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Summary Background The impact of enteral nutrition on post-operative recurrence has not been properly examined. Aim To investigate the impact of enteral nutrition using an elemental diet on clinical and endoscopic recurrence after resection for Crohn's disease. Methods Forty consecutive patients who underwent resection for ileal or ileocolonic Crohn's disease were studied. After operation, 20 patients continuously received enteral nutritional therapy (EN group), and 20 had neither nutritional therapy nor food restriction (non-EN group). In the EN group, enteral formula (Elental) was infused through a nasogastric tube in the night-time, and low fat foods were taken in the daytime. All patients were followed up regularly for 1 year after operation. Ileocolonoscopy was performed at 6 and 12 months after operation. Results One patient (5%) in the EN group and seven (35%) in the non-EN group developed clinical recurrence during 1-year follow-up (P = 0.048). Six months after operation, five patients (25%) in the EN group and eight (40%) in the non-EN group developed endoscopic recurrence (P = 0.50). Twelve months after operation, endoscopic recurrence was observed in six patients (30%) in the EN group and 14 (70%) in the non-EN group (P = 0.027). Conclusions Our long-term enteral nutritional therapy significantly reduced clinical and endoscopic recurrence after resection for Crohn's disease.

今回われわれは直腸尿道瘻を形成した骨盤直腸窩痔瘻(IV型痔瘻・隅越分類)に対して根治手術を施行し,痔瘻および直腸尿道瘻を治癒し得たきわめて稀な症例を経験したので報告する.症例は,肛門周囲腫脹,肛門痛にて近医を受診,切開排膿術をうけ,当院を紹介された70歳の男性.来院時,気尿および排尿時に尿が濁ると訴えがあり,尿道鏡および,直腸肛門の経肛門的超音波検査,MRI検査およびCT検査を施行し,直腸尿道瘻を形成した骨盤直腸窩痔瘻(IV型痔瘻・隅越分類)と診断された.直腸肛門の経肛門的超音波検査,MRI検査およびCT検査は痔瘻,直腸尿道瘻の診断にきわめて有用であり,適切な診断と治療にて根治術は可能と考えられた.

Background: The main aim of this prospective study was to examine whether systemic (plasma) and local (mucosal) cytokine production is a predictor of future relapse in patients with quiescent ulcerative colitis (UC). The impact of other clinical and laboratory parameters on relapse was also studied. Methods: Fifty consecutive patients with quiescent UC were included. At enrollment, blood and mucosal (rectal biopsies) samples were collected. All patients were followed up regularly for 1 year after enrollment. Plasma and mucosal cytokine levels were measured by enzyme-linked immunosorbent assay. To identify independent significant predictive factors for relapse, time-dependent analyses using the Kaplan-Meier method and the Cox proportional hazard model were performed. Results: Thirty-four patients remained in remission, and 16 patients relapsed during the 1-year follow-up. Higher interleukin (IL)-8 levels in the rectal mucosa were significantly associated with relapse. In contrast, IL-1β, IL-6, and tumor necrosis factor-α levels in the rectal mucosa were not associated with relapse. Conventional blood markers and plasma cytokines (IL-1β, IL-6, IL-8, and tumor necrosis factor-α) did not correlate with relapse. Among clinical factors, age and number of prior relapses were significantly associated with relapse. In multivariate analysis, a higher rectal mucosal IL-8 level (≥160 pg/mg of tissue; hazard ratio, 4.7), younger age (

Summary Aim : To assess safety and clinical efficacy of granulocyte and monocyte adsorptive apheresis for distal ulcerative colitis. Methods : Granulocyte and monocyte adsorptive apheresis therapy (five aphereses for 5 consecutive weeks) was performed for 30 consecutive patients with active distal ulcerative colitis. Patient compliance, adverse effects and clinical symptoms were regularly assessed. Results : Adverse effects were noted during nine (6%) apheresis sessions in eight patients; slight headache five, transient abdominal pain with tenesmus two, fever (38 °C) one and mild liver dysfunction one. None of these adverse effects was serious and all patients could complete five aphereses. Clinical symptoms (stool frequency and consistency, rectal bleeding, tenesmus and mucus in stools) significantly improved after the third apheresis. Clinical remission (normal stool frequency and no rectal bleeding) was achieved in 21 patients (70%) after five aphereses. The median Disease Activity Index score significantly decreased; from 6 [interquartile range (IQR): 4–7] to 2 (IQR: 1–3) (P

