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Patients with liver cirrhosis are at increased risk of various visceral hernia because of persistent ascites and tissue fragility. Here we report successful treatment in a patient with pararectal hernia due to liver cirrhosis by a less invasive approach via para-anal region. The patient was a 73-year-old woman with a history of chronic hepatitis B that had been untreated for at least 20 years. At the age of 68 years, she was referred to our hospital for treatment of persistent ascites and thrombocytopenia due to advanced liver cirrhosis. Neither diuretics nor cell-free and concentrated ascites reinfusion therapy could decrease the ascites. She needed repeated paracentesis. She was referred to the surgical department due to the painful swelling of the left buttock which was diagnosed as the pararectal hernia. The welling was huge enough with the erosion of the covering skin. Surgery was planned in view of concern about the possible rupture of the hernia. Due to the massive ascites with the advanced liver cirrhosis, we were reluctant to do the laparotomic approach, and simple closure of the hernial orifice via direct approach from the cutaneous side was planned and performed. The patient was fortunately discharged seven days after the operation without any complications. One year later, there has been no recurrence of the hernia. Even in cases with massive ascites, direct simple closure of the hernia by percutaneous approach may be one of the options for the treatment of the pararectal hernia in case of urgent situation.

Background Transomental hernias are a rare type of internal hernia. We report two cases of successful cases of laparoscopic repair. One required laparotomy due to concern for intestinal viability. Case presentation The first patient was a 67-year-old man who presented with abdominal pain and vomiting. He had no history of laparotomy or abdominal injury. Computed tomography suggested small bowel obstruction and possible intestinal strangulation. Emergent laparoscopy found approximately 200 cm of small bowel was strangulated around the greater omentum. The strangulation was released laparoscopically, but because of the color of the strangulated bowel, laparotomy was performed to evaluate viability. The involved portion of intestine was not resected. The patient experienced transient postoperative paralytic ileus and was discharged on postoperative day 14. The second patient was a 56-year-old man who presented with abdominal pain. Abdominal computed tomography revealed dilatation of the small intestine and a closed loop suggesting ileus due to intestinal strangulation. An emergency laparoscopy found a transomental hernia, and the strangulation was released laparoscopically. Recovery was uneventful, and the patient was discharged on postoperative day 6. Conclusion Transomental hernia can be successfully treated laparoscopically. In cases where bowel viability is a concern, laparotomy should not be hesitated.

Background Lenvatinib is a novel tyrosine kinase inhibitor that exhibits an antitumor effect on hepatocellular carcinoma (HCC). An established strategy that involves surgery and usage of lenvatinib for advanced HCC remains elusive. Case presentation A 58-year-old male patient with advanced HCC and untreated hepatitis B was referred to our hospital. The tumor at the right lobe was 10 cm in diameter with right portal vein thrombus. Because of the possible lung metastasis and concern about the remaining hepatic function after extended right hepatectomy, lenvatinib was initiated before surgery. After the confirmation of a sharp decrease of tumor markers during the 3-week lenvatinib therapy, only a right portal vein transection was done leaving the enlargement of the left lobe for improved post-hepatectomy liver function while lenvatinib therapy was continued. The laparotomy revealed that the tumor was invading the right diaphragm. After 7 weeks of lenvatinib administration after right portal vein transection, an extended right hepatectomy with resection of the tumor-invaded diaphragm was successfully done. The lung nodules that were suspected as metastases had disappeared. The patient has been doing well without any sign of recurrence for 1 year. Conclusion The strategy involving the induction of lenvatinib to conversion hepatectomy including the portal vein transection was effective for advanced HCC.

A 59-year-old female was referred to our hospital due to abnormal upper gastrointestinal(GI)findings in July 2019. Endoscopy showed an advanced type Ⅱ tumor at the esophagogastric junction. The bioptical diagnosis was adenocarcinoma. Computed tomography(CT)and positron emission tomography(PET)revealed a swollen lymph node and abnormal accumulation. Total gastrectomy and Roux-en-Y reconstruction were performed. The final diagnosis was esophagogastric junctional cancer and follicular lymphoma. The chance of encountering double cancer is likely to increase. It is vital to prioritize treatment and determine an appropriate treatment plan according to the clinical stage and prognosis in patients with double cancer.

