High-dose Chemotherapy with Peripheral Blood Stem Cell Transplantation for Patients with Poor PrognosisAdvanced Germ Cell Tumor

SUMMARYAbout one half of all advanced germ cell tumor( GCT) patients with poor prognosis defined by the InternationalGerm Cell Cancer Collaborative Group (IGCCCG) die of cancer. We evaluated salvage high-dosechemotherapy (HDCT) with peripheral blood stem cell transplantation (PBSCT) for patients with poorprognosis advanced GCT in Dokkyo Medical University. Three patients with poor prognosis advanced GCTwere treated with HDCT as salvage chemotherapy. Two patients had primary testicular GCT and one patienthad primary mediastinal GCT. Treatment responses were pathological complete remission( CR) in one,surgical CR in one and partial remission (PR) in one. Effectiveness and side effects of HDCT with PBSCTfor poor prognosis cases with advanced GCT were shown in this study. However, further accumulation ofthese studies is needed

A Case of Cystic Renal Cell Carcinoma Mimicking a Benign Complicated Renal Cyst on Computed Tomography;Usefulness of Magnetic Resonance Imaging

We present a case of cystic renal cell carcinoma( RCC) mimicking a benign complicated renal cyst. In thepresent case, the cystic renal mass was classified as Bosniak classification category II on computed tomography(CT), but magnetic resonance imaging (MRI) demonstrated additional septa and enhancement, whichled to an upgraded Bosniak classification( category III). The patient underwent radical nephrectomy. Histologicalexamination showed the cystic necrosis type of RCC

A Case of Renal Angiomyolipoma with Minimal Fat Mimicking Renal Cell Carcinoma

We present a case of renal angiomyolipoma (AML) with minimal fat mimicking renal cell carcinoma(RCC). AML is composed of variable amount of fat, smooth muscle and abnormal blood vessels. In general,AML can be differentiated from RCC with great accuracy using modern radiological techniques due to thefat component of the renal mass. In the present case, the renal tumor did not demonstrate intratumoral faton radiological studies. Surgery was performed and the renal tumor was removed. Histologically, the renaltumor showed abundant muscle that occupied almost the entire lesion, which demonstrated HMB-45 antigen.The tumor was diagnosed as renal AML

Amantadine can Ameliorate Lower Urinary Tract Dysfunction and Nocturnal Polyuria in Patients with Parkinson Disease and Vascular Parkinsonism

Background:Amantadine is a drug used for patients with Parkinson\u27s disease (PD) and vascular parkinsonism (VP). These patients often have lower urinary tract symptoms (LUTS) and nocturnal polyuria (NP). Thus, we investigated the effect of amantadine on these in parkinsonian patients.Methods:Twenty-two patients with LUTS, including 13 with PD and nine with VP, were recruited. We performed a urinary questionnaire, frequency-volume chart, and residual urine (RU) measurement before and after daily administration of 150 mg and 300 mg amantadine.Results:Before amantadine administration, mean daytime urinary frequency was 9.07(standard error [SE], 0.64), nighttime urinary frequency 2.89 (0.24), urinary urgency per week 24.2 (6.69), urge incontinence per month 15.1( 9.94), urine volume per void 145.6( 12.6) mL, and residual urine volume 12.5( 6.30) mL. After daily 150 mg amantadine administration, mean daytime and nighttime urinary frequency, urinary urgency, and urge incontinence decreased to 6.9( 0.42), 1.97( 0.21), 13.0( 3.58), and 14.2( 10.2), respectively, and urine volume per void increased to 174.1( 11.3) mL. NP( N=8) was ameliorated in six patients. No patient had side effects. After daily 300 mg amantadine administration( N=8), mean daytime and nighttimeurinary frequency, urinary urgency, and urge incontinence decreased to 6.90 (0.33), 1.69 (0.10), 5.88 (1.61), and 2.31 (0.61), respectively, and urine volume per void increased to180.2 (15.0) mL. NP (N=4) was ameliorated in two patients. One patient developed hallucination, and two patients developed flashing sensation.Conclusion:Amantadine has beneficial effects on LUTS and NP in patients with VP and PD

コウサンキュウ セイ ボウコウ エン ノ 1 レイ

症例は36歳男性.頻尿,排尿時痛,残尿感および食思不振を主訴に近医受診.抗生剤投与されるも症状軽快せず,当院紹介受診となる.初診時検査で,白血球,好酸球,IgEの上昇を認め,経腹膀胱超音波検査,MRIで膀胱壁の著明な肥厚を認めた.また,膀胱鏡検査では膀胱三角部を除く膀胱粘膜の著明な浮腫状所見を認め,上部消化管内視鏡検査では胃粘膜及び十二指腸粘膜も同様の浮腫状所見であった.確定診断のため膀胱全層針生検を施行し,病理所見では膀胱平滑筋内に著明な好酸球浸潤を認めたため好酸球性膀胱炎と診断.点滴ステロイド療法を開始し,症状軽快,画像上も改善を認めステロイド内服に切り替えたのち退院した.A 36-years-old man with pollakisuria and digestive symptom was referred to our hospital. A blood test showed inclease of serum white blood cell,eosinophil and IgE. Imaging study showed thickening of bladder wall, and endoscopy of bladder and stomach showed severe mucosal edema. Because there was a suspicion of the allergic diseases, we carried out transabdominal needle biopsy of bladder. Because of the pathological finding of severe eosinophilic infiltration into smooth muscle of urinary bladder, we diagnosed a case of eosinophilic cystitis. After that we started up steroid therapy immediately, he was recovering from pollakisuria and digestive symptom

