肺癌患者の末梢血、局所リンパ節および腫瘍浸潤リンパ球の自己腫瘍細胞傷害活性の研究

取得学位 : 博士（医学）, 学位授与番号 : 医博甲第1136号, 学位授与年月日：平成6年3月25日,学位授与年：199

New class development to cancel a life experience and the gap with the scientific definition

理科の授業では，物理量の定義を起点として学びの展開を構成する場合が多い（定義起点展開法）。一方，日常生活では，「目的地までの所用時間の短さ」と「速さ」を連動させて思考することが多い（生活起点展開法）。そのため，科学的定義に基づく扱いとのギャップに生徒が戸惑い，理科の学習内容を日常生活へ関連させて理解するときの障壁になっている可能性がある。中学校２・３年生679名を対象とした事前調査では，速さについて「生活起点」で考えている生徒が615名（90.6％），「定義起点展開法」で考えている生徒が51名（7.5％）であった。また，生徒の「速さ」の捉え方に対する回答反応時間の分析結果からも，「定義起点展開法」の正解者の反応時間の平均が22.0秒に比べ「生活起点展開法」の平均は18.4秒であり，「目的地までの所用時間の短さ」と「速さ」を連動して思考する「生活起点展開法」の考え方が多いと推測される

管状左上区切除＋左下葉分画肺切除により肺機能を温存した肺門部早期肺癌症例

金沢大学医薬保健研究域医学系A 59-year-old man complained of fever due to infection in the intralobar pulmonary sequestration. On bronchoscopic examination, squamous cell carcinoma was found out at orifice of the left upper division bronchus. His pre-operative pulmonary function test showed low pulmonary reserve because of myelopathy. He underwent left S1 + 2 + S3 sleeve segmentectomy and S9 + 10 segmentectomy for intralobar pulmonary sequestration. He is well without any evidence of recurrence 10 months after surgery

リンパ節転移の拡がりからみた, 広範囲郭清の必要性

金沢大学医薬保健研究域医学系During the past 20 years, 1,064 cases of non-small cell lung cancer underwent resectional surgery in which all accessible mediastinal lymph nodes were dissected. Among 288 patients with histologically proven N2 disease, 182 underwent complete dissection of the mediastinal lymph nodes; 77 had one-level and 105 had multi-level metastases. Fifteen percent of the patients having primary lesions with a maximal diameter between 21 and 30 mm had N2 disease. Nodal metastases to the lower mediastinum from upper lobe cancer (nonregional metastasis) were frequently observed as were metastases of lower lobe cancer to the upper mediastinum. In addition, there were often skip metastases to the nonregional parts of the mediastinum without regional nodal involvement in the mediastinum. Among left-lung cancer patients, the group that underwent nodal dissection after mobilization of the aorta by dividing the Botallo\u27s ligament frequently had a verified metastatic node at the tracheo-bronchial angle (#4) which might not have been detected without that procedure. In addition, many N2 and N3 diseases were detected by additional dissection through a median sternotomy. From the results of the present study, it appears that extensive mediastinal dissection should be recommended in surgery for lung cancer irrespective of the location and the size of the primary tumor

経皮肺生検にて確定診断を得た肺クリプトコッカス症の1例

金沢大学医薬保健研究域医学系A 53-year-old male was admitted with complaint of bloody sputum. The chest X-ray film revealed a solitary round mass with cavity formation in the left upper lung field. A diagnosis of pulmonary cryptococcosis was made by the percutaneous lung biopsy. As his chest X-ray film did not improve even by administration of antimycotic agents for 6 months, he underwent partial resection of left upper lobe. Thus, the percutaneous lung biopsy was a significant procedure for the definitive diagnosis of this case

HCG産生肺腺癌の1女性例

金沢大学医薬保健研究域医学系A 72-year-old female was admitted with complaints of cough and sputum. The chest X-ray film revealed a solitary round mass and pleural effusion in the left lower lung field. Laboratory tests demonstrated elevated levels of serum HCG and beta-HCG. Left lower lobectomy with parietal pleurectomy was performed under the diagnosis of primary lung cancer with malignant effusion. The serum HCG level decreased after the operation. Histologically, the tumor was diagnosed as moderately differentiated papillo-tubular adenocarcinoma of the lung. In the HCG staining using an immunohistochemical method, the tumor cells showed a positive reaction. Thus, this tumor was definitively diagnosed to be HCG-producing adenocarcinoma of the lung

80歳以上の高齢者肺癌に対する肺癌切除症例の検討

金沢大学医薬保健研究域医学系Seventeen lung cancer patients over 80 years of age were treated surgically at Kanazawa University Hospital from 1973 to 1991. The operative procedures were lobectomy (six patients), segmentectomy (seven patients), partial resection (three patients) and exploratory thoracotomy (one patient). Absolutely curative resection was done in two patients, relatively curative resection in two, relatively non-curative resection in ten, absolutely non-curative resection in two. The three-year survival rate after operation for all seventeen patients was 60.2%. Postoperative complication developed in eleven patients (64.7%). Patients who had lobectomy with mediastinal lymph node dissection had a high incidence of postoperative complications. In recent years, pulmonary resections have been performed in patients over 80 years of age who have been managed with pulmonary rehabilitation, resulting in better course. It is concluded that the limited resections produce good prognosis in patients over 80 years of age with lung cancer.

肋骨原発軟骨肉腫の2切除例

金沢大学医薬保健研究域医学系Chondrosarcoma of rib origin is rare in Japan. We treated two cases of chondrosarcoma of rib origin. Case 1: A 68-year-old man with anterior chest wall mass and chest pain was underwent aspiration biopsy in Inami General Hospital. The histological examination showed Class V. Operation was done in our department and the histological diagnosis was chondrosarcoma. The tumor was 30 x 20 x 20 mm in size arising from the left fourth rib. The defect of bony chest wall was repaired with a double layer of Marlex mesh. His postoperative course was uneventful. Case 2: 66-year-old man noticed a tumor in left anterior part of the chest 7 months ago. He was underwent incisional biopsy and the histological diagnosis was chondrosarcoma. Radical resection was performed. The tumor was 70 x 50 x 50 mm in size arising from the left rib. His postoperative course was uneventful

胸腺腫の外科治療

金沢大学医薬保健研究域医学系Sixty-seven patients with thymoma were surgically treated during the past 19 years in our department. The 5-year, 10-year and 15-year survival rates of total cases with thymomas were 69.2%, 59.6% and 59.6%, respectively. Survival rates of thymoma with MG and without MG were not significantly different. According to clinical stages in Masaoka\u27s classification, there were significant difference between Stage I and Stag III (p < 0.05), Stage I and Stage IV a (p < 0.01), and Stage I and Stage IV b (p < 0.01). We can conclude that complete resection of thymomas lead to better prognosis, and immunochemotherapy using cyclophosphamide, vincristine and OK-432 are effective.