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This paper proposes an environmentally friendly method involving water-based extraction of the samples, cleanup of the extracts by solid-phase extraction, and subsequent liquid chromatography coupled with tandem mass spectrometry, which was used for simultaneous determination of seven hydrophilic neonicotinoid insecticides as well as their metabolites in agricultural samples. The effects of sample matrix on detection of the target compounds were negligibly small. Mean recoveries obtained at spiked concentrations between 0.01 and 1.00 mg/kg were 71.2-122.3% with relative standard deviations of ≤ 7.5%. When the method was applied to crop samples sprayed with commercial formulations of the target compounds, the residual concentrations of the compounds determined by the proposed method (0.015-0.27 mg/kg in green peppers and 0.017-0.31 mg/kg in tomatoes) were equivalent to those determined by the official Japanese method (0.017-0.26 mg/kg in green peppers and 0.013-0.30 mg/kg in tomatoes).

This study presents the case of a patient with minute type Ha rectal cancer with a diameter at its largest of only 5 mm, with infiltration as far as the submucosal layer (sm) and positive parietal lymph node metastasis. The patient was a 54 year-old male who visited Yasuda Medical Hospital because of diarrhea which appeared in early May 1988. During sigmoidscopy, a small protruding lesion was seen in the rectum (Rs) about 12 cm from the margin of the anus, and the patient was referred to the authors' surgical service for an endoscopic polypectomy because of a biopsy diagnosis of adenocarcinoma. The polyp had a smooth, shiny surface, and had a well demarcated hemispherical shape. A histopathological examination of the polypectomized specimen, showed that it was an invasive carcinoma extending into the submucosal layer without any adenoma component. Since the cut end of the specimen strongly suggested positive cancer cells and lymphatic permeation was also confirmed from the polypectomized specimen, a low anterior resection was performed on August 4, 1988. The postoperative histological examination revealed a small amount of residual cancer cells in the submucosal layer which appeared to be at the cut end of the resected polyp. One metastatic focal point was seen in the pararectal lymphnode, and this patient's case provided valuable suggestions for deciding upon therapeutic policies for early cancer of the large intestine.

In terms of clinicopathological features of cases of gastric cancers as examined by age, the auther's investigations have confirmed that patients in their twenties and thirties hold biological properties in common. In this study, the authers examined the above patients as cases of juvenile gastric cancer and obtained the following results: Cases of juvenile gastric cancer represented 76 (9.2%) of a total of 827 resected cases, with sex ratio of 1:1. Of these 76 cases, 33 were all depressed type early cancers and 43 were advanced cancers with predominant IV type (15 cases). Juvenile 5-year-survival rate was 60.2%, which was practically equal to 59.3% for patients aged over 40 years. Curative resection was performed in 88.2% of the cases, 5-year-survival rate for which was 71.6%. Recurrence was noted in 13 curatively resected cases. Death occurred in 22 cases, 21 of which showed ps (+) as depth of penetration, and the cause was peritoneal dissemination in 19 cases.

49歳, 女性. 胸部中部食道癌 (Im, Stage IV) に対して1986年8月右開胸開腹胸部食道全摘兼胸骨後経路胃管挙上再建術を行った. 術後後照射を行い, その後経過良好であったが, 術後1年8か月後に吐血・下血を主訴としショック状態で再受診した. 緊急内視鏡にて挙上胃管後壁に深い潰瘍性病変があり, 同部には多量の凝血塊が付着し拍動性に動いていた.保存的に治療を行い, 一時的に止血しえたが, 翌日再検査中に突然噴水様の大量吐血が出現し心停止・呼吸停止状態となった. 蘇生術を施行しながら直ちに緊急手術を行った. 術中所見ではこの潰瘍は大動脈弓部前面に穿破しており, 穿破部大動脈壁の直接縫合により止血し救命することができた. 挙上胃管に発生する潰瘍性病変の報告は, 本邦では5例ときわめて少なく, このように大動脈へ穿通・穿破し, かつ救命しえた例の報告はいまだ見られない. 挙上胃管潰瘍発生の成因について検討をくわえ報告する.

Anisakiasis of the colon is a rare entity as compared with gastric anisakiasis, and its diagnosis is very difficult. We present here two cases--a 42-year-old woman and a 30-year-old woman--of anisakiasis of the colon treated by colonoscopic removal of the worm without surgery. The importance of colonoscopy for the diagnosis and treatment of this disease is briefly discussed.

