Impact of age on groin hernia profiles observed during laparoscopic transabdominal preperitoneal hernia repair.

BACKGROUND: How increasing age affects the characteristics of groin hernia remains uncertain. This study evaluated the association between age and the type of groin hernia, especially with respect to its multiplicity, observed during laparoscopic transabdominal preperitoneal (TAPP) hernia repair. METHODS: We retrospectively evaluated 634 consecutive patients with primary groin hernia who underwent laparoscopic TAPP repair between October 2000 and June 2017. Patients were stratified into 4 age groups: < 60 years, 60-69 years, 70-79 years, and 80 years or older. RESULTS: The incidence of occult contralateral hernia and multiple ipsilateral hernias increased significantly with each increasing age group: 7.3%, 10.4%, 12.7%, and 20.8% for occult contralateral hernia (p = 0.005), and 5.6%, 9.2%, 16.8%, and 21.7% for multiple ipsilateral hernias (p < 0.001), respectively. Univariate analyses showed that an older age (age ≥ 70 years) was the only factor significantly associated with the presence of multiple groin hernias (odds ratio, 2.69; 95% confidence interval, 1.89-3.81; p < 0.001). In patients with multiple ipsilateral hernias, the prevalent form in men was a pantaloons hernia, with an incidence of about 70% across all age groups, whereas in women it was groin hernias, with one component being a femoral hernia, an obturator hernia, or both. CONCLUSIONS: The multiple occurrence of groin hernias, either unilaterally or bilaterally, was a clinical feature in the elderly.

Highly sensitive detection of net hydrogen charged into austenitic stainless steel with secondary ion mass spectrometry.

Secondary ion mass spectrometry (SIMS) is used to detect local distributions of hydrogen in various materials. However, it has been well-known that it is extremely difficult to analyze net hydrogen (H(N)) in metals with SIMS. This was because hydrogen, which is originated from moisture (H(2)O), hydrocarbon (C(x)H(y)) or other organic materials (C(x)H(y)O(z)) existing on a sample surface or in the SIMS chamber, is simultaneously detected in the SIMS measurement of the H(N), and the H(N) and the background-originated hydrogen (H(BG)) cannot be distinguished in a SIMS profile. The effective method for reductions and determinations of the H(BG) in hydrogen measurements of metallic materials with the SIMS method has not been established. The present paper shows an effective method for reduction and estimation of H(BG) in SIMS analyses of hydrogen charged into type 316 L austenitic stainless steel, and an accurate estimation method of the net charged hydrogen. In this research, a silicon wafer is sputtered by a primary ion beam of a SIMS near an analyzed area (silicon sputtering method) to reduce H(BG). An uncharged type 316 L sample was prepared for estimation of H(BG) in SIMS measurements of the hydrogen-charged sample. The gross intensities of hydrogen between the hydrogen-charged sample and the uncharged sample were compared. The gross intensities of hydrogen of the uncharged sample (26.8-74.5 cps) were much lower than the minimal gross intensities of hydrogen of the hydrogen-charged sample (462-1140 cps). Thus, we could reduce the H(BG) enough to estimate the hydrogen charged into the type 316 L sample. Moreover, we developed a method to determine intensities of H(BG) in the measurement of the hydrogen-charged sample by estimating the time-variation of hydrogen intensities in the measurements of the uncharged sample. The intensities of the charged hydrogen can be obtained by subtracting the estimated intensities of the H(BG) from the gross intensities of hydrogen of the hydrogen-charged sample. The silicon sputtering method used to reduce H(BG) and the determination method for H(BG) in this research can be applied to the accurate hydrogen analysis for other various metallic materials.

In vitro reprogramming of adult hepatocytes into insulin-producing cells without viral vectors.

The pancreas and the liver share the same endodermal origin. We have been studying whether mature hepatocytes can be induced to differentiate into pancreatic beta-cells by in vitro delivery of transcriptional factors using a non-viral approach. Here we showed that nucleofection allowed suitable transfection of primary hepatocytes employing various non-viral methods. We introduced either pancreatic and duodenal homeobox 1 (Pdx1) or neurogenin 3 (Ngn3), or both, into the mature cells using nucleofection. Co-expression of pdx1 and ngn3 using a bicistronic vector activated the transcription of various islet-related genes, and the transfected hepatocytes acquired the ability to synthesize and secrete insulin. Our results suggest that simultaneous expression of Pdx1 and Ngn3 is an excellent inducer of liver-to-pancreas reprogramming, and that reprogramming will occur even in mature somatic cells without the need for viral vectors. These findings are of considerable significance for further therapeutic development for various intractable diseases including diabetes.

