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Hamamatsu University School of Medicine Library Bulletin “ Hikumano ” No.75
Get PDF特集 著作権、どこまで気にする？；館長挨拶 / 間賀田泰寛；図書館からのお知らせboo
3D-CT-derived lung volumes and mortality risk in patients with fibrotic hypersensitivity pneumonitis
Get PDF令和6年 浜松医科大学論文賞：優秀論文賞（学生特別枠）
受賞者：矢澤 秀介Background: Hypersensitivity pneumonitis (HP) is a complex and heterogenous interstitial lung disease (ILD) that occurs in susceptible individuals due to certain inhaled antigens. Fibrotic-HP is a major underlying disease of progressive pulmonary fibrosis. Therefore, in addition to the radiological features of HP, quantitatively measuring fibrosis is important to evaluate disease severity and progression. The present study aimed to compare three-dimensional computed tomography (3D-CT)-derived lung volumes (LVs) of patients with HP and determine its association with mortality risk.
Methods: In this retrospective and multicenter cohort study, 126 patients diagnosed with HP (fibrotic, n=72 and non-fibrotic, n=54) with a confidence level higher than moderate were enrolled. Each lobe LV was measured using 3D-CT at the time of diagnosis and standardized using predicted forced vital capacity. The 3D-CT LV was compared with those of 42 controls and 140 patients with idiopathic pulmonary fibrosis (IPF).
Results: Compared to patients with fibrotic-HP, the standardized total LV was significantly higher in controls and patients with non-fibrotic-HP and was similar in patients with IPF. Longitudinal analyses demonstrated that approximately half of the patients with fibrotic-HP had an annual decrease in total LV. Decreased total and lower-lobe LVs were associated with shorter survival, and were independently associated with mortality together with ongoing exposure to inciting antigens. A composite model consisting of ongoing exposure to inciting antigens and total or lower-lobe LV successfully classified mortality risk into three groups.
Conclusions: Quantitatively measuring standardized LV can help determine disease severity, progression, and mortality risk in patients with fibrotic-HP.journal articl
High-contrast and noise-robust image reconstruction with regularization minimizing entropy for diffuse optical tomography
Get PDF浜松医科大学Hamamatsu University School of Medicine博士（光医工学）doctoral医学系研究科thesi
Two cases of endometrial cancer in young woman with mismatch repair deficiency refractory to fertility-sparing treatment
Get PDF子宮体癌に対する妊孕性温存療法は再発率が高いことで知られ、中には治療抵抗性症例も認める。今回ミスマッチ修復機能欠損を背景に持つ若年患者で子宮内膜異型増殖症と診断され、妊孕性温存療法を行うも類内膜癌へ進行し、最終的に子宮全摘に至った2例を経験した。症例①は39歳、子宮内膜異型増殖症に対して妊孕性温存療法を開始し、一旦治療効果を認めたが、5か月後にMRIで子宮内膜の異常信号域拡大を認め、最終的に子宮体癌と診断された。症例②は35歳、子宮内膜異型増殖症の再発に対して再度妊孕性温存療法を開始したが、3か月後に子宮体癌へ進行し治療効果をほとんど認めず、合計9か月治療を施行したが類内膜癌の残存あり、子宮全摘の方針となった。いずれの症例も免疫組織化学でミスマッチ修復蛋白発現消失を認め、症例①は遺伝学的検査でリンチ症候群（LS）の診断に至り、症例②も既往歴と家族歴からLSの可能性が極めて高いと考えられた。Fertility-sparing treatment of endometrial cancer is associated with a high recurrence rate, and some cases are refractory to treatment. We encountered two cases of young patients with mismatch repair deficiency who were diagnosed with atypical endometrial hyperplasia and underwent fertility-sparing treatment, but progressed to endometrial cancer, ultimately resulting in total hysterectomy. Case 1 was a 39-year-old patient who initiated fertility-sparing therapy for atypical endometrial hyperplasia and once responded to treatment. After five months, MRI revealed an enlarged abnormal signal area in the endometrium, which was ultimately diagnosed as endometrial cancer, indicating resistance to treatment. Case 2 was a 35-year-old patient who re-initiated