下大静脈及び腸骨静脈血栓を伴った後腹膜線維症の1例

53歳女.両下肢の腫脹と乏尿を主訴に当院受診, CT上両側水腎症と両側腸骨動脈を取り囲む辺縁不整な軟部組織陰影を認めた, 腎後性腎不全に対し両側ダブルJカテーテル留置, 造影CTにて下大静脈及び左腸骨静脈内に血栓を認め, また下大静脈造影及びMRアンジオグラフィー(MRA)にて左腸骨静脈閉塞を認めた.中心静脈血栓を伴う特発性後腹膜線維症と診断し, 経口よりプレドニゾロン及びワーファリン投与開始した.投与1ヵ月後のCT及びMRAで血栓の消失を認め, 水腎症は改善, 再発を認めていないA 53-year-old female was hospitalized for evaluation of swelling in the bilateral lower extremities. A computed tomography (CT) scan of the abdomen revealed bilateral hydronephrosis and features consistent with retroperitoneal fibrosis. Transfemoral venography and magnetic resonance angiography (MRA) showed thrombosis of both the left common iliac vein and inferior vena cava, and filling of numerous collateral veins in the retroperitoneal area. A diagnosis of idiopathic retroperitoneal fibrosis with central venous thrombosis was made. Ureteral stenting, medication with corticosteroids and subsequent warfarin were started, resulting in marked improvement of renal function and the lower extremities. Diagnosis and follow-up of deep venous thrombosis can be aided by MRA. Administration of steroids with anticoagulation was considered to be successful in the case presenting with deep venous thrombosis caused by retroperitoneal fibrosis

The Persistence of Silodosin Monotherapy and the Reasons for Withdrawal from Treatment of Previously Untreated Japanese Patients with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia

Objectives. The persistence of silodosin and the reasons for withdrawal from treatment of previously untreated Japanese patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) were evaluated in real-life clinical practice. Methods. A total of 81 previously untreated Japanese patients diagnosed with LUTS/BPH were treated with silodosin monotherapy and prospectively followed for 4 years. The persistence rate was estimated using the Kaplan-Meier method. If silodosin had to be terminated or a patient did not come to the hospital, the reason was determined. Results. The 6-month, 1-year, 2-year, 3-year, and 4-year persistence rates were 63.0%, 56.8%, 50.6%, 44.4%, and 35.8%, respectively. The most frequent reason (22.2%) for withdrawal was symptom resolution. After silodosin treatment, the international prostate symptom score and the quality of life index were significantly improved and maintained for 4 years. Conclusions. 35.8% of previously untreated Japanese patients continued silodosin for 4 years. Many patients terminated silodosin for various reasons, the most frequent of which was symptom resolution. The effects of silodosin were maintained when the patients continued treatment. Trial Registration. This study was approved by the institutional review board of Hokkaido Prefectural Esashi Hospital (number 2007-2) and was registered in a public trial registry (UMIN000026910)

(R)-ketamine restores anterior insular cortex activity and cognitive deficits in social isolation-reared mice

Yokoyama R., Ago Y., Igarashi H., et al. (R)-ketamine restores anterior insular cortex activity and cognitive deficits in social isolation-reared mice. Molecular Psychiatry , (2024); https://doi.org/10.1038/s41380-024-02419-6.Chronic social isolation increases the risk of mental health problems, including cognitive impairments and depression. While subanesthetic ketamine is considered effective for cognitive impairments in patients with depression, the neural mechanisms underlying its effects are not well understood. Here we identified unique activation of the anterior insular cortex (aIC) as a characteristic feature in brain-wide regions of mice reared in social isolation and treated with (R)-ketamine, a ketamine enantiomer. Using fiber photometry recording on freely moving mice, we found that social isolation attenuates aIC neuronal activation upon social contact and that (R)-ketamine, but not (S)-ketamine, is able to counteracts this reduction. (R)-ketamine facilitated social cognition in social isolation-reared mice during the social memory test. aIC inactivation offset the effect of (R)-ketamine on social memory. Our results suggest that (R)-ketamine has promising potential as an effective intervention for social cognitive deficits by restoring aIC function

α-Mangostin extracted from the pericarp of the mangosteen (Garcinia mangostana Linn) reduces tumor growth and lymph node metastasis in an immunocompetent xenograft model of metastatic mammary cancer carrying a p53 mutation

