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With contributions from noted critics and film historians from both countries, The Japan/American Film Wars examines some of the most innovative and disturbing propaganda ever created. It analyzes the conflicting images of these films and their effectiveness in defining public perception of the enemy. It also offers pointed commentary on the power of visual imagery to enhance racial tensions and enforce both positive and negative stereotypes of the Other. In language that is both lively and accessible, the book evaluates the overt and veiled visual messages that influenced public opinion fifty years ago and discovers surprising similarities between these images and those presented during the recent Persian Gulf conflict.

We report a case of surgical resection of an early gastric cancer that coexisted with multiple submucosal heterotopic gastric glands.A man in the 80's referred to our department because of an increased level of CEA.He had undergone hepatectomy for heterochronous liver metastasis of colon cancer.Gastrointestinal endoscopy revealed an early gastric cancer that coexisted with multiple submucosal gastric glands.He underwent segmental gastrectomy for gastric cancer.He exhibited no symptoms at the time of discharge.He has had no recurrence of gastric cancer 6 months after the surgery.We should appropriately care for synchronous or heterochronous gastric cancer in the remnant stomach if total gastrectomy is not performed in cases of therapy for gastric cancer with multiple submucosal heterotopic gastric glands.

Urinary tract resection is the only procedure that can cure colorectal cancer that directly invades the ureter. In these cases, open surgery is commonly used. Here, we describe our experience of a case of sigmoidectomy following Boari flap construction with single-incision laparoscopic surgery (SILS) for advanced colon cancer with ureteric invasion. A 68-year-old woman was referred to our hospital with left flank pain. Left hydroureteronephrosis was detected on ultrasonography. Computed tomography revealed a solid mass in the sigmoid colon and hydroureteronephrosis due to swelling of a mesenteric lymph node. Computed tomography detected no signs of distant metastasis. Colonoscopy revealed an ulcerated, bleeding, and stricturing lesion in the sigmoid colon, which was identified as an adenocarcinoma with a moderate degree of differentiation at histological examination. Under general anesthesia, the patient was placed in the Trendelenburg semi-right lateral position. An umbilical incision was made for the insertion of a single multichannel port for SILS. Sigmoidectomy and Boari flap reconstruction were performed. There were no perioperative complications. The total operating time was 572 minutes (including Boari flap procedure of 174 minutes), and estimated blood loss was 200 mL. Single-incision laparoscopic sigmoidectomy with Boari flap construction is technically feasible with sigmoid cancer and ureteral invasion.

The safety of single-incision laparoscopic surgery (SLS) in elderly patients with colorectal cancer has not been established. The aim of the current study was to compare the outcomes of SLS and multi-port laparoscopic surgery (MLS) and to assess the feasibility of SLS in colorectal cancer patients aged ≥70 years. A retrospective case-control study of colon cancer patients undergoing elective surgical intervention between 2011 and 2014 was conducted. A total of 129 patients with colon cancer underwent surgery and were included in the analysis. Data regarding patient demographics, surgical variables, oncological outcomes and short-term outcomes were evaluated for statistical significance to compare MLS (n=79) and SLS (n=50) in colon cancer patients. No significant differences were observed in patient characteristics. No case required re-admission within 30 days post surgery. The mean surgery times were similar for the MLS and SLS groups when cases with left and right hemicolectomies were combined (207.7 and 215.9 min, respectively; P=0.47). In addition, overall perioperative outcomes, including blood loss, number of lymph nodes harvested, size of the surgical margin and complications, were similar between these groups. Thus, we suggest that SLS can be performed safely in elderly patients with colon cancer.

Creation of a cholecystojejunostomy has been recommended as one option in the palliation of biliary obstruction due to pancreatic carcinoma.However, it was a technique used for biliary drainage for acute cholecystitis a long time ago.We describe a patient who underwent a cholecystojejunostomy for acute cholecystitis 50 years prior to presentation, and then revealed a gallbladder carcinoma.

Hepatocellular carcinoma(HCC)is not commonly observed with bile duct thrombosis.Here, we report a case of HCC with bile thrombi that extended to the liver hilum.The patient was a 61-year-old man who visited us due to untreated type B hepatitis.He underwent screening with a CT scan that revealed LDA on the right posterior lobe of his liver with infiltration of the bile duct.Generally, bile resection and reconstruction should be considered for curative resection for bile thrombi; however, we attempted to conserve the common bile duct to preserve the options of percutaneous therapy in case of tumor recurrence.We performed right lobectomy of the liver.The bile duct thrombus was extracted without bile duct resection or reconstruction.The patient is alive 6 months after the surgery without any development.

