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The purpose of this study was to identify critical technical points that lead to increased ball speed in a maximal toe kick with no run-up (a 'static kick') in blind football. Six visually impaired male players and eight sighted male players participated in the experiment. All participants wore a blindfold to fully remove visual information and performed the static kick. The motion was captured three-dimensionally using an optical motion analysis system. Our results demonstrated that ball speed, maximum linear velocity of the kicking-side thigh, and maximum angular velocity of the kicking-side shank for the sighted player group were significantly greater than those for the visually impaired player group. The sighted players tended to perform the static kick in a similar motion pattern, which was characterised by a backwards rotation of the torso to adequately extend the kicking-side hip joint during the back-swing phase and a stable posture of the lower torso on the frontal plane during the forward-swing phase. This motion pattern is critical to both acceleration of the kicking-side foot and orientation of the foot for a more precise ball contact position.

The aryne-mediated three-component reaction of arynes, tertiary amines, and aldehydes followed by intramolecular nucleophilic aromatic substitution afforded novel 9- and 10-membered heterocycles. Thus, the reaction of 2-(trimethylsilyl)phenyl triflate with N-phenylmorpholine and benzaldehyde in the presence of CsF gave o-morpholinobenzhydryl phenyl ether in 76 % yield. By using N-methylindoline, nine-membered dibenzo[1,5]oxazonines were synthesized in moderate yields.

Introduction/Background Endothelial dysfunction occurs in chronic kidney disease (CKD) and increases the risk for cardiovascular disease. The mechanisms of endothelial dysfunction seem to evolve throughout kidney disease progression. In the present study, we investigate short-term and long-term effects of the vascular endothelium of intra-dialytic exercise for patients with end stage renal disease. Material and method Total 15 of subjects, included seven patients (32–89 years) with CKD and eight healthy adults participated in this study. The subjects were exercised handgrip training for the 2weeks home-based training program consisted of 7 daily handgrip session of 12 minutes each at the Borg rating of perceived exertion (RPE) for 11–13. The primary outcome was peripheral endothelial function. Secondary outcomes were physical function and biochemical tests such as cholesterol, IL6 and TNF-alpha. Results After the first intervention as the short-term effects, the patients in CKD group and healthy adults had significant improvement in peripheral endothelial function (P Conclusion In this study, the safety and efficacy of conventional handgrip training were confirmed without a sudden drop of blood pressure or any other side effects. Exercise training for handgrip is very convenient, has the potential to improve endothelial dysfunction. These results indicate that the exercise for handgrip training may improve the patient's condition equally to the lower limb exercise.

The aryne-mediated three-component reaction of arynes, tertiary amines, and aldehydes followed by intramolecular nucleophilic aromatic substitution afforded novel 9- and 10-membered heterocycles. Thus, the reaction of 2-(trimethylsilyl)phenyl triflate with N-phenylmorpholine and benzaldehyde in the presence of CsF gave o-morpholinobenzhydryl phenyl ether in 76 % yield. By using N-methylindoline, nine-membered dibenzo[1,5]oxazonines were synthesized in moderate yields.

A track mechanism has high mobility on irregular terrain and is typically used as a locomotion mechanism for all-terrain robots. To increase its traversal ability, subtracks (additional actuated tracks that change its mounting angles) are effective, and recently many small-sized tracked vehicles have used such mechanisms. The performance of track mechanisms is also typically much better than that of wheeled mechanisms on loose soil. However, they sometimes slip while traversing slopes composed of loose soil. To realize high mobility on weak soil, we developed a new locomotion mechanism, referred to as surface-contact-type locomotion. It uses a simple legged mechanism that has a wide contact area with the ground so as not to corrupt the contact surface. However, it has the disadvantage of low mobility on irregular terrain. To solve the problem of the above trade-off, we developed the leg-track hybrid locomotion mechanism by fusing the two locomotion mechanisms. It consists of three track modules. It mounts six actuators: three motors for standard tracked locomotion, two motors for subtrack motion to change mounting angles, and one motor for simple legged motion. To validate the mechanism, we conducted indoor and outdoor experiments. In this paper, we introduce the simple legged mechanism and discuss its stability, detail the developed leg-track hybrid mechanism, and report some experimental results. © 2011 Wiley Periodicals, Inc.

