Validation Study of the International Association for the Study of Lung Cancer Histologic Grading System of Invasive Lung Adenocarcinoma

[Introduction] A histologic grading system for invasive lung adenocarcinoma (ADC) has been proposed by the International Association for the Study of Lung Cancer (IASLC) Pathology Committee in June 2020. This study evaluated the prognostic value of the IASLC histologic grading system (the IASLC system) in a large Japanese cohort. [Methods] We performed comprehensive histologic subtyping using the semiquantitative estimation of five major patterns and complex glandular patterns in patients with a completely resected lung ADC and determined the histologic grade using the IASLC system. Concordance index and receiver-operating characteristic curves were used to evaluate the clinical utility of the IASLC system for recurrence and death; the comparison was performed with the architectural-pattern system (the Arch system) and the grading system on the basis of the two most predominant patterns (the Sica’s system). [Results] Of 1002 patients with invasive ADC, 235 had recurrent disease and 166 died of lung cancer. The concordance index and area under the curve of the IASLC system were 0.777 and 0.807 for recurrence and 0.767 and 0.776 for death, respectively. These were similar to those of the Arch system (0.763 and 0.796 for recurrence, 0.743 and 0.755 for death) and the Sica’s system (0.786 and 0.814 for recurrence, 0.762 and 0.773 for death). [Conclusions] We reported that the IASLC system for invasive lung ADC has prognostic significance by evaluating a large Japanese cohort. We believe that the IASLC grading system will provide physicians with better information for postsurgery treatment

Congenital-idiopathic superficial femoral artery aneurysm in a 7-year-old child

Superficial femoral artery aneurysm in children is distinctly uncommon, and usually results from infection, vasculitis, connective tissue disorder, or trauma. We report a 7-year-old girl who had multiple fusiform aneurysms of the right superficial femoral artery, with no evidence of related disorders. The patient successfully underwent aneurysm resection and femoral artery reconstruction with autogenous saphenous vein. Histologic examination revealed intimal thickening with fibroplasia without severe inflammatory infiltrates or cystic medial necrosis, suggesting a congenital-idiopathic arterial aneurysm. Three years after the procedure, the saphenous vein graft is fully patent and the patient is in good condition

当院における経皮的心肺補助装置の導入状況と予後について： 症例集積研究

京都府立医科大学附属北部医療センター循環器内科京都府立医科大学附属北部医療センター臨床工学科Department of Cardiovascular Medicine, North Medical Center, Kyoto Prefectural University of MedicineDepartment of Clinical Engineering, North Medical Center, Kyoto Prefectural University of Medicine経皮的心肺補助は、重症心不全（急性心筋梗塞、心筋症、劇症型心筋炎など）、開心術後の低拍出症候群、大血管手術（胸部下行大動脈瘤、胸腹部大動脈瘤）による補助循環や重症呼吸不全などの病態に用いられているが、近年救急医療の現場、とくに心肺停止患者への適用が急増している。しかしながら、装置が高価であることや導入にマンパワーを要する治療法であることから、導入をためらっている施設も少なくない。また、適用基準や使用方法についても各施設によってさまざまである。経皮的心肺補助装置は2008 年に当院に導入され、2018 年3 月までの約10 年間で16 例に用いられた。年齢の中央値は65.5 歳で、男性が12 例だった。原因疾患として急性冠症候群/ 急性心筋梗塞が11 例、劇症型を含む心筋炎が4 例だった。そのうち2 例は現在も当院外来に通院中であり、長期生存率は12.5% であった。高齢化率の高い丹後医療圏におけるPCPS の適用基準にまつわる問題点を挙げ、使用の心得を記述し、京都府下の病院におけるPCPS 導入状況を俯瞰する

仮性動脈瘤による静脈圧排が原因と考えられた下肢浮腫の1例

京都府立医科大学附属北部医療センター循環器内科Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine North Medical Center症例は７３歳女性。安静時胸痛を認め、不安定狭心症を疑い、冠動脈造影検査にて３枝病変を認めた。カテーテル治療を選択し、左大腿動脈より６Fr シースを挿入し、経皮的冠動脈ステント留置術を施行した。止血デバイスを用い止血を行い、穿刺部に問題なく術翌日に退院した。退院7 日後より左下肢の腫脹を認め、血管エコー検査にて穿刺部に仮性動脈瘤を認めた。カテーテル後の下肢浮腫の原因として仮性動脈瘤に留意すべきと考える

大学生に対する速読技術および読書方略指導がもたらす読書習慣の変化

修士（教育学