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Sachio Fushida,1 Masahide Kaji,2 Katsunobu Oyama,1 Yasuo Hirono,3 Hideaki Nezuka,4 Toshiya Takeda,5 Tomoya Tsukada,1 Daisuke Fujimoto,3 Shigekazu Ohyama,6 Takashi Fujimura,7 Tetsuo Ohta1 On behalf of the Digestive Disease Support Organization (DDSO) 1Department of Gastroenterological Surgery, Kanazawa University Hospital, Kanazawa, 2Department of Surgery, Toyama Prefectural Central Hospital, Toyama, 3First Department of Surgery, Fukui University Hospital, Fukui, 4Department of Surgery, Yatsuo General Hospital, Toyama, 5Department of Surgery, Ishikawa Matto Central Hospital, Hakusan, 6Department of Surgery, Kanazawa Medical Center, Kanazawa, 7Toyama City Hospital, Toyama, Japan Abstract: The standard regimen of second-line chemotherapy for patients with unresectable gastric cancer has not been established. However, weekly paclitaxel (wPTX) has become the preferable second-line chemotherapy in Japan. Histone deacetylase (HDAC) inhibitors have been shown to have antiproliferative activity through cell-cycle arrest, differentiation, and apoptosis in gastric cancer cells. One HDAC inhibitor, valproic acid (VPA), also inhibits tumor growth by inducing apoptosis, and enhances the efficacy of paclitaxel in a mouse xenograft model of gastric cancer. wPTX plus VPA as a second-line chemotherapy is expected to improve survival in gastric cancer patients. A multicenter randomized Phase II study was conducted to compare the effects of wPTX plus VPA and wPTX alone. A total of 66 patients participated in this study. The primary end point of the study was overall survival, and secondary end points were progression-free survival, response rate, and assessment of peripheral neuropathy. Keywords: valproic acid, paclitaxel, second-line therapy, advanced gastric cancer&nbsp

Objective Fibrin deposition on the peritoneum has been frequently observed in peritoneal fibrosis induced by long-term peritoneal dialysis. The present study was conducted to clarify the contribution of factor Xa through tissue factor and factor V expression in peritoneal fibrosis. Methods Wistar rats were intraperitoneally injected with chlorhexidine gluconate (CG) every day. For the interventional study, the factor Xa inhibitor fondaparinux was subcutaneously administered. After 28 days of CG injection, peritoneal specimens were examined by immunohistochemical analyses and in situ hybridization. Results The peritoneal submesothelial compact zone was observed to be markedly thicker in the CG-injected groups than in the normal group, and that thickness was dose dependent. Immunohistochemical study revealed massive fibrin, fibronectin, and type IV collagen depositions in the CG-injected groups, which was markedly higher than that in the normal group. Macrophage infiltration and staining for tissue factor, factor V, factor X, and protease-activated receptor-2 were intense in the CG-injected groups and negative/trace in the normal group. Tissue factor and factor V mRNAs were abundant in cells in the thickened peritoneum. A double-labeling experiment revealed that tissue factor was observed mainly in macrophages, and factor V was abundantly distributed in the fibrotic tissue together with macrophages. Fondaparinux treatment decreased the thickness of submesothelial fibrotic tissue, and size and number of CD31-positive vessels. Conclusion These results suggest that expression of tissue factor and factor V in infiltrated macrophages, together with factor X deposition, may progress angiogenesis and accumulation of extracellular matrix components, partly via profibrotic and procoagulant mechanisms in the peritoneum after inflammatory stimulation.

ノーパージ型減圧スイング吸着法を用いて揮発性有機化合物含有排気ガスの処理に向けて，揮発性有機化合物として酢酸エチル，メチルエチルケトンを用い，吸着剤にはメソ孔主体活性炭とミクロ孔活性炭を用いて基礎的検討を行った．原料ガス濃度変化が清浄ガス濃度に及ぼす影響と塔径変化が循環定常状態到達時間に及ぼす影響を測定した．ノーパージ型スイング吸着法では循環定常状態到達後の清浄ガス濃度は原料ガス濃度の変化に影響されず一定であることがわかった．これは吸着剤の平均吸着率が原料ガス濃度に比例して増減することに起因している．そして，この現象はミクロ孔主体活性炭よりもメソ孔活性炭の方が顕著である．減圧スイング吸着における塔径の影響は塔内物質移動係数を用いて評価した結果，吸着ステップよりも脱着ステップに大きく現れ，最適塔径の存在が認められた．

Direct somatic embryogenesis has been used to induce intact regenerated plantlets. We applied two-step direct somatic embryogenesis to the mass propagation of carrots and characterized this method. Morphological observation revealed that somatic embryos were generated from whole segments except for the callus part. Secondarily formed collenchyma-like structures were observed in the segments after the induction culture. The somatic embryos were generated from the collenchyma-like structure. When the longer-grown hypocotyls which had less potential to generate somatic embryos were used, the collenchyma-like structure did not develop. RAPD-PCR investigation showed that the regenerated plantlets had genetic stability. These results indicated that two-step direct somatic embryogenesis was a useful method for the mass propagation of plants without losing the quality of the donor plants.