In this paper, a novel crawler mechanism for sideways motion is presented. The crawler mechanism is of circular cross-section and has active rolling axes at the center of the circles. Conventional crawler mechanisms can support massive loads, but cannot produce sideways motion. Additionally, previous crawler edges sink undesirably on soft ground, particularly when the vehicle body is subject to a sideways tilt. The proposed design solves these drawbacks by adopting a circular cross-section crawler. A prototype has been developed to illustrate the concept. Motion experiments confirm the novel properties of this mechanism: sideways motion and robustness against edge-sink. Motion experiments, with a test vehicle are also presented.

Background Clinically, portal vein embolization has been proven to be useful as a preoperative treatment for major hepatic surgeries with impaired liver function. However, its effects on the metabolism and elimination of various drugs after portal vein embolization or ligation remain to be elucidated. Materials and methods A portal vein branch that perfuses the central and left lobes of the liver of male Wistar rat was ligated, and changes in the weights of ligated and nonligated lobules as well as hepatic levels and activities of cytochrome P450 (CYP) isoforms, such as CYP3A2 and CYP2C11, were determined. To evaluate in vivo the effect of PVL on hepatic drug metabolism, the narcotic activity (sleep time) of midazolam, a specific substrate for CYP3A2, was measured. Results Although plasma levels of alanine aminotransferase and hepatic weight returned to basal levels at day 7 after the portal vein ligation, hepatic activities of CYP3A2 and CYP2C11 still remained low (53% and 54% of control levels, respectively), and returned to their initial levels after about day 14. The metabolism of midazolam was prolonged by approximately three times at day 7 after ligation and returned to basal levels at day 14. Conclusions Because hepatic CYP-dependent drug metabolism by CYP isoforms recovered more slowly than the apparent recovery of hepatic volume and plasma alanine aminotransferase levels, the therapeutics of drugs metabolized by the CYP isoforms should be used carefully in patients who receive major hepatectomy with portal vein branch embolization.

Pancreatoduodenectomy can be difficult in patients with obstruction of the celiac axis because of the development of collateral arteries around the head of the pancreas. Bleeding from a pseudoaneurysm is a rare and serious complication of pancreatoduodenectomy. We report a case of a pseudoaneurysm of an enlarged dorsal pancreatic artery, which formed as a result of obstruction of the celiac axis after pancreatoduodenectomy. We assumed that a weakness in the wall of this dorsal pancreatic artery caused by the dissection led to the formation of the aneurysm. Although transcatheter arterial embolization (TAE) could not treat the aneurysm or stop bleeding from the aneurysm completely, it achieved transient hemostasis, whereby the patient's condition improved, making laparotomy safe. This case demonstrates that the dissection of arteries that have developed around the head of the pancreas must be considered in patients with obstruction of the celiac axis.

The failure of the vascular anastmoses is a devastating complication in free jejunum transplantation. We used color Doppler sonography to estimate blood flow in free jejunal grafts in 21 patients who underwent radical pharyngoesophagectomy. Fast Fourier transform (FFT) analysis of blood flow, the pulsatility index (PI) as a measure of peripheral vascular resistance, and thickening of the graft wall were evaluated for predictive value. The arterial wave patterns were classified into three types based on systolic–diastolic differences and magnitude of flow. Type I was physiologic flow, type III overtly pathologic, and type II intermediate. The three patients who required vascular reanastomoses intraoperatively had a type II pattern that degenerated to type III within 15 minutes. The PI increased to 3.5 to 4.5 over 1 hour. In the one patient who required retransplantation, the wave pattern became type III by 18 hours and had disappeared by 24 hours, at which point the PI could not be measured. Jejunal thickening increased from 1.0 mm to 5.0 mm after 24 hours, even in healthy grafts. Monitoring blood flow during the 24 hours after surgery is critical. A type III wave pattern or a PI >2.5 is an indication for reexploration. Doppler sonography offers a noninvasive way to measure blood flow in jejunal grafts semiquantitatively and can predict free jejunal graft failure.

We investigated the correlation between serum concentrations of type IV collagen 7s domain (7s collagen) and changes in the volume of the nonembolized liver lobe after subsequent portal vein embolization (PVE).The relationship between the pre-embolization results of laboratory tests and the increase in the left lobe volume was evaluated in 32 patients who underwent preoperative PVE via the right portal vein.By 2 weeks after PVE, the mean volume of the left lobe had increased significantly (P0.001). The percent increase in the left lobe volume correlated negatively with the pre-embolization serum concentration of 7s collagen (r = -0.472, P = 0.0063). In three of four patients with high serum concentrations (8 ng/ml), the percent increase was less than 100% and right lobectomy was not performed. The serum 7s collagen concentration correlated with the histologic activity score (r = 0.469, P = 0.0061) and the histologic fibrosis score (r = 0.425, P = 0.0145).The serum concentration of 7s collagen may predict the efficacy of PVE. Performing PVE before right lobectomy may not be indicated in patients with high serum concentrations of 7s collagen because the increases in left lobe volume may be insufficient.

