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In this follow-up of the R-NAC-01 study, we assessed the long-term oncological benefit of four courses of modified leucovorin, 5-fluorouracil (FU), and oxaliplatin (mFOLFOX6) chemotherapy before rectal surgery.In this prospective, multicenter study (UMIN 000012559) involving 11 hospitals in Japan, patients with lower rectal cancer underwent four cycles of mFOLFOX6 chemotherapy and subsequent surgery within four to six weeks. The 3-year recurrence-free survival and local recurrence rates were then reported.Of 41 patients (36 males, 5 females; mean age: 60.8 years old) who received 4 courses of chemotherapy, 40 underwent total mesorectal excision, and 1 underwent total pelvic exenteration. R0 resection was achieved in 40 patients, but none showed a pathological complete response. Twenty-nine patients received adjuvant chemotherapy for an average of 4 months. The 3 year recurrence-free survival and local recurrence rates in patients undergoing curable resection were 72.8% and 8.5%, respectively. cStage III patients with adjuvant chemotherapy had a significantly higher 3 year recurrence-free survival than those without adjuvant chemotherapy (76.6 vs. 40.0%, log-rank p = 0.03).Four courses of mFOLFOX6 chemotherapy before surgery may be a promising treatment strategy for locally advanced rectal cancer. Adjuvant chemotherapy might be needed for cStage III patients, even after four courses of neoadjuvant mFOLFOX6.

Background Hepatic cavernous hemangioma (CH) is the most common hepatic benign tumor. Most cases are solitary, asymptomatic, and found incidentally. In symptomatic cases with rapidly growing tumors and coagulopathy, surgical treatment is considered. In rare cases, diffuse hepatic hemangiomatosis (DHH) is reported as a comorbidity. The etiology of DHH is unknown. Case presentation A 29-year-old female patient had a history of endometriosis treated with oral contraceptives. Hepatic CH was incidentally detected in the segment IVa of the liver according to the Couinaud classification. Follow-up computed tomography (CT) and ultrasound sonography showed the growth of the lesion and formation of multiple new lesions near the first. Enhanced CT and magnetic resonance imaging (MRI) revealed that the new lesions were different from CH. Although oral contraceptives were stopped, all lesions grew in size. Malignancy and possibility of rupture of these tumors were considered due to the clinical course, and we opted for surgical removal of the tumors. Left liver lobectomy and cholecystectomy were performed. Surgical findings were small red spot spreading and a mass in segment IV of the liver. Pathological examination revealed a circumscribed sponge-like tumor with diffuse irregular extension to the adjacent area. Both of the lesions consisted of blood-filled dilated vascular spaces lined by flat endothelium without atypia. The diagnosis was hepatic CH with DHH. The patient was discharged on postoperative day 12 uneventfully. Conclusion We report the successful resection of CH with DHH. The case findings suggest a relationship between oral contraceptive use and enlargement of CH and DHH. Although DHH has been poorly understood, a few previously published cases reported DHH occurrence in patients using oral contraceptives. In such cases, the decision to perform surgical resection should be made after careful examination.

This paper reviews techniques for improving the temporal contrast and spatial beam quality in an ultra-intense laser system that is based on chirped-pulse amplification (CPA). We describe the design, performance, and characterization of our laser system, which has the potential for achieving a peak power of 600 TW. We also describe applications of the laser system in the relativistically dominant regime of laser-matter interactions and discuss a compact, high efficiency diode-pumped laser system.

The authors have demonstrated an optical parametric chirped-pulse amplification (OPCPA)/Yb:YAG ceramic thin disk hybrid laser system having hundred mJ level pulse energy sub-picosecond pulse duration with high temporal contrast. At an input chirped-pulse energy of 3.8 mJ from an OPCPA preamplifier an output energy of 130 mJ has been generated from multipass diode-pumped Yb:YAG ceramic thin disk amplifier. A recompressed pulse duration of 450 fs with a contrast level of less than 7.2×10−9 at −150 ps before the main pulse has been obtained. The contrast level is the highest value achieved in Yb:YAG chirped-pulse amplification (CPA) laser system at 100 mJ level.

