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Background Hepatic cavernous hemangioma (CH) is the most common hepatic benign tumor. Most cases are solitary, asymptomatic, and found incidentally. In symptomatic cases with rapidly growing tumors and coagulopathy, surgical treatment is considered. In rare cases, diffuse hepatic hemangiomatosis (DHH) is reported as a comorbidity. The etiology of DHH is unknown. Case presentation A 29-year-old female patient had a history of endometriosis treated with oral contraceptives. Hepatic CH was incidentally detected in the segment IVa of the liver according to the Couinaud classification. Follow-up computed tomography (CT) and ultrasound sonography showed the growth of the lesion and formation of multiple new lesions near the first. Enhanced CT and magnetic resonance imaging (MRI) revealed that the new lesions were different from CH. Although oral contraceptives were stopped, all lesions grew in size. Malignancy and possibility of rupture of these tumors were considered due to the clinical course, and we opted for surgical removal of the tumors. Left liver lobectomy and cholecystectomy were performed. Surgical findings were small red spot spreading and a mass in segment IV of the liver. Pathological examination revealed a circumscribed sponge-like tumor with diffuse irregular extension to the adjacent area. Both of the lesions consisted of blood-filled dilated vascular spaces lined by flat endothelium without atypia. The diagnosis was hepatic CH with DHH. The patient was discharged on postoperative day 12 uneventfully. Conclusion We report the successful resection of CH with DHH. The case findings suggest a relationship between oral contraceptive use and enlargement of CH and DHH. Although DHH has been poorly understood, a few previously published cases reported DHH occurrence in patients using oral contraceptives. In such cases, the decision to perform surgical resection should be made after careful examination.

This paper reviews techniques for improving the temporal contrast and spatial beam quality in an ultra-intense laser system that is based on chirped-pulse amplification (CPA). We describe the design, performance, and characterization of our laser system, which has the potential for achieving a peak power of 600 TW. We also describe applications of the laser system in the relativistically dominant regime of laser-matter interactions and discuss a compact, high efficiency diode-pumped laser system.

終末期消化器癌患者において出現する腹部救急病態のうち,消化管,胆管,尿管といった管腔の閉塞に対する外科的介入の効果について検討した.最近3年6カ月間に当科を死亡退院した98例のうち,消化管閉塞24例,胆管閉塞12例,尿管閉塞10例を対象とした.予後予測指標としてpalliative prognostic index (PPI)を用い, QOLの評価は腹部症状の改善度,経口摂取の可否,在宅移行率により行った.消化管閉塞に対しては,ストマ造設術や消化管バイパス術を行いえた場合,腹部症状や経口摂取は有意に改善し,胆管や尿管の閉塞に対しては,内瘻化が症状の改善や在宅移行率の上昇に寄与した.また, PPI

症例は43歳,男性.突然の吐血と下血による眩暈と動悸を主訴に当院受診.緊急上部消化管内視鏡検査でファーター乳頭の口側2 cmの十二指腸に約1.5cmの半球状膨隆型の粘膜下腫瘍より動脈性の出血を認めた.このため内視鏡的止血術やtrans arterial embolizationを施行したが止血できず,受診後4日目に腫瘍核手術を行い止血しえた.病理組織学的所見で十二指腸異所性膵と診断された.本症例は術後の検査で血友病Bと判明し,このための凝固異常が止血困難の一因と考えられた.十二指腸粘膜下腫瘍より出血を認めた場合,異所性膵を考慮する必要があり,保存的治療で止血しえない症例では,適切な時期に外科的治療を行う必要がある.

