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われわれが経験した十二指腸球部後壁のgastrointestinal stromal tumor（以下GIST）に対する十二指腸部分切除術の1例を報告する．症例は53歳，男性．黒色便の精査で施行された上部消化管内視鏡検査で十二指腸球部に20mm大の粘膜下腫瘍を認めた．超音波内視鏡検査および生検よりGISTが疑われた．腹部CT検査で原発巣は境界明瞭であり，浸潤および転移所見を認めなかった．以上より転移のない十二指腸GISTと診断し腹腔鏡下十二指腸部分切除術を施行した．腫瘍は球部の後壁に位置した．腹腔鏡下に全層を部分切除し，切除部を鏡視下に縫合閉鎖した．手術時間は229分，出血量はカウント外少量であった．術後合併症なく第9病日に退院となった．病理組織学的検査所見ではlow risk GISTと診断された．自動縫合器の使用できない後壁の腫瘍でも腹腔鏡下に切除可能であった．十二指腸GISTに対する腹腔鏡下十二指腸部分切除術は，腫瘍の大きさおよび局在によっては考慮すべき術式と考えられた．

Synchronous rotating cavitation is known as one type of cavitation instability, which causes synchronous shaft vibration or head loss. On the other hand, cavitation in cryogenic fluids has a thermodynamic effect on cavitating inducers because of thermal imbalance around the cavity. It improves cavitation performances due to delay of cavity growth. However, relationships between the thermodynamic effect and cavitation instabilities are still unknown. To investigate the influence of the thermodynamic effect on synchronous rotating cavitation, we conducted experiments in which liquid nitrogen was set at different temperatures (74K, 78K, and 83K). We clarified the thermodynamic effect on synchronous rotating cavitation in terms of cavity length, fluid force, and liquid temperature. Synchronous rotating cavitation occurs at the critical cavity length of Lc∕h≅0.8, and the onset cavitation number shifts to a lower level due to the lag of cavity growth by the thermodynamic effect, which appears significantly with rising liquid temperature. Furthermore, we confirmed that the fluid force acting on the inducer notably increases under conditions of synchronous rotating cavitation.

脾膿瘍は比較的稀な疾患であるが, 今回われわれは結腸癌が脾臓近傍まで浸潤し脾膿瘍を形成した症例を経験したので報告する. 症例は72歳の男性. 発熱にて来院し, 血液検査にて貧血, 白血球増多, CRP上昇を認め血液培養陽性で敗血症の診断にて入院となった. 腹部超音波検査, 腹部CT検査にて脾膿瘍を認めた. 大腸内視鏡検査にて下行結腸脾彎曲部に2型の腫瘍を認めた. 下行結腸癌穿通による脾膿瘍, 膵浸潤の術前診断で下行結腸, 横行結腸部分切除術, 脾臓摘出術, 膵尾部合併切除術を施行した. 摘出標本では, 病理組織学的には膵浸潤を認め, 脾臓近傍まで癌が浸潤し, 脾膿瘍が確認された. 本症例のように結腸癌の穿通による脾膿瘍が疑われる場合は手術による切除が第一選択と考えられる.

Poly[(phenylsilylene)ethynylene-1,3-phenyleneethynylene] (abbreviated MSP) which contains SiH and C⋮C bonds, produces a very highly thermally stable polymer by curing above 150 C. In this study, we determined the thermosetting mechanism of MSP using 13C and 29Si solid-state NMR methods and computational chemistry. From these results, we concluded that the intermolecular cross-linking reactions due to (1) the DielsAlder reaction between PhC⋮C and C⋮C and (2) the hydrosilylation reaction between SiH and C⋮C proceed above 150 C, and a very highly thermally stable structure is formed. Only the hydrosilylation reaction occurs above 300 C.

The case was a 70-year-old man with type-2 gastric cancer in the lesser curvature accompanied by multiple liver metastases. He received combination chemotherapy of S-1 and CDDP. S-1 was administered at 100 mg/body/day for 21 days followed by withdrawal for 14 days, and CDDP was prescribed at 80 mg/body/day div on day 8. After 3 courses of treatment, the multiple liver metastases disappeared. The primary gastric lesion had changed to a scar and endoscopic biopsy revealed no cancer cell. After the 4th course, we changed the therapy to S-1 alone and after that to UFT alone. Now, 3 years and 3 months after inducing CR, the patient continues to receive UFT with no regrowth of the tumor.

A 74-year-old male with advanced gastric cancer(cT3N1M0H0P0CY0, cStage III A)was treated with paclitaxel/ CDDP as neoadjuvant chemotherapy. Paclitaxel (80 mg/m(2)) and CDDP (25 mg/m(2)) were administered on days 1, 8 and 15 as one cycle. After the second course, a significant tumor reduction was obtained. Total gastrectomy, splenectomy, and D2 type nodal dissection were performed. The histological diagnosis revealed complete disappearance of cancer cells in the stomach and all of the lymph nodes, a so-called pathologically complete response. The patient has now been in good health without any recurrence for 9 months after surgery. This case suggests that neoadjuvant chemotherapy with paclitaxel/CDDP is a potential regimen for advanced gastric cancer.

Localization of Early-Stage Dysplastic Barrett's Lesions in Patients with Short-Segment Barrett's Esophagus

症例は64歳の男性で，2002年6月に他院で直腸癌に対し超低位前方切除術を施行し（stage I），術後は当科にて経過観察していた．2004年6月には右肺S1転移に対して右上葉切除術を施行した．2006年7月のCTにて膵尾部に低吸収域を認め，当初は膵臓の炎症性腫瘤を最も疑い経過を見ていた．緩徐な増大の経過であったが，2007年4月のCTで膵腫瘍は明らかに増大した．ERCP施行にて膵管の途絶像を認め，擦過細胞診でclass Vとなり，膵癌の術前診断で同年6月に膵体尾部切除術を施行した．病理組織学的検討により前回の肺転移病巣と今回の膵病変の組織像は酷似しており，CK7, CK20による免疫組織学的検討により，ともにCK7陰性，CK20陽性で，直腸癌の異時性孤立性転移と判断した．術後12か月現在無再発にて経過観察中である．

Soluble poly(p-phenylene) derivatives with fused thiadiazole units as well as their model compounds were synthesized and characterized by electron affinity, X-ray analysis, and n-doped conductivity.