Fluorine‐containing polyarylates having inherent viscosities of 0.2–0.8 dL/g were prepared from tetrafluoroisophthaloyl chloride and various bisphenols by low temperature solution polycondensation in chloroform with triethylamine or by two‐phase polycondensation in a dichloromethane‐water or nitrobenzene‐water system with benzyltriethylammonium chloride as the phase transfer catalyst. These polyarylates were amorphous and were readily soluble in various solvents, including chloroform and N‐methyl‐2‐pyrrolidone. The glass transition temperature of the polymer derived from 2,2‐bis(4‐hydroxyphenyl) propane was 150°C. These polyarylates started to lose weight around 350°C in an air or nitrogen atmosphere.

Patient: Male, 66-year-old Final Diagnosis: Pancreatic cancer Symptoms: Abdominal pain Medication:— Clinical Procedure: Adjuvant chemotherapy • neoadjuvant chemotherapy • radical resection Specialty: Surgery Objective: Unusual setting of medical care Background: Distal pancreatic cancers may be unresectable at the time of diagnosis because these cancers are asymptomatic and readily infiltrate neighboring organs. Radical resection of a pancreatic tail cancer with colonic perfo-ration is rare. We describe successful resection of a locally advanced pancreatic tail cancer with colonic perfo-ration using a multidisciplinary approach. Case Report: A 66-year-old man presented to our hospital with a chief concern of high fever. Abdominal computed tomography revealed a pancreatic tail tumor infiltrating the neighboring organs and causing colonic obstruction with perforation, which resulted in an intra-abdominal abscess. Colonoscopy revealed obstruction of the descending colon by extramural invasion. Laboratory tests showed high tumor marker concentrations (carcinoembryonic antigen, 11.6 ng/dL; pancreatic cancer-associated antigen-2, >1600 U/mL). We clinically diagnosed locally advanced pancreatic tail cancer with an intra-abdominal abscess caused by colonic perforation. First, we performed transverse colostomy and percutaneous drainage. We then started neoadjuvant chemotherapy with FOLFIRINOX for tumor shrinkage and prevention of distant metastases. The therapeutic effect was a partial response, and no distant metastases was found. We therefore performed radical surgery comprising distal pancreatectomy with partial resection of neighboring organs. Although pathological examination revealed a pancreatic tail tubular adenocarcinoma with direct invasion of the neighboring organs, R0 resection was achieved. The patient was discharged with no perioperative complications. Tegafur/gimeracil/oteracil potassium were administered as adjuvant chemotherapy. The patient remained recurrence-free for 19 months after surgery. Conclusions: We achieved successful en bloc resection of a locally advanced distal pancreatic cancer with colonic perforation by using a multidisciplinary approach.

Buscopan, glucagon, and/or saline flushing via cholangiogram catheter 2. Passage of cholangiogram catheter into the duodenum 3. Fluoroscopy-guided basket extraction 4. Choledochoscopy-guided basket extraction 5. Transpapillary stent placement when postoperative ERCP is required Passage of the cholangiogram catheter can be considered before basket or choledochoscopic exploration because it establishes that the cystic duct e bile duct junction can be safely traversed. It may also facilitate passage of gravel or fine stones in the distal bile duct into the duodenum without necessitating the use of basket along with the added risk from this. Conclusion: This stepwise approach allows reserving the use of the transcystic basket to a potentially smaller subset of patients with the aim of reducing the overall risk of bile duct exploration.

Introduction: IPMN is a common cystic neoplasm of the pancreas. It can be divided into main pancreatic duct type ,branch pancreatic duct type and mixed type. The malignant transformation rate of branch pancreatic duct IPMN is lower than that of pancreatic surgery, because the complication rate of pancreatic surgery is high, and the endocrine and exocrine function is abnormal after operation,So most patients need long-term follow-up. International consensus guidelines for the management of IPMN were first formulated in 2006 and subsequently revised in 2012 and 2017. Also,the AGA guideline in 2015, European guideline( 2013) and Guidelines for Cystic and Solid Tumors of the Pancreas in China(2015). All of these guidelines were constructed based on expert opinion and not on robust clinical data.The main limitation of the original Sendai guidelines was that it had a low positive predictive value resulting in many benign neoplasms being resected.However, although the updated guidelines resulted in an improvement in the positive predictive value over the Sendai Guidelines, the results of several studies validating these guidelines demonstrated that its positive predictive value remained low.Although these guidelines were associated with high negative predictive values, some investigators have demonstrated that some malignant IPMNs may be missed. Method: All cases of IPMN confirmed by pathology after operation in our hospital from 2000 to 2018 were collected. According to the above guidelines, the specificity and sensitivity of the guidelines in this group of cases were compared. Result: In this group of cases, there was no significant difference between the guidelines. Conclusion:There is no clinical guideline that can give full consideration to specificity and sensitivity. Individualized treatment should be given to patients according to their clinical characteristics and surgeon's surgical techniques.

例を対象とし，1)急性胆囊炎発症から手術までの期間(72 時間以上：n=42／未満：n=159)と 2)年齢 (85 歳以上：n=23／未満：n=178)に基づき各々 2 群に分類し，その治療成績の詳細を後方視的に検討し た．結果：1)発症から 72 時間未満の早期手術群では晩期手術群と比較し，有意に腹腔鏡下胆囊摘出術施 行率が高く(82.4% vs 57.1%；P=0.0005) ，術中出血量が少なく(92.9 ml vs 185.1 ml；P<0.0001) ，術後合併 症率は低値(6.3% vs 16.7%；P=0.03) ，術後入院期間は短期であった(7.4 日 vs 8.5 日；P=0.029) ．2)超高 齢者群(85 歳以上)では非超高齢者群と比較し，腹腔鏡下胆囊摘出術施行率や合併症発症率に差は認めな かったが，有意に術中出血量は増加し(166.1 ml vs 105.2 ml；P=0.04) ，術後入院期間は延長した(14.2 日 vs 6.8 日；P=0.