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クローン病に合併する続発性アミロイドーシスは稀な疾患であるとされているが,患者数の増加にともない今後遭遇する可能性も増えてくると思われる.続発性アミロイドーシスを合併したクローン病患者の背景や術中,術後の合併症について検討した.当院にて経験したクローン病の開腹腸管切除症例94症例について,アミロイド沈着の有無の検索を行ったところ,5症例にアミロイドの沈着を認めた.沈着ある,なしの2群に分け,病態周術期合併症などについて比較検討したところ,2回目3回目手術時の術中出血量,合併症の膵炎,肝不全,消化管出血,また蛋白尿3回目手術時の手術時間は,アミロイドの沈着のない群に比ベアミロイド沈着群で有意差(P

目的:後方浸潤をともなう直腸癌に対する仙骨合併切除の周術期経過と根治性について検討した.方法:1991～2002年において,後方浸潤をともなう直腸癌36症例(原発性;5例,局所再発;31例)を対象とし,骨盤内臓全摘+仙骨切除(TPES;25例)と直腸切断+仙骨切除(APRS;11例)を行った.なお,仙骨切除は仙骨前アプローチで行った.結果:両術式における手術時間,出血量,Morbidity,術後在院期間は,APRS症例で296.0±72.6分,2,443±1,697m1,45%,38.4±18.4日,TPES症例で441.6±111.7分,3,257±2,251ml,68%,62.4±30.6日であった.組織学的後方浸潤の程度別の5年生存率は,仙骨皮質浸潤8例;0%,仙骨前結合織浸潤9例;14.8%,非浸潤19例;49.8%であり,予後に有意差を認めた.結論:後方浸潤直腸癌に対する仙骨前アプローチによる仙骨合併切除は比較的安全な根治手術法と思われるが,仙骨皮質への浸潤例では根治的意義は少ない.

We present new techniques of stapling anastomosis at laparoscopic colorectal surgery with retrospective review of data. A triangulating stapling technique (T method) was performed in 101 laparoscopic colectomies. Adouble stapling technique (DST) with rectal division by a conventional linear stapler (Abd method) was used in 5 cases of upper/middle rectal cancers and subsequent eversion of the distal rectum from the anus (Ev method) was used for 4 low rectal cancers. Four hundred ninety-six colectomies and 280 rectal surgeries were reviewed. Leakage was lower in the T group (0.5%, n=196) than in the hand-sewn group (3.0%, n=233). Leakage of the DST using a laparoscopic linear stapler (12.1%, n=91) was significantly higher than with conventional DST (2.1%, n=189). There was no leakage with either Abd method or Ev method. The T-method is acceptable after laparoscopic colectomy. New methods of rectal division using conventional devices are expected to yield reliable anastomosis at laparoscopic rectal surgery.

大腸癌肝転移切除後長期生存に関連する因子と肝転移切除後再発に対する再切除の意義を検討した. 過去16年間に根治的切除を施行した大腸癌肝転移55例 (延べ65回の肝切除) の初回肝切除時起算, 50%生存期間は3年4か月であった. 肝転移切除後3年以上生存21例と3年未満死亡17例の臨床病理学的因子の検討では, 肝転移巣個数, 残肝再発の有無, 肺転移再発の有無, 原発巣n因子, 原発巣組織型の5因子が重要と思われた. 3年以上生存例で再発を認めた11例中, 6例は再切除, 5例は非再切除で, 各の5年生存率は80%と20%で, 長期生存例での再切除の有効性が示唆された. 原発巣組織型別の5年生存率は高分化型腺癌67%, 中分化型腺癌38%, 低分化型0%と高分化型の予後が良好で, 特に高分化型でH1, 単発肝転移14例の肝切除後の10年生存率は75%でsurgery aloneで良好な予後が期待された.

