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Background Depiction of bypass blood flow in patients who received extracranial–intracranial (EC–IC) bypass surgery is important for patient care. Purpose To develop a vessel-encoded arterial spin labeling (VE-ASL) method using surgical staples as a magnetic resonance (MR)-conditional product in patients who received EC–IC bypass surgery. Material and Methods Pseudo-continuous labeling was used for VE-ASL acquisition with a 3-T MR unit. First, an experimental study was conducted to determine the appropriate number of surgical staples to obtain a spatially sufficient saturation effect. Thereafter, four healthy normal volunteers underwent a VE-ASL study to confirm the sufficiency of the saturation effect to the right or left common carotid artery. Finally, VE-ASL scanning was performed in seven patients after EC–IC bypass surgery to confirm the ability of VE-ASL to visualize the territorial bypass perfusion. All qualitative evaluation was performed by two neuroradiologists using a 3-point grading system (2 = good, 1 = moderate, 0 = poor). Results A quantity of 200 staples was found to be appropriate for VE-ASL scanning. In healthy volunteers, one neuroradiologist rated the images of all four cases as good, while the other rated three cases as good and one case as moderate. For the seven patients after EC–IC bypass surgery, one neuroradiologist rated all seven cases as good, and the other rated six cases as good and one case as moderate. Conclusion VE-ASL using surgical staples might be useful for the evaluation of territorial bypass perfusion in patients after EC–IC bypass surgery.

Peritoneal lymphomatosis is an extremely rare presentation of lymphoma. We report a case of peritoneal lymphomatosis diagnosed by laparoscopic biopsy. A 56-year-old female presented to our hospital with a 2-week history of increasing abdominal distension associated with anorexia and generalized weakness. Abdominal CT findings demonstrated extensive disseminated peritoneal disease with marked thickening of the peritoneal surfaces and a large omental cake with large volume ascites. The examination of blood data and cytology of ascites indicated to the diagnosis of malignant lymphoma. She was proceeded to an urgent laparoscopic biopsy for diagnosis and observed the thickening of the peritoneal surfaces and large volume ascites. Pathological and immunohistochemical examination of the omentum revealed that it was diffuse large B-cell lymphoma presented by peritoneal lymphomatosis. The patient started an immediate course of combination chemotherapy consisting of rituximab, cyclophosphamide, doxorubicin vincristine and prednisolone(R-CHOP)and no recurrence has been noted for 5 years and 10 months from first visit. The differential diagnosis for disseminated peritoneal disease is vast. Laparoscopic biopsy was minimally invasive, and useful for an urgent and accurate the diagnosis and the treatment strategy of disseminated peritoneal disease.

We report a rare case of cavitary lung metastasis of rectal cancer, diagnosed initially as septic pulmonary embolism. A 55- year-old woman underwent emergency Hartmann's operation for perforation of the rectal cancer with multiple liver metastases. A 2 cm-sized thin-walled cavitary lesion was seen in the left upperlobe of the lung by CT, and septic pulmonary embolism was suspected. She recoverd from sepsis after intensive care treatment. Pathological diagnosis is adenocarcinoma (tub2), T3N1M1, Stage Ⅳ, she underwent chemotherapy. Serum CEA level was high preoperatively but gradually decreased to normal 4 months after the operation. Multiple liver metastases showed calcification, and the lung lesions remained unchanged on CT. She continued chemotherapy while changing the anticancer drug due to side effects. One year and 5 months after operation, lung CT showed thickened wall and spicula around the cavitary lesion. Serum CEA level was normal, SLX and NSE slightly increased and serum aspergillus antigen was positive. Bronchial lavage cytology was Class Ⅰ and scrape cytology was Class Ⅲ in bronchoscopy. Lung metastasis, primary lung cancer or aspergilloma were suspected and we performed partial lung resection. The pathological diagnosis was rectal cancer lung metastasis.

We report 2 cases of total remnant pancreatectomy for remnant pancreatic carcinoma after pancreaticoduodenectomy (PD). Case 1 pertained to a 51-year-old man who underwent PD for pancreatic carcinoma(pT3N0, R0). Twenty-seven months later, he developed a remnant pancreatic cancer. Total remnant pancreatectomy was performed, but he died due to liver and lung metastases 27 months after the second surgery. Case 2 pertained to a 58-year-old women who underwent PD for papilla of Vater cancer(pT1N0, R0). Eight-four months later, she developed remnant pancreatic cancer, for which total remnant pancreatectomy was performed. She died due to liver metastasis 8 months after the second surgery. Pathological findings revealed recurrent carcinoma in both cases and carcinoma in situ with extensive intraductal growth to the branch in case 2. Both cases had no complications after total remnant pancreatectomy and achieved good quality of life(QOL). Longterm follow up after pancreatectomy is necessary for early diagnosis of remnant pancreatic carcinoma.