<p>Abstract</p> <p>Background</p> <p>The mangosteen fruit has a long history of medicinal use in Chinese and Ayurvedic medicine. Recently, the compound α-mangostin, which is isolated from the pericarp of the fruit, was shown to induce cell death in various types of cancer cells in <it>in vitro </it>studies. This led us to investigate the antitumor growth and antimetastatic activities of α-mangostin in an immunocompetent xenograft model of mouse metastatic mammary cancer having a p53 mutation that induces a metastatic spectrum similar to that seen in human breast cancers.</p> <p>Methods</p> <p>Mammary tumors, induced by inoculation of BALB/c mice syngeneic with metastatic BJMC3879luc2 cells, were subsequently treated with α-mangostin at 0, 10 and 20 mg/kg/day using mini-osmotic pumps and histopathologically examined. To investigate the mechanisms of antitumor ability by α-mangostin, <it>in vitro </it>studies were also conducted.</p> <p>Results</p> <p>Not only were <it>in vivo </it>survival rates significantly higher in the 20 mg/kg/day α-mangostin group versus controls, but both tumor volume and the multiplicity of lymph node metastases were significantly suppressed. Apoptotic levels were significantly increased in the mammary tumors of mice receiving 20 mg/kg/day and were associated with increased expression of active caspase-3 and -9. Other significant effects noted at this dose level were decreased microvessel density and lower numbers of dilated lymphatic vessels containing intraluminal tumor cells in mammary carcinoma tissues.</p> <p><it>In vitro</it>, α-mangostin induced mitochondria-mediated apoptosis and G1-phase arrest and S-phase suppression in the cell cycle. Since activation by Akt phosphorylation plays a central role in a variety of oncogenic processes, including cell proliferation, anti-apoptotic cell death, angiogenesis and metastasis, we also investigated alterations in Akt phosphorylation induced by α-mangostin treatment both <it>in vitro </it>and <it>in vivo</it>. Quantitative analysis and immunohistochemistry showed that α-mangostin significantly decreased the levels of phospho-Akt-threonine 308 (Thr308), but not serine 473 (Ser473), in both mammary carcinoma cell cultures and mammary carcinoma tissues <it>in vivo</it>.</p> <p>Conclusions</p> <p>Since lymph node involvement is the most important prognostic factor in breast cancer patients, the antimetastatic activity of α-mangostin as detected in mammary cancers carrying a p53 mutation in the present study may have specific clinical applications. In addition, α-mangostin may have chemopreventive benefits and/or prove useful as an adjuvant therapy, or as a complementary alternative medicine in the treatment of breast cancer.</p

内シャント狭窄に対するPTAの有用性

2000年4月からの19ヵ月間に行った18例24回のPTAについてretrospectiveに検討した.男性11例, 女性7例, 平均63歳であった.狭窄部位は, 吻合部5病変, シャント静脈22病変, 計27病変であった.手技的成功率は82.5%, また一次開存率は1ヵ月で82.6%, 3ヵ月で74.5%, 半年で67.5%であった.5例で二次PTAを施行し, その開存率は一次開存率と有意差を認めなかった.また一次PTA群と外科的再建群での開存率に有意差を認めなかったPercutaneous transluminal angioplasty (PTA) has gained wide acceptance as an effective technique for the dilatation of stenoses in the arterial tree. We evaluated the long-term results of vascular access in a group undergoing hemodialysis, in particular the effects of PTA. Twenty-four percutaneous procedures were performed on 18 patients. Detection was based on physical examination, flow rate measurements, venous pressure, and analytical determinations performed at dialysis. The initial success rate was 87.5%, with 1-, 6-, and 18-month patency rates of 82.6, 67.5, and 38.5%, respectively. There was no difference between primary and secondary patency rates. The assisted primary patency rates for PTA and surgical revision were not significantly different. Although neither surgical nor endovascular management resulted in long-term function for the majority of shunts after stenosis or thrombosis, endovascular treatment can extend the life of dialysis shunts with results similar to surgical revision. Transluminal dilatation may be performed in appropriate cases to obviate the need for surgery

尿管エンドメトリオーシスの1例 (本邦報告例105例の臨床的検討)

