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The sulfur dioxide (SO2) contained in combustion exhaust gases from medium-scale facilities or ocean ships must be removed because of its role as an air pollutant. In this study, dry DeSOx filter of manganese oxide was used to capture SO2 with a simple sulfate reaction. The thermogravimetry (TG), experiments shows that the MnO2 sample having a specific surface area of 250 m2/g absorbed SO2 at about 0.45 g-SO2/g-MnO2 and 0.18 gSO2/gMnO2 at 450 °C and 250 °C, respectively. Desulfurization breakthrough experiment in a packed bed was employed to evaluate the possibility of deep desulfurization. As a result, the inlet SO2 is almost absorbed by the high specific surface area (HSSA) MnO2 bed, over 99.5% absorbed at space velocity of 0.5 × 104 h−1. Higher space velocity condition is targeting a more compact filter. Under the condition of 5.0 × 104 h−1, SO2 over 80% against inlet SO2 can be absorbed at early time. Conclusively, this material has a large enough SO2 absorption rate to capture significant amounts of SO2 gas.

完新世後期の濃尾平野における土砂堆積域の変遷について,低地の地形・地質と遺跡の分布や遺物の検出状況をもとに検討した.濃尾平野では縄文時代中期後葉(4,300yrs BP)以降,木曾川扇状地東部を中心に遺跡が分布するようになり,縄文時代後期末(3,000yrs BP)と弥生時代前期末(2,200yrs BP)の2度の画期を経て,西側と南側の地域にその分布域を段階的に拡大させた.各遺跡では,地表面下2m以浅の黒色有機物層やシルトを主体とした細粒堆積物層から遺物が出土しており,遺跡が立地して以降,洪水による堆積物の供給を受けにくい環境が継続したことが推定された.これらから,濃尾平野では完新世後期に木曾川の主流および土砂の堆積域が低地東部から西部へと移行するとともに,堆積環境の安定域が西部や南部へ拡大したことが考えられる.このような変遷過程は,養老断層を境に沈降する西下がりの傾動運動と対応しており,その影響を受けたものと推定される.また,縄文時代晩期(3,000yrs BP)以降における木曾川の顕著な西流傾向と海側の地域における土砂の集中的な堆積は,「弥生の小海退」に相当する海岸線の海側への急速な前進のおもな要因となったと考えられる.

Summary Background To study the survival benefit of adjuvant chemotherapy in gastric cancer, seven cancer centres in Japan carried out a phase III clinical trial of adjuvant chemotherapy after curative gastrectomy for macroscopically serosa-negative gastric cancer. Methods 579 patients were enrolled in the study, stratified by disease stage (T1, n=188; T2, n=323), and allocated randomly adjuvant chemotherapy or no further treatment 285 of 288 cases in the treatment group and 288 of 291 in the control group were eligible. Six cases were excluded because they did not fulfil the entry criteria. The treatment group had intravenous mitomycin (1·4 mg/m 2 ) and fluorouracil (166·7 mg/m 2 ) twice weekly for 3 weeks after surgery, and oral UFT (uracil plus tegafur, 300 mg daily) for 18 months. Analyses were by intention to treat. Findings No serious toxic effects were observed in the treatment group. At median follow-up of 72 months, 59 patients in the control group and 47 in the treatment group had died. There was no significant difference in survival between the groups (5-year survival 82·9% control vs 85·8% treated; hazard ratio 0·738 [95% CI 0·498–1·093]). 5-year survival of patients with T1 (mucosal or submucosal) cancer in the control and treatment groups was 94·9% versus 92·0%, and that of patients with T2 (muscularis propria or subserosa) cancer was 76·9% versus 83·0%. However, a test for heterogeneity and interaction over T1 and T2 subgroups revealed no significant difference in terms of drug response. Interpretation There was no survival benefit with this adjuvant therapy regimen for patients with macroscopically serosa-negative gastric cancer (T1 and T2) after curative gastrectomy. Patients with T1 cancer can be excluded from future trials, because curative surgery alone yielded a very good survival rate and there seemed no need for adjuvant therapy.