Mass production of the regenerated plantlets from carrot hypocotyls via two-step direct somatic embryogenesis (DSE) was investigated. Somatic embryos were induced in the induction culture with medium containing 2,4-dichlorophenocxyacetic acid (2,4-D) prior to the development culture in this method. The optimum condition for the regeneration efficiency was found to be 2 weeks of induction culture using hypocotyls shorter than 3 cm. The distribution profile of the regeneration efficiency corresponded to that of the normal distribution. The distribution range was observed to depend on the length of the hypocotyls. Calcium addition increased the regeneration efficiency but did not affect the distribution range. We also found that this procedure was applicable to the mass production of regenerated plants using a bioreactor.

In this study we propose new techniques for evaluating operating conditions employed for vacuum pressure swing adsorption (VPSA) in the recovery of volatile organic compounds (VOC). The new method incorporates a precoating step for the mesoporous activated carbon in the adsorption column, but does not use purge gas for the desorption step. The evaluation technique employs the arrival time of cyclic steady state (TA) as a measure of effectiveness. By precoating the mesoporous activated carbon with adsorbate, the concentration of purified gas was reduced to the detection limit of measurement without using purge gas, and VOC were recovered in the liquid state. We also performed evaluations under a variety of operating conditions using TA.

We report on treatment with capecitabine plus oxaliplatin (CapeOX) as adjuvant therapy for patients with colorectal cancer. Twenty patients were treated. The mean age was 69 years; 15 patients were male and 5 were female. Thirteen patients with colon cancer and 7 patients with rectal cancer were enrolled after curative surgery. In total, 55% of patients completed the planned number of treatment cycles. Dose modifications were required for oxaliplatin in 60% of patients and for capecitabine in 67% of patients. The median relative dose intensities of oxaliplatin and capecitabine were 86% and 88%, respectively. Treatment-related Grade 3/4 neutropenia and Grade 3/4 thrombocytopenia were documented in 2 and 3 patients, respectively. Grade 3/4 hand-foot syndrome occurred in 1 patient. Treatment with CapeOX as adjuvant therapy for patients with colorectal cancer seems to be safe.

幽門側胃切除後の再建方法に,吻合部狭窄予防や小胃症状改善目的に空腸pouchを用いたRoux-en Y法(以下pouch RY)を施行し経過観察を行ってきた. pouch RYの術後成績や術後愁訴について, Billroth-I法(以下B-I)による再建症例と比較検討を行い, pouch RYの有用性にっいて考察した.当科でのB-I症例31例とpouch RY症例58例を対象とした.術後愁訴の評価目的には,アンケート調査を用い集計を行った. B-Iとpouch RYとの間に術後合併症の発生率に差は認めなかった.体重変化率では,有意差はないもののpouch RYにおいても良好な結果が得られた.アンケートによる術後愁訴に関した検討でも有意差は認めなかった. pouch RYは, B-Iと比較しても遜色は無く,他の再建法と比較しても安全性や吻合部狭窄の予防の面などで利点を有することから,幽門側胃切除後の再建方法の一つになり得るものと考えられた.

We investigated gene expression responding to hydrodynamic stress in an agitation tank using RT-PCR. A novel fragment, tuf, was found to be expressed under turbulent flow conditions using a differential display method. The deduced amino acid sequence of the fragment was homologous to those of NBS (nucleotide binding site) domains in plant disease-resistant genes, but differed with respect to some of the functional motifs of those sequences. We also demonstrated that calcium-dependent protein kinase (CDPK) expression increased by agitation. A calcium channel blocker, verapamil, suppressed the expression of tuf, but did not affect the expression of CDPK.

Heating treatment as a permeabilization method for plant cells was examined on the release of anthocyanin pigments from strawberry cells. The release rate of anthocyanins followed an Arrhenius-type dependency on temperature. The death rate was observed to be peculiarly low at 45 °C, the temperature at which the heat shock protein was induced. Thus, the release of anthocyanin from viable cells depends on the functioning of the heat shock protein probably. The treatment with calcium after heating was observed to restore viability. An elevated rate of the release of anthocyanins, which were likely accumulated in vacuoles, was achieved after they had been gradually released for 45 min.

We investigated the effects of exogenously added calcium on somatic embryo formation in carrot cells. Elevation of calcium from 3 to 12 mM enhanced the somatic embryogenesis in carrots during the regeneration culture at 0 or 7 days. The addition of calcium ionophore A23187 also enhanced the somatic embryogenesis. This result suggested that an artificial influx of calcium into cytosol could enhance somatic embryo formation. However, the addition of calcium suppressed the somatic embryogenesis in cases of high cell concentration. The critical concentration of cells needed for the enhancement of somatic embryo formation was lower when there was a higher concentration of 2,4-dichlorophenoxy acetic acid (2,4-D) in the pre-culture. The additional calcium was adsorbed by cells within 2 min. And greater amount of calcium was adsorbed by cells pre-cultured with a higher concentration of 2,4-D. From these results, we hypothesize that an excess adsorption of calcium, which was probably caused by overcoming 2,4-D from the pre-culture, would suppress somatic embryogenesis.

