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Background & Aims: Capsaicin is known to contract smooth muscles and to have an excitatory action on thin, primary afferent neurons. The aim of this study was to test the hypothesis that intragastric capsaicin may have an excitatory effect on colonic motility. Methods: Mongrel dogs equipped with five strain-gauge force transducers on the colon (C1–C5) were used. In 5 dogs, the effect of intragastric capsaicin (0.05, 0.1, 0.3, and 0.5 mg/kg) on colonic motility in the presence or absence of the cholinergic blockers atropine and hexamethonium was studied. In 4 dogs, the effect of capsaicin (0.5 mg/kg) administration into a vagally innervated or denervated gastric pouch on colonic motility was investigated. Results: Motility at C2–C3, C1–C3, and C1–C5 was significantly increased by 0.1, 0.3, and 0.5 mg/kg of capsaicin, respectively. The excitatory effect of capsaicin on colonic motility was inhibited by atropine and hexamethonium. Colonic motility at C1–C4 was significantly increased by capsaicin administration into a vagally innervated pouch but was not affected by capsaicin administration into a vagally denervated pouch. Conclusions: These results indicate that intragastric capsaicin predominantly stimulates motility in the proximal half of the colon through neural pathways, probably through a vagovagal reflex, but sympathetic involvement cannot be excluded.

To know the role of lipid peroxidation in the pathogenesis of stress-induced gastric mucosal lesions, we performed the present study. Both gastric mucosal lesions and gastric mucosal phosphatidylcholine hydroperoxides (PCOOH) levels during cold water-immersion restraint (CWIR) stress were measured by the chemiluminecence-HPLC method in Sprague-Dawley rats. Ulcer indices increased time-dependently during the stress. Gastric mucosal PCOOH levels also significantly increased and reached a peak level (250% of untreated level) after 2 hr of stress. These results suggest that lipid peroxidation may play an important role in the pathogenesis of gastric mucosal lesions induced CWIR stress.

閉塞性黄疸時の急性潰瘍発生病態における胃粘膜adaptive cytoprotection (以下, AC) 発現を知る目的で, ラットを用いて対照群, 黄疸群, 減黄群の3群を作製しtaurocholate (以下, TA) 投与による急性潰瘍を作製し検討した. Mild irritant (以下, MI) としては低濃度TAを用いた. 潰瘍係数は対照群に比べ黄疸群で有意に高値であったが減黄群では対照群と差を認めなかった. MI投与ではいずれの群も非投与群に比べ低値となったが, indomethacin投与でMI投与の効果は消失した.高濃度TA投与時の胃粘膜ヘキソサミン量の低下がMI投与群では抑制され, また胃粘膜potential differenceはTA投与後の回復の促進が認められた. 胃内PHはMI投与群で非投与群に比べ低値を示した. 以上より, 黄疸時においてもACが発現し, 内因性prostaglandinの関与が示唆され, また減黄操作においてもその効果が維持されると考えられた.

The aim of this study was to clarify the risk and characteristics of intestinal failure (IF) in patients with Crohn's disease (CD).The present study was a retrospective study in 12 hospitals. CD patients who underwent initial surgery at any of the 12 hospitals between 1970 and 2009 were collected (n = 1,703). Those who developed IF were reviewed (n = 68), and the cumulative risk of IF was analyzed by the Kaplan-Meier method. In addition, IF patients who underwent initial surgery at other hospitals and were then treated at any of the 12 hospitals were also reviewed (n = 33). Thus, a total of 101 IF patients were collected, and the cumulative risk of IF-related death was analyzed.The cumulative risk of IF after the initial surgery was 0.8 % (5 years), 3.6 % (10 years), 6.1 % (15 years), and 8.5 % (20 years). In CD patients with IF, mean age at initial surgery, IF occurrence, and present age at the time of the study were 28.2, 38.2, and 46.1 years, respectively. The mean number of surgeries per patient was 3.3. The mean length of the remnant small bowel was 163 cm. Twelve IF patients (12 %) had died and the cumulative risk of IF-related death by the time from the occurrence of IF was 1.1 % (3 years), 3.7 % (5 years), 6.5 % (7 years), and 8.9 % (10 years).The occurrence of IF and IF-related death in CD patients is not rare over the long term. There is a pressing need to develop strategies for the prevention and management of IF.

We aimed to evaluate time changes in reoperation rate after initial surgery in Crohn's disease (CD) over the last five decades in Japan and to assess the risk factors for reoperation, given that a decrease in the reoperation rate for CD remains controversial.CD patients (n-476) who underwent initial intestinal surgery were examined. Case records were collected from 13 institutions and scrutinized retrospectively. The primary outcome measure was the reoperation rate needing intestinal surgery. To evaluate the time changes, we compared medical treatment and reoperation rate in patients from two different periods of time; before and after 2002 when infliximab became available in Japan (1963-2002 and 2003-2008 groups). Univariate and multivariate analyses were performed to examine the influence of independent variables on the cumulative reoperation rate.A total of 201 patients underwent reoperation. Overall 5-year and 10-year cumulative reoperation rates were 31.4% and 61.2%, respectively. In multivariate analysis, an onset of the disease between 1963-2002 (p=0.0199) and postoperative administration of infliximab (p=0.0003) and immunosuppressants (p0.0001) were significant risk factors for reoperation. The cumulative 5-year reoperation rate decreased significantly in the 2003-2008 group compared to the 1963-2002 group (6.3% vs. 32.9%, p0.05).The reoperation rate for CD has decreased significantly in recent years in Japan. However, to further confirm this time trend, we need to evaluate CD patients with a longer follow-up period.