A 53-year-old man complaining of left upper abdominal pain and back pain was referred to our department. Abdominal ultrasonography revealed a cystic lesion in the pancreas tail. Enhanced CT demonstrated a cystic mass with nodule in the pancreas tail. Angiography showed encasement of the splenic artery. We diagnosed the case as mucinous cystadenocarcinoma and performed a distal pancreatectomy associated with splenectomy. Histological examination of the resected material revealed the mixture of squamous cell carcinoma and adenocarcinom. It was diagnosed as adenosquamous cell carcinoma. There were metastasis to the liver and lymph nodes of the retroperitoneum 2 year and 10 months after the first operation, and chemotherapy and radiation therapy were performed. The patient died of liver failure 6 years and 6 months after the eperation. This adenosquamous cell carcinoma is thought to be squamatization of cystadenocarcinoma. The reasons of long survival may include unclear, but less compornent of squamous cell carcinoma and therapeautic effect of adjuvant therapy. There has been no report of squamatization of the cystadenocarcinoma and long time survivors of adenosquamous cell carcinoma. We consider this case precious.

This paper presents two patients with anomalous connection of pancreaticobiliary ducts without choledo-chal cysts in the bile duct (ACPBD). The first patient, a 52-year-old woman, was admitted to the hospital because of upper abdominal pain and a thickening of the gallbladder wall on ultrasonograpaphy (US) Which was pointed out at another hospital. With close examination, she was diagnosed as having an ACPBD without biliary dilatation. Cholecystectomy, resection of the bile duct, and choledo-duodenostomy were performed. The resected material showed hyperplastic mucosa and cholesterolosis of the gallbladder. The second patient, a 39-year-old woman, was admitted to the hospital because of upper abdominal pain and the gallbladder wall thickening which was detected by US. With close examination, she was diagnosed as having an ACPBD without cystic dilatation of the bile duct and adenomyomatosis of the gallbladder. Cholecystectomy, resection of the bile duct, and choledo-duodenostomy were performed. The resected material showed hyperplastic mucosa and adenomyomatosis of the gallbladder. For early detection of ACPBD without cystic dilatation, abdominal US is recommended that indicates the thickening of the gallbladder by characteristic image. And EUS or endoscopic retrograde cholangiopancreatography (ERCP) should be conducted if US revealed the characteristic image.

Although a few cases of granulocyte colony-stimulating factor (G-CSF) producing tumor have been reported recently, hepatocellular carcinoma (HCC) that produces G-CSF remains a rarity. At the same time, HCC with a solitary mediastinal lymph node metastasis in seldom observed. This is a report of a valuable case of HCC in which both of these peculiarities co-existed. A 68-year-old man visited a physician with pyrexia and general fatigue, and was referred to the nospital with a diagnosis of hepatic tumor. The elevation of serum α-fetoprotein level and the results of various imaging studies ledus to the diagnosis of HCC. After admission, further evaluation was carried out to identify the cause for the high fever exceeding 38°C and leukocytosis, and serum G-CSF level was found to be overtly elevated, hence the diagnosis of G-CSF producing HCC. Following an extended left hepatolobectomy, the pyrexia became convalescent and leukocyte-count decreased until the 7th postoperative day, when the fever and leukocytosis resumed. Further imaging studies revealed acute enlargement of a solitary mediastinal lymph node, and it was eventually diagnosed as node metastasis. Which had not been detected preoperatively. There being no evidence of other metastatic lesions, re-operation was performed to resect the metastatic node. Once again, the patient recovered from pyrexia and leukocytosis postoperatively. Histological examination of the liver tumor revealed poorly differentiated HCC, and the mediastinal node was confirmed to have been the metastasis. Furthermore, the immunostaining using anti-G-CSF antibody was positive not only for the primary liver tumor, but also for the metastatic node. These findings confirmed that the HCC secreted G-CSF and elicited pyrexia and granulocytosis.

Background and objectives The anatomical extent of nodal metastasis has been replaced by the number of metastatic nodes as a key indicator of prognosis (pN categories) in the fifth edition of Tumor Node Metastasis Classification for gastric carcinoma by the International Union Against Cancer. The rate of metastatic nodes among all the nodes harvested is also a good prognostic factor. The object of this study is to evaluate which of the three parameters for the assessment of nodal status is the most appropriate for use in the stage classification. Methods Retrospective survival analyses were performed in 656 consecutive patients with advanced gastric carcinoma who underwent D2 lymphadenectomy and for whom histopathologic data of more than 20 lymph nodes were available. Results Although all three systems served well to classify the patients into distinct groups in terms of survival curves, stratification by the number of metastatic nodes was vulnerable to stage migration because of differences in the number of lymph nodes harvested. Such stage migration was not evident for the other two parameters. Conclusions Lymph node metastatic rate can be recommended as an internationally applicable parameter for lymph node involvement of gastric carcinoma.

