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症例は59歳，男性．間歇的な腹痛を主訴に受診した．腹部CT検査では小腸腫瘤を先進部とする腸重積を，またダブルバルーン小腸内視鏡ではBauhin弁の口側70cmの回腸に腫瘤をみとめた．以上より，小腸腫瘍による腸重積と診断した．腹腔鏡補助下手術を施行し，腫瘤部位を含む小腸部分切除術を施行した．病理組織学的所見から腫瘤は内翻した真性憩室で，異所性胃組織を含むことからMeckel憩室の内翻による腸重積と診断した．成人腸重積症の原因としてMeckel憩室の内翻はまれであり，その術前診断は困難である．今回，Meckel憩室の内翻による腸重積の本邦報告例を集計し，その成因・診断・至適治療方針などを検討したので併せて報告する．

症例は77歳，女性．腹痛および発熱を主訴に近医より紹介され，CT・MRIで膵頭部に厚い被膜を有する直径11cmの多房性嚢胞性腫瘍を認めた．多数の比較的大きな壁在結節も認められたことより膵粘液性嚢胞腺癌（MCC）と診断し亜全胃温存膵頭十二指腸切除術を施行した．摘出標本の病理組織学的検索でも卵巣様間質を伴う腺癌を認めMCCと診断されたが嚢胞壁外への浸潤所見はなく非浸潤癌（Tis）と診断された．MCCに関する本邦および海外の報告では圧倒的に中年女性の膵体尾部原発が多く，高齢女性の膵頭部原発のMCCは稀であった．MCCでは術前の良悪性の鑑別は困難であるとされており，非浸潤癌であれば病巣の完全切除が達成されればリンパ節郭清は必ずしも必要ではないと思われるが，至適リンパ節郭清範囲に関しては再発形式も含めた症例の蓄積による検討が必要であると思われた．

Background and Objectives The incidence of gastric cancer, in people over 70 years of age, has increased remarkably. Aggressive lymphadenectomy with gastrectomy has been reported to improve survival in patients with gastric cancer. Because complication rates following gastrectomy increase with advancing age, we sought to determine whether this procedure was merited in elderly patients with gastric cancer. Methods We performed a retrospective analysis of 202 patients who underwent total gastrectomy with extended lymphadenectomy for gastric carcinoma. Postoperative complication rates were compared between patients over and under 70 years of age. Results The 10-year survival rates of patients under and over 70 years of age following total gastrectomy with extended lymphadenectomy were not significantly different. Although medical comorbidities in each group were similar, pulmonary dysfunction was significantly more common following total gastrectomy in patients over 70 years than in patients under 70 years. Moreover, logistic regression analysis revealed that patient's age was the only variable that independently correlated with the presence of postoperative complications. Conclusions The prognosis of the gastric cancer patients over 70 years of age was similar to that of younger patients after total gastrectomy with extensive lymphadenectomy. However, pulmonary dysfunction was significantly more common in patients over 70 years old. J. Surg. Oncol. 2005;91:232–236. © 2005 Wiley-Liss, Inc.

症例は69歳の女性. 右下腹部腫瘤を主訴に受診し, 同部位に圧痛を伴う小児頭大の腫瘤を触知した. 下部消化管造影検査では横行結腸に圧排像と腫瘍内腔と思われる壁外腔への造影剤の流出を認めた. 内視鏡検査では横行結腸に腸管腔の狭小化と瘻孔を認めたが瘻孔開口部周囲粘膜は正常であった. 開口部より腫瘍内腔へと内視鏡を挿入すると多量の便塊が認められ, 内腔壁よりの生検はmucinous car-cinomaであった. 手術所見では腫瘍は回腸瘻を形成しており, 回盲部から40cmにわたる小腸合併切除を伴う右半結腸切除術を行った. 病理組織学的検査にて横行結腸原発と診断された. 他臓器浸潤を伴う大腸粘液癌では腫瘍径が大きく腸管腔内への腫瘍の発育も顕著であることが多い. 本例の如く壁外性にのみ著明に発育する例は特異的であった. また, 瘻孔形成も十二指腸瘻もしくは空腸瘻のことがほとんどであり, 回腸瘻はまれであった.

Standard transanal excision of the rectal polyps is curative and is less invasive than transsacral resection or low anterior resction, but it is difficult to resect tumors that are distant from the anal verge. Moreover, in the case of large polyps, the risks of complications, such as hemorrhage or perforation, increase because exposure on the oral side of the tumor is poor. If exposure can be improved, transanal excision can be performed safely and completely when the polyp is large and distant from the anal verge. We used transsacral manual assistance to achieve transanal resection of a large tubulovillous adenoma of the rectum that was hard to be resected using the traditional transanal approach.

We previously developed a new formulation of methotrexate (MTX) that is adsorbed onto a suspension of activated carbon particles (MTX-CH) and reported the usefulness of local administration in murine tumors. The present study examines the effects of human colon carcinoma (LoVo) xenografts and the acute toxicity of MTX-CH compared with MTX aqueous solution (MTX-AQ) in mice. In therapeutic experiments, LoVo cells were implanted into the backs of BALB/c nude mice. When the cells had developed into tumors, we performed an intratumoral administration of a weekly dose of 30 mg/kg. The MTX concentration in the tumor was compared between the MTX-CH group and MTX-AQ group. In experiments on acute toxicity, MTX-CH and MTX-AQ were injected subcutaneously in BDF1 mice, and intoxication symptoms, changes in body weight, and date of death were recorded. In the therapeutic experiments, intratumoral administration of MTX-CH was much more effective in suppressing the tumor growth compared with MTX-AQ. In experiments of acute toxicity, the death time of the MTX-CH group was delayed to a greater extent, and the 50% lethal dose (LD(50)) values of MTX-CH were lower than those of MTX-AQ. The LD(50) values of MTX-CH are 75 times higher than the efficacious dose of 30 mg/kg. The present results suggest that intratumoral administration of MTX-CH is useful for local therapy and the therapeutic dose of MTX-CH can be safely injected subcutaneously.

The incidence of lung disease due to mycobacteria other than Mycobacterium tuberculosis (atypical mycobacteria) in Japan was estimated to be 0.9--1.9 per 10(5) population per year in 1971--1979. Although the incidence of lung tuberculosis is steadily decreasing, the incidence of lung disease due to atypical mycobacteria has remained at almost the same level. The number of patients newly infected per year in recent years was calculated to be approximately 2,000. The ratio of the number of patients with lung disease due to atypical mycobacteria to the number of patients with lung disease due to atypical mycobacteria to the number of patients with lung disease due to all species of mycobacteria was highest in hospitals on the southwest coast of the Pacific. The atypical mycobacteria that caused disease most frequently belonged to the Mycobacterium avium-intracellulare complex. Of the 537 cases of disease due to atypical mycobacteria, 491 (89.6%) were due to these organisms; 43 (8.0%), to Mycobacterium kansasii; and 7 (1.3%), to Mycobacterium fortuitum. The disease due to M. kansasii appeared most frequently in hospitals in the Tokyo and Kanagawa prefectures. Patients with lung tuberculosis had a high risk of lung infection due to M. avium-intracellulare. The incidence of such disease in tuberculous patients was estimated to be 18.7 per 10(5) population per year, a rate that is approximately 10 times that found in the general population.