We investigated the effects of exogenous polyamines on somatic embryo formation in carrot cells. The polyamines, spermidine and spermine, were added to a regeneration culture of carrots. A greater enhancement of somatic embryo formation was achieved with the addition of spermine. This enhancement was not, however, always observed. Additional spermine increased the DNA content regardless of whether somatic embryo formation increased. Based on the analysis of profile in somatic embryo formation, we note that the addition of spermine increased the lag time of somatic embryo formation and suppressed the protein secretion from cells.

Two polyacrylamide-degrading bacterial strains, No. 2 and No. 11, were isolated from soil, and identified asBacillus sphaericus No. 2 andAcinetobacter sp. No. 11, respectively. Both strains grew on medium containing polyacrylamide as sole carbon and nitrogen sources.B. sphaericus No. 2 andA. sp. No. 11 reduced by 16% and 19% of the initial polyacrylamide concentration, respectively. Optimal pH and temperature in growth ofAcinetobacter sp. No. 11 were 8.0 and 37°C, respectively. After 14-day cultivation ofA. sp. No. 11, the average molecular weight of polyacrylamide has been shifted from 2.3×106 to 0.5×106.

It is rare for cecal cancer to be associated with acute appendicitis signs, making it difficult to diagnose preoperatively. Case 1, a 59-year-old woman, suffered appendix swelling and the ulceration of its base penetrating into the retroperitoneum, forming a perityphlic abscess necessitating ileocecal resection. As the resected specimen was pathologically diagnosed as cecal cancer and ew(+), so we reoperated soon thereafter. She survived 7 years after operation. Case 2, a 58-year-old man, had the operative finding that a perityphlic abscess had spread throughout the retroperitoneum, necessitating ileocecal resection and partial peritoneal resection. The resected specimen was pathologically diagnosed as cecal cancer and ew(+), requiring reopertion. The man died 14 months after the first operation. Case 3, a 74-year-old man, had the operative finding of gangrenous appendix a hard tumor in the cecum, swollen lymph nodes near the cecum, and many nodules in the peritoneum. Because of a diagnosis of peritoneal dissemination of cecal cancer, we conducted ileocecal resection and lymph node dissection. The man died 7 months after operation. In high-grade appendicitis with perityphlic abscess in middle and old age, it is very important to investigate the case in detail preoperatively and intraoperatively.

We propose a design concept and operation of a flexible robot with multiple degrees of freedom to dive into debris. Pneumatic robots with flexibility previously developed did not have multiple degrees of freedom with high bending moment. We propose a new type of robot, called ""Active Hose,"" which has multiple degrees of freedom by connecting units of 2 degrees of freedom in a series and has high bending moment thanks to a spine structure and deformation by spiral tubes. ""Active Hose"" can thus be applied to rescue operations such as searching for victims under debris after earthquakes, supplying. fresh air and drinking water to victims, and carrying air jacks to make room for victims to escape.

腹膜原発漿液性乳頭状腺癌は, 卵巣の漿液性乳頭状腺癌と類似した組織でありながら卵巣に異常を認めないもので, 腹膜原発の腫瘍と考えられている. 症例は61歳の女性. 右下腹部痛と腹部膨満感を主訴に来院した. 腹水穿刺細胞診でclassV: adenocarcinomaと診断され, 全身の検索を行ったが, 原発巣は不明であった. 開腹所見では, 大網に多数の漿液性嚢胞を伴う腫瘍を認め, 術中迅速病理診断で卵巣の漿液性乳頭状腺癌に組織像が類似していた. 卵巣は肉眼上正常であり, 腹膜原発漿液性乳頭状腺癌と診断し, 可及的に腫瘍を切除した後, シスプラチンを腹腔内投与した. 術後はカルボプラチンとシクロフォスファミドによる化学療法が著効し, その後の再開腹では明らかな腫瘍は認められなかった. しかし, 腹腔洗浄細胞診にて癌細胞の遺残をみとめたことから, さらに化学療法を追加し, 退院した. 初回手術後12か月の現在, 腫瘍の再燃の兆候はない.

症例は50歳女性.臍周囲痛の増強を認め入院.腹部超音波検査では上行結腸のほぼ全長にわたりtargetsign,腹部CTでも同部に拡張した腸管の中心に腫瘤を認め,腸重積症と診断した.注腸では上行結腸肝彎曲部に蟹爪様欠損像を認め,整復により盲腸に径8cm大の腫瘤を認めた.大腸内視鏡では表面平滑な累々とした腫瘍を認め,生検による病理組織検査で悪性リンパ腫が疑われ,回盲部切除術, D3郭清を施行した.切除標本では,回盲弁を中心とする盲腸に8cm大の表面平滑な亜有茎性隆起性病変を認めた.病理組織検査では,固有筋層深部まで浸潤したmalignantlymphoma, non-Hodgkin, diffuselarge, Bcell typeと診断された.本症例のごとく回盲弁を中心とした盲腸に発生し,腸重積を呈した悪性リンパ腫は極めて稀であり,文献的考察を含めて報告する.