To determine the predictive value of the preoperative serum concentration of type IV collagen 7s domain (7s collagen) for postoperative hepatic failure in patients undergoing liver resection for hepatocellular carcinoma.Clear and reliable criteria for predicting hepatic failure after liver resection are needed. The serum 7s collagen concentration correlates with the histologic degree of active hepatitis and hepatic fibrosis and may predict the regenerative potential of the liver.Potential risk factors for postoperative hepatic failure, including the serum 7s collagen concentration, were evaluated in 251 patients who underwent liver resection for hepatocellular carcinoma. Prognostic significance was determined by univariate and multivariate analyses.Hepatic failure developed postoperatively in 25 patients, 4 of whom died. The serum 7s collagen concentration correlated with the histologic degree of hepatitis activity and hepatic fibrosis. The serum 7s collagen concentration was a risk factor for postoperative hepatic failure by univariate analysis and was the only risk factor on multivariate analysis. No patient with a serum 7s collagen concentration12 ng/mL died of postoperative hepatic failure, and all 4 patients who died had a serum 7s collagen concentrationor=12 ng/mL.The preoperative serum 7s collagen concentration correlated independently with hepatic failure following liver resection for hepatocellular carcinoma. Patients whose serum 7s collagen isor=12 ng/mL are poor candidates for hepatic resection.

To better understand how benign hepatocellular tumors acquire nutrient vessels, we investigated the angioarchitecture of the smallest vessels in hepatocellular adenoma (HA) and focal nodular hyperplasia (FNH). In biopsy or resection specimens, microscopic angioarchitecture was characterized in terms of intratumoral fibrous septa and portal tract. Immunohistochemistry for CD34, factor-VIII-related antigen (F-VIII), type IV collagen (collagen IV), α-smooth muscle actin (α-SMA), and CD68 was performed. HA had no portal tract in fibrous septa although FNH showed portal tract in fibrous septa. The smallest vessels in HA stained diffusely for CD34, and arterial segments of the smallest vessels were stained for F-VIII, and collagen IV. Pericyte surrounding the smallest vessels in HA were stained for α-SMA. The smallest vessels in all but one FNH specimen stained for CD34, F-VIII, collagen IV, and α-SMA along portal tract or the artery. Both HA and FNH stained for CD68, as did normal liver. The results indicate that the smallest vessels in HA and FNH are incomplete capillaries, that have both characters of sinusoid and capillaries morphologically and phenotypically, i.e., capillarized sinusoid as in chronic hepatitis or early well-differentiated hepatocellular carcinoma. Benign hepatocellular tumors such as HA and FNH would acquire new vessels gradually by sinusoidal capillarization, not by rapid arterial angiogenesis.

We are under obligation to coexist with natural ecosystem, for the next leap in the hydroelectric power development. In such circumstances, this paper proposes a new type hydraulic turbine, named “Gryo-Type Hydraulic Turbine”, accompanying with the principle of the rotor works and the model test results. The rotor is composed of some blades with high aspect ratio and is submerged nearly parallel to the stream. The turbine is suitable for shallow streams with high velocity in mountain torrents and/or rivers. The rotor has the self-motive power and is driven by the drag force of the blade facing to the downstream at the low rotational speed. With the increase of the rotational speed, the rotational torque comes to be caused successfully by the lift forces of the blade not only facing to the upstream but also facing to the downstream. The maximum output is at higher rotational speed, which is desirable as the turbine performance for the mini/micro hydroelectric power generation.

