Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

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Language：Japanese   Publisher：(株)癌と化学療法社  

進行胃癌に対する化学療法first-lineとして胃癌治療ガイドライン第5版にFOLFOXが追加された。同レジメンは静脈内投与で完結するため、経口摂取の安定しない進行胃癌において有用と考えられる。本稿ではFOLFOXが著効した進行胃癌症例を報告する。多発肝転移、傍大動脈リンパ節転移を伴うStage IVBの75歳、男性。S-1+CDDP導入後早期に重篤な有害事象を認めFOLFOXへ変更した。oxaliplatinによるアレルギーを来すまで継続投与しPRを維持した。経口摂取不良や内服コンプライアンス不良の進行胃癌症例において、FOLFOXは有用な選択肢である。(著者抄録)

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

症例は86歳の女性で,ふらつき・黒色便を主訴に当院受診となった.来院時にHb 7.3g/dlの貧血を認め,腹部造影CTで膵体尾部に56×28mm大の,内部不均一で一部に造影効果を伴う腫瘤性病変を認めた.上部消化管内視鏡検査にてVater乳頭より噴出する出血を認め,膵体尾部癌に伴うhemosuccus pancreaticus(以下,HPと略記)と診断した.同日緊急血管造影検査および脾動脈コイル塞栓術を施行し,塞栓術後に貧血は一過性に改善したが,濃厚赤血球製剤の投与を終了すると再び貧血の進行を認めた.第18病日に膵体尾部切除術を施行し,標本摘出後の術中内視鏡にてHPの消失を確認しえた.術後は貧血の速やかな改善を認め,第35病日に退院となった.摘出標本の病理結果はinvasive ductal carcinoma(pT3N1M0 pStage IIB)であった.(著者抄録)

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

症例は85歳の女性で,局所進行膵頭部癌(上腸間膜動脈,門脈浸潤)に対し,化学放射線療法後に亜全胃温存膵頭十二指腸切除術,門脈合併切除再建術を施行した.術後経過は良好であったが3ヵ月目に下血と貧血を認めた.CTで肝外門脈閉塞(extrahepatic portal vein obstruction;以下,EHOと略記)と肝管空腸吻合部周囲に増生した側副血行路を認めた.ダブルバルーン小腸内視鏡検査で静脈瘤を肝管空腸吻合部に認め,同部からの出血と診断した.門脈圧減圧による出血予防を目的に部分的脾動脈塞栓術(partial splenic embolization;以下,PSEと略記)を施行した.その後は出血を認めていない.EHOにより生じる異所性静脈瘤出血は診断・治療の困難な致命的な合併症であるが治療法は確立していない.PSEは肝管空腸吻合部静脈瘤出血に対し一考すべき治療法である.(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: Portal vein thrombosis (PVT) following hepatectomy is potentially life-threatening. We aimed to evaluate the incidence of PVT after hepatectomy for hepatocellular carcinoma and identify coagulation and fibrinolytic factors that could predict early-stage postoperative PVT. METHODS: A retrospective analysis was conducted on 65 hepatocellular carcinoma patients who underwent radical hepatectomy. The risk factors for postoperative PVT were identified based on univariate and multivariate analyses, and the levels of coagulation and fibrinolytic factors were measured during the perioperative period. RESULTS: The incidence of PVT after hepatectomy was 20.0%. The patients were divided into two groups: those with PVT (n=13; PVT group) and those without PVT (n=52; no-PVT group). The frequency of the use of the Pringle maneuver during surgery was higher in the PVT group than in the no-PVT group, and the postoperative/preoperative ratios of thrombin-antithrombin III complex (TAT) and of D-dimer were significantly higher in the PVT group. CONCLUSION: A high incidence of PVT was found in hepatocellular carcinoma patients after hepatectomy. The frequency of the Pringle maneuver is a potential risk factor for postoperative PVT, and the postoperative/preoperative TAT and D-dimer ratios may be used as early predictors of PVT after hepatectomy for hepatocellular carcinoma.

DOI： 10.1007/s00423-021-02125-9

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

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Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

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Language：English  

Herein we report a case of laparoscopic cholecystectomy in a 26-year-old pregnant woman with no remarkable medical history. Laparoscopic cholecystectomy was performed at 21 weeks of gestation. To prevent uterus injury, the first trocar was inserted into the right hypochondrium using the open method after marking the site of the uterus via ultrasonography. After confirming the site of the uterus, the second trocar with a balloon was inserted 3 finger widths above the umbilicus. Additional 5-mm trocars were inserted into the epigastric and hypochondrial regions. A good surgical view was obtained with a pneumoperitoneal pressure of 8 mmHg. Laparoscopic cholecystectomy was successfully performed without any complications during or after the operation. She had a normal delivery at 39 weeks of gestation. Laparoscopic cholecystectomy is a viable treatment option during pregnancy, provided there is close consultation and cooperation between obstetricians and anesthesiologists.

DOI： 10.7759/cureus.7656

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We report a case of metastatic pancreatic-head mucinous carcinoma (with multiple lymph node and bone metastases) and review the relevant literature. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) was useful for diagnosis, and a satisfactory outcome was achieved after systemic chemotherapy with FOLFIRINOX followed by resection of the primary lesion as conversion surgery. The patient was a 55-year-old man. Hematological findings included elevated serum tumor marker levels: CEA 12.7 ng/mL, DUPAN-2 400 U/mL. Findings from several imaging modalities and EUS-FNA confirmed a clinicopathological diagnosis of metastatic pancreatic mucinous carcinoma with multiple bone and lymph node metastases. Five courses of modified FOIFIRINOX (m-FFX) were given as systemic chemotherapy, which had an antitumor effect. Subtotal stomach-preserving pancreaticoduodenectomy and extensive lymph-node dissection were thus performed. Histopathological analysis showed invasive ductal carcinoma, muc (pT3, pN1b, cM1). After surgery, the clinical course was notable for the absence of complications. Tegafur/gimeracil/oteracil (S-1) was started as maintenance adjuvant chemotherapy postoperatively, and no disease progression has been observed at 10 months after surgery.

DOI： 10.1272/jnms.JNMS.2019_86-502

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BACKGROUND: We have modified and performed neoadjuvant chemotherapy (NAC) using capecitabine + epirubicin + cyclophosphamide combination therapy ( 'CEX' ) for HER-2 negative breast cancer. In this study, we investigate the outcomes achieved in our institute and report the effectiveness and tolerability of this therapy, retrospectively. METHODS: The patients included in this study had breast cancer that was negative for HER-2 and positive for lymph node metastasis or negative for lymph node metastasis with a tumor diameter of 20 mm or greater without any distant metastasis. Additionally, groups with performance status (PS) 0-1, aged 75 or less, and with an EF > 60% were targeted. Clinical evaluations were made after a total of 4 courses of epirubicin: 80 mg/m2, cyclophosphamide: 500 mg/m2 (administered every 3 weeks) and capecitabine: 1500 mg/m2 (administered for 2 weeks and withdrawn for 1 week). RESULTS: Eighteen patients received treatments between 2009 and 2013. All patients achieved clinical benefits. The clinical response rates (CRR) were 83.3% (15/18) and 50% for clinical complete response (cCR). All patients achieved positive aesthetic outcome with breast-conserving surgery. Those patients had satisfactory outcomes, with pathological complete response (pCR) in 33.3% (triple negative (TN): 6, luminal: 0) and n0 in 68.8% (TN: 8, luminal: 3). All patients with pCR are in a relapse-free survival state and are still under observation. The adverse events were grade 2 or lower for all patients. CONCLUSIONS: This study suggested that 'CEX' therapy as NAC could be an important option for individualized treatment. In particular, it was effective for TN breast cancer.

DOI： 10.1272/jnms.JNMS.2020_87-204

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Language：Japanese  

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Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: The common metastatic sites of renal cell cancer (RCC) are the lung, bone, liver, brain, adrenal glands, and contralateral kidney. Metastasis to the gallbladder is rare, and cystic duct metastasis from RCC has been reported in only one metachronous case. This is the first report of a case of synchronous cystic duct metastasis from RCC. CASE REPORT: A 72-year-old woman presenting with hematuria had a history of Cushing disease approximately 10 years previously. Enhanced computed tomography of the abdomen showed a mass measuring 5.8 × 3.0 cm in the left kidney, which was strongly enhanced in the early phase and washed out in the late phase. A mass measuring 2 cm in diameter was seen in the left adrenal gland, and a 1.0-cm mass was noted in the right adrenal gland. Multiple tiny masses were detected in the cystic duct. Left renal cell carcinoma, cystic duct metastasis, and bilateral adrenal gland metastases were diagnosed. Because the metastatic tumor was close to the common bile duct, we performed left nephrectomy, bilateral adrenalectomy, cholecystectomy, resection of the extrahepatic bile duct, and hepaticojejunostomy. Pathological findings showed that the renal tumor was clear cell carcinoma, as were the bilateral adrenal tumors and cystic duct tumor. The patient died 30 months after the operation.

DOI： 10.1272/jnms.JNMS.2018_86-405

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Language：Japanese   Publisher：(一社)日本内分泌外科学会  

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Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

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Language：Japanese   Publisher：日本外科系連合学会  

症例は71歳,男性.直腸癌に対し低位前方切除術を施行.術後に急性腎不全,心不全,誤嚥性肺炎,腹腔内膿瘍を併発したが保存的加療にて改善した.術後15ヵ月頃から下腹部膨満感が出現し,左下腹部のドレーン挿入部周囲の皮下気腫,および腹部単純CT検査で腹腔内にfree airを認めた.症状および炎症所見が軽度であったため腹腔穿刺・吸引を行い経過観察としていたが,症状が増悪したため精査を行った.下部消化管内視鏡検査で盲端部(S状結腸)に2mm大の穿孔部を認めたため,クリップによる閉鎖を施行した.経口摂食開始後,腹腔内の気体の微増と軽度の腹部膨満感を認めたが保存的に加療した.完全閉鎖は得られなかったが腸管内容の腹腔内への流出は認めなかったため外来で経過観察とした.穿孔後約1年経過したが全身状態は良好で現在通院加療中である.直腸切除術15ヵ月後の端側吻合盲端部に微小穿孔を認めた症例を経験したため報告する.(著者抄録)

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は59歳、女性。下血、ふらつきを主訴に当科を受診となった。高度貧血と腫瘍マーカーの上昇を認め、腹部造影CTにて多発肝転移を伴う小腸癌と診断した。小腸部分切除術を施行した。病理組織診断は高分化型腺癌であった。術後からS-1+irinotecan(IRIS)併用療法、IRIS+bevacizumab(IRIS+Bev)併用療法、S-1+oxaliplatin+Bev(SOX+Bev)併用療法、weekly paclitaxel(wPAC)療法とfourth-lineまで化学療法を施行し得たが、1年7ヵ月後に原病死となった。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00296&link_issn=&doc_id=20190604480025&doc_link_id=%2Fab8gtkrc%2F2019%2F004605%2F026%2F0949-0952%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2019%2F004605%2F026%2F0949-0952%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publishing type：Research paper (scientific journal)  

A 59-year-old woman who complained of melena and lightheadedness visited the outpatient clinic at our hospital.According to her blood test result, she had anemia, and her tumor marker levels were high.Enhanced computed tomography(CT) findings showed small intestinal cancer with multiple liver metastases.Partial resection of the small bowel for the small intestinal cancer was performed.Following the administration of fourth-line outpatient chemotherapy containing S-1 plus irinotecan( IRIS)and IRIS plus bevacizumab(IRIS plus Bev), S-1 plus oxaliplatin plus Bev(SOX plus Bev), and weekly paclitaxel (wPAC), she survived with good condition for 19 months after the surgery.

