Clinical significance of PMI with GC patients

Aim : We investigated whether preoperative or postoperative inflammatory markers and psoas muscle index (PMI), and their change after surgery, could predict postoperative recurrence in gastric cancer (GC). Methods : Thirty-five patients who underwent curative gastrectomy for pStage II and III GC were retrospectively reviewed. The relationship between neutrophil–lymphocyte ratio (NLR), prognostic nutritional index (PNI), Glasgow Prognostic Score (GPS), and PMI, as well as postoperative recurrence, was analyzed presurgery and at 6 months after surgery. Results : In the preoperative data, there was a significant association between postoperative recurrence and high NLR, low total protein, low albumin, low PNI, and high GPS. In the data from 6 months after surgery, there was a significant association between postoperative recurrence and high NLR, high C-reactive protein, and high GPS. The reduction in PMI at 6 months after surgery relative to preoperative data was significantly greater in the cases with recurrence than in those without recurrence. No patients whose PMI increased compared with presurgery had recurrence. Conclusions : The postoperative reduction in PMI at 6 months after surgery relative to presurgery could be a predictive marker of recurrence after curative gastrectomy for patients with pStage II and III GC

Rationale and design of a multicenter randomized controlled study to evaluate the preventive effect of ipragliflozin on carotid atherosclerosis : the PROTECT study

Background: Type 2 diabetes mellitus is associated strongly with an increased risk of micro- and macro-vascular complications, leading to impaired quality of life and shortened life expectancy. In addition to appropriate glycemic control, multi-factorial intervention for a wide range of risk factors, such as hypertension and dyslipidemia, is crucial for management of diabetes. A recent cardiovascular outcome trial in diabetes patients with higher cardiovascular risk demonstrated that a SGLT2 inhibitor markedly reduced mortality, but not macro-vascular events. However, to date there is no clinical evidence regarding the therapeutic effects of SGLT2 inhibitors on arteriosclerosis. The ongoing PROTECT trial was designed to assess whether the SGLT2 inhibitors, ipragliflozin, prevented progression of carotid intima-media thickness in Japanese patients with type 2 diabetes mellitus. Methods: A total of 480 participants with type 2 diabetes mellitus with a HbA1c between 6 and 10 % despite receiving diet/exercise therapy and/or standard anti-diabetic agents for at least 3 months, will be randomized systematically (1:1) into either ipragliflozin or control (continuation of conventional therapy) groups. After randomization, ipragliflozin (50–100 mg once daily) will be added on to the background therapy in participants assigned to the ipragliflozin group. The primary endpoint of the study is the change in mean intima-media thickness of the common carotid artery from baseline to 24 months. Images of carotid intima-media thickness will be analyzed at a central core laboratory in a blinded manner. The key secondary endpoints include the change from baseline in other parameters of carotid intima-media thickness, various metabolic parameters, and renal function. Other cardiovascular functional tests are also planned for several sub-studies. Discussion: The PROTECT study is the first to assess the preventive effect of ipragliflozin on progression of carotid atherosclerosis using carotid intima-media thickness as a surrogate marker. The study has potential to clarify the protective effects of ipragliflozin on atherosclerosis

長期の病悩期間を有し、中腸軸捻転を発症した成人腸回転異常症の１例

症例は70歳,女性、間欠的な腹痛,腹満症状で入退院を繰り返していた、初診より約8ヶ月目に腹満,嘔吐 症状により入院となったCTで上腸間膜動脈を軸としたwhirl-like patternを認め,絞拒性イレウスと判断し て緊急手術を施行した、術中所見では,絞拒されていたのは後腹膜に固定されていない移動盲腸および上行 結腸であり,腸回転異常症に起因する中腸軸捻転と診断した、絞拒腸管は渾腫が強くmotilityが不良と判断さ れたため,回腸30cmおよび右側結腸を切除した、術後経過は良好で,14日目に退院した、本症例は捻転と白 然整復を繰り返し間欠的な腹部症状を生じる慢性例であった、慢性の不定愁訴を症状とする腹痛患者の診察 においても,多彩な病態をとる本疾患の可能性も念頭にいれて診察を行うことが重要であると考えられる

乳癌術後に検診マンモグラフィで発見された対側乳房のアポクリン癌の１例

症例は右乳癌で乳切後の69歳女性.平成14年の手術後5年間アロマターゼ阻害剤を内服している.平成 21年の乳癌検診時,マンモグラフィで左乳房の異常陰影を指摘され当院受診.マンモグラフィでは左A領域 に長径1.Ocmの孤立性腫瘤陰影を認め,超音波検査でも同部位にhypoechoic lesionを認めたが,検診時には 触知されていない.局所麻酔下に摘出したところ,割面最大径1.Ocmの腫瘤を認め,病理組織学的にはscirr- housに浸潤した癌細胞の細胞質に広くアポクリン様変化を認めたためアポクリン癌と診断した. ER, PgR, HER2いずれも陰性であった.残存乳房照射以外に術後補助療法は実施せず経過観察中である