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Nodal metastasis is a leading attributable factor of poor survival in biliary tract cancer (BTC), and adjuvant chemotherapy targeting this high-risk feature has not been attempted to date. This study aimed to test the efficacy of adjuvant S − 1 for patients with node-positive BTC. This single-arm multicenter phase 2 trial enrolled patients who underwent resection for histologically proven node-positive BTC. In this trial, S − 1 was administered at a dose of 80–120 mg/day on 14 days of a tri-weekly cycle for 6 months. The primary end point of the trial was 3-year overall survival (OS), in which the result would be promising if the 90% confidence interval (CI) surpassed a threshold of 30% (alpha error, 0.1; beta error, 0.2). The secondary end points were relapse-free survival (RFS), feasibility, and toxicity. The trial included 50 patients with perihilar (n = 23) or distal (n = 20) cholangiocarcinoma, or gallbladder cancer (n = 7). The median numbers of positive lymph nodes and examined lymph nodes were respectively 2 and 15. The 3-year OS and RFS were respectively 50% (90% CI, 40.9–59.1%) and 32.0% (95% CI, 19.1–44.9%), with median survival times of 34.6 months (95% CI, 19.3–49.8 months) and 18.4 months (95% CI, 11.9–24.9 months). Although hematologic toxicity often occurred, grades 3 and 4 toxicity were rare. The completion rate of the test therapy was 64%, and the median relative dose intensity was 87.5% (interquartile range, 50–100%). Adjuvant chemotherapy with S − 1 may be promising for patients with node-positive BTC.

Objective This multicenter, single-arm phase II study (UMIN000008429) aimed to evaluate the efficacy and safety of capecitabine plus oxaliplatin (CapOX) as postoperative adjuvant chemotherapy for patients with locally advanced rectal cancer. Methods Patients with resectable clinical Stage II or III rectal cancer were enrolled to receive eight cycles of CapOX therapy (130 mg/m2 oxaliplatin on day 1 and 2000 mg/m2 oral capecitabine on days 1–14, every 3 weeks) after curative surgical resection. The primary endpoint was 3-year relapse-free survival (RFS) rate, and secondary endpoints were 3-year overall survival (OS) rate, treatment compliance, and safety. Results A total of 40 patients (Stage II, 21; Stage III, 19) were enrolled between September 2012 and November 2015 from seven institutions. Thirty-nine patients (97%) received R0 resection, and 32 patients (84%) received postoperative CapOX therapy. The completion rate of all eight cycles of CapOX therapy was 66%. Relative dose intensities were 87% for oxaliplatin and 84% for capecitabine. At a median follow-up period of 46 months, disease recurrence was observed in nine patients, including three with local recurrence. Three-year RFS and OS rates were 75% (95% CI 57–86%) and 96% (95% CI 80–99%), respectively. Frequencies of Grade ≥ 3 hematological and non-hematologic adverse events were 19% and 38%, respectively. Conclusion CapOX therapy is feasible as adjuvant chemotherapy for locally advanced rectal cancer.

Purpose Since oncological outcomes of transanal colorectal tube (TCT) placement, an endoscopic treatment for colorectal cancer (CRC) with acute colorectal obstruction (ACO), remain unknown, this study analyzed long-term outcomes of TCT placement for stage II/III CRC with ACO. Materials and Methods Data were retrospectively reviewed from consecutive patients with distal stage II/III CRC who underwent surgery between January 2007 and December 2011 at two Japanese hospitals. One hospital conducted emergency surgery and the other performed TCT placement as the standard treatment for all CRCs with ACO. Propensity score (PS) matching was used to adjust baseline characteristics between two groups. Results Among 754 patients with distal stage II/III CRC, 680 did not have ACO (non-ACO group) and 74 had ACO (ACO group). The PS matching between both hospitals identified 234 pairs in the non-ACO group and 23 pairs in the ACO group. In the non-ACO group, the surgical quality was equivalent between the two institutions, with no significant differences in overall survival (OS) and disease-free survival (DFS). In the ACO group, the rate of primary resection/anastomosis was higher in the TCT group than in the surgery group (87.0% vs. 26.1%, p < 0.001). No significant differences were noted between the surgery and the TCT groups in OS (5-year OS, 61.9% vs. 51.5%; p=0.490) and DFS (5-year DFS, 45.9% vs. 38.3%; p=0.658). Conclusion TCT placement can achieve similar long-term outcomes to emergency surgery, with a high rate of primary resection/anastomosis for distal stage II/III colon cancer with ACO.