鼠径ヘルニアは一般外科手術の中で占める割合の高い疾患であるが,鼠径ヘルニア嚢に悪性腫瘍が存在する頻度は少ない.今回,われわれはS状結腸癌が右鼠径ヘルニア嚢に転移をきたした症例を経験した.症例は55歳,女性. S状結腸癌術後CEA高値が遷延し腹部造影CTにて右鼠径部に増強効果のある約2.5cmの腫瘤を認めた.吸引細胞診にてS状結腸癌と同様の腺癌を認め, S状結腸癌の右鼠径ヘルニア嚢転移と診断された.その後の全身精査にて他に転移を認めず,単発性鼠径ヘルニア嚢転移と考えられ摘出術を施行した.浸潤の疑われた横筋筋膜,外腹斜筋腱膜の一部も含め合併切除し,組織欠損に対しては, PROLENE Hernia System® (Johnson & Johnson)を使用しTension freeにてヘルニア修復術を行った.

最近7年間に当科で手術を行ったgastrointestinal stromal tumor (以下, GIST)11症例について臨床病理学的および免疫組織学的検討を行った.発生部位は胃8例,十二指腸1例,小腸2例で,免疫組織学的検査の結果, c-kit, CD34, SMA, S-100の陽性率はそれぞれ100%, 81%, 27%, 0%であり,これよりuncommitted typeが8例, smooth muscle typeが3例と分類された.良悪性の診断は,病理組織学的に低悪性度が2例,悪性が4例であり,このうちの3例で転移再発を認めた. p53, Ki-67は悪性度診断,転移再発を予測する上で有用であった.本疾患の概念は未だ流動的だが,今後,個々の腫瘍の生物学的特性をさらに明らかにし,それに基づいた診断治療を確立することが重要である.

皮膚子宮内膜症は極めてまれな疾患である.今回,臍部に発生した子宮内膜症の1例を経験したので報告する. 症例は45歳女性で,月経時に疼痛を伴う臍部のしこりを主訴に当科を受診した.臨床症状,画像診断,生検などにより上記診断を得,全身麻酔下に腫瘤摘出術を行った.術後経過は良好であり, 5カ月を経た現在,再発の兆候は認められていない. 女性の臍部腫瘤をみた場合,念頭に置くべき疾患であると考えられた.

We investigated the absorption rates of acetaminophen, theophyline and lansoprazole after pylorus preserving-gastrectomy (PPG) with preservation of the vagal nerve as a treatment for patients with early gastric cancer. Postoperative functioning of the residual stomach 6 months after the operation in patients with early gastric cancer who had undergone PPG (PPG group, n=5) was compared with that in patients who had undergone distal gastrectomy (DG group, n=4). We also investigated recovery of body weight, findings in a series of gastrointestinal X-rays, gastroscopic findings, hormonal secretion and digestive and absorbtive abilities.The postoperative absorption rates of acetaminophen in the PPG group were almost the same as those before the operation, but they were slower in the PPG group than in the DG group.The absorption rate of theophyline from a sustained release formulation was faster in the DG group, and slower in the PPG group compared to the preoperative absorption rates. In the DG group, the absorption rate of an enteric-coated preparation of lansoprazole did not differ greatly from that before the operation. In the PPG group, however, there were large individual differences and a notable delay in absorption and reduction in the amount of absorption in the early stage.Recovery of body weight at 6 months after the operation was not significantly different in the PPG and DG groups. In the PPG group, postoperative gastrointestinal X-rays showed that the pyloric form had been retained, and gastroscopic examination showed that there had been no reflux gastritis or esophagitis. The rates of digestion and absorption were faster in the DG group than in the PPG group, and the plasma levels of glucose were higher but the serum levels of gastrin were lower in the DG group than in the PPG group.Furthermore, hormonal secretion in the PPG group was close to the normal physiological range.These results indicate that the rate of absorption was faster in the DG group and slower in the PPG group.The absorbability of drugs following gastric resection varies depending on the type of operation and the properties of the drug preparation.

症例は58歳,多発性内分泌腺腫症I型としての上皮小体腺腫および膵ガストリノーマの既往を有する男性. 19年前にクッシング症候群を伴う胸腺カルチノイドの摘出術を受けている.腫瘍は前縦隔左半を占拠しており,完全に摘除しえた.組織学的には19年前の腫瘍と同一の所見を呈し,胸腺カルチノイドの再発と考えられた.このように遠隔期に再発する胸腺カルチノイドもあることを念頭におくべきであると考えられた.

