肺癌根治手術治療成績の男女別検討

1998年から2004年までの間に原発性肺癌にて根治手術を施行した81例,男性59例,女性22例を対象として,男女間に肺癌病態の違いがあるかについて検討した.背景因子の比較では女性では腺癌が有意に多かった.5年健存率を比較すると,男性は53.9%であるのに対し,女性は73.1%と高かったが,有意差は認めなかった.Cox比例ハザードモデルで多変量解析をおこなうと,p-stageのみが有意な予後因子であり,性差は独立した予後因子とはいえなかった.Clinicopathological features and outcomes of 59 male and 22 female patients with primary lung cancer treated between 1998 and 2004 were analyzed. A comparison of the characteristics according to gender showed that adenocarcinoma was more frequent in women than in men but there was no significant difference in the distribution of other clinicopathological factors. The 5-year disease free rate of the women was not significantly higher than that of the men, being 73.1% vs 53.9%. A multivariate analysis of survival revealed that the p-stage was a significant prognostic factor, but gender was an insignificant determinant of survival

神奈川リハビリテーション病院脊髄損傷病棟における泌尿器科の役割について

神奈川リハビリテーション病院には脊髄損傷病棟が設置されている.今回我々は2001年4月から2003年9月の間に神奈川リハビリテーション病院脊髄損傷病棟に入院した患者のうち,泌尿器科受診患者のべ2,194人について入院目的,治療内容,手術内容について集計した.また1982年から2004年までの手術内容の変遷につき,10年毎3年間ずつの期間で比較検討した.結果は,脊髄損傷病棟における泌尿器科関与の症例は,急性期・回復期の排尿方法決定等と慢性期の合併症加療がほぼ半数ずつであった.排尿方法は上肢機能残存患者で基本的に間欠導尿を選択,導尿自立困難例では症例にあわせて自己導尿以外の排尿方法を選択している.この20年間で内視鏡的括約筋切開術は減少し間欠導尿を推奨し,また留置カテーテルフリーとする方向へ向かっていることが分かった.以上の傾向が膀胱尿管逆流症,膀胱高位切開術を要するような大きな膀胱結石の発生率を低下させており,尿道皮膚瘻などの合併も減少してきた.膀胱結石の発生率は依然高いが,早期発見によりほとんどの症例で内視鏡による治療が可能になっている.We made a statistical survey of urological treatments in the special wards for spinal cord injury, in Kanagawa Rehabilitation Hospital. Purpose of admission, treatment modality, management of urination, and types of surgical treatment were examined in 2,194 patients who had been to the hospital from April 2001 to September 2003. In particular, surgical treatment modalities were compared among 33-year periods, 1982 - 1984, 1992 - 1994, and 2002 - 2004, to elucidate the changing trend in choice of treatment. Through this survey, it became clear that the main role of a urologist in the wards was to give advice on management of urination and to treat urological complications of spinal cord injury. As the best management of urination, we recommend intermittent catheterization for patients able to use their arms. For those who are not able to do intermittent catheterization, several other options, such as cystostomy, were chosen. A comparative study of surgical treatments performed during last 20 years demonstrated a decrease in the use of endoscopic incision of the urethral sphincter muscle. This trend corresponded with increasing demand for intermittent catheterization that aims at a catheter-free state of the patients. These changes in the concept of treatment in fact decreased the incidence of complications such as large bladder stones and urethral fistula. Although bladder stone formation is still a common complication, they can be treated endoscopically if they are diagnosed at an early stage

Etanercept (ETN) with methotrexate (MTX) is better than ETN monotherapy in patients with active rheumatoid arthritis despite MTX therapy: a randomized trial. Modern Rheumatology 20:531–538 DOI

Abstract The superiority of the combination therapy of methotrexate (MTX) and anti-tumor necrosis factor (TNF) biological agents over anti-TNF monotherapy in MTXnaïve patients with rheumatoid arthritis (RA) has been demonstrated. We investigated the efficacy and safety of continuation versus discontinuation of MTX at the commencement of etanercept (ETN) in patients with active RA despite MTX therapy. In total, 151 patients with active RA despite treatment with MTX were randomized to either ETN 25 mg twice a week and MTX 6-8 mg/week (the E ? M group) or ETN alone (the E group). Co-primary endpoints included the European League Against Rheumatism (EULAR) good response rate and the American College of Rheumatology (ACR) 50 response rate at week 24. Demographic and clinical features between groups at baseline were similar. The EULAR good response rates were significantly higher in the E ? M group (52%) than in the E group (33%) at week 24 (p = 0.0001). Although the ACR50 response rate, one of the co-primary endpoints, and the ACR70 response rate at week 24 were not significantly greater in the E ? M group (64 and 38%, respectively) than in the E group (48 and 26%, respectively), the ACR20 response rate was significantly greater in the E ? M group (90%) than in the E group (64%; p = 0.0002). Safety profiles were similar for the groups. Thus, MTX should be continued at the commencement of ETN therapy, even in RA patients who show an inappropriate response to MTX

パーキンソン病及びパーキンソン症候群におけるすくみ足症例の画像的特徴

すくみ足は,歩行障害の一種で,パーキンソン病及びパーキンソン症候群に認められる症候の一つであるが,他のパーキンソン症候と異なる性質と病態で出現すると推測されている.そこで,外来受診中のすくみ足を伴う症例の画像所見を解析し,その責任病巣について検討した.その結果,すくみ足症例に高率に前頭葉病変が認められ,今まで報告のある前頭葉由来の仮説が裏付けられた.このことから,すくみ足治療は,前頭葉機能に注目して行うことが有用であると考えられた.Although it is known that frozen gait is a symptom of Parkinson\u27s disease (PA), it has not been fully studied in a variety of other diseases with parkinsonian syndrome, such as vascular parkinsonism, normal pressure hydrocephalus (NPH), progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), and multiple system atrophy. The present study was conducted to investigate whether common abnomalies of brain CT or MRI exist in patients with frozen gait. The subjects were of 7 patients with PA, 9 patients with stroke, 5 patients with both PA and stroke, 2 CBD patients, 1 PSP patient, and 1 NPH patient. Frontal white matter lesions were observed in 13 (93%) of 14 patients with PA or PA and stroke. Frontal lobe atrophy was observed in 5 (70%) of 7 patients with PA. Dysartheic disorders were associated in 6 (24%) of 25 patients with frozen gait. Since it is thought that frozen gait is a motor symptom related to frontal lobe dysfunction, the treatment of frozen gait might be conducted by improving frontal lobe function