The FT-IR spectra of clusters of UF6 seeded in argon were measured in a continuous supersonic Laval nozzle flow. We observed absorption peaks of UF6 clusters on both the red- and the blue-shifted sides of the monomer peak (around 627 cm−1) at a temperature below 130 K. We assigned these peaks using calculated results on the frequency shifts and transition strength of the IR spectra of UF6 clusters. Clusters as large as 10 in size were found to be formed under our experimental conditions. Vibrational predissociation of UF6 clusters was observed after a single shot from a Raman laser tuned to a vibrational mode of the UF6 clusters (614.8 cm−1) in the Laval nozzle. We monitored the concentration of UF6 monomers in the ground state with a diode laser spectrometer, and qualitatively interpreted the time-scale of the predissociation of the UF6 clusters and the recombination of UF6 monomers subsequent to the predissociation in the nozzle. After the UF6 clusters had dissociated in less than 1 ns, the excited monomers formed by the dissociation were deactivated with a time constant of about 0.3 μs via vibrational relaxation induced by collisions with carrier gas (argon) atoms. The recombination of UF6 monomers produced by the vibrational predissociation competed with vibrational relaxation. The time constant of the recombination (about 6 μs) was found to be much larger than that of the relaxation.

Cytogenetic analysis was performed on a specimen from a pulmonary metastasis of clear cell sarcoma originated on the right ankle of a 53-year-old Japanese woman. It revealed near-triploid with several numerical changes including abnormalities in the copy number of chromosomes 7, 8, and 22, and structural abnormalities of chromosome 22 and others. This is a minor case which showed the multiple abnormalities of chromosomes in the absence of a t (12;22) translocation.

A dry powder coating method has been applied to develop high-performance contact material for the electrical industry. Using a high-speed/high-shear type of mill, fine nickel powder was coated onto coarser particles of silver—nickel alloy. Various operating conditions were used to control the concentration and the state of dispersion of the nickel powder in the composite. The transformation of the particles throughout the process was assessed by the color of the powders, the power consumption curve and by SEM. The contact performance, i.e. , fusion and wear resistance, was improved using the product with a 3-dimensional network of fine nickel powders in a silver matrix.

Strain rate and temperature effects on the flow stress of 304N stainless steel were investigated using data obtained from torsion tests on thin-walled tubular specimens, at given strain rates of between 10−3 and 10−1 with temperatures ranging from 83 to 296 K. Initially, the apparent strain rate sensitivity of the flow stress, obtained at test temperatures of 83, 153, 213, and 296 K, was examined. The strain dependence and the strain rate dependence of the mechanical threshold stress (the flow stress at O K) at strains less than 0.1 and at strain rates of 2.4 × 10−3 and 8.3 × 102 s−1, is also discussed. It was concluded from the experimental results that the mechanical threshold stress depends not only on the strain but also on the strain rate.

Using a high-speed, high-shear mill, particle surfaces of Ag-Ni alloy in which Ni is finely dispersed in the Ag matrix were coated and compounded with Ni powder. Particles thus compounded can be processed into a wire. Post-processing compounded Ni forms a fibrous texture on the wire longitudinal section and a network on the cross-section. This characteristic metallurgical structure improves the contact performance (fusion and wear resistances).

Al-Zn-Mg system alloy matrix composite reinforced with 20 vol% Si3N4 whiskers has been extruded at 773 K with a reduction ratio of 100:1, and its superplastic properties have been investigated at an elevated temperature by a constant velocity tension test. A maximum elongation of 240% was obtained at 5 × 10−1 s−1.

The study deals with constant true strain tests carried out over a wide strain-rate range from 0.0001 to 100/s at an optimum superplasticity temperature of 833 K in air. The tensile axis is selected to be parallel to an extrusion direction for all tests, and the flow stress for each strain rate is determined at a fixed small true strain. The microstructural morphology of composites is discussed as well as the flow stress behavior and elongation. A high-strain-rate superplasticity is found in an as-extruded 20-vol-pct Si3N4/6061 aluminum composite; the maximum elongation of 620 pct is recorded at a strain rate of 2/s. 13 refs.

Superplastic-like behavior has been investigated for AlMgSi alloy matrix composites reinforced with either α-Si3N4 or β-Si3N4 whiskers. Both composites exhibited large elongations in the high strain rate range near 10−1 s−1. The superplastic potential of the composite reinforced with β-Si3N4 whiskers was superior to that of the composite reinforced with α-Si3N4 whiskers.

6061 aluminum matrix composites reinforced with 20 vol% Si 3 N 4 whiskers have been extruded at 773 K with a reduction ratio of 100: 1, and their properties have been investigated at an elevated temperature of 818 K. A large elongation of 600% was obtained at an initial strain rate of 2 × 10 −1 s −1 .

