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The antigen W22 was found to be subdivided into three components in the Japanese population. Population and family studies indicate that a t least two of these components are new antigens. By using both known and new antigens, gene and haplotype frequencies in the Japanese population are shown.

Building damage such as to side-walls or mid-story collapse is often overlooked in vertical optical images. Hence, in order to observe such building damage modes, high-resolution SAR images are introduced considering the side-looking nature of SAR. In the 2011 Tohoku, Japan, earthquake, a large number of buildings were collapsed or severely damaged due to repeated tsunamis. One of the important tsunami effects on buildings is that the damage is concentrated to their side-walls and lower stories. Thus this paper proposes the method to detect this kind damage from the change in layover areas in SAR intensity images. Multi-temporal TerraSAR-X images covering the Sendai-Shiogama Port were employed to detect building damage due to the tsunamis caused by the earthquake. The backscattering coefficients in layover areas of individual buildings were extracted and then, the average value in each layover area was calculated. The average value was seen to decrease in the post-event image due to the reduced backscatter from building side-walls. This example demonstrated the usefulness of high-resolution SAR intensity images to detect severe damage to building side-walls based on the changes of the backscattering coefficient in the layover areas.

肝虚血による肝ミクロソーム機能の変化を,トリメタジオン(TMO)負荷試験により調べた.TMO 4m/kgな急速静注し,血清中のTMOとTMOの代謝物であるジメタジオン(DMO)を測定した.無処置犬30頭におけるTMOの半減期は3.1±1.2時間,クリアランスは2.60±0.95ml/min/kgであった.TMO投与1時間後および2時間後の血清DMO/TMO比はそれぞれ0.63±0.27, 1.29±0.63で,どちらも半減期,クリアランスと有意(p

肝細胞癌手術の術前と術後に, リピオドール-抗癌剤懸濁液動注療法 (L-TAI) をおこなった, 絶対的非治癒切除例を除く肝切除耐術例34例の予後規定因子を検討した.そのうち11例 (32%) に再発を認めた.その無再発生存率は, 1年, 91%, 3年, 68%, 5年, 45%であった.L-TAIによる80%以上の腫瘍内壊死, 腫瘍径5cm以下, 組織学的被膜浸潤なし (fc-inf (-)) そして組織学的門脈侵襲なし (vp (-)) などの各因子は, 有意に予後に良い影響を与えた.被膜浸潤の有無にかかわらず, 3cm以下の腫瘍の5年無再発生存率は100%であった, さらにfc-inf (-) 例やfc-inf (+) 例のそれぞれにおいて, 壊死率の高いほど, また腫瘍径が小さいほど, 再発までの期間は延長した.

腸間膜動脈閉塞症の早期診断ならびに治療方針の確立を目的として, 診断, 治療ならびに予後について, 本症と絞扼性イレウスを対比検討した. 対象は, 腸間膜動脈閉塞症 (1群) 12例と絞扼性イレウス (II群) 27例である. 背景因子としては, 年齢 (1群69±9歳, II群54±21歳), 開腹術の既往 (各17%, 74%), 心疾患の併存 (各75%, 22%), 身体所見では腹部圧痛 (各58%, 96%), 反跳痛 (各25%, 78%), 筋性防御 (各8%, 70%), 検査所見ではLDH≧5001U/l (各92%, 26%), 治療では, 広範囲腸管切除率 (各70%, 11%), 予後では, 死亡率 (各50%, 4%) において1群とII群間に有意差 (p

Ten cases of acute superior mesenteric arterial (SMA) occlusion were subjected to a clinical study of diagnosis, treatment, and prognosis.The occlusion of SMA was correctly diagnosed in 14% by ultrasonography, in 40% by computed tomography, and in 100% by angiography. Therefore angiography should be performed in all suspicious cases of SMA occlusion. Eight of 10 patients were operated on. Two remaining patients were inoperable because of synchronous embolisms in other arteries as well as poor general condition. In 8 operated patients selective intraarterial infusion of urokinase, a fibrinolysis agent, followed by laparotomy saved lives in 2 and embolectomy did in one, whereas 3 out of 5 undergone bowel resection died. Bowel resection rate was 0% (0/3) in patients treated within 10 hours after the onset of symptoms versus 100% (5/5) in those whose treatment was delayed beyond 10 hours, with a significant difference (p

