Search

Background Encapsulating peritoneal sclerosis (EPS) is a serious complication of long-term peritoneal dialysis. The mortality rate for EPS is high, primarily due to complications related to bowel obstruction. Surgery was previously contraindicated; however, surgical enterolysis is performed for patients in whom bowel obstruction fails to improve. Methods This was a retrospective observational study of patients with EPS who received surgical intervention at a single center between November 1993 and October 2017. The severity of intestine damage was characterized by grade-3 peritoneal calcification on abdominal computed tomography (CT) scan and degeneration of the small intestinal wall in surgery. Results Two-hundred and forty-three patients with EPS opted for surgery. Among them, 58 had recurrence and required re-surgery; a total of 318 EPS surgeries were performed. Death was related to EPS in 61 patients (25.1%), of whom 15 died postoperatively. Sixty-seven patients (27.6%) died from other causes. The actuarial survival rates at 1, 2, 3, 5, and 8 years after EPS diagnosis were 91%, 83%, 77%, 66%, and 53% respectively. The 50% actuarial survival points after EPS diagnosis and surgery were 104 months and 85 months, respectively. Peritoneal calcification and small intestinal wall degeneration grading showed significant association with the mortality curve for EPS-related death. Conclusion Excellent outcomes for EPS are achieved with surgery. The degree of peritoneal deterioration affected the clinical outcomes. Currently, EPS is no longer recognized as a fatal complication.

Highlights • Appendicitis with liver abscess and sessile serrated adenoma/polyp is rare. • Ileocecal resection was performed for an inflammatory mass in the ileocecum. • The patient was successfully treated with a combination of surgery and antibiotics., Introduction Although appendicitis is a common disease, appendicitis concurrent with liver abscesses and sessile serrated adenoma/polyp (SSA/P) is rare. Presentation of case A 69-year-old man presented with symptoms of abdominal pain and fever. Computed tomography (CT) revealed multiple liver abscesses and an enlarged appendix with a pseudotumoral appearance, which suggested acute appendicitis. In the emergency operation, ileocecal resection was performed for the perforated appendicitis with an inflammatory mass in the ileocecum. On macroscopic examination, the torose lesion was localized at next to the appendiceal orifice. The tumor was diagnosed as SSA/P based on the microscopic finding. The postoperative course was uneventful, and the liver abscesses were cured by antibiotic therapy. The patient was discharged 17 days after the surgery. Discussion In this case, SSA/P localization at next to the appendiceal orifice was suggested as the cause of the perforated appendicitis with multiple liver abscesses. The patient was successfully treated with a combination of surgery and antibiotic therapy. Conclusion This is the first reported case of a patient with SSA/P that led to acute appendicitis with multiple pyogenic liver abscesses.

Highlights • De Garengeot hernia with a groin subcutaneous abscess is rare. • Appendectomy and herniorrhaphy via the same incision may be more effective. • Clinicians should consider de Garengeot hernia in patients with a groin hernia., Introduction De Garengeot hernia is rare. Although previous reports have suggested various surgical options according to patient condition, comorbidities, surgeon preference, and clinical findings during surgery, a treatment strategy has not been established. Presentation of case An 81-year-old woman presented with an irreducible tender mass that was subsequently diagnosed as an incarcerated femoral hernia with a subcutaneous abscess in the right groin. Intraoperative findings revealed a necrotic and perforated appendix strangulated by the femoral ring for which an appendectomy and herniorrhaphy was performed concurrently through the hernia sac. The subcutaneous abscess cavity was washed thoroughly and a drainage tube was placed within it. The patient recovered uneventfully. Discussion We suggest that the approach through the inguinal incision in both appendectomy and herniorrhaphy with drainage may be useful in avoiding intra-abdominal contamination in cases of de Garengeot hernia with subcutaneous abscess. Conclusion Here, we described a case of de Garengeot hernia with a subcutaneous abscess in the groin. Clinicians should consider de Garengeot hernia in patients with a groin hernia, make an early diagnosis, and promptly provide surgical treatment to reduce the risk of complications.

Serum carbohydrate antigen 19-9 (CA 19-9), a marker of malignant tumors, is generally slightly elevated in benign conditions. We report a case of acute cholecystitis with a significantly elevated level of serum CA 19-9 based on positron emission tomography (PET)-computed tomography (CT) findings. A 65-year-old woman presented with abdominal pain and fever. A CT image revealed an enlarged gallbladder without tumor shadows. The C-reactive protein (CRP) level was elevated to 7.66 mg/dl. Moreover, the serum CA 19-9 level was significantly elevated to 19,392 U/ml. We started antibiotic treatment, because we suspected acute cholecystitis, but still, we could not ignore the possible presence of malignant tumors. After 11 days of antibiotic treatment, serum CRP and CA 19-9 levels decreased to 0.11 mg/dl and 1,049 U/ml, respectively. There was an accumulation of fluorine 18-labeled fluorodeoxyglucose (maximum standardized uptake value, 9.3) without tumor shadows in the liver, near the gallbladder, on the PET-CT examination. We considered the possibility that the inflammation had spread from the gallbladder to the liver, made a diagnosis of acute cholecystitis, and performed a cholecystectomy 33 days after treatment initiation. The serum CA 19-9 level decreased to 45 U/ml after the surgery. One year after the surgery, the patient was alive, and the serum CA 19-9 level was 34 U/ml. Acute cholecystitis with a significantly high elevation of the serum CA 19-9 level is rare. In such cases, it is important to confirm the change in the serum CA 19-9 level over time after antibiotic treatment and perform imaging studies to distinguish between inflammation and malignancy.