To retrospectively compare the triangulating stapling technique for colocolonic anastomosis with hand-sewn anastomosis and functional end-to-end anastomosis.Data from 646 patients who underwent colectomy for cancer from 1993 to 2004 were extracted by chart review. Patients were divided into three groups based on the type of anastomosis: handsewn (n=233), functional end-to-end (n=71), and the triangulating stapling method (n=346). Demographic data and clinical characteristics of the three groups were similar.Anastomotic leakage was significantly more common in the hand-sewn group than the triangular stapling group (hand-sewn; 3.0%, functional end-to-end; 2.8%, triangulating, 0.6%) (P0.05). No patient developed bleeding or stenosis at the anastomosis, and the incidence of wound infection was equivalent among the three groups. One death due to anastomotic failure occurred in each of the functional end-to-end and triangulating stapling groups. The cost of triangulating stapling was approximately Yen 36,000 lower than the cost of the functional end-to-end anastomosis.The triangulating stapling technique is an attractive alternative to other methods for creating a colocolonic anastomosis.

Background The technique and results of laparoscopic gastrectomy in 110 patients with gastric cancer located in the upper third of the stomach are presented. Methods Proximal gastrectomy was performed for lesions in the upper third of the stomach, and total gastrectomy for those that spread over both the upper and middle third. D1 and D2 lymph node dissection was undertaken in patients with T1 or T2 lesions. Anastomosis of the oesophagus was performed intracorporeally using a conventional circular stapling device or a laparoscopic linear stapler. Results Median operating time was 247 min for proximal gastrectomy and 285 min for total gastrectomy; median blood loss was 207 and 334 ml respectively. A median of 23 lymph nodes was harvested from patients in the proximal gastrectomy group and 34 from those having a total gastrectomy. There was minimal morbidity and fast recovery after surgery. Postoperative recurrence occurred in only one patient, giving a recurrence rate of 0·9 per cent. Conclusion Laparoscopic gastrectomy for upper gastric cancer appears to be a safe and curative procedure.

Malignant mesenchymoma is a soft tissue tumor arising preferentially in the extremities and retroperitoneum. We report a case of primary malignant mesenchymoma of the left posterior mediastinum. A 24-year-old woman was admitted to our hospital for complaining of cough. Chest X-ray showed a giant mass occupying the 2/3 of the left hemithorax. Chest computed tomography (CT) revealed a lobulated large mass with fat density area and calcified spot in the mediastinum and left pleural space. Chest magnetic resonance imaging (MRI) demonstrated a large solid mass consisting mainly of areas with the same intensity as fatty tissue and partly of areas with heterogenous moderate intensity. The tumor was resected completely under left posterolateral thoracotomy. The pathologic diagnosis was malignant mesenchymoma; well differentiated liposarcoma with osteocartilagenous differentiation. The patient has been well for 3 years and 3 months after surgery.

A 53-year-old man presented with cough, sputa and chest pain. The chest X-ray revealed a large mass shadow in the right lower lobe. Massive tumor extending into the left atrium was diagnosed by computed tomography (CT). The brushing cytology by broncoscopy was squamous cell carcinoma and its stage was IIIB. Chemothrapy using cisplatin, paclitaxel and gemcitabine hydrochloride was performed 8 courses during 6 months. The effect of the chemotherapy was complete response, enabling the surgical treatment. The right pneumonectomy with partial resection of the left atrium was performed by using vascular clamp. The defect of the left atrium could be sutured directly. Wide-spread necrotic change with very small amount of cancer cells in the atrial wall was confirmed by pathology. The patient has been well for 3 years and 6 months after surgery.

Recent advances in surgical techniques have led to widespread acceptance of laparoscopic gastrectomy for gastric cancer. We performed distal gastrectomy with regional lymph node dissection in 235 patients with gastric cancer located in the middle and lower third of the stomach.In 171 cases, reconstruction was done using the Billroth I method intracorporeally and the aid of laparoscopic linear stapling devices. The Billroth II and Roux-en-Y methods were used in the remaining 56 and eight patients, respectively,Patients who underwent laparoscopic distal gastrectomy had a more rapid postoperative recovery than those treated via the open approach. Postoperative complications with this technique were within a permissible range. In terms of the survival curve, there was no statistical difference between the laparoscopic group diagnosed as clinical T2N0 (c T2N0) Preoperatively and the open group.The laparoscopic technique is not only less invasive, but is also similarly safe and curative compared to open gastrectomy.

