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To validate applicability of the novel hybrid meteorological model/engineering LES method to damage estimation of actual tornado events, simulation is performed focusing on the severely damaged area of the strong tornado on May 6, 2012 in the city of Tsukuba with the realistic tornado structure reproduced in the meteorological model, the actual building distribution, and the topography. The flows over the disaster-affected low-rise residential area show an evident converging character at a height close to the rooftops. Intense strong wind bands are formed by the influence of the buildings. The simulated maximum wind gust is compared with the distribution of actual building damage. It reveals that the hybrid method can reasonably estimate distribution of the building damage over the target area in the tornado event. The track nevertheless exhibits building-scale perturbation that may be attributed to chaotic randomness of the tornado behavior on the complex rough surface. Using the simulated aerodynamic force, simplified case studies on the occurrence and process of damage to two individual buildings is also presented.

A vesicular aggregate filled with lipid molecules exhibited crawling motion over a glass surface as a result of chemical reactions. The vesicular aggregate was composed of didodecyldimethylammonium bromide (DDAB) and sodium oleate with calcium ions. The crawling motion was induced by the chemical reaction between DDAB and iodide ions, and it caused discharge of the inner lipids. This was responsible for the size reduction of the aggregate. However, it engulfed the neighboring smaller vesicles, which were taken up into the vesicular aggregate in the dehydrated state and became a constituent of the aggregate. The size of the vesicular aggregate recovered and could translate in a sustainable manner. This is probably the first example of an amphiphilic molecular assembly that exhibits crawling motion as a result of chemical reactions without size reduction. This may be regarded as the cell-like behavior of an abiotic molecular assembly with a metabolic-like process.

A new hybrid meteorological model/engineering LES method was used to analyze a tornado and near-ground turbulence under realistic conditions. The hybrid method estimates high frequency turbulence regeneration in an actual severe storm that has complex thermal conditions in order to alleviate the problem of high frequency component dissipation in meteorological models and generate appropriate field data to investigate near-ground flow and wind loading on buildings. The high frequency regeneration method was validated in the convective boundary layer and the energy spectrum of the velocity field was successfully extended to higher frequency region in good agreement with −5/3 Kolmogorov law. Multi-scale simulations of a tornado were conducted based on meteorological model outputs with three different terrain conditions, including an actual urban building geometry and terrain, and the changes in the main tornado vortex and the interactions with near-ground turbulent field were examined. On roughened surfaces with uniform blocks and buildings, the main tornado vortex was connected to near-ground vertical vortices arising due to the urban geometry. The structure was significantly deformed, splitting into numerous finer vortices below several times the building height. These near-ground vortices create localized sharp pressure drop patterns and also affect the movement of the tornado. These effects of low pressure on buildings were quantitatively analyzed.

症例は62歳，男性．平成20年10月下旬より発熱症状あり，その後11月になり腹痛を認め，症状増悪したため当院受診．腹部CT検査で臍からやや尾側にかけて内部に気泡と液体貯留を要する直径約8cm大の腫瘍を認めた．消化管穿孔による腹膜炎，および腹腔内膿瘍の疑いで手術を施行したところ，腹腔内より中等量の膿性腹水とともに出血を呈しており，Treitz靱帯より約170cm部の小腸に認められた充実性腫瘤からの出血と考えられた．さらに，一部腫瘤近傍の正常腸管に穿孔を認めており，腫瘤を含め2カ所の小腸部分切除術を施行した．病理検査で腫瘤は小腸原発のGISTと診断された．今回われわれは穿孔性腹膜炎から発症し手術を施行した小腸GISTの1例を経験したので，若干の文献的考察を加えて報告する．

