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This research aims to determine the sacred indicators of the Cathedral Church before the Second Vatican Council. This research method was used quantitatively by taking 250 respondents as users and observers. The research findings are (1) Although the Cathedral Church building had been erected before the Second Vatican Council. There is a slight drawback, namely this church does not follow the Ideogram; (2) The expression of the Catholic church form can be considered sacred if its form follows the function by paying attention to the values of sacred indicators, both interior and exterior. Scientific findings in research are indicators of; Ideogram and Form follow function. So, searching for the intrinsic value of the sacredness of the Catholic Churches if one of these indicators is removed will reduce the sacredness of the Catholic Churches. This research is helpful for architectural practitioners and academics to find sacred indicators that can be added or removed if there is a change in the function of the building.

To determine the utility of mean standardized uptake value (SUVmean) of whole liver measured by 99mTc-GSA SPECT/CT fusion imaging, for evaluation of liver fibrosis. Eighty-six patients who underwent hepatectomy were enrolled, and were classified into the non-fibrosis or fibrosis group based on the pathological findings in the resected liver specimen. Univariate and multivariate analyses were performed between the two groups on four blood biochemical indices (albumin, total bilirubin, platelet count, and prothrombin time activity) and two 99mTc-GSA scintigraphy-derived liver function indices (LHL15 and SUVmean) to evaluate the independent predictive value for severe fibrosis. The diagnostic value of the index for severe fibrosis was assessed by calculating the area under the receiver operating characteristic curve. Multivariate analysis showed that prothrombin time activity [odds ratio (OR) 0.519], LHL15 (OR 0.513), and SUVmean (OR 0.168) significantly correlated with liver fibrosis. SUVmean showed the largest area under the curve, with value of 0.804, 0.730 for platelet count, 0.717 for LHL15, and 0.668 for prothrombin time activity. The optimal cut-off value for SUVmean was 6.7, which yielded 62.9% sensitivity and 96.9% specificity. SUVmean measured by 99mTc-GSA SPECT/CT fusion imaging enables highly accurate prediction of severe liver fibrosis.

The value of indocyanine green (ICG) test is negatively affected in patients with intrahepatic shunt, ICG excretory defect, or jaundice. This study evaluated 99mTc-GSA SPECT/CT fusion imaging for assessing liver function in patients with severely deteriorated ICG values. Thirteen hepatectomy candidates with ICG retention rates over 40% were retrospectively analyzed. The ICG clearance rate (KICG) and estimated KICG obtained by 99mTc-GSA scintigraphy (KGSA) were used to evaluate preoperative whole liver function. Remnant liver function was assessed using the remnant (rem) KICG (= KICG × volumetric rate) and remKGSA (= KGSA × functional rate) indices; hepatectomy was considered unsafe for values

Our aim was to determine the utility of Tc-99m-diethylenetriaminepentaacetic acid-galactosyl human serum albumin single-photon-emission computed tomography (99mTc-GSA SPECT/CT) fusion imaging for detecting incomplete portal vein embolization (PVE). Fifty-five candidates underwent PVE. Among them, five underwent second PVE. Detectability of first inadequate PVE using CT and 99mTc-GSA SPECT/CT fusion imaging was analyzed. Cases of inadequate PVE were detected in three patients using CT and in five using 99mTc-GSA SPECT/CT fusion imaging. Fusion imaging detected two cases of insufficient PVE in which portal branches were apparently well embolized on CT. Median value for volumetric rate in the embolized liver was 63.3% after the first PVE and 54.7% after the second (P

The present case study describes a rare case of secondary central nervous system (CNS) lymphoma that infiltrated the dura and leptomeninges around the area injured by subarachnoid hemorrhage and subsequent aneurysmal clipping. Invasion of the CNS was observed by computed tomography as slurred fissures of the right parietal lobe adjacent to the surgery area. Subdural and subarachnoid enhancement overlapping the area injured by past surgical procedures was observed by contrast-enhanced magnetic resonance imaging. Surgical resection revealed B-cell lymphoma infiltrating the dura and leptomeninges surrounding the post-hemorrhagic area. The patient was subsequently diagnosed with systemic lymphoma and bone marrow invasion, and multiple lymph node swelling. To the best of our knowledge, this is the first report of malignant lymphoma involving the CNS overlapping a previously injured area.