Background. Gastrointestinal stromal tumors (GISTs) are usually refractory to standard chemotherapeutic agents. We successfully treated a patient with a tyrosine kinase inhibitor (STI571) for GIST with peritoneal dissemination and liver metastases. Methods. In a 32-year-old man presenting with abdominal pain from diffuse peritonitis, a GIST and associated perforated small intestine were resected. Multiple liver metastases were present. After therapies with microwave coagulation, ethanol injection, and local and systemic antineoplastic drugs (fluorouracil, cisplatin, tegafur-uracil, and tegafur) failed, investigational treatment with a tyrosine kinase inhibitor was initiated (STI571, 300 mg, p.o. daily). Results. Anorexia and abdominal fullness resolved within a few days. At 24 days after initiation, positron emission tomography showed a remarkable decrease in the abdominal uptake of [18F] fluorodeoxyglucose. Adverse effects of STI571, including mild alopecia and anemia, were minimal. Conclusions. The tyrosine kinase inhibitor STI571 may be effective against GISTs.

In human cancer, alterations in the p53 tumor suppressor gene are the most common genetic alterations. The aim of the present study was to detect sensitivity of the p53 (+/-) mice and their littermates p53 (+/+) mice to N, N-dibutylnitrosamine (DBN) carcinogenicity. In experiment 1, 6-7-week-old p53 (+/-) and p53 (+/+) mice were treated with 0, 0.025 and 0.05% DBN, respectively, in drinking water for 20 weeks. Esophageal squamous cell and urinary bladder transitional cell carcinomas (TCCs) and fibrosarcomas were found to be significantly increased in p53 (+/-) mice treated with doses of DBN compared to p53 (+/+) mice administered similar doses. In experiment 2, 6-7-week-old p53 (+/-) and p53 (+/+) mice were administered 0 or 0.05 % DBN in drinking water for 8 weeks. Immunohistochemical staining revealed a significant increase in numbers of p53 and bromodeoxyuridine (BrdU) positive cells in the esophageal and urinary bladder epithelia of DBN-treated p53 (+/-) mice compared to p53 (+/+) mice administered DBN. Molecular analysis revealed point mutations in the residual p53 allele in four of eight (50%) esophageal mucosa of DBN-treated p53 (+/-) mice, and in three of eight (38%) of treated p53 (+/+) mice. The results show that p53 (+/-) mice were sensitive to DBN treatment with respect to esophageal and bladder tumor development, with a mechanism that could be confined to early mutations of the residual p53 allele and increased cellular proliferation in the target organs.

A 65-year-old Japanese man underwent radiofrequency ablation (RFA) therapy of a hepatocellular carcinoma. Hemobilia from the intrahepatic bile ducts adjacent to the tumor developed on the fifth day after the RFA therapy. Ultrasonograms and computed tomograms showed swelling of the gallbladder, which was filled with a clot, suggesting the diagnosis of hemocholecyst. The hemobilia resolved with conservative therapy, but a cholecystectomy was performed to manage postprandial abdominal pain. The resected gallbladder was filled with a clot, but injury or ulceration of the gallbladder was absent, suggesting that the hemocholecyst developed secondary to the hemobilia. Secondary hemocholecyst is a rare complication of RFA therapy. The number of cases of secondary hemocholecyst is likely to increase as hepatocentestic therapy becomes more common. Cholecystectomy is indicated for hemocholecyst because spontaneous liquefication and drainage of a clot in the gallbladder usually does not occur.

A 57-year-old woman underwent esophagectomy with three-field lymphadenectomy for lower esophageal cancer, followed by gastric roll reconstruction through the posterior mediastinum. A laparotomy and right thoracotomy with partial resection of the right fifth rib were performed. A purulent discharge requiring drainage developed postoperatively and continued for 3 months despite anastomotic integrity and the absence of a bronchopleural fistula. An empyema developed 3 months after drain removal, and a thoracostomy tube was reinserted. A displaced fragment of the right fifth rib was identified within the abscess cavity. Drainage and irrigation were not curative, and removal of the bone fragment was performed 18 months after the initial procedure. The patient has been symptom-free during 1 year of follow-up. We believe that the rib fragment functioned as a foreign body, which complicated treatment of the patient's postoperative infection.

