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Background: Sarcopenia is a prognostic factor for patients with liver cirrhosis and hepatocellular carcinoma, and it affects the onset of hepatic encephalopathy. Therefore, the prevention of sarcopenia contributes to the improvement of the prognosis of patients with chronic liver disease (CLD). We focused on changes of hand grip strength (HGS), one of the indicators of sarcopenia. However, there are little data investigating the impact of physical activity (PA) on HGS in patients with CLD. This study aimed to clarify whether PA contributes to the prevention of muscle weakness in patients with CLD. Methods: This was a prospective observational study. We examined the effect of PA on changes in HGS from the baseline to the endpoint in each group. Metabolic equivalents-hour/week (METs-h/w) was used to evaluate PA. In total, 183 outpatients with CLD were analyzed. We divided participants into four groups (low PA in younger patients (n = 20), high PA in younger patients (n = 33), low PA in elderly patients (n = 47), and high PA in elderly patients (n = 83)). Results: Fifty-eight percent of patients were men, and the median (interquartile range) age was 69.0 (63.0, 75.0) years. The most common etiology of liver disease was hepatitis C (38%). The frequency of living alone and low exercise habit was significantly high, and sarcopenia was more obvious in elderly patients with low PA than in those with high PA. Additionally, the elderly with low PA showed significantly reduced HGS compared to that of the elderly with high PA (-1.00 (-2.27, 0.55) kg vs. 0.10 (-1.40, 1.10) kg, P < 0.05). However, changes in HGS in younger patients were not significant (-0.02 (1.83, 1.47) kg vs. 0.25 (-2.45, 2.05) kg, P = 0.96). Logistic regression analyses identified PA as the independent factor for prevention of decrease in HGS (odds ratio: 1.91, 95% confidence interval: 1.00 - 3.62, P = 0.049). Conclusions: Young patients with low PA were characterized by a long sedentary time; however, there was no loss of HGS. In contrast, elderly patients with CLD and low PA had significantly reduced HGS compared to that in elderly patients with CLD and high PA.

DOI： 10.14740/jocmr3978

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier {BV}  

© 2018 The Authors Background & aims: Taste is a very important factor affecting nutritional intake and compliance. Subjective taste may differ among nationalities. In the present study we examined differences in subjective taste according to food composition and nationality. Methods: Twelve Japanese and 4 Sri Lankan students took part in the study. Food samples of 3 different mixtures of chicken and rice were tasted: Food 1, 3 g chicken/10 g rice; Food 2, 6 g chicken/10 g rice; Food 3, 9 g chicken/10 g rice. The sweet, salty, sour, bitter, and astringent taste of each of the food samples, as well as their deliciousness, were scored subjectively on a scale of 0–5. Results were compared between the 3 types of food samples, as well as between nationalities. In addition, concentrations of blood micronutrients were measured. Results: Across all 3 types of food, the change in subjective taste of salty, sweet, and sour differed significantly between Japanese and Sri Lankan students (P = 0.022, P = 0.008, and P = 0.025, respectively). However, bitter and astringent taste, as well as the perceived overall deliciousness of the foods, was comparable between the 2 groups. Serum zinc levels were significantly lower in Sri Lankan than Japanese students (P = 0.004). Conclusions: Subjective assessment of taste differs according to food composition and nationality, and it is important to consider taste preferences according to nationality when promoting oral nutritional support.

DOI： 10.1016/j.yclnex.2018.10.006

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Background: Sarcopenia can affect the prognosis of patients with cirrhosis or hepatocellular carcinoma. Exercise therapy and nutritional therapy are carried out to prevent processing sarcopenia. In addition, changing lifestyle is also important. However, there are only few reports on the physical activities (PAs) and lifestyle of chronic liver disease patients and their association with sarcopenia. The aim of this study is to examine the relationship between sarcopenia in patients with chronic liver disease and both PA and lifestyle. Methods: A total of 214 out-patients with chronic liver disease were enrolled into the present study. All patients were evaluated for with or without sarcopenia based on the sarcopenia diagnostic criteria of the Japan Society of Hepatology. Then, patient's characteristics and laboratory parameters were divided into two groups with or without sarcopenia and compared. In continuous variable with significant difference in univariate analysis, cut-off value was calculated by receiver operating characteristic curve. We determined which factors were associated with sarcopenia in univariate analyses, and variables significant in the univariate analyses were entered in a multivariable logistic regression model. Results: Patients with chronic liver disease had a prevalence of sarcopenia of 12.6% in this study. Sarcopenia patients were older (76.48 ± 6.69 versus 66.97 ± 11.19 years old; P < 0.01), had lower body mass index (BMI) (20.84 ± 2.44 versus 23.76 ± 3.72 kg/m2; P < 0.01), lower PA (6.6 (2.34 - 19.90) versus 16.5 (6.60 - 41.23) metabolic equivalents (METs)-h/week; P < 0.01) and longer total time sitting and lying on the day (7.43 ± 4.09 versus 5.68 ± 3.17 h/day; P = 0.01); retirement status (81.5% versus 48.1%; P < 0.01) and low frequency of driving (40% versus 20%; P = 0.01) were higher in sarcopenia patients than in non-sarcopenia patients. The independent predictive factors of sarcopenia, analyzed with logistic regression, were age (odds ratio (OR): 5.89, 95% confidence interval (CI): 2.15 - 16.20; P < 0.01), BMI (OR: 4.77, 95% CI: 1.87 - 12.10; P < 0.01) and PA (OR: 3.65, 95% CI: 2.15 - 16.20; P < 0.01). Conclusion: Sarcopenia patients' lifestyle characteristics were longer sedentary time and low frequency of driving, high retirement. Independent predictive factors of sarcopenia were elderly, low BMI and low PA. For these patients, intervention in the lifestyle for prevention of sarcopenia may be effective for patients with chronic liver disease.

DOI： 10.14740/jocmr3640

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Lippincott Williams and Wilkins  

© 2018 European Society of Anaesthesiology. All Rights Reserved. BACKGROUND In recent years, thoracic wall nerve blocks, such as the pectoral nerve (PECS) block and the serratus plane block have become popular for peri-operative pain control in patients undergoing breast cancer surgery. The effect of PECS block on quality of recovery (QoR) after breast cancer surgery has not been evaluated. OBJECTIVES To evaluate the ability of PECS block to decrease postoperative pain and anaesthesia and analgesia requirements and to improve postoperative QoR in patients undergoing breast cancer surgery. DESIGN Randomised controlled study. SETTING A tertiary hospital. PATIENTS Sixty women undergoing breast cancer surgery between April 2014 and February 2015. INTERVENTIONS The patients were randomised to receive a PECS block consisting of 30 ml of levobupivacaine 0.25% after induction of anaesthesia (PECS group) or a saline mock block (control group). The patients answered a 40-item QoR questionnaire (QoR-40) before and 1 day after breast cancer surgery. MAIN OUTCOME MEASURES Numeric Rating Scale score for postoperative pain, requirement for intra-operative propofol and remifentanil, and QoR-40 score on postoperative day 1. RESULTS PECS block combined with propofol-remifentanil anaesthesia significantly improved the median [interquartile range] pain score at 6 h postoperatively (PECS group 1 [0 to 2] vs. Control group 1 [0.25 to 2.75]; P=0.018]. PECSblock also reduced propofol mean (± SD) estimated target blood concentration to maintain bispectral index (BIS) between 40 and 50 (PECS group 2.65 (± 0.52) vs. Control group 3.08 (± 0.41)μgml -1 ; P<0.001) but not remifentanil consumption (PECS group 10.5 (± 4.28) vs. Control group 10.4 (±4.68)μgkg -1 h -1 ; P=0.95). PECS block did not improve the QoR-40 score on postoperative day 1 (PECS group 182 [176 to 189] vs. Control group 174.5 [157.75 to 175]). CONCLUSION In patients undergoing breast cancer surgery, PECS block combined with general anaesthesia reduced the requirement for propofol but not that for remifentanil, due to the inability of the PECS block to reach the internal mammary area. Further, PECS block improved postoperative pain but not the postoperative QoR-40 score due to the factors that cannot be measured by analgesia immediately after surgery, such as rebound pain.

DOI： 10.1097/EJA.0000000000000762

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BACKGROUND: A prospective randomized study was performed to investigate the validity of intravenous carnitine administration during postoperative parenteral nutrition (PN) with lipid emulsion. METHODS: Patients undergoing surgery for gastric or colorectal cancer were enrolled in the study and were randomly divided into two groups (n = 8 in each group): 1) group L, who received a peripheral PN (PPN) solution of 7.5% glucose, 30% amino acid, and 20% lipid emulsion; and 2) group LC, who received the same PPN solution, as well as carnitine intravenously. PPN was performed from postoperative day (POD) 1 to POD4. Clinical and laboratory parameters were compared between the two groups; statistical significance was set at P < 0.05. RESULTS: Serum carnitine concentrations were significantly higher in group LC on POD3 (P < 0.01) and POD7 (P = 0.01). Postoperative changes in laboratory parameters and morbidity were comparable between the two groups. However, the decrease in C-reactive protein from POD3 to POD7 was significantly greater in group LC than in group L (P = 0.011). CONCLUSION: The results show that intravenous carnitine administration in addition to PN is safe and may be beneficial for recovery from postoperative inflammatory reactions.

DOI： 10.14740/jocmr3113w

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier {BV}  

© 2016 The Authors Background and aims Transthoracic esophagectomy using 3-field lymphadenectomy (TTE-3FL) for esophageal cancer is one of the most aggressive gastrointestinal surgeries. Early enteral nutrition (EN) for TTE-3FL patients is useful and valid for early recovery; however, EN using a fat-containing formula risks inducing chyle leak. In the present study, we retrospectively examined esophageal cancer patients treated byTTE-3FL and administered postoperative EN to elucidate the validity of lowering the fat levels in elemental formulas to prevent postoperative chyle leak and improve postoperative recovery. Methods A total of 74 patients who received TTE-3FL for esophageal cancer were retrospectively examined. Patients were classified into two groups according to the type of postoperative EN: Group LF patients received a low-fat elemental formula, and Group F patients received a standard fat-containing polymeric formula. The following clinical factors were compared between the groups: EN start day, maximum EN calories administered, duration of respirator use, length of ICU stay, incidence of postoperative infectious complications, use of parenteral nutrition (PN), and incidence of postoperative chyle leak. Results Patients in Group LF were started on EN significantly earlier after surgery and they consumed significantly higher maximum EN calories compared to Group F patients (P < 0.01). Duration of respirator use and length of ICU stay were also significantly shorter, and TPN was used significantly less in Group LF compared to Group F (P < 0.05). Postoperative chyle leak was observed in six patients in total (8.1%); five patients in Group F and one patient in Group LF, although there was no significant difference in frequency of chyle leak per patient between Group LF and Group F. Conclusions Early EN using low-fat elemental formula after esophagectomy with three-field lymphadenectomy was safe and valid for postoperative recovery and potentially useful in preventing chyle leak.

DOI： 10.1016/j.clnu.2016.03.018

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© 2015, Society of Surgical Oncology. Background: This study aimed to compare the utility of the number of positive lymph nodes with the lymph node ratio (LNR) in predicting survival after resection of extrahepatic cholangiocarcinoma. Methods: A retrospective analysis of 142 consecutive patients who underwent radical resection of extrahepatic cholangiocarcinoma was performed. A total of 3066 regional lymph nodes were resected. The median number of nodes per patient was 21. The optimal cutoff values for the number of positive nodes and the LNR were determined using the Chi square scores calculated by the Cox proportional hazards regression model. Results: Nodal disease was found in 59 patients (42 %). In the subsequent analysis of the impact that nodal status has on survival, 18 patients with R1/2 resection and 6 patients with paraaortic nodal disease who did not survive for more than 5 years after resection were excluded. The optimal cutoff value for the number of positive nodes was 1, and the optimal cutoff value for the LNR was 5 %. Univariate analysis identified both the number of positive nodes (0, 1, or ≥2; P = 0.005) and the LNR (0, 0–5, or >5 %; P = 0.007) as significant prognostic factors. Multivariate analysis identified the number of positive nodes but not the LNR as an independent prognostic factor (P = 0.012). The 5-year survival rates were 64 % for the patients with no positive nodes, 46 % for the patients with one positive node, and 28 % for the patients with two or more positive nodes. Conclusions: The number of positive lymph nodes predicts survival better than the LNR after resection of extrahepatic cholangiocarcinoma, provided that nodal evaluation is sufficient.

DOI： 10.1245/s10434-015-4609-x

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BACKGROUND: In breast cancer, recent clinical trials have shown that sentinel lymph node biopsy (SLNB) alone without axillary lymph node dissection results in excellent prognosis if there is sentinel lymph node (SLN) metastasis in two or fewer nodes. The aim of the present study was to investigate the association between non-SLN metastasis and clinicopathological factors in case of SLN metastasis in two or fewer nodes in breast cancer. METHODS: Patients who underwent SLNB for invasive breast cancer and were found to have positive SLN in two or fewer nodes were evaluated. The associations between non-SLN metastasis and clinicopahological factors were examined. Statistical analyses were performed using the Mann-Whitney and Chi-square tests, with statistical significance set at P < 0.05. RESULTS: A total of 358 patients were enrolled during the study period and all of these patients were female and 54 patients had SLN metastasis (15%). Positive SLN in two or fewer nodes was identified in 44 patients (81.5%). Among these patients, 17 (38.6%) were found to have non-SLN metastasis. Non-SLN metastasis was associated with invasive tumor size (P = 0.015) and lymphatic involvement (P = 0.035). Multivariate analysis showed that tumor size (P = 0.011) and lymphatic involvement (P = 0.019) remained significant independent predictors of non-SLN metastasis, and that an invasive tumor size cut-off point of 28 mm was useful for dividing patients with positive SLN in two or fewer nodes into non-SLN-positive and non-SLN-negative groups. CONCLUSIONS: Non-SLN metastasis was found in more than 30% of patients with SLN metastasis present in two or fewer nodes. Large tumor size and the presence of lymphatic involvement were significantly associated with non-SLN metastasis.

DOI： 10.14740/jocmr2195w

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Background: Decoy receptor 3 (DcR3), a member of the tumor necrosis factor receptor (TNFR) superfamily, shows inhibitory effects on Fas-mediated apoptosis. Currently, data are lacking on the correlation between DcR3 and the recurrence of breast cancer. The authors examined DcR3 mRNA expression and genomic amplification in breast cancer, and investigated the effect of DcR3 gene amplification on prognosis of patients. Methods: A total of 95 patients formed the basis of the current retrospective study. DcR3 mRNA expression in breast cancer tissues was examined by RNase protection assay and in situ hybridization. DcR3 gene amplification was examined by quantitative polymerase chain reaction. The correlation between DcR3 gene amplification status and clinicopathological factors was examined and also the relationship between DcR3-Amp and relapse and survival. Results: The relative copy numbers of DcR3 genomic DNA correlated significantly with the levels of DcR3 mRNA expression (ρ = 0.755, P = 0.0067). In addition, lymphatic invasion correlated significantly with DcR3 gene amplification (P = 0.012). However, there was no correlation between the remaining clinicopathological factors and DcR3 gene amplification. In the univariate analysis, the recurrence-free survival (RFS) rate of patients who were positive for DcR3 gene amplification was significantly lower than that of patients who were negative for DcR3 gene amplification (P = 0.0271). Multivariate analysis showed that DcR3 gene amplification (P = 0.028) and disease stage (P < 0.001) remained significant independent predictors of RFS. Conclusions: DcR3 gene amplification was significantly correlated with lymphatic invasion, and also DcR3 gene amplification predicts recurrence after resection, which may be an important prognostic factor in breast cancer patients.

DOI： 10.14740/wjon764w

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BACKGROUND: Early enteral nutrition within 24 h after surgery has become a recommended procedure. In the present study, we retrospectively examined whether initiating EN within 24 h after esophagectomy improves the postoperative course. METHODS: Among 103 patients who underwent thoracic esophagectomy for esophageal cancer, we enrolled the cases in which EN was initiated within 72 h after surgery. The patients were divided into two groups: EN started within 24 h (Group D1) and EN started at 24 - 72 h (Group D2-3). Clinical factors including days for first fecal passage, dose of postoperative albumin infusion, difference in serum albumin between pre- and postoperation, incidence of postoperative infection, and use of total parenteral nutrition were compared. Statistical analyses were performed by the Mann-Whitney U test and Chi square test, with significance defined as P < 0.05. RESULTS: There was no significant difference between the groups in clinical factors. While pneumonia was significantly more frequent in Group D1 than in Group D2-3 (P = 0.0308), the frequency of infectious complications was comparable between the groups. CONCLUSION: Initiating EN within 24 h showed no advantage for the postoperative course in esophageal cancer, and thus EN should be scheduled within 24 - 72 h, based on the patient condition.

DOI： 10.4021/jocmr1665w

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Scientific Research Publishing, Inc.  

DOI： 10.4236/ojgas.2014.42011

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Other Link： http://www.scirp.org/journal/doi.aspx?DOI=10.4236/ojgas.2014.42011

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：MDPI AG  

We retrospectively examined esophageal cancer patients who received enteral nutrition (EN) to clarify the validity of early EN compared with delayed EN. A total of 103 patients who underwent transthoracic esophagectomy with three-field lymphadenectomy for esophageal cancer were entered. Patients were divided into two groups; Group E received EN within postoperative day 3, and Group L received EN after postoperative day 3. The clinical factors such as days for first fecal passage, the dose of postoperative albumin infusion, differences of serum albumin value between pre- and post operation, duration of systematic inflammatory response syndrome (SIRS), incidence of postoperative infectious complication, and use of total parenteral nutrition (TPN) were compared between the groups. The statistical analyses were performed using Mann-Whitney U test and Chi square test. The statistical significance was defined as p < 0.05. Group E showed fewer days for the first fecal passage (p < 0.01), lesser dose of postoperative albumin infusion (p < 0.01), less use of TPN (p < 0.01), and shorter duration of SIRS (p < 0.01). However, there was no significant difference in postoperative complications between the two groups. Early EN started within 3 days after esophagectomy. It is safe and valid for reduction of albumin infusion and TPN, for promoting early recovery of intestinal movement, and for early recovery from systemic inflammation. © 2013 by the authors; licensee MDPI, Basel, Switzerland.

