近年のmulti-parametric MRIとMRI-targeted biopsyの発展によって, 従来より精度の高い効率的なclinically significant cancerの検出が可能になってきた. さらに, 簡便にMRI/US画像融合が可能なソフトウェアも開発・上市され, MRIを基軸とした前立腺癌診断ストラテジー普及の追い風となっている. 一方で, 過剰診断・治療への危惧やMRI診断におけるinter-reader variabilityの存在, 現行のMRI-targeted biopsyの問題点なども少なからず表出してきた. 本稿では, これまでのmulti-parametric MRIおよびMRI-targeted biopsyの発展や現状の課題について整理し, 今後の方向性について考えてみたい.

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【目的】胃粘膜下腫瘍（胃SMT）の病理組織診断は，GIST診療ガイドライン上は通常の内視鏡では困難とされ，超音波内視鏡下穿刺吸引が推奨されている。近年，胃SMTの病理組織診断について，内視鏡的胃粘膜下層剥離術の原理を用いて粘膜を切開し腫瘍を露出させた後，生検を行う「粘膜切開」の有用性が報告されている。今回，同法の胃SMTに対する病理組織診断の有用性について検討した。【方法】当院にて，2013年4月〜2014年3月まで診断された胃SMTのうち，経過・形状から病理組織診断が必要と考えられた3例に対して粘膜切開を施行した。【結果】3例とも病理組織診断はGIST（gastrointestinal stromal tumor）であり，全例外科的切除を行った。術後病理組織診断も全例GISTであり，粘膜切開による術前病理組織診断は，術後診断と全例一致した。粘膜切開に伴う偶発症は認めなかった。【結論】胃粘膜下腫瘍の病理組織診断において，粘膜切開は有用である可能性が示唆された。

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原因菌を皮膚病変から直接に検出することが困難とされている蜂窩織炎の感染モデルを作成し，菌の検出方法について検討した．従来から報告されている，皮膚，needle aspiration法と切開圧迫法の3法で感染モデル病巣内のA群β溶血性連鎖球菌（A群溶連菌）の培養による検出限界を比較した．皮膚は他の2法に比べ，有意に菌の検出率が高かった．さらに少量の菌を検出するため，A群溶連菌のM蛋白を支配する染色体遺伝子の塩基配列からプライマーを作成し，PCR法で蜂窩織炎モデル病巣内の菌を確認する方法を検討した．血液寒天培地のA群溶連菌では10CFU以下の菌の存在で目的の遺伝子が検出できたが，病変部組織からは50CFUの菌量が必要であり，その感度は皮膚に比べ劣っていた．しかし抗菌薬を投与したマウスではで検出される菌量は減少したが，PCR法での感度は上昇した．

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Three hundreds percutaneous renal biopsy cases were analyzed for recorded clinical complications retrospectively. Incidence of fever (237.5°C), pain, and decrease in hematocrit (≥4%) was 21%, 28%, and 13% respectively. The incidence of fever and pain were less in the older patients. Prospectively, 125 cases who underwent ultrasonography following renal biopsies and 62 cases who underwent computerized tomography were analyzed. Bigger hematoma was followed by fever 5-7 days after renal biopsies. Incidence of pain and the decrease in hematocrit were correlated with the size of hamatoma. Use of the ultrasonographic localization and a Tru-Cut biopsy needle or a Biopty-Cut needle decreased the incidence of hematoma more than 50ml following renal biopsy (0-5%). Incidence of fever and pain was less by these new procedure. The risk of hematoma increased as the biopsy needle went deeper into medulla.

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B-mode ultrasonic guidance was used to perform 41 percutaneous renal biopsies in 40 patients. Puncture point of the kidney was determined at 3cm. above the lower pole, 1cm. inside from the lateral border of the kidney. Needle was punctured at an angle of 45 degrees for the skin surface. Renal tissue was obtained in 40 of the 41 procedures (97.6%), and 37 specimens contained 5 or more of glomeruli which were adequate for histological diagnosis. Gross hematuria was observed in 3 patients (7.3%) as the complication, and these were subsided within 1 to 4 days. Other complications did not occur. The depth of renal puncture site from the skin was 4.02cm. on the average and never exceeded 6 cm. in any case. A highly significant correlation was observed between the depth of the renal capsule from the skin and the distance of the skin puncture site from the median line (r=0.766, p<0.001). Determination of renal localization by ultrasonography has proved to be a safe and highly successful means of guidance for the performance of percutaneous renal biopsy, and it has many advantages over other techniques.

