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Changes in the cortical bone reaction around the stem after uncemented total hip replacement using short tapered wedge stem
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
Prognostic role of interferon-λ3 in anti-melanoma differentiation-associated gene 5-positive dermatomyositis-associated interstitial lung disease
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
UBL3 interacts with PolyQ-expanded huntingtin fragments and modifies their intracellular sorting
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
Corrective long spinal fusion to the ilium for patients with adult spinal deformity results in good physical function after mid- to long-term postoperative follow-up
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
Scope of practice of Japanese primary care physicians and its associated factors: A cross-sectional study
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 series of 23 risk-reducing salpingo-oophorectomy and literature review
Get PDF遺伝性乳がん卵巣がん（HBOC）におけるリスク低減卵管卵巣摘出術（RRSO）は現在のところ卵巣癌、卵管癌に対する最も有効な手段である。2020年4月の保険収載以降、当院で施行したRRSO 23 例について臨床的検討をおこなったので報告する。
RRSO施行年齢は中央値47歳（40－71歳）、婦人科初診より手術施行までの期間は中央値6ヶ月（2－168ヶ月）だった。手術は全て鏡視下に施行し、子宮全摘を併施した症例は5例（22%）だったがリスク低減乳房切除術（RRM）を併施した症例はなかった。SEE-FIMプロトコールにて評価した全例において病理所見ではBRCA1病的バリアント陽性の2例（9%）に漿液性上皮内癌（STIC）を認め、また別の1例において術後16ヶ月時に腹膜がんの発症を認めた。
RRSOは当院でも安全に施行できていると思われるが、STIC症例の取り扱い、腹膜がんサーベイランス方法、子宮全摘やRRMとの併施手術など検討課題は多く、今後も症例の集積と多施設での協議が重要である。Currently, risk-reducing salpingo-oophorectomy (RRSO) for ovarian and fallopian tube cancers in hereditary breast-ovarian cancer syndrome is the most effective treatment option. We clinically reviewed and reported 23 RRSO cases performed at our hospital in April 2020.
The median age of patients who underwent RRSO was 47 (40–71) years and median time from initial gynecological consultation to surgery was 6 months (2–168 months). All surgeries were laparoscopic. Five patients underwent total laparoscopic hysterectomy with RRSO, but none underwent concomitant risk-reducing mastectomy (RRM). All patients underwent pathologic examination according to the SEE-FIM protocol, and serous intraepithelial carcinoma (STIC) was found in two patients (9%) with positive BRCA1 pathologic mutations. One case developed primary peritoneal cancer 16 months postoperatively.
Although RRSO may be performed safely at our hospital, there are many points to consider, such as the handling of STIC cases, surveillance methods for peritoneal cancer, and combination with total hysterectomy and RRM. Moreover, continuously accumulating cases and conducting multicenter studies are important
Characterization of plasma vonoprazan and CYP3A activity using its endogenous marker and genetic variants in patients with digestive system disorders
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
Unicornuate uterus treated by laparoscopic resection of a rudimentary uterine horn: a case report
Get PDF単角子宮は比較的稀な子宮奇形である。今回我々は、月経困難症を契機に発見された副角を伴う単角子宮に対して腹腔鏡下副角摘出術を施行した症例を経験したので報告する。症例は17歳女性、月経困難症症状を主訴に婦人科を受診、画像検査から副角を伴う単角子宮が疑われた。月経困難症症状が強く、将来の副角妊娠のリスクも考慮し、手術加療を行った。術中所見では左卵管留血症を思わせる左卵管の腫大と左卵管采を中心とした子宮内膜症様所見、血性腹水が認められ、左副角の機能性内膜からの経血の逆流と子宮内膜症の存在が示唆された。腹腔鏡下副角摘出術＋左卵管切除術を施行、術後月経困難症症状は改善した。
副角子宮は月経困難症や子宮内膜症の原因となりうるため、早期の治療によりQOLの改善や子宮内膜症の予防に寄与すると考えられた。A unicornuate uterus is a relatively rare uterine malformation. We report a case of a unicornuate uterus with a rudimentary uterine horn that was discovered due to dysmenorrhea and treated with laparoscopic removal of a rudimentary horn. The patient was a 17-year-old girl who presented to the gynecology department with dysmenorrhea. Magnetic resonance imaging revealed a unicornuate uterus with a rudimentary uterine horn. She had severe dysmenorrhea and was at risk of future rudimentary horn pregnancy, so we decided to perform surgery. Intraoperative findings included swelling of the left fallopian tube, reminiscent of left hematosalpinx, endometriosis-like findings mainly in the left fimbria, and bloody ascites, suggesting reflux of menstrual blood from the functional endometrium of the left rudimentary horn and the presence of endometriosis. Laparoscopic removal of a rudimentary horn and left salpingectomy were performed, and the dysmenorrhea symptoms improved after surgery. A rudimentary uterine horn may cause dysmenorrhea and endometriosis. Early treatment may help improve quality of life and prevent endometriosis
Safety and validity of selective cerebrospinal fluid drainage in open and endovascular aortic repair
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
