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多孔質弾性舗装を施工した場合に, 通常舗装からの騒音低減量がどの程度見込まれるかを理論的に計算した.そして, これを導入すれば都市部全域にネットワークされた幹線道路の騒音環境基準適合率の向上が都市全体としてどの程度はかれるか, 北九州市内の主要道路を対象に評価した. その結果, 1) 通常舗装を多孔質弾性舗装に変更した時の自動車の平均パワーレベルの減少は大きい. 通常舗装からの騒音低減量の殆どの部分を占める.2) 多孔質弾性舗装上に遮音壁を設置した場合に期待される騒音低減量は, 通常舗装上のそれと大差ない. 3) 多孔質弾性舗装の導入により, 北九州市内の殆どの幹線道路で騒音環境基準に適合する. 4) ただ, 低減効果は大型車混入率が大きくなるにつれて減少するので, 大型車が多く混入する所では, 併せて大型車への対応を考える必要がある.

We report a case of an abdominal aortic aneurysm which ruptured into the inferior vena cava indicated by CT and angiography in a patient that had been transferred to our hospital with a diagnosis of acute cardiac failure. The patient was a 73-year-old male who had been examined at another hospital for chest pain, hypotension, vomiting and vertigo and had been admitted to our hospital for examination of acute cardiac failure of unknown cause. A pulsating giant mass was palpable in the abdomen, and a continuous murmur was also audible in the abdomen. The patient showed no anemia or abdominal pain, but CT indicated the possibility of the rupture of an abdominal aortic aneurysm into the inferior vena cava. Emergency surgery was successfully performed following confirmation of the rupture by angiography. The results of this case indicate the need to consider a ruptured abdominal aortic aneurysm as a possible cause of symptoms resembling acute cardiac failure.

In the new environmental standard for road traffic noise, equivalent sound level was adopted instead of medium value. At the same time, the prediction model of road traffic noise was proposed by Acoustical Soc. of Japan. This model is utilized for the environmental assessment, and the application range is also wide. However, designers can not calculate easily the value of the road traffic noise using this model. Therefore, authors proposed the calculation method which satisfied two following requirements regardless of usual pavement, drainage pavement, though the application range is limited to the roadside noise as the automobile steadily runs.(1) Equivalent sound level can be easily calculated using mathematical expressions and figures.(2) Designers can easily decide noise reduction countermeasure of the object site.

都市部においては自動車の騒音に係わる環境基準の達成率が依然低い状態にある。それゆえ本研究では、道路からの距離や高さによらず有効な音源の段階での対策を施した場合に、減音量がどの程度見込まれ、達成率の向上がどの程度はかれるのかについて、北九州市内の主要道路を対象に検討した。なおここでは、実現性が高いと思われる2種類の対策、排水性舗装の施工と電気自動車等の低騒音車 (小型) の導入を取り上げた。その結果、通常より骨材粒径が小さい5-10mmで排水性舗装を施工し、小型の低騒音車を導入すると、環境基準達成率は昼間で28から87%、夜間で32から69%、両時間帯で24から67%と著しく向上することが認められた。

血管吻合をより短時間で容易に施行できる器械吻合器VCSクリップを豚肝移植における肝動脈吻合において使用し, その有用性を検討した. 体重21～29kgの豚18頭に同所性肝移植を施行した. 肝動脈吻合はレシピエントとドナーの総肝動脈 (直径約3mm) の端端吻合で, 4点に支持糸をかけてその間をVCSクリップSサイズを約3～4針ずつ合計12～16針かけることで行った. 肝動脈吻合は顕微鏡を使用せず可能で, 吻合に要した時間は全例で20分以内であった. 術後3日目以上生存した豚は18頭中14頭 (77.8%) で, その内で1頭 (7.1%) のみに術後10日目に肝動脈血栓が生じたが, 全体の動脈の開存率は92.9%で解剖所見においても狭窄などは認めなかった. 術後45, 90日まで長期生存させた豚においても成長に伴った問題点はなかった. VCSクリップは肝動脈吻合を容易にし, 吻合時間を短縮させたので, 臨床においても使用すべき有用な器材であると考えられた.

The role of peritoneal lavage cytology (PLC) in surgery for gastric cancer was investigated in terms of the correlations between PLC and clinicopathological findings of advanced gastric cancers. Subjects were 49 patients who were diagnosed as having gastric cancer with the depth of tumor invasion of more than T_??_on imaging methods preoperatively and underwent peritoneal lavage at laparotomy. Positive carcinoma cells determined by PLC was found in 38.8% of the patients and the rate of positive cytology was significantly correlated with the following factors: macroscopic peritoneal dissemination; the depth of tumor invasion, especially serosal invasion; and the infiltrating growth pattern of the tumor. Among patients without macroscopic peritoneal dissemination, five were found as positive in PLC. None of these patients survived from peritoneal recurrence within 2 years after surgery. These results suggest that PLC are useful for predicting the peritoneal cancer dissemination. For future treatment of gastric cancer, patients with positive PLC are expected to be targeted for intensive adjuvant therapies during and/or after surgery.