Association of gene alterations and prognosis has not fully been elucidated in hepatocellular carcinoma (HCC). To clarify the relationship between p53 and hMSH2 mutations and prognosis, we analysed these mutations in 83 HCC cases and assessed their association with various clinicopathological factors. The 3-year disease-free survival (DFS) or overall survival (OS) rates in HCC patients with p53 mutation and p53 wild/hMSH2 mutation significantly decreased compared with those without these mutations (14.3-0x1.f824p+0nd 37.5% versus 67.5-0.000000or DFS; 35.7-0x1.f5cf80852f11p+0nd 50.0% versus 96.4-0.000000or OS, respectively). In the multivariate analysis, categories by p53 and hMSH2 mutation status, and liver cirrhosis demonstrated statistical significances for DFS and OS. Moreover, the frequency of patients with p53 and/or hMSH2 mutations in intrahepatic metastasis (75.0%) was significantly higher than that in multicentric occurrence (14.3%). Thus, p53 and hMSH2 mutations will be useful for identifying subsets of HCC patients with poor prognosis.

反回神経麻痺をきたした二次性副甲状腺機能亢進症の1例を経験した. 61歳, 女性. 45歳時に、慢性腎不全のため, 血液透析を導入. 平成15年7月より, 誤嚥および嗄声あり. 喉頭ファイバー検査にて右反回神経麻痺を認めた. 頸部CT・エコー検査で, 甲状腺右葉の腫瘍性病変と左右の副甲状腺2腺の腫大を認めた. 術中所見では, 右反回神経は甲状腺右葉下極の腫大した副甲状腺被膜内に取り込まれていた. 右反回神経を鋭的剥離温存し, 甲状腺右葉切除, 副甲状腺摘出術を行った. 病理組織検査は, 甲状腺乳頭癌, 副甲状腺過形成であった. 術後は嗄声の改善を認め, 喉頭ファイバー検査でも, 声帯の可動性は著明に改善した. 文献的検索では, 副甲状腺腫瘤により反回神経麻痺を呈した症例は11例であり, その中で二次性副甲状腺機能亢進症は3例のみであった.

乳腺原発扁平上皮癌は比較的稀な癌である.われわれは, epidermal growth factor receptor (EGFR)が強く発現した乳腺原発扁平上皮癌(腺癌併存)の1例を経験したので報告する.症例は66歳,女性.右乳房腫瘤を主訴として来院し,超音波検査, MRIなどで血流豊富な約4cm大の腫瘍を認めた.摘出標本のHE染色では,腫瘍の大部分は扁平上皮癌からなり,腫瘍の一部にcomedo carcinomaあるいはsolid-tubular carcinomaの混在を認め,腺癌の扁平上皮化生による変化と考えられた.免疫染色では腫瘍大部分のエストロゲンレセプター,プロゲステロンレセプターはともに陰性であり, HER2スコア0であった.抗EGFR抗体を用いた免疫染色では,腫瘍細胞の細胞膜にEGFRが強く発現していた.現在のところ術後経過は良好であり, 18カ月の経過観察中に再発は認めていない.

Renal cell carcinoma (RCC) in a kidney allograft is rare. We report the successful diagnosis and treatment of ade novoRCC in a nonfunctioning kidney transplant 20 years after engraftment. A 54-year-old man received a kidney transplant from his mother when he was 34 years old. After 10 years, chronic rejection resulted in graft failure, and the patient became hemodialysis-dependent. Intravenous contrast-enhanced computed tomography (CT) for the evaluation of gastrointestinal symptoms revealed a solid 13 mm tumor in the kidney graft. The tumor was confirmed on ultrasound examination. This tumor had not been detected on a surveillance noncontrast CT scan. Needle biopsy showed that the tumor was an RCC. Allograft nephrectomy was performed. Pathological examination showed that the tumor was a Fuhrman Grade 2 RCC. XY-fluorescence hybridization analysis of the RCC showed that the tumor cells were of donor origin. One year after the surgery, the patient is alive and has no evidence of tumor recurrence. Regardless of whether a kidney transplant is functioning, it should periodically be imaged for RCC throughout the recipient’s lifetime. In our experience, ultrasonography or CT with intravenous contrast is better than CT without contrast for the detection of tumor in a nonfunctioning kidney transplant.

We isolated murine and human cDNAs for SDF2L1 ( s tromal cell- d erived f actor 2 - l ike 1 ) and characterized the genomic structures. Northern blot analysis of the gene expression in various tissues revealed that both murine Sdf2l1 and human SDF2L1 genes are expressed ubiquitously, with particularly high expression in the testis. The SDF2L1 protein has an endoplasmic reticulum (ER)-retention-like motif, HDEL, at the carboxy (C)-terminus. Interestingly, SDF2L1 protein also shows significant similarity to the central hydrophilic part of protein O-mannosyltransferase (Pmt) proteins of Saccharomyces cerevisiae, the human homologues of Pmt (POMT1 and POMT2) and Drosophila melanogaster rotated abdomen (rt) protein. In a murine hepatocellular carcinoma cell line, Sdf2l1 was strongly induced by tunicamycin and a calcium ionophore, A23187, and weakly induced by heat stress but was not induced by cycloheximide. In conclusion, SDF2L1 protein is a new member of Pmt/rt protein family and Sdf2l1 is a new ER stress-inducible gene.