The current study attempts to clarify the possible immune response that occurs in medullary carcinoma with lymphocytic infiltration of the stomach by an immunohistochemical analysis of the subpopulations of tumor-infiltrating lymphocytes. This carcinoma was histologically characterized by the sparse population of small nests consisting of poorly differentiated carcinoma cells, widely separated by intervening nondesmoplastic stroma infiltrated uniformly with abundant lymphocytes frequently accompanied by lymph follicles. An immunohistochemical analysis revealed that T-cells were evenly distributed throughout the tumor with intimate contact with individual carcinoma cells, except the lymph follicles consisted mainly of B-cells. Because of the similarities of morphologic features and subpopulations of tumor-infiltrating lymphocytes of this carcinoma to the normal lymphoid tissue, an organized immune response combined with cell-mediated and humoral immunities against the invading carcinoma cells seemed to occur in this type of gastric carcinoma, resulting in a excellent prognosis compared with that in ordinary gastric carcinoma.

Successful simultaneous transplants of a cancer of the ascending colon from a 60 year old woman, taken from 3 sites: the primary focus, a lymph node metastasis, and a hepatic metastasis, into nude mice yielded KHC (-P, -N, -H) strains. These three strains were compared under uniform conditions of nude mouse transplantation from the standpoints of morphological variation, growth rate, and sensitivity to chemotherapy. The results showed no major differences in morphology or growth rate. However, an effect on chemotherapeutic sensitivity was observed in KHC-P and KHC-N, with reduction rates of 25.8 per cent and 31.4 per cent, respectively, in the MMC only treatment group with large doses, and in KHC-N and KHC-H, with reduction rates of 46.5 per cent and 34.9 per cent, respectively, in the UFTM group. Chemotherapy sensitivity not only exhibited heterogeneity by site, but also differed according to the chemotherapeutic agent used. These results indicate that this method of nude mouse transplantation is a good experimental system for comparing primary foci and metastases under uniform conditions, and also strongly suggest the presence of heterogeneity in sensitivity to chemotherapy.

The occurrence rate of laryngeal adenocarcinoma is approximately 0.3-0.7% in all malignancies and especially laryngeal adenosquamous cell carcinoma is extremely rare. The only one case report is found in the literature.A case of simultaneous occurrence of laryngeal adenosquamous cell carcinoma and esophageal squamous cell carcinoma is reported.The patient was a 56-year-old man who complained of hoarseness, dyspnea and dysphagia for approximately 3 years prior to his admission. Endoscopic examinations revealed primary double tumors in the larynx and esophagus. Biopsy specimens from both tumors showed adenosquamous cell carcinoma in the larynx and squamous cell carcinoma in the esophagus. Laryngectomy was performed for laryngeal cancer and lower esophagectomy was done for esophageal cancer. He is still alive in healthy condition for 13 months after surgery.This is the first case report in Japan.

肝転移を合併しやすい胃癌の特徴を得るため, 肝転移をともなった胃原発巣5cm以下の6症例と5cm以上の26症例を臨床病理学的に比較検討した. その結果, 肉眼的には萎縮領域に発生した小型のBorrmann2型を呈し, 組織型的には一般にいわれている乳頭状や高分化型よりむしろ, 低分化型や中分化型に多く, しかも髄様型の増殖をとるという特徴が認められた. さらに血清α-fetoprotein AFPげやCarcinoembryonic antigen (CEA) が陽性となる症例が多く, 特にAFPは6例中5例も陽性であった. この5例中3例は, 酵素抗体染色により胃原発巣にAFPの局在が証明された. 一方AFP産生胃癌の特徴は, 上述した肝転移を合併しやすい胃癌の特徴ときわめて類似しており, 非常に興味深い所見と考えられた.

Lymph node metastasis was studied in 263 patients with early gastric cancer, and the possibility of limited surgery for carcinoma confined to the mucosa (m-carcinoma) was discussed. Among these patients, 21 (8.0%) were lymph node metastasis-positive. Lymph node metastasis was noted in 5 (3.3%) of 153 patients with m-carcinoma and 16 (14.5%) of 110 patients with carcinoma limited to the submucosa (sm-carcinoma). Lymph node metastasis-positive cases of depressed-type mcarcinoma were characterized by ulcer of ul-III or IV type in relatively wide spread cancerous lesion. The lymph node metastasis-positive cases of protruded-type m-carcinoma consisted of one case of type I composed of poorly differentiated adenocarcinoma and one case with lymph vessel invasion of type IIa+IIc (multiple gastric cancer). Lymph node metastasis-negative cases of m-carcinoma were characterized by small lesions of type IIa, IIb and IIc associated with no ulcer in the cancerous lesion. In surgical management for these cases, it may thus be possible to reduce the extent of lymph node dissection.

