GISTs were diagnosed incidentally. Eight cases (40%) were classified as high risk grade GISTs. Skeinoid fibers (SkF), which are eosinophilic globular hyaline deposits in the extracellular interstitium of the tumor, were found in 12 patients. Skeinoid fibers were not recognized in 8 cases, and these included 3 cases (37.5%) where tumors recurred after surgery and the patient died. Tumors without SkF were larger (81 ± 92 vs. 23 ± 8 mm, P < 0.001) and had a higher mitotic count (224.0 ± 336.6 vs. 0.0 ± 0.0 /50 high-power field, P < 0.001) than those with SkF. Survival time was shorter in patients with tumors lacking SkF (52.9 ± 50.7 vs. 108.9 ± 86.5 months, P = 0.019). Conclusions We have identified clinical and histopathological characteristics that were useful in predicting the prognosis of patients with duodenal GISTs. In this study, 60% of the tumors were found incidentally, SkF were not recognized in tumors from 40% of patients, and all cases of post-operative tumor recurrence and death occurred in this subgroup of patients.