Background Phosphoglyceride crystal deposition disease (PGDD) is characterized by phosphoglyceride crystal deposition that simulates neoplasia in soft tissue scars or bone. Reports of PGDDs are rare. Here, we present the case of a patient with PGDD in the abdominal wall. Case presentation A 57-year-old Japanese man with worsening right lower abdominal pain had no significant family or occupational history. Laboratory data showed elevated inflammatory markers with a white blood cell count of 14,400 × 109/L and C-reactive protein of 11.8 mg/L, but no other abnormalities. Helical computed tomography (CT) revealed a tumor in the abdominal wall (longest dimension, approximately 10 cm). Positron emission tomography–CT revealed fluorodeoxyglucose accumulation in the mass only (SUVmax, 41). Clinical and radiographic findings suggested malignant lymphoma, undifferentiated sarcoma, or liposarcoma. He underwent exploratory laparotomy and further treatment. At surgery, we found a huge milky-whitish mass with a rough surface in the transversus abdominis. Complete resection was performed and his postoperative recovery was good. Surprisingly, the final pathologic diagnosis was phosphoglyceride crystal deposition disease with the characteristic crystal deposition in a corolla shape, histiocytic reaction with abundant foreign-body-type giant cells, and no evidence of neoplasia. The patient remains asymptomatic with no disease recurrence. Conclusion Although phosphoglyceride crystal deposition disease in the abdominal wall is rarely encountered in clinical practice, its inclusion in differential diagnosis is important. Given the occurrence at sites of invasive procedures, we believe efforts to reduce invasiveness when performing surgery and follow-up for early detection of recurrence are important.

A 65-year-old male patient presented with a chief complaint of abdominal pain. Abdominal computed tomography (CT) showed slight intestinal dilation and obstruction of the upper right quadrant of the small intestine, while ectopic gastric mucosal scintigraphy revealed abnormal accumulation in agreement with the CT-identified structure. The cause of bowel obstruction was diagnosed as Meckel’s diverticulum; the patient was referred for surgery. A small laparotomy was performed with a 35-mm skin incision to the center of the navel. Once a lap disk was attached, a laparoscope was inserted to visualize the abdominal cavity. The small intestine that includes the structure was pulled out from the umbilicus to the outside of the peritoneal cavity and partially resected. On the pathological tissue findings, the patient was diagnosed with Meckel’s diverticulum. We report our experience with single-lap laparoscopic surgery for a case of intestinal obstruction caused by Meckel’s diverticulum and review pertinent literature.

A 62-year-old man presented at our hospitalwith generalfatigue and tarry stool. Gastrointestinalendoscopy revealed a tumor in the first portion of the duodenum. Histologically, biopsy specimens indicated adenocarcinoma, and a subtotal stomach- preserving pancreatoduodenectomy was performed. The finalhistol ogicaldiagnosis was mixed adenoneuroendocrine carcinoma(MANEC)of the duodenum. Liver metastases appeared rapidly within 3 months after surgery. We report on the management of a rare case of MANEC in the duodenum.

Insulinomas are the most common functioning pancreatic neuroendocrine tumors (PNETs). We herein present the case of a 5-year survivor with insulinoma after complete response of postoperative liver metastases to hepatic arterial infusion combined with systemic chemotherapy. A 58-year-old woman was admitted to our hospital following loss of consciousness. Examination revealed a pancreatic tumor, and she underwent distal pancreatectomy following diagnosis of insulinoma. Superparamagnetic iron oxide magnetic resonance imaging (SPIO-MRI) revealed multiple liver metastases 3 months after surgery. Therefore, we performed hepatic arterial infusion of 5-fluorouracil (5-FU) combined with systemic gemcitabine infusion. We observed complete ablation of all metastatic liver nodules after 11 cycles of the chemotherapy using MRI. We continued this chemotherapy regimen for 20 cycles, and the patient remains alive without any recurrence 7 years after surgery.

Case The Nuss procedure is an established and widely approved minimally invasive technique for the correction of pectus excavatum. However, patients undergoing the procedure are at increased risk of cardiac arrest. It has not been established whether cardiopulmonary resuscitation is possible in patients who have received the Nuss procedure. We present here the case of a 14-year-old boy with pectus excavatum who underwent minimally invasive pectus repair but later had a fatal cardiac event before pectus bar removal. Outcome Bystander cardiopulmonary resuscitation was carried out immediately but resuscitation failed. Conclusion In patients who have undergone the Nuss procedure for pectus excavatum, it is important to manage perioperative events such as arrhythmia, develop measures for managing emergency situations in patients' areas of residence, and carry out continuing research and development of medical supply materials that can be used to manufacture Nuss bars.

