Background & Aims : True local recurrences (TR) and new primary tumors (NP) in the conserved breast after breast-conserving surgery with radiation therapy are determined by the initial surgical margin, the location of recurrent tumors and the histological consistency between initial tumors and recurrent tumors. Methods : A total of 15 patients with breast recurrence out of a group of 389 women with breast cancer who underwent breast-conserving therapy between 1991 and 2003 were included in this study. The biological differences between TR and NP were examined. Results : Eight patients had TR, and seven had NP. The disease-free interval was 34.6 months in the TR group and 94.1 in the NP group. Breast-free survival was significantly better in the NP group than the TR group. The accumulated 10-year overall survival after salvage surgery in patients with TR or NP tumors was 85.1%. The accumulated overall survival after salvage surgery was better in the NP group than the TR group. Conclusions : Patients with NP tumors have a favorable prognosis compared to those with TR tumors. It is important to determine the type of breast recurrence in order to accurately predict the prognosis of patients with breast recurrence.

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　1987年から慢性腎不全の臨床治療として腎移植治療を継続的に施行している. 2006年12月までの20年間で62回 (59名) の生体腎移植を施行した. 移植腎生着率は, 1年92％, 5年81％, 10年62％であり, 患者生存率は1年95％, 5年91％, 10年91％であった. 生体腎提供者は親が49名と最も多く, 姻族は4名であった. ABO血液型不適合移植を8名, 2次移植を3名に施行した. 急性拒絶反応出現率は後半の10年で激減した. 腎移植後の妊娠出産を3名に認め, 合計5名の挙児を得た. 移植腎機能喪失原因は, 慢性移植腎症が7例と最も多く, 次いで死亡が4例であった. 腎移植後に甲状腺癌1名, 精巣腫瘍1名を認めたが, 現在再発なく移植腎機能も良好である.

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【目　的】　認知症ケアのアウトカム項目を明らかにし, アウトカム評価票原案を開発することを目的とした. 【方　法】　文献検討, 質問紙調査, 専門家による検討により進められた. 【結　果】　既存の文献では認知症症状, 生活行動, 幸福感, QOL, 介護負担の領域にアウトカムがまとめられた. 認知症ケア経験者対象239人からは, 精神的安定, 生活行動, 認知症症状, 在宅療養継続などのアウトカムが明確になった. また, 在宅で認知症ケア経験者25人からは「笑顔, 不安なく安心して暮らせる, 楽しく喜ぶ」に重要度が高かった. 【結　語】　専門家の検討により, 最終的に以下の特徴をもった認知症ケアのアウトカム評価票を作成できた. (1)アウトカムの主項目は「認知症症状・精神的安定」,「生活・セルフケア行動」,「その人らしい生活」,「介護者の負担」で構成された. (2)2時点の状態をアセスメントし, 該当する番号を書き, 両者を比較して最高値持続, 改善, 維持, 悪化, 最低値持続と判定する. (3)アウトカムを高めるためのケア項目を設定した.

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【背景・目的】　口腔に存在する多数の常在菌は局所的疾患の原因となるだけでなく, 全身的障害をも引き起こす. そのため, 口腔ケアは全身疾患予防の観点から重要視されている. 今回, 各種含嗽剤による口腔常在菌数減少効果について検討した.　【対象と方法】　健常成人21名に対し, 含嗽前の唾液, および7％ポビドンヨード30倍希釈液, 薬用リステリン®(青色) 原液, 薬用クールミントリステリン®(黄色) 原液, おのおの30mlを, 15秒間口腔内に貯留後の唾液を検体とし, 一般細菌, カンジダの培養後, 含嗽剤作用前後のコロニー数を比較した.　【結　果】　一般細菌は, 含嗽前では全例から検出されたが, 含嗽後では69～93％で減少した. カンジダは, 含嗽前では27～47％に検出され, 含嗽後では25～88％で減少していた. いずれも薬用リステリン®(青色) の減少率が高かった.　【結　語】　含嗽剤を口腔に貯留することにより, 一般細菌, カンジダを減少させる効果が認められ, 特に薬用リステリン®(青色) の効果が高かった.

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A 67-year-old man suffered from retroperitoneal abscess and sepsis after left hemicolectomy due to advanced colon carcinoma, resulting in disseminated intravascular coagulation (DIC). Enhanced computed tomography (CT) showed a lack of cortical enhancement in the arterial phase images despite normally enhanced renal arteries and branches, and well-enhanced renal medulla with a narrow subcapsular cortical enhancement on the parenchymal phase images. These CT findings were typical of acute renal cortical necrosis (ARCN) and obviate the need for renal biopsy, which has been considered to the gold standard for diagnosis.

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A 74-year-old Japanese man was admitted to our hospital due to repeated episodes of upper gastrointestinal (GI) bleeding, anemia and melena, which he had suffered for the preceding two years. We performed several panendoscopic and angiographic examinations, but could not discover the cause of his anemia. In addition, we performed jejunectomy because arteriovenous malformation (AVM) was suspected to exist in the jejunum. However, we found no evidence of AVM in the resected portion of the jejunum. During an endoscopic GI study on his seventh admission, we found hemorrhaging gastric angiodysplasia (AGD) in the upper body of the stomach. Moreover, we found another small AGD in the lower body of the stomach. We treated these lesions endoscopically using a combination of hemoclip, endoscopic band ligation and argon plasma coagulation.
When diagnosing patients presenting with the symptoms described herein, the physician should consider small AGDs and check the GI tract accordingly, to prevent unnecessary resections. In the present subject, there has been no further bleeding and no other lesions have been detected in his upper GI on endoscopic examination during a 12-month follow up.

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Extramedullary plasmacytoma (EMP) of the gastrointestinal tract is an uncommon-type of neoplasms. This report describes a case of EMP in the small intestine. A 78-year-old male, with abdominal discomfort and vomiting, was found to have a 7-cm sized tumor of the small intestine and swollen lymph nodes. He underwent resection of the bowel and lymph nodes. Histological examination of the resected specimens revealed compact tumor cells from mucosa to subserosa and infiltrate into the fat tissue of the mesentery and the lymph nodes. Pathological examination of the resected specimen revealed plasma cell-like round cells, Dutcher bodies, and Russell bodies. Immunohistochemical examination showed that the cytoplasm of the tumor cells were positive for CD138 and the nuclei were positive for cyclin D1. Four months after surgical resection, the patient had recurrence of tumor cells in the para-aortic lymph nodes and lumbar vertebrae. Chemotherapy treatment was ineffective. Surgical resection followed by chemotherapy is thought to be effective in the case of intestinal obstruction, although there is a possibility of devastation which is resistant to chemotherapy. We propose that tumor cells positive for cyclin D1 may play a key role in devastation and could be a useful indicator of prognosis.

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