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症例は53歳の男性で，2009年3月貧血の精査目的で下部消化管内視鏡検査を施行し，上行結腸に腫瘤を指摘された．内視鏡下生検の結果，gastrointestinal stromal tumor（以下，GISTと略記）が疑われた．腹部造影CTにて肝尾状葉に孤立性の腫瘤を認めており，大腸GISTおよび肝転移の術前診断で，4月に回盲部切除術，Spiegel葉切除術を施行した．摘出標本の病理組織学的検査，免疫組織化学染色および遺伝子解析にて，大腸平滑筋肉腫とその肝転移と診断した．近年GISTの疾患概念は大きく変化し，かつて消化管平滑筋肉腫と報告されてきた腫瘍の大部分はGISTに分類されるようになり，真の消化管平滑筋肉腫は大変まれとなった．本症例は，GISTとの鑑別診断，さらには治療方針決定のため，遺伝子解析が有用であった．

Objectives The potent antioxidant activity of Eriobotrya japonica seed extract (ESE) and its usefulness in the prevention and treatment of various disorders has been reported previously. Its antioxidant activity associated with β-sitosterol and polyphenols contained in the extract was also validated. In this study, anti-allergic activity of Eriobotrya japonica seed extract was investigated. Methods The inhibition of histamine release-mediated type 1 allergy by Eriobotrya japonica seed extract was used as an index. Key findings The administration of this extract inhibited histamine release from rat mast cells, suggesting its usefulness in allergic disease treatment. In an experiment using a guineapig allergic rhinitis model, this extract reduced the frequency of sneezing and nose-scratching. Conclusions These results suggest that Eriobotrya japonica seed extract may contribute to the relief of allergic disease-related symptoms.

To evaluate combination therapy with warfarin potassium (WF) and bucolome (BUC),we assigned patients on warfarin potassium (WF) at Kochi University Medical School Hospital to a group also receiving BUC (BUC-combination group) and a group not receiving BUC (non-combination group),and compared the WF doses and TT values.In each patient,we investigated the doses of WF before and after the start or discontinuation of combination therapy with BUC.There was no significant difference in TT values between the two groups.However,the WF dose in the BUC-combination group was significantly lower than that in the non-combination group.BUC was therefore useful for maintaining anticoagulation activity and decreasing the dose of WF.Furthermore,there was a correlation between the doses of WF before and after the start or discontinuation of combination therapy with BUC in each patient.Based on the regression line obtained using WF doses,in the presence and absence of BUC,the subsequent dose of WF could be predicted at the start or discontinuation of combination therapy with BUC,suggesting that it would be useful in anticoagulation control.

The effect of Eriobotrya japonica seed extract (ESE) prepared with 70% ethanol on gastric mucosal injury was investigated. Six experimental models with different action mechanisms were used for the evaluation. Three concentrations of ESE were prepared for each model. ESE administration was initiated 14 days before induction of gastric mucosal injury, and its effect was investigated. ESE inhibited formation of gastric mucosal injury.

We herein report the case of a patient with mucinous gastric carcinoma with peritoneal dissemination that disappeared after neoadjuvant chemotherapy with S-1 alone. The patient has survived for over 23 months after surgery, without recurrence. A 60-year old man was referred to our hospital because of an advanced gastric cancer, detected by upper gastrointestinal endoscopy at another hospital. Staging laparoscopy was performed on October 25, 2002, and revealed massive peritoneal dissemination. Two courses of neoadjuvant chemotherapy with S-1 were administered, at 120 mg/day for 28 days, as one course. Total gastrectomy, with D2 lymph node dissection, was performed on January 24, 2003. The peritoneal dissemination had macroscopically disappeared and the cytology of the peritoneal lavage fluid was class III. His final diagnosis was gastric carcinoma, MLU, type 3, T2(SS), P0, H0, M0, N3, CY0, stage IV.

ビワの種子から70%エタノールを用いて抽出したエキス (Eriobotrya japonica seed extract ; ESE) について, LPS投与により炎症を惹起させたラットを用いて, ESEの効果について検討した.(1) LPS投与後24時間の血漿中TNF-α量は, LPS無投与群に比べ, その値は有意に高値を示したが, ESE投与群では水道水投与群に比べ, その値は低値を示す傾向が認められた.(2) LPS投与後24時間の血漿中NO量は, LPS無投与群に比べ, その値は有意に高値を示したが, ESE投与群では水道水投与群よりその値は有意に低値を示した.(3) LPS投与後24時間の血漿中SOD活性は, LPS無投与群に比べ, その値は有意に低値を示したが, ESE投与群では水道水投与群に比べ有意に高値を示した.(4) LPS投与後24時間の血漿中AST, ALT量は, LPS無投与群に比べ, その値は有意に高値を示したが, ESE投与群では水道水投与群より低値を示す傾向がみとめられた.

骨盤内臓全摘術 (TPE) は一般的にはdouble stoma の造設を伴い, 術後QOLが問題視されてきた. しかし, 最近ではstomaless TPEの良好な経過も報告されている. 我々は術前画像診断で広範囲に膀胱浸潤を来した進行直腸癌に対しTPEを施行し, Studer変法による膀胱再建を施行した1例を経験した. 患者は61歳の男性で, 主訴は便秘. 平成14年4月12日近医で大腸内視鏡検査を受け, 肛門縁より約4.5～20cmに全周性の狭窄を指摘され, 生検で中分化型腺癌と診断された. 画像診断で腫瘍は広範囲の膀胱浸潤が疑われたが他臓器転移は見られず, TPEの適応とした. 同年7月9日患者の同意のもと, TPE後にStuder変法による代用膀胱を作成した. 9月30日に退院後, 昼間のcontinenceは十分えられ, 腹圧排尿後の残尿は50ml程度となった. 骨盤内臓全摘術後のStuder 変法による膀胱再建は症例を選べば有用な方法であると考えられた.