Limited data on laparoscopic and robotic total pelvic exenteration (TPE) for gynecologic, urologic, and rectal malignancies have been published in the literature. Single-incision laparoscopic surgery (SILS) has been successfully introduced for colon cancer. Here, we describe our experience of TPE with SILS + 1 port (SILS+1) for advanced rectal cancer. A 64-year-old man was referred to our hospital with anemia. Computed tomography (CT) revealed a rectal tumor that was contiguous with the seminal vesicle and bladder. Rectoscopy revealed an ulcerated, bleeding, and stricturing lesion in the rectum, which was defined as an adenocarcinoma with a moderate degree of differentiation on histologic examination. The patient received neoadjuvant chemotherapy using capecitabine, oxaliplatin, and bevacizumab. After 3 courses of chemotherapy, a rectovesical fistula was suspected from examination of CT images. CT demonstrated intramural gas in the urinary bladder, which suggested a diagnosis of emphysematous cystitis. Thus, we constructed a transverse loop colostomy. Two months after the last administration of chemotherapy, we performed SILS+1 TPE. The procedure involved a 35-mm incision in the right side of the umbilicus for the insertion of a single multichannel port, and insertion of a 12-mm port into the right lower quadrant. Total operating time was 751 minutes, and estimated blood loss was 1100 mL (including urine). SILS+1 TPE is a technically promising alternative method for the treatment of selected patients with advanced rectal cancer.

We prove the safety and feasibility of single-incision plus 1 port (SILS+1) laparoscopic total mesorectal excision (TME) + lateral pelvic lymph node dissection (LPLD) via a medial umbilical approach for rectal cancer. Only a few reports have been published about single-incision multiport laparoscopic low anterior resection with LPLD. Recently, minimally invasive surgery such as single-incision plus 1 port (SILS + 1) for advanced rectal cancer has been reported as safe and feasible. To our knowledge, this is the first reported case of SILS + 1 used for LPLD. A wound protector was inserted through a 30-mm transumbilical incision. Next, a single-port access device was mounted to the wound protector and 3 ports (5 mm each) were placed. A 12-mm port was inserted in the right lower quadrant. Super-low anterior resection of the rectum and bilateral LPLD and temporary ileostomy were performed with SILS + 1, with a blood loss of 50 mL and a total surgical time of 525 minutes. The time for right lateral dissection was 74 minutes; the time for left lateral dissection was 118 minutes. The total number of dissected lymph nodes was 57 and the number of lateral lymph nodes dissected was 21 (8 left pelvic lymph nodes, 13 right pelvic lymph nodes). No postoperative anastomotic insufficiency or voiding dysfunction was observed. We have documented the safety and feasibility of SILS + 1-TME + LPLD via a medial umbilical approach for rectal cancer.

A 70's woman with a history of abdominal surgery for gastric cancer visited our hospital for the evaluation of bleeding during defecation.We diagnosed her with advanced rectal cancer and performed laparoscopic low anterior resection.As postoperative pathological staging was pT3N2M0, pStage III b, we included CapeOx therapy as adjuvant chemotherapy.One year and 4 months after the surgery, lung and liver metastases were revealed by CT and PET-CT scans.At the same time, dilatation of the main pancreatic duct(intraductal papillary mucinous neoplasm: IPMN)was detected.Thus, we first performed liver resection and then lung resection.After the surgery, new lung nodules and a mass lesion with IPMN with superior mesenteric venous invasion was found on CT scans.We then administered chemo-radiation therapy(CRT).After CRT, the lung and pancreatic lesions seemed to decrease slightly.Accidentally, a nodule on the cystic bladder was found, resected by transurethral resection of the bladder tumor(TUR-Bt), and diagnosed as a bladder cancer.Thirty months after the rectal surgery, she is continuing the S-1 chemotherapy with stable disease.

With regard to laparoscopic and robotic abdominoperineal resection (APR) for primary rectal malignancies, limited data have been published in the literature. Single-incision laparoscopic surgery (SLS) has been successfully introduced for treating colorectal cancer. Here we describe our experience of APR with SLS plus one port (SLS + 1) for treating advanced rectal cancer. A 65-year-old man underwent the procedure, which involved a 35-mm incision in the left side of the umbilicus for the insertion of a single multichannel port as well as the insertion of a 5-mm port into the right lower quadrant. The sigmoid colon and rectum were mobilized from the pelvic floor using a medial and lateral approach. After the rectum with the mesorectum was completely mobilized according to the total mesorectal excision, the sigmoid colon was intracorporeally transected. The specimen was removed through the perineal wound. Terminal colostomy was fashioned at the left lower trocar site. Lateral pelvic lymph node dissection was bilaterally performed. There were no perioperative complications. The total operating time was 592 minutes, and the estimated blood loss was 180 mL. To our knowledge, this is the first reported case of SLS + 1 APR with lateral pelvic lymph node dissection for treating rectal cancer. We conclude that SLS + 1 APR is a technically promising alternative method for treating selected patients with advanced rectal cancer.

