Olaparib, a poly (ADP-ribose) polymerase (PARP) inhibitor, has been shown to be effective in the treatmentof patients with metastatic castration-resistant prostate cancer (mCRAP) who have BRCA1/2 or ATM mutations,which are DNA repair genes. In addition to ovarian, breast, and pancreatic cancer, the indication was extended to“castration-resistant prostate cancer with BRCA mutation-positive distant metastasis” in December 2020 in Japan.Prostate cancer has also entered the era of “personalized cancer treatment based on genetic information,” or socalled “cancer genome medicine.”This article will discuss the following: 1) the relationship between DNA repair genes and prostate cancercarcinogenesis, 2) the mechanism of PARP inhibitors, 3) the results of the PROfound clinical trial of olaparib, and4) the timing of genetic testing for prostate cancer.
超音波ガイド下腕神経叢ブロック腋窩アプローチ法における 0.5％レボブピバカインの最少有効投与量を検討した報告はない．そこで最少有効投与量および低用量投与による臨床的効果を検討した．上肢手術が予定された 25 例を対象とした．最少有効投与量は，Dixon のPositive-negative up-and-down method を用いて求めた．1例目の投与量を各神経あたり 5 ml とし，ブロックが成功すれば次症例で 0.5 ml 減量，失敗すれば 0.5 ml 増量することとし，最低量は 1 ml と設定した．最少有効投与量，鎮痛効果持続時間，作用発現時間，術中鎮痛薬使用の有無について調査し検討した．ブロック成功率は100％であり，一例の失敗もなく最低量である 1 ml まで到達し，その後 1 ml で連続 16 例の成功が得られた．鎮痛効果持続時間は 11.2±4.7 時間であり，投与量と鎮痛効果持続時間との間に相関関係を認めなかった．術中鎮痛薬の使用はなかった．0.5％レボブピバカインの投与量は，各神経あたり 1 ml で十分な鎮痛効果が得られることが示唆された．
A 46-year-old male and a 53-year-old female each required a second surgery because of dilatation of the distalaortic arch (> 55 mm) approximately 5 years after ascending replacement for acute type A dissection. Bothpatients showed patent false lumen associated with endoleakage from the distal anastomosis. We performed distalarch to descending aorta replacement through a left thoracotomy using femorofemoral cardiopulmonary bypasswith a 50% assist rate. The dissecting flaps were excised from both the proximal and distal aortic stumps, and polyester grafts were anastomosed in a double-barrel fashion under the aortic cross-clamps. No changes in the aorticarch diameters were observed 1 year after surgery. Here, we report the efficacy of proximal double-barrel anastomosis for residual dissecting aneurysm caused by endoleakage from distal anastomosis after emergency repair fortype A dissection.
An adult male patient exhibited repetitive left hemiparesis of long duration caused by infarction in the distributionof the right lenticulostriate artery (LSA). Stroke occurred ten times in total and completely recovered within ashort period. Diffusion-weighted magnetic resonance imaging at each hospitalization showed an abnormal highintensity area in the region of the posterior limb of the internal capsule and the corona radiata on the right side;sometimes, the lesion extended to the lateral part of the thalamus, which indicated an acute infarct. The time duration between each stroke ranged from short to long periods. The periods between strokes extended up to 182 daysat the longest. The clinical diagnosis corresponded to capsular warning syndrome, based on repetitive infarctionof the LSA, with complete remission; however, the clinical course included prolonged periods between strokes,with some extending to a long duration, indicating an atypical aspect.