Search

Background: Appendicitis caused by a foreign body is extremely rare. We report a case of chronic appendicitis caused by a perforating fish bone. Case Report: The patient was a 50-year-old Japanese man. He felt dull lower abdominal pain for 2 months and diagnosed as appendicitis caused by a perforating fish bone. He underwent emergency laparoscopic surgery. The fish bone had perforated through the appendix wall. The fish bone was initially removed followed by laparoscopic appendectomy. Pathological investigation revealed a transmural cut line of approximately 0.5 mm that was surrounded by fibrous tissue with inflammation. Conclusion: This is the first reported case of fish bone-induced chronic appendicitis that underwent laparoscopic appendectomy. For optimum outcome, a correct diagnosis based on a detailed consultation and imaging tests, and an operation performed after careful planning are needed.

The accidental ingestion of foreign bodies is a common clinical issue. While most foreign bodies pass through the gastrointestinal (GI) tract without complications, a few cases unfortunately result in GI perforation. Fish bones are one of the most frequent foreign bodies found in the GI tract, and they are high-risk objects for GI perforation due to their hard and sharp-pointed ends. Here, we present a rare case of a 64-year-old man with perforation of a colorectal tumor by a fish bone. The patient received emergency Hartmann's operation with lymph node dissection. Although the patient experienced recurrence in the liver rather than peritoneal dissemination, systemic chemotherapy was considerably effective, and conversion therapy with hepatectomy was successfully performed; the patient achieved 5-year relapse-free survival after the operation. To our knowledge, this is the first report of the perforation of a GI tumor by a fish bone. This rare case suggests the significant clinical implication that proper preoperative diagnosis and prompt surgical treatment lead to better postoperative outcomes for patients with tumor perforation by a foreign body.

Perirectal abscesses often occur in the dorsal portion of the perirectal tissues. We report a patient who presented with fever, pain on defecation, and dysuria. He was found to have a perirectal abscess in the anterior perineum pressing on the urethra. After emergency surgery to drain the abscess, the symptoms improved., We present a case of perirectal abscess causing dysuria due to pressure on the urethra.

A 56-year-old man was admitted to our hospital with appetite loss, palpitations, orthostatic syncope, and hematochezia. Contrast-enhanced abdominal computed tomography (CT) revealed a proximal jejunal diverticulum with contrast extravasation. We immediately performed transoral double balloon enteroscopy (DBE) to treat the bleed in the jejunum, and this revealed a small ulcer with an exposed vessel at the opening of the jejunal diverticulum. Hemostasis was achieved endoscopically with argon plasma coagulation (APC) and hemoclips. During subsequent surgery, the diverticulum was found on the mesenteric side of the jejunum. We performed laparoscopy-assisted partial resection of the jejunum, and pathological examination showed that the diverticulum shared a common proper muscle layer with the jejunum and was covered by jejunal mucosa with no ectopic mucosa. Therefore, we diagnosed jejunal duplication. After hospital discharge, the patient had no recurrence of hematochezia or anemia. We report a rare case of jejunal duplication presenting with hematochezia, which was diagnosed as jejunal diverticular bleeding by CT and DBE before surgery. Pathological analysis confirmed jejunal duplication after surgery. We suggest that intestinal diverticular bleeding, as well as duplication of the gastrointestinal tract, should be considered as part of the differential diagnosis of obscure gastrointestinal bleeding.

症例は78歳，男性．開腹既往なし．関節リウマチのため，非ステロイド系消炎鎮痛剤（non-steroidal anti-inflammatory drugs:NSAIDs）を5年間服用していた．便秘，下痢で発症し画像診断で腸閉塞と診断した．絶食にて一時軽快したが再び悪化，イレウス管での治療でも軽快しないため手術を施行した．回腸には1m以上にわたり索状物が多発しており，切開にて粘膜の硬化と・肥厚により膜様狭窄を呈していた．170cm小腸切除し端々吻合した．NSAIDsによる小腸膜様狭窄は比較的稀な疾患でNSAIDs長期内服患者の腸閉塞には本疾患を念頭におく必要があると思われたため報告する．

