Journal of Nippon Medical School
Online ISSN : 1347-3409
Print ISSN : 1345-4676
ISSN-L : 1345-4676
69 巻, 5 号
選択された号の論文の21件中1~21を表示しています
グラビア
綜説
原著
  • Hirobumi Asakura, Akihito Nakai, Tsutomu Araki
    原稿種別:
    専門分野:
    2002 年 69 巻 5 号 p. 415-421
    発行日: 2002年
    公開日: 2002/10/25
    ジャーナル フリー
    We previously reported the correlation of placenta grade with low antithrombin III (ATIII) in pregnant women at term. In this report, the clinical relevance of grade III placenta in the assessment of low plasma ATIII was compared with other factors that raise the risk of blood hypercoagulability.
    Methods: We investigated the correlation of low ATIII with ultrasonographic placental grade as well as with age, parity, body mass index (BMI), blood pressure, platelet counts and hematocrit in 164 healthy pregnant women at term. We calculated the odds ratio for each variable (clnical factor) to predict low ATIII activity of less than 80% using a multiple logistic regression model.
    Results: Low ATIII activity was associated with BMI≥28, systolic blood pressure≥136 mmHg, diastolic blood pressure≥84 mmHg and the presence of grade III placenta. The odds ratio of low ATIII activity was 3.2 for women with BMI≥28 (95%Confidential Interval (CI) : 1.1-9.7) ; 2.7 (95% CI: 0.7-10.3) for women with systolic blood pressure≥136 mmHg; 1.9 (95% CI: 0.3-11.9) for those with diastolic blood pressure≥84 mmHg; and 2.4 (95% CI: 0.8-6.9) for those with placental grade III.
    Conclusion: We can assess low placenta ATIII activity by using placental grade with similar odds ratios to BMI and blood pressure in pregnant women at term.
  • Isao Kiriyama, Kenji Ogaki, Shuji Ohba, Taiji Nishimura
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    専門分野:
    2002 年 69 巻 5 号 p. 422-427
    発行日: 2002年
    公開日: 2002/10/25
    ジャーナル フリー
    Objectives: The effect of neoadjuvant hormonal therapy (NHT) prior to radical prostatectomy (RP) on pathological downstaging of prostate cancer and biochemical relapse of serum prostate specific antigen (PSA) level was evaluated.
    Materials and Methods: Twenty selected patients with prostate cancer, who were treated with hormonal therapy and demonstrated biochemical downstaging by reduction of PSA prior to RP and bilateral pelvic node dissection at the Tohsei National Hospital between January 1997 and August 2001, are reported on. The complete RP specimens of these 20 men were used for accurate evaluation of the pathological stage. All 20 patients received NHT; ten patients were treated with leuprolide plus flutamide and 10 received leuprolide plus chlormadinone acetate (CMA).
    Results: Decreases in serum PSA values were demonstrated from a pre-hormonal average of 49.7 ng/ml to an average of 0.52 ng/ml after NHT. Of the three clinical stages, A2-C, for cancer patients, two of the 20 patients had stage A2, two had stage B1, nine had stage B2, and seven had stage C. Of the 20 patients with biochemical downstaging, two had pathological stage B1, seven had pathological stage B2, eight had pathological stage C, and three had positive pelvic lymph nodes. Ten (50%) of the 20 patients were reported to have positive surgical margins. Seminal vesical extension was observed in two cases, and penetration was not observed. Positive nodes were identified in three (15%) patients. Among the seven clinical stage C patients, one had pathological stage B1 disease and two had pathological stage B2. Four of nine patients with clinical stage B2 prostatic cancer had pathological stage C disease. The actuarial incidence of a rising PSA at 3 years for the leuprolide plus CMA group was 28.9% compared with 37.5%for the group receiving leuprolide plus flutamide. The cases of biochemical relapse did not necessarily indicate a high stage and had no tendency to be high for baseline PSA level, positive margin rates or Gleason scores.
    Conclusions: A significant decrease in the rate of penetration could be observed after NHT, though it was not so effective for pathological downstaging, and changes in the preoperative PSA level did not predict those patients who might have a favorable result.
