臍帯血移植後の生着不全の機構解明のため，骨髄破壊的前処置の一つである放射線照射による骨髄ストローマの造血細胞維持能やホーミング関連因子SDF-1について検討した．マウスストローマ細胞(HESS-5) に10Gy 以上の放射線照射を行うと非照射細胞に比べ，SDF-1やJagged-1 のmRNA 発現が有意に低下し，同時に培養上清中のSDF-1 蛋白濃度も有意に低下した．一方，放射線照射したHESS-5 細胞とヒト臍帯血CD34^＋ 細胞との共培養実験では，20 Gy まで線量を増加させても臍帯血CD34^＋ 細胞の増幅・維持能は変化しなかった．10Gy 以上の照射を行ったHESS-5 細胞の培養上清は，臍帯血単核球の遊走能を有意に低下させた．マウスに10Gy 以上の放射線照射を行うと，マウス骨髄ストローマ分画の生細胞数は，非照射マウスに比べ約1/10 に減少し，SDF-1 の発現も低下していた．骨髄破壊的前処置に相当する線量の放射線照射は骨髄ストローマの細胞数やSDF-1 などの発現を減少させており，移植細胞の骨髄への生着を障害している可能性があることが明らかになった．

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Background and Aim: Cavo-tricuspid isthmus (CTI)-dependent atrial flutter (AFL) can develop in patients who have undergone percutaneous catheter ablation for atrial fibrillation (AF) or during left atrial (LA) ablation for AF. The electrocardiographic (ECG) characteristics of CTI-dependent AFL during LA ablation have not been described in detail. The purpose of this study was to ascertain and describe the ECG features of CTI-dependent AFL occurring during percutaneous LA catheter ablation for AF. Methods and Results: Of 72 patients underwent AF ablation at our institution between January 2011 and December 2012, 33 (45.8%) exhibited CTI-dependent AFL during ablation for AF. Of these 33 patients, 26 and 7 exhibited typical and atypical ECG patterns, respectively. Flutter waves in the inferior leads were biphasic in 5 patients and positive in 2. Conclusions: CTI-dependent AFL during LA ablation for AF often exhibits atypical ECG characteristics. In patients in whom atrial flutter develops during LA ablation, entrainment mapping should be performed at the CTI even if the ECG is uncharacteristic of CTI-dependent AFL.

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Introduction: We carried out diffusion tensor imaging (DTI) to detect the corticospinal tract (CST) during deep brain stimulation (DBS) of the subthalamic nucleus (STN), and we examined whether CST-based targeting could provide reliable internal fiducial markers for STN-DBS. Materials and Methods: Twenty-eight patients underwent bilateral simultaneous implantation of DBS electrodes for STN-DBS. We calculated the absolute values of the differences in the coordinates between the implanted DBS electrodes and the CST demonstrated by tractography in each patient at the level 3 mm inferior to the superior border of the red nucleus (RN). We also compared the distance between the implanted DBS electrodes and the estimated target points planned by RN-based and CST-based targeting. Results: The average distance from the center of the CST to the center of the implanted DBS electrode was 7.0 ± 2.3 mm in the x-direction, 2.1 ± 1.3 mm in the y-direction, and -4.3 ± 1.4 mm from the level of the AC-PC line as the z-coordinate. The average distance between the DBS electrode and planned targets estimated by RNbased targeting was 2.5 ± 1.1 mm, and that estimated by CST-based targeting was 3.9 ± 1.6 mm. The variances of these planned targets were not significantly different (p = 0.06, Mann-Whitney U-test). Conclusions: The stereotactic coordinates between the target points of STN and CST were confirmed by CSTbased targeting in this study. The results were not significantly different between RN-based targeting and DTIbased targeting for STN-DBS. The DTI-based targeting method using an internal fiducial marker has a possibility to become a powerful tool in stereotactic surgery.

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症例は72 歳男性．2 ヶ月間持続する呼吸困難を主訴に外来受診した．低酸素血症を認めたため，精査加療目的に入院した．新重症度分類IV 度の特発性肺線維症の診断となり，在宅酸素療法を導入した．外来通院中にピルフェニドンを開始し，投与開始から3 ヶ月後の肺機能検査では努力肺活量の改善を認めた．胸部CT 上すりガラス陰影の改善も認め，長期間にわたり良好な経過を得ることができた．

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Herein, we present a case report of the metastasis of a clear cell renal cell carcinoma (ccRCC) with an eosinophilic cell component to the skin of the submandibular region. An eosinophilic component has not been reported previously in the histological findings of ccRCC. The patient was a 74yearold man who had a painless papula in the right submandibular region. Six years earlier, he had undergone nephrectomy and had been diagnosed with stage 1 ccRCC (pT1a, N0, M0). At the current presentation, the dermis in the resected specimen was composed of a clear cell neoplasm with glycogen deposits. Upon immunohistochemical analysis, the clear cells were found to be positive for CD10 and vimentin. As these findings were similar to those from the nephrectomy specimen, the cutaneous lesion on the skin of the submandibular region was confirmed to be a lesion of the metastatic ccRCC. Even when a lowstage ccRCC with an eosinophilic cell component is diagnosed, critical pathological and clinical examinations are needed because distant metastases may occur to the head and neck region, as in this case. Furthermore, when a skin tumor is found in the head and neck region, metastatic RCC must be considered in the differential diagnosis.

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生物学的製剤（以下Bio）は関節リウマチ（以下RA）の治療において重要である．我々は両膝関節高度屈曲拘縮を伴い，歩行不能となったRA 症例に，メトトレキサート（ 以下MTX） による副作用のためBio単独投与後に両側同時人工膝関節置換術を施行した．本症例の問題点に (1) Bio 導入先行かもしくは外科的治療先行か，(2) MTX が併用できない場合Bio 単独療法施行時における薬剤選択が挙げられる．術後1 年経過良好であるが，今後も経過観察が必要である．

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