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Background The morphology of foot muscles that support the medial longitudinal arch differs between normal and pronated feet. The degree to which the difference depends on the severity of the pronated foot deformity is unclear. In the clinical setting, however, to reduce the pronated deformity, muscle-strengthening exercises are performed. Research question Does a relationship exist between foot muscle morphology and severity of the pronated foot deformity and foot kinematics during gait? Methods Using the six-item foot posture index (FPI-6), 26 study participants were assessed for their foot posture and divided into two groups of 13 participants each based on the FPI-6 score: pronated foot group (with a score of 6–9) and highly pronated foot group (with a score of 10–12). Select foot muscles were scanned with ultrasonography, and muscle thicknesses were measured. The following were the muscles of interest: abductor hallucis, flexor hallucis brevis and longus, flexor digitorum brevis and longus, and peroneus longus. Foot kinematic data during gait was collected using a three-dimensional motion capture system as a dynamic navicular drop. Results No between-group differences were noted for muscle thickness and dynamic navicular drop. However, the abductor hallucis and flexor hallucis brevis thicknesses were correlated with the dynamic navicular drop, but not with the severity of the pronated foot deformity. Significance In individuals with pronated foot deformity, more developed abductor hallucis and flexor hallucis brevis muscles may reduce the dynamic navicular drop that represents the degree of medial longitudinal arch deformation during the stance phase of gait.

Novice runners with pronated feet are at an increased risk of running-related injuries. However, not all runners with pronated feet have increased foot pronation during running. Moreover, although foot muscle morphology is related to static foot alignment, the relationship between foot muscle morphology and foot kinematics during running remains unclear. We aimed to determine foot kinematic patterns during running among novice runners with pronated feet and the presence of a relationship between these foot kinematic patterns and foot muscle morphology.Twenty-one novice runners with pronated feet participated in this study, and data on 39 lower limbs were collected. Data on foot kinematics during running (rearfoot strike) were collected using a three-dimensional motion capture system in terms of navicular height (NH) at initial contact and dynamic navicular drop (DND). A hierarchical cluster analysis method was used to identify the optimal number of clusters based on these two foot-related kinematic variables. Following identification of the clusters, differences in cluster variables and cross-sectional areas of selected foot muscles assessed using ultrasonography in each cluster were examined. The muscles of interest included the abductor hallucis, flexor hallucis brevis and longus, flexor digitorum brevis and longus, and peroneus longus.Three subgroups were identified based on foot kinematics during running: cluster 1, lowest NH at initial contact and larger DND; cluster 2, moderate NH at initial contact and smaller DND; and cluster 3, highest NH at initial contact and larger DND. Clusters 1 and 3 had a larger abductor hallucis compared with cluster 2, and cluster 3 had a larger flexor hallucis brevis compared with cluster 2.These subgroups may differ in terms of resistance to and type of running-related injury. Moreover, foot kinematics during running is possibly impacted by the morphology and function of medial intrinsic foot muscles.

Background Strengthening exercises of the plantar intrinsic foot muscles (PIFMs) are often prescribed to flat-footed subjects because of the capacity of the PIFMs to support the medial longitudinal arch (MLA). However, it is unclear whether the capacity of the PIFMs to support the MLA is enough to change the foot kinematics in flat-footed subjects. To confirm this, the current study examined changes in foot kinematics in flat-footed subjects during standing and gait accompanied by changes in the activity of the PIFMs. Methods Eighteen flat-footed subjects were randomly assigned to an electrical stimulation group (ESG) or a control group (CG). In the ESG, electrical stimulation to the PIFMs was applied during standing and gait to simulate reinforcement of the PIFMs. Then, foot kinematics were measured using 3D motion analysis, and the amount of change from baseline (when no electrical stimulation was applied) was compared between the groups. Results In the gait analysis, the time at which the MLA height reached its minimum value was significantly later in the ESG, with no reduction in the MLA height at that time. Moreover, forefoot inversion angle and tibial external rotation angle were significantly increased in the ESG at that time. In the standing analysis, there were no significant differences between the groups. Conclusion The results revealed that in flat-footed subjects, the PIFMs have the capacity to support the MLA enough to change foot kinematics during gait. Strengthening these muscles may be effective in preventing or treating lower extremity overuse injuries related to flat-foot alignment.

