検診発見と自己発見浸潤性乳癌のサブタイプの分布と予後に及ぼす影響について

藤田保健衛生大

The Practice of Computer-Assisted Planning and Navigation for Hip Arthroscopy

Despite significant developments in hip arthroscopic surgery in recent years, precise preoperative planning and accurate performance remain challenging. Preoperative planning is particularly important in cases of osteochondroplasty for cam-type femoroacetabular impingement (FAI), and can be aided by several computer-assisted tools, including three-dimensional imaging analysis or kinematic analysis. Initially, the exact point of the bony impingement is identified using simulation analysis; then, virtual osteochondroplasty is performed. Improvements in the range of motion can then be evaluated using computer simulation again. In this way, the required area and depth of bone resection can be assessed preoperatively. In addition, computed tomography-based navigation assistance can be used to complete the osteochondroplasty in accordance with the preoperative planning. After surgery, postoperative evaluation provides valuable feedback to improve future planning and procedures. In this chapter, we describe the practice of computer-assisted planning and navigation for hip arthroscopy

Results of a Screening Program for Multiple Endocrine Neoplasia Type 2A: A Clinical Study of a Japanese Family

A Japanese family of 87 members in five generations with multiple endocrine neoplasia type 2A (MEN 2A) is described regarding the utility of screening tests for early detection of medullary thyroid carcinoma and the potential for DNA diagnosis of MEN 2A gene carriers. The screening programs for family members in this series include measurements of plasma calcitonin concentrations after intravenous injection of pentagastrin (0.5 μg/kg/5 sec) and 24-hour urinary excretion of catecholamines. While 18 MEN 2A patients had been previously diagnosed, these screening programs revealed five additional patients with MEN 2A (aged 16, 19, 35, 37, and 57). Prediction of MEN 2A gene carriers by DNA analysis has been attempted but is not yet possible in this family

Differences in clinicopathologic features and subtype distribution of invasive breast cancer between women older and younger than 40 years

OBJECTIVES: We investigated and compared clinicopathologic features and subtype distribution of invasive breast cancer among women <40 and ≥40 years of age. METHODS: We retrospectively compared clinicopathologic characteristics and subtype distribution of invasive breast cancer in women <40 and ≥40 years of age, in a cohort of 1,130 patients. Subtypes included luminal A (positive for hormone receptors [HR]—estrogen receptor [ER] and/or progesterone receptor [PR]—and negative for human epidermal growth factor receptor 2 [HER2] with low Ki67), luminal B (HER2(–)) (HR(+)/HER2(–)/Ki67(High)), luminal B (HER2(+)) (HR(+)/HER2(+)), HER2-overexpressing (HR(–)/HER2(+)), and triple negative (ER(–)/PR(–)/HER2(–)). RESULTS: Breast cancers in younger women had unfavorable clinicopathologic characteristics, including larger tumors and more frequent node involvement. Subtypes among the 1,130 tumors were luminal A: 36.4%, luminal B (HER2(–)): 35.0%, luminal B (HER2(+)): 7.5%, HER2-overexpressing: 7.1%, and triple negative: 14.0%. The age groups significantly differed in subtype distribution (P<0.001). Luminal A subtype was more common in the older group (38.5%) than the younger group (16.2%), and luminal B (HER2(–)) was more common in the younger group (52.2%) than in the older group (33.2%; P<0.001). CONCLUSIONS: Breast cancers in women younger than 40 years have unfavorable clinicopathologic characteristics and are more likely to be luminal B (HER2(–)) and less likely to be luminal A than breast cancers in older women

Trends in quality of life of in-unit hemodialysis patients

本研究の目的は,外来透析者の主観的な評価によりQOLを測定し,そのQOLの傾向を明らかにすることである。対象者は,名古屋･大阪･岡山･広島の4施設における外来透析者で,研究に同意を得られた341名とし,研究方法は,自己記入式質問紙法を用いた｡測定用具は,Ferrans & PowersのQuality of Life Index (QLI)を翻訳して用い,データ分析はプロマックス法による因子分析を行なった｡QLI項目を因子分析した結果,｢社会･経済的な機能｣｢家族･他者からの支え｣｢心の安寧｣｢身体の健康｣｢医療と教育｣の5因子が抽出された｡そして,｢家族･他者からの支え｣および｢医療と教育｣はQLI得点が高く,｢社会･経済的な機能｣および｢身体の健康｣は低いことが明らかになった｡従って,QOLを高めるためには,社会的側面や身体面をより重視して看護していくことが重要であると考えられた｡The purpose of this study is to clarify the quality of life (QOL) of in-unit hemodialysis patients. The subjects were 341 in-unit hemodialysis patients who agreed to participate in this study from four hospitals in Nagoya, Osaka, Okayama, and Hirosima. The Ferrans and Powers Quality of Life Index (QLI) Hemodialysis version (an authorised translation into Japanese) was used for measuring perceived quality of life. By factor analysis, 'socio-economic functioning', 'support from family and others', 'well-being of mind', 'physical health' and 'medical treatment and education' were extracted as five factors of the QOL. The QOL score on the 'support from family and others' was the highest of all, whereas 'physical health' and 'socio-economic functioning' were lower than other three factors. These results showed importance of physical and social dimensions in caring hemodialysis patients in clinical practice

Perivascular and Diffuse Lymphocytic Inflammation are not Specific for Failed Metal-on-metal Hip Implants

Several studies suggest that histologic findings from tissues obtained at revision arthroplasty for failed metal-on-metal (MOM) total hip implants may reflect an immune reaction to particles or ions in some patients. However, only a limited number of cases without MOM implants were reported as controls in those studies. The purpose of this study is to better define the extent and distribution of morphologic features attributed to an immune reaction in tissues sampled at revision surgery for failed nonMOM THA. As part of a multicenter, prospective study, we reviewed 612 capsular and interface tissues obtained from 130 patients at revision THA. The samples were selected from periacetabular regions (154 samples from 103 patients), femoral implant/cement-bone interface (154 samples from 79 patients), and from areas of the joint capsule that had an intraoperative gross appearance suggesting the possibility of either infection or metallosis (256 samples from 129 patients). All patients had more than one sample obtained. The extent and distribution of lymphocytes and plasma cells, acute inflammation, and visible particles of debris were graded using criteria similar to those described to grade inflammation around failed MOM implants. We identified perivascular lymphocytes in 111 biopsy samples taken from 65 (50%) of 130 patients, and in 87 specimens from 57 (53%) of 107 patients thought to have aseptic loosening. Diffusely distributed lymphocytes were identified in 86 (66%) of 130 patients, and in 66 (62%) of the 107 hips with aseptic loosening, although few had the highest grade of inflammation. Increasing extent of diffuse and perivascular lymphocytes correlated with increasing extent of metal particles. Mild lymphocytic inflammation, diffuse and especially perivascular, is common in tissues around failed nonMOM implants. Although extensive inflammation in an inflammatory pseudotumor pattern is rare, it does occur in some cases of failed metal-polyethylene hip arthroplasties. The importance of inflammation is unknown, but the extent of diffuse inflammation shows a positive correlation with metal debris, so it could reflect a reaction to particles or ions in some patients