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手術が必要な腹部大動脈瘤と消化管悪性腫瘍の合併症例に対する治療戦略に明確なコンセンサスはない．今回われわれは腹部大動脈瘤合併進行直腸癌に対しステントグラフト内挿術後に直腸切断術を行った1例を経験したので報告する．症例は71歳，男性．血便を主訴に来院され進行直腸癌と診断．さらに腹部大動脈瘤（最大径57mm）を合併していることが判明した．いずれも早急な治療が必要であったが，まず腹部大動脈瘤に対しステントグラフト内挿術を先行した．経過は良好で治療後16日目に直腸切断術を安全に施行し得た．直腸切断術後22日目に軽快退院し，術後7カ月を経過した現在まで再発やグラフトに関連した合併症は認めていない．腹部大動脈瘤と消化管悪性腫瘍合併症例に対し，ステントグラフト内挿術は非常に有用な治療法であると考えられた．

NARCOBIT is the first anesthetic system for mice and rats to incorporate a ventilator. Therefore, it is expected to improve the reliability of mice and rat experiments by accurately controlling and maintaining the depth of anesthesia. In this study, we used NARCOBIT for inducing inhalational anesthesia in mice and evaluated the changes in their hemodynamic parameters. ICR mice were anesthetized with 5% isoflurane and room air, followed by endotracheal intubation. Subsequently, they were mechanically ventilated, and anesthesia was maintained by 2% isoflurane for a 60-min period (maintenance state) using NARCOBIT. In study 1, the heart rate (HR) and mean arterial blood pressure (MAP) were measured. The skin blood flow (SBF) from the hind legs was continuously measured during the maintenance state. Subsequently, the concentration-dependent effects of isoflurane on MAP were examined. In study 2, blood samples were obtained from the abdominal aorta for blood gas analysis. The HR and MAP decreased after anesthesia but were stable during the maintenance state. Decreased MAP and concentration-dependent effects of isoflurane were observed. The SBF increased slightly during the maintenance state but this increase was insignificant. The blood gas analysis showed neither hypoxia nor hypercapnia. Since the use of NARCOBIT enables the anesthetic concentration of isoflurane to be easily changed, a suitable anesthesia depth can be obtained for experimental purposes. Therefore, we conclude that NARCOBIT can be used for providing inhalational anesthesia to mice.

The artificial shoal area on the basis of ecosystem engineering has been appliedto the breakwater newly established at Mishima-Kawanoe Port, in Ehime Prefecture. The objective of this study is to evaluate how the target indicators established during the planning stage is achieved and to obtain ideas adopting to other environmental restoration projects relevant to port structure construction in future. The evaluation points of the ecosystem function are, 1) Index species appearing on the artificial shoal, 2) Reduction of organic carbon loaded from attached animals by various organisms activities. As a result, it is suggested that theecosystem is currentlyfunctioning well in the artificial shoal. Additionally, adaptive management concepts in developing the environmental restoration facilities are proposed.

MSUD is a hereditary metabolic disorder that is characterized by impaired activity of the BCKADC. Liver transplantation has been approved as a treatment for some MSUD cases in which the control of BCAAs is insufficient. Although there have been several reports about DDLT for MSUD, few LDLT cases have been reported. Because either of parents who are heterozygote of this disease usually applies to be a candidate of donor in LDLT, the impairment of BCKADC activity of graft liver should be concerned. We performed LDLT for 10 month-old girl with a left lateral segment graft from her father. BCKADC activities of the patient and her parents were measured using lysates of lymphocytes isolated from peripheral blood specimen before the transplant. As a consequence, the activity of BCKADC of father was not inferior to a normal range. The patient tolerated the operation well. Postoperative course was uneventful and mixed milk was started at 8th POD. The serum BCAAs levels have remained within normal range. It should be necessary to follow the physical growth and mental development of the recipient in the future.

