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脾膿瘍は稀であるが,穿孔性胃潰瘍術後に孤立性脾膿瘍を合併した症例を経験したので報告する.症例は54歳,男性.腹痛を自覚してから2週間後に来院.穿孔性胃潰瘍による腹膜炎に対し広範囲胃切除およびドレナージを行った.腹膜炎は炎症が高度で術前CT検査にて大網による腫瘤形成をみとめた.腹水中からは連鎖球菌が検出された.術後1日目には解熱し,抗菌剤を5日間投与した.術後経過は良好であったが,術後14日目に弛張熱と上腹部痛が再燃した.抗菌剤の投与を行うとともに, CT検査にて孤立性脾膿瘍と診断した.抗菌剤を3週間投与後には血液検査で炎症反応が消退, CT検査でも膿瘍は縮小した.術後37日目に軽快退院した.脾膿瘍は先行する感染症が消退してからでも発症することから,患者が一旦回復した後の発熱や腹痛に際しては脾膿瘍を念頭においた画像診断を行うことが必要である.

A 63-year-old man presented to our hospital with persistent dysphagia. Radiologic and endoscopic examination disclosed a 2.0-cm exophytic tumor in the middle third of the esophagus. An endscopically obtained biopsy specimen was found to represent undifferentiated small cell carcinoma. Computed tomography of the chest, abdomen, and cervical region was performed, as were gallium and bone scintigraphy. Metastasis to an adjacent lymph node was detected, without metastasis to distant organs. After neoadjuvant chemotherapy with carboplatin (CBDCA) (400 mg/m2) and etoposide (VP-16) (100 mg/m2), endoscopy and barium-swallow esophagography showed regression. Thoracic esophagectomy then was performed with mediastinal, abdominal and cervical lymph node dissection. The resected tumor was polypoid, measuring 0.5 x 0.5 cm. The lesion consisted mainly of small anaplastic cells, but included a small focus of squamous cell carcinoma. The patient has survived for more than 7 months with no further treatment and no evidence of recurrent disease.

Tacrolimus inhibits T-cell function and neutrophil chemotaxis during inflammation. We hypothesized that tacrolimus would enhance healing of a rat colon anastomosis by reducing the inflammatory response. Fifty-five male Sprague Dawley rats, 230-260 g body weight, underwent identical surgical manipulation consisting of a single-layer, inverted colon anastomosis and the implantation of osmotic pumps subcutaneously in the left flank area. The animals were randomly assigned to receive tacrolimus, at a dose of 0.01, 0.1, or 1.0 mg/kg/day, or only the control solvent solution. The animals were euthanized 4 days after surgery. Colon-bursting pressure (mmHg), anastomotic collagen content ( micro g hydroxyproline/mg wet tissue), and anastomotic type IV collagenase activity (mU/mg protein) were measured. Tacrolimus significantly increased colon-bursting pressure at all doses used (146 +/- 9, 158 +/- 10, 151 +/- 6 mmHg; 0.01, 0.1, and 1.0 mg/kg/day, respectively) vs. control (119 +/- 7 mmHg, p < 0.01). There was no effect on collagen accumulation except at a dose of 0.01 mg/kg/day, which significantly decreased anastomotic collagen content (p < 0.05). Tacrolimus at a dose of 0.01 mg/kg/day increased anastomotic collagenase activity, which was not changed by treatment with the higher doses. Microscopic examination revealed the preservation of the multilayered structure, including the mucosal muscle, a thickened submucosa, and the proper muscle of the anastomotic site in the tacrolimus-treated groups. These data suggest that tacrolimus enhances wound strength during acute anastomotic healing despite a reduction in collagen content.

Background: We examined the hemodynamic changes associated with recurrent esophageal varices after esophageal transection (ET) and evaluated the effectiveness of endoscopic injection sclerotherapy (EIS) as the treatment for these varices. Methods: Nineteen patients with recurrent esophageal varices after ET were treated by EIS. Endoscopic varicealography during injection sclerotherapy, following oral blockage of flow by a balloon, identified three patterns: (i) type 1: common type, continuous filling by the feeder vessel of the varix; (ii) type 2: retrograde-disappearing type, confirmed hepatofugal flow; and (iii) type 3: immediate washout type, immediate washout of contrast medium. Results: Angiography revealed that the hepatofugal feeder vessel was the right gastric vein in all cases. Fourteen patients (73.7%) were classified as type 1, 4 patients (21.1%) as type 2, and 1 patient (5.3%) as type 3. Fewer treatment sessions were required in type 1 than in type 2 (P

