東京女子医科大学雑誌
Online ISSN : 2432-6178
Print ISSN : 0040-9022
ISSN-L : 0040-9022
89 巻, 2 号
選択された号の論文の8件中1~8を表示しています
目次
総説 性差医療
  • 近藤 光子
    2019 年 89 巻 2 号 p. 31-37
    発行日: 2019/04/25
    公開日: 2019/04/25
    ジャーナル オープンアクセス

    Several women have been reported to have chronic respiratory disease. Symptoms such as cough and dyspnea markedly reduce the quality of life, and female patients tend to have mental stress. It is important to understand gender differences in respiratory diseases from the viewpoint of anatomical and physiological differences as well as psychosocial differences. Severe asthma, including phenotypes such as aspirin-intolerant asthma and obesity-related asthma, is reported to be more common in women. New therapeutic options such as biologics and bronchial thermoplasty are available. Chronic obstructive pulmonary disease (COPD) in women tends to be worse because of higher smoking susceptibility. Non-emphysematous type of COPD is common, and appropriate inhalation therapy is required. Among women with interstitial pneumonia, nonspecific interstitial pneumonia caused by collagen disease is common, and corticosteroid and immunosuppressant therapy should be considered. In addition, non-smoker's lung cancer and adenocarcinoma positive for EGFR gene mutation are common among women. Because molecular targeted drugs are effective, precise diagnosis is needed at the gene level. The incidence of pulmonary non-tuberculous mycobacteriosis with nodular bronchiectasis has been increasing in middle-aged and elderly women, but treatment options are limited. Pulmonary lymphangiomyomatosis and catamenial pneumothorax are rare diseases that occur only in women. Recently, rapid advancement has been noted in the treatment of respiratory diseases. The perspective of gender difference is associated with personalized medicine and paves a new path for respiratory medicine.

報告
  • 木下 翔太郎, 土岐 大介, 近藤 恒徳
    2019 年 89 巻 2 号 p. 38-41
    発行日: 2019/04/25
    公開日: 2019/04/25
    ジャーナル オープンアクセス

    We report the case of a 71-year-old woman with nivolumab-induced colitis, which was successfully treated with corticosteroid treatment. She underwent left-sided nephrectomy for renal cell carcinoma in 1989 at 43 years of age. Sorafenib was initiated in 2015 owing to progression of lung and adrenal metastasis; however, it was discontinued in 2016 secondary to nausea. In March 2017, she was switched to nivolumab administered as a biweekly dose of 3.0 mg/kg/day to treat worsening lung and adrenal metastasis. A partial response was observed after the administration of 7 cycles of nivolumab. In August 2017, she developed vomiting, severe diarrhea, and high fever after the administration of 10 cycles of nivolumab, necessitating admission to our hospital on an emergency basis. Initially, we suspected both, infectious enteritis and nivolumab-induced colitis, and she received meropenem; however, her symptoms persisted. Computed tomography showed intestinal wall thickening compatible with nivolumab-induced colitis. Thus, we initiated intravenous methylprednisolone therapy at a dose of 2.5 mg/kg/day. Her symptoms improved soon after the initiation of steroid, without any relapse. Nivolumab was discontinued based on the Immune-mediated Adverse Reactions Management Guide. Nivolumab-induced colitis may precipitate medical emergencies. Therefore, clinicians should be familiar with this condition and its appropriate management.

第84回東京女子医科大学学会総会 シンポジウム
  • 新浪 博
    2019 年 89 巻 2 号 p. 42
    発行日: 2019/04/25
    公開日: 2019/04/25
    ジャーナル オープンアクセス
  • 澤 芳樹
    2019 年 89 巻 2 号 p. 43-49
    発行日: 2019/04/25
    公開日: 2019/04/25
    ジャーナル オープンアクセス

    Heart failure is a life-threatening disorder worldwide, and the current end-stage therapies for severe heart failure are replacement therapies such as ventricular-assist devices and heart transplantation. Although these therapies have been reported to be useful, there are many issues in terms of the durability, complications, limited donors, adverse effect of continuous administration of immunosuppressive agents, and high costs involved. Recently, regenerative therapy based on genetic, cellular, or tissue engineering techniques has gained attention as a new therapy to overcome the challenges encountered in transplantation medicine. We focused on skeletal myoblasts as the source of progenitor cells for autologous cell transplantation and the cell-sheet technique for site-specific implantation. In vitro studies have reported that myoblast sheets secrete cytoprotective and angiogenic cytokines such as hepatocyte growth factor (HGF). Additionally, in vivo studies using large and small animal models of heart failure, we have shown that myoblast sheets could improve diastolic and systolic performance and enhance angiogenesis and antifibrosis as well as the expression of several cytokines including HGF and vascular endothelial growth factor (VEGF) in the tissues at the transplanted site. Based on the results of these studies, we performed clinical trials using autologous myoblast sheets in ischemic cardiomyopathy (ICM) and dilated cardiomyopathy patients. Some patients showed left ventricular reverse remodeling and improved symptoms and exercise tolerance. Recently, multiple medical institutions including our institution successfully conducted an exploratory, uncontrolled, open-label phase II study in subjects with ICM to validate the efficacy and safety of autologous myoblast sheets. Thus, we could get the evidence that autologous skeletal muscle sheet might occur reverse remodeling in the responder of severe heart failure patients.

  • 布田 伸一
    2019 年 89 巻 2 号 p. 50-56
    発行日: 2019/04/25
    公開日: 2019/04/25
    ジャーナル オープンアクセス

    There have been over 6,000 human heart transplants since the first transplant approximately 50 years ago. In Japan, 50-60 transplants have been performed annually since enforcement of the revised Organ Transplant Law; however, 600-700 people await transplantation, and even Status 1 patients wait over 1,000 days.

    Post-transplant management is divided into two categories. One, related to transplantation itself, includes open heart surgery, denervation/re-innervation, donor heart ischemia, and issues resulting from recipient heart failure. The other consists of manageable factors such as rejection control, risk of infection or tumor under immunosuppression, adverse effects of immunosuppressants, and frequent cardiac catheterization procedures.

    After transplantation, patients receive combined treatment with a calcineurin inhibitor (e.g., tacrolimus or cyclosporine), mycophenolate mofetil, and a steroid. Antibody-mediated rejection and its relationship to cardiac allograft vasculopathy have received significant attention. Immunosuppressants contribute to infection with pathogens such as cytomegalovirus, Epstein-Barr virus, and hepatitis virus within 30 days after transplantation.

    Cardiac allograft vasculopathy is characterized by diffuse coronary stenosis of mainly small- and medium-sized arteries. It is diagnosed by intravascular ultrasound observation of intimal hyperplasia, a lesion caused by immunologic and non-immunologic mechanisms and treated with mTOR (mammalian target of rapamycin) inhibitors.

    Compliance with post-transplantation maintenance therapies and behaviors enables good long-term health.

    Heart transplantation is part of an ideal health care system, complemented by evidence- and narrative-based medicine.

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