From October 1976 to May, 1990, a total of 86 patients with stage IV (TNM) gallbladder cancer were treated at Tsukuba University Hospital. Twenty-seven of the 86 patients underwent tumor resection; 43 patients received palliative surgery. The remaining 16 were too advanced to have surgery. Of 27 patients who had tumor resection, 9 had resection alone, 17 had intraoperative radiation therapy (IORT) +/- postoperative external radiotherapy (ERT), and 1 had postoperative ERT. The procedures used were: extended right hepatic lobectomy plus hepaticobiliary resection (HBR) (n = 2), hepatic segmentectomy (SIVb, SV) plus HBR (n = 9), hepatic segmentectomy (SIV, V, VI) with HBR (n = 1), hepatic segmentectomy (SIV, V) plus HBR with pancreaticoduodenectomy (PD) (n = 3), PD plus HBR (n = 1), cholecystectomy with wedge resection of the gallbladder fossa plus HBR (n = 3), and cholecystectomy plus HBR (n = 3), and cholecystectomy (n = 4). Regional lymph node dissections were performed in every patient and 17 of 27 patients underwent additional resections of adjacent organs such as the stomach, duodenum, colon, and abdominal wall. A single dose of 20-30 Gy was delivered intraoperatively for 17 patients. A mean total dose of 36.4 Gy (1.8/fraction) was added to IORT for 10 patients. The three-year cumulative survival rate was 10.1% for resection plus IORT but 0% for resection alone. The longest survivor is alive and well at 3 years and 3 patients are alive 16, 13, and 4 months after tumor resection followed by IORT plus ERT.

肝門部胆管癌切除57例中治癒切除は13例で, 非治癒切除は44例である.このうち9例が5年以上生存し, StageはII;1例, III;3例, IV;5例で, 6例が治癒切除, 3例が非治癒切除である.術式 (胆道癌取扱い規約) は肝門部胆管切除 [hilar bile duct resection (HBDR)];2, HBDR+pancreatoduodenectomy (PD);1, HBDR+拡大肝右葉切除+尾状葉 (SI) 切除;1, HBDR+拡大肝左葉切除 (SI合併切除4例);5例である.組織学的深達度では9例中4例 (40.4%) が他臓器に浸潤し, 1例のみが外膜にとどまる症例であった.肝実質に癌浸潤のある症例は9例中5例 (55.6%) で, リンパ節転移例は3例のみであった.剥離面に癌浸潤の明かな症例が3例あり, 肝臓側胆管断端に癌浸潤を認める症例は1例のみであった.3年以上生存例 (13例) の検討では剥離面及び肝臓側胆管断端の癌浸潤陽性頻度は3年末満死亡例 (36例) に比べて有意 (p

直腸癌術前照射療法(42.6Gy)の行なわれた53例を対象に,組織学的照射効果の著しいもの28例(著効群)とそれ以外のもの25例(非著効群)の2群に分け,それぞれの術後治療成績を比較検討した.壁深達度,ew(外科的剥離端までの距離),リンパ節転移において著効群では局所再発high risk症例が著しく減少し,非著効群との間に明らかな有意差が認められた.著効群の局所再発率は3.6%で非著効群(12.0%)に比べ低値を示し,再発までの期間も延長する傾向がみられた.累積5年生存率は著効群87.7%,非著効群57.9%であり両群間に有意差が認められた.以上の結果,照射効果の程度と治療成績の間には深い関連性が認められ,より高い照射効果の得られるような集学的治療法の重要性が示唆された.