症例は42歳,男性.内視鏡でRs直腸に大きな2型直腸癌を認めた. CTでは骨盤腔に,右尿管近傍への浸潤が疑われる大きな腫瘍を認め,上直腸動脈に沿うリンパ節腫脹も認められたが,遠隔転移はみられなかった. T4N2M0のRs直腸癌であり,剥離面陽性が危惧されることから,術前化学放射線療法を行った.放射線療法は骨盤腔全体に総量46Gy (1日2Gyを23回),化学療法はホリナート・テガフール・ウラシル療法を用い,放射線療法日に合わせて通常量内服した.治療後のCTでは腫瘍は著明に縮小し,リンパ節腫脹も消失,内視鏡検査でも瘢痕潰瘍を残すのみであった.著効と判断して手術を行ったが,摘出標本の病理検査では癌組織の遺残を認めず,組織学的CRであった.局所進行Rs直腸癌に対して,ホリナート・テガフール・ウラシル療法を用いた後前化学放射線療法は有効な治療法の選択肢になりえると考えられた.

Field experiments to estimate chlorophyll a of benthic algae habited at tidal flat were carried out by using portable fluorometer in the period from February to September, 2005. Chlorophyll a values obtained by fluorometer with in vivo analysis and by chemical analysis of DMF reagent indicate approximately in linear. The fluorometer method was introduced to measure a distribution of benthic algae quantity in some different conditions. For example, the survey results indicated that quantity of benthic algae was related to the habited ground elevation. It is ensured by the field test that this portable fluorometer enables much easily to evaluate a distribution of benthic algae.

Preparation of lithium ion conducting solid electrolytes in the composition 75Li 2 S· x P 2 S 3 ·(25− x )P 2 S 5 (mol%) was attempted by use of a high-energy ball-milling process at room temperature. Amorphous samples were obtained in the composition range of x =0 to x =5. In the samples with x ≥ 8.3, a crystalline Li 2 S phase was remained after the ball milling for 50 h. The lithium ion conductivity at 298 K of the amorphous samples was increased with an increase in x , and the amorphous sample with x =5 showed the highest lithium ion conductivity of 6.2×10 −4 S·cm −1 at 298 K among the obtained samples. A laboratory-scale all-solid-state lithium battery using the amorphous sample with x =5 showed good discharge–charge performance at room temperature.

透析患者に発症し,急激な経過をたどった気腫性胃炎(emphysematous gastritis)の1例を経験したので報告する. 症例は66歳,男性. 35歳時より腎不全にて透析中であった.透析中に右膝痛が出現し,化膿性膝関節炎の診断で整形外科に入院したが,入院3日目の夜間に突然意識レベルの低下を認め,疼痛刺激に反応する程度となった.胃管を挿入したところ血性排液があったため,緊急内視鏡を施行.小彎を中心とした胃壁全体の発赤とびらん,出血を認めた. CTにて食道,胃,十二指腸の壁内気腫と門脈内ガスが確認され気腫性胃炎と診断した.昇圧剤,輸血の使用にもかかわらず,全身状態が急速に悪化し発症後24時間で死亡が確認された.

肺・脳転移をきたした, Prevotellaによる肝膿瘍の1例を経験した. 症例は特に既往歴のない51歳,男性. 2004年12月初めより下痢, 39度台の発熱が持続し,急性腸炎の診断で入院.抗生剤治療を開始したが症状改善せず,入院5日目の胸腹部CTにて肝膿瘍を指摘され,同時に両葉に多発する肺膿瘍も認めた.肝膿瘍は開腹ドレナージを行い,肺は保存的に治療を行った.解熱し炎症所見も改善したが解熱後も軽度のふらつきが持続し,術後18日目に頭部CTを施行したところ,脳膿瘍が確認されたため穿頭術を行い症状は改善した.肝膿瘍の膿汁よりPrevotellaが検出され,腸管の炎症から経門脈的に肝臓に膿瘍を形成し,さらに肺・脳への転移性膿瘍を生じたものと考えた.

