Background & Aims : Evaluation of the extent of breast cancer lesions is important for selecting the appropriate surgical procedure or to determine the surgical margin. We aimed to assess the diagnostic accuracy of nipple-centered radiate multiplanar reconstruction (NRMPR) images using multidetector row helical computed tomography (MDCT), comparing it with conventional mammography. Methods : Our subjects were 26 breast cancer patients with a total of 29 lesions who sequentially received contrast-enhanced MDCT imaging for preoperative evaluation. We measured the maximum diameter of the breast cancer in the direction toward the nipple on NRMPR images and mammography. All data were correlated with histopathological mapping of the specimens. Results : The tumor extent measured on NRMPR images and in pathological examinations ranged from 12.4 to 66.0mm (average, 28.0mm) and 10 to 70mm (average, 27.9mm), respectively. The correlation coefficient of the two measurements was 0.898. On mammography, two lesions were not clearly identified. The correlation coefficient of mammography and pathological measurements was 0.554. Conclusions : The addition of NRMPR images to mammography provides more information to evaluate breast cancer extension toward the nipple. Potentially, it provides a clue for selecting the appropriate surgical procedure or surgical resection margin for breast cancer.

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Aim : The purpose of this study was to prospectively compare for clinical outcomes between single- and double-bundle anterior cruciate ligament reconstruction. Methods : One hundred fifty-three patients who underwent anterior cruciate ligament reconstruction using hamstring tendon were included. Single- or double-bundle reconstruction was performed for 94 (S group) or 59 patients (D group), respectively. At 2 years after surgery, the manual knee laxity test, anterior stability with KT-1000, range of motion, muscle strength and Lysholm score were evaluated. Second-look arthroscopy was performed for each knee. Results : The mean side-to-side difference of the KT 1000 value after surgery was 3.8mm in S group and 3.1mm in D group, which was not significant different. However, the percentage of less than 5mm of anterior knee laxity was significantly larger in D group. Other clinical results were not significantly different between the groups. Conclusions : Clinical outcomes were similar after single- and double-bundle anterior cruciate ligament reconstruction using hamstring tendon.

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【目　的】　血液透析患者に, EASEプログラムを使うことで, 運動に対する自己効力感を高め, 運動行動が向上するかを検討する.　【方　法】　運動チェック表だけによる1期 (6週間) の介入と, EASEプログラムのピア・ラーニング法, ステップ・バイ・ステップ法, セルフ・モニタリング法による2期 (6週間) の介入を行った. 介入効果の判定で, 運動に関する自己効力感と平均運動ポイントの変化を測定した.　【結　果】　運動に関する自己効力感の経時的変化は, 1期は運動説明前より開始時に有意に上昇したが, 開始時より終了時は有意に低下した. 2期に有意差はみられなかったが, 1期終了時と2期終了時では点数が上がる傾向が見られた. 1期と2期の運動ポイントの比較は, 1期に比べ2期は有意に上がった.　【結　論】　自己効力感と運動ポイントの比較から, EASEプログラムを行った2期は, 1期に下がっていた自己効力感を高め, 運動行動を向上することができた.

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【目　的】　先行文献から透析看護における患者教育の定義と必要な要素を明らかにする.　【方　法】　キーワードは国内外共に「透析 (dialysis)」「患者教育 (patient-education)」とし, 検索ソースは国内は医学中央雑誌Web版, 国外はPubMedを使った. 文献のナラティブレビューを行い, 要素について書かれている部分を抽出してカテゴリ化し, 抽出された要素を検討し患者教育の定義づけを行った.　【結　果】　検討した文献は国内55文献, 国外9文献であった. 結果, 要素は166個のコード, 16個のサブカテゴリ, 7個のカテゴリが抽出された. 抽出された要素を検討し, その上で透析看護における定義を明らかにした.　【結　論】　要素の検討から, 透析看護における患者教育の定義が明らかとなり, 透析看護の患者教育に必要な要素として, 「透析や腎疾患に特化した知識・技術提供」「疾病・透析受容を踏まえた関り」があった.

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A 49-year-old semi-conscious woman was admitted due to fever and dehydration. Disseminated intravascular coagulation (DIC), renal dysfunction and diabetic ketoacidosis were detected. Whole body computed tomography showed multiple nodular lesions in bilateral lungs and kidneys indicating septic emboli, and intrauterine lesions. We diagnosed multiple organ failure followed by intrauterine infection due to untreated diabetes mellitus. Vaginal discharge and blood culture revealed Klebsiella pneumoniae. We used multi-antibiotics for sepsis, respirator at low tidal volume ventilation, 200mg of sivelestat sodium hydrate and 300mg of hydrocortisone for respiratory failure, gabexate mesilate and anti-thrombin III for DIC, transfusion for bleeding from uterus and regular insulin aiming for a blood glucose range of from 80 to 140mg/dl. When we extracted the myoma uteri, the patient's fever subsided and the C-reactive protein became negative. Treating diabetes mellitus is important for the prevention of severe infection.

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Aggressive angiomyxoma (AA) is a rare soft tissue tumor that involves the vulvar and perineal regions of afflicted individuals. It is a slow-growing and locally infiltrating tumor that is characterized by an increased risk of local recurrence. In this report, we describe the case of a large AA in a 39-year-old woman. She was admitted to our hospital with a pelvic tumor, which was discovered during a gynecologic checkup, and magnetic resonance imaging revealed its presence traversing from the pelvic diaphragm to the perineum. The tumor was completely excised using an abdominal approach, and the pathological diagnosis was that of AA. The patient had an uneventful recovery and no evidence of recurrence exists 12 months after surgery. Long-term follow-up and careful monitoring, however, are necessary because AA is slow-growing. As AA is usually reported as a vulvar tumor, the present case is a rare incidence in which the AA grew largely into the pelvic cavity.

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A 65-year-old woman was admitted to our hospital after aspirating a peanut. Bronchoscopic examination revealed obstruction of the right basal bronchus. Use of clamps achieved incomplete removal. Hemoptysis appeared after a few days. Computed tomography (CT) of the lung revealed consolidation in the right lower segment. Methylprednisolone and antibiotics improved symptoms, but chest CT revealed persistent consolidation. Consolidation improved after bronchoalveolar lavage (BAL) of the right basal bronchus during bronchoscopic re-examination. BAL is useful in treating pneumonia resulting from an aspirated foreign body.

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　症例は52歳, 男性. 右下腹部痛で当院を受診し, 急性虫垂炎の疑いで入院となった. 血液検査では軽度の炎症所見のみであったが, 腹部CTで小腸内にhigh densityな線状の異物を認めた. 小腸異物による穿通と診断し手術を行った. 腹腔鏡で腹腔内の検索を行うと回腸の一部に発赤を認めた. 発赤部位の直上で小開腹を行い小腸を切開し異物を摘出した. 異物はV字型の骨様であり形状と本人の食事歴より鶏骨と判断した. 術後経過は良好で術後6日目に退院した. 消化管異物の症例に対する腹腔鏡アプローチは広範囲に腹腔内の観察が行え, 最小限の創で処置が可能である. 病状に応じてはファーストチョイスになりうると考えられる.

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