記述言語：日本語   掲載種別：研究論文（学術雑誌）  

We report 3 cases of patients with gastrointestinal cancer who were treated with a regimen including oxaliplatin(OX). The patients were presented with fever over 38.0℃, probably due to OX. Case 1: A 73-year-old male. In the second course of bevacizumab(BEV)plus mFOLFOX6 therapy for rectal cancer and liver metastases, chills appeared 1 h and 45 min after the start of OX, and a fever of 38.0℃ appeared 2 h and 35 min after the end of OX. The body temperature dropped to 37.2℃ with a single cylinder of flurbiprofen infusion. Case 2: A 64-year-old male with sigmoid colon cancer and liver metastases treated with BEV plus mFOLFOX6. After 3 h and 10 min since completion of OX, chills and a fever of 38.5℃ appeared. The body temperature was 38.3℃ 1 h after insertion of a 25-mg diclofenac suppository but dropped to 35.4℃ 10 h later. Case 3: A 76-year-old male. In the 8th course of mFOLFOX6 therapy for gastric cancer and peritoneal dissemination, 4 h and 45 min after completion of OX, the patient developed a fever of 38.3℃ with chills. Antipyretics were not used because of the patient's refusal, but the body temperature spontaneously decreased to 35.7℃ after 15 h. Although no DLST test was performed in any of the patients, we considered this to be an adverse reaction to OX, owing to lack of symptoms of chills or fever with 5-FU plus l-LV therapy except for OX. The patient should be treated with the knowledge that hypersensitivity reactions to OX do not occur only during the course of administration of OX.

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Capecitabine and oxaliplatin (CAPOX) plus bevacizumab (BEV) therapy (CAPOX/BEV) is a standard treatment recommended as the first-line treatment for colorectal cancer recurrence. Recently, sinusoidal obstruction syndrome (SOS) and resulting portal hypertension have been reported as important side effects of oxaliplatin. We herein report a rectal cancer patient who underwent percutaneous transhepatic stoma variceal embolization (PTO) and partial splenic artery embolization (PSE) for stomal variceal bleeding and splenomegaly due to portal hypertension caused by SOS after CAPOX therapy. A 43-year-old man who underwent robot-assisted laparoscopic abdominoperineal resection for advanced lower rectal cancer was started on CAPOX/BEV therapy for early recurrence 1 month after surgery. In the sixth course, splenomegaly rapidly worsened, stomal varices appeared, and the stoma began bleeding. At 5 months after the appearance of stomal varices, the splenomegaly worsened, the frequency of stomal bleeding increased, and PTO was performed. Five months later, PSE was performed for splenomegaly and thrombocytopenia. At 5 months since the PSE, the stoma bleeding has not recurred, and the thrombocytopenia has been corrected. The patient has been able to continue chemotherapy. We suggest that staged treatment by PTO and PSE be considered an important treatment option for stomal varices and splenomegaly associated with SOS.

DOI： 10.1007/s12328-022-01720-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The resolution of 8K ultra-high-definition imaging technology (7680 × 4320 pixels) is 16-fold higher than the current high-definition technology (1920 × 1080 pixels). 8K/two-dimensional (2D) laparoscopy was clinically available in 2014, but few reports concerning its application have been published. The aim of this study was to evaluate the appropriate methods of usage and problems learned from clinical use of 8K/2D laparoscopy. SUBJECTS AND METHODS: The patients were 100 colorectal surgery patients who underwent 8K/2D laparoscopy at Asahikawa Medical University Hospital between November 2018 and March 2021. We evaluated the effectiveness, operating conditions, methods and issues of 8K/2D laparoscopy. RESULTS: The median age was 68.5 years. The primary disease was malignancy of the left side of the colon and rectum in 92 patients. The right-sided colectomy was performed in five cases, total proctocolectomy of ulcerative colitis was performed in 3 cases. The proper application of 8K/2D laparoscopy can be achieved by adhering to certain tips, such as darkening the operation room and keeping an appropriate distance from the monitor. Regarding intraoperative complications caused by the 8K/2D laparoscope, skin burns due to heat from the tip of the laparoscope were observed in one patient. There were no cases of complications due to the 8K/2D laparoscopy. CONCLUSION: 8K/2D laparoscopy can be used safely in colorectal surgery. There are still some tips for proper use, such as keeping an appropriate distance to the monitor and darkening the room. However, 8K/2D laparoscopy can provide delicate images and can be used without any operational problems.

