Search

症例は59歳の男性で, 糖尿病の加療目的で入院中, 腹部CTで膵頭部に嚢胞性腫瘤を指摘された. 画像上, 膵頭部の分枝型IPMCの診断で膵頭十二指腸切除術を施行した. 病理組織学的診断は微小浸潤型IPMCで切除断端は癌陰性であった. 術後4か月目から腫瘍マーカーの上昇を認め, 6か月目の腹部CTで残膵に3cm大の腫瘍を認めたため, 残膵癌の診断で残膵全摘を施行した. 病理組織は高度な脈管浸潤を伴った中分化型管状腺癌で, 癌とその周囲組織ともに膵管内の腺腫成分や乳頭状増殖は認めず, 全切片で浸潤型発育を示していた. また, 初発IPMCではMUC1陽性, MUC2陽性でK-ras変異陰性であったのに対し, 残膵浸潤癌ではMUC1陽性, MUC2陰性, K-ras変異陽性であった. 以上より, 本症例におけるIPMCと残膵浸潤癌の発生源は異なるものと考えられた.

Background/Aims Well-organized turnover of the extracellular matrix is important in liver regeneration, which is regulated by the plasminogen activating system. The aim of this study was to investigate the role of plasminogen activator inhibitor-1 (PAI-1) after excessive hepatectomy and to ascertain whether angiotensin-converting enzyme (ACE) inhibitors, which are PAI-1 inhibitors as well, successfully improve the survival rate of rats that have undergone 95% partial hepatectomy (PHx). Methods Using liver tissues sampled after 90% or 95% PHx, the expression of PAI-1 mRNA was evaluated using reverse transcription polymerase chain reaction. Hepatic PAI-1 protein and urokinase-type plasminogen activator (uPA) levels were determined by enzyme-linked immunosorbent assay. Survival study and cytodynamic analysis by 5-bromo-2′-deoxyuridine staining were performed to evaluate the effects of ACE inhibition. Results The levels of PAI-1 mRNA and hepatic PAI-1 protein in the 95% PHx group peaked and were then maintained. By contrast, the uPA level fell relative to the 90% PHx group. Additionally, the hepatic PAI-1 protein level decreased and the survival rate improved in the 95% PHx rats that had undergone ACE inhibition. Conclusions Our experimental results suggest that PAI-1 plays a role in the occurrence of liver failure after excessive hepatectomy via accelerated maturation of pro-uPA and fibrinolytic factors. These are potential molecular therapeutic targets for liver failure after excessive hepatectomy.

Background and Aim: Post-hepatectomy infections require careful attention, because they may deteriorate into liver failure. We retrospectively reviewed such infections in cases without biliary or intestinal reconstruction. Methods: This retrospective study involved 535 patients with liver tumors who underwent hepatectomy at the Department of Gastroenterological Surgery of Yokohama City University Hospital between April 1992 and March 2005. After classification into four groups depending on changes in infection countermeasures used during different periods, the treatment outcomes were examined. No such anti-infection measures were taken during the first period; a closed suction drainage system and early enteral nutrition after surgery were introduced between the first and second periods; thorough management of bile leakage and prevention of nosocomial infection were added between the second and third periods; and surgical site infection (SSI) surveillance together with absorbable sutures instead of silk sutures between the third and fourth periods. Results: The incidence of postoperative infection decreased significantly with additional countermeasures: first period 44.7%; second period 24.1%; third period 15.0%; and fourth period 9.2%. The incidence of both SSI and remote infection were similarly reduced. Postoperative infection risk factors were age, presence of diabetes mellitus, the use of silk sutures and bile leakage, while those for SSI were the use of silk sutures and bile leakage. Conclusion: The incidence of postoperative infection and SSI were significantly reduced by our infection countermeasures, especially by bile leakage management and the use of absorbable sutures.

Delayed gastric emptying (DGE) sometimes occurs after left hepatectomy with lymphadenectomy. We performed fixation of the greater omentum to the peritoneum to prevent DGE and other complications in patients undergoing left hepatectomy with lymphadenectomy for cholangiocarcinoma.Patients undergoing left hepatectomy with lymphadenectomy for cholangiocarcinoma were divided into a fixation group (n = 9) and a nonfixation group (n = 10). In the fixation group, the greater omentum was sutured to the peritoneum 3 cm from the greater curvature of the stomach to prevent contact between the stomach and the cut surface of the liver.Mean age, sex, disease, and hepatectomy procedures were similar in the two groups. DGE developed in six patients in the nonfixation group (60.0%) versus no patients in the fixation group (P = 0.011). The total number of complications was higher in the nonfixation group (16 complications) than in the fixation group (3 complications; P = 0.003). Overall morbidity was higher in the nonfixation group (60.0%) than in the fixation group (22.2%). Postoperative hospitalization was longer in the nonfixation group (67.4 days) than in the fixation group (20.2 days; P = 0.0041).Fixation of the greater omentum to the peritoneum decreases the occurrence of DGE and other complications after left hepatectomy with lymphadenectomy for cholangiocarcinoma.

