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Background: Tumor vascular micro-environment has an important role in tumor progression and metastasis. The objective of this study was to assess the significance of metastatic hepatic tumor vascular micro-environment in relation to the response to the systemic 5-FU-based chemotherapy (FOLFOX or FOLFIRI).Methods: A total of 48 consecutive colorectal cancer (CRC) patients with hepatic metastasis were retrospectively reviewed, and factors, such as metastatic tumor vascular micro-environment, chemotherapy response, and hepatic resection, were analyzed. Tumor angiogenesis was microscopically evaluated by microvessel density (MVD) in sections stained immunochemically with CD34 in patients with hepatic resection. The angiogenesis in tumor micro-environment in association with ring enhancement (RE) on computed tomography (CT) was also examined.Results: Microscopic examination revealed that peripheral RE on CT of the metastatic tumor is associated with tumor angiogenesis by MVD. The overall response rate after 6 courses of first-line chemotherapy for the liver metastasis with RE on CT was 64% (23/36), whereas the response rate without RE was 25% (3/12), which was significantly different, although the survival rate of patients with RE-positive or without RE-negative tumors was not different.Conclusion: The peripheral RE on CT of the metastatic hepatic tumor was associated with the angiogenesis in tumor micro-environment and higher chemotherapy response.

Aim The purpose of this study was to evaluate the clinical impact of histological heterogeneity in patients with node-positive colorectal cancer (CRC). Patients and methods One hundred and twenty-nine patients who underwent curative surgical resection for histological node-positive CRC were enrolled. Patients were divided according to the histological heterogeneity in the primary lesion into p-hetero and p-homo groups. The p-hetero group was further divided according to histological heterogeneity in the metastatic lymph nodes into n-hetero and n-homo groups. Results There were no significant differences between p-homo and p-hetero groups and between n-homo and n-hetero groups in prognosis. However, the recurrence-free survival rate of the n-homo group was significantly lower than that of the n-hetero group in the N2 category. Conclusion Histological heterogeneity in metastatic lymph nodes may be useful for predicting prognosis, and prognosis in those with histological heterogeneity in a metastatic lymph node is not necessarily poor, even in those of the N2 category.

No clear policy has been established in Japan for proper lymph node dissection for rectal cancer. In our department, we examined the frequency of lateral lymph node metastasis, its treatment outcomes, and whether lateral dissection can narrow down necessary cases. In 10 years from 2003 to 2013, 98 cases of lower rectal cancer surgically treated in our department were examined. The clinicopathological factors in these cases were examined, and the risk factors were examined based on their correlation with the presence or absence of lateral lymph node metastasis. Based on the postoperative prognostic analysis, the dissection effect index(metastasis positive rate×5-year survival rate in cases with positive metastases)was also examined. Forty-three lateral lymph node dissections were performed. Cases involving a circumferential resection margin (CRM)of 1mm or less had significantly more lateral lymph node metastases. In the prognostic analysis, the 5-year survival rate of lateral lymph node metastasis-positive cases was 19%, and the dissection effect index was 3.5. It was suggested that CRM-positive patients had a higher risk of lateral lymph node metastasis before surgery. However, considering the results of this study and the results of JCOG0212, the presence or absence of lateral lymph node metastasis may be a prognostic predictor, although the prognostic improvement effect by dissection is considered to be limited.

Background and purpose Approximately 20% of all patients with colorectal cancer (CRC) are diagnosed at more advanced stages with synchronous distant metastasis, and the prognosis in these patients is usually poor. The aim of this study was to determine the factors that can identify subgroup(s) of patients with stage IV CRC who could benefit from curative (R0) resection of both primary and metastatic lesions. Patients and methods A total of 126 patients with stage IV CRC who underwent surgical resection of primary tumor were retrospectively analyzed. Among these patients, 26 cases of R0 resection were further examined subsequently. Information on various clinicopathological factors of the patients were obtained from hospital records. Overall survival was estimated using the Kaplan-Meier method, and log-rank tests were used to compare survival distribution. All the factors with P

