The subject of this study was a 64-year-old male. He had experienced a sensation of abdominal fullness during treatment for chronic hepatitis C at a neighborhood clinic. He was referred to our hospital for work-up upon discovery of elevated AFP.
Examination on admission revealed abdominal swelling, ascites and marked swelling of the liver. The AFP was 11, 535ng/ml. A tumor measuring 9 by 8 centimeters was revealed in the right lobe of the liver on the CT scan, and there were many metastatic lesion 1cm in diameter in both the lung field. Since the liver tumor was considered unresectable, in August 1992, MMC and ADM were administered intraarterially just once at doses of 10 and 20mg, respectively. At the end of August, oral administration of UFT at a dose of 600mg/day was started.
The patient was discharged after 3 weeks of treatment, but the administration of 300mg/day of UFT was continued, Since hepatic function tended to be aggravated, administration of Shosaiko-to (EK-9) was commenced at a dose of 6g/day. With the combination therapy, the symptoms were gradually relieved and the subjective symptoms disappeared. In September 1992 (8 months after initiation of Shosaiko-to administration), the shadows due to lung metastasis were absent on the chest x-ray examination, and the CT scan turned negative for the tumor in the right lobe. AFP and PIVKA-II decreased below 11.7ng/ml and 0.06AU/ml, respectively. As of December 1994, the patient is still on combination therapy consisting of Shosaiko-to and UFT. Neither adverse reactions such as weight loss have been induced nor has the tumor returned. The general condition of the patient is good.
The results obtained in this case suggest that Shosaiko-to and UFT in combination are effective in treating liver carcinoma.

A 75-year-old male visited Fuchu general hospital on foot because of possible acute mushroom poisoning. He had no symptom on admission. He twice ate some toxic mushrooms for lunch and for dinner on the previous day with his wife, who was found dead in her bed on the morning of his admission. A legally ordered autopsy was held on his wife, and a-amanitin was detected in her liver, brain and blood samples. Detection of a-amanitin in blood samples has never been reported in the literature. His liver and kidney failure rapidly progressed. He died on the 10th hospital day despite intensive treatment including hemodialysis and plasma exchange. On histological examination, his necropsy liver specimen revealed massive liver necrosis and new growth of pseudocholangioles, which apparently bore testimony to acute toxic mushroom poisoning.

In Western countries, the gold-standard therapeutic strategy for rectal cancer is preoperative chemoradiotherapy (CRT) following total mesorectal excision (TME), without lateral lymph node dissection (LLND). However, preoperative CRT has recently been reported to be insufficient to control lateral lymph node recurrence in cases of enlarged lateral lymph nodes before CRT, and LLND is considered necessary in such cases. We performed a literature review on aspects of pelvic anatomy associated with rectal surgery and LLND, and then combined this information with our experience and knowledge of pelvic anatomy. In this review, drawing upon research using a 3-dimensional anatomical model and actual operative views, we aimed to clarify the essential anatomy for LLND. The LLND procedure was developed in Asian countries and can now be safely performed in terms of functional preservation. Nonetheless, the longer operative time, hemorrhage, and higher complication rates with TME accompanied by LLND than with TME alone indicate that LLND is still a challenging procedure. Laparoscopic or robotic LLND has been shown to be useful and is widely performed; however, without a sufficient understanding of anatomical landmarks, misrecognition of vessels and nerves often occurs. To perform safe and accurate LLND, understanding the landmarks of LLND is essential.

Adenocarcinoma is a common histological type of ulcerative colitis-associated cancer (UCAC), whereas neuroendocrine carcinoma (NEC) is extremely rare. UCAC is generally diagnosed at an advanced stage, even with regular surveillance colonoscopy. A 41-year-old man with a 17-year history of UC began receiving surveillance colonoscopy at the age of 37 years; 2 years later, dysplasia was detected in the sigmoid colon, and he underwent colonoscopy every 3 to 6 months. Approximately 1.5 years thereafter, a flat adenocarcinoma lesion occurred in the rectum. Flat lesions with high-grade dysplasia were found in the sigmoid colon and surrounding area. The patient underwent laparoscopic total proctocolectomy and ileal pouch-anal anastomosis with ileostomy. Adenocarcinoma was diagnosed in the sigmoid colon and NEC in the rectum. One year postoperation, recurrence or metastasis was not evident. Regular surveillance colonoscopy is important in patients with long-term UC. A histological examination of UCAC might demonstrate NEC.