Tissue activator of the plasmin system is easily extracted into such high molar solutions as 1-2 M KSCN, KCl, KI or 30% sucrose, but not into physiological saline solution. A question, therefore, arises as to by what mechanism such activator can enter into the circulation. In order to clarify the activation mechanism of the plasmin system and to determine whether or not the tissue activator can enter into the circulation, fibrinolytic activity of blood obtained from the vasa efferentia of the uterus was determined and compared with that from the cubital vein.
A marked elevation of fibrinolytic activity was observed in blood from the vasa efferentia of the uterus. It was also found that the endometrial tissue activator extracted into KSCN solution was completely transferred to the physiological saline-soluble form after the Sephadex column chromatography.
Thosc findings may suggest one possible mechanism of entrance of the tissue activator into the circulation.

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In order to clarify the controversial findings concerned with the effect of estrogens on coagulation and plasmin systems, various preparations of estrogen having different chemical structures, i.e., desoxyestrone, estradiol and Premarin R, were administered to human subjects and the factors of blood coagulation and the plasmin systems were determined.
There was no significant change in the factors of the coagulation system excepting a slight decrease in the recalcification time with the administration of estriol or Premarin R, slight elevation of Factor VII with Premarin R, and a slight prolongation of the thrombin time with estradiol, estriol and Premarin R. On the other hand, a marked change was noted in the plasmin system, namely, a decreases in the total plasmin and antiplasmin, and a marked elevation of the spontaneous caseinolytic activity of the euglobulin fraction.

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As to the change of factors relating to the plasmin system during pregnancy and puerperium, some conflicts have been found in the literature. This paper deals with the results of systemic analysis of this enzyme system, and the relation be-tween sex hormones and the factors is discussed.
A marked elevation of factors of plasmin system during pregnancy was observed in fibrinogen, spontaneous caseinolytic activity of the euglobulin frac-tion, total plasmin and antiplasmin, but only a slight rise of fibrinolytic and fibrinogenolytic activities of the euglobulin.
The administration of progesterone to human females produced marked increases in total plasmin, antiplasmin and spontaneous fibrinolytic activity of the euglobulin, on the other hand, irregular changes in fibrinogen and spontaneous caseinolytic activity of the euglobulin.
Estrogen administration was responsible for an increase of spontaneous caseinolytic activity of the euglobulin and decreases in antiplasmin and spontaneous fibrinolytic activity of the euglobulin. However, essentially no change in fibrinogen and total plasmin was observed by the estrogen administration.
These findings suggest that the close relation exists between sex hormones and plasmin system.

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当施設のマンモグラフィ（MG）・超音波（US）併用乳癌検診は，MG を参照してUS を施行する同時併用総合判定を行っている。出張検診ではMG サーバーとノートパソコンをLAN ケーブルで接続しMG 画像を確認，US 技師はMG 画像で乳房の構成を評価し，左右差を比較し高濃度部分をチェックする。US は全乳房を走査，全走査を全例動画で記録し，US 所見の有無を記録用紙に記載している。読影はMG 一次読影１名，MG 二次読影と総合判定を１名の医師で行っている。MG を先に読影しMMG 単独のカテゴリーを付けた後に，US 画像を判定し最終的に総合判定を行っており，読影には一症例あたり約１．５分を要している。MG 所見とUS 所見に乖離がある症例は，動画を確認してから判定を行っている。平成２４年４月から平成２７年２月までに総合判定を行った９５６名の要精検率は，独立判定を行った場合５．３％であったが，総合判定では２．７％に低下した。１２例に動画確認が必要であったが，その理由は，MG 画像でFAD や腫瘤の所見をUS 技師がチェックしていないか正常乳腺と判断した症例であった。これらの改善にはMG の判読力の向上が必須であり，さらにUS 手技と知識の向上が必要と感じた。

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症例は12歳の女児で,下腹部痛と便秘にて小児科を受診した.当初は下剤にて軽快したが,4日後に再び下腹部痛にて来院した.小児科では確診がつかず,コメディカルによる腹部超音波検査が施行されたところ,膀胱背側に細かい点状エコーを有する嚢胞様病変が認められた.病変の内容は・患児のわずかに拡張した子宮と連続しており,子宮膣留血腫が疑われてただちに当科に紹介された・外来での外陰部所見では処女膜は完全に閉鎖しており,液がわずかに透見され,本症を確診し,外来にて穿刺小切開を施行して約300mlの暗褐色の貯留血を排除した.急速に症状は改善され,全身所見ならびに内分泌学的検索も異常なく,術後18日目の超音波検査にても膣腔,子宮腔に拡張等の異常所見を認めず,術後42日目に月経の発来をみた.本症例では腹部単純X線撮影と超音波検査以外の画像診断を併施することもなく,また入院の必要もなく終始した.以上のことから婦人科的疾患に対するコメディカルの超音波検査の有用性を確認した.〔産婦の進歩51(6);562～567,1999(平成11年11月)〕