Clinical and pathological features of primary carcinoma of the cystic duct.

BACKGROUND: According to Farrar's criteria, a tumor restricted to the cystic duct is defined as cystic duct carcinoma, but this definition excludes advanced carcinoma originating from the cystic duct. PATIENTS AND METHODS: For the purpose of this study, primary cystic duct carcinoma was defined as a tumor originating from the cystic duct. We investigated the clinicopathological features of 15 cystic duct carcinomas, including 13 that did not fit Farrar's criteria, and compared them with those of 52 cases of gallbladder carcinoma and 161 cases of extrahepatic bile duct carcinoma. RESULTS: The incidence of primary cystic duct carcinoma was 6.6% among all malignant biliary tumors. The main symptom was jaundice in 67% of cases. The operative procedures employed ranged from cholecystectomy to hepatopancreatoduodenectomy. The cases of cystic duct carcinoma and bile duct carcinoma showed a high frequency of perineural infiltration. The overall 5-year survival rate of the 15 patients was 40%. CONCLUSION: Patients with advanced cystic duct carcinoma show a high frequency of jaundice and perineural infiltration. Our data suggest that cystic duct carcinoma may be considered a distinct subgroup of gallbladder carcinoma. Radical surgery is necessary for potentially curative resection in patients with advanced cystic duct carcinoma.

Bone marrow-derived cells fuse with hepatic oval cells but are not involved in hepatic tumorigenesis in the choline-deficient ethionine-supplemented diet rat model.

Bone marrow cells (BMCs) have been reported to behave as tissue-specific stem cells in some organs and to participate in tumorigenesis. However, the roles of BMCs in hepatic regeneration and carcinogenesis are still unknown. A choline-deficient, ethionine-supplemented (CDE) diet leads to the appearance of oval cells, a type of hepatic progenitor cell, and activates their replication. Furthermore, this type of diet induces preneoplastic nodules and hepatocellular carcinomas (HCCs) derived from oval cell progenitors. The aims of this study were to determine whether oval cells are derived from BMCs and whether preneoplastic nodules or HCCs originate from BMCs in the CDE diet rat model. To clarify the origin of constituent cells in the liver, we transplanted BMCs from green fluorescent protein (GFP) transgenic female rats into male Lewis rats, which were then exposed to a CDE diet to induce hepatocarcinogenesis. Some oval cells showed both donor-derived GFP expression and the recipient-specific Y chromosome, indicating that donor BMCs fused with recipient oval cells. Several preneoplastic nodules (precancerous lesions) identified by their glutathione S-transferase placental (GSTp) positivity were induced by CDE treatment. However, these preneoplastic GSTp-positive nodules were not GFP positive. In conclusion, this study has produced two major findings. First, BMCs fuse with some oval cells. Second, BMC-fused oval cells and BMCs might not have malignant potential in the CDE-treated rat model.

Increased expression of thioredoxin-1, vascular endothelial growth factor, and redox factor-1 is associated with poor prognosis in patients with liver metastasis from colorectal cancer.

We examined whether the expression of thioredoxin-1 (Trx-1) was associated with patient prognosis after liver resection for metastatic colorectal cancer. Eighty-four patients underwent resection of liver metastases from colorectal cancer, leaving no macroscopic evidence of residual tumor. Immunohistochemical study was performed to evaluate the relation among Trx-1, vascular endothelial growth factor (VEGF), and redox factor-1 (Ref-1) expression and the clinicopathologic characteristics and patient survival. Thirty-seven patients (44.0%) with Trx-1-positive metastases had shorter survival after primary liver resection (P = .0003) than the 47 patients (56.0%) with Trx-1-negative metastases. The percentage VEGF-positive and Ref-1-positive metastases was significantly higher in patients with Trx-1 expression (P = .0009 and .0002, respectively). Multivariate analysis revealed that Trx-1 expression was an independent prognostic factor. Expression of VEGF and Ref-1 is associated with Trx-1 overexpression, which is related to a poor prognosis in patients with liver metastases from colorectal cancer.

Primary liver carcinoma exhibiting dual hepatocellular-biliary epithelial differentiations associated with citrin deficiency: a case report.