42歳, 女.腹部膨満感にて受診.検尿上, 顕微鏡学的血尿を認め, 血中CA125は軽度高値を示した.腹部CT検査では左水腎症と子宮に隣接する巨大腫瘤を認め, 逆行性腎盂造影では左下部尿管に陰影欠損を認めた.子宮筋腫及び左尿管腫瘍の診断から右附属器及び子宮摘除術と尿管部分切除術を施行.組織学的に左尿管腫瘤は粘膜下に存在する外性子宮内膜症であった.1971年以来本邦では104例が報告され, 術前診断は37.5%と, 悪性腫瘍との鑑別が困難な症例も少なくない.腎保存術も62.4%で施行され, 術後腎機能も良好な症例もみられる.尿路も視野に入れた各種検査と妊孕性を考慮した治療法の選択が望まれるA 42-year-old woman was referred to our hospital because of abdominal fullness and a large abdominal mass. Computed tomography (CT) demonstrated bilateral ovarian tumors, uterine myoma and left hydronephrosis. On excretory urography the left kidney was not visualized and retrograde pyelography (RP) revealed left hydronephrosis and a filling defect in the left lower ureter. Based on the diagnoses of endometriosis of bilateral ovaries, uterine myoma and a left ureteral tumor, abdominal total hysterectomy, right salpingo-oophorectomy and partial ureterectomy were performed. Pathologically, in the uterus, both leiomyoma and adenomyosis, and endometriosis of the right ovary and ureter were diagnosed. Medication with buserelin acetate was started

The predictive factors of α1-D/A adrenoceptor antagonist, naftopidil, dose increase therapy for male lower urinary tract symptoms caused by benign prostatic hyperplasia: INFORM study

Introduction: We evaluated the predictive factors which affect the efficacy of naftopidil 50 mg/day therapy and dose increase therapy to administration of 75 mg/day after an initial dose of 50 mg/day. Materials and Methods: A total of 92 patients with male lower urinary tract symptoms/benign prostatic hyperplasia were administrated naftopidil 50 mg/day for 4 weeks (50 mg therapy). At week 4, the patients were divided into an effective and an ineffective group (Group E and Group I, respectively). For further 4 weeks, the dosage of naftopidil was increased to 75 mg/day in all patients. At week 8, the patients of Group E and Group I were divided into an effective and an ineffective group (Group EE, Group EI, Group IE, and Group II, respectively). Results: Postvoid residual (PVR) urine volume at baseline was a predictive factor for efficacy of 50 mg therapy. In Group E, change in International Prostate Symptom Score storage symptoms subscore from baseline to week 4 was a predictive factor for efficacy of this dose increase therapy. In Group I, change in maximum flow rate from baseline to week 4 was a predictive factor for efficacy of this dose increase therapy. Conclusions: The short term of naftopidil 50 mg therapy was ineffective for the patients who had large PVR. The predictive factor of this dose increase therapy might be a dynamic variable in 50 mg/day of dose period, but not a baseline variable at the time of 75 mg/day dosage starts

Investigation of the reasons for withdrawal from long-term treatment with mirabegron of treatment-naïve Japanese female patients with overactive bladder in the real-world clinical setting

Purpose: The persistence of treatment with mirabegron and the reasons for withdrawal from the treatment among treatment-naïve Japanese female patients with overactive bladder (OAB) were prospectively investigated for 3 years in the real-world clinical setting. Materials and Methods: A total of 62 treatment-native Japanese female patients clinically diagnosed with OAB were treated with mirabegron and prospectively followed for 3 years. The persistence rate was estimated using the Kaplan-Meier method. If mirabegron had to be terminated or a patient did not come to the hospital to receive a prescription, the reasons for withdrawal from treatment were determined. Results: The 6-month, 1-year, 2-year, and 3-year persistence rates were 51.6%, 38.7%, 32.3%, and 25.8%, respectively. The most frequent reasons for withdrawal from treatment with mirabegron were symptom resolution (38.7%), deterioration of comorbidity unrelated to OAB (12.9%), lack of efficacy (8.1%), and adverse events (4.8%). Conclusions: The persistence rate of treatment with mirabegron among treatment-naïve Japanese female patients with OAB is low for 3 years in the real-world clinical setting. Many patients discontinue the treatment for various reasons, the most frequent of which is symptom resolution. These findings provide important considerations for clinicians whose patients are continuing medication for OAB