[Background]The treatment of colorectal cancer (CRC) with metastasis is now widely accepted to be systemic chemotherapy of 5-FU base chemotherapy (FOLFOX or FOLFILI) in combination with molecular antibody. The objective of this study was to determine the significance of tumor angiogenesis in metastatic hepatic tumors in relation to the response of systemic chemotherapy. [Methods]A total of 48 consecutive CRC patients with hepatic metastasis who had been treated with or without hepatic resection were retrospectively reviewed, and factors, such as metastatic tumor angiogenesis and chemotherapy response, were analyzed. Tumor angiogenesis in association with ring-enhancement (RE) on computed tomography (CT) was also microscopically evaluated by microvessel counting (MVD) in sections stained immunochemically with CD34. [Results]The overall response rate after 6 courses of first-line chemotherapy for the liver metastasis with RE on CT was 64% (23/36), whereas the response rate without RE was 25% (3/12), which was significantly different. The survival rate of patients with or without liver resection of all RE-positive tumors was not different, but the survival rate of patients with liver resection was longer than that of patients without liver resection for all RE-negative tumors. Microscopic examination revealed that peripheral RE on CT of the metastatic tumor was associated with tumor angiogenesis by MVD. [Conclusions]The peripheral RE on CT of the metastatic hepatic tumor was associated with tumor angiogenesis and may predict chemotherapy response. A combination of liver resection with chemotherapy improves the survival of patients who have multiple hepatic metastasis. Citation Format: Hirotaka Okamoto, Shugo Shiba, Hiroshi Iino, Makoto Sudoh, Hiroyuki Wakana, Suguru Maruyama, Kenji Kawashima, Toshio Fukasawa, Daisuke Ichikawa, Hideki Fujii. Correlation of tumor angiogenesis with peripheral ring-enhancement on CT: Its predictive value of chemotherapy responses of colorectal metastatic hepatic tumor [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1224.

e14505 Background: The treatment of colorectal cancer (CRC) with metastasis is now widely accepted to be systemic chemotherapy of 5-FU base chemotherapy (FOLFOX or FOLFILI) in combination with molecular antibody. The objective of this study was to determine the significance of tumor angiogenesis in metastatic hepatic tumors in relation to the response of systemic chemotherapy. Methods: A total of 48 consecutive CRC patients with hepatic metastasis who had been treated with or without hepatic resection were retrospectively reviewed, and factors, such as metastatic tumor angiogenesis and chemotherapy response, were analyzed. Tumor angiogenesis in association with ring-enhancement (RE) on computed tomography (CT) was also microscopically evaluated by microvessel counting (MVD) in sections stained immunochemically with CD34. Results: The overall response rate after 6 courses of first-line chemotherapy for the liver metastasis with RE on CT was 64% (23/36), whereas the response rate without RE was 25% (3/12), which was significantly different. The survival rate of patients with or without liver resection of all RE-positive tumors was not different, but the survival rate of patients with liver resection was longer than that of patients without liver resection for all RE-negative tumors. Microscopic examination revealed that peripheral RE on CT of the metastatic tumor was associated with tumor angiogenesis by MVD. Conclusions: The peripheral RE on CT of the metastatic hepatic tumor was associated with tumor angiogenesis and may predict chemotherapy response. A combination of liver resection with chemotherapy improves the survival of patients who have multiple hepatic metastasis.

Fertilizing livestock waste for forage rice production can remove nitrogen and reduce the need for chemical fertilizers. Furthermore, rice straw can be used for biogas production. Here, the growth characteristics of different forage rice varieties in Japanese paddy fields fertilized with liquid cattle waste were investigated. Six experimental plots were established in a paddy field planted with three varieties of forage rice developed for livestock feed. Methane production potential assays were then conducted to investigate the anaerobic digestion characteristics of the stems and leaves of these three varieties. The total methane production potential of the Leafstar variety was higher than that of other varieties, while its lag phase was significantly shorter. Co-digestion of ethanol fermentation residue with Leafstar straw revealed that the NH4+-N concentration decreased as the C/N ratio increased. Additionally, the methane production potential of the mixed substrate was higher than that of ethanol fermentation residue or forage rice straw applied alone. Hence, Leafstar forage rice is a promising variety for establishment of agricultural resource recycling systems in which higher straw biomass can be achieved by applying liquid cattle waste and more biogas can be produced due to the potential for increased methane production.

Chromatin remodeling through histone modification is an important mechanism of epigenetic gene dysregulation in human cancers. However, little is known about global alteration of histone status during tumorigenesis and cancer progression. Histone H3 status was examined in benign and malignant colorectal tumors by immunohistochemistry and Western blotting. For immunohistochemical evaluation, 4 anti-histone H3 antibodies, specific to dimethylation at lysine 4 (H3K4me2), acetylation at lysine 9 (H3K9ac), dimethylation at lysine 9 (H3K9me2), and trimethylation at lysine 27 (H3K27me3), were used. On immunohistochemistry, H3K4me2, H3K9ac, and H3K27me3 showed no significant changes between normal and colorectal tumors. On the other hand, the global level of H3K9me2 was distinctly higher in neoplastic cells (adenoma and adenocarcinoma) than in normal glandular cells. In addition, it was significantly higher in adenocarcinoma than in adenoma. Correspondingly, Western blotting confirmed that H3K9me2 expression was significantly higher in adenocarcinomas than in normal colorectal mucosa. No alteration of H3K9me2 was observed with tumor differentiation and with the histological subtypes of colorectal cancers. These results suggest that aberration of the global H3K9me2 level is an important epigenetic event in colorectal tumorigenesis and carcinogenesis involved with gene regulation in neoplastic cells through chromatin remodeling.