A 73-year-old male presented with melena and severe anemia. An esophagogastroduodenoscopy(EGD)and colonoscopy( CS)revealed no source of hemorrhage. Multiple small intestinal tumors were observed on abdominal ultrasound(US). CT also showed mesenteric lymph node metastases and multiple lung and liver metastases. Since active bleeding was suspected, we performed an emergency surgery. The small intestine including 2 tumors and 2 mesenteric lymph node metastases were resected. On histopathological examination, choriocarcinoma was diagnosed. The blood hCG level was remarkably elevated. The primary lesion could not be detected. Chemotherapy containing cisplatin(CDDP)and irinotecan(CPT-11)was initiated; although the blood hCG level was temporally lowered, the patient died of liver failure 8 months after the surgery.

We report a rare case of a resected recurrent lymph node on the posterior surface of the pancreatic head(lymph node No. 13)4 years after total gastrectomy. The patient was a 61-year-old man diagnosed with advanced gastric cancer. We performed total gastrectomy and splenectomy, after which histopathological analysis showed duodenal invasion and lymph node (No.17)metastasis. Because the pathological stage was Stage Ⅳ, he received chemotherapy(S-1 plus CDDP plus trastuzumab) for 1 year. Four years after primary surgery, lymph node(No.13)metastasis was detected on a CT scan. After 4 courses of chemotherapy(capecitabine plus CDDP plus trastuzumab), the size of the metastatic lymph node decreased. Subsequently, we performed surgical resection of the involved lymph node. Histopathological findings showed glanuloma and fibrous tissue without any remnant cancer.

Case 1: A 75-year-old man underwent distal gastrectomy with Billroth Ⅰ reconstruction and resection of the involved transverse mesocolon. Microscopic examination revealed adenocarcinoma(tub2, tub1), pT4b(SI)N3M0, pStageⅢc. Adjuvant chemotherapy with S-1 was performed for 6 months after the operation. One year later, CT revealed a localized dissemination in the transverse mesocolon; therefore, we performed transverse colectomy. Adjuvant chemotherapy with PTX was performed, and the patient remains free from recurrence 7 years after the initialoperation. Case 2: A 65-year-old man was diagnosed with gastric scirrhous carcinoma by esophagogastroduodenoscopy. CT and colonoscopy showed a tumorous lesion in the pelvis(Schnitzler's metastasis). Neo-adjuvant chemotherapy with S-1 plus CDDP was performed. After 6 courses, CT and endoscopy showed shrinkage of the tumors, and no other distant metastasis was detected by PET-CT. We performed totalgastrectomy(D2), splenectomy, and low anterior resection of the rectum simultaneously. Microscopic examination revealed adenocarcinoma(tub2, por2, sig), pT4a(SE)N0, and the histological response was Grade 1a. S-1 was administered, and the patient has had no recurrence in the 1 year 6 months after the operation. Dissemination of gastric cancer tends to be difficult to treat and has a poor prognosis. However, in some cases, the proper combination of chemotherapy and surgery might be beneficial for long survival.

The patient was a 78-year-old man with resection of distal pancreatectomy for pancreatic cancer with simultaneous multiple lung metastasis. They were papillary and tubular adenocarcinoma, Pt, TS3, infiltrative type, ly0, v0, pT3, CH0, DU0, S1, RP1, PV0, A1(Asp), PL0, OO0 and pN0, M1(PUL), pStage IV. He was received gemcitabine after the surgery. S-1 was added because of lung metastasis progression. Chemotherapy was continued for about 10 years from resection, and intra-abdominal recurrence was not observed and good performance status was maintained. 5-year survival rate of pancreatic cancer is as low as about 6.5%in Stage IV. There are cases where lung resection to isolated lung metastasis are performed after resection of pancreas and long-term-survival are obtained. A resected case of long-term-survival of pancreatic cancer with simultaneous multiple lung metastasis is rare, so we will report with a few literature considerations.

A 51-year-old man was admitted to our hospital because of anorexia and jaundice. Abdominal CT and MRCP taken after admission revealed tumor in the pancreatic head. Upper gastrointestinal endoscopy showed bleeding from the orifice of the major papilla. In angiography, an irregular image was found in the branch of the gastroduodenal artery, and a coil embolization surgery was performed mainly on the same part. We diagnosed pancreatic cancer and pancreaticoduodenectomy was performed. Pancreatic cancer with bleeding from the orifice of major papilla is very rare. We describe our case with known reports.