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Intrahepatic arterioportal fistula (IAPF) is a rare cause of portal hypertension. Interventional radiology (IVR) is generally selected as the first-line therapeutic option. Surgical treatment for IAPF is required in refractory cases of IVR. As the treatment success rate with IVR is high, cases requiring surgical treatment are extremely rare. CASE PRESENTATION: A 54-year-old man was admitted to another hospital complaining of hematemesis due to rupture of the esophageal varices. A computed tomography revealed ascites and arterioportal fistula in the left lobe of the liver. Transcatheter arterial embolization (TAE) was performed to occlude the fistula; however, it could not reach complete occlusion. Thereafter, there were a total of four hematemeses, and six endoscopic variceal ligations were required. The second TAE also failed to reach complete occlusion. He was transferred to our hospital for further treatment. Because liver function was low due to frequent hematemeses and there was also uncontrollable ascites, it was confirmed that hepatectomy could not be performed safely at this time. Therefore, we ligated the left portal branch and ligated and dissected the left gastric vein to decrease portal vein pressure. However, on the 5th day after surgery, the esophageal varices reruptured. As the disappearance of ascites was observed in the postoperative course and the general condition also improved, left hepatectomy was performed to remove IAPF. There was no recurrence of portal hypertension for 1 year and 3 months since hepatectomy. CONCLUSIONS: This case was difficult to treat with IVR and required surgical treatment. Our experience in the present case suggests that hepatectomy to remove arterioportal fistula was considered effective for improving portal hypertension due to IAPF. However, careful treatment selection according to the patient's overall condition and clinical course is necessary for IAPF presenting with severe portal hypertension.

DOI： 10.1186/s40792-019-0623-8

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Language：Japanese   Publisher：日本医科大学医学会  

症例は69歳女性で、子宮癌肉腫術後、腹腔内再発および盲腸癌を認め、回盲部切除術、小腸部分切除術、腫瘍摘出術を施行されていた。今回、腹部CT検査にて多発肝腫瘍を指摘され、精査加療目的にて入院となった。画像所見から子宮癌肉腫の肝転移と診断し、他に再発部位は画像上認められなかったため肝切除術を施行した。S7の腫瘍が最も大きく、S7グリソンに近接していたため、S7グリソンを切離する必要があった。そのほかの腫瘍は肝表面に認めているため腫瘍核出術を行う方針とした。術後経過は良好で、術後15日目に退院となった。3ヵ月後、腹部CTおよびPET検査にて骨盤内に再発所見を認め、術後経過良好で退院ののち、化学療法を行ったが、腫瘍の縮小は得らなかった。緩和病棟を持つ病院に転院し、肝切除術41ヵ月後に永眠された。

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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We report here a rare case of intestinal obstruction caused by a peach seed. A 15-year-old boy was admitted to our hospital because of abdominal pain and vomiting. The patient had no history of previous gastrointestinal surgery and his medical comorbidity was autism. A computed tomography (CT) scan showed an obstruction of the ileum by a foreign body. Surgical treatment was successfully performed, and we found a peach seed in the ileum. He was discharged eight days after the operation without postoperative complications. Intestinal obstruction caused by plant seeds without gastrointestinal disease is rare.

DOI： 10.7759/cureus.3767

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Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

61歳男性。C型肝硬変、アルコール性肝硬変、慢性腎不全にて近医を通院中、透析中に羽ばたき振戦を伴う意識障害が出現し、前医へ救急搬送された。前医では脾腎シャントに伴うシャント型肝性脳症と診断され、内服治療が行われるも抵抗性が強く、肝性脳症を繰り返すため当科へ紹介となった。各検査により、巨大側副血行路を有するシャント型肝性脳症と診断されたが、患者が透析症例で腹水コントロールに難渋すること、短絡路の最大径が5cmで血管内治療が不可能であったことから、外科的に短絡路を保存して脾静脈結紮切離(分流術)を施行することとなった。その結果、術後は肝性脳症は速やかに改善し、患者は目下、職場復帰している。

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Cutaneous metastasis of an internal malignancy is uncommon and is estimated to occur in 0.7-9% of patients with internal cancer including autopsy cases. We would like to report a case of long survival of sigmoid colon adenocarcinoma diagnosed as an instance of facial cutaneous metastasis. A 68-year-old male was admitted to our hospital for a tumor mass on the left side of his cheek. In his past history, acute myocardial infarction had occurred 2 years earlier. He also had chronic renal failure and chronic obstructive pulmonary disease. Histologic findings from the biopsy sample of this facial lesion were moderately differentiated adenocarcinoma. Colonoscopy revealed a tumor 20 mm × 30 mm in diameter in the sigmoid colon. Histologic findings of the biopsy sample of this tumor also indicated moderately differentiated adenocarcinoma. The patient was diagnosed with sigmoid colon cancer with cutaneous metastasis to the face. We performed a sigmoidectomy with lymph node dissection and resection of the facial cutaneous metastasis. After being discharged, low dose chemotherapy was performed in consideration of the patient's renal function. Although long-term management of his general condition was provided, the patient died 37 months after surgery because of chronic heart failure.

DOI： 10.1007/s12328-017-0767-7

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Language：Japanese   Publisher：(一社)日本外科感染症学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：English   Publisher：WILEY  

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Language：Japanese   Publisher：日本医科大学医学会  

H.pyloriをボノプラザンで除菌した50例(A群)とエソメプラゾールで除菌した33例(B群)について除菌率の比較を行った。更に、国内で行われたH.pyloriの除菌に関する第III相臨床試験での除菌率との比較も行った。その結果、A群の除菌率は一次除菌・二次除菌とも第III相臨床試験とほぼ同様に良好であったが、統計学的にはB群との間に有意差を認めなかった。なお、2群ともに下痢や口内炎、嘔気等の副作用は認めなかった。以上より、H.pyloriに対しボノプラザンとエソメプラゾールは同程度の除菌効果を有していると考えられた。

DOI： 10.1272/manms.13.38

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

DOI： 10.15106/J00393.2017097383

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本外科系連合学会  

施灸は温熱により血流を良好にすることで消化器症状などを改善する東洋医学の一つである.自宅での施灸も可能であり,危険性は少ないと考えられているが,施灸により腹腔内の癒着をきたした可能性のある症例を経験したので報告する.症例は手術歴のない84歳,男性.急性胆嚢炎に対し腹腔鏡下胆嚢摘出術を施行した.臍部よりopen法でポートを挿入し気腹後にスコープを挿入すると,臍周囲に限局する小腸と大網の著明な癒着を認めた.臍周囲に限局した施灸による皮膚変化があり,また頻繁に臍周囲のみに施灸をしていたことから,施灸が癒着の原因と考えられた.施灸による腹腔内癒着は文献的に報告がなく稀であるが,近年,商品の多様化と広告展開により施灸の普及が進んできており,今後遭遇する可能性がある.(著者抄録)

DOI： 10.4030/jjcs.41.719

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DOI： 10.1046/j.1440-1746.2003.03025.x

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

The uterus, ovary, and fallopian tube are rarely present in an inguinal hernia. We report on an operation to treat just such a rare condition for a right inguinal hernia. An 87-year-old Japanese woman was admitted with swelling in the right inguinal region and a purulent discharge from the vagina. Vital signs were stable, but the mobile mass was irreducible. Computed tomography of the abdomen indicated uterine tissue in a right inguinal hernia. We diagnosed an inguinal hernia with an incarcerated uterus and performed surgery on that basis. An incision approximately 6 cm long was made in the skin above the swollen area to open the inguinal sac, disclosing a tumor enveloped by a hernial sac. Opening the hernial sac revealed the prolapsed uterus, the fallopian tube, and the right ovary. Because no ischemic change was noted, the incarcerated uterus was returned to the abdominal cavity, and the hernial opening was closed with the onlay mesh technique. The posterior wall of the inguinal canal was found to have prolapsed laterally to the inferior epigastric artery, resulting in an external inguinal hernia. This case demonstrates that careful attention must be paid to inguinal hernias in female patients because the uterus, ovary, and fallopian tube may be involved.

DOI： 10.1272/jnms.83.93

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)南江堂  

食道・胃静脈瘤に対する手術療法には,直達手術とシャント手術がある.ほかに脾摘術,脾肺固着術,肝移植,Budd-Chiari症候群に対する静脈再建術やバイパス手術などもある.手術療法は長年にわたる門脈血行動態研究に基づき理論的に工夫・改良され,長期成績は良好となった.現在では侵襲面から保存的療法の難治例に対する最終手段となっているが,難治例はより複雑な血行動態となっており,外科医は門脈血行動態のより深い理解が必要である.(著者抄録)

DOI： 10.15106/J00393.2016089685

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J00393&link_issn=&doc_id=20160113090003&doc_link_id=issn%3D0016-593X%26volume%3D78%26issue%3D1%26spage%3D15&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0016-593X%26volume%3D78%26issue%3D1%26spage%3D15&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

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BACKGROUND: A clear operative view of the middle and lower mediastinum is possible in prone position during video-assisted thorocoscopic surgery of esophagus (VATS-E), but the working space in the upper mediastinum is limited and lymph node dissection along the left recurrent laryngeal nerve (RLN) is difficult in this position. METHODS: Esophagectomy and lymph node dissection are performed for pneumothorax by maintaining CO2 insufflation in the prone position. Working space in the left upper mediastinal area for lymph node dissection around RLN is limited in this position. To create space, the residual esophagus is stripped in the reverse direction and retracted toward the neck after the stomach tube is removed through the nose. Lymph node dissection is performed after stripping the residual esophagus. RESULTS: We could obtain a clear operative field in the upper left mediastinum by stripping the residual esophagus in the prone position, enabling safe and straightforward lymph node dissection along the left RLN. The rate of permanent RLN paralysis was 1.2%. CONCLUSIONS: Lymph node dissection along the left RLN after esophageal stripping is possible in the prone position during VATS-E.

DOI： 10.21037/jovs.2016.11.01

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Language：English   Publisher：NATURE PUBLISHING GROUP  

DOI： 10.14309/00000434-201510001-01628

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

We describe the spontaneous rupture of a simple hepatic cyst. A 62-year-old woman was admitted for right upper quadrant pain of sudden onset. The patient denied a history of abdominal trauma. Computed tomography of the abdomen showed a 13-cm-diameter solitary hepatic cyst in the right lobe. Part of the cyst surface was irregular, and the internal echo was heterogeneous. Retained fluid was detected under the liver capsule. Ten days after admission, computed tomography revealed that the volume of fluid retained under the liver capsule had decreased but that the hepatic cyst had enlarged again. The patient was referred to our hospital for further evaluation and treatment. Physical examination revealed mild right upper quadrant pain, but no signs or symptoms of peritonitis or abnormalities of the chest or heart. Percutaneous puncture was performed with a needle and an 8-French pigtail catheter under ultrasonographic guidance. Brown serous fluid was aspirated. After the removal of approximately 1,000 mL of fluid, contrast medium was injected to check for communications between the cyst and the biliary tree and to document the absence of leakage into the peritoneal cavity. After complete aspiration of the cyst fluid, 200 mg of minocycline hydrochloride dissolved in 10 mL of saline was injected into the cyst, and the catheter was flushed with 10 mL of saline (total volume of saline, 20 mL). The catheter was then clamped for 30 minutes. After percutaneous aspiration, the patient's symptoms resolved. Minocycline hydrochloride was injected daily for 7 days, and the catheter was removed. There has been no evidence of recurrence after 2 years.

DOI： 10.1272/jnms.82.113

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：金原出版(株)  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

A 56-year-old woman who received surgery for left breast cancer 10 years previously underwent 18F-fluorodeoxyglucose positron-emission tomography (FDG-PET) for postoperative follow-up. FDG-PET revealed high uptake of tracer in the esophagogastric junction. A slightly elevated, lobular lesion was found in the lower third of the esophagus on upper gastrointestinal endoscopy. An endoscopic biopsy revealed squamous cell carcinoma. We performed thoracoscopic subtotal esophagectomy. Histopathological examination showed a polypoid spindle cell tumor arising from superficial squamous cell carcinoma. Immunohistochemically, the spindle cells were immunopositive for vimentin and AE1/AE3, and a carcinosarcoma of the esophagus was diagnosed. MIB-1 labeling indexes estimated by Ki-67 immunostaining showed that the proliferative rate of the sarcomatous component was markedly higher than that of the carcinomatous component. This is the rare reported case of esophageal carcinosarcoma that showed increased accumulation of tracer on FDG-PET.

