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We present a case of acute esophageal necrosis (AEN) and two acquired esophageal stenosis cases which showed a similar clinical course after an episode of septic shock. Extensive stenosis of the distal esophagus developed in all cases, which were refractory to dilation therapy and required surgical intervention. The etiology of the latter two cases was deduced from the stenosis after septic shock-induced AEN. Since the diagnosis of AEN is based on its characteristic endoscopic findings which can only be confirmed at the onset of the disease, we therefore called these cases "septic shock-related esophageal stenosis" or abbreviated to "septic esophageal stenosis". Further study of similar cases is required for understanding the etiology and management of AEN and the relevant disorder which may cause esophageal stenosis.

We examined expression patterns of matrix metalloproteinase (MMP), tissue inhibitor of metalloproteinase (TIMP), and reversion-inducing cysteine-rich protein with Kazal motifs (RECK) in colorectal cancer tissues to assess their prognostic significance.mRNA expressions of 17 MMPs, 4 TIMPs, and RECK were measured in 112 colorectal cancerous tissues, 20 normal mucosa tissues, and 11 metastatic liver lesions by real-time reverse-transcriptional-polymerase chain reaction. The protein level expressions were confirmed with immunohistochemistry.Cancers and normal mucosa displayed highly significant differences (P0.01) in expression of nine genes (MMP-1, -3, -7, -9, -10, -11, -12, -14, and RECK). Primary cancers and metastatic lesions showed highly significant differences (P0.01) in MMP-1, -10, -11, and TIMP-1. MMP-12 expression was higher in the primary tumors that were associated without hepatic metastasis than those with metastasis (P0.01). High expression of MMP-15 was related to longer disease-free survival (generalized Wilcoxon test, P0.0062; Cox hazard model, P0.028, hazard ratio, 0.099).MMP, TIMP, RECK expression patterns may provide an insight into extracellular matrix degrading (which is characteristic of colorectal cancers) and its role in metastasis.

Matrix metalloproteinase 1 (MMP-1) degrades extracellular matrix and thereby promotes tumor invasion and progression. In this study we examined the prognostic significance of tissue expression levels of MMP-1 mRNA in patients with invasive breast carcinoma.We assessed the prognostic value of MMP-1 mRNA expression in tumor tissue specimens from 85 breast carcinoma patients with a median follow-up time of 38 months (range, 2-48 months). MMP-1 mRNA levels were measured by real-time quantitative reverse transcriptase polymerase chain reaction (real time RT-PCR). The results were correlated with various clinicopathological parameters and clinical outcomes.mRNA expression levels of MMP-1 were higher in tumor tissue specimens than in adjacent normal breast tissue specimens from 15 patients (P0.023). MMP-1 mRNA levels showed no significant relationship with either tumor size or axillary node status but correlated inversely with estrogen receptor levels (P0.0043). High MMP-1 mRNA expression as determined by real-time RT-PCR correlated significantly with a high frequency of recurrence and fatal outcome (P0.025 and P0.020). Multivariate analysis using the Cox regression model indicated that high MMP-1 mRNA expression was an independent unfavorable prognostic factor (risk ratio, 6.37; P0.019).We have demonstrated for the first time the high mRNA expression of MMP-1 in patients whose carcinomas lack estrogen receptor expression. Our results suggest that MMP-1 is an important gene implicated in the progression of human breast cancer.

異所性膵は粘膜下腫瘤の形態をとることが多いが,壁外性に発育することは稀である.今回われわれは壁外性に発育した成人回腸異所性膵の1例を経験したので報告する.症例は59歳,男性.主訴は上腹部痛,嘔吐であった.腹部単純写真にて小腸ガスおよびニポーを認め,イレウスの診断で入院となった.保存的治療で軽快したが,原因検索を目的とした血管造影にて回腸末端枝の偏位を認め,腸捻転あるいは内ヘルニアによるイレウスの可能性が示唆された.試験開腹手術を施行したところ,回腸末端から150cm口側で回腸腸間膜対側に壁外性に突出する約2.5cmの腫瘤を認め,また,腫瘤口側の腸管拡張がみられた.同腫瘤を含む回腸部分切除,端々吻合術を施行した.病理組織所見にて腫瘤は粘膜下層に主座をおき,壁外性に発育した異所性膵 (Heinrich I型)と診断された.術後経過良好で,その後約1年経過し,再発徴候は認められていない.

今回われわれは,早期胃癌に併存した脾門部孤立性悪性リンパ腫の1例を経験したので報告する.症例は69歳女性,健診の胃バリウム検査にて体中部に隆起性病変を指摘され,平成14年12月17日,当院消化器内科紹介受診となった.上部消化管内視鏡検査にて胃体部後壁にO-I型の腫瘍を認め,生検にて高分化型腺癌の診断であった.一方,造影CTにて脾門部に造影効果を認めない約2 cmの腫瘤を認めた.以上より平成15年1月22日,幽門側胃切除術D2,脾門部腫瘤摘出術を施行した.胃は病理組織診断では乳頭腺癌, sm2, n1, stage IB,脾門部腫瘤はnon-Hodgkin, diffuse large, B-cell typeとされた.術後施行したガリウムシンチグラフィーにて異常集積を認めず,脾門部孤立性節性悪性リンパ腫と診断され,内科にて化学療法を施行し現在再発無く経過中である.