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An 85-year-old man was hospitalized for a right greater trochanteric fracture. Rectal intussusception was found by diagnostic imaging but left untreated because of minor gastrointestinal symptoms. As a result of work-up for persistent mucous stool, he was diagnosed with sigmoid colon cancer with intussusception. The intussusception could not be reduced during barium enema examination but could undergo elective laparoscopic surgery with a good postoperative course. Adult intussusception may be asymptomatic and require no emergency treatment. In such a case, elective surgery can be performed. Many facilities employ laparotomy as a standard of care for intussusception. With the recent technological advances in endoscopic surgeries, laparoscopic surgery can be considered as a treatment option.

The patient was a 73-year-old male who was referred to our hospital for detailed examination because computed tomography(CT)revealed lymph node swelling. Upper gastrointestinal endoscopy revealed a 0-Ⅱc lesion in the greater curvature of the middle gastric body. The periphery of the lesion site was not reached using endoscopy. CT revealed lymph node swelling, but positron emission tomography(PET)-CT did not show abnormal accumulation in any area other than the lesion site involving the lymph nodes. Under a diagnosis of cT2N0M0, Stage Ⅰ tumor, total gastrectomy via laparotomy and lymph node dissection(D2+No.10)was performed. The histopathological diagnosis suggested early gastric cancer pT1b (SM)N0M0, Stage ⅠA. Although lymph node metastasis was not observed, the outgrowth of non-caseating epithelioid cell granulomas was observed in all lymph nodes. There was no granulomatous lesion at any other site, including the lung, leading to a diagnosis of sarcoid reactions. The"sarcoid reaction"refers to non-caseating epithelioid cell granuloma formation in a local area or the regional lymph nodes of a malignant tumor through reactions to extraneous foreign bodies in the absence of the general condition or signs as sarcoidosis. Sarcoid reactions to early gastric cancer are rare. In this study, we report a patient with early gastric cancer who showed sarcoid reactions of the regional lymph nodes and review the literature.

The aplastic anemia(AA)syndrome is characterized by pancytopenia and bone marrow hypoplasia. Although anemia, bleeding tendency, and susceptibility to infection are issues of concern during surgery, few reports have been published on the perioperative management, and management methods have not been established. A 77-year-old woman visited our hospital with chief complaints of melena and fatigability. Marked pancytopenia was observed at the first visit. After a detailed examination, she was diagnosed with ascending colon cancer accompanied by AA and solitary liver metastasis. As AA responded poorly to treatment, without improvement in pancytopenia, we decided to perform colectomy. The perioperative management, including blood transfusion and administration of a G-CSF preparation, was performed in collaboration with a hematologist, followed by right hemicolectomy and hepatic lateral segmentectomy. She was transferred to the department of hematology on hospital day 8 without complications. In conclusion, a highly invasive surgery, as in the present case, can be performed safely with an appropriate perioperative management even in cases complicated by AA.

Undifferentiated pleomorphic sarcoma develops in adult soft tissues and has a poor prognosis. It often recurs in the limbs and trunk, but is rare in the mesentery. Complete resection of the tumor is the first-line treatment, and there are previously reported cases of the usefulness of chemotherapy and radiation therapy; however, several factors remain to be clarified. We report a case of undifferentiated pleomorphic sarcoma originating in the ascending mesocolon.

The patient was a 26-year-old female who had undergone conservative treatment for acute appendicitis at another clinic and was referred to our hospital for interval appendectomy. We performed a single-incision laparoscopic appendectomy, and the patient was diagnosed with goblet cell carcinoid(GCC)based on the postoperative pathological examination. Since GCC is considered a high-grade tumor, we performed a laparoscopic ileocolic resection with D3 lymphadenectomy. There was no residual disease or lymph node metastasis detected in the resected specimen. Patients with advanced GCC typically have poor prognosis, because GCC is characterized by peritoneal dissemination and lymph node metastasis. However, our findings suggested that an additional laparoscopic surgery could be one of the curative and safe treatment options for selected pa- tients with GCC.

We report the case of an 80-year-old man with unresectable, advanced gastric cancer and pulmonary cancer because of multiple liver metastases. The serum hemoglobin level declined to 5.3 g/dL during fourth-line chemotherapy. Radiation therapy of 30 Gy was administered in 10 fractions. After radiation treatment was completed, the serum hemoglobin level increased to 8.5g/dL. No new adverse event was observed. Subsequently, the progression of anemia stopped, and oral intake became possible. Thus, palliative radiation therapy is useful for hemorrhage control in unresectable, advanced gastric cancer patients with a poor general condition and difficult surgical treatment.