DOI： 10.1272/jnms.81.401

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publisher：医学図書出版(株)  

膵尾部嚢胞性病変に対する腹腔鏡下脾臓・脾動静脈温存膵尾部切除術式(Lap-SPDP)の手術手技について解説した。脾臓温存術式は10番、11番、18番リンパ節を郭清する必要のない疾患に対して施行されるべき術式であるため、手術手技の記載に先立ち同病変に対する脾臓温存術式の適応について考察した。手術手技に関しては、膵尾部病変に対する脾臓温存術式という表題に即して、膵切離は脾動脈分岐部より左側で行われることを想定し、同術式における脾動静脈の露出法および膵実質からの遊離手法を中心に解説することとした。(著者抄録)

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Language：English   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

DOI： 10.1272/jnms.81.192

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本外科感染症学会  

はじめに:消化器外科手術はSSIの発生率が高く、胆膵領域はSSIが多い分野である。今回われわれは、腹腔鏡下尾側膵切除術(以下、Lap-DP)におけるSSIに着目し検討した。対象と方法:2010年7月から2014年3月に当院でLap-DPを施行した53例を対象とした。SSIの危険因子と、ドレーン排液培養結果、膵液瘻の発症および重症化についてretrospectiveに検討した。結果:SSIは19例(35.8%)に認められ、全例Organ/Space SSIであった。SSI群(n=19)と非SSI群(n=34)との比較において患者背景因子、術中因子には有意差は認めず、術後の膵液瘻の発生とその重症化においても有意差を認めた。ドレーン排液の細菌検出率は経時的に増加したが、術後早期のドレーンからの細菌検出が必ずしも膵液瘻の重症化に結びつかなかった。考察:Lap-DP後のSSIと膵液瘻の重症化には、開腹術と同様に関連性が示唆された。Lap-DP施行後のSSIと膵液瘻の発生率は低いものではなく、膵切離法の改良や、症例に応じたドレーン管理等の周術期管理が必要であると考えられた。(著者抄録)

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Language：Japanese   Publisher：(株)オプトロニクス社  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：English   Publishing type：Part of collection (book)   Publisher：Elsevier Inc.  

Increasing public concern about climate change over the last couple of decades has motivated the government of Japan to promote the production of bioenegy as alternatives for fossil fuel. This chapter provides the societal background and principal policies for the promotion of bionergy utilization in Japan, with a brief depiction of the issue concerning global warning caused by human activities. © 2014 Elsevier Inc. All rights reserved.

DOI： 10.1016/B978-0-12-404609-2.00001-5

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

We describe a cystic intraductal papillary neoplasm of bile duct (IPNB) of adenocarcinoma treated with surgical resection. An 82-year-old man was admitted to our hospital because of distension of the right upper quadrant of the abdomen. On admission, a huge nontender mass was palpated in the right upper abdomen. Initial laboratory tests revealed the following serum values: aspartate aminotransferase, 123 IU/L; alanine aminotransferase, 113 IU/L; alkaline phosphatase, 376 IU/L; bilirubin, 1.6 mg/dL; alpha-fetoprotein, 7.4 ng/mL; CA19-9, 39.8 U/mL; carcinoembryonic antigen, 4.1 ng/mL; and Duke pancreatic monoclonal antigen type 2, 200 U/mL. Abdominal ultrasonography revealed an anechoic mass with an elevated papillary lesion in the right paramedian section. Computed tomography showed a low-density hepatic lesion, measuring 12 x 10 cm, with thick, irregular walls. A T2-weighted magnetic resonance scan showed mural nodules with signal intensity higher than that of the liver. The cystic lesion was suspected to be a cystic IPNB, but we could not determine whether it was a carcinoma. We performed extensive right paramedian sectionectomy and cholecystectomy. The resected multilocular tumor was filled with a yellow fluid, and the cut surface showed multiple, yellowish papillary nodules lining the cystic wall. On histologic examination, the neoplastic biliary epithelium showed papillary growth in the dilated lumen. Papillary and micropapillary lesions exhibited cellular atypia: nuclear enlargement and hyperchromasia, mutilayering, and mitosis. Ovarian-like stroma was not detected. The tumor was diagnosed as an IPNB (carcinoma in situ lesion). These lesions had expanded into several intrabiliary ducts. No recurrence has been detected 2 year after operation.

DOI： 10.1272/jnms.80.234

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

症例は,73歳の男性。主訴は嚥下困難。既往歴は2年前に慢性閉塞性肺疾患(COPD)と診断された。上部消化管内視鏡検査にて胸部下部食道に腫瘍を認め,生検で扁平上皮癌であった。胸部CT検査にて食道壁肥厚とリンパ節転移を認め,cT2N1M0,cStageIIIの進行食道癌と診断した。COPDによる呼吸機能の低下から食道切除術は困難と判断し,化学放射線療法を施行した。治療終了後,腫瘍は縮小したが,著明な食道狭窄が残存した。内視鏡下拡張術および化学療法を施行中に,胆嚢結石による急性胆嚢炎を繰り返し併発した。腹腔鏡補助下食道バイパス手術と腹腔鏡下胆嚢摘出術を一期的に施行した。術後はCOPDの軽度悪化とminorな縫合不全を認めたが,保存的治療にて改善し軽快退院となった。死亡するまでの術後12ヵ月のうち約11ヵ月の間,固形物の摂取が可能であった。(著者抄録)

DOI： 10.11231/jaem.33.749

J-GLOBAL

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J02824&link_issn=&doc_id=20130620380016&doc_link_id=10.11231%2Fjaem.33.749&url=https%3A%2F%2Fdoi.org%2F10.11231%2Fjaem.33.749&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：医学図書出版(株)  

肝胆膵領域におけるステンティング療法について胆管ステントと膵管ステントに分けて述べる。胆管ステントでは、切除不能悪性胆道狭窄に対しては、金属ステント(Expandable metallic Stent:EMS)、悪性胆道狭窄術前および良性胆道狭窄に対しては、Plastic stentが適応である。胆管(肝管)消化管吻合部の減圧および狭窄防止目的として、内ステント(internal stent)や外ステント(external stent)が留置される。膵管ステントでは、良性疾患に対する膵液ドレナージ目的として、主にPlastic stentが使用される。膵消化管吻合部の減圧および狭窄防止目的には、節付き膵管チューブをexternal stentとして使用しているが、internal stentを留置する施設やstentを使用しない施設もある。さまざまなステントが開発され、目的に応じて留置するステントの種類も異なってくる。各ステントには長所短所があるため、各ステントの特性を把握し使用することが肝要である。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J00001&link_issn=&doc_id=20121203400007&doc_link_id=%2Faa6icutc%2F2012%2F003610%2F008%2F0747-0753%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa6icutc%2F2012%2F003610%2F008%2F0747-0753%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

Objective: The aim of this study was to analyze the efficacy and feasibility of gemcitabine monotherapy in patients with unresectable advanced or recurrent biliary tract cancer (BTC).
Methods: Six patients with unresectable advanced BTC and 12 patients with recurrent BTC received gemcitabine monotherapy. Gemcitabine (800-1.000 mg/m(2)) was administered intravenously over 30 minutes on days 1, 8, and 15 every 28 days. Disease and toxicity were assessed once a week in all patients until the completion of gemcitabine treatment. Computed tomographic/magnetic resonance imaging studies were done every 8 weeks during chemotherapy, and every 4 weeks if progressive disease was suspected. Tumor response was determined according to the Response Evaluation Criteria in Solid Tumors. Toxicity was assessed using the National Cancer Institute Common Toxicity Criteria version 2.0. The time to progression and survival time were also calculated.
Results: In patients with unresectable BTC, the overall response rate and the median time to progression for patients with partial response or stable disease was 66.7% and 5.68 months, respectively. Clinical benefit was observed in 3 patients with stable disease (50%). The median survival time was 5.2 months. In patients with recurrent BTC, 4 patients (33%) obtained partial responses and 2 patients (17%) had stable disease. The median time to progression was 8.2 months. Six of 12 patients (50%) obtained clinical benefit. The median survival time for cancer of the intrahepatic bile duct, the extrahepatic bile duct, and the ampulla of Vater were 2.8 months, 8.5 months, and 10.7 months, respectively. No significant correlation between the survival time and the resectability of the initial procedure (R number) was detected. The survival time for patients with a performance status of 0 or 1 was significantly longer than that for patients with a performance status of 2 (P=0.0051). Neither grade 3/4 hematologic toxicity nor grade 3/4 nonhematologic toxicity was observed. No treatment-related deaths were observed.
Conclusion: Gemcitabine monotherapy may provide a more favorable prognosis in patients with advanced BTC than does best supportive care alone. Moreover, this regimen may represent a therapeutic option for the adjuvant setting in patients with BTC. (J Nippon Med Sch 2012; 79: 204-212)

DOI： 10.1272/jnms.79.204

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

We present a rare case of hepatocellular carcinoma (HCC) in which spontaneous complete necrosis was confirmed with surgical resection. An 80-year-old man with HCC was referred to Nippon Medical School Tama Nagayama Hospital. The medical history included hypertension, managed with medication, and partial lobectomy of the lung owing to a lung schwannoma. A previously untreated abdominal aortic aneurysm. 51 mm in maximum diameter, was detected. The serum concentration of proteins induced by vitamin k antagonism or absence (PIVKA-2) was 14.300 mAU/mL. and that of alpha-fetoprotein was 184.2 ng/mL. Antibodies against hepatitis B surface antigens and hepatitis C virus were not detected in the serum. Computed tomography (CT) demonstrated a hypervascular tumor, 68 mm in diameter, in the left paramedian sector of the liver with washout of contrast medium in the delayed phase. An HCC in the left paramedian sector was diagnosed. Laparotomy was performed 40 days after CT scanning. Intraoperative ultrasonography showed that the HCC had shrunk to 30 mm in diameter. A left paramedian sectionectomy was performed. On macroscopic examination the surgical specimen was a firm mass, 30 mm in diameter, with a fibrous capsule. Histologic examination showed that the tumor in the cirrhotic liver had been completely replaced by central coagulative necrosis, circumferential fibrosis, and dense infiltrates of inflammatory cells. No viable HCC cells were observed in the coagulative necrosis. Organized thrombi in the hepatic artery were detected in the tumor. The tumor also contained multiple foci of old hemorrhage, ductular proliferation, and granulation tissue. The patient was discharged 10 days after the operation. After 1 month, the serum concentrations of PIVKA-2 (25 mAU/mL) and alpha-fetoprotein (5.9 ng/mL) had decreased to within their normal ranges. (J Nippon Med Sch 2012; 79: 213-217)

DOI： 10.1272/jnms.79.213

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Language：English   Publishing type：Research paper (scientific journal)  

An internal hernia may be either congenital or acquired. The reported incidence of such hernias is 1-2%. In rare cases, internal hernias are the cause of small bowel obstruction, with a reported incidence of 0.2-0.9%. Transmesocolic hernia of the ascending colon is especially rare. We report a case of transmesocolic hernia of the ascending colon with intestinal obstruction diagnosed preoperatively. A 91-year-old Japanese female was admitted to our hospital with abdominal distention and vomiting of 3 days duration. She had no past history of any abdominal surgery. Abdominal examination revealed distention and tenderness in the right iliac fossa. Abdominal computed tomography revealed ileus in the sac at the left side of the ascending colon and dilatation of the oral side of the intestine. We diagnosed a transmesocolic hernia of the ascending colon with intestinal obstruction and performed emergency surgery. At the time of operation, there was internal herniation of ileal loops through a defect in the ascending mesocolon, without any strangulation of the small bowel. The contents were reduced and the tear in the ascending mesocolon was closed. The postoperative course was uneventful and the patient was discharged 14 days after surgery. In conclusion, preoperative diagnosis of bowel obstruction caused by a congenital mesocolic hernia remains difficult despite the techniques currently available, so it is important to consider the possibility of a transmesocolic hernia when diagnosing a patient with ileus with no past history of abdominal surgery. Copyright © 2012 S. Karger AG, Basel.