症例は32歳,男性.呼吸困難,胸部痛,右腹部痛を主訴に,当科受診した.右腹部に自発痛,圧痛および腹膜刺激症状を認め、腹部CTでは右腎周囲にair像,液体貯留を認めたため,右腎周囲膿瘍の診断で即日緊急手術を施行した.開腹すると,虫垂穿孔がみられ,回盲部および右腎周囲に膿瘍形成を認めたため,穿孔性虫垂炎による右腎周囲膿瘍と判断し,虫垂切除術,腹腔内・右後腹膜腔洗浄ドレナージ術を施行した.しかし,術後も解熱傾向なかったため,第4病日に腹部CTを施行したところ,右腹壁の筋肉間に不連続に2カ所の膿瘍を認めた.右側腹部からアプローチし,腹壁を筋肉含めて大きくT字型に切開して洗浄ドレナージしたことで,解熱,状態改善し,救命しえた.腹腔内膿瘍から不連続性に腹壁膿瘍をきたした例は極めて稀なため,報告する.

閉鎖孔ヘルニアは,以前は術前診断が困難であり,致命率も高い疾患であった.近年においてはCTの発達により診断は容易となったものの,治療は緊急開腹術が行われているのが現状である.今回われわれは用手的に閉鎖孔ヘルニアの還納を試みて成功し,鼠径法で待機手術を行い得た2例を経験したので報告する.症例は81歳と78歳の女性.いずれも大腿内側に放散する突然の腹痛で同日受診, CTにより閉鎖孔ヘルニアと診断した.還納を試みるため鼠径靱帯下部において大腿動脈をまず同定し,そのやや内側を頭側に向かって軽く圧迫したところ,容易に還納できた.後日待機的に鼠径部よりアプローチしてメッシュを用いて根治術を行った. 2例ともに両側の手術を行ったが,手術時間は短時間であった.閉鎖孔ヘルニアに対する治療として,用手的還納とメッシュを用いた両側の鼠径法による待機手術が最も低侵襲治療であると思われた.

Amorphous solid electrolytes containing large amount of Li 2 S were prepared in the system Li 2 S–GeS 2 –P 2 S 5 by a high-energy ball-milling process. The region of amorphous-sample formation by the ball-milling process is much wider than the glass-forming region by a conventional melt-quenching method. The addition of a second network-forming sulfide, GeS 2 , to the Li 2 S–P 2 S 5 system caused an enhancement of ion conductivities of the amorphous samples. The 95Li 3 PS 4 ·5Li 4 GeS 4 amorphous sample showed the highest lithium-ion conductivity 4.0×10 −4 S cm −1 at room temperature among the obtained amorphous samples in the system Li 2 S–GeS 2 –P 2 S 5 . DC polarization measurements suggested that lithium-ion transport number of the 95Li 3 PS 4 ·5Li 4 GeS 4 sample was almost unity.

Background. The efficacy of additional venous reconstruction in the anterior segment has not been fully investigated for graft congestion in right-lobe liver grafts. Methods. Posttransplant graft venous congestion in the anterior segment was evaluated using magnetic resonance imaging in right-lobe living-donor liver transplantation. Additional venous reconstruction was categorized into two types: reconstruction of tributaries from segment 5 or 8 (n=11) and reconstruction of the middle hepatic vein (MHV) (n=9). Forty-five grafts only with right-sided hepatic vein(s) including the right hepatic vein served as controls. Results. No significant difference in congestion score of the anterior segment was observed between grafts with V5/8 and standard grafts 1 month after transplantation despite the patency of reconstruction. Only grafts with the MHV showed no congestion (P

Lithium-ion-conducting amorphous materials in the system Li2S-GeS2 were prepared by use of a high-energy ball-milling process. The amorphous materials were obtained over the wide composition range up to 66.7mol%Li2S content. The composition range in which the amorphous materials were obtained by the ball-milling process was much wider than the glass-forming region by conventional melt-quenching methods. The lithium-ion conductivities of the obtained amorphous materials increased with an increase in the Li2S content. The activation energies for conduction correspondingly decreased with increasing the Li2S content. The 66.7Li2S⋅33.3GeS2(mol%) sample showed the maximum conductivity 1.1×10-4Scm-1 at 298 K.DC polarization measurements suggested that a lithiumion transport number was almost unity for the obtained amorphous materials.