Surgical resection is the only available treatment for achieving long-term survival in cholangiocarcinoma. The purpose of this study is to elucidate the utility of chemoradiotherapy for initially unresectable locally advanced cholangiocarcinoma. Unresectable locally advanced cholangiocarcinoma was defined as those in which radical surgery could not be achieved even with aggressive surgical procedure. Fifteen candidates (7 intrahepatic cholangiocarcinomas and 8 hilar cholangiocarcinomas) underwent chemoradiotherapy. Fourteen of the 15 patients received oral S-1 chemotherapy. Radiotherapy was administered with 50 Gy for each patient. After chemoradiotherapy, the resectability of each cholangiocarcinoma was reexamined. Of the 15 patients with initially unresectable locally advanced cholangiocarcinoma, 11 (73.3%) were judged to have resectable cholangiocarcinoma after chemoradiotherapy, and received radical hepatectomy (R0 resection in 9 patients). Among the 11 patients who underwent surgical resection, 4 had recurrence-free survival and the median survival time (MST) was 37 months. The overall 1-, 2-, and 5-year survival rates were 80.8, 70.7 and 23.6%, respectively. Among the 4 patients who were unable to receive surgery, 3 died of the primary disease and the MST was 10 months. The overall 1- and 2-year survival rates were 37.5 and 0%, respectively. Patients who received radical surgery had significantly longer survival time than those who were unable to receive surgery (p = 0.027). Chemoradiotherapy allowed patients with initially unresectable locally advanced cholangiocarcinomas to be reclassified as surgical candidates in a substantial proportion. Chemoradiotherapy might be one of the treatment options for similarly advanced cholangiocarcinomas.

Some clinicians have argued that combining pancreatic and portomesenteric venous resection could improve the rates of long-term survival. However, whether resection of the portosplenomesenteric vein could provide an acceptable survival benefit to patients with pancreatic cancer involving the portosplenomesenteric system remains controversial. The purpose of this study was to determine the significance of pathological portosplenomesenteric venous invasion on survival in patients who underwent surgical management for pancreatic adenocarcinoma. Patients who underwent curative surgical treatment were divided into two subgroups: those with pathological invasion to the portosplenomesenteric vein (PV-positive group) and those without invasion (PV-negative group). Of 160 studied patients, the median overall survival was 48.0 months after pancreatic surgery in the PV-negative group and 18.0 months in the PV-positive group. The incidence of postoperative peritoneal dissemination was significantly lower in the PV-negative group than in the PV-positive group. Accordingly, patients in the PV-negative group showed a cumulative rate of pancreatic cancer recurrence at 2 years after pancreatic surgery of 54.4 %, while this rate was 89.4 % in the PV-positive group. Finally, an elevated presurgical serum CA19-9 level (>700 IU/mL) was found to be significantly associated with a poor outcome after surgery in pancreatic cancer patients with pathological portosplenomesenteric venous invasion. Pancreatic cancer carries a high risk of recurrence even if surgical resection is technically possible. The current study suggested that portosplenomesenteric involvement and preoperative high serum CA19-9 are poor prognostic indications; however, the findings provided little insight into the role of neoadjuvant therapy in such patients.