Toe flexor strength is important for preventing older adults from falling. Although intrinsic foot muscles are the main determinants of toe flexor strength, exercises for strengthening these muscles are difficult for older adults. This study therefore aimed to determine whether the use of electromyographic biofeedback helps older adults to perform intrinsic foot muscle strengthening exercises.This randomized controlled trial had two parallel arms. Participants were randomly allocated to the control group or the electromyographic biofeedback group. Control participants performed two progressive intrinsic foot muscle strengthening exercises twice a week for 6 weeks. Participants in the other group performed these exercises assisted by electromyographic biofeedback. Primary outcome measures were changes in toe flexor strength and the timed up-and-go and functional reach tests (the latter two being balance tests).Altogether, 23 older adults were randomized to the control group (n = 12) or the electromyographic biofeedback group (n = 11). After the 6-week intervention, toe flexor strength on the dominant side increased in both groups (P 0.017). However, toe flexor strength on the nondominant side increased only in the electromyographic biofeedback group (P 0.017), with a large effect size of 1.5. There were no changes in the two balance tests. Three of the control group and two of the electromyographic biofeedback group were lost to follow- up.Our results indicate that, the use of electromyographic biofeedback can enhance the effect of intrinsic foot muscle strengthening exercises on the nondominant side in older adults.UMIN000036521.

Background The plantar intrinsic foot muscles (PIFMs) contribute to support the medial longitudinal arch. But the functional role of the PIFMs during dynamic activities is not clear. The purpose of this study was to examine the change in the foot dynamics during gait accompanied with the change in the PIFMs activity to determine the functional role of the PIFMs during gait. Methods Twenty healthy male subjects were randomly assigned to the electrical stimulation group (ESG) or control group (CG). In the ESG, the electrical stimulation to the PIFMs was provided from mid-stance to pre-swing using surface electrodes to simulate reinforcement of the PIFMs. The foot dynamics during the stance phase of gait was measured using a 3D motion analysis, and the amount of change from baseline (electrical stimulation was not provided) was compared between groups using an independent sample t-test. Results In the ESG, the timing for the navicular height to reach the minimum value was significantly later, and the vertical ground reaction force (2nd peak) significantly decreased more. There were no group differences in the amount of change from baseline on gait velocity, stance phase duration, minimum navicular height and ground reaction force in other directions. Conclusion Results from this study showed that the functions of the PIFMs most likely include shock absorption and facilitation of efficient foot ground force transmission during the stance phase of gait.

[Purpose] There are no reliable evidences that the weakening of intrinsic foot muscles causes the decrease of the medial longitudinal arch (MLA) height. The purpose of this study was to confirm whether the fatigue of intrinsic foot muscles decrease the MLA height during standing and gait using 3D motion analysis system. [Subjects and Methods] Twenty healthy male subjects participated in this study. Foot kinematics was measured using an Oxford Foot Model before and after fatigue-inducing exercises of the abductor hallucis and flexor hallucis brevis muscles. [Results] Following fatigue-inducing exercise, in both standing and gait, the MLA height did not decrease but slightly increased. In addition, the reduction of a rear foot eversion angle was noted. [Conclusion] Fatigue of the abductor hallucis and flexor hallucis brevis muscles did not cause a change associated with collapsing of the MLA during both standing and gait. This suggested that the MLA support force from these muscles would be compensated by other MLA support structures, such as extrinsic foot muscles.

No reliable evidence has confirmed whether plantar intrinsic foot muscle strengthening exercises improve static and dynamic foot kinematics in individuals with pes planus.Does the short-foot exercise affect static foot alignment and foot kinematics during gait in individuals with pes planus?This was a randomized controlled single-blind trial involving 20 participants with pes planus who were randomly allocated to a short-foot exercise group (exercise) or a control group (controls). Exercise patients performed a progressive short-foot exercise three times per week for 8 weeks; controls received no intervention. Before and after the 8-week intervention, foot kinematics during gait, including dynamic navicular drop-the difference between navicular height at heel strike and the minimum value-and the time at which navicular height reached its minimum value were assessed, using three-dimensional motion analysis. We assessed static foot alignment by foot posture index and navicular drop test, and the thickness of the intrinsic and extrinsic foot muscles using ultrasound. All measurements were performed by one investigator (KO) blinded to the participants' allocation.After the 8-week intervention in the exercise group, foot posture index scores with regard to calcaneal inversion/eversion improved significantly (p 0.05). Moreover, the time required for navicular height to reach the minimum value decreased significantly (p 0.01).For individuals with pes planus, the short-foot exercise effectively corrected static foot alignment and temporal parameters of foot kinematics during gait. This temporal change, which shortens the time for navicular height to reach its minimum value, indicates an improved windlass mechanism. Therefore, short-foot exercise might effectively prevent or treat injuries related to the pes planus alignment.