We report herein the case of a 67-year-old man who was admitted to our hospital with a 3-month history of hoarseness, a cervical mass, and weak muscles of the extremities 6 years after undergoing a right colectomy for carcinoma. Physical and imaging examinations disclosed a nodule in the thyroid with swollen cervical lymph nodes, multiple pulmonary lesions with pleural effusion, and a cerebral mass. Fine-needle aspiration cytology of the thyroid nodule and brush cytology of the lung mass revealed adenocarcinoma, which was consistent with a diagnosis of metastases from the primary colon adenocarcinoma to the thyroid, brain, and lung. The patient eventually died from the malignancy, although he survived for 4 months after the disclosure of the metastases. The rarity, diagnosis, and prognosis of thyroid metastasis from colon carcinoma are discussed.

Background: Pancreaticoduodenectomy（PD）has become a standard operation for malignant and benign periampullary diseases. Although the operative mortality of PD has decreased to less than 4％ in hospitals with many cases of PD the leakage of pancreaticointestinal anastomosis（PIA）still carries a substantial risk of lethal outcome. The aim of this study was to evaluate the local factors that affect the incidence of PIA leakage by evaluation of exocrine function and fibrosis in the pancreatic remnant following PD. Method: Twenty‑eight patients（17 pancreatic disease 8 bile duct cancers and 3 ampullary cancers）underwent PD with complete extracorporeal pancreatic juice drainage. The cut‑end of the pancreatic remnant was histologically studied for its grade of fibrosis in comparison with the exocrine activity of the pancreatic remnant（EAPR）calculated by the value of the product of volume of drained pancreatic juice and its amylase activity. The influences of those factors and other clinicopathologic data on PIA outcome were evaluated. Results: The histological grade of fibrosis in the pancreatic stump was inversely correlated with EAPR（rs＝0.5848 p＝0.0011） . Three patients had major leakages and 6 had minor leakages of PIA; all the patients with leakages had biliary or ampullary diseases but not pancreatic diseases. The incidence of leakage of PIA was significantly higher in the patients with high values of EAPR（p＜0.05） . None with EAPR less than 10 7 had PIA leakage. The incidence of PIA leakage in low‑grade fibrosis of the pancreatic stump was significantly higher than that in high‑grade fibrosis（p＜0.05） . Other clinicopathologic data did not influence the incidence of leakage of PIA. Conclusions: The degree of fibrosis in the pancreatic stump is significantly related t ot he EAPR and affects the development of PIA insufficiency as a local factor. （J Nippon Med Sch 2002; 69: 549―556）

To improve the quality of thick bean sprouts and clarify their value as a material to supply amino acids, we cultivated thick bean sprouts of soybean and mung bean by the following methods and evaluated their growth and changes in the amino acid contents in the cultivation process and during storage : (1) Routine cultivation method (Control), (2) Carbon dioxide-enriched rotary cultivation (CRC), (3) Dipping in mixed phytohormone treated cultivation (DMP), and Dipping in mixed phytohormone combined application of artificial sunlight lamp cultivation (DPSL). The growth of both types of thick bean sprouts assessed in terms of the marketability of external quality was good in the order of DPSL>DMP>CRC>Control. By each cultivation method, the appropriate harvest time was 5 days after the initiation of cultivation for both types of thick bean sprouts. The total amino acid contents was markedly decreased in the both types of thick bean sprouts compared with beans as a raw material (dry matter). The total amino acid contents began to gradually increase in the early phase of cultivation and markedly increased, reaching a peak, in the middle phase of cultivation (after 3-5 days). This increase was marked in the order of DPSL>DMP>CRC>Control. In the cultivation process of both types of thick bean sprouts by each cultivation method, marked increases were observed in Met, Cys, Phe, Tyr, Thr, Trp, and Leu but slight increases in the other amino acid. Changes in amino acids during storage were similar to those in the cultivation process. The residual contents was the highest after 3 days storage at a temperature of 5±2°C or less. Both types of thick bean sprouts by showed the highest total quality at the time of consumption in terms of extension and appeared to be of value as a material the provides protein and amino acids.

