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症例は50歳男性で, 労作時呼吸困難を主訴に入院した. 心臓超音波検査・CTで心タンポナーデおよび右房内腫瘤を認めた. 心嚢穿刺を行い多量の血性心嚢液を排液した. 精査の結果心臓悪性腫瘍が疑われ転移巣を認めなかったため, 24日後に手術を施行した. 体外循環下に右房壁を含めて腫瘍を全摘出し, 右房は馬心膜で再建した. 洞結節は切除せざるを得ずペースメーカー植え込み術も併せ行った. 病理組織診断は右房原発血管肉腫で, 切除断端はすべて陽性であったため, 術後放射線療法を計50Gy施行した. 術後14カ月を経過する現在, 再発, 転移を認めず元気に社会復帰している. 本疾患は非常に予後不良で, 平均余命は6カ月以内である. 遠隔転移が認められない場合には早期に腫瘍を摘出し, 不完全切除に終っても術後放射線療法が奏効すれば延命効果が期待できる.

A 76-year-old female patient with diarrhea and lower abdominal pain was found by barium enema to have an ileocecal tumor. Endoscopic appearance was suggestive of malignancy; however, biopsy revealed v

✓ There are no previous reports correlating the in vitro bromodeoxyuridine (BUdR) labeling index (LI) with the clinical outcome in patients with brain tumors. The reliability of the LI as a predictor of patient survival or recurrence was examined in this study of 66 human brain tumors (19 gliomas, 18 meningiomas, and 29 others). Anti-BUdR staining was performed on surgically extirpated tumor tissue that had been treated with BUdR as previously described. Correlation of the BUdR LI with patient survival or tumor recurrence rate was carried out by the method of Kaplan and Meier. Deoxyribonucleic acid (DNA) aneuploidy was estimated in 52 cases. The results of this study indicate that BUdR LI values correlated well with the clinical course of patients with brain tumor. In comparison with patients with higher LI's, there was both a significantly higher survival rate for tumors other than meningiomas and a higher recurrence-free rate for meningiomas in patients with LI's of less than 4% and 1%, respectively. Although there was a tendency for patients without tumor aneuploidy to show better survival data than the others, no statistical difference was observed. These results suggest that the in vitro BUdR labeling method is reliable for prediction of a patient's prognosis, whereas prognosis on the basis of DNA aneuploidy alone is uncertain.

A rare case of extradural nasal and orbital extension of malignant glioma is presented. The development of malignant changes was observed during 10 years. The mode of transdural extension was via the olfactory nerve, where it was directly destructive in all four cases that have been reported to date. The biological malignancy of transdurally extending glioma is also described.

It is still unknown when and in which area endothelial regeneration occurs after brain injury, and to what extent such changes depend on the severity of the injury. We have, therefore, studied bromodeoxyuridine (BrdU) uptake by regenerating endothelial cells in two different groups of rats given cold lesions using immunohistochemistry employing anti-BrdU monoclonal antibody, anti-factor VIII-related antigen antibody and anti-glial fibrillary acidic protein antibody. The earliest evidence for the presence of BrdU-positive endothelial cells (BrdU + end) was observed at 2 days after injury, the injured endothelial cells regenerating from the edge toward the center of the lesion in both groups. We considered that edema fluid could act as an important factor, since at 2 days post-injury BrdU + end were not in contact with macrophages and were always found in Evans blue-stained areas. Study of endothelial cell kinetics also confirmed that the repair of injured endothelial cells was intimately involved in the reconstruction of the blood-brain barrier, since the time of disappearance of BrdU + end coincided with the disappearance of Evans blue-stained areas. The difference in the process of endothelial regeneration was first apparent on the 3rd day, there being no difference at 2 days.

Small-bowel obstruciton due to gastric bezoar is rare. This case was a 73-year-old gastrectomized woman who was admitted with nausea and abdominal pain and was suspected of having acute pancreatitis. She ate a lot of persimmons several days before the onset of her symptoms and was diagnosed as having gastric bezoar by gastrofiberscopy. Three weeks later severe abdominal pain and distension appeared abruptly. An upper gastrointestinal contrast series demonstrated small-bowel obstruction with a bezoar and emergent operation was performed. A hen-egg-sized bezoar was impacted in the jejunum 30 cm distal from Treitz's ligament. It was removed through enterotomy.Fifteen cases of small-bowel obstruction due to gastric bezoars including this case have been reported during the last 10 years. In all cases conservative treatment failed and laparotomy was necessary. In gastrectomized patients like this case, it is probable that dislodgement of gastric bezoars caused small-bowel obstruction. Therefore, prophylactic measures such as dietary to prevent bezoar formation are important.

It has not been determined when and in which area regeneration of the cerebral endothelium occurs after brain injury (Orita et al. 1988). We therefore studied bromodeoxyuridine (BrdU) uptake by regenerating endothelial cells in two different groups of rats given cold lesions using immunohistochemistry employing anti-BrdU monoclonal antibody, anti-factor VIII-related antigen antibody and anti-glial fibrillary acidic protein antibody.