We investigated the incidence of recurrence after resection of small hepatocellular carcinomas (HCC) in patients infected with hepatitis C virus (HCV) to determine the appropriate surgical management of these patients. Sixty-one patients with anti-HCV antibody who underwent curative liver resection for small HCC (≦ 2.0 cm in greatest diameter) were categorized into two groups. Group 1 consisted of 27 patients with serum concentrations of type IV collagen 7S domain (7S collagen), a marker for hepatic fibrosis, < 8 ng/ml. Group 2 consisted of 34 patients with serum concentrations of 7S collagen ≧ 8 ng/ml. Serum concentration of 7S collagen correlated with the severity of active hepatitis and the degree of fibrosis in the noncancerous hepatic tissue, both of which are related to risk potential of hepatocarcinogenesis. Serum concentration of total bilirubin, aspartate aminotransferase activity, indocyanine green retention rate at 15 minutes, the proportion of patients who were Child-Pugh class B, and the proportion of patients with severe active hepatitis or cirrhosis (determined by histologic examination) were significantly higher in group 2 than in group 1. Platelet count was significantly lower in group 2. Tumor-free survival rates were not different between the groups. In group 1, nonanatomic resection was a risk factor for recurrence by univariate and multivariate analyses (odds ratio = 3.45, p = 0.040). In group 2, nonanatomic resection was not a risk factor for recurrence. In patients with small HCV-related HCC, anatomic resection is recommended when the serum concentration of 7S collagen is low (< 8 ng/ml) because the potential of hepatocarcinogenesis may be low even after the operation.

We examined the usefulness of a transcription-mediated amplification and hybridization protection assay (TMA-HPA) for the evaluation of the degree of active hepatitis and estimation of recurrence after resection of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). We compared results obtained with TMA-HPA with results obtained with a branched DNA assay. Fifty-two patients with HBV-related HCC were divided into two groups; group 1 consisted of 28 patients with a high serum concentration of HBV (>/=3.7 LGE/ml) and group 2 consisted of 14 patients with a low serum concentration of HBV (

胸腔鏡下胸骨挙上術(Nuss法)を行った漏斗胸患児を年少児群(20例,手術時年齢6歳0カ月±1歳8カ月,男女比18:2,)と年長児群(6例, 17歳1カ月±2歳3カ月, 6:0)にわけて検討した.年少児群の手術時間は128±35分,手術から帰宅までの期間は7±3日であったが,年長児群では174±32分, 11±3日でありいずれも有意差を認めた.年少児の1例に気胸がみられ,年長児の3例にbarのshift, flipping,断裂したwireによる肺損傷と胸腔内異物が発生し,年長児群で合併症が多かった.しかし年齢に関わらずwireでbarを固定した症例に合併症が多かったことから, stabilizerを使用することによって合併症を減少できると思われた.また年長児では肋軟骨の柔軟性が乏しいためbarを回転した際に肋軟骨骨折をきたし,その疼痛のために離床が遅れたものと推察した.術後の胸郭形態も年少児群で良好であったが, Nuss法では年長児の広い陥凹を十分に挙上できなかった.

Background/Aims: Serum concentration of type IV collagen 7S domain (7S collagen) is a marker of hepatic fibrosis. We investigated the usefulness of measuring the serum 7S collagen concentration as a risk factor for recurrence after liver resection for hepatocellular carcinoma (HCC). Methods: The serum 7S collagen concentration was measured before liver resection for HCC in 219 patients. Group 1 included 102 patients with a high serum concentration of 7S collagen (≧8.0 ng/ml), and group 2 consisted of 117 patients with a low serum concentration of 7S collagen (Results: The results of liver function tests were better in group 2 than in group 1. The percentage of patients with cirrhosis or who underwent minor resection was higher in group 1 than in group 2. The percentage of patients with moderately or poorly differentiated HCC or portal invasion was higher in group 2 than in group 1. Univariate and multivariate analyses identified that a high serum concentration of 7S collagen (≧8.0 ng/ml) was an independent risk factor for recurrence. Conclusion: Measuring the serum 7S collagen concentration is useful to estimate the risk of recurrence after resection of HCC.

Vancomycin hydrochloride (VCM), a glycopeptide antibiotic, has a broad spectrum against methicillin-resistant Staphylococcus aureus (MRSA). As it is known to induce renal dysfunction, the dose and the duration of its administration are limited. Moreover, the mechanism of VCM-induced renal dysfunction remains to be unclear. To evaluate the involvement of free radical on VCM-induced renal dysfunction, we carried out analysis with a hexamethylenediamine-conjugated superoxide dismutase (AH-SOD) which rapidly accumulates in renal proximal tubule cells and inhibits oxidative injury of the kidney. Male Wistar rats (weighing 200-210 g) were intraperitonealy administered with 200 mg/kg of VCM twice a day for 7 days. AH-SOD 5 mg/kg/day was subcutaneously injected 5 min before every VCM injection. VCM induced renal injury dose-dependently. Biochemical analyses revealed that plasma levels of blood urea nitrogen and creatinine significantly increased in the VCM-treated group by an AH-SOD-inhibitable mechanism. VCM simultaneously elicited an increase of 8-OHdG levels and chemiluminescence intensity of free radical generation in the kidney. Histological examination revealed that VCM also elicited a marked destruction of glomeruli and necrosis of proximal tubules. AH-SOD inhibited these phenomena in the kidney. These results suggested that oxidative stress might underlie the pathogenesis of VCM-induced nephrotoxicity and targeting SOD and/or related antioxidants to renal proximal tubules might permit the administration of higher doses of VCM sufficient for eradication of MRSA without causing renal injury.

