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Resistance to thyroid hormone (RTH) is a genetic disorder characterized by reduced tissue responsiveness to thyroid hormone. We herein describe a 60-year old man who presented with the clinical features of cardiomyopathy, diabetes mellitus and elevated thyroid hormones with unsuppressed thyroid stimulating hormone. A genetic analysis of thyroid hormone receptor (TR) revealed a missense mutation (A268D) in the TRβ gene. Clinical manifestations of RTH may be variable due to different tissue distributions of TR subtypes and different actions of mutant receptors. The current case demonstrates that patients with a TRβ mutation may have impaired his glucose metabolism and a reduced cardiac function, although patients appear clinically euthyroid.

Immunoglobulin G4-related disease (IgG4-RD) is a new clinical entity that affects various organs with increased IgG4 positive plasmacytes and progressive fibrosis. While IgG4-RDs in association with Hashimoto's thyroiditis or Riedel's thyroiditis have been reported, the relationship between IgG4-RD and Graves' disease (GD) is yet unknown. To elucidate the relation of GD to IgG4-RD, serum IgG4 levels and their clinical implications in patients with GD were investigated.In this prospective study, serum IgG4 levels were measured in 109 patients with GD and classified into two groups according to the comprehensive diagnostic criteria of IgG4-RD previously established: (i) GD with elevated-IgG4 levels (≥ 135 mg/dL), and (ii) GD with nonelevated IgG4 (135 mg/dL).Seven out of 109 patients with GD (6.4%) had elevated serum IgG4 levels [mean ± standard deviation (range): 175.0 ± 44.5 (136-266) mg/dL] and elevated ratios of IgG4/IgG [12.7 ± 4.5% (7.6%-21.2%)]. The remaining patients with GD had serum IgG4 levels and IgG4/IgG ratios of 39.6 ± 27.6 (3-132) mg/dL and 3.2 ± 2.2% (0.3%-11.5%), respectively. Ages in the elevated IgG4 group were significantly higher than those of the nonelevated IgG4 group: 54.7 ± 6.2 versus 43.4 ± 15.4 years, respectively. Ultrasound examinations revealed that the elevated IgG4 group had significantly increased hypoechogenic areas in the thyroid in comparison to the nonelevated IgG4 group (low echo scoring: 1.66 ± 0.81 vs. 0.61 ± 0.89, respectively). In the correlation analysis, TSAb (rs=0.385, n=42) titers were significantly correlated with se rum IgG4 levels, while they were not significantly different between the two groups. In the elevated IgG4 group, symptoms were controllable with a small dose of antithyroidal drug (ATD; n=4), a combination treatment with ATD and L-T4 (n=1), or L-T4 administration only one year after the first visit (n=2).A small portion of GD patients harbored elevated serum IgG4 levels. They were older, had increased hypoechoic areas in the thyroid, and appeared to be responsive or prone to be hypothyroid after ATD treatment. Thus, the present study suggests the presence of a novel subtype of GD. Measuring serum IgG4 levels may help to distinguish this new entity and provide potential therapeutic options for GD.

A 72-year-old man presented with bilateral eyelid swelling and redness. An orbital CT scan showed bilateral proptosis, extraocular muscle enlargement and swollen lacrimal glands, mimicking thyroid-associated orbitopathy (TAO) with Hashimoto's thyroiditis (HT). During the patient's clinical course, spontaneous remission of lung consolidation (35 × 26 mm) was seen. A diagnosis of IgG4-related disease (IgG4-RD) was made based on an elevated serum IgG4 level (1,020 mg/dL; normal, 4-108), predominance of IgG4-positive plasma cells (IgG4/IgG: 35/70 in HPF) in the lacrimal glands and typical features of Mikulicz's disease. This report provides a novel description of this unusual disease entity among HT, TAO and IgG4-RD.

Aims/Introduction: We have previously reported that the Pro198Leu missense polymorphism in the glutathione peroxidase 1 (GPx-1) gene was associated with frequent macrovascular disease (MVD). Our goal was to examine whether the GPx-1 genotype is associated with diabetic neuropathy. Materials and Methods: We determined the GPx-1 genotype in 173 Japanese type 2 diabetic patients who received medical interviews, physical examinations, nerve conduction studies, quantitative vibratory perception (QVP), head-up tilt and heart rate variability tests by polymerase chain reaction-restriction fragment-length polymorphism. Diabetic sensorimotor distal symmetric polyneuropathy (DSPN) and diabetic autonomic neuropathy (DAN) were evaluated separately. DSPN and DAN were defined by two or more abnormalities of neuropathic leg symptoms, diminished Achilles tendon reflexes or impaired QVP in toes, and two autonomic dysfunctions, respectively. The association of the GPx-1 genotype with DSPN, DAN, MVD and other clinical manifestations was analyzed. Results: The prevalence of DSPN, impaired QVP and painful leg cramps in patients having a genotype with Pro/Leu at the codon 198 (Pro/Leu type) was significantly higher than those with Pro/Pro type. As a result of multivariate analyses that contained the GPx-1 genotype as an independent variable, the Pro/Leu type was extracted as a significant risk factor of DSPN, QVP impairment and MVD. The statistical significance did not disappear, even after proteinuria, retinopathy and a history of MVD were introduced as independent variables. In contrast, the GPx-1 genotype was not associated with DAN. Conclusions: The Pro198Leu missense polymorphism of the GPx-1 gene might have a common genetic predisposition to DSPN and MVD. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2011.00127.x, 2011)