抗癌剤を併用した直腸癌術前照射49症例の組織学的照射効果を5段階に評価し,照射前の臨床所見・生検組織所見と比較検討した.その結果,著効例の出現に20%以上の差を認めたのは,性別(女性>男性),環周度(2/3周未満>2/3周以上),組織学的分化度(高中低分化),cellular atypism(CAT2>1>3),structural atypism(SAT2>1>3),infiltration(INFβ>α>γ),癌細胞の粘液量(少いもの>多いもの)などの所見であった.これらのうちCATの程度と照射効果の間には統計的有意差(P

Adriamycin (ADR) was covalently conjugated with a copolymer of divinyl ether and maleic anhydride (DIVEMA). Either sole ADR or DIVEMA-ADR conjugate was injected intraperitoneally into mice, and the concentration of ADR in the serum and peritoneal fluid (PF) was measured by HPLC (high-performance liquid chromatography). A reversed phase liquid chromatography column enabled to measure the concentration of ADR as low as 6 ng/ml. In sole ADR administration, the ADR concentration in the PF reached 179 ng/ml at one hour then gradually decreased to 13 ng/ml at 24 hours after i.p. injection. In contrast, the concentration in the serum fell rapidly from 16.8 ng/ml at one hour to 6.6 ng/ml at 2 hours after the injection. In DIVEMA-ADR conjugate, the ADR concentration in the PF was elevated to 4, 057 ng/ml at one hour and decreased more slowly than in sole ADR. Even at 24 hours after i.p. administration of the conjugate, ADR was kept as high as 90 ng/ml in the PF. On the other hand, the serum concentration remained under the limit of detection at all times measured. Pharmacokinetic parameters were obtained based on the time-concentration curves of either sole ADR or DIVEMA-ADR administration, using two-compartment model. The results showed that the conjugate increased the AUC(area under the curve) of ADR in the PF by 15.4 times higher than that of sole ADR. These remarkable ability of DIVEMA conjugate on pharmacokinetics of ADR would be greatly contributable for improvement of cancer chemotherapy, especially for the treatment of peritoneal dissemination from intraabdominal malignancies.

Five male patients with extrahepatic cholelithasis and ten male patients with liver cirrhosis were administered simultaneously 4mg/kg trimethadione (TMO) and 500mg/man antipyrine (AP). Changes in phase I (AP and TMO) and phase II (AP) reactions of the model substrates in liver disease were examined. The patients with liver cirrhosis exhibited prolonged half-life (t1/2) and decreased metabolic clearance (CL) of AP when compared with cholelithasis patients, while no change was found in the apparent volume of distribution (Vd). The serum dimethadione (DMO)/TMO ratio at 4hr after oral administration of TMO was apparently decreased in the cirrhotic patients. The cirrhotic patients also exhibited significant decreases in urinary excretion and clearance for production of three major AP metabolites (4-hydroxyantipyrine, 3-hydroxymethyl-3-norantipyrine, and 3-hydroxymethylantipyrine), while no significant differences between the cirrhotic patients and cholelithasis patients were noted in percentages of either total or individual glucuronidation of these metabolites. These findings suggest that AP and TMO metabolisms (phase I) are severely impaired in cirrhotic patients, whereas glucuronidation of AP is unaffected (phase II).

Endoscopic sclerotherapy has been used to manage esophageal varices. Severe complications resulting from this therapy including renal dysfunction have been reported. Therefore, particular caution must be taken with patients who have serious renal damage. Sclerotherapy was performed for esophagogastric varices in a patient that had received a kidney transplant following chronic renal dysfunction. Ethanolamine oleate was used as the sclerosant, and contained a contrast medium for varicealography in order that the flow of the sclerosant be monitored by fluoroscopy. Varicography during the injection allowed us to stop injection into the varices and into the irregular passageways of the feeders to the varices before the agent entered the systemic circulation. There were no complications during therapy. The patient died due to respiratory failure 41 months after the first treatment. Macroscopic findings of the autopsied specimens showed no esophagogastric varices and microscopic findings showed organized varices with recanalization into the submucosal layer of the esophagogastric lesions. Injection sclerotherapy using varicography with sclerosant-contrast medium mixture allowed treatment of this patient without incurring renal dysfunction.

