Twenty-nine patients with advanced carcinoma of the bile duct or gallbladder underwent combined portal vein and liver resection. Segmental excision of the portal vein was performed in 16 cases and wedge resection of the vessel wall in 13. The operative mortality rate was 17 per cent. The median survival for the 24 patients who left hospital was 19.8 months. Actuarial survival rates at 1, 3 and 5 years for all 29 patients were 48 per cent, 29 per cent, and 6 per cent respectively, whereas the median survival for 46 patients with unresectable carcinoma was 3 months and the 1 and 3-year actuarial survival rates were 13 per cent and zero respectively. This difference in survival times between patients undergoing hepatectomy with portal vein resection and those with unresectable carcinoma were statistically significant (P less than 0.01). Combined portal vein and liver resection is recommended as a reasonable surgical approach in selected patients with advanced carcinoma of the biliary tract.

In order to clarify the relation of adenoma to carcinoma in the gallbladder, histopathologic examination was made on surgical specimens of 1605 cholecystectomies. Among them, 11 benign adenomas, seven adenomas with malignant change, and 79 invasive carcinomas were found. All of the benign adenomas were 12 mm or less in diameter (average diameter, 5.5 ± 3.1 mm), while the adenomas having cancerous foci were 12 mm or more in diameter (average diameter, 17.6 ± 4.4 mm). Most invasive carcinomas were more than 30 mm in diameter. The average patient age was 50.5 ± 16.3 years for benign adenomas, 58.3 ± 12.6 years for adenomas with malignant change, and 64.8 ± 9.6 years for invasive carcinomas. Transition of benign adenoma into carcinoma was histologically traceable. Adenomatous residue was found in 15 (19.0%) of 79 cases of invasive carcinoma.

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Objective: To establish reliable standards for surgical application to elderly patients 75 years old or older with gastric or colorectal cancer with special reference to the postoperative recovery of activities of daily living (ADL) and quality of life (QOL). Summary Background Data: ADL and QOL are important outcomes of surgery for the elderly. However, there has been only limited evidence on the natural course of recovery of functional independence. Methods: Two hundred twenty-three patients 75 years old or older with gastric or colorectal cancer were prospectively examined. Physical conditions, ADL, and QOL were evaluated preoperatively and at the first, third, and sixth postoperative month. Results: The mortality and morbidity rates were 0.4% and 28%, respectively. Twenty-four percent of patients showed a decrease in ADL at 1 month postoperatively, but most patients recovered from this transient reduction, with only 3% showing a decline at the sixth postoperative month (6POM). ADL of these patients was likely to decrease after discharge from the hospital. QOL of the patients showed a recovery to an extent equal to or better than their average preoperative scores. Conclusions: Of the patients 75 years old or older who underwent elective surgery for gastric or colorectal cancer, only a few showed a protracted decline in ADL and most exhibited better QOL after surgery. This indicates that surgical treatment should be considered, whenever needed, for elderly patients 75 years old or older with gastric or colorectal cancer. Estimation of Physical Ability and Surgical Stress is useful for predicting postoperative declines in ADL and protracted disability; this could aid in establishing a directed rehabilitation program for preventing protracted disability in elderly patients. (Ann Surg 2007;246: 222-228)

Since July 1975, percutaneous transhepatic biliary drainage (PTBD) has been performed in 533 cases, and since April 1977 we have developed percutaneous transhepatic cholangioscopy (PTCS) as a diagnostic and therapeutic endoscopical tool in 198 cases of malignant disease and 195 benign cases. After dilating the sinus tract of PTBD using a 15-Fr catheter about 2 weeks after PTBD, PTCS was carried out through the sinus tract. PTCS has diagnostic advantages: the lesion can be accurately diagnosed histologically and the extent of cancer in the biliary tract can be assessed by taking biopsy specimens before the operation. PTCS has been applied for cholangioscopic lithotripsy in 145 cases of gallstone disease. In 44 cases, the Nd-YAG laser and/or electrohydraulic shock wave has been used to break up the stones. The PTCS morbidity was 6% and mortality was 0.3%.

The BRCA1 COOH terminus (BRCT) motif is present in many nuclear proteins that contribute to cell cycle regulation or DNA repair. Polymerase chain reactionbased screening with degenerate primers targeted to the BRCT motif resulted in the isolation of a human cDNA for a previously unidentified DNA polymerase (designated DNA polymerase ␤2) that is closely related to DNA polymerase ␤ (Pol ␤). The predicted Pol ␤2 protein contains a BRCT motif in its NH 2 -terminal region; its COOH-terminal region exhibits 33% sequence identity to a corresponding region of human Pol ␤. The Pol ␤2 gene is expressed in a tissue-specific manner, with transcripts being most abundant in testis. A fusion construct comprising Pol ␤2 and green fluorescent protein exhibited a predominantly nuclear localization in transfected HeLa cells. Recombinant human Pol ␤2 from insect cells exhibited substantial DNA polymerase activity, but it did not possess terminal deoxyribonucleotidyl transferase activity. A truncated Pol ␤2 mutant lacking the BRCT motif retained substantial DNA polymerase activity, whereas a mutant Pol ␤2 with two alanine point mutations within the DNA polymerase active site did not. These results indicate that Pol ␤2 is a Pol ␤-related DNA polymerase with a BRCT motif that is dispensable for its polymerase activity.

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Of 25 cases of cancer in the intrahepatic bile ducts, 44 cases of cancer in the extrahepatic bile ducts, 30 cases of adenoma in the gallbladder, and 100 cases of infiltrating carcinoma in the gallbladder, several to about 20% of the cases showed Paneth's cell metaplasia and/or enterochromaffin cell metaplasia within the tumor mass or in its surrounding mucosa. These metaplasia were not found in small adenomata of the gallbladder, but they were frequently seen in large adenomata. Goblet cell metaplasia and marked hyperplasia of mucous glands were seen more frequently in the mucosa surrounding cancer than in the mucosa of 500 non‐neoplastic gallbladders. Although cancer in the gallbladder occasionally developed on the basis of intestinal metaplasia alone, intestinal metaplasia was not likely to be related to induction of most adenomata, but it was likely to be associated with growth and cancerous change of adenoma.