BACKGROUND: Primary tumor location is a critical prognostic factor that also impacts the efficacy of anti-epidermal growth factor receptor (EGFR) therapy in wild-type RAS (KRAS/NRAS) metastatic colorectal cancer (CRC). However, the association between the incidence of BRAF and phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) mutations and primary tumor location remains unclear. METHODS: We prospectively collected tumor samples and clinical data of patients from 15 hospitals between August 2014 and April 2016 to investigate RAS, BRAF, and PIK3CA mutations using a polymerase chain reaction-based assay. According to the primary tumor location, patients were classified to right-sided (from cecum to splenic flexure) and left-sided (from descending colon to rectum) tumor groups. RESULTS: In total, 577 patients with CRC were investigated, 331 patients (57%) had CRC with wild-type RAS; of these 331 patients, 10.5%, 4.8%, and 5.9% patients harbored BRAFV600E, BRAFnon-V600E, and PIK3CA mutations, respectively. BRAF/PIK3CA mutations were more frequent in females, patients with right-sided tumors, and patients with peritoneal metastasis cases and less frequent in patients with liver metastases. The prevalence rates of BRAFV600E and PIK3CA mutations were higher in patients with right-sided tumors than in those with left-sided tumors (32.3% vs. 4.8% and 17.2% vs. 3.6%, respectively). CONCLUSIONS: More than half of the patients with right-sided CRC and wild-type RAS harbored BRAF/PIK3CA mutations, including BRAFnon-V600E, which may contribute to the difference in the anti-EGFR efficacy between the right- and left-sided CRC.

Neoadjuvant chemotherapy (NAC) alone for locally advanced rectal cancer (LARC) remains an experimental treatment, and the efficacy in terms of long-term outcome has not been fully elucidated. The N-SOG 03 trial examined the safety and efficacy of neoadjuvant CAPOX and bevacizumab (Bev) without radiotherapy in patients with poor-risk LARC. Thirty-two patients with MRI-defined LARC received neoadjuvant CAPOX and Bev followed by curative resection between 2010 and 2011. The overall survival (OS), progression-free survival (PFS), and local-relapse rate (LRR) were calculated using the Kaplan–Meier method, and the risk factors were evaluated by multivariate analysis using the Cox proportional hazard models. This trial is registered with UMIN, number 000003507. In the entire cohort, the 5-year OS was 81.3%. Because of disease progression during chemotherapy, 3 patients ultimately did not undergo curative surgery. As a result, 29 patients underwent R0/1 resection. Among these 29 patients, the 5-year OS, PFS, and LRR were 89.7%, 72.4% and 13.9%, respectively. In multivariate analysis, cT4b tumor was an independent poor prognostic factor for OS and LRR, and ypT4b tumor and absence of N down-staging were independent poor prognostic factors for PFS. Patients with cT4b tumor were not suitable for NAC alone. However, the long-term outcomes of the other patients were satisfactory, and NAC alone might be an option for treatment of LARC. N down-staging was likely to bring favorable PFS, even in patients with cStage III.

Obstructive colorectal cancer (CRC) is an emergency situation with high morbidity and mortality, but long-term outcomes of stage II/III obstructive CRC remain unclear. The aim of this study was to evaluate prognostic factors, including colorectal obstruction. Data were retrospectively reviewed from consecutive patients with stage II/III CRC who underwent curative surgery between January 2007 and December 2011 at two Japanese institutions. We analyzed overall survival (OS) and relapse-free survival (RFS), according to various prognostic factors including colorectal obstruction. In total, 979 patients with stage II/III CRC were identified for this study. Among these 979 patients, 94 patients showed colorectal obstruction (9.6%). In both stage II and stage III CRCs, colorectal obstruction showed significantly poorer OS and RFS compared to non-obstruction (5-year OS, obstruction vs. non-obstruction, stage II: 65.9 vs. 86.5%, P = 0.002; stage III: 55.9 vs. 73.6%, P = 0.007) (5-year RFS, obstruction vs. non-obstruction, stage II: 59.2 vs. 77.8%, P = 0.008; stage III 31.3 vs. 56.3%, P = 0.001). Multivariate analysis demonstrated colorectal obstruction as a significant independent and poor prognostic factor in terms of both OS (hazard ratio (HR) 2.469; 95% CI 1.339–4.545; P = 0.004) and RFS (HR 1.992; 95% CI 1.160–3.425; P = 0.012) for stage II CRC, as well as pT4 stage. On multivariate analysis for stage III CRC, colorectal obstruction was a significant predictor of poor RFS (HR 1.626; 95% CI 1.070–2.469; P = 0.023), but not poor OS. Colorectal obstruction is an independent poor prognostic factor for stage II CRC. Adjuvant chemotherapy might be feasible for stage II CRC with colorectal obstruction.