Thirteen patients, who had recurrent esophageal varices after esophageal transection or esophagoproximal gastrectomy were treated by endoscopic injection sclerotherapy. Four patients successfully underwent emergency sclerotherapy to control active variceal hemorrhaging. Three of these patients and the remaining nine patients (including six rebleeding patients who were conservatively treated) underwent elective sclerotherapy. None of the patients had variceal rebleeding in the follow-up study with sclerotherapies. Only one patient with recurrent varices did not undergo any additional sclerotherapy following emergency treatment. In this study, no deaths occured nor any major complications. Minor complications such as low grade fever and chest pain were observed, but they were transient and disappeared within 2 or 3 days without specific treatments. It is concluded that endoscopic injection sclerotherapy is considered to be the most effective procedure for recurrent varice following surgery.

Survival period, causes of death and variceal rebleeding in 20 patients with esophageal varices associated with hepatocellular carcinoma and liver cirrhosis were analyzed to evaluate the effectiveness of injection sclerotherapy. The first injection sclerotherapy successfully stopped active variceal bleeding in all seven emergency cases. These were followed up as elective cases later on. The remaining 13 patients, who had a history of variceal bleeding, were treated as elective cases from the beginning. Endoscopic evaluation of the varices was performed at intervals of six months to one year, after the first sclerotherapy, and recurrence was treated by elective sclerotherapy. 85% of the patients died within one year. Three out of 20 cases were still alive until this study was performed. But, whereas 17 patients died mainly due to hepatic failure and hepatocellular carcinoma, only one patient died due to variceal rebleeding. No deaths were observed to have been directly due to sclerotherapy or its complications. Hence we think that injection sclerotherapy should be considered one of the treatments for esophageal varices in patients with hepatocellular carcinoma and liver cirrhosis.

High recurrence and rebleeding rates have been reported when endoscopic sclerotherapy has been performed on patients with esophageal varices. We studied the relationship between embolization range and recurrence rate in 26 patients in whom percutaneous transhepatic portography was carried out before and after sclerotherapy. Patients were divided into complete and incomplete embolization groups. The complete embolization group consisted of 16 patients whose esophageal varices had disappeared and in whom embolization of the feeders to the varices had occurred. The incomplete embolization group consisted of 10 patients whose esophageal varices had disappeared, but no embolization had occurred. Recurrence rates within 2 yr after the treatment were compared between complete and incomplete embolization groups. The recurrence rates in the respective groups were 6.7% (1 of 15) and 70.0% (7 of 10), indicating a significant difference between the two groups (p less than 0.05) and indicating that embolization of both esophageal varices and their feeders is essential to lower the recurrence rate after sclerotherapy.

The efficacy and safety of preoperative chemotherapy with carmofur (HCFU) for colorectal cancer were evaluated in a randomized controlled study involving 63 institutes in the Kanto area. Patients aged 75 or younger with Dukes' B or C colorectal cancer were eligible if curative surgery was expected. In the end, 326 were eligible from 405 consecutive colorectal cancer patients. Patients in both the control (n = 162) and the new treatment group (n = 164) were given intravenous mitomycin C (MMC) 6 mg/m2 on day 0 and 7 after surgery and HCFU 300 mg/day orally from day 14 for a year. Patients in the new treatment group were also given oral HCFU for 14 days or more prior to surgery. All 326 patients were followed for 5 years or longer. Five-year overall and disease-free survival rates were not significantly different between the two groups (75.4% and 71.6% for the control, and 71.8% and 71.5% for the study group, respectively). In the subset analysis, neither cancer site nor nodal status affected the differences in overall- and disease-free survival rates between the groups. The present findings show no additional efficacy of preoperative chemotherapy with HCFU in survival from advanced colorectal cancer. Further investigations in terms of patient selection, treatment regimen, combined use of radiotherapy, and other factors would be required to determine the significance of preoperative chemotherapy against advanced colorectal cancer.