当科における過去2年2カ月間に99mTC-2-methoxy isobutyl isonitrile (MIBI)シンチグラフィーを施行し,病理組織診断を得た乳腺腫瘍33例(良性5例,悪性28例)を対象に検討を行った. 600MBqの99mTc-MIBIを静注し, γカメラにてearlyとdelayedにSPECT撮影をし評価した. 99mTc-MIBIの良悪性の診断における有病正診率96%,無病正診率100%,正診率97%であり,リンパ節転移診断に関してはそれぞれ58%, 100%, 81%であった.抗癌剤の耐性と関連すると言われているwash outを認めた割合は悪性腫瘍39病変中14病変36%に認められた. 99mTc-MIBIは乳腺腫瘍の良悪性の鑑別診断およびリンパ節転移診断に有用であり,今後化学療法の耐性との関連を調査する必要があると考えられた.

Since the cellular origin of gastrointestinal mesenchymal tumors (GIMT) is uncertain, the definite classification of them has not been established as yet. Recently it has been increasingly clarified that most of GIMTs may be gastrointestinal stromal tumors (GIST) derived from intestinal cells of Cajal (ICC) which reveal immunoreactivities to CD34 and membrane-bound tyrosine kinase receptor, Kit (CD117). In this study a total of six patients with GIMT of the stomach treated in the hospital from 1994 to 1998 were reexamined clinicopathologically and immunohistochemically. Before entering the study, two cases were diagnosed as leiomyoma, two cases as leiomyosarcoma, and two cases as gastrointestinal autonomic tumor. In this reexamination, tissues from the six GIMTs were immunostaind for CD34, Kit, desmine (Des), alpha-smooth muscle actin (α-SMA) and S-100 protein (S100). All the six GIMTs exhibited CD34(+), Kit(+), Des(-), α-SMA(-), S100(-) immunophenotype. After reexamination, all six GIMTs were diagnosed as GIST originated from ICC. No pure myoid nor schwannian (or neural) differentiation was seen in this series. All tumors including one with liver metastasis were resectable. All the patients is still alive. We need further accumulation of clinical cases to know malignancy and prognosis for GIST.

非常に稀な非機能性副腎皮質癌の1例を報告する.症例は45歳,女性. 1カ月前から左季肋部痛あるも放置,痛みが増強し,発熱を認めたため当院受診,腹部エコーにて10cm大の腫瘍を指摘され入院となった.血管造影所見等から左副腎原発と推察され,内分泌学的検査を行うも副腎ホルモンはいずれも正常であった.非機能性副腎腫瘍の術前診断で開腹,腫瘍は左腎への直接浸潤も疑われ,一塊として摘出した.病理組織所見では,円型核と淡明～好酸性顆粒状胞体を有する円形～多角形細胞の増殖があり, nuclear gradeはII>IIIで, 1～2/10HPFのmitosisを伴うことから副腎皮質癌と診断された.治癒的切除と考えられるが血行性遠隔転移再発が多く,外来通院にて補助化学療法を施行する予定である.

This parer presents a case of pancretic cancer with liver and para-aortic lymph nodes involvement which was unresectable for prominent lymph nods metastasis and well responded to chemotherapy with low dose cisplatin and 5-fluorouracil. This patient was a 49-year-old man. After the unresectable operation, he was treated with chemotherapy of low dose cisplatin (CDDP) and 5-fluorouracil (5-FU) with low dose FP therapy which was given weelky by i. v. drip infusion at the first day. The combination of intravenous infusion of 5-FU (250mg/body) and CDDP (20mg/body) adminintered weekly. At 10 weeks, the serum CA19-9 and DUPANII level decreased within normal limits and the metastatic liver tumor and pancreatic cancer disappeared. The patient was discharged from the hospital and was given the low dose FP therapy biweekly on outpatient setting. Urticaria which is side effect of CDDP appeared after 38 courses of the low dose FP therapy, and thereafter only 5-FU (150mg/day oral) was given. After that, the tumor stopped to grow. The patient has been doing well as of 5 years after the admission. The lom dose FP therapy for patients with unresectable pancreatic cancer is recommended for selected cases.