Aims/Introduction: In order to diagnose diabetic symmetric polyneuropathy (DSPN) more simply and accurately, we identified symptoms that correlated with neurological functions and existed more frequently in diabetic than non-diabetic subjects. Materials and Methods: The relationships between 10 symptoms (numbness or paresthesia in toe and sole, numbness in hand, pain in foot or hand, coldness in legs, painful leg cramp, dizziness on standing, sweating restricted to face/trunk and frequent constipation/diarrhea) and clinical background, defined as DSPN and cardiovascular autonomic neuropathy (CAN) by the criteria proposed in the statement of the American Diabetes Association, and seven quantitative nerve function data were evaluated in 593 diabetic patients in Wakayama Medical University Hospital (WMUH). Furthermore, the prevalence of various symptoms was examined by three questionnaires: a WMUH survey (999 diabetic outpatients), a Nationwide survey (1524 male diabetic outpatients under a primary-care physician) and a Control survey (501 non-diabetic subjects). Results: Bilateral ‘numbness in toe and sole’, ‘paresthesia in toe and sole’, ‘pain in foot’ and ‘sweating restricted to face/trunk’ were significantly associated with diabetes duration, retinopathy, probable and confirmed DSPN, possible and advanced CAN, and all or six nerve functions. Questionnaire surveys clarified that symptoms that are not rare (>15%) and more frequent in diabetic than non-diabetic subjects were bilateral ‘numbness in toe and sole’, ‘paresthesia in toe and sole’, ‘coldness in legs’, ‘dizziness on standing’ and ‘sweating restricted to face/trunk’. Conclusions: Therefore, bilateral ‘numbness in toe and sole’, ‘paresthesia in toe and sole’ and ‘sweating restricted to face/trunk’ are suitable symptoms useful for the diagnosis of DSPN. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2011.00124.x, 2011)

OBJECTIVE Our goal was to ascertain the prevalence of pruritus in diabetic and nondiabetic subjects and the relevance of symptoms, signs, and nerve functions of diabetic polyneuropathy (DPN) of pruritus. RESEARCH DESIGN AND METHODS A large-scale survey of 2,656 diabetic outpatients and 499 nondiabetic subjects was performed. In diabetic subjects, the relationship between pruritus and age, sex, diabetic duration, A1C, Achilles tendon reflex (ATR), and abnormal sensation in legs was evaluated. In 105 diabetic subjects, nerve conduction studies, quantitative vibratory threshold (QVT), heart rate variability, and a fall of systolic blood pressure at a head-up tilt test (ΔBP) were performed, and the relationships between pruritus and nerve functions were evaluated. RESULTS Although the prevalence of truncal pruritus of unknown origin (TPUO) in diabetic subjects was significantly higher than that in age-matched nondiabetic subjects (11.3 vs. 2.9%, P = 0.0001), the prevalence of other pruritus was not different between the two groups. Multiple logistic regression analysis revealed that abnormal sensation and ATR areflexia were independent risk factors for TPUO in age, sex, duration of diabetes, and A1C. ΔBP in diabetic subjects with TPUO was significantly impaired compared with that in those without TPUO. Larger ΔBP was identified as a significant risk factor of TPUO independent of other nerve dysfunctions by multiple logistic regression analysis. CONCLUSIONS TPUO is significantly more frequent in diabetic than in nondiabetic individuals. TPUO is significantly associated with symptoms and signs of DPN, including impaired blood pressure response in a head-up tilt test. TPUO, therefore, might be a newly recognized symptom of DPN.

A unique TiO 2 /SiO 2 photocatalytic fiber has a photocatalytic activity and high strength. The fiber has a gradient TiO 2 surface structure and a silica core structure. By removing a nanosized SiO 2 in the TiO 2 surface region using hydrofluoric acid solution, one can generate 2–20 nm mesopores between coherently bonded TiO 2 particles (8 nm) in the surface TiO 2 layer. By using photoelectrical deposition, noble metals such as palladium can be deposited into interstices in the TiO 2 layer. The deposition of palladium selectively formed in the interstices of the TiO 2 layer between photoactive nanocrystal arrays readily proceeds. The photocatalytic activity of the palladium-deposited mesoporous TiO 2 /SiO 2 photocatalytic fiber is about twice as high as that of fiber without any deposits. Moreover, the photocatalytic activity remains for a long time. This result implies that the palladium precipitation does not peel off. Therefore, palladium-deposited mesoporous TiO 2 /SiO 2 fibers will be very useful and effective for water purification.