We report a case of nonseminomatous testicular tumor with lymph node involvement and multiple lung and liver metastases. The patient was considered to have a poor prognosis. He received systemic chemotherapy and cytoreductive surgery. Postoperatively a residual metastatic tumor in the liver was treated by intrahepatic arterial cisplatinum-diaminedichloride infusion. Follow-up observation has revealed no evidence of recurrence for 30 months since the last treatment.

我が国の水道管はこれから老朽化をむかえ更新を行っていく必要があるものが多い．一方で人口減少がすすみ，需要水量の変化や料金収入の減少が予想される．本研究においては，人口減少が顕著に進むと考えられる地方の水道管の更新について，人口が減少した状況を見据えて更新するとともに，その過程においても安定した給水状況と更新事業を保証しつつ進める手法について検討した．提案した方法で人口減少に配慮しつつ更新事業を進めることで，更新管の口径を小さくできることにより，予算内で更新管路を増やすことができ，完成後の管網は管内滞留時間が短く水の到達時間が改善された．

We investigated the indication for combined resection of the stomach and adjacent organs in patients diagnosed as having gastric cancer with macroscopic invasion to adjacent organs. The aim of the study was to determine whether the prognosis was related to regions of the gastric wall showing carcinoma invasion, macroscopic type, histological type, location, numbers of invaded adjacent organs, grade of disseminated peritoneal metastasis, grade of liver metastasis, curability of lymph nodes and the histological vertical depth of the lesion. It was found that in patients who underwent combined resection of the stomach and adjacent organs, the prognosis was related to the number of invaded adjacent organs, grade of disseminated peritoneal metastasis, presence or absence of liver metastasis and the grade of curability of lymph nodes, whereas it was not related to the regions of gastric wall showing carcinoma invasion, macroscopic type, histological type, location or vertical depth of the lesion. As mentioned above, combined resection of gastric cancer with macroscopic invasion to adjacent organs is indicated for patients who have only one invaded organ, little or no disseminated peritoneal metastasis and no liver metastasis. Consequently, it is concluded that it is important to perform this type of operation in which the metastatic or majority of the regional lymph nodes are resected.

進行直腸癌に対する術前照射療法の治療効果を高めるため, 抗癌剤の腫瘍内局注併用法を施行した.その治療効果を比較するため, 非照射25例, 照射単独15例, 局注併用21例の切除標本を用い癌巣の分布を比較した.照射前の注腸X線像をもとに壁深達度の改善が著しいと判定された症例は, 照射単独例4例 (26.7%), 局注併用例11例 (52.4%) であった.それぞれの組織構築図を作製し検討した結果では, 局注併用例は照射単例に比べ, 壁外浸潤 (a1以上) とew2mm以下の鯛がより狭くなっている傾向が示唆された.さらに局注併用例のうち著しい照射効果のみられた症例では, 癌胞巣の退行性変化 (のう胞状病変など) が広く認められた.

新しく開発した吸引式洗腸器の有用性を知る目的で, 従来より使用されていたストッパー式洗腸器と比較検討した.対象はMiles手術後の結腸終端人工肛門保有者で, それぞれの洗腸器を使用していた15症例 (計30症例) について対面調査を行った.その結果, 吸引式洗腸器の長所としては穿孔の危険が少いこと, 速やかに完全な洗腸が行えること, 臭気もなく清潔に行えることが挙げられた.一方, ストッパー式洗腸器に比べ十分な指導を必要とするなど, いくつかの短所も示唆された.以上の結果から, 本洗腸器は若い知識人に適しており, さらに狭窄様人工肛門症例の洗腸にも威力を発揮していることが明らかとなった.

