Search

症例は70歳の女性で, 脳梗塞症後の寝たきり状態で介護施設に入所中であったが, 腹痛と腹部膨満を主訴に来院した. 来院時血圧は83/33mmHg, 脈拍88回/分, 体温35.0℃であった.腹部膨満と圧痛を認めたが筋性防御はなかった. 血液生化学検査では白血球増多, CRPの上昇を認めた. 腹部X線検査で腹腔内遊離ガスを, 腹部CTでは腹水と肝両葉の門脈ガス, 小腸壁の肥厚と腸管気腫を認めた. 腸管壊死による消化管穿孔, 汎発性腹膜炎を疑い, 緊急手術を施行した. 手術所見では腸管壊死, 腸管穿孔はなく多量の腹水を認めたのみであった. 腹腔洗浄, 盲腸瘻, 空腸瘻, 胃瘻造設術を施行した. 術後は空腸瘻からの経管栄養により栄養状態も改善し介護施設へ転出となった. 本症例は, 明らかな原因は不明であるが, 便秘による腸管内圧の上昇に伴い, 粘膜損傷部から腸管気腫と門脈ガスを発症し, 漿膜のmicroperforationにより腹腔内遊離ガスが生じたと推測された.

症例は58歳, 女性. 2006年5月に右下腹部痛を主訴に紹介来院した. 腹部超音波, CT, DIC-CTで, 肝S6から肝外に発育した径7cmの嚢胞性腫瘤を指摘された. 嚢胞壁は薄く, 単房性で, 単純性嚢胞の可能性があったが, 有症状であったこと, 肝嚢胞腺腫が否定できなかったことから, 腹腔鏡下に手術を施行し, 完全切除した. 病理組織学的には嚢胞壁は立方円柱上皮からなる肝嚢胞腺腫であった. 一般的に, 肝嚢胞腺腫か腺癌かを術前に診断するのは難しい. また腺腫から癌への移行もあり, 肝嚢胞腺腫自体は良性腫瘍であるが, 悪性腫瘍に準じた完全切除が必要となる. 腹腔鏡下手術は嚢胞の破裂の危険性があり適応は慎重であるべきであり, 本邦での施行例は現在まで極めて稀である. しかし肝外発育型で肝切除の容易なもの, 大きさの小さいものに対しては適応になると思われる. 自験例は鏡視下手術の良い適応であったと思われ, 若干の文献的考察を加え報告する.

代表的な促成栽培用品種である‘とちおとめ’，‘女峰’および‘とよのか’を用いて，主茎腋芽の発達に及ぼす定植後の温度と施肥量の影響を検討した．植物体は温度条件と施肥量を各2段階に変え，これらを組み合わせた4条件下で栽培した．頂花房直下の腋芽を第1節腋芽とし，第4節までの腋芽のタイプを定植後52日目に調べた．腋芽は休眠芽，一次側枝，ランナーに分類した．3品種とも第1節腋芽はすべて一次側枝に発達した．いずれの品種でも第3，4節の腋芽は低温下では休眠芽となるものが多かったが，高温下ではランナーとなるものが増加した．‘とちおとめ’，‘女峰’では施肥量が増えると休眠芽の割合が減少したが，‘とよのか’では施肥量の影響は小さかった．第2節では，休眠芽の割合は低く，高温下でランナーの割合が増加した．施肥量が増えると，‘とちおとめ’では一次側枝の割合が増加したが，他の2品種では一次側枝の割合はほとんど変化しなかった．以上の結果は，第2節の腋芽の発達を調節するため，品種によって温度や施肥条件を変える必要があることを示唆している．

症例は54歳, 男性. 腹痛と嘔吐を主訴に来院した. 手術既往歴はなく, 腹部所見では圧痛と軽度の反跳痛を認めたが筋性防御はなかった. 腹部CTで小腸の拡張が著明で内ヘルニアが疑われたが, 症状が軽くイレウス管留置による保存的療法を行った. 連日排液は良好であったがイレウスの改善を認めなかったため, 入院4日目にイレウス管から小腸造影を行った. 左下腹部にループ状の拡張した小腸とその口側, 肛門側の締め付け様の狭窄部が造影された. 腹部CT所見とあわせ, S状結腸間膜ヘルニアを疑い腹腔鏡下手術を施行した. 腹腔鏡下に観察すると, S状結腸間膜左葉に小腸が引き込まれ, 回腸が約4cm嵌入していた. 鉗子によって整復を行い, S状結腸間膜左葉に約3cmのヘルニア門を確認した. ヘルニア門はクリップで縫縮した. 術後経過は良好で術後第12日目に退院となった.