Background & objectives: Despite advancements in molecular-based methods, the composition of the human ileal microbiota and the effects of synbiotics/probiotics on its microbes remain poorly understood. The aim of this study was to determine the composition of the mucus microbiota in the human ileum and to assess the effects of oral administration of synbiotics on the microbiota. Methods: As part of a clinical trial for synbiotics treatment and surgical infection, ileal mucus was sampled when resection of the ileocecal portion was required. The microbiota composition was examined using 16S rRNA-targeted real-time-quantitative polymerase chain reaction. Results: A total of 33 samples from the synbiotics group and 39 from the control group were analyzed. Total numbers of bacteria in the ileum were 108.5 cells/g in the synbiotics group and 108.4 cells/g in the control group, in which obligate anaerobes were dominant over facultative anaerobes. The level of Enterobacteriaceae was significantly lower in the synbiotics group than in the control group. The administered probiotics species Lactobacillus casei strain Shirota and Bifidobacterium breve strain Yakult were detected in 42 and 76 per cent of the synbiotics group, respectively. No significant correlations were observed between tumour stage/size and the various microbes present, except for a negative correlation between tumour size and Bifidobacterium. Interpretation & conclusions: The present analysis of a substantial number of samples from surgically resected intestines showed an abundance of obligate anaerobes as a characteristic feature of the ileal mucus microbiota. Our results also indicated that the synbiotics intervention induced a prominent reduction in Enterobacteriaceae in the ileal microbiota.

Purpose This Phase II trial evaluated the safety and efficacy of neoadjuvant chemotherapy (NAC) with S-1 and oxaliplatin (SOX) plus bevacizumab (Bev) in patients with colorectal liver metastasis (CRLM). Methods Patients with initially resectable CRLM received four cycles of SOX plus Bev as NAC. We adopted the R0 resection rate as the primary endpoint, and the threshold R0 resection rate was set at 80%. Results Between December 2010 and August 2014, 61 patients were enrolled in this study and all started NAC. The completion rate of NAC was 82.0%. Three patients (4.9%) developed severe liver dysfunction caused by NAC and one patient finally decided against resection. Three patients (4.9%) were judged as having progressive disease during or after NAC and did not undergo liver resection. Among 57 patients who underwent liver resection after NAC, three patients were diagnosed with CRLM by pre-treatment imaging modalities and received NAC although a final pathological diagnosis was another malignant disease or benign condition. Finally, 47 of the 54 patients (87.0%) with resected CRLM achieved R0 resection. The pathological complete response rate of the 54 patients was 13.0%, and 31.5% were judged as pathological responders. However, the R0 resection rate of 77.0% in the entire cohort did not meet the endpoint. Conclusions NAC with SOX plus Bev has an acceptable toxicity profile and achieved a satisfactory pathological response. However, accuracy of pre-operative diagnoses and liver dysfunction caused by NAC were serious problems. Easy introduction of NAC for initially resectable CRLM should not be performed.

Background Prospective studies are needed to understand the safety and feasibility of laparoscopic pancreatectomy. The aim of the present study was to describe laparoscopic pancreatectomy currently undertaken in Japan, using a prospective registration system. Methods Patient characteristics and planned operations were registered preoperatively, and then the performed operation and outcomes were reported using an online system. Collected data were also compared between institutions based on their level of experience. This study was registered with UMIN000022836. Results Available data were obtained from 1,429 patients at 100 Japanese institutions, including 1,197 laparoscopic distal pancreatectomies (LDPs) and 232 laparoscopic pancreatoduodenectomies (LPDs). The rates of completion for planned operations were 92% for LDP and 91% for LPD. Postoperative complication rates after LDP and LPD were 17% and 30%, and 90-day mortality rates were 0.3% and 0.4%, respectively. Shorter operation time, less blood loss, and lower incidence of pancreatic fistula were observed in institutions experienced in LDP. A higher rate of pure laparoscopic procedure and shorter operation time were noted in institutions experienced with LPD. Conclusion LDPs and LPDs are performed safely in Japan, especially in experienced institutions. Our data could support the next challenges in the field of laparoscopic pancreatectomy.

