トウイン ニオケル キョウクウ キョウカ ショクドウ セツジョ ノ ドウニュウ ト タンキ チリョウ セイセキ ノ ケントウ

【背景】食道癌に対する胸腔鏡手術は本邦で広く行われており、施設ごとに手術手技の定型化がなされている.胸腔鏡下手術の利点として拡大視効果や緻密な手術操作が可能となることが挙げられるが、当院でも2016年より腹臥位胸腔鏡下食道手術を導入し、出血の少ない安全かつ確実な郭清を目指し、定型化に向けてその手技を刷新している.【対象と方法】】2016年4月から2019年4月までに当院で施行した胸腔鏡下食道切除38例につき、その短期成績を検討した.【結果】男:女＝32:6、年齢中央値 66歳(41-76)、cStage I / II / III / IVa: 17 / 6 / 13 / 2であった.胸腔内出血量中央値は10ml(0-53)、胸部操作時間中央値は192分(97-478)、胸腔内郭清リンパ節個数中央値は17個(1-42)であった.術後合併症は、縫合不全3例(7.9％)、反回神経麻痺7例(18.4％)、肺炎12例(31.6％)であった.術後在院日数中央値は19日(11-38)であった.導入期からの前半19例では反回神経麻痺を6例(31.6％)に認めたが、後半19例では１例(5.2％)であった(p=0.036).【結語】当院における胸腔鏡下食道切除術は安全に導入、施行可能であった.手術手技が定型化されることで反回神経麻痺を少なくする郭清が可能になると考えられた.Background: Thoracoscopic esophagectomy (TE) is increasingly being used worldwide in patients with esophageal cancer. In this study, we investigated the clinical short-term outcomes of TE performed in patients placed in the prone position. Method: We investigated the surgical and clinical outcomes in 38 patients with esophageal cancer who underwent TE at our hospital between April 2016 and April 2019. Results: Of the 39 patients investigated, 32 were men. Median patient age was 66 (range 41–76) years, the median intraoperative blood loss was 10 (0–53) mL, and the median operation time for thoracoscopy was 192 (97–478) min. The mean operation time for thoracoscopy in the latter group was significantly shorter than that in the former group (188 min vs. 232 min, p=0.013). The following postoperative complications were observed: 7 (18.4%) cases of recurrent nerve palsy, 3 (7.9%) cases of anastomotic leakage, 12 (31.6%) cases of pneumonia, and 0 (0%) cases of chylothorax. The incidence of recurrent nerve palsy was lower in the latter group than in the former group (5.2% vs. 31.6%, p=0.036). Conclusions: TE in the prone position is safe and feasible. As experience performing the procedure increases, the performance of the procedure stabilizes