食道癌治療成績向上のため壁内転移例の実態を臨床病理学的に検討した.検索症例813例中壁内転移例は8.4%にみられた.転移巣は単数, 複数例ほぼ同率にみられ, 転移の方向は口側44%, 肛門側38%, 両側18%でa因子よりn因子が進んでいるものが多く, 手術時の進行度はIV度が79%を占めた.壁内の転移部位は1pm≧sm>mpの順に多くm-a (s) の全層型は全て胃壁内転移巣であった.転移距離は5cm以内が多かったが多発例では7～8cmもかなりみられ最高は口側12cm, 肛門側11.5cmであった.予後は進行度IV度は術後6ヵ月以内に約半数が死亡したがIII度は半数以上が術後1年以上生存した.長期生存例, 短期死亡例を検討し早期切除および術後合併療法の必要性を強調した.

食道癌取扱い規約により, 食道早期癌, 表在癌の定義も確立され, また食道癌のX線像も5型に分類され, 表在型が設けられ, その規定として単に平坦なものでなく, 深達度の浅い病変と考えられるものとしている.そこでわれわれはX線像と深達度の関連につき検討してきたが, 今回は深達度smまでの表在癌 (早期癌を含む) のX線像につき総括した.消化器病センターにおける23例の表在癌のX線像をみると, 表在陥凹型, 表在平坦型, 表在隆起型 (ポリープ様隆起), 腫瘤様隆起型, 腫瘤型の5型に分類することができる.進行癌を含めたX線壕でみると, 前3者はほぼ全例が表在癌であり, 腫瘤様隆起型には一部mpまでの進行癌が含まれるが, 多くはsmまでの表在癌であり, この型までをX線診断学的には一応表在型の範疇に入れることが出来る.たゞ腫瘤型については進行癌との鑑別は未だ困難であり, 今後の検討が必要である.つぎにこれら症例の遠隔成績をみると, 早期癌では5年生存率60%とよいのに対して, 表在癌 (リンパ節などへの転移を認める狭義の) では非常に悪く, この鑑別が重要となる.狭義の表在癌のX線像は早期癌のそれに比べ主病巣の周辺に浸潤をみとめるもの, 多発癌, 多中心性を思わせる所見等があり, 多彩であり, 鑑別の糸口は得られる様に思われる.

The pathological state of corrosive strictures of the esophagus differs in each clinical case depending on the nature and quantity of agents ingested and the mode of ingestion. Therefore, it is mandatory to take a suitable treatment that fits each case of corrosive strictures. For the reason that these strictures are not malignat in general, the authors have performed dilatation by bougienage or a by-pass operation in most cases.It should be noted, however, that carcinoma of the esophagus could occur secondary to corrosive stricture. Forty such cases have been reported in literature and two additional cases were also reported in Japan recently by Nakayama. The incidence of carcinoma of the esophagus has been claimed to be from 22 to 1, 000 times higher in the cases with corrosive stricture than in normal population.If the extent of corrosive stricture is limited or short, bougienage of the stricture is attempted as the first choice. When bougienage is found to be ineffective or the stricture is too extensive, srugical treatment should be considered. Considering the possibility of future development of malignancy at the site of corrosive legions, resection of the constricted portion of the esophagus is more desirable than a by-pass operation. Because of the fact that the procedure should be made from the prophylactic viewpoint, esophagectomy without thoracotomy-the so-called blunt dissection after Akiyama-is considered to be a reasonable and valuable approach. The authors operated one case using the same technique with successful result. Even in non-resected cases, a close long-term follow-up study should be made considering the possibility of later development of carcinoma.

今回, sm癌5例, mp癌2例を含む食道癌11例において, 5ヵ月から2年2ヵ月にわたってその発育経過を観察しえた. これら食道癌のX線像を全体像からみて混合型, 単独型, 多発転移型に分けて検討したところ, 単独型と多発転移型ではその腫瘍長径増大と時間の間に比例関係が見られ (平均0.24cm/月), その形態変化や発育経過の類推が可能であったが, 混合型では予測困難であった. 5例の切除時深達度sm症例の逆追跡にて少なくとも7～8ヵ月以上はX線所見陽性状態でsm以下の癌腫が存在する可能性を示した. 一方7～11ヵ月経過追求しえたsm癌5例の術後遠隔成績に大きな差がみられたが, これは癌の悪性度決定時期を推定する意味で興味深かった.