症例は64歳の男性. 平成14年1月初旬より嚥下困難が出現し, 食道造影で頸胸境界部食道の右側に約2.5cmの隆起性病変を認め, 上部消化管内視鏡検査では, 門歯列より約20cmの食道右壁に1pl型の隆起性病変を認めた. CT, 超音波検査では明らかなリンパ節転移, 血行性転移は認めなかった. 以上より, T2N0M0, Stage IIの頸胸境界部食道癌と診断し, 平成14年5月8日に胸腔鏡下食道切除術および3領域リンパ節郭清術を施行した. 腫瘍は肉眼的に径22×16mm, 1pl型で, 病理組織診断では類基底細胞癌であった. 深達度はsmでly0, v1, pN0, pStage Ibであった. 類基底細胞癌は非常にまれであり, 予後不良とされている. リンパ節転移のない表在型は予後がよいとの報告もあるが, 頸胸境界部食道に発生した表在型類基底細胞癌は本邦では報告例がなく, また細胞増殖能が高いことより再発に留意し経過観察中である.

はじめに: pT3食道癌に対する根治術としての胸腔鏡下食道切除の是非について, historical controlであるが通常開胸例と比較することにより検討した.対象と方法: 胸腔鏡下に食道切除・リンパ節郭清を行ったpT3食道癌28例 (VATS群) と胸腔鏡下食道切除術導入以前に右開胸下に根治術を行ったpT3食道癌39例 (Control群) の臨床病理学的因子や手術侵襲の諸因子および術後合併症, 予後, 再発形式を比較した.結果: 両群の背景因子には差がなく, 胸腔内操作時間・出血量にも差がなかった. 術後合併症としては肺炎が最も多く, VATS群では乳び胸が2例にみられた. 5年生存率はVATS群53.6%・Control群45.1%で差がなく, リンパ節転移陽性例のみの生存率にも差がなかった.考察: pT3食道癌に対しても胸腔鏡下手術で従来の通常開胸と同等の根治性が得られた.

Background/Aims: The improvement of diagnostic modalities and operative techniques has resulted in prolonged survival for cancer patients, but has also led to the diagnosis of an increasing number of patients with synchronous hepatocellular carcinoma (HCC) and extrahepatic primary cancer. It is necessary to determine the optimal surgical strategies for synchronous HCC and gastric cancer. Methods: In this retrospective study, clinicopathologic findings, diagnostic methods, treatment and outcome were reviewed in 13 patients who underwent curative surgery for synchronous HCC and gastric cancer. Results: Twelve of the 13 patients were men older than 60 years. All patients had chronic hepatic disease, and hepatitis viral infection was detected in 9 patients. Examinations of the esophagus to search for esophageal varices before liver resection for HCC, and imaging studies to rule out liver metastasis before gastrectomy for gastric cancer can lead to the incidental finding of a synchronous carcinoma. The most frequent postoperative complication was massive ascites, which occurred in 4 patients who underwent lymph node dissection, 1 of whom died of perioperative hepatic failure. HCC recurred in 7 patients, 4 of whom died of their disease; only 1 patient died of recurrence of gastric cancer. Conclusion: Careful follow-up for recurrence of HCC is necessary because the most common cause of death in patients with synchronous carcinoma is recurrence of HCC.