DOI： 10.1159/000339691

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Language：English   Publisher：W B SAUNDERS CO-ELSEVIER INC  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

We describe the surgical treatment of a patient with diaphragmatic invasion by a ruptured hepatocellular carcinoma (HCC) associated with biliary and portal venous tumor thrombi. A 67-year-old man was admitted because of jaundice (total serum bilirubin, 6.6 mg/dL). The serum concentration of alpha-fetoprotein was 236.1 ng/mL. The anti-hepatitis C virus antibodies were present in the serum. Computed tomography showed a large hypervascular mass in the right subphrenic region, surrounded by local effusion. Endoscopic retrograde cholangiography revealed dilatation of the left intrahepatic bile duct caused by biliary tumor thrombi extending from the right hepatic duct to the common bile duct. Endoscopic nasobiliary drainage was performed, and the total serum bilirubin level returned to the normal range. Angiography revealed a hypervascular tumor without extravasation of contrast medium in the right lobe and obstruction of the right anterior branch of the portal vein. Right hepatectomy was attempted 15 days after drainage. Severe invasion of the diaphragm by the ruptured HCC was detected. Bleeding of the ruptured HCC stopped spontaneously. Partial resection of the diaphragm was performed, followed by primary suture, without an artificial patch. Tumor thrombectomy was performed from the common bile duct. Macroscopic examination revealed that the ruptured HCC had invaded the diaphragm. Biliary and portal venous tumor thrombi were present. Histopathological examination showed a moderately differentiated HCC with biliary and portal venous tumor thrombi. The postoperative course was uneventful. The patient was discharged on postoperative day 14. Five months after the operation, local and intrahepatic recurrences of HCC were detected. Six months after operation, the patient died of liver failure. In conclusion, the outcome of a patient with diaphragmatic invasion by a ruptured HCC with biliary tumor thrombi was poor, even after curative hepatic resection. (J Nippon Med Sch 2012: 79: 147-152)

DOI： 10.1272/jnms.79.147

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

A 66-year-old male with a chief complaint of dysphagia was admitted to our hospital. Upper gastrointestinal endoscopy revealed a type 3 tumor on the gastric upper body, and pathological examinations of the biopsy specimens revealed a poorly differentiated adenocarcinoma. Computed tomography (CT) of the abdomen showed significant wall thickness of the stomach, and regional and para-aortic lymph node metastases. The CA19-9 level was high: 978 U/mL on admission. He received neoadjuvant chemotherapy using S-1 (120 mg/body, days 1-21) and cisplatin (108 mg/body, days 8) for faradvanced gastric cancer. After neoadjuvant chemotherapy, upper gastrointestinal endoscopy revealed that the gastric carcinoma had significant reductions in the size of its tumors, and CT showed that the lymph node metastases had disappeared, leading to a partial response. He underwent total gastrectomy, distal pancreatectomy, splenectomy and Roux-en Y reconstruction. Pathological examination of the resected specimens showed a small number of cancer cells in the submucosal layer, suggesting a Grade 2 pathological response, and gave a positive reaction to CA19-9 staining. The postoperative CA19-9 level decreased to a normal level. This case is diagnosed as CA19-9-producing gastric cancer. He was treated on an outpatient basis with adjuvant therapy.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

A 72-year-old male with a chief complaint of dysphagia was admitted to our hospital. Upper gastrointestinal endoscopic examination showed double cancers with thoracic esophageal cancer in the middle esophagus and gastric cancer in the antrum. Pathological examinations of the double cancer revealed the first one to be moderately-differentiated squamous cell carcinoma and the second to be well-differentiated adenocarcinoma. Computed tomography (CT) of the chest and abdomen showed no distant or lymph node metastases. Clinical stagings of the double cancer were stage II (T2N0M0) in esophageal cancer and stage I A (T1N0M0) in gastric cancer. The patient received neoadjuvant chemotherapy using docetaxel, CDDP and 5-FU. After 2 courses of chemotherapy, the adverse event was grade 2 in leucopenia and grade 2 in alopecia. Repeated macroscopic and histological examinations after chemotherapy revealed that the esophageal cancer had significant reductions in the size of tumors, leading to a partial response, and the gastric cancer had disappeared, leading to a complete response. He underwent thoracoscopy-assisted esophagectomy in the prone position, and laparoscopy-assisted gastric tube reconstruction. This neoadjuvant chemotherapy of docetaxel, CDDP and 5-FU might be effective and tolerable as with patients with double cancer of esophageal and gastric cancers.

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Language：Japanese   Publisher：日本医科大学医学会  

73歳女。間欠的な腹痛、嘔吐が出現し、当院消化器内科で大腸イレウスが疑われ当科入院となった。腫瘍マーカーCEA、CA19-9の高値、腹部CTで盲腸から上行結腸の壁肥厚および腫瘤像、口側小腸の著明拡張、X線で小腸ガス像、鏡面像を認め、大腸癌によるイレウスの診断でイレウス管を挿入した。注腸造影検査では盲腸Bauhin弁側に直径4cmの陰影欠損を、下部消化管内視鏡検査では盲腸に境界明瞭な2型腫瘍を認め、生検で高分化腺癌と診断された。盲腸進行癌によるイレウスと診断して手術施行し、術中所見で2群リンパ節の腫大を認めたため回盲部切除術およびD3郭清を行った。病理所見では中分化腺癌と高分化扁平上皮癌の増生を認め、両者に移行像を認めることから腺扁平上皮癌と診断した。また、リンパ節201番、202番に転移を認め、全てに腺癌と扁平上皮癌のいずれもを認めた。術後1ヵ月より5-FU/Leucovorin化学療法を開始したが、術後15ヵ月に大動脈周囲リンパ節転移を認め、以後は希望により緩和治療を行い、術後22ヵ月に癌死した。

DOI： 10.1272/manms.7.129

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

We describe a patient in whom a fish bone penetrated the duodenum and migrated into the right renal vein. The bone was successfully removed with surgery. The 75-year-old man was admitted to Nippon Medical School Tama Nagayama Hospital because of right upper abdominal pain persisting for 7 days. The patient's medical history was not relevant to the current disorder. Plain radiography showed no abnormalities. Computed tomography revealed a linear object of high intensity that had penetrated the duodenum and migrated into the right renal vein with thrombus. The object was surrounded by a low-density area, suggesting severe inflammation. The patient had eaten fish 1 day before the onset of abdominal pain. We diagnosed duodenal penetration caused by an ingested fish bone. Endoscopic examination showed erosion, but no fish bone or ulceration was detected in the duodenum. The patient was treated conservatively with fasting, peripheral parental nutrition, and intravenous antibiotics. Three days after admission, non-contrast-enhanced computed tomography showed no movement of the foreign body. The patient continued to have pain, and the decision was made to surgically explore the abdomen. Intraoperative ultrasonography showed that the foreign body had migrated completely into the right renal vein with thrombus. Severe inflammation of the right renal vein was observed. Because we could not remove the foreign body without seriously injuring the right renal vein, right nephrectomy was performed. Macroscopic examination of the surgical specimen confirmed the presence of a fish bone with thrombus in the right renal vein. The patient was discharged 9 days after operation, with no complications. (J Nippon Med Sch 2011; 78: 189-193)

DOI： 10.1272/jnms.78.189

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

Most hepatic cysts are asymptomatic, but complications occasionally occur. We describe a patient with biliary obstruction due to a huge simple hepatic cyst treated with laparoscopic resection. A 60-year-old Japanese woman was admitted to our hospital because of a nontender mass in the right upper quadrant of the abdomen. Laboratory tests revealed the following: serum total bilirubin, 0.6 mg/dL; serum aspartate aminotransferase, 100 IU/L; serum alanine aminotransferase, 78 IU/L: serum alkaline phosphatase, 521 IU/L; and serum gamma glutamic transpeptidase, 298 IU/L. Abdominal computed tomography, ultrasonography, and magnetic resonance cholangiopancreatography revealed a huge hepatic cyst. 13 cm in diameter, at the hepatic hilum, accompanied by dilatation of the intrahepatic bile duct and obstruction of the common bile duct. We diagnosed biliary obstruction due to a huge hepatic cyst at the hepatic hilum, and laparoscopic surgery was performed. A huge hepatic cyst was seen at the hepatic hilum. After needle puncture of the huge cyst, the anterior wall of the cyst was unroofed, and cholecystectomy was done. Intraoperative cholangiography through a cystic duct revealed stenosis of the duct. Subsequent decapsulation of the cyst was performed in front of the common bile duct. After this procedure. cholangiography revealed that the stenosis of the common bile duct had resolved. Histopathological examination of the surgical specimen confirmed the hepatic cyst was benign. The postoperative course was uneventful, and the results of liver function tests normalized. The patient was discharged 7 days after operation. Computed tomography 3 months after operation revealed disappearance of the hepatic cyst and no dilatation of the intrahepatic bile duct. U Nippon Med Sch 2011; 78: 105-109)

DOI： 10.1272/jnms.78.105

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Language：Japanese   Publisher：(株)篠原出版新社  

胃癌からの骨格筋への転移はきわめてまれな病態である。今回われわれは、高度進行胃癌が化学療法で消失したが、両側腸腰筋へ転移再発した症例を経験したので報告する。患者は59歳、男性。上部消化管内視鏡および腹部CT検査にて腹膜播種、腸間膜リンパ節転移を伴った高度進行胃癌と診断した。生検検査で低分化腺癌であった。切除不能と診断し、S-1/Cisplatin併用化学療法を5コース施行した。原発巣、リンパ節腫大および腹水は消失し、complete response(CR)が得られた。化学療法終了から12ヵ月後に腹膜播種が再燃し、両側腸腰筋転移の増大から両側水腎症へ急速に進行した。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

A 78-year-old male was admitted to our hospital because of dysphagia. He had been diagnosed as nephritic syndrome at 30 years of age and had been treated with prednisolone 10mg/day. Blood examination revealed renal dysfunction
BUN 25 mg/dL, Cr 1.9 mg/dL, and glomerular filtration rate (GFR) 47.4 mL/min. Endoscopy showed a type 2 tumor at the middle thoracic esophagus, and the biopsy specimen revealed moderately differentiated squamous cell carcinoma pathologically. Computed tomography (CT) of the chest and abdomen showed no metastases at distant regions and lymph nodes. Clinical staging was Stage II (cT2cN0cM0). Because of old age and renal function, we chose chemotherapy using docetaxel, nedaplatin and 5-fluorouracil. The adverse event was grade 2 in leucopenia and grade 1 in inappetence, but the renal function did not progress. Repeated endoscopic examinations after chemotherapy revealed that the esophageal cancer was significantly reduced in size, and no cancer cells were pathologically detected by endoscopic biopsy, resulting in a complete response (CR). This chemotherapy of docetaxel, nedaplatin and 5-fluorouracil might be effective and tolerable for patients with renal dysfunction due to nephritic syndrome.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

We describe a patient with symptomatic giant hepatic hemangioma treated with hepatectomy. A 53-year-old woman presented with upper abdominal distension and appetite loss. The medical history included multiple hepatic hemangiomas that had been detected 2 years earlier but were left untreated. Initial laboratory tests revealed pancytopenia and mild coagulopathy. Computed tomography and magnetic resonance imaging demonstrated a giant hemangioma, 27 cm in diameter, in the enlarged right lobe of the liver. The inferior vena cava was compressed by tumor without thrombus in the infrahepatic vena cava. The portal venous phase of supramesenteric arteriography revealed compression of the portal vein. There were several hemangiomas in the left lobe. Gastric outlet obstruction due to giant hepatic hemangioma in the right lobe was diagnosed. Laparotomy was performed, and a markedly enlarged liver was detected. Right hepatectomy was performed with an anterior approach. The liver-hanging maneuver could not be performed because of tumor compression of the inferior vena cava. Right hepatectomy was performed with intermittent clamping (Pringle maneuver). Hepatic hemangiomas of the left lobe were not resected because the remnant liver would be reduced. The weight of the resected specimen was 2,100 g. Pathologic examination of the surgical specimen confirmed the presence of benign hepatic hemangiomas. The postoperative course was uneventful, and the patient's appetite improved. The patient was discharged 8 days after the operation. Abdominal distension decreased and laboratory data improved after the operation. Computed tomography revealed hypertrophy of the left lobe of the liver after the operation. (J Nippon Med Sch 2011: 78: 34-39)

DOI： 10.1272/jnms.78.34

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Language：Japanese   Publisher：(一財)日本消化器病学会  

食道癌に対する化学放射線療法後の局所再発および遺残に対するサルベージ療法としてアルゴンプラズマ凝固法を行った3症例を経験した。方法は、APC300(ERBE社)を用いて出力60W、アルゴンガス流量1.8L/minで焼灼を行った。アルゴンプラズマ凝固法は、食道穿孔などの発生もなく安全に繰り返し施行可能で、有効な治療法であると考えられた。(著者抄録)

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Language：Japanese  

We report 3 cases of locoregional failure or remnant esophageal squamous cell carcinoma after chemoradiotherapy that were successfully treated by argon plasma coagulation (APC) as a salvage treatment Ablation was performed using argon plasma coagulation APC300 (ERBE). A power setting of 6OW and an argon gas flow of 1.8L/min was used. APC is able to be repeated multiply without adverse reaction, and is an effective treatment to control the tumor growth.