DOI： 10.4103/jmas.jmas_281_21

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: How does making origami cranes under a dry box affect Fundamentals of Laparoscopic Surgery (FLS) scores in medical students? DESIGN: Four medical students from Asahikawa Medical University (tertiary hospital) participated. They made origami cranes under a dry box (origami crane training) five days per week for four weeks. The time required to make each origami crane (origami crane time) and degree of completion were evaluated. FLS scores were measured before training and on days 5, 10, 15, and 20. We examined the relationship between "origami crane training" and FLS scores. RESULTS: At the beginning of the experiment, none of the participants could complete the origami crane, but they were able to complete it in 31 ± 7 min on day 20. The Total FLS score was 164 ± 48 before the start of training, and 1107 ± 112 on day 20. The average scores of the students closely approached the Proficiency Level for the FLS tasks of peg transfer, loop ligation and extracorporeal ligation (103→228, 61→137, 0→259). The change over time in the average of the increase in Total FLS Score (difference from the first time and each week's score) improved significantly in four weeks (P < 0.01). CONCLUSIONS: Origami crane training improved the medical students' FLS scores. We thought that origami crane training mainly enhanced hand-eye coordination and bi-hand coordination.

DOI： 10.1016/j.heliyon.2022.e11277

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Peristomal pyoderma gangrenosum (PPG), a variant of pyoderma gangrenosum, occurs adjacent to intestinal or urinary stomas and are typically seen in patients with active inflammatory bowel diseases (IBD). The present study evaluated 14 cases of PPG among 537 patients that had undergone ostomy surgery at Asahikawa Medical University Hospital from January 2017 to December 2021. The incidence of PPG among ostomy cases was calculated as 1.01 per 100-person-years. The median period from ostomy surgery to PPG onset was 192.5 days (36-1224 days). Significant differences in gender and ostomy subtype were observed in patients with PPG compared to all patients that had undergone ostomy surgery. IBD prevalence was comparable between groups. Topical corticosteroids or tacrolimus were sufficient for controlling PPG lesions in all cases other than one case controlled with oral prednisolone administered for a separate condition. Clinicians should be aware of recent developments in IBD therapies that may modify the risk of developing PPG. The present study results add to current knowledge of the pathogenesis of PPG.

DOI： 10.1111/1346-8138.16504

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Rectourethral fistula (RUF) after prostatectomy is a rare complication; however, when it occurs it is likely to be intractable and treatment requires surgical closure of the fistula. Several approaches to fistula closure have been reported, but there is no established treatment. CASE PRESENTATION: The patient was a 66-year-old man who had undergone robot-assisted laparoscopic radical prostatectomy for prostate cancer. On the 16th postoperative day, RUF was diagnosed. Cystostomy, laparoscopic ileostomy and transanal fistula closure were performed, and conservative treatment was continued for 5 months; however, the RUF remained, so the patient underwent fistula closure with a gracilis muscle flap using both transperineal and laparoscopic manipulation. Because it was a high fistula, the RUF was difficult to fill with a transperineal approach alone; however, in combination with laparoscopic manipulation, the appropriate filling of the fistula was possible. CLINICAL DISCUSSION: Although few reports have described the use of the laparoscopic transabdominal approach in combination with a transperineal gracilis muscle flap, the advantages of this technique are that the superior part of the fistula can be dissected, the flap can be filled more securely than with a transperineal approach alone, and transabdominal manipulation can be performed in a less invasive manner. In addition, by coordinating perineal and laparoscopic manipulation, we were able to close the fistula without organ damage by safe dissection. CONCLUSION: The laparoscopic approach is useful for RUF closure because it allows the interposition of the flap to reliably fill the space between the bladder and the rectum.