Background The short foot (SF) exercise is a strengthening exercise for the intrinsic foot muscles that is difficult to master. Objective To examine the effect of three different electromyographic (EMG) biofeedback methods on learning the SF exercise. Methods Thirty-six healthy subjects were randomly allocated to the control group (CTG), EMG-controlled electrical stimulation group (ESG), visual EMG biofeedback group (VSG), and combination EMG-controlled electrical stimulation with visual EMG biofeedback group (CBG). The CTG practiced the SF exercise for 5 minutes using the conventional method. The other groups each used the EMG biofeedback method and the conventional method. The EMG activity of the abductor hallucis (ABH), the medial longitudinal arch (MLA) angle, and the foot length during the SF exercise were measured before and after 5 minutes of practice. Results The EMG activity of the ABH in the VSG and CBG was significantly higher than that before practice. There were no intergroup differences in MLA morphology. Conclusions These results suggest that visual EMG biofeedback is an effective method of increasing the EMG activity of the ABH during the SF exercise in a short practice time.

Images recorded over a long term using a stationary camera have the potential for revealing various facts regarding the recorded target. We have been developing an analyzing system with a heatmap-based interface designed for visual analytics of long-term images from a stationary camera. In our previous study, we experimented with participants who were recorded in the images (recorded participants). In this study, we conducted a further experiment with participants who are not recorded in the images (unrecorded participants) to reveal the discoveries that participants obtain. By comparing the results of participants with different backgrounds, we investigated the difference between discoveries, functions used, and analysis process. The comparison suggests that unrecorded participants could discover many facts about environment, and recorded participants could discover many facts about people. Moreover, the comparison also suggests that unrecorded participants could discover many facts comparable to recorded participants.

症例は39歳,女性,昭和63年12月他院で後腹膜脂肪肉腫摘出術,平成6年11月と平成10年6月に再発のため当院で腫瘍摘出術施行.平成11年6月腫瘍再発が判明し入院治療を予定していたが7月1日突然の高熱をきたし緊急入院となった.翌2日には激しい腹痛が出現し,ショック状態に陥った.右下腹部中心に弾性硬,小児頭大の腫瘤を触知し,右側腹部から背部にかけて皮膚の発赤,腫脹がみられ,著明な圧痛を認めた.腹部CTで腫瘍内部に広範なガス像を認め,さらに腹腔内遊離ガス像と肝内門脈に樹枝状に広がるガス像が認められた.腫瘍の腹腔内ならびに腸管内穿破による敗血症と診断し緊急手術を施行.感染を伴った腫瘍をその周囲に癒着した腸管とともに可及的に摘出し,腹腔内洗浄の後,ドレナージ術を施行した.術後敗血症によるDICを併発したが集中治療により一般状態は回復した.しかし,術後1カ月目頃より急速な腫瘍再発をきたし術後73日目に死亡した.

症例は73歳男性, 1994年5月,直腸癌(Rs)穿孔による腹膜炎に対し緊急にてHart-mann手術を施行.術後経過は良好で他院にて通院加療を受けていたが, 1998年11月になりCEA, CA19-9の上昇を指摘され,精査目的にて12月当院紹介入院となった.腹部CTおよび超音波検査上肝S6に径約5cmの腫瘤を認め,腫瘤周囲の肝内胆管は限局性に拡張していた.腫瘤は辺縁不整,内部不均一に描出され石灰化を伴っていた.また造影CTでは周囲のみ造影効果を認めた. MRIで腫瘤はT1で低信号, T2で不整な高信号を呈し, MRCPではB6胆管末梢枝の拡張が認められた.胆管内進展を伴った直腸癌肝転移と診断し, S6亜区域切除を施行. B6胆管枝を切開すると胆管内腫瘍栓を認めたため,これを可及的に除去した.摘出標本で腫瘍は6.0×4.0cmでB6胆管枝に直接浸潤し腫瘍栓を形成していた.組織学的には高分化型腺癌であり,前回の直腸癌の組織像と類似しており,直腸癌肝転移と診断した.