A 50-year-old woman had a 12mm liver tumor at segment 4 and was diagnosed with hemangioma. Two years later, the liver tumor had grown to 27mm in diameter, and a new pancreatic tumor was detected using CT examination. The pancreatic tumor was suspected of being pancreatic carcinoma, based on the results of endoscopic-ultrasound-guided fine-needlebiopsy( EUS-FNA)of the pancreas. The liver tumor was diagnosed as adenocarcinoma using liver biopsy. Because of its slow growth and the solitary liver tumor, synchronous pancreatic cancer and intrahepatic cancer were suspected. We therefore performed pancreaticoduodenectomy with portal vein resection and partial liver resection of segment 4. Upon histological analysis, carcinoma in situ was detected in the liver tumor and the patient was diagnosed with synchronous double cancers of the liver(cholangiocellular carcinoma)and pancreas(invasive ductal carcinoma). Our case indicated that it is very difficult to distinguish cholangiocellular carcinoma from metastatic liver tumor using diagnostic images. We should therefore consider the possibility of cholangiocellular carcinoma when a solitary tumor in the liver is detected at the same time as pancreatic cancer.

Background Definitive chemoradiotherapy (dCRT) is one of the treatment strategies for patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC). In this report, we investigated the timing, pattern of recurrence, and prognosis in patients with LA-ESCC who achieved clinical complete response (cCR) following dCRT. Methods dCRT was performed for 71 patients with LA-ESCC from April 2006 and December 2017. We retrospectively examined the clinical records of 27 patients (38%) with ESCC who achieved cCR following dCRT assessed by the Response Evaluation Criteria in Solid Tumors (RECIST). These patients were classified into two groups: 19 patients (Group A) who did not recognize recurrence thereafter and 8 cases (Group B) who were confirmed to have recurred until Deccember 2017. Clinicopathological features and clinical course for two groups were examined. Results Clinical stages before treatment were cT1/2/3/4 = 7/3/6/3 cases, cN0/1/2/3 = 8/3/6/2, cM0/1 = 18/1 and cStage I/II/III/IV = 6/4/6/3 in Group A, and cT1/2/3/4 = 1/3/2/2, cN0/1/2/3 = 1/2/4/1, cM0/1 = 8/0, cStage I/II/III/IV = 1/0/5/2 in Group B, respectively. Patients in Group B had more advanced cases than Group A. In group A, 16 out of 19 patients (84%) are still alive without recurrence and 3 have died because of hypopharyngial cancer, lung cancer, and senility, respectively. Double cancers were confirmed in 12 patients (63%) including 6 head and neck cancers. In Group B, the recurrences were confirmed at 7–26 months (Median: 12.5M) from the diagnosis of cCR. Six out of 8 patients (6/8:75%) had the recurrence of mediastinal lymph nodes. In Group B, 6 out of 8 cases (75%) confirmed death, and the period from recurrence to death was 5–18 months (median: 9.5M). Conclusion After cCR was obtained by dCRT, recurrence was observed in 8/27 cases (29.6%) in about 13 months. In patients with recurrence, 75% of patients had mediastinal lymph node recurrence and had poor prognosis of about 10 months. Also in patients without recurrence, double cancers were observed in 12/19 cases, suggesting the importance of surveillance for the purpose of 2nd primary cancer screening. Disclosure All authors have declared no conflicts of interest.

A method for producing macroscopic epithelial nodules was developed in order to investigate the properties of epithelial stem cells in the large intestine of mice. The cecum was exteriorized and exposed to various doses of X-ray radiation. Numbers of nodules subsequently developing were counted and plotted against radiation dose. From the logarithmic regression line, the susceptibility to irradiation of nodule forming stem cells (NFSC) was determined. The susceptibility of cecal NFSC was comparable to the value reported for jejunal NFSC. Mice of (C57BL/6XDS) F1-Pgk-1b/Pgk-1a that carried X chromosome inactivation mosaicism for the phosphoglycerate kinase gene were used for examination of nodule clonality. Most cecal nodules contained only 1 type of phosphoglycerate kinase, suggesting a monoclonal origin of the nodules. Histochemical studies showed the presence of absorptive epithelial, goblet and entero endocrine cells in 17 day old nodules, implying multipotentiality of the NFSC. In spite of these similarities between cecal and jejunal NFSC, the macroscopic appearance of cecal nodules was quite different from that of jejunal nodules. Only crypt like structures were observed in the former, whereas both crypt like and villus like structures were present in the latter. A comparison between cecal and jejunal nodules may be useful for understanding the morphogenesis of the intestinal mucosa. Acta Pathol Jpn 40: 880–886, 1990.

Unresectable advanced esophageal cancer is often treated with chemotherapy or chemoradiotherapy(CRT). Nutritional disorders caused by dysphagia may lead to a poor prognosis. Placing a PEG before starting CRT for advanced esophageal cancer may maintain better nutritional status.The purpose of this study is to evaluate the clinical significance of placing a PEG before starting CRT for advanced esophageal cancer.Fifty-one cases were evaluated, 22 PEG (+) and 29 PEG (-). The rate of a CRT was better in PEG (+) than PEG (-) cases (91% vs 79%). Infection around the PEG was the only type of complication, affecting 5%.PEG feeding during CRT is important in the development of effective treatments for unresectable advanced esophageal cancer.