DOI： 10.1016/j.ijscr.2022.106856

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語  

Pembrolizumab is one of the treatment options for treatment-refractory unresectable advanced or metastatic colorectal cancer with microsatellite instability-high (MSI-H) or deficiencies in DNA mismatch repair (dMMR). Herein, we report a case in which a recurrent cecal cancer lesion showed specific imaging findings and local inflammatory findings during treatment with pembrolizumab, followed by marked shrinkage. The patient was an 80-year-old woman. Postoperative peritoneal recurrence of cecal cancer of approximately 7 cm in size was observed. The patient had MSI-H and was treated with pembrolizumab. After five courses of treatment, the patient presented to our hospital with a chief complaint of abdominal pain. A blood test showed a strong inflammatory reaction, and computed tomography (CT) showed diffuse low-density area in the tumor. Under the suspicion of an abscess, conservative treatment was initiated and the patient quickly recovered. A CT at 1 month showed a marked reduction in size at the same site, and a CT at 3 months showed that the recurrent foci had almost disappeared. The inflammatory reaction before shrinkage in this case may have been caused by tumor immune response to pembrolizumab.

DOI： 10.23922/jarc.2021-053

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Purpose Despite the established activity of regorafenib in metastatic colorectal cancer (CRC), gastrointestinal stromal tumor (GIST), and hepatocellular carcinoma (HCC), its toxicity profile has limited clinical use. We aimed to evaluate the pharmacokinetics of regorafenib and its active metabolites M-2/M-5, and to clarify the relationships between total drug-related exposure and clinical outcomes in real-world practice. Methods Blood samples at steady state were obtained during Cycle 1 from patients treated with regorafenib. Plasma concentrations of regorafenib and its metabolites were measured by liquid chromatography-tandem mass spectrometry. The efficacy and safety endpoints were progression-free survival (PFS) and dose-limiting toxicities (DLTs), respectively. The exposure-response relationships were assessed. Results Thirty-four Japanese patients with advanced cancers were enrolled (CRC, n = 26; GIST and HCC, each n = 4). Nine patients started regorafenib treatment at the recommended dose of 160 mg once daily (3 weeks on / 1 week off), while the other patients received a reduced starting dose to minimize toxicities. The median PFS was significantly longer in patients achieving total trough concentrations (Ctrough) of regorafenib and M-2/M-5 ≥2.9 µg/mL than those who did not (112 vs. 57 days; p = 0.044). Furthermore, the cumulative incidence of DLTs during the first 2 cycles was significantly higher in patients with summed Ctrough levels ≥4.3 µg/mL than in others (p = 0.0003). Conclusions Dose titration of regorafenib to achieve drug-related Ctrough levels between 2.9 and 4.3 µg/mL in Cycle 1 may improve efficacy and safety, warranting further investigation in a larger patient population.Clinical trial registry: Not applicable.

DOI： 10.1007/s10637-021-01115-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: 8K Ultra-high-definition (UHD) imaging has been developed in accordance with the progression of imaging technologies. We evaluated laparoscopic procedures performed by novice medical students using 2K/two-dimensional (2D), 2K/three-dimensional (3D) and 8K/2D monitors, with a particular focus on depth perception. METHODS: Nine medical students were enrolled. They performed two tasks using 2K/2D, 2K/3D and 8K/2D monitors. In Task 1, they were asked to grasp three metal rods with forceps using each hand. In Task 2, they were asked to grasp a metal rod with forceps held in the right hand, pass the metal rod through a metal ring and transfer it to their left hand. RESULTS: In Task 1, when performed with the dominant hand, the procedures performed using 2K/3D took a significantly shorter time than those performed using 8K/2D (P = 0.04). However, there was no significant difference among the three groups in the time required for procedures performed by the non-dominant hand. In Task 2, the procedure time with 2K/2D was significantly longer than that with 2K/3D or 8K/2D (P = 0.02). CONCLUSION: 2K/3D showed superior utility to 8K/2D for performing forceps procedures using the dominant hand. However, when the movement of both hands was coordinated ("bi-hand coordination"), the laparoscopic procedures were performed almost as deftly with 8K/2D and 2K/3D.

