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今回われわれは直腸平滑筋腫の1例を経験したので報告する.症例は66歳の女性, 肛門部不快感, 下血を主訴に入院した.注腸造影, 直腸鏡, 骨盤computed tomography, magnetic resonance imagingなどの検査により直腸粘膜下腫瘍 (平滑筋腫疑い) と診断し手術を施行した.全身麻酔下に経仙骨的に腫瘍に達し, 腫瘍を摘出した.摘出標本は4.0×4.0×5.2cmの白色の充実性腫瘍で2.0×3.0×3.0cmのdaughter noduleと一塊になっていた.病理組織学的に平滑筋腫と診断された.直腸平滑筋腫はその良性悪性の鑑別が時に困難で, 悪性化例も報告されており, 慎重な術後経過観察を要するものと思われた.

Long lasting postoperative hypocalcemia, an uncomfortable complication of a thyroid operation for hyperthyroidism, was treated with allotransplantation of parathyroid tissue. Small pieces of the parathyroid tissue offered from two unrelated donors were transplanted to an 18-year-old male with severe postoperative hypoparathyroidism. Prednisolone was given for 2 days, but no other immunosuppressive drugs were used. The remaining tissue was stored in frozen for the repeat transplantation. The functional activity of the frozen tissue was determined by the production of parathyroid hormone in the tissue culture medium adjusted to appropriate concentration of calcium. Loss of the graft function, probably due to rejection, was supplemented with repeated grafting. Hypocalcemia was improved by three times of transplantation using frozen tissue (once) and fresh tissue (twice). This preliminary trial demonstrates that the tissue transplantation of the parathyroid gland is effective to lessen the symptoms and medication of postoperative hypoparathyroidism.

We report a case on hemodialysis with liver metastases from anorectal malignant melanoma treated by dacarbazine (DTIC). A 61-year-old man presented with anal bleeding. An elastic soft mass was palpated in the anal canal, and a biopsy specimen was diagnosed as anorectal malignant melanoma histologically. After introducing hemodialysis for the chronic renal failure, abdominoperineal resection was performed. Two and a half years after surgery, computed tomography showed multiple liver metastases. We chose chemotherapy consisting of DTIC 100 mg for five consecutive days every 4 weeks in addition to hemodialysis (3 times a week). After three cycles of chemotherapy, liver metastases were stable, but new lung metastases were found. After 12 cycles of chemotherapy, liver metastases became stable, but lung metastases were progressive. Subsequently, the patient died of respiratory failure 4 years after surgery, 1 year and 7 months after the diagnosis of multiple liver metastases. No severe toxicity was observed during this period. We conclude that administration of DTIC undergoing hemodialysis for malignant melanoma with renal failure seems to be useful without severe adverse events.

We investigated the clinical efficacy and safety of S-1 retrospectively for the treatment of 32 patients with advanced gastric cancer after reduction surgery (gastrectomy). S-1 was administered orally twice daily, at a standard dose of 80 mg/m(2) per day for 28 days, followed by a 14-day rest. There were 21 patients having only a single residual metastatic site and 11 with two or more metastatic sites. Major residual metastatic sites were peritoneum in 25 patients, lymph nodes in 7, liver in 4 and lung in 2. The response rate by target organ was 28.6% for lymph node metastasis, and 0% for liver and lung metastasis. Peritoneal metastasis was not considered measurable site. The median survival time (MST) after S-1 administration was 573 days (95% confidence interval, 439 to 707 days). The 1-, 2- and 3-year survival rates were 62.3%, 40.3% and 28.2%, respectively. Of the 32 patients, 14 received S-1 for more than a year, and the MST in these patients was 897 days (95% confidence interval, 255 to 1,539 days). The incidence of adverse events was 90.6%, but the incidence of grade 3 or 4 was 12.5%. Long-term administration of S-1 may serve to prolong the survival period of patients with gastric cancer after reduction surgery, particularly in peritoneal metastasis.

Enteric anisakiasis is relatively rare, and the preoperative diagnosis is difficult. We report 3 cases of enteric anisakiasis: 1 was confirmed by operation, and the other 2 cases were suspected by the patient history. The 1st patient was a 48-year-old female presenting with abdominal pain. An abdominal computed tomography scan showed a dilated small intestine and accumulation of ascites. We performed partial resection of the small intestine, and an Anisakis nematode was found on the wall of the resected bowel. After surgery, the detailed history revealed that the patient consumed a raw sardine with vinegar and miso, fermented soybean paste. Three days after her operation, 2 men presenting with abdominal pain visited the hospital, and computed tomography scans of the patients showed dilated small intestines and accumulation of ascites. By taking patient histories, we found that both of them consumed sardines with vinegar and miso, and both were given conservative treatment with fasting and transfusion. By the experience of the 1st case, we could diagnose the following 2 cases as having enteric anisakiasis. In conclusion, the possibility of anisakiasis should be considered in patients with abdominal pain after ingesting raw fish, especially when intestinal obstruction is suspected.

We report a case of advanced gastric cancer resected after successful treatment with the novel oral anticancer drug TS-1. The patient was a 52-year-old male. Gastrointestinal fiberscopy showed advanced gastric cancer. Examinations by computed tomography revealed gastric cancer invasion of the pancreas and swollen para-aortic lymph nodes. This patient was treated by preoperative chemotherapy with oral administration of TS-1 (120 mg per day). After 3 courses of treatment of TS-1, the primary lesion and swollen lymph nodes were remarkably reduced. This chemotherapy enabled total gastrectomy in curative resection. The pathological effectiveness of chemotherapy was Grade 1b in the primary lesion and Grade 2 or 3 in the lymph nodes. The patient sustained few side effects. This preoperative chemotherapy regimen seems to be an effective and promising therapy for patients with advanced gastric cancer.