A 78-year-old-man visited a nearby doctor for treatment of hepatitis C and high blood pressure.He was diagnosed with right hydronephrosis by abdominal echography conducted in follow-up of hepatitis C treatment in November 2011; he was then introduced to our hospital for close inspection and medical treatment.We observed wall hyperplasia and narrowing of the lumen in the central sigmoid part by contrast-enhanced computed tomography (CT).The right ureter at the L4/5 level showed wall hyperplasia and a deep color, and the right ureter, renal pelvis, and calix were expanded on the head side. By examination for CF, we observed a type 2 lesion in the sigmoid colon, and a biopsy showed well-differentiated adenocarcinoma. Based upon these findings, he was diagnosed with synchronous sigmoid colon cancer (cT4aN0M0, cStage II) and ureter cancer (cT2N0M0, cStage II); we performed laparotomy sigmoidectomy(D3 dissection)and full extraction of the right kidney urinary tract (lymph node dissection in front of the vena cava, the latter outside and between the aorta and vena cava). The postoperative course was particularly uneventful, and the patient was discharged from the hospital on day 38 after the operation. More than 2 years after the surgery, the patient exhibits no sign of sigmoid colon cancer or ureter cancer recurrence.

Single-incision laparoscopic colectomy (SLC) is touted as an improved approach to minimally invasive surgery, although no data currently exist regarding the acquisition of this technique. The aim of this study was to evaluate resident performance and outcomes in patients undergoing SLC performed by residents vs. staff colorectal surgeons. A retrospective case-control study was conducted, including 220 patients who underwent elective surgical intervention with multiport laparoscopic colectomy (MLC, n=141) or SLC (n=79) for colon cancer over a 24-month period at Yao Municipal Hospital (Yao, Japan). Data on patient demographics, operative data, oncological outcomes and short-term outcomes were evaluated for statistical significance. To investigate issues regarding the surgical procedures, the entire operation was recorded on video for all patients and was divided into 6 procedures, with each procedure measured in seconds. Senior-level residents were able to safely perform MLC under appropriate experienced supervision. For SLC, 1 case required conversion to an open procedure. No case required additional trocar placement. The mean operative times were similar for the staff and resident groups for total colon cancer (192.5 and 217.5 min, respectively; P=0.88), whereas the operative times of the staff group for right-sided colon cancer were significantly longer, and the operative times of the resident group for left-sided colon cancer were significantly longer. In addition, the overall perioperative outcomes, including blood loss, number of harvested lymph nodes, length of the surgical margin and complications, were similar between the two groups. When video recordings were evaluated by dividing the surgical process for the right colon into 4 procedures and that for the left colon into 6 procedures, the results demonstrated that the residents required more time to close the mesenteric margin for the left colon compared with the staff performing the same procedure (3,470.1±1,258.5 vs. 5,218.6±2,341.2 sec; P=0.01). Therefore, senior-level residents were able to safely perform SLC under appropriate experienced supervision. For the left colon, the main challenge for the residents appeared to be the closure of the mesenteric margin. Our data support that it is possible to train senior residents to complete a SLC safely and with the same efficacy as staff surgeons.

A woman between 50 and 60 years of age was diagnosed with a rectal carcinoid tumor and synchronal multiple liver metastases. We performed a transanal local resection of the rectal tumor, which was 10mm in diameter. During surgery, ultrasonography revealed 8 hypoechoic masses in the liver, and we performed a partial hepatectomy (S5/6, S8) and administered microwave coagulation therapy. Thirty-seven months after surgery, abdominal computed tomography revealed multiple low-density tumors in the bilateral lobe of the liver. We diagnosed these tumors as a recurrence of the liver metastases of the rectal carcinoid and performed trans-arterial chemo-embolization (TACE). After repeated TACE treatments, the liver metastases were controlled favorably. The patient is alive more than 50 months after diagnosis of the recurrent liver metastases. TACE appears to be effective for treating non-resectable multiple liver metastases of rectal carcinoids.

Radiotherapy for breast cancer reduces the incidence of disease recurrence and breast cancer mortality.However, it has also been associated with an increased risk of developing secondary cancers in exposed sites.Recently, we observed a 64-year-old woman who developed squamous cell lung carcinoma in the field irradiated with a total dose of 55 Gy after conservative breast surgery for left breast cancer 16 years previously.The patient underwent left upper lobectomy combined with chest wall resection.She had no recurrence of the breast cancer for 16 years.The secondary lung cancer tumor was of a different histological type than the primary breast cancer, and it appeared in the irradiated field.In conclusion, we regarded her lung cancer as a radiation-induced cancer, although it is difficult to clearly define radiation-induced cancer.In addition, the patient 's lung cancer may not only be a result of the late effect of irradiation, but might also be due to her smoking habit.

It is widely accepted that antimicrobial prophylaxis is useful for the prevention of surgical wound infection, especially in colorectal surgery. While many reports support the finding that the first dose should be administered immediately before surgery, there is less evidence concerning the ideal timing for the second dose. The purpose of this study is to examine the significance of intraoperative repeated dosing. A surgical series of 131 patients with primary colorectal cancer was retrospectively analyzed for 14 parameters, including the protocols of antimicrobial administration to determine the clinical risk factors for surgical wound infection. The overall surgical wound infection rate of the 131 patients was 16.0% (21/131). When the operation finished within 4 h after the first dose (n = 29), wound infection was observed in only one patient (3.4%). In a prolonged operation exceeding 4 h after the first dose, the surgical wound infection rates were 8.5% and 26.5%, respectively, for those with (n = 47) and without (n = 49) intraoperative repeated dosing, which were significantly different based on both a univariate analysis (P = 0.031) and a multivariate analysis (P = 0.0079). Intraoperative repeated antimicrobial dosing is therefore recommended to prevent the surgical wound infection for prolonged colorectal surgery.