We report the highest energy broadband laser pulses at a center wavelength of 1030 nm based on optical parametric chirped-pulse amplification (OPCPA). We have demonstrated amplification of 1030 nm femtosecond laser pulses from a broadband Yb oscillator to over 6.5 mJ with a total gain of greater than 107 achieved in a single pass through only 56 mm of gain material at a 10 Hz repetition rate. The amplified spectral bandwidth of 10.8 nm affords recompression to a 230 fs pulse duration following amplification. As an alternative to the regenerative amplifier (RA) this system is one of the more promising candidates for realizing compact, high intensity, direct diode-pumped, high repetition rate femtosecond Yb:YAG chirped-pulse amplification (CPA) in laser systems.

We report the approaches of output improvement for a cesium vapor laser, which was pumped by a volume-Bragg-grating (VBG) coupled broad-area laser-diode-array (LDA) with the quasi-continuous-wave (QCW) drive mode, in adopting an appropriate heating procedure and improving the pump configuration.

終末期消化器癌患者において出現する腹部救急病態のうち,消化管,胆管,尿管といった管腔の閉塞に対する外科的介入の効果について検討した.最近3年6カ月間に当科を死亡退院した98例のうち,消化管閉塞24例,胆管閉塞12例,尿管閉塞10例を対象とした.予後予測指標としてpalliative prognostic index (PPI)を用い, QOLの評価は腹部症状の改善度,経口摂取の可否,在宅移行率により行った.消化管閉塞に対しては,ストマ造設術や消化管バイパス術を行いえた場合,腹部症状や経口摂取は有意に改善し,胆管や尿管の閉塞に対しては,内瘻化が症状の改善や在宅移行率の上昇に寄与した.また, PPI

症例は43歳,男性.突然の吐血と下血による眩暈と動悸を主訴に当院受診.緊急上部消化管内視鏡検査でファーター乳頭の口側2 cmの十二指腸に約1.5cmの半球状膨隆型の粘膜下腫瘍より動脈性の出血を認めた.このため内視鏡的止血術やtrans arterial embolizationを施行したが止血できず,受診後4日目に腫瘍核手術を行い止血しえた.病理組織学的所見で十二指腸異所性膵と診断された.本症例は術後の検査で血友病Bと判明し,このための凝固異常が止血困難の一因と考えられた.十二指腸粘膜下腫瘍より出血を認めた場合,異所性膵を考慮する必要があり,保存的治療で止血しえない症例では,適切な時期に外科的治療を行う必要がある.

鼠径ヘルニアは一般外科手術の中で占める割合の高い疾患であるが,鼠径ヘルニア嚢に悪性腫瘍が存在する頻度は少ない.今回,われわれはS状結腸癌が右鼠径ヘルニア嚢に転移をきたした症例を経験した.症例は55歳,女性. S状結腸癌術後CEA高値が遷延し腹部造影CTにて右鼠径部に増強効果のある約2.5cmの腫瘤を認めた.吸引細胞診にてS状結腸癌と同様の腺癌を認め, S状結腸癌の右鼠径ヘルニア嚢転移と診断された.その後の全身精査にて他に転移を認めず,単発性鼠径ヘルニア嚢転移と考えられ摘出術を施行した.浸潤の疑われた横筋筋膜,外腹斜筋腱膜の一部も含め合併切除し,組織欠損に対しては, PROLENE Hernia System® (Johnson & Johnson)を使用しTension freeにてヘルニア修復術を行った.

最近7年間に当科で手術を行ったgastrointestinal stromal tumor (以下, GIST)11症例について臨床病理学的および免疫組織学的検討を行った.発生部位は胃8例,十二指腸1例,小腸2例で,免疫組織学的検査の結果, c-kit, CD34, SMA, S-100の陽性率はそれぞれ100%, 81%, 27%, 0%であり,これよりuncommitted typeが8例, smooth muscle typeが3例と分類された.良悪性の診断は,病理組織学的に低悪性度が2例,悪性が4例であり,このうちの3例で転移再発を認めた. p53, Ki-67は悪性度診断,転移再発を予測する上で有用であった.本疾患の概念は未だ流動的だが,今後,個々の腫瘍の生物学的特性をさらに明らかにし,それに基づいた診断治療を確立することが重要である.