A compartmental model for plant cell culture was proposed. This model considers respiratory intermediates as the rate-limiting components in the growth of cells and formation of secondary metabolites. Cell structural components and storage carbohydrates were also considered as constituting compartments. The storage carbohydrates were considered as a reservoir of substrates for the respiratory intermediates. Growth regulation by intracellular phosphates was considered the major factor controlling interconversion between the respiratory intermediates and the storage carbohydrates. The growth of safflower cells and the vitamin E (tocopherol) production were described using this model. The calculated profile of cell growth and vitamin E formation agreed with experimental values in both batch cultivations and semi-continuous cultivations. Furthermore, the conditioning effect (which is assumed to be responsible for lag phase) was included in this model with the assumption of respiratory intermediate release.

On a etudie les reponses metaboliques de cellules d'eucalyptus et de carthame aux contraintes hydrodynamiqes dans un reacteur agite de 550 cm 3 . A un taux de dissipation d'energie de 0,5-2,3 m 2 /s 3 , la diminution de la vitesse de respiration et de la teneur en ATP est de la teneur en ATP est plus importante que la diminution de l'integrite membranaire. Le NAD(P)H intracellulaire a ete reduit et la teneur en calcium cytosolique augmentee par agitation. L'EGTA, le verapamil et le W-7 suppriment la baisse du NAD(P)H. Ces resultats suggerent que le calcium cytosolique, comme deuxieme messager, conduit le signal de contrainte hydrodynamique dans le metabolisme, entrainant la diminution de la vitesse de respiration. En outre, on a observe une baisse de la teneur en actine filamenteux due a l'agitation.

症例は75歳の男性. 1997年1月19日に下腿浮腫, 肉眼的血尿に気付き他院を受診した. 施行した諸検査でBUN 85mg/dl, Cr 4.8mg/dl, Hb 9.7g/dl, 尿蛋白1+, 尿潜血3+が認められたため, 急速進行性糸球体腎炎 (RPGN) と診断され1月22日に当科に転医入院した. 入院時検査でMPO-ANCAが488 EUと高値を示し, その後に行った腎針生検で糸球体に半月体形成はなかったが, 小・中血管の血管炎所見とフィブリノイド変性が高度に観察されたため, MPO-ANCA関連の古典的多発動脈炎と診断した. 血液透析療法, ステロイドパルス療法, 二重膜濾過法 (DFPP) を施行した. その結果, 入院後13日目に血液透析から離脱できた. 治療中にMPO-ANCAとCRPが再上昇し, この時期に右腸腰筋出血を合併した. MPO-ANCA陽性の古典的多発動脈炎に右腸腰筋出血を合併した報告は少ないため, 文献的考察を加えて報告する.

We report having treated patients with metastatic colorectal cancer with panitumumab in our department. Ten patients were treated. The mean age was 65. 7 years-old with 7 males and 3 females. Seven patients were treated with only panitumumab, and three patients were treated with panitumumab and another drug. The median number of infusions was 8 times. In the 9 cases that could be evaluated, the disease control rate was 66. 6%. Skin toxicity was observed in all patients. A low serum magnesium value of grade 3 was observed in one patient. We consider that treatment with panitumumab for patients with metastatic colorectal cancer was a safe option.

症例は37歳の男性で1989年10月にネフローゼ症候群と診断されて治療を受けていた. その後腎機能の低下がみられ, 1992年7月から末期腎不全のために血液透析療法が開始された. 1994年10月に母親を提供者として生体腎移植を希望し当院へ転院してきた. 慢性腎不全の基礎疾患を知る目的で諸検査を施行した. その結果, 全身性エリテマトーデス (SLE) 由来の腎不全であると診断した. また同時にSLEの活動性が認められ, ステロイドパルス療法を含む副腎皮質ステロイド療法と免疫吸着療法を施行した. 血清補体価, 抗DNA抗体価はともに改善傾向がみられたが1994年12月外泊後に肺炎, 出血性脳梗塞を併発し17日後に死亡した. 剖検によって中大脳動脈のアスペルギルス塞栓による出血性脳梗塞を認めた. 一般的にSLE症例では脳血管障害の合併は少ないが, その中では閉塞性脳血管障害が約半数以上を占めている. 本症例のようにSLEに合併した中枢神経系アスペルギルス症の報告は特に少ないと思われたので, 文献的考察を加えて検討した.

The occurrence of apocrine carcinoma is rare, representing from 0.04% to 1.0% of all breast carcinomas. About 40 cases have been reported in Japan so far. The biological behaviors of the tumor are still obscure in that further studies are expected. This paper presents our experience with such a rare case. A 51-year-old woman was seen at the hospital because of a small lump of the right breast. Excisional biopsy was done. Histopathological examination subsequently revealed apocrine carcinoma of the breast. Modified radical mastectomy was performed. As histopathological examination showed subclavicular lymph node metastasis, postoperative radiation at 50 Gy and chemotherapy with tamoxifen citrate and 5-FU were added. She is now doing well with no evidence of recurrence, as of 14 months after the surgery.

