4569 research outputs found
Sort by
子宮頸管妊娠に対するMTX局所投与後の血清hCG値推移と再投与基準の検討
Get PDF子宮頸管妊娠に対するメソトレキセート（methotrexate：MTX）局所投与法の有益性を示す報告が近年増えている。ただし、MTX投与後に血清ヒト絨毛性ゴナドトロピン（human chorionic gonadotropin：hCG）値上昇を示す症例も多く、一過性の上昇なのか治療不十分でMTXの再投与を要するのか判断に苦慮することが少なくない。MTXの再投与基準としては1991年にStovallらが示した投与4日目と比較して7日目に上昇を認める場合再投与を行うとするものがあるが、これは卵管妊娠に対する全身投与における検討であり、子宮頸管妊娠は卵管妊娠と病態が異なるため7日目での再投与は必須ではない可能性が示唆されている。今回、2013年1月から2022年12月に当院でMTXの局所投与を行った子宮頸管妊娠7症例を後方視的に検討したところ、投与4日目から7日目に血清hCG値上昇を認めた3例を含め全7症例で10日目には血清hCG値が減少に転じていたことが確認された。子宮頸管妊娠は卵管妊娠に比べてMTX投与後のhCG値の低下が遅れる可能性があり、早期破裂のリスクも卵管妊娠よりは低いと考えられるため、投与7日目ではなく10日目までは再投与を延期して安全に管理できる可能性が高いと考えられた。A growing number of reports have shown the benefit of local methotrexate (MTX) therapy for cervical pregnancy. However, many patients experience an increase in human chorionic gonadotropin (hCG) levels after MTX administration, making it difficult to determine whether the increase is transient or if additional MTX treatment is required because of insufficient treatment. Regarding the criteria for MTX readministration, Stovall et al. reported in 1991 that MTX should be readministered when an increase in hCG levels is observed on Day 7 compared with Day 4 after systemic administration for tubal pregnancy. However, since the pathological condition of cervical pregnancy differs from that of tubal pregnancy, it has been suggested that cervical pregnancy may be safely monitored for several days without immediate readministration. We retrospectively investigated seven women with cervical pregnancy who received local MTX therapy at our hospital between January 2013 and December 2022. Serum hCG levels began to decrease on Day 10 in all seven cases, including three cases where hCG levels had risen between Day 4 and Day 7. The decrease in serum hCG levels after MTX administration may be delayed in cervical pregnancy compared with tubal pregnancy, and the risk of early rupture differs between these conditions. We conclude that cervical pregnancy may be safely managed without MTX readministration until Day 10 instead of Day 7.journal articl
Evaluation of the widths of the mucosal strips in pathological examination of specimens of endoscopic submucosal dissection for early gastric 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
Impact of prognostic nutritional index on the occurrence of post-operative delirium after total knee arthroplasty
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
A case report of Granjon surgery for microperforate hymen in an adolescent woman
Get PDF処女膜閉鎖は先天性尿生殖洞奇形のひとつで、処女膜が腟入口部を完全に覆う病態である。多くは初経後に腟留血腫や子宮留血腫で診断されることが多い。今回性交障害を主訴に診断された処女膜閉鎖の症例を経験した。小孔を有する不完全閉鎖のため典型的な症状を呈さず、思春期は無症状で経過した。青年期に性交渉を有するようになったことで発覚し、尿道性交の結果として尿路感染症などの二次的な症状を引き起こした。治療として、処女膜閉鎖症に対する術式であるGranjon手術を試み、瘻孔の位置を考慮しながら切開ラインを工夫し、ほぼ原法通りの手術を施行することができた。術後狭窄は認めず、術後5ヵ月で性交可能となり、良好な経過をたどっている。Imperforate hymen is a congenital urogenital sinus malformation, a condition in which the hymen completely obstructs the vaginal orifice. It is often diagnosed after menarche with hematocolpos or hematometra. We report a case of microperforate hymen found due to dyspareunia. Due to the subtotal hymenal occlusion, the patient did not have the typical symptoms of a microperforate hymen during puberty. The diagnosis of microperforate hymen was made after sexual intercourse in adolescence with secondary symptoms such as urinary tract infection due to urethral intercourse. Granjon surgery, a technique for imperforate hymen, was performed. The incision line was adjusted based on the location of the fistula, and the surgery was largely performed according to the original method. There was no postoperative stenosis and sexual intercourse was possible 5 months after surgery
Glycogen Storage Diseases : Unmet Need and Advances in Diagnosis and Treatment
Get PDF糖原病は，グリコーゲン合成・分解，解糖経路の酵素欠損や輸送体異常により引き起こされる疾患群である．糖原病I，VI，IX型などに出現する低血糖や肝腫大や，少量頻回食やコーンスターチ療法などの食事療法はよく知られているが，糖原病には15疾患以上が存在するため，疾患により，また同一疾患であっても亜型や重症度により，症状（肝腫大，肝硬変，低血糖，筋力低下，心筋症，腎障害など）や治療法は様々である．糖原病VI，IX型は予後良好な症例が多いが，多くの糖原病では長期合併症が出現し，外科手術が必要な例も少なくない．本稿では，糖原病の多発性肝腺腫など長期合併症に対する多くの診療科による管理，糖原病Ib型の好中球機能障害に対するナトリウム/グルコース共輸送体2（SGLT2）阻害薬の新たな推奨，Pompe病の酵素補充療法後の新しい表現型，糖原病III型に対する高蛋白食やケトン食療法の有効性など，糖原病における進歩とアンメットニーズについて概説する．