Our aim was to determine the utility of Tc-99m-diethylenetriaminepentaacetic acid-galactosyl human serum albumin single-photon-emission computed tomography (Fifty-five candidates underwent PVE. Among them, five underwent second PVE. Detectability of first inadequate PVE using CT andCases of inadequate PVE were detected in three patients using CT and in five using

The treatment of locally advanced unresectable pancreatic cancer remains extremely challenging, particularly as the efficacy of concurrent chemoradiotherapy (CRT) remains unclear.We studied 93 patients (8.0%) with locally advanced unresectable pancreatic cancer without distant metastases from among a total group of 1168 patients who were diagnosed with pancreatic cancer from March 2005 to November 2015 at the Kochi Health Sciences Center, Kochi, Japan. We therefore evaluated the clinical efficacy of CRT in patients with locally advanced unresectable pancreatic cancer.Of the 93 patients with locally advanced unresectable pancreatic cancer, 35 patients (37.6%) were subsequently classified as having resectable disease following CRT. The median overall survival of patients who received CRT alone for locally advanced unresectable pancreatic cancer was 8.0 months, and all died within 3 years. On the other hand, the overall 1-, 3- and 5-year survival rates in patients who were reclassified as having resectable tumour after CRT were 71.3%, 39.2% and 23.5%, respectively. Our pathological assessments after surgical resection suggested that CRT might be associated with a significant reduction in the risk of lymph node metastases in patients with locally advanced unresectable pancreatic cancer.The results of this study suggested that CRT is clinically effective in improving survival, particularly in association with the resultant possibility of curative resection. Advances in knowledge: The best treatment strategy for patients with locally advanced unresectable pancreatic cancer is the subject of considerable debate, and CRT is only recommended if cancer has only grown around the pancreas without any distant metastases.

We report a rare case of pancreatic serous cystadenoma, which shrank remarkably from 6 to 1.5 cm in diameter, with cystic degeneration, over a period of only 3 weeks. A 29-year-old woman who presented with epigastric pain and jaundice underwent computed tomography, which showed a 6-cm monolocular cystic tumor in the pancreatic head. Endoscopic retrograde cholangiopancreatography showed stenosis and deviation of the inferior part of the extrahepatic bile duct. We performed surgery 3 weeks later for suspected mucinous cystadenoma or macroscopic serous cystadenoma of the pancreas. At laparotomy, the tumor in the pancreatic head was found to have shrunk remarkably. We excised the tumor completely by performing the Whipple procedure. Macroscopically, the mass was a 1.5-cm monolocular cyst. Microscopically, the cystic tumor was composed of a thick fibrous wall with granulation tissue and hemorrhage. Although epithelial cells were not found inside the cystic wall, numerous grossly invisible microcysts with glycogen-containing epithelial cells were seen at its periphery. Based on these findings, the tumor was diagnosed as a serous cystadenoma with cystic degeneration.

A 13-year-old boy was referred to us for investigation of a giant liver mass, approximately 16 cm in diameter. Sonographically guided percutaneous needle biopsy was performed and histological examination revealed a fetal-type hepatoblastoma. After four courses of chemotherapy, we performed a left hepatic trisegmentectomy. Follow-up computed tomography, 55 months after the surgery, showed a 1-cm tumor on the route of the preoperative needle biopsy. A second laparotomy revealed a peritonealised tumor, which was excised. The histology of this tumor was identical to that of the primary hepatoblastoma. To our knowledge, this is only the second report of needle tract implantation of hepatoblastoma after percutaneous needle biopsy.

We conducted a multicenter prospective study to clarify the efficacy and safety of surgery and imatinib for liver oligometastasis of gastrointestinal stromal tumors. Eligible gastrointestinal stromal tumor patients were enrolled in the surgery trial or the imatinib trial. Primary endpoints were recurrence-free survival and progression-free survival, respectively. The trials were prematurely terminated due to amendment of guidelines for adjuvant imatinib therapy and low patient accrual. In the surgery trial, all the six patients showed hepatic recurrence: median recurrence-free survival was 145 days (range: 62-1366 days). Of the five patients receiving salvage imatinib therapy, two showed progressive disease although no death was observed. Of the five patients enrolled in the imatinib trial, one died of pneumonia after progressive disease, and four had not shown progressive disease as of last visit. The results suggest that liver oligometastasis of gastrointestinal stromal tumor may not be controllable by surgery alone and require concomitant imatinib therapy.