In this paper, a personal-CIM system to improve the efficiency of experiments on ULSI development in the ULSI R&D line is described. We have developed the personal-CIM system which works in cooperation with a Manufacturing Execution System (MES) in order to reduce the preparation time for an experiment performed by each engineer on semiconductor technology. The personal-CIM system is realized by developing an acceptance agent, an inspection agent and a report agent. As the personal-CIM system acts as a private secretary who examines faithfully variable conditions in the ULSI R&D line instead of each engineer, the engineer gets various information in a timely manner that is needed to prepare for his or her experiment.

In this paper, a framework for 'advance control' to prevent various troubles on lot processing in ULSI development and fabrication lines is described. The features of the framework are preventing in advance troubles caused by the deterioration of equipment performance by a computer system and bringing abilities of experts on semiconductor technology into full operation. We have developed a Computer Integrated Manufacturing (CIM) system with advanced control functions to realize this framework. The multimedia information system is one of the new methods which can transfer the abnormal information to experts at any location and any situation, immediately.

Many kinds of scheduling systems have been devised in order to realize an efficient operation of production lines by means of, for example, shortening turn around time (TAT). The VLSI development line requires the following special key items: (1) an efficient lot processing schedule as the number of process steps in given period are maximized; (2) the quick making of a schedule counteracting the alternation of recipes and changes of the period demanded for the experimentation. We developed a new hierarchical scheduling system (DYSCHE II: DYnamic SCHEduling system II) using a Weight Assigned Function (WAF) to overcome the problem of conventional scheduling systems.

Out of 97 cases of thymoma for the last 20 years, we have experienced 7 cases (9%) of thymoma associated with cancer of the other organs. The average age of the 7 cases was 60 years old and there were 3 females and 4 males. The organ with cancer was stomach in 3 cases, thyroid in 2, and lung, breast, colon and leukemia in one respectively. Histological classification of 8 thymomas in 7 cases was 3 epithelial type, 2 lymphocytic type and 3 mixed type. Myasthenia gravis with thymoma was only one out of them. we have to follow up carefully the patient with thymoma about occurrence of cancer of the other organs without thymus for a long time.

We report a case of basaloid carcinoma originated from the wall of a large thymic cyst, which is a very rare subtype of thymic carcinoma. A 60-year-old man admitted at our hospital due to dyspnea with pericardial and left thoracic effusion on chest X-ray. A computed tomography and a magnetic resonance imaging demonstrated a large anterior mediastinal cyst and a small mass lesion on the part of the wall. We performed as possible as resection of the thymic cyst and the tumor with median sternotomy. The pathological diagnosis was a thymic basaloid carcinoma originated from the wall of a thymic cyst, which classified into a low-grade histology in thymic carcinoma. He has been well with no evidence of recurrence for three years since operation followed by a post-operative radiation therapy (total 57 Gy) to the residual tumor and mediastinum.

We reviewed 21 patients with bilateral multiple bronchogenic carcinomas. Eleven of them had synchronous carcinomas and 10 had metachronous carcinomas. We treated 6 patients with lobectomy and wedge resection under median sternotomy synchronously, and 2 patients with lobectomy on both lungs under standard thoracotomy, 2 patients with lobectomy and wedge resection, 1 patient with segmentectomy on both lung, 1 patient with lobectomy and segmentectomy, 1 patient with pneumonectomy and wedge resection, and 8 patients with lobectomy and thoracoscopic wedge resection on each lung metachronously. Two patients who had lobectomy on both lungs were dead, one of whom of pulmonary edema 2 weeks after second operation and the other of respiratory failure 3 years after second operation. We concluded that lobectomy on both lungs are not recommended because of high mortality rate (10%) and the limited resection under thoracoscopic surgery should be considered to treat the other contra lateral primary lung cancers.