It is clinically and pathophysiologically important to elucidate the mechanism of cellular injury during hepatic ischemia and subsequent reperfusion. Ischemia-reperfusion injury is complex. Effective prevention strategies will require specific actions during the different phases of ischemia-reperfusion injury, but optimal conditions will only be achieved once the mechanisms of injury at the cellular and molecular levels are understood. It is, therefore, important to study the intracellular signal transduction pathway for its clinical application. This review represents recent advances of the mechanism of hepatic ischemia and reperfusion injury, with special reference to the free radical-mediated injury, the activation of Kupffer cells and neutrophils and the implications of NF-kB activation.

We report here a case of Pancoast's syndrome that developed 15 years after a radical mastectomy for right breast cancer. The patient had undergone a radical mastectomy on February 1, 1979. Following surgery, numbness and pain persisted from the right shoulder to the right anterior chest region, and in 1993, the pain gradually became stronger. Right blepharoptosis occurred in 1994, and lymph node swelling in the supraclavicular region was noted in June of the same year. Aspiration biopsy was performed on the lymph nodes, and a cytological diagnosis of metastatic adenocarcinoma was made. Since the findings from a CT scan suggested Pancoast-type cancer, we performed a right upper lobectomy and dissection of the mediastinal lymph nodes, including the right supraclavicular lymph nodes. However, pulmonary and lymph node metastases were diagnosed 15 years after the breast cancer operation. The patient underwent chemo-endocrine therapy and irradiation after the operation and remains well at the present time, five years after this operation.

In a series of 709 patients with breast cancer operated on at the department in a recent three decades from 1968 to 1998, there were 33(4.7%) patients with primary bilateral breast cancer. Eleven patients(1.6%) had synchronous and 22 patients(3.1%) had metachronous bilateral breast cancers. These 33 patients were clinicopathologically compared with those having unilateral breast cancer. Average age at operation for the first cancer in metachronous patients was 42.9 years, that was significant younger than others. Patients with bilateral breast cancer had history of familial cancer or other multiple primary cancers in a high frequency. In metachronous patients 80% of them found the second cancer by themselves, which 27% of synchronous patients found it by themselves, with a significant difference. The 5-year survival rates were 86.9%, 88.9% and 76.7% in unilateral cases, synchronous cases and metachronous cases, respectively. Therefore, we have recognized the importance of early discovery and treatment of contralateral breast cancer.

We report a rare case of synchronous multiple carcinomas of the colon. A 65-year-old man visited our hospital because of anal bleeding. Colonoscopy disclosed an ulcerative lesion in the sigmoid colon and 10 polypoid lesions in the ascending and sigmoid colon. After endoscopic polypectomy of the 10 polypoid lesions, anterior resection with lymph node dissection was performed for the ulcerative lesion. Histological study revealed one advanced carcinoma with invasion of the subserosa, 5 early carcinomas with invasion of the mucosa or submosa, and 3 adenomas with moderate to severe atypia. The genetic instability of these 9 lesions was examined using microsatellite assay. In all of these lesions, no replication errors were detected at any of the microsatellite loci analyzed.

The effectiveness of combining mitomycin C (MMC), tamoxifen (TAM), and 1-(2-tetrahydrofuryl)-5-fluorouracil (tegafur) was evident in patients with estrogen receptor-positive (ER+) breast cancers. UFT, an oral preparation of tegafur and uracil at a molar ratio of 1:4, was reported to have higher antitumor effects than tegafur alone for patients with breast cancer. Therefore, the combined chemotherapy of MMC, TAM and UFT may possibly be effective for breast cancer.

Aneurysmal disease of the visceral arteries is found in only about 0.2% of the population, and the celiac trunk and superior mesenteric artery (SMA) are involved in less than 10% of all visceral aneurysms. We present herein the case of a 71-year-old woman who suffered rupture of a SMA aneurysm. Histological examination of the periarterial tissues which existed next to the aneurysm revealed a heterotopic pancreas. To the best of our knowledge, no other case of an SMA branch aneurysm presenting in association with a heterotopic pancreas has ever been described in either the Japanese or English literature. This is the first report to indicate that a heterotopic pancreas is a likely incidental factor predisposing to visceral aneurysms.

We investigated the feasibility and validity of near-infrared (NIR) spectroscopy for evaluation of acute lung injury (ALI). In an in vitro model simulating the spectrophotometric characteristics of the lung, NIR spectroscopy could precisely detect changes in water volume, suggesting its ability to assess the extent of pulmonary edema caused by ALI. The different grades of ALI were induced in rats by administering oleic acid and varying the pulmonary ventilation conditions, and NIR spectroscopy was employed to determine lung water content and hemoglobin (Hb) oxygenation of the lungs. NIR spectroscopy detected increased water content even in histologically mild ALI. The changes in lung water content measured by NIR spectroscopy were significantly correlated with gravimetric lung water content (r = 0.877, p < 0.0001). Deoxy-Hb measured by NIR spectroscopy consistently reflected the histological changes in the lungs, and the deoxy-Hb levels correlated with changes in SaO2 (r = -0.798, p < 0.0001). These findings demonstrate that NIR spectroscopy can evaluate lung water content and Hb oxygenation quantitatively, and may be a useful tool for assessing pathological status in ALI.