教室では十二指腸潰瘍に対する外科的治療法の一つとして迷走神経切離兼幽門成形術を90例に行った.本法術後の減酸効果は全体としてほぼ満足すべき結果であった.とくに完全迷切例では術後早期 (術後3-4週) と遠隔時 (術後1-10年) のいずれ場合も, 減酸率は60-80%で良好であった.しかしながら不完全迷切例では, 術後早期には満足すべき灘効果を示したが, 遠隔時では基礎分泌とインスリン胃酸分泌が上昇回復して, 術後早期よりかなり高値となり, 減酸効果は不十分で潰瘍再発の可能性が生じる.再発潰瘍例は90例中5例に発生し, 5.5%の頻度となる.再発潰瘍例の遠隔時胃酸分泌の特長は, 不完全迷切例と同様に刺激後胃酸分泌が高値を示す一方, 基礎分泌が不完全迷切例より有意に高いことであった.

A 68-year-old man was admitted to the hospital because of epigastralgia after meal and right lower abdominal tumor. The tumor was firmly adherent to the abdominal wall and there was slight abdominal distension. On barium enema examination, a filling defect and stricture of ileocecal region were found, and the terminal ileum was dilatated. On fiberscopic examination, the tumor occupied the whole circumference of ileocecal wall and the endoscope could not be inserted beyond the stricture. Endoscopic diagnosis was carci-noma of the cecum, and biopsy was performed. Because of obstructive symptoms the patient was operated on at the 10th hospital day, before pathological diagnosis had been made.On operation the disseminated miliary tuberculi were found on the whole peritoneum and ileocecal resection was performed, followed by side-to-side anastomosis of stenosed ileum. Microscopic examination revealed classic tuberculous granuloma, and pathological diagnosis was ileocecal tuberculosis. The patient was discharged on 37th day after operation, followed by chemotherapy.Active pulmonary tuberculosis was not observed in this case.Although rare, hypertrophic intestinal tuberculosis occures almost 85% in the ileocecal region and it mimics carcinoma of the cecum.We reported a case of hypertrophic intestinal tuberculosis which had been very diffi-cult to differentiate from carcinoma of cecum.

A case of an obturator hernia preoperatively diagnosed by computed tomography (CT) is reported. The key CT findings for the diagnosis are a bowel loop located posterior to the pectineus muscle, deformed muscular bands of external obturater muscle and dilated bowel loop proximal to the obturator foramen. We believe that CT can be a very useful tool for the diagnosis of obturator hernia.

For the purpose of inducing the specific tolerance by bone marrow transplantation, the PHA non-responding cells out of the bone marrow cells were transplanted to mongrel dogs in order to avoid the acute graft-versus-host reaction after conditioning the animals with cyclophosphamide. And nine out of 13 mongrel dogs survived under the condition of successfully established chimerism. The mixed lymphocyte culture between donor and recipient showed no response after chimerism had been established, while chimera dogs responded normally against heterologous antigens. However, the phenomenon that the degree of donor cell occupancy decreased as time went by forced us to consider the existence of immunological reaction of recipient to donor cells.

最近, 診断法の著しい進歩により, 肝門部胆管癌あるいは乳頭部癌などの肝胆膵系癌の適確な術前診断が可能になり, この方面の切除例が増加してきたと同時に, これらに対する高カロリー輸液を施行する機会が多くなつてきた.ほとんどの例が黄疸を伴い, 食思不振もあいまつて栄養不良状態に陥つていることが多く, 根治術例も多くの例で他の消化器外科術後よりも食事摂取の進み方も遅く, 時に術後腸管出血等も経験する.このような患者にも, 高濃度ブドウ糖をベースにした高カロリー輸液は可能であり, インスリンを必要とした例はむしろ少ない.いままでのアミノ酸代謝に関する数多くの報告は, ほとんどが低カロリー輸液におけるものであり再検討が早急に望まれるところである.必須アミノ酸液ならびにそれからフェニールアラニンを除いたもの, アルギニンを除いたもの, 濃度の異なる総合アミノ酸液など5種類のものを用いて検討したが, 単独投与で血中アンモニアに変化をおよぼすものも, 高カロリー輸液施行中では, 2g/kg投与でも血中アンモニア, 意識レベルの変化はなく, 十分高カロリー輸液を維持することは可能である.肝切除後などは, 必須アミノ酸のみでなく, 総合アミノ酸を併した高カロリー輸液の方が, 尿中での遊離アミノ酸の排出は少ないことも示唆する結果が得られた.