A case of benign schwannoma originating from the lowest trunk of the left brachial plexus with intrathoracic extension was reported. Intrathoracic growth of a schwannoma of the brachial plexus has been reported in only five cases in the literature. The patient was a 35-year-old man and had been pointed out an abnormal shadow at the left lung apex on the roentgenogram since 20-year-old. The tumor shadow was increased to seven cm from four in size on recent chest X-ray. We performed a video-assisted thoracoscopic surgery with the oblique skin incision at the left neck and removed the tumor completely and safely.

Constitutive activation of the ERK pathway is associated with the neoplastic phenotype of a relatively large number of human tumor cells. Blockade of the ERK pathway by treatment with PD98059, a specific inhibitor of mitogen-activated protein (MAP) kinase/ERK kinase (MEK), completely suppressed the growth of tumor cells in which the pathway is constitutively activated (RPMI-SE and HT1080 cells). Consistent with its prominent antiproliferative effect, PD98059 induced a remarkable G(1) cell cycle arrest, followed by a modest apoptotic response, in these tumor cells. Selective up-regulation of p27(Kip1) was observed after PD98059 treatment of RPMI-SE and HT1080 cells. Overexpression in RPMI-SE cells of either a kinase-negative form of MEK1 or wild-type MAP kinase phosphatase-3 also induced up-regulation of p27(Kip1). The up-regulation of p27(Kip1) correlated with increased association of p27(Kip1) with cyclin E-cyclin-dependent kinase (CDK) 2 complexes, a concomitant inhibition of cyclin E-CDK2 kinase activity, and a consequent decrease in the phosphorylation state of retinoblastoma protein, which would culminate in the marked G(1) cell cycle arrest observed in these tumor cells. These results suggest that the complete growth suppression that follows specific blockade of the ERK pathway in tumor cells in which the pathway is constitutively activated is mediated by up-regulation of p27(Kip1).

We report a case of superficial undifferentiated small cell carcinoma of the esophagus. The histology of the tumor was interesting; there was squamous cell differentiation within the epithelial layer and undifferentiated small cells growing within the submucosal layer. The tumor had a negative Grimelius reaction, suggesting no differentiation into a hormone-producing carcinoma known as an apudoma (Amine Precursor Uptake and Decarboxylation (APUD)). The serum levels of ACTH and calcitonin were within normal limits. As the patient was elderly and had a history of pleural tuberculosis causing poor pulmonary function, and owing to the fulminant nature of this carcinoma, he underwent blunt dissection of the esophagus by posterior mediastinal gastric pull-up. The patient recovered quickly and was able to be discharged with a good quality of life until the tumor recurred as a liver metastasis 6 months later.

We examined the efficacy of concurrent use of ondansetron hydrochloride and dexamethasone, and the effective dose of dexamethasone against nausea and vomiting in lung cancer patients receiving chemotherapy including single high dose cisplatin. The study was carried out on total of 44 courses of chemotherapy in either initial onset or recurrence of lung cancer. The patients were given 4 mg of ondansetron injection on the day of cisplatin injection (Day 1), and 4 mg/day of ondansetron tablet for Days 2 to 4. These patients were randomly allocated into 2 groups, i.e., those who, on Day 2, concomitantly received 10 mg of dexamethasone (D10 Group, 22 courses) or 20 mg (D20 Group, 22 courses), for comparing the antiemetic effects in a different concomitant dose of dexamethasone. An efficacy rate of 70% or more was achieved in each group for acute emesis on Day 1. The efficacy rate was 80% or above for emesis on Day 2 when dexamethasone was concurrently administered, and Days 3 and 4 in both groups. No significant difference was observed between the groups. A higher complete suppression rate against nausea was seen in D20 Group even though the difference from D10 Group was not significant. Furthermore, food intake rate on Day 2 was significantly better in D20 Group. However, in the cases that were graded effective or markedly effective for acute emesis on Day 1, the efficacy rate was also high in both groups through Days 2-4. It was notable that the efficacy rate of Days 2-4 was 100% in D2 Group. The high efficacy rate was shown in male patients regardless of which dose of dexamethasone was used. However, control of emesis was unfavorable in female patients on Day 1 and was still unfavorable even though dexamethasone was combined from Day 2. We considered from the above results that 10 mg/day of concurrent dexamethasone is sufficient in suppression of delayed emesis on Day 2. However, in order to improve nausea or food intake, or to suppress emesis in patients who are highly likely to show unfavorable control for Day 2 and onward, 20 mg/day should also be effective.