As part of proactive efforts to support working cancer patients at medical establishments, patients were given advice not to quit working after diagnosis and invited to a cancer counseling and support center. Further, medical treatment plans focusing on treatment period were presented prior to the start of treatment. These plans can be useful for cancer patients who seek support from their employers about changing their working conditions during treatment. Although these active support initiatives for newly diagnosed working cancer patients tended to contribute to a decrease in the rate of early job termination, the number of cancer patients who quit their work did not decrease significantly. There was a limit to work-related support at the clinical site. It is essential for many professionals to collaborate, such as clinicians, occupational health staff and working support professionals in the promotion of measures for balancing work and treatment for cancer patients. In the Tokai area, we set up the Cancer and Employment Workshop in 2015. We have been working to establish a local network to comprehensively support these patients.

The present study reports the case of a 45-year-old pre-menopausal woman treated with 6courses of TAC chemotherapy by the pegfilgrastim for preoperative chemotherapy. The patient visited our hospital in February 2010 with the chief complaint of a mass in the right breast. A 40mm tumor in the outer lower area of the right breast and the axillary lymph nodes was palpable. Pathological findings revealed scirrhous carcinoma with an ER(+), PgR(+), HER2(1+), and Ki-67 80%profile. Pre-operatively, the patient underwent 6courses of triweekly TAC(docetaxel[75mg/m / 2], adriamycin[50mg/m2], cyclo- phosphamide[500mg/m2])chemotherapy. Pegfilgrastim(3.6m g)was subcutaneously injected on the next day of each course. The side effect of 6courses of TAC was stomatitis and low back pain(Grade 2). Relative dose intensity(RDI)was not reduced and there was no occurrence of febrile neutropenia(FN). Partial resection of the tumor was facilitated. Pathologically viable tumor cells still lay scattered in the range of 45 mm, and a ductal carcinoma in situ was seen. However, metastasis to axillary lymph nodes was not observed. Radiation therapy(50 Gy)was performed on the residual breast. There was no recurrence, and now she survival free with tamoxifen(20mg/day)of 8 years four months after operation. TAC with pegfilgrastim therapy could be an effective pre-operative chemotherapy regimen in breast cancer.

Colorectal cancer (CRC) with acute colorectal obstruction (ACO) is an emergency. Transanal colorectal tube (TCT) use can be a safe single-stage surgery with laparoscopy-assisted colectomy; it offers long-term outcomes equivalent to emergency surgery for stage-II/III CRC with ACO. Self-expanding metallic stent use, another alternative, may have detrimental pathological and molecular effects, whereas the pathological impact of TCT placement remains unclear. We hypothesized that TCT placement might exert little damage on primary tumor. Hence, the current study analyzed the pathological impact of TCT placement for CRC with ACO compared to emergency surgery. Data from consecutive patients with stage-II/III distal CRC with ACO who underwent surgery between January 2007 and December 2015 were retrospectively reviewed at two Japanese affiliate hospitals. Inflammatory and malignant potential-related parameters were analyzed by a single blinded pathologist. We extracted mRNA from tumor tissues to analyze inflammatory cytokines. Sixty-eight patients with stage-II/III distal CRC with ACO were identified (surgery: 25 patients; TCT: 43 patients). Baseline characteristics were well balanced between the two groups. TCT showed a significantly lower frequency of abscess (surgery vs TCT, 36.0% vs 11.6%; P = 0.017) and a lower tendency of pathological perforation (surgery vs TCT, 20.0% vs 4.7%, respectively; P = 0.091), compared to the surgery group. There were no significant intergroup differences in oncological factors, including perineural invasion (surgery vs TCT, 52.0% vs 62.8%; P = 0.383), microlymphatic involvement (surgery vs TCT, 52.0% vs 58.1%; P = 0.623), and microvascular involvement (surgery vs TCT, 32.0% vs 25.6%; P = 0.570). No significant intergroup differences were found in interleukin (IL)-6, IL-8, or IL-1β gene expression levels (P = 0.580, 0.250, 0.941). TCT placement had no pathologically detrimental effects on the tumor or surrounding tissues and might be an attractive non-invasive strategy for cases of curative distal CRC with ACO.