迷入異物が総頸動脈を貫通した稀な1例を報告する.症例は, 71歳男性. 5カ月前に交通外傷で右鎖骨遠位端を骨折し, Kirschner鋼線(K-wire) 2本による観血的整復固定術を受けた.そのうちの1本が徐々に前縦隔内に迷入したため外科に紹介された.自覚症状はなく,術前検査でも臓器損傷を疑わせる所見はなかった.十分な視野を確保するため胸骨縦切開でアプローチしワイヤーを摘出したところ, K-wireの入っていた瘻孔先端部より大出血が見られた. K-wireが左総頸動脈を貫通していたことが判明したため,血管損傷部を切除し端々吻合を行った.術後の経過は順調であった. K-wire迷入の報告は散見されるが動脈を貫通した報告は国内では1例目である.たとえ無症状であっても縦隔内の異物は重要な臓器損傷を起こす可能性があり,十分な視野のもとで摘出術を行う必要がある.

はじめに: 本邦において, 胆管細胞癌のC型肝炎罹患率は増加してきている. 最近10年間の当院における胆管細胞癌症例を検討し, C型肝炎併存例の臨床的特徴を明らかにするため, 非併存例との比較を行った. 方法: 過去10年間 (1992-2001) において, 当院内科と外科に入院治療した胆管細胞癌35例を対象とした. 当該症例のC型肝炎罹患率を前・後半期5年ごとに比較し, 切除症例におけるC型肝炎併存例と非併存例の臨床的特徴や生命予後を比較した. 結果: 前・後半期の症例数は9例/26例で, うちC型肝炎罹患率は22%/50%であった. 切除症例のC型肝炎併存例7例と非併存例10例の背景因子を比較したところ, C型肝炎併存例でaspartate aminotransferase (AST) 値は有意に高く, ICGR15分値や術中出血量も高い傾向を示した. 病理学的進行度には差は認められなかった. 手術術式に関して, 非合併例は70%以上が葉切除以上であったのに対し, 併存例では57%が亜区域以下の切除で, 86%が根治度Cであった. 累積生存率はC型肝炎併存例で低い傾向を示した. まとめ: C型肝炎併存胆管細胞癌は術前より肝機能障害があり, 肝予備能低下のため切除範囲が制限され根治切除が困難になる傾向があった. C型肝炎併存例は明らかに増加してきており, 早期発見と集学的治療の必要性が示唆された.

We have classified the surface defects present in two kinds of wafers processed by high-dose separation by implanted oxygen (HD-SIMOX), for which the starting substrates were grown by the Czochralski (CZ) and epitaxial (EPI) methods, respectively. Our classification included several kinds of categories, based on our investigations of the densities and distributions of these defects. In addition, we varied the shapes of the defects by sacrificing the oxide layers, and investigated their cross-sectional structure. The two main classes of surface defects are pit-type defects and undulation-type defects. Our view is that the former are attributable to grown-in defects such as crystal-originated particles (COPs), the latter to the behavior of these particles during the implantation and SIMOX anneal stages. We also investigated the influence of surface defects on the integrity of the oxide layer and the quality of the buried-oxide (BOX) material. We found that some undulation-type defects that lose the silicon-on-insulator (SOI) layer during the thinning process can degrade the oxide film integrity, while those defects that lose both the BOX layer and the SOI layer during the thinning process can lead to both degradation of the oxide film integrity and BOX leakage. © 2003 Wiley Periodicals, Inc. Electron Comm Jpn Pt 2, 86(7): 64–72, 2003; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/ecjb.1125

Background. Although living-donor liver transplantation (LDLT) has been accepted for adult populations, the occurrence and pathogenesis of small-for-size syndrome remain highly controversial. Methods. Portal venous pressure (PVP) was measured in 79 cases of LDLT from anhepatic phase to day 14. PVP was monitored through a catheter inserted via the inferior mesenteric vein. In a separate series of seven cases of adult LDLT, the splenic artery was ligated following arterial reperfusion. Results. For days 2 to 4 and 9 to 11, recipients of small-for-size graft (