PURPOSE: CA19-9 is often used in combination with carcinoembryonic antigen to manage patients with colorectal cancer, even though there is insufficient evidence to support this use of CA19-9. Carcinoembryonic antigen, by contrast, has been regarded as a better indicator of poor prognosis and recurrence. The purpose of this study is to clarify whether CA19-9 is, in fact, a useful marker in the management of colorectal cancer patients by comparing it with carcinoembryonic antigen. METHODS: A retrospective investigation was done for a consecutive series of 155 patients with colorectal adenocarcinoma who underwent potentially curative surgery between 1995 and 1999. Excluded were patients with postoperative assays performed less than three times for either carcinoembryonic antigen or CA19-9 and those who had developed secondary cancers. Data from 118 patients were analyzed in terms of prediction of prognosis and detection of recurrences. RESULTS: The sensitivities of preoperative CA19-9 and carcinoembryonic antigen were 29.8 percent and 45.3 percent, respectively. In the univariate analysis of preoperative carcinoembryonic antigen and CA19-9 assays in 114 patients, high carcinoembryonic antigen level was significantly associated with poor prognosis (P = 0.0090 by log-rank test). We could not find a significant association between preoperative CA19-9 abnormality and survival (P = 0.12). Multivariate analysis of preoperative factors indicated significance in TNM stage (P = 0.0094) and tumor location (P = 0.036) but in neither carcinoembryonic antigen (P = 0.061) nor CA19-9 (P = 0.22). Among 40 patients with recurrences, postoperative elevations of tumor markers were seen in 19 cases for CA19-9 and in 37 for carcinoembryonic antigen throughout the follow-up periods. Sensitivity, specificity, positive predictive value, and negative predictive value were 0.48, 0.88, 0.68, and 0.77, respectively, for CA19-9, and 0.93, 0.88, 0.80, and 0.96, respectively, for carcinoembryonic antigen. In patients with recurrences, the initial postoperative elevation of tumor markers was seen earlier than the detection of recurrence in 68.4 percent of those with CA19-9 elevation and in 67.6 percent of those with carcinoembryonic antigen elevation. There was only one patient with recurrence who had CA19-9 elevation without carcinoembryonic antigen elevation, while 19 recurrent patients had carcinoembryonic antigen elevation without CA19-9 elevation. Multivariate analysis showed a significant risk of carcinoembryonic antigen elevation against recurrence with an odds ratio of 32.0 (P < 0.0001), in contrast to an insignificant association of CA19-9 elevation (P = 0.23). CONCLUSION: We could not find clinical significance to support the use of CA19-9 to predict the prognosis and detect recurrence of colorectal cancer. Because of this, we do not recommend routine use of CA19-9 in staging and surveillance of colorectal cancer patients.

進行胃癌を伴った食道破裂の1例を経験した.症例は57歳男性.昼食後に嘔吐し,急激に右胸部痛,上腹部痛が出現し,発症から約4時間後に当院救急外来を受診した.胸腹部所見,胸部単純レントゲン,胸腹部CT,食道造影により胸部下部食道破裂,幽門狭窄と診断し緊急手術となった.上腹部正中切開による経食道裂孔アプローチにて一期的単純縫合閉鎖術,有茎大網被覆術,縦隔ドレナージ術,胃空腸バイパス術を施行した.胃癌による幽門狭窄のうえ,出血が催吐因子となって発症した,と考えられた.胃癌に伴った食道破裂は自験例を含め本邦9例目であったが,同時に診断されたのは5例であった.また進行胃癌に伴ったものは4例であった.食道破裂は早期診断,治療をしないと死亡率が高く,併存疾患がある場合の診断はより困難である.まず食道破裂の存在を念頭におき,催吐因子として併存疾患の検索も重要であると考えられた.

Background/Purpose: The efficacy of intraoperative celiac plexus block was compared with that of pharmacological therapy in the treatment of pain caused by unresectable pancreatic cancer. Methods: Twenty-one patients were included in the study: 15 patients underwent intraoperative celiac plexus block (group 1) and 6 received pharmacological therapy (group 2). The effectiveness at 1 week after treatment and from treatment to death was evaluated at follow-up by looking at mean analgesic consumption, mortality and morbidity, and any postoperative complications. Statistical analysis was performed using unpaired t-tests. Results: One week after the operation, the analgesic consumption of 14 patients in group 1 was the same as that before treatment, and 1 patient's consumption had decreased. Pain in 4 patients in group 2 did not change, but in 2 patients it increased. Mean opioid consumption was significantly lower in group 1. Complications related to the block were transient diarrhea and hypotension (P not significant between groups). There was no operative mortality or major complication related to the block. The incidence of adverse drug-related effects, such as constipation, nausea, and vomiting, was significantly lower in group 1 than in group 2. Conclusions: Intraoperative celiac plexus block made pain control possible with reduced opioid consumption, representing an effective, safe, and simple tool for the treatment of pain caused by unresectable pancreatic cancer.