Background: We aimed to evaluate the efficacy of a new combination antiemetic therapy comprising aprepitant, granisetron, and dexamethasone in gastric cancer patients undergoing chemotherapy with cisplatin and S-1. Methods: Gastric cancer patients scheduled to receive their first course of chemotherapy with cisplatin (60 mg/m2) and S-1 (80 mg/m2) were treated with a new combination antiemetic therapy aprepitant, granisetron, and dexamethasone on day 1; aprepitant and dexamethasone on days 2 and 3; and dexamethasone on day 4. The patients reported vomiting, nausea, use of rescue therapy, and change in the amount of diet intake, and completed the Functional Living Index-Emesis (FLIE) questionnaire. The primary endpoint was complete response (CR; no emesis and use of no rescue antiemetics) during the overall study phase (0-120 h after cisplatin administration). The secondary endpoints included complete protection (CP; CR plus no significant nausea); change in the amount of diet intake; and the impact of chemotherapy-induced nausea and vomiting (CINV) on daily life during the overall, acute (0-24 h), and delayed (24-120 h) phases. Results: Fifty-three patients were included. CR was achieved in 88.7, 98.1, and 88.7 % of patients in the overall, acute, and delayed phases, respectively. The corresponding rates of CP were 67.9, 96.2, and 67.9 %. Approximately half of the patients had some degree of anorexia. FLIE results indicated that 79.5 % of patients reported "minimal or no impact of CINV on daily life". Conclusions: Addition of aprepitant to standard antiemetic therapy was effective in gastric cancer patients undergoing treatment with cisplatin and S-1. © 2013 Springer Japan.

The effect of pancreatic resection for periampullary carcinoma in the elderly was studied by comparing the pre-and perioperative factors affecting survival in 102 patients less than 70 years of age (group A) with those in 28 patients 70 years and older (group B). Concomitant cardiac and pulmonary diseases were significantly more frequent in group B (P < 0.05), but the difference in routine laboratory data was not significant. The overall operative mortality was 7% (7/102) in group A and 18% (5/28) in group B, while the actuarial 5-year survival rates were 31%o in group A and 23% in group B, these differences not being significant. A multivariate analysis using a logistic model showed that blood loss was the greatest risk factor for early postoperative death in the elderly patients, whereas anastomotic dehiscence and postoperative bleeding were significant factors in the younger patients. Thus, we conclude that age is not a contraindication to pancreaticoduodenectomy which offers the only hope for long-term survival in patients with periampullary carcinoma; however, meticulous dissection to minimize blood loss is especially important in elderly patients.

The effect of hydrodynamic stress on intracellular factors of plant cells was investigated. Safflower (Carthamus tinctorius) cells were cultivated in a stirred tank reactor. The aggregate size distribution was determined with an image analyzer and it was confirmed that the aggregate size became smaller in a stirred tank. The resultant changes in the cells were evaluated on the basis of cell number, dry cell weight, cell viability, ATP amount and cell membrane fluidity. The viability was estimated by growth potential, membrane integrity and respiration activity of the cells. The cells were damaged by hydrodynamic stress in the respiration activity before the occurrence of the cell lysis and the damage of membrane integrity. ATP amount decreased as the agitation rate increased. The extent of ATP loss was larger than that of viability loss. These results indicated that hydrodynamic stress affected the metabolic system and that the loss of viability was probably due to this metabolic change. The degree of ATP reduction showed a power law dependence on the power dissipation rate per unit mass, e, which is calculated from agitation rates.

Apolipoprotein A-1 is known to be one of inhibiting factors of cholesterol nucleation in bile, and decreased activity of apolipoprotein A-1 is considered to predispose cholesterol-supersaturated bile to formation of cholesterol crystals. To study the pathogenesis of the intrahepatic formation of cholesterol stones, we examined surgically resected liver specimens from six patients with intrahepatic cholesterol stones and compared the characteristic histopathological features with those of intrahepatic calcium bilirubinate stones, using morphological examination and immunohistochemical staining against apolipoprotein A-1. Morphologically, in all six patients with cholesterol stones the severity of chronic proliferative cholangitis with proliferation of the mucus-producing glandular elements in the walls of the large bile duct or periductal tissues was less extensive than that seen with calcium bilirubinate stones, and cholesterol crystals had formed in the septal and interlobular bile ducts. Immunohistochemically, unlike the normal liver and calcium bilirubinate stone-containing lobes, the hepatocytes and the epithelial lining of the bile ducts and peribiliary glands of the cholesterol stone-containing lobes did not react completely (some of the epithelial cells reacted only faintly) with apolipoprotein A-1 antibody. These findings suggest that an abundance of mucous substance and bacterial infection of the biliary tree may not be necessary for the formation of cholesterol stones, compared with findings in cases of calcium bilirubinate stones. We suggest that cholesterol crystals may be produced in the septal and interlobular bile ducts in the microenvironment of cholesterol-supersaturated bile and decreased activity of apolipoprotein A-1. (HEPATOLOGY 1993;17:531–537.)