Purpose To compare the diagnostic accuracy of contrast-enhanced computed tomography (CE-CT), contrast-enhanced ultrasonography (CE-US), superparamagnetic iron oxide-enhanced magnetic resonance imaging (SPIO-MRI), and gadoxetic acid-enhanced MRI (Gd-EOB-MRI) in the evaluation of colorectal hepatic metastases. Materials and methods In all, 111 patients with colorectal cancers were enrolled in this study. Of the 112 metastases identified in 46 patients, 31 in 18 patients were confirmed histologically and the remaining 81 in 28 patients were confirmed by follow-up imaging. CE-CT, CE-US, SPIO-MRI, and Gd-EOB-MRI were evaluated. Mean (of three readers, except for CE-US) area under the receiver operating characteristic curve (A(z) ), sensitivities, and positive predictive values (PPV) were calculated. Each value was compared to the others by variance z-test or chi-square test with Bonferroni correction. Results For all lesions, mean A(z) and sensitivity of Gd-EOB-MRI (0.992, 95% [56/59]) were significantly greater than those of CE-CT (0.847, 63% [71/112]) and CE-US (0.844, 73% [77/106]). For lesions ≤1 cm, mean A(z) and sensitivity of Gd-EOB-MRI (0.999, 92% [22/24]) were significantly greater than those of CE-CT (0.685, 26% [13/50]) and CE-US (0.7, 41% [18/44]). Mean A(z) (95% CI) of SPIO-MRI for all lesions (0.966 [0.929-0.987]) and lesions ≤ 1 cm (0.961 [0.911-0.988]) were significantly greater than those of CE-CT and CE-US. Mean sensitivity of SPIO-MRI for lesions ≤1 cm (63%, 26/41) was significantly greater than that of CE-CT. Conclusion Gd-EOB-MRI and SPIO-MRI were more accurate than CE-CT and CE-US for evaluation of liver metastasis in patients with colorectal carcinoma.

Three varieties of forage rice (Oryza sativa L. cv. Hamasari, Kusahonami, and Leafstar) were transplanted in plots established in a paddy field. Each of these varieties of rice was then subjected either to basal treatment alone (control plots), or to basal treatment plus subsequent treatment with liquid cattle waste (treatment plots). The nitrogen transformations differed significantly between the control plots and the treatment plots. The nitrogen uptake of the plants in the treatment plots was significantly higher than that in the control plants, even though no significant increase was observed in biomass production. A mass-transfer model calculation revealed that ammonia volatilization also increased following slurry application because of the high ammonium concentration and pH of the flood water. However, the total percentages of nitrogen loss through nitrous oxide, ammonia emission, and leaching loss in the treatment plots were only approximately 7–8%, which was significantly lower than the portion assimilated by the rice plant. Moreover, denitrification was considered to be a major pathway for nitrogen removal in the treatment plots; this probably accounted for most of the “Unknown” portion in the nitrogen balance.

Purpose To compare the diagnostic accuracy of contrast-enhanced ultrasonography (CE-US), contrast-enhanced CT (CE-CT), and superparamagnetic iron oxide-enhanced MRI (SPIO-MRI) with diffusion-weighted imaging (DWI) in the evaluation of colorectal hepatic metastases. Materials and Methods Thirty-six patients with colorectal cancers were prospectively enrolled and retrospectively evaluated. Of the 86 metastases identified, 16 were confirmed histologically and the remaining 70 were confirmed by follow-up imaging. CE-CT and SPIO-MRI + DWI were independently evaluated by two readers, whereas CE-US was evaluated by consensus reading of two different readers. Area under receiver operating characteristic curve (Az), sensitivities, and positive predictive values (PPVs) were calculated and compared. Results For both readers, SPIO-MRI+DWI had significantly greater Az (0.879 and 0.904) and sensitivity (78% and 87%) for all lesions compared with CE-CT (0.779 and 0.793; 59% and 59%) and CE-US (0.811; 69%), and significantly greater Az (0.783 and 0.837) and sensitivity (56% and 73%) for lesions ≤1 cm compared with CE-CT (0.562 and 0.601; 20% and 22%) and CE-US (0.66; 37%). For lesions >1 cm, there was no significant difference in Az, sensitivity and PPV between all the image sets. Conclusion SPIO-MRI with DWI was the most reliable modality for evaluation of liver metastases particularly for lesions ≤1 cm. J. Magn. Reson. Imaging 2010;32:1132–1140. © 2010 Wiley-Liss, Inc.