The purpose of this study was to investigate the clinical outcomes of bland embolization using superabsorbent polymer microspheres (SAP-TAE) as an initial therapeutic option for previously untreated hepatocellular carcinoma (HCC) ineligible for resection or ablation. Fifty-nine patients with previously untreated HCC unamenable to surgery or ablation underwent bland embolization using 100- to 200-mum reconstituted SAP particles (SAP-TAE) as the initial treatment. SAP-TAE was repeated as needed based on tumor response but was switched to chemoembolization when necessary to control residual or progressive tumor. Early tumor response was assessed by contrast-enhanced CT according to RECIST and EASL criteria 1 month after the initial SAP-TAE. The overall survival was calculated using the Kaplan-Meier method. The overall mean follow-up period was 30.6 months (range, 7-59 months). A total of 121 sessions of SAP-TAE were performed, with 1-5 sessions per patient (mean, 2.1 sessions). The mean period of repeated SAP-TAE was 15.6 months (range, 1-51 months), and it exceeded 1 and 2 years in 32 (54%) and 15 (25%) patients, respectively. Thirteen (22%) patients underwent repeated SAP-TAE alone, and the remaining 46 (78%) patients underwent subsequent chemoembolization. No major complication was observed and postembolization syndrome was minimal after SAP-TAE in all patients. Response rate was 14% and 66% by RECIST and EASL criteria, respectively. Overall survival rates were 100% and 83% at 1 and 2 years, respectively, and median survival time was 30 months. In conclusion, SAP-TAE was a safe and repeatable option as the induction therapy for HCC unamenable to surgery or ablation, despite the high incidence of converting to TACE during the total course.

Intraductal tubulopapillary neoplasms (ITPNs) of the pancreas are rare. The purpose of this study was to collate and analyze published data on ITPNs of the pancreas to determine the clinicopathological features of the tumors and the surgical outcomes of patients.We searched MEDLINE and Igakuchuo-Zasshi for the period of 1980 to 2015 for case reports on surgical resection for ITPN of the pancreas. We evaluated the clinicopathological data associated with pancreatic ITPNs, the prognosis for each patient, and surgical outcomes described in the case reports.We obtained clinicopathological data for 58 patients (33 men and 25 women) with a mean age of 61 years (range, 35-84 years) who had undergone surgical resection for ITPN of the pancreas, including one patient from our clinic. Although ITPNs of the pancreas have different clinicopathological features to intraductal papillary mucinous neoplasms, the treatment strategy for patients with ITPNs is the same as for patients with other cystic neoplasms of the pancreas. The immunohistochemical features of ITPNs included testing positive for cytokeratin 7 and/or cytokeratin 19 and negative for trypsin, MUC2, MUC5AC, and fascin. The overall 1-, 3-, and 5-year survival rates after surgery for the 37 cases with available data were 97.3, 80.7, and 80.7 %, respectively.Surgical treatment is the only curative management option for patients with ITPN of the pancreas. To determine the best management strategy for this tumor and improve accuracy of prognosis for patients, we will continue to collect and analyze epidemiological and pathological data.