fertility-sparing treatment for recurrent atypical endometrial hyperplasia. Three months later, however, the tumor progressed to endometrial cancer, with almost no treatment effect. Hormone treatment was administered for nine months, but the endometrial cancer persisted, and we decided to perform a total hysterectomy. In both cases, immunohistochemistry revealed loss of mismatch repair proteins. Genetic testing for Case 1 led to the diagnosis of Lynch syndrome. Lynch syndrome was also considered likely in Case 2 based on past medical and family history
Serous tubal borderline tumor diagnosed by prophylactic salpingectomy during total laparoscopic hysterectomy: Two case reports
Get PDF漿液性卵管境界悪性腫瘍は極めて稀な疾患である。その症例のほとんどが、健康診断等で子宮付属器腫大を指摘されたり、子宮付属器捻転による急性腹症を起こしたりすることで判明していると言われている。今回、我々は子宮全摘出術に加え卵管切除（予防的卵管切除術）を施行後、術後に漿液性卵管境界悪性腫瘍と診断された2例を経験したので報告する。症例1は50歳、1妊1産。多発性子宮筋腫、過多月経のためにレルゴリクスによる前治療を行った後、全腹腔鏡下子宮全摘出術に加え両側卵管切除術を施行した。術中に卵管病変を指摘できなかったが、病理診断で左卵管の Serous borderline tumor と診断された。卵巣境界悪性腫瘍に準じ、両側卵巣切除術・大網切除術を勧めるも希望されず、現在術後3年経過しているが再発所見は認められていない。症例2は48歳、2妊2産。多発性子宮筋腫、過多月経のためにレルゴリクスによる前治療を行った後、全腹腔鏡下子宮全摘出術に加え両側卵管切除術を施行した。術中に左傍卵管のう胞を認めた。病理診断で左卵管の Serous borderline tumor と Paratubal cyst と診断された。卵巣境界悪性腫瘍に準じ、両側卵巣切除術・大網切除術を勧めるも希望されず、現在術後1年5か月経過したが再発所見は認められていない。予防的卵管切除により偶発的に卵管病変が診断されることがあり、摘出卵管の病理検査は推奨される。しかし卵管境界悪性腫瘍については未だ報告が極めて少なく、追加治療や経過観察期間などの一定の見解は得られていないため、今後もデータの集積が必要である。Serous tubal borderline tumor is an extremely rare disease. It is said that most of these cases are discovered when appendage swelling is noted during a medical examination or when acute abdominal pain occurs due to adnexal torsion. Here, we report two cases in which, after total hysterectomy and salpingectomy (prophylactic salpingectomy), a serous tubal borderline tumor was diagnosed postoperatively. Case 1 is a 50-year-old woman, G1P1. The patient underwent surgery after taking relugolix for multiple myoma and excessive menstruation. In addition to total laparoscopic hysterectomy, bilateral salpingectomy was performed. Pathological diagnosis was a serous borderline tumor of the left fallopian tube. Additional postoperative treatment was recommended, but the patient did not request it, and no recurrence has occurred past 3 years. Case 2 is a 48-year-old woman, G2P2. After taking relugolix for multiple myoma and excessive menstruation, she underwent total laparoscopic hysterectomy and bilateral salpingectomy. A left paratubal cyst was observed. Pathological diagnosis was a serous borderline tumor and paratubal cyst in the left fallopian tube. Although additional treatment was recommended after surgery, the patient did not request it, and no recurrence has occurred past 1 year 5 months.
[Conclusion] Fallopian tube lesions may be diagnosed incidentally due to prophylactic fallopian tube resection, and pathological examination of the removed fallopian tubes is recommended. However, there are still very few reports on tubal borderline tumors, and no definitive opinion on additional treatment or follow-up period has been obtained, so data will continue to be collected
High-fat diet modulates bile acid composition and gut microbiota, affecting severe cholangitis and cirrhotic change in murine primary biliary cholangitis
Get PDF浜松医科大学Hamamatsu University School of Medicine博士（医学）doctoral医学系研究科thesi
Intraoperative rapid diagnosis of pleural lavage cytology in non-small cell lung cancer
Get PDF浜松医科大学Hamamatsu University School of Medicine博士（医学）doctoral医学系研究科thesi
Exophthalmos associated with chronic progressive external ophthalmoplegia
Get PDF浜松医科大学Hamamatsu University School of Medicine博士（医学）doctoral医学系研究科thesi