Free cancer cells exfoliated from the cancer-invaded serosa contribute to peritoneal dissemination, the most frequent pattern of recurrence in gastric carcinoma patients. This study was designed to evaluate the prognostic relevance of such free cells in peritoneal washes detected by reverse transcriptase-polymerase chain reaction (RT-PCR) and cytology. RT-PCR analysis with primers specific for carcinoembryonic antigen and conventional cytologic examination by Papanicolaou staining were performed on peritoneal washes, collected at laparotomy from 148 gastric carcinoma patients. Prognostic analyses were performed with 1) death due to cancer recurrence and 2) peritoneal dissemination as endpoints. RT-PCR was found to be more sensitive than cytologic examination for detection of free cancer cells in the peritoneal washes, with a higher detection rate for each of the T categories in the tumor-node-metastasis (TNM) classification. Five patients with synchronous or recurrent peritoneal dissemination were found among 17 patients with positive RT-PCR and negative cytologic results. Both positive cytologic results and positive RT-PCR results had significant influences over the survival of patients with advanced gastric carcinomas (n = 75, p < .002). Detection of free cancer cells in peritoneal washes, most reliably by RT-PCR, is promising as a predictor of peritoneal dissemination in patients with gastric carcinoma.

It is designated that carcinoids of the rectum with the diameter of more than 1cm and less than 2cm without invasion into muscularis are candidates for local resection. We have, however, experienced 2 such cases in which lymph node metastasis was detected after radical operation. In Case 1, a 51-year-old woman had a Isp type carcinoid of Rb and 17mm in diameter with a central depression (histologicaly, sm, ly1, and v1), as well as a rectovaginal tumor (which eventually lymph node metastasis). Both tumors were locally excised. Thereafter, abdominoperineal excision of the rectum and associated resection of the uterus and vaginal posterior wall were added, when another metastasis to internal iliac lymph node was found. There have been no signs of recurrence, 8 years after the operation. In Case 2, a 37-year-old man had a Isp type carcinoid of Rs and 13mm in diameter, and underwent a low anterior resection of the rectum. Histologically, the resected material showed sm, ly1 and v0, and a metastasis in the pararectal lymph node of group I was detected. There have been no signs of recurrence, 2 years after the operation. From our experience with these cases, we may have a useful indication for the treatment of rectal carcinoids with the diameter of more than 1cm and less than 2cm without muscularis invasion: It seems likely that both a thorough preoperative exploration with EUS for pararectal lymph node metastasis and a consideration of resected material for vascular invasion are very important to select more appropriate treatment predicting possible lymph node metastasis.

A case of carcinoid of the accessory papilla which is extremely rare is reported. A 52-year-old man consulted another a hospital for hematemesis and was diagnosed as gastric ulcer. During the treatment of gastric ulcer, a submucosal tumor of the duodenum was detected and he was sent to the hospital. The tumor was located on the anterior wall of the duodenal second portion, at 2.5cm oral side of Vater papilla, measuring about 10mm in diameter. Accessory papilla was not identified on examinations. Biopsy showed carcinoid cells invaded the smooth muscle. Pancreaticoduodenectomy with adjacent lymph node dissection was performed. Resected specimen showed the carcinoid tumor invaded submucosal layer in the accessory (papilla, measuring 12×12mm, with adjacent lymoh node metastasis. The careful choice of treatment is needed in treatment of carcinoid tumor near the accessory papilla, even if, it is small in size and not invaded to muscular layer. And the smooth muscle in biopsy specimen is a special bundle of smooth muscle in the accessory papilla like a sphincter of Oddi.

We investigated the correlation between the histopathologic findings in the submucosal invasive front of early colorectal carcinoma and the regional lymph node involvement. In 144 patients who underwent curative large bowel resection against early colorectal cancer eleven patients (7.6%) had regional lymph node involvement at the initial operation. We evaluated the relationship between lymph node involvement and following seven factors: budding, vessel permeation, INF, tumor differentiation in the invasive front, mucus collection, the depth of submucosal invasion and the shape of submucosal invasion. Twenty-one percent of budding (+) patients and 16% of ly (+) patients had regional lymph node involvement. In contrast, only 5% of budding (-) patients and 4% of ly (-) patients had it (p

OBJECTIVE: The authors defined a new macroscopic classification of liver metastases from colorectal cancer. SUMMARY BACKGROUND DATA: There were different prognostic results after the same operative procedure for liver metastases with similar background factors. METHODS: Eighty-one resected liver metastases were classified into simple nodular (SN) or confluent nodular (CN) types according to the characteristics of the cut surface of the tumor. RESULTS: The 5-year survival rates after hepatectomy were 41.7% for the SN lesions (n = 39) and 23.1% for the CN lesions (n = 42). The difference between the survival curves was statistically significant (p = 0.0307). Multivariate analysis using Cox's proportional hazards model revealed that the macroscopic type (p = 0.023), the tumor diameter (p = 0.0001), and the presence of lymph node metastases (p = 0.0016) were statistically significant independent prognostic factors. CONCLUSION: The new macroscopic classification may be valuable as a prognostic factor reflecting the biologic behavior of liver metastases.

