岡山医学会雑誌
Online ISSN : 1882-4528
Print ISSN : 0030-1558
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125 巻, 1 号
選択された号の論文の18件中1～18を表示しています
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平成23年度岡山医学会賞
総説
  • 免疫チェックポイント制御とがん免疫治療
    鵜殿 平一郎
    2013 年 125 巻 1 号 p. 13-18
    発行日: 2013/04/01
    公開日: 2013/05/01
    DOIhttps://doi.org/10.4044/joma.125.13
    ジャーナル フリー
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    　がんワクチンによる免疫治療では，如何にCD8T細胞を感作（プライミング）しその数を増やすか（免疫増強）という点に多大の努力が払われて来た．樹状細胞への抗原デリバリーと抗原プロセシング／提示，Toll様受容体などの刺激，即ち自然免疫系の活性化の併用などはそれに該当する．しかし十分に活性化されたＴ細胞をもってしても癌の拒絶は容易ではない．それには癌組織という特殊な環境が禍している．Ｔ細胞は癌塊内に入り込み莫大な数の癌細胞と遭遇する．癌組織内での繰り返す抗原認識の過程でＴ細胞は疲弊し，次第に本来あるべき機能を喪失していく．この疲弊（exhaustion）と呼ばれる現象は，Ｔ細胞に発現する複数の免疫抑制性分子―免疫チェックポイント分子―と腫瘍に発現するそのリガンドの結合によってもたらされる．代表的なチェックポイント分子の機能を抑制し，エフェクターＴ細胞が疲弊することなくその機能を長く維持できれば，これからのがん免疫治療に飛躍的な進展がみられるかもしれない．
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  • 免疫・炎症が関与する動脈硬化の病態生理学的機序と抗体工学の臨床応用
    松浦 栄次
    2013 年 125 巻 1 号 p. 19-28
    発行日: 2013/04/01
    公開日: 2013/05/01
    DOIhttps://doi.org/10.4044/joma.125.19
    ジャーナル フリー
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原著
  • メサラジン坐薬調製の工夫と臨床経験
    船隠 恵子, 堀田 修次, 濱岡 照隆, 田阪 武志, 立花 広志, 村上 敬子, 豊川 達也, 佐藤 英治, 友田 純
    2013 年 125 巻 1 号 p. 29-33
    発行日: 2013/04/01
    公開日: 2013/05/01
    DOIhttps://doi.org/10.4044/joma.125.29
    ジャーナル フリー
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    Ulcerative proctitis (UP) is a prevalent condition associated with increased morbidity, and topical mesalazine (5-aminosalicylic acid [5-ASA]) is known to inhibit the inflammatory processes in UP. We successfully devised mesalazine suppositories, in which 250mg mesalazine was equally distributed and remained stable for at least 2 weeks. We evaluated the effect of using mesalazine suppositories twice a day (BID) on two UP patients. The results demonstrated that mesalazine suppositories were efficacious, well tolerated and safe for the long-term maintenance of UP remission.
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症例報告
  • 内陸地津山で発症した季節外れのVibrio vulnificus感染症
    萩谷 英大, 塩田 澄子, 三好 伸一, 黒江 泰利, 野島 宏悦, 大谷 晋吉, 杉山 淳一, 内藤 宏道, 川西 進, 萩岡 信吾, 森 ...
    2013 年 125 巻 1 号 p. 35-39
    発行日: 2013/04/01
    公開日: 2013/05/01
    DOIhttps://doi.org/10.4044/joma.125.35
    ジャーナル フリー
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     A 68-year-old man with alcohol addiction, who lived in the suburbs of Tsuyama, an inland city located in northeast Okayama prefecture, was transported to the emergency unit of the Tsuyama Central Hospital in a state of cardiopulmonary arrest (CPA). Despite rigorous systemic investigation and treatment, the patient died 2 hours after arrival. After his death, Vibrio vulnificus was isolated from his blood culture.
     Vibrio vulnificus causes fatal infection in humans, usually only in areas located close to the sea where appropriate temperature and suitable salt concentration for its growth are available. Therefore, its occurrence is epidemiologically restricted ; in Japan, the western coastal areas, especially in summers, are reported to be the high-risk regions. This is a rare case because it occurred in a city approximately 50 kilometers from both the Sea of Japan and the Pacific coast of Okayama, and at the end of October in 2011. Economic development and distribution systems have made it possible to transport various food products from coastal areas or abroad to any place in a short time, such that these infections can potentially develop in areas other than expected. We should be aware of the increasing risk of Vibrio vulnificus infection during any season and at any place, especially in patients with abnormal liver function.
