東京女子医科大学雑誌
Online ISSN : 2432-6178
Print ISSN : 0040-9022
ISSN-L : 0040-9022
87 巻 , 4 号
選択された号の論文の9件中1~9を表示しています
目次
総説 循環系の基礎と臨床
  • 瀧田 守親
    2017 年 87 巻 4 号 p. 81-88
    発行日: 2017/08/25
    公開日: 2017/08/25
    ジャーナル フリー

    Cancer is the primary cause of deaths in Japan. Both cancer metastasis and relapse are the major issues, which have not been overcome until now. Cancer cells preferentially metastasize from the primary tumor to the distant target organs. Especially, carcinomas originating from the breast and prostate preferentially metastasize to the bone. However, the mechanism underlying bone-tropic metastasis has been unclear for long time. In recent years, metastatic niches, which are microenvironments that support both metastasis and relapse of cancer, are proposed. These niches are formed before or after the arrival of cancer cells to the distant target organs. In this review, I focus on the bone metastatic niche and introduce the mechanisms underlying bone-tropic metastasis induced by the bone metastatic niche regulators. In the pre-metastatic phase, primary tumor-derived pre-metastatic niche regulators, such as receptor tyrosine kinase MET and lysyl oxidase, can induce the pre-metastatic niche to support metastatic growth of cancer in the bone. However, post-metastatic niche regulators, such as VCAM-1, TGF-β, PGE2, IL-6, and periostin, were produced after the arrival of a minor population of cancer cells, such as cancer stem cells, and supported tumor dormancy, relapse, and bone lesions. Taken together, the bone-tropic metastasis may be accomplished by the cell-to-cell interaction between cancer cells and host cells forming the bone metastatic niche through the bone metastatic niche regulators. In the future, development of novel molecular medicines targeting the bone metastatic niche regulators would be desirable to prevent the formation of metastatic niches in the bone.

総説 最終講義
  • 内潟 安子
    2017 年 87 巻 4 号 p. 89-95
    発行日: 2017/08/25
    公開日: 2017/08/25
    ジャーナル フリー

    Two topics, insulin autoimmune syndrome and early-onset diabetes care, have been selected for the final lecture in the Tokyo Women's Medical University (TWMU).

    Insulin autoimmune syndrome (IAS), or Hirata's disease, first described by Hirata in 1971, is characterized by fasting hypoglycemia without evidence of exogenous insulin administration, high concentration of total serum immune reactive insulin, and the presence of high titer autoantibodies against native human insulin in serum. Other characteristics associated with IAS are the high frequencies of HLA-DR4 positivity, the prevalence of IAS in Japan, and the intake of drugs containing sulfhydryl compounds before IAS onset. We found that IAS showed a strong association with HLA-DR4 (mostly with DRB1*04:06, less frequently with DRB1*04:03 or DRB1*04:07), which encode glutamate at position 74 in the HLA-DR beta molecules, and is presumed to be essential to the production of polyclonal insulin autoantibodies in IAS.

    As part of a physicians' professional duty of care for early-onset diabetes patients, the staff at our clinic aim to provide high-quality care for these patients with early-onset DM to improve treatment outcomes. Patients with type 1 diabetes were found to have a better prognosis compared to those attending other clinics, which suggests an improved care system at TWMU diabetes center.

原著
  • 米澤 麻利亜, 飯塚 文瑛, 中村 真一, 長嶋 洋治, 徳重 克年
    2017 年 87 巻 4 号 p. 96-107
    発行日: 2017/08/25
    公開日: 2017/08/25
    ジャーナル フリー

    Purpose: This study was undertaken to clarify the clinical significance of dysplasia graded according to the Ministry of Health, Labour and Welfare study group classification (none, UC-I, IIa, IIb, or III) in patients with ulcerative colitis (UC).

    Subjects and Methods: We analyzed the clinical features, colonoscopy findings, incidence of malignancy, and risk factors for malignancy in 420 UC patients who underwent colonoscopy at our hospital. These patients were stratified by the histopathological grade of dysplasia at initial biopsy. We focused on the clinical course and the factors associated with malignancy in patients with UC-III dysplasia (severe dysplasia) during the observation period.