A 70-year-old man was referred to the hospital because of an upper abdominal pain, fever and jaundice. Laboratory data showed mild jaundice (T-Bil 4.0mg/dl, D-Bil 3.1mg/dl) and high levels of bile duct enzymes, CRP and CA19-9 (340U/ml). CT revealed a cyst, 9×8cm in size, in the segment 4 of the liver, atrophy of the lateral segment and dilatation of the left intrahepatic bile duct. MRCP revealed the compression of the left hepatic duct by the cyst and a dilatation of the bile duct in the lateral segment. ERCP revealed no communication between the bile duct and cyst, and the left hepatic duct retracted downwards and obstructed by compression of the cyst. Portography via superior mesenteric arteriogram did not demonstrated the left portal branch. After improvement of jaundice and inflammation, a left hepatic lobectomy including the left caudate lobe was performed. The cyst was filled with 500cc of serous fluid, and its wall was smooth. The bile duct in the lateral segment was filled with biliary sludge. Histological examination showed that the cyst wall had single layer of cuboidal epithelium without any malignancy.

A 68-year-old man was seen at the hospital because of epigastric distress. Endoscopic study revealed a tumor in the lower thoracic esophagus. A biopsy showed findings compatible with the diagnosis of poorly differentiated squamous cell carcinoma. A total thoracic esophagectomy were performed, and a cholecystectomy were added to prevent postoperative cholecystitis. The tumor was a type 2 lesion of 4.0×3.5cm in size which was macroscopically blackish in some parts. It was histopathologically diagnosed as malignant melanoma. A polypoid lesion of 3mm in size was also detected in the gallbladder, which was proved to be a metastasis (pT2N2M1, pStage IVb). Since no other primary lesion was seen, the tumor was considered to be primary malignant melanoma. Despite postoperative chemotherapy, he died five months after the operation bucause the tumor had already metastasized to the paraaortic lymph nodes and liver. Primary malignant melanoma arising in the esophagus is rare, and its prognosis is extremely poor. And malignant melanoma rarely metastasize to the gallbladder. Only three cases have been reported in the Japanese literature, but none of them involved primary tumor of the esophagus. We present this case with some bibliographical comments.

Retroperitoneal masses are commonly solid tumors, and rarely cystic ones. In the present paper, we report a case of retroperitoneal serous cyst. A 51-year-old woman complaining of an abdominal tumor visited another hospital and was referred to the hospital, because an abdominal cystic lesion was demonstrated by ultrasonography. The retroperitoneal serous cyst was suspected on various imaging studies and an operation was performed. The tumor was a unilocular cyst 12×6×6cm in diameter, without adhesion to the surrounding tissues. It could be extirpated easily. The specimen weighted 420g. The cyst contained colorless and clear serous fluid, and the cystic wall was thin and was covered with a layer of cylindrical epithlium. Retroperitoneal serous cyst was diagnosed. The levels of CEA and CA125 in the cyst fluid were high, and immunohistological stainings for CEA and CA125 were positive in the epithelium of the cyst. In a review of the literature, the origin of the retroperitoneal serous cyst was mainly discussed, and it was inferred that the origin in the present case might be the remnant of Mullerian duct at the embryonal stage.

We report a rare case of leiomyosarcoma of the ileum showing a pedunculated extraluminal development, which was succoesbully diagnosed preoperatively. A 69-year-old man visited his primary physician because of lower abdominal discomfort. Abdominal ultrasonography (US) showed a mass in the lower abdomen and he was transferred to the hospital. From the results of imaging studies, especially abdominal angiography, the patient was diagnosed as having a leiomyosarcoma of the ileum. The tumor, 11×10×8cm in size, showed a pedunculated extraluminal growth from the antimesenteric side of the ileum at 100cm from the Bauhin vulve. The ileum including the tumor was excised by a wedge resection. The diagnosis of leiomyosarcoma of the ileum was made based on the histological findings of the resected tumor. The patient has been in good health without any signs of recurrence, as of 1 year after the operation.