Summary Aim : To examine whether mucosal cytokine production during remission after resection for Crohn's disease is a predictor of future relapse. Methods : Thirty-six patients who remained in remission after resection for terminal ileal or ileo-caecal Crohn's disease were included. At enrolment, blood and mucosal (ileal and rectal biopsies) samples were collected. All patients were followed up regularly for 1 year after enrolment and the disease activity was assessed according to the Crohn's disease activity index. Results : Twenty patients remained in remission and 16 patients relapsed during the 1-year follow-up. Interleukin-1β, interleukin-6 and tumour necrosis factor-α levels in the ileal mucosa were significantly higher in relapsed patients than in patients in remission. These cytokine levels in the rectal mucosa were not associated with relapse. Conventional blood markers and plasma cytokine levels did not correlate with relapse. Amongst the clinical parameters, a younger age, short disease duration before operation and fistulating disease were risk factors for relapse. In multivariate analysis, only the ileal interleukin-6 level was an independent significant predictor for relapse. Conclusions : The interleukin-6 level in the ileal mucosa during remission after resection for ileal or ileo-caecal Crohn's disease is an independent significant predictor for future relapse.

症例は75歳女性.主訴は左臀部腫瘤.既往歴,家族歴に特記事項なし.平成13年11月上旬より左臀部に腫瘤があることに気づき,近医受診.精査加療目的にて当科紹介入院となった.腫瘤は弾性硬,手拳大で,USにて多房性であった.CTおよびMRIでは下部直腸および肛門管を3/4周取り囲むようにして多房性嚢胞性病変がみられ,隔壁にのみ軽度の造影効果がみられた.穿刺細胞診はクラスIIであった.以上より肛門周囲皮下類皮様嚢腫の診断にて手術を施行.腫瘤の一部は尾骨と強靱に付着しており,尾骨原発類皮様嚢腫と診断した.病理組織診断も同様であった.稀な仙骨前類皮様嚢腫の一例を経験したので,報告する.

Immunohistochemical staining for epithelial (E)-cadherin and alpha-catenin was performed using frozen sections taken from fresh operative specimens, by the avidin-biotin-peroxidase complex method. Tumors were classified into three types according to the expression modality. Cancer cells with expression at the cell-cell boundaries were defined as normal; when the expression was positive, but not concentrated at the cell-cell boundaries, they were defined as cytoplasmic; and when the tumor showed no staining, they were defined as lost. The relationship between these three expression types and the clinicopathological features of colorectal cancer was investigated. In all 50 normal mucosa samples, E-cadherin and alpha-catenin were coexpressed normally. The expression type of E-cadherin and alpha-catenin was normal in 11 and 13 of the cancer tissue specimens, respectively, cytoplasmic in 26 and 29, respectively, and lost in 13 and 8, respectively. Cytoplasmic or lost expression was observed in cancer demonstrating an advanced clinical stage (E-cadherin, P = 0.0065; alpha-catenin, P = 0.0069), advanced tumor penetration (P = 0.0003, P = 0.0001), undifferentiated tumor histology (P = 0.0196, P = 0.0343), widespread lymph node involvement (P = 0.0204, P = 0.0340), and liver metastasis (P = 0.0063, P = 0.0299). In conclusion, the expression type of E-cadherin is significantly correlated to that of alpha-catenin, and the loss of their expression indicates the metastatic potentiality of colorectal cancer.