A 63-year-old man presented with the chief complaint of an unpleasant feeling in the chest after a meal.Esophagogastroduodenoscopy revealed interminglement of ulcer infiltration type lesions and protruding lesions in the lower esophagus.A large type 1 protruding lesion was located mainly in the esophagogastric junction(EGJ)and it progressed towards the stomach.A hypertrophic and protruding lesion on the lower esophageal wall and a 6 cm tumor in the major axis of the fornix were observed on thoracic and abdominal CT, and an endocrine cell carcinoma or basaloid carcinoma were suggested after biopsy.Finally, we diagnosed a basaloid carcinoma after immunohistochemistry analysis.We administered 4 courses of TS-1 plus CDDP as pre-operative chemotherapy.Because of a significant reduction in tumor size, approximately 5 months after first presentation, we performed esophageal resection by right thoracotomy and laparotomy, and reconstructive surgery for the thoracic gastric duct.The pathological diagnosis was basaloid carcinoma with multiple foci of squamous cell carcinoma.After surgery, we continued chemotherapy with TS-1 plus CDDP, which was previously effective, but a liver metastasis appeared 8 months later.We discontinued chemotherapy because of a prominent decline in platelets.Because of the clinical symptoms, we diagnosed secondary thrombotic thrombocytopenic purpura accompanied by a malignant tumor.We implemented plasma exchange and steroid pulse therapy, but this patient experienced no therapeutic effect and died.

A 67-year-old woman underwent laparoscopy-assisted left hemicolectomy for early descending colon cancer(pTis, pN0, cH0, cM0, Stage 0).Her postoperative course was uneventful, without fever and/or tenderness at the anastomotic site.A month following discharge from the hospital, enhanced computed tomography revealed a liver abscess measuring 80mm in diameter at the lateral segment and a left adrenal abscess measuring 30mm in diameter.Although some free air and fluid collection was noted near the anastomotic site, there was no tenderness, and a gastrografin enema did not reveal leakage and/or pooling of the contrast agent near the anastomotic site.We administered antibiotics and performed percutaneous transhepatic abscess drainage following which imaging revealed shrinkage of her liver and adrenal abscesses and lowering of fever.However, enhanced computed tomography, performed a month later, revealed recurrence of the liver abscess, for which we performed a hepatic lateral segmentectomy.After undergoing the hepatectomy, she has shown no recurrence of the liver and adrenal abscesses.Several cases of liver abscess have been reported in association with colorectal cancer; however, an adrenal abscess occurring in association with colorectal cancer has not yet been reported.This case reveals that a minor leak could be associated with a liver and adrenal abscess.

A contrast agent can be pushed by a saline solution more effectively through a spiral flow tube than through a conventional T-shaped tube in contrast-enhanced magnetic resonance angiography (CEMRA). To compare the degree of contrast enhancement and signal stability in the carotid artery by using CEMRA between a spiral flow tube and a T-shaped tube.A total of 100 patients were analyzed in this retrospective study. The first 50 patients underwent CEMRA of the carotid artery with the T-shaped tube, while the last 50 patients used the spiral flow tube. Gadoterate meglumine was diluted with saline to make a total volume of 20 mL. Injection was performed with a bolus rate of 2.5 mL/s for 8 seconds. Five regions of interest (ROIs) were placed on the contrast-enhanced area in each carotid artery and the signal intensity (SI) in the ROI was used for the analysis. The ROIs on the brain stem were also placed and the average SI in this ROI was used as a reference signal. The enhancement of the artery (Eartery) was calculated as a normalized signal using the following equation: Eartery = SI in the ROI of the carotid bifurcation/SI in the ROI of the brain stem. Signal homogeneity in the contrast-enhanced area (SHenhance) was assessed by calculating the coefficient of variation from the SI in the 5 ROIs. The value of SHenhance and Eartery between the data obtained from the spiral flow tube and the T-shaped tube were compared. P-values

We encountered 4 cases of colorectal cancer with para-aortic lymph node(LN)metastases.Para -aortic LN dissection was performed after the diagnosis of solitary LN metastases.Case 1: A 69-year-old woman was diagnosed with ascending colon cancer.She underwent right hemicolectomy with D3 LN dissection.After 1 year and 3 months, tumor marker levels(CEA) were elevated, and para-aortic LN metastases were detected on CT.She was administered FOLFOX.After 1 year, para-aortic LN dissection was performed.She is doing well without any recurrence for 8 years and 9 months.Case 2: A 52-year-old man was diagnosed with rectal cancer.He underwent abdominoperineal resection with lateral pelvic LN dissection.After 5 months, his tumor marker levels(CEA)were elevated, and para-aortic LN metastases were detected on CT.He was administered various chemotherapies, but the LN were swollen.After 6 years and 2 months, para-aortic LN dissection was performed.He received systematic chemotherapy, and is alive with recurrent disease.Case 3: A 67-year-old man was diagnosed with obstructive sigmoid colon cancer.He underwent high-anterior resection with D3 LN and para-aortic LN dissection.He received systematic chemotherapy and is alive with recurrent disease.Case 4: A 61-year-old man was diagnosed with obstructive rectal cancer.He underwent low-anterior resection with D3 LN and para-aortic LN dissection.He is doing well without recurrences for 2 years and 1 month.Our results suggest that patients with localized para-aortic metastases of colorectal cancer may achieve good long-term survival after dissection of para-aortic LN.and surgical treatment is indicated in selected cases.