Associations of BMI with body composition and health outcomes may differ between Asian and European populations. Asian populations have also been shown to have an elevated risk of type 2 diabetes, hypertension, and hyperlipidemia at a relatively low level of BMI. New surgical indication for Asian patients should be discussed by the expert of this field. Forty-four bariatric experts in Asia-Pacific and other regions were chosen to have a voting privilege for IFSO-APC Consensus at the 2nd IFSO-APC Congress. A computerized audience-response voting system was used to analyze the agreement with the sentence of the consensus. Of all delegates, 95% agreed with the necessity of the establishment of IFSO-APC consensus statements, and 98% agreed with the necessity of a new indication for Asian patients. IFSO-APC Consensus statements 2011. Bariatric surgery should be considered for the treatment of obesity for acceptable Asian candidates with BMI ≥ 35 with or without co-morbidities. Bariatric/GI metabolic surgery should be considered for the treatment of T2DM or metabolic syndrome for patients who are inadequately controlled by lifestyle alternations and medical treatment for acceptable Asian candidates with BMI ≥ 30. The surgical approach may be considered as a non-primary alternative to treat inadequately controlled T2DM, or metabolic syndrome, for suitable Asian candidates with BMI ≥ 27.5. Other eight sentences are agreed with by majority of the voting delegates to form IFSO-APC consensus statements. This will help to make safe and wholesome the progress of bariatric and metabolic surgery in Asia.

This study was designed to investigate the current status of pylorus-preserving gastrectomy (PPG) for the treatment of gastric cancer by sending a questionnaire to institutions in Japan. The questionnaire was prepared and sent to 930 institutions approved by the Japanese Society of Gastroenterological Surgery. Questions were the indications for PPG, preservation of the vagus nerves and the infra-pyloric artery, whether suprapyloric lymph nodes are dissected, distance between the pylorus and the gastrogastrostomy, and the advantages and disadvantages of PPG. Responses were obtained from 345 institutions (37.1%). In 148 institutions, PPG was included in the choices of operations for gastric cancer and indicated for patients with tumors no deeper than the submucosal layer for differentiated-type carcinoma, or for tumors limited to the mucosa even in poorly differentiated types in 105 institutions. The vagus was preserved in 73.5%, the infrapyloric artery was preserved in 49.4%, and the dissection of suprapyloric lymph nodes were partly performed in 56.2%. The distance between gastrogastrostomy and the pyloric ring was 3–3.9 cm in 43.4% and 2–2.9 cm in 39%. Layer-to-layer anastomosis was the most representative technique for gastrogastrostomy. The advantages of PPG with decreased incidence of dumping syndrome and remnant gastritis were quoted in 130 and 82 institutions, respectively. Delayed gastric emptying was considered as the most frequent disadvantage of PPG, as quoted by 111 institutions. These results indicate that standard technique in PPG includes the preservation of the vagus and infrapyloric artery, in part dissection of suprapyloric lymph nodes, and layer-to-layer anastomosis for reconstruction. The optimal length of the antral cuff is still controversial.

5-FU is a core anticancer agent for GI and other malignancies, and infusional 5-FU regimens have been widely utilized. Orally administrable fluoropyrimidine prodrugs have been developed to enhance the anticancer efficacy of 5-FU and to reduce its adverse reactions.S-1 is an FT-based oral 5-FU prodrug in combination with a DPD inhibitor (CDHP) and an OPRT inhibitor (Oxo), which exerts the following effects: i) maintaining normal gut immunity, Oxo can decrease GI toxicities of 5-FU; ii) sustaining high plasma 5-FU concentrations, Cmax of FBAL after S-1 administration is extremely low, which dramatically decreases adverse reactions such as HFS, neurotoxicities and cardiotoxicities; iii) plasma 5-FU concentrations vary less extensively after S-1 administration and iv) S-1 can be safely administered to patients with DPD deficiency. Furthermore, the alternate-day S-1 administration can reduce the GI toxicities and myelotoxicities of 5-FU without reducing its anticancer efficacy, enabling patients to continue the oral administration for 6 - 12 months.Replacement of regimens with infusional 5-FU and other fluoropyrimidines by the alternate-day S-1 administration may be recommended because the latter procedure is efficient for patients while sustaining the enhanced anticancer efficacy of 5-FU and without reducing its dose intensity.