We report a case of multiple neurinomas arising in the posterior mediastinum and the retroperitoneum. A 49-year-old man was admitted to our department for operation after an abnormal shadow appeared on routine chest X-ray film. A left adrenal tumor was found incidentally with ultrasonography at the time of a previous thoracic surgery. First, the posterior mediastinal tumor was surgically removed. Histologic diagnosis was neurinoma. After resection, endocrinologic findings were within normal limits. A left adrenal tumor was diagnosed, and surgery was performed. The tumor was separated from the adrenal gland; the histologic diagnosis was neurinoma. Neurinomas are usually solitary; multiple neurinomas are extremely rare.

Metastatic tumors of the tonsils are rarer than primary tumors. Few cases of metastatic tonsillar tumor have been reported. A 51-year-old man expectorated a portion of a tumor from the left side of the pharynx after an operation for cancer metastatic to the lung. Biopsy revealed that the pharyngeal tumor was rectal cancer (adenocarcinoma) metastatic to the tonsil. To our knowledge, this is the first case of primary rectal cancer metastatic to the tonsil to be reported in Japan. The clinical features of metastatic tonsillar tumor are discussed.

The patient was a 20-year-old male. On routine check-ups, a posterior mediastinal tumor was found radiologically and referred to our hospital for the operation. During the Video-Assisted Thoracic Surgery (VATS), sudden elevation of the blood pressure up to 270 mmHg was observed by the tumor palpation. At once we diagnosed as pheochromocytoma. Changing the VATS to usual thoracotomy the tumor was completely removed and histologically confirmed. After the operation the patient was uneventful and the value of norèpinephrine reduced to normal range from 2912 pg/ml. The posterior mediastinal pheochromocytoma is rare and this report is the 6 th case in Japan. Clinical characteristics were discussed in addition to the review of the literature.

Background The prognosis of gastric cancer with peritoneal metastasis is extremely poor. Neither systemic chemotherapy nor surgery alone prolongs survival of patients significantly. Methods Patients diagnosed with advanced gastric cancer underwent staging laparoscopy and received chemotherapy when peritoneal dissemination and/or cancer cells on peritoneal cytology were confirmed. The chemotherapy regimen consisted of S-1, weekly intravenous and intraperitoneal paclitaxel, which was verified in our phase II trial (Ann Oncol 2009). S-1 was administered at 80 mg/m2/day for 14 consecutive days, followed by 7 days rest. Paclitaxel was administered intravenously at 50 mg/m2 and intraperitoneally at 20 mg/m2 on days 1 and 8. Clinical response of chemotherapy was assessed by computed tomography, gastroendoscopy, peritoneal cytology and second-look laparoscopy. Radical gastrectomy was carried out when macroscopic curative resection was made achievable by chemotherapy. Chemotherapy was restarted after operation as soon as possible. Overall survival, relapse free survival, morbidity and mortality of gastrectomy were evaluated. Results Out of 100 patients with peritoneal metastasis who received chemotherapy, 60 patients underwent gastrectomy after response to chemotherapy, including 54 with macroscopic metastasis and 6 with positive peritoneal cytology only. A median of three courses were administered preoperatively (range 1–16). Total or distal gastrectomy with lymphnode dissection was carried out in 54 or 6 patients, respectively. The median survival time was 34.5 months. The median relapse-free survival was 16.7 months. The first site of relapse was the peritoneum in 24 patients and the other organ site in 17 patients. Postoperative complications included anastomotic leakage and pancreatic fistula in two patients each, which were healed conservatively. There were no treatment-related deaths. Conclusions Gastrectomy combined with S-1, intravenous and intraperitoneal paclitaxel is safe and active for gastric cancer patients with peritoneal metastasis.

In this study, I investigated the molecular weights of keratin-subunits in the tissue of esophageal cancer by enzyme-labeled antibody technique with four kinds of antikeratin monoclonal antibodies with different spectrums of reacting keratin-subunits. Further more, the correlation between the molecular weights of keratin-subunits and clinicopathological factors was evaluated, and that between the molecular weights and the prognosis was studied also. The positive rates of four kinds of primary antibodies did not correlate to clinical feature or prognosis, and each primary antibody showed different attitude regarding correlation to histopathological factors. I analyzed the molecular weights of keratin-subunits increased in the carcinoma tissue by the difference of staining intensities of four monoclonal antibodies. The histological findings of the cases with carcinoma tissues in which 48, 56 kd keratins increased were in high malignancy compared with other groups, and their prognosis was significantly poor. Examination of prognostic factors with multivariate analysis revealed that the increase of 48, 56 kd keratins in the carcinoma tissues was the most important determining factor of prognosis next to lymphatic invasion.