Background: Lazaroids are nonglucocorticoid analogs of methylprednisolone with multiple actions. We investigated whether lazaroid U-74389G could attenuate endotoxin-induced liver injury. We hypothesized that U-74389G treatment may protect against hepatic injury by suppressing proinflammatory gene up-regulation through inhibition of activation of nuclear factor κB (NF-κB). We also compared the efficacy of U-74389G with methylprednisolone in endotoxin-induced liver injury. Methods: Lipopolysaccharide ( Escherichia coli , 30 mg/kg given intraperitoneally) was administered to male ICR mice, and U-74389G (3 mg/kg intraperitoneally) or methylprednisolone (30 mg/kg intravenously) was administered simultaneously. Phosphate-buffered saline solution (0.15 mL intravenously) was administered to mice that served as a control group. Results: U-74389G and methylprednisolone treatment significantly increased survival rates 48 hours after lipopolysaccharide injection and protected against lipopolysaccharide-induced liver injury in vivo, as indicated by the decreased hepatic lipid peroxidation, tumor necrosis factor-α, and inducible nitric oxide synthase messenger RNA formation, hepatic enzyme release, and neutrophil infiltration in the liver. U-74389G and methylprednisolone also showed inhibitory effects on NF-κB activation in the liver. Conclusions: These findings suggest that U-74389G can suppress proinflammatory gene up-regulation through inhibition of NF-κB activation and that it is a promising new antioxidant drug for the treatment of endotoxin shock. (Surgery 1999;125:421-30.)

A 64-year-old woman underwent total gastrectomy, splenectomy, and lymph node dissection for a gastric leiomyosarcoma in November 1989. We found a liver tumor, 3cm in diameter, by abdominal ultrasonic study and CT in June 1994, but the patient refused surgical treatment. Hepatic arterial infusion was therefore performed, and the tumor subsequently gradually enlarged. We obtained the patient's consent to surgery and performed left lobectomy in March 1995. The histopathological diagnosis was metastatic liver tumor from gastric leiomyosarcoma. No recurrence or metastasis was detected during about 4-year follow up. Liver metastasis of leiomyosarcoma of the stomach is generally thought to occur in high grade malignancy, but a good outcome can be obtained by early detection of postoperative recurrence and repeated curative operations.

We report a very rare case of retroperitoneal extraskeletal osteogenic sarcoma. A 49-year-old man was admitted to the hospital because of left flank pain. CT examination revealed a large left tumor existed in the retroperitoneal region. Retroperitoneal tumor was removed with combined resection of the spleen, left kidney, and descending colon. The tumor was 16cm in maximum diameter and weighed 1, 930g. Pathological examination revealed osteosarcoma. Pulmonary metastasis was diagnosed 6 months after the first operation, and a partial resection of the right lung (S2) was performed by using a video-assisted thoracic surgery. However, recurrent metastasis was observed in the right lung 11 months after the second operation, and he died 1 year and 9 months after the first operation. Fourteen cases of retroperitoneal osteosarcoma including our case have been reported in the literature, and we have found that all patients died from recurrence or distant metastasis by a follow-up research.

著者らは人工血管を用いた内シャント術用皮下トンネラー (以下HT (Haruta Tanaka) トンネラーと訳す) を考案し試用してきたので報告した.材質はSUS303ステンレススチールで, シャフト部の長さは180mm, 外径は5mmと6mmの2種類を作成した. シャフト末梢側55mmは15度に屈曲し, 不必要な組織損傷を避け, 術後の皮下出血・浮腫を軽減するため先端の形状を鈍とした. シャフト先端部は取り外し可能なキャップ状とし, 内筒には人工血管縫着固定用に二箇所の穴を設けた. 指先での把持・操作を目的に, ハンドル部の形態を小型で扁平とした. この結果ハンドル部を握り込む形式のトンネラーに比べ, 皮下トンネルの深さの調整が容易となった. また人工血管を引き抜く際に, 屈曲や捻れは生じず, さらに従来の大型のトンネラーのように末梢側より中枢側へ引き抜く際に, 患者の身体に支え, 操作に困難を生じることもなかった.以上のようにHTトンネラーは内シャント手術手技の簡素化に役立った.

A 65-year-old woman was admitted to the hospital for the purpose of operation for an enlarging left breast tumor in 1996. In 1993, the patient visited another hospital because of a left breast tumor, but thereafter the tumor spontaneously began to shrink and she left it alone. She noticed the tumor starting to grow again in October 1995, when an aspiration cytology biopsy revealed class IIIa and she was referred to the hospital. On admission, a pulmonary metastasis was noticed and clinical staging resulted in stage IV. Modified radical mastectomy (Bt+Ax) was performed on February 27th, 1996. Clinicopathologically, our case followed t 2n 3m 1 stage IV. Histopathological examination revealed that papillotubular carcinoma changed to solid tubular carcinoma or scirrhous carcinoma causing invasion to the outside of the cyst wall. It is thought that the carcinoma became more malignant as it grew, and it is interesting from the point of view of pathogenesis.