皮膚子宮内膜症は極めてまれな疾患である.今回,臍部に発生した子宮内膜症の1例を経験したので報告する. 症例は45歳女性で,月経時に疼痛を伴う臍部のしこりを主訴に当科を受診した.臨床症状,画像診断,生検などにより上記診断を得,全身麻酔下に腫瘤摘出術を行った.術後経過は良好であり, 5カ月を経た現在,再発の兆候は認められていない. 女性の臍部腫瘤をみた場合,念頭に置くべき疾患であると考えられた.

We investigated the absorption rates of acetaminophen, theophyline and lansoprazole after pylorus preserving-gastrectomy (PPG) with preservation of the vagal nerve as a treatment for patients with early gastric cancer. Postoperative functioning of the residual stomach 6 months after the operation in patients with early gastric cancer who had undergone PPG (PPG group, n=5) was compared with that in patients who had undergone distal gastrectomy (DG group, n=4). We also investigated recovery of body weight, findings in a series of gastrointestinal X-rays, gastroscopic findings, hormonal secretion and digestive and absorbtive abilities.The postoperative absorption rates of acetaminophen in the PPG group were almost the same as those before the operation, but they were slower in the PPG group than in the DG group.The absorption rate of theophyline from a sustained release formulation was faster in the DG group, and slower in the PPG group compared to the preoperative absorption rates. In the DG group, the absorption rate of an enteric-coated preparation of lansoprazole did not differ greatly from that before the operation. In the PPG group, however, there were large individual differences and a notable delay in absorption and reduction in the amount of absorption in the early stage.Recovery of body weight at 6 months after the operation was not significantly different in the PPG and DG groups. In the PPG group, postoperative gastrointestinal X-rays showed that the pyloric form had been retained, and gastroscopic examination showed that there had been no reflux gastritis or esophagitis. The rates of digestion and absorption were faster in the DG group than in the PPG group, and the plasma levels of glucose were higher but the serum levels of gastrin were lower in the DG group than in the PPG group.Furthermore, hormonal secretion in the PPG group was close to the normal physiological range.These results indicate that the rate of absorption was faster in the DG group and slower in the PPG group.The absorbability of drugs following gastric resection varies depending on the type of operation and the properties of the drug preparation.

We have demonstrated a laser oscillation in the highest concentration and the shortest Nd-doped silica fiber, an only 5-cm multimode Nd-doped silica fiber. This fiber-core glass was fabricated by the zeolite method, and the glass contained 1.25 wt.% of Nd2O3, which is 10 times higher than previously reported Nd-doped silica fiber. The laser output power was 10 mW at 1062 nm, and the threshold power and slope efficiency of the laser oscillation was 1.39 W and 2.4%, respectively.

症例は58歳,多発性内分泌腺腫症I型としての上皮小体腺腫および膵ガストリノーマの既往を有する男性. 19年前にクッシング症候群を伴う胸腺カルチノイドの摘出術を受けている.腫瘍は前縦隔左半を占拠しており,完全に摘除しえた.組織学的には19年前の腫瘍と同一の所見を呈し,胸腺カルチノイドの再発と考えられた.このように遠隔期に再発する胸腺カルチノイドもあることを念頭におくべきであると考えられた.

A two-dimensional multi-lens array 350 mm in diameter with spherical element lenses has been tested to improve the irradiation uniformity of a high power glass laser for inertial confinement fusion (ICF). A circular shape for the element lens aperture is chosen to eliminate azimuthally asymmetric intensity distribution. An approximate flat-top intensity distribution is obtained with a lens array of 37 lenses. Beam patterns of a coherent laser and partially coherent light (PCL) with the random phase plate (RPP) and the multi-lens array (MLA) are measured in a GEKKO XII glass laser system. Spherical mode structure of the irradiation nonuniformity of 5.6% with MLA is estimated with cos3 θ distribution of absorption coefficient in the target plasma.