Pb(Zr, Ti)O3 thin films were grown on 8-inch Ir(111)/SiO2/Si substrate by a MOCVD system aiming at application utilizing high-density ferroelectric memory (FRAM). Two types of solvents, THF and cyclohexane were used for liquid source delivery. It was found that the ferroelectric properties of the MOCVD-PZT films using cyclohexane solvent were better than them using THF solvent. By choosing cyclohexane as solvent, the MOCVD-PZT thin films showed strong ⟨111⟩ preferred orientation and the Pt/PZT/Ir capacitors exhibited promising ferroelectric performances, for instance, large switching charge (Qsw) of 56.4 uC/cm2.

早期胃癌, 大腸癌同時性重複癌を合併した皮膚筋炎と診断された興味ある1例を経験した. 症例は72歳の男性. 平成11年6月頃より顔面～頸胸部を中心とする落屑を伴う紅斑が出現した. 同年9月検診目的の胃内視鏡検査にて胃体上部に1型胃癌を指摘された. CPK 394 IU/L, LDH 686 IU/Lであったが, 術前皮膚生検では皮膚筋炎の確診は得られなかった. 同年10月8日開腹術施行し, 術中腹腔内検索にて発見された横行結腸癌とともに切除した. 術後3日目には上半身の紅斑, 掻痒感ともに消失したが, 術後約1か月目より自力歩行困難となるほどの筋力低下を来した. ミオグロビン-S 454 ng/mlであり, 筋生検, 筋電図, 臨床経過から皮膚筋炎と診断した. 12月25日よりプレドニン50mg/dayで内服を開始したところ, 内服後3日目より自力歩行も容易となり筋力は著しく改善した.

When normal rabbits were administered various samples of deep-sea water, their biochemical values changed within normal limits, and no differences from distilled water administration (control) group levels were observed. Furthermore, no histopathological changes were observed in internal organs on the 28th day after administration. The serum total cholesterol (T-Cho) and low density lipoprotein cholesterol (LDL-Cho) levels of normal rabbits fed with a 1% cholesterol-containing diet simultaneously administered deep-sea water (desalinated water, hardness 28, 300, and 1200) increased with time up to about 1500 mg/dl. However, the degrees of increase were smaller than those of the control group, which received distilled water. Furthermore, when prepared hyperlipemia rabbits were administered deep-sea water (desalinated water, hardness 28, 300, and 1200), there were no significant changes in aspartate aminotransferase (AST), alanine aminotransferase (ALT), high density lipoprotein cholesterol (HDL-Cho), or triglyceride (TG) levels. On the other hand, T-Cho and LDL-Cho levels were reduced when the rabbits were changed to normal food, and the degree of reduction was more than that of the control group. In the liver and main artery bow, as the hardness of the deep-sea water increased, the accumulation of lipid and permeation of macrophages was reduced. This result was well in agreement with the results of the T-Cho and LDL-Cho levels. From these results, it is clear that deep-sea water controls the increase of serum lipid values (T-Cho and LDL-Cho) of cholesterol-fed rabbits, and promotes the reduction of serum lipid hyperlipemia rabbits. The minerals in deep-sea water greatly influence this effect.

Sho-saiko-to extract, a Chinese herbal medicine, is widely used for treatment of chronic hepatitis in Japan. However, it is not clear what conditions Sho-saiko-to extract improves hepatic inflammation and fibrosis. We therefore induced various stages of liver injury in model rats and administered Sho-saiko-to extract. We then evaluated the liver inflammation and liver fibrosis-improving effects of Sho-saiko-to extract. The liver injury model rats were produced by administration of various doses of dimethylnitrosamine (DMN) and Sho-saiko-to extract was administered to these rats. Then the liver inflammation and fibrosis-improving effects of Sho-saiko-to extract were evaluated according to L-asparate aminotransferase (AST), L-alanine aminotransferase (ALT), liver retinoid levels, levels of hydroxyproline, Transforming Growth Factor-beta (TGF-beta), and the liver fibrosis area. These indicators depended on the total doses of DMN. The ability of Sho-saiko-to extract to improve liver inflammation and fibrosis was limited to the following levels of the respective parameters: AST levels (234-264 U/l), ALT levels (208-232 U/l), TGF-beta levels (1102-1265 pg/g liver tissue), hydroxyproline levels (633-719 nmol/g liver tissue), and liver fibrosis area (9.7-10.6 times for normal rat). These findings suggested that Sho-saiko-to extract is effective in the treatment of liver inflammation and fibrosis up to a certain degree of severity, but it produces no improvement in more severe cases.

