The purpose of this study was to evaluate clinical significance of chromosomal instability(CIN)in primary gastric cancer. In 90 sporadic gastric carcinomas, we measured numerical aberrations for chromosome 7, 11, 17 and 18 by fluorescence in situ hybridization(FISH)with genomic probes for the centromeres of chromosome. Hybridization signals were counted in 200 interphase nuclei. The modal copy number of each chromosome was determined. The fraction of cells with chromosome numbers that differed from the mode(Variant Fraction:VF)was calculated for each chromosome. The degree of CIN was defined according to the size of VF. The degree of CIN was associated significantly with increased tumor depth, lymphnode metastasis, lymphatic invasion and venous invasion. When the grade of CIN was defined as follows:CIN1;VF<20% of the cells, CIN2;20%≦VF<40% of the cells, CIN3;40% of the cells≦VF, CIN status significantly correlated with overall survival(chromosome 7:CIN1 vs. CIN3 p=0.0385, chromosome 17:CIN1 vs. CIN3 p=0.0798, chromosome 18:CIN1 vs. CIN2 p=0.0658, CIN1 vs. CIN3 p=0.00744).Analysis of CIN status may be clinically significant in evaluation of degree of malignancy in patient with gastric cancer.

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Denver pleuroperitoneal shunts were placed percutaneously in two patients with intractable hepatic pleural effusion in order to drain pleural fluid into the peritoneal cavity. Both patients successfully obtained significant relief of pleural effusion and dyspnea. They were both allowed to return home on a temporary basis as a result of such improvements. There was no severe complication, while one experienced delayed wound healing and the other had postoperative bloody pleural effusion. Both symptoms were successfully treated with conservative therapy. Insertion of pleuroperitoneal shunt can offer effective palliation of severe respiratory distress and remove the burden of repeated thoracentesis related to hepatic plural effusions. Thus, we conclude that pleuroperitoneal shunting can be an alternative option in the palliative treatment of hepatic plural effusion that enables patients to continue living at home. We present an overview of all the cases in Japan that were previously reported the use of pleuroperitoneal shunt in the management of intractable hepatic pleural effusion and further discuss what are the advantages and disadvantages of this technique.

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A 40-year-old woman was admitted to the hospital with constipation since three days, which developed after she underwent an upper gastrointestinal fluoroscopic examination with barium. An abdominal X-ray revealed numerous spherical fecal stones between the rectum and the descending colon;Barium fecal was diagnosed. The fecal stones were endoscopically fragmented with polypectomy snare, and then eliminated through physiological excretion.

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We report a case of effective treatment of mFOLFOX6 plus bevacizumab for endocrine cell carcinoma of ascending colon. A 79-year-old man was admitted for abdominal pain and fullness. Colonoscopy showed a tumor with ulceration in the ascending colon and the tumor was diagnosed by the biopsy as carcinoma combined with small cell carcinoma. Right hemicolectomy was done(stageⅣ,SiN3M1)and endocrine cell carcinoma was diagnosed finally by histological examination because of positive immunohistochemical staining with chromograninA and synaptophysin. One month after the surgery, multiple lymph nodes, liver and lumbar spine metastasis were found in CT. mFOLOFOX6 plus bevacizumab chemotherapy was started. After 4 cycles of the therapy, the tumor diminished and the patient has remained progression free. Endocrine cell carcinoma of the colon is rare and an effective chemotherapy has not been established. We report this case with a review of the literature.

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We reported a patient who had received single incision laparoscopic partial gastrectomy for more than 5.1cm gastric GIST. A 81-year-old woman was admitted to our hospital because of a gastric submucosal tumor detected by medical examination. Physical examination did not reveal intraabdominal mass. Preoperative abdominal computed tomography(CT)showed an extra-gastric tumor 60mm in diameter and neither invasion nor metastasis was found. We suspected that it was a gastrointestinal stromal tumor(GIST)at the posterior wall on the greater curvature side of the upper stomach. We performed single incision laparoscopic partial gastrectomy. Immunohistochemical findings, the tumor was c-kit(+),CD34(+)and MIB1 index(less than 1%),was diagnosed as GIST of the stomach with intermediate grade risk because of the size of more than 5cm. The patient had no postoperative complication and was discharged on postoperative day 8. There is no sign of recurrence as of a year after the operation.

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A 29-year-old woman with Crohn's disease that had been treated medication for 8 years, presented to our hospital with abdominal pain, fever and diarrhea on October, 2006. Based on the results of detailed examinations, we diagnosed ileoileal fistula, vesicoileal fistula, and a urinary tract infection. Surgery was performed via a 7cm lower median skin incision. We ligated and then cut the vesicoileal fistula, which was about 5 mm long. Ileocecal resection was performed, followed by reconstruction with a functional end-to-end anastomosis. The patient had uneventful postoperative course, and was resumed Infliximab therapy, 16 days after surgery. Her subsequent clinical course has been good on medication. Because Crohn's disease often recurs after surgery, it is important to perform minimally invasive surgery through a small incision, with the continuation of Infliximab therapy.

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A 73-year-old man was seen at the medical clinic because of suffering from hematochezia and narrowing of stool. Colonoscopy showed a black tumor occupying almost half round of tract, 2cm from anal verge. Biopsy revealed malignant melanoma. He was treated by abdomino-perineal resection with D2 lymphadenectomy(pMP, pN1, sH0sP0pCY0cM0, fStageⅢa1).He didn't received adjuvant chemotherapy, but contrast enhanced CT half a year after the operation showed sign of recurrence. The DAV chemotherapy was scheduled.

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