Immunoglobulin G4-related disease (IgG4-RD) is characterized by elevated serum IgG4 levels, IgG4-positive plasmacytes, and lymphocyte infiltration into multiple organs. IgG4 thyroiditis is a subset of patients with Hashimoto's thyroiditis (HT) who exhibited histopathological features of IgG4-RD; its source of serum IgG4 is suggested to be the thyroid gland. Although a relationship between IgG4-RD and IgG4 thyroiditis has been reported, the meaning of serum IgG4 in HT is uncertain. In this report, we prospectively evaluated serum IgG4 levels and clinical features of patients with HT. A total of 149 patients with HT were prospectively recruited into this study. According to the comprehensive diagnostic criteria of IgG4-RD, patients were divided into two groups: elevated IgG4 (>135 mg/dL) and non-elevated IgG4 (≤135 mg/dL). Median serum IgG4 levels of HT patients were 32.0 mg/dL (interquartile range, 20.0-65.0), with a unimodal non-normal distribution. Six patients (4.0%) had elevated serum IgG4 levels above 135 mg/dL. The elevated IgG4 group was older and exhibited enlarged hypoechoic areas in the thyroid gland, as revealed by ultrasonography, relative to the non-elevated IgG4 group. Levothyroxine (L-T4) replacement doses and titers of anti-thyroid antibodies did not differ significantly between the two groups. Two out of six HT patients with elevated serum IgG4 levels had extra-thyroid organ involvement as seen in IgG4-RD. In conclusion, HT patients with elevated serum IgG4 levels shared clinical features with both IgG4-RD and IgG4 thyroiditis. Longer follow-up periods and histopathological assessments are needed to further understand the meaning of elevated serum IgG4 levels in HT.

The effect of hydrogen peroxide on the photo-oxidation of salicylic acid (SA) in aqueous solutions under UV-irradiation was investigated in both purely homogeneous and photocatalytic conditions. Results obtained show that in absence of photocatalyst and under UV-irradiation, the SA degradation rate increases with increasing the amount of hydrogen peroxide added, although for high concentrations of H 2 O 2 the enhancement of the activity is progressively attenuated. In the case of the photocatalytic degradation, nanocrystallites of anatase immobilised over SiO 2 fibres were used as catalyst. In the present of TiO 2 /SiO 2 , the addition of hydrogen peroxide results in almost a three-fold increment of the photoactivity at low concentration (29.1 mM). In contrast, when the amount of H 2 O 2 added exceeds certain limit, the rate of SA removal becomes slightly lower than those measured in absence of photocatalyst. A simple kinetic model which considers the summation of both photochemical and photocatalytic contributions is used to account for the dependence of the rate on the H 2 O 2 concentration. The efficiency of the SA mineralization was also evaluated by monitoring the evolution of total organic carbon (TOC) with irradiation time. In this respect, remarkable differences are found when comparing pure photochemical degradation, which only reduce the TOC concentration in about a 3% after 300 min of irradiation, with the photocatalytic treatment, which achieve a 38% of SA mineralization in the same period.

Ceramics are often prepared with surface layers of different composition from the bulk1,2, in order to impart a specific functionality to the surface or to act as a protective layer for the bulk material3,4. Here we describe a general process by which functional surface layers with a nanometre-scale compositional gradient can be readily formed during the production of bulk ceramic components. The basis of our approach is to incorporate selected low-molecular-mass additives into either the precursor polymer from which the ceramic forms, or the binder polymer used to prepare bulk components from ceramic powders. Thermal treatment of the resulting bodies leads to controlled phase separation (‘bleed out’) of the additives, analogous to the normally undesirable outward loss of low-molecular-mass components from some plastics5,6,7,8,9; subsequent calcination stabilizes the compositionally changed surface region, generating a functional surface layer. This approach is applicable to a wide range of materials and morphologies, and should find use in catalysts, composites and environmental barrier coatings.

A ceramic matrix composite (CMC) containing Si-Zr-C-O fibers with a surface carbon layer formed by heat treatment in CO atmosphere was studied. The thickness of surface carbon layer on Si-Zr-C-O fiber increased by adding 0.1% CO2 in CO atmosphere, compared with that formed in pure CO atmosphere. The flexural strength of the CMC containing the Si-Zr-C-O fibers with carbon layer increased with increasing the thickness of the carbon layer. This result indicated that the formation of a carbon layer by heat treatment on the Si-Zr-C-O fibers is a suitable way for modifying the interface structure of CMC.

A new type of continuous SiC-based, Si-M-C-O fiber, containing zirconium instead of titanium, has been developed. This new Si-Zr-C-O fiber exhibits improved thermal stability compared to a Si-Ti-C-O fiber. In this study, oxidation resistance of Si-Zr-C-O fiber was investigated in order to clarify the role of zirconium in the fiber. It was cleared that the oxidation resistance of Si-Zr-C-O fiber was better than that of Si-Ti-C-O fiber. Zirconium plays an important role in inhibiting of crystallization of the oxide material which forms on the surface of the fiber during oxidation.