The aim of this study was to evaluate the characteristics, and treatment of gastric remnant cancer based on an analysis of the surgical results of Nippon Medical School over the past 18 years. Thirty seven patients (27 males and 10 females, mean age 60 years) underwent surgery for gastric remnant cancer. Patients who had undergone gastrectomy with Billroth II anastomosis for benign disorder underwent re-gastrectomy for the cancer of gastric remnant 20 years after the first gastrectomy. While, patients who had undergone gastrectomy with Billroth I anastomosis for malignant disorder underwent re-gastrectomy within 10 years after the first gastrectomy. Early-type gastric remnant cancers were not observed in the suture line or gastric stump region, while advanced-type cancers were observed in the anastomotic region. Surgical treatment was carried out by the method of total gastrectomy with Roux-en-Y esophago-jejunal anastomosis. The 5 year survival rates were 77%for early cancer and 14%for advanced cancer. Periodic follow-up endoscopies in gastrectomized patients may be useful for the early detection of gastric remnant cancer after operations for gastric cancer.

Along with the increasing need for living-donor liver transplantation (LDLT), the issue of organ shortage has become a serious problem. Therefore, the use of organs from elderly donors has been increasing. While the short-term results of LDLT have greatly improved, problems affecting the long-term outcome of transplant patients remain unsolved. Furthermore, since contradictory data have been reported with regard to the relationship between donor age and LT/LDLT outcome, the question of whether the use of elderly donors influences the long-term outcome of a graft after LT/LDLT remains unsettled. To address whether hepatocyte telomere length reflects the outcome of LDLT, we analyzed the telomere lengths of hepatocytes in informative biopsy samples from 12 paired donors and recipients (grafts) of pediatric LDLT more than 5 years after adult-to-child LDLT because of primary biliary atresia, using quantitative fluorescence in situ hybridization (Q-FISH). The telomere lengths in the paired samples showed a robust relationship between the donor and grafted hepatocytes (r = 0.765, p = 0.0038), demonstrating the feasibility of our Q-FISH method for cell-specific evaluation. While 8 pairs showed no significant difference between the telomere lengths for the donor and the recipient, the other 4 pairs showed significantly shorter telomeres in the recipient than in the donor. Multiple regression analysis revealed that the donors in the latter group were older than those in the former (p = 0.001). Despite the small number of subjects, this pilot study indicates that donor age is a crucial factor affecting telomere length sustainability in hepatocytes after pediatric LDLT, and that the telomeres in grafted livers may be elongated somewhat longer when the grafts are immunologically well controlled.

Background: Reconstruction of the portal vein with autologous veins requires extra incisions. Prosthetic material is associated with an increased risk of infection. We therefore created an animal model of portal vein reconstruction using the peritoneum. Methods: A 2.5 × 2.5 cm piece of the peritoneum was resected from Landrace pigs weighing 30 to 40 kg and was dipped in 100% alcohol for 10 minutes. The anterior wall of the portal vein measuring 1.2 × 0.6 cm was resected. The peritoneal patch-graft fitting the defect of the portal vein was used to repair it. Results: All 7 pigs survived the surgery, and were killed at 2, 7, 7, 14, 21, 35 and 49 days, respectively, after surgery. There was no evidence of thrombosis or obstruction of the reconstructed portal vein or any other complications. Complete endothelialization of the patches were noted at day 14. Conclusions: Our patch-graft technique using the peritoneum is considered to be a good and safe alternative for reconstruction after partial resection of the portal vein in clinical surgery.

石灰乳胆汁を伴った胆石,総胆管結石症を経験した.症例は61歳男性.右季肋部痛にて当科受診,腹部CTおよび超音波検査で胆嚢および総胆管内に結石を認めた.また腹部単純X線写真にて右季肋部に臥位では円形の,立位では鏡面形成のある石灰化像を認め,胆嚢内の石灰乳胆汁が確認された.術前にENBD tubeを挿入留置後,胆石に対しては腹腔鏡下胆嚢摘出術を施行,総胆管結石は術後EPBDを行い採石した.胆嚢および総胆管結石ともにコレステロール結石であり,また胆嚢内胆汁のph8.2と胆汁のアルカリ化を認めた.胆嚢内の石灰乳胆汁は炭酸カルシウムが98%以上を占めており,摘出後まもなく固形化した.石灰乳胆汁を有する症例では,炎症や結石などによる胆嚢管の閉塞や術中操作による石灰乳胆汁の総胆管内への流入の可能性があるため,術前にENBD tubeを留置,術中造影および術後にこれを利用できるようにしておく必要があると考えられた.

