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Furthemore, there were statistical significances in the changes of peripheral white blood cell and lymphocyte counts before and after treatment in the RT and the CRT. The incidence of postoperative pneumonia and colitis in CRT were There were no statistically significant differences in morbidity and mortality rates at 30 days after operation between the groups. The incidence of postoperative pneumonia between patients with and without CRT exhibited a statistically significant difference by univariate analysis. Additionally, logistic regression analysis revealed the CRT was one of the most important risk factors for postoperative pneumonia.

Therefore, after neoadjuvant chemoradiotherapy patients should be considered as in an immunosupressive state prior to surgery which will require careful and special postoperative management. To investigate the usefulness of reconstructive procedures after proximal gastrectomy, we examined the extent of gastrectomy and the models of jejunal interposition.

Assessment of the quality of life and a functional evaluation was examined in patients who had undergone 4 kinds of reconstructive procedures after proximal gastrectomies including total gastrectomy. In the Pouch group, the remnant stomach was observed by endoscopy in all cases, while 2 cases in the Pouch group showed finding of esophagitis. In proximal gastrectomy, the extent of the distal stomach should be preserved, and when the remnant stomach is small, the reserve function should be increased with a jejunal pouch. The aim of our study was to identify prognostic factors in advanced resectable gastric cancer patients.

We investigated 50 advanced gastric cancer surgical specimens by immunohistochemical methods. Measurements of microvessel density, expression of urokinase-type plasminogen activator u-PA , plasminogen activator inhibitor-1 PAI-1 , urokinase-type plasminogen activator receptor u-PAR and vascular endothelial growth factor VEGF were made by the streptoavidin-biotin complex staining method.

We then compared these parameters with the survival, and clinicopathorogical factors. Microvessel density was between Monovariate analysis showed that u-PA expression and microvessel density had a significant influence on survival after surgery. The other two u-PA families had no impact on survival. Ten variables were entered into the Cox proportional hazard regression model to identify factors that independently influenced survival. Multi-variate analysis revealed that clinical stage and the expression of u-PA independently influenced survival in patients. In conclusion, it is suggested that the u-PA expression is useful as a new prognostic factor in advanced gastric cancer patients.

We investigated the clinical course and the therapeutic outcomes for 11 patients with hepatocellular carcinoma HCC coexisting with bone metastasis after hepatectomy between and Cases of solitary bone metastasis were alive longer than 1 year after bone metastasis, and their prognoses were relatively good. Most therapies for bone metastasis were performed conservatively to reduce the pain The resection of the bone was performed in 3 patients.

The Japanese Journal of Gastroenterological Surgery

Though the bone metastases of these patients were progressive and finally changed to multiple foci, they had longer survivals than the other patients and took longer painless period. For HCC patients whose intrahepatic lesion is controllable and the metastatic bone lesion is solitary and easily resectable, resection of the lesions seemed to be effective as the intensive therapy for HCC with bone metastasis. EBV-DNA was not detected in any gallbladder which was resected for gallstones without acute inflammation, and in normal gallbladders.

These 37 cases had latent EBV infection. Latent EBV infection may be one of the etiologic factors for the development of acute cholecystitis.

The Effectiveness of intraductal ultrasonography IDUS through the cystic duct during laparoscopic operation was evaluated in 11 patients with cholelithiasis. The IDUS probe 2mm diameter was inserted easily through the cystic duct to the common bile duct in 10 of 11 patients. In one patient, common bile duct stone was detected by IDUS, that was not detected by intraoperative cholangiography. In another patient only one common bile duct stone was demonstrated by intraoperative cholangiography, however, 2 stones were revealed by IDUS.

We suggest that IDUS in useful for the detection of small stones that were difficult to demonstrate by intraoperative cholangiography, and effective to ascertain the presence of residual stones after endoscopic treatment for common bile duct stones.


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An Approach from immunohistochemistry. The significance of MMP-7 and type IV collagen expression in human colorectal cancer was investigated by immunohistochemical assay, and its correlation with liver metastasis was analyzed. Thus the metastatic groups show significantly higher expression of MMP-7 in the lymph channel than the control group. The expression of MMP-7 in the lymph channel is the most useful paraneter to predict liver metastasis in colorectal cancer.

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A year-old man was admitted to our hospital with a diagnosis of gastric tumor during a health screening X-ray examination. The submucosal tumor was detected with endoscopy, endoscopic ultrasonography and X-ray examination. The preoperative diagnosis was leiomyoma of the stomach because of the smooth and hypoechoic lesion seen during endoscopic ultrasonography. Laparoscopic partial resection of the stomach was performed. The histological examination revealed the tumor to be a glomus tumor. In Japan, a glomus tumor of the stomach was first reported in and only 69 cases have been reported in the Japanese literature up to now, of which only one case has been resected by laparoscopic surgery.