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The perineal biopsy for the prostate with the Vim Silverman needle was performed 243 times, during May of 1959 to January of 1963, on 217 cases which were diagnosed by the palpation as the prostatic cancer (40 cases), doubted on the prostatic cancer (34 cases), diagnosed as the prostatic hypertrophy (107 cases), and the prostatitis (36 cases), respectively.
In comparison of the results on the detection of the prostatic cancer by the palpation or the perineal needle biopsy, the cancer was detected by the biopsy in the rate of 71% among the cases which were diagnosed as the cancer by the palpation, while 11.5% of the cases which were doubted on the cancer by the palpation was confirmed as the cancer in the same manner.
Furthermore, 59% of 107 cases which were diagnosed as the hypertrophy by the palpation, was also revealed the same findings, however, the cancer was discovered in the rate of 11.3% of them by the perineal biopsy. While, 77.2% of 36 cases which were diagnosed as the inflammation by the palpation, has showed the same results by the biopsy, but 11.4% of them revealed the cancerous sign by the same way.
The accuracy rate of the diagnosis by the perineal biopsy was examined by the comparison of the histological findings of the specimens which were prepared by the operation of the prostate.
The cancer was proved significantly in the rate of 93.7% of the cases which were diagnosed as the same by the biopsy, while only 2 of 5 cases, which were doubted on the cancer by the biopsy, was confirmd as the cancer.
The latent carcinoma was recognized in 2 of 3 cases which were diagnosed as the same by the biopsy but on the another one case only the findings of the hypertrophy was noticed.
The hypertrophy was confirmed on 41 of 45 cases (91.10), which were diagnosed as the same by the biopsy, however, 2 cases of the latent carcinoma and 2 cases of the inflammation were found by the histological examination of the extirpated prostate through out the operation.

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透析患者におけるH. pylori感染の実態についてはいまだ不明な部分が多い. H. pyloriは胃炎はもとより胃癌との関係も示唆されており, 正確な診断が必要である. われわれは広く一般に行われている抗体法と侵襲的な検査であるの相違について調査した. 対象は透析患者81例と非透析患者34例であった. 抗体法, についてそれぞれ行い陽性率を検討した. 結果はでの透析患者群ではH. pylori陽性率は27.2%, 対照群では61.8% (p<0.01) であったのに対して, 抗体法では透析患者群では45.7%, 対照群では61.8% (p=0.15) であった. 透析患者での抗体法における特異度は69.5%と低値であった. 透析患者での抗体法には偽陽性が多く含まれる傾向が認められ, 抗体法単独による診断には注意を要すると考えられた.

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Thirty one cases of biopsy were performed and the results obtained are as follows.
1) The succeeded percentage were 95% in liver, 30% in kidney and 100% in spleen.
2) As the by-effects, in liver biopsy cases abdominal pain was complained in 50 per cent, in kidney biopsy cases light microscopic hematuria and lumber pain were observed.
3) In the homogenous pathological changes of liver (liver cirrhosis, acute hepatitis, serum hepatitis etc.), the percentage of diagnostic accuracy is very high, but in the solitary changes (for instance liver cancer) is very low.
4) In comparison with the bioscopic and operative diagnosis it could be confirmed.
5) The another applied aspect of the biopsy is the so-called necropsy, which is carried on instead of autopsy.
6) When the indication is strict, the preparations are complete and the diagnostic decision is cautious, the biopsy is a very safe useful diagnostic method.

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肺癌の診断向上策の一つとして教室では独自の穿刺針を考案し, 93例の胸部疾患に計105回の経皮穿刺生検を行った. 肺癌における診断率は45例中41例 (91%), 2cm以下の小型のものでは9例中7例 (78%) の成績で, 特に末梢発生の小型癌に対しては有力な診断法であることを認めた. 合併症として喀血, 気胸, 膿胸など計7例で, これらはいつれも軽症であった.
本穿刺針はその安全性から広く胸部疾患の診断に応用しうる.

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養成下におけるトゲノコギリガザミの産卵の予測・制御技術を開発する一環として, 卵巣卵径と生殖腺指数の関係を調査するとともに, で卵巣卵を採取した雌ガニを産卵まで養成し, 卵巣卵径と産卵までの積算水温の関係を調べた。生殖腺指数は卵巣卵径にともない増大したことから, 卵巣卵径は卵巣の発達状態を表すものと考えられる。産卵までの積算水温 (CWT) は卵巣卵径 (IED) の増大にともない減少し, その関係は次のべき乗式で表された。
CWT=7.8×10²³OED^-8.3872 (n=35, R²=0.5665, P<0.001)
今回求めた関係式からで採取した卵巣卵の長径を測定することで, 産卵までの積算水温を予測することができるが, 卵巣卵径360μm以下では産卵までの積算水温は大きく変動する傾向を示した。

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　胃粘膜下腫瘍の診断では画像検査に加えてEUS-FNAが行われるが，検体量が少なく詳細な病理組織学的検討が困難な場合がある。ESDに準じて，フックナイフで粘膜と腫瘍表面の被膜を切開して腫瘍を露出させた後に通常の生検鉗子を用いる「直視下」では充分量の組織が採取された。本法を用いた生検診断と摘除標本の組織診断との比較検討した結果，対象とした5例全例で的確な病理診断（GIST : 4例，平滑筋腫 : 1例）が得られた。さらに，外科的切除が施行された4例の摘除標本の病理組織診断は免疫染色やKi-67染色など詳細な検討も含めて本法による術前診断と一致した。特記すべき偶発症は認めなかったことから，種々の画像診断において鑑別が困難で治療方針を決定するために病理組織学的診断が必要な胃内発育型の胃粘膜下腫瘍に対する生検組織採取法として「粘膜切開直視下」は有用な方法のひとつであると考えられた。

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