症例は69歳の男性.腹部手術の既往はない.1990年5月突然激烈な左下腹部痛が出現し, 急性腹症の診断にて開腹したところ, 回腸の一部が180度時計方向に軸捻転をおこしていた.小腸の血流は良好であったため, 捻転整復のみにて閉腹した.術後, 退院し何事もなく生活していたが, 1993年1月再び腹痛を訴え, 小腸軸捻転の再発の疑いにて開腹した, 開腹したところ中部小腸が反時計方向に360度軸捻転を生じておりその間の腸管は壊死状態であった.捻転部を解除し壊死腸管を切除し腸管を端々吻合にて再建した.術後経過は良好で現在再発は認められていない.成人の原発性小腸軸捻転症は本邦ではまれな疾患でこれまでに11例の報告があるのみである.また, これまでに再発の報告はなく, 本症例が最初である.

FUKUSHIMA, K., SASANO, H., SASAKI, I., NAGURA, H., FUNAYAMA, Y., MATSUNO, S. Increased Expression of Mineralocorticoid Receptor in Human Ileum after Total Colectomy: Immunohistochemical and Immunoblotting Studies. Tohoku J. Exp. Med., 1994; 173 (4), 383-390-Aldosterone is known to regulate transmembrane ion transport and water absorption through its binding to mineralocorticoid receptor (MR) in the mammalian colon. A possible roles of aldosterone has been suggested in increased water absorption from remnant ileum in the patients with total colectomy. We, therefore, studied immunolocalization of MR in remnant ileal mucosa in the patients with total colectomy in order to study the role of aldosterone in water and sodium absorption in these patients. Immunohistochemical localization of MR was performed in ileal mucosa of 7 patients with total colectomy and 5 cases of normal ileum obtained from the resection of ascending colon due to carcinoma by using a polyclonal antibody raised against a mineralocorticoid receptor fusion protein as a primary antibody and a biotin-streptavidin system for immunostaining. Immunoblotting was also performed. Positive MR immunoreactivity was observed in both cytoplasm and nucleus of absorptive cells of ileum of total colectomy patients but not in control normal ileum. Immunoblotting revealed the presence of an approximately 100kDa immunoreactive product corresponding to mineralocorticoid receptor. Aldosterone is considered to act on ileal mucosa following total colectomy and the aldosterone dependent sodium transport and water absorption may be accelerated in ileal mucosa after total colectomy, which is consistent with the postoperative decrease in the stool volume observed in these patients. In conclusion, increased expression of the mineralocorticoid receptor in remnant ileum may play an important role in intestinal adaptation in total colectomized patients.

閉塞性黄痘時の急性潰瘍発生における胃粘膜エネルギー代謝についてSprague-Dawley ratを用い, 実験1では対照群, 黄疸2, 4, 6, 8週群および減黄群(黄疸2週後減黄3日間) を作成し, 実験2では対照群, 黄疸2週群および減黄群に対して水浸拘束ストレスを負荷し, それぞれ壁細胞ミトコンドリア(Mt) の超微形態を組織計測学的に検討し以下の成績を得た. 1) 黄疸2週では対照群に比べMt数, クリステ数は有意に増加した. 2) 黄疸4週, 8週ではMtの膨化などの形態異常が出現した. 3) 減黄群ではMt数, クリステ数, Mt断面積が対照群とほぼ同様レベルに回復した, 4) 水漫拘束時のMtは対照群に比べ黄痘群でより高度の障害像を呈した. 以上より, 黄痘時の急性潰瘍発生には壁細胞Mtの超微形態像で示される胃粘膜エネルギー代謝障害が深く関与すると考えられた. また, これらは滅黄により改善されることが確かめられた.

大腸癌の血行性転移再発の組織学的予知因子の検索を行った.進行大腸癌の治癒切除症例で, 術後の血行性転移再発症例 (A群) 25例, 非再発症例 (B群) 32例の合計57例を対象とし, 浸潤に伴う, より低い分化程度への形態変化の有無, 癌深部での先進部における低分化腺癌の要素 (以下, por compo.) の有無, 粘液成分 (以下, muc compo.) の有無の点より検討した.形態変化は, A群では25例中16例64.0%にみられ, B群の32例中8例25.0%に比べ有意に高頻度であった.またpor compo-もA群では21例84.0%にみられ, B群の13例40.6%に比べ有意に高頻度であった.しかし, muc compo-に関しては両群間に有意差を認めなかった.以上より, 癌組織内で浸潤につれ低い分化形態への形態変化を認める症例, 特に癌先進部において低分化腺癌の要素を認める症例は, 血行性転移再発の可能性が高く, 組織学的予知因子となるものと考えられた.

Ulcerative colitis is occasionally exacerbated by fulminant manifestation of colitis. Severe ulcerative colitis is usually defined based on Trulove and Witts’ criteria (Table 1) (Truelove & Witts, 1955). The incidence of severe colitis in ulcerative colitis is 5 to 15 percent (Chen et al., 1998). If the patient is not improving despite intensive medical therapy, emergency colectomy is mandatory. In such a case, the patient is often malnourished and anemic, and has received high dose of steroids; therefore, the usual option in patients with severe ulcerative colitis is subtotal colectomy and ileostomy with preservation of the rectum (Gurland & Wexner, 2002). Restorative proctectomy can be done at a later time after the patient has recovered fully and steroids have been withdrawn (Fig. 1).