We aimed to assess isolated caudate lobectomy by the anterior approach for the treatment of large hepatocellular carcinomas originating in the paracaval portion of the caudate lobe. The surgical procedures consisted of ligation and dissection of the caudate branch of the portal vein and short hepatic veins from the right side of the hepatic hilum; liver resection cranially from the right side of the process portion; ligation and dissection of the short hepatic veins from the left side; hepatic resection between the lateral segment and Spiegel lobe; and, finally, dissection of the liver at the right of the Cantlie line, reaching the tumor in the paracaval portion of the caudate lobe. The important point in this procedure was the appropriate management of the short hepatic veins, the branches of the hepatic vein, and the glisson's vessels of the paracaval portion. The operative times for the three patients reported here were 430, 355, and 575 min, with blood loss of 1100, 1180, and 2000 ml, respectively. The duration of the operation was short and blood loss was minimal; severe complications were not observed. Complete recovery of liver function after this surgery tended to be slow. Early recurrence was observed during long-term follow-up. This procedure is considered to be a safe method, with optimal surgical vision for caudate lobe tumors of a relatively large size. However, adjuvant therapy to prevent recurrence is required.

Apoptosis is considered to play an important role in rejection of organ transplants, although the precise mechanism has not been elucidated. In this study, we screened for the expression of bcl-2 homologues (bcl-2, bax, bcl-xl, and bcl-xs) and Fas ligand (FasL) by RT–PCR method in grafts during acute rejection in rats following liver transplantation. Both bax and bcl-xs (inducers of apoptosis) mRNA levels increased steadily in the allografted group from postoperative day (POD) 2 to 8, while no remarkable changes of bcl-2 and bcl-xl expression (inhibitors of apoptosis) were recognized. Significant induction of FasL gene expression was observed in the allografted group on POD 4 and expression gradually decreased thereafter, although minimal FasL mRNA expression was seen in isografts. Our results indicated, for the first time, that rejection-induced cell apoptosis is closely associated with upregulation of bax and bcl-xs expression besides FasL, but not with down-regulation of bcl-xl.

The present study was designed to analyze the immunosuppressive activity of FTY720 in concordant xenotransplantation. When T and B lymphocytes of human peripheral blood were incubated with FTY720, the number of viable cells decreased in a dose-dependent manner at doses higher than 4 x 10(-5) M. DNA fragmentation was observed at doses higher than 1 x 10(-5) M in T cell-rich fractions and at doses higher than 4 x 10(-5) M in B cell-rich fractions. These data demonstrate that FTY720 is cytotoxic to B lymphocytes as well as T lymphocytes and apoptosis may play an important role in this cytotoxicity. Golden Syrian hamsters were the donors and Lewis rats the recipients of skin grafts. The recipients were divided into the following four groups: (1) untreated recipients, (2) FTY720 (5 mg/kg per day) was administered orally for 8 days (days-1-6), (3) FK506 (1 mg/kg per day) was injected i.m. for 7 days (days 0-6), and (4) FK506 (1 mg/kg per day) was injected i.m. for 7 days (days 0-6) and FTY720 (5 mg/kg per day) was administered orally for 8 days (days-1-6). The mean graft survival times in groups 1-4 were 9.7 +/- 0.52 days (n = 6), 12.0 +/- 0.71 days (n = 6), 13.2 +/- 1.6 days (n = 6), and 37.7 +/- 4.3 days (n = 6), respectively. There was a significant difference in the mean survival time between groups one and four. Combined therapy with FTY720 and FK506 is a useful tool for immunoregulation in xenotransplantation.

We examined the effects of a Japanese fermented soybean product, miso, and tamoxifen (TAM), alone and in combination, on N-nitroso-N-methylurea (MNU)-induced rat mammary cancer. Seven-week-old female CD/Crj rats received a single i.v. dose (50 mg/kg body weight) of MNU. After administration of MNU, the rats were divided into 4 groups: regular diet (control), 10% miso diet, regular diet + TAM, and 10% miso diet + TAM. TAM was implanted s.c. in the form of pellets containing 2.5 mg at the same time as MNU was administered. All rats were observed for 18 weeks after MNU administration. Incidence (percentage of rats with tumors) and multiplicity (mean tumors/rat) of mammary tumors were 91% and 4.5 in the control, 77% and 2.4 (P < 0.05) in the 10% miso group, 68% and 1.4 (P

We examined the effects of soybeans, a soy product (miso) and biochanin A, an isoflavone derivative, on N‐nitroso‐N‐methylurea (MNU)‐induced rat mammary carcinogenesis. Seven‐week‐old female CD/Crj rats received a single i.v. dose (40 mg/kg body weight) of MNU. After administration of MNU, rats were fed diet containing 0% (control), 2% or 10% soybeans, or 10% miso as a soy‐supplemented diet, or 10 or 50 mg/kg biochanin A. All rats were observed for 18 weeks after MNU administration. At 18 weeks, the multiplicity (mean tumors/rat) of palpable mammary tumors was significantly decreased in the 10% soybean (1.1) and 10% miso (1.2) diet groups compared to the control (2.2) (P