Eriobotrya japonica is considered a medicinal plant, and its leaves (Eriobotrya folia) have been used to treat skin diseases, as well as to relieve inflammation, pain, coughing, and sputa. In our evaluation of the pharmacological efficacy of the seed extracts, constituents of the seeds were found to contain the unsaturated fatty acids linolenic and linoleic acids and the sterol β-sitosterol in the 70% EtOH and the MeOH extracts. The seed extracts were orally administered to rats with dimethylnitrosamine-induced hepatopathy, and blood L-asparate aminotransferase (AST) and L-alanine aminotransferase (ALT) levels, liver retinoid level, and hydroxyproline level were measured. Liver fibrosis rates calculated after Azan-Mallory staining and evaluation of the liver function-improving effects of extracts were showed that AST, ALT, and hydroxyproline levels and liver fibrosis rates were significantly lower, and retinoid levels were significantly higher in hepatopathic rats treated with 70% EtOH and MeOH extracts of the seed than in water-treated control rats. This suggests that the positive effect on liver function of the extracts varies depending on the extracting solvent used. 70% EtOH and MeOH extract of the seeds inhibited the development of liver fibrosis in hepatopathic rats, thus exhibiting potent improvement. The unsaturated linolenic and linoleic acids and the sterol β-sitosterol contained in these extracts may also contribute to the improvement of liver function.

肝門部胆管癌50切除例について,リンパ節転移状況を検索し,予後との関連性を検討し,適切なリンパ節郭清を模索した. リンパ節転移度別の予後では, n0症例の5年生存率は20.9%, n1の5年生存率は16.7%で,共に1例ずつ5年以上生存例を認めた. n2, n3症例では最長1年5カ月死亡と不良であった.部位別リンパ節転移率では, No.8 (a, p)が最も多く, No.12b, 12pが次いでおり,第2群リンパ節転移が多くを占めていた.第3群リンパ節転移は少なかった. No.5, 6リンパ節に転移の認められた症例があった. 以上より,リンパ節郭清は, D2を基本とし, No. 5, 6郭清を加え, n2, n3転移を明らかに認めるような症例では,拡大郭清や拡大切除は控える配慮が必要になってくるものと思われる.

Selenium is a component of glutathione peroxidase (GPx), which metabolizes oxygen radicals. Generally, selenium is obtained from such foods as grains and fish. Therefore, for patients with severe motor and intellectual disabilities (SMID) who cannot orally consume meals, a selenium deficiency remains a problem. To overcome this problem, selenium oral solution was administered to SMID patients under long-term total parenteral nutrition, and the usefulness of selenium oral solution was evaluated using the serum selenium concentration and GPx activity as indices.Before selenium oral solution administration, the serum selenium concentration of SMID patients was 3.0 ± 0.7, μg/dL, which is an extremely the low value compared with 11.2 ± 1.2, μg/dL which is the normal value for a healthy adult. Moreover, the GPx activity of 48.5 ± 12.3 n mol/min/mL was also extremely low in comparison to a healthy adult' s value of 112.6 ± 5.6 n mol/min/mL. When a selenium oral solution (6, μg/kg) was administered to SMID patients for two weeks once per day, the serum selenium concentration and the GPx activity increased, and there was no difference from a normal healthy adult' s value. Although the selenium oral solution thereafter decreased to 1.5μg/kg once per day, the serum selenium concentration and the GPx activity were mostly maintained in the normal region. Moreover, a significant positive correlation was observed between the serum selenium concentration and the GPx activity. (p< 0.001)These results suggested that the administration of oral selenium solution to patients with selenium deficiency diseases, such as SMID, and patients under long-term total parenteral nutrition, thus improved the serum selenium concentration and GPx activity.

To achieve a high-density integration of non-volatile memory, NbO x selector-cell prepared by a sputtering process is developed for cross-point 3D-ReRAM. By optimizing sputtering conditions, NbO x film with a threshold voltage of ±0.5V is obtained as a bidirectional selector. Furthermore, ReRAM with a stack of NbO x selector-cells is confirmed to have a good switching property at the threshold voltage of ±0.5V.

One-dose package dispensations of tablets and capsules were performed in all outpatients in order to improve the medication compliance and prevent any incorrect drug ingestion and the effect of this method was evaluated based on a questionnaire survey for outpatients. As a result, it became clear that the age of the patient, the interval of taking medicine, the kind of drugs in the one-dose packages, the number of prescriptions and the dosage days were judgment factors in the evaluation process. In other words, the outpatients who gave “good” answers were aged, had been taking the medicine for a long time, and had received many kinds of drugs in a one-dose package. On the other hand, the outpatients who gave “not good” answers had more types of medicine prescribed, and had been taking the medicine for longer periods of time. After being the one-dose package method the number of dispensing errors decreased from 6.0 cases to 3.5 cases per day on the average.