Background: The efficacy of thoracoscopic radical esophagectomy for cancer has yet to be established, mainly because previous reports have not included a sufficient number of cases. Methods: Seventy-five treatment-naive patients with esophageal cancer without contiguous spread underwent esophageal mobilization and extensive mediastinal lymphadenectomy through a 5-cm mini-thoracotomy and four trocar ports. Results: Video-assisted thoracoscopic surgery was performed without major intraoperative complications or emergency conversion to open surgery. We retrieved 34.1±13.0 mediastinal nodes, including 11.5±3.8 tracheobronchial nodes and 6.2±3.0 recurrent laryngeal nodes. Mean time of operation and blood loss were less in the last 39 patients than the first 36 (186.7±25.3 min and 165.4±101.8 g vs 270. 2±96.0 min and 421.5±31.2 g, respectively: p

A 63-year-old woman successfully underwent a graft replacement of the retrohepatic inferior vena cava with a ringed polytetrafluoroethylene graft for primary leiomyosarcoma of the inferior vena cava (IVC). Although anticoagulant had been administered, a thrombus was found in the IVC just cranial of the downstream anastomosis 67 months after the operation. The patient remained free of symptoms, and she had no evidence of any tumor recurrence. She underwent a complete resection with a prosthetic reconstruction for leiomyosarcoma of the IVC and has since been able to enjoy a reasonably long-term survival. The occurrence of thrombosis must be kept in mind in the long-term follow-up of such cases.

BACKGROUND: Patients with unresectable malignant gastroesophageal strictures often are troubled with reflux esophagitis after stent placement. METHODS: A self-expandable metallic stent (SEMS) without an antireflux mechanism was placed in seven patients with unresectable malignant gastroesophageal strictures (group A), and SEMS with an antireflux mechanism was placed in five patients (group B). After we obtained monitoring systems, two patients in group A and all the patients in group B underwent measurement of bilirubin and pH in the esophagus using a 24-h bilirubin and pH monitor. RESULTS: The mean percentage of total time less than 0.14 for use of the bilirubin absorbance unit was 12.4% in group B and 64.0% in group A. The mean percentage of total time for a pH less than 4 was 2.9% in group B and 37.8% in group A. CONCLUSION: The placement of SEMS with the antireflux mechanism can be effective not only for palliation of gastroesophageal stricture, but also for prevention of reflux.

Background Bile leakage is one of the frequent and disturbing complications of hepatic resection. Study design Clinical records of the 363 patients who underwent hepatic resections without biliary reconstruction for hepatic cancers between January 1994 and June 2001 were reviewed. Postoperative bile leakage was defined as continuous drainage with a bilirubin concentration of 20 mg/dL or 1,500 mg/d lasting 2 days. Leakage that continued longer than 2 weeks or that required surgical intervention was defined as uncontrollable. Differences in incidence and frequency of uncontrollable leakage for the different types of hepatic resection, tumors, and underlying liver disease were investigated. Outcomes after treatment for uncontrollable bile leakage were also reviewed. Results Postoperative bile leakage occurred in 26 of 363 patients (7.2%). Although the incidence in patients with cholangiocellular carcinoma (3/9 [33%]) was higher (p = 0.03) than in patients with hepatocellular carcinoma, rates of occurrence were similar among the different types of hepatic resection and underlying liver disease. Eight of the 26 patients (31%) had uncontrollable leakage. Two patients required reoperation to control leakage; one of these developed hepatic failure and died 2 months after surgery. Four patients underwent endoscopic nasobiliary drainage 21 to 34 days after hepatectomy, and the leakage resolved within 3 to 21 days. Fibrin glue sealing was effective in two patients whose leaking bile ducts were not connected to the common bile duct. Conclusions Although meticulous surgical technique can minimize the risk of postoperative bile leakage, some instances of leakage are unavoidable. Nonsurgical treatments, such as nasobiliary drainage or fibrin glue sealing, are preferable to reoperation.

Treatment of patients with lung neoplasms, who often suffer from additional medical problems with attendant surgical risk, is controversial. No standard treatment exists, so innovative treatments should be developed to manage patients with this clinical presentation. Radiofrequency (RF) ablation therapy has recently attracted attention with other minimally invasive strategies to treat malignant disease. Although satisfactory clinical results have been reported using this method for liver tumors, only a few reports have been published regarding RF ablation therapy for human lung neoplasms, and its clinical benefit has not been established. We carried out a pilot study on the clinical feasibility and safety of RF ablation therapy for lung neoplasms.