DOI： 10.3390/nu5093461

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL PUBLISHING, INC  

Aim: Women at high risk for hereditary breast/ovarian cancer require specific management strategies for cancer prevention and early detection. The authors sought to determine the prevalence of family histories suggestive of a hereditary breast/ovarian cancer syndrome in patients with a personal history of breast or ovarian cancer in Japanese women. Methods: Family history (first- and second-degree relatives) data were collected by a self-administered questionnaire for women with a history of breast or ovarian cancer in six major cancer treating hospitals in Niigata prefecture, Japan. Results: Data were obtained from 1463 women: 626 women with a history of breast cancer, 289 women with a history of ovarian cancer and 548 women without a history of any cancer as controls. Women with a family history of breast and/or ovarian cancer had OR of breast cancer of 2.3 (95% confidential interval [CI] 1.5-3.7) and ovarian cancer of 2.2 (95% CI 1.3-3.8). The risk was higher when the proband was younger or when two or more relatives were affected. Among women with a history of breast or ovarian cancer, 7.5% met the criteria for a 10% risk of a BRCA1 or BRCA2 mutation according to the Myriad model. Conclusion: Obtaining a detailed breast and ovarian cancer family history and the application of the Myriad model is useful for identifying women at an elevated genetic risk of breast and ovarian cancer. The estimation for the prevalence of hereditary breast/ovarian cancer syndrome has significant implications for a patient's management, as well as for the capacity for risk assessment and testing. © 2009 Japan Society of Obstetrics and Gynecology.

DOI： 10.1111/j.1447-0756.2009.01090.x

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Background: In this study, an alternative analytical method was used to model colorectal cancer (CRC) patients' long-term survival by assessing the prognostic value of the Ki-67 protein as a marker of tumor cell proliferation, and to illustrate the interaction between standard clinicopathologic variables and the proliferation marker in relation to their impact on survival. Methods: A cohort of 106 surgically treated CRC patients was used for analysis. The expression of the cell-cycle-related Ki-67 protein in tumor samples was evaluated by immunohistochemistry. A score was assigned as the percentage of positive tumor cell staining, denoted as proliferation index (PI), and was used in a multivariate analysis using a recursive partitioning algorithm referred to as classification and regression tree (CART) to characterize the long-term survival after surgery. Results: Of the covariates selected for their prognostic value, PI contributed most to the classification of survival status of patients. However, CART analysis selected the presence of distant metastasis as the best first split-up factor for predicting 5-year survival. CART then selected the following covariates for building up subgroups at risk for death: (1) PI; (2) pathological lymph node metastasis; (3) tumor size. Seven terminal subgroups were formed, with an overall misclassification rate of 16%. Conclusions: These analyses demonstrated that a Ki-67-protein-based tumor proliferation index appeared as an independent prognostic variable that was consistently applied by the CART algorithm to classify patients into groups with similar clinical features and survival. © 2006 Society of Surgical Oncology.

DOI： 10.1245/s10434-006-9145-2

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Authorship：Lead author,　Corresponding author   Publishing type：Research paper (scientific journal)  

Lymph node metastasis is a major prognostic factor for esophageal cancer patients. However, the molecular mechanisms underlying node metastasis remain unclear. Vascular endothelial growth factor-C (VEGF-C) and vascular endothelial growth factor-D (VEGF-D), which are ligands for VEGFR-3, have been reported to be capable of stimulating lymphangiogenesis under in vivo experimental conditions. The aim of the present study was to measure VEGF-C and/or VEGF-D mRNA expression in clinical specimens of esophageal squamous cell carcinoma, and to examine the correlation between VEGF-C or VEGF-D messenger ribonucleic acid (mRNA) expression and conventional clinicopathological parameters, especially the lymphatic involvement of esophageal squamous cell carcinoma. As a previous study has demonstrated that an expression pattern of high VEGF-C and low VEGF-D is correlated with both lymph node metastasis and lymphatic invasion of cancer cells, we also investigated the VEGF-C/D ratio. Total RNAs were isolated from 51 surgical specimens of esophageal carcinoma tissue and 42 normal esophageal mucosae. The relative mRNA abundance of VEGF-C and VEGF-D was measured by real-time quantitative reverse transcription polymerase chain reaction (PCR) analysis, and mRNA expression of VEGF-C and VEGF-D was standardized against glceraldehyde-3-phosphate dehydrogenase (GAPDH) mRNA expression. VEGF-C mRNA was expressed similarly in esophageal carcinoma tissue and normal mucosal tissue; however, VEGF-D mRNA expression was significantly lower in carcinoma tissue compared with normal mucosal tissue, and therefore the VEGF-C/VEGF-D ratio was significantly increased in tumors compared with normal mucosae. However, neither mRNA expression of VEGF-C or VEGF-D nor the VEGF-C/VEGF-D ratio correlated with any clinicopathological factors, including lymphatic invasion, venous invasion, lymph node status, and tumor stage. VEGF-C and VEGF-D gene expression do not appear to be involved in the lymphatic progression of esophageal carcinoma.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MOSBY, INC  

Background: The aim of this study was to clarify whether preoperative squamous cell carcinoma-antigen messenger RNA (SCC-Ag mRNA) level in peripheral blood can be used to predict tumor recurrence after curative resection for esophageal squamous cell carcinoma. Methods: A prospective analysis was conducted for 46 consecutive patients who underwent curative esophagectomy and who had no residual tumor. The SCC-Ag mRNA level in the peripheral blood of each patient was measured preoperatively by using quantitative reverse transcriptase-polymerase chain reaction. Median follow-up period was 34 months. Results: Receiver operating characteristic analysis demonstrated that the optimal cutoff level of SCC-Ag mRNA was 40. Patients were divided into the high SCC-Ag mRNA level group (n = 14) and the low SCC-Ag mRNA level group (n = 32). The cumulative probabilities of tumor recurrence were higher in the high SCC-Ag mRNA level group (probability of recurrence was 71% at 2 years) than in the low group (22% at 2 years; P = .0005). SCC-Ag mRNA level (relative risk, 3.00; 95% confidence interval, 1.05-8.54; P = .040) was the strongest independent predictor of recurrence by multivariate analysis. Conclusions: Preoperative SCC-Ag mRNA levels in the peripheral blood are the best predictive factor for recurrence in patients with esophageal squamous cell carcinoma who undergo curative resection (R0). © 2006 Mosby, Inc. All rights reserved.

DOI： 10.1016/j.surg.2005.09.022

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Purpose: NY-ESO-1, a member of the cancer/testis antigen (CTA) family, elicits humoral and cellular immune responses in patients with advanced cancer. Unresectable or metastatic esophageal carcinoma patients do not benefit from the present multimodality treatment regimens in terms of survival. The objectives of this study were to analyze the antibody response to NY-ESO-1 antigen in patients with esophageal cancer and to determine the potential of NY-ESO-1 for use in tumor-specific immunotherapy. Methods: Serum from 69 patients with esophageal cancer was investigated for antibody production against NY-ESO-1 by Western blot analysis. Also analyzed by immunohistochemistry were 56 tissue samples from these patients for NY-ESO-1 protein expression. Results: NY-ESO-1 protein expression was found in 18 of 56 (32%) esophageal carcinomas. Serum immunoreactivity specific for NY-ESO-1 was found in 9 patients (13%) of whom 8 were in the advanced stage (stages III and IV). There was no relationship between clinicopathologic features and serum immunoreactivity for NY-ESO-1. NY-ESO-1 protein expression was detected in three of five antibody-positive patients whose tissue was available for analysis. Survival analysis showed no significant difference between antibody-positive and antibody-negative patient groups. Conclusions: A humoral immune response to NY-ESO-1 antigen was established in patients with advanced esophageal cancer. NY-ESO-1 is a good candidate for vaccine-based immunotherapy for advanced esophageal carcinoma. © Springer-Verlag 2004.

DOI： 10.1007/s00280-004-0768-3

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier Inc.  

Lymph node metastasis is a major prognostic factor for patients with breast cancer. Vascular endothelial growth factors (VEGF) - C and VEGF-D are capable of stimulating lymphangiogenesis, and VEGF-C enhances lymphatic metastasis. The aim of the present study was to determine whether VEGF-C and VEGF-D messenger RNA (mRNA) expression is correlated with lymphatic invasion and lymph node metastasis in patients with breast cancer. Total RNAs were isolated from 33 surgical specimens of breast cancer tissue and 7 samples of normal breast tissue. VEGF-C and VEGF-D mRNA expression was measured by quantitative reverse transcription-polymerase chain reaction analysis. There was no correlation between VEGF-C mRNA expression and lymphatic invasion or lymph node metastasis. However, VEGF-D mRNA expression was decreased in cancer tissue, and it was inversely correlated with lymphatic invasion and the number of metastatic lymph nodes. An increased VEGF-C/VEGF-D ratio was also correlated with lymph node metastasis and the number of metastatic lymph nodes. Our results suggest that a decrease in VEGF-D mRNA or an increase in the VEGF-C/VEGF-D ratio may have an association with tumorigenesis and/or lymph node metastasis in breast cancer.

DOI： 10.3816/CBC.2003.n.041

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：OXFORD UNIV PRESS  

Therapy combining radioguided parathyroidectomy (PTx) followed by intravenous maxacalcitol was given to a 50-year-old Japanese man referred for treatment of uraemic secondary hyperparathyroidism. After laboratory and radiological examinations, the patient underwent uncomplicated, successful surgery, but glands that had not been detected radiologically before the procedure became apparent with a scintillation counter immediately after the removal of the swollen gland. To prevent relapse of secondary hyperparathyroidism in the remaining glands, 10 μg of maxacalcitol was injected intravenously after each dialysis session. Following a minimally invasive radioisotope-guided PTx, the potential risk of relapse in the remaining glands has to be considered and intensive medical therapy should be instituted immediately after the operation. Further study needs to elucidate whether this treatment strategy can improve the long-term prognosis of patients with secondary hyperparathyroidism.

DOI： 10.1093/ndt/gfg1019

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A new aquaporin (AQP10) was identified in human small intestine. This gene encoded a 264-amino-acid protein with high sequence identity with AQP3 (53%), 9 (52%), and 7 (43%). These AQPs constitute one subfamily of AQP family that is differentiated from the other subfamily of AQP (AQP0, 1, 2, 4, 5, 6, and 8) by sequence homology. Ribonuclease protection assay and Northern blotting demonstrated almost exclusive expression of AQP10 mRNA in the duodenum and jejunum. In situ hybridization localized it in absorptive jejunal epithelial cells. Xenopus oocytes expressing AQP10 exhibited an increased osmotic water permeability in a mercury-sensitive manner. Although AQP10 belongs to the AQP subfamily, which has been characterized by permeability to water and neutral solutes such as urea and glycerol, it was not permeable to urea nor glycerol. The specific expression of AQP10 suggests its contribution to the water transport in the upper portion of small intestine. © 2001 Academic Press.

DOI： 10.1006/bbrc.2001.5661

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Background and objectives: Fas ligand (FasL) is expressed in many cancers and plays an important role in establishing immunologically privileged environments that allow tumors to escape the host's immune surveillance. We investigate the expression of FasL in human colorectal cancer and colorectal adenoma and elucidate the relationship between FasL expression and the clinicopathological characteristics of colorectal cancers. Methods: We examined 214 colorectal cancer specimens and 83 colorectal adenoma specimens. Expression of FasL was determined by immunohistochemical staining using a specific monoclonal antibody. We analyzed the relationship between the results of FasL expression and clinicopathological data statistically. Results: FasL expression was detected in 173 (80.8%) of 214 colorectal carcinomas and 34 (40.9%) of 83 colorectal adenomas. The status of FasL expression in colorectal carcinoma was independent of clinicopathological features including tumor stage, histologic grade, lymphatic invasion, venous invasion, lymph node metastasis, liver metastasis, and Dukes stage. In colorectal adenoma, FasL expression was more frequently observed in high-grade atypia than in low-grade atypia (P = 0.05). Conclusions: FasL expression is commonly observed not only in cancer but also in highly dysplastic tissue. These observations suggest that FasL expression may be an important event in the transformation process leading to adenocarcinoma. © 2001 Wiley-Liss, Inc.

DOI： 10.1002/1096-9098(200101)76:1<63::AID-JSO1011>3.0.CO;2-C

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ASSOC RESEARCH VISION OPHTHALMOLOGY INC  

Purpose. To determine the role in the eye of chondromodulin (ChM)-I, which has been identified in cartilage as an angiogenic inhibitor, the expression and localization and a possible function of ChM-I were investigated. METHODS. Expression and localization of ChM-I in rat eyes were examined by RNase protection assay and in situ hybridization and by immunostaining, using an antibody against a synthetic peptide. The effect of recombinant ChM-I on tube morphogenesis of retinal endothelial cells was examined in culture. Results. The rat ChM-I gene was determined to encode the open reading frame of 334 amino acid residues, and ChM-I mRNA was exclusively expressed in cartilage, eye, and cerebellum in rats. ChM-I mRNA expression was evident in the iris-ciliary body, retina, and scleral compartments, but not in other compartments of the eye. In situ hybridization revealed mRNA expression in the ganglion cells, inner nuclear layer cells, and pigment epithelium in the retina and in the nonpigment epithelium of the ciliary body. Immunoreactive ChM-I was present in these cells and also in the vitreous body. Western blot analysis detected an ∼25-kDa band of ChM-I presumed as a secretory form in the aqueous humor and vitreous body and an ∼37-kDa band as a precursor form in the retina. Recombinant human ChM-I inhibited tube morphogenesis of human retinal endothelial cells in vitro. Conclusion. These observations indicate a potential role for ChM-I in inhibition of angiogenesis in the rat eye.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japan Society of Histological Documentation  

Expression of aquaporin-8 mRNA has previously been shown in hepatocytes, pancreatic acinar cells, colon epithelial cells and seminiferous tubules of the testis in the rat by in situ hybridization technique. However, immunolocalization of this water channel has not yet been demonstrated. In the present study, the localization of immunoreactive aquaporin-8 and expression of the mRNA were examined in rat organs (cerebrum, cerebellum, eye, salivary gland, heart, lung, liver, pancreas, esophagus, stomach, jejunum, ileum, colon, testis, ovary, kidney, spleen and lymphnode) by immunohistochemistry using an antibody against aquaporin-8 and ribonuclease protection assay. Aquaporin-8 was distinctly immunolocalized on the apical membranes of pancreatic acinar cells and mucosal epithelium of the colon and jejunum. In the liver, the bile canalicular membrane of hepatocytes was immunostained. In the testis, immunoreactive aquaporin-8 was demonstrated on the luminal side of the seminiferous tubules. At high magnification, the peroxidase reaction products appeared on the ramified cytoplasmic membrane of Sertoli cells surrounding the residual bodies or spermatogenic cells. Specificity of the antibody was verified by Western blot analysis showing a minor ∼28 kDa band (deduced deglycosylated form of aquaporin-8) and a major ∼30 kDa band (glycosylated form) in these organs. The intensity of aquaporin-8 immunoreactivity was approximately comparable to that of aquaporin-8 mRNA expression in the liver, pancreas, colon, jejunum and testis. The aquaporin-8 mRNA expression in the hepatocytes was presumed to be closely associated with the structure of bile canaliculi since the message was detected in hepatocytes immediately after isolation from the liver but not in cells following cultivation for three days. The localization of immunoreactive aquaporin-8 indicated functions for this water channel in the secretion of bile and pancreatic juice, and the secretion or absorption of water in the colon and jejunum, and the maturation or liberation of spermatogenic cells in the testis.

DOI： 10.1679/aohc.64.159

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japan Society of Histological Documentation  

The aquaporin (AQP)-9 gene was recently isolated from human and rat liver cDNA libraries as a member of the water channel family for water and neutral solutes. Although the expression of AQP9 mRNA has been demonstrated in several organs including the liver and testis by Northern blot analysis, the cellular and subcellular localization of the AQP9 protein remains unclear. In the present light and electron microscopic immunohistochemical study, the localization of the AQP9 immunoreactivity was examined in fifteen kinds of rat organs using an antibody against rat AQP9 synthetic peptide. The antibody immuno-stained a major band of ∼33 kDa in the liver by Western blot analysis. Immunoreactivity for AQP9 was found exclusively in the liver and testis among the organs examined. In the liver, positive staining appeared selectively along the space of Disse. Immunoelectron microscopy confirmed the localization of AQP9 on the surface of hepatocyte microvilli facing the space of Disse. In the testis, the plasma membrane of Leydig cells located between seminiferous tubules was conspicuously immunoreactive to the antibody. Intense mRNA expression was detected in the liver and testis but not in other organs by ribonuclease protection assay. These findings suggest a specific role for AQP9 in the transport of water and non-charged solutes in hepatocytes and Leydig cells.

DOI： 10.1679/aohc.64.81

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

A gene encoding olfactomedin-related glycoprotein was isolated from rat glomerulus despite its prior identification as a neuron-specific gene. The mRNA expression was remarkably intense in renal glomerulus and brain and faint in the lung and eye among rat systemic organs. Although the brain contained four mRNA variants (AMY, AMZ, BMY, and BMZ) transcribed from a single gene, the glomerulus, lung, and eye expressed only two variants (BMZ and BMY). The glycoprotein was intensely immunolocalized in glomerular podocytes and neurons by using an antibody against synthetic peptide of the M region, but weak in endothelial cells of the kidney and lung. Bronchiolar epithelial cells in the lung, and ciliary, corneal, and iris epithelial cells in the eye were also stained. Immunogold electron microscopy revealed selective localization of olfactomedin-related glycoprotein at the Golgi apparatus in podocytes. In glomerular culture, the staining was also intense at a juxtanuclear region in synaptopodin-positive epithelial cells of irregular shape (phenotypic feature of podocytes), whereas it was weak in synaptopodin-negative ones of cobblestone-like appearance (phenotypic feature of parietal epithelial cells of Bowman's capsule). Interestingly, Western blot analysis identified an intense band corresponding to BMZ isoform and another faint band corresponding to BMY isoform in the glomerulus, whereas the intensity of these two bands were nearly equal in the lung and eye. In the brain, four bands corresponding to four isoforms were observed apparently. Computer sequence analysis predicted coiled-coil structures in the secondary structure of the glycoprotein similar to those in Golgi autoantigens, suggesting significant roles in the unique functions of the Golgi apparatus in rat podocytes and neurons.