症例は59歳，男性．2003年2月，下部直腸癌に対して，術前化学放射線療法を施行した後，同年3月に低位前方切除術を施行した（pStageIIIa）．術後吻合部縫合不全を生じ，人工肛門造設術を施行した．ドレーン抜去部が糞瘻となっていたが自然閉鎖した．縫合不全が画像上認められないことを確認して，2004年5月，人工肛門を閉鎖したところ，2005年4月，左下腹部のドレーン抜去部に直腸皮膚瘻が再燃した．経皮的なフィブリノーゲン注入では閉鎖しないため，経下部消化管内視鏡的にERCP用の造影カテーテルを瘻孔内へ約5cm挿入し，シアノアクリレートを注入した．瘻孔は閉鎖し，3年10カ月後の現在再燃を認めない．特に放射線治療後は，消化管術後縫合不全により生じる瘻孔が難治性となり，治療に難渋することがあるが，本症例では経内視鏡的シアノアクリレート注入が有効と考えられた．

Dye-sensitized solar cells were fabricated using natural dyes and synthesized dyes in which rear metal was not contained. Effects of pH of dyes on the characteristics of the dye-sensitized solar cells were also examined. As a result, it was found that the conversion efficiency of the dye-sensitized solar cell fabricated using red-cabbage dye with a pH of 2.5 was 0.10 point larger than that of the solar cell fabricated using red-cabbage dye with a pH of 4.0. It was also found that the conversion efficiency of the solar cell fabricated using red-perilla dye with a pH of 3.1 was 0.10 point larger than that of the solar cell fabricated using red-perilla dye with a pH of 5.8. The results are discussed on the bases of the molecular structure of mainly contained dye and the optical absorption spectra.

Dye-sensitized solar cells are expected to be used for future clean energy. Recently, most of the researchers in this field use Ruthenium complex as dye in the dye-sensitized solar cells. However, Ruthenium is a rare metal, so the cost of the Ruthenium complex is very high. In this paper, various dye-sensitized solar cells have been fabricated using natural dye, such as the dye of red-cabbage, curcumin, and red-perilla. As a result, it was found that the conversion efficiency of the solar cell fabricated using the mixture of red-cabbage and curcumin was about 0.6% (light source: halogen lamp), which was larger than that of the solar cells using one kind of dye. It was also found that the conversion efficiency was about 1.0% for the solar cell with the oxide semiconductor film fabricated using polyethylene glycol (PEG) whose molecular weight was 2,000,000 and red-cabbage dye. This indicates that the cost performance (defined by [conversion efficiency]/[cost of dye]) of the latter solar cell (dye: red-cabbage) is larger by more than 50 times than that of the solar cell using Ruthenium complex, even if the effect of the difference between the halogen lamp and the standard light source is taken into account.

目的: 自動縫合器を用いた機能的端端吻合の普及にともない，吻合部再発の報告が増加している．吻合部再発の原因の1つと考えられる腸管内遊離癌細胞の存在について検討した．対象と方法: 2005年11月から2007年8月までに当科で開腹手術を施行した大腸癌67例を対象とした．病変部腸管を摘出後，口側，肛門側腸管内をpovidone-iodine綿球を用いて3回清拭し，その前後で吻合部腸管粘膜面の擦過細胞診を施行した．さらに，2006年10月以降は，癌細胞の術中腸管内散布を防止する目的で開腹直後に癌部の口側，肛門側の腸管を結紮した．細胞診でclass IV, Vとされたものを癌細胞陽性とした．結果: 腸管粘膜面の癌細胞の検出率は，清拭前には口側断端12.5%，肛門側断端21.2%であった．一方，清拭後には，全例がclass Iで癌細胞陰性であった．癌細胞の検出率は，腸管結紮の有無，癌の占居部位，深達度，肉眼型，腸管切除断端までの距離では有意差を認めなかったが，肛門側腸管では，腫瘍径が50mm以上あるいは腫瘍の環周率が80%以上の群で有意に癌細胞が検出される頻度が高かった．術前腸管処置の有無でみると，肛門側では前処置としてニフレック®を服用しなかった群で癌細胞の検出率が高い傾向がみられた．考察: 大腸癌切除時の吻合部再発の原因の1つと考えられる腸管内遊離癌細胞が存在することが明らかとなった．遊離癌細胞が断端腸管粘膜面の清拭により除去された．大腸癌切除時の腸管内腔の清拭は吻合部再発の予防に極めて有用である．