肝細胞癌(hepatocellular carcinoma;以下, HCCと略記)の治癒切除施行49例を対象に術前の肝動脈塞栓術(transcatheter arterial embolization;以下, TAEと略記)施行例をA群(24例),非施行例B群(25例)の2群に分類し術前TAEの有用性を再発および長期予後に及ぼす効果から検討した.患者背景因子では,臨床病期ではA群においてII期のものが有意に多かった.病理学的因子では両群に有意差はなかった. 1年無再発生存率はA群76.3%, B群69.7%, 2年無再発生存率はそれぞれ31.8%, 41.3%, 3年ではそれぞれ34.4%, 25.4%で有意差なく,生存率でも, 1年累積生存率がA群91.1%, B群86.3%, 3年累積生存率はそれぞれ63.9%, 68.0%, 5年ではそれぞれ47.3%, 46.6%と両群間に有意差は認められなかった.以上から,術前TAEは治癒切除可能なHCCに対しては,再発,長期予後の点から有用性は低く,ルーチン化すべきでないと考えられた.

Pancreatic cancer frequently causes extrahepatic cholestasis. To identify the direct effects of bile acids in jaundiced serum on pancreatic cancer, the proliferation of PANC-1 and MIA PaCa-2 cells as well as the ultrastructural alteration of PANC-1 cells cultured in crude bile modified media were studied. The growth of these cells in the RPMI-1640 media with or without 1%, 2%, and 4% of the refined crude bile was assessed after 48 and 96 h of incubation. The ultrastructure of PANC-1 cells was investigated by scanning and transmission electron microscopy after 24 and 48 h of incubation. The proliferation of both cell lines in the bile-treated media was greatly inhibited. The inhibitory rates of bile on PANC-1 ranged from 24.1% +/- 3.3% to 66.9% +/- 6.6% (P < 0.01) and those on MIA PaCa-2 ranged from 16.7% +/- 3.8% to 50.7% +/- 5.5%. (P < 0.01). When the bile-added media were replaced, the cells were able to restore their proliferating ability. The PANC-1 cells incubated in the bile-supplied media indicated that the mirovilli, mitochondria, and other organelles had thus been injured. These results suggest that bile acids appear to inhibit the proliferation of PANC-1 and MIA PaCa-2 cells, and the probable inhibitory mechanism is mainly considered to be due to the cytotoxicity of such bile acids.

Background: Reconstruction of the vena cava with an autologous vein requires extra incisions. Prosthetic material is associated with an increased risk of infection. We therefore created an animal model of vena cava reconstruction using the peritoneum. Methods: A 2.5 × 2.5 cm piece of peritoneum was resected from 7 pigs weighing 30 to 40 kg. An oval window (long axis: 1.5 cm) was made in the infrarenal vena cava. This was repaired with the peritoneal patch fixed in alcohol. Results: In 2 animals sacrificed at 5 hours, there was no evidence of thrombosis, but there was fibrin clot on the patches. Two animals sacrificed on day 8 exhibited excellent patency of the vena cava. Complete endothelialization of the patch was noted at day 15. At 6 weeks, the vena cava was healed. No infections or other problems were noted. Conclusions: The peritoneum is an accessible and safe substitute for reconstruction of the vena cava.

At our institute, laparoscopic hepatectomy for hepatocellular carcinoma has been successfully performed in two cases. Each tumor was located solitarily, one in segment IV of the liver and another in the segment VI. Introducing a minimum of four trocars, the exact location of the tumor and the distance from main vessels to the tumor were determined by laparoscopic intraoperative ultrasonography. Hepatic parenchymal resection was carried out using a laparoscopic coagulating shears in combination with a microwave tissue coagulator to minimize the blood loss. After the operation, these patients made a rapid recovery. Although this technique has been available for good quality of life to the patient, a longer time for observation of the clinical course will be necessary to determine the long-term effectiveness.