Case 1 is a 57-year-old man with pelvic recurrence 1 year 8 months after surgery for ascending colon cancer.We performed a Hartmann's operation.He has been relapse-free for 11 years.Case 2 is a 67-year-old man with intraperitoneal small intestinal relapse 4 years after surgery for cecum cancer.We performed resection.He has brain metastases recurrence in 2 years 6 months after surgery, died after 2 years 9 months.Case 3 is a 53-year-old man with recurrence in the bladder rectal fossa 5 years after sigmoidectomy.We performed resection.He has been relapse-free survival at 1 year 2 months.

A 67-year old woman underwent laparoscopy-assisted high anterior resection for sigmoid colon cancer. A histopathological examination revealed no lymph node metastasis, but extramural cancer deposits were present. Four years later, enhanced computed tomography revealed recurrence in the retroperitoneum and metastasis to the left kidney. A left nephrectomy and left hemicolectomy were performed. A year after the second operation, computed tomography revealed metastasis to the lung. Histopathological reexamination for extra-lymph nodal spread after the first operation revealed venous involvement. Generally, colon cancer with extra-lymph nodal spread has a higher risk of retroperitoneal recurrence, and venous involvement leads to a poor prognosis. We describe our case with the known report.

To improve the production of recombinant human antithrombin III (AT-III) in Chinese hamster ovary (CHO) cells, the genes encoding transcription factors, ATF4 (activating transcription factor 4) and XBP-1s (the spliced form of X-box binding protein 1), which were involved in the mammalian unfolded protein response (UPR), were cloned from CHO-K1 cells. Overexpression of ATF4 significantly enhanced the production of recombinant AT-III in CHO 13D-35D cells. The specific rate of AT-III production in the ATF4-overexpressed CHO 13D-35D cells reached approximately 23 pg/cell/day. After 144 h of incubation, the AT-III concentration in the culture supernatant was twofold greater compared to that observed with parental CHO 13D-35D cells. In contrast, ectopic expression of XBP-1s failed to enhance the production of recombinant AT-III in CHO 13D-35D cells. RT-PCR analysis revealed that high levels of XBP-1s mRNA were present in the CHO cells, regardless of ectopic expression of XBP-1s. Our results indicate that overexpression of the UPR transcription factor ATF4 is a promising means for improving the production of secreted protein pharmaceuticals in CHO cells. Biotechnol. Bioeng. 2008;100: 317–324. © 2007 Wiley Periodicals, Inc.

We encountered a case of colorectal cancer with macroscopic invasion to the adjacent organs. A 61-year-old man with abdominal pain and nausea was diagnosed as having sigmoid colon cancer invading the ileum, ureter, internal iliac artery, and external iliac vein. A lower anterior resection and resection of the small bowel, ureter, external iliac vein, and internal iliac artery was performed and succeeded in an R0 resection. The patient was discharged from the hospital in 29 POD. Pathology results revealed an adenocarcinoma, pT4b, pSI, INF b, int, ly0, v, pPM0, pDM0, pN0, Type 2, Stage Ⅱ. Four courses of XELOX plus bevacizumab were administered. The patient underwent ileostomy closure, and is currently free of relapse 3 years 2 months after resection. The survival rate of patients with combined resection of the invaded organs is significantly higher than that of patients with a non-combined resection. The survival rate after curative resection is also significantly higher compared with non-curative resection. Aggressive resection of invaded organs seems to be important for a good outcome.

We present a case of sigmoid colon cancer with isolated para-aortic lymph node metastasis in a 67-year-old male patient. We treated this patient using simultaneous curative lymph node dissection with primary tumor resection. After inserting a transanal tube and decompressing the proximal colon for obstructive colitis, we performed high anterior resection with paraaortic lymph node dissection without neoadjuvant chemotherapy. The pathology results were as follows: tub2, SE, N3, H0, P0, M1(No. 216, 280), stage Ⅳ, curability B. Adjuvant chemotherapy with the XELOX regimen was administered, and the patient remains alive with no signs of recurrence 24 months after surgery. Although simultaneous dissection of para-aortic lymph node metastasis is controversial, curative dissection is advisable for localized cases.

