外科的に切除しえた, 肝硬変を伴う維持透析患者に発症した右腎癌下大静脈腫瘍塞栓の1例

症例は54歳, 男性。1900年, CGNにて血液透析導入となった。2005年2月に肉眼的血尿が出現。CTにて右腎癌を指摘され, 3月9日当科紹介。当科にて施行したCTでは直径7cm大の右腎腫瘍とともに下大静脈内の肝静脈流入部まで達する腫瘍塞栓を認めた。右腎腫瘍, 下大静脈塞栓, T3bN0M0 stage IIIの診断で4月28日, 根治的右腎摘除ならびに腫瘍塞栓摘除術を施行した。手術時間4時間28分, 出血量1, 400ml, 摘出標本は重量800g, 病理所見はrenal cell carcinoma, G2, pT3bであった。術前の凝固系検査は異常を認めなかったが, 肝硬変が原因と考えられる出血時間の延長と血小板数の低下を認めたため, 周術期は血小板輸血などにて対応した。術後経過は良好で, 後出血などの術後合併症もなく, 術後18日目に退院した。現在IFNα投与にて後療法を施行中であるが, 再発を認めていない。透析患者における下大静脈腫瘍塞栓を伴う腎癌に対して外科的治療を施行した症例についての報告例については比較的少なく, 文献的考察も含めて報告する。(著者抄録)A 54-year-old man who had been under hemodialysis therapy for 16 years presented with gross hematuria at our department in February 2005. Imaging findings revealed right renal tumor of8.2 cm in diameter. In addition, the tumor extended into inferior vena cava at the level of the hepatic vein. There were no findings of distant metastasis. Right radical nephrectomy and thrombectomy were performed on April 2006. Histopathological analysis showed that the tumor was renal cell carcinoma of clear cell type, grade 2. Postoperative course was uneventful, and the adjuvant therapy with interferon alpha was initiated. He has been free from recurrence for 22 months after surgery

前立腺癌発生に及ぼす食事の影響 : 健診センターにおける検討

欧米とアジアの前立腺癌の発生率が異なる理由の一つとして,社会環境因子の一つである食事の差異があげられている.前立腺癌に対する食事,栄養素の影響を調べるため前立腺癌患者と非前立腺癌患者の摂取食事内容,摂取栄養素の違いについて検討した.東京女子医大成人医学センターにおける健康診断男性会員2,500名中,前立腺癌と診断された患者39名と,2年間6ヵ月毎に行った計4回の健康診断で,PSAが常に4.0ng/ml以下の会員416名を対照(非前立腺癌患者)とし比較検討した.健康診断前3日間の食事質問票を用いて,前立腺癌患者は確定診断前の摂取内容を,対照は最新の摂取内容を食事分析ソフトで解析した.前立腺癌患者の食事では,肉類が有意に多く摂取されており,栄養素としてビタミンAの摂取が多く,ビタミンDの摂取が少なかった.肉類摂取と前立腺癌の発生の関連が疑われた.ビタミンAは動物性食品に多く含まれており,前立腺癌患者は肉類の摂取が多いため有意差がでた可能性が考えられた.ビタミンDは魚介類に多く含まれ,非前立腺癌患者での癌細胞の増殖抑制効果との関連が推察された.肉食を少なくし,ビタミンDが多く含まれる魚介類の摂取を勧めることにより,前立腺癌の発生を抑制する可能性が考えられた.One of the reasons for the differing incidence of prostate cancer between Asian and Western countries is diet, which is a socioenvironmental factor. In order to ascertain the effects of food and nutrient intake on prostate cancer, the present study investigated 2,500 men who underwent health screening at our Institute. Subjects were patients who were diagnosed with prostate cancer (n=39) and those without prostate cancer (patients in whom Prostate specific antigen (PSA) was consistently below 4.0 ng/ml over a two-year period, n=416). Questionnaires were used to ascertain food intake for three days before each health screening, and diet analysis software was used to compare food intake. For the prostate cancer patients, meat intake was significantly higher, and in terms of nutrients, vitamin A intake was higher, while vitamin D intake was lower. Vitamin A is abundant in animal meat and vitamin D is plentiful in seafood, thus suggesting a correlation between seafood intake and cancer cell suppression for the men without prostate cancer. The results suggest that it may be possible to lower the incidence of prostate cancer by recommending people to eat less meat and consume more seafood rich in vitamin D