Background: Stage IV gastric carcinoma is rarely curatively resected and almost invariably carries a poor prognosis. Several clinicopathologic factors are involved, but lymphatic spread of the cancer may significantly affect survival. Study Design: A retrospective study was designed to evaluate whether the nodal metastatic rate (number of lymph node metastases/number of resected lymph nodes) is a parameter of lymphatic spread and could provide a significant prognostic factor. Several prognostic factors were assessed by multivariate analysis in 153 stage IV gastric carcinoma patients with histopathologic data on nodal metastasis. Results: A significant difference in survival was observed in the stage IV cancer patients with total nodal or gastric nodal metastatic rates 50%. Multivariate analysis revealed that a total nodal or gastric nodal metastatic rate > 50% was a highly significant prognostic factor. The gastric nodal metastatic rate can be used in patients who do not undergo an extended lymphadenectomy. Conclusions: Lymphatic spread of gastric carcinoma expressed in terms of the total nodal or gastric nodal metastatic rate is a significant prognostic factor. The latter can be calculated without pathologic data derived from extended lymphadenectomy, and so it is universally applicable.

Cytological examination of peritoneal washes is a useful predictor of peritoneal recurrence in gastric carcinoma patients. In the present study, even more sensitive detection of free cancer cells could be achieved through amplification of carcinoembryonic antigen (CEA) mRNA by means of the reverse transcriptase-polymerase chain reaction (RT-PCR). CEA was first confirmed to be present in all the gastric cancer cell lines examined, irrespective of the differentiation degree, and absent in blood and mesothelium, indicating the specificity of this approach for detection of carcinoma cells in peritoneal lavage fluid. In sensitivity tests, CEA RT-PCR proved to be capable of detecting 10 carcinoma cells per sample. Peritoneal washes of 15 of 48 gastric carcinoma patients, including all 10 patients with positive cytology results, proved positive for CEA mRNA. None of the 5 patients with benign disease was positive. Moreover, a close association with the depth of cancer invasion was established. The results indicate that the assay is more sensitive for detection of free carcinoma cells in the peritoneal cavity than conventional cytology. This is the first study to suggest the feasibility of the RT-PCR method for prediction of peritoneal recurrence in gastric cancer patients.

S状結腸癌根治術後1年7か月を経て腹壁創瘢痕に再発し, 再発腫瘤切除6年後の今なお無再発生存中の1例を経験したので報告する.症例は60歳の女性.S状結腸癌は2型, 6×4cm, SEP0H0M (-) D3, se, ly0, v0, n (-) であった.1年7か月後腹壁正中創臍部に再発した.他に転移は認めず, 腫瘍から約2cm離して, 腫瘍に癒着した小腸約10cmとともに腹壁を切除した.腹壁欠損部はマーレックスメッシュを用い補強した.腫瘍は原発結腸癌と同様の中分化腺癌であり, 転移再発と診断された.腹壁創瘢痕への転移再発形式は術中操作による腫瘍細胞の創へのimplantationと思われた.

Background The clinical significance of plasma concentration of matrix metalloproteinase 9 (MMP-9) was investigated in patients with gastric cancer. Methods Plasma was obtained from 138 healthy individuals and 70 patients who underwent gastrectomy for gastric cancer at Aichi Cancer Centre between August 1994 and July 1995. Plasma concentrations of MMP-9 were measured using a one-step sandwich enzyme immunoassay employing monoclonal antibodies. Results Patients with gastric cancer had plasma higher concentrations of MMP-9 than normal subjects. Postoperative concentrations of MMP-9 were lower than preoperative levels. In addition to patients with advanced cancer, those with early gastric cancer also exhibited higher mean values of and positivity rates for MMP-9 than healthy individuals. Preoperative plasma MMP-9 concentration correlated closely with Union Internacional Contra la Cancrum tumour node metastasis (pTNM) stage, severity of T, N and M classification, and tumour size. Conclusion Plasma MMP-9 concentration can be used for detection of primary or recurrent gastric cancer, and for estimation of tumour extent.