To clarify the pattern of lymph node metastasis in carcinoma of the pancreas, lymph node involvement was examined in forty-two patients who underwent extensive nodal dissections, including the paraaortic lymph nodes. The correlation between the spread of the tumor and lymph node involvement was evaluated: The most common site of involved lymph nodes was the retropancreatic region. The prevalence of nodal metastases was 78.6%. Metastases to the paraaortic region were present in seven patients, among whom metastases in the paraaortic region were most common in the median region from the celiac artery to the inferior mesenteric artery and in the space between the aorta and the vena cava. The risk of lymph node metastases tended to increase with tumor size, except in the paraaortic region, where the correlation between the frequency of metastasis and tumor size was poor. The probability of lymph node metastases increased with the degree of lymphatic invasion (ly) and the growth pattern of the tumor (INF) and was high in patients with invasion into the retropancreatic tissue and in tumors with scirrhous histology. These results indicate that even in small cancers, lymph nodes of the paraaortic region frequently harbor metastases and should be dissected en block during radical resections of pancreatic cancer.

膵頭部領域癌耐術肉眼的治癒切除例92例を対象に再発形式を検討し, 外科治療の問題点を考案した.膵頭部癌では組織学的治癒, 非治癒を問わず大動脈周囲リンパ節再発, 後腹膜局所再発が高頻度であり, 画像確認24例の検討では肝転移のみが2例, 後腹膜再発のみが12例, 両者が10例であった.また, Stage I, IIの膵頭部癌では拡大郭清の効果がみられたが, Stage III, IV症例に対してはいまだ十分とはいえなかった.下部胆管癌では膵浸潤が認められる場合には再発例がみられるようになり, リンパ節再発や肝十二指腸間膜内再発などの後腹膜再発が多かった.乳頭部癌では後腹膜局所に加え肝再発が重要であった.以上より, 膵頭部癌においては大動脈周囲リンパ節郭清, さらびに神経叢切除を伴う現行の拡大手術は不可欠であり, 下部胆管癌, 乳頭部癌では上腸間膜動脈周囲リンパ節を確実に郭清する手術が必要と考えられた.

Factors affecting α-tocopherol production using safflower (Carthamus tinctorius) cells were studied from the engineering aspects for plant cell culture. The specific production rate was evaluated as a function of rate-limiting factors. The conditioning factor released from cells, dissolved oxygen (DO) and medium components were considered as the limiting factors responsible for the specific production rate. Increasing the conditioning factor enhanced α-tocopherol production. Increasing DO concentration up to 9 mg-O2/l also caused a linear increase in specific production rate. The specific production rate in batch cultivation decreased, however, at a constant DO concentration with a sufficient amount of the conditioning factor. In repeated batch cultivation, the specific production rate was recovered by the addition of fresh medium. These results showed that an essential component in the medium was exhausted at an early stage of the batch cultivation and that the medium-feeding operation with sufficient CF and DO concentrations was required to maintain high productivity. By repeated batch cultivation, the content of α-tocopherol in the cell was increased to 9 mg/100 g-dry cell, which was considerably higher than that in natural safflower seeds.

Cavernous transformation of the portal vein is a rare disease in the adult. We report a case of a 60-year-old woman with a large carcinoma of the body of the pancreas, who underwent a curative resecti

Chemostat culture for non-adhesive recombinant CHO cells (rCHO) at the wide range of glucose and glutamine feed concentration was carried out in the serum-free media. The specific monoclonal antibody production rate was independent of glucose concentration, however increased by decrease of glutamine concentration in low glutamine concentration range. Intracellular fluxes were estimated from extracellular utilization and production rates. It was elucidated that in low glutamine concentration, fluxes of glycolysis and the TCA cycle were accelerated, and the flux of the direct pathway to α-ketoglutalate increased with decrease of glucose concentration, however the flux of glutamine decomposition was not influenced by glucose concentration.

Twenty-seven cases of carcinoma of papilla Vater, which were taken by microscopically absolute curative resection, were investigated clinicopathologically. The five-year survival rate for these 27 patients was 56.4% and ten-year survival rate, 50.1%. In point of gross appearance of the tumor, the prognosis of the protruded type was better than of the ulcerated type. Microscopically, the cases with pancreatic invasion or with invasion beyond the duodenal wall showed poorer prognosis than the cases without these factors. The lymphatic involvement were seen mainly at the anterior pancreaticoduodenal region, posterior pancreaticoduodenal region and around the superior mesenteric artery. The prognosis was closely related to lymphatic involvement (p

膵頭部領域癌に対する拡大郭清膵切除術式のうち上腸間膜動脈周囲郭清の意義について, 術式の根治性と術後quality of life (QOL) の面から検討した.上腸間膜動脈周囲神経叢浸潤と腸間膜根部リンパ節転移の頻度は膵頭部癌 (61例) で68.9%, 36.1%, 下部胆管癌 (21例) で4.8%, 33.3%, 乳頭部癌 (34例) で0%, 14.7%であり, 根治性向上のうえで上腸間膜動脈周囲郭清の重要性が示唆された.同部位の郭清程度を拡大, 準拡大, 標準の3群に分類すると, 累積生存率では準拡大郭清群が最も良好であつたが, 膵頭部癌, 拡大群の3例を含む7例に5年生存を得た.一方術後QOLは術後入院期間, 在院死亡率, 再入院率, 術前後のperformance statusの変化, 術後糖尿病, 難治性下痢, 脂肪肝の発生率において拡大郭清群で不良であつた.治療成績の現状からみて根治性の向上が急務であり, 術後QOLについては再入院加療を含めた長期の栄養管理により対処している.