虫垂切除後の遺残虫垂より発生したと考えられた粘液嚢胞腺癌の1例を経験したので報告する．症例は76歳，男性．30年前に虫垂切除術の既往あり．右下腹部痛が出現し，虫垂切除を行った際の手術創から膿性の浸出がみられるようになった．腹部CT検査上，盲腸付近で腹壁の瘻孔に連続する内部不均一な腫瘤性病変が認められ，難治性の腸管皮膚瘻，腹腔内膿瘍と診断し，手術を施行した．開腹所見では回盲部に約6cmの腫瘤が存在し，その近傍の腹膜には小結節性病変を認め，手術は回盲部付近の腫瘤を含め回盲部切除と腹膜結節性病変の切除を行った．病理組織学的に，腫瘍細胞は粘液産生に富み，遺残虫垂の末端部に相当すると思われる正常粘膜と連続しており，遺残虫垂から発生した粘液嚢胞腺癌と診断した．

OBJECTIVE. The objective of our study was to evaluate the usefulness of high-b value diffusion-weighted MRI (DWI) in the detection of pancreatic adenocarcinoma.SUBJECTS AND METHODS. Twenty-six patients with pancreatic adenocarcinoma were included in the study. Twenty-three other patients who were being followed up due to pancreatic diseases other than adenocarcinoma were included as control subjects. All patients and subjects underwent DWI, and the images were evaluated by three blinded radiologists.RESULTS. Receiver operating characteristic (ROC) curve analysis yielded Az values (i.e., area under the ROC curve) of 0.998, 0.998, and 0.995 for the three radiologists. The mean sensitivity and specificity for the detection of pancreatic adenocarcinoma were 96.2% and 98.6%, respectively. The kappa values indicating interobserver agreement between different pairs of radiologists were in the category of excellent.CONCLUSION. High-b value DWI allows the detection of pancreatic adenocarcinoma with a high sensitiv...

OBJECTIVE. The purpose of this article is to evaluate the usefulness of high-b-value diffusion-weighted MRI (DW-MRI) in the detection of colorectal adenocarcinoma.CONCLUSION. High-b-value DW-MRI allows detection of colorectal adenocarcinoma with a high sensitivity and specificity.

動注化学療法は一般的となり成績も良好となっているが,致死率の高い合併症もみられる.今回われわれは,動注用ポート感染に対して血行再建を先行した後にポートを摘除し救命できた1例を経験したので報告する.症例は60歳,男性,直腸癌術後肝転移に対して右総大腿動脈より肝動脈にカテーテルを挿入,ポートを右鼠径部に留置した.最近1年間は使用していなかったが,発熱および右鼠径部の発赤・疼痛などを認めるようになったため当科に紹介となった.ポート感染の診断で緊急手術を行った.左大伏在静脈を用いて感染巣を避けるルートで右外腸骨一浅大腿動脈バイパスを行い,創を閉鎖してから感染ポートを摘除した.総大腿動脈は2重結紮の後に切離し,さらに右外腸骨動脈をバイパスの中枢側吻合部末梢で結紮した.その後肝・脾膿瘍,肝動脈瘤を合併したが,保存的治療にて改善し術後40病日に退院となった.

症例は57歳の男性. 6年前,盲腸とS状結腸の多発癌に,胃癌を併存した重複癌に対して,結腸右半切除術, S状結腸部分切除術,胃全摘術を施行した.術後のfollow upの大腸内視鏡検査で,直腸S状部に直径20mm大の病変を指摘された.色素撒布にて,腫瘍の中央部は局面を有さない陥凹のV型pit pattern,辺縁部は花弁状のIIIL型pit patternであった.大腸側方発育型腫瘍の非顆粒型病変,深達度SM以深の浸潤癌と診断し,直腸高位前方切除術(D2)を施行した.病理組織学的には,深達度mの高分化腺癌で,腫瘍の辺縁部に,中～高度異型を伴った腺管絨毛腺腫の併存を認めた.癌抑制遺伝子p53蛋白は,癌部,腺腫部共に過剰発現を示した. Microsatellite instabilityの解析では,初回手術で切除した3臓器を含めmicrosatellite stabilityであった.

症例は80歳,男性.便潜血反応陽性を指摘され来院.注腸造影検査,大腸内視鏡検査にてS状結腸に大きさ20mm大の有茎性ポリープが認められた.同病変からの生検ではGroup 1であった.非腫瘍性ポリープの診断でポリペクトミーを施行した.病理組織診断は若年性ポリープであった.いわゆる孤立性の若年性ポリープは各年齢層でも認められるとされているが,特に2峰性の年齢分布を示す.しかし70歳以上の高齢者では比較的稀である.主にS状結腸から直腸にかけ,大きさ10-20mmの孤立性の(亜)有茎性ポリープが認められた場合,腺腫や癌腫の他に,高齢者であっても若年性ポリープも鑑別診断の一つとして,改めて念頭に入れて置く必要があると考えられたので報告した.