A case of microcystic disease of the pancreas which was clearly demonstrated by magnetic resonance cholangiopancreatography (MRCP) is reported herein. Cystic dilatation of the pancreatic duct was recognized by computed tomography scanning and endoscopic retrograde cholangiopancreatography (ERCP). Furthermore, the existence of microcystic clusters surrounding the dilated pancreatic duct were clearly visualized by MRCP. These microcystic clusters were strongly suspected preoperatively of having caused dilatation of the major pancreatic duct. Based on these findings, a distal pancreatectomy was performed. The operative specimen showed no accumulation of mucin and no evident lesions in the dilated pancreatic duct, being inconsistent with the entity of a mucus-producing tumor. Pathological examination revealed that the inner parts of microcysts constituted columnar epithelium with mucus production and papillary growth. Thus, a final histological diagnosis of intraductal papillary adenoma with idiopathic pancreatic duct ectasia was confirmed. In conclusion, MRCP, being a less aggressive diagnostic procedure than ERCP, proved extremely useful for obtaining precise information on cystic lesions of the pancreas in this patient.

Background A variety of liver diseases accompany significant elevation of both type IV collagen 7S (IV-c-7S) and procollagen type III N-terminal proppeptide (P-III-P), suggesting the presence of liver fibrosis. We investigated whether metastatic liver tumors from colorectal carcinoma cause hepatic fibrosis at metastatic sites, and if serum levels of collagen precursors would suggest fibrous changes of metastatic liver tumors.

The serum levels of intercellular adhesion molecule-1 (sICAM-1) and endothelial leukocyte adhesion molecule-1 (sELAM-1) were determined in 40 patients with colorectal cancer. The sICAM-1 and sELAM-1 levels in the drainage venous blood adjacent to a tumor were significantly correlated with those in the peripheral venous blood in patients without evident hematogenous dissemination of tumor cells. The sICAM-1 levels in peripheral venous blood were significantly higher in patients with hepatic metastases, while the sELAM-1 levels were significantly higher in those with pulmonary metastases. An immunohistochemical study of metastatic sites in the liver revealed that ICAM-1 was expressed in cancer stroma, but not in the cancer cells. In conclusion, the sICAM-1 and sELAM-1 levels in the peripheral venous blood in colorectal cancer patients without any distant metastasis are likely to reflect the topical production of these cell adhesion molecules, and appear to be instructive in predicting hematogenous dissemination in patients with colorectal cancer.

It has been reported that malignant tumors during pregnancy are uncommon representing 0.1% of all malignant tumors, especially colorectal cancers, in a frequency of 0.002%. We report a rare case of colonic cancer in a 27-year-old woman during puerperium with a veview of the literature. The patient had anal bleeding and lower abdominal pain at defecation after delivery of her daughter, but she considered them as symptoms due to hemorroid or so and did not consult any practitioner. On 20th day after delivery, nausea and vomiting also occurred and she visited another hospital and was found to have an almost whole-ciucumferential elevated lesion in the sigmoid colon on colonoscopy. The patient was referred to the hospital. On admission she was diagnosed as having a sigmoid colon cancer with multiple liver metastases. At operation, multiple liver metastases and lymph nodes involvement were confirmed. Palliative resection of the sigmoid colon was performed. Resected specimen was histologically identified as well-differentiated adenocarcinoma. The patient died of liver failure 6months after the surgery. The diagnosis of the disease can be often delayed since pregnancy sometimes misleads the symptoms suggestive of colonic tumour.

We report the case of a 67-year-old man in whom hemorrhage from a ruptured celiac trunk pseudoaneurysm, which occurred as a consequence of leakage at the site of gastroduodenostomy, was successfully controlled by transcatheter arterial embolization (TAE) with stainless steel coils and N-butyl cyanoacrylate (NBCA). The occurrence of a pseudoaneurysm of the celiac trunk associated with anastomotic leakage is etiologically rare. We compiled reports from the literature on TAE for ruptured aneurysms of the celiac trunk, and compared its therapeutic value with that of surgical treatment. Operative death occurred in 4 of a series of 43 patients with aneurysms of the celiac trunk that were surgically treated (9.3%). In 5 patients with ruptured aneurysms, the operative mortality rate was 40% (2/5). Conversely, while the unsuccessful rate of TAE therapy was 17% (1/6), the mortality rate was nil. The patient whose case is presented here was affected by methicillin-resistant staphylococcus aureus (MRSA) at the site of leakage and in the lung. Under septic conditions such as hemorrhage secondary to pancreatitis, the mortality rate of surgical therapy was 23%-29%, whereas the success rate of TAE therapy was 79% and the mortality rate was 4%. Based on these findings, it is suggested that TAE therapy is a viable alternative to surgery for patients even with ruptured pseudoaneurysms of the celiac trunk.