Functional dyspepsia (FD) is a common condition seen in primary gastroenterology practice. The present study was conducted to compare the clinical effectiveness of mosapride and teprenone in patients with FD.Prospective clinical comparative study with random allocation of open labeled medications was performed as a multicenter trial in Japan. 1042 patients presenting symptoms of FD, either with gastric stasis (GSS) and/or epigastric pain (EPS), were enrolled. After initial endoscopic evaluation, medication either with mosapride 5 mg tid or teprenone 50 mg tid was started. Severity and frequency of GSS and EPS, health-related quality of life (HR-QOL) by the SF-36 Japanese version, and patients' compliance to medication was evaluated.Organic lesions were found in 90 patients (9%) in the 1027 patients examined by endoscopy. Among those without any specific lesions detected by endoscopy, gastrointestinal symptoms were resolved within one week after the endoscopy in 264 (28%) patients before initiating medication. 618 patients who remained symptomatic were randomized to medication either with mosapride (n = 311) or teprenone (n = 307). Two-week treatment with mosapride significantly improved GSS and EPS, while teprenone tended to improve only GSS. Mosapride also improved HR-QOL. 91% of patients treated with mosapride favored their medication, while only 52% of patients treated with teprenone favored their medication.Endoscopic evaluation at patients' presentation was effective to find active lesions and to improve FD symptoms. Mosapride was more favorably accepted than teprenone by the patients with sufficient safety and efficacy.

We previously investigated fecal flora of the pouch after total proctocolectomy using terminal restriction fragment polymorphism analysis. Although the results of the cluster analysis demonstrated clearly that bacterial populations, including an unidentified bacteria generating a 213-bp PCR fragment, moved toward a colon-like community in the pouch, it did not track changes in the individual species of fecal bacteria.The aim of the present study was to estimate genome copy number of ten bacterial species, clusters, groups, or subgroups (including the bacteria generating 213-bp fragment in the previous study) in feces samples from pouches at various times following ileostomy closure.A total of 117 stool samples were collected from patients with ulcerative colitis after surgery as well as healthy volunteers. We used real-time polymerase chain reaction of the 16S rRNA gene to estimate genome copy numbers for the nine bacterial populations and the bacteria generating 213-bp fragment after identification by DNA sequencing.We demonstrated a time-dependent increase in the number of anaerobic and colon-predominant bacteria (such as Clostridium coccoides, C. leptum, Bacteroides fragilis and Atopobium) present in proctocolectomy patients after stoma closure. In contrast, numbers of ileum-predominant bacterial species (such as Lactobacillus and Enterococcus faecalis) declined.Our data confirm previous findings that fecal flora in the pouch after total proctocolectomy changes significantly, and further demonstrate that the number and diversity of ileal bacteria decreases while a more colon-like community develops. The present data are essential for the future analysis of pathological conditions in the ileal pouch.

Our aim was to study the effect of the viscosity of enteral nutrient solutions on upper gut motility and gut hormone secretion.We used 5 beagle dogs equipped with strain gauge force transducers to measure upper gastrointestinal motility. Upper gut motility and gut hormone secretion were compared across 6 experimental conditions; control (oral solid meal), liquid-120, liquid-5 (liquid enteral nutrients administered for 120 and 5 min, respectively), low, middle, and high viscosity conditions.The magnitude of receptive relaxation was decreased in the liquid-120 compared to control, but this decrease was reversed with the increase of viscosity. The duration of the postprandial contractions in the proximal jejunum was decreased in the liquid-5 compared to the control, but this decrease was reversed in the middle and high viscosity conditions (p0.05). Rapid increase in plasma concentrations of gastric inhibitory polypeptide observed in the liquid-5 compared to the control was reversed in the low, middle, and high viscosity conditions.Although patterns of upper gut motility and gut hormone secretion after liquid enteral nutrients were considerably altered compared to those after solid meal ingestion, increasing the viscosity of liquid enteral nutrients reversed those altered patterns.

A 45-year-old man underwent a low anterior resection for rectal cancer [T3, N1, M0, Stage IIa: UICC]. He received a postoperative systemic chemotherapy with 5-FU and LV. Five months after the operation, multiple liver metastases were detected in the right hepatic lobe (S5, 6, 8). Right hepatectomy was performed. Seventeen courses of postoperative hepatic arterial infusion (HAI) chemotherapy (weekly high-dose 5-FU regimen) were performed without severe adverse events. He was still alive with no sign of recurrence for 69 months after hepatectomy. After liver resection for metastases of colorectal cancer, although a systemic chemotherapy has been mainly performed, HAI chemotherapy is one of the important options for prevention of local recurrence.

