悪性食道狭窄に対する金属ステント療法

Self-expandable metallic stents were used for palliative treatment of malignant esophagogastric strictures. Twelve patients, nine men and three women, with a mean age of 73.1 years old (range, 48-87 years old) had dysphagia due to esophagogastric strictures with advanced malignant tumors. A total of 13 expandable metallic stents were placed, four non-covered Ultraflex stents (nitinol stents), two non-covered Wallstents and seven covered Wallstents. The strictures were caused by esophageal carcinoma (n=7), gastric carcinoma with lymphnode metastasis (n=2), lung carcinoma with mediastinal lymphnode metastasis (n=2), and cardioesophageal carcinoma (n=1). All stents were placed with fluoroscopic and endoscopic guidance. No technical failure or procedural critical complications occurred and the dysphagia was relieved in all patients. The mean dysphagia score was 0.58±0.52 (standard deviation) before treatment and 3.25±0.97 after insertion. Complications included chest and epigastric pain in four, gastroesophageal reflux in two, tumor ingrowth in one, and food impaction in one. Six complications easily managed with medical, endoscopic, or radiologic intervention. At the end of this study, eight patients were dead with a mean survival of 28.3 weeks (range, 4-96 weeks), and four patients were alive with a mean follow up of 35.5 weeks (range, 8-98 weeks). In our experience, self-expandable metallic stents provide relatively safe and long-term palliation in patients with malignant esophagogastric obstruction

シン サルコイドーシス シンダン ノ テビキ ニオケル カクシュ シンダン モダリティー ノ ケントウ

Background : Sarcoidosis is a multiple organ granulomatous disease of undefined cause. Although cardiac involvement often leads to adverse outcomes in patients with sarcoidosis, diagnosis of cardiac sarcoidosis（CS）remains difficult due to the lack of sensitive diagnostic tests. Purpose : To determine an appropriate combination of diagnostic tests for detecting CS. Method and Results : Thirteen patients were diagnosed with CS from December ２００６ to November２０１０by the use of２００６revised guidelines for diagnosing CS of the Japanese Society of Sarcoidosis and Other Granulomatous Disorders. Positive rate of each major or minor criterion in the guidelines was examined. We also evaluated positive rate of each diagnostic test. In the major criteria, basal thinning of the ventricular septum showed a high positive rate of７１．４％, although the others were less than５０％. In the minor criteria, positive rates of abnormal electrocardiogram findings and abnormal echocardiogram were７６．９％ and８４．６％, respectively. Late gadolinium enhancement （LGE）of the myocardium on cardiac MRI scanning（CMR）showed a positive rate of１００％ ; however, CMR was not performed in four patients due to life-threatening arrhythmia. All１３patients showed abnormal findings at least in either echocardiogram or LGE on CMR. Conclusion : Echocardiography is a convenient diagnostic test for detecting CS. The combination of cardiac MRI and echocardiography may improve diagnostic sensitivity

シシツ テイカ リョウホウ ニヨル ケイドウミャク プラーク アンテイカ ノ ヒョウカ : チョウオンパ integrated backscatter オ モチイタ カラー マッピング システム ノ カイハツ ト リンショウ オウヨウ

Background : The carotid plaque vulnerability is related to myocardial and cerebral infarction. We intended to develop an imaging system which enables to visualize tissue characteristics in the carotid plaques based on ultrasound integrated backscatter（IB）. And to test its clinical efficacy, effect of the statin therapy on the plaques was evaluated with our software. Methods and Results : Carotid ultrasound examination was performed and ultrasonographic RAW data of the plaques were obtained from８patients undergoing carotid artery endarterectomy. Tissue characteristics in the plaques of resected examples were compared with preoperative ultrasonic images and the tissue IB values corresponding to the specimens were determined for developing our imaging system. Using this system, Color-coded maps of plaques in the three patients were constructed before and after lipid lowing therapy. We could demonstrate that lipid fraction in each plaque decreased and fibrous or calcification fraction increased in the follow-up study. Conclusions : Changes in histology of carotid plaques by statin could visualized with our imaging system. This technique may become a useful tool for the management of atherosclerosis