無脾症は種々の他臓器の合併奇形を伴う先天奇形である.著者らは17歳の男性で,十二指腸潰瘍穿孔時に発見された,稀な無脾単独症例を経験したので報告する.平成12年2月8日発熱,咽頭痛を主訴に近医を受診し,急性上気道炎と診断された.抗生剤と解熱剤の坐剤ジクロフェナクナトリウムの投与を受けた.坐剤使用数時間後から心窩部痛,嘔気が出現し2月10日当院を受診した.体温は38.7度,白血球数は18630/μ1, CRP値は28.7mg/dlであった.右上腹部に著明な圧痛と筋性防御を認めた.腹部レントゲン検査・CT検査で上部消化管穿孔,無脾症と診断し同日緊急開腹を行った.十二指腸球部前壁に径5mmの穿孔を認め,穿孔部単純閉鎖術を施行した.脾臓は認めず,腹腔内に合併奇形は認めなかった.術後施行した心エコー検査で異常は指摘されず,脾シンチグラフィ検査で副脾も含めて脾臓への集積は認めなかった.術後経過は良好で第23病日に退院した.

われわれは極めて稀な虫垂原発の印環細胞癌の1例を経験したので報告する. 32歳の女性が右下腹部痛を主訴に来院した.体温は36.5度,右下腹部に圧痛を伴う腫瘤を触知した.白血球数11000/μl, CRP値1.1mg/dlと軽度の炎症反応を認め,腫瘍マーカーは血清CEA11ng/ml,血清CA19-9 2400U/mlと高値であった.腹部超音波・CT検査では,回盲部領域に径5×3cmの境界不明瞭で内部不均一な腫瘤を認め,大腸内視鏡検査では, Bauhin弁から肛門側5cmにわたり粘膜下腫瘍様の隆起性病変を認めた.回盲部悪性腫瘍を疑い結腸右半切除術を施行した.病理組織学的には, signet ring cell carcinoma of the vermiform processus, ss, ly2, v0, n0, ow (-), aw (-), ew (-)と診断された.術後,化学療法を施行したが, 16カ月目に死亡した.

工学部学生に対し社会の中での技術者の役割を理解させる「社会と技術者」という授業を開発し.11学期で約2000名に実施したので報告する.この授業の目的は.学生にこれからの社会が要求する技術者の職能.倫理と大学での人間形成の重要性を説明し.大学で学ぶ心構えを自ら考え理解させようとするものである.講義を行うだけでは学生自身に考えさせることが難しいことから.学生にレポート課題を与え.最近の社会の変化を自ら勉強させ自分の人生を考えさせ思考力.表現力を付けさせることに主眼をおいた.最近の社会の動きから技術者の仕事の中味や倫理まで広汎な問題を扱う多忙な授業であるが学生めアンケートでは良好な結果を得ている.

症例は58歳の女性.健診で便潜血反応陽性を指摘された.大腸内視鏡検査で,S状結腸に15×10×8mmの表面発赤調の有茎性ポリープが認められた.鉗子生検材料で腺管絨毛腺腫と診断されたため,内視鏡的ポリペクトミーを勧めたが,患者の家庭の事情により経過観察となった.9か月後には病変は亜有茎性の腫瘤へ,その3か月後には無茎性の隆起性病変へと変化し,SM'癌の診断にて腹腔鏡補助下にS状結腸切除術を施行した.病理組織学的には,腫瘍の一部に腺腫成分を認める中分化腺癌で,深達度はmpであった.大腸腫瘍の自然史を考えるうえで,prospectiveに腫瘍の形態変化を観察できた貴重な症例であり,その経過を報告する.

大腸腺腫の発生と背景粘膜の関係を解析する目的で, 進行大腸癌症例の非癌部に発生した大腸腫瘍 (併存例) 32症例57病変と, 進行大腸癌を伴わない大腸腫瘍 (非併存例) 35症例49病変を用い, 両者における大腸腫瘍の細胞増殖能とp53蛋白の発現の程度を比較し, 進行大腸癌の併存が他の大腸腫瘍に及ぼす影響を検討した.検体は組織学的異型度により5段階に分類した.両群ともPCNAL.I.は細胞の異型度が増すにつれ上昇し, p53蛋白の染色性も細胞異型度の上昇と共に高くなった.併存例のPCNAL.I.は非併存例に比べてGrade II・III・IVにおいて有意に高値 (p