DOI： 10.11405/nisshoshi.107.1786

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Language：Japanese   Publisher：(株)癌と化学療法社  

患者は73歳、男性。主訴は嚥下困難。上部消化管内視鏡検査で食道胃接合部に腫瘍を認め、生検で低分化腺癌であった。胸腹部CT検査で横隔膜浸潤を認め、Stage IVの高度進行食道胃接合部癌と診断した。5-FU(350mg/m2、24h持続点滴静注、day 1〜5)、nedaplatin(10mg/body、1h点滴静注、day 1〜5)、docetaxel(40mg/m2、3h点滴静注、day 1)を放射線照射と同時に開始し、全放射線照射量は40Gy(2Gy/day、20回)とした。治療終了後、腫瘍は著明に縮小し、抗腫瘍効果はRECISTに基づいてPRと判定した。壁側腹膜に転移を認めたが合併切除を行い、左開胸開腹下部食道・胃全摘術を施行した。切除標本の病理組織検査ではT3N2P1CY0、Stage IVであった。術後経過は良好で軽快退院となった。その後は無治療で外来通院していたが、肝・脾・リンパ節転移が著明となり術後6ヵ月目に死亡した。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：INT COLLEGE OF SURGEONS  

Malignant granular cell tumors (MGCTs) are very rare soft tissue sarcomas. Definite criteria for pathologic diagnosis and the optimal treatment strategy have not been fully established. Here, we describe a 76-year-old woman with a huge MGCT in the right gluteal region, who developed a local recurrence and died from that tumor 14 months after undergoing an operation for the primary tumor. Although microscopic examination revealed that round and granular tumor cells staining for S-100 protein were dominant, components of the spindle cell sarcoma reacting with alpha smooth muscle actin were partially observed. MGCT is believed to originate from Schwann cells; however, pathologic findings in our case showed both Schwannian and non-Schwannian features. This is the first report on MGCT with these 2 features appearing simultaneously.

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Language：English   Publishing type：Research paper (international conference proceedings)  

DOI： 10.1272/jnms.77.53

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

The patient, a 73-year-old male, was admitted to our hospital because of dysphagia. A far-advanced cancer was diagnosed at the esophagogastric junction by upper gastrointestinal endoscopic examination. Pathological biopsy examinations revealed poorly-differentiated adenocarcinoma. Computed tomography (CT) of the chest and abdomen showed invasion to the diaphragm. Clinical Stage was IV in an unresectable far-advanced tumor. He received radiation therapy (40 Gy/total, 2 Gy/ day X 20 times) in combination with chemotherapy using docetaxel (40 mg/m2, day 1), nedaplatin (10 mg/body, days 1-5) and 5-fluorouracil (500 mg/body, days 1-5). After this combination chemoradiation therapy (CRT), macroscopic examinations showed significant reductions in the size of tumor, leading a partial response according to the RECIST guidelines. He underwent total gastrectomy, partial resection of the lower esophagus via left thoracotomy, and Roux-en Y reconstruction with jejunostomy. Pathological examination of the resected specimens revealed Stage IV (T3N2P1CY0). The postoperative course was uneventful. He was treated on an outpatient basis without adjuvant therapy, and died 6 months after the operation by liver, spleen and lymph node metastases.

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Language：English   Publishing type：Research paper (scientific journal)  

The treatment of splenic cysts remains controversial. A 25-year-old Japanese woman with a 10-cm-long abdominal mass in the left upper quadrant of the abdomen complained of mild, dull pain. A huge splenic cyst was confirmed on computed tomography and magnetic resonance imaging. The cyst wall was adherent to the splenic parenchyma to approximately 30% of its maximum diameter, calculated with magnetic resonance imaging. Laparoscopic unroofing of the cyst was performed. After the great omentum adhering to the cystic wall of the spleen was dissected, branches from the splenic hilar vessels were clipped. Histological examination of the cyst revealed pseudocyst of the spleen. The postoperative course was uneventful. Laparoscopic unroofing is a safe surgical procedure for patients with symptomatic pseudocyst of the spleen.

DOI： 10.1272/jnms.76.319

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

75歳男性。患者は進行胃癌で胃全摘術、Roux-en-Y再建術の既往があった。今回、術後20ヵ月に嚥下困難が出現し、上部消化管内視鏡で食道空腸吻合部から肛門側約3cmの再建挙上空腸に狭窄を認め、入院となった。狭窄部位は送気で拡がらず、この狭窄部位より先への内視鏡通過は困難であった。一方、上部消化管造影では再建挙上空腸に全長4.5cmの全周性狭窄、CTで空腸周囲に軟部陰影が認められ、胃癌術後の局所再発による再建挙上空腸の癌性狭窄と診断された。治療は患者が腫瘍切除や全身化学療法を希望せず、インフォームドコンセントより透視下にself-expandable metallic stent(SEMS)留置術が行なわれた。その結果、留置ステントの拡張と位置が良好にて嚥下困難は軽快し、患者は退院となった。尚、以後、腫瘍のステント内増殖とステント周囲に腫瘍の増大を認められたが、SEMS留置から死亡までの6ヵ月間は経口摂取は可能であった。

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

We report a rare case of granulocyte-colony stimulating factor (G-CSF)-producing undifferentiated carcinoma of the ascending colon. A 52-year-old Japanese man presented with a rapidly growing, aggressive abdominal tumor, and severe leukocytosis (63 000/mm(3)). The serum level of G-CSF was remarkably elevated to 640 pg/ml (normal, < 18.1 pg/ml). The patient underwent palliative cytoreductive surgery for ascending colon carcinoma with lymph node and liver metastases. Histological examination revealed an undifferentiated carcinoma of the ascending colon. The tumor cells were positive for G-CSF on immunohistochemical staining. The leukocyte counts and G-CSF level decreased after surgery. Thus, we diagnosed G-CSF-producing colon carcinoma. His general condition deteriorated rapidly and he died of residual tumor growth on postoperative day 24.

DOI： 10.1007/s00595-008-3941-1

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Language：English   Publishing type：Research paper (scientific journal)  

A 69-year-old woman with a chief complaint of jaundice was referred to our hospital. She underwent exploratory laparotomy under a diagnosis of advanced biliary tract cancer. Histological examination of a biopsy specimen of the gallbladder revealed adenocarcinoma. The tumor was unresectable because of invasion into a wide area of the hepatoduodenal ligament and liver bed. Retrograde transhepatic bile drainage tubes were inserted through the common bile duct into the right and left branches of the intrahepatic bile ducts. After metallic biliary stent implantation, gemcitabine (1,000 mg) was administered intravenously once a week for 2 weeks, followed by 1 week of rest. After 2 courses of chemotherapy, computed tomography showed significant reductions in the size of target tumors and serum CA19-9 levels had normalized. Tumor size was stable for more than 6 months. The patient has been able to maintain a good quality of life without any severe adverse effects of chemotherapy. Gemcitabine therapy after metallic biliary stent implantation might be safe and effective in patients with unresectable gallbladder cancer.

DOI： 10.1272/jnms.76.253

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SOC LAPAROENDOSCOPIC SURGEONS  

A 7-year-old girt was diagnosed with viral enteritis and was admitted to Our hospital. Sudden right upper quadrant tenderness appeared 2 days after admission. Ultrasonography revealed a large thick-walled cystic gallblader and an inflammation-induced hyperechoic Cystic duct. The long axis of the gallbladder was in a horizontal rather than a vertical alignment. Computed tomography demonstrated a markedly enlarged gallbladder with a slightly thickened wall and an enhanced twisted cystic pedicle. The diagnosis of gallbladder torsion led to laparoscopic detorsion and cholecystectomy. The gallbladder was gangrenous and was rotated counterclockwise with the attachment of the mesentery to the inferior surface of the liver. Although it Occurs more rarely in children than in adults, torsion of the gallbladder must be considered in the differential diagnosis of an acute abdomen. Early diagnosis and immediate laparoscopic intervention can help to achieve an excellent patient outcome.

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Language：Japanese   Publisher：(株)篠原出版新社  

患者は51歳、女性で、27歳時に潰瘍性大腸炎(ulcerative colitis:以下、UC)と診断された。2ヵ月前から血便を自覚。大腸内視鏡検査で全大腸炎型UCおよび直腸癌を認め、大腸全摘術(D3)、回腸人工肛門造設術を施行した。病理組織検査では、中〜低分化腺癌、pA、pN1(+)、H0、P0、stage IIIaであった。術後2ヵ月後から5-FU/LV療法を3週投与1週休薬で6クール行ったが、術後7ヵ月目に骨盤内局所再発と肝左葉転移を認めた。modified-FIREFOX療法に変更し、grade 3の消化器症状とgrade 1の末梢神経障害を認めたが、局所再発は消失、肝転移巣は著明に縮小した。肝転移は術後21ヵ月目に肝左葉外側区域切除を行った。UC合併直腸癌術後再発に対しmodified-FIREFOX療法が奏効した症例を経験したので報告する。(著者抄録)

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Language：Japanese   Publisher：(株)丹水社  

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は69歳、男性。嚥下困難を主訴に来院。上部消化管内視鏡検査で下咽頭と胸部下部食道に腫瘍を認め、生検で両腫瘍ともに中分化型扁平上皮癌であった。CT検査にて右頸部、噴門部リンパ節転移を認め、下咽頭癌(T1、N1、M0、Stage III)と胸部下部食道癌(T3、N1、M0、Stage III)の同時性重複癌と診断した。docetaxel(DOC)/5-fluorouracil(5-FU)/nedaplatin(CDGP)併用化学放射線療法を行った。有害事象は、grade 2の白血球減少と消化器症状であった。治療終了後のCT、内視鏡検査を行い、画像および組織学的にも腫瘍は消失していたため、complete response(CR)と判定した。治療終了後20ヵ月経過したが再燃、増悪を認めていない。DOC/5-FU/CDGP併用化学放射線療法は、同時性重複癌合併食道癌に対して有効であり安全に施行できた。(著者抄録)

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は58歳、女性。進行上行結腸癌に対し、右半結腸切除術(D2)を施行。術後6ヵ月後にCEAとCA19-9値の上昇を認め、胸腹部CT検査、上部下部消化管内視鏡検査を施行するも再発所見はなかった。その後も腫瘍マーカーの値は上昇し、腹部CT再検査でも明らかな再発はなかったが、術後9ヵ月目のPET-CT検査で右側腹部に集積の上昇を認め、結腸癌再発と診断した。modified-FOLFOX6とFOLFIRIを2週ごとに4回交互に投与するmodified-FIREFOX療法を施行した。経過中にgrade 3の白血球減少とgrade 2の消化器毒性を認めた時点で化学療法は中断したが、腫瘍マーカー値は徐々に正常化した。現在、治療終了後12ヵ月経過したが、PET-CTでの異常集積は消失(CR)し、再燃・再発の所見はない。(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2009&ichushi_jid=J00296&link_issn=&doc_id=20090319480029&doc_link_id=%2Fab8gtkrc%2F2009%2F003603%2F034%2F0505-0507%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2009%2F003603%2F034%2F0505-0507%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：日本臨床外科学会  