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Shwartzman reaction in pregnant animals was invited by single injection of endotoxin without any preparatory procedure. This specific phenomena had been explained by hypercoagulability of blood during pregnancy, which produced intravascular fibrin deposition. In this paper, it was dealt with the possible role of plasmin system in this specific type of Shwartzman reaction during pregnancy.
In human subject, total plasmin (caseinolytic and fibrinolytic activities of SK-euglobulin) and spontaneous proteolytic activities of euglobulin fracti onwere elevated as the stages of pregnancy advanced. The whole blood or plasma, however, showed suppression of fibrinolytic which might be caused by predominat antiplasmin level during pregnancy. A marked elevation of fibrinolytic was found in blood samples from vasa efferentia of the non-pregnant uterus, while no fibrinolytic activity was proved in blood from the pregnant uterus. Plasminogen activator extracted from kidneys of pregnant rat, guinea pig and rabbit had significantly lower activity than the non-pregnant controls.
The results described above seemed to suggest that in pregnant state, Shwartzman reaction was easily induced by not only hypercoagulability but also lowered fibrinolytic activity, depositing fibrin and remaining it in the vessels.

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Composite hemangioendothelioma is a rare vascular neoplasm of intermediate malignant potential, characterized by complex admixtures of benign, intermediate, and malignant vascular components. Here we describe a case of composite hemangioendothelioma arising in the tongue. An 81-year-old man presented with a several-day history of a mass in the right edge of the tongue. On presentation, a painless, blue-violet, wellcircumscribed tumor mass measuring approximately 10 mm in diameter was found in the right edge of the tongue. Coloration of the mass faded on pressure. There was no swelling or tenderness of the lymph nodes. The mass was surgically excised, including the normal tissue. On histopathological examination, the tumor comprised retiform hemangioendothelioma, epithelioid hemangioendothelioma, and cavernous hemangioma. We diagnosed composite hemangioendothelioma based on the admixture of multiple vascular lesions. There has been no evidence of recurrence or metastasis as of 2 years postoperatively.

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過食による肥満, カロリー不足によるるい痩を改善し, 適正な体重を維持できるように食事指導を検討した.
透析導入後1年以上の安定透析患者を対象に透析導入1年前, 導入後1ヵ月を経過し体内に貯留した余分な水分が除去され水分管理の安定した時期の体重, 導入1年後の体重を調査した. 結果, 保存療法期の厳しい食事制限のため導入1ヵ月後には体重が減少する者が多かったが, 導入1年後には徐々に体重が増加する者が増え, 標準体重を基準に考えてみると肥満患者の増加傾向がみられた. これは従来指導してきた熱量2,400kcal, 蛋白量90gの透析食に問題があると考えられた. そこで透析食をA食 (熱量2,400kcal, 蛋白量90gの高カロリー食), B食 (熱量1,600kcal, 蛋白量80g) に分け, A食を体重増加を目的としてるい痩患者へ, B食を減量を目的として肥満患者へ指導した. その結果, 指導1年後, A食指導群中, 体重増加を示した患者が43%, B食指導群中, 減量できた患者が45%であった. 標準体重に近づき得なかった患者は, 運動量が少ない, また理解力に欠けるため指示量が守れず減量できない症例と食事量を増やすよう指導しても食生活を変えられず, 摂取量が少なく体重増加しなかった症例であった.
そして, 指導に従い標準体重に近づき得た症例における栄養状態は, ほぼ満足できる値であり, コレステロール, トリグリセライドも正常範囲を維持していた.
透析導入後は, 単に高蛋白, 高カロリー食を指導するのではなく, 導入時より患者の肥満度, 年齢, 運動量などに応じた食事指導を継続して行い, 適正体重を維持するように指導することが望ましいと考える.

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Barrett食道癌は本邦では稀な疾患であるが,逆流性食道炎の増加 や診断率の向上により, Barrett食道癌の治療機会は今後増加すると考えられる.今回われわれは早期Barrett食道癌を外科的治療する機会を得たので報告する.症例は55歳男性,上腹部不快感を主訴に当院にて精査.食道内視鏡にて食道胃接合部(esophagogastric junction; 以下EGJ)より6cm口側までBarrett食道を認めた.さらに, EGJより3cm口側左壁に1.5cmの低い隆起性病変を認め0-IIaと診断,生検の結果は腺癌であった. Barrett食道癌と診断し, 1999年6月15日に左開胸開腹下にBarrett食道を含めた下部食道噴門部切除(D1),食道空腸・残胃空腸吻合術を施行した.術後の病理診断はtub1, m, ly0, v0, n (-)であった.術後経過は良好で術後27病日に退院,術後1年6カ月の現在再発を認めていない.早期Barrett食道癌の日本人症例55例について検討し,その治療法について述べた.