症例は76歳, 女性. 平成18年7月1日, 下血を主訴に来院した. 腹部CT検査にて回腸末端と癒着する腫瘤影を認めた. 腹部MRI検査にてT1強調像, T2強調像で共にlow intensityを呈した. 下部消化管内視鏡検査にて出血所見を認めなかったが, 虫垂開口部に潰瘍様病変を認め, 同部にクリッピング施行. 腹部血管造影, 99mTc-HSA出血シンチで明らかな出血所見を認めなかった. 以後, 下血なく経過し, 7月14日, 退院となる. 9月10日, 再び, 下血を主訴に当科再入院となる. 下部消化管内視鏡検査で, 出血所見は認めず, 虫垂開口部の潰瘍様病変よりbiopsyを施行し悪性所見は認めなかった. 腹部CT検査でクリップと連続する腫瘤影を認めた. 診断, 治療目的に, 9月20日, 回盲部切除術施行した. 虫垂開口部に腫瘤性病変を認め, 病理組織検査では炎症性肉芽腫で虫垂炎と診断した.

症例は56歳, 女性, 平成17年6月, 胃癌にて噴門側胃切除術施行. TS-1® 80mg/body内服にて外来通院中, 平成18年3月, CT, MRIで転移性肝腫瘍を認め, 当科入院となる. 腹部超音波にて腫瘍は描出困難であった. CTガイド下PEITおよびリピオドールにてマーキングした後, 超音波ガイド下RFAを施行した. 現在, 術後7カ月で局所再発認めず, 焼灼後のlow density areaは縮小している. 転移性肝腫瘍で超音波描出困難症例に対し, 本方法は低侵襲で有効であると考えられた.

症例は18歳, 女性. 右下腹部痛を主訴に当院受診. 腹部造影CT検査で盲腸と連続した微細石灰化, air像を伴う造影された軟部腫瘤影を認め, 急性虫垂炎の診断で緊急手術施行した. 虫垂間膜, 虫垂突起は肥厚し, 一塊となり手拳大の炎症性腫瘤を呈していた. 虫垂を鋭的剥離した後, 虫垂切除術を行った.病理組織検査では多数のリンパ球, 形質細胞, 好中球の浸潤を伴う虫垂組織を認め, 漿膜に末梢神経ならびに神経細胞を含む線維組織の増生を認めた. 免疫組織化学染色では, S-100蛋白とNSEは陽性, Glimerius反応, Chromogranin A, c-kitは陰性であった.虫垂腫瘍は稀な疾患であるが大部分はカルチノイドであり, 続いて粘液嚢胞腺腫や腺癌が認められるが, その他の良性腫瘍の報告例は極めて稀である. 免疫組織化学的検索を併用して虫垂神経腫と診断した症例を経験したので報告する.

アルコール性慢性膵炎・膵仮性嚢胞2例を経験し, いずれも経時的に嚢胞の増大を認めた後破裂した. 症例1は内科的治療中に嚢胞の増大・破裂を認め, 汎発性腹膜炎となったため緊急手術を施行した. 残存した嚢胞壁と周囲臓器の臓側腹膜を空腸と吻合し経過良好だった. 嚢胞と空腸吻合部内に留置したドレーンのアミラーゼ値は高値を示さず, 仮性嚢胞と主膵管とは交通がなかったものと思われた. 症例2は内科的治療中に嚢胞の増大を認め, 破裂した直後は腹膜刺激症状が出現せず, 経過観察されたが, 数日後に血性腹水排液のための腹腔内ドレナージと, 嚢胞再増大を認め, 嚢胞の経皮的穿刺ドレナージを要した. 膵外瘻状態であり, 造影にて嚢胞と主膵管の交通が確認された. 膵仮性嚢胞は感染を合併した状態で破裂すると緊急処置が必要であり, 嚢胞と主膵管との交通の有無で経過が異なると思われた. 感染合併や嚢胞の増大を認める場合, 早期の嚢胞穿刺ドレナージ術が何より肝要である.