Fistula-cancer is a carcinoma arised from a chronic anal fistula. We report here a case of fistula-cancer with a review of the literature. The patient was a 62-year-old male who had undergone an operation for an anal fistula 18 years before. Sometimes he has felt anal discomfort postoperatively. Mucous discharge from the operation scar appeared 1 year before and did not improve despite of several re-operations. Recently a painful tumor appeared on the same portion. Histopathologically, the tumor was adenocarcinoma. Under the diagnosis of an anal cancer arised from the anal fistula, abdominoperineal excision of the rectum and left inguinal lymph node dissection were performed. The tumor was 2cm in diameter, Borrmann 5 type and was located in the direction from 2 to 5 O'clock of the anus. Histopathologically, the tumor was well-differentiated adenocarcinoma.

過去19年間に教室で切除した右側結腸癌86例について,郭清リンパ節の転移度と予後から,現行の郭清術式の妥当性を評価した.86例のうち治癒切除と判定されたものは70例で,そのうちR2郭清症例は17例,R3郭清症例は53例だった.両群に臨床病理学的事項,および進行度に統計学的な有意差は認あられなかった.再発症例11例では,リンパ節転移の遺残によると思われるリンパ節再発は認めなかった.リンパ節転移を部位別に比較したが,治癒切除症例で223番,214番リンパ節に転移を認めた症例はなく,R2症例とR3症例の生存率に差を認めなかった.すなわち右側結腸癌に対して,現行のR2以上の郭清を伴う結腸右半切除術は十分な根治性を有するものと考えられた.

潰瘍性大腸炎に対する結腸全切除,回腸直腸吻合術後19年を経た53歳女性にみられた直腸癌の1例を報告した,切除標本の病理組織学的検索では,直腸に2個の癌とそれを囲む異型粘膜がみられた.DNA flow cy-tometryでは癌組織と異型粘膜からDNA aneuploidyが見いだされたが,正常粘膜からはDNA diploidyのみが検出された.ここに報告した症例でみられた所見と文献的考察から,潰瘍性大腸炎に合併する大腸癌の早期発見,大腸癌合併の高リスク群の同定に内視鏡下のtarget biopsyが重要であることが示唆された.

Five cases of intestinal Behcet's disease in 2 males and 3 females were reported. The patients experienced the onset of symptoms at the ages of 10 to 35 years. Initial symptoms included oral ulceration in 4 and arthralgia in one patient. As the major symptoms, oral ullceration was seen in all the 5 patients, skin lesion in 4, and genital ulceration in 3, while none had iritis. The minor symptoms, in addition to intestinal complaints, included arthritis in 3 patients. Operative treatment was necessary in all but one patient who responded well to conservative treatment. There has been no recurrence after right hemicolectomy. Two out of the 4 patients underwent emergent operation because of perforation or penetration of the ulcer. Elective operation for a recurrence of the disease was undertaken in the remaining 2 patients who had undergone the initial operation elsewhere. Among of them an interesting case in a 31-year-old woman, who delivered a child by Caesarean section during active phase of the disease, was reported in details.