Nitrogen is one of the most effective elements for improving not only the strength but also the corrosion resistance of stainless steels. In this study, three low carbon and high nitrogen martensitic stainless steels, which contain less than 0.1 mass% C and more than 0.45 mass% N, have been produced through the pressurized induction melting process, in which nitrogen is introduced from the pressurized N2 atmosphere. The hardness and corrosion resistance of these steels were mainly investigated in various heat treatment conditions. The hardness of these steels after spheroidal annealing treatment was about 95 HRB and the cold workability was superior to that of AISI440C, which was a high carbon martensitic stainless steel. The hardness of these steels after hardening and sub-zero treatment was about 53 to 56 HRC, which was lower than that of high carbon martensitic stainless steel. In tempering process, however, high nitrogen steels showed the secondary hardening by about 4 point in HRC compared with the quenched hardness after sub-zero treatment and had the maximum tempered hardness of 56 to 60 HRC at around 723 K. The corrosion resistance of hardened and tempered materials under 723 K exhibited better than that of AISI304 evaluated by pitting potential in 3.5 % NaCl aqueous solution. Both remained Cr2N in hardening and precipitated Cr2N in tempering were found to degrade the corrosion resistance of high nitrogen martensitic stainless steels. The best balanced developed steel had the hardness of 60 HRC and better corrosion resistance than AISI304 at the same time under the optimized heat treatment condition.

A 60-year-old woman with primary sclerosing cholangitis (PSC) and high levels of ALP, gamma-GTP, and DUPAN-2 was admitted to our institution for examination. The patient did not have ulcerative colitis or pancreatic intraductal papillary mucinous neoplasm. Imaging studies revealed atypical dilation of bile ducts in the left lobe of the liver. Repeated cytologic examinations of the bile showed atypical cells consistent with adenocarcinoma. The patient underwent extended resection of the left lobe of the liver and was found to have intraductal papillary carcinoma with associated mucin-producing bile duct carcinoma. This carcinoma fills dilated bile duct lumens with mucin. This tumor differs morphologically from typical cholangiocarcinoma, which is usually seen in the late stages of PSC. Just one case of mucin-producing bile duct carcinoma arising from PSC has been reported worldwide. The patient has had no signs of recurrence after 27 months. Patients with mucin-producing bile duct carcinoma, as in the case of its pancreatic counterpart, may have a better prognosis and a higher survival rate than patients with typical cholangiocarcinomas.

Eighty-four patients underwent laparoscopic cholecystectomy (LC) from January through August 2006. Of these patients, 4 (4.7%) were found to have occult gallbladder carcinoma (GC) either during or after the procedure. Two of the patients were women and 2 were men. The mean age was 75.0 years. One patient had mucosal tumors, 2 had subserosal tumors, and 1 had a serosal lesion. One of the 2 patients with subserosal tumors underwent radical surgery. In a previous study, 0.83% (10 of 1,195) of patients who had undergone LC were found to have occult GC, either during of after the procedure. The prevalence of gallbladder carcinoma has recently been increasing. GC has been reported in 0.3% to 1.5% of patients who have undergone cholecystectomy. Since the introduction of laparoscopic surgery, the number of cholecystectomies being performed has increased, which may explain why occult GC seems to be occurring more frequently. The prognosis for GC is poor, and surgical resection is the only potentially curative treatment. However, GC is difficult to diagnose at an early stage and difficult to recognize even in the advanced stages. Fifteen percent to 30% of patients show no preoperative or intraoperative evidence of malignancy. Occult GC is also increasing. Because flat infiltrating GC and GC with cholecystitis and numerous stones are difficult to diagnose preoperatively, we recommend taking frozen sections from patients who are of advanced age (older than 70 years), have a long history of stones, or have a thickened gallbladder wall.

Novel electrodeposition (ED) techniques utilizing supercritical carbon dioxide (scCO2) emulsions (SCE) are introduced. ScCO2 has low surface tension and high compatibility with hydrogen. Thus, this method is applied in fine Cu wiring to allow the complete filling of Cu into nanoscale confined space. The electrochemical reactions are carried out in emulsions composed of an aqueous electrolyte, scCO2, and surfactants. Three aspects in fine Cu wiring will be introduced, which are the dissolution of the Cu seed layer in the SCE, the gap-filling capability of the ED-SCE, and the contamination in the plated Cu. At first, the dissolution of the Cu seed layer in the SCE was observed. In order to prevent the dissolution of the Cu seed layer, the addition of Cu particles into the SCE was found to be effective. The electrolyte containing the SCE and the Cu particles is named scCO2 suspension (SCS). The gapfilling capability was evaluated using test element groups (TEGs) with patterns of vias with a diameter of 70 nm and an aspect ratio of 5. Many defects were observed in the vias filled using the conventional electrodeposition (CONV) method. On the other hand, defect-free fillings were obtained by the ED-SCS method. Because of the highpressure environment needed to form the scCO2, the reaction cells are usually batchtype high-pressure vessels. In order to improve the feasibility of the ED-SCS technique, a continuous-flow reaction system is also proposed and examined using a round-type large-area TEG with a diameter of 300 mm. Complete fillings were obtained for vias with a diameter of 60 nm and an aspect ratio of 5 on the large-area TEG. This result was in good agreement with that of the batch-type reaction system and demonstrated the successful application of the continuous-flow system with EDSCS.