Background: Sairei-to is a herbal prescription originating from traditional Chinese medicine. We conducted an experimental study on rat peritoneal fibrosis to clarify the suppressive mechanisms of sairei-to. Methods: Wistar rats were intraperitoneally injected with chlorhexidine gluconate (CG) every day. Peritoneal specimens were collected after 28 days of CG injection and oral administration of sairei-to. Macrophage infiltration, extracellular matrix accumulation, and angiogenesis were evaluated by immunostaining for ED-1, fibronectin, and CD-31, respectively. To observe oxidative stress in the tissue, 4-hydroxy-2-noneal (HNE) accumulation and plasma levels of superoxide dismutase (SOD) activity were detected. As a candidate of antioxidative components in sairei-to, plasma levels of baicalin were determined by high-performance liquid chromatography. Results: Compared with the disease control group, serum total protein levels were significantly recovered in the sairei-to treatment group. Thickness of the submesothelial compact zone, trichrome-stained area, ED-1-positive cells, fibronectin-staining area, and HNE accumulation were suppressed in the treatment group. Concurrently, decreased plasma levels of SOD activity were recovered by sairei-to treatment. Increased CD-31-positive vessel number and area were also suppressed in the sairei-to group. Baicalin was detected in the plasma samples of the sairei-to group at 0.29 ± 0.11 µg/ml (mean±SEM). Conclusion: These results suggest that sairei-to ameliorates peritoneal fibrosis, partly through suppressing oxidative stress and macrophage infiltration.

Fibrin deposition on the peritoneum has been frequently observed in peritoneal fibrosis induced by long-term peritoneal dialysis. The present study was conducted to clarify the contribution of factor Xa through tissue factor and factor V expression in peritoneal fibrosis.Wistar rats were intraperitoneally injected with chlorhexidine gluconate (CG) every day. For the interventional study, the factor Xa inhibitor fondaparinux was subcutaneously administered. After 28 days of CG injection, peritoneal specimens were examined by immunohistochemical analyses and in situ hybridization.The peritoneal submesothelial compact zone was observed to be markedly thicker in the CG-injected groups than in the normal group, and that thickness was dose dependent. Immunohistochemical study revealed massive fibrin, fibronectin, and type IV collagen depositions in the CG-injected groups, which was markedly higher than that in the normal group. Macrophage infiltration and staining for tissue factor, factor V, factor X, and protease-activated receptor-2 were intense in the CG-injected groups and negative/trace in the normal group. Tissue factor and factor V mRNAs were abundant in cells in the thickened peritoneum. A double-labeling experiment revealed that tissue factor was observed mainly in macrophages, and factor V was abundantly distributed in the fibrotic tissue together with macrophages. Fondaparinux treatment decreased the thickness of submesothelial fibrotic tissue, and size and number of CD31-positive vessels.These results suggest that expression of tissue factor and factor V in infiltrated macrophages, together with factor X deposition, may progress angiogenesis and accumulation of extracellular matrix components, partly via profibrotic and procoagulant mechanisms in the peritoneum after inflammatory stimulation.

This paper reports on a 0.9-m-high fixed bed charged with hollow fibers containing amidoxime groups placed on the coast of the Pacific Ocean for the recovery of uranium from seawater. Continuous flow of seawater at a superficial velocity of 4 cm/s provided an averaged uranium content of 0.97 g of U/kg in the amidoxime hollow fiber along the bed after 30 days contact. An elution curve having a 230 g of U/m{sup 3} peak concentration and a 45 g of U/m{sup 3} integrated concentration of uranium was obtained at a superficial velocity of 1 N HCl of 0.0125 cm/s. The required cross-sectional area of the amidoxime hollow fiber-packed bed to produce 10 kg of U per annum was calculated as 9.4 m{sup 2} with a 0.9-m bed height.

We report a case of granulocyte-colony stimulating factor producing gastric cancer with multiple liver metastases. A 68-year-old woman who complained of epigastralgia visited our hospital. Upper gastrointestinal endoscopic examination revealed a type-2 gastric cancer. The laboratory data at admission indicated leukocytosis (35,900/microl) and a high level of serum granulocyte-colony stimulating factor (61 pg/mg). Granulocyte-colony stimulating factor producing gastric cancer was diagnosed by immunohistochemistry of biopsy specimen. Since we detected multiple liver metastases, chemotherapy was performed. Granulocyte-colony stimulating factor-producing gastric cancer is relatively rare and we summarize previous reports.