DOI： 10.1681/ASN.V115803

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：EDIZIONI MINERVA MEDICA  

Background: An increase in serum diamine oxidase (DAO) activity reflects intestinal mucosal damage. This was used to estimate the effect of surgical stress after elective abdominal surgery on gut integrity. Methods: Patients with gastrointestinal tract cancers were placed in either group T (transthoracic esophagectomy for esophageal cancer, n = 9) or group L (laparotomy, n = 10). The serum DAO activity was measured pre-operatively, and on postoperative days 1, 3, and 8. Results: Transthoracic esophagectomy was associated with a more extensive stress than the operations in group L, as measured by the intra-operative blood loss, the amount of blood transfused, and the operative time (P = 0.007, P = 0.0002, P = 0.0011, respectively). Following surgery, the serum DAO activity was decreased markedly in all patients in group T. In contrast, the activity was unchanged in group L (P = 0.04). Conclusions: The severity of the surgical insult plays a significant role in the decrease in serum DAO activity. These results suggest that surgical stress influences gut integrity following elective abdominal surgery.

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

A family of water-selective channels, aquaporins (AQP), has been demonstrated in various organs and tissues. However, the localization and expression of the AQP family members in the gastrointestinal tract have not been entirely elucidated. This study aimed to demonstrate the expression and distribution of several types of the AQP family and to speculate on their role in water transport in the rat gastrointestinal tract. By RNase protection assay, expression of AQP1-5 and AQP8 was examined in various portions through the gastrointestinal tract. AQP1 and AQP3 mRNAs were diffusely expressed from esophagus to colon, and their expression was relatively intense in the small intestine and colon. In contrast, AQP4 mRNA was selectively expressed in the stomach and small intestine and AQP8 mRNA in the jejunum and colon. Immunohistochemistry and in situ hybridization demonstrated cellular localization of these AQP in these portions. AQP1 was localized on endothelial cells of lymphatic vessels in the submucosa and lamina propria throughout the gastrointestinal tract. AQP3 was detected on the circumferential plasma membranes of stratified squamous epithelial cells in the esophagus and basolateral membranes of cardiac gland epithelia in the lower stomach and of surface columnar epithelia in the colon. However, AQP3 was not apparently detected in the small intestine. AQP4 was present on the basolateral membrane of the parietal cells in the lower stomach and selectively in the basolateral membranes of deep intestinal gland cells in the small intestine. AQP8 mRNA expression was demonstrated in the absorptive columnar epithelial cells of the jejunum and colon by in situ hybridization. These findings may indicate that water crosses the epithelial layer through these water channels, suggesting a possible role of the transcellular route for water intake or outlet in the gastrointestinal tract.

DOI： 10.1152/ajpcell.1999.276.3.c621

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-LISS  

Background and Objectives: The importance of nodal involvement as a prognostic factor in differentiated carcinoma of the thyroid gland remains controversial. We therefore attempted to confirm the prognostic factors in differentiated thyroid carcinoma, with special reference to nodal status. Patients and Methods: A total of 139 patients with differentiated thyroid cancer followed for 2-27 years, with a median follow-up of 7 years were studied. All patients underwent surgical resection, either subtotal, total, or lobectomy, with modified radical neck dissection. Survival was calculated using the Kaplan-Meier method. Results: Ten (7%) patients have died from thyroid cancer. Adverse prognostic factors included age >45 years (P = 0.0120), the presence of distant metastases (P = 0.0006), and TNM stage (P = 0.0002). The number of lymph nodes dissected ranged from 6 to 92, with an average of 26. Lymph node metastases were found in 102 (73%) patients. There was no difference in survival according to the level of nodal disease by the TNM classification. Furthermore, the number of cervical lymph nodes involved had no effect on the survival. Conclusion: Our results suggest that the presence of histologically confirmed lymph node metastases is not an important prognostic factor in patients with differentiated thyroid carcinoma.

DOI： 10.1002/(SICI)1096-9098(199811)69:3<151::AID-JSO6>3.0.CO;2-V

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：AMER PHYSIOLOGICAL SOC  

Aquaporin (AQP) 5 gene was recently isolated from salivary gland and identified as a member of the AQP family. The mRNA expression and localization have been examined in several organs. The present study was focused on elucidation of AQP5 expression and localization in the eye, salivary gland, and lung in rat. RNase protection assay confirmed intense expression of AQP5 mRNA in these organs but negligible expression in other organs. To examine the mRNA expression sites in the eye, several portions were microdissected for total RNA isolation. AQP5 mRNA was enriched in cornea but not in other portions (retina, lens, iris/ciliary body, conjunctiva, or sclera). AQP5 was selectively localized on the surface of corneal epithelium in the eye by immunohistochemistry and immunoelectron microscopy using an affinity-purified anti-AQP5 antibody. AQP5 was also localized on apical membranes of acinar cells in the lacrimal gland and on the microvilli protruding into intracellular secretory canaliculi of the serous salivary gland. In the lung, apical membranes of type I pulmonary epithelial cells were also immunostained with the antibody. These findings suggest a role of AQP5 in water transport to prevent dehydration or to secrete watery products in these tissues.

DOI： 10.1152/ajpcell.1998.275.4.c1151

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：AMER SOC BIOCHEMISTRY MOLECULAR BIOLOGY INC  

A new water channel (aquaporin-8, gene symbol AQP8) was isolated from rat pancreas and liver by homology cloning. Ribonuclease protection assay showed intense expression of the gene in pancreas and liver, less intense in colon and salivary gland, and negligible in other organs. The full-length cDNA was obtained by ligation of ~1.4-kilobase (kb) cDNA isolated from the rat liver cDNA library to ~0.5 kb of the 5'-end fragment obtained by the rapid amplification of cDNA ends method. A major transcript of ~1.45 kb was demonstrated in liver and colon by Northern blot analysis. Expression of the cRNA in Xenopus oocytes markedly enhanced osmotic water permeability in a mercury-sensitive manner, indicating a water channel function of this molecule. The open reading frame encoded a 263- amino acid protein with a predicted molecular size of 28 kDa. Hydropathy analysis represented six membrane spanning domains and five connecting loops containing two sites of NPA motif as preserved in other aquaporins. Unlike other mammalian aquaporins, AQP8 has an unusual structure with a long N terminus and a short C terminus, which are found in plant aquaporin, γ-tonoplast intrinsic protein. By in situ hybridization, AQP8 mRNA expression was assumed in hepatocytes, acinal cells of pancreas and salivary gland, and absorptive colonic epithelial cells. The physiological role(s) of AQP8 remain to be elucidated.

DOI： 10.1074/jbc.272.48.30329

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We examined the effect of malnutrition on liver regeneration and changes in plasma insulin-like growth factor-I (IGF-I) concentrations, and the effect of the administration of IGF-I to rats following hepatic resection. Twenty-nine male Sprague-Dawley rats were allocated to one of three groups. Group I (n = 11) consisted of normally nourished rats which each underwent a 70% partial hepatectomy by the method of Higgins and Anderson.) Group II (n = 8) was composed of malnourished rats which also underwent partial hepatectomies. Group III (n = 10) consisted of malnourished rats which each underwent a partial hepatectomy and received 200 μg of exogenous IGF-I for 24 h following surgery. Group I rats were permitted to eat ad libitum., rats in Groups II and III received 50% of their normal intake for one week prior to and following hepatectomy. The rats were killed after 48 h of hepatic regeneration, and the livers were weighed and prepared for hamatoxylineosin staining to facilitate an assessment of the number of mitotic cells. Decreases in the remnant liver weights and mitotic indices were more extensive in the malnourished rats. Additionally, malnutrition was associated with low plasma IGF-I concentrations following partial hepatectomy. IGF-I administration was not associated with an improved nitrogen balance following hepatectomy. These results suggest that an adequate nutritional status is essential for liver regeneration, and that malnutrition is associated with lower plasma IGF-I concentrations following partial hepatectomy. An inadequate nutrient supply may abolish the anabolic effect of the administration of IGF-I on nutritional repletion postoperatively.

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Resting energy expenditure (REE) was studied in five patients undergoing transhiatal and in 14 undergoing transthoracic oesophagectomy for carcinoma. All resections were performed with an intention to cure. REE was measured by indirect calorimetry before operation and on days 1, 3, 5 and 7 after surgery. Following transthoracic oesophagectomy, REE increased significantly on days 1, 3, 5 and 7 after operation, and on day 7 the value was significantly higher (P <0·05) than that obtained after transhiatal surgery. Energy expenditure following transhiatal oesophagectomy is lower than that after transthoracic oesophagectomy; this may be a result of reduced surgical stress. Copyright © 1993 British Journal of Surgery Society Ltd.

DOI： 10.1002/bjs.1800801119

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(株)ジェフコーポレーション  

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Language：Japanese   Publisher：新潟看護ケア研究学会  

嗜好の違いによる嚥下運動を確認するために、美味しさの評価の見える化の実現のための基礎的研究として、健常者を対象に嗜好が関与する食品サンプルによる喉頭隆起周囲の嚥下運動を情報工学的手法で解析し、嗜好と嚥下運動との関係を検証した。成人12名を対象にして甲状軟骨切痕をマーキングし瞬間的(約0.67秒)における運動から各時刻における加速度とマーキングの方向を算出し、嚥下時の最大加速度と嚥下開始時間をWilcoxon符号付順位和検定で比較した。結果、最大加速度について上甲状切痕部は美味しいサンプルを嚥下した時が優位に高かった(p=0.034)が、嚥下開始時間については嗜好による有意差はなかった(p=0.754)。よって嗜好による嚥下加速度の差が視覚的にえられる可能性があることが示唆された。(著者抄録)

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Language：Japanese   Publisher：(株)ジェフコーポレーション  

【目的】我が国では平均寿命が延び、高齢者数の増加に伴い、誤嚥や誤嚥性肺炎の発生数も増加している。口腔内の衛生状態や口腔機能の低下は誤嚥・誤嚥性肺炎の発生に関わるため、口腔アセスメントを行い、誤嚥や誤嚥性肺炎を予防する、あるいは発生のリスクがある場合には口腔ケアを実施することが重要である。口腔アセスメントの評価法は既に開発され、臨床でも用いられているが、口腔内の状態評価が主であり嚥下機能や食事状況を含めた口腔アセスメント法は開発されていない。本研究では、嚥下機能や食事状況などの項目を追加した高齢者用口腔アセスメントシートを作成し、信頼性・妥当性を確認し、看護師が高齢患者の口腔内を客観的に評価しスクリーニングでき、臨床現場で有用であるツールであることを明らかにすることを目的とした。【方法】既存の口腔アセスメントシート(OHAT)に高齢者特有の誤嚥リスク等に関わる嚥下や食事の項目を含めた高齢者用の口腔アセスメントシートを作成した。2021年9月～2022年9月の入院患者(65歳～100歳)を対象に、担当看護師と院内の歯科衛生士(1名)がそれぞれ口腔アセスメントを実施し、評価スコアの一致率(%)およびk係数を比較して信頼性を確認した。妥当性の確認は、院内の歯科衛生士(1名)と院外の歯科衛生士5名で評価スコアの一致率(%)およびk係数の比較により行なった。さらに、シートの有用について、評価終了後に看護師に対するアンケート調査にて確認した。【結果】当該期間に実施した入院患者は58名(男性38名、女性20名、平均年齢81.1歳)であった。合計平均スコアは、看護師4.7点、歯科衛生士4.9点、一致率92.7%、k係数0.82ポイントであった。評価項目別では一致率84.5%～98.3%、k係数0.60～0.97ポイントであった。歯科衛生士間では合計平均スコアの一致率91.7%、k係数0.84ポイントであり、評価項目別での評価スコア一致率は80.0%～100.0%であった。評価後の看護師へのアンケート調査では、58名中55名(94.8%)から回答が得られ、口腔チェック表の使いやすさ、判定のしやすさ、項目数の適切さについては80%、口腔チェック表の心要性については78%が支持していた。アセスメントに要した時間では90%以上の看護師が5分以内に実施できていた。【結論】既存の口腔アセスメントシートのOHATに食事・嚥下項目を追加した高齢者用口腔アセスメントシートは、信頼性と妥当性、有用性を有し、入院中の高齢者の口腔スクリーニングに有用であることが示唆された。(著者抄録)

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BACKGROUND: Ceramide and sphingosine-1-phosphate (S1P) play opposing roles in cell death and survival, and maintain a dynamic balance called the sphingolipid rheostat. Glucosylceramide is a substrate to generate ceramide but its effect on breast cancer by oral administration was never tested. The purpose of this study was to reveal the anticancer activity of glucosylceramide and its potential as a new therapeutic agent in breast cancer. METHODS: E0771 cells were inoculated into the breast tissue of female C57BL/6NJcl mice. Glucosylceramide was administered orally to the mice for nine consecutive days. The concentrations of sphingolipid mediators including ceramide, glucosylceramide, and S1P in tumor tissues and serum were determined by mass spectrometry. RESULTS: Oral administration of glucosylceramide significantly suppressed E0771 tumor growth compared with the control group (P = 0.006). There were no significant differences in the serum concentrations of sphingolipid mediators including ceramide and S1P between the mice treated with glucosylceramide and control-treated mice. The ceramide concentration was significantly lower in tumor tissues (P = 0.026), and the S1P concentration was significantly higher than that in paired non-tumor tissues (P = 0.009). The S1P concentration in tumor tissues was significantly lower in mice treated with glucosylceramide than in control-treated mice (P = 0.001). The ceramide-to-S1P concentration ratio in tumor tissues was significantly higher in mice treated with glucosylceramide than in control-treated mice (P = 0.034). CONCLUSIONS: Breast tumors could enhance their survival by increasing S1P conversion from ceramide. Oral administration of glucosylceramide suppressed tumor growth by affecting the ceramide/S1P balance. Oral administration of glucosylceramide is a promising basis for a new therapeutic approach.

DOI： 10.14740/wjon1656

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The migrant population of Japan is gradually increasing, but it is not well known how and why diet and physical activity (PA) change post-migration. Therefore, this study used a mixed-method approach to investigate the changes in dietary patterns and PA through a web- and paper-based survey (n = 128) and understand the contextual factors for those changes through semi-structured interviews (n = 21). Descriptive and thematic analyses of quantitative and qualitative data were conducted, respectively. The majority of survey (57.8%) and interview (66.7%) participants were female, and the mean duration of stay in Japan was 5 and 3.6 years, respectively. The survey revealed an increased consumption of foods attached to Japanese culture, frozen and microwavable food, and a reduced consumption of fruits. We identified environmental (availability, accessibility, and affordability of foods; food safety and diet-related information; and climate), individual (living status; post-migration lifestyle; and food preferences and limitations), or socio-cultural (relationships with Japanese people; cultural differences; and religious influences) factors that impact diet changes. Language proficiency and the duration of stay shape dietary behaviors. Determinants of PA changes were climate, lifestyle, and the influence of Japanese culture. In conclusion, immigrants in Japan experience post-migration diet and PA changes, and this study adds knowledge about how and why such changes occur.

DOI： 10.3390/nu15163639

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BACKGROUND: Zinc (Zn) deficiency, malnutrition, sarcopenia, and frailty are prevalent among older adults and are prominent factors contributing to disability and mortality. OBJECTIVE: This scoping review was conducted to aid understanding of the extent and types of research addressing the role of Zn in nutritional status, sarcopenia, and frailty, among older individuals. METHOD: A systematic search was performed in August 2022 of 3 electronic databases (PubMed, Web of Science, and ProQuest) using predefined search terms. The review was conducted referring to the Arksey and O'Malley framework and PRISMA-ScR. RESULTS: The search retrieved 16 018 records, and a total of 49 studies were included in this review after the screening. Of those, 30 were based on dietary Zn intake, 18 on tissue Zn levels, and 1 on both. Most studies were based on cross-sectional data from community-dwelling older adults. Studies addressing the associations between Zn status and individual anthropometric and sarcopenia-related variables reported inconsistent results. However, most studies reported inverse associations between malnutrition, frailty, and Zn status. CONCLUSION: There was more consistent evidence of the relationship of Zn status with malnutrition, sarcopenia, and frailty rather than with individual nutritional parameters. Validated screening and assessment tools and criteria and prospective studies are required to elucidate the relationship of Zn with sarcopenia and frailty in the older population.

DOI： 10.1093/nutrit/nuad094

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Publishing type：Research paper (scientific journal)   Publisher：Kitakanto Medical Society  

DOI： 10.2974/kmj.73.191

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BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a significant global cause of mortality, and Emergency Medical Services (EMS) response interval is critical for survival and a neurologically-favorable outcome. Currently, it is unclear whether EMS response interval, neurologically-intact survival, and overall survival differ between snowy and non-snowy periods at heavy snowfall areas. METHODS: A nation-wide population-based cohort of OHCA patients, registered from 2017 through 2019 in the All-Japan Utstein Registry, was divided into four groups according to areas (heavy snowfall area or other area) and seasons (winter or non-winter): heavy snowfall-winter, heavy snowfall-non-winter, other area-winter, and other area-non-winter. The first coprimary outcome was EMS response interval, and the secondary coprimary outcome was one-month survival and a neurologically-favorable outcome at one month. RESULTS: A total of 337,781 OHCA patients were divided into four groups: heavy snowfall-winter (N = 15,627), heavy snowfall-non-winter (N = 97,441), other area-winter (N = 32,955), and other area-non-winter (N = 191,758). Longer EMS response intervals (>13 minutes) were most likely in the heavy snowfall-winter group (OR = 1.86; 95% CI, 1.76 to 1.97), and also more likely in heavy snowfall areas in non-winter (OR = 1.44; 95% CI, 1.38 to 1.50). One-month survival in winter was worse not only in the heavy snowfall area (OR = 0.86; 95% CI, 0.78 to 0.94) but also in other areas (OR = 0.91; 95% CI, 0.87 to 0.94). One-month neurologically-favorable outcomes were also comparable between heavy snowfall-winter and other area-non-winter groups. CONCLUSIONS: This study showed OHCA in heavy snowfall areas in winter resulted in longer EMS response intervals. However, heavy snowfall had little effect on one-month survival or neurologically-favorable outcome at one month.

