<症例>受傷後4年を経過して発症した外傷性右横隔膜ヘルニアの1例 : 本邦鈍的外傷性横隔膜ヘルニアの統計的観察

We describe our experience with a patient in whom a traumatic right diaphragmatic hernia developed 4 years after sustaining injury and review cases of delayed diaphragmatic injury reported in Japan. The patient was a 28-year-old man who sustained a severe contusion of the right epigastric region and fractured a right rib in a traffic accident in September 1992. In August 1996, the patient presented with shortness of breath on effort or after meals. A chest roentgenogram revealed intestinal gas in the right side of the thoracic cavity. A right diaphragmatic hernia was diagnosed on the basis of a gastrointestinal series, and the patient was operated on. The hernial orifice extended anteriorly from the central tendon in an 11:00 direction and measured 11×6 cm. The small intestine, right side of the colon, and liver were herniated. A total of 297 cases of blunt traumatic diaphragmatic hernia were reported in Japan between 1981 and 1996, including 47 cases (left side, 32 cases; right side, 15 cases) of delayed diaphragmatic hernia, defined as occurring one month or more after injury. Diaphragmatic hernia should be considered as a possible diagnosis in patients with abnormal shadows in the thoracic region who have recently sustained injury or who have a past history of injury.受傷後4年を経過して発症した外傷性右横隔膜へルニアの1例と本邦の鈍的外傷性横隔膜へルニアの報告例の統計的観察について検討した. 【症例】28歳, 男性. 1992年9月交通事故により右肋骨骨折を伴う右上腹部の鈍的外傷を受けた. 1996年8月労作時や食後の息切れが出現した. 胸部X-P 写真およひ消化管造影検査で右横隔膜ヘルニアと診断し手術を施行した. 破裂部位は右横隔膜の腱中心の前方11時方向で, 筋線維方向に 11×6cm の破裂部位を認めた. 脱出臓器は小腸, 右結腸および肝右葉であった. また, 1981年から1996年までに本邦で鈍的外傷による横隔膜へルニアの報告例は297例であった. そのうち受傷後1ヶ月以降に発症した遅発性横隔膜ヘルニアは47例 （右32例, 左15例）であった. 受傷直後はもとより外傷の既往があり, 胸部異常陰影のある患者には本疾患を念頭におくことが大切である

Desmoplastic Fibroblastoma Invading the Humerus

Desmoplastic fibroblastoma (DFB) is an uncommon, benign, soft tissue tumor. The tumor most often presents as a slowly growing, painless soft tissue mass and is usually small. There have been only a few reports of patients with DFB who presented with bone invasion. Herein, we report the case of a 66-year-old woman with DFB with bone invasion in her left axilla. A lump under the left axilla was detected and was associated with pain and limited range of motion (ROM) of the shoulder. Computed tomography showed a soft tissue mass with invasion of the adjacent left humerus. Magnetic resonance imaging revealed a lesion with low signal intensity on T1- and T2-weighted images, and weak internal enhancement on postcontrast T1-weighted images with fat suppression. Histologic evaluation of a preoperative needle biopsy revealed DFB with FOSL1 expression. The tumor was marginally excised. Postoperative outpatient follow-up demonstrated a significant improvement in pain and ROM of the shoulder and no recurrence after 1 year. Even though DFB with bone invasion can cause pronounced clinical symptoms with pain and limited ROM, we conclude that simple excision is an adequate treatment

Loss of SMAD4 From Colorectal Cancer Cells Promotes CCL15 Expression to Recruit CCR1(+) Myeloid Cells and Facilitate Liver Metastasis.

[Background & Aims]Loss of the tumor suppressor SMAD4 correlates with progression of colorectal cancer (CRC). In mice, colon tumors that express CCL9 recruit CCR1+ myeloid cells, which facilitate tumor invasion and metastasis by secreting matrix metalloproteinase 9. [Methods]We used human CRC cell lines to investigate the ability of SMAD4 to regulate expression of CCL15, a human ortholog of mouse CCL9. We used immunohistochemistry to compare levels of CCL15 and other proteins in 141 samples of human liver metastases. [Results]In human CRC cell lines, knockdown of SMAD4 increased CCL15 expression, and overexpression of SMAD4 decreased it. SMAD4 bound directly to the promoter region of the CCL15 gene to negatively regulate its expression; transforming growth factor-β increased binding of SMAD4 to the CCL15 promoter and transcriptional repression. In livers of nude mice, SMAD4-deficient human CRC cells up-regulated CCL15 to recruit CCR1+ cells and promote metastasis. In human tumor samples, there was a strong inverse correlation between levels of CCL15 and SMAD4; metastases that expressed CCL15 contained 3-fold more CCR1+cells than those without CCL15. Patients with CCL15-expressing metastases had significantly shorter times of disease-free survival than those with CCL15-negative metastases. CCR1+ cells in the metastases expressed the myeloid cell markers CD11b and myeloperoxidase, and also matrix metalloproteinase 9. [Conclusions]In human CRC cells, loss of SMAD4 leads to up-regulation of CCL15 expression. Human liver metastases that express CCL15 contain higher numbers CCR1+ cells; patients with these metastases have shorter times of disease-free survival. Reagents designed to block CCL15 recruitment of CCR1+ cells could prevent metastasis of CRC to liver

Extension of Improved Particle and Energy Confinement Regime in the Core of LHD Plasma

Recent two major topics of Large Helical Device (LHD) towards fusion relevant conditions, high-density operation and high-ion-temperature operation, are reported. Super dense core plasma was obtained by the combination of repetitive hydrogen ice pellet injection and high power neutral beam injection (NBI) heating. A very peaked density profile with the highest central density of 1.1 × 1021 m-3 was produced showing that the particle transport was suppressed very well in the plasma core. The spatial density profile varies as the position of magnetic axis (Rax), and the steepest profile is obtained at Rax = 3.95 m. The highest central ion temperature of 5.6 keV was obtained in hydrogen plasma at electron density of 1.6 × 1019 m-3 by NBI, where a peaked ion-temperature profile with internal ion energy transport barrier was observed. The profile of electron temperature did not change much and was broad even when the ion temperature had a peaked profile. The central ion temperature is higher than the electron temperature, which is a new operation regime of LHD. High central ion temperature accompanied strong toroidal rotation and an extreme hollow profile of carbon ions (impurity hole). These steep temperature profiles were obtained so far at around Rax = 3.6 m. The compatibility between particle and energy confinement is a new issue of LHD to explore a new operation regime for attractive fusion reactor