After a primary operation for bronchogenic carcinoma, eight out of 253 patients (3.2%) underwent reoperation for local recurrence or intrathoracic metastasis. The histology was well or moderately differentiated adenocarcinoma in all cases. The average interval between the first and second operation was 34 months (range: six to 63 months). There were three local recurrences, two lung metastases and one mediastinal lymph node metastasis (#3a) ipsilaterally two lung metastases contralaterally. Completion pneumonectomy was underwent in one, wedge or segmental resection in five and excision of lymph node in one case after an initial ipsilateral lobectomy. Two patients underwent contralateral wedge or segmental resection after initial lobectomy. Four of eight patients died of brain, liver, or bone metastases after reoperation, the time of survival averaging 63 months. Two patients died of pneumonia, the time survival averaging 92 months. Two patients are still alive, one in 52 months and another in 20 months after reoperation.

A large population survey was made for the determination of aldehyde dehydrogenase 2 (ALDH2) genotypes among 630 unrelated Japanese adults by PCR using allele specific primers. The frequencies of three genotypes were 60% ALDH2*1/ALDH2*1 (NN) type, 35% ALDH2*1/ALDH2*2 (ND) type and 5% ALDH2*2/ALDH2*2 (dd) type. Average amounts of alcohol consumption per month for three genotypes were 965.8 g/month for NN type, 629.5 g/month for ND type and 179 g/month for DD type. The differences in average alcohol consumption were significant (p0.01) among the three genetic different groups. When male and female date were analyzed separately for these three groups, significant differences among three groups were found in both genders. These results indicated that ALDH2 mutant is an important genetic factor for limiting the alcohol consumption. The frequencies of ALDH2 genotypes were not significantly different between male and female population groups, however, their average alcohol consumption were significantly different between the two groups. Therefore, various social factors and life styles, in addition to genetic factors, might concern in the difference of alcohol consumption.

The analysis of cavity growth mechanism in superplastic flow of 7475 aluminum alloy by the thermal activation energy has been carried out. The cavity growth is unlikely controlled only by plastic growth theory, because the thermal activation energy for cavity growth obtained is a 140kJ/mol as equal as that of lattice diffusion of aluminum.

Diffuse esophageal spasm is a rare condition, which has generally been treated conservatively in Japan. A case of this disorder treated successfully by long myotomy is reported with a knowledge of prolonged pressure monitoring of the esophagus. A 56-year-old woman was admitted to our hospital with dysphagia. Barium swallow and esophagoscopy showed contraction of the esophagus, and manometry showed normal peristalsis, so the diagnosis of achalasia was ruled out. Prolonged pressure monitoring of the esophagus showed spastic contractions with the pressure over 130 mmHg that continued for 25 sec during meals, which led us to the diagnosis of diffuse esophageal spasm. Extramucosal long myotomy of the esophagus and a modified Belsey Mark IV operation were performed. The postoperative course was satisfactory and esophageal functional tests showed no spasms. The patient regained weight without dysphagia.

Responses of the upper esophageal sphincter (UES) to distention of the esophageal wall by use of a balloon catheter were measured in 30 patients after subtotal esophagectomy for esophageal cancer and 33 volunteers with unrelated disorders (control group). Patients were divided into extended dissection group and non-extended dissection group according to the width of lymph node dissection, or palsy group and non-palsy group according to recurrent-laryngeal nerve palsy. The resting upper esophageal sphincter pressure (UESP) and the upper esophageal sphincter contraction (UESC) following UES induced by swallowing were measured after esophageal distention. Neither of UESP nor UESC without distention was significantly different among each group. But those of the extended dissection group and palsy group after esophageal distention were significantly lower values than those of control group. These findings suggest that responses of the UES to distention of esophageal wall are decreased, thus protection against aspiration is probably decreased.