Background: Postoperative normalization of serum carcinoembryonic antigen (CEA) level has been reported to be a favorable prognostic predictor in lung cancer. However, serum CEA levels of some patients’ groups re-elevate during their postoperative course. The aim of study was to find predictors of CEA re-elevation in patients with preoperative high and postoperative normal CEA. Methods: Sixty-one consecutive lung cancer patients with preoperative high serum CEA level (>5 ng/mL) and postoperative normal level were reviewed retrospectively. Among these patients, serum CEA levels of 23 patients re-elevated during their postoperative course. We compared patients with and without re-elevation of serum CEA levels. Results: The 5-year survival of patients with and without re-elevation of serum CEA level was 13.20% and 88.68%, respectively (P

We report a rare case of bleeding ileal varices successfully treated with emergency enterectomy. A 72-year old woman with hepatic cirrhosis due to hepatitis C was admitted to our hospital because of anemia and hematochezia. An endoscopic examination showed no evidence of bleeding in the upper and lower gastrointestinal tracts. Angiographic studies of portal hemodynamics revealed extravasation from the ileal varices and total occlusion of the portal vein due to portal thrombus. This made it difficult to remove the ileal varices using interventional radiology. Therefore, the patient underwent emergency enterectomy for the ileal varices. No further gastrointestinal bleeding occurred during the 1-year follow-up.

食道静脈瘤に対する内視鏡的静脈瘤結紮術（EVL）後に出現し，脳症治療に難渋した特異シャントを経験した．症例は40歳代女性，原因不明の肝硬変にて2001年から他院で経過観察されていた．他院にて食道静脈瘤に対し2度のEVL歴，肝性脳症にて2度の入院歴がある．Lg-cf（F2, RC（-））の胃静脈瘤に対し，精査加療目的にて当科紹介となった．血管造影にて，左胃静脈と傍臍静脈を介する門脈大循環シャントを認め，脳症に対する治療をおこなう方針となった．初めに門脈圧を下げる目的で部分的脾動脈塞栓術（PSE）施行し，左胃静脈は経皮経肝的シャント塞栓術（PTO），傍臍静脈は全身麻酔下に外科的結紮術を施行したが，術後早期に後胃静脈を介する新たなシャントを認め，アンモニア値の改善も得られなかった．肝性脳症を有する門脈大循環シャントに対しシャント閉塞術施行し著効を認めたとする報告は散見するものの，その治療適応に関しては明確な基準はなく，示唆に富む症例と考えられた．

症例は76歳男性. アルコール性肝硬変, 多発性肝細胞癌 (stage III) に対し動注リザーバーを留置し, CDDP静注併用5-FU持続動注化学療法 (CDDP 10 mg×2/week静注および5-FU 1000 mg/5 days動注, 4投1休を1クール) を施行した. 3クールで副作用にて投薬中止するも, AFPが160 ng/ml から9.4 ng/ml と著明な減少を認め, 画像上も多発性肝細胞癌の縮小, 一部消失し長期生存が得られている. CDDP静注併用5-FU持続動注化学療法が, 多発性肝細胞癌に対して有用であった1例を報告する.

Recently magnesium alloys sheets have been widely applied to the chassis of electronics appliances such as laptop PCs, cellular phones, digital cameras. So far AZ31(Mg-3 mass%Al-1 mass%Zn) with relatively good hot-workability has been used for the material of such applications. On the other hand higher strength sheets are strongly required because high rigidity and stiffness are necessary to the chassis with smaller form factors. In this study the effect of heat treatment and small amount of calcium addition up to 0.03 mass% on the hot-workability of cast AZ61(Mg-6 mass%Al-1 mass%Zn) alloy was investigated. Although AZ61 has poor hot-workability in the as-cast condition, it drastically improves by heat treatment at 673 K for 360 ks because of the dissolution of β-Mg17Al12 phase that becomes the origin of crack. Heat treated AZ61 with small amount of calcium addition has better hot-workability than that without calcium addition. That is due to the suppression of grain growth in the heat treatment by existing calcium bearing inclusions as small particles with pinning effect. The hot workability of AZ61 with 0.01 mass% calcium is as good as that of AZ31, a conventional magnesium alloy for hot rolling.

BACKGROUND Several reports have indicated that preoperative high serum carcinoembryonic antigen (CEA) levels are associated with poor survival after surgical resection in lung cancer. METHODS 82 consecutive lung cancer patients with preoperative high serum CEA levels (> 5 ng/mL) were included in this study. Postoperative serum CEA level was also measured. Prognostic indicators were evaluated. RESULTS Among patients with a preoperative high serum CEA level, a serum CEA level higher than 10 ng/mL, pT status, pN status, and positive pleural lavage cytology findings were unfavorable prognostic indicators, whereas age, gender, smoking status, histologic subtype were not. Postoperative serum CEA levels of all but 2 patients decreased, however those of 28 patients did not return to normal range. Our result showed that patients with postoperative high serum CEA level had poor prognosis. Multivariate analysis demonstrated that pT status, pN status, and postoperative high serum CEA level was an independent prognostic determinant. CONCLUSIONS In lung cancer patients with preoperative high serum CEA levels, pT status, pN status, and normalization of serum CEA level after surgery are significant prognostic determinants.