DOI： 10.1017/S1049023X23006040

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(株)ジェフコーポレーション  

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Language：Japanese   Publisher：新潟医学会  

【症例】60歳代女性.右乳癌に対して,右乳房切除術ならびに腋窩リンパ節郭清術を施行され,pT3N0M0,pStage IIB,ホルモン受容体陰性,human epidermal growth factor receptor type 2(HER2)陽性と診断された.術後補助療法(trastuzumab,pertuzumab併用療法)中の術後1年5ヵ月時に右胸壁再発(ホルモン受容体陰性,HER2陰性),多発肺転移再発をきたした.Paclitaxel,bevacizumab併用療法を開始したが,右胸壁再発巣が増大したため放射線治療を行い,縮小を得た.しかし,多発肺転移再発巣は増大したため,右胸壁再発巣の針生検検体でPD-L1(SP142)陽性であることを確認し,nab-paclitaxel,atezolizumab併用療法を施行した.3コース終了後,右胸壁再発巣と多発肺転移再発巣は縮小し,部分奏効と判断した.4コース目の治療中に下垂体機能低下症を発症したため治療を中止し,以後は無治療経過観察の方針とした.治療中止後1年8ヵ月経過時点で,全ての再発巣は縮小した状態を維持している.【結語】HER2陽性乳癌では再発巣がHER2陰性である可能性があり,再発巣のサブタイプに応じた適切な治療選択が重要である.(著者抄録)

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Language：Japanese   Publisher：新潟医学会  

【症例】60歳代女性.右乳癌に対して,右乳房切除術ならびに腋窩リンパ節郭清術を施行され,pT3N0M0,pStage IIB,ホルモン受容体陰性,human epidermal growth factor receptor type 2(HER2)陽性と診断された.術後補助療法(trastuzumab,pertuzumab併用療法)中の術後1年5ヵ月時に右胸壁再発(ホルモン受容体陰性,HER2陰性),多発肺転移再発をきたした.Paclitaxel,bevacizumab併用療法を開始したが,右胸壁再発巣が増大したため放射線治療を行い,縮小を得た.しかし,多発肺転移再発巣は増大したため,右胸壁再発巣の針生検検体でPD-L1(SP142)陽性であることを確認し,nab-paclitaxel,atezolizumab併用療法を施行した.3コース終了後,右胸壁再発巣と多発肺転移再発巣は縮小し,部分奏効と判断した.4コース目の治療中に下垂体機能低下症を発症したため治療を中止し,以後は無治療経過観察の方針とした.治療中止後1年8ヵ月経過時点で,全ての再発巣は縮小した状態を維持している.【結語】HER2陽性乳癌では再発巣がHER2陰性である可能性があり,再発巣のサブタイプに応じた適切な治療選択が重要である.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00990&link_issn=&doc_id=20240528040003&doc_link_id=%2Fdg3nigta%2F2023%2F013705%2F003%2F0179-0184%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2023%2F013705%2F003%2F0179-0184%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本外科学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elmer Press, Inc.  

BACKGROUND: Severe neutropenia, including febrile neutropenia, is a major toxicity of systemic chemotherapy that leads to delays in treatment, higher costs, and mortality. Severe neutropenia may occur during neoadjuvant chemotherapy even when the patients are free from known risk factors. Pegfilgrastim, a covalent conjugant of filgrastim that stimulate the production of neutrophils, is used for prevention. The current study aimed to reveal the characteristics of patients who need pegfilgrastim for primary prophylaxis to prevent severe neutropenia, including febrile neutropenia and grade 3 neutropenia, during neoadjuvant chemotherapy. METHODS: A retrospective analysis of 83 patients treated with neoadjuvant adriamycin/cyclophosphamide followed by docetaxel chemotherapy was performed. The factors which associated with severe neutropenia were examined by univariate and multivariate analyses. RESULTS: Severe neutropenia developed in one of 22 patients (5%) with pegfilgrastim for primary prophylaxis and in 17 of 61 patients (28%) without it. In 83 patients, the incidence of severe neutropenia was significantly decreased in the patients with pegfilgrastim for primary prophylaxis shown by the univariate analysis (P = 0.023) and multivariate analysis (P = 0.030). In 61 patients without pegfilgrastim for primary prophylaxis, the univariate analysis showed that severe neutropenia was associated with tumor size (P = 0.004), clinical stage (P = 0.009), and cancer antigen 15-3 (CA15-3) (P = 0.026). The multivariate analysis showed that clinical stage was associated with severe neutropenia (P = 0.021). CONCLUSIONS: The current study demonstrated that advanced stage is a risk for severe neutropenia in patients treated with neoadjuvant adriamycin/cyclophosphamide followed by docetaxel chemotherapy. Given that prophylaxis with pegfilgrastim was associated with significantly lower incidence of severe neutropenia, patient with advance stage breast cancer may benefit from pegfilgrastim during neoadjuvant chemotherapy.

DOI： 10.14740/wjon1530

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Authorship：Last author   Publishing type：Research paper (scientific journal)   Publisher：MDPI AG  

(1) Background: End-of-life care (EoL care) for cancer patients is stressful for nurses and can easily lead to burnout. Newly graduated nurses (NGNs) have a particularly difficult time, but no scale or inventory has been designed to evaluate their difficulties. This study developed and tested the reliability and validity of a scale to measure NGNs’ difficulties with EoL care for cancer patients (NDEC scale). (2) Methods: This study population consisted of 1000 NGNs and 1000 nurses with at least five years of clinical experience (GNs) that were working in hospitals in Japan. The initial scale consisted of six factors and 28 items. The reliability and validity of the scale were tested. (3) Results: A total of 171 NGNs and 194 GNs responded to the survey. The scale consisted of five factors and 25 items with the factors including “Feeling painful”, “Can’t deal with patients and their families”, “Don’t know the answer”, “Cannot afford”, and “Being afraid of death”. The criteria validity, known population validity, and internal consistency were confirmed. (4) Conclusions: The scale was validated to have a certain level of reliability and validity. The NDEC scale is expected to be used for self-care for NGNs and as an effectiveness indicator for educational programs.

DOI： 10.3390/nursrep12030063

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本遺伝カウンセリング学会  

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Language：Japanese   Publisher：(一社)日本遺伝カウンセリング学会  

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Authorship：Last author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：MDPI AG  

BACKGROUND: Treatment of high blood pressure is a combination of lifestyle changes and medications, and appropriateexercise therapy is recommended as one of the lifestyle-related changes. Recently, stretching, a low-intensity exercise, was reported to be antihypertensive and effective for improving arteriosclerosis, in addition to aerobic exercise. The present study investigated the short-term effects of continuous stretching and rest-induced rebound on vascular endothelial function in hypertensive patients. METHODS: This study was conducted as a single-arm prospective interventional study including patients between 30 and 70 years of age undergoing treatment for hypertension from October 2019 until May 2021. The intervention consisted of six months of daily stretching, one month of rest, and another three months of stretching. We measured arteriosclerosis indices such as cardio ankle vascular index (CAVI), ankle brachial pressure index (ABI) and reactive hyperemia index (RHI), and flexibility at the baseline and one, three, six, seven, and ten months from the baseline. RESULTS: We included a total of ten patients (three males and seven females) with an average age of 60.10 ± 6.05 years. The exercise rate for the entire period was 90% or more, and the anteflexion measurement value improved significantly before and after the intervention (p &lt; 0.001). Blood pressure and CAVI/ABI were well controlled throughout the study period. RHI did not show any significant improvement during the initial six months, and only slightly improved by the third month (p = 0.063). Even after the rest phase and resumption of stretching, RHI remained stable. CONCLUSIONS: The compliance of the stretching program we used, evaluated by the exercise implementation rate for the entire period, was 90% or more; therefore, easy to perform and continue by hypertensive patients. However, we did not observe a significant positive effect on arteriosclerosis index or blood pressure in this study.

DOI： 10.3390/clinpract12030036

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MDPI AG  

Although numerous experiments revealed an essential role of a lipid mediator, sphingosine-1-phosphate (S1P), in breast cancer (BC) progression, the clinical significance of S1P remains unclear due to the difficulty of measuring lipids in patients. The aim of this study was to determine the plasma concentration of S1P in estrogen receptor (ER)-positive BC patients, as well as to investigate its clinical significance. We further explored the possibility of a treatment strategy targeting S1P in ER-positive BC patients by examining the effect of FTY720, a functional antagonist of S1P receptors, on hormone therapy-resistant cells. Plasma S1P levels were significantly higher in patients negative for progesterone receptor (PgR) expression than in those positive for expression (p = 0.003). Plasma S1P levels were also significantly higher in patients with larger tumor size (p = 0.012), lymph node metastasis (p = 0.014), and advanced cancer stage (p = 0.003), suggesting that higher levels of plasma S1P are associated with cancer progression. FTY720 suppressed the viability of not only wildtype MCF-7 cells, but also hormone therapy-resistant MCF-7 cells. Targeting S1P signaling in ER-positive BC appears to be a possible new treatment strategy, even for hormone therapy-resistant patients.

DOI： 10.3390/ijms222413367

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 70-year-old female with liver metastases from gastrointestinal stromal tumor(GIST)that were found 3 months after partial gastrectomy for the primary GIST underwent Auchincloss operation for left breast cancer with ipsilateral axillary lymph node metastases. The diagnosis was microinvasive ductal cancer that was pT1miN1M0, pStage ⅡA, hormone receptor negative, and HER2 positive. Given the impact of this cancer on the prognosis of liver metastases of GIST, imatinib therapy, but not adjuvant chemotherapy, was started promptly for breast cancer after surgery. Four months after the surgery, left subclavian lymph node recurrence of breast cancer was found. Since the liver metastases of GIST had been stable, imatinib was discontinued, and paclitaxel and anti-HER2 therapy were administered. After confirming tolerability, imatinib was carefully added in combination. Because the lymph nodes shrank and liver metastases of GIST were stable, both anti-HER2 therapy and imatinib were continued. There are few reports of combined chemotherapy for synchronous double cancer, and we report our experience in which careful treatment was required.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MDPI AG  

Background and Objectives: For effective function of the rapid response system (RRS), prompt identification of patients at a high risk of cardiac arrest and RRS activation without hesitation are important. This study aimed to identify clinical factors that increase the risk of intensive care unit (ICU) transfer and cardiac arrest to identify patients who are likely to develop serious conditions requiring ICU management and appropriate RRS activation in Japan. Materials and Methods: We performed a single-center, case control study among patients requiring a rapid response team (RRT) call from 2017 to 2020. We extracted the demographic data, vital parameters, blood oxygen saturation (SpO2) and the fraction of inspired oxygen (FiO2) from the medical records at the time of RRT call. The patients were divided into two groups to identify clinical signs that correlated with the progression of clinical deterioration. Patient characteristics in the two groups were compared using statistical tests based on the distribution. Receiver operating characteristic (ROC) curve analysis was used to identify the appropriate cut-off values of vital parameters or FiO2 that showed a significant difference between-group. Multivariate logistic regression analysis was used to identify patient factors that were predictive of RRS necessity. Results: We analyzed the data of 65 patients who met our hospital's RRT call criteria. Among the clinical signs in RRT call criteria, respiratory rate (RR) (p < 0.01) and the needed FiO2 were significantly increased (p < 0.01) in patients with severe disease course. ROC curve analysis revealed RR and needed FiO2 cut-off values of 25.5 breaths/min and 30%. The odds ratio for the progression of clinical deterioration was 40.5 times higher with the combination of RR ≥ 26 breaths/min and needed FiO2 ≥ 30%. Conclusions: The combined use of RR ≥ 26 breaths/min and needed FiO2 ≥ 30% might be valid for identifying patients requiring intensive care management.

DOI： 10.3390/medicina57111194

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Language：Japanese   Publisher：(一社)日本がん看護学会  

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Authorship：Lead author   Language：Japanese   Publisher：(株)ジェフコーポレーション  

市販の油淋鶏弁当の主食:副食の割合を10g:3g、10g:6g、10g:9gに調整し、この順序で一口に食し主観的味覚を点数化した。20〜25歳の健常な日本人女性12名とスリランカ人女性4名を対象とした。副食が増量していくに従い日本人は酸味・渋味・旨味の評価が高くなっていったが、スリランカ人では塩味・甘味・苦味の評価が高くなった。同様の3パターンの食事を味覚センサーで分析した。その結果、白飯をコントロールとした場合、副食の増量に従い酸味・旨味が高くなり、炒飯をコントロールとした場合は酸味が強く影響され、旨味や渋味は副食を6gより増加させてもほとんど変化しなかった。コントロールとして白飯を用いた場合と炒飯を用いた場合とでは味覚のパターンが異なり、日本人・スリランカ人各々の主観的味覚評価のいずれともパターンが一致しなかった。

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Language：English   Publisher：日本外科代謝栄養学会  

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Language：Japanese   Publisher：新潟大学医学部保健学科  

一般病棟に勤務する新卒看護師の終末期がん患者の看取りケアに対する困難感尺度の原案作成を目的とした。対象は全国のがん診療連携拠点病院に勤務する卒後2年目看護師とした。質問票の内容は、死別経験、文献レビューをもとに作成した困難感尺度55項目(5件法)、看取りケアに対する困難感のVisual Analogue Scale(VAS)とした。因子分析の結果、1.患者の死に対する恐怖・不安、2.患者とのコミュニケーションの難しさ、3.看取りケアに対する後悔、4.最期の時を話題にすることへの戸惑い、5.亡くなる間際のケアの悲しさ、6.看取りケアに関する能力の不足感の6因子21項目が採用された。採用された6因子は、患者の死に対して恐怖や不安を抱くという、新卒看護師の特徴的な困難感を表していた。今後は、尺度の信頼性・妥当性のさらなる検討および質問項目の修正・洗練を行い、新卒看護師の教育に活用できる尺度開発を行う。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 68-year-old woman who had leftbreastcancer (cT2N0M0, cStage ⅡA)underwentbreast -conserving therapy and sentinel lymph node biopsy. Pathological diagnosis of the resected specimen revealed a 60mm cancer lesion including a 50 mm invasive ductal carcinoma with surrounding ductal carcinoma in situ, although the pre-operative MRI suggested a 30mm invasive cancer. The surgical margin was positive with the exposure of ductal carcinoma in situ. Additional resection was performed with a resection margin of 20mm from the head-side stump of the previous surgery. Pathological diagnosis of the additionally resected specimen revealed a 6mm invasive carcinoma with its exposure on the surface of the specimen around the new surgical stump distant from the initial surgical margin, where no remnant cancer was noted. She underwent left mastectomy. Pathological diagnosis further revealed 7mm and 2mm invasive carcinomas in the remnant breast. The preoperative imaging was reviewed retrospectively, and it was found that identifying the nodules in the remnant breast was quite difficult based on the images, including MRI. We report a case of breast cancer with metastatic nodules in additionally resected specimens.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 33-year-old woman underwent resection of a right breast mass, which was diagnosed as a fibroadenoma 15 years ago. Ten years later, a right breast mass appeared again, and it was diagnosed as a fibroadenoma based on core needle biopsy. After observation for a while, the mass increased in size, and she underwent resection of the tumor, which was diagnosed as a borderline-malignant phyllodes tumor. A mass appeared again in the right breast and rapidly expanded. A malignant phyllodes tumor was suspected, and right mastectomy was performed. The pathological diagnosis revealed a benign phyllodes tumor. Four years ago, a left breast mass was also detected. Because the mass was suspected to be a fibroadenoma, it has been observed for a few years. The mass has increased in size since 1 year ago, and another mass emerged 2 months ago. Core needle biopsy of the 2 masses revealed that both were phyllodes tumors. She underwent left mastectomy, and the pathological examination revealed that both masses were benign phyllodes tumors. We report this rare case of metachronal phyllodes tumors that presented bilaterally.

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Language：English  

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Language：Japanese   Publisher：(NPO)生物試料分析科学会  

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Language：Japanese   Publisher：新潟医学会  

副乳癌は全乳癌の0.2～0.6%と比較的まれな疾患である．また，近年，高齢者乳癌の一次治療として忍容性の高い内分泌療法が選択される機会が増えている．今回，内分泌療法施行後に根治切除を実施した高齢者副乳癌の1例を経験したので報告する．症例は96歳，女性．右腋窩腫瘤を主訴に受診し，画像検査で右腋窩に径2cmの腫瘤と多数の腫大リンパ節を認めた．腫瘤の針生検は，充実腺管癌，エストロゲン受容体陽性，プロゲステロン受容体陰性，HER2陽性であり，右副乳癌と診断した．高齢で手術を積極的には希望されず，抗HER2療法併用化学療法の実施は忍容性の面から困難と考え，内分泌療法を一次治療として選択した．原発巣，腋窩リンパ節ともに一旦は縮小したが，治療開始9か月目にはリンパ節の一部が増大した．高齢ではあるが耐術可能と判断し，腋窩広範囲切除と右腋窩リンパ節郭清を施行した．術後3年が経過し，明らかな再発を認めずに生存中である．高齢者乳癌治療では，年齢，併存症，臓器機能等を考慮し，手術療法を含めたバランスのとれた治療を選択することが大切である．

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Language：Japanese   Publisher：新潟医学会  

【目的】患者の高齢化, 併存症をもつ患者の増加により, 在院期間の延長, 転院先の受け入れ困難等が社会的な問題となっている. 一方で, 急性期疾患を対象とする基幹病院においては在院日数の短縮が求められており, 各病院 ・施設における医療連携 ・退院支援部署と連動した病病 ・病診連携が重要となっている. 本研究の目的は, 2016年から積極的に開始した新潟医療圏地域包括ケアシステムの構築を目指した病病 ・病診連携の取り組みとその成果を報告することである. 【対象と方法】始めに新潟医療圏における病病 ・病診連携の現状把握を行った. 2015年5月から10月の6か月間に, 新潟大学医歯学総合病院消化器 ・ 一般外科で退院支援部署に退院支援依頼を行った入院患者37名に対して, 依頼までの日数, 実際の支援日数, 在院日数, 転帰等を調査した. その結果を踏まえ, さらにスムーズな連携が行われることを目的として2016年3月に第1回新潟医療圏地域包括ケア推進協議会を開催した. 新潟医療圏11施設の協力を得て, 病病・病診連携を進めていく同意が得られた. 【結果】2015年5月から10月の期間での検討では, 入院後の退院支援依頼までの日数 (中央値) は18日 (範囲 : 1-161日) , 在院日数は31日 (14-322日) であった. 第1回新潟医療圏地域包括ケア推進協議会の後, 2016年5月から12月の期間では, 退院支援依頼までの日数 (中央値) は6日 (1-71日) , 在院日数は29日 (2-101日) であり, 第1回新潟医療圏地域包括ケア推進協議会の後で, 退院支援依頼までの日数, 在院日数が有意に短縮していた (P=0.008, P=0.048) . 【結論】地域包括ケアシステムの構築を目指した我々の取り組みは, 入院早期からの退院支援依頼につながり, 在院日数の短縮に寄与している.