An year-old woman who was pointed out an abnormal shadow of the stomach by upper gastrointestinal series at a gastric cancer screening was diagnosed to have a submucosal tumor of the stomach and cholecystolithiasis.

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At surgery, a 11 cm tumor growing extraluminally from the anterior wall of the cardia and a hard right ovarian tumor with massive bloody ascites was observed. Total gastrectomy, cholecystectomy and right oophorectomy were performed. Immunohistochemical study showed that the gastric tumor was negative for myogenic and neurogenic markers, but was positive for CD34 and vimentin. From these observations, the gastric tumor was suspected to be gastrointestinal stromal tumor GIST with low malignant potential. The ovarian tumor was diagnosed as thecoma by Sudan stain and silver impregnation method.

We suspected that the massive bloody ascites was due to thecoma and rupture of the GIST with bleeding. The postoperative course was uneventful and she had no sign of recurrence for three years. A year-old woman was admitted with discomfort caused by a tumor mass in the lower abdomen, which was suspected to be an ovarian tumor. Bilateral oophorectomy was performed and the tumor was histopathologically classified as signet ring cell carcinoma.

Postoperative gastrointestinal fiberscopy revealed an early gastric carcinoma of the IIc-type on the greater curvature of the middle potion of the gastric body. The biopsy specimens were diagnosed as signet ring cell carcinoma, and a total gastrectomy was carried out. Krukenberg's tumor is reported to be a kind of tumor cell dissemination, but our case did not show any peritoneal dissemination.

Six cases of intramucosal gastric cancer with Krukenberg's tumor have been found in the Japanese literature. A case of gastric lymphoma of mucoa-associated lymphoid tissue MALT exhibiting marked plasma cell differentiation with idiopathic portal hypertension is reported.

A year-old woman was admitted to our hospital because of appetite loss and general fatigue. Upper gastrointestinal endoscopy revealed multiple stomach ulcers. Macroscopic examination revealed morphological similarities to the superficial type of malignant lymphoma. Abdominal CT and angiography showed splenomegaly and proliferation of the collateral vessels. Under the diagnosis of malingant lymphoma of the stomach and idiopathic portal hypertension, on the 29th of May, No abnormality of the liver was observed.

The diagnosis was thus idiopathic portal hypertension.


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  7. No case of gastric lymphoma of MALT exhibiting marked plasma cell differentiation with idiopathic portal hypertension has been reported and so this case is very important. A gastrointestinal stromal tumor GIST of the duodenum in a year-old male is reported. The patient presented with a history of repeated tarry stools and was admitted to our hospital. An elevated lesion with ulceration was found in the third portion of duodenum as a result of various types of examinations.


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    Biopsy revealed a GIST originating in the duodenum, and partial duodenectomy was performed. Pathological examination revealed dense fascicular proliferation of spindleshaped tumor cells in a bundle and nuclear divisions in 10 HPFs. GISTs originating in the duodenum are rare and more malignant than GISTs originating at other sites in the digestive tract, and therefore careful follow-up may be required.

    A year-old man with no complaint was referred to tur hospital because of a subpedunculated tumor at the opposite side of Vater's papilla, which was detected by upper gastrointestinal endoscopy during screening. Hypotonic duodenography revealed a subpedunculated tumor, and was diagnosed as a benign tumor of the duodenum.

    Incision of the duodenal wall and resection of the tumor were performed. Histological examination revealled slightly enlarged tumor cells located on the submucosal layer and proliferating in a papillary pattern, which suggested they had originated from Brunner's glands and also showed few cellular and structual atypia, which indicated adenoma. However, destruction of the muscularis mucosae and invasion to the propria mucosae, therefore, we concluded that the tumor was carcinoma arising in Brunner's glands.

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    This case presented cancer in adenoma, so these findings seemed to propose an interesting problem in the development of carcinoma arising in Brunner's glands. We reported a case of carcinoid tumor of the Vater's papilla, accompanied by liver metastases and lymph node metastases. The patient was a year-old women, who was admitted to our hospital for control of diabetes mellitus. As she had complained of some liver disfunction, several examinations were performed. By endoscopical and radiological investigations, a tumor approximately 4cm in diameters was found at the Vater's papilla.

    The biopsied specimen demonstrated a positive reaction to chromogranin A stain and Grimerius stain. This case was thus diagnosed as a carcinoid tumor of the Vater's papilla. At operation, although there were two liver metastases at the surface of the liver S 4 and regional lymph node metastases, we selected pancreatoduodenectomy with D 2 lymph node dissection and enucleation of the liver metastases.