A 72-year-old man underwent Miles' operation for rectal cancer. Histological findings showed moderately differentiated adenocarcinoma, a, ly0, v1, n0, stage Ⅱ(ly0, v1). Five months later, left lateral segmentectomy and left adrenalectomy were performed owing to the metastasis of the rectal cancer to the liver and adrenal glands. Two years after these operations, left nephrectomy was performed for retroperitoneal recurrence around the left kidney. All resected specimens showed metastatic adenocarcinoma derived from the rectal cancer. No recurrence has been detected in the 4 years since the left nephrectomy. Aggressive resection of well-controlled metastatic lesions including those in the adrenal glands is recommended.

The first patient was of a 71-year-old woman who was examined for abdominal protuberance. Computed tomography (CT) and magnetic resonanc e imaging(MRI)revealed a giant tumor almost occupying the entire abdomen. En-bloc resection was performed. The tumor was 30 cm in size and weighed 6,500 g. The histological diagnosis was a well-differentiated liposarcoma. The second patient was a 72-year-old woman who visited our hospital after she had been diagnosed with an abdominal tumor by her family doctor. CT and MRI revealed a massive tumor involving various components. The tumor had invaded the left ureter and descending colon; therefore, we performed tumorectomy, left nephrectomy, and descending colectomy. The histopathological findings indicated a well-differentiated, myxoid, pleomorphic liposarcoma. The tumor recurred 4, 5, and 7 years after the first operation. By the fourth operation, the histological subtype of the tumor had changed to a dedifferentiated type.

We encountered a rare case of gastric cancer consisting predominantly of undifferentiated carcinoma.The patient was a 64-year-old man who underwent various tests because of symptoms of dysphagia in September 2012.We found a subcircumferential type II tumor at the gastroesophageal junction.A total gastrectomy, splenectomy, and Rouxen-Y reconstruction were performed.Adhesiotomy was also performed for the ileus on postoperative day (POD)2.The patient subsequently experienced septic shock with disseminated intravascular coagulation (DIC) and acute kidney failure due to complications of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia and MRSA colitis.As a consequence, the patient required respiratory management and continuous hemodiafiltration (CHDF). In addition, the patient experienced hemorrhage from the Roux-en-Y-anastomotic site in the contact with the ileus tube during treatment for septicemia on POD14, which was resolved with endoscopic treatment.Moreover, a cholecystectomy was performed on POD52 for gangrenous cholecystitis.The patient's progress was satisfactory.The pathology results revealed an undifferentiated carcinoma with the following characteristics: pT4a (SE), ly1, v0, pPM1, pDM0, type 2, 80 × 75 mm, UE, Less.In addition, immunostaining results revealed a tumor consisting of at least 90% of undifferentiated carcinoma tissue.Four months after surgery, local recurrence at the site of the esophagojejunostomy, disseminated recurrence around the left kidney, and metastases in the left adrenal gland appeared. The partial response (PR) was maintained by treatment with CPT-11+ cisplatin (CDDP) + trastuzumab.However, left adrenalectomy was performed 1 year and 4 months after the initial surgery was performed for metastasis to the left adrenal gland that started 10 months after surgery.One year and 10 months after the initial surgery, the patient continues to receive treatment with trastuzumab and has not exhibited signs of recurrence.

In October 2007, a 69-year-old woman underwent right hemicolectomy and D3 lymph node dissection for the treatment of adenocarcinoma (type 2, por2]tub2, pSS, pN3, fStage IIIb). Serum carcinoembryonic antigen (CEA) concentration was 152.8 ng/mL preoperation, but returned to normal after the operation. Adjuvant chemotherapy using 450 mg/day UFT-E was added. Computed tomography (CT) examination revealed a swollen paraaortic lymph node 3 months after the operation, while serum CEA concentration had increased to 92.7 ng/mL. After the chemotherapy was changed to FOLFOX, the paraaortic lymph node shrank and serum CEA concentration decreased. However, after 6 courses, serum CEA concentration increased again and bevacizumab-FOLFIRI therapy was initiated. After 3 courses of bevacizumab-FOLFIRI were not effective, paraaortic lymph node dissection was performed in February 2009. Pathological examination of the resected specimen showed metastatic adenocarcinoma. At present, the patient is alive without any signs of recurrence. Although the effectiveness of chemotherapy for paraaortic lymph node metastasis of colorectal cancer has been described, complete cure has not been reported. Thus, surgical resection has the potential to cure solitary recurrence of paraaortic lymph node metastasis, and therefore, should be considered in the treatment of such cases.