再発を繰り返し3回の切除によって5年以上生存している胆管細胞癌症例を経験したので報告する. 62歳の男性, 検診で発見された肝外側区域の5.5cmの腫瘍に対し肝左葉切除を施行, 3年9か月後肝切離端の再発腫瘍を摘出した. さらにその5か月後直腸に浸潤した3個の腹膜播種結節をHartmannの手術により摘出した. 1年4か月経過した現在, 再発の徴候なく生存中である. 3回の摘出標本はいずれも病理組織学的に中分化型腺癌で胞体内にMallory小体様の構造を認め, CA19-9免疫組織染色陽性であり, 新たな発癌ではなく初回病巣の転移再発と診断した. 残肝再発に加え腹膜播種結節を切除しえて, 長期生存している報告例は見当たらず, 特異な経過の胆管細胞癌と考えられた.

Background. The molecular genetic changes associated with colorectal carcinoma are among the best understood of any common human cancer. The genetic changes during the late stages of colorectal carcinomas may be useful in clinical management for determining the metastatic potential of the carcinoma. Methods.Tumor tissues were evaluated by restriction fragment length polymorphism (RFLP) analysis of chromosomes 5q, 17p, 18q, and 22q (n = 98), by reverse transcription-polymerase chain reaction (RT-PCR) analysis of messenger RNA expression of the DCC gene (deleted in colorectal carcinoma) (n = 27) and by immunohistochemical analysis of p53 protein expression (n = 44). Results. Loss of heterozygosity (LOH) on chromosomes 17p, 18q, and 22q, but not on 5q, was much more frequently detected in advanced carcinomas than in intramucosal carcinomas (P < 0.01). 17p LOH was significantly correlated with vascular invasion (P < 0.001), whereas 18q LOH was correlated with lymphatic invasion and hepatic metastasis (P < 0.01), and 22q LOH was correlated with lymph node metastasis (P < 0.05). LOH on 5q did not show a significant correlation with any factors of tumor invasion or metastasis. DCC expression was not observed in any of five hepatic metastasis or in five of seven advanced carcinomas that were accompanied by hepatic metastasis (10 of 12). However, a similar lack of expression was observed in only 5 of 15 carcinomas without hepatic metastasis (P < 0.05). p53 Expression was found to vary in both primary and metastatic carcinomas by immunohistochemistry. Conclusions. The clinical application of molecular genetics (i.e., RFLP analysis of chromosome 17p, 18q, and 22q and RT-PCR analysis of DCC expression into messenger RNA) can be used to determine the metastatic potential of colorectal carcinomas. Cancer 1994; 73:1324–31.

症例は45歳の男性.慢性膵炎,胃十二指腸潰瘍の診断で近医にて投薬治療を受けていたが,大量の吐血で当科に入院,出血性十二指腸潰瘍の診断で緊急下に幽門側胃切除術を施行した.退院後,再び心窩部痛が出現し,慢性膵炎,膵仮性嚢胞の診断で再入院となった.血液検査では汎血球減少が認められた.腹部CTにて膵仮性嚢胞,脾腫が認められ,腹部血管造影では脾動脈に動脈瘤と脾静脈の狭窄,さらに著明な側副血行路の形成が認められた.膵体尾部切除,脾合併切除術を施行した.切除標本では膵尾部に主膵管と交通する仮性嚢胞が認められ,これに脾動脈が穿破していた.脾静脈も周囲の線維化により狭窄していた.以上より,出血の原因はHemosuccus pancreaticusと考えられ,さらに局所性門脈圧亢進症も併存しており,きわめてまれな症例と思われるので文献的考察を加え報告する.

症例は57歳の男性,1981年10月,上行結腸癌で右側結腸切除術を施行した.病理組織学的には高分化型腺癌で,大腸癌取扱い規約に従うと,占拠部位はAでs,n(―),P0,H0,M(―), stage II,絶対的治癒切除であった.以後外来でfollow upしていたが,1984年6月頃より血清carcinoembryonic antigen(CEA)値の上昇を認めた。腹部CTで右副腎にlow density massを認め副腎転移と診断した.他に転移巣を認めず,1985年1月21日,腫瘤を摘出した,摘出標本は6×4×3cmで重量66g,割面は黄白色分葉状で一部に正常の副腎組織が残存していた.病理組織学的には高分化乳頭状管状腺癌で上行結腸癌からの転移と考えられた.その後,血清CEA値は正常化し,副腎摘出より9年経た現在,画像的に再発の所見なく,血清CEA値の上昇も認めず,患者は健在で社会復帰している.大腸癌の孤立性副腎転移巣の切除例はきわめてまれであり,本例のごとき長期生存例は文献上みあたらない.