肝腫瘍患者24例(肝細胞癌16例,転移性肝腫瘍8例)に対しcomputed tomography during arterial portography (CTAP) とhelical-CTを施行し,両者における腫瘍検出率の差を比較検討した. 24例においてCTAPでは101個の腫瘍が検出されたが, helical-CTでは36個 (35.6%) にすぎなかった. 1cm未満の腫瘍はCTAPで20個検出されたが, helical-CTでは4個 (20%) にすぎなかった. helical-CTで手術可能とされたがCTAPで手術不能と判断された症例は24例中5例(肝細胞癌3例,転移性肝腫瘍2例)だった.これらの症例でCTAPでは63個の腫瘍が検出された. 1cm以上の腫瘍は47個検出されたが, helical-CTでは13個 (27.7%) にすぎなかった. 1cm未満の腫瘍は16個検出されたが, helical-CTでは4個 (25%) にすぎなかった.このように多発傾向にある肝腫瘍の局在診断においてhelical-CTでは不十分であり,手術適応の判断も含めCTAPは必要不可欠な検査法と思われる.

There is a need to establish animal models which are suitable for investigation of human gastric cancer metastasis to the liver. To this end, a human gastric carcinoma line, AZ521 was injected into the spleens of nude mice. Cells from the few liver metastatic foci of injected AZ521 were expanded "in vitro" and subsequently injected into the spleens of nude mice. By repeating these procedures three times, we were able to obtain a cell line, designated as AZ-H3c, with high metastatic potential in nude mice. Liver metastasis developed in 15 of 21 (71%) animals injected with AZ-H3c, but only in 14% of those injected with parental AZ521. Further, AZ-H3c caused faster tumor development than did AZ521. However, the primary AZ-H3c tumors and liver metastatic AZ-H3c tumors showed essentially the same histological appearance. We also analyzed the cell surface expression of adhesion molecules. The data showed that the expression of VLA-1, VLA-2, VLA-3, VLA-4, VLA-5 was enhanced in AZ-H3c. In contrast, the expression of VLA-6, (alpha(v)beta3), E-cadherin, ICAM-1 and LFA-1 was reduced in this high-metastatic line. These results suggest that (beta1) integrins play an important role in the liver metastasis of human gastric carcinoma cells. Our high-metastatic line should be useful for studies aimed at the prevention of liver metastasis.

早期胃癌に対する局所治療の問題点について, sm微小浸潤癌の臨床病理学的特性および超音波内視鏡による術前深達度診断の精度という2つの観点から検討を加えた. 過去20年間に当科で切除した早期胃癌420例の深達度別リンパ節転移率はm0.5%, sm1 (微小浸潤) 11.1%, sm220.8%, sm318.9%であり, sm1の転移率はmより有意に高率であった. このことからmとsm1を臨床上同等に抜うことは危険であると考えられた. 一方, 超音波内視鏡による早期胃癌56例のm-sm鑑別正診率は66.1%であった. 誤診例の内訳は過大診断が10例 (17.9%), 過小診断が9例 (16.1%) であった. 局所治療を行う際に最も問題となる深達度の過小診断については, 9例中8例がsm1であったことから, 微小浸潤の診断における超音波内視鏡の限界がうかがわれた.以上から, 術前診断精度が不十分である現状においては, 局所治療の実施にはより慎重な姿勢が必要であると考えられた.

Liver actinomycoses are relatively rare. We report a case of liver actinomycosis with bronchohepatic fistula. A 56-year-old man was admitted to a local hospital for a subcutaneous abscess on his right chest wall in March 1993. Dissection and drainage were performed, but he suffered from relapse and fell into sepsis. He was admitted to our university hospital on April 22, 1994. Under a preoperative diagnosis of liver abscess with a bronchohepatic fistula, which was based on findings from CT scan, ultrasonography, and endoscopic retrograde cholangiopancreatography, we resected the right lobe of the liver, inferior lobe of the right lung and a part of the right diaphragm on May 18, 1994. On postoperative histological examination, there was a mycelium of actinomyces in the liver and lung tissue. After the operation, he was treated with potassium penicillin G, and miliary nodes of the bilateral lungs decreased remarkably. It is necessary to entertain actinomycosis as a probable diagnosis, for liver abscess in which any causative pathogen can not be identified.