  • Tomoyuki Rokugo, Toshitsugu Takeuchi, Hiromoto Ito
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    専門分野:
    2002 年 69 巻 5 号 p. 428-433
    発行日: 2002年
    公開日: 2002/10/25
    ジャーナル フリー
    The effects of pain stimulant and transcutaneous electrical nerve stimulation (TENS) on changes in substance P (SP) levels were investigated in the dorsal root ganglion (DRG) and dorsal horn of the spinal cord of Sprague-Dawley rats. The rats were divided into three groups: control, formalin stimulation and formalin+TENS. In all rats, the right sciatic nerve was attached to a hook electrode for recording, and the right lower leg was connected to a ring electrode. As a pain stimulant for the formalin stimulation group and formalin+TENS group, 50μl of a 5%formalin was injected into the right paw. At the same time, TENS (50Hz, 50V) for 5 minutes was applied via the ring electrode to the formalin+TENS group. After completing the stimulation, the components of the sciatic nerve, i. e. the DRG of the fourth to sixth lumbar spinal roots and a part of spinal cord, were removed. SP-like immunoreactivity (SP-LI) in the DRGs was quantified by the ELISA method. For the spinal cord, immunohistochemical staining for SP was carried out using an avidin-biotin immunoperoxidase method. Using an NIH image, the SP grains in the nerve ends, which were seen as dark brown stains on the Rexed laminae I and II in the dorsal horn of the spinal cord, were counted within a 450μm2 area. The results showed that SP-LI levels of both the DRG and the dorsal horn of the spinal cord in the formalin+TENS group were significantly reduced as compared with formalin stimulation group. Based on the fact that SP is a nociceptive neurotransmitter, the present study suggests that TENS reduces production of SP in the DRG, and shows analgesic effects by suppressing nociception via C-fiber in the peripheral nerves.
  • Yuji Okajima, Hiroyuki Tajima, Tatsuo Kumazaki, Munehiko Onda
    原稿種別:
    専門分野:
    2002 年 69 巻 5 号 p. 434-444
    発行日: 2002年
    公開日: 2002/10/25
    ジャーナル フリー
    Prior reports of CT-guided lung biopsy of the small lung nodules of less than 2 cm have been unsatisfactory. In January 1998, we began a preliminary study of CT-guided lung biopsy in our conventional CT room. With the basic results achieved, we constructed a novel CT-guided lung biopsy system.
    Together with Hitachi Corporation we have developed CT, the Radix Prima, exclusive for interventional procedures especially for CT-guided lung biopsy. As reconstruction delay time of the procedures has been shortened from 1.0 sec. to 0.6 sec. , real time CT fluoroscopy monitoring is possible on the Cathode Ray Tube (CRT) monitor in the CT room, very closed to the patient. Multiple confirmations of the tip of the biopsy needle have been possible with this specially equipped CT. A semi-automatic-type needle have been selected for reliable biopsy, because the old fully-automatic-type needle was very heavy and easily misfired. Multiple punctures have been also used, because single punctures have a greater risk of obtaining inadequate specimens.
    In our clinical study at our IVR center, the subjects comprised 41 patients (26 males, 15 females, ranging in age from 34 to 79, mean 64 years old). The mean nodule diameter was 1.9 cm, the mean distance from skin surface to lesion was 5.5 cm, and the mean number of punctures was 3.0. The biopsy results included 23 malignancies. In 13 patients the results were benign tumors or specific inflammation. In 4 patients the results were nonspecific inflammation. In only 1 patient was the specimen inadequate. There was no false negative. The correct rate of benign/malignant diagnoses was 98%. A complication of pneumothorax was observed in 22 patients, but all were improved by conservative treatment. Pulmonary hemorrhage was observed in 21 patients, 7 of whom also had hemoptysis. Each of these patients also responded to conservative treatment from specialist medical staff at the IVR center.
    The 98%accuracy of our results indicates that multiple punctures using a semi-automatic-type biopsy needle and multiple confirmations of the needle tip on our method of real time CT fluoroscopy are extremely important for CT-guided lung biopsy of small lung nodules of less than 2 cm.
  • Takashi Matsushima, Hisayuki Kaseki, Kaisuke Ishihara, Tsutomu Araki
    原稿種別:
    専門分野:
    2002 年 69 巻 5 号 p. 445-450
    発行日: 2002年
    公開日: 2002/10/25
    ジャーナル フリー
    Fallopian tube cytology has been used as a useful tool in the diagnosis of infertility.
    In this study, we developed an intra-fallopian tube cell collection method with the simultaneous use of a laparoscope and hysteroscope, and examined its safety and applicability for the diagnoses of endometriosis and hydrosalpinx. Fallopian tube cells were collected at laparoscopy and hysteroscopy from 20 volunteer patients who visited the infertility clinic. There were 10 patients with normal fallopian tubes (Group 1), 7 with pelvic endometriosis (Group 2), and 3 with hydrosalpinx (Group 3). The collected cells were fixed onto glass slides using an auto-smear method, stained by the Papanicolaou method and subjected to detailed cytomorphological examinations. In each case, an adequate number of cells with well-preserved morphology for a reliable evaluation was obtained. Cells from normal fallopian tubes were mainly fallopian tube epithelial cells including ciliated columnar cells and secretory cells. The number of inflammatory cells was quite low. A characteristic feature in cases with pelvic endometriosis was the presence of a large number of macrophages, some of which showed hemosiderin phagocytosis. In contrast, cases with hydrosalpinx showed an extremely low cellular component. No complications were found in any of the patients. Our study indicates that the present intra-fallopian tube cell collection method using a laparoscope and hysteroscope is a reliable and safe method that can be applied to the diagnosis of endometriosis, hydrosalpinx, as well as pelvic infertility.