The objective of this study was to determine the utility of Tc-99m-diethylenetriamine-penta-acetic acid-galactosyl human serum albumin ((99m)Tc-GSA) single-photon emission computed tomography (SPECT)/CT fusion imaging for posthepatectomy remnant liver function assessment in hilar bile duct cancer patients.Thirty hilar bile duct cancer patients who underwent major hepatectomy with extrahepatic bile duct resection were retrospectively analyzed. Indocyanine green plasma clearance rate (KICG) value and estimated KICG by (99m)Tc-GSA scintigraphy (KGSA) and volumetric and functional rates of future remnant liver by (99m)Tc-GSA SPECT/CT fusion imaging were used to evaluate preoperative whole liver function and posthepatectomy remnant liver function, respectively. Remnant (rem) KICG (= KICG × volumetric rate) and remKGSA (= KGSA × functional rate) were used to predict future remnant liver function; major hepatectomy was considered unsafe for values0.05. The correlation of remKICG and remKGSA with posthepatectomy mortality and morbidity was determined.Although remKICG and remKGSA were not significantly different (median value: 0.071 vs 0.075), functional rates of future remnant liver were significantly higher than volumetric rates (median: 0.54 vs 0.46; P .001). Hepatectomy was considered unsafe in 17% and 0% of patients using remKICG and remKGSA, respectively. Postoperative liver failure and mortality did not occur in the patients for whom hepatectomy was considered unsafe based on remKICG. remKGSA showed a stronger correlation with postoperative prothrombin time activity than remKICG.(99m)Tc-GSA SPECT/CT fusion imaging enables accurate assessment of future remnant liver function and suitability for hepatectomy in hilar bile duct cancer patients.

To determine the functional discrepancy between the two liver lobes using technetium 99m ((99m)Tc) diethylenetriamine-pentaacetic acid-galactosyl human serum albumin ( GSA diethylenetriamine-pentaacetic acid-galactosyl human serum albumin ) single photon emission computed tomography (SPECT)/computed tomography (CT) fusion imaging following preoperative biliary drainage and portal vein embolization ( PVE portal vein embolization ) in patients with jaundice who have bile duct cancer ( BDC bile duct cancer ).This retrospective study was approved by the institutional review board, with waiver of informed consent. Preoperative (99m)Tc- GSA diethylenetriamine-pentaacetic acid-galactosyl human serum albumin SPECT/CT fusion images from 32 patients with extrahepatic BDC bile duct cancer were retrospectively reviewed. Patients were classified into four groups according to the extent of biliary drainage and presence of a preoperative right PVE portal vein embolization : right lobe drainage group (right drainage), bilateral lobe drainage group (bilateral drainage), left lobe drainage group (left drainage), and left lobe drainage with right PVE portal vein embolization group (left drainage with right PVE portal vein embolization ). Percentage volume and percentage function were measured in each lobe using fusion imaging. The ratio between percentage function and percentage volume (the function-to-volume ratio) was calculated for each lobe, and the results were compared among the four groups. Statistical analysis was performed with Wilcoxon signed-rank tests and Mann-Whitney U tests.The median values for the function-to-volume ratio in the right drainage, bilateral drainage, left drainage, and left drainage with right PVE portal vein embolization group were 1.12, 1.05, 1.02, and 0.81 in the right lobe; and 0.51, 0.88, 0.96, and 1.17 in the left lobe. Significant differences in the function-to-volume ratio were observed among the four groups (right drainage vs bilateral drainage vs left drainage vs left drainage with right PVE portal vein embolization ; with P.002, P = .023, and P.002 for the right lobe and P.001, P = .023, and P.002 for the left lobe).Hepatic lobar function significantly differs between the two lobes, depending on the extent of biliary drainage and the presence of portal vein embolization.

We investigated the cytolytic mechanism by CD4+ T cells in anti-CD3 mAb-induced redirected cytotoxicity against a murine Fc receptor-bearing mastocytoma (P815) transfected with either CD80 or CD137 ligand (CD137L). CD137 costimulation preferentially induced anti-CD3-induced redirected cytotoxicity within 4 h. This cytotoxicity was efficiently abrogated by the addition of anti-CD137L or anti-CD95L mAb, or by treatment with a broad caspase inhibitor, Z-VAD, suggesting that the induced cytotoxicity against CD137L-P815 is dependent on CD95L-mediated apoptosis. In contrast, the cytotoxicity against CD80-P815, but not CD137L-P815 was efficiently inhibited by an inhibitor of perforin-dependent cytotoxicity, concanamycin A. Involvement of CD95L in the CD137L-dependent cytotoxicity was confirmed by a failure of induction of cytotoxicity by CD4+ T cells from CD95L-gene mutated gid mice. A rapid and remarkable induction of CD95L transcription within 1 h was observed by CD137L costimulation. These results demonstrated that CD137L costimulation induces a rapid induction of CD95L on CD4+ T cells and leads to apoptosis of CD95-sensitive target cells. This biological function of CD137 in CD4+ T cells may play an important role for immune homeostasis.