A case of extramedullary plasmacytoma (EMP) of the breast in a 49-year-old woman is reported. Six cases of EMP of the breast have been previously reported in the world literature, but this case is unusual in that it was associated with serum IgD lamda monoclonal protein detected by serum immunoelectrophoresis. The protein was identical to the immunoprotein found in proliferating cells of the breast. Bone marrow aspiration revealed normal plasma cells indicating that the breast tumor did not represent extramedullary involvement of multiple myeloma or myelomatosis. An associated tumor was found in the nasal cavity after local treatment (mastectomy) of the breast tumor, but the patient remained disease-free 12 months after adjuvant chemotherapy using nidlan, natulan, alkelan, prednisone, cyclophosphamide and vincristine.

In order to clarify the predictors of postoperative respiratory complications in patients over 80 years old who had undergone gastrectomy for gastric cancer with lymph node dissection to the extent of group 1 or 2, 21 patients were divided into two groups according to postoperative respiratory complications, eight with and 13 without complications. Univariate analysis revealed %VC, VC/m2 and FEV1.0/m2 as the predictor for respiratory complications, and Nutritional Risk Index or performance status (PS) had a tendency to be the predictor. The following formula which means possibility of postoperative respiratory complications, Y=1.184+0.186×curability-0.645×VC/m2+0.216×PS was elicited by stepwise logistic analysis. Y value of 0.47 established as the cut off point obtained accuracy in 90.5%, sensitivity in 90.5% and specificity in 92.3%. In order to prevent postoperative respiratory complications, preoperative exercise of respiratory function to raise vital capacity should be involved and an adequate method of operation should be selected by taking PS and stage of gastric cancer into consideration.

In order to obtain the high heat-resistant fibre, Si-Zr-C-O fibre has been developed. Si-Zr-C-O fibre was produced by the use of polyzirconocarbosilane as the precursor polymer. In this paper, the difference in heat-resistance between Si-Ti-C-O and Si-Zr-C-O fibres was clarified. Si-Zr-C-O fibre showed excellent heat resistance (up to 1773 K) compared with Si-Ti-C-O fibre (up to 1573 K). Generally speaking, decomposition reaction of this type of fibre proceeds accompained by the release of CO gas which was formed by the reaction between excess carbon and oxygen included in the fibre. In the case of Si-Zr-C-O fibre, Zr can strongly capture the oxygen atoms, so that the aforementioned decomposition hardly proceeds up to 1873 K (ZrO2 + 3C = ZrC + 2CO; ΔG < 0 at over 1906 K).

A 55-year-old man was admitted to the hospital because of epigastralgia and was found having a tumor of the esophagus by upper gastrointestinal endoscopy. It was a yellowish white elevated lesion 30mm in size covered with normal esophageal mucosa and placed at Ei portion of the posterior wall of the esophagus. Endoscopic ultrasonography demonstrated a normoechoic mass with homogenous internal echo in the submucosal layer. Endoscopic resection was impossible because of its size. It was resected under laparotomy. Histologically, the resected tumor was made from many foamy cells having amount of eosinophilic cytoplasm which showed positive reaction for S-100 protein. NSE and PAS stains. The diagnosis of granular cell tumor was made. In Japan 152 cases of esophageal granular tumor have been reported in detail. Follow-up, endoscopic resection and/or surgical resection were performed for these tumors. We confirm that endoscopic resection in the first choice for esophageal granular cell tumor, considering its size, histological depth of invasion and the sign of malignancy.

A continuous photoreactor, working in a total recycle mode and irradiated by a low-pressure Hg lamp, has been used to study the bactericidal effect of a photocatalyst, formed by TiO2 embedded in SiO2 fibres, on Legionella pneumophila and a consortium of common gram-negative aerobic bacteria: (Escherichia coli, Klebsiella sp., Pseudomona sp. and Proteus sp.) in water. The kinetic modeling of the inactivation process, carried out with the measured values of viable bacteria concentration at the outlet of photoreactor, evidenced that for each pass inside the photoreactor the ratio between the outlet and inlet cell concentrations was of order of 0.01 for the inactivation of L. pneumophila. For the other aerobic bacteria, which are usually taken as reference in photocatalytic bacteria inactivation studies, this ratio was of order of 0.3 for the first hour of illumination, while upon prolonged irradiation (up to 9 h) this ratio increased to 0.7. Several factors inducing this latter decrease of efficiency are possible, as e.g. competition for photocatalytic attack between microorganisms and organic compounds released by damaged bacteria or photoinduced alteration of a small fraction of still viable bacteria making them less interactive with the photocatalyst. The inactivation mechanism normally proposed for common bacteria involves an initial attack of the photogenerated radicals to the outer membrane; the consequent membrane dispersion allows the radicals to damage the cytoplasmic membrane. The higher lethality of the photocatalytic method observed towards Legionella: (in comparison to the other aerobic bacteria) is explained considering that the radicals attack the Legionella secretion system, which is adapted for high virulence and would become activated for and through adhesion to the TiO2 surface. This attack would then be able to inactivate L. pneumophila without dispersing the outer membrane. Apart from this, the water flow through the catalyst fibres can facilitate the bacteria transport towards the anatase surface, and additionally the generated shear stress may help adhesion, at least for some bacteria as E. coli, contributing further to improve the photokilling efficiency; both factors may contribute to the efficiency of this photoreactor configuration.