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Language：Japanese   Publisher：新潟大学医学部保健学科  

In this study we aimed to elucidate the current situation and future issues for the Nutrition Support Team (NST) in Niigata prefecture. A questionnaire which included a hospital form, a sickbed scale, whether there was a NST or not, NST activities, effect of the NST intervention, and extent of cooperation with other facilities was administered in hospitals in Niigata prefecture. Among 129 hospitals, 103 hospitals participated, and a NST was established in 57 hospitals. NSTs were more frequently established in hospitals for acute illness and in hospitals with a capacity of ≧150 beds. Remuneration for the NST was calculated and charged more frequently in hospitals with ≧150 beds. Number of NST interventions for past several years increased in 36.5% of hospitals, and effects of NST intervenitons such as a decreased TPN-use, increased EN-use, increased lipid emulsion-use, improved nutritional knowledge of medical staff were recognized. It was shown that many hospitals do not cooperate sufficiently with other hospital NSTs, but do see a need for this. This study suggests there is a need to establish an inter-hospital NST network.

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Authorship：Lead author,　Corresponding author   Language：Japanese   Publisher：(株)ジェフコーポレーション  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Although ductal carcinoma in situ(DCIS)is generally cured by surgical resection, it has been suggested that resection is over-treatment for some patients with DCIS. The aim of this study was to reconsider operative indications for patients with DCIS by examining clinicopathological features of 23 patients who underwent surgical resection for DCIS in our institute over a single year. Postoperative histological examination revealed that there were Luminal and HER2-positive subtypes, but no triple negative cancers. We found coincidental invasive ductal carcinoma(IDC)in 5 patients, and in all 5 the tumor size exceeded 60 mm. There was no coincidence of IDC in patients with a Ki-67 index ≤5%. Positive surgical margins were observed in 7 patients, all of which were histologically diagnosed as DCIS. Only 1 of the 7 patients underwent additional surgical resection; the 6 remaining patients, including 2 patients who received no treatment, did not undergo additional resection. All patients including those with positive surgical margins have had a 5-year relapse-free survival. Our findings imply that the subgroup of DCIS patients without IDC could be followed up without surgery.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Societas Neurologica Japonica  

We report a case of slowly progressive anti-Yo-associated paraneoplastic cerebellar degeneration (PCD) with breast cancer in a 54-year-old woman. The symptoms of limb and truncal ataxia, and dysarthria gradually progressed during the course of 1 year, and the modified Rankin scale (mRS) score was 2. A mastectomy with sentinel lymph node resection was performed for the breast cancer. No malignant cells were found on histopathological examination of the lymph node. Combination chemotherapy with adriamycin and cyclophosphamide (AC) prevented neurologic deterioration. However, subsequent treatment with trastuzumab and paclitaxel did not prevent progression of the symptoms (mRS score 3). Brain magnetic resonance imaging showed atrophy of the cerebellar hemispheres without brain stem atrophy. Anti-Yo antibody was detected in the serum, which led to a diagnosis of anti-Yo-associated PCD. We resected an enlarged axillary lymph node, which was found on computed tomography. The histopathological analysis of the lymph node revealed foreign body granuloma, which suggested an association with necrotic malignant tissue. Following additional tegafur-uracil therapy and two courses of intravenous immunoglobulin (IVIg), the cerebellar signs and symptoms gradually improved (mRS score 2). The clinical course shows that PCD can present as a slowly progressive cerebellar symptom. We propose an active treatment for anti-Yo-associated PCD consisting of tumor resection, combined chemotherapy, and IVIg.

DOI： 10.5692/clinicalneurol.cn-000872

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Language：English   Publishing type：Research paper (international conference proceedings)   Publisher：ELSEVIER SCIENCE INC  

© 2016 Elsevier Inc. All rights reserved. Background Complete immune tolerance is the chief goal in organ transplantation. This study aimed to evaluate patients who successfully withdrew from immunosuppressive (IS) agents after living donor liver transplantation (LDLT). Materials and Methods A retrospective review of all adult LDLT from July 1999 to March 2012 was conducted. In patients who acquired immune tolerance after LDLT, their background and the course of surgical procedures were evaluated. Results Of a total of 101 adult LDLT patients, 8 patients were completely free of IS agents. Six of these patients (75%) were female, and the median age at the time of transplantation was 56 years (range, 31-66 years). The primary disease causing liver failure was type C liver cirrhosis (50%), fulminant hepatitis (25%), type B liver cirrhosis (12%), and alcoholic liver cirrhosis (12%). The median Child-Pugh score and MELD score were 13 points (range, 8-15 points) and 19 points (range, 10-18 points), respectively. The living related donor was the recipient's child (75%), sibling (12%), or parent (12%). ABO compatibility was identical in 62%, compatible in 25%, and incompatible in 12%. Conclusions In this study, we evaluated the adult patients who successfully withdrew from IS agents after LDLT. In most cases, it took more than 5 years to reduce IS agents. Because monitoring of the serum transaminase level is not adequate to detect chronic liver fibrosis in immune tolerance cases, further study is required to find appropriate protocols for reducing IS agent use after LDLT.

DOI： 10.1016/j.transproceed.2015.12.093

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 63-year-old woman was found to have a mass in her right breast and visited our hospital to undergo a detailed examination. A histopathological examination by using ultrasound-guided core needle biopsy revealed ductal carcinoma in situ. A partial mastectomy with sentinel lymph node biopsy was performed for the cancer of the right breast. The postoperative histopathological examination indicated apocrine carcinoma with a predominantly intraductal component without lymph node metastasis. The discrimination between ductal adenoma and apocrine carcinoma sometimes becomes a problem in making decisions about treatment. We need to take care when making a diagnosis.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 58-year-old woman presenting with abdominal distension was diagnosed with a tumor in the right ovary. A chest-abdominal-pelvic computed tomography scan revealed multiple lung metastases, multiple liver metastases, and peritoneal dissemination. Invasion of the rectum by peritoneal dissemination of the Douglas' pouch was suspected. She was diagnosed with Stage Ⅳ right ovarian cancer and was treated with preoperative chemotherapy. After chemotherapy, debulking surgery of the abdominal cavity (total hysterectomy, bilateral salpingo-oophorectomy, partial omentectomy, and Hartmann's procedure) was performed. Because there was swelling observed in multiple mesorectal lymph nodes, lymph node dissection was performed based on methods used for rectal cancer surgery. Postoperative histopathological examination revealed multiple mesorectal lymph node metastases arising from ovarian cancer. We suggest that mesorectal lymph node dissection be considered a part of debulking surgery for ovarian cancers that have invaded the rectum.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 64-year-old woman discovered a mass in her left breast and visited our hospital. A thorough examination resulted in a diagnosis of left, locally advanced breast cancer (cT4bN3, M0, cStage Ⅲc) with muscle invasion and Level Ⅲ lymph node metastases. Because of drug-induced lung disease following 4 courses of adriamycin and cyclophosphamide, the chemotherapy had to be stopped. Halsted's operation and postoperative radiotherapy (50 Gy) were performed. The patient was alive with no evidence of recurrence 9 months after surgery. Although multidisciplinary therapy is recommended in locally advanced breast cancer, chemotherapy sometimes cannot be performed due to factors such as age and physical status. Halsted's operation could be considered as a treatment of choice in patients with locally advanced breast cancer. It is important to choose the treatment strategy based on the condition of the patient.

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Language：Japanese   Publisher：新潟医学会  

症例は80歳女性. 前医で下部直腸癌に対し経肛門的局所切除術が施行された. 局所切除後2年1か月目に, 外陰部から肛門にかけて掻痒を伴う紅色扁平隆起性病変が明らかとなった. 生検でPaget細胞が認められた. 乳房外Paget病は, 皮膚原発の一次性乳房外Paget病と二次性乳房外Paget病に分類され, 鑑別診断には免疫組織化学染色が有用である. 本症例では, 免疫組織化学染色でGCDFP-15陰性, CK20陽性, CK7陰性であり, Pagetoid spreadを伴う直腸癌局所再発と診断した. CT検査で所属リンパ節および遠隔転移を認めなかった. 外陰部膣合併切除を伴う腹会陰式直腸切断術を行うことで, 治癒切除となった. 直腸癌局所切除後のPagetoid spreadを伴う再発形式は稀であるが, Paget細胞遺残の可能性を考慮し, 外来通院時の肛門皮膚観察に注意すべきである.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

Pneumatosis cystoides intestinalis (PCI) is a relatively rare condition, characterized by subserosal or submucosal air within the bowel wall. Herein, we report a rare case of PCI secondary to treatment with an epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI). A 71-year-old man, who had received gefitinib therapy for 2 years and 5 months for lung adenocarcinoma with metastases to the bones and brain, presented with abdominal pain, diarrhea, and vomiting. Computed tomography of the abdomen revealed intramural air in the small bowel, free air in the abdomen, and moderate ascites. A diagnosis of PCI was made, and the patient was managed conservatively by discontinuing gefitinib treatment, because his vital signs were stable and there was no sign of peritonitis. The patient's symptoms gradually improved, and follow-up CT after 1 week revealed that the initial findings had almost completely resolved. Clinicians should note that treatment with gefitinib might cause PCI.

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Language：Japanese   Publisher：新潟医学会  

近年、マンモグラフィー検診の普及に伴い、非触知乳癌の発見率が上昇してきている。非触知乳癌の中には、石灰化病変のみで発見される非浸潤性乳管癌(Ductal carcinoma in situ:DCIS)も多く含まれるが、石灰化病変を超音波検査で描出することは困難なことがあり、手術に際し切除範囲の設定には苦慮することも多い。臨床上、実際に十分切除できているのか否かを術中に判断することは、その後の局所再発を防ぐ上で極めて重要である。今回、石灰化病変のみで発見された乳癌症例に対し、術中に切除標本のマンモグラフィーを撮影し、石灰化病変が切除できていることを確認できた症例を経験した。症例は51歳、女性。検診マンモグラフィーで右乳房の石灰化を指摘され、ステレオガイド下マンモトーム生検を施行し乳癌と診断された。超音波検査では石灰化病変の描出は困難であったが、マンモトーム生検時に留置したクリップ部位をマーキングし、乳房温存手術を施行した。術中に切除標本マンモグラフィーを施行し、ターゲットとした石灰化病変が切除できていることを確認して手術を終了した。術後病理診断でも術前に予測した石灰化病変が完全に切除できていることを確認できた。切除標本マンモグラフィーは、簡便に石灰化病変の切除範囲の確認が可能な方法として有用であり、文献的考察を加えて報告する。(著者抄録)

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Language：Japanese   Publisher：新潟医学会  

甲状腺腫瘍に対し甲状腺全摘術施行後に濾胞腺腫と診断され, その3年後に骨転移が出現し, 初回の摘出腫瘍が濾胞癌であったことが判明した1例を経験したので報告する. 症例は61歳, 男性. 他院で甲状腺腫瘍に対し甲状腺全摘術が施行され, 術中迅速診断および永久病理診断で腺腫と診断されていた. しかし, 術後3年目頃から腰痛・下肢痛が出現, その後, 下肢麻痺を認めたため当院整形外科で第5腰椎切除が行われ, 術後病理診断では甲状腺濾胞癌の骨転移の診断であった. 経過から初回甲状腺腫瘍が濾胞癌であったと考えられた. 甲状腺濾胞癌は細胞異型がほとんど認められないため術前細胞診での診断は困難とされている. 濾胞腺腫を疑った場合でもサイログロブリン高値等の場合は濾胞癌の可能性を考慮して治療やフォローアップを行っていく必要がある.

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Other Link： http://hdl.handle.net/10191/44091

Language：Japanese  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

We report three cases of esophageal carcinoma all of which achieved a pathological complete response after neoadjuvant chemotherapy (NAC) with cisplatin and 5-fluorouracil (CF). All three patients were men with clinical stage II squamous cell carcinoma of the middle thoracic esophagus. We administered 2 courses of CF treatment as NAC and then performed radical esophagectomy. Pathologic examination revealed no viable tumor cells in the resected esophagus. The patients are currently alive with no evidence of disease.

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Language：Japanese   Publisher：(株)癌と化学療法社  

術前CDDP/5-FU(CF)療法にて組織学的完全奏効(pathological complete response:pCR)が得られた食道癌の3例を経験した。全例男性、胸部中部食道、臨床病期IIの扁平上皮癌であった。3例とも標準的CF療法を2コース施行後、根治的食道切除、3領域リンパ節郭清を施行した。切除標本に癌細胞の遺残は認められず、pCRと判定された。現在3例ともに無再発生存中である。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

A 34-year-old woman presenting with bloody stools was diagnosed with a rectal tumor. Computed tomography (CT) revealed multiple liver masses in Couinaud segments IV, V, and VU. The lesions were diagnosed as multiple liver metastases from rectal cancer. Right trisegmentectomy of the liver was considered the optimal treatment option for curative resection; however, liver volumetric examination using CT estimated that the remnant liver volume after right trisegmentectomy would be only 24.6 % of the total liver volume. Therefore, she underwent resection of the primary lesion followed by systemic chemotherapy for multiple liver metastases. She showed a partial response, according to the Response Evaluation Criteria in Solid Tumors, after 5 courses of capecitabine/oxaliplatin plus bevacizumab. Embolization of the right branch of the portal vein was performed to increase liver volume. A subsequent liver volumetric examination with CT estimated that the remnant liver volume after right trisegmentectomy would be 38.4 % of the total liver volume. Therefore, she underwent right trisegmentectomy of the liver for curative resection of the liver metastases. She had had no signs of recurrence at 3 years and 6 months after initial surgery.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

Herein, we present a case of long-term survival after lateral pelvic lymph node dissection for recurrence in the form of skip metastasis of rectal cancer. A 63-year-old man underwent abdominoperineal resection without lateral pelvic lymph node dissection for advanced lower rectal cancer. The histological diagnosis was type 2, 85×50 mm, tub1, pT4a, ly0, v1, pPM0, pDM0 and pN0, pStage II (Japanese Classification of Colorectal Carcinoma, 8th edition). Six months after surgery, enhanced computed tomography showed right obturator lymph node metastasis. We performed lateral pelvic lymph node dissection. Histological examination revealed moderately differentiated adenocarcinoma in the right obturator lymph node. The lymph node metastasis was diagnosed as a skip metastasis of the rectal cancer. The patient has had no recurrence for 9 years after resection of the lateral pelvic lymph node.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

An 81-year-old man presented with chief complaints of abdominal pain and vomiting. Intestinal obstruction was found at the time of admission to a local hospital in October 2011. Conservative treatment provided symptomatic relief; however, he was readmitted with similar symptoms in December 2011. Small-intestinal wall thickening was detected by abdominal and pelvic computed tomography, and he was referred to our hospital. Small-bowel endoscopy revealed an elevated subcircumferential tumor in the jejunum. Biopsy revealed well to moderately differentiated adenocarcinoma diagnosed as jejunal cancer, which caused narrowing of the jejunum. Single-incision laparoscopy-assisted small-bowel resection was performed. The intraoperative findings were a tumor with inflammatory changes in the jejunum and enlarged surrounding lymph nodes. We performed regional lymph node dissection. Histopathological analysis showed moderately differentiated small-intestinal tubular adenocarcinoma and 2 of 5 lymph nodes positive for metastatic cancer cells. After an uneventful postoperative course, he was discharged on day 7. He preferred not to undergo postoperative adjuvant chemotherapy and quickly recovered his activities of daily living postoperatively. He stayed home until he developed abdominal distention resulting from peritoneal recurrence 1 year and 6 months postoperatively and died 1 month later.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

Purpose: In the present study, we aimed to describe the surgical results of single-port laparoscopic stoma creation in our institution. Methods: We examined the safety of the surgical procedure and short-term results in 10 consecutive patients who underwent single-port laparoscopic stoma creation at our hospital between April 2011 and July 2013. Results: The median age of the patients was 60.5 (range, 31-75) years. Five patients were men, and 5 were women. There were 5 cases of colorectal cancer, 2 each of extramammary Paget's disease and uterine cancer, and one of perineal neurofibroma. Eight surgeries were performed for bowel obstruction or stenosis, and two surgeries were performed for other reasons. The median operative time was 59.5 (range, 40-91) min, blood loss volume was 0 (range, 0-10) mL, postoperative duration before commencement of oral intake was 2.5 (range, 1-4) days, and duration of postoperative hospital stay was 11 (range, 5-19) days. No short-term complications were noted after the surgery. Conclusion: Single-port laparoscopic stoma creation appears to be feasible in terms of safety and short-term surgical results, and may improve the quality of life of patients requiring fecal diversion.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

