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A 69-year-old man was seen at the department because of epigastralgia on the left side and vomiting. Admixture of an ulcerative lesion and a torose lesion of the body of the stomach were observed by an endoscopy. The diagnosis of malignant lymphoma (diffuse large B cell type) was made based on a biopsy. Instead of preoperative chemotherapy as one of the choices of treatment a lapalotomy was performed with the aim of avoiding the risk of perforation of the ulcer legion. Direct invasion of the tumor into the pancreas, spleen and transverse mesocolon and widespread invasion around the left part of the diaphragm were observed. Therefore, the lesion was unresectable. The postoperative course was satisfactory, and THP-COP therapy was started. But headaches occurred at 38 postoperative day, and then blurred vision and dextral deviation of the right eye also occurred. Depression of the optic nerve by a tumor was observed in the ocular orbit by computerized tomography of the head; thus, metachoronous metastasis of the malignant gastric lymphoma to the intraorbital tissue was diagnosed. Steroid and radiation therapy at 26 Gy were administered. The symptoms were alleviated and also the tumors disappeared as observed by computerized tomography. Although intraorbital metastasis of malignant lymphoma has rarely been reported, we have experienced this case which showed a remarkable response to radiation therapy at the metastatic focus. When we consult the case of malignant gastric lymphoma, it is necessary to consider the metachronous onset in the general organs.

症例は83歳の男性. 腹痛と発熱を主訴に来院した. 腹部CT検査にて腸間膜のdensityの上昇と, その内部にhigh densityな索状影を認めた. 腸間膜脂肪織炎を疑うも, 腹膜刺激症状が強く認められたため, 汎発性腹膜炎の診断で開腹した. 小腸間膜のほぼ全域に肥厚を認め, 小腸の血行障害も認められた. 術中, 腸間膜脂肪織炎と判断し, 小腸間膜の減張切開, 生検および腹腔ドレナージ後閉腹した. 病理組織学検査でも腸間膜脂肪織炎の診断であった. 術後第1病日よりステロイドを投与し, 腹部症状の改善とCRPの低下を認めた. また自験例では経時的に腹部CT画像を観察し, この疾患に特徴的と思われる腸間膜のdensityの上昇と, 症状改善に伴うdensityおよびvolumeの正常化が認められたので, 併せて報告した.

We identified nine single-nucleotide polymorphisms (SNPs) in the human integrin beta4 (ITGB4) gene (17q24-q25), which encodes a cell-surface receptor, by screening all exons and exon-intron boundaries. Seven of these SNPs were present in coding regions and two in intronic sequences; four of the coding SNPs involved amino-acid substitutions. As the gene is implicated in the tumorigenesis of breast cancers, the polymorphic sites will serve as useful markers not only for distinguishing alleles in loss of heterozygosity (LOH) analyses but also for studying genetic susceptibility to malignancies in humans.

Preoperative diagnosis of the tumors of the small intestine is generally considered to be difficult. We were able to diagnose a benign hemorrhagic tumor of the small intestine by preoperative angiography in a patient who had bloody stools and abdominal pain. This patient is described with a review of the literature.A 47-year-old male complained of bloody stools and abdominal pain, and presented with marked anemia on admission. No lesion considered to be the source of bleeding was detected by close examination of the upper and lower digestive tract. The presence of a bleeding lesion in the small intestine was suspected and angiography was performed. A high-density image of a tumor supplied by a branch of the jejunary artery was observed, and emergency operation was carried out. A mass, partially accompanied with vessel exposure, was found 230 cm anally from the ligament of Treitz and was resected. Histologically, the tumor was leiomyoma of the jejunum.Angiography, especially the disital subtraction type, is useful when a bleeding tumor of the small intestine is suspected, as in this patient.

The surgical technique of esophagojejunostomy in total gastrectomy using a machine is reported and its advantage and safety was compared with anastomosis by hand, performed during the same period. Provided that usage of the machine was well learned and that surgical procedure was carefully performed, the following advantages were obtained in esophagojejunostomy. 1. It facilitates the shortening of surgical time, thus resulting in expected relief of surgical stress. 2. It allows the positive performance of surgery with higher curability such as excision combined with other organs. 3. The volume of transfusion can be decreased as the volume of hemorrhage is small. 4. It facilitates the positive performance of total gastrectomy even for poor risk patients such as those advanced in age and those with complications in the heart, etc. 5. The incidence of postoperative complications such as suture failure is low.