  • 塩田 吉宣, 恩田 昌彦, 佐久間 隆, 堀 雅睛, 高崎 秀明, 長谷川 博一
    原稿種別:
    専門分野:
    2002 年 69 巻 5 号 p. 451-455
    発行日: 2002年
    公開日: 2002/10/25
    ジャーナル フリー
    Endoscopic hemorrhoidal ligation with a rubber band was carried out on 40 patients with internal hemorrhoids. All the patients were treated in the outpatient ward. Seven patients complained of mild to moderate aches in the early postoperative days, which were easily controlled by medication. One week after the treatment, no patient complained of pain. None of the patients had any postoperative bleeding. The results of this treatment were classified as good (no complaint or symptoms after the treatment), fair (at least some improvement), or poor (no change or worse than before the treatment). Twenty-nine of the 40 patients were classified as good, and the remaining 11 patients were fair. No patients were classified as poor. EHL is a harmless and painless procedure and is easily performed in the outpatient ward.
    When internal hemorrhoids of operative indication are detected by colonoscopy, EHL can be easily and simultaneously carried out.
特 集: 第12回公開「シンポジウム」21世紀を見据えた画像診断とInterventional Radiology(IVR)
臨床および実験報告
  • Keiji Tanaka, Naoki Sato, Masahiro Yasutake, Shinhiro Takeda, Teruo Ta ...
    原稿種別:
    専門分野:
    2002 年 69 巻 5 号 p. 481-488
    発行日: 2002年
    公開日: 2002/10/25
    ジャーナル フリー
    This study aimed to analyze the clinical course, timing of rupture and relationship with percutaneous coronary intervention (PCI) in patients with cardiac free wall rupture (FWR) following acute myocardial infarction (AMI). FWR was observed in 77 (2.3%) of 3, 284 patients with AMI in our CCU over 28 years. 47 (61.0%) cases were male and mean of age was 69.8 year old. Rupture occurred on Day 1 of infarction in 46 patients (59.7%). 22 cases (28.6%) had cardiogenic shock before FWR. 10 cases (13.0%) had double rupture preceded by ventricular septal perforation (VSP). 25 cases (32.5%) were treated with thrombolytic agents, and only 10 cases (13.0%) had percutaneous coronary intervention (PCI). Before 1981, when PCI was not indicated, incidence of FWR was 2.7%. After 1988 (the era of PCI), the incidence decreased to 1.1%. FWR and the era showed a significant negative correlation (r=0.519: P=0.0056).
    Rupture was abrupt in 51 cases (66.2%: abrupt type) and was gradual in 26 cases (33.8%: oozing type). The percentages of female, patients with cardiogenic shock before rupture, patients treated by thrombolytic agents and survival rate were significantly higher in the slow-onset rupture group than in the abrupt-onset rupture group. The percentage of patients treated by PCI was extremely low (7.8%) in abrupt-onset group.
    Of all patients, only 8 (10.4%) survived by emergency operation. One patient with abrupt type survived emergency pericardtomy in the CCU. One patient with abrupt type and 4 patients with oozing type who had emergency operation in operation room survived. 2 patients with oozing type survived by pericardial drainage and strict blood pressure control.
    We conclude that early recognition and emergency surgery without thrombolytic therapy may substantially reduce mortality in oozing ruptures. Moreover, immediate and adequate reperfusion by PCI may prevent development of abrupt rupture following acute myocardial infarction.
  • 張 玉宝, 徳永 昭, 増田 剛太郎, 奥田 武志, 木山 輝郎, 吉行 俊郎, 加藤 俊二, 松倉 則夫, 田尻 孝, 恩田 昌彦
    原稿種別:
    専門分野:
    2002 年 69 巻 5 号 p. 489-493
    発行日: 2002年
    公開日: 2002/10/25
    ジャーナル フリー
    The aim of this study was to evaluate the characteristics, and treatment of gastric remnant cancer based on an analysis of the surgical results of Nippon Medical School over the past 18 years. Thirty seven patients (27 males and 10 females, mean age 60 years) underwent surgery for gastric remnant cancer. Patients who had undergone gastrectomy with Billroth II anastomosis for benign disorder underwent re-gastrectomy for the cancer of gastric remnant 20 years after the first gastrectomy. While, patients who had undergone gastrectomy with Billroth I anastomosis for malignant disorder underwent re-gastrectomy within 10 years after the first gastrectomy. Early-type gastric remnant cancers were not observed in the suture line or gastric stump region, while advanced-type cancers were observed in the anastomotic region. Surgical treatment was carried out by the method of total gastrectomy with Roux-en-Y esophago-jejunal anastomosis. The 5 year survival rates were 77%for early cancer and 14%for advanced cancer. Periodic follow-up endoscopies in gastrectomized patients may be useful for the early detection of gastric remnant cancer after operations for gastric cancer.
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