Duodenal Crohn's disease is rare, and patients without obstruction are treated medically. We herein report one case whose duodenal Crohn's disease was successfully managed with low-speed elemental diet infusion through a nasogastric tube. A 28-year-old female developed acute duodenal Crohn's disease. Upper GI radiologic and endoscopic examinations showed a stricture in the duodenal bulb. Using the duodenal biopsy specimens, mucosal cytokine levels were measured; interleukin (IL)-1beta, IL-6, IL-8, and tumor necrosis factor-alpha levels were remarkably elevated. For initial 2 wk, powdered mesalazine was orally given but it was not effective. For the next 2 wk, she was treated with low-speed elemental diet therapy using a commercially available Elental(TM), which was infused continuously through a nasogastric tube using an infusion pump. The tip of the nasogastric tube was placed at an immediate oral side of the pylorus. The infusion speed was 10 mL/h (usual speed, 100 mL/h). After the 2-wk treatment, her symptoms were very much improved, and endoscopically, the duodenal stricture and inflammation improved. The duodenal mucosal cytokine levels remarkably decreased compared with those before the treatment. Although our experience was limited, low-speed elemental diet infusion through a nasogastric tube may be a useful treatment for acute duodenal Crohn's disease.

Progressive, severe anemia developed in a 66-year-old man with advanced gastric cancer. A total gastrectomy was performed, after a rapid blood transfusion, to stop possible bleeding from cancer. There was no blood accumulation in the resected stomach. Laboratory data showed remarkable hemolysis and disseminated intravascular coagulation after the operation. A peripheral blood smear showed leukoerythroblastosis, which is indicative of bone marrow metastasis. Intensive therapy failed to control hemolysis and disseminated intravascular coagulation. On the 17th postoperative day, the patient suffered sudden respiratory arrest and subsequently died, possibly of a cerebrovascular accident. This is a rare case of microangiopathic hemolytic anemia associated with metastasis of gastric cancer to the bone marrow. Operative procedures should not considered for the patient with microangiopathic hemolytic anemia caused by cancer metastasis, because they offer no advantages for the patient's prognosis. Evaluation of causes of anemia can be helpful in managing patients with cancer.

The etiology of pouch inflammation after restorative proctocolectomy is unknown. The fecal stream and immunological reactions are potential pathological factors. This study was performed to examine the impact of the fecal stream and stasis on immunological reactions in the pouch.Patients who underwent a restorative proctocolectomy with a covering ileostomy for ulcerative colitis were studied. Mucosal biopsy specimens were obtained from both the pouch and the proximal ileum at the time of ileostomy closure, and 3, 6, and 12 months after ileostomy closure. As a control group, normal ileal biopsies were obtained from patients with colonic polyps.At the time of ileostomy closure, mucosal interleukin-1beta, interleukin-6, interleukin-8, and tumor necrosis factor-alpha levels in the pouch and the proximal ileum were not significantly different from those in the normal control group. At 3 months after ileostomy closure, the mucosal cytokine levels in the pouch increased significantly compared with those at ileostomy closure, and their levels were significantly higher than those in the proximal ileum. At 6 and 12 months after ileostomy closure, the mucosal cytokine levels in the pouch did not change significantly compared with those at 3 months after ileostomy closure. The mucosal cytokine levels in the proximal ileum did not change significantly during the entire study.The immunological reactions in the pouch occurred soon after ileostomy closure, and continued for at least 1 yr. The fecal stream and stasis play an important part in the pathogenesis of immunological reactions in the ileal pouch.

Background The aim of this study was to examine the impact of elemental diet on mucosal inflammation in Crohn's disease (CD), mainly by cytokine measurements. Methods Twenty-eight consecutive patients with active CD were treated with an elemental diet (Elental) for 4 weeks. The mucosal biopsies were obtained from the terminal ileum and large bowel before and after treatment. As a control group, mucosal biopsies were obtained from 20 patients without inflammation. Mucosal cytokine concentrations were measured by enzyme-linked immunosorbent assay. Results After treatment, clinical remission was achieved in 20 patients (71%). Endoscopic healing and improvement rates were 44% and 76% in the terminal ileum and 39% and 78% in the large bowel, respectively. Histologic healing and improvement rates were 19% and 54% in the terminal ileum and 20% and 55% in the large bowel, respectively. Before treatment, the mucosal concentrations of interleukin (IL)-1beta, IL-1 receptor antagonist (IL-1ra), IL-6, IL-8, and tumor necrosis factor-alpha in the ileum and large bowel were significantly higher than in controls. These cytokine concentrations decreased to the levels of control after treatment. IL-1ra/IL-1beta ratio in the ileum and large bowel was significantly lower than in controls before treatment. The ratio increased to the level of controls after treatment. The endoscopic and histologic healing of the mucosal inflammation was associated with a decline of the mucosal cytokines and an increase of the IL-1ra/IL-1beta ratio. Conclusions The elemental diet (Elental) reduced mucosal cytokine production and corrected an imbalance between proinflammatory and anti-inflammatory cytokines in CD.