Six types of FRP cables were subjected to an exposure test lasting more than fifteen years under maritime conditions, and the retrieved cables were evaluated mainly by SEM and FT-IR microscopy. Loss of surface resin was observed for all the tested FRP cables; however, deterioration between the fiber and matrix resin was not found by SEM. Observation by FT-IR microscopy detected surface deterioration of AFRP cables, and the feasibility of this method for evaluating the deterioration of some FRP cables was indicated.

FRP is used for corrosion protection and/or as structural members utilizing its anti-corrosion properties. Moreover, since the weight of a superstructure can be significantly reduced due to its specific strength, FRP is expected to offer structural functionalities such as rapid construction, substructure downsizing, and improved seismic performance. We constructed an FRP bridge made entirely of pultruded and hand-lay-up GFRP materials, and have been monitoring its functionality and durability. This paper reports the changes in structural load-bearing behavior during nine years of field exposure. Loading response of the FRP bridge after long-term exposure was almost the same as that just after its completion and deterioration in structural performance has not been observed in nine years. The results prove that FRP materials have good durability and functionality for long-term field exposure as structural materials for bridges.

The postoperative clinical superiority of the interposition of jejunum reconstruction (INT) to Roux-en-Y reconstruction (RY) after total gastrectomy has not been clarified. Postoperative quality of life (QOL) was evaluated between the 2 methods by a multi-institutional prospective randomized trial.A total of 103 patients with gastric cancer were prospectively randomly divided into groups for RY (n = 51) or INT reconstruction (n = 52) after total gastrectomy. They were stratified by sex, age, institute, histology, and degree of lymph node dissection. Postoperatively, body mass index (BMI) and nutritional conditions were measured serially, and QOL and postoperative squalor scores were evaluated at 3, 12, and 60 months and compared between the 2 groups.After removing patients who did not complete the follow-up survey or censured cases, 24 patients in the RY group and 18 patients in the INT group were clinically available and their postoperative status was assessed. QOL scores were increased and complication scores were improved in the postoperative periods (P.01). Postoperative BMI significantly deteriorated compared with preoperative BMI in each group. The postoperative QOL and complication scores at 60 months after surgery were significantly better than those at 3 months after surgery in each group (P.01). However, there was no significant difference of QOL scores and postoperative complication scores between the 2 reconstruction groups. The nutritional condition in the INT group was nearly the same as that in the RY group.Although our patient sample was small and patients who did not complete the follow-up survey were present, we could not identify any clinical difference between INT and RY after total gastrectomy 60 months after surgery. The safer and simpler RY method may be a more suitable reconstruction method than INT after total gastrectomy.

Infliximab is effective in the treatment of steroid-resistant Crohn disease. However, there is clinical concern about a possible correlation between an increased risk of anorectal cancer and infliximab treatment. We report a case of anorectal cancer in long-standing perianal Crohn disease. A 34-year-old patient with a long-standing perianal lesion of Crohn disease underwent 3 sessions of infliximab therapy. After therapy, the concentration of plasma CEA was 36.5ng/ml and rose to 91.4ng/ml. We suspected anorectal cancer, so abdominoperineal resection was performed. The histological findings indicated mucinous adenocarcinoma. Monitoring of patients with long-standing perianal Crohn disease is considered essential for early diagnosis of anal cancer after obtaining biopsy samples from perianal lesions. Additionally, when infliximab is started for perianal Crohn disease, thorough examination for perianal lesion should be performed.

A 75-year-old male who with type 3 gastric cardia cancer with multiple liver metastases was initially treated with S-1 in July of 2005. After 4 courses of the treatment, the liver metastases became undetectable on abdominal CT scan, with reduction in size of the primary tumor of the stomach. After 7 months of S-1 treatment, however, the progression of the primary lesion was endoscopically detected, and irinotecan was administered, demonstrating primary tumor regression. When re-growth of the primary tumor was observed, 3 courses of paclitaxel treatment showed little effect and was replaced by docetaxel treatment for 5 months, which had a grade 3 adverse effect. The next 10 courses of 5-FU combined with methotrexate were applied for one year until the primary tumor showed enlargement. Then 12 courses of CDDP with S-1 were administered until now, and the size of the primary carcinoma is under control. The patient is being followed on an outpatient basis without any surgical treatment, while the liver metastases have not relapsed on abdominal imaging.

Crohn病計70例の外科治療例のうち47例(67%)に肛門部病変の合併を認めた.病型別にみると小腸大腸型,大腸型に高頻度に合併が見られ,とくに直腸病変にはほとんどの例で合併していた.内訳は肛門周囲膿瘍,痔瘻が39例(83%)と最も高頻度で,skin tag,肛門腫脹(痔核既手術例2例をふくむ)が14例(30%),ついで裂肛,潰瘍2例,直腸腟瘻2例,肛門狭窄3例であった.肛門周囲膿瘍,痔瘻に対する現時点での最終的な外科治療についてみると,自潰,または切開排膿は19例で治癒したのは2例のみであった,切開開放術は10例に,括約筋温存痔瘻切除術は4例に行v,全例に治癒が見られ良好な成績が得られた,ストーマ造設術は5例に行ったが,いずれも直腸病変を有する難治例であり3例に直腸切断術を余儀なくされた.痔瘻手術後の排便困難を伴う肛門狭窄例2例に対し肛門拡張を指導したが,症状は消失し有効な方法であると考えられた.