腸間膜デスモイド腫瘍はまれな疾患で, 家族性大腸腺腫症, 手術, 外傷, 妊娠などの既往を有する症例に発生することが多い. 今回我々は, 小腸間膜原発デスモイド腫瘍の1例を経験したので報告する. 症例は58歳の男性で, 56歳時に食道癌の手術を受けた. 腹部腫瘤触知・腹痛を主訴に近医受診, 腹部腫瘤と診断され当科紹介となった. 腹部超音波・CT・MRI・血管造影検査にて小腸間膜に境界比較的明瞭な腫瘤を認め, 小腸間膜充実性腫瘍と診断し, 腫瘤摘出術を施行した. 腫瘤は110×65×58mmで, 組織学的には分化した線維芽細胞と豊富な膠原線維からなり, 核分裂像は認めず, Masson染色で青染, Vimentin染色陽性にてデスモイド腫瘍と診断した. 腸間膜腫瘍の術前質的診断は困難なことが多いが, 本症例のように画像上腫瘍血管像を認めない充実性腫瘍の場合, デスモイド腫瘍も念頭において手術に臨むべきである.

The effect of the histamine H2 receptor antagonist, ranitidine, on plasma concentrations of acetaminophen was investigated with respect to hepatic metabolism, in five volunteers. Acetaminophen (1000 mg) together with ranitidine (300 mg), placebo or at 1 h after ranitidine (300 mg) was orally administered to five healthy male volunteers. Venous blood samples were taken before and after drug administration. Plasma acetaminophen and acetaminophen conjugates (glucuronide and sulphate) were determined by HPLC. The pharmacokinetic parameters were calculated from the plasma acetaminophen concentration-time curves from each volunteer. The area under the plasma acetaminophen concentration-time curve from 0 to 3 h (AUC0–3) significantly (P < 0.01) increased from 13.03 ± 0.84 μg h mL−1 (placebo coadministration) to 21.30 ± 0.60 μg h mL−1 (ranitidine coadministration). The peak plasma acetaminophen concentration significantly (P < 0.01) increased from 18.30 ± 2.26 μg mL−1 (placebo coadministration) to 34.14 ± 1.07 μg mL−1 (ranitidine coadministration) 30 min after administration. Plasma acetaminophen concentrations with ranitidine were significantly increased at 15 to 120 min compared with placebo. Plasma acetaminophen glucuronide conjugate concentrations with ranitidine were significantly decreased at 15 to 45 min compared with placebo, whereas plasma acetaminophen sulphate conjugate concentrations were not significantly altered. Plasma acetaminophen and acetaminophen conjugate concentrations were not significantly different between placebo-coadministration and in the case where acetaminophen was orally administered 1 h after ranitidine. Coadministration of acetaminophen and ranitidine reduced plasma acetaminophen glucuronide concentrations and significantly increased plasma acetaminophen concentrations. The effects of ranitidine are as a result of the prevention of first-pass hepatic metabolism, by prevention of acetaminophen glucuronyltransferase. Thus care must be taken when acetaminophen and ranitidine are coadministered.

A sensitive and specific enzyme immunoassay (EIA) for a secretin-like immunoreactive substance (secretin-IS) was developed using a synthetic carboxy-terminal (C-terminal) fragment (residue 5-27) of a porcine secretin conjugated with β-D-galactosidase and an anti-rabbit lgG coated immunoplate. The activity of the enzyme on the plate was fluorometrically determined. The present immunoassay allows the detection of 1.7 to 67 fmol/ml (0.068 to 2.7 fmol/well) of secretin. Using the present EIA, the secretin-ISs in human plasma were determined.Moreover, significant changes in the plasma secretin-IS levels were found after the oral administration of famotidine (vs.placebo).

We have developed a patient medication instruction provision system linked to a prescription order entry system in Oita Medical University. We have provided basic information, efficacious information and safety information of the drugs for each patient. Basic information was registered by pharmacists while other information was inputted by doctors on the entry system. Such information was combined, sent to a dispensing support system and outputted as a patient medication instruction sheets, namely, “OKUSURINITSUITE” .In this system, it is possible to provide drug information which reflects the doctor's intention to the patient. Also, it is capable to cope with the prescription of anti-cancer drugs and their nonapplicable use.We evaluated the provision rate of the instruction sheets to the prescription for 4 months. As a result, the whole rate was about 25% and on the increase to out-patients. In the clinical division, surgery and pediatrics gave a higher rate. On the other hand, the rate for inpatients has remained almost unchanged.