The aim of this prospective blinded study was to examine whether measurement of plasma cytokines is a predictor of strangulation in patients with bowel obstruction.Seventy-seven consecutive patients diagnosed with bowel obstruction were included. Blood samples were obtained at enrollment in all patients and at surgery (immediately before operation) if patients required surgery.Forty-three patients were managed conservatively (group 1) and 34 patients required surgery, of whom 20 had no bowel strangulation (group 2) and 14 had bowel strangulation (group 3). The mean plasma interleukin (IL)-6 levels at enrollment were significantly higher in group 3 (107.8 pg/ml) than in groups 1 (11.3 pg/ml, P0.0001 vs. group 3) and 2 (23.6 pg/ml, P0.0001 vs. group 3). The sensitivity and specificity of plasma IL-6 level (or = 40 pg/ml) in predicting strangulation were 86 percent (95 percent confidence interval, 60-97 percent) and 86 percent (95 percent confidence interval, 80-88 percent), respectively. The plasma IL-6 levels at surgery significantly increased compared to those at enrollment (from 107.8 pg/ml to 205.8 pg/ml, P = 0.0003) in group 3, however, they did not increase significantly in group 2. Among other clinical and laboratory parameters, plasma lactic acid levels (or = 15 mg/dl) at enrollment were significantly associated with strangulation. In the multivariate analysis, both plasma IL-6 (/or = 40 pg/ml) and lactic acid (/or =15 mg/dl) levels at enrollment were significant predictive factors for strangulation. IL-1beta and tumor necrosis factor-alpha were not detected in the plasma of most patients during the study.Plasma IL-6 measurement might be an additional diagnostic tool that can predict strangulation in patients with bowel obstruction.

This prospective, blinded study was designed to assess intraperitoneal cytokine productions and their relationship to clinical presentations and systemic inflammatory markers in patients with inflammatory bowel disease.Fifty patients who required abdominal surgery for active inflammatory bowel disease (ulcerative colitis, 27; and Crohn's disease, 23) were investigated. Interleukin-1beta, interleukin-6, and tumor necrosis factor-alpha levels in intraperitoneal fluid (obtained by intraoperative lavage) and plasma were measured by enzyme-linked immunosorbent assay. To compare intraperitoneal cytokine productions between diseases with a different degree of inflammation, intraperitoneal cytokine measurement also was performed for patients who required surgery for colorectal cancer (n = 25) and acute appendicitis (n = 25).The median intraperitoneal cytokine (interleukin-1beta, interleukin-6, and tumor necrosis factor-alpha) levels were significantly higher in patients with inflammatory bowel disease than in patients with colorectal cancer and acute appendicitis. In patients with inflammatory bowel disease, intraperitoneal cytokine levels were significantly higher in patients with intraperitoneal sepsis (abscess/fistula) than in patients without intraperitoneal sepsis at laparotomy. Intraperitoneal cytokine levels did not correlate with type of disease (ulcerative colitis/Crohn's disease), age, gender, duration of disease before surgery, preoperative medical treatment, and the extent or site of disease. There were no significant correlations between intraperitoneal cytokine levels and the following systemic inflammatory markers: plasma cytokine levels, white blood cell count, platelet count, erythrocyte sedimentation rate, and C-reactive protein levels. Postoperative intraperitoneal septic complications (anastomotic leak/abscess/enterocutaneous fistula) more frequently occurred in patients with higher intraperitoneal cytokine levels.Intraperitoneal cytokine productions were greatly elevated in patients with inflammatory bowel disease, and their levels correlated with the presence of intraperitoneal sepsis at laparotomy and development of postoperative intraperitoneal septic complications. Intraperitoneal cytokine levels showed no correlations with systemic inflammatory markers.