To investigate flower induction in June-bearing strawberry plants, morphological changes in shoot apices and Histone H4 expression in the central zone during flower initiation were observed. Strawberry plants were placed under flower inducible, short-day conditions (23 °C/17 °C, 10 h day length) for differing number of days (8, 16, 20, 24 or 32 days) and then these plants were transferred to non-inducible, long-day conditions (25 °C/20 °C, 14 h day length). The shoot apices of plants placed under short-day conditions for 8 days were flat, similar to shoot apices of plants in the vegetative phase of development, and Histone H4 was not expressed in the central zone during the experimental period. On the other hand, the shoot apices of plants placed under short-day conditions for 16 days remained flat, similar to shoot apices of plants placed under short-day conditions for 8 days, but Histone H4 was expressed in the central zone at the end of the short-day treatment. Morphological changes in the shoot apices of these plants were observed 8 days after the change in day-length. These plants developed differentiated flower organs after they were grown for another 30 days under long-day conditions. These results indicate that changes in the expression pattern of the Histone H4 gene occur before morphological changes during flower induction and that the expression of the gene in the central zone can be used as one of the indicators of the flowering process in strawberries.

栄養繁殖作物のイチゴでは，限られた育種材料間での交配を繰り返すため近親交配が問題となる．そこで，近年育成されたイチゴ品種の近交係数を計算した．また，近交係数と収量との関係を調べた．近交係数の計算は推論型言語Prologとパーソナルコンピューターを利用した手軽な処理系で計算プログラムを作成した．交雑実生の近交係数と実生の選抜率との間に相関関係は認められなかった．栃木県農業試験場栃木分場の育成系統（3次選抜系統）の近交係数と収量の関係を調べたところ，−0.37（危険率1％）の有意な負の相関が認められた．また，イチゴでは近交係数が0.3程度までであれば，近交弱勢による収量の低下は見られないことが明らかになった．近年育成されたイチゴ品種の近交係数は，一季成り性品種では0.2を超えるものが多く，‘とちおとめ’，‘章姫’，‘さがほのか’，‘あまおう’，‘さつまおとめ’，‘ひのしずく’，‘やよいひめ’はそれぞれ0.261，0.222，0.257，0.213，0.257，0.247，0.346であった．一方，四季成り性品種では‘サマープリンセス’と‘きみのひとみ’ の2品種がが0.183と0.195でやや高い値であったが，それ以外はいずれも0.1以下であった．代表的な一季成り性品種15品種の総当たり交配による雑種の近交係数を計算した結果，自殖を除いた近交係数の値は0.067～0.440で平均は0.210となり，近親交配の程度が高くなることが明らかになった．

結腸癌術後ダグラス窩腹膜転移に対しpharmacokinetic modulating chemotherapy (PMC)を施行し, 2年経過して根治切除が可能であった1例を経験したので報告する.症例は66歳,男性.平成8年11月上行結腸癌に対し結腸右半切除術を施行(中分化腺癌, se, n2, stage IIIb).平成11年10月CEAの上昇に伴い直腸指診でダグラス窩転移が疑われ,平成12年1月経肛門的に腫瘤生検施行し,高分化腺癌の診断を得た.ダグラス窩腹膜再発に対しPMCを週1回外来通院で施行した. PMCを20カ月施行したところで,腫瘍の増大に伴い直腸RaRbでの腸管狭窄が高度となり,排便障害改善の目的から平成13年10月に開腹術施行.腹膜転移巣と直腸は合併切除可能であり低位前方切除術を施行した. PMCは腹膜再発に対し長期のno change (NC)を得ることができ,人工肛門を回避した根治切除を可能とした.また経過中に有害反応は認められず,再発大腸癌に対してPMCは有効であると考えられた.