We report herein the case of a 38-year-old man found to have a rectal arteriovenous malformation (AVM). The patient was admitted to our hospital for investigation of fresh anal bleeding and general malaise. Barium-enema examination showed a slightly elevated lesion in the rectum, and a selective superior rectal angiogram subsequently revealed an AVM in the peripheral region of the superior rectal artery, which was presumed to be the cause of the anal bleeding. Colonoscopic examination disclosed a submucosal tumor-like lesion in the left posterior wall of the rectum, 3cm above the anal verge. After marking the boundaries by clipping, transanal resection of the lesion was performed. Histological examination revealed an irregularly expanded arteriovenous aggregation in the submucosal layer. The patient had a favorable postoperative course, and no residual AVM was seen on a postoperative selective inferior mesenteric arteriogram. There have been no signs of recurrence in the 2 years since his operation.

The case of a 91-yr-old man who had a tumor of the pancreas head successfully resected is reported. He was admitted to our hospital because of obstructive jaundice, and then percutaneous transhepatic biliary drainage (PTBD) was performed. Cholangiography via PTBD tube showed marked stenosis of the bile duct in the head of the pancreas. Endoscopic retrograde pancreatography (ERP) showed obstruction of the main pancreatic duct in the head of the pancreas, and carcinoma in the head of the pancreas was diagnosed. Abdominal angiography showed stenosis of the celiac trunk caused by compression from the median arcuate ligament, but no tumor stain or encasement in the pancreas was detected. Because the patient had lived an extremely healthy life and had no serious concurrent disease before admission, laparotomy was performed. The tumor in the head of the pancreas was about 2 cm in diameter and restricted inside the pancreas. Pylorus-preserving pancreatoduodenectomy (PpPD) with regional lymph node dissection was performed. The tumor was 1.5 cm in its maximal diameter, and histopathologically was diagnosed as an invasive ductal carcinoma of the pancreas with moderately differentiated tubular adenocarcinoma. The patient had an uneventful postoperative course and now, 3 yr after surgery, he is doing very well and leading a normal daily life.

We report a resected case of carcinoma developed in the reconstructed gastric tube 13 years after esophagectomy for a thoracic esophageal cancer. In February, 1984, he underwent a subtotal esophagectomy and an intrathoracic esophagostrostomy for an early carcinoma in the middle intra-thoracic esophagus (Im). The tumor was superficial and flat type, 2.0×1.5cm in size, and microscopically squamous cell carcinoma (sec) with m, n0, v0, ly0, and in stage 0. Since September, 1996 he had experienced chest discomfort and appetite loss. He visited the department of internal medicine in our hospital, and a pace maker was implanted for sick sinus syndrome in February, 1997. The symptom was not improved and an endoscopic examination showed a gastric carcinoma of type 5 in the lesser curvature of the antrum. So he was referred to the department in March, 1997. Preserving the right gastroepiploic artery and vein, a distal gastrectomy and a Roux-en-Y anastomosis for the remnant stomach and jejunum were performed. Histologically, the tumor was well-differentiated adenocarcinoma with tubl, ss, n(-), ly1, v1, in stage Ib. As of 12 months after the operation, the patient is disease-free without an signs of recurrence. Some bibliographical notes on 65 cases of carcinoma in the gastric tube reconstructed after esophagectomy in Japan are also presented.

We report herein the case of a 35-year-old woman with aplastic anemia who developed hepatocellular carcinoma after long-term therapy with oxymetholone. She was treated with 60 mg/day of oxymetholone for 3 years (total dose 64.8 g). Alpha-fetoprotein, hepatitis B surface antigen, and hepatitis C antibody were all negative, but serum titers of carcinoembryonic antigen and carbohydrate antigen were elevated. Lateral segmentectomy of the liver was performed. The histopathological findings were compatible with those of multiple hepatocellular carcinoma without liver cirrhosis. Three years since the operation, the patient is doing well and no signs of tumor recurrence have been detected. According to our review of Japanese cases of hepatocellular carcinoma associated with anabolic steroid therapy, in all instances the tumors developed after long-term administration of anabolic steroids for hematologic diseases. In patients under long-term anabolic steroid therapy, routine screening of the liver by ultrasonography and computed tomography should be performed to detect liver tumors in the early stages.