DPSL法(間欠的植物ホルモン混合溶液浸漬と人工太陽灯照射併用処理栽培法)によるリョクトウ,ダイズ両太もやしの生長は,胚軸,根部ともに伸長度は抑制され,胚軸が肥大し,側根数は減少し,硬度と咀嚼度が強化され,市場の許容範囲に合致して外観品質が向上した.胚軸部の表面色調は,太陽灯照射処理により両太もやしともに淡黄色から薄黄緑色の着色様相を示し,野菜感覚及びサラダ感覚での利用範囲の拡大などの付加価値の付与が認められた.水分含有量と収穫量は,両太もやしともに水みずしさに欠け,水分含有率が低く,収量の増加効果は認められず,栽培条件の整備,再検討が必要となった.三大成分含有量のタンパク質,糖質は増加し,脂肪は減少した.水溶性ビタミン含有量は,両太もやしともに栽培日数の増加とともに増加し,VB1のみ減少した.クロロフィル含有量は,両太もやしともに栽培1-2日目では含有されず,3日目より生成され,栽培日数の増加とともに顕著に増加した.カロチン含有量は,リョクトウ太もやしではControlでは含有されず,栽培3日目より含有され,ダイズ太もやしでは種子中に極微量含有され,両太もやしともに栽培3日目以後増加傾向を示したが,クロロフィルに比して増加量は少ない様相を示した.DPSL法は,豆類太もやしの生長と含有成分及び外観品質の向上を促し,太陽灯照射により胚軸部に着色性をもたらし,付加価値の付与による利用面の拡大など,栽培法として有益となった.一方,収量は,両太もやし個体の生長抑制による嵩の減少と低水分化により増加効果は認められなかった.

Background: We devised a new combined method of endoscopic variceal ligation and injection sclerotherapy, namely, endoscopic scleroligation, for the treatment of esophageal varices. The aim of this prospective randomized trial was to compare endoscopic scleroligation with endoscopic variceal ligation alone with regard to efficacy, complications, variceal recurrence, and survival. Methods: Fifty-one patients with cirrhosis and esophageal varices were randomly assigned to be treated by endoscopic scleroligation (n = 25) or endoscopic variceal ligation (n = 26). In the initial session in the endoscopic scleroligation group, endoscopic injection sclerotherapy was performed with injection of 5% ethanolamine oleate around the lower esophagus to obliterate the feeding veins. This was followed by endoscopic variceal ligation from the injection site to the most orad varix. In subsequent sessions, endoscopic injection sclerotherapy was performed with 1% polidocanol. In the endoscopic variceal ligation group, that procedure was performed in all treatment sessions. Results: Both methods were equally effective in achieving complete eradication of esophageal varices. Among the cases in which complete eradication was achieved, the 1- and 3-year cumulative recurrence rates in the endoscopic scleroligation group (9.5%, 22.1%) were significantly lower than those in the endoscopic variceal ligation group (61.9%, 72.2%) ( p Conclusions: Endoscopic scleroligation is superior to endoscopic variceal ligation in preventing variceal recurrence. (Gastrointest Endosc 1999;50:7-12.)

Allelic loss of loci on chromosome 10q occurs frequently in hepatocellular carcinomas. Somatic mutations of the PTEN/MMAC1 gene on this chromosome at 10q23 were recently identified in sporadic cancers of the uterus, brain, prostate and breast. To investigate the potential role of PTEN/MMAC1 gene in the genesis of hepatocellular carcinomas, we examined 96 tumors for allelic loss on 10q and also for subtle mutations anywhere within the coding region of PTEN/MMAC1 gene. Allelic loss was identified in 25 of the 89 (27%) tumors that were informative for polymorphic markers in the region. Somatic mutations were identified in five of those tumors: three frameshift mutations, a 1-bp insertion at codon 83-84 in exon 4 and two 4-bp deletions, both at codon 318-319 in exon 8; two C-to-G transversion mutation, both at -9 bp from the initiation codon in the 5' non-coding region of exon 1. No missense mutation was observed in this panel of tumors. In most of the informative tumors carrying intragenic mutations of one allele, we were able to detect loss of heterozygosity as well. These findings suggest that two alleles of the PTEN/MMAC1 gene may be inactivated by a combination of intragenic point mutation on one allele and loss of chromosomal material on the other allele in some of these tumors.

