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During routine ultrasound examination, a hyperechoic mass was detected in the anterior segment of the liver in an 80-year-old woman with hepatitis C virus-related cirrhosis. Computed tomography and magnetic resonance imaging findings suggested a malignant tumor with abundant fibrous stroma, similar to cholangiolocellular carcinoma. However, subsequent partial hepatectomy revealed a mass characterized by abundant fibrosis without tumor cells, dilated blood vessels, and marginal ductular reaction. Accordingly, focal confluent fibrosis was diagnosed. Generally, the diagnosis of focal confluent fibrosis is straightforward because of its well-established imaging characteristics. However, its differentiation from a malignant tumor can occasionally be difficult because of variation in presentation depending on the amount of fibrous stroma and the degree of inflammatory cell infiltration. In the present case, diagnosis was difficult because the lesion was more localized than usual, presenting a mass-like shape, and there was obvious hyperintensity on T2-weighted imaging and ring-shaped hyperintensity on diffusion-weighted imaging. Moreover, hepatic capsular retraction was indistinct, which can be one of the key findings of focal confluent fibrosis. When a hepatic mass is associated with a fibrous lesion, focal confluent fibrosis should be considered in the differential diagnosis, even though the lesion is associated with several atypical findings.

An octogenarian man complaining of bloody stool was referred to our hospital. A digital examination, abdominal enhanced CT and endoscopy led to a diagnosis of intussusception due to rectosigmoid colon cancer, but he was not suffering from bowel obstruction. An elective laparoscopic Hartmann's operation was performed after reduction by transanal insertion of a circular sizer. It may be difficult to reduce an intussusception induced by rectal cancer. We report this case with a review of the relevant literature.

Background Sclerosing mesenteritis is a non-neoplastic inflammatory disease that occurs in the bowel mesentery. Distinguishing sclerosing mesenteritis from neoplasms may be difficult because of the clinical and radiographic similarities between the two disease entities. Case presentation We report a case of sclerosing mesenteritis mimicking peritoneal metastases of colorectal carcinoma. A 73-year-old man with stage II descending colon adenocarcinoma with poor prognostic features was found to have developed left lower abdominal quadrant masses on computed tomography (CT) 9 months after undergoing radical surgery. These masses were diagnosed as peritoneal metastases because they grew in size and displayed fluorodeoxyglucose (FDG) uptake 3 months later; thus, a laparotomy was performed. The masses, which were localized in the jejunal mesentery, were excised completely via segmental jejunal resection. Histopathological analysis confirmed that the masses were sclerosing mesenteritis. The patient showed no signs of sclerosing mesenteritis or colorectal carcinoma recurrence during follow-up. Conclusions In patients suspected of having localized peritoneal metastasis from malignancies, any masses must be sampled by surgical excisional biopsy and subsequently examined to rule out alternative diagnoses, such as sclerosing mesenteritis.

A 67-year-old man was treated for diabetes mellitus by his family doctor. A splenic tumor was suspected based on his pain in the left side of the abdomen. He was admitted to our hospital for close inspection and medical treatment. Abdominal CT and MRI scans showed a tumor, 10 cm in diameter, in the spleen. An opaque boundary with the diaphragm was also observed. On PET-CT, accumulations of FDG were observed in the left supraclavicular fossa and the left axilla. The serum levels of LDH and sIL-2R were elevated, and therefore a diagnosis of malignant lymphoma was suspected. Due to the risk of splenic rupture, a splenectomy was performed. After pathological examination, the patient was diagnosed with diffuse large B-cell malignant lymphoma. He is currently being treated with chemotherapy at another medical institute. Splenic rupture occurs in some cases of splenic malignant lymphoma, although the number of reported cases is low. In some of the cases, splenic rupture occurred during treatment of the malignant lymphoma. There is no specific way to measure the risk of splenic rupture; however, performing a prophylactic splenectomy is one option in cases where tumor cells have extended to the capsula lienis, similar to that in our patient.