On February 4th 1994, the maiden flight of H-II rocket was successfully conducted. With the completion of H-II development work, Japan has eventually got a world level spacecraft launching capability and both 1000 and 100 kN thrust class LOX/LH2 engines, LE-7 and LE-5A. H-II will be a work-horse rocket for Japan's near-term future space activities. A number of studies for improving vehicle launching capability and further cost reduction are under considerations, with regard to Upgraded H-II rocket; H-IIA rocket which will be launched on 1st February 2000. The LE-7A and LE-5B are key components of the H-IIA propulsion system and also the main subject of study in these improvement plans. This paper overviews the current status of LE-7A and LE-5B according to the H-IIA configurations.

Let x be a Banach space with a Schauder basis, for which the hypothesis (X) in the sense of Lempert is satisfied, and Ω be a pseudoconvex domain in x. Let L be an Abelian complex Lie group. A L or eL be, respectively, the sheaves over Ω of germs of holomorphic or continuous mappings into L and be the canonical inclusion. Then the mapping induced by the canonical inclusion i is injective for any positive integer p.

原発性小腸癌は消化管悪性腫瘍の中で稀な疾患であり,臨床症状や理学的所見に乏しく,内視鏡検査や生検も施行しにくいため,術前診断することが極めて困難である.また一般に腹部超音波検査は,腸管ガスが存在するため消化管病変を描出することが困難である.今回われわれは,腹部超音波検査を契機に回腸癌と術前診断された症例を経験したので若干の文献的考察を加え報告する. 症例は69歳,女性.慢性C型肝炎で前医通院中に腹部超音波検査で回腸末端の壁肥厚と周囲リンパ節腫大を指摘され,精査目的で当科紹介となった.小腸造影検査や内視鏡検査の結果,回腸癌と術前診断され,結腸右半切除術を施行した.

A case of primary T cell of the small intestine with perforated peritonitis is reported. A 26-year-old man who had 2-month lasting poor appetite, high fever of unknown origine, and abdominal pain lost his body weight by 6kg, and the abdominal pain spreaded entire the abdomen one day before adomission. The patient was admitted to the hospital with a suspicion of peritonitis. Plain abdominal X-ray films and computed tomography revealed remarkable ascites and free air. Emergency laparotomy was performed under a diagnosis of perforative peritonitis. Two sites of perforations associated with ulceration were present in the small intestine approximetely 15cm and 80cm from the ligament of Treiz. Partial resections of the small intestine were performed. A histological diagnosis of diffuse lymphoma, mixed-sized, T cell type was confirmed from the positive findings immunochemical stain with UCHL1. The patient was discharged from the hospital 36days after operation. A total of 15 cases of primary T cell lymphoma of the small intestine including our case have been reported in the Japanese literature.

National Space Development Agency of Japan (NASDA) started to develop H-II launch vehicle in 1983 and succeeded in the 1st flight on February in 1994. Meanwhile, several troubles were experienced in the development of LE-7 which is the 1st stage engine of H-II. The LE-7 is a staged combustion cycle engine with high pressure and high Isp like SSME. Therefore, high delivery pressure and high performance were required for LH2 turbopump, which is the main key component, and caused several troubles in the development. This paper describes the development of LH2 turbopump containing the design description, the contents of some troubles and their counterplans. In addition, some activities to solve turbopump life and endurance will be introduced.

A man in his 30s visited our hospital after a local doctor diagnosed him with a rectal submucosal tumor. Colonoscopy and fine needle biopsy revealed a lower rectal gastrointestinal tumor (GIST). Pelvic MRI examination revealed apparent tumor invasion of the left levator ani muscle. Curative abdominoperineal resection( APR) of the tumor was required. Our strategy involved the initiation of neoadjuvant imatinib therapy to facilitate subsequent sphincter-preserving resection. Neoadjuvant chemotherapy for 11 months reduced the tumor size and permitted the R0 laparoscopic sphincter-preserving resection. He was discharged without any postoperative complications. The pathological findings revealed semi-curative effects and pR0 resection. Thus, neoadjuvant chemotherapy for advanced rectal GIST was a useful strategy for this function- preserving operation.

A 75-year-old man with a complaint of right hypochondrial pain consulted our hospital, and was diagnosed as having acute cholecystitis. We performed percutaneous transhepatic gallbladder drainage (PTGBD), and the cholecystitis resolved. However, obstructive jaundice occurred 2 weeks later. Thus, we performed an in-depth investigation and detected duodenal papilla cancer (cT3N1M0, Stage III). Pancreatoduodenectomy was performed. As postoperative histological diagnosis yielded positive and strongly positive immunostaining for synaptophysin and Ki-67, respectively, we diagnosed the patient as having neuroendocrine carcinoma (NEC) of the duodenal papilla. Three months after surgery, computed tomography (CT) scan showed multiple liver metastases and lymph node metastasis. Chemotherapy with carboplatin and etoposide was administered, but severe neutropenia developed, and therefore, the chemotherapy was discontinued. Subsequently, we decided on a policy of best supportive care (BSC). The patient died 11 months after surgery. NEC of the duodenal papilla is reported to be a rare and rapidly progressing disease and is associated with a very poor prognosis. Herein, we report a case of a patient in whom NEC of the duodenal papilla was resected.