Epidermal growth factor receptor (EGFR) is a receptor tyrosine kinase that is frequently over-expressed in human cancers and is associated with tumorigenesis, and increased tumor proliferation and progression. Also found in breast tumors with high levels is B-Myb, a transcription factor whose expression is activated by E2F1/3 at the late G1 phase and the level is sustained through the S phase. Recent reports suggest a casual correlation between EGFR and B-Myb expression in primary breast carcinomas. However, the mechanism for such co-expression remains un-investigated. Here, we report that EGFR is important for B-Myb expression and the underlying mechanism involves cooperated effects from EGFR and E2F1. EGF stimulation and forced expression of EGFR significantly increase B-Myb gene activity and such increase occurs in the G1 phase. EGF-induced B-Myb expression was not significantly suppressed following inhibition of PI-3K and ERK, two major EGFR downstream pathways. In contrast, we observed EGF-induced in vivo association of nuclear EGFR to the B-Myb promoter and the association is only detected at the G1/S phase and is abolished by EGFR kinase inhibitor. As EGFR lacks DNA-binding domain but contains transactivational activity and E2F1 activates B-Myb expression in the G1/S phase, we further reasoned that nuclear EGFR might cooperate with E2F1 leading to activation of B-Myb. Indeed, we found that EGFR co-immunoprecipitated with E2F1 in an EGF-dependent manner and that EGF activated in vivo binding of E2F1 to the B-Myb promoter. Consistently, forced expression of both EGFR and E2F1 in EGFR-null CHO cells greatly enhanced B-Myb promoter activity, compared to the vector control and expression of EGFR or E2F1 alone. Promoter mutagenesis studies showed that EGF-induced activation of B-Myb promoter required both E2F and EGFR target sites. In summary, our data suggest that deregulated EGFR signaling pathway facilitate tumor cell proliferation partly via EGFR interaction with E2F1 and subsequent activation of B-Myb gene expression. 2005 Wiley-Liss, Inc.

嚢胞内腔に早期癌を合併した胃重嚢胞の1例を報告する. 症例は64歳の男性で, 胆嚢炎の治療中に施行された上部消化管内視鏡検査にて残胃大彎側に粘膜下腫瘤を認め, その頂上にポリープ状の隆起性病変を認めた. 超音波内視鏡検査では, 腫瘤内部は均一低エコーで, 嚢胞壁の内腔の一部に不整を認めた. 腹部造影CTでは, 残胃大彎側に約2cmの嚢胞状病変を認めた. 胃粘膜下腫瘤について診断確定ができなかったため, 胆嚢摘出術と同時に胃粘膜下腫瘤切除術を施行した. 病理診断にて胃重複嚢胞と診断され, その内腔の胃粘膜上皮に類似した嚢胞内上皮の一部に腺癌を認めた. 胃重複嚢胞はまれな疾患であり, その悪性例は本症例を含めて8例と極めてまれな疾患である. しかし, 無症状で長期経過したと考えられる消化管重複症については, その悪性化例の存在も念頭におく必要がある.

Class A macrophage scavenger receptor (SR-A) is one of the major receptors of macrophages and plays important roles in atherogenesis and host defense mechanisms. To assess the role of SR-A, monoclonal antibodies were generated by immunizing SR-A-deficient mice with a recombinant protein of human type I SR-A as immunogen. Four antibodies (SRA-C6, SRA-D10, SRA-E5, and SRA-F8) were confirmed to be specific for SR-A by Western blot analysis. In early atherosclerotic lesions, these antibodies recognized scattered macrophages in intima and foamy macrophages in the periphery of atheromatous cores. Interestingly, foamy macrophages in the core lesion were only weakly stained. In other organs, the antibodies recognized tissue macrophages such as alveolar macrophages, Kupffer cells in the liver, red pulp macrophages in the spleen, sinus macrophages in lymph nodes, and interstitial macrophages in various organs. Perivascular macrophages in the brain (Mato cells) were also positive for these antibodies. Freshly isolated blood monocytes were negative; however, they became positive for these antibodies after 1 day in culture. At 3–5 days in culture, the reaction intensity became stronger along their differentiation towards macrophages. Dendritic cells such as interdigitating cells of lymphoid tissues and epidermal Langerhans cells were invariably negative. In the reaction with animal tissues, each antibody showed a unique reaction pattern. Among four antibodies, SRA-E5 recognized SR-A molecules in all animal species examined, including rats and mice. These antibodies will be useful tools for the study of SR-A in atherogenesis and various other pathological conditions in humans and animal species.