Endoscopic variceal ligation (EVL) is a safe and simple procedure now being used on a widening scale. Yet most patients who undergo endoscopic treatment for esophageal varices eventually require additional treatment for recurrent varices. In this study, we investigated and compared the efficacy and long-term results of EVL performed in three treatments with a total of sixteen O-rings at two different intervals; bi-weekly (once every 2 wk: the conventional interval) and bi-monthly (once every 2 months). A total of 63 patients with esophageal varices were randomly assigned to groups receiving bi-weekly or bi-monthly EVL treatment. Optimal medical therapy was assessed by one medical doctor who was unaware of the patients' treatment assignments. Three parameters of treatment outcome were evaluated: the rate of recurrence, rate of additional treatment, and overall survival. The overall rates of variceal recurrence and additional treatment were both higher in the bi-weekly group than in the bi-monthly group (p < 0.001). In conclusion, EVL performed for the treatment of esophageal varices at bi-monthly intervals brought about better results than the same treatment performed at bi-weekly intervals. The treatments intercalated by the longer interval obtained a higher total eradication rate, lower recurrence rate, and lower rate of additional treatment.

━━ Background. Distant metastatic lesions of lung cancer are generally regarded as inoperable. This case report describes long-term survival achieved with surgical resection of primary and metastatic lesions in combination with perioperative chemotherapy. Case. A 62-year old man was referred to our institution with an irregularly shaped right upper lobe nodule in October 1999. Intraoperative frozen section of the nodule at the time of right upper lobectomy and mediastinal lymph node dissection confirmed adenocarcinoma of the lung. A left humeral head lesion identified by bone scintigraphy in January 2000 was confirmed to be metastatic adenocarcinoma by biopsy. Following 2 courses of chemotherapy(CDDP & TXT)the patient underwent left humeral head resection and reconstruction in April 2000. The final pathologic examination failed to demonstrate any malignant cells in the specimen, which was interpreted to indicate a complete histologic response to chemotherapy. Five years later, the patient is well without evidence of recurrence. Conclusion. Long term survival in a patient with primary lung cancer and a solitary bone metastasis was achieved through lobectomy, perioperative chemotherapy, and resection of the metastatic lesion. (JJLC. 2005;45:829832)

We investigated whether the combined use of computed tomography, thallium-201 single photon emission computed tomography and serum carcinoembryonic antigen level improves preoperative non-invasive mediastinal. 128 consecutive non-small cell lung cancer patients (85 adenocarcinomas, 31 squamous cell carcinomas and 12 others) who underwent a surgical resection were enrolled in this study. The results of the combined procedures were compared with the pathologic findings. Our results showed that the combined evaluation of mediastinal nodal involvement with the three procedures might increase underestimation, but decrease overestimation as compared to computed tomography alone. Thallium-201 single photon emission computed tomography for patients with enlarged nodes at computed tomography showed 81.3% and 100% of positive predictive value in overall and squamous cell carcinoma patients, respectively. The negative predictive value of thallium-201 single photon emission computed tomography for patients without enlarged nodes at computed tomography was highly accurate in adenocarcinoma (93.9%) as well as squamous cell carcinoma (94.4%). Combining computed tomography findings and serum carcinoembryonic antigen level had a poor predictive value. However, in patients with adenocarcinoma, a negative examination was highly accurate (95.2%). In conclusion, our results show a trend that combined use of the three procedures might improve non-invasive mediastinal staging in non-small cell lung cancer.

Background/Aims : The liver has the capacity to regenerate after partial hepatectomy. In order to clarify the mechanism of liver regeneration, we observed the initial stage, especially the mechanism of gene expression during progress from G0 to S phase (0–24 h), and attempted to identify new genes controlling progress to the S phase. Methods : We applied large-scale gene expression analysis with complementary DNA microarrays in mouse hepatectomy models to clarify the mechanism of liver regeneration after partial hepatectomy. Results : As a result, 23 new immediate-early gene candidates such as interleukin-1 receptor associated kinase-1 and karyopherin α-1, which are involved in transportation within the nucleus, were discovered. Candidates for new genes concerned with the progress to the S phase were discovered: inhibitor of DNA binding 2 (ID2) and inhibitor of DNA binding 3 (ID3), both new liver regeneration factors that promoted progress to the S phase, and GADD45 γ (growth arrest and DNA-damage-inducible protein) as a factor inhibiting that process. Conclusions : The above results not only suggest the importance of NFκB in the initial stage of liver regeneration but also points to the orderly maintenance of the proliferation of the cells in liver regeneration.

Corrosion tests of 10 kinds of stainless steels have been conducted for 5 years under three conditions of marine environments, which are atmospheric corrosion, intermittent seawater spray and intermittent seawater immersion. Rating number increased with PRE(Cr+3.3Mo+16N;mass%) value in all test conditions and the stainless steels of which the value were over 37 showed excellent corrosion resistance under marine environments. Maximum pit depth decreased with increasing PRE value in all test conditions. Rating number settled after a couple of months from the start and then the number almost unchanged. On the contrary maximum pit depth grew with increasing test duration. It is suggested that the progress of corrosion mainly depened on the pit growth.