Neuroendocrine tumors are neoplasms with various pathologic features. They occur in many areas such as the pituitary gland, digestive tract, and lung. Here, we report the case of a 68-year-old man who developed a neuroendocrine tumor in the Glissonean pedicle of the hepatic hilum. At a routine medical screening, the patient was found to have a hepatic tumor adjacent to the portal bifurcation measuring 2.0 cm in diameter. Results of laboratory and imaging studies were highly suggestive of well-differentiated hepatocellular carcinoma. The patient underwent excision of the tumor, which was located within the Glissonean pedicle. On immunohistochemical examination, the tumor was positive for synaptophysin, chromogranin A, and CD56 immunostaining. The final pathologic diagnosis was low-grade neuroendocrine tumor, according to the World Health Organization’s WHO Classification of Tumours of the Digestive System. The patient is doing well, with no evidence of recurrence, more than 1 year after the operation.

BackgroundDelayed haemorrhage (DH) is a life-threatening complication of pancreatic resection (PR) and the mortality rate for DH is very high. However, the risk factors and prognostic factors associated with DH are rarely evaluated.MethodsA pancreatic resection was performed on 457 patients. Delayed haemorrhage was defined as bleeding from the surgical site ≥5days after PR. Risk factors for DH were assessed according to demographics and pathological and operative parameters. Prognostic factors after DH were evaluated for the shock index (heart rate/systolic blood pressure) and systemic inflammatory response syndrome (SIRS) scores.ResultsOf the 457 patients, 11 (2.4%) experienced DH after PR. Logistic regression analysis showed that age >60years and a diagnosis of malignant disease were risk factors for DH. The shock index and SIRS scores at the onset of DH were significantly higher in patients who died as compared with those patients that survived (P < 0.05).DiscussionPR-associated DH carries an increased risk for patients aged >60years with malignant disease. Prognostic factors were a shock index score ≥0.7 and SIRS at the onset of DH.

Several previous studies have revealed that the Glasgow Prognostic Score (GPS) is a clinically useful scoring system to predict the prognosis of patients with various kinds of advanced cancers. However, there have been few reports on the relationship between the GPS and prognosis after hepatectomy for hepatocellular carcinoma (HCC). Therefore, we performed an analysis of the relationship between the GPS and prognosis after hepatectomy for HCC.Between January 2005 and December 2009, 352 HCC patients underwent hepatectomy at Kumamoto University Hospital. Nineteen clinicopathologic factors were analyzed, using univariate and multivariate analyses.Univariate analysis showed that significant risk factors for poor survival included serum albumin level (3.5 g/dL), tumor size (35 mm), presence of ascites, portal vein invasion, operation time (400 min), blood loss (360 mL), requirement for blood transfusion, and GPS. Multivariate analysis revealed that tumor size [hazard ratio (HR) 3.355; p = 0.003], operation time (HR 2.634; p = 0.006), portal vein invasion (HR 2.419; p = 0.009), and GPS (HR 3.796; p0.001) were independent factors for poor prognosis.The GPS was demonstrated to be a statistically significant prognostic factor after hepatectomy for HCC.

Biliary obstruction (BO) is one of the complications after hepatobiliary surgery decreasing patients' quality of life. Existing interventional methods, such as endoscopic retrograde biliary drainage, occasionally fail to treat this condition. This is the first report of treatment of BO using an endobronchial ultrasound (EBUS) system. A 65-year-old woman developed BO at the confluence of the bile duct of segment 3 of the liver (B3) and segment 2 (B2) after extended right hepatectomy for hepatocellular carcinoma. Percutaneous transhepatic biliary drainage (PTBD) was performed through B3, and its fistula was dilated up to the size of an 18-Fr PTBD silicone catheter. An EBUS endoscope was inserted through the dilated PTBD route. B2 was punctured through the EBUS endoscope inserted to B3 just before the obstruction with a needle for fine-needle aspiration biopsy. A guidewire was inserted to the common bile duct through the needle, and a 7.2-Fr PTBD catheter was placed over the guidewire. The inserted PTBD catheter was clamped, and internal biliary drainage was established. The catheter was patent for 24 months, and the patient had no episodes of jaundice or cholangitis. This technique using the EBUS system can be a treatment option for BO.