症例は58歳,女性.基礎疾患として,子宮癌治療に起因する神経因性膀胱およびそれによる慢性腎不全がある. 39度の発熱,腹痛を主訴に来院,腹部全体に筋性防御がみられ,汎発性腹膜炎の状態であった.血液検査では高度の炎症反応と腎不全および代謝性アシドーシスが認められた.腹部CT検査では拡張した膀胱,両側水尿管,両側水腎症がみられ,腹腔内には右側優位の腹水と遊離空気像が,さらに右拡張腎盂内と膀胱内にも空気像が認められた.穿刺腹水は混濁のみで消化液を混じておらず,気腫性尿路感染症に続発した気腫性腹膜炎と診断し,開腹術は行わず抗生剤による保存的治療を行い治癒せしめた.腹膜炎であっても腹腔内に異常のない原発性腹膜炎という病態もあり,この場合は抗生剤治療が第一選択であるが診断は難しく,本例は腹腔内と尿路系の両方に存在した気腫が診断根拠となり保存的治療をしえた稀な症例であった.

症例は57歳の男性.腹部腫瘤の診断で近医で開腹術を受けたが,摘出不能と判断されそのまま経過観察されていたところ, 10カ月後に突然激しい腹痛をきたしたため当院に救急搬送された. CTで下腹部に直径15cmの被膜を有した境界明瞭な腫瘤が認められ,内部は液体と空気が混在して膿瘍を形成していた.敗血症におちいっていたため緊急手術を行い,膿を1,600mlドレナージした.一時多臓器不全におちいったが,抗生剤および血液浄化で軽快した.その後CT, MRIで回腸原発粘膜下腫瘍の瘻孔形成による膿瘍と診断し,摘出術を行った.免疫学的検査で回腸腫瘍はc-kit, CD34, smooth muscle actin陽性, S100, desmin陰性であり,回腸GISTのsmooth muscle typeであった.回腸GISTが膿瘍を形成し,敗血症におちいった例は極めて稀であるため報告した.

We report the clinical outcomes of 214 patients with HCC who underwent partial liver resections using MTC in accordance with the tumor sizes for patients with HCC.Seventy-three percent of the patients suffered from type C hepatitis and 45% of the patients had pathologically proven liver cirrhosis. The overall patient survival rates were 95, 79, and 65 % at 1, 3 and 5 years, respectively. Disease-free survival rates were 81, 53, and 32% at 1, 3 and 5 years, respectively. Postoperative morbidity was 28% and hospital mortality was 2.4%. Complications in most patients were well controlled although intractable bile leakage was observed in three patients.In conclusion, liver resections using MCT, in accordance with tumor sizes, can be achieved safely with acceptable results and without the need to use special techniques.

症例は67歳の男性. S状結腸癌および肝転移のためS状結腸切除, 2回の肝部分切除術を受けた後, 右大腿動脈よりリザーバーシステムを留置し, 持続化学療法を行っていたが, 体動により留置針が移動し, 薬液が皮下に少量漏れたことがきっかけでリザーバーが露出した. 感染兆候が認められなかったため露出したリザーバーのみ摘除したが, 3か月後残存カテーテル感染によるカテーテル先端部巨大肝仮性動脈瘤を形成した. インターベンション治療により, 流出血管である脾動脈の閉鎖には成功したが, 流入血管である腹腔動脈の閉鎖は不可能であった. 動脈瘤は急速に成長して閉塞性黄疸をきたし切迫破裂となったが, 手術的に左胃動脈分岐後の腹腔動脈を結紮することにより救命しえた. リザーバーシステム感染は重篤な合併症を引き起こす可能性があり, 感染予防および感染に対する適切な評価, 対処の重要性が示唆された. また, 治療としては流入血管遮断術が有効であった.