A 75-year-old woman presented with a pulsatile, movable mass, about 5 cm in diameter, in her lower abdomen. Abdominal ultrasonography revealed a circular mass with a variable hypo- and isoechoic border and a hypoechoic center. Color Doppler echography showed blood flow in the hypoechoic center, which was strongly enhanced on contrast-enhanced computed tomography. Based on these findings, we diagnosed a splanchnic artery aneurysm; however, celiac arteriography, performed twice, could not definitively identify it. An operation was performed under the tentative diagnosis of an aneurysm of the superior mesenteric artery or the gastroepiploic artery. On laparoscopic exploration, a globe-shaped mass, about 5 cm in diameter, was found in the right side of the greater omentum, which was diagnosed as an aneurysm of the right gastroepiploic artery. We resected the aneurysm laparoscopically and the patient had an uneventful postoperative course. Thus, laparoscopic surgery was effective for this patient who required no vascular reconstruction.

Endopolygalacturonases are involved in the degradation of pectin by hydrolyzing the α-1, 4 glycosidic bonds. Crystal structure of endopolygalacturonase I from Stereum purpureum was solved at atomic (0.96 A) resolution. The enzyme folds into a right-handed parallel β-helix with 10 complete turns. The crystal structures of its binary complex with one D-galacturonate a and its ternary complex with two D-galacturonates were also determined at 1.0 and 1.15 A resolutions, respectively. The active site architecture of the complexes provides insight into the mode of substrate binding. These structures reveal that Asp 173 is the general-acid catalyst and, Asp 153 or Asp 174 is the general-base catalyst.

61歳,男性。出生時より右下腿後面に黒色斑を認めたが増大傾向なく放置していた。1年前より同部に腫瘤を形成し,徐々に増大してきたため,2001年8月15日当科を受診した。右下腿後面に13×13mmの濃淡のある頂部の潰瘍化した黒色ドーム状腫瘤を認め,excisional biopsyの結果,悪性黒色腫と診断し,同年8月23日精査加療の目的で入院した。胸部CTにて右肺下葉S6胸膜直下に径約10mmの腫瘤像を認め,当初は悪性黒色腫の肺転移と診断していたが,胸部CTガイド下の針生検では扁平上皮癌の組織所見を認めた。悪性黒色腫と肺癌の重複癌は極めて稀であり,また肺の腫瘤性病変に対する生検方法についての文献的考察も行ったので報告する。

We attempted to inactivate endopolygaolacturonase from Stereum purpureum (EndoPG) IV of identical origin by linking the pro-sequence of S. purpureum Pro-EndoPG I to the C-terminus. The recombinant Pro-EndoPG IV, expressed in Escherichia coli, had no polygalacturonase (PG) activity, but activity was acquired after partial degradation of the pro-sequence with V8 protease, as was the case for Pro-EndoPG I. These results indicate that the pro-sequence of Pro-EndoPG I can suppress the PG activity of EndoPG IV.

A 61-year-old woman was admitted to our hospital with an abnormal shadow on chest roentgenogram. She had undergone a radical mastectomy for right breast cancer 18 years previously. Since pleural dissemination was noted at the time of thoracotomy, only tumor biopsy was performed. Although a decisive diagnosis could not be obtained histologically, the tumor resembled breast cancer and the estrogen receptor status was positive. She underwent post-operative chemotherapy and tamoxifen treatment. After tamoxifen treatment, complete response was observed. The patient is now doing well without recurrence about 10 years after thoracotomy. Based on the clinical course, we obtained both a definitive diagnosis and complete remission.

Nitrogen is one of the most effective elements to increase not only strength but also corrosion resistance of stainless steels. Since high nitrogen stainless steels have been produced in the commercial scale by the recent pressurized melting methods, the research on high nitrogen stainless steels is now vigorous all over the world. In this work, an experimental low carbon and high nitrogen martensitic stainless steel, 0.004C-0.5N-18Cr-1Mo (mass%) , was melted under 0.9MPa in a pressurized induction furnace and the 20mm round bars were quenched from 1373K to 77K and tempered at 473K to 823K for 3.6ks. The corrosion resistance was evaluated from the pitting potential in 3.5% NaCl aq. solution.The hardness of the steel increased with tempering temperatures and reached about 56HRC at 623K through 773K. On the other hand its corrosion resistance decreased drastically when it was tempered over 723K, while the bars as-quenched or tempered under 723K exhibited the very high resistance comparable to austenitic Type 316. The TEM observation revealed that the deterioration in corrosion resistance is due to the precipitation of beta-Cr2N at pre-austenite grain boundaries.

胸腔鏡下に切除したduplication cystの1例を経験したので報告する.症例は54歳,女性.乾性咳嗽を主訴に当院内科を受診し, CT, MRI,超音波内視鏡にて食道筋層に接し,右肺静脈,右主気管支の間に存在する先天性縦隔嚢胞と診断された.先天性縦隔嚢胞の悪性化の報告は稀であるが,圧迫症状や,肺食道縦隔内への穿破をきたすことがあり,無症状でも手術適応とされている.このため胸腔鏡下に嚢胞摘出術を行った.嚢胞は術前診断どおり,食道壁に接し,右肺静脈,右主気管支,心膜に癒着していた.このような症例に対し小開胸併用VATS,通常開胸に移行するべきであるとの意見もあるが,本症例では吸引,凝固電極鉗子などを用いた鈍的剥離と電気メスにて安全に摘出しえた.嚢胞は病理組織学的検査にてduplication cystと診断された.術後8日目に退院し,術後7カ月目の検査にて再発を認めていない.