The present study was designed to investigate the effects of dietary miso and NaCl supplementation on the development of aberrant crypt foci (ACF) induced by azoxymethane (AOM) in male F344 rats. A total of 76 rats, six weeks of age, were divided into seven groups and given weekly subcutaneous injections of AOM (15 mg/kg body wt) for three weeks to induce ACF. The animals were placed on diets one week before the first AOM dosing. Group 1 was fed a normal diet as a control. Groups 2-4 were fed diets containing 5%, 10%, and 20% miso, respectively, and Groups 5 and 6 were fed diets containing 2.2% and 4.4% NaCl, respectively, for five weeks. Group 7 was fed a normal diet without carcinogen exposure. Dietary miso inhibited the development of ACF in a dose-dependent manner (y = -3.9x + 140, r = -0.94). Thus the mean numbers of ACF per colon were significantly lower in Groups 3 and 4 than in Group 1 (p < 0.01), and there were fewer aberrant crypts per colon in Group 4 than in Group 1. NaCl supplementation was associated with fewer ACF, but this was not statistically significant. 5-Bromo-2'-deoxyuridine labeling indexes in the colonic epithelium were significantly lower in Group 3 than in Group 1 (p < 0.05). The present results indicate that dietary miso could act as a chemopreventive agent for colon carcinogenesis.

今回, 我々はserrated adenomaの多発を認めた若年者大腸癌の1例を経験したので報告する. 症例は29歳の女性. 腹部腫瘤の自覚で近医を受診. 精査にて横行結腸に限局潰瘍型の腺癌とS状結腸から横行結腸にかけてポリープの多発を認めた.結腸右半切除術・D3のリンパ節郭清を施行した. 病理組織学的所見では限局潰瘍型病変は高分化腺癌 (壁深達度se, 脈管侵襲ly1, v1)) であった. 切除標本上の多数の小隆起性病変はhyperplastic polypとserrated adenomaであった.正常部・腫瘍部に対し遺伝子不安定性を検討したがreplication errorは認めなかった. 補助化学療法はテガフールーウラシル配合剤300mg/dayの経口投与を施行している. 術後経過良好にて軽快退院し, 術後18か月の現在, 癌の転移・再発, 第2癌の発癌は認めていない.

Mutations of the p53 tumor suppressor gene are the most prevalent genetic alteration observed in a wide variety of human cancers. In this study we examined 63 methylcholanthrene (MCA)-induced sarcomas from C57BL/6N x C3H/HeN F1 (BCF1) or C3H/HeN x C57BL/6N F1 (CBF1) mice for p53 gene mutations and loss of heterozygosity (LOH) of chromosome 11. Mutation analysis was done on exons 5 to 8 of the p53 gene by polymerase chain reaction-single strand conformation polymorphism analysis. This identified 53 potential mutations in 45 sarcomas. Mutations were further confirmed by direct sequencing of the region. Forty-nine of the 53 cases (94%) were missense mutations, while the rest included two nonsense mutations, one silent mutation and one insertional mutation. Spectra of base substitutions were: 25 cases (47%) of G:C-->T:A transversion, 13 cases (25%) of G:C-->A:T transition (CpG site 15%), 13 cases (24%) of G:C-->C:G transversion, a case (2%) of A:T-->T:A transversion and a case (2%) of insertion. In addition, analysis of 5 polymorphic markers of mouse chromosome 11 revealed LOH in ten cases (22%) among those carrying p53 mutations. In nine of these 10 cases, the loss involved all 5 markers. In addition, the loss was biased toward the C57BL allele (9 cases). The present study establishes the pattern of mutation of the p53 gene in MCA-induced mouse sarcomas.

症例は69歳女性で,下腹部痛・血便を主訴に来院した.注腸造影大腸内視鏡にて2型進行S状結腸癌と診断し,S状結腸切除術を施行した.病理学的には,ss,n1(+)の中分化腺癌であった.他院での2回の注腸造影写真をretrospectiveに検討すると,23カ月前に,ほぼ同一の部位に長径0.6cmのIsp型隆起性病変を認め,また8カ月前には,同部位に長径3.1cmの隆起性病変を認めていた.tumor doubling time(DT)は全経過で76.4日と極めて短期間であり,また前半で64.4日,後半で117.9日とむしろ後半で延長していた.分子生物学的検査では,p53蛋白の異常蓄積を認め,Ki-67が強陽性であり,急速な発育との関連が示唆された.今後は,遡及的検討例において,DTと分子生物学的検査との相関についてさらに集計・検討が必要と考えられた.

A rare case of adrenocortical carcinoma in an adult with vilirism is reported. A 25-year-old woman, with hirsutism, acne, and amenorrhea was diagnosed as having an androgen producing tumor of the right adrenal gland by abdominal computed tomography, ultrasonography and endocrinal examinations. We resected the tumor and performed lymph node dissection. The tumor had a smooth surface and a cystic region, but was not invasive. Histopathological study revealed adrenocortical carcinoma. Adrenocortical carcinoma with vilirism in adults is very rare, and have been only 14 cases reported in Japan previously. The prognosis of adrenocortical carcinoma is very poor, and additional follow up should be performed.