Treatment results and clinicopathological features of 41 myogenic tumors of the stomach resected a_??_ the institution in the past 30 years were analyzed. No difference in survival curves was observed betwee_??_ the patients who underwent distal or proximal gastrectomy and those who underwent wedge resectio_??_ A likely explanation for this was that no lymph node metastasis was observed among the cases investiga_??_ ed. Wedge resection without lymphadenectomy, therefore, is feasible, provided that the tumor be resecte_??_ en bloc without residual disease. Perfect histological separation of benign and malignant tumors by_??_conventional HE staining was not constantly attained for cases of borderline malignancy even wit_??_ well-fixed resected specimens. This denotes that preoperative diagnosis by biopsy specimens could b_??_ even more unreliable, and there is a need to establish certain criteria for selecting an adequate therapeuti_??_ strategy for each lesion through endoscopic findings and imaging studies alone. At the same time_??_ emergence of a novel prognostic factor that reflects the malignant potential of the tumors is eagerly_??_ awaited to replace the conventional histopathological diagnosis of whether the tumor be benign o_??_ malignant.

Postoperative enterocutaneous fistula is a very serious problem in abdominal surgery. Here in we report a case successfully treated for enterocutaneous fistula with two layer local flaps. Under a diagnosis of ascending colon cancer, a 78-year-old man had undergone right hemicolectomy and resection of the involved ileum and abdominal wall. On the 10th postoperative day, enterocutaneous fistula occurred at the midline incision. Although we tried various conservative treatments, the fistula had not closed six months after the first operation. Thus, we decided to attempt operative treatment. Under local anesthesia, the fistula was closed with a “donor flap”, and the new skin defect was covered with a “rhomboid flap”. Using these two layer local flaps, fistula closure was achieved, and the patient was discharged without fistula recurrence.

Matrix metalloproteinase 9 (MMP-9, 92 kDa gelatinase/type IV collagenase, gelatinase B) is a substance of current interest that can dissolve normal tissue basement membranes consisting of type IV collagen. The release of MMP-9 by tumor cells allows penetration of the stroma. This is an important mechanism for cancer invasion and metastasis. This study measures MMP-9 in the plasma of normal subjects and patients with gastric cancer. The measurement of MMP-9 is found to be a useful tool for gastric cancer screening. Plasma was obtained from 138 healthy individuals and 73 patients with gastric cancer who underwent gastrectomy at Aichi Cancer Center between August 1994 and July 1995. A one-step sandwich enzyme immunoassay using monoclonal antibodies was employed to measure the concentrations of MMP-9 in plasma. Seventy-three patients with gastric cancer had higher concentrations of plasma MMP-9 than normal subjects. The sensitivity in these patients was 56%, and the specificity as a cancer screening test for MMP-9 in healthy individuals was 96%. Postoperative plasma MMP-9 concentrations were lower than preoperative concentrations. Patients with advanced gastric cancer and early cancer exhibited higher mean values of plasma MMP-9 than healthy individuals. Preoperative plasma MMP-9 concentrations correlated closely with the many clinicopathologic factors and stages of the Japanese classification of gastric carcinoma. The measurement of plasma MMP-9 is helpful for early detection of primary or recurrent gastric cancer, and useful for evaluating the tumors.

Nine-hundred and seventy-six patients with primary gastric cancer, who were operated on in a recent 5-year period from 1985 to 1989, were classified according to the staging system and curability classification of both the Eleventh and Twelfth Editions of the General Rules for Gastric Cancer Study. The object of this study is to evaluate the feasibility of new staging system and curability classification in the Twelfth Edition. The survival curves of the patients belonging to each stage or curability were calculated by Kaplan-Meier's method and comparisons were made between the two editions as to the distribution of the curves. The survival curves for the seven stages as designated in the Twelfth Edition were distributed evently with statistically significant differences between the consecutive stages, a nd the classification was considered feasible. There were, however, subgroups within stage II with differences in depth of the lesion and extent of nodal metastasis, exhibiting significant differences in the survival. The curability classification of the Twelfth Endition, on the other hand, resulted in three distinct groups of patients with statistical differences in the survival curves, and was considered to be much more useful than that of the Eleventh Edition as a prognostic indicator.

Advantages and disadvantages of para-aortic lymph node dissection were retrospectively studied. Of 123 cases of gastric cancer in which dissection of No. 16 was performed, metastasis to these lymph nodes was confirmed in 32 cases (26.0%). The frequencies of metastasis to No. 16 were significantly higher in cases with hepatic metastasis, peritoneal metastasis, serosal invasion of S2 and above, macroscopic lymph node metastasis of N2 and above, a tumor size of 5cm or greater. The 32 cases with histologically confirmed metastasis to No. 16 had a 5-year survival rate of 8.3%. Of these 32 cases, the 22 cases without hepatic or peritoneal metastasis had a 5-year survival rate of 12.1%, with two cases achieving relapsefree prolonged survival. Postoperative complications were studied in another 297 patiens who underwent curative B operation for advanced gastric cancer. The incidence of complications in cases with dissection of three or more areas of No. 16 was significantly higher than in those with dissection of one or two areas and those without dissection of No. 16. Therefore, No. 16 dissection should not be performed on all cases of gastric cancer, but will be useful if performed on the high risk group without hepatic and/or peritoneal metastasis.