A novel mixed-valence Cu(I)–Cu(II) coordination polymer with an infinite one-dimensional (1-D) structure, [CuI4CuIII4(Mor-dtc)2(CH3CN)2]n (Mor-dtc−: morpholine dithiocarbamate), was prepared and st...

Novel 1-D polymeric metallo-organic triazole iron(II) complex {[Fe(C5C12C10-trz) 3 ](ClO 4 ) 2 } n ( 1 ) with branched long alkyl chain was synthesized and characterized in detail. The compound exhibited liquid crystal transition and spin crossover behavior. The liquid crystal transition occurred at 233 K, and the spin crossover was observed at T 1/2 ↑ = 250 K and T 1/2 ↓ = 248 K.

Background: The previous study of ours showed the prognostic impact of preoperative neutrophil to lymphocyte ratio (NLR) in resected non-small cell lung cancer (NSCLC) patients.Methods: In the present study, the relationship between postoperative NLR and patients' prognosis was examined in NSCLC patients with preoperative high NLR. Consecutive 85 resected NSCLC patients with preoperative high NLR (≥2.5) were reviewed retrospectively. In this study, patients with a follow-up period less than 5 years were omitted.Results: Among these 85 patients, the postoperative NLR in 46 patients were persistently higher than 2.5. The 5-year survival of the patients with postoperative NLR≥2.5 was significantly worse than that of the patients with postoperative NLR

Laparoscopic distal pancreatectomy (Lap-DP) has been recognized worldwide as a feasible and highly beneficial procedure. The aim of this study is to investigate whether Lap-DP techniques are being implemented safely by surgeons training to perform this procedure.We retrospectively compared the perioperative outcomes of Lap-DP in patients operated on by the surgeon originating this procedure at our hospital (expert surgeon group [E group], n = 47) and patients operated on by surgeons training to perform this procedure (training surgeons group [T group], n = 53).The median operating times for the E group and T group were 321 min (range, 150-653 min) and 314 min (range, 173-629 min), respectively; these times were not significantly different (P = 0.4769). The median blood loss in the T group (100 mL; range, 0-1950 mL) was significantly smaller than in the E group (280 mL; range, 0-1920 mL) (P = 0.0003). There were no significant intergroup differences in other operative results: combined operation ratio, spleen- and splenic vessels-preserving ratio, hand-assisted procedure ratio, and the ratio of transition to open. The frequency of pancreatic fistulas in the E group and T group was 12.8% and 16.9%, respectively; these rates were not significantly different (P = 0.5886). There were no significant differences between the two groups in terms of other complications and reoperation rates. The median hospital stay for the E group was significantly shorter than for the T group (10 vs 13 days; P = 0.0307).This retrospective analysis shows that teaching safe Lap-DP techniques to surgeons is reflected in stable perioperative outcomes.

Mucoceles of the appendix are a group of mucus‑filled lesions causing obstructive dilation of the ileocecal appendix. We report a rare case of giant appendiceal mucocele. A 48‑year‑old woman with no discomfort was admitted to our hospital after a mass was det ected in the right lower quadrant of the abdomen. The patient underwent right hemicole ctomy on the basis of the clinical diagnosis of a possible appendiceal tumor. The final pathologic diagnosis was mucocele of the appendix. (J Nippon Med Sch 2014; 81: 110―113

β-Primeverosidase (PD) is a disaccharide-specific β-glycosidase in tea leaves. This enzyme is involved in aroma formation during the manufacturing process of oolong tea and black tea. PD hydrolyzes β-primeveroside (6-O-β-d-xylopyranosyl-β-d-glucopyranoside) at the β-glycosidic bond of primeverose to aglycone, and releases aromatic alcoholic volatiles of aglycones. PD only accepts primeverose as the glycone substrate, but broadly accepts various aglycones, including 2-phenylethanol, benzyl alcohol, linalool, and geraniol. We determined the crystal structure of PD complexes using highly specific disaccharide amidine inhibitors, N-β-primeverosylamidines, and revealed the architecture of the active site responsible for substrate specificity. We identified three subsites in the active site: subsite −2 specific for 6-O-β-d-xylopyranosyl, subsite −1 well conserved among β-glucosidases and specific for β-d-glucopyranosyl, and wide subsite +1 for hydrophobic aglycone. Glu-470, Ser-473, and Gln-477 act as the specific hydrogen bond donors for 6-O-β-d-xylopyranosyl in subsite −2. On the other hand, subsite +1 was a large hydrophobic cavity that accommodates various aromatic aglycones. Compared with aglycone-specific β-glucosidases of the glycoside hydrolase family 1, PD lacks the Trp crucial for aglycone recognition, and the resultant large cavity accepts aglycone and 6-O-β-d-xylopyranosyl together. PD recognizes the β-primeverosides in subsites −1 and −2 by hydrogen bonds, whereas the large subsite +1 loosely accommodates various aglycones. The glycone-specific activity of PD for broad aglycone substrates results in selective and multiple release of temporally stored alcoholic volatile aglycones of β-primeveroside.