A 65-year-old man was admitted to the hospital because of epigastric discomfort. X-ray examination revealed an elevated lesion in the body of the stomach and a polypoid lesion in the duodenal bulb. Endoscopic examination showed a 18×16mm IIa+IIc gastric tumor. The polypoid lesion of the duodenal bulb could not be detected by endoscopy. The biopsy specimen from the gastric lesion showed histological evidence of malignancy. Distal gastrectomy was performed including the duodenal polyp adjacent to the pylorus. Histological examination showed that the lesion of the stomach was moderately differentiated tubular adenocarcinoma that invaded the submucosal layer without lymph node metastasis and that the duodenal polyp was 10×10×10mm well-differentiated adenocarcinoma limited to the mucosal layer. The patient is well two years after the operation, without any evidence of recurrence. The family and past histories of this patient meet the criteria of hereditary nonpolyposis colorectal cancer. Our survey of the literature suggested that this is the 8th reported case of early carcinoma of the stomach associated with early duodenal carcinoma in Japan.

A 6-axis portable manipulator, weighing 120 N (12.3 kg) which traces over a 3-dimensional curved surface for ultrasonic testing has been developed. The manipulater body is made of carbon-fiber-reinforced plastic and magnesium alloy. A feature of the system is that deviation of the manipulator from its nominal path caused by arm bending due to its own weight can be corrected. The deviation is calculated by premeasuring spring coefficients and hysteresis characteristics of the arm structure. In a mock-up calibration performance test the accuracy was shown to be as high as that of a human inspector. The manipulator can be installed within 3 minutes by a single person. Joint angles are calculated with a direct memory access (DMA) handler using a poling method. Signals are transmitted to servo-controllers through an optical fiber of 2..5 Mbps.

To improve the production of recombinant human antithrombin III (AT-III) in Chinese hamster ovary (CHO) cells, the gene encoding growth arrest and DNA damage inducible protein 34 (GADD34), which is a transcription factor involved in the unfolded protein response (UPR), was cloned from CHO-K1 cells. Overexpression of GADD34 significantly enhanced the production of recombinant AT-III in CHO 13D-35D cells. The specific rate of AT-III production in the GADD34-overexpressing CHO 13D-35D cells reached approximately 28 pg/cell/d. After 144 h of incubation, the AT-III concentration in the culture supernatant was approximately 40% higher than that observed in the case of the parental CHO 13D-35D cells. The mRNA expression, specific activity, and fucosylation of AT-III were not affected by GADD34 overexpression. Overexpression of GADD34 is a promising method of improving the production of secreted protein pharmaceuticals in CHO cells.

We aimed to examine the safety and antitumor effects of a combination of S-1 and paclitaxel in patients with unresectable or recurrent gastric cancer in a phase I/II setting.The study was designed as a phase I/II clinical trial. In phase I portion, the dose of paclitaxel was escalated to estimate the maximum-tolerated dose (MTD) and recommended dose (RD) of paclitaxel with fixed dose of S-1. S-1 (daily dose, 80 mg/m(2)) was given orally on days 1-21 every 35-day cycle (rest on days 22-35). Paclitaxel was administered intravenously on days 1, 8 and 15, at an initial dose of 40 mg/m(2), stepping up to 70 mg/m(2) in 10-mg/m(2) increment. Dose-limiting toxicity (DLT) was defined as grade 4 hematological toxicity, grade 3 or higher nonhematological toxicity, and treatment discontinuation due to adverse reactions during the first course of treatment. In phase II portion, the efficacy and toxicity at the RD of paclitaxel with S-1 were assessed.The MTD of paclitaxel was estimated to be 60 mg/m(2), because33.3% of patients (2/3) developed DLTs. DLT included postponement of treatment due to grade 2 neutropenia, and grade 3 stomatitis, anorexia, and nausea. Therefore, the RD of paclitaxel was estimated to be 50 mg/m(2). In the phase II portion, 22 patients were evaluated with 50 mg/m(2) paclitaxel and 80 mg/m(2) S-1 in a 35-day cycle. The response rate was 54.5% (95% CI, 32.2-75.6%). The median survival time was 283 days (95% CI, 218-508 days). The median number of treatment courses was 4 (range 1-10), indicating that this regimen could be given repeatedly.This phase I/II trial of combination therapy with S-1 and paclitaxel in patients with unresectable or recurrent gastric cancer showed that this regimen has substantial antitumor activity and can be given safely.

The case reported here was a 80-year-old male who was presented with a diffuse type of hepatocellular carcinoma accompanied by thrombosis of the main trunk of the portal vein. The primary focus and portal vein thrombosis improved considerably following repeated transcatheter arterial chemoembolization using DSM (DSM-TACE). DSM-TACE was suggested to have the potential for becoming a new treatment method for advanced hepatocellular carcinoma, for which conventional transcatheter arterial embolization (TAE) using Lipiodol and so forth is contraindicated tue to thrombosis of the main trunk of the portal vein.