餅による食餌性サブイレウス状態が3カ月継続した末,小腸穿孔を起こし汎発性腹膜炎となった症例を経験したので報告する.症例は66歳,男性.胃切除術の既往がある.平成13年12月18日腹痛のため内科入院.イレウスの診断で保存療法を受け軽快したため退院した.その後も腹痛がときどき出現していたが, 3月29日朝より突然激しい腹痛となり来院.腹部に腹膜刺激症状と,腹部CTでイレウス像,腹腔内遊離ガス像および回腸に長径4cmの高濃度を示す食物塊が認められた. 12月の腹部CTを見直したところすでに同様の食物塊が描出されていた.以上より3カ月にわたる食餌性サブイレウスの末の消化管穿孔,汎発性腹膜炎の診断で開腹術を行った.回腸に嵌頓した餅と,その180cm口側の空腸に穿孔部を認めた.術後敗血症となったが,集中治療の末救命しえた.食餌性のサブイレウスが3カ月継続した末,小腸穿孔を起こした例は極めて稀であるため報告した.

We have studied the behavior of metal impurities such as Cu and Ni with different isolation techniques in ULSI devices. We have found by using convergent beam electron diffraction (CBED) that the stress in a shallow trench isolation (STI) structure is larger than that of a local-oxidation-of-silicon (LOCOS) structure. With LOCOS, the highly doped substrate efficiently gettered Cu. However, with STI, a small amount of Cu diffused to the device area because of the high stress. On the other hand, high density of bulk micro defect (BMD) generated with the thermal processing of STI effectively getters Ni impurities. With the LOCOS-based wafer, a large amount of Ni diffuses to the device region because of the low BMD density.

Acute GVHD is a rare complication after liver transplantation that has a high mortality rate. We experienced an infant case complicated with acute GVHD. An 8-month-old infant with biliary atresia underwent LDLT with a graft obtained from his mother. Their HLAs showed a donor-dominant one-way match, not at HLA-DR but at HLA-A, HLA-B, and HLA-C (recipient; A 31/33, B 51/54, C 1/14, DR 9/11, donor; A 31/-, B 51/-, C 14/-, DR 8/11). The patient exhibited a high fever, skin rash, and diarrhea, and was diagnosed with acute GVHD based on the blood chimerism test. Despite immunosuppression treatment with prednisolone and tacrolimus, plasma exchange, blood transfusion including cord blood transplantation, and antibiotics, the child died on postoperative day 126. Donor-dominant one-way matching at HLA class 1 can be a high-risk factor for acute GVHD despite HLA class 2 mismatching.

The carrier concentration in a gallium nitride (GaN) substrate of a GaN-on-GaN wafer grown by hydride vapor phase epitaxy (HVPE) was evaluated by Raman spectroscopy and Kelvin probe force microscopy (KFM). On the basis of the longitudinal optical phonon–plasmon coupled (LOPC) mode of Raman spectra and surface potential measurements by KFM, the carrier concentration at the periphery of the HVPE-GaN substrate was found to be about one order of magnitude lower than that at the center. The decrease in carrier concentration is considered to be due to the out-diffusion of dopants during the metal organic chemical vapor deposition (MOCVD) of the epitaxial layer. In silicon (Si) epitaxial wafers, the autodoping of out-diffused dopants introduces nonuniform device characteristics. This undesirable effect needs to be suppressed to successfully move from prototype GaN-on-GaN power devices to commercial products.

We have observed a commercial silicon-carbide Schottky barrier diode (SiC-SBD) using our novel analysis system, in which atomic force microscopy (AFM) is combined with both Kelvin probe force microscopy (KFM; for surface-potential measurement) and scanning capacitance force microscopy (SCFM; for differential-capacitance measurement). The results obtained for the SiC-SBD under an applied reverse bias indicate both the scan area in the sample and a peak value of the SCFM signal in the region where the existence of trapped electrons is deduced from the KFM analysis. Thus, our measurement system can be used to examine commercial power devices; however, novel polishing procedures are required in order to investigate the Schottky contact region.