Background: Japanese Red Cross Nagoya Daini Hospital provides medical care for COVID-19 as a designated type 1 medical institution for infectious diseases and provides safely anti-cancer drugs administration for cancer patients as a regional cancer treatment cooperation base hospital. Purposes and methods: Purposes of this questionnaire are to identify the psychological aspects of cancer patients under COVID-19 pandemic, the evaluation of in-hospital countermeasures, and the points for improvement. We conducted a questionnaire to cancer patients receiving chemotherapy. Objects: Two hundred and fifty-six patients who received chemotherapy at our outpatient chemotherapy center from August 14 to September 4, 2020. Results: Of the 256 patients, 253 agreed to fill out this questionnaire. One hundred and thirty-one patients (51.8%) were worried about visiting a medical institution. One hundred and fifty-six ones (61.7%) were worried about cancer treatment. On the other hand, two hundred and thirty-four ones (92.5%) had never wanted to quit their treatment. Two hundred and twenty-seven ones (89.7%) evaluated the countermeasures against COVID-19 taken by our hospital and did not consider options other than our hospital. The main answers to the question “What kind of information and consideration did you want to receive from the medical staff?” were as follows;(1) Patients are exposed to many information through media, so medical staff just answer individual questions. (2) No special information and consideration are required. (3) Countermeasures and prevention for COVID-19 are a matter of personal awareness. Others, there were several answers that it was difficult to understand how the in-hospital measures changed. Discussion: About half of the patients continued to receive the cancer treatment with anxiety. We confirmed that patients receiving chemotherapy were highly conscious of infection prevention. We will consider safer countermeasures based on these opinions.

The aim of this study was to assess whether laparoscopic appendectomy (LA) for complicated appendicitis (CA) effectively reduces the incidence of postoperative complications and improves various measurements of postoperative recovery in adults compared with open appendectomy (OA). This single-center, randomized controlled trial was performed in the Nagoya Daini Red Cross Hospital. Patients diagnosed as having CA with peritonitis or abscess formation were eligible to participate and were randomly assigned to an LA group or an OA group. The primary study outcome was development of infectious complications, especially surgical site infection (SSI), within 30 days of surgery. Between October 2008 and August 2014, 81 patients were enrolled and randomly assigned with a 1:1 allocation ratio (42, LA; 39, OA). All were eligible for study of the primary endpoint. Groups were well balanced in terms of patient characteristics and preoperative levels of C-reactive protein. SSI occurred in 14 LA group patients (33.3 %) and in 10 OA group patients (25.6 %) (OR 1.450, 95 % CI 0.553–3.800; p = 0.476). Overall, the rate of postoperative complications, including incisional or organ/space SSI and stump leakage, did not differ significantly between groups. No significant differences between groups were found in hospital stay, duration of drainage, analgesic use, or parameters for postoperative recovery except days to walking. These results suggested that LA for CA is safe and feasible, while the distinguishing benefit of LA was not validated in this clinical trial.

The aim of this study was to assess the effect of perioperative oral administration of synbiotics on the surgical outcome in patients undergoing laparoscopic colorectal resection. In this single-center randomized, controlled trial, patients scheduled to undergo elective laparoscopic colorectal surgery were eligible to participate and randomly assigned to a synbiotics group or a control group. The primary study outcome was the development of infectious complications, particularly surgical site infection (SSI), within 30 days of surgery. In this study, 379 patients were enrolled and randomly assigned (173 to the synbiotics group and 206 to the control group), of whom 362 patients (168 to the synbiotics group and 194 to the control group) were eligible for this study. SSI occurred in 29 (17.3 %) patients in the synbiotics group and 44 (22.7 %) patients in the control group (OR: 0.761, 95 % CI 0.50–1.16; p = 0.20). Overall, the rate of postoperative complications, including anastomotic leakage, did not differ significantly between the two groups. Synbiotics treatment reversed the changes in fecal bacteria and organic acids after surgery and suppressed the increases in potentially pathogenic species, such as Clostridium difficile. The efficacy of perioperative administration of synbiotics was not validated as a treatment for reducing the incidence of infectious complications after laparoscopic colorectal resection. However, the microbial imbalance, in addition to the reduction in organic acids, could be improved by perioperative synbiotics treatment.

We previously showed that S-1 after curative resection of colorectal liver metastasis had acceptable toxicity and a high rate of completion of therapy in a prospective phase II trial. We here reported the primary endpoint of disease-free survival (DFS). Between October 2008 and August 2010, 60 patients were eligible for this study and received S-1 for 28 days followed by a 2-week rest period. Treatment was started within 8 weeks after surgery and repeated for eight cycles. Median follow-up was 41 months. Among 60 patients, 45 had solitary metastasis, and the median maximum tumor diameter was 2.6 cm. The 3-year DFS and overall survival were 47.4 and 80.0 %, respectively. Recurrences developed in 31 patients, with the remnant liver the most common site (19 patients). Multivariate analysis showed that positive lymph node metastasis around the primary site (p = 0.013) and early liver metastasis (synchronous disease or metachronous disease within 12 months) (p = 0.041) were independent poor prognostic factors for DFS. Patients having both risk factors had a significantly worse DFS than those without these risk factors (p