    Results: The median observation period of the 420 patients was 7 years. Endoscopy generally showed a significant increase of elevated lesions as the grade of dysplasia increased. The incidence of malignancy increased along with the grade of dysplasia. Patients with UC-IIa or higher dysplasia had a significantly higher incidence of malignancy compared to those with UC-I or no dysplasia (p<0.05). Juvenile onset of UC and inflammatory polyps were significantly associated with malignancy. During the observation period, UC-III dysplasia was detected in 29 patients. Among them, 8 patients (27.6 %) developed cancer, with the median period until detection of UC-IV being 2.5 months.

    Conclusion: Careful follow-up by surveillance colonoscopy is required for patients with UC-IIa or higher dysplasia. Early detection of dysplasia (suggesting the presence of precancerous lesions), inflammatory polyps, and juvenile onset are useful for predicting a higher risk of colitis cancer.

  • 今野 雅之, 浅野 秀胤, 藤井 優輔, 小西 良幸, 村垣 善浩
    2017 年 87 巻 4 号 p. 108-116
    発行日: 2017/08/25
    公開日: 2017/08/25
    ジャーナル フリー

    超音波はその非侵襲性に注目が集まり, 様々な治療に用いられるようになってきた. 中でも低出力超音波パルス (Low Intensity Pulsed Ultra-Sound: LIPUS) による骨癒合促進効果が広く利用されている. しかしながらLIPUS照射期間と時期の仮骨形成に関する研究では, 骨の機械的強度やX線画像による評価が主であり, 骨組織の3次元的な形態評価は少ない. 本研究はLIPUS照射による仮骨形成を3次元的に形態評価し, 骨癒合に最適な照射時期および期間を明らかにする. 7週齢の雄SDラットを使用し実験を行った. 大腿骨にドリルを用いて直径2 mm, 深さ2 mmの骨損傷を形成した. 炎症期が3日であることを考慮し, 5群に分け実験を行った. 骨損傷処置を行いLIPUS照射を行わなかった群 (0 L群), 骨損傷処置を行いDay 1~3にLIPUS照射した群 (1-3 L群), 骨損傷処置を行いDay 1~14にLIPUS照射した群 (1-14 L群), 骨損傷処置を行いDay 4~14にLIPUS照射した群 (4-14 L群), コントロールとして骨損傷処置を行わずにDay 1~14にLIPUS照射した群 (Cont群), 各群6匹の計30匹で, 実験日数は15日とした. LIPUS照射は周波数1.5 MHz, 繰り返し周波数1.0 kHz, 超音波強度30 mW/cm2, パルス幅200 μs, 照射時間は1日あたり20分間とし, 全群に対してDay 1, 3, 7, 10, 15にラット大腿骨のX線マイクロCT撮影を行った. 骨の癒合促進効果を3次元的に評価するために, CT値を元に軟組織を除く硬組織のボクセルデータの数を体積とみなした骨体積と平均CT値による骨の密度を比較した. Day 7, Day 10ではLIPUSを当て続けた1-14 L群の骨体積が大きく, 特に炎症期におけるLIPUS照射のない群との比較では有意に骨体積が大きいことから, 炎症期のLIPUS照射が特に重要であることがわかった. 本研究よりLIPUS照射は, 骨損傷直後から仮骨形成期までの間に照射し続けることが望ましく, LIPUSは特に炎症期に照射することで仮骨形成を促進させることが示唆された.

  • 山﨑 琢磨, 平松 健司, 山崎 健二, 新浪 博士
    2017 年 87 巻 4 号 p. 117-121
    発行日: 2017/08/25
    公開日: 2017/08/25
    ジャーナル フリー

    Introduction: Ventricular septal perforation (VSP) after acute myocardial infarction (AMI) is often complicated by a worsening of rapid hemodynamics, thus remaining a poor prognostic emergency disease. In our department, during the repair of VSPs with lesions in the left anterior descending artery area, infarct lesions are pre-operatively detected with ECG synchronized contrast computed tomography, and the scope of approach and exclusion is determined. Furthermore, in order to prevent complications of residual shunt, a double patch exclusion technique (DPET) is used in combination to preserve left ventriclar function.