We evaluated whether donor computed tomography (CT) with a combined technique of lower tube voltage and iterative reconstruction (IR) can provide sufficient preoperative information for liver transplantation.We retrospectively reviewed CT of 113 liver donor candidates. Dynamic contrast-enhanced CT of the liver was performed on the following protocol: protocol A (n = 70), 120-kVp with filtered back projection (FBP); protocol B (n = 43), 100-kVp with IR. To equalize the background covariates, one-to-one propensity-matched analysis was used. We visually compared the score of the hepatic artery (A-score), portal vein (P-score), and hepatic vein (V-score) of the 2 protocols and quantitatively correlated the graft volume obtained by CT volumetry (graft-CTv) under the 2 protocols with the actual graft weight.In total, 39 protocol-A and protocol-B candidates showed comparable preoperative clinical characteristics with propensity matching. For protocols A and B, the A-score was 3.87 ± 0.73 and 4.51 ± 0.56 (P < .01), the P-score was 4.92 ± 0.27 and 5.0 ± 0.0 (P = .07), and the V-score was 4.23 ± 0.78 and 4.82 ± 0.39 (P < .01), respectively. Correlations between the actual graft weight and graft-CTv of protocols A and B were 0.97 and 0.96, respectively.Liver-donor CT imaging under 100-kVp plus IR protocol provides better visualization for vascular structures than that under 120-kVp plus FBP protocol with comparable accuracy for graft-CTv, while lowering radiation exposure by more than 40% and reducing contrast-medium dose by 20%.

Intracorporeal esophagojejunostomy represents the most difficult step during laparoscopic total gastrectomy (LTG). A novel technique for intracorporeal esophagojejunostomy was recently developed and named the "overlap method." However, this procedure is thought to have some technical disadvantages. To facilitate intracorporeal esophagojejunostomy, we developed some modifications for the overlap method.From October 2009 to July 2013, 63 consecutive patients with gastric cancer underwent LTG at our institution. Our modified overlap method was used for 54 patients with the following modifications. First, the esophagus was transected while being rotated by approximately 90 degrees in the clockwise direction. Second, an endoscopic linear stapler was used through the right lower trocar to create a side-to-side esophagojejunostomy. Third, the entry hole of the linear stapler was closed with intracorporeal hand-sewn continuous suturing. This procedure was termed the "modified overlap method."In 53 patients with the exception of one case, the modified overlap method was successfully completed (98.1%). Only one patient developed esophagojejunal anastomotic leakage (1.9%), which recovered well with conservative management. No postoperative anastomotic stricture or bleeding occurred.Our modified overlap method for intracorporeal esophagojejunostomy provides amazingly satisfactory outcomes. We believe this procedure could become a standard method for intracorporeal esophagojejunostomy after LTG.

When marine development works are conducted in coastal regions, it is necessary to consider the preservation of the environment in the vicinity. Construction of port structures results in new physi...

Diagnosis of gallbladder cancer in terms of invasion depth and spread is an important factor in determining cumulative survival after surgical treatment. However, diagnostic methods available at present occasionally fail to judge staging correctly. We report a case of gallbladder cancer which showed extreme discrepancy between the preoperative macroscopic and imaging diagnosis (positive direct invasion to the liver and invasion to the bile duct and duodenum through the serosal layer; S3, Hinf3, Binf2, and stage IV by the Japanese Society of Biliary Surgery classification) and the pathological findings (limited in vasion within the subserosal layer; ss, hinf0. binf0, and stage II). This discrepancy allowed us to perform curative treatment by hepatopancreatoduodenectomy, including extended right lobectomy of the liver, external bile duct resection, resection of the mesocolon, and lymph node dissection. Surgeons should aim for curability of advanced gallbladder cancer by radical resection until accurate methods for the preoperative diagnosis of cancer spread are available, because the clinical picture may be modified by inflammatory changes.

To clarify the vibration characteristics in central Maesawa Town of Oshu City, Iwate Prefecture, the dense survey of seismic intensity was done using questionnaires for the 2011 off the Pacific coast of Tohoku Earthquake and the aftershock occurred at April 7, 2011. This earthquake was the aftershock of the 2011 off the Pacific coast of Tohoku Earthquake. JMA reported that the seismic intensities at the Maesawa Town of Oshu City were 6 weak for the main shock and same for the aftershock. The questionnaire revised by Ohta et al.(1998) was used for calculating seismic intensity. The seismic intensities estimated from questionnaires were averaged for 250 m square meshes to clarify the distribution of seismic intensity in the central area of Maesawa Town. To avoid differences among individuals for questionnaire survey, the effective mesh where the number of the questionnaire was more than three was used for analysis. The mesh that seismic intensity was 6 strong was found for the result of the aftershock. The results show that the seismic intensity was large at the area where houses were damaged. Microtremor observations with a single and/or array sencers were also carried out in this area. Results of microtremor H/V show clear peaks in the damaged area, namely Gojunin-machi area, but do not in other area. Estimated shallow S wave velocities from microtremor array survey are small, e.g. about 100 m/s in the damaged area but not in other area.