We report a 50-year-old male patient with primary liver carcinoma exhibiting dual hepatocellular and biliary epithelial differentiations associated with citrin deficiency (asymptomatic adult-onset type II citrullinemia, CTLN2). Although so far 14 CTLN2 patients with hepatocellular carcinoma have been reported, this report describes a unique case of liver carcinoma showing the features of both hepatocellular and cholangiocellular carcinoma. In addition to the clinical data of the 14 patients reported previously, the findings in our patient suggest that the citrin deficiency might be one of the key disorders causing hepatocellular carcinoma especially at younger ages and can also play an important role in hepatocarcinogenesis of the hepatic progenitor cells, which have the bipotential to differentiate into both hepatocytes and cholangiocytes.

Cystic mixed adenoneuroendocrine carcinoma of the pancreas: A case report.

INTRODUCTION: Pancreatic mixed adenoneuroendocrine carcinoma (MANEC) is a rare tumor. We report herein a case of pancreatic MANEC with cystic features. PRESENTATION OF CASE: A 67-year-old woman presented with jaundice. A CT scan revealed an 18-mm mass at the pancreatic head that obstructed the common bile duct and another 35-mm cystic lesion containing a mural nodule in the pancreatic body, which was suspected to be an intraductal papillary mucinous carcinoma. A biopsy of the head mass led to the diagnosis of adenocarcinoma. The patient underwent pancreatoduodenectomy, and the body cyst was resected with the head mass. A histopathological analysis revealed that the body cyst had two components, ductal adenocarcinoma and neuroendocrine tumor. We diagnosed the cystic tumor as MANEC. DISCUSSION: Cases of MANEC have been reported as originating from the stomach, small intestine, and colon, but pancreatic MANEC is rare. The histogenesis and the therapeutic strategy for pancreatic MANEC are controversial. CONCLUSION: The clinicopathological features of pancreatic MANEC remain unclear; therefore, more reports of cases of pancreatic MANEC are necessary for a complete analysis.

Radical surgery for advanced squamous cell carcinoma of the gallbladder: a report of three cases, including a 10-year survivor.

We report three patients who underwent radical resections for advanced squamous cell carcinoma of the gallbladder, two of whom are still alive without recurrence 10 and 9 years after surgery. The other patient, who had lymph node involvement, suffered recurrence of the disease and died 9 months after surgery. Our experience indicates that radical surgery can sometimes provide a chance for long-term survival in patients with this neoplasm. Lymph node metastasis, albeit a rare event, might be a poor prognostic factor in patients with this type of gallbladder carcinoma.

Selection criteria for simultaneous resection in patients with synchronous liver metastasis.

HYPOTHESIS: While simultaneous resection has been shown to be safe and effective in patients with synchronous metastasis, neoadjuvant chemotherapy followed by hepatectomy has gradually gained acceptance for both initially nonresectable metastasis and resectable metastasis. The boundary between these treatments is becoming unclear. We hypothesized that factors associated with colorectal cancer may play an important role in the prognosis of patients with synchronous metastasis and may be useful for identifying patients who can be expected to have adequate results following simultaneous resection. DESIGN: Outcome study. SETTING: Tertiary referral center. PATIENTS: From January 1980 to December 2002, 187 patients underwent curative resection for synchronous liver metastasis from colorectal cancer. One hundred forty-two patients received simultaneous resection, 18 underwent staged resection, and 27 underwent delayed hepatic resection. Twenty-one clinicopathological factors were analyzed, and long-term prognosis was assessed. MAIN OUTCOME MEASURES: Prognostic factors and patient survival. RESULTS: There was no in-hospital death. In a multivariate analysis, the factors that significantly affected the prognosis of synchronous metastasis were 4 or more lymph node metastases around the primary cancer (P<.001) and multiple liver metastases (P = .003). In patients with 3 or fewer lymph node metastases around the primary cancer, the 5-year survival rates of those with 1, 2 to 3, and 4 or more liver metastases were 63%, 33%, and 40%, respectively, but these rates were 15%, 22%, and 0%, respectively, in patients with 4 or more lymph node metastases around the primary cancer. CONCLUSIONS: The results support the application of simultaneous resection in patients with 0 to 3 colorectal lymph node metastases. However, in patients with 4 or more colorectal lymph node metastases, biological selection by neoadjuvant chemotherapy may be more suitable.

Predictive factors for intrahepatic cholangiocarcinoma recurrence in the liver following surgery.