    Materials: We identified two consecutive VSP patients who underwent this procedure from September to December 2015. There was an average of five days between AMI and the onset of VSP, and an average of one day between onset of VSP and surgery.

    Results: All cases were extubated on the day after surgery and intra-aortic balloon pump assistance was also withdrawn. Without perioperative complications, patients were able to leave the intensive care unit, on average, 6.5 days post-operation. Early postoperative echocardiographic and magnetic resonance angiography showed good left ventricular wall contraction except at the infarcted area, with no evidence of residual shunt.

    Conclusion: The use of the double patch exclusion technique prevents residual shunt more effectively that in cases without, and it is thought that it is useful for maintaining postoperative cardiac function.

  • 遊佐 裕明, 東 隆, 山崎 健二
    2017 年 87 巻 4 号 p. 122-127
    発行日: 2017/08/25
    公開日: 2017/08/25
    ジャーナル フリー

    Objective: Patients with ruptured abdominal aortic aneurysms (AAA) are often treated via open repair despite the existence of endovascular aortic repair (EVAR), a less invasive and widely accepted approach beneficial for elective AAA patients. We aimed to evaluate the early clinical results of EVAR of ruptured AAA in emergency setting.

    Methods: Patients with ruptured AAA who underwent emergency EVAR between January 2012 and March 2017 were included in this study. There were 16 men and 9 women (mean age, 76.4±9.6 years). Six patients were hemodynamically unstable with a systolic blood pressure of ≤70 mmHg before procedure. Two patients required the insertion of aortic occlusion balloons, preoperatively. In all cases, preoperative computed tomography (CT) was performed, which revealed a mean AAA maximum diameter, proximal neck length, and proximal neck diameter of 71.4±11.4 mm, 22.5±17.8 mm, and 23.0±3.8 mm respectively.

    Results: There were no intraoperative deaths, the early mortality rate was 8 %, and the technical success rate was 96 %. No patient underwent open surgery, all participants underwent EVAR with bifurcated graft, and 3 underwent concomitant coil embolization of the internal iliac artery. One case showed type I endoleak on intraoperative digital subtraction angiogram and postoperative enhanced CT. Postoperatively, 2 patients had abdominal compartment syndrome, 1 needed dialysis, 7 required prolonged ventilator use. Aneurysm sac shrinkage was seen in 13 patients on postoperative CT examination.

    Conclusion: EVAR for ruptured AAA is feasible and relatively safe. Our early clinical findings suggest that it could be considered the first-line therapy in ruptured AAA with favorable anatomy.

報告
  • 井藤 尚武, 塩澤 俊一, 碓井 健文, 久原 浩太郎, 河野 鉄平, 浅香 晋一, 山口 健太郎, 横溝 肇, 島川 武, 吉松 和彦, ...
    2017 年 87 巻 4 号 p. 128-131
    発行日: 2017/08/25
    公開日: 2017/08/25
    ジャーナル フリー

    A 72-year-old woman with no abdominal surgery presented with a sudden-onset pain in the left lumber region accompanied by nausea and vomiting. Computed tomography confirmed a cluster of dilated small bowel loops with ischemic change near the posterior side of the transverse colon and to the left of the Treitz ligament. This cluster had a sac-like-appearance. The patient was diagnosed with small bowel obstruction caused by a left paraduodenal hernia and emergency surgery was performed. The hernia sac was found between the anterior and posterior lobes of the descending mesocolon. We resected the herniated small intestine with ischemic change and closed the hernia orifice. On the 10th day after the surgery, the patient was discharged without any complication. Recently improvements in imaging techniques have enabled early diagnosis of paraduodenal hernia, thus helping avoid intestinal resection in most cases. In our case although the patient had no peritoneal irritation sign and slight inflammation at the time of preoperative diagnosis, the intestine already had accompanying ischemic change. Therefore, it is crucial to perform an emergency surgical intervention as soon as possible even if the patient has minor symptoms. We herein report a case of a left paraduodenal hernia needed intestinal resection in spite of preoperative diagnosis.

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