We experienced a case of poorly differentiated adenocarcinoma arising in the remnant gastric mucosa with marked extension to the esophageal submucosal layer which developed 20 years after a total gastrectomy for a gastric cancer. A 61-year-old man, who had undergone a total gastrectomy for a gastric cancer at another hospital 20 years before, was admitted to the hospital. There was a history of repeated hospitalization because of malnutrition after the gastrectomy. In a recent endoscopic examination for anemia, redness and easy bleeding in the esophageal mucosa at the anastomotic region was found. The lesion was diagnosed as adenocarcinoma by biopsy. The esophagus in the bdominal and lower thoracic portions including the esophagojejunostomy site was resected. Macroscopic examination of the resected specimen showed a slightly elevated area of the esophageal mucosa at the anastomotic site, but neither color change nor ulcerated lesion was found. In the histological examination, the remnant gastric mucosa was detected and transformation of severe dysplastic epithelium into poorly differentiated adenocarcinoma was observed at the anastomotic site. The carcinoma markedly extended into the esophageal submucosal layer. It was thought that malnutrition after total gastrectomy might be caused by reflux esophagitis. A long-term exposure of the esophagojejunostomy site to enteric juice seemed to be associated with the development of cancer from the remnant gastric mucosa.

Intrasplenic extension of pancreatic tail carcinoma is rather uncommon, and localized intrasplenic invasion, an indication for radical surgery, is extremely rare, because intrasplenic extension of pancreatic carcinoma is mainly found as part of widespread tumor dissemination. A 57-year-old woman was admitted because of left upper abdominal pain. Physical examination of the abdomen showed no abnormal findings. Laboratory data showed mild anemia and marked increased CEA and CA19-9 levels. US, CT and MRI revealed a solid tumor in the splenic hilus, but continuity with the pancreas was unclear. Angiography revealed stenosis of the splenic artery at the pancreatic tail. A tumor arising in the pancreatic tail and extending into the spleen was found at operation, and distal pancreatectomy with splenectomy was performed. No invasion of surrounding tissues or lymph node metastasis was detected. Histological examination revealed moderately differentiated ductal adenocarcinoma of the pancreas. The postoperative course was uneventful. Twelve months after the operation, however, the patient died of multiple liver metastasis.

慢性膵炎に対する手術術式と, 遠隔期の除痛効果や膵内外分泌機能について検討した.慢性膵炎手術60例中膵直接手術は52例で, うち主膵管拡張例28例では膵管狭窄が全膵に多発した22例に膵管空腸側々吻合 (うち嚢胞空腸吻合併施5例), 膵管狭窄が膵管開口部に限局した4例に乳頭形成兼膵管口形成, 病巣が膵頭部に限局した2例中1例に膵頭十二指腸切除, 1例に膵横断膵管空腸二重吻合を施行した.膵管非拡張例24例では病巣が全膵にびまん性にみられた, 1例に膵全摘, 病巣が膵頭部に限局していた3例中2例に膵頭十二指腸切除, 1例に嚢胞空腸吻合, 病巣が膵尾部に限局した20例中18例に膵体尾部切除, 2例に嚢胞空腸吻合を施行した.遠隔期の疼痛消失率は膵切除術84.2%, 膵管減圧術81.5%と両者で差はなく, 膵機能の維持, 回復の点では膵管減圧術が優れていた.術式の選択には主膵管拡張の有無や膵病変の部位が重要な指標となるが, 遠隔期の成績も考慮して適切な術式を選択すべきである.

Solid cystic tumor of the pancreas is a primary pancreatic neoplasm of unknown etiology that most commonly occurs in young women and ordinarily contains hemorrhagic tissue. We report herein the unusual case of a 75-year-old man found to have a solid cystic tumor in the body and tail of the pancreas, who is the oldest such male patient to be documented in Japan. The results of laboratory data and imaging studies indicated that the patient had a nonfunctioning islet tumor or solid cystic tumor of the pancreas, and distal pancreatectomy with splenectomy was performed. The diagnosis of solid cystic tumor was confirmed based on macroscopic and histological findings of the resected pancreatic tumor. The patient is currently in good health, without any signs of tumor recurrence 1 year and 4 months after his operation. A total of 181 cases of solid cystic tumors of the pancreas reported in the Japanese literature, including our case, were reviewed to evaluate the clinical differences between patients aged 50 years or over and those younger than 50 years.

