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Background: Preoperative chemoradiotherapy (CRT) with 5-FU has been widely used to improve local control of disease and to preserve anal sphincter in the treatment of rectal cancer. UFT and S-1 as oral dihydropyrimidine dehydrogenase (DPD)-inhibitory fluoropyrimidines enhance the therapeutic effect of 5-FU by modulating its metabolic pathways. The purpose of this study was to evaluate the efficacy and toxicity of CRT using UFT versus S-1 in patients with locally advanced rectal cancer. Methods: Fifty-nine patients who received preoperative CRT (40 Gy radiotherapy) were randomly assigned to either UFT or S-1 groups. UFT and S-1 were administered during the radiotherapy course. Response to CRT was determined using a histopathologic examination and RECIST of surgically resected specimens and classified as responders (CR, PR and grade 2, 3) or nonresponders (SD, PD and grade 0, 1). Results: All patients were randomly allocated to S-1 group (n = 30) or UFT group (n = 29). Pathological response rate (Grade2 and Grade3) was 57% in the S-1 group and 45% in the UFT group (p = 0.36). Pathological complete response (CR) rate (Grade3) was 7% in the S-1 group and 4% in the UFT group (p = 0.98). There was no statistically significant difference between the two groups in regard to the response rate of RECIST (p = 0.52). There was no statistically significant difference between the groups based on the downstaging rate, resection of tumor, sphincter preservation and marginal invasion. The incidence of Grade 3 diarrhea was significantly more frequent in the S-1 group (7%) compared with the UFT group (0%) (p = 0.02). Conclusion: The results supported the conclusion that CRT using UFT or S-1 is effective and feasible for patients with locally advanced rectal cancer.

A 71-year-old woman was referred to the department bacause of a pulsatile abdominal mass. CT scan showed an abdominal aortic aneurysm with the maximum diameter of 6cm. Platelet count was 12.0× 104/mm3 two and a half years before admission, 9.3×104/mm3 one year before admission and 6.4×104/mm3 on the day before operation and the value of PAIgG was increased to 116.4ng/107 cells. On the day before operation 15g of γ-globulin was transfused. On the operation day the same amount of γ-globulin and 20 units of platelet and on the first postoperative day 10 units of platelet were transfused. The aneurysm was successfully replaced with a Y graft without any complications. Platelet count was 12.8×104/mm3 just after the operation, 9.7×104/mm3 on the second day, and increased to the maximum of 23.4×104/mm3 on the 18th day. Then it turned to decrease and dropped to 7.0 × 104/mm3 10 months after the opration. With the administration of highdose of γ-globulin and platelets, the aneurysm was replaced safely.

肝細胞癌手術症例の初回術式について関連肝炎別に検討した.対象は遺残例を除くHBs抗原陽性例 (B群) 24例, HCV抗体陽性例 (C群) 67例で, B群で若年者に多く腫瘍径が大きかった.門脈侵襲, 肝内転移など予後に与える因子の陽性率は腫瘍径5cm以上の群で有意に高かったので, B群18例, C群63例の腫瘍径5cm未満症例について検討した.再発例はB群が4例 (22.2%), C群が36例 (57.1%) で, 再発様式はB群は2例 (50.0%) が残肝多発再発であったが, C群では多発再発は5例 (13.9%) のみで, 同側葉, 対側葉の別で差は見られなかった.[結論] 1.B群では肝機能が良好で再発様式も遺残再発が多く, 初回手術時に病巣をできるだけ大きく系統的に治癒切除すべきである, 2.C群では初回, 再発ともに多中心性発生と考えられる症例が多く局所のコントロールを目的とした支配グリソンを処理した部分切除で良いと考えられた.

A space-occupying lesion in the right hepatic lobe, with dilated peripheral bile ducts, was observed by ultrasonography and computed tomography in a 50-year-old man with right upper quadrant abdominal pain. One month later, this lesion evidenced rapid growth and a tumor thrombus, which completely occluded the main trunk and the left primary branch of the portal vein, had developed. The tumor was diagnosed as a cholangiocellular carcinoma with an unusual pattern of intravascular extension. The primary tumor and the portal tumor thrombus were resected via a right hepatic trisegmentectomy combined with resection of the portal vein and extrahepatic bile duct, using a superior mesenteric vein—left femoral vein catheter bypass (SMV—FV bypass). The SMV—FV bypass was found to effectively reduce intraoperative hemorrhage.