A surgical resection of metastatic liver lesions from colorectal cancer contributes to an improved prognosis. However, the postoperative recurrence rate remains high, particularly in the residual liver. This is probably the result of the failure to detect small lesions. In the present study, we histologically examined the presence of intrahepatic micrometastases, which are considered to be related to recurrence in the residual liver. Intrahepatic micrometastases were histologically examined in 31 resected specimens of 25 patients undergoing a hepatic resection because of metastasis to the liver from colorectal cancer. Micrometastases were found in 14 of 25 cases (56.0%). They were located in the portal veins, central veins, sinusoid, and bile ducts. The longest distance from the main metastasis was 38.2 (mean 7.5 +/- 8.0) mm. The size of the macrometastases became larger, and the frequency of micrometastases and the distance of micrometastases from macrometastases had a tendency to increase. Continuous invasion of the macrometastases into the micrometastases through the vasculature or bile duct was also observed. These results suggested that some micrometastases observed in the metastatic liver from colorectal cancer were thus seeded from the primary lesions, while other micrometastases originated from the macrometastatic lesions as satellite lesions.

A 56-year-old man who had been operated on for a cancer of the thoracic esophagus was admitted to the hospital with a suspicion of pleural recurrence on February 28, 1996. On March 14, dyspnea along with hallucination and disorientation appeared. Since severe impaired ventilation was noted, endotracheal intubation was emergently performed and the patient was entered the ICU. At that time, Ca level was 18.6mg/dl, showing significant hypercalcemia, and the white blood cell count increased to 18, 100/mm8. PTH-rP level in blood was as high as 260Pmol/ml. The elevated Ca level gradually decreased with a combinated use of elsitonine and bisphosphonate and his clinical condition became better, however, the Ca level converted to increase gradually since April 7, and appearance of arrhythmia and aggravation of ventilatory impairment were associated. On May 8, the patient died of abrupt cardiac arrest, when the white blood cell count was 21, 600/mm3 and Ca level was 14.8mg/dl. It is thought that hypercalcemia in this case might be caused by pleural recurrence of the esophageal cancer based on an increase in PTH-rP, and the cause of his death might be due to hypercalcemia crisis because the increase in Ca level was correlated with the clinical symptoms.

進行胃癌に対する自律神経系(とくに交感神経系)を温存した大動脈周囲リンパ節(No.16)郭清の意義を検討した. 過去5年間にNo.16郭清を施行した進行胃癌115例(H0P0深達度mp以深)を対象とした. 左右大小内臓神経(SN), 両側腹腔神経叢(CP), SMA神経叢(SMA)を完全温存した全温存61例, SMAと右側のSN, CPを温存した右温存47例, SMAと左側のSN, CPを温存した左温存4例, すべての神経および神経叢を切除した全切除3例であった. 深達度ss以深ではNo.16転移率が20%を越えており, No.16郭清の適応と思われた. No.16転移個数15個以上, あるいはNo.16a2, b1の全領域転移例にはNo.16郭清の意味はなかった. H0P0se, H0P0siに対するD4はD2よりhistoricalに良好な成績であった. CP, SMA, SNを温存した(全温存, 右温存)No.16郭清は術後難治性水様下痢の発症が4%以下で, No.16の単独再発もなく郭清効果は満足できるものと考えられたが, 男性の射精機能が犠牲となっていた.

胃癌大動脈周囲リンパ節郭清78例に, CH40を投与し, リンパ流とリンパ節転移との関連を検討した.転移陽性リンパ節の黒染率は46.7%で陰性の55.4%に比較し有意に低率だった.リンパ流はA領域でNo.3→7, 8a→9→16, 4d→6→14v→16が多く, No.16a1の黒染率が最も高かったが, n1 (+) では通常のリンパ流がブロックされ, No.5, 6へ直接流入するリンパ流が増加した.また, M領域ではNo.3→7→9→16が多かったが, n1 (+) ではNo.5, 4sa, 2へ直接流入した.C領域ではNo.2→16, 4sa→10, 11→16が多く, No.16a2lateroの黒染率が高かった.No.8p, 12, 14vの黒染率は低く, n1 (+) ではNo.7へ直接流入した.跳躍転移例とn0症例のリンパ流は変化なく, 跳躍転移という概念は現行取扱い規約から生じる歪みと考えられた.リンパ節の群別化を解剖学的にではなく, 転移程度や郭清効果に準じ分類し, リンパ流を考慮した術式が治療成績向上に重要である.