This study was designed to examine postoperative change of mucosal inflammation at strictureplasty segment in Crohn's disease mainly by cytokine measurements.Patients who underwent strictureplasty for Crohn's disease in the terminal ileum were investigated. Mucosal samples at the strictureplasty site were obtained during operation. At 3, 6, and 12 months after operation, biopsy specimens were taken from the strictureplasty site and macroscopically normal ileum at endoscopy. Mucosal cytokine concentrations were measured by enzyme-linked immunosorbent assay.The mucosal concentrations of proinflammatory cytokines (interleukin-1beta, interleukin-6, interleukin-8, and tumor necrosis factor-alpha) and anti-inflammatory mediator (interleukin-1 receptor antagonist) at the strictureplasty segment greatly increased at the time of operation. Interleukin-1beta, interleukin-1 receptor antagonist, interleukin-6, interleukin-8, and tumor necrosis factor-alpha concentrations at the strictureplasty segment decreased during a 12-month period after operation. Twelve months after operation there was no significant difference in each cytokine concentration between the strictureplasty and macroscopically normal segments. The mucosal interleukin-1 receptor antagonist/interleukin-1beta ratio at the strictureplasty segment increased during a 12-month period after operation. Twelve months after operation there was no significant difference in the ratio between the strictureplasty and macroscopically normal segments. The endoscopic and histologic severities of mucosal inflammation at the strictureplasty site also decreased; however, their findings were not normalized during the study.During one year after strictureplasty for Crohn's disease, cytokine production at the strictureplasty segment was decreased to the level of the macroscopically normal ileum and an imbalance between proinflammatory and antiinflammatory cytokines was corrected.

Four cases of patients who developed hepatic infarction caused by an operative injury to the hepatic circulation during gastric cancer surgery are reported herein. In two patients, the hepatic infarction resulted from accidental injury to the proper hepatic artery, and in the other two, it was possibly due to persistent pressure on the folded liver by a retractor during surgery. In the former two patients, the proper hepatic artery had been collapsed by the spread of enlarged metastatic lymph nodes before the onset of the arterial injury. In the latter two patients, postoperative laboratory data and computed tomography scanning revealed hepatic infarction even though preservation of the proper hepatic artery was confirmed by angiography. Elevated serum levels of hepatic enzymes released from the infarcted tissue recovered to the normal range within three weeks in all four patients. In conclusion, when an operative injury to the hepatic artery is encountered, the hepatoduodenal ligament should not be manipulated any more than necessary to preserve the collaterals, and the gallbladder should be removed to prevent necrotic perforation. Although close observation is mandatory, conservative therapy seems to be sufficient when an infarcted area is restricted to the lateral segment and a small part of the medial segment of the liver.

The bromodeoxyuridine (BrdU) labeling index was determined in 40 primary colorectal carcinomas by DNA flow cytometry using a BrdU-specific monoclonal antibody. The labeling index, or the fraction of cells in the S-phase of the cell cycle, ranged from 12% to 52%, with a mean of 28% (SEM, 2%). The labeling index in 19 patients was over 30%, which was termed a higher labeling index. There was no significant difference in the labeling index based on the clinical stage of the disease. During the 5-year follow-up after the apparently curative resection, 14 patients died of the disease, 1 died of an unrelated cause, 1 is alive with a recurrence of the disease, and 24 are alive without the disease. The higher labeling index was thus associated with a significantly poorer patient survival (P = 0.03 based on the generalized Wilcoxon test). The present study therefore disclosed that the S-phase fraction of tumor cells thus determined had prognostic significance in primary colorectal carcinoma.