BACKGROUND: We performed hepatectomy without lymph node (LN) dissection for intrahepatic cholangiocarcinoma (ICC) limited to the peripheral region of the liver, and hepatectomy with extrahepatic bile duct resection and regional LN dissection for any types of ICC extending to the hepatic hilum. Surgical outcomes were evaluated to elucidate the prognostic factors that influence patient survival with respect to intrahepatic recurrence. METHODS: Forty-one patients underwent resection of ICC with no macroscopic evidence of residual cancer. RESULTS: Significant risk factors for poorer survival included preoperative jaundice (P = 0.0115), serum CA19-9 levels >37 U/ml (P = 0.0089), tumor diameter >4.5 cm (P = 0.017), ICC extending to the hepatic hilum (P = 0.0065), mass-forming with periductal-infiltrating type (P = 0.003), poorly differentiated adenocarcinoma, portal vein involvement (P = 0.0785), LN metastasis at initial hepatectomy (P < 0.0001), and positive surgical margin (P = 0.023). Intrahepatic recurrence, which was the predominant manner of recurrence, was detected in 20 patients (74.1%). Patients with intrahepatic recurrence had a significantly high incidence of high serum CA19-9 levels (>37 U/ml; P = 0.0006), preoperative jaundice (P = 0.0262), ICC extended to the hepatic hilum (P = 0.0349), large tumors (>4.5 cm; P = 0.0351), portal vein involvement (P = 0.0423), and LN metastasis at initial hepatectomy (P = 0.009) compared with disease-free patients. The multiple logistic regression analysis revealed that preoperative CA19-9 elevation and obstructive jaundice influenced intrahepatic recurrence of ICC. CONCLUSIONS: Although LN metastasis is a significant prognostic factor, the most obvious recurrence pattern after surgery was intrahepatic recurrence, which could be predicted preoperatively by a combination of elevated serum CA19-9 levels and manifestation of obstructive jaundice.

Results of 404 hepatic resections including 80 repeat hepatectomies for hepatocellular carcinoma.

BACKGROUND/AIMS: To evaluate our treatment protocol applied to patients with hepatocellular carcinoma. The protocol consists of the selection criteria for hepatectomy, the use of techniques that minimize intraoperative blood loss, strict follow-up after surgery, and an aggressive surgical approach for intrahepatic recurrence. METHODOLOGY: We conducted a retrospective cohort study that included 337 patients with hepatocellular carcinoma treated between 1990 and 2001. The type of resection was selected according to the serum bilirubin value and the indocyanine green retention rate at 15 minutes. Perioperative data and long-term outcome were examined. RESULTS: We performed 324 initial hepatectomies with an in-hospital mortality rate close to zero. There was one operative death and one hospital death (0.3% each), and the 5-year survival rate for all patients was 53.2%. Eighty repeat liver resections, including 18 third and two fourth, were performed with no mortality, and the 5-year survival rate was 52.9% after the second hepatic resection. The resectability rate for second and third hepatectomies reached 29% and 33% of all patients with isolated liver recurrence, respectively. CONCLUSIONS: Liver resection is a safe and effective treatment modality for hepatocellular carcinoma. Our results are likely attributable to the routine application of our treatment protocol.

Interrelationship of platelet-derived endothelial cell growth factor, liver macrophages, and tumor microvessel density in patients with cholangiocellular carcinoma.

BACKGROUND/AIMS: Microvessel density (MVD) has been studied extensively as the only factor reflecting angiogenesis and a prognostic factor in various malignant tumors. Macrophages and platelet-derived endothelial cell growth factor (PD-ECGF) also play important roles in regulating angiogenesis. The present study was conducted to examine the interrelationship of MVD, liver macrophages and PD-ECGF-positive cells in patients with cholangiocellular carcinoma. METHODOLOGY: Thirty-one patients underwent resection of cholangiocellular carcinoma, and samples of the tumors were immunostained with CD34 antibody to evaluate the relationship between MVD and prognosis. Double immunohistochemical labeling for CD68 and PD-ECGF-positive cells was performed and classified as grade 0, grade 1, or grade 2 according to the number of double-positive cells. We also evaluated the relationship between the double-positive cell grading and prognosis or MVD, and furthermore the relationship between cancer cell PD-ECGF immunoreactivity and prognosis or MVD. RESULTS: Univariate analysis showed that patients with a median MVD exceeding 48/field had asignificantly poorer prognosis (p=0.02). The survival rate of grade 2 patients was significantly worse than that of the other two groups (p=0.011, p=0.0001), and the survival rate of grade 1 patients was significantly worse than that of grade 0 patients (p=0.007). MVD differed significantly among the three grades (p=0.0007, Kruskal-Wallis test), and there was a significant positive correlation between MVD and grade (p=0.0001). No correlation was observed between MVD and the number of cells positive for PD-ECGF alone (p=0.42). Neither the survival rate nor MVD of PD-ECGF (+) patients differed significantly from that of PD-ECGF (-) patients (p=0.08, p=0.6). CONCLUSIONS: Although the present results are based on a small number of patients, they suggest that liver macrophages at the invasive margin of cholangiocellular carcinoma might contribute to tumor angiogenesis through PD-ECGF secretion, and thus influence the prognosis of patients.