目的:乳癌細胞診におけるgrade分類法を提案し, histological gradeとの対比, 組織型, ER, HER2, 組織学的リンパ節転移 (n), grade分類に用いられる因子や再発との関連性について検討した.方法:対象は原発性浸潤性乳管癌50例である. Cytological grade分類は, 核径, N/C比, 核の多形性, 核小体, 核クロマチン, 核分裂像数の因子をスコア化しgrade 1～3に分類した.結果:Cytological gradeと, histological grade, ER, HER 2, nに相関が認められた. 多家によるgrading法を含めた各因子とnとの関連性についての検討では, nとクロマチン, 細胞の解離に相関が認められた. 再発症例の検討では, 再発とER, HER 2, nに相関が認められた.結論:Cytological grade分類は, histological gradeやその他の予後因子と相関が認められた. Gradingに用いる因子の検討では, 核径, 核の多形性, 細胞の解離が再発や予後との関連性が認められ, 重要であると思われた.

今回われわれは,子宮体癌術後に胃漿膜に発生したclear cell carcinomaの1症例を経験したので若干の文献的考察を加え報告する. 症例は50歳,女性.当院産婦人科にて平成14年10月に子宮体癌に対して子宮全摘+両側付属器切除術,術後化学療法を施行し経過観察していた.平成15年5月の腹部CT上脾門部周囲に腫瘤像を認め,その後増大を認めたため外科にコンサルトされた.精査の結果,原発性胃粘膜下腫瘍と診断し腹腔鏡下に手術を施行した.病理組織検査の結果,胃漿膜に発生したclear cell carcinomaの診断であった.さらに4カ月後に同部位近傍に再発病巣を認め平成16年5月に腹腔鏡下腫瘍切除術を施行した.病理組織検査の結果,前回同様のclear cell carcinomaの診断であった. 術後6カ月現在,明らかな再発を認めていないが,症例の蓄積がなく今後も厳重な経過観察が必要と考えられた.

症例は71歳男性.胃体上部後壁の進行胃癌の診断にて,平成15年1月8日,胃全摘術および膵体尾部,脾合併切除術を施行した.術後,ウィンスロー孔へ挿入していたドレーンによる圧迫壊死のため挙上した空腸に穿孔をきたしたが,保存的に治癒し退院した.同年6月30日,右側腹部腹壁膿瘍にて入院し切開排膿ドレナージを施行した.上部消化管造影検査にて,前回手術後に発生した挙上空腸の穿孔部から造影剤の漏出を認めたため,同部が難治性瘻孔となって長期間存在し,腹壁に膿瘍を形成したものであると診断した.その後瘻孔は閉鎖せず,経内視鏡的に瘻孔内にヒストアクリルを注入したところ,瞬時に瘻孔は閉鎖し経口摂取が可能となった.消化管に発生した難治性瘻孔は治療に難渋するが,ヒストアクリルを用いて瘻孔閉鎖に成功したという報告はわれわれが検索した限り,過去1例のみであった.本法は極めて簡便であり,試みてみるべき治療法の-つであると考えられた.

症例は86歳,女性.食思不振およびタール便を主訴に近医を受診した.近医にて行った血液検査で,貧血と著明なCEA値の上昇を指摘され,消化管の精査目的で当科入院となった.胃内視鏡検査で,前庭部小彎に2型の進行胃癌,腹部CT検査では胃前庭部の腫瘍濃染像と胆嚢壁の肥厚像を認めた.胃癌の診断で幽門側胃切除術(D1)を施行したが,術中,胆嚢が非常に硬く触知されたので胆摘術を追加した.手術所見はH0P1T3N1のStage IV胃癌であった.胆嚢は壁は硬いが,肉眼的に粘膜面は正常であった.病理組織学的に,胃癌は,大きさ85×70mm, 2型,腺扁平上皮癌, se,1y3, v2であり,胆嚢は,主として間質内を中心に増殖する腺癌で,胃癌の腺癌成分の組織像と同一であった.以上より胃癌の胆嚢転移と診断した.胃癌の胆嚢転移は極めて稀であり,本邦で過去4例の論文報告例があるのみである.中でも胃腺扁平上皮癌の胆嚢転移はわれわれが検索した限りでは報告例がなかった.