症例は82歳,男性.平成12年2月27日交通事故に遭い,翌日,外傷性消化管穿孔の診断にて,緊急手術を行った.回腸の完全断裂を認め,回腸部分切除を行い,端々吻合した.周術期に著明な好中球減少と敗血症性ショックを認めた.術直後にG-CSFを投与し,数時間後に白血球上昇とともにショックから脱した. G-CSFは,本症例のような好中球減少を伴う重症感染症には積極的に投与すべきと考える.

Membrane-associated guanylate kinases (MAGUKs) are known to function as scaffolds for forming multiprotein complexes at the synaptic junctions of neuronal cells and at sites of epithelial cell-cell contact. In Drosophila, mutations of the lethal (1)-discs large (dlg) gene, which encodes a MAGUK protein, leads to post-synaptic structure defects in neuronal cells and neoplastic overgrowth of epithelial cells. We previously showed that NE-dlg (neuronal and endocrine dlg), a human homolog of the dlg, plays a crucial role in formation of synaptic structure in human neuronal cells. Here we demonstrate that NE-dlg, similar to Drosophila dlg, is involved in regulation of cell cycle progression and adhesive ability of non-neuronal cells. Overexpression of NE-dlg in proliferating cells including various cancer cell lines induced growth suppression and impairment of cell adhesive ability. Furthermore, NE-dlg overexpression caused the down-regulation of β-catenin in cancer cells regardless of mutations in the APC (adenomatous polyposis coli) gene. The PDZ domains of NE-dlg were found to be essential for the growth suppression, loss of adhesive property and down-regulation of β-catenin. We propose that NE-dlg regulates the cell growth and adhesive ability by controlling the level of β-catenin through an APC-independent pathway. Inactivation of NE-dlg may therefore contribute to development and/or progression of human neoplasms. Int. J. Cancer 86:480–488, 2000. © 2000 Wiley-Liss, Inc.

胸骨, 左腕頭静脈に浸潤し, 頸部・腋窩リンパ節および頸胸椎に転移をきたしていた進行胸腺扁平上皮癌に対し, 抗癌剤感受性試験による術前化学療法を行い, 著効を得た1治験例を報告する.術前腋窩リンパ節を生検し, 抗癌剤感受性試験を施行した.選択された抗癌剤 (CDDP, 5FU, MTX) の全身的および経動脈的 (左右内胸動脈および甲状頸動脈より) 投与にて, 原発巣は著明に縮小した (縮小率90%).これにより腫瘍を胸骨, 左腕頭静脈および頸部・腋窩リンパ節とともに切除し得た.切除標本では腫瘍のほとんどが線維化していた.術後, 化学療法および頸胸椎に放射線療法を施行した.術後1年の現在, 患者は経過良好で社会復帰している.この症例の経験から胸腺癌に対しても, 抗癌剤感受性試験に基づいた術前化学療法が奏効しているものと考え, 今後も当治療法の有効性について検討されるべきと思われる.

逆流性食道炎の術式の適応に関して自験例30例を非狭窄例と狭窄例に分けて検討した.非狭窄例22例にHill変法+3/4周fundoplication (H-F法) を施行し, 術後のAFP (anatomy, function, pathol.ogy) 分類ではA gradingで12例中12例 (100%), F gradingで12例中11例 (92%), P gradingで12例中10例 (83%) に改善が認められた.術後遠隔期 (2～11年) のアンケート調査では「胸やけ」や「逆流」症状が「毎日ある」症例はみられなかった.手術終了時のlower esophageal sphincter pressure (LESP) は18.0～40.0mmHgに上昇した.狭窄例8例中4例にCollis-Nissen法 (C-N法), 3例にBelsey Mark IV法 (B法), 1例に食道切除術を行い, C-N法2例に再発が認められた.B法3例では術後LESPが11mmHg, 18.7mmHg, 31.3mmHgに上昇し術後経過良好であった.以上の結果より非狭窄例にはHsF法を, 狭窄例にはB法を第1選択と考えているが, 狭窄例では, 術前拡張療法および食道内圧検査施行後に最適の術式選択を行うべきである.