患者は54歳,女性.主訴は下血.ツベルクリン反応は硬結・水疱を伴う強陽性を示したが,喀痰と便の抗酸菌検査では結核菌は陰性であった.一方注腸検査および大腸内視鏡検査では,上行結腸から下行結腸までのhaustraの消失および盲腸の同定不能,Bauhin弁の開大を認めた.さらに上行結腸と横行結腸は短縮し,上行結腸に潰瘍瘢痕と偽憩室,下行結腸に潰瘍瘢痕を認めた.また結腸の肝彎曲部に潰瘍性病変を認め,生検では高分化腺癌,それ以外の大腸壁瘢痕部からは非特異性炎症所見を得た.以上の所見より陳旧性腸結核に大腸癌が併存した症例と診断し,拡大右半結腸切除術を施行した.組織所見でも術前診断のとおり高分化腺癌と非特異性炎症所見を認めた.現在,術後3年を経過しているが再発転移は認めていない.

Purpose: To compare the accuracy of dynamic contrast-enhanced multidetector-row computed tomography (CT) and superparamagnetic iron oxide-enhanced magnetic resonance imaging (MRI) in the evaluation of small hepatic metastases of colorectal carcinoma. Materials and Methods: Of 94 patients with colorectal carcinoma analyzed, 76 hepatic metastases (

Overexpression of HER-2 and the epidermal growth factor receptor (EGFR) has been observed in many cancers, sometimes accompanied by gene amplification. To assess whether novel chemotherapies targeting these overexpressed proteins may be effective for the treatment of colorectal cancers, we examined the exact frequency of HER-2 and EGFR overexpression, the relationship between gene amplification and protein expression, and the heterogeneity of gene amplification within and between primary and metastatic tumors. We evaluated 244 colorectal cancers immunohistochemically. All tumors found to overexpress HER-2 or EGFR were further analyzed for gene amplification by fluorescent in situ DNA hybridization. Overexpression of HER-2 and EGFR was found in 8 (3%) and 19 (8%) of the 244 colorectal carcinomas, respectively. Gene amplification was observed in 100 and 58% of the tumors exhibiting HER-2 and EGFR overexpression, respectively. HER-2 amplification in cancer cells was characterized by clusters of hybridization signals, suggesting amplicons in homogeneously staining regions that were predominant in most primary and metastatic tumors. EGFR amplification, observed as scattered signals reminiscent of amplicons in double minute chromosomes, or coamplification of EGFR with the centromeric regions was observed as a minor population within primary tumors, and found in variety of populations in metastatic tumors. Overexpression of HER-2 and EGFR were observed in only a small fraction of colorectal carcinomas, but were frequently accompanied by gene amplification.

Arteriovenous malformation (AVM) of the stomach is extremely rare. We report a patient with asymptomatic gastric AVM detected during mass screening of the upper gastrointestinal tract. The patient, a 69-year-old female, had no history of gastrointestinal bleeding. Endoscopy revealed a gastric submucosal tumor (3 cm in diameter) at the posterior wall below the esophago-cardiac junction. Endoscopic ultrasonography (EUS) showed a hypoechoic structure in the third layer of the stomach, suggesting gastric AVM in the submucosal layer. Complete resection of the AVM tissue was performed by strip biopsy with surgical resection. Histological examination showed AVM in the submucosal layer. EUS examination was useful for the diagnosis of gastric AVM in this case.

11道府県試験場所有および近在農家のホルスタイン種初産牛の乳量記録のうち1963年から1977年に至る699頭の成績を用い,泌乳曲線実験式を簡便化した記録にあてはめ305日間乳量を推定し,その正確度を検討した.その結果,7ヵ月までの毎日記録に基づく305日間推定乳量では,遺伝率0.46,305日間乳量との表型,遺伝相関はそれぞれ0.96,0.99と推定され,この期間までの泌乳能力検定の短期化の可能性が示唆された.検定の短期化簡易化を組み合せた場合,1,2および3週間隔記録では,8ヵ月までの記録に基づく305日間推定乳量で遺伝率0.41～0.44,305日間乳量との表型,遺伝相関はそれぞれ0.97～0.98,0.97～1.00,4週間隔記録では9ヵ月までの記録に基づく305日間推定乳量で遺伝率0.39,305日間乳量との表型,遺伝相関はそれぞれ0.99,1.00と推定され,これらの期間までの簡易•短期化の可能性が示唆された.短期化および簡易化の記録に泌乳曲線実験式をあてはめた場合,この曲線を形成するパラメータの遺伝率推定値は,最高乳量を除いて不安定であった.また,305日間毎日記録より求められたパラメータとの相関は,乳量推定の場合と比べて若干低かった.