We report a patient with extrahepatically growing large hepatocellular carcinoma (HCC) associated with dis-seminated intraabdominal tumor and spontaneous tumor bleeding who was treated with four operations, transcatheter arterial embolization, systemic chemotherapy, and hyperthermia. It took 12 months for the multimodal treatment to normalize the alpha-fetoprotein (AFP) level, and remission continued for 6 months. We performed the fourth surgical treatment for a recurrent abdominal tumor involving the small intestine and mesentery, but the patient died 26 months after the first admission. Multimodal treatment, including repeat surgical treatments, for such advanced HCC should be encouraged, to prolong life and to maintain quality of life.

Surface defects on two types HD SIMOX wafers that made of CZ wafers and epitaxial wafers as starting materials were examined for their shape and density. It was found that surface defects on HD SIMOX wafers were mainly classified into two categories. One was “pit-type” and another was “undulation-type”. It is considered that the former defects are originated from grown-in defects, such as COPs, and the latter defects are caused by SIMOX process, such as oxygen ion implantation and/or SIMOX anneal. Furthermore, deformations of surface defects by sacrificed oxidization for SOI thinning and the influences on GOI and BOX quality were investigated. It was found that some undulation-type defects that lost the SOI layers during SOI thinning degraded GOI and that some other undulation-type defects that lost aboriginally the SOI layers degraded both the GOI and BOX quality.

症例は52歳の女性. 以前よりときどき, 右上腹部痛を自覚していた. 市民検診にて肝嚢胞を指摘され, 精査目的にて入院となった. 腹部CT, 超音波検査にて肝左葉に直径7cm大の嚢胞性病変を認め, 嚢胞壁から内腔に突出した乳頭状隆起が見られた. MRIではT1強調画像で高信号, T2強調画像でも高信号な嚢腫を肝左葉に認め, その内部に嚢胞壁と連続し内腔へ突出した充実性部分が見られた. 画像検査上, 胆管嚢胞腺癌に特徴的所見であり, 術前, 胆管嚢胞腺癌と診断し, 拡大肝左葉切除, 尾状葉切除, リンパ節郭清術を施行した. 嚢胞内溶液はゼリー状で粘液性であり, 肉眼的に薄い嚢胞壁と嚢胞壁から突出した充実性の部分から成っていた. 病理組織学的に嚢胞内に存在する充実性部分には異型性のある粘液上皮が塊をなして浸潤増殖しており, 胆管嚢胞腺癌と診断した. 術後2年10か月経過した現在, 再発兆候なく健在である.

Heat shock pretreatment induces heat shock protein (HSP)72 strongly in rat livers and provides the tolerance against subsequent ischemia-reperfusion injury. In this study, the effects of repeated heat shock pretreatment on the production of HSP72 in rat livers and on subsequent ischemic tolerance were investigated.Rats pretreated with repeated heat shock were compared with those that received a single heat shock pretreatment. The production of HSP72 was analysed using Western-blotting and densitometer. At 48 h after heat shock pretreatment, all rats were subjected to warm liver ischemia for 30 or 45 min and then reperfused. Survival rate of the animals and liver functions during reperfusion were analysed.The production of HSP72 increased in the repeated heat shock group more than in the single heat shock group. Although there were no significant differences in animal survival or in liver functions after a 30-min ischemia between the single heat shock group and the repeated heat shock group, animal survival and liver functions after a 45-min ischemia were significantly better in the repeated heat shock group.In rats, repetition of heat shock pretreatment augmented the production of HSP72 in liver tissue and protected the liver from ischemia-reperfusion injury.