前立腺癌発生に及ぼす食事の影響 : 健診センターにおける検討

欧米とアジアの前立腺癌の発生率が異なる理由の一つとして,社会環境因子の一つである食事の差異があげられている.前立腺癌に対する食事,栄養素の影響を調べるため前立腺癌患者と非前立腺癌患者の摂取食事内容,摂取栄養素の違いについて検討した.東京女子医大成人医学センターにおける健康診断男性会員2,500名中,前立腺癌と診断された患者39名と,2年間6ヵ月毎に行った計4回の健康診断で,PSAが常に4.0ng/ml以下の会員416名を対照(非前立腺癌患者)とし比較検討した.健康診断前3日間の食事質問票を用いて,前立腺癌患者は確定診断前の摂取内容を,対照は最新の摂取内容を食事分析ソフトで解析した.前立腺癌患者の食事では,肉類が有意に多く摂取されており,栄養素としてビタミンAの摂取が多く,ビタミンDの摂取が少なかった.肉類摂取と前立腺癌の発生の関連が疑われた.ビタミンAは動物性食品に多く含まれており,前立腺癌患者は肉類の摂取が多いため有意差がでた可能性が考えられた.ビタミンDは魚介類に多く含まれ,非前立腺癌患者での癌細胞の増殖抑制効果との関連が推察された.肉食を少なくし,ビタミンDが多く含まれる魚介類の摂取を勧めることにより,前立腺癌の発生を抑制する可能性が考えられた.One of the reasons for the differing incidence of prostate cancer between Asian and Western countries is diet, which is a socioenvironmental factor. In order to ascertain the effects of food and nutrient intake on prostate cancer, the present study investigated 2,500 men who underwent health screening at our Institute. Subjects were patients who were diagnosed with prostate cancer (n=39) and those without prostate cancer (patients in whom Prostate specific antigen (PSA) was consistently below 4.0 ng/ml over a two-year period, n=416). Questionnaires were used to ascertain food intake for three days before each health screening, and diet analysis software was used to compare food intake. For the prostate cancer patients, meat intake was significantly higher, and in terms of nutrients, vitamin A intake was higher, while vitamin D intake was lower. Vitamin A is abundant in animal meat and vitamin D is plentiful in seafood, thus suggesting a correlation between seafood intake and cancer cell suppression for the men without prostate cancer. The results suggest that it may be possible to lower the incidence of prostate cancer by recommending people to eat less meat and consume more seafood rich in vitamin D

巨大副腎悪性褐色細胞腫の1例 : 大型の褐色細胞腫の管理について

69歳男.直径約30cmの左側腹部腫瘤の診断及び治療の為, 当科へ紹介された.血中ノルエピネフリン値及びその尿中代謝産物の高値, CTスキャンにより巨大な嚢胞性後腹膜腫瘤, 大動静脈リンパ節の腫大が認められ, 悪性褐色細胞腫と診断.血行動態学的に循環血液量の低下と血管抵抗値の上昇が認められた為, 血管拡張剤の使用と共に循環血液量の補充が行われた.これらにより血行動態は正常化し, 腫瘍摘除術が施行された.病理学的に, リンパ節転移を伴う褐色細胞腫と診断され, 腫瘍重量は5, 930gであったA 69-year-old man was referred to our hospital for a left abdominal tumor measuring about 30 cm in diameter. Laboratory examination revealed an elevation of norepinephrine in plasma and of its metabolites in urine. CT scan disclosed a huge cystic tumor in the retroperitoneal space and an enlarged aortocaval lymph node, suggesting a diagnosis of malignant pheochromocytoma. The hemodynamic studies showed low blood volume and high vascular resistance, and therefore, he was treated with vasodilators and volume expansion. His hemodynamic status normalized and a complete excision was performed. Pathological examination revealed that the patient had a pheochromocytoma with metastasis to a lymph node. The total weight of the tumor was 5, 930 g. Since pheochromocytomas can become a large with a risk of malignancy, they should be surgically excised as completely as possible with further treatment after making a definite diagnosis