Case 1: Recurrent tumors from gastric GIST in the liver and the abdominal wall showed partial response with 200mg/day imatinib and maintained partial response at 100mg/day. Case 2: Metastatic liver tumors from the jejunal GIST showed partial response with 200mg/day imatinib. The tumors have been enlarged for interruption of imatinib administration, however, re- treatment with imatinib resulted in partial response again and kept partial response at 100mg/day of imatinib. The two cases seldom encountered adverse events at 100mg/day of imatinib. There are some cases successfully treated with low-dose imatinib mesylate for recurrent GIST.

There are many reports that octreotide acetate(SMS)is effective for terminally ill cancer patients with malignant bowel obstructions such as nausea, vomiting and abdominal distension. We retrospectively found that the clinical efficacy of SMS in 23 patients with these symptoms depended on the early terminal stage(about six months until death)or middle terminal stage(within one month until death). SMS was more effective to relieve abdominal distension(p=0. 01)and these bowel symptoms occurred among cancer patients in the early terminal stage rather than in the middle terminal stage(p0. 001).

We report a case of recurrent breast cancer with solitary lung metastasis that has shown no recurrence with treatment by trastuzumab alone after partial resection of the right lung upper lobe. A 56-year-old woman, who presented with left breast cancer, underwent quadrantectomy and axillar lymph node dissection in March 2004. Pathological findings were as follows: invasive ductal carcinoma, 3. 7 cm in size, histological grade 3, positive invasion of lymphatic and blood vessels, negative nodal status, negative ER/PgR status, and overexpression of HER2/ neu. She had received adjuvant radiotherapy followed by cyclophosphamide, methotrexate and fluorouracil combination chemotherapy; however, a lung nodule developed 14 months after first operation, which had grown gradually. Partial resection of the lung with thoracoscope assistance revealed metastatic lung cancer from breast cancer. Trastuzumab treatment for 6 months after second operation has maintained no recurrence for 4 years.

The safety and efficacy of S-1 in hemodialysis patients have not been established. We evaluated the safety and efficacy and pharmacokinetics of S-1 in a hemodialysis patient with advanced gastric cancer. A 66-year-old Japanese man with chronic renal failure, who had undergone hemodialysis three times a week for 3 years. Based on the diagnosis of stage IV gastric cancer, S-1 therapy was started. S-1 was administered 11 times at a daily dose of 23.5 mg/m2 (40 mg/body) after hemodialysis, followed by a rest. One course was a period of 28 days. Blood samples were obtained after the first administration of S-1 and before beginning the fourth course. The concentration of 5-FU was determined by high-performance liquid chromatography. Area under the concentration–time curve (AUC) of 5-FU was 2647.2 ng h/mL after administration of S-1 of 23.5 mg/m2 (40 mg/body). During the S-1 treatment, serious adverse events such as neutropenia were not observed; however, decreases in hemoglobin level were observed (grade 3). The treatment was well tolerated. After the second course of chemotherapy, the primary lesion showed a partial response and lymph node metastases and liver metastases showed stable disease. Our results suggest that S-1 is an important treatment option for patients with hemodialysis with advanced gastric cancer.

A 76-year-old man was admitted to our hospital because of tarry motions. Endoscopic findings showed an ulcer on a large submucosal tumor in the stomach. Abodminal CT scan showed a protruding lesion of approximately 13 cm at the lumen of the gastric body. FDG-PET imaging revealed FDG uptake in the gastric body and abdominal cavity. We diagnosed it as GIST with peritoneal dissemination clinically, and treatment with 300 mg of imatinib mesylate was started in December 2006. The main tumor was reduced(reduction rate of 27%)and FDG-PET imaging revealed a decrease in FDG uptake in the main tumor and all disseminated tumors after 5 months of treatment. However, the drug was discontinued for arthritis(grade 3). Partial gastrectomy with sampling peritoneal nodules was performed in June 2007. The present case suggests that low-dose chemotherapy with imatinib mesylate may be useful as a preoperative therapy for a minimal surgery.

We experienced a case of good response in acute respiratory distress syndrome (ARDS) treated with sivelestat sodium hydrate during chemotherapy for cholangiocarcinoma. A 66-year-old male treated with combined paclitaxel (PTX) and S-1 suffered from ARDS following neutropenia. Sputum and blood culture examinations demonstrated an unknown origin, so sivelestat sodium hydrate was considered more effective than antibiotics. Sivelestat sodium hydrate ought to be used for ARDS treatment even during administration of anti-cancer agent.