肝切除後早期の腹水発生関連因子につき検討した.1985年1月から1993年12月までの肝細胞癌肝切除例中77例を対象とし, 術後腹腔ドレーンからの1日最大総排液量が500ml未満をA群 (53例, 68.8%), 500ml以上をB群 (24例, 31.2%) に分類した.両群間 (A vs B) で有意差を認めたものは, 術前因子でChE (0.58±0.21 vs 0.45±0.15ΔpH), ICGRmax (1.15±1.01 vs 0.78±0.42mg/kg/min), 総合的Risk (2.35±0.64 vs 2.65±0.43), 術中因子で手術時間, 出血量, 輸血・輸液量, 術後因子で組織学的肝硬変度であった.両群間で, アプローチ法, 肝阻血法, 阻血時間, 脱転操作の有無, 切除部位・範囲, 切除重量に有意差はなかった.術後大量腹水の発生にはChE, ICGRmax, 総合的Risk, 肝組織の硬変度が重要であり, 長時間手術や術中出血量, 輸血・輸液量の多い症例に好発した.術後管理は, 体液バランスと肝機能保護, 術後合併症予防とその治療が重要と考えられた.

The therapeutic outcome after hepatic resection for hepatocellular carcinomas (HCC) smaller than 5cm in diameter was examined in 65 patients followed up for more than 6 months postoperatively. Patients were divided into two groups: patients with solitary tumors (ST, n=46) and those with two or more tumors (n=19). The latter group was subdivided into an intrahepatic metastasis (IM) group (n=10), and multicentric occurrence (MT) group (n=9). There was one perioperative death (1.5%), and 21 patients suffered from postoperative complications (32.3%). The overall 1-year, 3-year, and 5-year survival rates were 86.1%, 72.3%, and 44/7%, respectively. The 3-year survival rate was significantly higher in the MT than IM group (86% versus 42%, p

Studies were made in dogs on ischemic injury of the liver induced by clamping the portal triad and inferior vena cava and on the influences of urinary trypsin inhibitor (Ulinastatin) on the ischemic changes. The increases in aspartate aminotransferase and alanine aminotransferase activities in the peripheral blood serum induced by ischemia and reperfusion were lowered by perfusion treatment of ischemic liver with ulinastatin for 60min or its injection into the general circulation 5min before reperfusion. The increase in lipid peroxides, measured by the TBA-method, in the post-ischemic liver was also decreased by administration of ulinastatin. α-Tocopherol in the liver decreased during ischemia-reperfusion, and its decrease was completely prevented by ulinastatin treatment. However, infiltration of neutrophils into post-ischemic liver tissue was not inhibited by ulinastatin. The effect of in vitro addition of ulinastatin on the formation of superoxide anion radicals by the xanthine-xanthine oxidase system and NADPH oxidase in polymorphonuclear leukocytes (PMNs) was also investigated. Ulinastatin did not affect xanthine oxidase activity or O2- formation. It also did not scavenge O2-. On the contrary, it inhibited O2- formation by PMNs induced by N-formylmethionylleucylphenylalanine, concanavalin A plus cytocalasin B, or phorbol 12-myristate 13-acetate. The mechanisms of the protective effect of ulinastatin on ischemic liver injury are discussed from the view point of its antioxidant properties.

Background. Hepatocellular carcinoma is likely to accompany liver cirrhosis in which the portal pressure increases with portasystemic shunt. When portal tumor thrombus is present in the primary bifurcation, blood flow differs between the thrombolic lobe and the non-thrombolic lobe. In those cases, it is difficult to evaluate exactly residual liver function by conventional test. Therefore, the following studies were performed. Materials and Methods. Adult mongrel dogs are divided into a control group (C group), group undergoing ligation of theleftportalbranch(PLgroup),groupundergoingportacaval anastomosis (PCS group) and group undergoing both ligation of the left portal branch and portacaval anastomosis (PL+PCSgroup)(n=5). ICG-R15 and MEGX15 in peripheral venous blood and right hepatic venous blood were determined. Mitchondrial metabolic capacity (adenosine triphosphate level, energy charge) was measured by high-performance liquid chromatography using liver biopsied specimens. Results. The MEGX ratio (right hepatic venous blood MEGX15/peripheral venous blood MEGX 15) positively correlated with energy charge in the right hepatic lobe. Conclusions. In evaluating liver function of the right hepatic lobe during portacaval shunt and the left portal branch ligation, the MEGX ratio may sensitively reflect the mitochondrial function. J. Med. Invest. 51 : 84-95, February, 2004