Allogeneic Islet Transplantation and Future

Pancreatic islets contain beta cells which produce insulin based on the blood glucose levels resulting in tight control of blood glucose levels. In type 1 diabetic patients, most of the beta cells are destroyed, therefore, pharmaceutical insulin injection is mandatory to avoid diabetes-related illness and death. Even with recent advanced insulin therapy, hypoglycemia is a critical limiting factor to control blood glucose levels. There is no doubt that hypoglycemia can be fatal. Allogeneic islet transplantation can prevent severe hypoglycemia and provide excellent blood glucose control. On the other hand, allograft donor shortage is the major issue. To overcome donor shortage, xenograft has been used and shown safety and efficacy. Recently stem-cell-derived beta cells are clinically applied. In this chapter, the history and current status of allogenic islet transplantation and future scope are described

イ ゲンパツ ジュウモウガン ノ 1レイ

A 79-year-old man, complaining of right hypochondralgia, was admitted to our hospital. Gastrointestinalendoscopy revealed a elevated lesion on the anterior wall of the gastric antrum. Adistal gastrectomy was performed. Histological findings confirmed the diagnosis of gastric choriocarcinoma,and there was coexistence of adenocarcinoma. The patient left the hospital in uneventfulpostoperative course. He had recurrence on remnant stomach on the third postoperativemonth. Also chemotherapy with TS-1 and paclitaxel was performed, was no effective, resulting inpatient death on the fourth postoperative month. The patient died of recurrence complicatedpneumonia. We reported on this case with some bibliographical comments

カン ノウホウセイ シュヨウノ 2セツジョレイ

We report two cases of cystadenoma and cystadenocarcinoma of the liver. Case 1 : A 38-yearold woman, complaining of discomfort of upper abdomen, was detected a cystic tumor in segment 5of the liver by abdominal CT scan. A part of the tumor had an enhanced lesion the angiographyshowed an enhanced peripheral staining of the cystic lesion. S 5-6 segmentectomy was performed.The resected material showed that the tumor was a multilocular and cystic lesion, histopathologicallywas diagnosed as hepatobiliary cystadenoma. Case 2 : A 72-year old man was incidentallypointed out a liver tumor in the left lobe at an examination of pneumonia. Abdominal CT scanshowed a papillary enhanced solid lesion in cystic tumor with invasion to the caudate lobe. ERCPshowed a filling defect in the common bile duct. Extended left hepatic lobectomy, caudate lobectomyand extrahepatic bile duct resection were performed. The final diagnosis was hepatobiliarycystadenocarcinoma.Cystadenoma is known to have a carcinogenic potential. In the case with suspition of neoplasticcyst, resection must be perfomed

トクシマ シミン ビョウイン ダイキボ ビョウイン ニオケル ソシキテキ Safety Management

Numerous medical errors have been reported on mass media recently. It is a regret that people have become less confident in medicine and have a great deal of skepticism in medical service. Medical profession is now committing to do everything possible to remove their skepticism and restore the confidence in medicine. However, increasing complexity in medical technologies and diversified medical services have made it difficult to eradicate medical errors completely. Nevertheless, we must do everything possible to reduce medical mistakes to an acceptable level. This can be only achieved by the all-out effort of the entire hospital staffs, not by the vigilance of the individual doctor, nurse or technician. We have to face a challenge to improve patient safety and build safer system by the joint effort of all the members of the hospital staffs. We have just initiated the systematic safety programs for the patients, though there are still many problems remaining to be solved. We documented and discussed our concept of informed consent at Tokushima Municipal Hospital, how it is practiced in our daily medical service

