It is conceivable that the carcinomatous and sarcomatous components grow separately from the early stage of the tumors, and that the sarcomatous component forms a protruding tumor mass because it has abundant stroma positive for type IV collagen and laminin.

The charge‐discharge behavior of a lithium metal anode in propylene carbonate (PC) electrolyte containing added CO2 was investigated using in situ ac impedance measurements during galvanostatic cycling. In PC electrolyte with CO2 , the anode's cycle life was twice as long and its charge transfer resistance was smaller than in the same electrolyte without CO2 . These enhancements are observed only when lithium is electrodeposited in the presence of CO2 on nickel substrate; the enhancement does not occur when lithium is deposited without CO2 and is cycled with CO2 . Even large amounts of H2O in the electrolyte during cycling do not adversely affect the cycle life enhancement by CO2 . The CO2 enhancement seems to be due to products formed by reaction of lithium with CO2 on the electrodeposited lithium surface.

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Abstract. In this study, a total of 108 patients with primary colorectal cancer who underwent hybrid 2-port hand-assisted laparoscopic surgery (HALS) were classified as 58 patients with colon cancer and 50 patients with rectal cancer. The mean operating time, mean blood loss, postoperative complications, and mean postoperative hospital stay were compared between the two groups. In patients who underwent colon cancer surgery, the mean operating time was 2 h and 26 min, the mean blood loss was 166.3 ml, and the postoperative complications were wound infection in 5/58 patients (8.6%), postoperative ileus in 3 patients (5.2%), and anastomotic stricture in 1 patient (1.7%). There was no anastomotic leakage and no conversion to conventional open laparotomy. The mean postoperative hospital stay was 12.6 days. In patients who underwent rectal cancer surgery, the mean operating time was 3 h and 38 min, the mean blood loss was 238.8 ml, and the postoperative complications consisted of wound infection in 6/50 patients (12.0%), anastomotic leakage in 3/35 patients (8.6%), anastomotic stricture in 3/47 patients (6.4%), postoperative ileus in 3/50 patients (6.0%), and conversion to conventional open laparotomy in 1/50 patients (2.0%). A covering stoma was constructed during surgery in 12/47 patients (25.5%). The mean postoperative hospital stay was 19.1 days. These results suggest that hybrid 2-port HALS (Mukai's operation) could become a standard method for the treatment of colorectal cancer, and that the long-term outcome should be compared in detail with that of standard laparotomy in the future. IntroductionLess invasive surgery such as laparoscopy-assisted colorectal surgery (LACS) has become popular in recent years, and its indications have expanded markedly from additional resection in patients with stage I colorectal cancer to radical resection in patients with stage II/III cancer and palliative surgery for patients with advanced stage IV disease (1-5). Unlike Western countries, where hand-assisted laparoscopic surgery (HALS) and hybrid HALS combined with open manipulation are performed (6-9), the main type of surgery employed in Japan is pure LACS with 5-6 ports including a camera port for manipulation and a small incision of 35-45 mm (10-12). However, at least 3 surgeons experienced with smooth camera operation are required for pure LACS since the operation is mostly performed by the operator and first assistant manipulating four forceps. Pure LACS has the following disadvantages compared with ordinary open laparotomy: i) poor palpation/tactile sensation, ii) limited applicability with respect to large and heavy tumors, ii) difficulty in assessing the total operating field, iv) a longer operating time as laparoscopic manipulation while observing the monitor is the main procedure, and v) a requirement to acquire specific skills and pass the certification exam in Japan. In addition, LACS cannot become the standard operation even at a relatively large general hospital since it requires several experienced surgeons to s...

Electrodeposited lithium was evaluated by ac impedance measurement and optical microscopy in two solutions containing LiClO4 ; a propylene carbonate (PC) solution and a blended solution consisting of PC and 1,2‐dimethoxyethane (DME) false(normalvolume ratio=1:1false) . The ac impedance data were analyzed in the higher frequency region, where the charge‐transfer resistance false(Rnormalctfalse) of Li++e−⇄normalLi can be evaluated. The value of Rnormalct was always larger in the PC electrolyte solution than in the PC‐DME(1:1) electrolyte solution, and Rnormalct depended on the lithium deposition charge. Microscopic observation indicated that lithium deposited more uniformly in PC‐DME (1:1) than in PC solution. The results of morphological evaluation of the electrodeposited lithium using optical microscopy corresponded to the variations in the value of Rnormalct obtained from ac impedance measurements, showing that the behaviour of Rnormalct accurately represented the morphological state. The cycleability of the lithium anode was investigated by charge‐discharge testing. The cycle efficiency was worse in PC than in PC‐DME (1:1) solution; this seems to be related to the morphological properties of the lithium deposits.

A 69-year-old woman presented to her local clinic with vomiting and abdominal distension. Since a bowel obstruction by left colon cancer was suspected due to a marked dilation of the transverse colon, she was referred to our hospital. On admission, an enema disclosed a complete obstruction at the splenic flexure of the colon. An emergency operation was performed, and a temporary loop colostomy was fashioned on the left side of the transverse colon within the range of resection for 2-stage radical surgery. On hospital day 16, a left hemicolectomy D2 was performed by 2-port hand-assisted laparoscopic surgery (2P-HALS) using the stoma as the hand access site, and the tumor was resected along with the removal of the stoma. After surgery, a slight wound infection occurred at the hand access site, but this healed with conservative management. On day 36, she was discharged from hospital. The histological diagnosis was Type 2 circumferential well-differentiated adenocarcinoma with local peritoneal dissemination. Our experience suggests that 2-stage surgery combined with 2P-HALS is applicable even to a large obstructing left colon cancer. This method is less invasive, safe and achieves excellent results, including a good cosmetic outcome.

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Abstract. To safely avoid the construction of a covering stoma in patients with advanced lower rectal cancer undergoing laparoscopy assisted colorectal surgery (LACS), we added circumferential manual reinforcing sutures via the transanal approach at the site of mechanical anastomosis. In June 2008, LACS was performed for a tumor of 6 cm in longer diameter in the Rb region of the lower rectum ~5 cm from the anal verge. After intraperitoneal coloproctal anastomosis was performed in the pelvis by the double stapling technique (DST), reinforcement was provided by manual trans-anal suturing (trans-anal reinforcing sutures: TARS). A covering stoma was constructed because this was a high-risk case. Complications such as mild wound infection and stoma trouble occurred, and the patient was discharged after conservative therapy. In June 2008, LACS was performed for a tumor of 5 cm in longer diameter in the Ra region of the lower rectum ~7 cm from the anal verge. After intraperitoneal colorectal anastomosis was performed in the pelvis by DST, TARS were added to avoid a covering stoma. Minor leakage occurred postoperatively, but this was controlled conservatively and the patient was discharged. In patients having surgical treatment of advanced lower rectal cancer, good results were obtained by adding circumferential reinforcing sutures via the trans-anal approach at the site of ultra-low anastomosis after DST.