A 55-year-old man suffering from melena was admitted to our hospital. A blood test showed severe anemia. Contrast-enhanced computed tomography (CT) revealed a huge lesion in the duodenum and dilatation of the common bile duct. Upper gastrointestinal endoscopy also identified hemorrhaging from the tumor in the duodenum. Due to the low density of the tumor mass, we performed emergency pylorus-preserving pancreaticoduodenectomy. Histology revealed an area of well-differentiated liposarcoma as well as an area of high-grade spindle cells and pleomorphic sarcoma without obvious differentiation. The final pathological diagnosis was dedifferentiated liposarcoma. This is the first case report of primary liposarcoma of the duodenum.

Carcinosarcoma of the hepatobiliary tract is highly aggressive and has a poor prognosis even after curative resection. The purpose of this study was to collate and analyze published data to clarify the surgical outcome of carcinosarcoma of the hepatobiliary tract and the relationships between potential prognostic factors and survival after surgery. We surveyed worldwide literature from 1970 to 2012 and obtained clinicopathological data for 131 patients who had undergone surgical resection for carcinosarcoma of the hepatobiliary tract, including one patient from our clinic. The relationships between potential prognostic factors and survival rates were examined using the Kaplan-Meier method and the log-rank test. The overall 1-, 3-, and 5-year survival rates for patients with carcinosarcoma of the hepatobiliary tract after surgery were 44.0, 29.3, and 27.0 %, respectively. In univariate analyses, age and gender were not significant prognostic factors; however, advanced stage according to the classification of the Union for International Cancer Control in resected specimens was significantly associated with a shorter survival time after surgery. Although carcinosarcoma of the hepatobiliary tract remains a rare disease worldwide, its poor prognosis, even after curative resection, demands further epidemiological and pathological study that could lead to the development of new management strategies.

We have analyzed the mutagenic specificity of an abasic site in DNA using the yeast oligonucleotide transformation assay. Oligonucleotides containing an abasic site or its analog were introduced into B7528 or its derivatives, and nucleotide incorporation opposite abasic sites was analyzed. Cytosine was most frequently incorporated opposite a natural abasic site (O) (‘C-rule’), followed by thymine. Deletion of REV1 decreased the transformation efficiency and the incorporation of cytosine nearly to a background level. In contrast, deletion of RAD30 did not affect them. We compared the mutagenic specificity with that of a tetrahydrofuran abasic site (F), an abasic analog used widely. Its mutation spectrum was clearly different from that of O. Adenine, not cytosine, was most favorably incorporated. However, deletion of REV1 decreased the transformation efficiency with F-containing oligonucleotide as in the case of O. These results suggest that the bypass mechanism of F is different from that of O, although the bypasses in both cases are dependent on REV1. We also found that the mutagenic specificity of F can be affected by not only the adjacent bases, but also a base located two positions away from F.

We describe the technique, efficacy, and complications of fluoroscopy-guided implantation of a central venous access device using a peripherally accessed system (PAS) port via the forearm.Beginning in July 1994, 105 central venous access devices were implanted in 104 patients for the long-term infusion of antibiotics or antineoplasmic agents, blood products, or parenteral nutrition. The devices was inserted under fluoroscopic guidance with real-time venography from a peripheral route.All ports were successfully implanted. There were no procedure-related complications. No thrombosis or local infection was observed; however, in six patients catheter-related phlebitis occurred.Fluoroscopy-guided implantation of a central venous access device using a PAS port via the forearm is safe and efficacious, and injection of contrast medium through a peripheral IV catheter before introduction of the catheter helps to avoid catheter-related phlebitis.