Endocrine cell carcinoma (ECC) of the stomach is a rare pathological type with a poor outcome. Standard chemotherapy has not yet been established. We experienced a case of partial response in the liver metastasis from the gastric ECC treated with TS-1. The patient was a 68-year-old female. An upper GI series and gastroendoscopy revealed pyrolus stenosis and CT-scan showed liver metastasis. A non-curative total gastrectomy was performed to allow oral intake. Since the histopathological examination revealed that tumor cells were partially positive for chromogranin A on immunohistochemical study, we diagnosed tumor ECC of the stomach. The patient with liver metastasis was treated using TS-1, and CT-scan showed a remarkable decrease (PR) in the metastatic lesion. TS-1 administration can improve the clinical outcome for ECC of the stomach.

A 75-year-old man underwent partial resection of the small intestine for GIST in January 2000. A recurrent tumor revealed in the intra pelvic space was removed by two operations, and imatinib (400 mg/day) was given after the third operation. As successive administration was not able to be continued due to side effects such as anorexia and fatigue, the recurrent tumor enlarged. After imatinib was given at 200 mg/day, the defecation trouble was improved and the tumor decreased partially on CT image. His partial response has continued over one year. Mutation analysis revealed deletion and point mutation in exon 11 of c-kit gene. Low-dose imatinib administration should be considered in case of side effects at the standard dose.

Nuclear exclusion of the forkhead transcription factor FOXO3a by protein kinase Akt contributes to cell survival. We investigated the pathological relationship between phosphoylated-Akt (Akt-p) and FOXO3a in primary tumors. Surprisingly, FOXO3a was found to be excluded from the nuclei of some tumors lacking Akt-p, suggesting an Akt-independent mechanism of regulating FOXO3a localization. We provide evidence for such a mechanism by showing that IkappaB kinase (IKK) physically interacts with, phosphorylates, and inhibits FOXO3a independent of Akt and causes proteolysis of FOXO3a via the Ub-dependent proteasome pathway. Cytoplasmic FOXO3a correlates with expression of IKKbeta or Akt-p in many tumors and associates with poor survival in breast cancer. Further, constitutive expression of IKKbeta promotes cell proliferation and tumorigenesis that can be overridden by FOXO3a. These results suggest the negative regulation of FOXO factors by IKK as a key mechanism for promoting cell growth and tumorigenesis.

To investigate the effects of the expression of Bcl-2 protein in bladder cancer on the apoptosis induced by cisplatin or adenoviral-mediated p53 gene (Ad5CMV-p53) transfer, we transfected the bcl-2 gene into KoTCC-1, a human bladder cancer cell line that does not express the Bcl-2 protein. The Bcl-2-transfected KoTCC-1 (KoTCC-1/B) exhibited significantly higher resistance to both cisplatin and Ad5CMV-p53 transfer than did either the parental KoTCC-1 (KoTCC-1/P) or the vector-only transfected cell line (KoTCC-1/C). The flow cytometric analysis of the propidium iodide-stained nuclei and DNA fragmentation analysis after cisplatin or Ad5CMV-p53 treatment revealed DNA degradation in both KoTCC-1/P and KoTCC-1/C, whereas KoTCC1/B showed a marked inhibition of DNA degradation. Following the treatment with cisplatin or Ad5CMV-p53, the accumulation of p53 protein was highly detectable for a long period in KoTCC-1/B compared to that in KoTTC-1/P and KoTCC-1/C. Furthermore, the cisplatin and Ad5CMV-p53 treatments each reduced the volume of the subcutaneous tumors established in nude mice formed by KoTCC-1/P or KoTCC-1/C; in contrast, their reductive effects on the tumors formed by KoTCC-1/B were significantly suppressed. The intraperitoneal tumor cell implantation model revealed that the prognoses of mice injected with KoTCC-1/B were significantly inferior to those of the mice injected with either KoTCC-1/P or KoTCC-1/C after treatment with cisplatin or Ad5CMV-p53. These findings suggest that the expression of Bcl-2 in bladder cancer cells interferes with the therapeutic effects of cisplatin and Ad5CMV-p53 through the inhibition of the apoptotic pathway.