The patient was a 49-year-old man with persistent fever since the introduction of hemodialysis(HD). Vomiting and abdominal swelling appeared 4 months after initiating hemodialysis. Computed tomography(CT)scan revealed a tumor measuring 9 cm, and disorders of passage from the jejunum. Surgery was performed, and resection was impossible because of peritoneal dissemination. Histopathological examination of the disseminated nodes suggested an undifferentiated pleomorphic sarcoma. Postoperatively, drainage from the gastric fistula was approximately 2,000mL/day. Chemotherapy was considered impossible because of HD, and palliative therapy was selected. However, the volume of drainage from the gastric fistula gradually decreased, and the disorders of passage reduced. CT scan confirmed marked reduction in the size of the intraperitoneal tumor and its subsequent disappearance. At the 2-year-and-5-month postoperative follow-up, no relapses were observed, and the course had been uneventful. Undifferentiated pleomorphic sarcomas develop in the soft tissue of adults and have a poor prognosis. However, mesenteric development is rare. Total tumorectomy is the first choice of treatment. A consensus on the usefulness of chemotherapy or radiotherapy has not been reached. Furthermore, no studies have reported spontaneous tumor disappearance in the absence of treatment. Here, we report a case of minor undifferentiated primary mesenteric sarcoma and its spontaneous disappearance and review the literature.

It has been pointed out that adverse effects due to influenza vaccine recorded in clinical on-site reports differ from those mentioned in package inserts. While there have been many studies on the effects of vaccines to date, there have been few detailed studies on adverse effects. Their clinical symptoms resemble those of SARS. Also, while rare serious adverse effects have been a source of concern, slight or moderate adverse effects have drawn little attention. Against this background, we conducted an investigation of adverse effects following the inoculation of our hospital staff (361 males, 908 females) with influenza vaccine.The occurrence rate of local reactions was 45.1% and that of systemic reactions 20.8%, which were higher than the rates stated in the package inserts. Also, on checking the results of the previous year's vaccination, we found that rates had increased. While the occurrence rate was significantly higher in females than in males, the rate in elderly subjects of 60 or older was significantly lower than that in younger subjects. We also determined the impact of various independent factors using a multiple logistics model.In conclusion, actual occurrence rates for adverse effects do not necessarily agree with those stated in package inserts, which may be because rates are affected by vaccination history and various other factors. Our findings will aid the prediction and management of adverse effects.

This paper deals with progressive ply-cracking damage and nonlinear deformation of CFRP cross-ply laminate. Tensile tests in 0°-axis direction and in off-axis direction are carried out on five kinds of CFRP cross-ply laminates which are different in stacking lay-up. Under 0°-axis tension, initiation and evolution of the ply-cracking damage in 90° plies are observed, and corresponding stress-strain relation is slightly nonlinear after the damage. On the other hand, under off-axis tension, the stress-strain response exhibits nonlinear deformation, while the ply-cracking damage is not remarkable except for the specimen with large fracture strain. Therefore, it is concluded that the nonlinear deformation of the laminates under off-axis tension is mainly attributed to the nonelastic deformation of the matrix resin. Numerical analyses for the progressive ply-cracking damage and the nonlinear deformation of the CFRP cross-ply laminates are conducted based on a ply-cracking damage theory and a nonlinear lamination theory, respectively, and applicability of these theories are discussed based on the experimental and numerical results.

This paper deals with a theory of ply cracking damage on 90° and 0° plies in cross-ply laminate and its application to finite element method. An energy approach is extended to predict the initiation and evolution of ply-cracking damage on 90° and 0° plies and the corresponding nonlinear stress-strain behavior of the cross-ply laminate under multiaxial in-plane loading. In this approach, the stress and strain condition for the progressive damage are determined by equating the decrease in potential energy to the released energy, where the former and latter are estimated from the stiffness reduction due to ply-cracking damage and from the mixed-mode critical energy release rate for cracking of unidirectional ply, respectively. This approach provides us with the constitutive relation of cross-ply laminates including the progressive plycracking damage. This theory is applied to the finite element method in order to analyze the ply-cracking damage and stress/strain distributions of the structures made of cross-ply laminates. As an example, finite element analysis is carried out on the seven kinds of CFRP cross-ply laminates with a circular hole. The numerical results show that the transverse cracking damage in 90° plies is widely spread out on the ligament of the plate, and the splitting damage in 0° plies extends in the longitudinal direction from the edge of the hole. The details of the damage evolution around a circular hole in CFRP cross-ply laminate depend on the stacking lay-up.

This paper deals with the deformation and damage of CFRP cross-ply laminates under off-axis tension and develops a non-linear lamination theory. Off-axis tensile tests were carried out on five kinds of CFRP cross-ply laminates which were different in stacking lay-up. On the laminates under off-axis tension, the stress-strain response shows the non-linear deformation, while the ply-cracking damage is not remarkable except for the specimen with large fracture strain. Therefore, It is concluded that the non-linear deformation of the laminates under off-axis tension is mainly attributed to the non-linear deformation of the matrix resin. In order to describe the deformation of the laminates, a non-linear lamination theory is developed. An incremental constitutive relation of the unidirectional composite containing elastic long fibers in the elastic-plastic matrix is derived based on Eshelby's equivalent inclusion method and Mori-Tanaka mean field concept. Then, this constitutive relation is introduced Into the classical lamination theory. Numerical results by the present theory for off-axis tension of the CFRP unidirectional and cross-ply laminates well described the experimental stress-strain relations.