A 57-year-old woman was referred to our hospital because of descending colon cancer with multiple liver metastases. Abdominal magnetic resonance imaging (MRI) revealed 13 liver metastases across the lobes. We started combination chemotherapy with capecitabine/oxaliplatin (CapeOX) and bevacizumab. After 9 courses of the treatment, the number and size of the liver metastases were remarkably reduced on MRI. Left colectomy and partial hepatectomy were performed. Histopathological examination revealed no residual cancer cells in the colon but revealed a few cancer cells in 4 of 7 resected liver specimens. At 11 postoperative months, 1 liver metastasis reappeared, for which we performed laparoscopy-assisted partial hepatectomy. At 21 months after the second operation, the patient was well without any signs of recurrence. Thus, the combination chemotherapy with CapeOX and bevacizumab allowed for the successful resection of the tumor and metastasis in our patient who initially had unresectable colon cancer and multiple liver metastases.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

Herein, we present a case of advanced rectal cancer surgically resected after chemotherapy. A 65-year-old woman presented with anal pain, and rectal cancer extending beyond the anus was diagnosed. The primary tumor was a well-differentiated adenocarcinoma with a KRAS mutation. Computed tomography revealed cancer invasion into the vagina and sacral and coccygeal bones, and cancer metastases to the bilateral inguinal lymph nodes and the left lung. Sigmoid colostomy and subcutaneous venous port insertion were performed. The patient was treated with modified oxaliplatin, leucovorin, and 5-fluorouracil (FOLFOX6) plus bevacizumab. She showed a partial response according to the Response Evaluation Criteria in Solid Tumors after 13 courses of chemotherapy. The primary tumor was then resected via posterior pelvic exenteration, bilateral inguinal lymphadenectomy, and sacral/coccygeal resection. Histological examination of the resected specimens revealed moderately differentiated adenocarcinoma with vaginal invasion. Metastasis to a right inguinal lymph node was observed. The pathological stage was ypT4bN0M1b, ypStage IV according to the tumor-node-metastasis system of the eighth edition of the Japanese Classification of Colorectal Carcinoma. The pathological response grade of the tumor after chemotherapy was determined to be Grade 1b.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

A 69-year-old man with advanced rectal cancer and liver metastases was treated with 2 courses of chemotherapy with irinotecan and S-1 followed by low anterior resection and partial hepatectomy. Chemotherapy with S-1 was then administered for 22 months. However, lung metastases developed, for which partial pneumonectomy was performed. Seven months later, computed tomography (CT) revealed swelling of the left supraclavicular lymph node. Despite chemotherapy with 5-fluorouracil, Leucovorin, and oxaliplatin (mFOLFOX6); 5-fluorouracil, Leucovorin and irinotecan (FOLFIRI); and capecitabine plus bevacizumab, the lung metastases recurred and Virchow lymph node swelling was noted again. Accordingly, palliative therapy was administered. The patient died 3 years 1 month after Virchow lymph node resection. Herein, we describe a case of advanced rectal cancer, in which lung and Virchow lymph node metastases developed after liver metastasis. Surgical excision of the metastases resulted in long-term survival of 6 years following the first operation.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

A 70-year-old man was referred to our hospital with ascending colon cancer (cT3N1M0, Stage IIIa), which was found during examinations following a positive fecal occult blood test. The patient was also diagnosed with early gastric cancer (cT1a, NO, MO, Stage IA) during a preoperative gastroscopy examination. A laparoscopically assisted right colectomy and D3 lymphadenectomy was performed for the ascending colon cancer. The postoperative pathological diagnosis was Stage IIIb (pT3N2), he was administered in combination with capecitabine plus oxaliplatin (CapeOX) as adjuvant chemotherapy before the treatment for the colon cancer. After 6 months of adjuvant chemotherapy, we were unable to detect any gastric lesions at the same location using gastroscopy, and so diagnosed a clinical complete response. A follow-up gastroscopy 6 months later showed the same findings. The patient has had no recurrence of gastric cancer for 18 months after the initial operation. He will continue to be followed up closely using gastroscopy. In this case, CapeOX as adjuvant chemotherapy for advanced colon cancer was also effective for early gastric cancer.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

A 71-year-old man was referred to our hospital because of repeated bowel obstruction. He had previously undergone cystectomy with ileal conduit urinary diversion for the treatment of bladder cancer at the age of 28 years. Computed tomography revealed a mass in the ascending colon. Ileostomy was initially performed because of poor general condition that improved with postoperative nutrition management. Enema findings revealed ascending colon cancer and we therefore decided to perform curative surgery. Intraoperative findings revealed that the ascending colon cancer had invaded the ileal conduit. However, it was confirmed that the ureter-ileal conduit anastomosis and the mesentery of the ileal conduit could be preserved. We performed right colectomy and partial resection of the ileal conduit with curative intent. The pathological stage was pT4bpN0cM0, pStage II. There were no signs of recurrence 15 months after curative surgery.

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は81歳、男性。主訴は腹痛、嘔吐で腸閉塞を生じ、近医で入院加療が行われた。保存的治療で症状は改善したが、2ヵ月後に同じ症状で再入院となった。腹部骨盤部CT検査で小腸壁の肥厚が指摘されたため、当院紹介となった。小腸内視鏡検査で空腸に亜全周性の隆起性腫瘍を認め、生検で高分化〜中分化腺癌と診断された。狭窄所見を伴う空腸癌と診断し、単孔式腹腔鏡補助下空腸部分切除術を行った。術中所見として、空腸に炎症性変化を伴う腫瘍が確認された。リンパ節の腫大を認めたため腸管周囲リンパ節の郭清を行った。病理組織結果は小腸中分化管状腺癌、リンパ節は2/5個で転移陽性であった。術後経過は良好で、7病日に退院となった。術後補助化学療法は希望されなかった。術後すぐに日常生活動作は回復し、自宅で生活されていた。術後1年6ヵ月ごろより腹膜再発による腹部膨満を生じ、1年7ヵ月で永眠された。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

A 49-year-old woman with a growing tumor of the left anterior chest wall was admitted to our hospital. This patient was diagnosed with a malignant well-differentiated tumor by needle biopsy and underwent surgery involving wide resection of the tumor, associated excision of the major pectoralis muscle, and part of the mammary tissue and skin. The tumor measured 14.2X 17.8 cm and weighed 1,220 g. Histopathologically, the tumor was confirmed to be a dedifferentiated liposarcoma, and local recurrence and metastasis often occurs in spite of complete surgical resection. However, no local recurrence or metastasis has been detected 2 months post-surgery. The main anatomic sites of liposarcomas are the retroperitoneum and lower extremities; only 19 liposarcoma cases of the anterior chest wall have been reported in Japan.

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Language：Japanese   Publisher：新潟医学会  

【緒言】消化器外科領域では, 術前・術後の栄養管理に加え, 昨今では化学療法の重要性が急速に増してきており, CVカテーテルの必要性が増大している. 体表解剖に基づいたランドマーク法による鎖骨下静脈(以下SCV)穿刺は, ブラインド穿刺のため, 時に気胸・動脈穿刺など, 種々の合併症を引き起こすことがある. リアルタイムエコーガイド下のSCV(USgSCV)穿刺で, これらの合併症が激減することが報告されているが, 主に放射線科で実施されており, 広く普及するには至っていない. そこで, 我々は一般外科診療において, 市中病院で容易に入手可能な材料を用いて, 安全にSCVの穿刺を行える手技の工夫および検証を行ったため, 報告する. 【方法・結果】Sakamotoらの穿刺法に筆者の工夫を加え, 7.5MHzの体表プローベを用いてSCVを長軸に描出し, エコー観察下にフリーハンドでSCV穿刺を行う手技を施行した. USgSCV穿刺施行例のうちCVポート増設を行ったものは3施設18例で, 合併症の発生はみられなかった. 平均手術時間は30分であり, 経験症例数やBMIによって手術時間は影響を受けなかった. 【結語】USgSCV穿刺法は, 動脈・静脈の走行を直接確認しながら, 合併症フリーでのSCV穿刺が可能であった. 手術室のみならず, 病棟での処置にも十分応用可能であり, エクストラコストを最小限に留めながら安全性のメリットを享受できうる方法であった.

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Language：Japanese   Publisher：新潟医学会  

肝細胞癌の主たる再発形式は肝内再発であるが, リンパ節再発は比較的稀である. 今回, 肝細胞癌に対して肝切除後に異時性リンパ節転移再発を認めた症例を経験したので, 文献的考察を加えて報告する. 症例は66歳, 男性. C型肝硬変の経過観察中に肝S6, S8-4の多発肝細胞癌を指摘され, 各々肝部分切除術が施行された. 病理組織診断は, 肝S6病変が中分化型, 肝S8-4病変が低分化型肝細胞癌であったが, 肝S8-4の病変はサイトケラチン7,19陽性の肝細胞癌であった. 術後1年4か月後のCT検査で膵頭部背側のリンパ節の腫大を認めたため, 肝細胞癌の孤立性リンパ節転移再発と診断し, リンパ節摘出術を施行した. 病理組織診断は, サイトケラチン7,19陽性の肝細胞癌のリンパ節転移であった. 本症例は, 肝細胞癌2病変のうち, 胆管上皮マーカーであるサイトケラチン7,19陽性であった肝S8-4病変からリンパ節転移再発をきたしたと考えられた. サイトケラチン7,19陽性の肝細胞癌は, 肝内胆管癌と類似した生物学的悪性度を有しリンパ節転移をきたす可能性があるため, 肝硬変に伴うリンパ節腫大との鑑別および術後の経過観察の際には肝外病変に対しても注意が必要である.

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

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Language：Japanese   Publisher：新潟医学会  

【目的】本研究の目的は, 局所進展が高度な肝内胆管癌に対する術前化学療法の効果と周術期に及ぼす影響を明らかにすることにある. 【方法】当科で2009年1月から2012年8月までに術前の画像診断で根治切除が困難・不能と判断された症例に対して術前化学療法を行った5例を対象とした. 根治切除が困難・不能と判断した因子は, 高度局所進展(腹壁・胃への浸潤, 腹膜播種)が4例, 高度局所進展+大動脈周囲リンパ節転移が1例であった. 術前化学療法としては, gemcitabine(GEM)が2例, テガフール・ギメラシル・オテラシルカリウム配合剤(S-1)が1例, GEM+S-1が1例, GEM+S-1からGEM+cisplatinに変更が1例であった. 抗癌剤効果判定基準(RECISTガイドライン)に準じて術前化学療法の効果を判定した. 【成績】標的病変の抗癌剤効果判定は, 部分奏功(PR)が1例(GEM+S-1を施行し腫瘍縮小率68%), 安定(SD)が3例, 進行(PD)が1例であり, 奏功率は20%であった. Grade3の有害事象を1例に認めたが, 全例で術前化学療法前に立案していた術式の遂行が可能であった. 全例にR0切除が行われ, pStage Iが1例, pStage IVAが3例, pStage IVBが1例であった. 術後合併症を3例に認めた. その内訳は, 腹腔内膿瘍2例, 仮性動脈瘤破裂1例, 腸炎1例, リンパ漏1例(重複あり)であった. 術後在院死亡は認めなかった. 術前化学療法の効果判定がPRとSDであった2例が, 各々術後9か月, 14か月に原病死したが, 残り3例は生存中であった. 全症例の累積1年生存率は75%, 累積2年生存率は50%, 生存期間中央値は14か月であった. 【結論】局所進展が高度な肝内胆管癌に対する術前化学療法は安全に施行でき, 化学療法前に立案していた術式を遂行可能である. ただし, 術前化学療法の奏功率が低いこと, 奏功しないPD症例が存在することが臨床上の問題点として挙げられる.

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Language：Japanese   Publisher：(株)メディカルレビュー社  

精神科病院に入院している患者は薬剤の副作用、食事摂取量や運動量の低下などにより低栄養に陥っている可能性も少なくないと考えられる。そこで今回、精神科病院入院患者の入院時栄養状態の調査を行った。その結果、国民健康・栄養調査の結果と比較すると、精神科病院入院患者ではヘモグロビン値、血清蛋白値、血清アルブミン値が低く、栄養不良の割合が高い可能性が考えられた。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

We compared the effects of the Airway Scope (R) on haemodynamic responses during tracheal intubation with those of direct laryngoscopy in normotensive and hypertensive patients. The systolic blood pressure, diastolic blood pressures and heart rate were recorded: (a) before anaesthesia; (b) immediately before intubation; (c) at intubation; and (d) 1, 2, 3, 4 and 5 min after intubation. In normotensive patients, the increase in blood pressure and heart rate over time were significantly lower with the Airway Scope than with the Macintosh laryngoscope (p &lt; 0.003). In hypertensive patients, however, there was no difference in the changes over time in any of these haemodynamic measures between the two devices (p &gt; 0.05). We conclude that the Airway Scope attenuates haemodynamic responses to tracheal intubation in comparison with the laryngoscope in normotensive but not in hypertensive patients.

DOI： 10.1111/j.1365-2044.2011.06802.x

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Language：English   Publisher：WILEY-BLACKWELL  

DOI： 10.1111/j.1365-4632.2010.04483.x

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Language：Japanese   Publisher：The Japanese Society of Pediatric Surgeons  

We herein report a case of phyllodes tumor occurring in the right breast of an 11-year-old girl. She first noticed a mass in the right breast at the age of 11 years. She consulted our hospital due to an ongoing increase in the size of mass three months after the first notice of the mass. The well margined mass of 12×12×9cm in size was elastic and soft and occupied the whole right breast. Fine needle aspiration cytology demonstrated component of epithelial cells without any evidence of malignancy. CEA and CA15-3 were within normal range. Because the tumor was diagnosed as a benign tumor such as a fibroadenoma or phyllodes tumor by the preoperative imaging studies with CT and MRI, a simple tumor extirpation was performed through an inframammary incision leaving as much breast gland as possible. The postoperative histological examination confirmed the diagnosis of a benign phyllodes tumor. The postoperative progress is uneventful without a local recurrence in a follow-up of three years, even though the development of the remaining breast gland is still not compensated.

DOI： 10.11164/jjsps.47.2_251

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Authorship：Lead author,　Corresponding author   Language：Japanese   Publisher：日本外科代謝栄養学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER TOKYO  

A 58-year-old woman was admitted to our hospital with the complaint of dysphagia that had developed 37 months after initiation of treatment for breast cancer. Endoscopy revealed severe stenosis 32 cm from the incisors through which the endoscope could not pass. No mucosal irregularities were observed, and biopsies of the stenotic lesion were negative for malignancy. Computed tomography showed wall thickening of the midthoracic esophagus and left pleural effusion, which had increased metabolic activity as detected by 18F-fluorodeoxyglucose positron emission tomography. Cytological examination of the pleural effusion showed adenocarcinoma compatible with metastasis from a prior lobular carcinoma of the breast. Vinorelbine effectively relieved her symptoms, and the disease stabilized for approximately 1 year. However, she died 16 months after the diagnosis of metastatic esophageal tumor from the preceding breast cancer. © Japan Esophageal Society and Springer 2010.

DOI： 10.1007/s10388-009-0216-x

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Language：Japanese  

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Language：Japanese   Publisher：日本外科代謝栄養学会  

通常の食事が摂取可能な担癌生体における抗酸化成分付加作用を調べるため、ラット乳癌モデルに対し抗酸化成分含有栄養剤を投与した場合の(1)摂食量及び全身状態(2)腫瘍増殖(3)抗酸化機構、への効果について検討を行った。雌性F344ラットを2群に分け抗酸化成分含有栄養剤(AO diet)又はControl dietを3週間制限給餌した。開始1週間の時点で乳癌細胞MATB-IIIを背部皮下へ移植し、移植7、14日後に解剖した。移植4日後まで及び11日後にControl群と比較してAO群において栄養剤摂食量が有意に多かった。腫瘍容積はControl群に比較してAO群では6、7、9日目で有意に低値を示した。Superoxide Dismutase活性はControl群と比較してAO群において移植後日数の経過による低下が見られず、Catalase活性はControl群と比較してAO群で移植後に有意に高値を示した。さらにAO群でのみ両酵素に相関が見られた。これらの結果から担癌ラットに対する抗酸化成分含有栄養剤の投与は、活性酸素消去系の活性維持に影響する可能性が示唆された。(著者抄録)

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Language：Japanese   Publisher：(株)メディカルレビュー社  

低栄養では亜鉛(Zn)の欠乏を伴う場合も少なくないが、入院時の栄養スクリーニングとして血漿Zn値の測定が有用なのかを検討した。CONUT法による栄養評価と血漿Zn値により、入院時栄養状態良好なZn低値群およびZn正常群を抽出し、入院後の栄養評価を行った結果、Zn低値群で栄養状態が悪化する割合が有意に高かった。入院時に血漿Zn値を測定することが栄養状態の変動予測につながる可能性が示唆された。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)  

A 49-year-old man was referred to our hospital for treatment of an esophagorespiratory fistula following 5-year airway stenting for stenosis of tracheal anastomosis. In consideration of the prior polysurgery and the patient's poor general status and malnutrition, we selected multistep esophageal bypass combined with feeding enterostomy for nutritional support. Respiratory symptoms and pneumonia were rapidly improved by esophageal transection and decompression via a catheter esophagostomy. Nutritional status was also improved by enteral nutrition via a catheter gastrostomy. Four months after the esophageal transection, we conducted an esophageal bypass using an ileocolonic conduit because the right gastroepiploic artery had been used for omental reinforcement of tracheal anastomosis. The patient had no postoperative complications and was discharged 53 days after the bypass surgery. Multistep esophageal bypass including feeding enterostomy for perioperative nutritional management is a safe and useful alternative to direct closure for a critically ill patient with an esophagorespiratory fistula who is at high risk for operative mortality. © 2008 Japan Esophageal Soceity and Springer.