This study was designed to define the diagnostic advantage of computed tomography during arterial portography (CTAP) combined with computed tomography-assisted hepatic arteriography (CTHA) for the preoperative detection of liver metastases secondary to pancreatic cancer compared with that of multidetector computed tomography (MDCT).From January 2002 to December 2007, we retrospectively studied 197 consecutive patients with pancreatic cancer. MDCT was performed on 192 patients prior to preoperative visceral angiography; 153 patients underwent CTAP + CTHA at the time of preoperative angiography.Liver metastases were identified in 39 patients by means of MDCT. Of the 153 patients who had no evidence of liver metastases on MDCT, 129 patients underwent CTAP + CTHA, and 53 of these 129 patients (41.1%) were diagnosed as having liver metastases that could not be detected by MDCT. These tumors missed by MDCT ranged from 3 to 15 mm in size. On CTAP + CTHA, a solitary nodule in the liver was detected in 11 patients, 2 nodules were detected in 6 patients, 3 lesions were detected in 2 patients, and ≧4 lesions were detected in 34 patients. The sensitivity and specificity of CTAP + CTHA versus MDCT were 94.2 versus 48.4% and 82.7 versus 97.9%, respectively.The combination of CTAP and CTHA is useful to confirm liver metastases and can potentially offer more accurate staging of pancreatic cancer compared with MDCT.

Little is known about the clinical significance of TS and DPD in pancreatic cancer. We aimed to evaluate TS and DPD expression levels in not only pancreatic cancer but also surrounding normal pancreatic tissues to assess the clinical implications of the expression of TS and DPD in this study. Pancreatic cancer and normal pancreatic tissues were obtained from 18 patients with pancreatic cancer who underwent pancreatic resection to measure TS and DPD activities. The TS and DPD activities were determined by enzyme-linked immunosorbent assay using non-fixed fresh-frozen specimens. Pancreatic cancer tissues had significantly higher DPD and TS enzyme activities than surrounding normal tissue. Anaplastic ductal carcinoma had higher DPD and TS activities than the other histological types. Patients with high DPD in this study demonstrated poorer prognosis than those with low DPD. On the other hand, there was no statistically significant difference in survival between the high and the low TS groups. The efficacy of 5-FU may be lower in pancreatic cancer tissue than in normal tissue because DPD activity is upregulated in pancreatic cancer tissue compared to normal pancreatic tissue. It is necessary to develop an effective 5-FU delivery system and/or 5-FU combined with an inhibitor for DPD that can be used when 5-FU must be administered to patients with pancreatic cancer. High DPD activity may be a prognostic factor in patients with pancreatic cancer.

Rapid industrialization in East Asia is causing adverse effects due to atmospheric deposition in terrestrial and freshwater ecosystems. Decreasing stream pH and alkalinity and increasing NO3 − concentrations were observed throughout the 1990s in the forested Lake Ijira catchment in central Japan. We investigated these changes using data on atmospheric deposition, soil chemistry, stream water chemistry, and forest growth. Average atmospheric depositions (wet + dry) of 0.83, 0.57, and 1.37 kmol ha−1 year−1 for hydrogen, sulfur, and nitrogen, respectively, were among the highest levels in Japan. Atmospheric deposition generally decreased before 1994 and increased thereafter. The catchment was acid-sensitive; stream alkalinity was low (134 μmolc l−1) and pH in surface mineral soils decreased from 4.5 in 1990 to 3.9 in 2003. Stream NO3 − concentration nearly doubled (from 22 to 42 μmolc l−1) from the late 1980s to the early 2000s. Stream NO3 − concentration was controlled primarily by water temperature before 1996/1997 and by stream discharge thereafter. Stream NO3 − concentrations decreased during the growing season before 1996/1997, but this seasonality was lost thereafter. The catchment became nitrogen-saturated (changing from stage 1 to 2) in 1996/1997, possibly because of declining forest growth rates due to the 1994 summer drought, defoliation of Japanese red pine by pine wilt disease, maturation of Japanese cedar stands, and stimulation of nitrogen mineralization and nitrification due to alkalinization of soils (increased exchangeable Ca2+ and soil pH) after the summer drought. Stream pH and alkalinity began decreasing in 1996/1997. The enhanced growing-season NO3 − discharge since 1996/1997 appeared to be the major cause of stream acidification. Increased atmospheric deposition since 1994 may have contributed to this change.