Intersphincteric resection (IRS) is a surgical technique used to preserve sphincter function, mainly cases of low rectal cancer located less than 5 cm from the anal verge [1, 2]. There have been reports of laparoscopic ISR [3, 4], but discussion of the specific techniques used in this laparoscopic surgical procedure have not been sufficient. For better outcomes of this sophisticated procedure, extreme care must taken to prevent perforation of the rectal wall and to preserve the external sphincter muscle. The most difficult steps for ISR are the circular dissection and separation of the internal sphincter muscle from the external sphincter and puborectalis using the perineal approach. The authors' techniques and the advantages of laparoscopic ISR are shown by a video presentation of three rectal tumor cases. Also, the perioperative outcomes for the patients who underwent laparoscopic ISR with this technique are described.From January 2006 to September 2009, laparoscopic ISR with total mesorectal excision was performed for 15 patients (10 men and 5 women). The median age of the patients was 60.5 years. The T categories of the tumor node metastasis (TNM) classification for the rectal cancers were Tis for two patients, T1 for one patient, T2 for four patients, and T3 for eight patients. The median distance from the anal verge to the tumor in this series was 3.7 cm. The Tis cases had large laterally spreading tumors that could not be removed by endoscopic submucosal dissection. The T1 case presented in the video had a small tumor just above the dentate line that had developed in the presence of chronic ulcerative colitis. Because this case required total proctocolectomy and ileal pouch anal anastomosis, local resection was not used (Table 1). Table 1 Patients' clinical characteristics (2006.1-2009.8) No. of patients: 15 Gender (M/F):10/5 Age: years (range): 60.5 (31-75) pT*: Tis (n=2), T1 (n=1), T2 (n=4), T3 (n=8) Distance from anal verge: cm (range): 3.7 (2-5) * Pathological T categories of the tumor node metastagis (TNM) classificationThe 68-year-old man in case 1 had a large, laterally spreading rectal tumor. The 61-year-old man in case 2 had rectal cancer, with a tumor located 4 cm from the anal verge. Laparoscopic surgery was performed after neoadjuvant chemoradiotherapy. The 71-year-old woman in case 3 had T1 rectal cancer, with a tumor located just above the dentate line. After dissection of the intersphincteric space, the prolapsing technique was used.In the male patients, the rectum with the mesorectum was first dissected to the anal hiatus, initially on the posterior side along the avascular plane. Second, Denonvilliers' fascia was dissected, and the seminal vesicle was exposed. The third step was dissection of the lateral tissues followed by incision of Denonvilliers' fascia with the rectal wall exposure and care taken not to injure the neurovascular bundle (Fig. 1). Along this dissection plane, the puborectalis could be reached and intersphincteric space entered from the lateral side of the rectal wall (Fig. 2). The final step was dissection of the hiatal ligament at the posterior side of the rectum. Nearly circular dissection of the intersphincteric space could be completed. The difficulties associated with the perineal approach were reduced by this abdominal approach, and the tumor could be exteriorized easily. Fig. 1 After incission of the Denonvilliers' fascia at the lateral side of the seminal vesicle puborectalis muscle can be reached at the lateral side of the rectum. Fig. 2 Adhesion line between the puborectalis muscle and rectal wall is enposed. Intersphinecteric space can be entered along this dissection plane at the lateral side of the rectum.The mean duration of surgery was 386 min, and the mean blood loss was 108 ml. The mean postoperative hospital stay was 18 days. The diverting ileostomy was closed at a mean of 7.3 postoperative months. No remarkable perioperative complication was encountered (Table 2). Table 2 Perioperative outcomes (n=15) Duration of surgery: min (range) 386 (319-510) Blood loss: ml (range) 108 (0-180) Postoperative hospital stay: days (range) 18 (11-31) COMPLICATIONS: n (range) Anastomotic leakage 1 Stricture of the anastomosis 1 Pelvic abscess 1 Postoperative period until the stoma closure (months) 7.3 (3-16) CONCLUSION: Laparoscopic ISR enabled reduction of the difficulties associated with the perineal approach. An advantage of laparoscopic ISR is the ability clearly to visualize anatomic structures in the deep pelvic cavity.

患者は71歳女性,主訴は右乳頭部びらん. 2年前の左乳癌術後からtamoxifen (TAM)の内服治療を行い通院中であった. 1998年8月頃より右乳頭部びらんを認め,皮膚生検にてPaget病と診断し乳房切除術施行.また婦人科検診にて最大径4.0cmの大きな子宮内膜ポリープが発見され子宮内容除去術施行した.乳癌術後の補助療法として広く使用されているTAMの長期投与によるエストロゲン作用が子宮内膜の増殖状態を持続させ,内膜ポリープや子宮内膜癌などの発生を高めることが知られている.一方対側乳癌の発生頻度を有意に低下させるとの報告もある.今回経験した症例は初回乳癌術後2年間TAMを投与中に,対側乳房のPaget病,および子宮内膜ポリープの発生をみた.本症例のPaget細胞のER免疫染色は陰性であった. TAM投与中は投与期間や量にかかわらず対側乳房の観察や,婦人科的検査は行われるべきである.

When the Y chromosome of Mus musculus domesticus (Y(TIR)) was introduced onto the C57BL/6J (B6) mouse background, testis development was impaired and half of the XY progeny (Y(TIR).B6) developed a female phenotype. Y(TIR).B6 fetal ovaries showed massive death of medullary oocytes and, after birth, produced abnormal levels of steroid hormones, exhibited irregular estrous cycles, and failed to become fertile. In this study we examined whether alterations during perinatal development observed in Y(TIR).B6 ovaries permanently impaired the establishment of the hypothalamus-pituitary-ovary axis (HPOa). B6 fetal and postnatal ovaries at different stages (fetal, infantile, or adult) were transplanted orthotopically (to the ovarian bursa) to either ovariectomized B6 normal females or Y(TIR).B6 sex-reversal females. Percentage of pregnancy, litter size, and capacity to feed pups were recorded. Reciprocally, XY(TIR).B6 ovaries were orthotopically transplanted into B6 females. After crossing with fertile males, several Y(TIR).B6 sex-reversal females with B6 ovarian transplants at all ages became pregnant, had offspring, and fed their pups. On the other hand, none of the B6 female hosts with XY(TIR) ovaries became pregnant. Results demonstrated that Y(TIR).B6 sex-reversal females maintain a functional HPOa and that their failure to reproduce is primarily due to an ovarian defect.