Preoperative oral carbohydrate therapy has been suggested to attenuate postoperative insulin resistance. The purpose of this study was to investigate the effect of a carbohydrate-rich beverage given preoperatively on intraoperative glucose metabolism.This study was a randomised, open-label, placebo-controlled trial. Patients undergoing oral-maxillofacial surgery were divided into two groups. In the glucose group, patients took glucose (50 g/278 mL, p.o.) 2 h before anaesthesia induction after overnight fasting; control-group patients took mineral water. Primary outcome was blood concentrations of ketone bodies (KBs); secondary outcomes were blood concentrations of free fatty acids, insulin and glucose. Concentrations were measured 2 h before anaesthesia (T0), induction of anaesthesia (T1), and 1 h (T2), 3 h (T3), and 5h after anaesthesia start (T4).In the control group (n=11), KBs increased continuously from anaesthesia induction. In the glucose group (n=12), KBs were maintained at low concentrations for 3h after beverage consumption but increased remarkably at T3. At T1 and T2, concentrations of KBs in the glucose group were significantly lower than those in the control group (T1, p=0.010; T2, p=0.028). In the glucose group, glucose concentrations decreased significantly at T2 temporarily, but in the control group, glucose concentrations were stable during this study (T2, p0.001: glucose vs control).Preoperative intake of glucose (50 g, p.o.) can alleviate ketogenesis for 3 h after consumption but can cause temporary hypoglycaemia after anaesthesia induction.

Objective This Phase II trial was designed to evaluate the safety and efficacy of neoadjuvant oxaliplatin and capecitabine and bevacizumab without radiotherapy in patients with poor-risk rectal cancer. Methods Patients with magnetic resonance imaging-defined poor-risk rectal cancer received neoadjuvant oxaliplatin and capecitabine and bevacizumab followed by total mesorectal excision or more extensive surgery. Results Between February 2010 and December 2011, 32 patients were enrolled in this study. The completion rate of the scheduled chemotherapy was 91%. Reasons for withdrawal were refusal to continue therapy in two patients and disease progression in one, with two of these three patients not undergoing surgery. Among the 29 patients who completed the scheduled chemotherapy, one refused surgery within 8 weeks after the completion of chemotherapy, which was the period stipulated by the protocol, and another had rectal perforation, requiring urgent laparotomy. As a result, the completion rate of this experimental treatment was 84%. Of the 30 patients who underwent surgery, the R0 resection rate was 90% and a postoperative complication occurred in 43%. A pathological complete response was observed in 13% and good tumor regression was exhibited in 37%. Conclusions Neoadjuvant oxaliplatin and capecitabine plus bevacizumab for poor-risk rectal cancer caused a high rate of anastomotic leakage and experienced a case with perforation during chemotherapy, both of which were bevacizumab-related toxicity. Although the short-term results with the completion rate of 84.4% and the pathological complete response rate of 13.3% were satisfactory, we have to reconsider the necessity of bevacizumab in neoadjuvant chemotherapy (UMIN number, 000003507).

This review article provides doctors and dentists with an introduction to the clinical applications and sig- nificance of magnetic resonance cisternography (MRC) for the evaluation of neurovascular compression of the trigeminal nerve in patients with trigeminal neu- ralgia (TN). Specifically, the method and characteris- tics of MRC are first explained using the relevant MR sequences. Next, clinical applications for the diagnosis of TN are discussed. Finally, the significance and util- ity of MRC for effective treatment of patients with TN, such as carbamazepine administration and/or local anesthetic blocks, are presented.

This phase II trial was designed to evaluate the safety and efficacy of adjuvant chemotherapy with S-1 in patients with curatively resected liver metastasis from colorectal cancer. Results of an interim analysis of safety and short-term outcomes are reported. Patients who underwent curative resection of liver metastasis from colorectal cancer received S-1 monotherapy (on days 1–28, followed by 14 days’ rest, 8 cycles) as adjuvant chemotherapy. Among 62 patients enrolled between October 2008 and August 2010, a total of 60 patients were eligible for analysis. The most frequent grade 3 or higher hematologic toxicity involved neutropenia in three patients (5.0 %). Nonhematologic toxicities of grade 3 or higher were fatigue in 6.7 % of patients. Grade 4 enteritis occurred in one patient, but resolved promptly after withdrawal of S-1 therapy. The completion rate of the eight scheduled cycles of chemotherapy was 58.3 %. The most common reasons for withdrawal of treatment was the detection of early relapse in 16 patients (64 %). When the 16 patients who had recurrence during adjuvant treatment were excluded from analysis, 79.5 % of the remaining 44 patients completed the scheduled treatment. Early recurrence within 1 year after curative liver resection occurred in 21 patients (35 %). The most common site was the remnant liver in 14 patients. Orally administered S-1 after curative liver resection has an acceptable toxicity profile and a high rate of completion of the therapy. S-1 can be safely used and might be a viable treatment option in an adjuvant setting.