In the present study, we performed immunohistochemical staining with a lymphatic epithelium-specific marker, D2-40, to analyze the status of lymphatic spreading in the hepatoduodenal ligament in T2 gallbladder carcinoma (GC). One hundred and eighty-six paraffin-embedded specimens from 15 T2 GC patients were reviewed. Lymph vessels lined with D2-40 were visualized in the submucosal layer of the common bile duct in all cases. In 3 of 15 patients, clusters of cancer cells were identified in the submucosal lymph vessels of the extrahepatic bile duct, and this lymphatic invasion of cancer cells failed to be detected with only conventional hematoxylin–eosin staining. The frequency of the invasion to the submucosal lymph vessels in T2 GC correlated with presence of microscopic invasion to hepatoduodenal ligament and perineural invasion. There were lymph vessels in the submucosal layer of the common bile duct, and cancer cells can spread through these channels in addition to the large lymph vessels in subserosal layer around the extrahepatic bile duct in GC. The present results would support the concept of en bloc resection of the extrahepatic bile duct in curative resection for T2 GC.

The differentiation between benign and malignant abdominal lymph nodes is difficult, especially if no primary site is evident or if cancer resection was remote in time. The aim of this study was to evaluate the yield of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in patients with undiagnosed intra-abdominal lymphadenopathy.Fifty-seven consecutive patients with undiagnosed abdominal lymphadenopathy who were registered in our EUS-FNA database from January 1997 to December 2007 were reviewed. EUS-FNA was carried out using a 22-G needle. The final pathological diagnosis was based on the cytopathological, histological, and immunohistochemical (IHC) findings.Adequate specimens were obtained in 93% cases. The final diagnoses included local recurrence of malignancy after resection (n = 16), lymphoma (n = 12), and benign/reactive changes (n = 17). The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of EUS-FNA were 94, 100, 100, 90 and 96%, respectively. In addition, it was also possible to classify lymphoma subtypes in 83% of cases. No complications occurred during the procedures.EUS-FNA is clinically very useful for establishing the diagnosis of abdominal lymphadenopathy of unknown cause and can provide sufficient tissue for IHC and subtyping of lymphomas.

We developed a method for estimating the substrate coherent strength of a net-spinning caddis larva, Stenopsyche marmorata, in the field. Plastic experimental cages (prefabricated containers with 5-mm mesh; 0.1 m high, 0.12 m wide, 0.2 m long) that enclosed gravel substrate and an objective stone (5–6 cm in diameter) were prepared. We expected the caddisflies to build a retreat(s) between the objective stone and cage substrate when submerged in a riffle channel reach for 6 days. Ten final-instar larvae (4–5 cm long) were placed in the cage and allowed to form retreats. Two treatments (cages with and without larvae) with 15 replicates each were used in two experimental trials. The vertical lift-force of objective stones associated with a retreat (coherent strength) was measured using a spring weighing scale. In 87% of 30 cages of with-larvae treatment, retreats were formed between the objective stone and cage substrate. Coherent strength ranged from 0.0 to 1.6 kg. Our approach can be used under varying flow velocities, substrate conditions, and larval biomass, all of which are normally difficult to test in flume experiments. Findings based on our field method provide unique physical properties of the caddisfly retreats in stream ecosystems.

Since 1983, the Ministry of the Environment of Japan has conducted nation-wide acid deposition surveys. To investigate the effects of acid deposition on surface water, we used the nonparametric Mann–Kendall test to find temporal trends in pH, alkalinity, and electrical conductivity (EC) in more than 10 years of data collected from five lakes and their catchments (Lake Kuttara: northernmost; Lake Kamakita: near Tokyo; Lake Ijira: central; Lake Banryu: western; and Lake Unagiike: southernmost). The pH of Lake Ijira water has declined slightly since the mid-1990s, corresponding with the downward trends seen in the pH and alkalinity of the river water flowing into the lake. There were significant upward trends in the EC of both the lake and stream water; the same trends were also found for \( {\text{NO}}^{ - }_{3} \) concentrations. These trends show evidence of acidification due to atmospheric deposition, and this is the first such finding in Japan based on significant long-term trends. Lake Ijira is located about 40 km north of the Chukyo industrial area near Nagoya. The annual depositions of H+, nss-\( {\text{SO}}^{{2 - }}_{4} \), and \( {\text{NO}}^{ - }_{3} \) in Lake Ijira were among the highest of all deposition monitoring sites, suggesting that this is the main cause of the significant acidification observed in Lake Ijira. No significant trends suggesting acidification were observed in any of the other lake catchments in spite of the significant upward trends in EC. Upward trends in pH and alkalinity at Lake Banryu and upward trends in alkalinity at Lake Kamakita were detected, but no change in pH or alkalinity at Lake Kuttara and Lake Unagiike was observed.