This preliminary study was undertaken to ascertain whether our newly developed model of the cold ischemic rat liver in situ is applicable to studies designed to assess the metabolism of nutrients. Ischemia of the whole liver of 12 Wistar rats was induced by clamping all supply and drainage vessels. The ischemic liver was perfused in situ. The duration of ischemia of the liver was 20 minutes. Saline was infused into six rats throughout the experiment (group A). An intravenous infusion of glucose at a rate of 0.75 g/h per rat was begun immediately after the induction of blood-reflow to the liver (group B, n = 6). Six rats (group C) did not undergo the procedure for induction of hepatic ischemia and received glucose at the same rate as rats in group B. Changes in hepatic levels of sugar phosphates (phosphomonoesters [PMEs]), inorganic phosphorus, and beta-positioned phosphorus in adenosine triphosphate (beta-ATP) were monitored by 31P magnetic resonance spectroscopy. Ischemia caused a significant increase in levels of PMEs and a decrease in levels of beta-ATP. The infusion of glucose caused a further increase in levels of PMEs and a further decrease in levels of beta-ATP in group B. In contrast, in group C such infusion did not induce any changes in levels of PMEs or beta-ATP. In group A, PMEs and beta-ATP returned to basal levels 5 hours after the induction of blood-reflow to the liver. The changes in levels of PMEs were similar to those in levels of inorganic phosphorus in all groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Two cases of ulcerative colitis are described: a 33-year-old woman who developed widespread bronchiectasis 7 months after undergoing colectomy, and a 72-year-old man whose colonic disease began coincidentally with the appearance of diffuse interstitial pulmonary infiltrates. In both cases, clinical correlation and common patterns of response of lung and bowel diseases suggested that the co-existence of these two pathologies might not be merely a casual relation.

The DNA index (DI), defined as the ratio of the G0/G1 channel number of tumor cells to the G0/G1 channel number of stromal cells, was analyzed in 121 aneuploid colorectal cancers. In patients with aneuploid tumors, a high DI significantly correlated with tumor penetration beyond the proper muscle layer, positive vascular invasion, and the presence of liver metastasis. This observation led us to conclude that a high DI is likely to be associated with hematogenous dissemination in aneuploid colorectal cancer.

大腸癌培養細胞株3例および大腸癌臨床検体41例を対象として, bromodeaxyuridine (BrdU) 標識 DNA flow cytometry を行った. すなわち, FITC 抱合抗 BrdU monoclonal 抗体でS期細胞を in vitro にFITC標識し, さらに細胞核DNAをPI染色して, flow cytometer にかけ DNA ploidy を決定するとともに%Sを算出した. BrdUの取り込みは培養細胞株では middle S phase を中心に, 臨床検体では early および late S phase を中心にみられた. 臨床検体の検討では, 大腸癌部は正常平担粘膜に比べ有意に%Sが高く, 深達度 ss 以上の群も pm までの群に比し, 有意に%Sが高かったが, %Sと他の臨床病理学的事項の問には有意な関連は見いだせなかった. DNA ploidy は臨床病理学的所見ととくに関連はなく, diploid 群と aneuploid 群で%Sに有意差はなかった.

Two cases of chronic idiopathic intestinal pseudo-obstruction (CIIP) are reported. One is a 51-year-old man, and the other is a 47-year-old woman. Both patients presented with severe constipation and barium enema showed a marked dilation of the right colon, and a narrowing in the left colon. Studies done on the motility of the colon and anorectum revealed normal resting pressure profiles of the anorectom, a normal recto-anal reflex, and a normal resting tone of the collapsed colon. Administration of methacholine chloride, however, provoked large, non-propulsive movements in the collapsed colon, which were inhibited by the administration of atropin sulfate. Histologic examination disclosed a marked decrease in neurons and an increase of Schwann cells in the myenteric plexus of the collapsed colon. CIIP due to acquired visceral neuropathy localised in the left colon, was diagnosed as a result of manometric and histologic findings. One case was cured surgically, by a left hemi-colectomy, and the other was cured medically using choline antagonists and laxatives.