A 47-year-old man was pointed out having a retroperitoneal tumor on ultrasonography at a medical checkup in March 1993, and was kept under medical observation. In May 1994 the patient was referred to the department because of an enlargement of the tumor. On preoperative imaging diagnosis, the tumor positioned on the left side of the aorta and at the inferior margin of the pancreas, and was 50 mm in longer diameter, almost spherical in morphology and cystic with a solid part. The feeding vessels were branched from the dosal pancreatic artery. During surgery, it was found that the tumor continued to the superior mesenteric plexus. The tumor was extirpated by resecting a part of the plexus. Histologically, it revealed findings of paraganglioma that the tumor was positive for two staining methods, and that polymorphologic cells with hranular cytoplasm solidly proliferated associating with small vessels. This paper describes this very rare case of retroperitoneal paraganglioma together with a review of the Japanese literature.

In order to clarify the predictive risk factors of postoperative pulmonary complications after surgery for esophageal cancer, 33 cases undergoing esophagectomy under thoracotomy were evaluated using univariate analysis and stepwise logistic regression analysis. In our department, postoperative pulmonary complications are defined as those demanding respiratory management for more than one week or those needing oxgen administration for more than 2 weeks. Postoperative pulmonary complications were observed in 9 cases (27.3%). With univariate analysis, FEV1.0/m2, MVV/m2 and bledding volume during surgery were significantly different between the cases with and without pulmonary complications, with stepwise logistic regression analysis, FEV1.0/m2, bleeding volume during surgery and duration of thoracotomy were selected as predictive factors of pulmonary complications. Risk score=0.742+0.0001517×bleeding volume during surgery+0.002655×duration of thoracotomy-0.796×FEV1.0/m2 was obtained by multivariate statistical analysis. Significantly high incidence of pulmonary complications was observed in patients with risk socre more than 0.36, These results suggested that to prevent postoperative pulmonary complications, over surgery should be avoided especially in the patients with obstructive pulmonary dysfunction.

The aim of this study is to evaluate the usefulness of intraoperative continuous hyperthermic peritoneal perfusion therapy (CHPP) combined with paraaortic lymph node dissection for the patients with serosal exposed gastric cancer. The survival and recurrent rates between CHPP combined (CHPP(+)) group (n=29) and CHPP not combined (CHPP(-)) group (n=35) were discussed. In 7 peritoneal disseminated cases the apoptosis index before and after CHPP were examined at several lesions of peritoneal dissemination. The 3-year survival rates were 42.6% in CHPP(+) group and 46.4% in CHPP(-) group and the rates in n4(-) cases were 72.5% and 48.1% respectively. The rates of peritoneal recurrence were 31.0% in CHPP(+) group and 34.3% in CHPP(-) group. Especially in the n4(-) cases, the rates were 16.7% in CHPP(+) and 30.8% in CHPP(-). And no peritoneal recurrence was observed in n4(-) cases with the mean intraperitoneal temperature was more than 42°C. The apoptosis index was 3.5±2.3% before CHPP or 51.5±7.5% after CHPP. In conclusion, CHPP is effective as a local therapy and paraaortic node dissection combined with CHPP is useful for the patients with no paraaortic lymph node metastasis and those whose mean intraperitoneal temperature had been maintained at more than 42°C.

膵癌・大腸癌患者において燃蛋白に対する免疫応答を検討した. 血清中の抗ras抗体陽性率は正常人の5% (2/40) に対し, 大腸癌で40% (51/150, p

Matrilysin and gelatinase A, B mRNA expressions were examined in colorectal tumors. Matrilysin mRNA was observed exclusively in tumors, while the others were also found in normal mucosa surrounding tumors. Further analysis revealed that colorectal adenomas with severe dysplasia, not with mild dysplasia, expressed matrilysin with lower levels than cancers. The level of matrilysin mRNA expression increased with the advancement of stages of colorectal cancers, consequently a relatively higher expression was observed in liver metastatic tumors than primary tumors. These results suggest that matrilysin mRNA expression was correlated with the progression of colorectal tumors, and this enzyme may also play a role in developing metastatic tumors in liver.

マトリックスメタロプロテアーゼ (MMP)-2, 7, 9のmRNA発現を, 大腸癌手術標本を用いて観察した.その結果, MMP-7 (マトリライシン) mRNAは, 癌組織にのみ特異的に強く発現し, その発現量は大腸癌の進展度に伴い増加し, 肝転移巣においても非常に強く発現していた.そこで, マトリライシンmRNAに対するアンチセンスオリゴヌクレオチドを設計, 合成し, 大腸癌の浸潤, 増殖に及ぼす影響を検討した.アンチセンスオリゴはマトリライシン産生直腸癌細胞株CaR-1のマトリライシンmRNA発現を特異的に抑え, 濃度依存性にその浸潤および増殖能を抑制した.以上の臨床および基礎データから, マトリライシンは大腸癌の浸潤, 転移に関わるものと考えられ, 現在, マトリライシンmRNAのアンチセンスオリゴを肝動注投与することにより, 微小肝転移の増殖抑制および肝内への浸潤抑制の可能性について検討している.

