当院における嚥下機能評価の現状

当院では嚥下障害患者に対して嚥下内視鏡検査（Videoendoscopic examination of swallowing：以下VE）を行っている．2007年7月～2008年8月までの１14ヶ月間にVEを行った患者は188人，のべ365回であった．平均年齢は77.2才（21～96才），男女比は男性132人（70.2％），女性56人（29.8）であった．疾患別の内訳は急性肺炎患者が75人（39.9）と最も多く，脳外科患者が46人（24.5），循環器科患者が28人（14.9）などであった．藤島の摂食・嚥下のグレードに従い，それぞれの患者の嚥下能を評価した．また言語聴覚士による嚥下訓練の効果についても検討したので報告する

GRENE-TEA Model Intercomparison Project (GTMIP) stage 1

第4回極域科学シンポジウム横断セッション：[IA] 「急変する北極気候システム及びその全球的な影響の総合的解明」―GRENE北極気候変動研究事業研究成果報告2013―11月12日（火） 国立極地研究所 ２階大会議

Comparative double-blind trial of KN-7 tablet and Robaveron injection in the treatment of neurogenic bladder

37施設で, 神経因性膀胱233例を対象に, ロバベロン注射剤を標準薬とし, KN-7錠剤の経口投与による排尿障害に対する有用性を, 二重盲検群間比較試験で比較検討した.解析対象例はKN-7群108例, ロバベロン群107例である.KN-7群は1日6錠投与した.改善度の効果判定では改善以上K群40.7%, R群38.7%, やゝ改善以上それぞれ76.9%, 72.6%と有意差はなかった.臨床所見中改善の良かった項目は, 尿意, 残尿感, 尿失禁, 排尿までの時間, 排尿時間, 尿勢-排尿力と尿線中断の改善などで, これらの改善以上はK群35.8%, R群30.8%で, 有意差はなかった.副作用はK群0.9%, R群6.8%, K群が有意に少なかった.両剤とも主として下痢で, R群ではその他頭痛, 頻脈, 肝機能障害, 発熱感などを少数例認めた.臨床検査値ではGOT, GPTの上昇が2例あった.有用度有用以上はK群46.3%, R群45.8%で有意差はなかった.疾患別では, 末梢神経疾患, 膀胱の性状では弛緩性, 時期では12ヵ月以内の例で特に改善率が高かった.以上から, KN-7錠剤は, ロバベロン注射剤に比べ, 同等の効果が期待でき, 安全性も高く, 長期投与あるいは外来患者の治療にも適するThe clinical effectiveness, safety and usefulness of KN-7 tablet as a new oral application of the prostatic extract, on urinary dysfunction of neurogenic bladder were compared with those of Robaveron injection by the double-blind test method. In the study, 2 tablets t.i.d. and a shot of intramuscular injection 1 ml a day were given successively for 3 weeks. A total of 233 cases were reported from 37 facilities belonging to the KN-7 Clinical Research Group. Some of them were excluded or dropped out. The number of cases used for analysing the effectiveness, safety and usefulness were 214, 232 and 215, respectively. There was no bias between the two groups with a significant homogeneity in the background. In the overall clinical effectiveness, the effective rate including excellent, moderate and slightly effective was 76.9% with KN-7 and 77.4% with Robaveron. In the clinical usefulness, the rate of usefulness of slightly useful or above was 75.0% with KN-7 and 75.7% with Robaveron. There was no significant difference between the two groups in the clinical effective and useful rates at a significant level of 5%. Side effects were observed in 1 of the 114 (0.9%) patients given KN-7 and 8 of the 118 (6.8%) patients given Robaveron. The incidence of adverse reactions with KN-7 was significantly lower than that with Robaveron. Based on the results, it was concluded that KN-7 tablets, 2 tablets t.i.d., would be as effective and useful as a Robaveron injection 1 ml daily and safer than the latter in the treatment of neurogenic bladder

A case of intra-abdominal abscess that developed 4 years after pancreatic cancer surgery

