The aim of this study was to assess the association between perinatal status and insulin resistance in neonates during the birth period. The subjects were 49 neonates (27 boys, 22 girls) who had been admitted to the neonatal intensive care unit at Nihon University Itabashi Hospital within 2 h after birth. We retrospectively analyzed the associations between perinatal status (Apgar score, sex, gestational age, birth weight, etc.) and insulin resistance (assessed by plasma immunoreactive insulin (IRI), plasma cortisol, homeostatic model analysis ratio (HOMA-R), quantitative insulin sensitivity check index (QUICKI), plasma glucose/IRI ratio, and plasma IRI/cortisol ratio) based on the medical records. The preterm neonates had significantly lower plasma cortisol levels (P = 0.02) and significantly higher plasma IRI/cortisol ratios (P = 0.04) compared with the full-term neonates. No significant differences were found in any of the parameters between neonates with asphyxia and those without. In cases with hyperinsulinemia, male predominance was significant (P < 0.01) in neonates with hypoglycemia; furthermore, birth weight, HOMA-R, and plasma glucose/IRI ratio tended to be lower (P = 0.07, P = 0.01 and P < 0.01, respectively), while QUICKI and plasma IRI/cortisol ratio tended to be higher (P = 0.02 and P = 0.09, respectively) in neonates with hypoglycemia compared with those without. One possible reason for these findings could be the immaturity of the hypothalamic-pituitary-adrenal axis in preterm infants. There was no significant correlation between perinatal status and the indices of insulin resistance in neonates during the birth period.

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自動縫合器で切離した気管支断端部の耐圧がどのくらいあるのかを切除肺を利用して検討した．対象は自動縫合器を用いて気管支処理をした20 症例．自動縫合器は2 種類（Echelon^® のグリーンカートリッジとEndoGIA^® のパープルカートリッジ）使用し，各10 例ずつとした．方法は水没状態にした切除肺の気管支断端に18 G のサーフロ針を挿入し，マンシェットによる加圧を行うことで測定した．結果は平均圧は Echelon^® が112.5 cmH₂O，EndoGIA^® が113.5 cmH₂O であった．両者の耐圧に統計学的な有意差を認めなかった．通常，気道内圧は20-30 cmH₂O（呼気時）であることを考慮すると，十分な耐圧が示された．一方で，縫合に比べて自動縫合器の方が，気管支断端瘻の発生率が高かったとの報告も散見される．自動縫合器では術者の手加減で自在に締め具合を調節できず，症例毎の適切なstapler の選択やstapling 前の気管支の圧挫も念頭に置くべきである．

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81 歳女性，左乳癌術後トレミフェンクエン酸塩剤(TOR) の服用後，子宮内膜肥厚を指摘され，婦人科的精査を行った．内膜細胞診は陰性，組織診はMicroglandular hyperplasia (MGH) の診断であったが，内膜癌を否定できず子宮全摘術を施行．最終組織診断は悪性所見を認めなかった．MGH は子宮内膜悪性腫瘍との鑑別を要する例があるため，乳癌治療剤の服用女性の子宮内膜所見には慎重管理が必要である．

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A 14-year-old boy with hypertrophic cardiomyopathy experienced ventricular fibrillation while running in his schoolyard. He was resuscitated and admitted to our hospital. Delayed enhancement cardiac magnetic resonance imaging revealed asymmetric ventricular septal hypertrophy and delayed enhancement of the ventricular septum. Monomorphic ventricular tachycardia (VT) was induced by double ventricular extrastimuli. During electroanatomical mapping, a low voltage area was found in the right ventricle, but none was found in the left ventricular endocardium. Pace-mapping from the anterior right ventricular outflow tract, i.e., the low voltage area, revealed delayed potentials, and pacing at this site generated an 85% morphological match to the induced VT. Endomyocardial biopsy of the right ventricular septum revealed differences in myocyte size and myocardial disarray, along with moderate interstitial fibrosis. A cardioverter defibrillator (ICD) was implanted. Genetic testing identified a novel heterozygous missense mutation in the cardiac myosin heavy chain gene.

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要旨　症例は88 歳男性．2012 年に小腸gastrointestinal stromal tumor に対して小腸部分切除術を施行．術後10 ヵ月で十二指腸水平部近傍に腹腔内再発し，imatinib 400 mg/day による治療を開始した．治療後2 週間でざ瘡様皮疹が出現したため治療を中断した．しかし腫瘍縮小効果が確認されたため，imatinib 100 mg/day に減量し治療を再開した．ざ瘡様皮疹は改善し，液状変化を伴う著明な腫瘍縮小効果は27 ヵ月以上継続している．

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腹腔鏡下ヘルニア修復術（transabdominal preperitoneal repair: 以下，TAPP）後の再発鼠径ヘルニアに対し，再度TAPP を施行した2 例を経験した．TAPPは手技の習熟は必要であるものの，腹腔鏡による観察を活かした再発形式の評価や確実な診断および修復が可能であると考えられた．

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Pulmonary tumor thrombotic microangiopathy (PTTM) は，癌による肺血管内膜増殖が原因で肺血管が狭窄・閉塞する病態である．症例は62 歳男性．呼吸困難感を主訴に入院した．肺血栓塞栓症が疑われ抗凝固療法を行ったが，急激な呼吸不全をきたし翌日死亡した．剖検で胃癌および肺小血管内腫瘍塞栓と肺血管内膜肥厚を認め，PTTM と診断した．原因不明の急激な呼吸不全を呈する時は本疾患も念頭におくべきである．

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