The aim of this study was to clarify the risk factors associated with recurrence in patients with stage II colorectal cancer.We performed a retrospective analysis of 316 patients with stage II colorectal cancer who underwent gross radical colectomy between 1994 and 2003.The overall recurrence rate was 10.8%. Univariate analysis identified 5 risk factors associated with recurrence: depth of tumor invasion (tumor penetration of the serosa[SE]-tumor invasion of adjacent structure[s SI]), lymphatic invasion( ly2-3), venous invasion( v2-3), budding( grade 2-3), and perineural invasion (PN1). Multivariate analysis identified 3 risk factors associated with recurrence: budding (grade 2-3; p=0.008), depth of tumor invasion( SE-SI; p=0.008), and venous invasion( v2-3; p=0.034).The results of this study suggest that active postoperative adjuvant chemotherapy should be considered for the treatment of patients with stage II colorectal cancer with budding( grade 2-3), venous invasion( v2-3), or tumor depth of SE or SI.

Eosinophilia often occurs in malignant diseases. This report concerns a female patient aged 76 years, diagnosed with rectal carcinoma with eosinophilia. Sera were obtained at two different periods (at diagnosis and after the operation) for the evaluation of levels of interleukin-5 (IL-5). The serum IL-5 level increased to 264 pg/mL, and returned to an undetectable level after the operation. The serum at diagnosis enhanced the viability of normal eosinophils in vitro, and this activity was inhibited by antihuman IL-5 polyclonal antibody. Immunohistochemistry and in situ hybridization revealed that stromal eosinophils contained IL-5 protein and messenger RNA (mRNA), but no IL-5 transcripts were detected in eosinophils attached to carcinoma cells. In situ detection of apoptosis showed that several eosinophils attached to tumor cells underwent apoptosis and lost their eosinophil secreted cationic protein (ECP) and major basic protein (MBP). These results may suggest that activated eosinophils by IL-5 play an important role in host defense mechanisms, releasing their toxic granule proteins on adjoining tumor cells.

Succesful surgical outcome has been obtained for a carcinoma arising in the substituted gastric tube after radical operation for an esophageal cancer, in which the section of the natural feeding arteries, namely, right gastric and right gastroepiploic arteries, which partial resection of the gastric tube was carried out.A 75-year-old man was admitted to the hospital because of a subcutaneous mass in the forechest. About 5 years before, the patient underwent curative subtotal esophagectomy with reconstruction by antesternal gastric tube substitution for an esophageal cancer. The subcutaneous mass was diagnosed as cancer of the gastric tube by biopsy. For an advanced age of the patient, a safe and still curative resurgery was intended. First, the two feeding arteries, right gastric and right gastroepiploic, nurishing the gastric tube were clamped for 20 minutes to insure that the blood supply to the substituted stomach was not jeopardized. Then, the two vesseles were sectioned and lymph nodes dissection was performed. The tumor-bearing gastric tube was resected with a 2 cm proximal and a 3 cm distal clearace followed by a reconstruction with a Roux-en-Y gastrojejunostomy. The patient has been well for more than 3 years.This surgical procedure may be recommended for aged patients or those with poor general conditions whom it will promise the therapeutic effects.

今回われわれは直腸平滑筋腫の1例を経験したので報告する.症例は66歳の女性, 肛門部不快感, 下血を主訴に入院した.注腸造影, 直腸鏡, 骨盤computed tomography, magnetic resonance imagingなどの検査により直腸粘膜下腫瘍 (平滑筋腫疑い) と診断し手術を施行した.全身麻酔下に経仙骨的に腫瘍に達し, 腫瘍を摘出した.摘出標本は4.0×4.0×5.2cmの白色の充実性腫瘍で2.0×3.0×3.0cmのdaughter noduleと一塊になっていた.病理組織学的に平滑筋腫と診断された.直腸平滑筋腫はその良性悪性の鑑別が時に困難で, 悪性化例も報告されており, 慎重な術後経過観察を要するものと思われた.

