日大医学雑誌
Online ISSN : 1884-0779
Print ISSN : 0029-0424
ISSN-L : 0029-0424
81 巻, 3 号
日大医学雑誌
選択された号の論文の11件中1~11を表示しています
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特  集
  • 山崎 慎太郎
    原稿種別: 研究論文
    2022 年 81 巻 3 号 p. 127-132
    発行日: 2022/06/01
    公開日: 2022/08/11
    ジャーナル フリー

    Surgical treatment for metastatic liver cancer from colorectal cancer has reached a positive consensus owing toeffective new chemotherapies and improvements in surgical techniques. There is currently some evidence available about surgical treatments for metastatic liver cancer from various organs, and it is the beginning of a new erafor radical treatment for noncolorectal cancer. Clinically, the treatment strategy for metastatic cancer is graduallychanging for each organ. Therefore, it is true that some categories of patients can reach longer survival than before.However, the number included in each study is very small, and robust evidence has not been obtained. Therefore,the indication for metastatic liver cancer from noncolorectal cancer remains controversial. The aim of this reviewarticle is to show the current treatment strategies for metastatic liver cancer from various organs, focusing on livermetastasis from colorectal cancer.

  • 小島 敏雄, 大幸 英至, 中西 一義
    原稿種別: 研究論文
    2022 年 81 巻 3 号 p. 133-137
    発行日: 2022/06/01
    公開日: 2022/08/11
    ジャーナル フリー
総  説
  • A Case Report and Literature Review
    Naito Keisuke, Sugita Atsunori, Chiba Nobutaka, Saito Takeshi, Sakurai ...
    原稿種別: 研究論文
    2022 年 81 巻 3 号 p. 139-146
    発行日: 2022/06/01
    公開日: 2022/08/11
    ジャーナル フリー

    Background: Purpura fulminans is a fulminant debilitating disorder with a high mortality rate; its characteristicsinclude disseminated intravascular coagulation, thrombosis, tissue necrosis, cardiovascular collapse, and multipleorgan failure. The most frequent causative pathogens are gram-negative bacteria whose pathogeneses are relatedto endotoxin secretion. Brevundimonas diminuta (B. diminuta) is a ubiquitous aerobic, gram-negative, rod bacterium that causes opportunistic infections, mostly in immunocompromised patients. Although B. diminuta supposedly has low virulence, the clinical features of its infection are unclear due to the limited number of publishedreports.Case presentation: A 30-year-old, previously healthy male presented to the emergency department several hoursafter developing fever, joint pain, and upper abdominal pain. The patient was in shock; his condition rapidly deteriorated, and he subsequently developed skin purpura, hyperfibrinolytic coagulation abnormalities, disturbed consciousness, and multiple organ failure, including acute renal failure. Severe hypercytokinemia and endotoxemiawere observed. Despite intensive care, the patient died 21 hours after hospitalization. B. diminuta was isolatedfrom blood cultures collected prior to antibiotic administration.Conclusion: We describe a fulminant case of hyperfibrinolytic coagulopathy in a previously healthy adult.Although rare, B. diminuta was isolated from blood cultures, and its relationship with purpura fulminans shouldbe considered in this case.

症例報告
  • 木村 友洋, 若林 正和, 小堀 秀一, 吉田 隼人, 田中 花奈, 蓑島 考, 堂本 佳典, 穂坂 美樹, 牛久 秀樹, 船津 健太郎, ...
    原稿種別: 研究論文
    2022 年 81 巻 3 号 p. 147-150
    発行日: 2022/06/01
    公開日: 2022/08/11
    ジャーナル フリー

    症例は 65 歳,男性.早期胃癌の診断で Endoscopic Submucosal Dissection (ESD) を施行し,eCuraC-2 となっ たために,腹腔鏡下幽門側胃切除術を施行した.術中に Adachi VI 型の総肝動脈走行異常を認めたが,術前 CT にて血管構築を確認していたため,術中合併症なく手術 施行可能であった.Adachi VI 型では総肝動脈の腹側に 門脈が存在し,膵上縁のリンパ節郭清時に総肝動脈をメ ルクマールとすることができず,また門脈損傷に注意が 必要となる.術前に血管走行の破格を認識することが, 安全に手術を行う上で,極めて重要であると考えられた.