We have demonstrated an optical parametric chirped pulse amplification (OPCPA)/Yb:YAG ceramic thin disk hybrid laser system having hundred mJ level pulse energy sub-picosecond pulse duration with high temporal contrast. At an input chirped-pulse energy of 3.8 mJ from an OPCPA preamplifer an output energy of 130 mJ has been generated from multipass laser diode-pumped Yb:YAG ceramic thin disk amplifier. A recompressed pulse duration of 450 fs with a contrast level of less than 7.2×10−9 at −150 ps before the main pulse has been obtained. The contrast level is the highest value achieved in Yb:YAG chirped pulse amplification (CPA) laser system with hundred mJ level.

Between January 1985 and June 1992, 208 cases of hepatocellular carcinoma (HCC) were resected in the institute. In this study 22 cases of giant HCC (larger than 10cm in diameter) were clinicopathologically compared to the other 186 cases of HCC (smaller than 10cm). The mean age of 22 patients with giant HCC was 51.0 years old. There were 14 males and 8 females. The frequency of positive HBsAg was higher, while the frequency of concomitant liver cirrhosis was lower than the smaller HCC group. More than 50% of cases showed higher α-fetoprotein above 1000ng/ml. Eighteen cases out of 22 cases underwent more than 2 segment hepatectomy. Portal invasion and intrahepatic metastasis showed significantly higher frequency. The cumulative 3-year survival rate of giant HCCs was 28.4%, versus 61.7% in the smaller HCC group. Three out of 22 cases alived more than 5 years after the operation. These cases were treated by adjuvant chemotherapy, 2 of them received 5-FU via the portal vein and the other was infused adriamycin via the hepatic artery after hepatectomy.

Administration of TNP-470 (AGM-1470), a newly developed angiogenesis inhibitor, elevated serum copper concentrations (SCu) in a dose-dependent manner in normal rats as well as tumor-bearing rats. After discontinuation of TNP-470, SCu returned to the normal range in normal rats. In tumor-bearing rats, however, SCu decreased and then became elevated in relation to the tumor growth and capillary density in this hepatic tumor. The mechanisms leading to serum copper elevation may reflect a specific pharmacologic action of TNP-470, though it may also be related to tumor growth and reactivation of tumor angiogenesis after cessation of TNP-470.

Yb:YAG CPA have a potential to develop a compact, high peak power at high repetition rates. For high energy pulses of short duration Yb:YAG regenerative amplifiers have mainly been studied for which significant prepulse and amplified spontaneous emission (ASE). In laser proton acceleration studies it is very important to suppress the prepulse and ASE levels, because a preplasma is generated before the peak of the laser pulse, therefore the maximum proton energy is limited. To overcome this problem, the OPCPA can efficiently provide high gain for the main pulse while suppressing prepulse amplification. Here we have first demonstrated a hundred mJ level, femtosecond of an OPCPA/Yb:YAG hybrid laser system with a contrast level of 10−9 at −150 ps.

Short length fiber less than a few centimeters has many attractive applications in information and communication fields, for example, developments of over GHz clocking signals, optical integrated circuit elements.

We demonstrated a laser oscillation in the shortest Nd-doped silica fiber, an only 4-mm multimode Nd-doped silica fiber. This fiber-core glass was fabricated by the zeolite method, and the glass contained 1.25 wt% of Nd 2 O 3 .