We report a case of undifferentiated carcinoma of the duodenum. A 40-year-old man was referred to our hospital as he experienced upper abdominal pain that had persisted for half a year. Gastrointestinal endoscopy revealed a semicircular tumor in the duodenum. Enhanced computed tomography( CT) revealed that the tumor had not invaded the adjacent tissues, and lymph node metastases were not detected. Biopsy indicated a diagnosis of Group V cancer. Because the tumor was diagnosed as primary duodenal cancer, pancreatoduodenectomy and lymphadenectomy were performed. Histopathological examination revealed the presence of variant cells with irregular cores; we then diagnosed the tumor as undifferentiated cancer of the duodenum. No lymph node metastasis was detected microscopically. This patient has remained well without recurrence for 17 months since the operation. Undifferentiated carcinoma of the duodenum is rare, as only 9 cases have been reported in the Japanese literature.

Chemotherapy followed by surgery for Stage IV gastric cancer with passage obstruction poses a problem in terms of poor postoperative nutritional status. By maintaining an adequate postoperative nutrition status with jejunostomy catheter feeding, chemotherapy may possibly be continued. We treated 40 cases of Stage IV gastric cancer with passage obstruction from January 2008 to December 2011. In every case, jejunostomy catheter feeding tubes were placed during gastric cancer surgery. We performed 13 total gastrectomies, 20 distal gastrectomies, and 7 gastrojejunal bypass surgeries. Tube obstruction in 4 cases( 10%) and tube deviation in 1 case( 2.5%) occurred during the tube feeding period. Chemotherapy could be resumed in 37 cases( 92.5%), and the duration of chemotherapy was 330 days( range, 41-721). In cases of Stage IV gastric cancer, patients are obliged to start postoperative chemotherapy at an unstable period. By starting jejunal catheter feeding at an early stage after surgery, improved results could be expected in terms of shortening of the hospital stay or continuation of chemotherapy.

The patient was a 50-year-old woman who had undergone pancreaticoduodenectomy for bile duct carcinoma in April 2010. In August 2011, abdominal computed tomography (CT) revealed a solitary tumor (30×17 mm in diameter) behind the anastomosis of gastrojejunostomy. Gastrointestinal endoscopy revealed gastrojejunal ulceration (biopsy: Group V adenocarcinoma). Positron emission tomography (PET)-CT revealed a solitary tumor without any recurrence. We diagnosed the patient as having solitary recurrence of peritoneal dissemination of bile duct carcinoma. In September 2011, we performed resection of the peritoneal dissemination. The patient was discharged from the hospital 12 days after the operation and had a good postoperative course. Histologically, the tumor was diagnosed as peritoneal dissemination of bile duct carcinoma. Subsequently, the patient received postoperative chemotherapy. The patient remains alive with recurrence of peritoneal dissemination 37 months after pancreaticoduodenectomy and 20 months after resection of the peritoneal dissemination.

Nondestructive creep and fatigue life evaluation technology was investigated for INCONEL718 in the LE-7 rocket engine. Metallurgical microstructural change is not considered to be a criterion for life prediction because it is very small in high-stress and short-term creep and fatigue damage processes such as in the LE-7 engine. Crack length observation on the metal surface is the most effective method to estimate damage rate. Correlation of maximum crack length and life consumption rate was shown for the parent metal and welded joint based on the interrupted creep and fatigue test specimen. Furthermore, the analytical life prediction method by means of structural strength analysis and reference material data was checked using notched specimen creep and fatigue test data.

Welded joint structural failure has been observed in the LE-7 engine main injector, which is subjected to high thermal stress during an engine start and stop sequence. Failure analysis showed that these failures were caused by extremely-low-cycle fatigue due to a low number of hot-fire tests in a very high-strain condition. It was revealed that the welded joint has a considerably short low-cycle fatigue life and low fracture toughness, contrary to expectation. Based on several kinds of material tests, countermeasures such as design change of the welded structure, modification of the welding process, strengthening during non-destructive inspection and application of solution heat treatment were taken to improve welded joint strength characteristics. Using the modified main injector, a complete qualification test of LE-7 engine was performed without occurrence of failure and the first H-II rocket was launched successfully.

The LE-7 rocket engine main injector has undergone a few occurrences of welded joint structural failure because it is subjected to high thermal stress during the engine start and stop sequence. The low-cycle fatigue test and high-strain fatigue test which were conducted as part of failure analysis revealed that the welded joint has a considerably shorter fatigue life than expected. To improve the ductility and toughness of the welded joint, high-temperature-solution heat treatment was applied after welding. The low-cycle fatigue life of a welded joint subjected to this solution heat treatment became three times longer than that without it. A design criterion was established for low-cycle fatigue life estimation, and the life requirement was found to be satisfied.