Laparoscopic hepatectomy has become a widespread procedure in Japan, now that the national medical insurance system covers partial resection and lateral segmentectomy. An important procedure during laparoscopic hepatectomy is the division of the vascular pedicles. In this paper we report a practical and useful method for vascular division with an Endo Mini-Retract(TM) retractor and a shortened Nelaton catheter (2.5-mm-diameter) developed in our department.

大量下血にて発症し緊急手術を余儀なくされた小腸gastrointestinal stromal tumor (GIST) の1例を経験したので報告する. 31歳男性,持続する大量下血による貧血にて近医より紹介となる.腹部CT検査で腹腔内に9×7cm大の経時的に移動する腫瘤があり,出血シンチグラフィーで小腸より出血が確認された.血管造影検査では明らかな造影剤の漏出像はなかったが回腸動脈の分枝より栄養される腫瘍を認めた.下血は入院後も持続し緊急手術を施行,トライツ靱帯より250cmの回腸腸間膜対側に11×8cm大の腫瘤を認め,腫瘍を含む小腸部分切除を行った.術後経過順調にて第16病日退院となった.病理・免疫組織学的所見よりGIST (uncommitted type) と診断された. 十二指腸を除く小腸は部位的にも質的診断が困難な上,小腸出血は消化管出血の頻度としては稀であるが,下血の際には小腸GISTも念頭におき加療する必要性があることが示唆された.

稀な非定型抗酸菌症を伴った肺分画症の1切除例を報告する.症例は43歳男性で, 近医にて右肺下葉に嚢胞を伴う非定型抗酸菌症の診断にて治療されていたが, 症状が反復再燃し, 嚢胞内の鏡面像も存在したため, 嚢胞の持続感染を疑い, 当科紹介になった.紹介時点で, 胸部X線写真および胸部CT上, 右肺全体に小葉中心性の結節および細気管支の拡張を認め, Mycobacterium intracellulareの喀痰排菌を認めたため, RFP, EB, clarithromycin (CAM) の3剤併用療法を行った.胸部CTにより肺分画症が疑われたため血管造影を行ったところ, 下行胸部大動脈より右肺下葉嚢胞部に走行する1本の動脈を認め, 肺分画症の診断を得た.右肺浸潤影の軽快を確認し, 手術を施行した.右下葉の嚢胞性病変内は, 隔壁を伴う多嚢胞性で, 黄白色の膿を認めた.分画症病変を含めた右中下葉切除を施行した.

Stereum purpureum endopolygalacturonase (endoPG; EC 3.2.1.15) is a causal protein for silver-leaf disease in apple trees. Endopolygalacturonase I, is a mixture of three components (Ia, Ib, and Ic) that produce three bands on SDS/PAGE but have the same polypeptide and sugar chains. Electrospray ionization mass spectrometry (ESI-MS) analysis of three endoPG I proteins and deglycosylated endoPG Ia revealed a molecular mass of 37 068, 38 285, and 39 503 for Ia, Ib, and Ic, respectively; the number of N-binding sugar chains matches that of a high-mannose type of sugar chain. Two, three, and four sugar chains are present in endoPG Ia, Ib, and Ic, respectively. Deletion of 44 amino acids from the deduced sequence occurred in the C-terminal region. Positions of the glycosylation sites and disulfide bridges were decided by tryptic digestion followed by liquid chromatography-electrospray mass spectrometry (LC-ESI-MS) analysis of reductive and nonreductive pyridylethylated endoPG I proteins. The glycosylated asparagines were determined to be Asn92 and 161; Asn92, 161, 279, or 302; and Asn92, 161, 279, and 302 in Ia, Ib, and Ic, respectively. Three disulfide bridges were noted at Cys3–Cys17, Cys175–Cys191, and Cys300–Cys303. These results are the first findings for fungal endoPG and may contribute to clarification of the relationship between stereostructure and catalytic activity.

A Case of a foregut cyst of the posterior mediastinum in a 5-year-old boy is reported. The patient was admitted to the hospital because of fever and abdominal pain. Chest x-ray films revealed an egg-shaped tumorous shadow on the left side of the posterior mediastinum. Esophagography visualized a left anterior displacement of lower third of the esophagus. Chest CT revealed a 7.5×5.8cm tumor with a low density center in the left posterior mediastinum adjacent to the pericardium, esophagus, and aorta. With a diagnosis of cyst of the posterior mediastinum, an operation under left thoracotomy was performed. The cyst which adhered to the esophageal wall was freed from the esophagus and excised. The excised tumor was 5×6cm in size, oval in shape, and unilocular, and contained brown serous liquid. Histologically, the cyst wall was not lined with epithelium, and contained one muscle layer. There was no cartilage. We diagnosed the cyst as foregut cyst.

A 55-year-old woman was seen at the hospital because of a right breast tumor and pain. On clinical examination, there was an elastic soft, ill-defined tumor with the diameter of 1.0cm in the A-area of the right breast. Ultrasonography suggested papillo-tubular carcinoma, and a specimen of a core needle biopsy showed invasive ductal carcinoma. Then we performed a quadrantectomy with axillary lymph node dissection. Histological examination revealed adenoid cystic carcinoma. Adenoid cystic carcinoma of the breast has a relatively good prognosis. Breast conserving operation is recommended for the disease if surgical margin is free, though long term and careful follow-up of the clinical course would be needed.