To examine the effects of Sho-saiko-to extract on liver fibrosis, the drug was administered to rats with dimethylnitrosamine-induced liver-injury at various doses. Hydroxyproline and retinoid levels in the liver were measured as indicators of liver function. In liver-injured rats, the hydroxyproline level in the liver (957 ± 154nmol g−1) was about 4.16-times that found in normal liver (230 ± 11 nmol g−1), but administration of Sho-saiko-to extract (0.75%, 1.5% or 3%) reduced the hydroxyproline level significantly (554 ± 58, 356 ± 51, 374 ± 66 nmol g−1, P < 0.01). Single administration of the active constituents of Sho-saiko-to extract, glycyrrhizin, baicalin or baicalein, decreased the hydroxyproline level significantly compared with the ordinary food group (P < 0.05), but the decrease was smaller compared with the Sho-saiko-to extract group. The liver retinoid level was higher in the Sho-saiko-to extract group than the ordinary food group and the value increased dose-dependently. A significant negative correlation, r = −814 (P < 0.001) was detected between the hydroxyproline level and retinoid level in the liver of liver-injured rats. Significant negative correlations, r = 0.728 (P < 0.001) and r = −0.873 (P < 0.001), were also detected between the liver hydroxyproline level and the liver concentrations of the active constituents (glycyrretic acid, baicalin and baicalein) in the liver-injured rats. From these findings, it was considered that the liver concentrations of hydroxyproline and retinoid as well as the active constituents were involved in the improvement of liver fibrosis in the liver-injured rats administered Sho-saiko-to extract. Administration of Sho-saiko-to extract inhibited collagen production while an increase in retinoid level inhibited activation of Ito cells leading to inhibition and prevention of liver fibrosis.

About 50% of patients who have a permanent stoma experience some degree of parastomal hernia formation. To prevent this complication, the extraperitoneal route is considered to be more effective than the transperitoneal route in the case of open colorectal surgery. This technique also has superiority in avoiding postoperative intestinal obstruction. Although laparoscopic surgery for rectal cancer has not been proved to be as safe as open surgery by a randomized-controlled trial, some studies have shown the equality of long-term results with laparoscopic low anterior resection and laparoscopic abdominoperineal resection. It is anticipated that cases of laparoscopic abdominoperineal resection will increase in the near future. However, a laparoscopic technique for creation of a permanent stoma has hardly been discussed. Most operative procedures for laparoscopic stoma creation have been performed with transperitoneal route, which may cause parastomal hernia and/or intestinal obstruction. This report describes a laparoscopic technique for permanent sigmoid stoma creation through the extraperitoneal approach.

The reactive ion etching (RIE) of the binary transition-metal oxides (TMOs) NiO, CuO and CoO, which are expected to be key materials of resistance random access memory (RRAMTM), was investigated. We found that inductively coupled plasma using CHF3-based discharge, which is highly compatible with conventional semiconductor RIE, is effective for the TMOs studied here. Furthermore, device fabrication using Pt/CoO/Pt trilayers is carried out, and a large change in resistance, which is an essential functionality of RRAM, was successfully observed. This should be definite evidence of a successful RIE realized in the present device fabrication.

Xanthogranulomatous changes in the pancreas are extremely rare. A 66-year-old man presented with a 2-year history of epigastralgia. Computed tomography scan revealed a 4-cm low-density area around the body of the pancreas. Magnetic resonance imaging demonstrated that the mass appeared hyperintense on a T2-weighted image and isointense on a T1-weighted image. Based on a diagnosis of invasive ductal carcinoma of the pancreas, distal pancreatectomy and splenectomy were performed. Sections examined from the mass showed an aggregation of many foamy histiocytes, lymphocytes, and plasma cells. The surrounding pancreatic tissue showed fibrosis and chronic inflammation. These findings suggested a xanthogranulomatous inflammation, and resulted in a diagnosis of xanthogranulomatous pancreatitis.

Primary carcinoma of the vermiform appendix is a rare disease. It presents difficulty in diagnosis preoperatively and postoperative histopathologic examination ofen offers the definite diagnosis for the first time. We have experienced four cases of primary carcinoma of the vermiform appendix. Preoperative diagnoses were ileocecal tumor in case 1 and 3, ovarian cancer in case 2, and pseudomyxoma peritonei arising from the appendix in case 4. We performed an appendectomy in case 1, ileocecal resection and extirpation of the uterus and ovary in case 2, ileocecal resection in case 3, and appendectomy and peritoneal levage (with 2, 500ml of 5% dextorose water) in case 4. At laparotomy, case 2 and 4 showed psuedomyxoma peritonei. Pathological diagnoses were mucinous cystadenocarcinoma in case 1, 2 and 4, and adenocarcinoma in case 3. After the surgical resection of the tumor, intraperitoneal administration of cisplatin and intravenous injection of pirarubicin and cyclophosphamide were executed in case 2, and peritoneal lavage and intraperitoneal administration of 5-FU were executed in case 4. All patients are still alive.