DOI： 10.1007/s00595-020-02215-z

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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担当区分：筆頭著者   記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   出版者・発行元：北海道外科学会  

本邦においてはStage II、IIIの進行胃癌に対するD2郭清を伴う胃切除術後の補助化学療法として、S-1単剤療法(1年間)とXELOX療法(6ヵ月間)が確立されているが、そのいずれを選択すべきかについての明確な基準はなく、また最近SOX療法の安全性、有効性も報告されている。治癒切除可能だが予後不良な4型/大型3型、高度リンパ節転移およびStage III症例に対する術前補助化学療法による予後改善効果が期待されているが、いまだ標準治療としては確立されていない。Stage IV胃癌に対する減量手術の意義は否定されたが、化学療法が奏効しR0切除が可能となった症例では、conversion therapyによる予後の改善が期待されており、今後の検討が期待される。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2019&ichushi_jid=J01375&link_issn=&doc_id=20200204040003&doc_link_id=%2Fdc7hksrg%2F2019%2F006402%2F004%2F0128-0133%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdc7hksrg%2F2019%2F006402%2F004%2F0128-0133%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：北海道外科学会  

1999年に販売が開始された手術支援ロボットもテクノロジーの進歩とともに様々な改良が加えられてきました。我が国においても2012年4月に前立腺悪性腫瘍手術に対するロボット支援手術の保険収載が認められて以降、da Vinci Surgical Systemを用いたロボット支援手術の導入がすすんできました。また、本年4月より新たに12の術式にda Vinci Surgical Systemを用いたロボット支援手術の保険収載が決まりました。これにより泌尿器科中心であった我が国のロボット支援手術も心臓外科・呼吸器外科・消化器外科・泌尿器科・婦人科の5領域でのロボット支援手術の保険診療が可能となりました。また、来年以降には我が国をはじめ各国から手術支援ロボットの販売が開始される予定です。いよいよ従来の腹腔鏡下手術からロボット支援手術へと新たな時代の幕開けとなりました。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2018&ichushi_jid=J01375&link_issn=&doc_id=20190118150002&doc_link_id=%2Fdc7hksrg%2F2018%2F006302%2F003%2F0088-0093%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdc7hksrg%2F2018%2F006302%2F003%2F0088-0093%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：北海道外科学会  

進行直腸癌は結腸癌に比して予後不良であり、特に局所再発のコントロールが重要である。近年、欧米では全直腸間膜切除術(以下TME)+術前化学放射線療法が標準化されている一方、本邦ではTMEに側方リンパ節郭清を行うことで局所再発率が欧米と同等であったことから術前化学療法、術前化学放射線療法の大規模臨床試験が行われてこなかった。一方、さらなる局所再発の低下、生存率の向上を目指し、また腹腔鏡下手術の普及に伴って日本の各施設で臨床試験レベルでの術前化学療法、術前化学放射線療法が施行されている。しかし未だエビデンスレベルのあるレジメンはなく、大腸癌治療ガイドラインでも化学放射線療法の推奨度は1Bとされているが臨床試験レベルとして行うべきとされている。また、術前化学放射線療法を施行した際の側方郭清の必要性、及び適応縮小化については議論の渦中である。本稿では下部消化管、特に局所進行直腸癌における最近の治療戦略について、術前化学放射線療法を中心として述べる。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2015&ichushi_jid=J01375&link_issn=&doc_id=20160318100004&doc_link_id=%2Fdc7hksrg%2F2015%2F006002%2F005%2F0132-0137%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdc7hksrg%2F2015%2F006002%2F005%2F0132-0137%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：日本臨床外科学会  

症例は71歳,女性.発症から23年経過した全大腸炎型,再燃・緩徐型の潰瘍性大腸炎のサーベイランス内視鏡検査にて直腸癌を指摘された.造影CTおよびMRIにて左側方リンパ節領域に15mm大の腫瘤を認め,左側方リンパ節転移が疑われた.潰瘍性大腸炎関連直腸癌,T3N3M0,Stage IIIbの診断にて,腹腔鏡下大腸全摘,回腸嚢肛門吻合とともに左側方郭清を施行したところ,閉鎖神経に連続するように紡錘状に腫大する類円型腫瘤を認め,閉鎖神経を切離して腫瘤を摘出した.病理組織所見では,免疫染色にてS-100陽性,MIB-1 index 1.6%,異型核分裂像を認めず,Antoni A type主体の良性神経鞘腫と診断した.術後にADLに支障をきたすような左下肢の神経学的症状は認めなかった.閉鎖神経発生の後腹膜神経鞘腫は稀であり,文献的考察を加えて報告する.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2015&ichushi_jid=J03156&link_issn=&doc_id=20150508130035&doc_link_id=10.3919%2Fjjsa.76.850&url=https%3A%2F%2Fdoi.org%2F10.3919%2Fjjsa.76.850&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