ジョセイ コツバン ゾウキ ダツ カンジャ ニ タイスル Tension-free Vaginal Mesh シュジュツ ノ ハイニョウ キノウ ト Quality of Life ニ アタエル カイゼン コウカ ノ ケントウ

骨盤臓器脱にTVM 手術を施行した51 症例を対象としてUFM, 残尿量,P-QOL,ICIQ-SF 及びIPSSを調査することによりTVM 手術の下部尿路症状,排尿機能とQOL に与える改善効果を評価した.周術期成績と解剖学的改善度は良好であり,IPSS による下部尿路症状の評価では夜間頻尿以外のすべての項目で有意に改善した.またP-QOL を用いたQOL 評価でも有意な改善を示した.本研究では骨盤臓器脱に対してTVM 手術が下部尿路症状,排尿機能,QOL を短期間の評価ながら改善する事を示した.今後は解剖学的治療効果のみでなく,排尿や性機能を含めて長期間評価することが必要と考えられた.The aim of this paper is to describe the perioperativemedical outcome, complications and the improvement ofvoiding function and their quality of life( QOL) in 51 casesof tension-free vaginal mesh (TVM) for the treatment ofpelvic organ prolapse( POP) at our institute. Perioperativemedical outcome and anatomical restoration were good atsix months after the operation. Lower urinary tract symptomand QOL of the patients were statistically much improvedbased on the results of IPSS and prolapse quality oflife questionnaire( P-QOL), except for nocturia. This studyshowed improvement of voiding function and QOL for thefemale POP.Further studies will be needed for a long period not onlythe anatomical restoration but also the voiding and sexualfunction

フククウキョウカ シュジュツ ショケン カラ ノ ジンウ ニョウカン イコウ ブ キョウサクショウ ノ ケイタイ ブンルイ ト ジュツゴ ケイカ

【目的】水腎症の原因である腎盂尿管移行部閉塞(Uretero-Pelvic Junction Obstruction;UPJO)の病因を形態的に分類し,患者背景,術後の経過との関連性について検討した.【方法】2009年3月から2013年4月までに獨協医科大学越谷病院で施行した腹腔鏡下腎盂形成術(Laparoscopic Pyeloplasty;LPP)38症例について検討した.術中所見とビデオの見直しから以下のように3つの病因に分類した.Type 1:血管による閉塞を有するもの.Type 2:肥厚した被膜が腎盂尿管を包み込むもの.Type 3:硬い被膜に包まれ尿管の屈曲,狭窄を認めるもの.上記病因と術前後における症状,腹部超音波所見および利尿レノグラムを用いて評価した手術成績について比較検討した.【結果】38症例を手術ビデオで見直した結果,Type 1は14例,Type 2は13例,Type 3は11例であった.小児症例はType 1の症例が少なく,Type 2およびType 3が多かった.各Typeでの術後の症状,腹部超音波所見,利尿レノグラムの改善率に有意差はなかった.【結語】UPJOの形態と年齢には関連を認めたが,術後成績には明らかな違いは認めなかった.Background:To analyze the relationship between the etiology of ureteropelvic junction obstruction (UPJO) and surgical outcomes using laparoscopic clear view during pyeloplasty. Method:Total 38 patients who underwent laparoscopic pyeloplasty by Anderson-Hynes technique from 2009 March to 2013 April at Dokkyo Medical University Koshigaya Hospital, were enrolled into the study. According to the structure of the ureteropelvic junction under the laparoscopic view UPJO was divided to 3 types, type 1 (n= 14):vascular causes of ureteral obstruction, type 2 (n= 14):the presence of adhesion around UPJ, type 3 (n= 11):the presence of angulation due to ureteral kinks or adhesion. The relationships between types of UPJO and surgical outcomes were analyzed.Results:Many of pediatric patient were included in type 2 and 3. Types of UPJO were not related to operation time, symptom, abdominal ultrasonography, and results of diuretic renogram.Conclusion:Most of pediatric patients with hydronephrosis had no vascular cause. There are no significant differences between each types and surgical success rate in patients underwent laparoscopic pyeloplasty

ホンガク ドウソウ カイイン ノ キンム ジョウキョウ : ジョセイ イシ シエン オ メザス ヨビテキ ケンキュウ トシテ

雇用の分野における男女の均等な機会及び待遇の確保のために,「男女雇用機会均等法」が成立し,妊娠や出産を理由として職場で不利益な取り扱いをすることは禁じられている1).さらに,「男女共同参画社会基本法」が施行され,2006 年には日本医師会に男女共同参画委員会が設立している2).しかし,我が国の女性医師の就労に影響を与える因子を検討した先行研究によると,性差による就労上の不利益を経験した女性医師が多く,就労格差を女性医師は強く認識しているという結論となっている3).このことは日本ばかりではなく,海外でも同様に報告されている4,5).特に,女性医師は男性医師に比較して,非常勤パートタイムで勤務することが多いと報告されている3,4).パートタイムで働く主たる理由は,出産と子育てである5).多くの女性医師が子育てを優先するために仕方なくパートタイム勤務を選択していることは事実である.また,母性を優先させる選択は職場での昇進・キャリアアップを閉ざすという結果につながる 3).しかし,一方で女性にとって出産や育児は非常に大切な母性の獲得であり,出産を経験した女性医師は医師を職業として選択したことにより満足していると報告されている6).これが女性医師にとってのワーク・ライフ・バランスのジレンマになっている.さらに,現在,医師を養成する大学医学部では,男女は平等に入学できるが,過酷な労働を強いられる大学病院では,女性医師は常勤勤務から離職せざるを得なくなるというアンバランスが生じている.本研究は,本学の女性医師支援のあり方を考える予備的研究として,本学同窓会会員の現況報告を検討し,さらに女性医師支援に関する先行文献を考察することを目的とした