The postoperative results of pylorus-preserving gastrectomy (PPG) for gastric ulcer performed in 134 patients during the past 25 years (mean postoperative period, 16.6 years) were studied. The incidence of postoperative complications was low. Dumping syndrome occurred in only 4.4% and 0% of cases as assessed by questionnaire and interview, respectively. Four (5.4%) of 74 patients available for this study had ulcer recurrence. In one of these four patients concurrent gastroduodenal ulcer was suspected from preoperative gastric analysis. The site of recurrence was found in all cases to be the remnant antral gland area along the greater curvature between the proper gastric gland area and the duodenum. Basal and maximal acid outputs at the time of relapse were significantly higher in patients with recurrence than in patients without recurrence. The fasting and postprandial serum gastrin levels were high in one patient with recurrence, whose antrum was preserved as long as 3 cm proximal to the pyloric ring; this was longer than that described in our original method of PPG. In two other recurrent cases the serum gastrin levels were not different from those in nonrecurrent cases. Immunohistochemical examination of the residual antrum showed no increase in the G-cell density in patients either with or without recurrence. These results suggest that the long-term quality of life of patients treated with PPG remains favorable. Recurrence rate can be further reduced if PPG is strictly indicated for gastric ulcer only and carried out by meticulous surgical techniques. In the pathogenesis of the ulcer recurrence the role of gastrin release from the residual antral mucosa seems to be limited.

Crohn病7例の狭窄性小腸病変に対する,strictureplasty(SXPL)の手術成績を検討した.症例は男4例,女3例,SXPL施行時の平均年齢は32.7歳であった,術後平均経過期間は17.1カ月(3～34カ月)であり,初回手術時の病型は,小腸大腸型5例,小腸型2例で,4例は同時に腸切除を行った.施行したSXPLの内容はHeineke-Mikulicz型22カ所,Finney型5カ所,Jaboulay型3カ所の計30カ所であった.術後,重篤な合併症はなく,全例症状とIOIBD scoreの改善を認め,良好な経過を示した.SXPLは安全な術式であり,積極的に施行すべき術式であると考えられた.

The main strategy in surgical treatment of Crohn's disease is resection of the diseased segment, despite possible development of postoperative nutritional impairment and lowered quality of life (QOL) caused by short bowel syndrome and early postoperative relapse. To overcome postoperative short bowel syndrome, minimal resection is highly recommended, and furthermore strictureplasty is now used in many institutions. Many reports have shown that strictureplasty is safe, has a low rate of surgical complications, and displays identical surgical results as intestinal resection. To apply this procedure to various types of Crohn's disease, different derivatives of this procedure, such as Heineke-Mikulicz, Finney, Jaboulay, and double Heineke-Mikulicz type, as well as side-to-side isoperistaltic strictureplasty have evolved. In performing strictureplasty, the severity of stenosis is more important than the length of the stricture, because a simple but long stricture can be easily managed by any method of this procedure. Further, it is necessary to investigate the surgical specimens via histopathological analysis of frozen section when neoplastic change is suspected. Now, functional end-to-end anastomosis using a linear stapler has become the most frequently used method in intestinal surgery. Many studies have documented less leakage, morbidity, and anastomotic recurrence as well as shorter hospital stay following stapled anastomosis. As part of the postoperative maintenance treatment regimen, various drugs, such as masalamine, immunomodulators, and infliximab, have been shown to demonstrate positive efficacy when used solely or in combination. Endoscopic examination should be done regularly, and the maintenance treatment regimen should be adjusted according to the disease activity.

Colorectal cancer is one of the most common malignancies worldwide and 70% of tumors are resectable, but patients with metastatic diseases cannot be cured with current treatment modalities. Inhibition of the apoptotic pathway is one of the factors that may be responsible for carcinogenesis and drug resistance, and the inhibitor of apoptosis protein (IAP) family is thought to prevent apoptosis through inhibition of direct caspases and pro-caspases. Recently an increasing amount of evidence has been accumulated regarding cIAP2 and other IAP proteins of the antiapoptotic pathway and NF-kappaB signal transduction. IAPs are abnormally regulated and expressed in the majority of human malignancies at elevated levels. As a result, they have recently been reported to be therapeutic targets. The downregulation of cIAP2 efficiently enhances apoptosis through the activation of caspase 3/7 and 5-fluorouracil (5-FU) sensitivity in colorectal cancer cells exposed to 5-FU. This report reviews the evidence for cIAP2 and other IAP molecules as a therapeutic target for malignancies including colorectal cancer. So far, the information on colorectal cancer is limited; so this study includes other malignancies as well, in order to summarize the current knowledge of drug development targeting IAP molecules and provide an overview of the future course.