DOI： 10.1007/s10388-008-0148-x

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Aquaporins (AQPs) are a family of water channel proteins comprising 13 members, of which five (AQP1, AQP 4, AQP 5, AQP 8 and AQP12) have been detected in the rat exocrine pancreas. However, the dynamics and role of AQPs in pancreatitis, which is characterized by interstitial edema and acinar cell injury, are unclear. This experimental study using a caerulein-induced pancreatitis model aimed to investigate the kinetics of AQPs in pancreatitis. Male Wistar rats received a caerulein infusion (10 μg/kg/h) for three h and then were sacrificed at three h and 72 h after the start of infusion. The expression of mRNA and protein for AQP1 and AQP8 were examined by quantitative reverse transcription polymerase chain reaction (RT-PCR), Western blotting, and immunohistochemistry. In the control group, AQP1 was located in the pancreatic ductal cells and capillary endothelia, whereas AQP8 was positive only in the acinar cells. Macroscopically and microscopically, obvious pancreatitis was observed in the acute pancreatitis phase (three h group), while it disappeared in the recovery phase (72 h group). AQP1 expression in the pancreatic ductules decreased in both the three h and 72 h groups. AQP8 expression was depressed in the three h group when the acinar cell swelling was observed, while AQP8 expression was focally decreased in the 72 h group. These results suggest that the decrease in AQP1 and AQP8 show a latent injury in the ductal cells and acinar cells. They can be related to the mechanisms of edematous pancreatitis.

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Language：Japanese   Publisher：Niigata University  

消化管の手術後にSerratia marcescesによる敗血症を発症した4例を報告する.症例1は59歳の男性で,上行結腸癌に対し結腸右半切除術後5日目に敗血症を発症.エンドトキシン吸着(以下,PMX)施行,救命しえた.症例2は34歳の女性で,家族性大腸線腫症に対し回腸人工肛門閉鎖術後17日目に腸閉塞を発症,その4日後に腸閉塞は軽快するも敗血症を発症.急激な全身状態の悪化を認め死亡.症例3は74歳の男性で,胃癌に対し幽門側胃切除術後7日目に敗血症を発症.敗血症性ショックに陥り,PMX施行するも死亡.症例4は78歳の男性で,胃癌に対し胃全摘術,脾摘術後24日目に敗血症を発症.PMX施行し,救命しえた.Serratia marcescesによる敗血症は症状が急速に進行するため致命率が高い.発症した場合は血液浄化療法を迅速に行う必要がある.

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/01.mpa.0000278691.71059.90

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Language：Japanese   Publisher：(一社)日本臨床栄養学会  

PPN療法の適応となる消化器術後患者で,経口的栄養補給が不能のため術後3日間を超える絶食期間が予想される患者125名を対象に,TAJ-01投与により血中ビタミンB1濃度が基準値下限(28ng/ml)を下回らずに維持できることを確認するため,既承認のPPN輸液剤GABを対照薬とした多施設共同無作為割付並行群間比較試験を実施した.その結果,術後4日目及び6日目の早朝空腹時血中ビタミンB1維持度はPPN用キット輸液剤(TAJ-01)群64例がアミノフリード(GAB)群61例に比べ有意に高かった.又,TAJ-01群のビタミンB1投与量と血中ビタミンB1濃度には相関はなかった.安全性については発現した有害事象・副作用は両群で同定でお出問題はないと思われた.TAJ-01はPPN療法において,血中ビタミンB1濃度を維持し,安全にPPN療法ができる臨床的に有用な製剤と思われた

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Authorship：Lead author,　Corresponding author   Language：Japanese   Publisher：Niigata University  

In mammals, a family of water-selective channels, aquaporins (AQP0〜10) has recently been identified and localized in various organs and tissues. In digestive organs, AQP1 and AQP3 were generally present from esophagus to colon. In contrast, AQP4 expression was selectively observed in the epithelium of lower stomach and small intestine and AQP8 in the epithelium of jejunum and colon. AQP8 mRNA expression was exclusive in the pancreas and liver. The wide distribution of AQP family members in digestive organs suggested their essential roles in water transport across plasma membranes of various cells, especially in epithelia of organs where marked water intake or outlet is presumed.

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Language：Japanese   Publisher：Japan Surgical Association  

A 77-year-old woman presented with an enlarged cervical mass for nine months. Fine needle aspiration cytology of the mass showed papillary carcinoma. Preoperative contrast enhanced computed tomogram and magnetic resonance imaging scan of the neck revealed a 10&times;9.5&times;6.5cm tumor with extensive tumor thrombi in the left internal jugular vein. A total thyroidectomy with modified radical neck dissection, combined with resection of the left internal jugular vein was performed and the entire tumor including tumor thrombi was removed macroscopically.<br> Patients with differentiated thyroid carcinoma, especially papillary carcinoma rarely develops macroscopic tumor thrombus. Only a few cases of differentiated thyroid carcinoma showing such invasive nature have been reported, but they generally had a poor prognosis and high mortality. This patient has been followed for 28 months after successful operation without recurrence.

DOI： 10.3919/jjsa.67.28

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER TOKYO  

We present herein a rare case of a long-term survivor after major hepatectomy performed for a metastatic liver tumor from carcinoma of the papilla of Vater. A 74-year-old man had undergone a pancreaticoduodenectomy for carcinoma of the papilla of Vater with obstructive jaundice, in April 1995. Histologically, an exposed mass-forming type of tumor, measuring 40 × 30mm, was composed of mucinous and papillary adenocarcinoma, invading into the muscularis propria of the duodenum, without lymph node metastases. The patient did not receive any type of chemotherapy. In September 1999, a solitary hepatic tumor, 3.5cm in diameter, was detected in segment VIII of the liver by computed tomography. In November 1999, right hepatic lobectomy was carried out. The anterior and posterior portal pedicles were ligated and dissected in the hepatic parenchyma so as not to compromise the hepaticojejunostomy. After the hepatectomy, the patient was treated with low-dose tegafur/uracil/cisplatin therapy for approximately 2 years. He has been doing well, without recurrence, for 5 years after the hepatectomy. Hepatectomy for hepatic metastases from carcinoma of the papilla of Vater is thought to be a useful surgical treatment in selected patients. © Springer-Verlag Tokyo 2005.

DOI： 10.1007/s00534-005-0972-5

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Language：Japanese   Publisher：Japan Surgical Association  

We report a case of a breast tumor in which differentiation from clear cell carcinoma was difficult. A 41-year-old woman was seen at our hospital because of a right breast mass. A mass 1.5 cm in diameter was observed in the A area of the right breast, and was suggestive of malignancy from the physical findings, mammography and ultrasonography. An excisional biopsy was performed to make a final diagnosis; the histological diagnosis was fibromatosis, but a part of the specimen contained clear cells that were suspected as being clear cell carcinoma. Finally the lesion was diagnosed as clear cell metaplasia to identify its seriality to a lobule. The recognition of clear cell metaplasia is important in preventing its misinterpretation as clear cell carcinoma.

DOI： 10.3919/jjsa.65.1197

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Language：Japanese   Publisher：金原出版(株)  

24歳経産婦.妊娠18週に胃のもたれ感,心窩部痛,腹痛,嘔吐が出現した.近医で急性胃腸炎とされたが,MRIで先天性胆道拡張症と診断した.妊娠継続を強く希望したが,保存的治療では改善が得られず,妊娠23週に,分娩後に根治術を予定した二期的手術を行った.術後経過は良好で,妊娠39週4日に正常経腟分娩で女児を出産した

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Language：Japanese  

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Language：Japanese  

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Language：Japanese   Publisher：(株)ジェフコーポレーション  

症例は39歳女性で,平成7年1月に子宮頸癌術後に化学療法,外照射施行された後,11年に膀胱腟瘻が出現した.回腸導管造設術が施行され,この時からCVカテーテルが留置されていた.術後腸閉塞に対して回腸部分切除術および回腸横行結腸バイパス術を施行したが,術後熱発を認めたため術後7日目にCVカテーテルを抜去した.カテーテル先端細菌培養は陽性で,抗生剤投与で軽快したが,術後27日目より高熱が出現し,精査にてCVカテーテル抜去後の感染性静脈血栓から右鎖骨下静脈完全閉塞をきたしていた.抗生剤治療により軽快した

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Language：Japanese  

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Language：Japanese  

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Language：Japanese  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER-VERLAG  

During the period between 1983 and 1998, a total of 58 patients were admitted to the surgical department of Akita Red Cross Hospital with acute duodenal perforation. Of these 58 patients, 16 were treated operatively and 42 were treated nonoperatively. Among the 38 men and 4 women who received nonoperative treatment, 3 developed reperforation. The incidence of reperforation was 7.1% and the mean average interval from the initial treatment until reperforation was 3.5 years. Endoscopic biopsy and/or serum anti-H. pylori IgG measurement revealed Helicobacter pylori infection in all three patients. No serious complications developed during the nonoperative treatment of reperforation in these three patients, and their recovery was uneventful. The hospital stay ranged from 10 to 18 days, with a mean stay of 12 days after the first perforation and from 14 to 18 days, with a mean stay of 15.6 days after the reperforation. Nonoperative treatment proved successful as a life-saving procedure for reperforation of a duodenal ulcer in all three patients.

DOI： 10.1007/s005950070029

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Language：Japanese  

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Language：Japanese   Publisher：(株)日本小児医事出版社  

1)10歳6ヵ月男児.9年間,周期性嘔吐症として治療されていた腸管逆回転症例. 2)注腸造影では異常を指摘できなかったが,上部消化管造影で狭窄を認めた. 3)嘔吐を反復する患児の診察においては,器質的疾患が存在する可能性を常に念頭におく必要がある

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は70歳、女性。胃GIST術後3ヵ月目に左乳癌、腋窩リンパ節転移、GIST肝転移を認め、左乳癌に対し手術を施行した。病理組織学的結果はHER2陽性乳癌、pT1miN1M0、pStage IIAであった。予後規定因子はGIST肝転移と考え、イマチニブを開始した。乳癌術後4ヵ月目に乳癌左鎖骨下リンパ節再発を認めた。GIST肝転移の病勢は安定していたためイマチニブをいったん休薬し、パクリタキセル、抗HER2療法を開始した。忍容性を確認した後、慎重にイマチニブを併用した。リンパ節は著明に縮小し肝転移も増大を認めず、パクリタキセルを7コースで終了した。現在は抗HER2療法、イマチニブを継続中である。転移性の重複癌において両者に対する薬物療法を同時併用した報告は少なく、若干の考察を加えて報告する。(著者抄録)

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(株)北隆館  

我が国は世界でも最高位に位置する長寿国となり、日本人の平均寿命・健康寿命は共に世界第1位となっているが、平均寿命と健康寿命の間には乖離があり、晩年の約10年間を「自立した生活ではない期間」として過ごしていることとなる。高齢者の健康寿命の障害となるものフレイル・ロコモ・サルコペニアを予防・改善することが健康寿命を延伸していくために大切である。フレイル・ロコモ・サルコペニアの共通項目である筋力・筋肉量低下の原因となる栄養障害の1つに、亜鉛欠乏による味覚障害があり、亜鉛補給による味覚障害の改善は食欲・食事摂取量を増進しフレイル・ロコモ・サルコペニアの予防・改善につながる可能性がある。(著者抄録)

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Language：English   Publisher：(一社)日本臨床栄養代謝学会  

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Language：Japanese   Publisher：日本外科代謝栄養学会  

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Language：Japanese   Publisher：(株)日本メディカルセンター  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(株)じほう  

＜Points＞▼栄養障害にはいわゆる栄養不良・低栄養のみならず、肥満につながる栄養過剰、摂食障害、栄養が病因に関与する疾患なども含まれる。▼近年、基礎疾患や炎症の有無などを考慮した栄養障害の分類が提唱され、普及してきている。▼栄養スクリーニングは、できるだけ簡便な指標を用いて効率良く実施することが望まれる。▼栄養アセスメントでは、さまざまな指標を用いて多角的かつ詳細に栄養状態を評価する。▼これまでに簡便な指標を用いた栄養スクリーニングツールが開発され用いられている。▼世界規模で統一された栄養不良の診断基準であるGLIM criteriaでは、栄養状態のリスクスクリーニングと診断的アセスメントにより栄養障害の診断と重症度判定を行う。(著者抄録)

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本摂食嚥下リハビリテーション学会  

【目的】精神科病院の病棟内食堂で食事摂取可能な入院患者における誤嚥性肺炎リスクの影響要因を明らかにし、誤嚥性肺炎予防に向けた支援への示唆を得るために調査研究を行った。【方法】対象者は、A精神科病院入院患者約400名のうち、病棟内食堂で食事摂取可能な20歳以上85歳未満の者100名とした。対象者を誤嚥性肺炎リスク評価により高・中・低リスクに分け、その群のそれぞれの基本属性、日常生活の状況、食事摂取の状況、栄養状態(Body Mass Index:BMI、Geriatric Nutritional Risk Index:GNRI)、血液生化学所見(Total Protein:TP、Albumin:Alb、Hemoglobin:Hb、Hematocrit:Ht、White Blood Cell:WBC)を調査し、統計学的に検討した。【結果】対象者のうち、高リスク群0名、中等度リスク群24名、低リスク群76名であった。群間比較において、年齢は、中等度リスク群で有意に高値であった。BMI、GNRI、Ht、Hb、Peak Expiratory Flow:PEF、Repetitive Saliva Swallowing Test:RSSTは、中等度リスク群で有意に低値であった。Spearmanの順位相関係数では、年齢、BMI、GNRI、Alb、Ht、Hb、PEF、RSSTにおいて相関を認めた。二項ロジスティック回帰分析において、BMI、PEF、RSSTが独立変数として得られた。【結論】精神科病院の病棟内食堂で食事摂取可能な入院患者における誤嚥性肺炎リスクの影響要因は、BMI、PEF、RSSTの低下であることが示唆された。誤嚥性肺炎予防に向けた支援として、栄養状態や呼吸機能、嚥下機能の維持・改善を目指す取り組みが必要と考える。(著者抄録)

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Language：Japanese   Publisher：(一社)日本臨床栄養代謝学会  

【目的】2006年にヨーロッパで始まったnutritionDayであるが,2012年よりがん患者に特化した調査も行われている.今回,2015年から2017年のnational reportをもとに本邦および世界のがん患者の現況について報告する.【対象】日本から748例,世界から4,630例のがん患者が登録されており,平均年齢はそれぞれ71.3歳,65.4歳,BMIについては21.6,24.1となっていた.【結果】終末期の入院患者の割合が,日本の13.4%に対して世界では4.8%であった.栄養療法についてみると,静脈栄養がおこなわれていたのは日本で18.0%であったが,世界では10.9%しかなかった.逆に経口栄養補助食品の摂取については,日本では3.9%しかなかったのに対し,世界では14.4%であった.【結論】本邦のがん患者の現状を客観的に評価し,今後の栄養療法の改善に向けた基礎資料となる.(著者抄録)

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Language：Japanese   Publisher：(一社)日本呼吸ケア・リハビリテーション学会  

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Language：Japanese   Publisher：(一社)日本臨床栄養代謝学会  

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Language：Japanese   Publisher：(一社)日本精神保健看護学会  

本研究の目的は,精神科看護師が体験している誤嚥性肺炎予防に関するケアの実態を明らかにし,誤嚥性肺炎防止と患者の食生活に関するQOL向上に向けた支援の在り方について示唆を得ることである.A県内16ヶ所の精神科病院に勤務する病棟看護師55名を対象にフォーカスグループインタビュー調査を行い,収集したデータを質的帰納的に分析した.精神科看護師は,【精神科における誤嚥性肺炎予防ケアの困難】があるために,誤嚥性肺炎予防ケアにおいて,見守りの徹底に象徴される【目前の誤嚥・窒息リスクを回避したいという強い思いに基づくケア】を提供していた.一方では,精神疾患患者にとって食はQOLの重要な要素であることから,【食べることのQOLを志向したケア】に取り組んでいた.また,看護業務の一環として日常的に【誤嚥性肺炎予防に有効とされる日常生活援助】に努めていた.さらに,限られた環境の中で,【精神科医療の強みを活かすチームケア】を取り入れていた.本研究結果から,有効な資源の少なさや精神疾患をもつ人に特有の困難さがある中での,看護師のケアが明らかとなった.本研究により,一人ひとりの患者のニーズに立ち返り,多職種連携や包括的支援に取り組むことの重要性が示唆された.(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J02771&link_issn=&doc_id=20210303360007&doc_link_id=10.20719%2Fjapmhn.20-007&url=https%3A%2F%2Fdoi.org%2F10.20719%2Fjapmhn.20-007&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(一社)日本臨床栄養代謝学会  

nutritionDayプロジェクトとは毎年特定の日をnutritionDayと定め、世界的規模で実施される入院患者の栄養状態についてのアンケート調査であり、日本では2008年より当時の日本静脈経腸栄養学会(現日本臨床栄養代謝学会)主導の下に参加している。今回、ちょうど栄養サポートチーム(nutrition support team;以下、NSTと略)加算が評価された2010年から3年間の日本における集計結果を世界のものと比較し検討した。BMIでは3年間とも同様に経過し、日本では22前後、世界では25前後であった。栄養療法では、経腸栄養施行患者割合が日本では2010年から年々増加し、2012年には7%前後と世界とほぼ同程度に達していた。一方静脈栄養は日本では3年とも15%を超えていたのに対し、世界では5%前後であった。この変化は、日本でNSTが健康保険制度として評価され浸透したことが関係していると考えられる。今後も継続して報告していく予定である。(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J07204&link_issn=&doc_id=20210113460006&doc_link_id=10.11244%2Fejspen.2.5_332&url=https%3A%2F%2Fdoi.org%2F10.11244%2Fejspen.2.5_332&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：新潟県医師会  

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Language：Japanese   Publisher：(株)ジェフコーポレーション  

外来癌化学療法中の患者は、癌による代謝異常に加え、抗癌剤による有害事象(悪心・嘔吐、食欲不振や味覚障害、口内炎、下痢・腹痛)などで栄養障害に陥る危険が少なくない。栄養障害は予後、QOL、治療継続などにも影響するため、適切な栄養管理(栄養療法、栄養サポート)を行うことが望ましい。外来癌化学療法患者における栄養管理の有用性に関するエビデンス蓄積が期待される。