まれなRhabdoid featureを呈した巨大直腸癌を報告する．症例は75歳の男性で，肛門痛，肛門出血を認め，近医を受診した．肛門皮膚に浸潤した腫瘍を認め，直腸癌疑いにて当科入院となった．大腸内視鏡検査にて直腸Rbから肛門皮膚にかけて全周性で約10cmの腫瘍を認めた．腹部CT，MRIにて直腸下部から肛門にかけて巨大腫瘤を認め，仙骨前面に浸潤が疑われ，直腸切断術を施行した．病理組織学的診断では腫瘍細胞は核が偏在し，好酸性の細胞質を有していた．免疫染色ではcytokeratin，vimentinに陽性であり，電子顕微鏡像では細胞質内の渦巻状の中間径フィラメントの集族により核は圧排されていた．以上より，rhabdoid featureを呈した直腸癌と診断した．術後2か月で左鼠径部リンパ節転移を認め，化学療法を開始するも，術後5か月で死亡した．Malignant rhabdoid tumorの多くは幼小児期に発生する予後不良な腎原発腫瘍であり，消化管でrhabdoid cellを認めることはまれである．

膵内副脾に発生した嚢胞性疾患は極めて稀であり，世界でも報告は50例に満たない．今回われわれは膵内副脾に発生した上皮嚢胞の1例を経験したので報告する．症例は68歳，女性．発熱を主訴に当院内科受診．精査の結果，肺炎の診断にて入院となったが，その際の腹部CTにて膵尾部に径3cmの嚢胞を伴う腫瘤性病変を認めた．退院後，各種画像学的検査を施行したが，造影MRIにて同病変は嚢胞部と三日月状の充実部に分かれており，充実部は脾臓と同程度の信号を示した．結果，鑑別診断として膵内副脾に発生した嚢胞性疾患やsolid-pseudopapillary tumorが疑われた．手術加療を希望されたため，当科紹介となり膵尾部切除・脾合併切除術が施行された．術後病理学的検査所見にて，腫瘤は膵尾部に連続した形で存在した副脾であり，内部に嚢胞を認めた．また，壁の外側が膵組織であったため，膵内副脾に発生した上皮嚢胞の診断となった．

患者は42年前に腸骨骨髄炎にてS状結腸に人工肛門が造設され40年前に閉鎖された既往のある58歳の男性で，人工肛門閉鎖創からの膿排出を主訴に来院した．創部に便汁の排出を伴う瘻孔形成を認め，瘻孔造影検査，注腸透視検査では結腸癌による結腸皮膚瘻の形成と考えられた．内視鏡検査にてS状結腸に2型腫瘍を認め，生検にて腺癌と診断した．CT所見はS状結腸癌の腹壁浸潤であり，明らかな転移を認めなかった．腹壁浸潤，皮膚瘻を伴うS状結腸癌と診断し，リンパ節郭清を伴うS状結腸切除と腹壁合併切除を施行した．病理組織学的検査所見上，癌は皮下まで浸潤した中分化型腺癌であり，皮下膿瘍を介して皮膚瘻を形成していた．根治度はAであった．本症例は腹壁の筋膜欠損という脆弱な部位から癌が皮下まで浸潤し，膿瘍を介して皮膚縫合部に瘻孔を形成したものであり，皮膚瘻形成には手術創による腹壁の脆弱性が関与していると考えられた．

患者は59歳の女性で, 健診の腹部超音波検査で膵臓に異常を指摘され, 近医受診し, CT, MRIにて膵体部に充実性腫瘤を認めたため, 当科紹介入院となった. 入院時の身体所見, 血液検査では特に異常を認めなかった. CT, 血管造影にて膵体部に造影早期から強く濃染される約2cmの充実性腫瘤を認めた.嚢胞成分は伴っていなかったが, MRIのT2強調では血液成分よりも高信号を示し, 漿液性の液体成分に富む腫瘤と考えられた. 以上より, 漿液性. 胞腺腫が疑われたが, 内分泌腫瘍も否定できないため, 膵体尾部切除術を施行した. 割面の肉眼所見では嚢胞成分は存在せず, 充実性腫瘍であったが, 病理学的には漿液性嚢胞腺腫と診断された.画像所見, 肉眼所見で嚢胞成分を伴わず充実性を呈した膵体部漿液性嚢胞腺腫は極めてまれで, 文献的考察を加え報告する.