An LE-7 rocket engine main injector is subjected to both internal pressure stress and high thermal stress due to large temperature difference between the fuel manifold (600°C) and LOX dome (-180°C). Therefore thermal ratchetting was considered to be one of the problems. A failure-mode simulation test was conducted using the structure model of an INCONEL718 welded joint, which ended with cracking of the weldment after 70 cycles of axial mechanical load and thermal load. Measured accumulated strain was smaller than that estimated from Bree's ratchetting diagram. Elastic-plastic thermal analysis showed a fairly good agreement between estimated life and test result, and this failure mode was due to mainly creep damage. It is confirmed that the thermal ratchetting effect on this failure mode is negligible, and the analytical method of creep-fatigue life evaluation is adequate for the prediction of structure life.

A 57-year-old woman was discovered to have a cystic tumor, 8 cm in diameter, at the pancreas tail, during routine screening with ultrasonography. The patient did not complain of tenderness, and no abdominal mass was palpable at physical examination. Enhanced computed tomography(CT) revealed that the tumor had mural nodules in the cyst wall, and we suspected it to be a malignant tumor that had occurred in the mucinous cystic neoplasm(MCN). Therefore, surgical resection was attempted, upon which the tumor was found to be hard and the surrounding tissue adhered widely to the stomach. We separated it carefully from the stomach and then performed a distal pancreatectomy. The cut surface revealed that the posterior wall of the cystic tumor was partly thickened, and microscopic examination revealed it to be invasive ductal carcinoma. No ovarian-like stroma was involved and some degree of dysplasia(PanIN 1-3) was found in the neighboring tissues. Therefore, we re-diagnosed it to be invasive ductal carcinoma of the pancreas derived from intraductal papillary mucinous tumor(IPMT), not from MCN. The patient received adjuvant chemotherapy, although 5 months later multiple lung metastases had appeared. The international consensus guidelines for management of IPMN and MCN of the pancreas suggest that they can usually be distinguished preoperatively, if there is a complete understanding of their clinical and imaging features. However, we sometimes find it difficult to distinguish the 2, because some IPMN or MCN cases have shared preoperative features. Herein, we report the case of invasive ductal carcinoma of the pancreas derived from IPMT that was originally misdiagnosed as a MCN.

Our patient was a 67-year-old man, with a chief complaint of brown urine. He subsequently underwent medical examination in June. Because the results of his blood examination revealed liver dysfunction, he was admitted to our hospital for further careful examination. An abdominal computed tomography(CT) scan showed the presence of a pancreas tumor, with a diameter of 2 cm, at the pancreas head, as well as common biliary duct dilatation and main pancreatic duct dilation from the head to the tail of the pancreas. The patient was diagnosed with pancreatic cancer[cT3( CH+, DU+), cN0, cM0, cStage III], with obstructive jaundice. After biliary drainage, we performed laparotomy in August. During the operation, other than the tumor on the pancreas head, identified at the preoperative diagnosis, we found 2 white nodules on the pancreas surface. One nodule was located at the body of the pancreas and the other, at its tail. On intraoperative pathological examination of the nodules, they were found to be invasive ductal carcinomas. On the basis of these findings, we suspected multiple cancers or overall pancreatic cancer; therefore, we performed total pancreatectomy, not pancreaticoduodenectomy (PD). We choose pancreatectomy over PD because it was impossible to confirm the cancerous area. Pathological examination of the resected specimen did not reveal any malignant lesion. Thus, if we had not performed pancreatectomy, assuming that the pancreas body or tail had no cancer lesion, based on the pathological examination result, the cancer would have persisted. Further, careful examination involving inspection and palpation is considered to be essential before resection of the pancreas tumor.

A 66-year-old man with multiple hepatocellular carcinomas(HCCs) underwent transcatheter arterial chemoembolization(TACE) twice and radiofrequency ablation(RFA) twice at another hospital in June 2009. In November 2010, abdominal computed tomography(CT) revealed a solitary lymph node metastasis( 23 mm in diameter) in the hepatoduodenal ligament, after which he was admitted to our hospital in December 2010. In February 2011, ethoxybenzyl diethylenetriamine pentaceric acid-enhanced magnetic resonance imaging (EOB-MRI) showed revealed a growing solitary lymph node metastasis(33 mm in diameter) and good control of the intrahepatic lesion. Positron emission tomography(PET)-CT confirmed the solitary lymph node metastasis without any other extrahepatic recurrence. We performed lymph node resection in March 2011 because of good control of the intrahepatic lesion and the lack of extrahepatic recurrence. He was discharged from our hospital 11 days after surgery with a good postoperative course. Histologically, the tumor was diagnosed as a lymph node metastasis of poorly differentiated HCC. Subsequent abdominal CT in January 2012 revealed multiple recurrent lesions, and he underwent TACE therapy in February 2012. Currently, the patient is alive 1 year 3 months after lymph node resection without any other extrahepatic recurrence.