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We investigated whether the administration of small-dose etoposide for a long period of time as a post intensive therapy is effective on remission duration and survival of patients with non-Hodgkin's lymphoma. After complete remission following CHOP or VEPA therapy, 33 patients were registered and administered etoposide at a daily oral dose of 25mg/body for a long time (median days; 211). Twenty-seven patients who were treated without the maintenance therapy, were used as a historical control.
The long-term complete remission ratio at 3 years was 54% for the etoposide group compared with 36% for the control group. Especially in patients over 65 years of age, the remission ratio was 61% for the etoposide group compared with 25% for the control group.
The long-term survival ratio at 5 years was 67% for the etoposide group compared with 59% for the control group. The small-dose etoposide as a post intensive therapy seemingly showed a beneficial effect but not statistically significant on the remission duration (P=0.08, Generalized Wilcoxon test) and the survival length (P=0.96, Generalized Wilcoxon test).
Side effects and abnormal laboratory findings were minimal in the etoposide group except one patient with leukopenia (grade 4).
These preliminary data suggested the usefulness of the small-dose etoposide as a post intensive therapy for treatment of non-Hodgkin's lymphoma.

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患者は73歳男性,主訴は背部痛.精密食道透視で下部食道に明瞭な立ち上がりを有する隆起性病変を認め,不整な狭小化を認めた,食道裂孔ヘルニアを合併し,食道胃接合部では左側壁に約2.5cmにわたり陰影欠損を認めた.内視鏡検査では下部食道まで進展したBarrett食道を認めた.その内部に凹凸不整で発赤調の隆起性病変を認め,同部の生検診断は印環細胞癌であった.下部食道から食道胃接合部では全周性になだらかな狭窄を示し一部潰瘍も存在した.ヨード染色では濃染・不染が混在していた.胃噴門部大彎は白色調で粘膜下腫瘍様に隆起していた.以上より,びまん浸潤型Barrett食道癌と診断し,手術を施行した.病理組織学的にはpType 4 ns, pT 2 (mp), por+sig, infβ, ly2・v0, pN1, EG, 10.5×6.5cmの食道胃接合部癌で,Barrett食道を合併しており,Barrett食道癌の可能性が高いと考えられた.

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腰部には上腰三角，下腰三角と呼ばれる2つの腹壁抵抗減弱部が存在し，この部位に腹壁ヘルニアを発症することがあり，腰ヘルニアと称されている．今回われわれは，腹腔鏡下ヘルニア修復術を施行した腸骨採骨術後の腰ヘルニアの1例を経験したので報告する．症例は74歳男性．67歳時に頸椎圧迫骨折に対し椎体形成術を受け，その際に右腸骨採骨術が施行された．今回2年前より右腰部膨隆を自覚し当科初診．上行結腸をヘルニア内容物とする腸骨採骨術後の腰ヘルニアと診断し手術を施行した．左半側臥位，3ポートで手術を開始．回盲部を授動し，4.2cm大のヘルニア門を剖出，3cmのオーバーラップを確保するため直径10cmの円形に形成したバードコンポジックスメッシュ^®を留置，全周をアブソーバータック^®で固定，回盲部を腹壁に数針固定し，良好な視野，操作性のもと終了とした．術後経過良好で第6病日退院，術後7カ月再発なく経過中である．

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解剖学的抵抗減弱部位として知られている上腰三角, 下腰三角より発生する腰ヘルニアは, 比較的稀な疾患である. 今回われわれは特発性上腰ヘルニアの1例を経験したので, 若干の文献的考察を加え報告する.
症例は67歳, 女性. 右腰背部膨隆を主訴に受診した. 右腰背部に約6cm大の境界不明瞭, 弾性軟な無痛性の腫瘤を認めた. CTにて右内腹斜筋と脊柱起立筋の間に腹壁欠損部を認め, 同部より皮下に突出する後腹膜脂肪織を認めたため, 上腰ヘルニアと診断した. 手術は後腹膜脂肪織を還納後, 内腹斜筋と脊柱起立筋を直接縫合し, さらにMarlex Meshを被覆縫着した. 術後, 現在まで再発を認めていない.

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Effects of concentration of Aerosol OT and amount of solubilized water on degree and rate of removal of water soluble soil from various fabrics in nonaqueous washing were studied. Sodium chloride and thiourea were applied as model of water soluble soil. Wool, cotton, acryl, polyester, and polyester-cotton blend were used as test fabrics.
In the nonaqueous solution of Aerosol OT containing solubilized water, the soils are transfered from the soiled fabric to the unsoiled with the aid of the water and the amount of the soil adhering to each fabric becomes equal to reach the equilibrium. Degree of soil removal from the soiled fabrics at equilibrium increases as the amount of the solubilized water increases and also as the concentration of Aerosol OT decreases. Further, the degree of soil removal from the hydrophobic fabric is higher than that from the hydrophilic. Rate of soil removal from fabrics indicated that it was almost of the reaction of the first order. It increases as the amount of the solubilized water increases and as the concentration of Aerosol OT decreases.
It was proved, therefore, that removal of the water soluble soil from fabric was mainly due to its dissolving into the solubilized water in the nonaqueous solution of Aerosol OT while the removal as solid dispersion in the solubilized water was partly observed in such cases as the amount of the water was small and the concentration of Aerosol OT was high.

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