Perforation of a diverticulum of the colon is extremely rare in juvenile people, and it commonly appears in the sigmoid colon and in patients who have multiple diverticula if it occurs. This time we have experienced a case of perforation of solitary diverticulum in the ascending colon in a juvenile patient. In this patient a barium enema study and abdominal computed tomography scan presented difficulty in differential diagnosis from acute appendicitis. This case which is thought to be rare as well as to be suggestive in terms of the differential diagnosis is reported here, together with a review of the literature.

This paper deals with initiation and evolution of cracking damage on 90° plies in cross-ply laminate. An energy approach is extended to predict the progressive ply cracking damage and the corresponding nonlinear stress-strain behavior of the cross-ply laminate under multi-axial in-plane loading. In this approach, the stress and strain condition for the progressive damage are determined by equating the decrease in potential energy to the released energy, where the former and latter are estimated from the stiffness reduction due to ply cracking damage and from the mixed-mode critical energy release rate for cracking of unidirectional ply, respectively. This approach provides us with the constitutive relation of cross-ply laminates including the progressive ply cracking damage. Tensile tests and numerical simulation based on the above approach were carried out on five kinds of CFRP cross-ply laminates which were different in stacking lay-up. The obtained results are as follows : (1) The stress-strain response of the laminates is affected by the ply cracking damage. (2) The stress for ply cracking initiation decreases with increasing laminate thickness even if the thickness ratio of 90° plies to 0° plies is constant. (3) The ply cracking damage behavior depends on the lay-up. (4) The above ply cracking damage theory fairly well describes the experimental results.

A 62-year-old woman who had been medicated for hypertension was admitted to our hospital with a chief complaint of epigastralgia. Plain abdominal X-ray showed air-fluid levels in the right hypochondriac region surrounded by abnormal gas and free air under the right diaphragm. Abdominal CT showed air-fluid levels in a swollen gallbladder and gas in the thickened wall of the gallbladder, in the common bile duct and under the abdominal wall. Under a diagnosis of gastrointestinal perforation and emphysematous cholecystitis, emergency operation was performed with laparoscopy. We did not find gastrointestinal perforation but rather found the gallbladder to be dark purple and swollen. When we punctured it with the trocar, gas escaped. Cholecystectomy was performed under laparotomy because of gallbladder weakness. Pathologic examination of the gallbladder revealed gangrenous cholecystitis, and Clostridial organisms in the wall by Gram stain. There have been no reports of emphysematous cholecystitis with intraabdominal free air in Japan.

Here we report a rare case of Trousseau’s syndrome in a patient with gastric cancer with multiple intramural metastases and metastasis to the small intestine. A 70 year-old male complaining of appetite loss and weight loss of 7 kg within 3 months was admitted to hospital. Esophagogastroduodenal endoscopy revealed an advanced gastric cancer at the pylorus almost occluding the outlet of the stomach, and multiple ulcerative lesions throughout the stomach. A biopsy showed poorly differentiated adenocarcinoma. The patient underwent total gastrectomy. During surgery, part of the distal ileum was found to be abnormally firm and approximately 1 m of the ileum with the cecum colon was resected. Pathologic examination confirmed poorly differentiated adenocarcinoma at the pylorus and multiple intramural metastases in most other areas of the stomach. Lymph node metastases were confirmed in 12 out of 40 harvested regional lymph nodes including one positive paraaortic lymph node. The resected ileum contained multiple tumors with ulceration. Massive lymphatic invasion in the stomach and the small intestine was observed, which strongly suggested lymphatic spread of the gastric cancer. The patient was discharged on post-operative day 21; however, 2 months after surgery, he developed multiple cerebral thromboembolisms and died 2 weeks later.

穿刺吸引細胞診Pap. 染色標本を用いて, 浸潤性乳管癌通常型142例 (乳頭腺管癌23例, 充実腺管癌47例, 硬癌72例) の小型細胞癌例の頻度, 浸潤性小葉癌14例の特徴を分析した. 95%以上の細胞が小型細胞から成る通常型乳管癌例を142例中29例20.4%に認めた. 最も多いのは硬癌で72例中18例25-0%であった. 小型細胞癌例か否かの認識は, 組織標本との問に乖離がみられた.組織で淡明豊富な胞体をもつ細胞が小型核を有する場合, 細胞診では小型細胞癌例として認識される例を乳頭腺管癌, 充実腺管癌でみられた. 細胞診で小型細胞とされるのは核径に左右されることが明らかとなった. 小葉癌細胞の出現パターンをTYPE-IからTYPE-Vに分類した.組織型推定上, TYPE-II: 敷石状の疎な結合を示す立方状・多辺形細胞, TYPE-V: 索状配列が特に有用と考えられたが, それぞれ28.6%, 35.7%と低出現率であった.小型明瞭な核小体を含む, スリガラス状から細顆粒状クロマチンの細胞と, 出現パターンとの組み合わせが大切である.