Recently, function-preserving operations have become popular, and pylorus-preserving pancreatoduodenectomy (PPPD) is frequently performed for diseases of the head of the pancreas. However, there are only a few basic studies on the pyloric function after PPPD. Using strain gauge force transducers (SGTs), we studied the pyloric motility of normal and PPPD dogs. We prepared three normal and three PPPD dogs in which the SGTs were implanted onto the antrum and pyloric ring, etc. In conscious dogs, the spontaneous gastrointestinal motility was recorded, and the plasma motilin concentration was measured during the interdigestive state. Following the administration of exogenous Leu13-motilin, the motility was again recorded. The relaxation and opening of the pyloric ring was observed synchronously with intense contractions of the antrum during the phase III of normal dogs. Phase III-like motility was recorded in the PPPD dogs, which was not a typical periodic motility. The plasma motilin concentration of one PPPD dog could be measured, and the motilin levels during the phase III-like motility were higher than during phase I. The phase III-like motility was induced by Leu13-motilin in both normal and PPPD dogs. The phase III-like motility recorded in the PPPD dogs was not a typical periodic one, and this aberrant motility was considered to be one of the causes of delayed gastric emptying. Phase III-like motility was induced by the administration of Leu13-motilin; therefore, it is possible that Leu13-motilin improved the motility of the pyloric ring after PPPD.

A study was conducted to clarify the mechanism of donor specific immunological unresponsiveness in renal transplant recipients with a well functioning kidney, since this might provide a clue to the nature of donor specific immunosuppression. Peripheral blood lymphocytes (PBL) were obtained from three renal transplant recipients, the donors (mother), the fathers and healthy volunteers as 3rd party and used in the present study. PBL from one of the three renal transplant recipients, which were donor specific unresponsive in MLR (Mixed Lymphocyte Reaction) and CML (Cell Mediated Lympholysis), suppressed the MLR, CML and synthesis of IL-2 from 3rd party PBL in a double chamber assay only when stimulated by the donor PBL. This suppression was abolished by the treatment with CD3 or CD8 antibodies and complement. RT-PCR was performed to investigate the suppressive effect of the recipient's PBL on IL-2 mRNA expression. In the double chamber MLR, expression of IL-2 mRNA by the PBL from 3rd party was also suppressed only when the recipient's PBL were stimulated by the donor PBL. These results indicate that one of the mechanisms responsible for donor specific immunological unresponsiveness is the presence of donor specific suppressor T cells in recipient's PBL and that these cells project suppressive effect on lymphocytes by producing a humoral suppressive factor(s) that suppress the expression of the IL-2 mRNA only when stimulated by donor PBL.

The therapeutic results of liver transplantation for primary liver cancer have not been satisfactory. The high rate of recurrence appears to be due to the inadequate care taken in selecting the most appropriate candidates for orthotopic liver transplantation (OLT), the presence of circulating hepatocellular carcinoma (HCC) cells and micrometastases at the time of liver transplantation, and the tumor growth-promoting effects of immunosuppressive agents. We believe that HCC patients must be carefully staged in order to identify those most suitable for OLT. We therefore induced HCC in pure-strain rats by the oral administration of diethylnitrosamine (DEN) and studied the outcomes of liver transplantation at various time points (70, 120, and 134 days) after the initiation of carcinogenesis. The mean survival time (MST +/- SD) of the non-OLT control group (N = 14) was 18.2 +/- 5 days after Day 120. The survival time of the four rats in the OLT Day 120 group was 81.3 +/- 20.6 days after transplantation. One rat showing full weight recovery soon after transplantation survived for 97 days after transplantation and then succumbed to recurrence. The survival time of the four rats in the OLT Day 134 group was 7.3 +/- 5.0 days after transplantation. The survival time of the three rats in the OLT Day 70 group was 145.3 +/- 70.0 days after transplantation, with a maximum survival of 221 days until death. Significantly prolonged survival, as compared with that in the non-OLT group, was observed in the OLT Day 70 and OLT Day 120 groups (p < 0.01), while there was no significant prolongation in the OLT Day 134 group (NS). The timing of liver transplantation is a very important factor. Preoperative assessment of factors potentially affecting recurrence in HCC patients is imperative for selecting the most appropriate candidates for OLT. Careful selection of candidates for OLT should always be considered the key to successful liver transplantation (i.e., long-term survival) for patients with liver cancer.

We have successfully managed a 34-year-old man with popliteal artery entrapment syndrome by a left popliteal artery bypass operation for intermittent left calf claudication; and by prophylactic transection of the right medial head of the right gastrocnemius muscle for the asymptomatic right lower extremity. Because the lower right extremity did not show ischemic symptoms in particular, but the popliteal artery showed interruption upon stress-angiography. Popliteal artery entrapment syndrome is an uncommon congenital disorder of the artery, caused by faulty insertion of the mediate gastrocnemius muscle caput or popliteal muscle. It is possible to inhibit progression of the disease by conservative therapy, but a cure cannot be expected. The choice of surgical procedure depends entirely upon the condition of the popliteal artery. When the popliteal artery has had no permanent structural changes, myotomy may prove to be curative. When structural changes have already occurred, in addition to the correction of the anatomic abnormalities, replacement of the artery with a vein or by thromboendarterectomy angioplasty may be required to restore flow. Most case reports indicate that unilateral correction is sufficient, but it is essential to examine both limbs, since bilateral corrections may be necessary. From our experience with this patient, we recognized the importance of a positive operative indication, because the prognosis for immediate restoration of flow to the extremity is excellent.