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Language：Japanese   Publisher：(一社)日本臨床栄養代謝学会  

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Language：English   Publisher：The Society of Analytical Bio-Science  

CiNii Article

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Language：Japanese   Publisher：(株)ジェフコーポレーション  

市販の油淋鶏弁当の主食:副食の割合を10g:3g、10g:6g、10g:9gに調整し、この順序で一口に食し主観的味覚を点数化した。20〜25歳の健常な日本人女性12名とスリランカ人女性4名を対象とした。副食が増量していくに従い日本人は酸味・渋味・旨味の評価が高くなっていったが、スリランカ人では塩味・甘味・苦味の評価が高くなった。同様の3パターンの食事を味覚センサーで分析した。その結果、白飯をコントロールとした場合、副食の増量に従い酸味・旨味が高くなり、炒飯をコントロールとした場合は酸味が強く影響され、旨味や渋味は副食を6gより増加させてもほとんど変化しなかった。コントロールとして白飯を用いた場合と炒飯を用いた場合とでは味覚のパターンが異なり、日本人・スリランカ人各々の主観的味覚評価のいずれともパターンが一致しなかった。

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Language：Japanese   Publisher：(一社)日本臨床栄養代謝学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：English   Publishing type：Research paper, summary (international conference)  

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Language：Japanese  

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Language：Japanese   Publisher：(一社)日本臨床栄養代謝学会  

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Language：Japanese   Publisher：(一社)日本臨床栄養代謝学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese  

DOI： 10.11638/jssmn.53.3_76

J-GLOBAL

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Language：Japanese   Publisher：(公社)日本婦人科腫瘍学会  

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Language：Japanese   Publisher：(株)ジェフコーポレーション  

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Language：Japanese   Publisher：新潟大学医学部保健学科  

中国都市部に居住する高齢者の主観的健康感と、健康習慣及びソーシャル・キャピタル(以下SCと略す)との関連を明らかにすることを目的とした。老人活動センターを利用する65歳以上の高齢者を対象に無記名自記式質問紙調査を実施し、207人から回答を得た。調査内容は基本属性、主観的健康感、生活満足度、健康習慣、SCであった。主観的健康感と健康習慣では、喫煙、運動、睡眠に有意差がみられた。主観的健康感とSCでは、「付き合い・交流指数」「信頼指数」「社会参加指数」のすべてにおいて「健康」群の平均値は有意に高かった。主観的健康感を従属変数とし、二項ロジスティック回帰分析を行った結果、健康習慣の「睡眠」とSCの「付き合い・交流指数」に有意な関連がみられた。高齢者の主観的健康感は客観的健康や生活満足度とも関連することから、適正な睡眠への支援や、社会参加および地域交流の促進が重要であることが示唆された。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J06421&link_issn=&doc_id=20190528370003&doc_link_id=1900537&url=https%3A%2F%2Fkango-sakuin.nurse.or.jp%2Fnid%2F1900537&type=%8D%C5%90V%8A%C5%8C%EC%8D%F5%88%F8Web&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00014_1.gif

Language：Japanese   Publishing type：Research paper, summary (national, other academic conference)  

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Language：Japanese   Publishing type：Research paper, summary (national, other academic conference)  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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Language：Japanese   Publisher：(一社)日本集中治療医学会  

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J-GLOBAL

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は68歳、女性。左乳癌、cT2N0M0、cStage IIAに対して、左乳房部分切除術、センチネルリンパ節生検を施行した。術前MRI検査で浸潤癌の長径は30mmと診断されていたが、術後病理組織診断では浸潤癌は長径50mmで周囲に非浸潤性乳管癌を伴い、病変全体の範囲は60mmに及び、頭側断端に非浸潤性乳管癌の露出を認めた。追加切除を希望し、前回手術の頭側断端より20mmの切除範囲で、乳房追加部分切除術を施行した。病理組織診断では前回手術断端周囲に癌の遺残は認めなかったが、その頭側に6mm大の浸潤癌を認め、体表側断端に癌が露出していたため左残存乳房に対して全摘術を行った。病理組織診断では7mmと2mmの浸潤癌をさらに認めた。術前画像の見直しを行ったが、乳房内転移と一致する結節の同定はできなかった。追加切除した乳房内に転移結節を認めた1例を報告する。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J00296&link_issn=&doc_id=20190107600024&doc_link_id=%2Fab8gtkrc%2F2018%2F004513%2F024%2F1860-1862%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2018%2F004513%2F024%2F1860-1862%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)癌と化学療法社  

症例は33歳、女性。15年前に右乳房の腫瘤摘出術を施行され、線維腺腫と診断された。5年前に再度右乳房に腫瘤を認め、針生検で線維腺腫と診断され経過観察となったが、その後増大を認め4年前に腫瘤摘出術が施行された。病理診断は境界悪性葉状腫瘍で、切除断端は陰性であった。2年前に右乳房に再度腫瘤を認め、針生検で葉状腫瘍と診断された。急速な増大を認めたため悪性化を疑い、右乳房切除術を施行された。病理診断は良性葉状腫瘍であった。また、左乳房には4年前より腫瘤を指摘されていたが、線維腺腫の疑いで経過観察されていた。1年前より腫瘤の増大を認め、2ヵ月前よりさらに新たに腫瘤が出現し増大を認めた。針生検でいずれの腫瘤も葉状腫瘍と診断され、左乳房切除術を施行した。病理診断はいずれも良性葉状腫瘍であった。両側に異時性に多発した葉状腫瘍の1例を経験したので報告する。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J00296&link_issn=&doc_id=20190107600022&doc_link_id=%2Fab8gtkrc%2F2018%2F004513%2F022%2F1854-1856%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2018%2F004513%2F022%2F1854-1856%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本褥瘡学会  

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Language：Japanese   Publisher：(公社)日本人間ドック学会  

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Language：Japanese   Publisher：(公社)日本人間ドック学会  

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Language：Japanese   Publisher：日本外科代謝栄養学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(株)ジェフコーポレーション  

脂肪乳剤が国内で市販されてから数十年が経過した現在、必要な症例に対して適切かつ十分に使用されているのかは疑問である。脂肪の静脈内への投与は17世紀から実験的に試みられていたが、効果的な乳化剤の開発により1900年代に脂肪の静脈内投与への発展に結びついていった。1961年A.Wretlindが大豆油に卵黄レシチンを乳化剤として使用し、安全に使用できる脂肪乳剤を開発した。その後、n-6系脂肪酸の炎症活性を抑えるために、大豆油ベースのみではなく、ココナッツ油、オリーブ油、魚油などを組み合わせた製剤が開発されていった。脂肪乳剤の禁忌の根拠となっている文献はかなり以前の報告であり、実際には脂肪乳剤が投与できる状況もあり得る。また、日本ではn-6系脂肪乳剤しか市販されていないため、侵襲下の症例では使用されにくい状況であるが、カルニチンの併用などでn-6系脂肪酸のβ酸化を促進することで炎症反応を抑えられる可能性がある。(著者抄録)

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(株)ジェフコーポレーション  

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Language：Japanese   Publisher：Japanese Society for Parenteral and Enteral Nutrition  

DOI： 10.11244/jspen.33.721

CiNii Article

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2018256100

Language：Japanese   Publisher：日本内分泌外科学会・日本甲状腺外科学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：日本外科代謝栄養学会  

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Language：Japanese   Publisher：(一社)日本精神保健看護学会  

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Language：Japanese   Publisher：医歯薬出版(株)  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：Japanese   Publisher：(株)癌と化学療法社  

非浸潤性乳管癌(ductal carcinoma in situ:DCIS)は、切除により治癒が期待できるが、一部の患者ではover treatmentとなる可能性が示唆されている。今回われわれは、自施設で単年に手術を施行したDCIS 23例の臨床病理学的検討から、手術適応について再考した。術後病理では、サブタイプ分類でLuminalとHER2のみが認められ、triple negativeは認められなかった。5例に浸潤癌の併存を認めたが、浸潤癌症例は腫瘍径が60mm以上と大きい傾向にあった。またKi-67 index≦5%の症例では、浸潤癌の併存は認めなかった。切除断端陽性例は7例あり、すべてDCISでの断端陽性であった。追加切除は1例に行われた。無治療経過観察の2例を含む6例では追加切除を行わなかったが、術後5年が経過し全例無再発生存中である。DCISには浸潤癌の合併がなければ、経過観察できるサブグループが存在すると考えられる。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J00296&link_issn=&doc_id=20161222480042&doc_link_id=%2Fab8gtkrc%2F2016%2F004312%2F042%2F1544-1546%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2016%2F004312%2F042%2F1544-1546%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(NPO)日本乳癌検診学会  

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Language：Japanese   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本内分泌外科学会・日本甲状腺外科学会  

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Language：Japanese   Publisher：日本内分泌外科学会・日本甲状腺外科学会  

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Language：Japanese   Publisher：医歯薬出版(株)  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：日本外科代謝栄養学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：AMER ASSOC CANCER RESEARCH  

DOI： 10.1158/1538-7445.SABCS15-P2-05-11

Web of Science

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は63歳、女性。検診で右乳房腫瘤を指摘され、当科を受診した。精査で非浸潤性乳管癌と診断され、右乳房部分切除術、センチネルリンパ節生検を施行した。術後病理組織学的検査では診断に苦慮したが、最終的に乳管腺腫を背景に発生した微小浸潤アポクリン癌と診断した。乳管腺腫とアポクリン癌の鑑別は難しく病理診断上しばしば問題となる。本症例のように乳管腺腫を背景としてアポクリン癌を合併することもあり、良悪性の判別には注意を要する。乳管腺腫とアポクリン癌の鑑別が困難な場合は診断を兼ねた完全切除が望ましいと考えられる。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J00296&link_issn=&doc_id=20160225470018&doc_link_id=%2Fab8gtkrc%2F2016%2F004302%2F019%2F0235-0237%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2016%2F004302%2F019%2F0235-0237%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publishing type：Research paper, summary (international conference)   Publisher：AMER ASSOC CANCER RESEARCH  

DOI： 10.1158/1538-7445.SABCS15-P1-03-03

Web of Science

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Language：Japanese   Publisher：(株)ジェフコーポレーション  

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は58歳、女性。腹部膨満を主訴に近医を受診し、その後当院産婦人科へ紹介された。胸腹骨盤部CT検査では、右卵巣腫大、多発肺転移、多発肝転移、腹膜播種を指摘され、さらにダグラス窩の腹膜播種は直腸への浸潤が疑われた。卵巣癌Stage IVに対して術前化学療法(paclitaxel+carboplatin療法)を3コース行った。その後、腹腔内の腫瘍減量手術(子宮・両側付属器摘出、大網部分切除、腹膜播種切除、Hartmann手術)を施行した。直腸間膜内に多発するリンパ節腫大を認めたため、下腸間膜動脈根部までのリンパ節郭清を行った。術後の病理組織学的診断では、右卵巣漿液性腺癌の診断となった。また、傍直腸リンパ節にも卵巣癌の転移が認められた。術後は化学療法を再開し、現在加療中である。卵巣癌の直腸浸潤では、直腸切除と直腸所属リンパ節郭清を行うことで卵巣癌の腫瘍減量手術に寄与する可能性が示唆された。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J00296&link_issn=&doc_id=20151224470285&doc_link_id=%2Fab8gtkrc%2F2015%2F004212%2F285%2F2300-2302%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2015%2F004212%2F285%2F2300-2302%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)癌と化学療法社  

症例は64歳、女性。左乳房腫瘤を自覚し当科を受診した。精査の結果、左乳癌cT4bN3(左腋窩、胸筋間、左鎖骨上リンパ節転移陽性)、M0、cStage IIIcと診断され、針生検診断は浸潤性乳管癌、サブタイプはトリプルネガティブであった。術前化学療法としてadriamycin+cyclophosphamide(AC)療法4コースを施行したが、grade 2の薬剤性肺障害が出現したため継続を断念した。遠隔転移を認めなかったことから、局所制御に重点を置いた治療方針の下、ハルステッド手術、術後放射線療法を施行した。9ヵ月経過した現在も再発を認めていない。化学療法有害事象発生例においては、患者の状態に合わせ施行可能な治療法を選択することが重要である。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J00296&link_issn=&doc_id=20151224470119&doc_link_id=%2Fab8gtkrc%2F2015%2F004212%2F119%2F1803-1805%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2015%2F004212%2F119%2F1803-1805%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：日本内分泌外科学会・日本甲状腺外科学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は71歳、男性。骨転移、脳転移を伴う肺腺癌に対して、2年5ヵ月前よりgefitinib(250mg/日)を連日投与され、安定(stable disease:SD)を維持中に腹痛、下痢、嘔吐を発症した。腹部骨盤造影CT検査を施行すると小腸壁内ガス像、腹腔内遊離ガス像、中等量の腹水を認め、腸管嚢腫様気腫症(pneumatosis cystoides intestinalis:PCI)の診断となった。バイタルサインが安定し、腹部理学所見で腹膜炎を疑う所見がみられなかったため、gefitinibを休薬して保存的に治療を開始した。自覚症状は徐々に改善し、治療開始7日後の腹部骨盤造影CT検査では画像所見も著明に改善した。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J00296&link_issn=&doc_id=20150729440015&doc_link_id=%2Fab8gtkrc%2F2015%2F004207%2F016%2F0847-0849%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2015%2F004207%2F016%2F0847-0849%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：日本外科代謝栄養学会  

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Language：Japanese   Publisher：新潟医学会  

近年, マンモグラフィー検診の普及に伴い, 非触知乳癌の発見率が上昇してきている. 非触知乳癌の中には, 石灰化病変のみで発見される非浸潤性乳管癌(Ductal carcinoma in situ : DCIS)も多く含まれるが, 石灰化病変を超音波検査で描出することは困難なことがあり, 手術に際し切除範囲の設定には苦慮することも多い. 臨床上, 実際に十分切除できているのか否かを術中に判断することは, その後の局所再発を防ぐ上で極めて重要である. 今回, 石灰化病変のみで発見された乳癌症例に対し, 術中に切除標本のマンモグラフィーを撮影し, 石灰化病変が切除できていることを確認できた症例を経験した. 症例は51歳, 女性. 検診マンモグラフィーで右乳房の石灰化を指摘され, ステレオガイド下マンモトーム生検を施行し乳癌と診断された. 超音波検査では石灰化病変の描出は困難であったが, マンモトーム生検時に留置したクリップ部位をマーキングし, 乳房温存手術を施行した. 術中に切除標本マンモグラフィーを施行し, ターゲットとした石灰化病変が切除できていることを確認して手術を終了した. 術後病理診断でも術前に予測した石灰化病変が完全に切除できていることを確認できた. 切除標本マンモグラフィーは, 簡便に石灰化病変の切除範囲の確認が可能な方法として有用であり, 文献的考察を加えて報告する.

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Other Link： http://hdl.handle.net/10191/44092

Language：Japanese   Publisher：新潟医学会  

甲状腺腫瘍に対し甲状腺全摘術施行後に濾胞腺腫と診断され、その3年後に骨転移が出現し、初回の摘出腫瘍が濾胞癌であったことが判明した1例を経験したので報告する。症例は61歳、男性。他院で甲状腺腫瘍に対し甲状腺全摘術が施行され、術中迅速診断および永久病理診断で腺腫と診断されていた。しかし、術後3年目頃から腰痛・下肢痛が出現、その後、下肢麻痺を認めたため当院整形外科で第5腰椎切除が行われ、術後病理診断では甲状腺濾胞癌の骨転移の診断であった。経過から初回甲状腺腫瘍が濾胞癌であったと考えられた。甲状腺濾胞癌は細胞異型がほとんど認められないため術前細胞診での診断は困難とされている。濾胞腺腫を疑った場合でもサイログロブリン高値等の場合は濾胞癌の可能性を考慮して治療やフォローアップを行っていく必要がある。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J00990&link_issn=&doc_id=20151009040005&doc_link_id=%2Fdg3nigta%2F2015%2F012906%2F005%2F0326-0330%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2015%2F012906%2F005%2F0326-0330%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：新潟医学会  

甲状腺癌のうち乳頭癌(papillary carcinoma)の頻度は90%と大部分を占め, 頸部リンパ節転移の頻度が高く, 高齢者では未分化癌に転化することもある. 今回, 結腸癌術後の全身検索で発見され, 胸骨縦切開を追加して切除可能であった無症候性進行甲状腺癌の1例を経験したので文献的考察を加えて報告する. 症例は76歳, 女性. 上行結腸癌手術後7年目にCA19-9値の上昇傾向を指摘され, CT検査では上縦隔へ進展した7cm大の甲状腺腫瘤と1.5cm大の右頸部リンパ節腫大を認めた. 穿刺吸引細胞診では class III であったが甲状腺癌が強く疑われたため, 手術目的に当科入院となった. 術前の頸部CTおよびMRI検査では, 甲状腺腫瘍は上縦隔まで進展していたが, 明らかな血管への浸潤所見は認めず, 気管支鏡検査では明らかな気管浸潤は認めなかった. 手術を施行し, 右頸部リンパ節を摘出し術中迅速病理診断に提出したところ乳頭癌の診断が得られたため, 甲状腺全摘術および頸部リンパ節郭清の方針となった. 術中所見では, 上縦隔内の無名静脈および右頸動脈への浸潤が疑われ, 切除可能か否かの判定が困難であった. 視野を確保し, 血管等への浸潤の有無を判定するために胸骨縦切開を追加した. その結果, 良好な視野が得られ, 無名静脈, 右左総頸動脈への直接浸潤を認めず, 腫瘍の切離が可能となり, 甲状腺全摘術および頸部リンパ節郭清を施行した. 甲状腺癌, 特に乳頭癌は10年生存率が80～90%と良好であり, また, 放置した場合に気管浸潤, 血管浸潤を伴うと, 生命予後のみならず, 患者QOLも著しく損なわれるので, 可能であるならば積極的に切除を行うことが望ましい.

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：English   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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