A diode-pumped joule class in a 10 Hz output Nd:YLF ring amplifier has been developed. A phase conjugate plate was developed as a wavefront corrector for the residual wavefront distortion of an Nd:YLF rod. We have demonstrated a 0.46 J output of 10 ns pulse duration at 10 Hz repetition rate with 1.5 nJ of input energy. The effective gain of the ring amplifier system was 84.8 dB. To our knowledge, this is the highest magnification with joule-level output energy in a single-stage amplifier system that has ever been built. As a preamplifier system, this system contributed a demonstration of 21.3 J in a 10 Hz output diode-pumped Nd:glass zigzag slab laser system with a stimulated Brillouin scattering- phase conjugation mirror. We describe a robust and effective method of wavefront correction for high-energy laser systems.

門脈本幹に腫瘍塞栓を合併する肝細胞癌3例において, 腫瘍塞栓に対し放射線照射を施行し, 腫瘍塞栓の縮小後に肝切除を行った. 症例は39歳の女性, 57歳の男性, 38歳の男性で, 術前に腫瘍塞栓に対し30.0～34.5Gyの放射線照射を施行した. 全例で腫瘍塞栓の門脈1次分枝までの退縮を認め, おのおの右3区域切除, 拡大右葉切除, 右葉切除を定型的に行った. 病理組織学的変化では, 全例に腫瘍塞栓の変性, 壊死が高度に認められ, 術中操作による経門脈性播種の危険性を低下させると考えられた. 術前放射線照射を併用しなかったVp3切除症例の平均生存期間が診断より7.5か月, 術後無再発期間の平均が1.7か月であったのに対し, これら術前放射線照射を併用した肝切除症例では, おのおの13.3か月, 5.3か月と有意に延長しており, 術前放射線照射併用肝切除術の有効性が示唆された.

The broad absorption bandwidth of ytterbium (Yb) is well-suited to laser diode pumping at 940 nm. Because Yb is known for its low quantum defect, thermal loading is significantly reduced. Consequently, Yb doped crystals, especially Yb:YAG, show promise for developing compact, high peak power laser systems at high repetition rates. For high energy pulses of short duration Yb:YAG regenerative amplifiers have mainly been studied where the generation of significant prepulse and amplified spontaneous emission (ASE) is known. At higher intensities (for example ∼ 1018Wcm−2 and beyond) laser-matter interactions can require suppression of prepulse and ASE intensity in order to maintain or control the target state that a short or ultrashort main pulse would irradiate. In many cases it is therefore critical to avoid significant preplasma formation. To solve these problem, the optical parametric chirped pulse amplification (OPCPA) can efficiently provide high gain of the main pulse while suppressing prepulse amplification and reducing gain narrowing of the spectrum. We present in this conference the first Yb femtosecond oscillator based OPCPA demonstration at 1030 nm and with spectral bandwidth adequate for amplifying femtosecond pulses. Direct laser diode (LD) amplification of 1030 nm light makes this OPCPA a feasible preamplifier for a compact, high contrast, energetic, short pulse laser systems that can be considered for development of laser-driven proton accelerators.

A clinical study has been conducted since August 2001 to investigate whether chemotherapy with CPT-11/l-LV/ 5-FU/UFT could be an effective regimen for advanced or recurrent colorectal cancer. The chemotherapy consisted of CPT-11 30 mg/m2 iv, as a 120-minute infusion, followed by l-LV 30 mg/m2, as a 60-minute infusion, followed by 5-FU 300 mg/m2, as a 120-minute infusion. This treatment was administered weekly for 6 weeks followed by a 2-week rest period and repeated every 8 weeks. UFT (250 mg/m2/day) was orally administered daily. All patients were evaluable for efficacy, 2 CR, 5 PR, 3 SD and 7 PD. The overall response rate was 41.1% with a median time to progression of 7.1 months and a median survival time of 12.0 months. No grade 3/4 toxicities were observed. The present study suggests that combination chemotherapy with CPT-11, l-LV, 5-FU, and UFT is well tolerated and might be a promising regimen for advanced or recurrent colorectal cancer.