Renal cell carcinoma (RCC) easily metastasizes on blood. So, metastases from RCC to the lung, liver and bone are common, but the pancreas in a rare site. We report a resected case of multiple pancreatic and hepatic metastases of RCC occurred 8 years after operation in a 61-year-old man. The patient had undergone a right nephrectomy for a primary RCC 8 years before, and a sigmoidectomy for a metastatic tumor of the sigmoid colon 5 years before admission. And this time, abdominal CT and magnetic resonance imaging (MRI) demonstrated multiple tumors at the pancreatic head and tail and a solitary tumor at the posterior segment of the liver. A Pylorus-preserving pancreatoduodenectomy, a distal pancreatectomy, a partial resection of the pancretic body and a partial resection of the posterior segment of the liver were performed under the diagnosis of the multiple pancreatic and hepatic metastases of RCC. Histopathological findings of the resected material showed metastases of RCC to the pancreas and liver. There have been 57 resected cases of pancreatic metastasis of RCC in the Japanese literature. In about 78% of them, pancreatic metastasis occurred metachronously and after elasping for a relatively long time. Long-term follow up is necessary for the patient after nephrectomy for RCC.

Twenty-four cases of intrahepatic cholangiocarcinoma resected in our hospital in the 12 years from 1986 to 1997 were studied with respect to macroscopic classification and prognostic factors. 20.8% of the patients had stones of the intrahepatic or common bile duct. The serum level of carcinoembryonic antigen and of carbohydrate antigen 19-9 was positive in 38.1% and in 86.4% of the patients, respectively. The outcome were poor: one-and five-year survival rates were 55.3% and 22.1%, respectively. Macroscopic classification was made into mass-forming, periductal infiltrating, and intraductal growth types, following a report of The Liver Cancer Study Group of Japan (1994). The outcomes of the mass-forming type (n=9) and the periductal infiltrating type (n=11) were very poor and showed no significant difference. But the patients of the intraductal growth type (n=4) were all living with good prognoses. Prognostic factors were examined according to the Classification of Primary Liver Cancer (Third Edition, 1992). Lymph node involvement, serosa invasion, and portal invasion were significant indicators of a poor prognosis.

To confirm the stability of tablets and capsules in one-dose packaging dispensation, we studied changes in three different storage conditions regarding the external appearance, weight, hardness, disintegration time and contents.A change in the external appearance change was observed in two medicines under severe (temperature: 30°C), RH (relative humidity: 75%) one-dose package and naked conditions. Changes were in medicines in which the naked eye could not detect any changes regarding the color for 3 medicines. A weight change was observed in tablets made in one medicine. The hardness of the Lorazepam was found to decline by about 50% in severe conditions. A decline in the disintegration time was seen in Lisuride Maleate after 24 hours with (temperature: 26-32°C, RH: 43-70%). On the other hand, the Same disintesation time increased in severe condition. Change were seen regarding ofthe 5 medicines. A decline of about 50% was observed in Serrapeptase in under severe conditions. Based on the above findings the stability of medicines should therfore be carefully monitored when using one-dose packaging

We have developed a Pb(Zr,Ti)O3 (PZT) piezoelectric thin-film-actuator manufacturing technique by sputtering and dry etching processes. PZT etching rate and taper angle were investigated, and we obtained a very high etching rate (about 190 nm/min) and a high taper angle (62°). (001)/(100)-oriented PZT thin films on a (111)Pt/Ti/SiO2/Si substrate (6 in.) were prepared by RF magnetron sputtering, and Pt on PZT were prepared by DC magnetron sputtering. Pt/PZT/Pt piezoelectric thin-film actuators were fabricated by dry etching using an inductively super magnetron (ISM) plasma source. The characteristics of the ISM plasma source are high-density plasma and low-pressure operation attributable to the effect of the permanent magnet. The electrical properties of a piezoelectric thin-film-actuator cell fabricated by dry etching were investigated. The remanent polarization (Pr value) of a piezoelectric thin-film actuator with 3-µm-thick PZT film was 41 µC/cm2 at an applied voltage of 30 V, and remanent polarization characteristics without the dependence on element size (30–300 µm diameter) were obtained. Moreover, the displacement of a PZT thin-film-actuator was measured by contact atomic force microscopy (C-AFM), and a displacement of 4 nm was obtained at 3 µm thickness of the PZT film, 30-µm-diameter element size, and an applied electric field of 100 kV/cm. It was clarified that the fabrication of PZT piezoelectric thin-film-actuators by dry etching using an ISM plasma source is effective.

SrBi2Ta2O9 (SBT) thin films were deposited on 6-inch Pt/Ti/SiO2/Si substrates by rf magnetron sputtering using a 12-inch ceramic SBT single target. It is found that several sputtering parameters such as argon (Ar) pressure and rf power were very effective to control the Bi content of SBT thin films which is essential for obtaining good ferroelectric properties.

Sho-saiko-to, one of the most widely used Chinese herbal preparations, has long been used for the treatment of chronic liver diseases. We have investigated its effect in retarding the process of liver fibrosis and accelerating liver regeneration, especially its effect on Ito cells that are thought to be deeply involved with liver fibrosis. Sho-saiko-to extract and its active constituents were orally administered to rats with dimethy lnitrosamine-induced liver-injury. After treatment with sho-saiko-to extract hepatic function improved, histopathological results confirmed repair of liver tissue, and retinoid levels increased. On the other hand, when active constituents of sho-saiko-to extract were administered alone, liver retinoid levels remained low, implying that interaction among active constituents of the extract was suppressing Ito cell activation. When sho-saiko-to extract was administered to 70% hepatectomized normal and liver-injured rats, liver weight, the number of S-phase-cells and retinoid levels increased with time. However, these changes were different for normal and liver-injured rats, suggesting that the site of action of sho-saiko-to extract in regenerating liver is different for normal and liver-injured rats. These results show that sho-saiko-to extract was useful for suppressing the activation of Ito cells.