Purpose We examined the effects of sweet taste stimulation on pain tolerance threshold (PTT) of oral mucosa in children. Subjects and methods Subjects comprised 10 children (mean age, 7.3±1.2 years) for whom PTT of oral mucosa was measured 2min after oral administrations of sucrose or xylitol and water. Sine wave current stimulation (2kHz, 250Hz and 5Hz, SWCS) which can stimulate sensory nerve fiber selectively (A β , A δ and C) was used to measure PTT. Results Sweet taste stimulation with sucrose or xylitol increased oral mucosa PTT in children, but not in adults. No difference in the increased PTT was seen between sucrose and xylitol. Conclusions Oral administration of sucrose and xylitol may potentially relieve pain associated with local anesthetic injections in children.

光通信やDVD，BDなどの光記録等に使われるレーザを発振する光素子の接続には，従来，フラックスレスで接続でき，融点278℃のAu–Snはんだが使われてきたが，接続後の残留応力により光素子の特性が劣化する場合がある。そこで，より低温で接続することで残留応力を低減できるはんだの開発に取り組んだ。本研究では，Sn（融点232℃）上にSn表面の酸化を防止するため，AgおよびAuを形成したSn/Ag/Auはんだを考案し，各層の膜厚を調整して，低融点（206℃）組成としたはんだを開発した。開発したはんだで，フラックスレスで接続でき，良好な濡れ性と接続信頼性を実現できることを明らかにした。

症例は64歳，男性．他疾患検査中の腹部CTで膵尾部腫瘍を指摘された．手術40日前のMagnetic resonanse cholangiopancreatographyでは主膵管は膵尾部で途絶しているのみで途絶部より乳頭側の膵管に異常は認めなかった．血清ソマトスタチンおよびカルシトニン値の上昇を認めた．膵体尾部脾合併切除を施行した．術中主膵管内に腫瘍栓を認め，2回の追加切除にて断端を陰性にすることができた．切除標本にて腫瘍辺縁から頭側へ約4cmの膵管内腫瘍栓を認めた．組織学的にはwell differentiated endocrine carcinomaで免疫組織学的にソマトスタチン，カルシトニンが陽性であった．本症例は比較的短期間に膵管内腫瘍栓を形成したものと考えられた．臨床的にソマトスタチンおよびカルシトニンを同時に分泌する内分泌腫瘍の報告はまれであり文献的考察を加えた．

Background Dentists need to be aware of the relationship between malignancies and paresthesia or complete loss of sensation in a jaw segment. In particular, dentists should be aware of numb chin syndrome (NCS) and its clinical manifestations, as well as the limitations of using panoramic radiographs to detect the causative malignancy. Case Descriptions The authors report two cases of paresthesia in the mental region. No lesions were readily apparent on the patients' panoramic radiographs. To exclude the presence of disease in the mandible that could have been responsible for the NCS, the authors obtained computed tomographic (CT) images. They identified metastases to the mandible from primary malignant tumors elsewhere in the body. Clinical Implications To prevent misdiagnosis of NCS, dentists need to be aware of the clinical manifestations of NCS, the need for CT imaging, the shortcomings of panoramic radiographs and the value of obtaining detailed and accurate medical and dental histories from patients.

術後創感染を伴う患者の入院期間短縮を目的に感染創の処置法を変更した．2000年1月から2006年6月までに当科で施行した大腸手術中，創感染をきたした200例を対象に，変更前の2004年9月までを前期，変更後の同10月以降を後期とし術後在院期間などを検討した．前期（n=146）では，創を開放後，消毒しガーゼで被覆した．後期（n=54）では，創洗浄しアルギン酸塩創傷被覆剤を充填した．また患者へは自己洗浄処置を指導した．創感染発症までの期間は差がなかったが，術後平均在院日数は前期44.18±29.0日vs.後期25.1±16.9日（ρ=0.0009），総医療費は前期22.6±17.1万点vs.後期13.4±4.1万点（ρ=00013）と有意に減少した．大腸・直腸手術の術後創感染において，創の開放ドレナージ・洗浄・アルギン酸塩創傷被覆剤・患者への啓蒙・指導が入院期間・入院費用削減に有用であった．