We report herein the case of a 53-year-old man with disseminated intraperitoneal metastases caused by the rupture of small hepatocellular carcinoma (HCC). He was admitted to our hospital in shock after suffering a trauma injury to the upper abdomen. Ultrasonography revealed a massive hemoperitoneum. At surgery, 4000 ml of blood was drained from the abdominal cavity and a ruptured tumor, 2 cm in diameter, was found in the right lobe of the liver. The tumor was resected with an adequate surgical margin and subsequent microscopic examination confirmed a diagnosis of moderately differentiated HCC without associated liver cirrhosis. The patient was readmitted 14 months later, following the development of right lower quadrant pain. Ultrasonography and computed tomography revealed extrahepatic abdominal tumors, and abdominal angiography demonstrated four intraperitoneal tumors. At surgery, four implanted metastases adhered to the greater omentum were found and resected. No other tumors were detected. Microscopically, all four tumors were confirmed as moderately differentiated hepatocellular carcinoma. Ruptured HCC may lead to implanted intraperitoneal metastasis, but rupture of small HCC is very rare. While hepatic resection is the treatment of choice for ruptured HCC, according to our review of the literature, only a few patients have survied long-term after resection of implanted metastasis.

We describe herein the case of a 73-year-old woman who developed a giant leiomyosarcoma in the remnant stomach 4 years after undergoing a distal gastrectomy for gastric carcinoma. Abdominal ultrasonography and computed tomography revealed a huge tumor, 22 cm in maximum diameter, in the left hypochondrial region. Selective abdominal angiography showed a hypervascular tumor fed by the branches of the splenic artery and left inferior phrenic artery. The tumor arose from the posterior wall of the remnant stomach, and demonstrated marked extragastric growth and direct invasion of the pancreas, transverse colon, and diaphragm on the left side. Total resection of the remnant stomach with en bloc resection of these adjacent organs was subsequently carried out. We reviewed the Japanese literature on this extremely rare tumor and evaluated its clinical profile. In comparison with leiomyosarcoma of the unresected stomach, that of the remnant stomach more frequently showed endogastric-type growth and was accompanied by ulceration of the gastric mucosa. The prognosis of patients with leiomyosarcoma of the remnant stomach appears to be greatly affected by the presence of liver metastases and the tumor diameter, similar to that of patients with leiomyosarcoma of the unresected stomach.

A case of primary adenosquamous carcinoma of the liver in a patient with an elevated level of serum squamous cell carcinoma-related antigen is reported. A 68-year-old man was admitted to our hospital with a 10-day history of fever and jaundice. From the results of laboratory and imaging studies before surgery, a diagnosis of cholangiocellular carcinoma was made, and the patient underwent right trisegmentectomy with regional lymph node dissection. Histopathological examination of the resected specimen revealed adenocarcinoma, squamous cell carcinoma, and a transitional area containing both types of cancer cells. The number of argyrophilic nucleolar organizer regions and the labeling index of proliferating cell nuclear antigen were markedly elevated and the deoxyribonucleic acid ploidy pattern was aneuploid in the squamous component. The patient died due to liver metastases 3 months after the operation. We reviewed the 31 cases of adenosquamous carcinoma of the liver reported in the Japanese and English language literature, including the present case.

A 79-year-old man was admitted to our hospital because of severe epigastric pain. Ultrasonography and computed tomography revealed a slightly distended gallbladder with a small amount of free intraabdominal fluid. At emergency laparotomy, perforation of the gallbladder was recognized and thus a cholecystectomy was performed. Histopathologically, localized necrosis was seen at the site of perforation: however, the inflammation of the surrounding tissue was mild and no thrombus was detected within the intramural vessels. In addition, the gallbladder contained no stones and a bile culture was negative. Postoperatively, the diagnosis of idiopathic perforation of the gallbladder was established. The findings of this case help to emphasize the importance of considering this disorder in elderly patients presenting with peritonitis of unknown origin.