[Survey of gemcitabine treatment for advanced pancreatic cancer in 20 hospitals of Nagano Prefecture].

To establish an effective therapy for pancreatic cancer, we made a retrospective survey of gemcitabine treatment performed at 20 hospitals in Nagano Prefecture. We analyzed data of 106 patients (64 men and 42 women, median age 66 years (33-83 years old)), half of whom had stage IV disease. Gemcitabine was administered for 3 consecutive weeks with one week rest in 57 patients, biweekly in 30 patients, initially for 3 weeks with 1 week rest and switched to biweekly schedule to 15 patients, and with another regimen to 4 patients. Analysis of the results of gemcitabine treatment between the 3 weeks with 1-week-rest regimen and the biweekly regimen revealed no differences between regimens in growth inhibition and symptom alleviation. However, we found less occurrence of blood toxicity in the biweekly regimen (40%) than in the 3 weeks with 1 week-rest regimen (59%). Median survival time for the biweekly regime was 9.7 months, only slightly longer than that of the 3 weeks with 1-week-rest regimen (8.5 months). The present study showed that a biweekly regimen for gemcitabine administration may be equivalent to the standard regime of 3 weeks with 1-week-rest regimen. Moreover, the biweekly regimen has advantages over the 3 weeks with 1-week rest regimen both economically and in terms of convenience for outpatient treatment. Therefore, the present results should be confirmed in future prospective studies, with the hope of developing a new standard treatment regimen for pancreatic cancer.

Morphometric analysis of liver macrophages in patients with colorectal liver metastasis.

Kupffer cells, residential liver macrophages, have binding sites for carcinoembryonic antigen (CEA), but their role in metastatic liver tumor progression has not been well addressed clinically. Liver macrophages were analyzed morphometrically and their relationship with CEA and tumor microvessel density (MVD) was examined in 71 patients who underwent macroscopic curative hepatectomy for metastatic liver tumors from colorectal cancer. In paraffin-embedded sections, MVD was evaluated by CD34-positive cell counts, liver macrophages visualized using anti PG-M1 (CD68) antibody were analyzed, and membrane-bound CEA was assessed by immunoreactivity of tumor cells for CEA. The area of liver macrophages in peritumoral regions (43.0 +/- 11.6 microm2) was significantly larger than that in non-tumor regions (25.2 +/- 24.2 microm2) (P < 0.0001). The liver macrophage density in peritumoral regions was 154 +/- 49 per field, and was significantly higher than in non-tumor regions (74 +/- 24 per field) (P < 0.001). The density and the area of liver macrophages had no correlation with serum CEA levels and the degree of tumor CEA expression. A weak positive correlation was observed between MVD and liver macrophage density (P = 0.0104, Spearman rank correlation coefficient = 0.31). Cox multivariate regression analysis showed that MVD greater than 50 (P = 0.0233, hazard ratio = 2.463), and the area of liver macrophages larger than 40.9 microm2 (P = 0.0485, hazard ratio = 2.127), were significant independent prognostic factors. The present morphometric analysis suggests that the liver macrophages are accumulated and activated in peritumoral regions in patients with colorectal liver metastasis and this accumulation and activation of liver macrophages, with which soluble or membrane-bound CEA might not be associated, are related with patients' poor prognosis.

Dendritic cells, T-cell infiltration, and Grp94 expression in cholangiocellular carcinoma.