We report a case of gastric leiomyosarcoma showing a pedunculated extragastric development that is very rare. A 75-year-old woman was admitted to the hospital because of an abdominal tumor and epigastralgia. gastric transillumination, gastric camera and abdominal CT offered a suspicion of extramucosal tumor of the stomach. Endoscopic ultrasonography was performed and extragastric leiomyosarcoma was diagnosed. Upon laparotomy a tumor with the size of 17×12×9cm and pedunculated from the posterior wall of the body of the stomach was present and it was excised by a wedge resection. Cross section showed yellowish white solid tumor with necrosis. The pathological diagnosis of the excised tumor was extragastric leiomyosarcoma. There was no distant metastasis and direct invasion of adjacent structure, but microscopically mitosis was found 8/10 High Power Field, and the tumor was 17cm in diameter, so that her prognosis might be very poor. There have been no signs of recurrence, and the patient is in good health to date.

Tubular adenomas of the breast are rare benign tumors that commonly occur in younger women. The authers describe a case of rapidly enlarging tubular adenoma occurred in a pregnant woman. A 17-year-old woman was sent to the hospital because of a breast tumor. She had a baby girl 4 days before. The tumor had grown rapidly during pregnancy. The tumor, measuring 9.0 cm×8.0 cm was palpable in the CD area of the left breast. Ultrasonography and mammography showed no apparent signs of malignancy. Under the diagnosis of fibroadenoma or phyllodes tumor, the tumor was extripated. Pathohistologically, the tumor was diagnosed as tubular adenoma. Tubular adenomas are so rare that only 32 cases have been reported in the Japanese literature. Among of them, this case is thought to be clinically rare in such a longer diameter of the tumor and a rapid growth during pregnancy.

For the purpose of treating intractable decubitus and skin ulcer, streptokinase (SK) jellies containing different types of thickening agents were prepared. Adhesion to the affected sites, the spreading ability of the jelly preparation, and the properties of the SK in the jelly, which are all considered to greatly affect the clinical efficacy, were examined pharmaceutically using the viscosity, spreading area, and release and stability of SK as indexes. Regarding the viscosity and spreading area which are thought to affect both adhesion and spreading greatly, when sodium polyacrylate (PANa) was used as a thickener, higher viscosity and smaller spreading area were obtained in comparison with carboxymethylcellulose sodium (CMCNa) and sodium alginate (Alg Na). In addition, the viscosity and the spreading area obtained with PANa were also slightly more affected by temperature than with CMCNa and AlgNa. Regarding the release of SK from the jelly preparations, with PANa no initial burst was observed and SK was continuously released at a constant rate in contrast with CMCNa and AlgNa, thus obviously showing the superiority of PANa in the retention of SK. Although no loss of the potency of SK was found in the jellies containing PANa, CMCNa or AlgNa at 5°C, for 30 days, the remaining potency was greatly decreased to 49-62% at 25°C after 30 days and 33-42% at 37°C after 30 days. These results showed that the adhesion, spreading ability and SK-release were greatly different among the tested thickening agents, and the properties of PANa were found to be clearly superior to those of the other agents. According to these results, SK jelly containing 2% PANa was used for the treatment of intractable decubitus and skin ulcer, and an excellent therapeutic effect was obtained.

This paper deals with development of sputtering technology of Ta2O5/TaOx stacked film for ReRAM mass-production. Thickness of TaOx film deposited by sputtering process is possible to obtain with good uniformity. However, if a high deposition rate is required for mass production, it is very difficult to obtain good controllability and uniformity of TaOx film. These problems affect the switching characteristics of the ReRAM. In order to solve these problems, sputtering tool and process for ReRAM mass-production are developed. We report the result of TaOx film with good resistance uniformity and controllability and deposition stability without low deposition rate. Moreover, switching characteristics of Pt/Ta2O5/TaOx/Pt-ReRAM-cells are evaluated.

We investigated in vitro the properties of glycyrrhizin (GL), such as dissolution, absorption and resolution, using a Sho-Seiryu-To extract, a Sho-Saiko-To extract, both including a licorice root, and licorice extract. The dissolution of GL differed with the pH of the solvent. The absorption (partition coefficient) of GL decreased with an increase in pH, and increased in the presence of other active constituents, such as baicalin, baicalein, and ephedrine. In the case of the Sho-Saiko-To extract, the conversion from GL to glycyrrhetic acid (GA) by beta-glucuronidase originated from E. coli occurred slowly. It was also suppressed by adding baicalin. We determined in vivo the pharmacokinetics of GA after oral administration of Kampo extracts in healthy volunteers. In each Kampo extract, the time of administration had no influence on the mean maximum blood concentration (Cmax) and the area under the blood concentration-time curve (AUC). Tmax was delayed in the case of the administration after meal (p < 0.05).

Aeromonas sobriaによる電撃的経過をたどった敗血症の1例を報告した. 患者は82歳の女性.残胃癌にて根治術施行.術後第1日目後半より, 低血圧, 頻脈となり輸液負荷, 塩酸ドパミン投与により経過をみたが, 術後2日目に敗血症ショックによる末梢循環不全およびDICをきたした. 強度の代謝性アシドーシス, 血小板減少をきたし, 胸部, 腹部の皮下出血斑, 皮下気腫を呈した. ICUに入室し呼吸循環管理を行ったが, ショック状態から離脱できず同日死亡した. 動脈血培養にてAeromonas sobriaが検出された.Aeromonas sobriaの術後感染症としての報告はわれわれが調べえた範囲では本症例が第1例目であるが, 急激な経過をたどることや, ペニシリン系抗生物質に感受性が乏しいなど診断治療において特に注意すべきと考えられる.