There have been few epidemiological studies on gastroenteropancreatic neuroendocrine tumors (GEP-NETs) in Japan.We examined the epidemiology of GEP-NETs [pancreatic endocrine tumors (PETs) and gastrointestinal neuroendocrine tumors (GI-NETs)] in Japan in 2005 using a nationwide stratified random sampling method.A total of 2,845 individuals received treatment for PETs. Prevalence was estimated as 2.23/100,000 with an annual onset incidence of 1.01/100,000. Non-functioning tumor (NF)-PET constituted 47.4%, followed by insulinoma (38.2%) and gastrinoma (7.9%). Distant metastases were reported in 21% patients with NF-PETs and occurred more frequently as tumor size increased (2 cm). Multiple endocrine neoplasia type 1 (MEN-1) was detected in 10% of PETs but only in 6.1% of NF-PETs. NF-PETs were detected incidentally by physical examination in 24% patients. In 2005, an estimated 4,406 patients received treatment for GI-NETs. Prevalence was estimated as 3.45/100,000, with an annual onset incidence of 2.10/100,000. The locations of GI-NETs varied: foregut, 30.4%; midgut, 9.6%; and hindgut, 60.0%. Distant metastases were observed in 6%. Lymph node metastases occurred more frequently as tumor size increased (1 cm). The frequency of MEN-1 complications was 1%. Physical examination revealed GI-NETs in 44% patients. The frequency of symptomatic GI-NETs was 3.4%. Interestingly, 77.1% of patients with foregut GI-NETs had type A gastritis.Our results show there are large differences in GEP-NETs between Japan and Western nations, primarily due to differences in the presence of MEN-1 in NF-PETs and the location, symptomatic status, and prevalence of malignancy in GI-NETs.

We encountered a rare operative case of hyperthyroidism followed by ulcerative colitis (UC). A 26-year-old mam was referred to our department to undergo an operation. We suspected the possible complication of adrenal insufficiency, since he suffered from severe weight loss, a high fever and palpitation on admission. We diagnosed hyperthyroidism, however, based on the presence of high serum free T3 and T4 levels and a decreased TSH level. After improving the symptoms and the thyroid function by administering thiamazole, we then performed a total proctocolectomy. Although a high rate of association of autoimmune thyroid diseases with UC has been suggested, only 9 cases of hyperthyroidism coexisting with UC have so far been reported in Japan. A common immunological process has been suggested to be implicated in the pathogenesis of this association, however, the exact mechanism needs to be elucidated in the future.

Background The aim of this study was to investigate the effects of intracolonic capsaicin on colonic motility and defecation. Methods The effects of capsaicin (1, 2, 5, and 10 mg) administrated into the proximal colon on ileocolonic motility and defecation were studied in neurally intact dogs with or without various antagonists (atropine, hexamethonium, ondansetron, propranolol, and FK224), dogs with extrinsic denervation of an ileocolonic segment, and dogs with enterically isolated ileocolonic loops equipped with strain gauge force transducers. Results Capsaicin at 5 and 10 mg evoked giant migrating contractions in a dose-independent manner, and it induced defecations with more than 90% probability in neurally intact dogs. These effects of capsaicin were abolished by atropine and hexamethonium. Ondansetron inhibited the capsaicin-induced increase in colonic motility but did not affect the induction of defecation. The other antagonists had no effect. In dogs with extrinsic denervation, capsaicin did not evoke giant migrating contractions in the colon but still induced defecation in 30–40% of experiments. In dogs with ileocolonic loops, capsaicin did not stimulate colonic motility nor induce defecation. Conclusion These results indicate that intracolonic capsaicin causes giant migrating contractions and defecation. Intact extrinsic innervation, continuity of the colon, and intraluminal contents were considered necessary for this effect.

Background/Aims: To investigate if restoration of esophago-intestinal or esophago-gastric continuity with a jejunal pouch after total or proximal gastrectomy has clinical benefits. Methods: We reviewed all relevant reports published after 1990 that dealt with the clinical results of reconstruction with a jejunal pouch after total and proximal gastrectomies and correlated those findings with results for gastrointestinal motility. Reports were chosen from a search of the literature using PubMed. Results: After total gastrectomy, the benefit of a jejunal J pouch interposition was not apparent compared to simple jejunal interposition; indeed, one trial concluded that simple interposition was better than pouch interposition in terms of food intake. In contrast, results with a jejunal J pouch during Roux-en-Y (RY) type reconstruction were better than with conventional RY reconstruction in terms of food intake, nutritional status, body weight (BW) and symptoms. Advantages were also shown for a jejunal pouch with an inverted U shape interposed between the esophagus and residual stomach after proximal gastrectomy. Reconstruction using a jejunal pouch after proximal gastrectomy was better than esophagogastrostomy or simple jejunal interposition in terms of food intake, BW and symptoms. There were not enough data to conclude any benefits of a jejunal J pouch between the gastric remnant and the duodenum after distal gastrectomy. Conclusions: Clinical results of restoration of intestinal continuity with a jejunal pouch after total and proximal gastrectomies may be attributed, at least in part, to the relationship between the motor activity of the gastric remnant, duodenum and jejunal pouch.