We report a case ofa 60-year old male esophageal cancer patient who was unable to take oral medication, but was successfully treated using a fentanyl citrate buccal tablet. The patient survived a suicide attempt as a youth in which he ingested poison, but was left with a stricture of the esophagus. It became difficult for him to take nutrition orally, and he underwent an esophageal bypass operation, although he still required frequent endoscopic esophageal dilation. He subsequently presented with an anastomotic stenosis due to anastomotic leakage, and oral intake became completely impossible. The onset of esophageal cancer presented as corrosive esophagitis. We used oxycodone hydrochloride to treat a sharp pain resulting from cataplectic cancer in the jejunal tube, but this provided only limited pain relief. We therefore used a fentanyl citrate oral mucosa absorption preparation with a rescue agent, which did provide effective pain relief. Thus a fentanyl citrate buccal tablet could effectively relief pain in cancer patients who are unable to receive oral medication.

The characteristic histological feature of pancreatic mucinous cystic neoplasm (MCN) is ovarian-like stroma (OS) underlying the epithelium and existence of estrogen receptors and progesterone receptors in the nucleus of OS. We experienced a case of pancreatic MCN which was activated during pregnancy and confirmed the existence of estrogen receptors and progesterone receptors. In cases with potential factors for malignancy, surgical resection of MCN may be needed during pregnancy. On the other hand, in cases without these, as female sex hormones may have an influence on the behavior of pancreatic MCN during pregnancy, the timing of surgery should be decided on a case-by-case basis, taking into consideration the status of the malignancy, the stage of the pregnancy, and the condition of the mother and fetus.

The influence of the net-spinning caddisfly larva Stenopsyche marmorata on streambed substratum stability was examined in 14 riffles of 5 rivers in northern Hokkaido, Japan. In each riffle, 6 representative stones were measured and 7 variables were quantified for each stone: 1) ambient flow velocity, 2) ambient depth, 3) extent of embeddedness, 4) force required to initiate shifting of the stone parallel to the flow direction, 5) biomass of S. marmorata living on and under the stone, 6) wet mass of the stone, and 7) size of the stone. Regression analyses were used to examine which of the variables best predicted the coherent strength of a particle with the stream bed (FC). Riffle-scale patterns derived from the means of 6 stones showed significant influences of biomass of S. marmorata/stone and embeddedness on FC; however, the collinearity of these 2 variables hindered evaluation of their relative importance. At the stone scale, biomass of S. marmorata/stone was positively related to FC when stand...

症例は36歳,女性. 31歳時(平成11年3月)に上行結腸癌に対し,結腸右半切除術を施行され,術後補助療法として5-FU系内服薬を内服した.平成15年9月にFDG-PETにて骨盤内リンパ節の異常集積を指摘され,単発巣であったため切除術を施行した。病理学的検査所見は31歳時の大腸癌とは異なる所見であった.全身検索にて明らかな原発巣を認めず,原発不明癌リンパ節転移の診断であった.術後paclitaxel+carboplatinによる化学療法を施行した.同患者は平成16年11月にFDG-PETにて肝動脈周囲リンパ節転移を指摘された.またしても単発巣であり,また, CT上,左卵巣に嚢胞性病変を認めたため,肝動脈周囲リンパ節郭清術+単純子宮全摘術+両側附属器切除術を施行した.病理学的検索にてリンパ節は原発不明癌リンパ節転移,子宮および卵巣には悪性所見は認めなかった.平成17年ll月のPET検査では異常を指摘されておらず,原発不明癌としては良好な経過をたどっている.