ダイズ太もやしの栽培法の有効性を,加熱処理による食品物性度の消長と含有成分の保持性につき,加熱処理耐性と加熱限界より判断すれば,生鮮時で物性度に優る人工生長抑制栽培法の回転式栽培床法(RC),回転式炭素ガス富化栽培法(RCC)及び植物ホルモン混合溶液浸漬栽培法(PC)が有効性を有し,生長の速い通常栽培法(Control)と生長抑制度の弱い間欠的二酸化炭素照射栽培法(CO2)は有効性に欠けた.物性度の消長は,生鮮時の物性強度と加熱温度に依存し,加熱限度は,RC, RCC, PCでは100℃・1min, Control, CO2では70℃・1-2 min以内となった.含有成分の総合的な保持率は,生鮮時の物性強度と加熱時間に影響され,三大成分の保持率による加熱限界は,100℃・5 min以内となり,脂肪,糖質,タンパク質の順に全栽培法で高い安定性を示した.一方,水溶性ビタミン類の加熱限界は,100℃・3 min以内となり,加熱処理時に煮汁液中への溶出率が高いことが認められ,PC, RCC, RCが僅かに加熱処理耐性を有した.含有成分の総合保持率では,三大含有成分は全栽培法で溶出率は低く安定性を示し,加熱限界は100℃・10 min以内となり,水溶性ビタミン類では全栽培法での100℃・6 min以上では溶出率が顕著に高まり,加熱処理耐性に欠け,加熱限界は100℃・5min以内となった.

A 69-year-old woman was admitted to our hospital for the treatment of a dorsal pancreatic artery aneurysm detected with abdominal computed tomography. Angiography revealed celiac axis occlusion, a large aneurysm in the dorsal pancreatic artery, and small aneurysms in the celiac and splenic arteries. Transcatheter arterial embolization with microcoils, N-butylcyanoacrylate, and lipiodol was successfully performed for the dorsal pancreatic artery and the aneurysm. In the 2 years after treatment the dorsal pancreatic artery aneurysm has not recurred, and other aneurysms have not enlarged.

A 45‑year‑old man was admitted to our hospital with left subcostal pain of sudden onset. Although this symptom had occurred frequently no diagnosis had been established. An emergency chest roentgenogram suggested diaphragmatic hernia. Computed tomography and gastrography revealed Bochdalek hernia. It is important that diagnostic imaging be performed while symptoms are present in suspected cases of diaphragmatic hernia. （日本医科大学医学会雑誌 2007; 3: 102―104）

Meckel's diverticulum is silent in the clinical course in most cases, and is often detected incidentally at laparotomy. It sometimes causes some complications which include perforation due to a foreign body in a lowest frequency. This paper reports a rare case of perforation of Meckel's diverticulum due to a fish bone. A 60-year-old man was referred to the hospital with a diagnosis of acute appendicitis from another hospital. With a diagnosis of perforative peritonitis due to acute appendicitis, an emergency operation was conducted. It revealed that a foreign body was stipping a 3×5 cm Meckel's diverticulum at 70 cm oral side from the ileocecal region. We made a diagnosis of perforation of the Meckel's diverticulum due to the foreign body, and performed a resection of the diverticulum. The foreign body was a sharp fish bone, 3.5 cm in length and 1.5 mm in diameter. It was comfirmed as a salmon's bone that was inferred from the menu he ate. Pathological study indicated true diverticulum with infiltration of inflammatory cells extending the full thickness. No aberrant tissue, however, was demonstrated. There have been only ten cases of perforation of Meckel's diverticulum due to a fish bone in the Japanese literature so far. This case is thought very rare.

A patient who presented with multiple esophago-gatroduodenal ulcer associated with hypergastrinemia developed a stricture of the esophagus due to cicatrization of the ulcer and perforation of duodenal ulcer. An impregnation of the greater omentum into the perforation site and gastrotomy were performed, and then a H2 receptor antagonist (ranitidine) and a proton pump inhibitor (lansoprazole: PPI) were administrated when the effects were evaluatd on the total volume of gastric juice collected. A significant decreasing effects of gastric juice and pH were obtained when PPI was administrated at double dose. For hypergastrinemia in which various imagings, angiography, and selective measurement of srum gatrin levels failed to confirm the localization of gastrinoma, and for the severe esophageal stricture, the stomach which is the target organ of gastrin was totally removed in a two-step approach and the patient successfully recovered. However, thereafter, the patient experienced various malignancies in a short period, including a polyp of the sigmoid colon soon after the operation, a left colonic cancer one year later, and its hepatic metastasis 6 months after the colonic cancer. Furthermore, serum gastrin levels varied along with total gastrectomy, resection of the sigmoid colon and hepatectomy. It is noteworthy that there might be some correlations between hypergastrinemia and progression of malignant tumors.