目的:再発鼠径ヘルニア症例に対する腹腔鏡下経腹的腹膜前メッシュ修復法(transabdominal preperitoneal mesh repair:TAPP)とopen mesh repair(OMR)の短期的な成績と有用性を検討した.対象と方法:1996年から2007年までの鼠径ヘルニア手術694例中再発は27例(4%)であり,その内メッシュを用いた修復は21例であった.TAPP(10例,61±4歳)とOMR(11例,62±2歳)を比較検討した.成績:手術時間は,TAPP 96±12分,OMR 108±11分と差はなかったが,術中出血量ではTAPP2±1mlに対しOMR 14±5mlと有意に高値であった.術後入院期間も,TAPP5±1日に対しOMR8±1日と有意に長かった.TAPPでは術後合併症を認めなかったが,OMRでは3例に皮下出血,1例に著しい疼痛を認めた.結論:再発鼠径ヘルニアにおけるTAPPはOMRより術後早期の愁訴が少なく早期に社会復帰可能な治療法として有用である.(著者抄録)

DOI： 10.3919/jjsa.70.368

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Language：Japanese  

An 86-year-old man was admitted with dysphagia. Endoscopic examination revealed an advanced esophageal cancer located in the lower thoracic esophagus. Histological analysis revealed moderately differentiated squamous cell carcinoma. The clinical stage was diagnosed as T2N0M0, stage II. He received radiation therapy in combination with chemotherapy using docetaxel 5-fluorouracil and nedaplatin. After chemoradiotherapy (CRT), the carcinoma could not be detected by CT or endoscopy, and endoscopic biopsy revealed no cancer cells in categorization as resulting complete response. Adverse event consisted of grade 2 in leukopenia We could not detect relapse, metastases or late side effect of CRT at present 24 months after CRT.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

A 58-year-old woman underwent right hemicolectomy with lymph node dissection (D2) for advanced ascending colon cancer which pathological examinations revealed to be moderately-differentiated adenocarcinoma. CEA and CA19-9 levels increased 6 months after the operation. She started adjuvant chemotherapy with oral administration of UFT-E (400 mg/day), but CEA and CA19-9 levels continued to elevate. However, a recurrent tumor was not detected by computed tomography (CT) and endoscopic examinations. A local recurrence in the right lateral abdominal wall was confirmed by PET-CT examination. We then conducted modified-FOLFOX6/FOLFIRI alternating regimen (modified-FIREFOX regimen). After this therapy, repeated PET-CT showed that the abnormal FDG-uptake concentration had disappeared, leading to a complete response (CR). The adverse event was grade 3 in leucopenia and grade 2 in gastrointestinal toxicity. She had maintained CR for the 12 months since undergoing chemotherapy. CEA and CA19-9 levels reduced to the normal range. We report this case with some review of the literature.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

A 69-year-old male was admitted to our hospital because of dysphagia. The diagnosis was double cancer with hypopharyngeal and esophageal carcinoma from upper gastrointestinal endoscopic examination. Pathological examinations of the double cancer revealed moderately-differentiated squamous cell carcinoma. Computed tomography (CT) of the neck and abdomen showed metastases of the right neck and cardiac lymph nodes. Clinical stagings of the double cancer were Stage III (T1, N1, M0) in hypopharyngeal carcinoma and Stage III (T3, N1, M0) in esophageal carcinoma, respectively. He received radiation therapy in combination with chemotherapy using docetaxel (DOC), 5-fluorouracil (5-FU) and nedaplatin (CDGP). After this combination chemoradiation therapy (CRT), the adverse event was grade 2 in leucopenia and grade 2 in gastrointestinal toxicity. Repeated macroscopic and histological examinations after CRT revealed disappearance of the hypopharyngeal and advanced esophageal carcinoma with lymph node metastasis, leading to a complete response (CR). He had maintained CR for the 20 months since undergoing CRT. This combination chemotherapy of DOC, 5-FU and CDGP with radiation may well be effective and tolerable for patients with double cancer of hypopharyngeal and esophageal carcinoma.

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Language：English  

We developed short-term pancreatic cancer models in hamsters using PGHAM-1 cells and examined the utility of the models for research on metastasis and for therapeutic trials. With 3 PGHAM-1 models, including 1) primary pancreatic cancer and simultaneous liver metastasis by intrapancreatic transplantation, 2) liver metastasis alone by intrasplenic transplantation, 3) peritoneal dissemination by intraperitoneal transplantation, within 21 days after inoculation, we studied the specific characteristics of metastases and the effects of several antiangiogenic substances on primary and metastatic pancreatic tumors. Several experiments showed that vascular endotherial growth factor and anatomical characteristics were important factors for metastasis. In therapeutic experiments, the incidence, size, diameter, microvessel density, and apoptotic index of the tumors were preferably influenced by the antiangiogenic substances. In addition, PGHAM-1-Luc, which is luciferase-positive PGHAM-1 cell line, was newly developed and is expected to be a useful new animal model. These models would be suitable for the study of pathogenesis of pancreatic cancer and its metastasis and for preclinical trials of chemotherapeutic agents, such as antiangiogenic substances.

DOI： 10.1272/jnms.75.325

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

患者は56歳、男性。肛門よりロウソクを挿入し、腹痛にて受診し入院となった。腹部CTにて直径65mm×長さ150mmの直腸内異物を確認した。大腸内視鏡検査にて直腸Raに異物の肛門側端を認めたが除去不可能であり、経肛門イレウス管を異物の口側に挿入して減圧した。腰椎麻酔下での経肛門的摘出を試みたが不可能であった。経肛門イレウス管の挿入により内服による腸管洗浄が可能であった。3日後、腹腔鏡下に小切開を置き、術者の右手を腹腔内に挿入し、用手的圧迫により経肛門的に異物を除去し得た。腹腔鏡補助下手術は腸管を詳細に観察でき、かつ最小の創で的確な手術が可能であり、非観血的に除去不可能な巨大直腸内異物に対しても非常に有用であった。(著者抄録)

DOI： 10.11477/mf.4426100246

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Language：Japanese   Publisher：日本医科大学医学会  

下咽頭癌、胸部中部食道癌の69歳男性例(症例1)、胃体中部後壁の胃癌、胸部下部食道癌の63歳男性例(症例2)、下咽頭癌、胸部食道癌の72歳男性例(症例3)に対し、Docetaxel、5-fluorouracil、Nedaplatinを用いた化学放射線療法を施行した。症例1は下咽頭癌、食道癌とも肉眼的、組織学的に消失し、CRと判定した。症例2は胃癌、食道癌とも著明に縮小し、腹部リンパ節転移巣が消失したため、PRと判定した。症例3は下咽頭癌、食道癌とも組織学的、肉眼的に消失し、原発巣はCRであったが、頸部リンパ節転移は著明に縮小したが残存したため、PRと判定した。奏効率は100%であった。有害事象は、Grade 2の白血球減少を症例1、2に認めG-CSF製剤を使用した。脱毛は症例3に、Grade 2の消化器症状は症例1に認めた。症例1は治療終了後12ヵ月の現在無再発であるが、症例2と3は治療終了後169日、185日に癌腫増大で死亡した。

DOI： 10.1272/manms.4.197

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Language：Japanese   Publisher：(株)南江堂  

62歳男。脳梗塞後遺症のリハビリ中、貧血を指摘された。直腸診にて黒色便の付着および血液検査にて高度貧血を認め、精査加療目的で入院した。上部消化管内視鏡検査所見では、十二指腸球部前後壁に活動期潰瘍を認めた。プロトンポンプ阻害薬を使用し2週間後に再検したところ、瘢痕期まで改善した。画像所見では、黄色肉芽腫性胆嚢炎(XGC)も否定しえなかったが、十二指腸および横行結腸に浸潤した進行胆嚢癌と診断し、肝床部合併胆嚢摘出術、幽門側胃切除術、横行結腸部分切除術を施行した。一塊となった切除標本の術中迅速病理診断で悪性像は認めず、XGCと診断した。病理組織所見では、悪性像は認めず、XGCと診断した。経過は良好で術後第5病日より飲水開始し、第7病日より食事を開始した。全身状態良好にて術後第16病日に軽快退院となった。

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Other Link： http://search.jamas.or.jp/link/ui/2008300522

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：W J G PRESS  

A 39-year-old male underwent distal gastrectomy for a high grade gastrointestinal stromal tumor (GIST). Computed tomography (CT) and magnetic resonance imaging (MRI) 107 mo after the operation, revealed a cystic mass (14 cm in diameter) and a solid mass (9 cm in diameter) in the right and left lobes of the liver, respectively. A biopsy specimen of the solid mass showed a liver metastasis of GIST. The patient received imatinib mesylate (IM) treatment, 400 mg/day orally. Following the IM treatment for a period of 35 mo, the patient underwent partial hepatectomy (S4 + S5). The effect of IM on the metastatic lesions was interpreted as pathologic complete response (CR). Pathologically verified cases showing therapeutic efficacy of IM have been rarely reported. (C) 2008 The WJG Press. All rights reserved.

DOI： 10.3748/wjg.14.3763

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Language：Japanese   Publisher：(株)東京医学社  

近年の研究により脂肪組織は、多彩な内分泌機能を有する免疫器官としての役割を持つことが明らかになってきた。脂肪細胞から特異的に産生されるアディポネクチンは、抗炎症作用を有することが報告されている。今回、食道癌、大腸癌症例を対象に周術期における血中アディポサイトカインの変動から、脂肪細胞と手術侵襲後の生体防御反応および術後感染症との関連を検討した。血中アディポネクチン値は、食道癌・大腸癌手術症例ともに術後一過性に低下した。しかし、大腸癌症例では急速に回復するが、食道癌症例ではその回復が遅れ、手術侵襲の程度によって差がみられた。また、大腸癌手術後感染症発生群では、血中アディポネクチン値は感染症非発生群に比べ術前後において常時低値であった。周術期における脂肪細胞の機能低下が術後感染症の発生に関与している可能性が示唆された。(著者抄録)

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An 81-year-old woman, who had undergone left radical nephrectomy for renal cell carcinoma 17 years previously, was found to have a mass approximately 5 cm in diameter in the body of the pancreas and an early gastric cancer. The patient was suspected of having pancreatic metastasis from renal cell carcinoma and an early gastric cancer and underwent distal pancreatectomy, splenectomy, and distal gastrectomy. Histologic examination showed that the pancreatic tumor was a clear cell renal cell carcinoma that had metastasized to the body of the pancreas and that the gastric cancer was a well-differentiated adenocarcinoma that had invaded the mucosa. Twenty months after the operation, the patient was well, without any evidence of recurrence. Renal cell carcinoma metastatic to the pancreas with gastric cancer rarely occurs, and surgical resection might have improved the quality of life in this patient. Careful long-term follow-up is necessary for patients who have undergone surgery for renal cell carcinoma.

DOI： 10.1272/jnms.75.41

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Language：Japanese   Publisher：日本膵臓学会  

膵癌は早期より転移を生じるため、その制御は予後改善に重要である。新しい観点からの基礎的研究が行われているが、特に分子生物学的知見からヒトへの応用までの過程には実験モデルによる検証が必要である。われわれはN-nitrosobis(2-oxopropyl)amine(BOP)をシリアンゴールデンハムスターに皮下注射し発生させた膵癌からPGHAM-1細胞株を樹立した。PGHAM-1細胞による膵癌モデルは、病理学的特性および生物学的特性もヒト膵癌に類似し、膵内、脾内、腹腔内という3種類の同種移植方法によって、膵腫瘍、肝転移、腹膜播種というヒト膵癌におけるすべての病態を21日という短期間で実験的に作製できる。このモデルは、転移特性の解明とともにその特性を生かした治療実験も可能であり、各種の血管新生阻害剤の治療実験でも、転移率、腫瘍径、微小血管密度などの検討から有用性が示された。動物を用いた研究モデルに関しては、実験動物をとりまく社会的環境の変化からも、屠殺することなしに生体観察が可能な方法など、さらなる改善が望まれている。(著者抄録)

DOI： 10.2958/suizo.23.60

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Language：Japanese   Publisher：多摩消化器シンポジウム  

クリニカルパス(パス)適応例につき、それ以前の症例と比較することにより、その評価と問題点を検討した。外来にて胆石症と診断し、手術目的に入院した患者を対象とした。パスを適応し2004年5月から2006年12月までに腹腔鏡下胆嚢摘出術を施行したパス群79例と、パス導入以前に2003年1月から2004年4月までに腹腔鏡下胆嚢摘出術を施行した前パス群59例を対象とした。総在院日数、術後在院日数は、パス群において有意に短縮した。診療報酬点数は、パス群において低値となったが、1日単価診療報酬点数は、逆にパス群の方が高値を示した。パス群79例中24例にバリアンスが発生した。患者希望による退院延期が7件、患者希望による早期退院が5件、胆管チューブ挿入が5件、腹痛による退院延期が3件、他疾患の追加治療による退院延期が3件、ドレーン出血による抜去時期の遷延が1件であった。

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Hepatic portal venous gas (HPVG) is a rare condition with a poor prognosis. A 40-year-old man underwent esophagectomy for stage IV esophageal cancer followed by chemotherapy. Four months later, he admitted to our hospital because of the increases of residual tumors and started chemoradiotherapy (CRT) with 5-FU, CDDP and radiation. Computed tomography (CT) scan revealed PR, and blood examination showed decreases in WBC and platelet counts. Fourty days after CRT, he suddenly complained severe pain in the left chest and abdomen, and vomiting. CT scan showed HPVG in the left lobe of the liver and pneumatosis cystoides intestinalis in the wall of the gastric tube. He died of multiple organ failure. To our knowledge, this is a first case of HPVG associated with CRT for esophageal cancer.