症例は心窩部痛を主訴とする69歳の男性.内視鏡的逆行性膵管造影では膵管癒合不全が認められ, 膵頭部背側膵管に約2.5cmの不整な狭窄とその尾側膵管の途絶を認めた.腹側膵管には悪性所見は認めなかった.CTでは膵頭部に径4cmの腫瘤を認め, 門脈への浸潤が疑われた.以上より, 膵管癒合不全の背側膵から発生した膵頭部癌と診断し, 膵頭十二指腸切除術, 門脈合併切除術を施行した.切除標本では腫瘍は3.5×3.8×4.0cmの結節型の膵癌で膵頭部の大半を占め, 膵頭下部辺縁に正常な腹側膵が三日月状に残存していた.膵管癒合不全に発生した膵癌の論文報告はいまだ少なく, 本邦では自験例が25例目である.これらを集計すると, 背側膵癌が24例を占めること, 閉塞性黄疸をきたしにくいなどの特徴がみられた.

Quality of life after surgical procedures of various types of esophagogastrostomy were retrospectively evaluated. Thirty-six patients were divided into three groups; group A (16 patients): end-to-side anastomosis with pyloroplasty, group B (14 patients): end-to-side anastomosis without pyloroplasty, and group C (6 patients): end-to-end anastomosis without pyloroplasty. There were no significant differences among these three groups in the background factors such as age, sex, invasion to the esophagus, pathological type, depth of invasion, lymph node metastasis, degree of dissection and curability. In an early phase after the surgery, smaller proportion of patients complained of vomiting while period of hospitalization was shorter in group A. In a late phase after the surgery (five years postoperatively), inadequate food intake and consequent loss of body weight were frequently observed in group B patients. 25% of group A patients maintained 100% or more of preoperative body weight. Frequent and severe heartburn was observed in group C. From these results, we conclude that the surgical procedure of end-to-side anastomosis of esophagogastrostomy combined with pyloroplasty is the most adequate mode of reconstruction following proximal gastrectomy.

Background: The feasibility of the latest edition of the Japanese General Rules for Gastric Cancer Study (GRGCS) is evaluated by comparison with the TNM system. Methods: In a 5-year period from 1985 to 1989, 978 patients with gastric cancer underwent laparotomies at the Dept. of Gastroenterological Surgery, Aichi Cancer Centre, Japan. All the patients have now been followed up for 5 years or until death. These patients were retrospectively classified into appropriate clinical stages and residual tumour status on the basis of the GRGCS and the 4th edition of the TNM classification by the UICC, and survival curves for various stages and subgroups were evaluated. Results: The GRGCS classification provided useful information by splitting UICC stage IV into stages IVa and IVb, and R0 into curabilities A and B, both subgroups showing significant differences in the survival curves. Conclusions: The new edition of the GRGCS can be recommended as a useful staging manual for gastric cancer.

In a phase III randomized trial of adjuvant chemotherapy for gastric cancer, interinstitutional differences were analyzed. A trial of three regimens: mitomycin C, 5-fluorouracil(5-FU) and CA (MFC) + continuous oral 5-FU (Group C); MFC + continuous oral UFT(tegafur and uracil) (Group B); and MF + UFT (Group C) after operation was conducted in 466 patients with gastric cancer (stage II and III) at four hospitals in Japan (CIH, CAD, ACC and NCC). Patients were stratified by the institution, stage, and tumor size (8 cm). The 5-year survival rates were in the order of Group A (79.0%)B (70.0%)C (61.0%) (P = 0.1228) in total, A (95.0%)B (80.0%)C (58.0%) (P0.05) at CAD (82 patients), ACB at CIH (215), CAB at ACC (95), and BAC at NCC (78). The survival rate of patients with S2(serosal exposure), 8 cmand N0-1 cancer was higher at CIH than at the other institutions. The interinstitutional differences in patient characteristics and surgical technique were more powerful than the differences among the three groups.