    This patient is doing well without recurrence 2years 1month postoperatively. We experienced a rare case of choledocholithiasis caused by metal clips which were engaged at the site of a previous laparoscopic cholecystectomy Lap. C performed nine months before. The patient was a 53 year-old-woman with cholecystolithiasis, who underwent the Lap. C in another hospital in April, The operation was converted to an open cholecystectomy to stop bleeding from the liver bed at the time of surgery.

    During the follow-up period, the patient suffered from intermittent high fever and abdominal pain. In January, , endoscopic retrograde cholangiography revealed a stone shadow with metal clips in the common bile duct CBD , and a stenotic lesion in the middle portion of the CBD. Surgery was subsequently performed on March 8, 11months after the initial operation. The CBD was explored and the stone was removed.

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    The stone appeared to be a pigmented gall stone with a nidus comprised of the metal clips used in the Lap. We performed a hepaticoduodenostomy, and the patient had an uneventful recovery, and maintained good bile flow. Surgical clips have previously been reported to form choledochal stones. In this case, the clips were located at the end of the cystic duct near the juncture with the CBD.

    Surgeons must exercise caution in the use of metal clips and electric cauterization to avoid damage to the CBD, which can result in local inflammation around the CBD. A year-old women complaining of diarrhea was admitted to our hospital. During the examination, computed tomography showed a mass in the cystic duct of the gallbladder.

    Subsequently, cholecystectomy and choledochectomy were performed. Adenocarcinoma in the mucosa showed gradual transition to endocrine cell carcinoma in the deeper tissues. Immunostaining disclosed a transitional form which was bonding between adenocarcinoma and endocrine cell carcinoma. Electron microscopy revealed that endocrinegranules detected even in adenocarcinoma cells were in transitional position. The granule was 0. There was no finding of exocytosis. These granules may suggest a differentiation marker to transitional form of the endocrine cells from the adenocarcinoma cells, beecause both kinds of cells were detected in the identical tubule.

    Developement of adenoendocrine cells are thought to bo a clonal growth of endocrine cells in deeper tissues. We believe that the debree of biological malignancy was very high in this case, because of the rapid progressive, vascular invasion, metastasis in a lymph node, and multiple metastases in liver observed 10 months postoperation. Two cases of inflammatory pseudotumor of the spleen are reported.

    In the first case, a splenic mass was incidentally detected by abdominal ultrasonography in a year-old man during follow up of the postoperative course of distal gastrectomy for gastric cancer. An abdominal CT scan revealed a wellencapsulated splenic mass, and only the capsule was enhanced. Solitary splenic metastasis of the gastric cancer and splenic hamartoma were considered in the differential diagnosis, and splenectomy was performed. In the second case, a year-old woman who had undergone total hysterectomy six years before was also incidentally found to have a splenic mass by abdominal ultrasonography during observation of a gastric submucosal tumor.

    Based on our experience in the first case, we diagnosed the mass as an inflammatory pseudotumor of the spleen and performed splenectomy. Both tumors were histologically diagnosed as inflammatory pseudotumor of the spleen. Laparotomy had been performed previously in both cases, and this operative procedure appeared to be associated with the pathogenesis of the inflammatory pseudotumors. A year old woman was admitted with severe abdominal pain of 9 hours duration. Past medical history included a polycytemia vera for two years.

    Laboratory measurements were as follows: Abdominal X-ray CT scan showed a high density ascites. Intraoperatively, 2, ml of intraabdominal haemorrhage and a massive hematoma in the free margin of the omentum were noted. Histological examination of the resected omentum revealed a ruptured mycotic aneurysm. A year-old woman was referred to our hospital with an elevated right hemidiaphragm on a chest X-ray.

    Preoperative angiography showed a huge tumor whth feeding arteries branching off the right and left hepatic and right subphrenic arteries, and surgery was performed whth a preoperative diagnosis of subdiaphragmatic liver tumor. The intraoperative diagnosis was diaphragmatic tumor with liver compression and right lung invasion, and complete extirpation of the tumor with partial resection of the right diaphragm and right lower lung was performed. The tumor was cm in size and weighed 1, g. Microscopically, fibroblastic tissue was tightly arranged with no evidence of dysplasia.

    The patient's postoperative course has been good, with no evidence of recurrence after 12 months. We experienced a case of an advanced age patient with extended necrosis of the small intestine cm caused by strangulation a rare structure attributed as Meckel's diverticulum. A year-old man came to the hospital with abdominal pain and vomiting as the chief complaints.

    The selection panel gave the following reasons for the selection: The author will be presented with the award at a ceremony in November Her work has now been celebrated in the release, on 18 September , of a limited edition set of Japan Post stamps. See details on Japan Post homepage. Now, the series is available as miniature book boards, perfect for popping into a bag to take along with you on a day out for entertainment on the go. A gift set is also available, which includes miniature versions of all three books, and makes an ideal present for little readers with little hands.

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