Although dendritic cells (DCs) play an important role in tumor immunity, there have been no reports on their role in cholangiocellular carcinoma (CCC). In 26 formalin-fixed, paraffin-embedded tissue sections from patients with CCC, cells positive for CD83 (a marker of mature DCs), CD1a (a marker of immature DCs), and CD8 and CD4 (T cell markers) were counted, and expression of glucose-regulated protein (grp) 94, which is considered to participate in the maturation of DCs, was evaluated by immunohistochemistry and Western blot analysis to study the relationship between their expression and patients' disease outcome. The number of CD83-positive DCs at the invasive margin of CCCs correlated significantly with the number of CD8-positive or CD4-positive T cells in the cancerous region and was significantly higher in grp94-positive cancer than in grp94-negative cancer (P = 0.0006). CD83-positive patients (positive cells in invasive margin > 12.4/field) had both a significantly lower incidence of lymph node metastasis (23.1% vs 69.2%; P = 0.0206) and a better outcome than CD83-negative patients (P <0.001). We conclude that mature DCs are distributed predominantly at the invasive margin of cancers, and a significantly higher number of mature DCs at the invasive margin are observed in patients with grp94-positive cancer cells. Mature DCs may enhance CD8- and CD4-positive cell infiltration into cancers and improve prognosis in patients with CCC, due in part to abatement of lymph node metastasis.

Successful treatment for combined pancreatoduodenal injury by a second-stage pancreatojejunostomy following pancreatoduodenectomy.

A case of combined pancreatoduodenal injury requiring pancreatoduodenectomy is described. A two-stage approach was used, which included a pancreatoduodenectomy followed by a tube pancreatostomy for complete external drainage of pancreatic juice and subsequent second-stage pancreatojejunostomy. This approach, first advocated by Miyagawa et al., enabled us to handle the normal soft pancreas without any complications. It is suggested that the described second-stage pancreatojejunostomy can be considered as an alternative method of restoring pancreatoenteric continuity following pancreatoduodenectomy in emergency cases.

A novel nonsense mutation with a compound heterozygous mutation in TGFBI gene in lattice corneal dystrophy type I.

PURPOSE: We examined transforming growth factor beta-induced (TGFBI) gene mutations in a family with lattice corneal dystrophy type I. METHODS: The proband was one of the offspring of a consanguineous marriage; 4 affected and 3 unaffected individuals of the family were investigated. Genomic DNA of each case was extracted and used for polymerase chain reaction (PCR). The exon 4, 11, and 12 of the TGFBI gene were directly sequenced. The mutations were confirmed by PCR restriction fragment length polymorphism analysis. RESULTS: There was no significant difference in phenotype between the proband and the other 2 patients, except for progression of the corneal opacity with age. R124C mutation was detected in all affected individuals. In addition, G470X, a novel nonsense mutation, was detected in the proband, resulting in the proband being a compound heterozygote with the TGFBI gene. Her unaffected daughter was found to be heterozygous for G470X. CONCLUSION: It is most likely that the novel nonsense mutation is not pathogenic, and that the mutant keratoepithelin protein with R124C is responsible for the phenotype.

[Complete disappearance with oral UFT administration of recurrent hepatocellular carcinoma of the remnant liver and multiple lung metastasis after hepatic resection].

UFT is an anti-cancer drug which combines uracil with tegafur at a mole rate of 1:4, and shows a high anti-tumor effect by raising the 5-FU level in a tumor. A 55-year-old man with hypochondriac pain was admitted to Shinshu University Hospital. The preoperative diagnosis was giant hepatocellular carcinoma (HCC) of the right hepatic anterior region, and extended anterior segmentectomy of the liver was performed. Three months later, serum alpha-fetoprotein (AFP) and PIVKA-II were elevated markedly, and computed tomography (CT) and magnetic resonance imaging (MRI) revealed a recurrence in the remnant liver and multiple lung metastasis. Chemotherapy with oral UFT (300 mg/day) administration alone was started for the unresectable HCC. Three months later, CT and MRI showed complete disappearance of the recurrent HCC and multiple lung metastasis. Also, the titers of AFP and PIVKA-II were reduced to normal levels. This case suggests that oral UFT administration is a safe and effective therapy for postoperative HCC, even with lung metastasis.

[Clinical problems in gemcitabine treatment for unresectable pancreatic cancer in the elderly--a multicentric retrospective study of 53 cases].

In Gemcitabine treatment, elderly patients with unresectable pancreatic cancer are more likely to suffer from haematological and non-haematological adverse effects than non-elderly patients. Forty percent of the elderly patients were dropped from the initial protocol due to the adverse effects, mainly because of non-haematological events or symptoms. To avoid adverse effects, the administration schedule for Gemcitabine tended to be less often and at a lower dose for elderly patients among members of the Nagano Pancreatic Cancer Study Group. However, the fact that some cases showed a limited effect from this administration schedule albeit without adverse effect, might suggest that the frequency of ordinary administration schedule should be maintained, although the Gemcitabine dose could be decreased in unresectable pancreatic cancer patients in poor condition.