Although curative surgical resection provides the best chance of long-term survival for patients with intrahepatic cholangiocarcinoma, the presence of bile duct invasion decreases postoperative survival rates in patients with mass-forming intrahepatic cholangiocarcinoma. We carried out this study to determine a surgical strategy for patients with bile duct invasion of these tumors. Forty-one patients with mass-forming intrahepatic cholangiocarcinoma were classified as either having bile duct invasion (n= 26) or not having bile duct invasion (n= 15). Clinicopathologic findings, including postoperative outcomes, were compared between these two groups. Perineural invasion, lymphatic invasion, and a positive resection margin were more frequent in patients with ductal invasion. Patients with ductal invasion had lower survival rates than those without ductal invasion. Intraoperative frozen section examination of the bile duct stump to confirm a clear resection margin is required in patients with mass-forming tumors. Resection of the extrahepatic bile duct should be considered when tumor cells are identified at the surgical margin of the resected bile duct.

A gradient index (GRIN) lens is the optical device, which has the distribution of the refractive index in the glass medium. A chromatic aberration is very important when the GRIN lens is used for the optical systems under a source of white light such as a camera and microscope. So, we designed r-GRIN glass composition, which has an improvement in refractive index and a low dispersion distribution to reduce a chromatic aberration, and we also examined suitable preparation method. Then we chose SiO2-TiO2-BaO-K2O glass system and sol-gel process. The theoretical proof of the selection of the SiO2-TiO2-BaO-K2O glass system and the promising composition of the low distributed dispersion r-GRIN lens with large Δn were shown by this study.

食道癌との重複癌例における治療上の問題点について検討した。〈対象と方法〉1986年より1998年までの食道癌根治施行263例のうち，53例(20.2%)に他臓器重複癌を認めた。これら症例を対象に，臨床病理学的因子，治療法，予後について非重複癌例と比較検討した。〈結果〉対象53例中23例が同時性，30例が異時性であった。癌重複臓器は胃21例，頭頸部16例，肝3例，結腸3例，肺3例，乳腺3例，腎2例，前立腺2例，子宮2例で，白血病を1例に認めた。重複癌例と非重複癌例の臨床病理学的因子に差はなかった。胃癌先行あるいは同時性の18例中，胃が使用不可の14例では有茎空腸再建を8例，有茎結腸再建を6例に行った。食道癌切除後再建胃に癌を認めた3例では，1例に内視鏡下粘膜切除，1例に再建胃切除・有茎空腸再建を行った。他の1例は，TS-1投与によりCRで健存中である。頭頸部癌重複16例では，7例に切除が，9例に放射線・化学療法が施行された。重複癌例の食道切除後5年生存率は44%で，非重複癌例の40%と差がなかった。多変量解析では食道癌リンパ節転移の有無が最も有意な予後因子であった。〈結語〉食道癌根治切除例では約20%の高い頻度で重複癌を認めた。癌重複臓器は胃が最も頻度が高く，再建術式に工夫を要す。他臓器重複癌はそれのみでは予後不良因子ではなく，それぞれの癌に対する根治的治療が予後向上に最も重要である。

The refractive index distribution shape of SiO2-TiO2-BaO-K2O systems r-GRIN lens can be controlled by the kind of solvent used for providing of concentration distribution process of barium. The expansion of the concentration difference of barium was also examined. The kind of solvent used in providing of concentration distribution process has a significant influence on the refractive index distribution shape in terms of Δn or N20′. Solvents which enable to large Δn was aliphatic ether, having an ether bond as a functional group. In this case, the dielectric constant of these solvents was between 3 and 6. A mixture solvent of methanol and di-isopropyl ether was suitable as a solvent to expand the Δn of r-GRIN lens.

肝細胞癌(以下HCC)に対する前区域切除術13年後に根治切除した食道癌の稀な異時性重複癌を報告する.症例は71歳,男性.1987年, HCCに対し肝右葉前区域切除を施行した.術後13年間順調に経過したが, 2000年7月上旬より嚥下困難が出現し,胸部中部食道左側に4cm, 2型の中分化型扁平上皮癌を認めた.術前血液検査で肝機能の軽度低下を認め, CEAが7.5ng/ml, HCV(+)であった. 2000年8月30日,慢性C型肝炎を合併していたため,開腹先行にて開胸開腹食道亜全摘術,胸部,腹部の2領域D2リンパ節郭清と後縦隔経路全胃管再建を行った.病理診断は中分化型扁平上皮癌, pStage IVa,総合的根治度pBで,術後経過は良好である. HCCとの重複癌においてはHCCが予後規定因子となることが多いが, HCCが根治であれば第2癌に対しては,肝機能が許される範囲であれば重複癌に対して根治的な手術をすべきと考える.