  • Maedomari Taishin, Fuwa Kazumasa, Nagano Nobuhiko, Kaneda Hide, Koshin ...
    原稿種別: 研究論文
    2022 年 81 巻 3 号 p. 151-154
    発行日: 2022/06/01
    公開日: 2022/08/11
    ジャーナル フリー

    Terminal deletion of the long arm of chromosome 10 is frequently associated with urogenital anomalies. Renal dysfunction sometimes progresses despite aggressive treatment, and timely interventions are indispensable. Serum creatinine (Cr) overestimates renal function in children with low muscle mass. Meanwhile, serum cystatin-C (cysC) is unaffected by muscle mass. We report the case of a patient with terminal deletion of chromosome 10q associated with low muscle mass and renal dysfunction due to urinary anomalies. Treatment for renal dysfunction was performed by monitoring cysC. At 2 years of age, as cysC increased, although Cr was normal, prostatic diverticulectomy and vesicostomy were performed. At 3 years of age, as cysC was high, although Cr normalized, residual prostatic diverticulectomy was performed. At 5 years of age, cysC normalized later than Cr. CysC enabled accurate evaluation and early intervention of renal dysfunction compared to Cr in a patient with chromosomal abnormalities with low muscle mass.

  • 植田 雄一, 牧野 裕子 , 西田 卓弘 , 落合 昂一郎, 丸塚 浩助, 盛口 清香 , 大友 直樹
    原稿種別: 研究論文
    2022 年 81 巻 3 号 p. 155-159
    発行日: 2022/06/01
    公開日: 2022/08/11
    ジャーナル フリー

    42 歳の女性.HER2 陰性転移性乳癌に対する標準治療 が終了後,遺伝子パネル検査 FoundationOne®CDx を施行 した.ERBB2 遺伝子の増幅を認めた.また,生検検体 での HER2 IHC 法で 2+ であったため,FISH 法を施行し たところ陽性であった.抗 HER2 療法を開始したところ, 部分奏功を認めた.既存の HER2 テストでは抗 HER2 療 法の適応とならなかった症例でも,遺伝子パネル検査を 行うことで,抗 HER2 剤の適応となる症例を拾い上げる ことが可能であり,一部の乳癌患者の予後を大きく変え る可能性がある.

  • Uchida Naotaka, Suda Takako, Matsui Yasuki , Yoshida Manabu
    原稿種別: 研究論文
    2022 年 81 巻 3 号 p. 161-164
    発行日: 2022/06/01
    公開日: 2022/08/11
    ジャーナル フリー

    Magnetic resonance imaging (MRI) is widely recognized as an imaging method with relatively higher sensitivity than other imaging modalities for detecting breast cancer (BC), although the specificity is controversial. Wetreated a patient with BC that was detected by MRI and confirmed by examination of an MRI-guided biopsyspecimen. The tumor was not clearly identified by ultrasonography (US), mammography (MMG), or a physicalexamination. A 50-year-old female came to our hospital because a focally asymmetric density (FAD) in the leftbreast was seen on MMG. Physical and US examinations were unremarkable. However, MRI showed enhancednodules distributed segmentally in the right lower internal quadrant. An US performed 3 months later did notshow any findings in the region. Therefore, we referred the patient to a hospital that was equipped to performMRI-guided biopsy. Ultrasound-guided fine needle aspiration and core needle biopsy of the region were unable toconfirm the presence of BC, but ductal carcinoma in situ (DCIS) was seen on an MRI-guided biopsy specimen.The patient then underwent surgery at our hospital. This case taught us the importance of breast MRI andMRI-guided biopsy for lesions not demonstrated on US or MMG.

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