We evaluated the appropriate storage temperature for thin bean sprouts produced by the conventional culture method and thick bean sprouts produced by growth inhibition by immersion culture in phytohormone solution. The bean sprouts were packed with CPP (30u), for 10 days from immediately after harvest. The appropriate storage temperature was evaluated in terms of maintenance of moisture content, food physical properties, color tone, shape, and freshness during storage compared with those at the time of harvest. The optimal storage temperature in terms of marketability based on appropriate values on the market was 5°C for both thin and thick bean sprouts. At this temperature, thin bean sprouts could be stored for 5 days and thick bean sprouts for 7 days. At 17-20°C, thin bean sprouts could be stored for 1-2 days and thick bean sprouts for 3 days. At 10°C, thin bean sprouts could be stored for 3-4 days and thick bean sprouts for 5 days. Compared with thin bean sprouts produced by the conventional culture method, thick bean sprouts produced by artificial growth inhibition culture showed a wide appropriate storage temperature range (5-10°C), and prolongation of 1-2 days of the storage term with recognized superior storage properties.

A 55-year-old man was admitted to our hospital to evaluate a large pseudocyst. Computed tomography showed a 5-cm pseudocyst filled with contrast medium in the head of the pancreas, and color Doppler ultrasonography revealed high-velocity pulsatile flow inside the cyst. Celiac angiography confirmed bleeding from the superior anterior pancreaticoduodenal artery into the cyst. Pancreaticoduodenectomy was performed. Pathologic examination showed a thick-walled pseudocyst filled with clots. The postoperative course was uneventful. Five years after the operation, the patient remained free from bleeding. Bleeding from pancreatic pseudoaneurysms may cause sudden death in patients with chronic pancreatitis, therefore, this entity should be borne in mind, and prompt treatment is of utmost importance in cases of major bleeding.

A 70‑year‑old woman visited our hospital for evaluation of epigastric pain. She had been treated for a gastric ulcer by her home doctor with H2‑receptor antagonist or PPI for 30 years. An upper GI series revealed a gastroduodenal fistula from the lesser curvature to the prepyloric region and the duodenal bulb. Eighteen months later endoscopic examination revealed a double pylorus without additional changes. （日本医科大学医学会雑誌 2006; 4: 213―215）

We present a case of abdominal incisional hernia that was successfully treated with laparascopic surgery. An 81-year-old woman presented with symptoms of abdominal pain and discomfort. In the past history, she had distal gastrectomy for gastric carcinoma in 1995 and total gastrectomy for the remnant of gastric carcinoma combined with a cholecystectomy in 2003. Subsequently, she developed a swelling in the abdominal region. She had consulted a local hospital and surgery was suggested, but she rejected. Finally, she visited Keihin General Hospital with the hope for a treatment by endoscopic surgery. On medical examination, longitudinal and horizontal surgical scars were observed on the upper abdominal region and an incisional hernia measuring 14×15 cm in diameters was found. Laparoscopic repair operation was performed under general anesthesia using a 19.6×24.6 cm Bard Composix Kugel Patch (Bard, Inc.), inserting through three ports of about 11 mm in diameter in the lower abdomen. At present, the patient is under follow up with no pain or recurrence. In conclusion, we report a better prognosis of a case with huge incisional hernia under laparoscopic repair operation.

We studied the hepatic functional reserve in the lobes of the liver in 28 patients with chronic liver disease and 13 controls using single photon emission computed tomography (SPECT) imaging with a radiolabeled asialoglycoprotein analog, Technetium-99m-diethylenetriaminepentaacetic acid-galactosyl-human serum albumin (Tc-99m GSA). Counts of Tc-99m GSA radioactivity in the liver on SPECT images significantly correlated (P < .0001) with the serum albumin level (r = .612), log (serum cholinesterase activity) (r = .618), serum bilirubin level (r = .628), prothrombin time (r = .715), hepaplastin test (r = .637), and indocyanine green retention rate at 15 minutes (r = .771), making it possible to estimate the distribution of functional reserve in the liver based on counts. Using the intact hepatocyte theory, we estimated the number of viable hepatocytes based on the counts. With progression of hepatic functional degeneration, counts per unit hepatic volume decreased (rho = .779, P < .0001), and left lobe to right lobe ratio of this parameter increased (rho = .491, P = .0019) significantly. These findings suggest that the reduction of hepatic functional reserve per unit hepatic volume and numerical density of the hepatocytes, and the proliferation of fibrosis in patients with chronic liver disease is slower in the left lobe than in the right. We discuss a possible biological basis for these apparent lobar differences and for hepatic morphological changes seen in cirrhosis.