症例は86歳,男性.吐血を主訴に当院内科を受診し,食道静脈瘤破裂と診断された.止血目的に施行した内視鏡的食道静脈瘤結紮術(EVL)中に縦隔脂肪が観察された.その直後の食道造影にて造影剤の食道壁外への流出を認め,医原性食道穿孔と診断した.頸・胸部CTでは,頸部から気管分岐部にまで及ぶ広範囲な縦隔気腫像を認め,発症5時間後に緊急手術を施行した.右開胸し,胸腔内からと左頸部創の両方からアプローチしたが,穿孔部は頸・胸境界部食道であり,直視下に確認できなかった.一期的縫合は断念し,有茎肋間筋弁を作製し,穿孔部に充填した.術後は合併症なく経過し, 4週後より経口摂取を開始した. 食道穿孔および破裂に対する手術法は多種報告されているが,肋間筋弁を充填したという報告は過去1例のみである.今回われわれは,医原性食道穿孔患者に対して,肋間筋弁充填術を施行し,良好な結果が得られたので若干の文献的考察を加え報告する.

手術胃癌478例のうち70才以上の高令者が34.1%を占めた。70才以上を70才代 (29.3%) と80才以上 (4.8%) に分けて, 69才以下 (65.9%) 群を対照として検討した。70才代では, 3群のなかでもっとも早期癌が少なく進行癌が多く, リンパ節転移率が高く, 腹膜播種や肝転移も多く, 治癒切除率が低かった。80才以上では, 早期癌率が高いものの進行癌も多く, 早期か進行かのどちらかという傾向であった。80才以上には手術はひかえめになされてR2郭清は68.4%と低かったが, リンパ節転移率も低かったので, 切除例における治癒切除率は84.2%でもっとも高かった。80才以上の占居部位は幽門前庭部が多く, 小彎・後壁が減って, 大彎・前壁が増える傾向がみられた。また, 分化度の高い限局型が多かった。80才以上では手術危険度は高いが手術には十分耐えられるものが多く, 術後合併症の予防に十分な注意を払いながら積極的に切除し, R2郭清をめざすことが治療成績の向上をもたらすものと考える。

手術胃癌478例について検討した。男294例, 女184例, 男女比1.6であった。70才以上群 (高令群) と69才以下群 (非高令群) とで比較すると, 高令群に男が多い傾向がみられた。全胃癌に占める高令群の割合は34.1%で全国集計より高かった。高令群では胃集検や健康診断による発見例は少なく, stage IVが多く, 非切除がやや多く, 胃全摘が少なく, 切除術がやや低かった。癌病巣数は多発傾向がみられた。占居部位や拡がりおよび組織型では, 上部が少なく下部が多く, 前壁・全周が多く, 高分化型の限局性のものが多い傾向がみられた。手術直接死亡率は差を認めなかったが, 5年生存率は不良で他病死の影響が示唆された。高令者では, 既往症, 術前合併症が92%に, 術前検査値異常は96%にみられ, 術後合併症は42%に発現した。術後は精神障害に対する配慮が必要である。高令者であっても手術可能な症例には積極的に根治手術を目指して手術に臨むべきであるが, 胃全摘には慎重に対応すべきであると考える。術前のリスク評価を慎重にして充分な前準備のもとに根治手術を施行すれば, 高令者も非高令者と比べて大差ない治療成績とQOLが得られるものと考える。

1978年から1989年までの12年間の大腸癌手術症例304例について検討した。結腸癌56.8%, 直腸癌43.2%で, 比率1.3と結腸癌が多かった。男女別では性差はない。年令区分では60才代28.0%がもっとも多く, 70才代24.0%が次ぎ, 50才以上が86.5%を占めた。有症状の外来症例が95.1%と大部分で, 検診などの無症状発見例は少数であった。癌の占居部位別頻度では, 結腸癌ではSが39.4%でもっとも多く, Aが次ぎ, 直腸癌ではRbが50.7%であった。大腸を左右に分けて比較すると, 左側が74.8%を占めた。切除率は91.5%, 治癒切除率は71.8%であった。組織学的病期分類では, stage I11.7%, II30.9%, III21.8%, IV11.7%, V23.8%であった。5年生存率は平均57.1%であった。術前検査でのCEA陽性率は46.6%に過ぎず, とくに早期のものの陽性率はきわめて低く, 補助診断としての有用性は認めなかった。