Glycogen storage diseases (GSDs) are a group of disorders caused by enzyme deficiencies or transporter abnormalities in glycogen synthesis, glycogenolysis, and glycolytic pathways. Although the hypoglycemia and hepatomegaly that occur in GSD type I, VI, and IX and the dietary treatments such as frequent small meals and cornstarch therapy for these diseases are well known, there are more than 15 GSDs, so the symptoms (hepatomegaly, cirrhosis, hypoglycemia, muscle weakness, cardiomyopathy, renal failure, etc.) and treatments vary depending on the disease or subtype and severity of the disease even within the same disease. GSD type VI and IX have a good prognosis in many cases, but many other types of GSDs have long-term complications and require surgical intervention in many cases. This article reviews the unmet needs and challenges in GSDs including the management of long-term complications such as multiple hepatic adenomas in GSDs, new recommendations for sodium/glucose cotransporter 2 (SGLT2) inhibitors for neutrophil dysfunction in GSD type Ib, new phenotypes of Pompe disease after enzyme replacement therapy, and the efficacy of high protein diet and ketone diet in GSD type III.journal articl
Diagnosis and Prognosis of Food Protein-Induced Enterocolitis Syndrome (FPIES)
Get PDF食物蛋白誘発胃腸炎（food protein induced enterocolitis syndrome：FPIES）は，現時点でメカニズム不明の疾患である．その診断は，被疑食品を摂取して概ね1–4 時間後に消化器症状が誘発されることを繰り返すことでなされる．ただし，2回の症状誘発の既往がある児に食物経口負荷試験（oral food challenge：OFC）を行うと，約半数は陰性となる．また，発症前に無症状摂取歴が無い場合もOFCが陰性となる可能性が高い．そのため，これらをふまえて積極的に診断目的のOFCを行い，不要な除去をしないことが肝要である．また，発症から半年など早期に寛解しやすいという一般的認識に対しては，確定診断をもとにした真の予後調査を行い，評価されるべき内容と考えられる．真のFPIESの予後を明らかにし，適切な寛解確認目的のOFC間隔を決定していくことや経口免疫療法の有効性などが，今後の検討課題である．Food Protein-Induced Enterocolitis Syndrome (FPIES) is a disorder with an unknown mechanism at present. Diagnosis is made by repeatedly inducing gastrointestinal symptoms approximately 1–4 hours after ingestion of the culprit food. However, when an oral food challenge (OFC) is conducted on children with a history of two symptom inductions, about half test negative, indicating they may not have FPIES. Additionally, if there is no history of asymptomatic ingestion before onset, it is also likely not FPIES. Therefore, it is crucial to actively perform diagnostic OFCs to avoid unnecessary elimination. Furthermore, true prognosis studies based on confirmed diagnoses should evaluate whether early remission, such as within six months from onset, is common. Clarifying the true prognosis of FPIES, determining appropriate intervals for remission confirmation OFCs, and assessing the feasibility and effectiveness of oral immunotherapy are future research topics.journal articl
A case of stage IIB adenocarcinoma of the cervix identified as cervical mass at 24 weeks' gestation
Get PDF妊娠に合併した子宮頸部扁平上皮癌は妊娠初期の頸部細胞診で診断できることが多いが、腺癌は細胞診の正診率が低いことが知られている。妊娠初期の頸部細胞診で指摘されず、妊娠中期に粗大な頸部腫瘤として発見され、診断に苦慮したが根治治療を行った子宮頸部腺癌ⅢC1期の1例を経験した。患者は29歳、4妊2産。前医で行った妊娠初期の頸部細胞診はNILMであった。妊娠24週に6cm大の頸部腫瘤が出現した。擦過細胞診はAGCで腺癌が疑われたが、組織診で確定診断できず、妊娠27週に当院へ紹介となった。頸部後唇に9cmの腫瘤を認め、直腸診では右基靭帯に硬結を触知した。針生検を施行したがやはり確定診断出来なかった。臨床的に頸部腺癌ⅡB期を強く疑い、周産期科および新生児科と検討の上、妊娠28週で帝王切開、その4週間後に広汎子宮全摘術を施行した。病理診断は子宮頸部腺癌（通常型内頸部腺癌と粘液性癌の混在、pT2bN1M0）で、腫瘤内に異なる組織型が混在していた。術後同時化学放射線療法を行い、治療終了後、再発所見なく経過観察中である。妊娠中の頸部腫瘤は悪性腫瘍を念頭におき、進行期や妊娠週数を十分に検討した管理・治療が重要である。In pregnant women, cervical squamous cell carcinoma can often be diagnosed in early pregnancy by cervical cytology, but adenocarcinoma is difficult to diagnose by cytology. The patient was 29 years old (gravida 4, para 2). Cervical cytology in early pregnancy found that she was negative for intraepithelial lesions or malignancy. A 6-cm cervical mass appeared at 24 weeks’ gestation. Uterine cervical adenocarcinoma was suspected, but histology could not confirm the diagnosis, and the patient was referred to our hospital at 27 weeks' gestation. A 9-cm cervical mass was found. A needle biopsy was performed, but the diagnosis could not be confirmed. Clinically, we strongly suspected stage IIB cervical adenocarcinoma, and, after consulting the perinatology and neonatology departments, we performed a cesarean section at 28 weeks' gestation, followed by abdominal radical hysterectomy four weeks later. The pathological diagnosis was adenocarcinoma of the cervix (mixed with endocervical adenocarcinoma, usual type and mucinous carcinoma, pT2bN1M0). The patient was treated with concurrent chemoradiotherapy and is under observation with no evidence of recurrence at 20 months after treatment. It is important to manage and treat cervical masses during pregnancy with malignancy in mind after carefully considering the disease stage and stage of pregnancy.journal articl
Chronotherapy with a renin-angiotensin system inhibitor ameliorates renal damage by suppressing intrarenal renin-angiotensin system activation
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