We report a case on hemodialysis with liver metastases from anorectal malignant melanoma treated by dacarbazine (DTIC). A 61-year-old man presented with anal bleeding. An elastic soft mass was palpated in the anal canal, and a biopsy specimen was diagnosed as anorectal malignant melanoma histologically. After introducing hemodialysis for the chronic renal failure, abdominoperineal resection was performed. Two and a half years after surgery, computed tomography showed multiple liver metastases. We chose chemotherapy consisting of DTIC 100 mg for five consecutive days every 4 weeks in addition to hemodialysis (3 times a week). After three cycles of chemotherapy, liver metastases were stable, but new lung metastases were found. After 12 cycles of chemotherapy, liver metastases became stable, but lung metastases were progressive. Subsequently, the patient died of respiratory failure 4 years after surgery, 1 year and 7 months after the diagnosis of multiple liver metastases. No severe toxicity was observed during this period. We conclude that administration of DTIC undergoing hemodialysis for malignant melanoma with renal failure seems to be useful without severe adverse events.

We investigated the clinical efficacy and safety of S-1 retrospectively for the treatment of 32 patients with advanced gastric cancer after reduction surgery (gastrectomy). S-1 was administered orally twice daily, at a standard dose of 80 mg/m(2) per day for 28 days, followed by a 14-day rest. There were 21 patients having only a single residual metastatic site and 11 with two or more metastatic sites. Major residual metastatic sites were peritoneum in 25 patients, lymph nodes in 7, liver in 4 and lung in 2. The response rate by target organ was 28.6% for lymph node metastasis, and 0% for liver and lung metastasis. Peritoneal metastasis was not considered measurable site. The median survival time (MST) after S-1 administration was 573 days (95% confidence interval, 439 to 707 days). The 1-, 2- and 3-year survival rates were 62.3%, 40.3% and 28.2%, respectively. Of the 32 patients, 14 received S-1 for more than a year, and the MST in these patients was 897 days (95% confidence interval, 255 to 1,539 days). The incidence of adverse events was 90.6%, but the incidence of grade 3 or 4 was 12.5%. Long-term administration of S-1 may serve to prolong the survival period of patients with gastric cancer after reduction surgery, particularly in peritoneal metastasis.

We report a case of advanced gastric cancer resected after successful treatment with the novel oral anticancer drug TS-1. The patient was a 52-year-old male. Gastrointestinal fiberscopy showed advanced gastric cancer. Examinations by computed tomography revealed gastric cancer invasion of the pancreas and swollen para-aortic lymph nodes. This patient was treated by preoperative chemotherapy with oral administration of TS-1 (120 mg per day). After 3 courses of treatment of TS-1, the primary lesion and swollen lymph nodes were remarkably reduced. This chemotherapy enabled total gastrectomy in curative resection. The pathological effectiveness of chemotherapy was Grade 1b in the primary lesion and Grade 2 or 3 in the lymph nodes. The patient sustained few side effects. This preoperative chemotherapy regimen seems to be an effective and promising therapy for patients with advanced gastric cancer.

We treated a patient with unresectable rectal cancer with multiple liver, pulmonary and lymph node metastases that responded remarkably to pharmacokinetic modulating chemotherapy (PMC). The patient was a 63-year-old male. Colonoscopy showed a type 3 advanced lower rectal cancer. Examinations by computed tomography and chest X-ray revealed unresectable rectal cancer invading the sacrum and bladder with multiple liver and pulmonary metastases and swollen para-aortic lymph nodes. The patient was treated by colostomy and postoperative PMC. UFT (400 mg/day) was orally administered daily and a continuous infusion of 5-FU (1,000 mg/24 h) was given once a week. After 10 courses of treatment with PMC, the primary lesion was remarkably reduced. This chemotherapy also produced partial responses in the pulmonary metastases and para-aortic lymph node swelling. The patient experienced few side effects and had good QOL in the terminal stage. This chemotherapy regimen appears to be an effective and promising therapy with few side effects, even for patients with unresectable advanced colorectal cancer.