担当区分：筆頭著者   記述言語：日本語   掲載種別：研究論文（大学，研究機関等紀要）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 47-year-old woman with a 2-year history of rheumatoid arthritis (RA) undergoing methotrexate treatment developed a perforated ulcer in the ileum for which she underwent emergency surgery. A histological analysis of the extirpated specimen presented a possible Epstein-Barr virus (EBV) infection in the ulcerative lesion without a feature of lymphoproliferative disorder. Interestingly, the patient's serological tests with a paired serum diagnosed a primary EBV infection. The present case emphasizes the importance of being aware of severe enteritis as a possibility for patients with RA, for an accurate diagnosis.

DOI： 10.2169/internalmedicine.54.4735

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：北海道外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 49-year-old woman was admitted to our hospital because of epigastralgia and abdominal distension. She was diagnosed as advanced colon cancer with para-aortic and common iliac lymph node metastases, without liver and lung metastasis. Extended right hemicolectomy was performed to remove symptoms of stenosis. Bevacizumab (BV) (5 mg/kg) + mFOLFOX6 was performed as the initial postoperative chemotherapy. The tumor marker CEA, CA19-9 decreased, and reduction in the size of distant lymph node metastasis was confirmed, which obtained PR. In July 2009, computed tomography revealed the right pulmonary hilar lymph node metastases and progressive disease was confirmed; therefore, cetuximab and FOLFIRI combination therapy was initiated. However, in October 2009, bilateral inguinal lymph node metastases was seen; therefore we changed chemotherapy to BV (10 mg/kg) and FOLFIRI. Although the abdominal lymph node was decreased slightly after 2 months, chemotherapy was changed to BV (10 mg/kg) and mFOLFOX6 since the inguinal lymph node had enlarged. Skin metastases appeared, and there was no change in the inguinal lymph node and abdominal lymph node. She was deceased due to peritonitis carcinomatosis; however, her survival time exceeded 30 months. There was a possibility that long-term survival could be obtained by increasing the quantity of BV and re-administering it in second-line chemotherapy after PD in BV + FOLFOX first-line chemotherapy.

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は49歳、女性。上腹部不快感、腹満を主訴に当科を受診し、上行-横行結腸癌、大動脈周囲リンパ節～総腸骨リンパ節転移の診断がなされた。肝・肺転移なし。狭窄症状を認めたため、2007年10月下旬に拡大右半結腸切除術を施行。術後約1ヵ月後に全身化学療法の一次治療としてベバシズマブ(bevacizumab:BV 5mg/kg)+mFOLFOX6を開始。腫瘍マーカーは減少、遠隔リンパ節転移も縮小しPRを得た。2009年7月に右肺門部リンパ節転移が出現しPDとなり、cetuximab+FOLFIRIに変更するも、3ヵ月後に両側鼠径リンパ節転移出現を認めBV(10mg/kg)+FOLFIRIに変更。2ヵ月半後に腹部リンパ節はわずかに縮小したが、鼠径リンパ節が増大したためBVを10mg/kgに増量したBV+mFOLFOX6に変更した。その2ヵ月後に皮膚転移が出現するも、鼠径リンパ節、腹部リンパ節には変化を認めなかった。その後、癌性腹膜炎などを生じ死亡したが、30ヵ月を超える生存期間が得られた。一次治療でPDとなったBV+FOLFOX療法でも、二次治療以降でBVを増量し再投与することで、長期生存が得られる可能性が示唆された。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2013&ichushi_jid=J00296&link_issn=&doc_id=20131022340025&doc_link_id=%2Fab8gtkrc%2F2013%2F004010%2F027%2F1401-1404%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2013%2F004010%2F027%2F1401-1404%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：北海道外科学会  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 71-year-old male with unresectable pancreatic cancer treated with gemcitabine (GEM) by another doctor came to our hospital because of stenosis of duodenum and hydronephrosis. There was peritoneal dissemination in his abdominal cavity, and gastro-jejunostomy was performed. After surgery, GEM therapy was continued until he was judged as PD. The regimen was switched to S-1/GEM combination therapy. After that, the tumor marker was down to within normal range, and abdominal symptoms improved. He is now being treated as an outpatient. S-1/GEM combination therapy is effective for patients with unresectable advanced pancreatic cancer.