Thick bean sprouts cultivated using a rotary box (rotary cultivation, RC) have a decreased yield and inferior quality, although the growth of sprouts from the beans is promoted and the nutrient content of the sprouts is improvedBecause exposure to high levels of carbon dioxide was useful for promoting the growth of the hypocotyl and increasing the quantity of harvested sprouts, we combined the rotary box method with the CO2-enriched method Herein the usefulness of this combination method for improving the physical properties and the yield of bean sprouts by controlling hypocotyl growth were examined.

We report a rare case of cardiac tamponade after esophageal resection for esophageal cancer. A 69-year-old man underwent subtotal esophagectomy and reconstruction of the gastric tube with cervical anastomosis via the poststernal route and three-field lymphadectomy via a median sternotomy. On postoperative day 4, the patient developed dyspnea, chest oppression, and hemodynamic instability due to cardiac tamponade. Emergency percutaneous catheter drainage was performed to manage the cardiac tamponade. Acute pericarditis due to the original surgical procedure was suspected to be the cause of the tamponade. Although rare, cardiac tamponade should be considered as a cause of hemodynamic instability after esophageal resection.

We treated two patients with symptomatic hepatic cyst with minocycline hydrochloride (MINO) injections. Patient 1 was a 72-year-old woman who experienced upper abdominal discomfort brought on by a large hepatic cyst, 12 cm in diameter. MINO (200 mg) was injected daily for 8 days with a continuous drainage catheter. After the treatment, the size of the cyst decreased markedly and the symptoms disappeared. There has been no recurrence in a 55-month follow-up. Patient 2 was a 52-year-old man who experienced abdominal fullness and exhibited hepatomegaly. Investigations revealed many large hepatic cysts. Three continuous drainage catheters were inserted into the three largest cysts for the injection of MINO; a total of 5600 mg was injected over a period of 27 days. The cysts decreased in size and symptoms abated.

豆類太もやしの栽培法として,ダイズ,リョクトウを用いて胚軸部が短く太く,根部が短く根毛の少ない良質の太もやしで水分含有量と生産性に富み,表面色調が透明感と艶を有することを目的に,植物ホルモン(オーキシン;Indole-3-Acetic Acid: IAA,アブシジン酸;Abscisic Acid: ABA,サイトカイニンBenzyl Ade-nine: BA,ジベレリン;Gibberellin: GA1) 10.0ppm溶液浸漬処理栽培法を試み,生長度,水分含水量と生産量,食品物性度および色調より有効適性値を検討した.原料豆を5時間浸漬(25～27℃)して発芽促進を行い,発芽床(27～39℃)内で6時間毎に散水(27±2℃)を行い,24時間処理後に栽培床(27～30℃)に置床し,毎日6時間毎の散水と通気を行い7日間栽培した.本法でのダイズ,リョクトウ両太もやしの生長は,各ホルモン溶液浸漬処理下では類似した傾向を示した.IAA, BA処理栽培では市場適性値を基準とする比較では,収穫適期と判断される栽培5日での胚軸部の伸長,根部伸長と根毛発生数は抑制され,胚軸部の肥大,食品物性度は強化促進され,色調は肉眼的観察下で市場適性度を満たし,品質面で総合的に有効で適性を示し,高品質の豆類太もやしの栽培が可能となった.一方,GA1, ABAでは胚軸部の伸長過度や根毛多発および食品物性度の低下など不適格となった.経済面で重要となる生産量と水分含有量では,ABAが適性を有し,IAA, BAは生産量,水分含有量ともに低下し,経済的要素より判断して不適格となった.GA1は両者の中間的様相を示すが適性度は認められなかった.豆類太もやしのホルモン溶液浸漬処理栽培法は,生産量の強化や水分含有量の増加促進策としては不十分であり,ホルモン溶液浸漬処理の単独および併用処理や溶液濃度,処理時期と期間などの栽培条件の再考など幾多の課題が残されたことより更なる検討が必要である.一方,胚軸部と根部の生長抑制や食品物性度の強化法としての品質改良策としては,IAA, BA溶液浸漬処理は有効で適性を有した.