A quasi-cw 290-kW diode-pumped zig-zag slab laser has been developed in order to demonstrate a concept of the IFE driver. Thermally managed glass slab has yielded an amplifier gain of 10. 8.74 J and 5.17 J per pulse at 1 Hz and 10 Hz, respectively, with a 5 times diffraction limited beam quality were achieved using a multi-pass amplifier architecture. This result indicates that diode-pumped solid-state laser based on Nd:glass material can be a candidate of the high energy and high average power driver for the IFE and related applications.

A 56-year-old man who underwent distal gastrectomy at another hospital was admitted to our hospital because of advanced gastric cancer with synchronous liver metastasis. As we considered that the metastatic liver tumor was unresectable one, an intra-arterial catheter was inserted and weekly chemotherapy including methotrexate (MTX) (intra-venous) and 5-fluorouracil (5-FU) (intra-arterial) was started. The metastatic liver tumor was gradually reduced and resulted in partial response (PR) after 12 courses. Eight months later, the size of the metastatic liver tumor increased and lung metastasis occurred, so we started a new regimen of chemotherapy using CPT-11 (intra-venous) and CDDP (intra-arterial). After 4 courses of this regimen, we gained PR both in the metastatic liver and lung tumor. This case indicates that the combination therapy of systemic and hepatic arterial infusion chemotherapy is a treatment option in cases of advanced gastric cancer with liver metastasis.

A 62-year-old Japanese man with hepatitis B virus-related liver cirrhosis revealed alpha-fetoprotein (AFP) elevation. Dynamic computed tomography, taken at this time, showed a liver tumor in the anterior segment. As the patient refused any further medical treatment, he was observed in an outpatient clinic. The size of the tumor reduced and the serum level of AFP decreased gradually without any treatment. Twelve months after the initial diagnosis, the tumor could not be detected by computed tomography (CT) scan, and the level of AFP had declined to the normal range. Blood supply is essential for tumor growth and an arterioportal shunt near the tumor may change the dynamics of blood flow to the tumor. The shunt found in this patient was thought to be one of the causative factors leading to regression, but it could not be denied that immunological mechanisms may have played an important role in the spontaneous regression of hepatocellular carcinoma.

The laser irradiation uniformity on the target surface has been improved using a 2D scheme of the smoothing by spectral dispersion. The laser beam was dispersed in both orthogonal directions by installing the series of pair of phase modulator and diffraction gratings. A polarization- preserving single mode fiber was utilized as the first phase modulator by which the modulation frequency and depth are easily controlled by using the cross-phase modulation. The second phase modulator was a quasi-velocity matched LiTaO3 modulator driven by 9.4-GHz microwave. Using these modulators, the combination of modulation frequencies was varied in a range from 5/9.4 GHz to 14/9.4 GHz. The advanced phase modulation was obtained by adopting the self-phase modulation in conjunction with the cross-phase modulation in the optical fiber. It has been confirmed that the temporally changing modulation frequency (the chirped phase modulation) is favorable for better smoothing in comparison with the ordinary scheme with fixed modulation frequencies.© (1997) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

Resection of the liver offers the most favorable prognosis for primary liver cancer (PLC) [1]. Recently, an increasing number of patients with hepatocellular carcinoma (HCC) have been treated with resection, and the survival periods have been prolonged. However, the rate of recurrence after resection is still high, and there is much room for improvement. [2–5].

Wavefront correction until Zernike polynomial of degree three by a phase conjugate plate has been demonstrated in a high-energy Nd:YLF amplifier system. 108, amplification of 380 mJ has been achieved with a near-diffraction-limited beam quality.

We propose cryogenic Yb:YAG ceramic as a novel reactor laser-driver material instead of conventional Nd:glass. Our research on cryogenic Yb:YAG revealed that both of stimulated emission cross section and thermal conductivity can be tuned well by controlling the material temperature. Using the obtained laser parameters in our experiments, a 1.3-MJ, 16-Hz diode-pumped laser system has been conceptually designed. The overall electrical-optical conversion efficiency is numerically calculated to be as high as 17%. The compact main amplifier with about 3000, m3 volume size would be realized by using the active mirror architecture. In addition, a 1-kJ laser system 'GENBU' has been designed as a milestone for the new driver.