The control mechanism of canine colonic motor activity measured by means of chronically implanted force transducers was studied by comparing diurnal changes and migrating patterns in control dogs and dogs with innervated and extrinsically denervated colonic loops. Five force transducers (C1-C5) were placed on the colon, and the middle colon was transected to construct a loop including C2 and C3 transducers. Colonic continuity was established by an end-to-end anastomosis. In the fasted state, colonic motor complexes of 8-13 minutes' duration were observed to occur at intervals of 22-32 minutes in all three groups, but response to feeding was clearly different; significant enhancement of the colonic motor indexes lasting for 8-16 hours after feeding, which was observed at all recording sites in control dogs, was identified only in the proximal and distal colon in dogs with innervated and extrinsically denervated loops. In the innervated loop, significant enhancement of the motor indexes was observed only in the first 2 hours after feeding. In the extrinsically denervated loop, feeding did not induce any response. In both groups with loops, greater than 40% of the motor complexes that occurred in the proximal colon migrated to the distal colon directly across the anastomosis and less than 20% propagated to the loop. In addition, the migration time between the proximal and the distal colon was greatly reduced in both groups with loops compared with that in the control group. Another change observed within the loop was an increase in numbers of retrograde migrating colonic motor complexes. It is concluded that colonic motor activity is under the predominant control of intraluminal contents in the digestive state but that extrinsic nerves may play an important role in the response observed in the innervated loop in the first 2 hours after feeding, which should be defined as the gastrocolonic response in dogs. In the interdigestive state, the intrinsic nervous system and/or humoral factors may control the occurrence of colonic motor complexes.

直腸癌に対する腹会陰式直腸切断術術後,S状結腸人工肛門周囲に生じた静脈瘤に対し,硬化療法を行い出血に有効であった症例を経験したので報告する.症例は65歳,男性で1986年1月,60歳時に直腸癌にて腹会陰式直腸切断術を施行され,ーその際,肝硬変を指摘された,1987年5月頃よりストーマからの出血がみられるようになり,次第に出血が頻回となったため1990年10月,1991年1月,5.月の3回に分け硬化療法を行った.その後,ストーマからの出血はなく良好に経過している.旁ストーマ静脈瘤に対して硬化療法は安全,簡便で良好な止血効果が得られ,優れた方法と考えられた.

閉塞性黄疸 (以下, 黄疸) 時の急性潰瘍発生におよぼす黄疸持続期間の影響について減黄操作の効果を含めて検討した.黄疸2, 4, 6週および黄疸2, 4週兼減黄ラットを作成し水浸拘束の前後で潰瘍係数, 胃粘膜potential difference (以下, PD), 胃内pHを測定した.その結果, 黄疸が持続するほど潰瘍係数が高く, 黄疸2週では減黄操作により潰瘍係数の減少を認めたが, 黄疸4週では減黄操作のみで潰瘍発生を認め水浸拘束時の潰瘍係数の減少も認められなかった.胃粘膜PDは黄疸2週では減黄操作により水浸拘束時の低下が抑制されたが, 黄疸4週では効果が明かではなかった.胃内pHに対する黄疸持続期間および減黄操作の影響は明かではなかった.以上より黄疸持続期間が長いほど潰瘍発生が多く胃粘膜防御因子の低下もより著明となり, また, 黄疸が長期間持続すると減黄操作を行っても潰蕩発生は抑制されにくくなり, 減黄操作のみで潰瘍が誘発されることが示された.

We examined the risk factors of sleep apnea syndrome (SAS) with 64 patients (59 males and 5 females) who referred to our hospital complaining of heavy snoring, excessive daytime sleepiness and breathing abnormalities during sleep. All patients underwent the questionnaire including the habit of smoking and drinking, onset of snoring and apnea during sleep, and also were examined clarify the degree of apnea with apnomonitor for two consecutive nights. According to the apnea index (A.I.) by the analysis of apnomonitor recording, they were divided into two groups, SA positive (A.I. ≥5no. /hour, n=44) and SA negative (A.I.

FUKUSHIMA, K., SASANO, H., NAGURA, H., SASAKI, I., MATSUNO, S, and KROZOWSKI, Z.S. Immunohistochemical Localization of Mineralocorticoid Receptor in Human Gut. Tohoku J. Exp. Med., 1991, 165 (2), 155-163-Immunohistochemical localization of mineralocorticoid receptor in the human adult gut was examined by using a polyclonal antibody raised against a mineralocorticoid receptor fusion protein. Immunoreactive staining was observed in columnar cells in the middle of the intestinal glands of the proximal colon, but not in goblet cells. Western blot analysis also revealed the presence of an approximately 100kDa immunoreactive species consistent with the mineralocorticoid receptor protein in the ascending colon as well as the kidney. These results suggest that aldosterone-sensitive sodium transport and water absorption may be mainly carried out in the proximal colon in human adult gut at non-pathological state.