Kazutsugu Sakamoto

Serum fatty acid concentrations in patients on postoperative parenteral nutrition with and without fat

To examine changes in fatty acid composition of serum lipids, sixteen patients with gastric cancer were maintained on total parenteral nutrition (TPN) or intravenous feeding immediately after total gastrectomy. Subjects receiving no fat showed decreases in linoleic acid, linolenic acid and arachidonic acid and increases in palmitoleic acid and oleic acid, whereas those receiving fat emulsion showed no detectable changes. Decrease in the linoleic acid content was greater in subjects on a higher carbohydrate intake, but less in those on a higher fat intake. Multiple regression analysis of the relationships among carbohydrate intake (X1) and fat intake (X2) and changes in the linoelic acid percentage of total serum fatty acids (Y) in each case yielded an equation: Y=−4.75 X1+69.0 X2−27.9 (R=0.885, p<0.05). Approximately 1 g/kg/day of fat provided in 40–50 kcal/kg/day of nonprotein energy intake was estimated to prevent decrease in the linoleic acid content in the serum fatty acid pattern during the postoperative catabolic stage.

Breast metastasis from EGFR-mutated lung adenocarcinoma: A case report and review of the literature

Although lung cancer rarely metastasizes to the breast, we report a case of breast metastasis from lung adenocarcinoma harboring an epidermal growth factor receptor mutation. This breast metastasis was initially considered recurrent breast cancer and was later diagnosed based on histopathological and molecular examinations as metastasis from lung cancer.

A CASE OF NON-SPECIFIC MULTIPLE ULCER OF THE SMALL INTESTINE

症例は, 23歳,女性.平成11年,十二指腸潰瘍穿通にて広範囲胃切除術施行された.同年,癒着性イレウスの診断にて,癒着剥離術を施行した.この際,回腸末端部より約80cm付近に8カ所の輪状の壁肥厚を認めたため一部を切除した.肥厚部にはびらんを認め,病理学的には非特異的炎症所見のみであった.平成14年8月,突然の下腹部痛が出現し,外来を受診した.受診時,下腹部に強い圧痛を認めたが腹膜刺激症状は認めなかった.腹部CTで小腸の拡張とTargetsign様の所見を認めたため,腸重積を疑い緊急手術を施行した.回腸末端部に8カ所の壁肥厚を認め,それより口側の腸管の拡張を認めたため同部を切除した.切除標本では輪状の潰瘍瘢痕様の病変を8カ所に認め,病理学的には浅い潰瘍形成と粘膜下層の非特異的炎症像が認められ非特異的多発性小腸潰瘍症と診断した.

Clinical and histopathological study on colorectal carcinoma in young adults.

当教室で最近13年間に経験した大腸単発癌手術施行例570例を対象とし, 39歳以下の若年者大腸癌の臨床病理学的所見ならびに手術成績について検討した.若年者大腸癌は570例中57例 (10.0%) であり, 女性が多かった.若年者大腸癌では, 組織型は粘液癌が多く, 壁深達度, リンパ節転移率, 腹膜播種, 組織学的進行程度において進行度の進んだ症例が有意に多かった.若年者の全手術例の累積5年率は41.0%と非若年者とくらべ有意に低率であったが, 治癒切除例の累積5年率は71.6%と非若年者の76.3%とくらべ有意差はなかった.若年者における大腸癌の早期診断ならびに治癒手術への努力が重要であると思われた.