It has been well documented by short-term artificial experiments that the CH4 uptake is inhibited by N input, especially NH4 p+-N input. To investigate the effect of the natural N input by throughfall and other factors on the CH4 uptake in forest soils, we measured the CH4 uptake rates for 6 months during the snow-free period of the year and N input by throughfall throughout the year at 10 sites in Hokkaido, Japan, from 1997 to 2002. Water filled pore space (WFPS) and pH values in the soils varied widely among the sites (38-93% and 3.9-6.2, respectively). The rates of NH4 p+-N and NH3 p--N inputs ranged from 1.3 to 6.9 kg N hap-1 yearp-1 and from 0.8 to 2.9 kg N hap-1 yearp-1, respectively. The NH4 p+-N input was generally higher than the NH3 p--N input. Total N input by throughfall amounted to 2.3-9.4 kg N hap-1 yearp-1. The highest CH4 uptake rate occurred within the period from July to September (41-215 μg CH4 mp-2 hp-1) each year at most sites. CH4 uptake rate was relatively low (~50 μg CH4 M...

In this report, we propose a new method of evaluating the effect of nitrogen deposition on forest ecosystems, namely the spatial variation in nitrogen deposition enables to detect readily the effect of anthropogenic N deposition on biogeochemical processes in forest ecosystems. We analyzed the nitrogen deposition (throughfall fluxes) and stream water chemistry over five adjacent small catchments in which soil types (Hapludants) and vegetation composition (50 to 60 years old larch plantation) were fairly identical. Thirty-two throughfall collectors were set up in the five catchments (six to eight collectors in each catchment) and throughfall samples were collected after a rain event, while stream water samples were collected once or twice a month. The monitoring was carried out during a period of 6 months (2002 June to 2002 November). Throughfall dissolved inorganic nitrogen (DIN) fluxes were highly variable: the highest N input, 1.32 kg N ha -1 6 months -1 , was sixty-six times higher than the lowest input, 0.02 kg N ha -1 6 months -1 . The mean DIN inputs and the mean nitrate concentrations in streams showed a three-time variation across the five catchments. In addition, the DIN inputs showed a high correlation with the stream nitrate concentrations (r = 0.88).

Goals of the study: To evaluate the outcome in patients with lung cancer found on lung cancer mass screening roentgenograms, but who did not subsequently consult a doctor. Patients and Methods: This study enrolled 198 asymptomatic patients with lung cancer found by lung cancer mass screening during the 9-year period. Five-year survival rates in patients who did not consult a doctor or who stopped consulting a doctor in spite of abnormal shadows detected on last mass screening chest roentgenograms ( n =45, delayed consultation group) and in patients who subsequently consulted a doctor when abnormal shadows were detected ( n =153, control group) were evaluated by the method of Kaplan and Meier and clinical variables were examined as possible predictors of survival time by the Cox proportional-hazards model. Results: There was a significant difference between the 5-year survival rates in the delayed consultation group and in the control group (21 vs. 51%, log rank: P =0.0003, Wilcoxon: P =0.0009). The risk of death increased 115.0% for the 1-year delay in consultation (hazard ratio: 2.150, 95% CI: 1.203–3.842, P =0.0097). With regard to the reason why they did not consult a doctor, many of them answered that they did not have any respiratory symptoms. Conclusion: The 1-year delay in consultation had a great significance in that these patients did not receive any treatment for lung cancer for 1 year, and the 1-year delay in treatment itself affected the outcome.

Abstrac The effects of 3 oxides (Fe, Al, and Mn oxides) and 3 clay minerals (kaolin, montmorillonite, and allophane) on the adsorption and subsequent kinetic properties of acid phosphatase were compared. The amount of enzyme adsorbed by the oxides and clay minerals followed the order: montmorillonite ≫ kaolin > Mn oxide > Fe oxide > Al oxide ≫ allophane. The adsorption isotherms of the enzyme on the oxides and clay minerals, except for montmorillonite and allophane, fitted the Langmuir equation. The activity of the enzyme immobilized by the inorganic components studied was in the order of allophane > kaolin > Fe oxide > montmorillonite > Al oxide ≒ Mn oxide. Compared to the free enzyme, the V max, Km, and V max / K m values of the immobilized enzyme decreased, increased, and decreased, respectively. Among the oxides or clay minerals, the higher the ability of the inorganic components to adsorb the enzyme, the lower the value of the V max / K m ratio of the immobilized enzyme. These findings suggest that t...