An indwelling catheter was dislocated into the duodenum during the course of hepatic arterial infusion for multiple metastases of colon cancer to the liver. A possible cause of extravascular dislocation includes an exposure to highly concentrated anticancer due to defective positioning of the catheter side hole and bending of the catheter. A dislocation of the hepatic arterial infusion catheter into the digestive tract is a serious complication and accounts for 10% of all dislocations. Although countermeasures consisting of monitoring progress, laparotic catheter extraction and endoscopic catheter extraction, a monitoring process is selected in nearly all cases. Even though hepatic arterial infusion has established as being effective against liver tumors, there is a possibility of encountering more of these cases in the future along with an increase in the number of cases and a prolongation of treatment that improves prognoses. In the case, a catheter extravascular dislocation has occurred in addition to complications stemming from the dislocation itself. There was also a risk of exacerbation of prognosis resulting from being forced to discontinue the treatment. It is therefore necessary to pay close attention to positioning of the catheter side hole and its immobilization.

We herein report a simple method using intestinal clamps to prevent intraoperative contamination during an immediate mucocutaneous suture of the intestinal stoma. Using this technique, a protruded intestinal stoma can be constructed reliably without soiling. The technique can be used both for constructing an end as well as a loop intestinal stoma.

Colorectal cancer and gastric cancer are the two most commonly associated malignancies in Japan. We examined mismatch repair deficiency in the tumors of patients with primary colorectal and gastric cancers retrospectively. In 103 cases and 102 healthy control subjects, surgical specimens of colorectal and gastric cancer underwent immunohistochemical analysis of mismatch repair proteins (hMLH1 and hMSH2) and microsatellite instability testing. Immunohistochemical and microsatellite instability testing produced similar results. High microsatellite instability in colorectal cancer was found in 23 of 103 cases (23 percent) with colorectal and gastric cancers, and in 8 of 102 healthy control subjects (8 percent). Twelve (12 percent) had mismatch repair deficiency in both colorectal and gastric cancers, and both tumors had loss of the same mismatch repair protein (hMLH1, n = 5; hMSH2, n = 7). They had the first cancer at a younger age, with a higher frequency of familial colorectal cancer than the others. Seventeen had mismatch repair deficiency in either tumor, which showed loss of expression of hMLH1. Multiple cancers and right-sided colon cancers developed more frequently in patients with mismatch repair deficiency. Patients with both colorectal and gastric cancers are more likely to have phenotypic evidence of hereditary nonpolyposis colorectal cancer than patients with colorectal cancer only. Among patients with double tumors, 12 percent showed a common deficiency in the same mismatch repair protein in both tumors by immunohistochemistry, and they should undergo genetic counseling for germline mutational analysis. Immunohistochemistry was effective in detecting mismatch repair deficiency of colorectal and gastric cancer as well as microsatellite instability testing, and may be more practical to perform phenotypic analysis of tumors because of its cost-effectiveness.

A 14-year-old female with Turner syndrome (karyotype 45,X) had a history of abdominal pain with distention, constipation, and fever. She was first operated on for the suspicion of appendicitis, failed to improve, and was later hospitalized for further investigation and treatment. Studies demonstrated an obstructing tumor of the transverse colon, and an emergency laparotomy was performed. The final diagnosis was a signet-ring cell carcinoma of the colon with diffuse peritoneal dissemination and metastasis to paracolic lymph nodes. On the basis of this case, we report the association of Turner syndrome with malignancies and also some aspects of colon cancer in childhood.

The addition of surfactants such as n-C7H15SO3Na or n-C7H15COONa is effective in acceleration of the carboxylation of benzyl chloride using a water-soluble catalyst, [PdCl2{PPh2(m-C6H4SO3Na)}2], in an aqueous NaOH–heptane solution. Phenylacetic acid is easily isolated from the aqueous layer in high yields. However, the addition of n-C7H15SO3Na has no effect on the carboxylation using hydrophobic catalysts, [PdCl2(PPh3)2] and [Pd(PPh3)4], under the two phase conditions.

There has been an increase in the number of recognized early gastric cancers with the recent advance in diagnostic modalities1. In some cases, less aggressive procedures are indicated and local resection, with or without limited lymph node dissection, is one of the treatments of choice. It is, however, sometimes difficult to ensure adequate excision with tumour-free margins because such lesions are movable and may not be firmly fixed to the muscle layer. A simple technique to determine the sites to be incised to allow adequate resection of the tumorous lesion with ease and safety is reported here.