縮小手術の普及により一層重要な問題となりつつある多発胃癌は, 全割標本の詳細な検討により, 相当高頻度に見られることが明らかとなった. そこで, われわれは過去16年間の多発胃癌および同期間中の胃癌手術後に診断された残胃の癌について検討した. 多発胃癌は治癒切除例中6.4%に見られ, その臨床病理学的特徴は既に報告されている通りであった. 残胃の癌の頻度は1.8～2.8%であり, これをすべて同時性多発胃癌の見落としと仮定してもわれわれの多発胃癌の頻度はなお最近の報告に比べ少なく, 残りは胃切除時に同時に切除されているものと考えられた. したがって, 局所切除, EMRなどでは, 多発胃癌の見落としは必発とも考えられるが, 残胃の癌の予後は診断率の向上にともない改善しており, 多発胃癌の見落としを常に念頭においた術後フォローアップを行うことが縮小手術を行う上での必要条件と考えられた.

A 74-year-old woman was seen at the hospital because of a right lower abdominal pain. Barium enema revealed a narrowing of the hepatic flexure and remarkable shortenig with pseudo diverticula formation of the ascending colon. Colonoscopy demonstrated a whole circumferential stricture in the hepatic flexure and old inflammation in the anal side area from the stricture. Since an biopsy yielded moderated differentiated adenocarcinoma, right hemicolectomy was performed. The resected specimen showed that the tumor was categorized as carcinoma of Borrmann 2 type. A few the scarred area with discoloration was observed in the shortened ascending colon, and so we recognized this change as the old colonic tuberculosis. This case and 51 cases of colonic tuberculosis with a colonic cancer seen in the Japanese literature were reviewed. It took about 30 years to develop colonic cancer in the cases which actually had a previous history of tuberculosis. The causal relation between colonic tuberculosis and colonic cancer is not indisputably interpretated. But it is assessed that colonic cancer affected with tuberculosis may be exist, because macroscopically atypical carcinoma type was frequently observed and “dysplasia” around the cancer was revealed in about 19% of all cases.

膵脾合併切除 (PS) をしなくても脾門リンパ節 (No.(10)) と脾動脈幹リンパ節 (No.(11)) の郭清が可能であることを証明する目的で, リンパ節転移陽性例の術式別術後生存率の比較と組織学的なリンパ節遺残の有無を検討した.1981～1990年の胃癌切除例のうちNo.(10) とNo.(11) に組織学的に転移を認めたのは76例と82例であった. No.(10) 転移陽性76例の5年累積生存率は, 摘脾 (+) 38例が10.7%, PS (+) 21例が17.9%, PS (-) 17例が17.6%で差がなく, No.(11) 転移陽性82例の5年累積生存率も, PS (+) 19例が10.5%, PS (-) 63例が12.8%で差がなかった.また, No.(10), No.(11) の “すだれ状郭清” の後にPSを行い, 遺残リンパ節の有無を調べた.9例中1例にNo.(10) が, 3例にNo.(11) が各1個ず つ遺残していたが, いずれも直径0.5～1mmと小さく, 癌の転移を認めなかった. 以上より, No.(10) とNo.(11) の完全郭清のためにはPSが必要であるが, PSをしなくても予防的郭清は可能であり臨床上有用な方法と考えた.

悪性リンパ腫に対する研究の進歩にともない, 胃悪性リンパ腫に対しても新しい観点での治療法の導入が試みられている.胃悪性リンパ腫のなかでも新しい知見が得られている表層拡大型 (表拡型) リンパ腫を今回研究対象とした.1965年から1990年までに手術した胃悪性リンパ腫102例のうち表拡型リンパ腫は26例であった.26例のうち深達度sm 19例, 腫瘍最大径20cm以上10例, リンパ節転移陽性11例, R2の郭清23例, 全摘術19例であった.10生率は86.8%と高く, 再発死亡は1例のみであった.リンパ節郭清, 切除範囲が適切であれば予後は良好と考えられた.24例の組織型がIsaacsonら1)によるMALTリンパ腫 (mucosa-associated lymphoid tissue lymphoma) であり, 中村ら2) によるRLH (reactive lymphoreticular hyperplasia) はMALTリンパ腫であると考えられるようになっている.表拡型リンパ腫の認識は胃悪性リンパ腫の理解において重要な意味をもつものと考えられる.