129 Background: At the 2007 ASCO meeting, two RCTs from Japan showed that S-1 (S) and S-1/CDDP (S+P) therapy now are an accepted standard 1st-line chemotherapeutic regimens for ARGC. Today in Japan, S+α are the mainstay CTs for ARGC. However, it is important to acquire a longer survival for ARGC and therefore development of a 2nd or higher line CT after S+α failure is thus required. At the 2012 ASCO meeting, WJOG4007G trial showed that weekly PTX was regarded as a temporary standard 2nd-line CT for ARGC after the failure of S+P. However, some clinical questions to appropriate 2nd-line CT have been unsolved. The present study set out to identify the factors, which make it appropriate to perform the CT after S+α failure, and to examine the validity of this treatment. Methods: Sixty-one pts with ARGC who failed to sufficiently respond to S+α therapy between Dec. 2004 and May 2010 were retrospectively reviewed. Results: The patient characteristics were: mean age, 63.8 y.o.; sex, M/F=42/19; patient status: unresectable: 35, non-curative operation: 17 and postoperative recurrence: 9. The initial CT regimens consisted of S: 32, S+α: 29. The 2nd-line CT regimens included Taxanes (TA): 40, CPT-11 (IRI): 20, S+α: 1. The median number of 2nd or higher treatment courses was 2 (1-6). The RR of 2nd-line CT was 24.6%. The mTTF and MST since the 2nd-line CT was administered were 112 days and 311 days, respectively. The transition rate to 3rd-line was 65.6%. The OS since the S+α administration significantly correlated with the TTF of S+α (p

Erosive hemorrhage due to pseudoaneurysm is one of the most life-threatening complications after pancreatectomy. Here, we report an extremely rare case of rupture of a pseudoaneurysm of the common hepatic artery (CHA) stump that developed after distal pancreatectomy with en block celiac axis resection (DP-CAR), and was successfully treated through covered stent placement. The patient is a 66-year-old woman who underwent DP-CAR after adjuvant chemoradiotherapy for locally advanced pancreatic body cancer. She developed an intra-abdominal abscess around the remnant pancreas head 31 d after the surgery, and computed tomography (CT) showed an occluded portal vein due to the spreading inflammation around the abscess. Her general condition improved after CT-guided drainage of the abscess. However, 19 d later, she presented with melena, and CT showed a pseudoaneurysm arising from the CHA stump. Because the CHA had been resected during the DP-CAR, this artery could not be used as the access route for endovascular treatment, and instead, we placed a covered stent via the inferior pancreaticoduodenal artery originating from the superior mesenteric artery. After stent placement, cessation of bleeding and anterograde hepatic artery flow were confirmed, and the patient recovered well without any further complications. CT angiography at the 6-mo follow-up indicated the patency of the covered stent with sustained hepatic artery flow. To our knowledge, this is the first reported case of endovascular repair of a pseudoaneurysm that developed after DP-CAR.