Between January 1985 and June 1992, 208 cases of hepatocellular carcinoma (HCC) were resected in the institute. In this study 22 cases of giant HCC (larger than 10cm in diameter) were clinicopathologically compared to the other 186 cases of HCC (smaller than 10cm). The mean age of 22 patients with giant HCC was 51.0 years old. There were 14 males and 8 females. The frequency of positive HBsAg was higher, while the frequency of concomitant liver cirrhosis was lower than the smaller HCC group. More than 50% of cases showed higher α-fetoprotein above 1000ng/ml. Eighteen cases out of 22 cases underwent more than 2 segment hepatectomy. Portal invasion and intrahepatic metastasis showed significantly higher frequency. The cumulative 3-year survival rate of giant HCCs was 28.4%, versus 61.7% in the smaller HCC group. Three out of 22 cases alived more than 5 years after the operation. These cases were treated by adjuvant chemotherapy, 2 of them received 5-FU via the portal vein and the other was infused adriamycin via the hepatic artery after hepatectomy.

A diode-pumped joule class in a 10 Hz output Nd:YLF ring amplifier has been developed. A phase conjugate plate was developed as a wavefront corrector for the residual wavefront distortion of an Nd:YLF rod. We have demonstrated a 0.46 J output of 10 ns pulse duration at 10 Hz repetition rate with 1.5 nJ of input energy. The effective gain of the ring amplifier system was 84.8 dB. To our knowledge, this is the highest magnification with joule-level output energy in a single-stage amplifier system that has ever been built. As a preamplifier system, this system contributed a demonstration of 21.3 J in a 10 Hz output diode-pumped Nd:glass zigzag slab laser system with a stimulated Brillouin scattering- phase conjugation mirror. We describe a robust and effective method of wavefront correction for high-energy laser systems.

門脈本幹に腫瘍塞栓を合併する肝細胞癌3例において, 腫瘍塞栓に対し放射線照射を施行し, 腫瘍塞栓の縮小後に肝切除を行った. 症例は39歳の女性, 57歳の男性, 38歳の男性で, 術前に腫瘍塞栓に対し30.0～34.5Gyの放射線照射を施行した. 全例で腫瘍塞栓の門脈1次分枝までの退縮を認め, おのおの右3区域切除, 拡大右葉切除, 右葉切除を定型的に行った. 病理組織学的変化では, 全例に腫瘍塞栓の変性, 壊死が高度に認められ, 術中操作による経門脈性播種の危険性を低下させると考えられた. 術前放射線照射を併用しなかったVp3切除症例の平均生存期間が診断より7.5か月, 術後無再発期間の平均が1.7か月であったのに対し, これら術前放射線照射を併用した肝切除症例では, おのおの13.3か月, 5.3か月と有意に延長しており, 術前放射線照射併用肝切除術の有効性が示唆された.

Wavefront correction until Zernike polynomial of degree three by a phase conjugate plate has been demonstrated in a high-energy Nd:YLF amplifier system. 108, amplification of 380 mJ has been achieved with a near-diffraction-limited beam quality.

We propose cryogenic Yb:YAG ceramic as a novel reactor laser-driver material instead of conventional Nd:glass. Our research on cryogenic Yb:YAG revealed that both of stimulated emission cross section and thermal conductivity can be tuned well by controlling the material temperature. Using the obtained laser parameters in our experiments, a 1.3-MJ, 16-Hz diode-pumped laser system has been conceptually designed. The overall electrical-optical conversion efficiency is numerically calculated to be as high as 17%. The compact main amplifier with about 3000, m3 volume size would be realized by using the active mirror architecture. In addition, a 1-kJ laser system 'GENBU' has been designed as a milestone for the new driver.