We report on a very rare case of peritoneal clear cell adenocarcinomas. A 49-year-old Japanese woman underwent hysterectomy and bilateral salpingo-oophorectomy for endometrial endometrioid adenocarcinoma grade III, which was composed of undifferentiated carcinoma cells (98%) and tubular carcinoma cells (2%). No clear cell adenocarcinoma elements were noted in this tumor. Two peritoneal cystic tumors were detected by imaging modalities around the stomach and spleen, 15 months and 21 months after the follow-up period of the endometrial carcinoma, respectively. These two tumors were surgically resected. They were cystic tumors encapsulated by fibrous capsules and showed the same morphologies. They showed proliferation of carcinoma cells arranged in solid nest, tubular, and papillary patterns. They showed clear cytoplasm positive for periodic acid-Schiff stain, hobnail cells, and occasional hyaline globules. The morphologies fulfilled the criteria of clear cell adenocarcinoma. The morphologies and immunohistochemical findings of the two peritoneal clear cell adenocarcinomas were different from those of endometrial carcinoma. We believe that the two clear cell adenocarcinomas are not metastatic lesions from the endometrial carcinoma of the uterus, and that they are primary clear cell adenocarcinomas of the peritoneum. Our case was characterized by cyst formations and encapsulation in addition to the common histological features of clear cell adenocarcinoma of the uterus and ovary.

We report a rare case of minute (5 mm x 4 mm) mixed ductal-endocrine carcinoma of the pancreas with predominant intraductal growth. A 34-year-old Japanese man was admitted because of elevated serum pancreatic enzymes. Endoscopic retrograde pancreatography revealed an unidentified material of 18 mm within the main pancreatic duct. Stone or parasite with acute pancreatitis was suspected clinically, and the biopsy revealed malignant cells positive for CA19-9, carcinoembryonic antigen (CEA) and synaptophysin. No apparent tumor was identified in the pancreas by various imaging techniques. Resection of pancreatic body and tail was performed. Grossly, the main pancreatic duct in the pancreatic body was occluded by as much as 20 mm. The pancreas had minute carcinoma of 5 mm x 4 mm just around the occluded main pancreatic duct. The tumor cells invaded the main pancreatic duct and spread within it as long as 20 mm. Histologically, the carcinoma had biphasic pattern; one was ductal carcinoma with tubular formations and another was carcinoma with neuroendocrine features. These two elements were admixed, and the ductal element comprised 30% while the endocrine element comprised 70%. The ductal element was immunoreactive for cytokeratins, CEA and CA19-9, while the endocrine element was immunoreactive for chromogranin A and synaptophysin. No immunoreactivity for pancreatic enzymes was noted. Ultrastructural observations showed dense core granules and no zymogen granules. Our case is unique clinically in that the tumor manifested as an intraductal material and no apparent tumor was found by imaging modalities, and pathologically in that the tumor was rare mixed ductal-endocrine carcinoma and the tumor was very small and mainly grew within the main pancreatic duct.

Restriction landmark genomic scanning (RLGS) was utilized to identify novel genomic alterations in hepatocellular carcinoma (HCC). Thirty-one HCC samples were examined by RLGS. Two high intensity spots were common to several RLGS profiles of different HCCs. Nucleotide sequencing and homology search analysis showed that these spots represented repetitive sequences, Human tandem repeat sequence (Genbank, L09552) and centromeric NotI cluster (Genbank, Y10752). These intensified signals were attributable to the occurrence of demethylated areas in the recognition sequence of the NotI site of the corresponding fragments. The intensity of these spots in the RLGS profile reflects their degree of demethylation, which was significantly correlated with postoperative recurrence, even in patients regarded as belonging to the good prognosis group by conventional prognostic factors. Multivariate analysis showed that the intensities of the two spots retained independent prognostic value. This is a new type of predictive factor for HCC based on epigenetic changes in hepatocarcinogenesis, and in the future it is expected to be of great value in making preoperative diagnosis and selecting postoperative therapy.