PubMed

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は71歳、男性。切除不能進行膵癌の診断にて前医でgemcitabine(GEM)単剤療法を施行中であったが、十二指腸狭窄と右水腎症が出現し当科紹介となった。術中所見で腹膜播種を認め、胃空腸バイパス手術を施行した。その後もGEM単剤療法を継続していたがPDとなり、S-1/GEM併用療法へ変更した。その後腫瘍マーカーの低下、腹部症状の改善があり、現在外来で治療継続中である。S-1/GEM併用療法はGEM単剤療法が無効となった切除不能進行膵癌の予後改善に有効であると考えられた。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2011&ichushi_jid=J00296&link_issn=&doc_id=20110531420030&doc_link_id=%2Fab8gtkrc%2F2011%2F003805%2F031%2F0853-0855%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2011%2F003805%2F031%2F0853-0855%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

担当区分：筆頭著者   記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

膵癌の初発症状は腹痛,黄疸,背部痛の順に多く,腫瘍栓に伴う症状で発症することは極めて稀である.今回,上腸間膜静脈腫瘍栓により発症した膵癌を経験した.症例は77歳,男性.腹痛,下血を主訴に救急外来受診.強い心窩部痛と心電図上心房細動を認めたため上腸間膜動脈血栓症を疑い,動脈相中心の腹部造影computed tomography(以下CT)を施行.CTでは原因の特定に至らなかったが,症状が強いため試験開腹術を施行した.開腹所見では血性腹水,小腸と腸間膜の黒赤色変化,腸間膜静脈の血栓を認め,小腸切除,血栓除去,人工肛門造設を行った.術中採取した静脈壁の内部に腫瘍所見ありとの病理診断を得た.原発巣の検索を行い,膵頭体移行部に腫瘍を認め膵管細胞診でadenocarcinomaとの結果より,膵癌に伴う上腸間膜静脈腫瘍栓・血栓と診断した.自験例のように上腸間膜静脈腫瘍栓・血栓を初発症状とした膵癌の報告例は検索した限りではなく,極めて稀な症例と思われ報告する.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2011&ichushi_jid=J03156&link_issn=&doc_id=20110510220035&doc_link_id=10.3919%2Fjjsa.72.1022&url=https%3A%2F%2Fdoi.org%2F10.3919%2Fjjsa.72.1022&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

Nonalcoholic Steatohepatitis(以下,NASH)症例に対する肝切除においてはNASHによる肝予備能低下の可能性を念頭においた慎重な術前評価,切除術式の適応が必要である.症例は71歳の女性で,肝胆道系酵素の上昇を契機として左右肝管合流部から右肝管に主座をおく肝門部胆管癌と診断した.糖尿病,高脂血症,脂肪肝を有しておりNASHの合併が疑われた.ICGR15(%),99mTc-GSAシンチでのHH15,LHL15はいずれも正常値で肝予備能は良好と判断した.門脈塞栓術にて99mTc-GSAシンチによる推定残肝予備能は39.1%と増大が得られ,肝拡大右葉切除術を施行した.術後は肝不全の発症なく良好な経過であった.病理組織学的検査所見でもNASHと診断された.本症例はNASH症例においてもICGR15,99mTc-GSAシンチを中心とした肝硬変症例に準じた肝予備能評価,術式の適応が可能であることを示唆するものである.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2009&ichushi_jid=J01117&link_issn=&doc_id=20090807090010&doc_link_id=10.5833%2Fjjgs.42.1407&url=https%3A%2F%2Fdoi.org%2F10.5833%2Fjjgs.42.1407&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