AIM: To evaluate the functional differences between the 2 liver lobes in non-cirrhotic patients by using computed tomography/99mTc-galactosyl human serum albumin (CT/99mTc-GSA) single-photon emission computed tomography (SPECT) fusion images. METHODS: Between December 2008 and March 2012, 264 non-cirrhotic patients underwent preoperative liver function assessment using CT/99mTc-GSA SPECT fusion images. Of these, 30 patients, in whom the influence of a tumor on the liver parenchyma was estimated to be negligible, were selected. Specifically, the selected patients were required to meet either of the following criteria: (1) the presence of an extrahepatic tumor; or (2) presence of a single small intrahepatic tumor. These 30 patients were retrospectively analyzed to calculate the percentage volume (%Volume) and the percentage function (%Function) of each lobe. The ratio between the %Function and %Volume (function-to-volume ratio) of each lobe was also calculated, and the ratios were compared between the 2 lobes. Furthermore, the correlations between the function-to-volume ratio and each of 2 liver parameters [lobe volume and diameter ratio of the left portal vein to the right portal vein (LPV-to-RPV diameter ratio)] were investigated. RESULTS: The median values of %Volume and %Function were 62.6% and 67.1% in the right lobe, with %Function being significantly higher than %Volume (P < 0.01). The median values of %Volume and %Function were 31.0% and 28.7% in the left lobe, with %Function being significantly lower than %Volume (P < 0.01). The function-to-volume ratios of the right lobe (1.04-1.14) were significantly higher than those of the left lobe (0.74-0.99) (P < 0.01). The function-to-volume ratio showed no significant correlation between the lobe volume in either lobe. In contrast, the function-to-volume ratio showed significant correlations with the LPV-to-RPV diameter ratio in both lobes (right lobe: negative correlation, rs = -0.37, P = 0.048; left lobe: positive correlation, rs = 0.71, P < 0.001). The function-to-volume ratio in the left lobe tended to be higher, and that in the right lobe tended to be lower, in accordance with the increase in the LPV-to-RPV diameter ratio. CONCLUSION: CT/99mTc-GSA SPECT fusion images demonstrated that the function of the left lobe was significantly decreased compared with that of the right lobe in non-cirrhotic livers.

e15668 Background: At the 2007 ASCO annual meeting, JCOG 9912 and the SPIRITS trial showed that S-1 (S) and CDDP/S-1 (S+P) therapy to now be an accepted standard chemotherapy for advanced and recurrent gastric cancer (ARGC). Today in Japan, S- 1+αincluding S+DTX, S+CPT-11 and S+PTX are the mainstay treatments for ARGC. There are some case reports of pts with UNGC who were operated on due to the good anti-tumor effect of S-1+α, however, no consensus for performing a gastrectomy after chemotherapy has yet been reached. This study aims to identify the factors which make it appropriate to perform a gastrectomy after S- 1+α and to examine the validity of this chemotherapeutic regimen in combination with surgery. Methods: Twenty-five chemo-naïve pts with UNGC who received S-1+α (excluding neo-adjuvant) between May 2005 and Dec. 2007 were retrospectively reviewed, using the RESIST, Kaplan-Meier method, and Japanese Classification of Gastric Carcinoma (Eng. ed.). Results: The characteristics were: mean age 62; sex: M/F=18/7; cancer status; locally advanced (L):11, distant metastasis (D):9, lymph node swelling ≥group 3 (N):12, and peritoneal dissemination (P):11. Treatment regimens; S:13, S+DTX:3, and S+P:9. The median number of courses was 5. RR was 56% (PR:14, SD:9, PD:2). MST was 780 days. Twelve pts underwent a gastrectomy. The reasons for performing an operation were downstaging (DOWN):8, and palliative (PAL):4 (anemia:2/passage disturbance:2). The features were DOWN (M/F=5/3/65 yrs/PR:8/L:6, D:0, N:4, P:3) and PAL (M/F=4/0/57 yrs/SD:4/L:1, D:3, N:1 P:1). The median PFS and mean OS were 445 days and 312 days, respectively. No significant difference was observed between DOWN and PAL regarding the PFS and OS. All PAL cases were free from painful symptoms. Three pts received a curative A resection. In addition, 8 pts experienced histological changes, in particular, one pt achieved Grade 3 (No viable tumor cells were found.). Ten pts received adjuvant chemotherapy. Nine pts are alive at this writing. Conclusions: The findings of this study suggest that the above described chemotherapeutic regimen combined with a second-look gastrectomy might therefore be a new potentially effective strategy for the treatment of UNGC. No significant financial relationships to disclose.