A 73-year-old man was referred to our hospital because of appetite loss and weight loss in January 2009. Endoscopy showed an advanced type II gastric tumor at the middle of the gastric wall, and computed tomography showed multiple liver metastases. Immunohistological examination confirmed a diagnosis of large cell neuroendocrine carcinoma which was chromogranin A(+), CD56(+), and synaptophysin(+). Oral administration of S-1(100mg/body)was given 5 days on and 2 days off, while cisplatin(CDDP 40 mg/body)was administered intravenously once every 2 weeks. The patient achieved a partial response(PR), and no serious adverse effects were observed. This case suggests that S-1/CDDP chemotherapy may be an effective treatment in patients with large cell neuroendocrine carcinoma of the stomach.

The model introduced in the previous report (Nakahara 2000: Soil Sci. Plant Nutr., 46, 11–20) described cation adsorption on Choyo B soil satisfactorily. The optimized parameters, r SO, n tot, d IHP, are physically sound. When the total number of cations per one allophane particle n M is less than 1.0, major type of cation adsorbed was in the form of diffuse ion swarm. On the other hand, when n M was higher than 1.0, the fraction of surface complexes increased with n M. The reason for the suitability of the Freundlich-type adsorption isotherm for application to the cation adsorption on allophane was clarified.

Simple lattice statistics was applied to formulate the monovalent-bivalent cation exchange reaction on lattice surfaces. The Davis and Gapon selectivity coefficients KD and KG could be derived for two-dimensional lattices with different reactions between bivalent cations and exchange sites. On the other hand, the Vanselow selectivity coefficient Kv could not be derived for twodimensional surfaces, but was found to be suitable for one-dimensional arrays of exchange sites. These results suggest that the use of Kv should be restricted to one-dimensional exchangers like linear polyelectrolytes and humic substances, while KD is suitable for general purposes.

I discussed the problem we face if attempts are made to derive the Freundlich isotherm equation as an electrostatic adsorption model like the surface complexation models. To derive this equation we need the following electrostatic energy: , where n is the number of ions adsorbed, and C, D, and E are constants with a positive value. This equation requires that when the number of ions adsorbed is relatively small, there must be attractive forces among adsorbed ions on the surface. The partial derivative of this equation: , diverges to minus infinite at the limit n→0. This divergence requires that the attractive forces among adsorbed ions diverge to infinite at the limit n→0. To derive the Freundlich isotherm equation, we need to reveal the mechanism that leads to the requirements described above.

We evaluated the ability of a new surface complexation model “multi-layer model” of Nakahara and Wada (1995: Soil Sci. Plant Nutr., 41, 659-669) to predict the K+-Ca2+ exchange equilibria on a humic Andisol. Under the assumption that the relative permittivity of the interfacial region is constant at any points, we could calculate the K+-Ca2+ exchange equilibrium conditions using the four parameters previously obtained from K+ and Ca2+ adsorption data. The model predicted the variation of the exchange selectivity coefficient of Van-selow (K V) and the pH of the bathing solutions as a function of the equivalent fraction of adsorbed K+ satisfactory. We concluded that our model can be used for the calculation of the chemical equilibria of soil solutions of humic soils.

As compared to constant charge soils, the data on ion exchange equilibria on Andisols are very limited (Perrott 1981; Okamura and Wada 1984; Escudey and Galindo 1988; Delvaux et al. 1989). Therefore we examined K-Ca exchange on humic and allophanic Andisols to reveal the characteristics of the cation exchange equilibria, and to solve the following problems.

Disseminated carcinomatosis of the bone marrow derived from solid cancer has a very poor prognosis, with disseminated intravascular coagulation(DIC). A 72-year-old man was admitted to our hospital after detection of a tumor in the pancreatic tail by CT imaging. Several images revealed that he suffered from cancer of the tail of the pancreas with multiple liver and bone metastases. Endoscopic ultra-sonography-guided fine needle aspiration detected adenocarcinoma cells from the tumor of the pancreatic tail. We also performed bone marrow aspiration, which confirmed adenocarcinoma cells in the bone marrow. We started to administer 1,000 mg/m2 of gemcitabine weekly. Laboratory data revealed that thrombocytopenia had occurred, and it developed into DIC after the first the administration of gemcitabine. In spite of the DIC state with thrombocytopenia, we were able to provide anticancer treatment using combination gemcitabine and S-1. He recovered from his DIC state, and the primary tumor was shrunk with a decrease of tumor markers after 2 courses of combination chemotherapy. Chemotherapy might be required for disseminated carcinomatosis of the bone marrow in order to promote tumor shrinkage and to prolonged expected survival, even if DIC was developed.