DOI： 10.11405/nisshoshi.105.1504

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Society of Gastroenterological Surgery  

A 44-year-old autistic man undergoing psychiatric therapy at a mental health center was admitted 1 week after ingesting magnets due to abdominal pain with pyrexia. Laboratory data showed severe inflammation and abdominal X-ray, and computed tomography showed 9 intestinal metallic foreign bodies necessitating emergency surgery to remove 9 magnets used in psychiatric treatment. Duodeno-jejunal and jejunojejunal fistula were found at points of magnet contact with the duodenum and jejunum. Magnets were removed and the necrotic duodenum and jejunum partially resected together with the fistula. Duodenojejunostomy, jejunojejunostomy, and duodenostomy with an 8 Fr Atom catheter were successful and the postoperative course was uneventful. Although 26 cases of magnet ingestion have been reported in children in the world, to our knowledge, this is a first such report involving intestinal perforation and fistula after magnet ingestion in an adult. ©2008 The Japanese Society of Gastroenterological Surgery.

DOI： 10.5833/jjgs.41.2069

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Language：Japanese   Publisher：(株)癌と化学療法社  

高齢者の転移性乳癌患者に対して、capecitabineとcyclophosphamideの併用療法(XC療法)を行い、臨床的完全奏効(CR)を得た1例を経験したので報告する。症例は78歳、女性。76歳時に左乳癌(DC領域)にてAuchincloss手術施行(硬癌、pT1c(2.0cm),n(1/10),ly3,v1,ER(-),PgR(-),HER2:score 1)。術後1年半目に左鎖骨上リンパ節、左胸筋間リンパ節および縦隔リンパ節に転移を認め、初回化学療法としてXC療法を開始した。8コース目にCRとなり、現在も外来通院にて19コース目投与中で9ヵ月CRが持続している。本療法は副作用の発現も軽微でQOLの低下を来すことなく、その臨床効果を確認できたことから転移性乳癌のfirst-line治療における選択肢の一つとなり得ると考えられる。(著者抄録)

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

72歳女。患者は腹痛および嘔吐を主訴とした。腹部は全体的に膨隆し、下腹部に圧痛を認めた。腹部CTではイレウス管先端より肛門側の回腸末端は拡張し、腸管壁の肥厚を認めた。そして拡張した腸管内にはfat densityの腫瘤が集簇した像を認めた。一方、大腸内視鏡および小腸造影検査では回腸が盲腸内に重積しており、重積先端部には表面平滑で黄色および赤色調の多発した粘膜下腫瘍がみられ、鉗子で圧排すると陥凹した。以上より多発回腸脂肪腫による腸重積症と診断し、腹腔鏡補助下回盲腸部切除術を施行した結果、組織学的には成熟した脂肪細胞が増生しており、異型細胞は認めず脂肪腫と診断された。術後経過は良好で、患者は第9病日目に退院となった。

DOI： 10.11477/mf.4426100084

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Language：English   Publisher：MARY ANN LIEBERT INC  

A 39- year- old Japanese man was admitted to our hospital after experiencing recurrent episodes of pancreatitis over the previous 2 years. On the first episode, he had been admitted to our hospital with elevated serum amylase levels and epigastralgia. Abdominal computed tomography ( CT) revealed a diffuse, uncircumscribed area with heterogeneous density in the pancreas. No previous history of pancreatitis, gallstones, drinking, or abdominal injury was elicited. Magnetic resonance cholangiopancreatography ( MRCP) demonstrated that the Wirsung duct was unconnected to the Santorini's duct. Endoscopic retrograde cholangiopancreatography through the papilla of Vater and accessory papilla revealed an enlarged ventral pancreatic duct, pancreas divisum, and a cystic lesion in the pancreatic body. On the second and third episodes, endoscopic drainage of the pancreatic pseudocysts through the accessory papilla and ultrasonography- guided transmural drainage were unsuccessful. A follow- up CT and MRCP demonstrated that the pancreatic cyst had enlarged to 9 x 8 cm in diameter. A laparoscopy- assisted cystgastrostomy was performed with an intragastric approach. An anastomosis was performed using an endoscopic linear stapler through the small cystotomy and gastrotomy openings on the posterior wall of the stomach. The postoperative clinical course was uneventful. Over 6 months later, the patient remains well and with a good quality of life. A laparoscopy- assisted cystgastrostomy, using an intragastric surgical technique, offers a safe, less- invasive procedure for cyst drainage by the pancreas divisum.

DOI： 10.1089/lap.2006.0091

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

55歳の女性。発熱・黄疸を主訴に来院。血清ビリルビン値とトランスアミナーゼ値の上昇,および腹部CT検査で,胆道気腫と胆嚢壁の著明な肥厚を認めた。緊急内視鏡的胆道ドレナージを行い,総胆管結石を認めたが,胆嚢は描出されなかった。上部消化管造影検査で胃前庭部に瘻孔形成を認めた。術中に胆嚢は同定できなかった。胆嚢と考えられた部位の迅速病理診断で黄色肉芽腫性胆嚢炎が強く疑われたが,胆嚢癌との鑑別は困難であったため,拡大胆嚢摘出術,肝外胆管切除術に加え,幽門側胃切除術を施行した。再建は肝管空腸吻合および胃空腸吻合とした。病理組織学的診断は黄色肉芽腫性胆嚢炎であった。摘出標本で胆嚢内腔から胃前庭部前壁への瘻孔形成を認めた。黄色肉芽腫性胆嚢炎は比較的まれな疾患で,胃壁と瘻孔を形成した報告は1例のみであった。(著者抄録)

DOI： 10.11231/jaem.27.503

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Language：Japanese   Publisher：(一社)日本肝臓学会  

C型慢性肝炎に対するインターフェロン(以下、IFN)治療後にHCV-RNAの持続的陰性化とALT値の正常化が得られる著効例からの肝細胞癌(以下、HCC)の発生率は少ないとされる。患者は65歳の男性で、C型慢性肝炎に対してIFN-βによる治療により著効を得た。IFN著効12年後の肝S7の破裂HCCに対し、動脈塞栓術による止血後にS7亜区域切除を施行した。切除標本では、IFN開始時、新犬山分類のF3/A2であった線維化と壊死、炎症所見が切除時にはF0/A0まで改善していた。また、極めて多くのMib-1陽性細胞を有する低分化型肝細胞癌であった。IFN長期著効例であっても発癌の可能性を十分に考慮した経過観察が必要であると考えられた。(著者抄録)

DOI： 10.2957/kanzo.48.48

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2007&ichushi_jid=J00263&link_issn=&doc_id=20070308230002&doc_link_id=10.2957%2Fkanzo.48.48&url=https%3A%2F%2Fdoi.org%2F10.2957%2Fkanzo.48.48&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Medical Association of Nippon Medical School  

The effectiveness of the clinical pathway for laparoscopic cholecystectomy was evaluated, and the efficiency of medical care was analyzed. The duration of hospitalization and the number of National Health Insurance (NHI) points for medical service fees were compared between 86 patients treated after introduction of the clinical pathway (pathway group) and 56 patients treated before introduction of the clinical pathway (pre-pathway group). In the pathway group, variance from the pathway occurred in 24 patients (27.9%) due to postponement of discharge in 7 patients, to earlier discharge in 5 patients, and to insertion of a bile duct catheter in 5 patients. Total and postoperative hospitalization times were significantly shorter in the pathway group than in the pre-pathway group (8.0 ± 1.6 vs 13.7 ± 9.0 days, p&lt
0.0001, 5.4 ± 1.1 vs 6.5 ± 2.2 days. p&lt
0.0001. respectively). In the pathway group, the total number of NHI points was lower and the number of points per day was higher. By simulation, the total number of NHI points for the 5-day pathway (discharge on postoperative day 3 or earlier) was significantly lower than that for the current 7-day pathway. Moreover, the weekly profit per bed with the 3-day pathway (discharge on postoperative day 1) was more than twice that with the current pathway. The results suggest that the clinical pathway for laparoscopic cholecystectomy is beneficial for patients and useful for the introduction of diagnosis procedure combination in our hospital.

DOI： 10.1272/jnms.74.409

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は66歳、男性。前医で下行結腸ポリープの内視鏡的摘出術を行い、腺腫内癌・断端陽性であった。4年間未治療であったが、下腹部痛が出現し、精査にて下行結腸癌、多発肝転移、大動脈周囲リンパ節転移と診断した。左結腸切除術を施行した。病理検査で中分化型腺癌、stage IVであった。術後5-FU/LV療法を開始したが、3クール後に高度の食欲不振が出現したため中止した。TS-1 100mg/dayに変更したが、再び食欲不振が出現し1週間で中止となった。TS-1を80mg/dayと減量し3週連日投与1週休薬で経口投与し、irinotecan(CPT-11)65mg/m2をday 1,15に点滴投与した。4週を1クールとして10クールを外来で1年間繰り返した。治療後、大動脈周囲リンパ節腫脹は著明に縮小した。経過中grade 2以上の有害事象は認めなかった。TS-1/CPT-11療法は、外来で安全に継続でき、今後進行・再発大腸癌に対する有用な外来化学療法になり得ると思われた。(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2006&ichushi_jid=J00296&link_issn=&doc_id=20060925480025&doc_link_id=%2Fab8gtkrc%2F2006%2F003309%2F025%2F1337-1340%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2006%2F003309%2F025%2F1337-1340%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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Language：Japanese   Publisher：多摩消化器シンポジウム  

著者らは腹腔鏡下総胆管切石術(Lap.CBDE)における手技上の進歩とその意義について検討した.対象は1993〜2002年までにLap.CBDEを施行した73例で,術式間の手術時間,術後在院日数を比較検討した.実際に行われた術式は腹腔鏡下胆摘(Lap.C)+腹腔鏡補助下総胆管切開切石術(LA-CBDE)or腹腔鏡下総胆管切開切石術(L-CBDE)+T-tube drainageが25例,Lap.C+経胆嚢管的結石除去(L-TCCBDE)+C-tube drainageが30例,経皮経肝胆道ドレナージ(PTBD)or内視鏡的胆道ドレナージ(ENBD)施行後にLap.C+L-CBDE+primary sutureが13例,開腹術に移行が5例であった.平均手術時間はT-tubeドレナージ法が343分,C-tubeドレナージ法が235分,術前のPTBDおよびENBDに加えた一期的縫合法が190分であった.また,平均術後在院日数はT-tubeドレナージ法が31日,C-tubeドレナージ法が16日,一期的縫合法が16日であった.総胆管切開部の閉鎖にラプラタイ(Ethicon)が導入され,平均手術時間が240分と導入前の310分に比し短縮された

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Language：Japanese   Publisher：(株)南山堂  

肝がん診療に際しては,まず肝細胞がんはほかのがんと異なる臨床的特徴を有していることを理解することが重要である.重要な特徴は,(1)わが国の肝細胞がん90%以上がB型(10%),C型(80%),肝炎ウイルスの持続感染者すなわち慢性肝疾患患者に発生することである.(2)またこれら慢性肝障害は80%以上が肝硬変を有している.(3)症状は高度進行肝障害,肝がん合併があっても症状は乏しい.(4)C型慢性肝炎は最終的には肝硬変,肝がんになる.(5)がん発生率は肝障害が高い程高率となるが,早期発見,抑制が可能である.(6)治療法は背景肝の特徴を認識し,肝障害度と肝がん進行度を評価した上で治療方針が決定される.(7)多中心性発生,治療後の高率な残肝再発がみられる.(8)予後は肝がん進行度と肝障害度が重要な決定因子である(著者抄録)

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Other Link： http://search.jamas.or.jp/link/ui/2005127665

Language：English   Publishing type：Research paper (international conference proceedings)   Publisher：MEDIMOND PUBLISHING CO  

Severe surgical trauma is relatively high risk for hepatic failure cased by postsurgical sepsis. We have tested the hypothesis whether pretreatment with methylprednisolone (MP) could reduce liver dysfunction following postsurgical sepsis. In 32 patients who underwent esophagectomy, 11 patients (MP group) were given 10 mg/kg of MP and 21 were served as controls. Serum samples were analyzed for hepatobilliary function parameters, sICAM-1 and TNF-alpha. Liver dysfunction due to sepsis was observed in 5 patients (24%) of the control group, and in 1 patient (9 %) of the MP group (p < 0.05). The levels of total bilirubin, sICAM-1 and TNF-alpha in the control group were significantly higher than those in the MP group. Total bilirubin level correlated with the levels of sICAM-1 and TNF-alpha. Pretreatment with MP may attenuate liver dysfunction following sepsis.