症例は60歳の男性で, 併存症に糖尿病. 発熱, 心窩部痛を主訴に当院を受診. 急性胆嚢炎の診断で経皮経肝胆嚢ドレナージ(perctaneous transhepatic gallbladder drainage; 以下, PTGBD)を施行した. CT上胆嚢は門脈臍部の左側に存在するように見え, 左側胆嚢を疑った.PTGBD造影と内視鏡的逆行性胆管造影検査で, 右肝管が胆嚢管に合流する胆管走向異常を認めた. ドレナージで炎症が消退したのち, 腹腔鏡下胆嚢摘出術を施行した. 胆嚢の炎症は高度で, 胆嚢底部は肝円索の左側に位置していた. 門脈臍部を損傷しないよう慎重に胆嚢床の切離をすすめ, また右肝管の損傷を避けるためCalot三角部は剥離せず, 胆嚢頸部をステイプラーで閉鎖した. 困難症例であったが, 腹腔鏡手術を完遂し, 第6病日に退院した. 右肝管が胆嚢管に合流する胆管走向異常と左側胆嚢が併存する極めてまれな症例であった.

右胃大網動脈（RGEA）を使用した冠動脈バイパス手術（CABG）後に発生した転移性肝腫瘍に対し肝外側区域切除術を施行した症例を経験した．症例は77歳，男性．６年前に心筋梗塞に対して当院で右胃大網動脈を用いたCABGを施行した．４年前にS状結腸癌に対して腹腔鏡補助下S状結腸切除術を施行している．外来通院中にCTにて肝外側区域に転移性肝腫瘍を認めたため肝外側区域切除を施行した．RGEAグラフトは肝表面に癒着していたが注意深く剥離を行い温存した．術中，術後に合併症は認めなかった．当院では本例を含めRGEA使用CABG後の上腹部手術を７例経験しているが，全例RGEAグラフトを温存しえた．RGEAグラフト使用CABG後の上腹部手術症例においてはグラフトの温存の可否や術式に関して術前の詳細な検討が必要である．

はじめに: 胃切除後の胆管結石症の治療に際しては, 消化管再建のため経乳頭的アプローチが困難な例も多く, 手術的治療のウエイトが大きくなる. 方法: 腹腔鏡下手術を試みた胃切除の既往を有する胆管結石症19例の成績を検討した. 成績: 15例で腹腔鏡下切石に成功した. 既往胃手術の内容は幽門側胃切除B-I再建7例, B-II再建7例, 胃全摘Roux-Y再建5例であった. 開腹移行率はおのおの14%, 29%, 20%で術式との間に有意な関連は見られなかった. 胃疾患は良性11例, 悪性8例で開腹移行率は良性27%, 悪性13%でこれも有意差はなかった.胃手術から胆管結石手術までの期間の長さと開腹移行率の間にも関連は見られなかった. 術前にERCを施行しえたのは19例中6例で施行率はB-Iでは57%, B-IIでは29%, 胃全摘では0%であった. 腹腔鏡下に完遂できた症例での胆管結石の切石方法は経胆嚢管法が5例と胆管切開が10例であり, 術後在院日数はおのおの4.6日と12.7日であった. 結語: 胃切除後症例では癒着剥離に時間がかかるものの, 多くの症例で腹腔鏡下手術が可能であり, 試みるべき術式と考えられた.

The removal of ferric ions from acid mine water was investigated with the neutralizer of recycled rock wool (RRW) in this study. The performance on the removal of ferric ions by the neutralizer of RRW was also compared with that in the neutralizer of virgin rock wool (VRW). Some wastes like the materials from rock wool fire-resistant cover of steel-frame buildings, rock wool insulator wastes of thermal power plants and so on were collected in order to make RRW. In the intermediate process, the objectives were separated and other matters were removed. Sample particles were made after adding blast furnace cement and water as a binder to the objectives and mixing together. When the cumulative volume of passing water increased at the average rate of passing water from 3.85 to 3.89 L/day, the removal performance of ferric ions on RRW was inferior to that on VRW. It is considered that since RRW has larger bulk density, that is, smaller specific surface area, the chemical reactivity of RRW is inferior to that of VRW. When the average rate of passing water was changed from 1.81 to 1.91 L/day, the removal performance of ferric ions on RRW was almost equal to that on VRW.