Background and Aims : We examined whether the lung injury produced in rats by intravenous injection of TNF-α could be inhibited by the intravenous administration of human urinary trypsin inhibitor (UTI), since the results of previous investigations showed the ability of UTI to bind bacterial toxins and superantigen, to markedly inhibit serum TNF-α production, and reduce myeloperoxidase content of rat lungs.
Methods : The rats were infused with PBS, TNF-α (100 or 250 ng/rat) or UTI-TNF-α, through the rat tail vein under Nembutal anaesthesia. All lungs were then excised in individual experimental groups 5 h after the infusion, and examined histologically, histochemically and biochemically.
Results : Intravenous injection of TNF-α caused punctate areas of haemorrhage on the lung surface. Histological, histochemical and ultrastructural examinations revealed lung injuries of different extents, vasculitis with concentration of inflammatory cells, and infiltration of numbers of eosinophils around the arteries and veins of the pulmonary lobules and bronchioles. These morphological presentations were similar to those induced by intraperitoneal injection of the superantigen, staphylococcal enterotoxin B. However, the administration of UTI markedly attenuated the lung injuries and vasculitis induced by intravenous injection of TNF-α, involving a marked reduction in the number of inflammatory cells, infiltration of eosinophils, the extent of injury and myeloperoxidase content of rat lungs.
Conclusions : Taken together, UTI may have defensive effects on inflammation and/or infection by suppressing the early responses of stimulated cells.

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Background and Aims : To determine the optimal treatment of superficial carcinoma of the thoracic esophagus, we retrospectively analyzed the site and prevalence of lymph node metastases in three-field dissection specimens removed during radical esophagectomy.
Methods : We reviewed the medical charts and surgical and histopathological reports of 34 patients with superficial carcinoma of the thoracic esophagus, who were treated with esophagectomy and three-field lymph node dissection.
Results : Lymph node metastases were found in 14 of 34 patients (41%). None of five cases with tumor invasion of only the pEP or pLPM had lymph node metastases. However, the prevalence of lymph node metastases from tumors that invaded the pMM or pSM was 22% and 60%, respectively. Even when the cancer was located in the lower esophagus, the prevalence of cervical lymph node metastases was 20%. Two of three (67%) patients had cervical lymph node metastases even when there were no metastases in mediastinal nodes (“jumping lymph node metastases”). The 5-year survival rates in patients with and without lymph node metastases were 83% and 100%, respectively.
Conclusions : A radical esophagectomy with three-field lymph node dissection should be performed on patients who have superficial carcinoma of the thoracic esophagus that invades the pMM or deeper.

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Background and Aims : We are making efforts to shorten the hospital stay for the purpose of improving patients' QOL and also resolving the shortage of beds with an increase in the number of surgery, while taking into consideration the revision of the medical expense system and medical system itself. Day surgery is performed for pediatric inguinal hernia because of its merits such as that the mother-child separation period can be shortened and that the daily lives of affected children and their families are not changed. This paper is a study of the present situation in day surgery for pediatric inguinal hernia.
Patients and Methods : From July, 1995 to January, 2002, 127 patients with pediatric inguinal hernia (male:female=65:61) underwent day surgery at our department, their mean age being 4.3 years. The surgery was performed under general anesthesia with a mean surgical time of 22.5 minutes.
Results : The day surgery was shifted to overnight hospital stay in 3 cases : 2 cases developing fever due to a postoperative symptom like upper airway inflammation and 1 case as requested by her mother. No case required readmission after discharge. No case revisited our hospital complaining of abnormality at the site of operation. So far as our confirmation is concerned, there is no case of recurrence after surgery.
Conclusion : Surgery for pediatric inguinal hernia being surgery on the body surface is quite safe because it can be done in a short time and its wound is small. Therefore, it is suitable for day surgery. We intend to continue practicing this day surgery for pediatric inguinal hernia.

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Background and Aims : Five cases of abdominal incisional hernia were repaired with prosthesis for the tension-free method in surgery on inguinal hernia to prevent recurrence. The results were satisfactory.
Patients and Methods : The cases were all female with a mean age of 77.2 years. Colorectal diseases including appendicitis were found to be the causative disease in 4 out of 5 cases. The period from primary surgery to the development of abdominal incisional hernia ranged from 1 year to 59 years. However, the development of this hernia within 6 years was noted in 4 out of 5 cases. The 5 cases of abdominal incisional hernia broke down to 3 initial cases and 2 recurrent cases. The prostheses used this time were Bard Per Fix plug + onlay patch (plug) in 1 case and PROLENE Hernia System (PHS) in 4 cases.
Results : The size of hernia ranged from tip of the thumb to 8 × 5 cm. The patients left the hospital average 8.2 days after surgery, and all the cases have been free of recurrence up to the present.

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A 32-year-old man complaining of abdominal pain was admitted hospital. CT examination revealed a large abdominal mass, renal tumor and multiple lung tumors. No abnormal findings were observed in either testis. The serum α-fetoprotein level was within the normal range, but the serum human chorionic gonadotropin β level was remarkably elevated. The patient was diagnosed as having an extragonadal germ cell tumor in the retroperitoneal space. The pathological findings of cervical node specimens were embryonal carcinoma with choriocarcinoma differentiation. Radiographical responses of metastatic sites showed partial response and the tumor marker levels returned to within the normal ranges after 4 courses of PEB chemotherapy. A residual tumor dissection was performed. The patient received 3 courses of VIP chemotherapy after the operation because a small amount of viable cells was found in the resected tumors. The patient is presently in good health with no evidence of disease.

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A self expanding metallic stent (SEMS) for the esophagus was used to improve QOL in a patient with inoperable advanced gastric cancer (59-year-old male) and a patient with recurrent gastric cancer (80-year-old female), both of whom presented passage failure and became unable to take food by mouth. After expanding the stenosed portion with a balloon under fluoroscopy, the SEMS was inserted. From immediately after insertion of the stent, QOL apparently improved in terms of disappearance of severe vomiting, release from a nasogastric tube and recovery of ingestion.

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