PURPOSE: There are numerous reports on the subject of effectiveness in radio-chemotherapy with regard to esophageal cancer, suggesting especially the combination therapy of 5-FU + CDDP aimed for recovery. Treatment becomes difficult when distal metastases appear during an adjuvant therapy followed by surgery. Our report here is a case in which a complete recovery was obtained after changing to S-1, a prodrug of 5-FU, in response to multiple lung metastases which appeared during the combined 5-FU + CDDP therapy followed by surgery for esophageal cancer. CASE: The patient was a 71-year-old male. Endoscopy during a physical examination showed a Type 1 tumor 27-30 cm from the anterior teeth. Detailed tests provided a preoperative diagnosis of esophageal cancer: Ut Type 1, T2-T3, N2, MO, IMO. A right thoracolaparotomic subtotal esophagectomy and retrosternal reconstruction were performed. Pathological findings showed well-differentiated squamous cell carcinoma, pT1b (sm), pN1 (106-rec R), pStage II. Postoperative combination of 5-FU + CDDP (day 1-5, 5-FU 500 mg; CDDP 10 mg/body) was started. Because of the appearance of multiple lung metastases after the completion of 3 courses, 2 courses of S-1 + CDDP (S-1 120 mg/body day 1-14; CDDP 5 mg/body day 1-5, day 8-12) were performed. After completing the chemotherapy, CT revealed the resolution of the lung metastases and complete recovery was diagnosed. Following this, a treatment with S-1 alone was continued until the appearance of bone metastases at which time radiotherapy was performed. The treatment is currently ongoing and no recurrence of the lung metastases has been shown. CONCLUSION: There have been numerous reports of the combination of S-1 + CDDP in esophageal cancer for NAC or in inoperable cases. However, our report suggests that this method may be effective in cases of recurrence or distal metastases.

PubMed

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は71歳、男性。切除不能進行膵癌の診断にて前医でgemcitabine(GEM)単剤療法を施行中であったが、十二指腸狭窄と右水腎症が出現し当科紹介となった。術中所見で腹膜播種を認め、胃空腸バイパス手術を施行した。その後もGEM単剤療法を継続していたがPDとなり、S-1/GEM併用療法へ変更した。その後腫瘍マーカーの低下、腹部症状の改善があり、現在外来で治療継続中である。S-1/GEM併用療法はGEM単剤療法が無効となった切除不能進行膵癌の予後改善に有効であると考えられた。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2011&ichushi_jid=J00296&link_issn=&doc_id=20110531420030&doc_link_id=%2Fab8gtkrc%2F2011%2F003805%2F031%2F0853-0855%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2011%2F003805%2F031%2F0853-0855%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

Nonalcoholic Steatohepatitis(以下,NASH)症例に対する肝切除においてはNASHによる肝予備能低下の可能性を念頭においた慎重な術前評価,切除術式の適応が必要である.症例は71歳の女性で,肝胆道系酵素の上昇を契機として左右肝管合流部から右肝管に主座をおく肝門部胆管癌と診断した.糖尿病,高脂血症,脂肪肝を有しておりNASHの合併が疑われた.ICGR15(%),99mTc-GSAシンチでのHH15,LHL15はいずれも正常値で肝予備能は良好と判断した.門脈塞栓術にて99mTc-GSAシンチによる推定残肝予備能は39.1%と増大が得られ,肝拡大右葉切除術を施行した.術後は肝不全の発症なく良好な経過であった.病理組織学的検査所見でもNASHと診断された.本症例はNASH症例においてもICGR15,99mTc-GSAシンチを中心とした肝硬変症例に準じた肝予備能評価,術式の適応が可能であることを示唆するものである.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2009&ichushi_jid=J01117&link_issn=&doc_id=20090807090010&doc_link_id=10.5833%2Fjjgs.42.1407&url=https%3A%2F%2Fdoi.org%2F10.5833%2Fjjgs.42.1407&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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開催年月日： 2023年4月

記述言語：日本語   会議種別：ポスター発表  

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記述言語：英語   会議種別：シンポジウム・ワークショップ パネル（公募）  

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開催年月日： 2022年4月

記述言語：日本語   会議種別：ポスター発表  

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