重度進行性歯周炎 (RPP) 患者, および性, 年齢の一致した健常者それぞれ11名の末梢血より得た好中球および単球の走化性を, ボイテン・チャンバー法により調べた。その結果, RPP患者の好中球ランダム遊走能および走化性は, 健常者のそれと有意な差がなかったが, 至適濃度の走化性因子 (FMLP) に対する反応性は, RPP患者の方がより大きく分散した。単球の走化性および血清中の走化性活性も, RPP患者と健常者の問で差がなかった。また, FMLPによる好中球からのリソゾーム酵素放出性を, リゾチーム活性を測定することにより調べたが, RPP患者と健常者の間で差はなかった。以上の結果より, 食細胞が局所に遊走し, 脱顆粒して酵素を細胞外に放出するまでの過程では, RPP患者に顕著な機能欠損はないことが示唆された。

早期発症型歯周炎は宿主一寄生体相互作用の概念から注目される。家族性に発症した早期発症型歯周炎の1症例に対し, 細菌学的ならびに宿主防御機能の面から検索を行った。38歳の母親は, 重篤な歯肉の炎症症状と進行した骨破壊を呈し, 重度進行性歯周炎と診断した。16歳の娘は, 歯肉の炎症はないが, 局所的骨破壊が進行し, 限局型若年性歯周炎と診断した。母のポケットでは, 桿状菌とスピロヘータが高率を占めた。娘のポヶット内も, 桿状菌の占有率は高いが, スピロヘータは少なかった。母娘ともに優勢菌はFusobacterium種であった。A. actinomycetemcomitansは検出されなかった。体液性免疫応答は, 母娘ともにA. actinomyoetemcomitans, B. gingivalis, F. nucleatumに対して高いIgG抗体反応で示された。好中球機能は, 母は貪食能において, 娘は貪食能と遊走能において低下があった。母娘の病態は酷似しており, 発症のメカニズムが同じであると推測される。

An unusual case of a coexistence of pancreas divisum and intestinal malrotation in a patient with cholecystolithiasis is described herein. The diagnosis of pancreas divisum was established by endoscopic retrograde pancreatography, and the intestinal malrotation was diagnosed by duodenography and barium enema. An operation was performed for the cholecystolithiasis. The pancreas was soft, and its shape was almost normal. Cholecystectomy and prophylactic appendectomy were performed, however nothing was done to the pancreas.

白血球は, 歯周疾患において宿主の生体防御のための重要な役割りを担っている。歯周疾患患者の白血球の諸機能は, 病態を反映する指標となると思われる。そこで, 病態の解析が急がれている重度進行性歯周炎 (rapidly progressive periodontitis) 患者13名について, 末梢血好中球の貪食能を健常人と比較・検討した。RPP患者の貪食能は, 健常人に比べて, 付着能と細胞内取り込み能のいずれにおいても有意に低下しており, これは, 主として貪食反応に関与している好中球数の減少によるものであった。さらに, 貪食能低下の機序を調べるために, 被験好中球のロゼット形成能, 血漿中の因子の影響, 血漿のオプソニン活性などについても検討した結果, RPP患者の好中球貪食能の低下は, 好中球自身に由来していること, さらに, 白血球機能評価は歯周疾患を解析する上で有用であることが示唆された。

歯周病関連細菌に対する血清IgG抗体価と歯周病の病型あるいは, 臨床症状との相関を検索することを研究目的とした。血清抗体の定量には, 超音波抽出上清を抗原とするELISA法を用いた。歯周炎患者129名を臨床的な病状によって, 若年性歯周炎, 急速進行性歯周炎活動期, または非活動期, および成人性歯周炎に分類し, ポケット長測定およびレントゲン写真検査を行なって, 各種臨床症状をあらわす指数を算出した。それぞれの病型群で各種臨床検査から得た指数と血清抗体価との相関係数を計算し, 若干の有意な正の相関を得た。しかし, 病型に特徴的な病状を説明できるような指数と抗体価の組合わせをすべての病型で見出すことはできなかった。血清IgG抗体価は, 病態の表現型の1つであるが, それは, 各種臨床検査から得られるパラメータとは独立したカテゴリーに属するものであろうと考察される。