A longitudinal characteristic curve of chronic liver disease (LCC-LD) is derived for the first time by a new method of time series data analysis, where a hospital information system is utilized as a clinical research application of the database. It describes a typical pattern of development of disease from the beginning of chronic hepatitis to the final stage of cirrhosis. The LCC-LD is obtained by effectively using patient data with various stages of developments of liver disease and the present method is applicable to derive the LCC of other diseases. The obtained LCC-LD may be useful for a clinical decision making support such as the prospective assessment (for example, the onset time of cirrhosis) of liver disease in individual patients, an evaluation of drug effect, etc.

The prevalence of a paracolostomy hernia has been reported to be from 10% to 50%, with serious impairment of the quality of life and sometimes life-threatening morbidity in some cases. Most essential in avoiding the need for further treatment of an end-sigmoid colostomy is prevention of a parastomal hernia.We examined the effects of the extraperitoneal route for stoma creation to prevent parastomal hernia after laparoscopic abdominoperineal resection for rectal neoplasms.This is a study of a retrospective cohort.Data on a total 37 consecutive patients who underwent abdominoperineal resection from March 2005 to December 2010 in Kochi Health Sciences Center were examined retrospectively in this study. Group A included 22 patients whose stoma was created through the extraperitoneal route, and group B included 15 patients whose stoma was created through the transperitoneal route.The main outcome measures were the rate of parastomal hernia determined through CT and clinical examinations in the 2 groups.In Group A, 1 case was diagnosed as having a parastomal hernia, whereas, in Group B, 5 cases were diagnosed by CT examination as having a parastomal hernia; the difference in incidence between the 2 groups was significant (p = 0.0305). Furthermore, median duration of the follow-up period between the latest CT examination and the primary operation was 722 days in group A, which was significantly longer than that in group B (442 days) (p = 0.001).: This study was limited by its nonrandomized retrospective design.Group B developed parastomal hernia more frequently within a significantly shorter period. A permanent sigmoid colostomy created through the extraperitoneal route can prevent the incidence of parastomal hernia after laparoscopic abdominoperineal resection.

A83 -year-old man was admitted to our hospital for the treatment of advanced ascending colon cancer with liver metastases. He had initially undergone an ileocecal resection for ascending colon cancer. Subsequently, we started oral administration of UFT/LV(UFT 400mg/day, LV 75 mg/day, and 4 weeks of therapy followed by a week suspension of treatment). After 3 courses, his tumors responded well to treatment, and CT showed marked regression of liver metastases. After 10 courses, liver metastases had almost disappeared. Two years passed without any adverse events since UFT/LV therapy was started. These findings suggest that UFT/LV therapy is very safe and effective for elderly patients with unresectable colorectal cancer.

This paper describes proposal of ReRAM switching mechanism, development of production tool for ReRAM sputtering and improvement in TaOx-ReRAM switching characteristics. We propose that a ReRAM-cell has stack a structure in which an oxygen vacancy supply layer (TaOx) and an oxygen accumulation layer (Ta2O5) sandwiched by the top and bottom electrodes. Resistance change of the ReRAM-cell is caused by the oxygen vacancies migrating between the TaOx and the Ta2O5 layers by applied voltage. This prediction corresponded to the experimental facts. The thickness of Ta2O5 film sputtered by a mass production tool had good uniformity (±1.0%) and excellent stability (±1.0%). Also the sheet resistance uniformity (1σ) of TaOx film had 3.6%. By examining the sputtering conditions, the ReRAM-cell having a Ta2O5/TaOx bi-layer operated in less than 100μA with a forming-free and had excellent endurance property to 1010 cycles at 50nsec.

We prepared chitin-containing cis-diamminedichloroplatinum(II) (CDDP) albumin microspheres with various particle sizes, and investigated in vitro CDDP release; the antitumor effect towards VX2 tumor introduced into rabbits was then examined. It was found that the rate of release of CDDP from chitin-containing CDDP albumin microspheres in vitro was increased with reduced particle size. Administration of microspheres to VX2 tumor-bearing rabbits via the hepatic artery resulted in different profiles of plasma platinum concentration depending on the particle size, and a higher concentration of platinum was released from the beginning of administration as particle size was reduced. The platinum content in hepatic tissue following the administration of CDDP microspheres was increased as the particle size decreased, although the rate of increase was not uniform. The antitumor effect of CDDP assessed by the suppression of tumor growth tended to be higher when microspheres of smaller sizes were used. However, no significant difference was observed in tumor growth rate between rabbits injected with microspheres smaller than 20 microns and those injected with sizes between 20 and 37 microns (p0.05). We also examined the relationship between the CDDP dose and antitumor effect using microspheres of less than 20 microns and observed a dose-dependent antitumor effect. No significant difference was observed, however, between 2 and 4 mg eq CDDP/kg dose levels (p0.05). From these results, we concluded that microsphere size and CDDP dose were strongly correlated with the augmentation of antitumor effect of chitin-containing CDDP albumin microspheres used in chemo-embolization therapy via the hepatic artery.