A detailed retrospective analysis of the efficacy of intraoperative radiotherapy (IOR) in advanced carcinoma of the pancreas is presented. During a 10-year period from 1973 through 1982, 70 patients with advanced carcinoma of the pancreas were treated by multimodal methods, separate or combined therapy of surgery, IOR, and chemotherapy in two different institutions. Among these, 33 patients underwent IOR, mostly combined with additive surgery. A single dose of 20.1 to 40.0 Gy with 8 to 25 meV electrons was delivered through radiation cones ranging from 6 to 10 cm in diameter. Excellent relief was noticed in 50% of the patients who had complained of pain. Among Stage IV patients, a significant difference of survival rate was observed between IOR and control groups (P less than 0.05); the mean survival time of the IOR group was 4.6 +/- 2.6 (SD) and that of the control group 2.5 +/- 1.4 (SD) months. Intraoperative radiotherapy proved to be effective in prolonging the survival of patients with advanced stage of the lesion.

Two cases of carcinoma of the bifurcation of the main hepatic ducts are presented. The tumors were successfully removed by resection of the bifurcation in one case, and by left hepatic lobectomy in the other. Some other 38 cases of the same condition collected from the world literature are briefly reviewed and discussed with particular reference to their surgical interventions.

人工肛門より明瞭な注腸造影を得るために, 内外2筒からなる陰圧型の人工肛門注腸補助器を開発した.これとgyroscopeとの併用により, 直腸癌術後などの人工肛門保有者30例に注腸X線検査を行い, つぎのような利点が判明した.すなわち (1) 残存結腸の完全な二重造影像が得られ,(2) 人工肛門周囲を汚すことなく検査が終了し,(3) 腸管穿孔の心配が全くないことなどである.これらの検査でわれわれの補助器が有用であった症例を紹介し, さらに人工肛門からの高圧浣腸にも応用しているのでその実際について説明した.

College of Medical Technology and Nursing, University of Tsukuba The strains and number of bacteria in the peritoneal washed-out fluid obtained just before the closure of the wound was examined in order to obtain the standard for the prophylactic administration of antibiotics. Sixty nine strains were found from forty four cases examined. Staphylococcus epidermidis and other dropping bacteria were found from gastrectomy, cholecystectomy and Miles operation. Gram negative rods and Enterococcus faecalis were often detected from cholecystectomy with choledocotomy and the operation of large intestine. Anaerobes were infrequently detected. The highest count of a strain found from peritoneal washed-out fluid was 2.7×105, but no post-operative infection was evident. Cefmetazole which was used in the majority of the cases was effective in two-third of the strains detected. The numbers of bacteria found during operation indicated that prophylactic administration of antibiotics should desirablly maintain enough tissue concentration to inhibit at least 106 of expected strain.

RES機能の診断に応用するために肝のシンチグラフィー用試薬99mTc-フチン酸を用いたRES機能総量の測定法について薬物動力学的解析による基礎的検討を行った.99mTc-フチン酸静注後の循環血中のγ線量の減衰はα相とβ相からなる二相性を示し,2-コンパートメントオープンモデルで解析された.β値は肝切除群や肝障害群そしてDIC群などに関係なくほぼ一定であった.そこで静注直後に出現する分布相(α相)の消失速度定数であるα値をもってRES機能総量の値とした.肝切除モデルの検討では,RES機能は肝切除後の残存肝容積に近似した変動を示した.またDICモデルや急性肝障害モデルにおけるRES機能は低下した.また慢性肝障害モデルでは脾のフチン酸の取り込みは増加したが,全身のRES機能は低下した.本測定法は,臨床例におけるRES機能の診断に応用可能と思われた.