カンサイボウガン ト カンベツ ガ コンナンデアッタ カンケッカンキン シボウシュ ノ １レイ

肝原発の血管筋脂肪腫（angiomyolipoma; AML）は、肝細胞癌と鑑別が困難な場合がある。今回、単発の肝腫瘍に対して肝細胞癌を否定できず切除を行ったが、病理組織学的検査でAMLと診断した一例を経験したので報告する。症例は50歳代の女性。検診にて外側区域の肝腫瘍を指摘され、加療目的に紹介となった。造影CT検査では肝外側区域、門脈臍部に接して2cm大の腫瘍性病変を認め、動脈相で濃染し平衡相でwashoutしていた。腹部MRI検査では同部位にT2強調像で高信号、T1 out of phaseにて若干の信号低下を認めた。Gadolinium-ethoxybenzyl-diethylene-triaminepentaacetic-acid(Gd-EOB-DTPA; EOB) MRIでは動脈相で濃染、門脈相から平衡相にかけてwashoutし、肝細胞相では低信号であった。画像所見から肝細胞癌を疑い、腹腔鏡下肝左葉切除術を施行した。病理組織学的には好酸性紡錘形細胞や淡明～淡好酸性細胞の上皮様配列がみられ、内部に脂肪組織が島状に介在し、また、平滑筋性の厚い壁を持った血管構造も一部存在しており、肝血管筋脂肪腫と診断した。一般に脂肪成分の少ないAMLは、肝細胞癌との鑑別が困難である。最近では、肝静脈への流出血管の有無が鑑別診断に有用であるとの報告が見られるため、これらを注意深く観察すべきと考えられた。Hepatic angiomyolipoma (AML) may be difficult to distinguish from hepatocellular carcinoma. Here we report a resected case of a hepatic AML mimicking hepatocellular carcinoma. The patient was a woman in her 50s referred for further evaluation of a tumor in the left lateral segment of the liver. Contrast-enhanced computed tomography showed a two cm-sized tumor attached with the umbilical portion in the left lateral segment of the liver, which was enhanced in the arterial phase and washed out in the portal venous phase. Abdominal MRI showed a high-intensity tumor on T2-weighted image and a slight decrease of signal intensity on T1 out of phase. The tumor on Gd-EOB-DTPA enhanced MRI displayed high intensity in the arterial phase and washout in the portal venous phase, and low signal intensity in hepatobiliary phase. Based on these imaging findings, we suspected hepatocellular carcinoma and a laparoscopic left lobectomy was performed. Histopathological examination showed spindle and perivascular epithelioid cells and a few fat cells, and immunohistochemical analysis revealed positive staining of HMB-45 and αSMA. The tumor was diagnosed as a hepatic AML. Hepatic AML with a small fatty component is generally difficult to distinguish from hepatocellular carcinoma. More recently, the presence of outflow blood vessels to the hepatic vein has been reported to be useful in the differential diagnosis for AML. These imaging findings should be carefully observed

ドウニュウ カガク リョウホウ ニテ コンチ セツジョ ガ カノウ トナッタ ケイブ ショクドウガン ノ 1レイ

　症例は50歳代，男性．咽頭痛，嚥下障害を主訴に近医受診し，上部消化管内視鏡検査にて頸部食道に1/4周性のtype3病変(squamous cell carcinoma)と食道胃接合部に0-IIa+IIc病変(adenocarcinoma)を指摘され，当院当科紹介となった．造影CT検査にて左頸部に原発巣と一塊となった腫瘤を認め，左総頸動脈及び気管への浸潤を認めた．精査の結果，頸部食道癌cT4bN2M0 cStageIVa，バレット食道腺癌cT1bN0M0 cStageIと診断し，切除不能局所進行食道癌であり導入化学療法の方針とした．DCF(Docetaxel/Cisplatin/5-Fluorouracil) 療法3コースで病変の縮小が得られ，頸部腫瘍は長径37mmから17mmとなり，総頸動脈の浸潤が解除されたため，根治術を行う方針とした．手術は咽頭喉頭食道全摘，頸部縦隔腹部リンパ節郭清，後縦隔経路遊離空腸付加胃管再建，腸瘻造設術を施行した．術中偶発症なく，手術時間846分，出血量670mLであった．病理組織学的検査では，頸部食道癌ypT4aN2M0 ypStegeIII，治療効果Grade 1b，バレット食道癌ypT1b-SM2N0M0 ypStageI，治療効果Grade 1aであった．術後経過は概ね良好で術後9日目より経口摂取を開始し，術後18日目に退院となった．　切除不能局所進行食道癌に対する標準治療は化学放射線療法であるが，近年，DCF療法による導入化学療法後の外科的切除の有用性が報告されている．今回，導入化学療法により根治切除可能であった頸部食道癌，食道腺癌の重複例を経験したため報告する．　A 58-year-old man with sore throat and dysphagia revealed type 3 lesion in cervical esophagus and 0-IIa+IIc lesion in esophagogastric junction on upper gastrointestinal endoscopy. Histopathologic examination of biopsy specimens showed squamous cell carcinoma at cervical esophagus and adenocarcinoma at esophagogastric junction. Computed tomography suggested that the large tumor in left neck infiltrated into the common carotid artery and trachea. According to these findings, we diagnosed locally advanced unresectable cervical esophageal cancer (cT4bN2M0, cStageIVa) and Barret’s esophageal adenocarcinoma (cT1bN0M0, cStageI), and decided to perform induction chemotherapy with Docetaxel, Cisplatin, and 5-Fluorouracil (DCF). After 3 courses of that, the primary tumor decreased from 37 mm to 17 mm as major axis and released infiltration into the common carotid artery. Therefore, we performed conversion surgery, pharyngolaryngectomy and total esophagectomy. Histopathological findings showed cervical esophageal cancer (ycT4aN2M0, ycStageIVa) and Barret’s esophageal adenocarcinoma (ycT1b-SM2N0M0, ycStageI). The postoperative course was uneventful, he resumed eating 9 days after surgery and was discharged 18 days after surgery.　Conversion surgery after induction chemotherapy for locally advanced unresectable esophageal cancer may contribute to radical resection and better clinical outcome