胃上中郡および全領域の原発胃癌557例を対象に, 進行度に応じたNo.(10),(11) 郭清術式の選択について検討した.No.(10),(11) 転移率の高い因子としては腫瘍径8cm以上, 大彎・後壁に位置するもの, S2以上, N (+) 例などが挙げられ, 一方, 腫瘍径4cm未満, S1以下, N (-) 例などではNo.(10),(11) 転移率が低かった.No.(10),(11) のen bloc郭清は238例に行われ, 郭清術式の内訳は膵脾合併切除190例, 脾動静脈切除膵温存術48例であった.これらの根治切除例における5年生存率はそれぞれstage I: 96.3%, 100%, stage II: 64.0%, 79.6%, stage III: 39.8%, 35.6%, stage IV: 20.8%, 0%であった. stage I, IIではNo.(10),(11) 転移率が低く, 生存率にも差を認めないことから膵温存術の適応が合理的である. stage IIIでは郭清術式による生存率の差を認めないが, No.(10),(11) 転移率の高い症例が含まれるため, 完全郭清を目的とした膵脾合併切除を選択すべきと考える. stage IVでは根治切除可能であれば膵脾合併切除の絶対適応である.

過去17年間に教室で治癒切除を施行した原発胃癌733例を対象に転移リンパ節個数, リンパ節転移度 (転移リンパ節個数/摘出リンパ節個数) の術後遠隔成績に及ぼす影響について臨床病理学的に検討した.その結果, これらのリンパ節因子が予後規定因子としての機能を発揮するのはn2例においてであり, n1, n3例では転移リンパ節の量的多寡による予後の差は明らかでなかった.転移個数については単純な総和値よりもn-numberを組み合わせた考え方が有用で, n2例における第2群リンパ節転移個数別の5生率は, 1～2個: 37.5%, 3～5個: 22.8%, 6個以上: 9.1%であった.リンパ節転移度 (F) 別のn2例の5生率は, F

We established a new cell line, AZ-P7a, with high peritoneal-metastatic potential in nude mice. AZ-P7a cells were derived from the human gastric carcinoma line AZ-521, which has low capacity for peritoneal dissemination. AZ-P7a cells developed peritoneal metastasis in 11 / 14 (78.6%) mice, whereas the parental AZ-521 cells developed metastasis in 2 / 6 (33.3%) mice. The metastatic foci in the peritoneum showed essentially the same histological appearance as those induced by parental cells. The tumorigenicity and the motile activity of AZ-P7a cells were stronger than those of the parental AZ-521 cells; in contrast, adhesion to the extracellular matrix and the production of vascular endothelial growth factor by AZ-P7a cells were decreased. In fluorescence-activated cell sorter (FACS) analysis, AZ-P7a cells expressed significantly greater levels of integrins alpha2, alpha3, alpha5, alpha6 and alphavbeta5, as compared with AZ-521 cells. However, alpha1, alpha4, alphavbeta3, hCD44H, hCD44v3, hCD44v6 and hCD44v10 were not expressed in either cell line. AZ-P7a cells developed no liver metastasis when administered by the intrasplenic injection method, though the highly liver metastatic cell line AZ-H5c showed the same rate of peritoneal dissemination as that exhibited by AZ-P7a cells after intraabdominal injection. These findings suggested that the mechanism of peritoneal dissemination differed from that of hematogenous metastasis. Moreover, the latter appears to be controlled by more complex mechanisms than the former. Thus, this cell line might be useful for investigating the mechanism of peritoneal dissemination of human gastric cancer.

The correlation between nm23 protein (nm23) expression and the expression of several cell adhesion molecules was studied immunohistochemically in 110 resected gastric carcinomas. Formalin-fixed and paraffin-embedded samples were serially sectioned and stained with antibodies against nm23, integrin beta1 subfamily members (alpha2beta1, alpha3beta1 and alpha4beta1), LFA-1, ICAM-1, sialyl Lewis(x) (sLex) and CD44H, -V3, and -V6. Primary carcinomas presenting with either lymph node involvement or liver metastasis expressed significantly reduced levels of nm23 compared to tumors without metastasis. The percent of tumors expressing each adhesion molecule was as follows: alpha2beta1, 27.3%; alpha3beta1, 20.0%; alpha4beta1, 14.5%; LFA-1, 14.5%; ICAM-1, 12.7%; sLex, 67.3%; CD44H, 55.5%; CD44V3, 20.0%; and CD44V6, 4.5%. Expression of alpha2beta1 integrin and high levels of sLex were significantly correlated with lymph node metastasis, and expression of alpha3beta1 integrin and high levels of sLex were correlated with liver metastasis. Expression of ICAM-1 was inversely correlated with liver metastasis. Comparing the expression of each cell adhesion molecule with nm23 immunoreactivity, expression of sLex was significantly associated with nm23 expression. Of tumors expressing high levels of sLex, 75% showed reduced nm23 expression, compared to 52% of tumors with weak or no sLex expression (P < 0.05). A similar tendency was also observed in the metastasized secondary tumors. These results suggest that reduced nm23 expression may promote the metastatic properties of cancer cells in concert with increased sLex expression.