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  • イマチニブが長期に奏効している同時性肝転移を伴う消化管間質腫瘍の１例
    宇野 太, 藤原 康宏, 藤原 俊義
    2013 年 125 巻 1 号 p. 41-45
    発行日: 2013/04/01
    公開日: 2013/05/01
    DOIhttps://doi.org/10.4044/joma.125.41
    ジャーナル フリー
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    Radical surgery is the primary treatment for gastrointestinal stromal tumor (GIST), so that unrsectable GIST has been considered a fatal disease, and the median duration of survival for patients with an unresectable GIST before the era of molecular targeted therapy has been about 18 months. Since the recent development of agents for molecular targeted therapy, including imatinib mesylate, the prognosis of unrsectable GIST has been dramatically improved. The B2222 trial reported that a median time to progression and a median overall survival for advanced GIST treated with imatinib of 24 months and 57 months, respectively. We recently experienced a case of gastrointestinal stromal tumor with synchronous liver metastases maintained in whom the disease was controlled for 4 years by imatinib. The patient is 37-year-old man and he took imatinib mesylate at 400mg/day with no adverse events. Both primary and metastases lesions responded well to imatinib treatment, and this efficacy has endured for 4 years, such that surgical intervention is now considered possible. While GIST is a relatively rare disease and clinical evidence is still poor, we document our considerations for the therapy in this case as well as the results.
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  • 予後不良な経過をたどったBRAF遺伝子変異を伴うStage IV 大腸癌の１例
    稲田 涼, 永坂 岳司, 竹原 清人, 杉原 正大, 母里 淑子, 楳田 祐三, 久保田 暢人, 森川 達也, 近藤 喜太, 宇野 太, 貞 ...
    2013 年 125 巻 1 号 p. 47-50
    発行日: 2013/04/01
    公開日: 2013/05/01
    DOIhttps://doi.org/10.4044/joma.125.47
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      A 79-year-old woman visited a previous hospital with a complaint of general fatigue. The patient was diagnosed with cecal cancer with multiple liver metastases and lymph node metastases on colonoscopy, abdominal ultrasonography and CT scan, and was referred to our division for treatment. Based on the diagnosis of non-curative colonic cancer, we planned to perform systematic chemotherapy after local surgical treatment. We performed an ileocecal resection, and the specimen showed poorly differentiated adenocarcinoma with mutation in the BRAF oncogene. After the surgical treatment, the tumor grew rapidly and the patient died from cancer on the 19th postoperative day without having the opportunity to undergo chemotherapy.
      Multiple genetic and epigenetic alterations in oncogenes and tumor suppressor genes are involved in the process of colorectal carcinogenesis. Some of the alterations have been identified as predictive and prognostic biomarkers. A mutation in the BRAF oncogene was reported to be associated with a very unfavorable prognosis in colorectal cancers. Some of the cases with rapid progression are suggested to have the BRAF oncogene mutation. According to our experience, chemotherapy before surgical treatment might improve the prognosis of cases with the BRAF mutation.
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  • 一次治療でセツキシマブ不耐となった後，三次治療での再使用により奏功した進行大腸癌の一例
    稲田 涼, 永坂 岳司, 母里 淑子, 楳田 祐三, 久保田 暢人, 森川 達也, 近藤 喜太, 宇野 太, 貞森 裕, 八木 孝仁, 藤原 ...
    2013 年 125 巻 1 号 p. 51-55
    発行日: 2013/04/01
    公開日: 2013/05/01
    DOIhttps://doi.org/10.4044/joma.125.51
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     A 55-year-old man who had been diagnosed with rectal cancer with multiple liver metastases and lymph node metastases on colonoscopy and computed tomography (CT) was referred to Okayama University Hospital for treatment. Based on the diagnosis of non-curative rectal cancer, we planned to perform systematic chemotherapy after surgical resection. We performed a low anterior resection of a 36×35 mm upper rectal moderately differentiated adenocarcinoma with wil-type KRAS. After the resection, a FOLFIRI regimen with cetuximab was given as the first-line chemotherapy. Although metastatic lesions in the liver showed shrinkage, we decided to switch regimens because of intolerable adverse events. A modified FOLFOX6 regimen with bevacizumab was administered as the second-line treatment. There were no signs of disease progression until eight months later, when positron emission tomography (PET)/CT scans revealed that the new metastatic lesions appeared. As the third-line treatment, an irinotecan with cetuximab regimen was administered, leading to a good response for over 12 months.
     We experienced a successful rechallenge with cetuximab for a case with metastatic rectal cancer. For patients with wild-type KRAS colorectal cancer, rechallenge with cetuximab-based chemotherapy can be an effective therapeutic option.
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特集
分子標的治療
ガイドライン
感染症シリーズ
神経内科シリーズ
ニュース&ビュー
シリーズ：ためになる薬の話
キーワード
学会報告
学会抄録
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