症例は49歳の男性で心窩部痛を主訴に来院, 胃内視鏡検査で胃角部後壁の0' (IIc+III) T2型胃癌と診断した.CT検査でNo.7と16b1リンパ節の腫大を認め, 血清alpha-fetoprotein (AFP) 値は3.0ng/mlと正常であったが, carbohydrate antigen 19-9 (CA19-9) 値は490ng/mlと高値を呈した.胃全摘術および膵体尾部・脾臓・左副腎・胆嚢合併切除によるD4郭清を施行した.原発巣は深達度ssの低分化型腺癌でNo.7と16b1の転移リンパ節にのみ肝様腺癌を認めた.AFPおよびCA19-9染色は原発巣ではともに陰性であったが, 転移リンパ節の肝様腺癌ではAFP陽性細胞が散在性に認められ, CA19-9染色はすべての細胞がびまん性に染色された.以上より本例は転移リンパ節の肝様腺癌がCA19-9を産生したまれな症例と思われた.肝様腺癌はAFP産生胃癌に特徴的な組織型であるが, 本例のようにCA19-9値が高値の肝様腺癌は広範なリンパ節転移をきたすので十分なリンパ節郭清が必要である.

In a single-nucleotide polymorphism array-based analysis of 56 hepatoblastoma (HB) tumors, allelic imbalances were detected in 37 tumors (66%). Chromosome gains were found in 1q (28 tumors), 2q (24), 6p (8), 8q (8), 17q (6), and 20pq (10), and losses in 1p (6), 4q (9), and 16q (4). Fine mapping delineated the shortest overlapping region (SOR) of gains at 1q32.1 (1.3 Mb) and 2q24.2-q24.3 (4.8 Mb), and losses at 4q34.3-q35.2 (8.7 Mb) and 4q32.3 (1.6 Mb). Uniparental disomy of 11pter-11p15.4 (IGF2) and loss of 11pter-p14.1 were found in 11 and 2 tumors, respectively. Expression of HTATIP2 (11p15.1) was absent in 9 of 20 tumors. Amplification was identified in four tumors at 1q32.1, where the candidate oncogene MDM4 is located. In the 4q32.3-SRO, ANXA10S, a variant of the candidate tumor suppressor ANXA10, showed no expression in 19 of 24 tumors. Sequence analysis of ANXA10S identified a missense mutation (E36K, c.106G>A) in a HB cell line. Multivariate analysis revealed that both 4q deletion and RASSF1A methylation (relative risks: 4.21 and 7.55, respectively) are independent prognostic factors. Our results indicate that allelic imbalances and gene expression patterns provide possible diagnostic and prognostic markers, as well as therapeutic targets in a subset of HB.

We describe a case of schwannoma of the colon with a cyst in a 55-year-old female. The patient, who was suffering from constipation since 5-6 years before, underwent enema for searching its cause, and was found to have a polyp-like lesion 4.0 cm in diameter in the descending colon. Endoscopic examination of the low gastrointestinal tract revealed a 2/3-circumference hemispheric, large, submucous, and tumor-like lesion in the same region. It was a mild degree of colitis by biopsy. Abdominal ultrasonography revealed a low echoic lesion 3 cm in diameter, probably indicating a cyst, below the left kidney. Abdominal CT also showed a cystic lesion near the left kidney. From these findings, a diagnosis of submucous tumor of the colon was made. Laparotomy was carried out, and the tumor of the descending colon was palpated that coincided with the result of preoperative examination. Partial excision of the descending colon including the tumor was performed. The excised tumor was 4.5×3.5×3 cm in dimension, and a cystic tumor covered with thick wall in its section. Histopathological diagnosis led to schwannoma. Schwannomas of the colon and rectum are considered rare from a fact that, including this case, only 23 cases of the disease have been reported in this country.

We developed an new in-situ process for production functional ceramic fibers with gradient surface layer by means of precursor methods using polycarbosilane. Using this new technology, high-strength photocatalytic fiber, which is composed of anittase-TiO 2 and amorphous SiO 2 phase, was developed. This fiber could effectively decompose harmful organic chemicals by irradiation with UV light.

Lymphatic flow and the incidence of lymph node metastasis in remnant stomach cancer after distal gastrectomy are obscure. There is consequent controversy about appropriate lymph node dissection in such cases.Thirty-three consecutive patients with remnant stomach cancer and 44 consecutive patients primary gastric cancer in the upper third of the stomach were investigated retrospectively about lymphatic flow by injection of activated carbon particles, and about the incidence of lymph node metastasis.Lymphatic flow and the incidence of lymph node metastasis in remnant stomach cancer after distal gastrectomy without lymph node dissection were the same as those in primary gastric cancer in the upper third of the stomach. Lymphatic flow after distal gastrectomy with lymph node dissection frequently streamed toward the para-aortic lymph nodes through the lymph nodes along the greater curvature and the suprapancreatic lymph nodes. Lymphatic flow toward the jejunal and colonic mesentery was observed regardless of the method of reconstruction. This lymphogenesis was clearly observed, especially in patients with tumors invading the anastomosis site of Billroth-II reconstruction. Station Nos. 110 (lower paraesophageal) and 111 (supradiaphragmatic) lymph nodes were also stained, despite being considered sites of distant metastasis irrespective of the method of reconstruction.On the basis of the evidence of altered lymphatic flow and the incidence of lymph node metastases in remnant stomach cancer, left upper abdominal evisceration with para-aortic lymph node dissection should be performed in advanced remnant stomach cancer.