症例は66歳男性.1989年8月27日, 腹痛, 嘔吐, 発熱が出現.8月28日, 他院に急性腹症として緊急入院し, 胃内視鏡内視鏡生検, computed tomographyなどにより, 胃癌および癌性腹膜炎と診断された.9月19日, 当院へ転院.当院の胃生検では癌は証明されなかったが, 上部消化管造影などでBorrmann4型胃癌と診断し, 10月6日, 手術を施行した.切除標本では胃大弯側に穿孔部を認め, その外側に炎症性肉芽腫が存在した.それとは別に小弯に潰瘍性病変が存在し, その中にアニサキス虫体と思われる異物を認めた.摘出標本の検索では胃癌は存在せず, 両病変ともにアニサキスによるものと診断した.本症例は, アニサキスにより胃に潰瘍性病変を形成し, さらに, 別な部分に胃穿孔を起こしたというきわめてまれな症例であり, さらに, 術前に画像検査および病理組織検査で癌と診断されたという点でも示唆に富む症例であった.

Hepatocellular carcinomas occasionally grow into the bile duct, evidencing itself in symptoms such as obstructive jaundice and abdominal pain. This report discusses a case of small liver cancer grown into the bile duct which was marked by an initial symptom of r-hypochondral pain. In December 1988, a 60-year-old male experienced attacks of abdominal pain similar to that caused by gallstones and came to our hospital. Computed tomography showed liver cirrhosis and a tumor in the left intrabileduct combined with dilatation of its peripheral ducts. Endoscopic retrograde cholangiography (ERC) also revealed a polyp-like tumor in the left bile duct. Cytology of the bile showed the presence of adenocarcinoma. Based on these examinations, a diagnosis was at first made as an intrahepatic cholangiocarcinoma, and surgery was performed. During surgery, a tumor of 2 cm in diameter was found on the surface of the left lateral lobe of the liver. With the diagnosis of hepatocellular carcinoma, combining with initial bile duct tumor, left hepatic lobectomy was performed. Out surface of the excised material showed that the tumor exposed on the surface was connected to the intrabileduct tumor. The final pathological diagnosis resulted in the hepatocellular carcinoma which had grown into the bile duct.

症例は, 66歳の男性で腹痛と発熱を主訴に来院.諸検査の結果, 胆嚢総肝管瘻を合併した胆嚢癌の胆管浸潤, または胆管癌の胆嚢浸潤と診断し, 胆嚢, 胆管切除, 肝門部胆管十二指腸吻合を施行した.切除標本を検索すると, 胆嚢と総肝管は広く交通し, 瘻孔を形成しており, 腫瘍は胆嚢頚部に茎を持ち, 結節状に発育しこの瘻孔を通って総肝管内に突出していた.なお, 一部胆嚢体部で胆嚢粘膜からさらに肝床に直接浸潤していた.腫瘍と周囲組織との接合点は茎の部位と, 肝床への浸潤部のみであり, 他の胆嚢粘膜, 瘻孔壁, および総肝管粘膜との間には連続性はなかった.また胆嚢内および胆管内には同一の形状の混合石が存在していた.病理組織学的には, papillary adenocarcinomaで, リンパ節転移はなかった.以上より, この腫瘍は, 胆嚢癌で, 胆石症に続発して形成された胆嚢総肝管瘻を通じて胆管内に発育進展したものと考えられた.

Summary The protective effect of 5,6,7,8-tetrahydroneopterin (NH.) against radiation injury in mice was studied. (C57BL/6x A/J)F1 mice received whole body irradiation with a single fatal dose of 8.0 Gy X-ray. NH4 was injected intraperitoneally into irradiated mice at various protocols. NH. was significantly effective to prolong the survival of the irradiated mice. The most effective protocol of NH4 administration was 3 times injections (10 minutes before and after irradiation and additional one 12 hours after that.) with a dose of 30 mg/kg body weight for each. Some mice that received such treatment survived more than 30 days after irradiation. In conclusion, these results indicate that NH4 has an inhibitory potential on radiation injury as an endogenous superoxide dismutase like substance.

BACKGROUND: Matrix metalloproteinase 9 (MMP-9) facilitates tumor invasion and metastasis via basement membrane degradation. Control of MMP-9 production by cancer-stromal cell interactions in these processes has been observed.METHODS: We measured plasma MMP-9 concentrations, using a one-step sandwich enzyme immunoassay, and also immunohistochemically localized MMP-9 in patients with small gastric cancers limited to the mucosa. The cancers were classified as intraepithelial tumor (Tis) and T1 disease according to the tumor-node-metastasis (TNM) classification of the International Union Against Cancer.RESULTS: Patients with T1 disease had a higher positivity rate for and mean value of MMP-9 than patients with Tis disease. In T1 tumors, MMP-9 expression determined immunohistochemically, was greater in cells in cancer stroma than in cells in noncancerous stroma, a situation found in only a few Tis tumors.CONCLUSIONS: These results suggest that MMP-9 is related to the initial step of gastric cancer invasion.