Oxidative Dimer Produced from a 2,3,4-Trihydroxybenzoic Ester

The DPPH radical-scavenging abilities of the naturally occurring phenolic acid, 2,3,4-trihydroxybenzoic acid, and its methyl ester were evaluated. Both compounds in acetonitrile scavenged as many as four radicals compared to three or fewer radical consumption in acetone or ethanol. Only the ester showed relatively high ability in methanol. Oxidation with o-chloranil in acetonitrile resulted in methyl 2,3,4-trihydroxybenzoate giving a novel benzocoumarin-type dimer, its chemical structure being confirmed by spectroscopic evidence. The formation of this dimer might partly account for the higher radical-scavenging efficiency of the ester in acetonitrile or methanol

New concept for the prevention and treatment of metastatic lymph nodes using chemotherapy administered via the lymphatic network

iii, 186 hlm., 16 x 24 cm

Enhancement of Biomass and Lipid Productivities of Water Surface-Floating Microalgae by Chemical Mutagenesis

Water surface-floating microalgae have great potential for biofuel applications due to the ease of the harvesting process, which is one of the most problematic steps in conventional microalgal biofuel production. We have collected promising water surface-floating microalgae and characterized their capacity for biomass and lipid production. In this study, we performed chemical mutagenesis of two water surface-floating microalgae to elevate productivity. Floating microalgal strains AVFF007 and FFG039 (tentatively identified as Botryosphaerella sp. and Chlorococcum sp., respectively) were exposed to ethyl methane sulfonate (EMS) or 1-methyl-3-nitro-1-nitrosoguanidine (MNNG), and pale green mutants (PMs) were obtained. The most promising FFG039 PM formed robust biofilms on the surface of the culture medium, similar to those formed by wild type strains, and it exhibited 1.7-fold and 1.9-fold higher biomass and lipid productivities than those of the wild type. This study indicates that the chemical mutation strategy improves the lipid productivity of water surface-floating microalgae without inhibiting biofilm formation and floating ability

Differences in dry matter production, grain production, and photosynthetic rate in barley cultivars under long-term salinity

<p>Soil salinity is a major environmental stress causing significant loss of crop productivity. Barley (<i>Hordeum vulgare</i> L.) is one of the few field crops that can grow in salt-affected fields and varietal differences in productivity under salinity conditions were known. To clarify the trait most responsible for grain production under salt stress, barley cultivars that were salt tolerant (OUE812) or salt sensitive (OUC613) were grown from seedling to harvest stage in vermiculite containing various concentrations of NaCl. Dry weight of aboveground parts and grain weight decreased significantly with increasing NaCl concentration. The dry weight of the aboveground parts and grain weight decreased more significantly in OUC613 than in OUE812 for plants treated with 150 mM and 200 mM NaCl. A marked reduction in ripening percentage caused significantly decreased grain production in OUC613 as compared with OUE812. In plants treated with 200 mM NaCl, the photosynthetic rate decreased three weeks after starting the NaCl treatment, but a significant difference between cultivars in photosynthetic rate did not appear until seven weeks of NaCl treatment. OUE812 kept a higher photosynthetic rate during ripening than did OUC613 and dry matter production during the period from ripening to harvest was significantly larger in OUE812 than in OUC613. Keeping a higher photosynthetic rate might have contributed to higher grain production in OUE812. Higher ripening percentage and higher rate of photosynthesis during ripening might be target traits in breeding to improve the tolerance of barley to long-term salt stress.</p