キョダイ チョクチョウ gastrointestinal stromal tumor（GIST） ノ 1セツジョレイ

A 75-year old woman, complaining of prolapse of the uterus, was detected a giant tumor in therectum by abdominal CT scan. Enhanced CT revealed a heterogeneous mass in the pelvic cavitymeasuring 8 cm. MRI demonstrated a mass in the rectovaginal seputum, showing heterogeneoushigh intensity on T1 and T2 weighed image. Abdominoperineal excision of the rectum was performed.Macroscopically, the resected specimen showed a solid tumor with central hemorrhagicnecrosis, 10×5 cm in size. Histological examination showed fascicular proliferated spindle-shapedcells invaded to subserosa. Immunohistochemical studies showed a GIST of the rectum withpositive staining for c-kit and CD34, and negative staining for α-SMA, S-100 protein. No evidenceof recurrence has been found in the 2 years since. We report a case of giant GIST of the rectum.Because the risk of the recurrence depends on operation curability adequate resection margin isneeded for surgical approach for GIST

A case report of posttraumatic growth from a psychosomatic disorder due to traumatic stress in a 50s woman

【目的】本研究では，トラウマ性ストレスによる心身障害を抱えた50代女性に対する，トラウマ体験を物語ることに焦点を当てた介入の症例から心的外傷後成長（Posttraumatic growth: PTG）の生起過程を考察する。【現病歴】a 市における自然災害死目撃を機に不安，恐怖が持続。薬物治療で回復に向かうも，a 市に帰郷すると体調が増悪するというサイクルを繰り返した。【事例の経過】トラウマ体験を物語ることを目的に，ナラティブ・エクスポージャー・セラピー（Narrative Exposure Therapy: NET）を実施した結果，不安と恐怖が軽減した。その過程の中で夫との親密さが増し，ともにトラウマに立ち向かった結果，症状なくa 市に帰郷できるようになった。【考察】トラウマ体験を物語ることで，PTG に必要な「意図的反芻」，「語りの発展」，「スキーマの変化」を促進し「人間としての強さ」，「他者との関係」の領域においてPTG が生起したと考えられる。【Purpose】 This clinical study is to report the effectiveness of narrative approach for PTG to open up traumatic experiences in a 50s women with psychosomatic disorder due to traumatic stress.【History of present illness】 I anxiety and fear continued after witnessing the death of a natural disaster in a city. The patient recovered with medication. However, she repeated the cycle that his physical condition got worse when he returned to a city.【Progress】 As she described her traumatic experience, her anxiety and fear lessened. In the process, the intimacy with the husband increased, and they faced the trauma together. Two years after intervention, She was back to a city without symptoms.【Disccusion】 It is considered that “intentional rumination”, “development of the narrative”, and “change of the schema”necessary for PTG were promoted by telling the traumatic experience, and PTG arose in the region of “strength as a human” and “relation with others

Clinical characteristics of pleomorphic carcinoma of the lung

Background: Pleomorphic carcinoma of the lung is a malignant epithelial tumor that contains carcinomatous and sarcomatoid components. Due to its rarity, few studies have been reported, and its clinical and pathological characteristics remain unclear. Method: We retrospectively investigated 22 cases of pleomorphic carcinoma of the lung. Results: Fifteen cases were diagnosed by surgical resection, four by autopsy, and three by transbronchial biopsy. Nineteen patients were male and three were female, and their mean age at diagnosis was 68.3 years (± 10.1). Eighteen were current- or ex-smokers with substantial smoking histories (mean 46.4 pack-years). Sixteen patients had symptoms: hemoptysis and cough were commonly seen. Chest computed tomography (CT) findings revealed that the tumors were quite large (mean diameter 45.3 ± 21.9 mm; range 14-110 mm), and 21 tumors were peripherally located. Positron emission tomography with 18-fluorodeoxy-glucose (FDG-PET) was performed in 12 patients, and the Standardized Uptake Value (SUV) tended to be high (9.44 ± 4.98). In the 15 patients who underwent surgical resection, recurrence was common; systemic metastases were also frequently found. Patients who had received surgical treatment with proper follow-up care survived longer than those who did not undergo surgery. Responses to chemotherapy were generally poor, although one patient exhibited partial response to gefitinib. Conclusions: Pulmonary pleomorphic carcinoma has strong malignant potential with frequent distant metastases, as has already been reported. However, this study demonstrated that surgical treatment and appropriate follow-up therapy might result in better prognoses