Eighteen patients with far advanced and recurrent gastric cancer with peritoneal dissemination were treated with a novel oral anticancer drug, TS-1, and assessed according to clinical effect. TS-1 was administered at a dose of 80-120 mg/day. One course consisted of consecutive administration of TS-1 for 28 days followed by 14 days rest. The 1- and 2-year survival rates and median survival time after administration of TS-1 were 63.2%, 23.7% and 437 days, respectively. Eight patients (44.4%) survived for 1 year or more. Adverse reactions consisted of reduction in hemoglobin level and hyperbilirubinemia at grades 3 and 4, which were observed in 3 patients and 1 patient, respectively. TS-1 is a promising drug for gastric cancer with peritoneal dissemination.

胃癌患者275例を対象に術前, 術後のcarcinoembryonic antigen (CEA) を測定し, その臨床的意義について検討した. 術前CEAの平均値は7.6±35, 5ng/mlで, 5.1ng/ml以上の陽性率は21.5%だった. 術前CEAおよび陽性率は胃癌stageの進行とともに有意に高くなり, その構成因子である肝転移, 腹膜播種, リンパ節転移, 深達度とも有意な関連が認められた. 組織型では乳頭腺癌, 膠様腺癌でCEA陽性率が比較的高かった. 胃癌治癒切除率はCEA高値群では有意に低下していた. 再発形成では, 肝転移型再発例の術前CEAは高値例が多く, 再発時, その急激な上昇をみた. 術前CEA高度陽性群は陰性群に比べ予後不良だった.

A polypeptide of Mr 26,000 and pI 6.7 that was markedly increased in rat livers bearing hyperplastic nodules (HNs) induced by chemical carcinogens was identified immunochemically as the subunit of neutral glutathione (GSH) transferase (GSHTase; RX:glutathione R-transferase, EC 2.5.1.18; also called GSH S-transferase) purified from placenta (GSHTase-P) and was demonstrated immunohistochemically to be localized in preneoplastic foci and HNs. In the present study, GSHTase-P has been purified from the HN-bearing liver, and the distribution and inducibility have been examined quantitatively using anti-GSHTase-P antibody. Elevation of GSHTase-P in the HN-bearing livers was also confirmed by in vitro translation of mRNAs isolated from the HN-bearing livers. The purified GSHTase-P was homogeneous in size but had two charge isomers on two-dimensional gel electrophoresis. In normal tissues, including liver, placenta, and fetal liver, the protein content of GSHTase-P was generally low but was significantly high in kidney and pancreas. In contrast, the amount of GSHTase-P in HN-bearing livers (primary hepatomas) and transplantable Morris hepatoma 5123D were several 10-fold higher than that in normal liver but were undetectably low in transplantable Yoshida ascites hepatoma AH 130. Different from ordinary drug-metabolizing enzymes, GSHTase-P was uninducible by administration of drugs and carcinogens prior to appearance of the preneoplastic foci and HNs. In addition, species specificity of GSHTase-P was low as it was crossreactive among rat, hamster, and human.

The effects of removing apices on the development of branch crowns were studied in 'Tochiotome' and 'Nyoho' strawberry plants to estimate their ability to produce branch crowns at a later stage of growth. Nodes were numbered from the base; node 1 was designated as the node of the oldest leaf of the plant. More stolons were formed in 'Nyoho' than in 'Tochiotome' during the flower-induction treatment. Axillary buds at nodes 1 to 4 were dormant in most 'Tochiotome' plants; those at nodes 3 and 5 were dormant in about one third of 'Nyoho' plants. Few branch crowns were formed in the basal parts of the main crowns of both cultivars. Removing apices increased the number of branch crowns below node 1 in 'Tochiotome', but not in 'Nyoho'. The results indicate that the inhibitory effects of apical dominance on the growth of axillary buds are stronger in 'Tochiotome' than in 'Nyoho'. It is likely that the greater production of basal branch crowns in 'Tochiotome' at the later stage is associated with strong apical dominance.