側脳室三角部腫瘍に対し,intraparietal sulcusを用いたtranssulcal approachにて腫瘍摘出術を行った.本アプローチは,superior pariental iode incision modificationのmodificationとして脳のretractionをより少なくできる点で有用であった.ただし,手術に先だって,MRIによるsulcal pattemと腫瘍との位置関係の把握が重要である.

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A synthetic 3-benzothiepin derivative, TAK-778, promotes osteoblast differentiation. If a mixture of TAK-778 and β-tricalcium phosphate (β-TCP) can be a substitute for autografts used for packing interbody fusion cages, donor-site related complications should be avoided. The lumbar vertebrae from L1 to L5 were exposed in 8 dogs using a posterolateral approach, and discectomy and interbody cage fusion were performed in three disc spaces. In group A, the cage was filled with autograft bone, in group B with β-TCP, and in group C with β-TCP and TAK-778. The lumbar spine was excised at 16 weeks post-surgery, and mechanical, microradiographical and histological evaluations were made. The microradiographical and histological examinations revealed four fusions in eight operations in group A (50.0%), three in group B (37.5%), and five in group C (62.5%). The mean percentage of trabecular bone area in the cages was 53.4% in group A, 45.6% in group B and 64.4% in group C. Although the effect was not significant, addition of TAK-778 to β-TCP had some beneficial influence and there was a trend toward an improved fusion status in cages filled with β-TCP and TAK-778. β-TCP combined with TAK-778 could be used as a substitute for autografts in clinical spine surgery, especially for those patients who are anticipated to have a poor graft bone status.

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症例は先天性胆道閉鎖症の9歳の男児.生後46日で肝門部空腸吻合術を施行した.術後,黄疸は消退したが肝機能障害は持続していた.9歳時に続発性肺動静脈痩が原因と考えられた多発性脳膿瘍を発症し,膿瘍ドレナージ術,脳室ドレナージ術,V-Pシャント術などにて治療し,脳神経機能障害を残したが,救命し得た症例を報告した.当今の先天性胆道閉鎖症の長期生存例が増加する傾向に鑑み,今後,同様の症例も稀ならず発症する可能性が示唆されたので,文献的考察も加え報告した.

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A 34-year-old single female nurse was refered to our psychosomatic unit due to severe anemia and loss of consciousness. Her mother and younger sister were also nurses, but her father had died from malignant lymphoma 4 years before. Laboratory data revealed iron deficiency anemia. On admission, she had a mild fever and was vomiting. She was administered a blood transfusion because her hematologic data showed pancytopenia as Hgb. 3.3g/dl, W.B.C. 1700/, μl, Pit. 6.7×10^4/μl. We found she had syringes and needles and observed her self-induced bloodletting. Furthermore she had complicated alopecia areata and trichotillomania. Her anemia was gradually treated by intravenous ferrous injection and she was discharged from hospital. During outpatient treatment, the vomiting disappeared and binge eating appeared. Nevertheless, she was readmitted because of the progression of anemia and dehydration due to vomiting and wrist cutting. Her vomiting continued and she had pyrexia due to factitious behavior like self-induced leakage of instillation instead of self-induced bloodletting. We assessed that her life history of self-sacrifice was related to her masochistic pathology. For example, she injured herself through self-induced bloodletting and she overdrove herself in spite of having a severe anemia. We regarded this case's self-induced bloodletting not only as compulsive behavior but also as an equivalent to drug addiction. We reviewed 11 factitious anemia cases including this case in Japan. They were aged from 21 to 42 (average of 28.1±5.8) ; of the 9 females, 7 were in medical professions, especially nurses. Minimum data of Hgb., W.B.C. and Pit. are 1.3g/dl, 8001/μl, 6.7x10^4/μl (this case) respectively. 4 cases were accompanied with eating disorders. Patients diagnosed as having factitious disorders often give up treatment, so that their prognoses are pessimistic. So, after making an early definite diagnosis, we emphasize that the first step of the therapy should be to make a continuous therapeutic collaboration

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高速液体クロマトグラフィーを用いた血中teophylline測定法を改良し, 新しい血中TP代謝測定法を考案した.この測定法を使用してteophylline投与中の気管支喘息患児において血中teophyllineとその代謝物濃度との関係について検討を行った.今回の血中teophylline代謝物測定法は, 検体量が微量で済みかつ操作が簡単であり, しかも正確に測定できるものであった.RTC療法中の気管支喘息患児において血中teophyllineの代謝物としてのcaffeineが新たに検出された.またteophyllineの維持用量を10mg/kg/dayに換算した時の血中teophylline濃度対, 血中teophylline濃度の実測値と血中代謝物濃度の実測値の合計との比には高い相関関係が認められ, 血中teophyllineと代謝物濃度との比が低い患児ほど血中teophylline濃度が上昇しにくいことが示唆された.今後, 血中teophylline代謝物をも測定することは, 患者各個人に対する最良の投与を行う上で有用であると思われる.

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脳変性疾患,脳腫瘍,脳血管障害では,既存の治療法には限界があり,遺伝子治療は新しい治療法の一つの選択肢として期待されている.すでに脳腫瘍,Canavan病,amyotrophic lateral sclerosisなどでclinical trialが施行され,一定の効果は認められているが,ベクターによる免疫反応,細胞毒性など,安全性の面でクリアすべき問題も多い.しかし,以前に比較してより効率的で安全なベクターの開発も進んでおり,今後,Parkinson病やAlzheimer病,脳血管障害においてもその応用が期待される.

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