Leiomyosarcoma of the inferior vena cava (IVC) is a rare neoplasm of venous smooth muscle. A case of leiomyosarcoma of the IVC which was successfully resected by early detection is described. A 63-year-old woman was seen at the hospital because of right abdominal pain, and abdominal ultrasonography revealed a 26×21mm sized tumor in S1 portion of the fiver. The correct diagnosis was not made even by computed tomographic scan, magnetic resonance imaging and transhepatic biopsy of the tumor. An exploratory laparotomy was carried out and the tumor was resected together with the hepatic IVC by using the femoro-axillary V-V bypass. We reconstructed the IVC by a EPTFE graft with rings. Pathologically this tumor was leiomyosarcoma of the IVC. The tumor was 4.0×2.5×2.0cm in size, protruded to the surface of the lumen of inferior vena cava, and its outside was adjacent of the liver through capsula fibrosa. The postoperative course was uneventful. There has been no sign of recurrence as of 6 months after the operation.

胸腺カルチノイドは縦隔腫瘍の中で緩慢に発育する比較的稀な悪性腫瘍であり, 術後遠隔期にも再発を起す事が多い.当科で経験した胸腺カルチノイド3例の初回手術術式と再発形式について検討した。初回手術時に腫瘍の周囲への癒着を認めた症例は, 腫瘍を剥離摘出しており, 再発時に局所再発を来した.病理組織学的検査では, 腫瘍は被膜を有するが, 被膜内への腫瘍細胞の高度浸潤を認めた.初回手術時, 周囲リンパ節に転移を認めた症例は3例中1例であったが, 再発時にはすべての症例で縦隔リンパ節転移を認めた.従って, 手術術式では, 周囲組織を含めた切除が必要であり, 系統的縦隔リンパ節の郭清を要すると考えられた.また, 再発時でも再手術により長期生存が得られる可能性があり, 積極的に再切除を行うべきであると考えられた.

Ten cases of thyroid carcinoma in juveniles were experienced at the hospital in a recent 22-year period. These cases represented 1.6% of all 610 cases of thyroid malignant tumor operated on at the department. The age of the patients ranged from 9 to 19 years, and nine cases were female, except one case in a 9-year-old boy. Pathologically there were two cases of follicular carcinoma and eight cases of papillary carcinoma. Eight patients had a clinical carcinoma over the T2 stage, and two had an incidental carcinoma. Lymph node metastasis was observed in four cases, including N1a in two cases, N1b in two cases, and N0 in another six cases. One patient died of fluminent hepatitis, but nine patients are alive.

We experienced a case of malignant pheochromocytoma performed two times of resections for hematogenous metastatic lesions. A 41-year-old woman underwent a left adrenalectomy for a pheochromocytoma which was likely benign. Ten months after the operation, a metastasis to the first lumbar vertebra was found out and a laminectomy was performed. However, another metastasis in the caudate lobe of the liver was diagnosed and the third operation was performed one year and seven months after the left adrenalectomy. The patient died of multiple bone and liver metastase two years and three months after the initial operation.

維持透析患者の食道癌手術は侵襲が大きいと考えられるが, 今回我々は縦隔鏡, 腹腔鏡補助下食道抜去術を施行し, 良好な術後経過を得たので報告する.症例は59歳, 男性で, 透析歴は1年10か月, 原疾患は糖尿病. 下血, 嚥下困難を主訴として入院となり, 精査の結果, 食道胸部中部の進行食道癌と診断し, 食道抜去術を施行した. 手術用縦隔鏡を用い頸部から食道の剥離を行い, 腹腔側からは腹腔鏡補助下に剥離を行った.術中出血量は350mlと少なく, 本術式は維持透析患者に安全かつ侵襲の少ない食道癌術式と考えられた.

Controversy exists over how the nutritional condition of the donor liver affects transplant outcome. Some studies suggest that livers from fasted animals (liver glycogen-depleted) are more readily injured than livers from fed animals. Our previous study suggested the opposite, i.e., livers from donors fasted for 4 days were significantly more viable on orthotopic liver transplantation. Fasting may decrease the sensitivity of the liver to an inflammatory response or block Kupffer cell activation following transplantation. Thus, long-term fasting may be beneficial for reasons unrelated to liver glycogen content. In this study we attempted to separate out the roles of fasting and liver glycogen in liver transplant outcome by fasting donors for 2 days and then feeding them only glucose to elevate liver glycogen. Rats (Brown Norway) were fed (standard diet), fasted (4 days), or fasted 2 days and then fed glucose (in water) for 2 days. Livers were preserved for either 30 or 44 h in UW solution and transplanted. Four-day fasting of the donor improved the survival rate in liver transplantation (50%–100% in 30-h cold storage, 29%–83% in 44-h cold storage). However, feeding glucose for 2 days to fasted animals caused a decrease in survival in this series of transplants (40% in 30-h cold storage, 0% in 44-h cold storage). In the glucose-fed group, liver glycogen was 240% of that in the control group. This suggests that the presence of a high concentration of liver glycogen is not beneficial to the preserved and transplanted rat liver.