Background: A positive family history is a major contributor to risk of development of breast cancer. Methods: Somatic and germ line mutations of p53 and genetic instability were evaluated for an extremely early-onset breast cancer case in a cancer-prone family. Results: The mode of inheritance in this case was clearly autosomal dominant. DNA replication error was recognized by detecting microsatellite allelic alterations. However, mutations of p53 were not found at either somatic or germ-line level. Conclusion: These genetic studies suggest that an increased genetic instability did not lead to p53 gene mutations in this breast cancer patient.

We studied the effects on survival time of postoperative immuno-chemotherapy, including the streptococcal preparation OK-432, in patients with gastric cancer and synchronous peritoneal dissemination. The patients were prospectively randomized and a valid statistical assessment could be made for 109. Patients randomized to group B received therapy that is widely used in Japan to treat patients with gastric cancer: mitomycin C (MMC) and UFT, a combination of tegafur and uracil in a molar ratio of 1:4, for 1 year. Patients randomized to group A received the same drugs as were given to group B patients plus OK-432 i.p. for 7 days, beginning on postoperative day 0, and OK-432 by intradermal injection for 1 year, at 2-week intervals. There were no differences between the two groups in any known prognostic factor or in the dose of any drug administered except for OK-432. There was no difference in the toxicity rate between the groups. In this negative trial, there was no improvement in survival time with the addition of OK-432 to MMC and UFT for patients with gastric cancer and peritoneal dissemination.

33 patients with gasric carcinoma were studied to examine the relationship between the micrvessel count and their histological findings or prognosis.Microvessels were identified by staining their endotherial cells for factor VIII-related antigen with use of a standard immunoperoxidase technique and counted per 200x field.The mean microvessel count was 39.1±28.6. The microvessel count was being higher according to tumor growth and occurence of lymphnode metastasis.Borrmann4 type and poorly differentiated adenocarcinoma had high microvessel count.But themicrovessel count was not correlated with the site of recurrence or prognosis of gastric carcinoma.

症例は左側腹部痛と粘血便を主訴とした69歳の男性で,注腸X線検査および大腸内視鏡検査の結果,下行結腸に浅い小潰瘍を伴う大きさ4×3cmの粘膜下腫瘍を認め,左半結腸切除術および横行結腸直腸端々吻合を施行した,標本は組織学的に反応性のリンパ球増殖であるのか悪性リンパ腫なのか通常の染色では診断に苦慮した.そこでリンパ球の各抗原に対するモノクロナール抗体を用いたAvidin-Biotin-Colnplex法によって免疫組織学的検索を行った,パラフィン切片では膜抗原の保存性が悪く,凍結切片を用いることにより,λ-chainだけからなるIgMを産生するモノクローナルなB細胞の瀰慢性増殖を示す悪性リンパ腫であると診断できた.またこの悪性細胞はintermediateB細胞,matureB細胞およびlarge non-cleavedcellの一部にみられるB2抗原が陽性であった.

Peripheral blood T-lymphcyte subsets defined by monoclonal antibodies (OKT-series; OKT3: pan T-cell, OKT4: inducer/helper T-cell, OKT8: suppressor/cytotoxic T-cell) were analysed in patients with gastric cancer.The results were as follows.(1) Percentages of OKT3+, OKT4+ and OKT8+ cells as well as the OKT4/OKT8 ratio showed no significant change according to the clinical stages.(2) In recurrent cases, proportion of OKT4+ cells was decreased and that of OKT8+ cells was increased, and the OKT4/OKT8 ratio was reduced, compared with cancer free patients after operation.(3) The OKT4/OKT8 ratio was not correlated with the percentages of IgGFcR+ T-cell (Tγ) and ConA/PHA ratio.(4) In patients with high proportion of Tγ and low OKT4/OKT8 ratio, the peripheral blood T-cell response to PHA was deminished.(5) The OKT4/OKT8 ratio was remarkably decreased after palliative operation.

大腸癌根治手術後の再発の防止および早期発見による治療成績の向上を目的として治癒手術後3年以上経過例における再発について検討を行った. 再発は415例中145例 (34.9%) にみられ約80%は2年以内, 約90%は3年以内にみられた. 再発形式は結腸癌では肝再発が半数をしめ, 直腸癌では局所再発が最も高頻度であった. 再発後5年生存例は3例のみであり, 再発死亡例129例の平均生存期間は11.6ヵ月であった. carcinoembryonic antigen, computed tomographyの導入により特に肝再発の切除率の向上がみられ, 再発巣の切除により生存期間が延長したと考えられる症例もあり, 腫瘍マーカー測定や画像診断などによる定期的なフォローアップを行い早期に再発を診断することが重要であると考えられた.