症例は23歳の女性. 右下腹部痛, 発熱を主訴に当科受診. 典型的な急性虫垂炎の所見を呈していたため, 腹腔鏡下に虫垂切除術を施行した. 虫垂の病理診断はAcute on chronic appendicitisと報告された. しかし, 術後も微熱, 右下腹部痛, CRP高値の持続がみられ諸検査にてCrohn病と診断された.その後, 上行, 横行結腸の狭窄が高度となりイレウス症状も出現したため結腸右半切除を施行し, その切除標本において病理学的にCrohn病が確認された. 虫垂の病理所見を再検討したところ虫垂根部に裂溝に伴う限局性急性炎症像がみられ, その深層に巨細胞を伴う非乾酪性肉芽腫を認めたことから, Crohn病による急性化膿性炎症と最終診断された. 本症例のように急性虫垂炎の原因としてCrohn病によるものがありえるため, 鑑別診断の1つとして本症を念頭に置くべきであり, また虫垂切除後の発熱, 腹痛, 炎症反応の持続がみられた場合は早期に本症を疑った精査が重要である.

The treatment of choice for mediastinal paraganglioma is complete surgical resection. Its local recurrence, however, is very difficult to treat surgically because it usually involves important structures of the mediastinum, such as the aorta and trachea. We report a 64-year-old woman with aortico-pulmonary paraganglioma who developed local recurrence after complete resection. The recurrent tumor responded dramatically to single-agent chemotherapy with cyclophosphamide, whereas it did not respond to radiotherapy or combination chemotherapy with mitomycin C, vindesine, and cisplatin. We therefore consider that single-agent chemotherapy with cyclophosphamide could be an alternative treatment for unresectable recurrent paraganglioma.

The influence of Mn/S on the outgas property and the machinability of type 430F has been investigated and the following results were obtained. 1) The degree of outgas decreased with Mn/S because of enhancement of the chemical stability of sulfide by substitution of Cr for Mn in sulfide. 2) The machinability in turning and drilling decreased with Mn/S. The reasons have been suggested that the aspect ratio of sulfide got larger and also the hardness of sulfide increased with Cr contents in sulfide. On the basis of the above results, a new free-machining ferritic stainless steel, DHS1 has been developed for hard disk drives, which has 19Cr-0.35Mn-0.26S+Pb, Te ;mass%. This advanced steel is superior in machinability and corrosion resistance to type 430F and also has low outgas emissivity.

Recently, video assisted thoracoscopic surgery (VATS) has become widespread surgical method because the patients can have less injury and pain than those with the traditional operation. We have experienced a series of 156 cases of VATS from July 1992 to July 1998. When they were classified by the purpose of performing the procedure, 144 cases underwent VATS for treatment and remaining 12 cases for the diagnosis. The former 144 cases of the treatment included 74 cases of lung partial resection, 33 cases of pneumothorax, 18 cases of mediastinal tumor, 12 cases of lung lobural resection, four cases of intrapleural hyperthermo-chemotherapy and three cases of pleural tumor. In 7.7% of these cases, thoracootomy was seeded and in 3.8% of these cases, minor complications have occured. In this paper we present a study on VATS cases in our institution as well as VATS cases in the institutions of Kyusyu area analyzed by quentionnaire survey conducted in 1996.

Relationship between thrombocytosis and poor prognosis has been reported in lung cancer. However, the majority of previous studies included many advanced stage and small cell lung cancer patients. Few studies focused on resectable non-small cell lung cancer patients. In the present study, therefore, consecutive 240 non-small cell lung cancer patients who received surgical resection were reviewed retrospectively, and investigated the survival impact of preoperative platelet count. In our results, the frequency of preoperative thrombocytosis was only 5.83% (14/240). The 5-year survival of patients with and without thrombocytosis was 28.87% and 63.73%, respectively. Both univariate and multivariate analyses indicated the independent prognostic impact of thrombocytosis. The present study is the first evaluation of prognostic effect of thrombocytosis in patients with resectable non-small cell lung cancer. Preoperative platelet count was a prognostic factor for resectable non-small cell lung cancer patients.

We experienced a case of malignant stromal tumor of the ileum. A 59-yer-old women complaining of abdominal pain, abdominal fullness and vomiting was referred to the hospital with a diagnosis of intestinal obstruction. She was treated by a long tube to release the obstruction. Thereafter, upper gastrointestinal series, ultasonography, CT, magnetic resonance imaging, and angiography revealed a tumor which was 11cm in diameter, well-delineated and hypervascular, and developed extramurally at the ileum. Under the diagnosis of leiomyosarcoma, a partial resection of the ileum including the tumor was performed. Histologically, the tumor was mainly composed of proliferated spindle cells and partially epithelioid cells which have mitotic figure 6/10 high power field. Immunohistologically, the tumor was not stained for α-smoogh muscle actin, desmin and S-100 protein, but for NSE and CD34. Though the tumor was positive for NSE, the differentiation to the nerve was not found. Therefore, it was diagnosed as uncommitted type of malignant gastrointestinal stromal tumor (GIST) of the ileum. GIST is a relatively new concept, and hence, further studies on the prognosis, mode of recurrence, frequency, and differences in imaging methods according to sub-classification of GIST would be needed.