内視鏡的硬化療法の手技と治療成績における透明フードの有用性

Objective: Although the effectiveness of a transparent hood has been reported in various endoscopic procedures, there are only a few reports regarding the benefit of a transparent hood in endoscopic injection sclerotherapy(EIS). In the current study, we conducted a retrospective evaluation of the efficacy and long-term benefit of an oblique transparent hood on EIS. Methods: The transparent hood, manufactured by Olympus (MAJ295 or MAJ296), consisted of a reusable wide oblique distal attachment with rim. This hood was attached when the varix was fine (F0 or F1). In this retrospective study, a total of 201 patients were recruited, and 99 patients (designated as the "Hood Group") received this hood while 102 patients (designated as the "Conventional Group") did not. We compared the rate of intravariceal injection, enhanced supply vessels, variceal eradication, and recurrence between these two groups. Results: This transparent hood provided a better visual field, and there was no serious complication in any of the patients. Intravariceal injection rates in the Hood Group and Conventional Group were 73.9% (190/257) and 57.7% (146/253) respectively (p<0.01). The rates of enhanced supply vessels in the Hood Group and Conventional Group were 89.8% (89/99) and 72.5% (74/102) respectively (p<0.01). The rates of variceal eradication did not differ significantly. We also assessed the cumulative non-recurrence probability for up to 3000 days between the two groups. The Hood Group was statistically superior to the Conventional Group (p<0.01) Conclusion: The application of an oblique transparent hood method is safe and effective for intravariceal EIS. This hood contributes especially to reduction of the long-term recurrence probability.博士（医学）・乙第1365号・平成27年11月27

A CASE OF TYPE II POLYGLANDULAR AUTOIMMUNE DISEASE (SCHMIDT'S SYNDROME) ASSOCIATED WITH A MYOPATHY OF UNKNOWN ETIOLOGY

A 44-year-old female with Schmidt's syndrome associated with a myopathy of unknown etiology is reported. The myopathy, characterized by general muscle weakness and extensive atrophy and loss of muscle fibers, developed since the age of 23 y and progressed. The myopathy could not be diagnosed by immuno-histochemistry nor ser- ological examination. Skin pigmentation developed since 40 y. At 44 y, she was diagnosed with Schmidt's syndrome due to the association of autoimmune Addison's disease and Hashimoto's disease. Although the supplemental therapy of hydrocortisone and thyroxin improved adrenal insufficiency and hypothyroidism, the therapy could not improve the muscle weakness of the myopathy. This is the first case of Schmidt's syndrome with a myopathy of unknown etiology like this case

A CASE OF CUSHING'S SYNDROME ASSOCIATED WITH ISOLATED ADRENOCORTICOTROPIN (ACTH) DEFICIENCY AFTER THE REMOVAL OF CORTISOL-PRODUCING ADRENAL ADENOMA

A 45-yr-old woman with Cushing's syndrome who could not be withdrawn from postoperative hydrocortisone supplement for over 3 years after the removal of an adrenocortical adenoma is presented. This was diagnosed as associating with isolated ACTH deficiency. She had suffered from persistent severe general fatigure since 5 years prior. However, after 2 years, obesity, hypertension and moon face developed, while the malaise improved. She was then diagnosed as having Cushing's syndrome and underwent the extirpation of right adrenal adenoma. The dosage of supplementary hydrocortisone was gradually reduced after surgery. However the hydrocortisone dose could not be reduced lower than 10mg/day after several trials of dose reduction as severe general fatigue would ensue. The pituitary function tests at postoperative 2 years and a half-year, revealed an association of isolated ACTH deficiency. It was unknown whether the isolated ACTH deficiency arose before or after the surgery. In the present report, we discuss the association of isolated ACTH deficiency and Cushing's. syndrome

Ribosome Incorporation into Somatic Cells Promotes Lineage Transdifferentiation towards Multipotency

Abstract Recently, we reported that bacterial incorporation induces cellular transdifferentiation of human fibroblasts. However, the bacterium-intrinsic cellular- transdifferentiation factor remained unknown. Here, we found that cellular transdifferentiation is caused by ribosomes. Ribosomes, isolated from both prokaryotic and eukaryotic cells, induce the formation of embryoid body-like cell clusters. Numerous ribosomes are incorporated into both the cytoplasm and nucleus through trypsin-activated endocytosis, which leads to cell-cluster formation. Although ribosome-induced cell clusters (RICs) express several stemness markers and differentiate into derivatives of all three germ layers in heterogeneous cell populations, RICs fail to proliferate, alter the methylation states of pluripotent genes, or contribute to teratoma or chimera formation. However, RICs express markers of epithelial–mesenchymal transition without altering the cell cycle, despite their proliferation obstruction. These findings demonstrate that incorporation of ribosomes into host cells induces cell transdifferentiation and alters cellular plasticity

Impact of A Transparent Hood on The Performance and Therapeutic Result of Endoscopic Injection Sclerotherapy.

Objective: Although the effectiveness of a transparent hood has been reported in various endoscopic procedures, there are only a few reports regarding the benefit of a transparent hood in endoscopic injection sclerotherapy(EIS). In the current study, we conducted a retrospective evaluation of the efficacy and long-term benefit of an oblique transparent hood on EIS. Methods: The transparent hood, manufactured by Olympus (MAJ295 or MAJ296), consisted of a reusable wide oblique distal attachment with rim. This hood was attached when the varix was fine (F0 or F1). In this retrospective study, a total of 201 patients were recruited, and 99 patients (designated as the "Hood Group") received this hood while 102 patients (designated as the "Conventional Group") did not. We compared the rate of intravariceal injection, enhanced supply vessels, variceal eradication, and recurrence between these two groups. Results: This transparent hood provided a better visual field, and there was no serious complication in any of the patients. Intravariceal injection rates in the Hood Group and Conventional Group were 73.9% (190/257) and 57.7% (146/253) respectively (p<0.01). The rates of enhanced supply vessels in the Hood Group and Conventional Group were 89.8% (89/99) and 72.5% (74/102) respectively (p<0.01). The rates of variceal eradication did not differ significantly. We also assessed the cumulative non-recurrence probability for up to 3000 days between the two groups. The Hood Group was statistically superior to the Conventional Group (p<0.01) Conclusion: The application of an oblique transparent hood method is safe and effective for intravariceal EIS. This hood contributes especially to reduction of the long-term recurrence probability.博士（医学）・乙第1365号・平成27年11月27日identifier:Journal of Nara Medical Association Vol.65 No.4,5,6 p.51-61identifier:13450069identifier:http://ginmu.naramed-u.ac.jp/dspace/handle/10564/3083identifier:AA11252383, 65(4,5,6): 51-6