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Intake of soy and isoflavone in relation to ovarian reserve among women of reproductive age
Get PDF自治医科大学博士（医学）令和5年度doctoral thesi
Intraperitoneal administration of paclitaxel combined with S-1 plus oxaliplatin followed by conversion surgery in a patient with stage IV gastric cancer and intestinal malrotation: Report of a case.
Get PDFBackground: The prognosis of patients with stage IV gastric cancer remains unsatisfactory despite recent advances in multidisciplinary therapy. Asymptomatic intestinal malrotation in adults is rare and usually diagnosed incidentally by imaging or during abdominal surgery. Intestinal malrotation associated with primary gastric cancer is extremely rare. We report here a patient with stage IV gastric cancer and intestinal malrotation successfully treated with induction chemotherapy followed by gastrectomy.
Case presentation: The patient is a 57-year-old woman diagnosed with gastric cancer with peritoneal metastases. Staging laparoscopy showed disseminated nodules on the peritoneal surface with a peritoneal cancer index score of 15 points. Peritoneal fluid cytology was class V. The patient was treated with intraperitoneal administration of paclitaxel combined with S-1 plus oxaliplatin. After twelve courses of combined chemotherapy, 2nd look laparoscopy showed that peritoneal metastases were not macroscopically present and cytological examination of peritoneal washing fluid was negative for malignant cells. Total gastrectomy with regional lymph node dissection was then performed. Pathological examination of the specimen revealed grade 1b efficacy of IP-PTX plus SOX chemotherapy. She also had the non-rotation type of malrotation. Anatomical anomalies could cause difficulties for lymph node dissection and reconstruction during the gastrectomy against gastric cancers. The postoperative course was uneventful. Following resection, the patient received 14 courses of the same combined chemotherapy without oxaliplatin. She has done well for more than 6months after resection without evidence of recurrence.
Discussion: This is the first report of successful conversion surgery for a patient with stage IV gastric cancer and intestinal malrotation after intraperitoneal administration of paclitaxel combined with S-1 plus oxaliplatin. Gastrectomy performed after an excellent response to combined chemotherapy of peritoneal metastases may contribute to improved patient outcomes. Establishing the diagnosis of intestinal malrotation preoperatively in adults is necessary to safely perform abdominal surgery.departmental bulletin pape
A case of acromegaly complicated with toxic multinodular goiter
Get PDF60歳女性。変形性股関節症の手術前精査で機能性甲状腺結節が疑われ，先端巨大症様顔貌と成長ホルモン（GH），インスリン様成長因子1（IGF-1）の高値を指摘され当科紹介となった。75gブドウ糖負荷試験でGH抑制に乏しく，下垂体腫瘍を認めたことから先端巨大症と診断した。甲状腺結節は腺腫様甲状腺腫であり，甲状腺中毒症と99mTcシンチグラフィで不均等集積を認めたことから中毒性多結節性甲状腺腫（TMNG）と判断し，先端巨大症とTMNGの合併例と診断した。チアマゾールで甲状腺機能をコントロールし，下垂体腫瘍縮小のためランレオチド投与後に，経蝶形骨洞的下垂体腫瘍摘出術を施行した。本邦では先端巨大症とTMNGの合併は稀であり，先端巨大症におけるGH，IGF-1の過剰が甲状腺腫と甲状腺機能亢進症に関連する可能性が示唆されており，その病態の理解は治療方針の決定に重要と考えられたため報告する。departmental bulletin pape