Axillary dissection has been considered essential for breast cancer staging because nodal metastasis is the most powerful predictive factor for recurrence. On the other hand, morbidity, such as lymphedema and shoulder dysfunction, may occur. Sentinel node biopsy is a good way to avoid unnecessary axillary dissection. We used tin colloid as a carrier of Tc99m tracer together with the blue dye method. The detection rate of the sentinel node was 27 cases out of 29 (90%) for the blue dye method, 10 cases out of 19 (53%) for the Rl method, and 27 out of 33 (82%) for the combined method. The detection rate of the Rl method was improved after adding the subcutaneous injection over the tumor from 45% before adding the subcutaneous injection to 82% after adding it. The false negative rate was 11% for the blue dye method, 0% for the R1 method, and 10% for the combined method. This yields a sensitivity of 89% for the blue dye method, 100% for the R1 method, and 90% for the combined method. Specificity was 100% for all three methods. Accuracy was 96% for the blue dye method, 100% for the R1 method, and 96% for the combined method. There were two false negative cases. The average number of sentinel lymph nodes was 2.12 for the dye method, 1.66 for the R1 method, and 1.95 for the combined method. There were three of 49 cases with identified parasternal lymph nodes by R1 imaging. Lymphatic mapping using tin colloid may be useful for detecting sentinel nodes.

Leiomyosarcoma of the rectum is rare. Experience with a patient in our department prorated a review of the Jpanese medical literature. Our patient was a 49-year-old woman, who was seen in consultation because of anal mass and difficult defecation. A hemishperic tumor was noted in the lower rectum. Biopsy revealed leimyosarcoma. Abdominoperineal resection with lymph node dissection was performed. The tumor size was 7×6×4cm. The patient was well in July, 1985, 2 years after the operation. In a review of the Japanese midecal literature, we found 83 cases including ours, 44 (54%) of whom were in the fifth and sixth decades of life. There were 49 men, 32 women, and two whose sexes were not mentioned. The main symptoms were anal bleeding, bloody stool, anal pain, difficult defecation and sensation of anal mass. The anal margin of most tumors (89%) was between the anal margin and 5cm above it, 45 (59%) had tumors between 5 and 10cm in diameter, and 38 (46%) manifested ulceration. At surgery, invasion to local tissues was noted in 25 (30%), and lymph nodes metastasis in four (5%), while no distant metastasis was noted. Twenty-nine patients died of recurrence five years after the operation. Because of occasional discrepancies between histological malignancy and clinical course, leimyosarcoma of the rectum should be treated by abdominoperitoneal resection with lymph node dissection in general.

Postgastrectomy intussusception is an important disease, although rare, because it can be lethal without early treatment. We report a case with hematemesis 15 years after gastrectomy. A 57-year-old male had often complained of dumping syndrome after gastrectomy with the B-II method (antecolica with Braun's anastomosis). No ulcer was present at anastomosis. The tumor at the lower abdomen, which was the size of an infant's head, was proved to be intussusception with US and CT. A 150cm of section of anal jejunum was ascendingly invaginated into the anastomosis, forming the tumor. Circulation of the intestine was preserved, and resection was not done. Recently US has become a useful method for ileus as well, and it provides characteristic findings of intussusception. When ileus or hematemesis is shown after gastrectomy, intussusception should also be considered, and treatment must be started without delay.

A 55 year-old male with traumatic rupture of the pericardium, diaphragm and spleen, and with crush of the pancreas was successfully operated upon. The diagnosis of rupture of the diaphragm was done on the chest X ray on admission, and the rupture of the pericardium was diagnosed at the time of laparotomy and thoracotomy. The ruptured spleen and the crushed pancreas tail were removed, and the ruptured pericardium and diaphragm were closed successively.