Seventy-four patients were treated with a radical or a nonradical pancreatectomy for ductal cell carcinoma of the head of the pancreas. Their survival rates and the selection of the operative procedure were evaluated. In 32 patients, a radical pancreatectomy was attempted where there was sufficient clearance of regional or juxta-regional lymph nodes beyond the group of suspected metastatic nodes, as well as a resection of a greater margin of soft tissue around the pancreas. These patients' cumulative 5-year survival rate was 33.4%. In 14 Stage I or Stage 11 patients, the cumulative 5-year survival rate was 46.4%. In 18 Stage 111 or Stage IV patients, the cumulative 5-year survival rate was 20.7%. For 42 patients treated with a nonradical pancreatectomy with the dissection of lymph nodes adjacent to the pancreas or of regional lymph nodes but with insufficient clearance of the soft tissue around the pancreas, the cumulative 2-year and 3-year survival rates were 5.4% and 0%, respectively. In seven patients with Stage I1 carcinoma, the survival rate was 16.7% after 2 years and 0% after three years. In 35 Stage I11 or Stage IV patients, the survival rate was 3.2% after 2 years and 0% after 3 years. Thus, the survival rates were significantly higher in patients treated with radical operation than in patients who had nonradical operation. These results indicate that a radical pancreatectomy with sufficient lymph node clearance with the surrounding connective tissue around the pancreas is indispensable to cure patients with ductal cell carcinoma of the pancreas. Cancer 64:1132-1137. 1989. ESPITE the development of new diagnostic aids such D as ultrasonography, computerized tomography, en-doscopic retrograde pancreatocholangiography, and an-giography, the prognosis for patients with pancreatic car-cinoma, particularly pancreatic ductal cell carcinoma, is poor because of the tumor's low resectability and a limited postoperative survival time when compared with other gastrointestinal malignant neoplasms. In most cases, tumors extend to the outer margin of the pancreas and infiltrate the pancreatic capsule and adjacent vessels. ',* Even if these lesions appear to be resected in the course of pan-createctomy, they are often overlooked since invisible microscopic lesions may be left behind. Therefore, the primary lesion should be removed with as much surrounding, apparently noncancerous tissues as is feasible, including an en bloc removal of the regional From the First

A case of spinal cord glioblastoma multiforme with intracranial dissemination is reported. A 23-year -old female was admitted to a local hospital complaining of lumbago. Myelography revealed an in tramedullary thoracic tumor. The tumor was partially removed through a laminectomy at Th 11-L1. The histological diagnosis was glioblastoma multiforme, and focal irradiation (total 50 Gy) was given. Eight months after the operation, symptoms of increased intracranial pressure appeared. Computed tomographic (CT) scans showed marked hydrocephalus, and multiple tumors at anterior horns of bilateral lateral ventricles. A ventriculoperitoneal shunt and an Ommaya reservoir into the left lateral ventricle were emplaced. Three months later, she was transferred to our hospital. CT scans showed enhanced lesions in the fourth ventricle, anterior horn of the left lateral ventricle, sep tum pellucidum, and pituitary gland. Suboccipital craniectomy was performed, and the mass around the fourth ventricle was partially removed. Histological examination of the tumor specimens showed glioblastoma multiforme. Postoperatively, she received whole brain irradiation (total 50 Gy), and intrathecal injection of β-interferon via the Ommaya reservoir. However, she died of respira tory insufficiency. It is considered that the spinal cord glioblastoma multiforme disseminated into the intracranial space.

The role of free radicals in the development of pancreatitis was evaluated by measuring the level of activities of xanthine oxidase (XOD), lipid peroxide (LPO) and superoxide dismutase (SOD). Acute pancreatitis was induced in female mice fed a choline-deficient meal containing 0.5 % DL-ethionine (CDE meal). Acute pancreatitis was confirmed by the changes in serum amylase level and other typical features observed microscopically 24 h after the meal was taken. Activity of XOD was elevated significantly (p < 0.05) from the baseline of 1.13 ± 0.19 U/g tissue to 2.34 ± 0.46, 2.59 ± 0.33 and 3.46 ± 0.70 U/g tissue, 8, 12 and 24 h, respectively, after the CDE meal. The LPO level was also increased from an undetectable amount to 1.10 ± 0.47 nmol/ml (p < 0.05), 1.03 ± 0.18 (p < 0.01) at 6 and 8 h, respectively, and then returned to an undetectable amount at 12 h. The peak level of LPO was shown at 24 h, 1.76 ± 0.40 nmol/ml (p < 0.01) and gradually decreased until 48 h, 1.17 ± 0.37 nmol/ml (p < 0.01) after the CDE meal. Changes of LPO took a biphasic pattern. SOD was decreased significantly from 47.1 ± 3.4 mU/g tissue to 30.7 ± 2.5, 24.8 ± 1.7 and 20.6 ± 1.1 mU/g tissue at 8 (p < 0.01), 12 (p < 0.01), and 24 (p < 0.01) h, respectively. These results indicate that oxygen-derived free radicals play an important role in the development of acute pancreatitis and that the imbalance of the offense system represented by XOD and LPO and the defense system reflected by SOD in the tissue might be an important cause of tissue damage induced by oxygen-derived free radicals.

Investigations to determine the cause of jaundice in an 83-year-old man led to the diagnosis of incomplete obstruction of the common bile duct due to stone formation around an ingested fish bone. Abdominal ultrasound and computed tomography performed preoperatively revealed evidence of chronic cholecystitis with a gallstone and calcification in the common bile duct. Endoscopic retrograde choangiopancreatography showed stone formation in the common bile duct. After normalizing the serum bilirubin level by endoscopic retrograde bile duct drainage, we performed cholecystectomy and choledocholithotomy, which revealed stone formation around an ingested bone in the common bile duct. To the best of our knowledge based on a computer-assisted search, this is only the third report of the formation of a choledocal stone around an ingested fish bone. We reviewed the literature on choledocholithiasis caused by a foreign body, in an attempt to classify this entity according to the pathways through which a foreign body can migrate into the common bile duct.