小児生体肝移植におけるヒトヘルペスウイルス6型に関する臨床経過

藤田医科大

Treatment of postmenopausal osteoporosis

It is well recognized that estrogen deficiency leads to acceleration of bone resorption and is the main trigger for postmenopausal osteoporosis. It is important to raise the peak bone mass and to inhibit the bone loss after menopause in order to prevent the postmenopausal osteoporosis. Te therapy is based on the high calcium diet and exercise therapy, and the medication is mainly by the drugs that inhibits bone resorption. Especially estrogen administration can prevent bone loss and osteoporotic fracture as well as improve vasomotor symptoms and lipid metabolism. Therefore hormone replacement therapy (HRT) will be the key medication for total care for postmenopausal women. However, HRT does not prevail in Japan due to its side effects and mental rejection. We hope that HRT will be more utilized by reducing its side effects (for example by selective estrogen receptor modulator) and by providing more information

Effects of radiofrequency ablation on individual renal function: assessment by technetium-99m mercaptoacetyltriglycine renal scintigraphy.

We quantitatively evaluated total and individual renal function by technetium-99m mercaptoacetyltriglycine (Tc-99m MAG3) renal scintigraphy before and after radiofrequency ablation (RFA) of renal tumors. Eleven patients who underwent Tc-99m MAG3 renal scintigraphy 1 week before and after RFA were evaluated (7 men and 4 women ; age range : 23-83 years ; mean age : 60.6 years). Five patients had solitary kidneys, and five had normally or minimally functioning contralateral kidneys. One patient had a renal cell carcinoma in the contralateral kidney. One patient with a solitary kidney underwent RFA a second time for a residual tumor. In patients with a solitary kidney, MAG3 clearance decreased after 5 of 6 RFAs, and in patients with a normally functioning contralateral kidney, MAG3 clearance decreased after 4 of 5 RFAs, but no significant differences were observed between before and after treatments. In addition to the total MAG3 clearance, the split MAG3 clearance was evaluated in patients with a normally functioning contralateral kidney. MAG3 clearance decreased in 4 of 5 treated kidneys, while it adversely increased in the contralateral kidneys after 4 of 5 RFAs. No significant differences, however, were observed between before and after treatments. The results of our study revealed no significant differences in sCr, BUN, CCr, or MAG3 clearance between pre- and post-RFA values. These results support data regarding the functional impact and safety of renal RFA in published reports. We evaluated total and individual renal function quantitatively using Tc-99m MAG3 renal scintigraphy before and after treatment. This scintigraphy was very useful in assessing the effects of RFA on renal function

コウネンキ ジョセイ ニ ミラレル セイシン シンケイ ショウジョウ

Declining estrogen level associated with ovarian failure has wide-ranging and unwelcome consequences and leads to diverse metabolic changes and symptoms. The short-term effects are vasomotor instability and psychological symptoms, and medium-term effects include urogenital atrophy. On the other hand, long-term consequences are an increased risk of coronary artery disease, osteoporosis and possibly Alzheimer's disease. The hormonal change occurring around menopause and their influence may be enough to trigger emotional reactions such as depression. Furthermore, life events, personality also affect psychological symptoms which include forgetfulness, fatigue, irritability, loss of concentration, depressed mood, anxiety and sleep-related problems. Middle age is considered to be a period of increased role change and occurrence of stressful life events, particularly those called exit events. Such events include children moving out, elderly parents developing illnesses and requiring assistance or dying, partners or close friends aging or developing disease, separation and divorce. Hormone replacement therapy (HRT) improves mood and increases a sense of well-being in postmenopausal women, however estrogen was not effective in women with more severe depressive symptoms. When HRT is not advisable, other treatments such as Kampo medicine, anti-anxiety drugs and counseling should be considered. It is important for postmenopausal women suffered from psychological symptoms to look for signs of increased vulnerability to hormonal fluctuation and individualize treatment

Percutaneous sclerotherapy for venous malformations using polidocanol under fluoroscopy.