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Language：English   Publishing type：Research paper (international conference proceedings)   Publisher：MEDIMOND PUBLISHING CO  

The relation between the degree of lymph node metastasis (N) and the relapse death were examined by using the gastric cancer patient undergone curative resection. The relapse mortality rate of the example of the curative resection was 18.8%. As for the example without lymph node metastasis, the relapse mortality rate was 5.1% and that with lymph node metastasis was 45.1%, and the metastasis of the lymph node had exerted a big influence on the relapse death. In comparison with the degree of lymph node dissection (D), the relapse mortality rate of D2 or more did not differ from D1 or less in the same degree of lymph node metastasis. The effect of lymph node dissection did not appear to the prognostic result, and the prognosis was influenced greatly by the degree of lymph node metastasis. However, the existence of the relapse route with a little influence of lymph node metastasis was suggested in the extra-hepatic hematogenous, gastric bed and peritoneal relapse.

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

症例1(8歳男児),症例2(2歳6ヵ月女児).急性膵炎を発症し,腹部画像で合流形式新古味分類IIa型の膵胆管合流異常に伴う先天性胆道拡張症と診断した.保存的治療により症状が軽快後,根治を目的に腹腔鏡下総胆管切除,および直視下にRoux-en Yによる肝管空腸吻合術を施行した.症例1は成人用機器,症例2は小児用機器を使用し,手術時間はそれぞれ8時間45分,7時間20分であった.術後,症例1は胆汁のleakageを認めたが超音波ガイド下経皮的ドレナージで軽快して34日目に退院し,症例2は21日目に退院した.術後それぞれ3年3ヵ月,2年9ヵ月経過して症状の再発はみられず元気である

DOI： 10.11477/mf.4426900506

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Language：Japanese   Publisher：日本膵臓学会  

過去10年間に経験した膵癌症例を対象とし,特に糖尿病先行例を検討することにより,糖尿病の膵癌における特徴やリスクファクターとしての意義について考察した.膵癌73例を対象にし,男性46例,女性27例であり,平均年齢63.6歳であった.占拠部位別では膵球部癌(PP)49例,体・尾部癌(M-DP)24例であった.糖尿病先行膵癌12例では男性9例,女性3例であり,平均年齢66.4歳であった.糖尿病先行例においては体・尾部優位であり,予後不良のものが多いという結果になった.糖尿病増悪は体・尾部癌に多く見られる傾向にあり,また長期例においては比較的高率に膵癌が認められ糖尿病が膵癌発生の危険因子となる可能性が示唆された.病悩期間が短いものはスクリーニング検査を進めていくことが早期発見に有用であることが示唆された

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Language：Japanese   Publisher：多摩消化器シンポジウム  

1993年〜2002年迄の大腸癌肝転移症例79例を対象に,治療方針および予後を中心に検討した.手術は肝切除26例,ラジオ波凝固療法3例,化学療法は動注療法10例,全身化学療法施行例40例であった.肝切除または凝固療法の症例群では,3年生存率50%,5年生存率約30%であったが,動注療法群の3年生存率は約20%で,全身化学療法のみ適応となった症例群の大半は1年以内に死亡していた.肝切除は化学療法と比較し,有意に生存率が高いことが確認された.肝切除施行症例26例の術式は,葉切除7例,区域切除7例,部分切除8例,腫瘍核出術4例で,腫瘍径では5cm未満の転移巣が18例と大半を占めていた.転移個数では単発が10例と最も多く,4個未満の転移を示した症例が18例,4個以上が8例で,転移巣が4個未満の症例と,4個以上の症例では5年生存率に有意差がみられた.転移性肝癌には根治的な肝切除或いは肝凝固療法の併用が施行されるべきと考えられた

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

59歳男.膵頭十二指腸切除術後16日目に腹腔内出血によるショック状態を呈し緊急開腹術を行った.初回手術時に誤って損傷した総肝動脈が出血点であり,これを縫合止血した.しかし,この手術後11日目に再び出血,動脈塞栓療法を試みるも不成功であったため再度の緊急開腹術を施行した.出血部位は前回と同じであったが血管壁脆弱のため縫合修復不可能であり,やむをえず刺入結紮を行い止血した.術後,軽度の肝機能障害が認められたが比較的速やかに軽快し,初回手術から88日目に退院となった

DOI： 10.11231/jaem1993.23.905

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Language：English   Publishing type：Research paper (scientific journal)  

Background/Purpose. Radiofrequency ablation (RFA) and microwave coagulation therapy (MCT) have been gaining acceptance as a standard method in the management strategy of liver cancer, for reasons of minimally invasive techniques and effective results. We present our experience of RFA and MCT in patients with liver cancer, and analyze retrospectively the advantages and disadvantages of both of the percutaneous and laparoscopic approaches. Methods. Thirty-two consecutive patients (23 men and 9 women) with 19 hepatocellular carcinomas (HCC), 12 metastatic liver cancers, and recurrent cholangiocellular carcinoma (CCC), were enrolled in this study. Out of these 32 patients, as a prior laparotomy, 19 underwent hepatectomy, colectomy, gastrectomy or cholecystectomy, and 15 were treated with the laparoscopic approach, 17 treated with the percutaneous approach, and 2 treated with the combined approach of those two. All of these procedures were carried out under general anesthesia with ultrasound guidance. Seven and 30 days after these procedures, an assessment helical computed tomography was done. Results. No sign of the residual tissues was noted in all patients except only one case. Conclusions. The percutaneous approach was thought to be a more practical and less invasive method regardless previous laparotomy. For the laparoscopic approach, tumors located at the hepatic surface or margin were preferable candidates.

DOI： 10.1007/s00534-002-0830-7

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会-関東支部  

53歳男.クローン病による小腸狭窄に対して大腸内視鏡を用いてバルーン拡張術を施行し,良好な結果を得た.本症例では炎症による回盲弁変形及び終末回腸の可動性低下の為に,内視鏡の病変部到達が非常に困難であった.狭窄部は直視できず,透視下にガイドワイヤーを進め,バルーン拡張術に成功した.本拡張術は繰り返し行える低侵襲で比較的安全な手技である.クローン病のように再狭窄や再手術率の高い疾患に対しては,短腸症候群やポリサージェリーを回避する為にも有用な治療法と考えられた

DOI： 10.11641/pde.59.2_114

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Other Link： http://search.jamas.or.jp/link/ui/2002124914

Language：Japanese   Publisher：北村山公立病院医学雑誌編集委員会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本膵臓学会  

N-nitrosobis(2-oxopropyl)amine誘発ハムスター実験膵癌の皮下継代移植腫瘍から腫瘍細胞株(PGHAM-1)を樹立し,腫瘍の同種膵内移植およびその経時的検討を行った.PGHAM-1細胞は類円形で付着性に増殖し,細胞倍加時間は14.4時間,染色体数は46XXであった.腫瘍生着は1週間で100%であり,移植後3週目以降では60%に肝転移が認められた.組織学的には高分化型管状腺癌であり,散在性の腫瘍が増大に伴い充実性の増殖増へと経時的に変化した.腫瘍先進部は線維性間質成分が豊富に存在し,これを介した浸潤性の増殖形態が認められた.免疫組織化学的には,血液型A型関連物質が癌細胞膜上に高率に発現した

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J-GLOBAL

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Language：Japanese   Publisher：(NPO)日本食道学会  

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症例は52歳女性で、乳房に腫瘤を自覚し、当院を受診、触診にて左乳房中央部領域に長径25mmの円形腫瘍を認めた。針生検による病理診断は浸潤性乳管癌、Nuclear grade 2、Estrogen receptor 0%、Progesterone receptor 0%、HER2スコア0、Ki67陽性率10%、サブタイプはtriple negativeであった。化学療法を行うも病変の縮小は得られず、乳腺部分切除術および腋窩リンパ節郭清を施行した。術後、放射線療法と化学療法を施行したが倦怠感が出現し、血液検査にて血小板数の著明な減少を認め緊急入院となった。骨髄穿刺を施行し、乳癌の骨髄転移と診断された。血小板輸血を施行したが、輸血を中止すると血小板数は数日で2.0×10^4/μL以下に減少し、化学療法を再開することはできなかった。血小板輸血を中止しbest supportive careを選択されてから1週間後、上肢筋力の低下が出現し、頭部CT検査にて脳出血の所見を認めた。翌日に意識レベルが低下し、乳癌術後7ヵ月目に永眠された。

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Language：Japanese   Publisher：(一社)日本内分泌外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本外科感染症学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(NPO)日本食道学会  

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Language：Japanese   Publisher：日本膵臓学会  

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Language：Japanese   Publisher：日本膵臓学会  

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Language：Japanese   Publisher：日本膵臓学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：English   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：日本内科学会-関東地方会  

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：日本手術医学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

DOI： 10.3919/jjsa.77.650

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

DOI： 10.3919/jjsa.77.967

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Language：Japanese   Publisher：(一社)日本外科感染症学会  

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Language：Japanese   Publisher：(一社)日本外科感染症学会  

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Language：Japanese   Publisher：(一社)日本外科感染症学会  

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Language：Japanese   Publisher：(一社)日本外科感染症学会  

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Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：(NPO)日本食道学会  

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Language：Japanese   Publisher：(NPO)日本食道学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本乳癌学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

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Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

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Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

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Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：(公社)日本化学療法学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：(公社)日本超音波医学会  

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Language：Japanese   Publisher：(公社)日本超音波医学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(NPO)日本乳腺甲状腺超音波医学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会-関東支部  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：WILEY-BLACKWELL  

Web of Science

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：WILEY-BLACKWELL  

Web of Science

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Language：Japanese   Publisher：(一社)日本外科感染症学会  

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Language：Japanese   Publisher：(一社)日本外科感染症学会  

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Language：Japanese   Publisher：(一社)日本外科感染症学会  

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Language：Japanese   Publisher：(一社)日本外科感染症学会  

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Language：Japanese   Publisher：(一社)日本外科感染症学会  

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Language：Japanese   Publisher：(一社)日本外科感染症学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：NATURE PUBLISHING GROUP  

Web of Science

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

DOI： 10.3919/jjsa.76.743

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本肝臓学会  

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Language：Japanese   Publisher：日本胆道学会  

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Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

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Language：Japanese   Publisher：(一社)日本門脈圧亢進症学会  

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Language：Japanese   Publisher：(NPO)日本食道学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本乳癌学会  

J-GLOBAL

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Language：English   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(NPO)日本食道学会  

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Language：Japanese   Publisher：(NPO)日本食道学会  

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Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

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Language：English   Publisher：(一社)日本肝胆膵外科学会  

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Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

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Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

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Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

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Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

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Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

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Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

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Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：日本膵臓学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：(公社)日本超音波医学会  

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