経尿道的前立腺切除術後の感染症に対する経口抗菌剤Levofloxacin予防的投与の効果の検討

われわれは前立腺肥大症患者98例を,リスク群(術前尿路感染症を有する患者および糖尿病患者)と非リスク群とに分け,経尿道的前立腺切除術(TURP)後感染症に対する経口剤の予防的効果を検討した.術後急性期(手術日を含め7日以内)の化学療法は,リスク経口群(Ia群)ではlevofloxacin(LVFX)600mg/日を7日間,非リスク経口群(IIa群)ではLVFX400mg/日を2日間およびLVFX200mg/日を5日間投与した.対照として,リスク点滴静注群(Ib群)および非リスク点滴静注群(IIb群)では2日間のみ抗生剤の点滴静注を行い,3日から7日までは経口群(IaおよびIIa群)と同様とした.また創傷治癒期(術後7日目以降)には,4群ともにLVFX100mgを就寝前に1回服用させ,膿尿が白血球10コ/high power field以下になるまで継続した,感染症については,38.0℃以上の発熱および尿路性器感染症の有無を検討した.急性期感染症を示した症例は,Ia群(n=11):9.1%,Ib群(n=16):18.8%,IIa群(n=39):15.4%,IIb群(n=32):12.5%であった.創傷治癒期感染症は,検討できた63例のうち,リスク群(Ia+Ib群,n=15):20.0%,非リスク群(IIa+IIb群,n=48):16.7%であった.術後急性期における経口抗菌剤LVFXによる化学療法は,リスク症例,非リスク症例ともに,注射用抗生物質を併用した群に比べ感染症発症頻度に有意差を認めず,有用であった.また創傷治癒期においても,LVFXの少量就寝前1回投与法は,安全で有用であると考えられた.Recently, oral antibiotics have been evaluated in place of parenteral antibiotics for prophylactic chemotherapy against infections after transurethral resection of the prostate (TURP). We studied the prophylactic effect of levofloxacin (LVFX) on infections following TURP in 98 patients with prostatic hypertrophy. The subjects were divided into a high-risk group (patients with preoperative urinary tract infection and/or diabetes mellitus) and a low-risk group. For postoperative acute-phase prophylaxis (within 7 days of surgery), 600 mg/day of LVFX was administered orally in the high-risk oral group (Group Ia) and 200～400 mg/day was given in the low-risk oral group (Group IIa). A parenteral antibacterial agent was initially administered for 2 days in the high-risk intravenous group (Group Ib) and the low-risk intravenous group (Group IIb), after which they subsequently received the oral LVFX regimens mentioned above. In the healing phase (from postoperative day 8 onwards), 100 mg of LVFX was administered orally before bedtime until the disappearance of pyuria (less than 10 WBC/HPF) in all groups. The percentage of patients with acute phase infection was 9.1% in Group Ia (n=11), 18.8% in Group Ib (n=16), 15.4% in Group IIa (n=39), and 12.5% in Group IIb (n=32). The percentage of patients with healing phase infections was 20.0% in the high-risk group (Ia+Ib, n=15) and 16.7% in the low-risk group (IIa+IIb, n=48). Oral LVFX therapy was useful for the prevention of acute phase infections in both the high-risk group and the low-risk group. In addition, administration of a low dose of LVFX once before bedtime was safe and useful for prophylaxis in the healing phase after TURP

経尿道的前立腺切除術後の感染症に対する経口抗菌剤Levofloxacin予防的投与の効果の検討

われわれは前立腺肥大症患者98例を,リスク群(術前尿路感染症を有する患者および糖尿病患者)と非リスク群とに分け,経尿道的前立腺切除術(TURP)後感染症に対する経口剤の予防的効果を検討した.術後急性期(手術日を含め7日以内)の化学療法は,リスク経口群(Ia群)ではlevofloxacin(LVFX)600mg/日を7日間,非リスク経口群(IIa群)ではLVFX400mg/日を2日間およびLVFX200mg/日を5日間投与した.対照として,リスク点滴静注群(Ib群)および非リスク点滴静注群(IIb群)では2日間のみ抗生剤の点滴静注を行い,3日から7日までは経口群(IaおよびIIa群)と同様とした.また創傷治癒期(術後7日目以降)には,4群ともにLVFX100mgを就寝前に1回服用させ,膿尿が白血球10コ/high power field以下になるまで継続した,感染症については,38.0℃以上の発熱および尿路性器感染症の有無を検討した.急性期感染症を示した症例は,Ia群(n=11):9.1%,Ib群(n=16):18.8%,IIa群(n=39):15.4%,IIb群(n=32):12.5%であった.創傷治癒期感染症は,検討できた63例のうち,リスク群(Ia+Ib群,n=15):20.0%,非リスク群(IIa+IIb群,n=48):16.7%であった.術後急性期における経口抗菌剤LVFXによる化学療法は,リスク症例,非リスク症例ともに,注射用抗生物質を併用した群に比べ感染症発症頻度に有意差を認めず,有用であった.また創傷治癒期においても,LVFXの少量就寝前1回投与法は,安全で有用であると考えられた.Recently, oral antibiotics have been evaluated in place of parenteral antibiotics for prophylactic chemotherapy against infections after transurethral resection of the prostate (TURP). We studied the prophylactic effect of levofloxacin (LVFX) on infections following TURP in 98 patients with prostatic hypertrophy. The subjects were divided into a high-risk group (patients with preoperative urinary tract infection and/or diabetes mellitus) and a low-risk group. For postoperative acute-phase prophylaxis (within 7 days of surgery), 600 mg/day of LVFX was administered orally in the high-risk oral group (Group Ia) and 200～400 mg/day was given in the low-risk oral group (Group IIa). A parenteral antibacterial agent was initially administered for 2 days in the high-risk intravenous group (Group Ib) and the low-risk intravenous group (Group IIb), after which they subsequently received the oral LVFX regimens mentioned above. In the healing phase (from postoperative day 8 onwards), 100 mg of LVFX was administered orally before bedtime until the disappearance of pyuria (less than 10 WBC/HPF) in all groups. The percentage of patients with acute phase infection was 9.1% in Group Ia (n=11), 18.8% in Group Ib (n=16), 15.4% in Group IIa (n=39), and 12.5% in Group IIb (n=32). The percentage of patients with healing phase infections was 20.0% in the high-risk group (Ia+Ib, n=15) and 16.7% in the low-risk group (IIa+IIb, n=48). Oral LVFX therapy was useful for the prevention of acute phase infections in both the high-risk group and the low-risk group. In addition, administration of a low dose of LVFX once before bedtime was safe and useful for prophylaxis in the healing phase after TURP