This retrospective study evaluated the safety and efficacy of using polidocanol with X-ray fluoroscopy for percutaneous sclerotherapy of venous malformations of the limbs, head, and neck. The subjects were 16 of 18 patients who presented to our department with venous malformations. Two patients were excluded because they were unlikely to benefit from the treatment. Of the 16 included in the study, 1 could not be treated because of inaccessibility, and another was lost to follow-up. Among the 14 cases that we were able to follow-up, 11 cases had had pain as their primary symptom. Following treatment, this symptom remained unchanged in 1 patient, was improved in 4, and had disappeared in 6; however, there was a recurrence of pain for 3 of these patients. Two patients had sought treatment for cosmetic purposes; following treatment, the lesion disappeared in one and showed a significant reduction in the other. The remaining patient presented with a primary symptom of mouth bleeding, which disappeared following treatment. There were no critical complications. Percutaneous sclerotherapy of venous malformations using polidocanol is safe and effective, and permits repeat treatments. The efficacy is especially good for resolving pain, and complications are minor. It is desirable to use fluoroscopy for these procedures</p

Radiofrequency Ablation of Lung Cancer at Okayama University Hospital: A Review of 10 Years of Experience

The application of radiofrequency ablation for the treatment of lung cancer by our group at Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences began in June 2001, and in the present report, we review our 10-year experience with this treatment modality at Okayama University Hospital. The local efficacy of radiofrequency ablation for the treatment of lung cancer depends on tumor size and the type of electrode used, but not on tumor type. An important factor for the prevention of local failure may be the acquisition of an adequate ablative margin. The combination of embolization and radiation therapy enhances the local efficacy. Local failure may be salvaged by repeating the radiofrequency ablation, particularly in small tumors. Survival rates after radiofrequency ablation are quite promising for patients with clinical stage I non-small cell lung cancer and pulmonary metastasis from colorectal cancer, hepatocellular carcinoma, and renal cell carcinoma. The complications caused by radiofrequency ablation can be treated conservatively in the majority of cases. However, attention should be paid to rare but serious complications. This review shows that radiofrequency ablation is a promising treatment for patients with lung cancer

Oxidative stress induction of DJ-1 protein in reactive astrocytes scavenges free radicals and reduces cell injury

Astrocytes, one of the predominant types of glial cells, function as both supportive and metabolic cells for the brain. Under cerebral ischemia/reperfusion-induced oxidative conditions, astrocytes accumulate and activate in the ischemic region. DJ-1 has recently been shown to be a sensor of oxidative stress in living cells. However, the function of astrocytic DJ-1 is still unknown. In the present study, to clarify the effect of astrocytic DJ-1 protein under massive oxidative insult, we used a focal ischemic rat model that had been subjected to middle cerebral artery occlusion (MCAO) and reperfusion. We then investigated changes in the distribution of DJ-1 in astrocytes, DJ-1 release from cultured astrocytes, and the effects of recombinant DJ-1 protein on hydrogen peroxide (H2O2)-induced death in normal and DJ-1-knockdown SH-SY5Y cells and on in vitro scavenging of hydroxyl radicals (•OH) by electron spin resonance spectrometry. At 24 h after 2-h MCAO and reperfusion, an infarct lesion was markedly observed using magnetic resonance imaging and 2,3,5-triphenyltetrazolium chloride staining. In addition, reactive astrocytes enhanced DJ-1 expression in the penumbral zone of the ischemic core and that DJ-1 protein was extracellularly released from astrocytes by H2O2 in in vitro primary cultures. Although DJ-1-knockdown SH-SY5Y cells were markedly vulnerable to oxidative stress, treatment with glutathione S-transferase-tagged recombinant human DJ-1 protein (GST-DJ-1) significantly inhibited H2O2-induced cell death. In addition, GST-DJ-1 protein directly scavenged •OH. These results suggest that oxidative stress induces the release of astrocytic DJ-1 protein, which may contribute to astrocyte-mediated neuroprotection