Eighteen patients with far advanced and recurrent gastric cancer with peritoneal dissemination were treated with a novel oral anticancer drug, TS-1, and assessed according to clinical effect. TS-1 was administered at a dose of 80-120 mg/day. One course consisted of consecutive administration of TS-1 for 28 days followed by 14 days rest. The 1- and 2-year survival rates and median survival time after administration of TS-1 were 63.2%, 23.7% and 437 days, respectively. Eight patients (44.4%) survived for 1 year or more. Adverse reactions consisted of reduction in hemoglobin level and hyperbilirubinemia at grades 3 and 4, which were observed in 3 patients and 1 patient, respectively. TS-1 is a promising drug for gastric cancer with peritoneal dissemination.

閉塞性黄疸の重篤な合併症の1つである腎不全の病態を明らかにする目的で,ラットに閉塞性黄疸を作成し,腎機能,腎皮質ミトコンドリア(以下腎Mtと略す)機能を検索し,さらに血圧低下および腎動脈遮断による腎不全モデルについても同様の検討を行なった.クレアチニンクリアランス等の腎機能には変化はみられなかったが,腎Mt呼吸能の指標であるRC, P/O, S2, ATP生成能は胆管閉塞期間の延長とともに低下した.cyt a, cyt cはともに胆管閉塞により減少したが,cyt aは比較的よく保たれていた.latent ATPaseの活性化率は閉塞例で高く,Mt損傷の存在が推定された.脱血,低血圧負荷により腎機能に変化はみられなかったが,腎Mt呼吸能は長期閉塞例で低下し,回復能も乏しかった.腎動脈遮断ではほぼ全例に腎不全が発生し,黄疸腎Mt呼吸能は著しく障害され,長期間黄疸のある例は低血圧などを契機に生ずる腎不全の準備状態にあることが示唆された.

ラットに閉塞性黄疸を作成して肝ミトコンドリア機能を検索し,併せて胆汁酸のミトコンドリア呼吸阻害,低血圧負荷の影響などを検討した.RC, P/O, S3, ATP生成能などミトコンドリア呼吸能の諸指標はいずれも胆管閉塞期間の延長とともに低下した.またcyt a, cyt cも同様に減少した.DNP stimulated ATPaseとlatent ATPaseの検索からこれらは胆管閉塞により上昇するが長期閉塞例ではむしろ低下した.しかし,ATPaseの活性化率は上昇しており,ミトコンドリア膜の損傷が示唆された.これらミトコンドリアの呼吸阻害を惹起する1因子として胆汁酸の意義を検討し,遊離CDCAの阻害度が最も高く,次いでその抱合型,CAは遊離型も抱合型も毒性の少いことを明らかにした.黄疸ラットに低血圧負荷をすると呼吸阻害が著明となり,黄疸時の出血により肝不全発生の可能性の高いことが証明された.

Arginine synthetase activity and ammonia removal in liver slices were determined in rats with obstructive jaundice or acute carbon tetrachloride (CCl4)-induced liver dysfunction and the following results were obtained: (1) Urea synthesis and ammonia removal in liver slices progressively decreased with prolonged biliary obstruction. The effects of ATP and/or ornithine addition were also markedly decreased, particularly in the group with 6 weeks of biliary obstruction. (2) Arginine synthetase activity also fell with prolongation of biliary obstruction and the fall was most pronounced in the 6-week group. (3) The CCl4-induced liver dysfunction group showed a significantly higher level of arginine synthetase activity than the group with 6 weeks of biliary obstruction, but ammonia removal was markedly decreased and the effects of ATP and ornithine addition were prominent. From the results, it is concluded that, due to a fall in the enzyme activity of the urea cycle in obstructive jaundice, liver dysfunction can easily occur with prolongation of the obstruction, while hepatic urea cycle dysfunction is brought about by severe metabolic disruption in the liver damaged by CCl4.

閉塞性黄疸の肝線維化を抑制する目的で胆管閉塞ラットにPrednisolone 5mg/kg, 25mg/kgを5回投与し,肝collagenの量,生成能などを検索した.その結果collagenのHydroxyproline量は減少しないがその生成活性の低下がみられPrednisoloneにdose dependentであった.組織学的にも間質が減少しHepatocyteの占拠率が増加した.これら肝線維化抑制の機序としてproline水酸化率の低下,free proline poolの減少,monoamine oxidase活性低下によるcollagenの成熟化の抑制,ムコ多糖の生成抑制および分解促進などを示唆する所見が得られた.これらの成績よりPrednisoloneの大量,短期投与は線維化高度な黄疸肝に対する有効な治療手段と思われた.

胃癌患者275例を対象に術前, 術後のcarcinoembryonic antigen (CEA) を測定し, その臨床的意義について検討した. 術前CEAの平均値は7.6±35, 5ng/mlで, 5.1ng/ml以上の陽性率は21.5%だった. 術前CEAおよび陽性率は胃癌stageの進行とともに有意に高くなり, その構成因子である肝転移, 腹膜播種, リンパ節転移, 深達度とも有意な関連が認められた. 組織型では乳頭腺癌, 膠様腺癌でCEA陽性率が比較的高かった. 胃癌治癒切除率はCEA高値群では有意に低下していた. 再発形成では, 肝転移型再発例の術前CEAは高値例が多く, 再発時, その急激な上昇をみた. 術前CEA高度陽性群は陰性群に比べ予後不良だった.