比較的稀な転移形式である髄膜播種を伴った劇症型乳癌を経験したので報告する.症例は右乳房腫瘤と複視を主訴に外来を受診した62歳の女性.既に遠隔転移(骨,肝)を伴う右乳癌(T2, N1以上, M1, Stage IV)で,ホルモンレセプター検索のために乳房切除のみを行った.複視の原因は当初は小脳橋角部の髄膜腫によるものと考えられていたが,術後新たに脳転移が出現したため, γ-ナイフ治療を行った.これにより脳圧亢進症状は改善したが化学療法を導入する間もなく急速に進行した肺癌性リンパ管症により患者は全経過3カ月余りで死亡した.剖検では,広範な血行性転移,髄膜播種,腹膜播種および全身のリンパ節転移を認め,複視は髄膜播種が局所的に増大したことが原因であると診断された.乳癌は癌腫の中でも比較的予後良好で経過も長いとされているが,稀に発症後急速に進展して死の転帰をとる劇症型が存在する.本例は急激な経過より劇症型乳癌と考えられた.

分節型胆嚢腺筋症に合併した石灰乳胆汁に対し,腹腔鏡下胆嚢摘出術を施行した症例を経験したので報告する.症例は72歳,女性.近医にて肝機能障害を指摘され精査加療目的に当科紹介となった.入院時検査成績では肝胆道系酵素の上昇を認めた.腹部単純X線で右上腹部に立位で鏡面形成を示す石灰化陰影を認め,石灰乳胆汁が疑われた.腹部超音波,腹部CT, 腹部MRIにて胆嚢頸部の分節型胆嚢腺筋症に合併した石灰乳胆汁と診断し,腹腔鏡下胆嚢摘出術を施行した.胆嚢頸部に分節型の胆嚢腺筋症を認め,それより底部側は糊状緑色の石灰乳胆汁が充満していた.病理組織検査にて胆嚢腺筋症と診断された.術後経過は特に問題なく第8病日に退院となった.分節型胆嚢腺筋症に合併する石灰乳胆汁は極めて稀であり,文献的考察を加え報告する.

Aim: Several surgical procedures have been developed for reducing portal vein pressure to prevent postoperative liver injury. Nitric oxide synthase expression (NOS) induced by elevation of portal vein pressure is thought to play an important role in liver regeneration, but the details are not well understood. Methods: Rats in the control group and in the subcutaneous splenic transposition (SST) group underwent 90% partial hepatectomy. Survival and portal vein pressure were analyzed. The serum IL-6 and TNF-α levels were measured by enzyme-linked immunosorbent assay (ELISA). Hepatocyte proliferation and apoptosis 12 hours after hepatectomy were analyzed immunohistochemically. The protein and messenger RNA expression of inducible and endothelial NOS were analyzed using Western blotting and quantitative reverse transcriptase polymerase chain reaction, respectively. Results: The survival rate of the SST group was significantly higher. Portal vein pressure, TNF-α level and the apoptotic index were significantly lower in the SST group. Twelve hours after surgery, liver inducible NOS (iNOS) protein expression was significantly lower in the SST group. However, protein expression of endothelial NOS was not significantly different between the groups. Conclusion: Inducible NOS expression after extended hepatectomy is related to the effects of porto-systemic shunting on the splanchnic circulation. Also, iNOS induction and concomitant nitric oxide generation appear to participate in the cytotoxicity of excessive portal pressure after extended hepatectomy.

We report a 47-year-old man with abdominal distension without other distinct signs. Massive ascites with any singular lesions was revealed on computed tomography, and the ascites was high-amylase and high-protein. on these findings, pancreatic ascites was suspected and he was first treated with conservative therapy, but it failed. Computed tomography one month from the start of therapy demonstrated a pancreatic cyst, and endoscopic retrograde pancreatography revealed transudation of contrast medium from the cyst. A pancreatic duct stent was placed, and the ascites was smoothly eliminated. Endoscopic pancreatic stenting is considerable treatment for pancreatic ascites.

Characteristics of piezoelectric dampers built with piezoelectric materials were investigated as part of a smart structural system for buildings. Piezoelectric materials can be applied not only to the sensors and the actuators, but also to the dampers. Here, first the damping mechanism and the complex stiffness for a piezoelectric damper were derived from the piezoelectric equations. Then, based on the complex stiffness and Biggs's formula, an equation used to evaluate the damping performance for building structures with piezoelectric dampers was derived. Finally, to determine the applicability and availability of piezoelectric dampers, the habitability of a building with piezoelectric dampers to strong wind was investigated for a high-rise steel apartment building. The results show that piezoelectric dampers enable high-rise apartments of practical dimensions to satisfy H-2 grade habitability.