Intraepithelial lesion spreading around the main lesion of esophageal carcinoma may be significant for the evaluation of the prognosis. Therefore, we classify it into 5 types from X-ray findings and compare these types with the findings of the resected specimens.i) A-type is characterized by slight rigidity seen at the margin of the esophagus and coarseness of the mucosal pattern.ii) In B-type, together with rigidity of the esophageal wall, a fine granular pattern is seen on double contrast film.iii) C-type, in which nodular and granular features of various sizes are seen, is divided into 2 sub-types, i. e., C1 and C2. Small nodular features belong to C1 and large nodular ones with deep ulcer to C2.iv) Big nodules with smooth surface and scattered lesions with fine elevations characterize D-type.Histological examination of the superficially spread lesion of A-type reveals carcinoma in situ. Likewise, carcinoma in situ with erosion is found in many cases of B-type. In C1- and C2-types, carcinoma infiltrates to or beyond the submucosal layer to form nodules. In most cases of D-type, lymphatic vessel invasion is seen in the mucosal layer and metastatic lesion comes out to the surface of the mucosa.The prognosis of early esophageal carcinoma of A-type is good, but that of B-, C- and D-types is rather poor.

Sixty-two cases of esophageal varices have been examined in our hospital for the last one and a half years. Bleeding varices were found in 32 cases. The characteristic differences in the esophagoscopic findings between bleeding and non-bleeding varices were as follows. (1) Varices extending the entire length of the esophagus were seen in the bleeding cases more often. (2) Bluish varices were seen in 25% of the bleeding cases, while they were found in 8% of the non-bleeding cases. The red sign was found in the majority of the bleeding cases. (3) The tumorous and nodular forms of varices were found in the bleeding cases more frequently. (4) Erosive esophagitis was rare, and it was seen in only 2 of the bleeding cases.Forward viewing fiberscopes, such as the esophagofiberscope and the pan-endoscope, were utilized for the examination of the varices. An esophagofiberscope with a tip bendable up to 210 degrees was especially appropriate for observation throughout the esophagus and the gastric cardia.In 334 cases of urgent endoscopy, gastric or duodenal ulcers were found in 51%. Esophageal varices were seen in 11%, in some of which gastric and/or duodenal lesions were also found.For the surgical treatment of esophageal varices, esophageal transection, splenectomy and devascularization around the stomach have been carried out. Transection of the esophagus was easily performed using a sewing instrument. In a long-term follow-up over one year after surgery, a relapse of varices was seen in 10% of the cases.

食道再建術のうち, 胸壁前食道胃吻合はその安全性の反面, 吻合部の縫合不全のおきやすいことが指摘されてきた.今回, 食道と胃の吻合を挙上胃の後壁に端側吻合することにより, 縫合不全の発生をいちじるしく改善することができたので, その術式を中心に報告する.挙上胃の作成には, 右胃動静脈をかなり温存した大きい胃管とし, 伸展が不十分の際は, 胃管の漿筋層を輪状に切離して伸展をはかり, 食道胃吻合は, 挙上胃の最先端より2cm肛側の後壁に, 層々吻合で行うというのが本術式の一連の操作である.従来の40%に近い移開率を, 小縫合不全のみの3.6%に改善することができた.

ラジアルスキャン超音波内視鏡を使用し, 胃癌36例を対象に超音波断層像による癌深達度の判定について検討した.正常胃壁は高エコー層, 低エコー層が交互に現れる5層構造として明瞭に認識出来た.癌巣は一般に低エコーレベルを呈し, 正常5層構造の中断・破壊・不整が深達度判定の指標となった.1群の壁在リンパ節では5mm以上に腫大したものは描出可能であった.正確な深達度診断には癌巣が超音波振動子と垂直方向に位置することが必要で, 幽門狭窄症例などこの条件を満たさない症例では描出不能であった.

食道癌のうち深達度が粘膜下層までにとどまるいわゆる食道表在癌のうち, リンパ節転移などの認められない進行度0度の早期癌とそれ以外の表在癌ではその予後には大きな開きがあり, これを術前に予測することは予後判定, 治療方針決定にも大きな意味を有する.本稿においては術前の食道X線像における病巣のX線型, 陰影欠損の大きさ, 病巣の表面の性状, 全体像とリンパ節転移, さらにはmp癌を含めたa0癌における主病巣に随伴する表在病変とn因子の関連につき検討した.食道のX線像を詳細に観察することにより, 食道早期癌と狭義の食道表在癌の鑑別が可能なることを記した.

An unusual case of extrahepatic disseminating hepatocellular carcinoma in a 64-year-old man is reported. The initial symptom was abdominal fullness and progressive ascites. Alpha-fetoprotein in the serum was 117,000 ng/ml. Exploratory laparotomy disclosed dissemination of tumor nodules throughout the abdominal cavity without any other possible primary tumor. CT scan, ultrasonography and hepatic angiography were unable to detect any tumor lesion in the liver. The final histologic diagnosis was hepatocellular carcinoma, although at first epithelioid mesothelioma was suspected. The present case of hepatocellular carcinoma was thought to have possibly developed from ectopic liver on the peritoneum. ACTA PATHOL JPN 38: 1575-1581, 1988.