Peritoneal dissemination can be prevented by the responsible surgeon at least in part by proper surgical technique used to resect the primary malignancy. What most people do not know is that cancer surgery can do great harm. It can convert a contained malignant condition into a disseminated disease that unnecessarily becomes a deadly process. Containment must be the number one priority of the gastrointestinal cancer surgery. Also, established peritoneal carcinomatosis can be cured if it is attacked in a timely fashion with peritonectomy procedures and heated intraoperative intraperitoneal chemotherapy. Many small changes can make a big difference in survival with gastrointestinal cancer surgery. (J Nippon Med Sch 2000; 67: 5-8)

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Background: Endoscopic treatment using glutaraldehyde cross-linked (GAX) collagen was conducted on 4 children with bilateral primary vesicoureteral reflux (VUR)…a 1-year-old boy and three 5- to 8-year-old girls…all having a history of repeated hospitalization for fever due to acute pyelonephritis, visiting as pediatric outpatients regularly and receiving antibiotics continuously. By international VUR classification, 4 ureters were grade 3, 2 grade 4, and 2 grade 5. Methods: After nonallergy to GAX collagen was confirmed intracutaneously, a needle was used through a 9.5 Fr cystoscope channel to puncture bladder mucosa 4 to 5 mm from the affected ureteral orifice at 6 o'clock under general anesthesia; 1.1 to 1.9 ml of GAX collagen was injected immediately below affected orifices. Results: Three months after surgery, voiding cystourethrography showed reflux had disappeared in 6 ureters, for a short-term success rate of 75%. VUR in the Remaining 2 ureters improved from grade 3 to 1 and from grade 5 to 4. No postoperative urinary tract infection occurred and antibiotics were stopped. Conclusion: Since GAX collagen is less viscous than Teflon paste, it is easily injected into sub-mucosa, does not from granuloma or migrate to other organs, and is noncarcinogenic. Endoscopic VUR treatment using GAX collagen is indicated when less invation and shorter hospitalization are considered, although it requires general anesthesia, which itself involves some risk. (J Nippon Med Sch 2000; 67: 9-12)

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Spinal cord stimulation (SCS) is one of the most minimally invasive and effective treatments for intractable pain. We report the efficacy of a very small diameter neuroendoscope on setting the electrode to the proper site in the epidural space. Our cases include thalamic hemorrhage, and each patient had unilateral intractable pain on L1 or less as the main complaint. They had been treated for over two years in other hospitals, but no significant relief was achieved. Because each patient had been given frequent epicural blocks, the adhesion in the epidural space was expected. In Group A (3 cases), we used very small diameter neuroendoscope to dissect adhesion in the epidural space and to make optimal space for lead placement under direct vision. Conventional lead placement under fluoroscopy was performed in Group B (3 cases). Medtronic's PISCES lead system was used for SCS. In Group A, stimulation and pain regions matched in all cases, and good pain relief was also achieved. In Group B, however, stimulation and pain regions matched incompletely and the increase in stimulation caused stimulation on the pain-free side. (J Nippon Med Sch 2000; 67: 13-17)

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Objective: To examine the effect of prior pregnancy and lactation on bone density in aged rats. Materials and Method: 2 month-old female Fischer-344 rats were divided into 4 groups: 1)13 rats were allowed to get pregnant and to nurse their offspring for two or three cycles; 2)14 rats were allowed to get pregnant two or three times and were immediately separated from their young after each delivery prior to lactation; 3)10 rats were not allowed to become pregnant; and 4)7 rats were sacrificed at the beginning of the experiment. All rats were fed ad libitum. After the rats had completed two or three pregnancies with or without subsequent lactation, all were fed a restricted diet until they were 25 months old (aged rats). Then they were sacrificed and both femurs were removed from each rat. One bone was used for analysis of mineral content and the other bone was used for photodensitometry of the diaphysis. Results: 31 rats (83.8%) survived until they were sacrificed. The femurs of the aged rats showed increased ash weight compared to those of 2 month-old rats. Aged rats with prior pregnancies with or without subsequent lactation had higher femoral ash weight than those without prior pregnancies. There were no differences among aged rats in regard to marrow diameter, bone diameter, cortical width or bone density of the diaphysis in femur by photodensitometry. Conclusion: In aged rats, past pregnancies but not lactation were related to increases in bone density of the femur. (J Nippon Med Sch 2000; 67: 18-23)

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1. Objective: Addition of contrast dynamics to three-dimensional hepatic tumor CT imaging. 2. Materials and Methods: Six patients with hepatic cavernous hemangioma with a mean age of 57 years were included in the study. Two of the patients were male and four were female. Contrast enhanced computed tomography (CT) was carried out on the tumors in six phases by helical CT, using bolus injection of contrast medium intravenously. Using maximum intensity projection (MIP), a separate three-dimensional image was then reconstructed for each phase, and rotational images around the longitudinal axis of the torso were observed using the CRT monitor. 3. Results: The patterns of contrast enhancement of hepatic cavernous hemangiomas were obtained on 3D-images. In all patients, the reciprocal relations between the tumor and the portal veins and the hepatic veins were clearly imaged three-dimensionally. 4. Conclusions: We have succeeded in adding the dynamic observation of a contrast medium to static three-dimensional imaging. This will be valuable for the diagnosis of hepatic tumors, and it opens up new prospects for diagnostic imaging. (J Nippon Med Sch 2000; 67: 24-27)

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The present study was conducted to evaluate clinicopathologically 26 patients whose primary colorectal carcinoma and resulting pulmonary metastatic tumors had been resected, and to determine the relationship between tumor progress and prognosis by PCNA immunostaining. Patients with solitary pulmonary metastasis were found to have much better prognoses than those with multiple metastasis. There was no correlation between tumor size of pulmonary metastasis and prognosis. Survival rates of patients with disease-free intervals (DFIs) of 2 years or longer were higher than for those with DFIs of less than 2 years. Mean PCNA expression of pulmonary metastatic lesions was significantly higher than that of primary lesions. It was suggested that the higher PCNA expression stemming from the relation between depth of tumor invasion and PCNA expression was greater with tumor progress. (J Nippon Med Sch 2000; 67: 28-31)

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Surgical reduction and fixation using Wolter clavicular plates was performed in 16 patients with distal clavicle fractures. Good bony union was obtained in all cases. The patients had neither postoperative pain nor muscle weakness. Compared with tension band wiring, the Wolter clavicular plates were better able to maintain the anatomic repositioning of comminuted distal clavicle fractures. However this method takes longer and requires a second operation for plate removal. Wolter clavicular plate placement is the treatment of choice for unstable distal clavicle fractures with small comminuted fragments. (J Nippon Med Sch 2000; 67: 32-34)

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