　症例は74歳男性．膵体部癌を指摘され当院消化器外科にて201X 年に膵体尾部切除施行．術後半年間テガフール・ギメラシル・オテラシルカリウム内服． ３ヶ月ごとの computed Tomography（CT）と腫瘍マーカーで当院消化器外科にて経過観察していた．術後４年に腹痛で当院消化器外科外来を受診．CT で新たに胃大弯側から横行結腸にかけて内部壊死を疑う造影不良域を伴った腫瘤性病変を認めた．膵癌の大網播種を疑われ，abdominal ultrasonography（AUS）でも同様に腹膜播種が疑われた．消化器内科で化学療法の方針となり病理学エビデンス取得目的で endoscopic ultrasound-guided fine-needle aspiration（EUSFNA）を施行したが EUSFNA では明らかな腫瘍細胞を認めず，壊死様の蛋白様物質とともに多数の細菌を認めた．採血で炎症反応高値であったことから，膵癌の腹膜播種ではなく腹腔内膿瘍を疑い抗生剤で治療を開始．治療後の画像検査では膿瘍の縮小を認めた．今回膵癌術後４年目に発症した腹腔内膿瘍の一例を経験したため若干の文献的考察を加えて報告する．　We report the case of intra-abdominal abscess that developed 4 years after pancreatic cancer surgery, with a review of the literature. A 74-year-old man was diagnosed with cancer of the pancreatic body and underwent pancreatic tail resection in 201X at the department of gastrointestinal surgery of our hospital. Oral Tegafur, Gimeracil, and Oteracil Potassium chemotherapy was administered for 6 months postoperatively. The patient was followed-up at the department of gastrointestinal surgery, and computed Tomography (CT) and tumor marker assessment were performed every 3 months. Four years after surgery, the patient visited the outpatient clinic of the department of gastrointestinal surgery with a complaint of abdominal pain. CT showed a new mass lesion with poor contrast, and internal necrosis of the transverse colon approximating the gastric curvature was suspected. abdominal ultrasonography (AUS) examination suggested omental and peritoneal dissemination of pancreatic cancer. Endoscopic ultrasound-guided fine-needle aspiration (EUSFNA) biopsy, which was performed for obtaining pathological evidence for chemotherapy as per the policy of the department of gastroenterology, revealed a large number of bacteria along with necrotic-like protein-like substances, but no obvious tumor cells were found. Since hematological examination revealed a strong inflammatory reaction, an intraperitoneal abscess was suspected instead of peritoneal dissemination of pancreatic cancer, and treatment with antibiotics was initiated. Post-treatment imaging showed shrinkage of the abscess

Clinical early phase II study of bicalutamide (Casodex) in patients with prostatic cancer

ビカルタミド1日1回50mg群, 80mg及び100mgを12週間投与する3群比較の無作為化非盲検試験を実施した. 1)登録症例は124例で, 適格例は122例であった. 2)総合効果における奏効率は50mg群, 80mg群及び100mg群でそれぞれ50.5%, 61.0%及び53.7%であった. 3)PSAに対する奏効率は50mg群, 80mg群及び100mg群でそれぞれ84.2%, 92.7%及び97.6%であった. 4)副作用発現率は3群ほぼ6割で副作用による中止例は80mg群の1例のみで, 安全度において3群間に有意差はなかった.主な副作用は乳房腫脹, 乳房圧痛等であったTo investigate the efficacy and safety of bicalutamide (Casodex(R)) with its clinically recommended dose, the randomized early phase II study was performed in 124 patients with prostatic cancer (stage C, D). The patients were given 50, 80 or 100 mg of bicalutamide orally once a day in fixed doses for 12 weeks ; 122 patients were eligible for evaluation. The overall response rate was 50.0% (20/40); 61.0% (25/41) and 53.7% (22/41) in the 50 mg, 80 mg and 100 mg groups, respectively. The response rate in prostate lesion, bone and lymph node metastases was slightly higher in the 80 mg group than in the 50 mg and 100 mg groups. The proportion of patients showing a response with regard to serum PSA (CR and PR) was 84.2, 92.7 and 97.6% in the 50, 80 and 100 mg groups, respectively. The incidence of adverse reactions was 65.0, 61.0 and 61.0% in the 50, 80 and 100 mg groups, respectively, and there was no significant difference in overall safety rating in the three groups. Frequent adverse reactions were gynecomastia and breast pain. Only one patient in the 80 ing group was withdrawn due to shortness of breath. Serum concentrations of LH, testosterone and estradiol increased significantly after treatment. Bicalutamide was concluded to be effective and well tolerated in patients with prostatic cancer, and its recommended dose was 80 mg once daily

当院におけるギラン・バレー症候群および類縁疾患の現況

当院におけるギラン・バレー症候群(GBS)GBS)および類縁疾患の最近6.5年間の状況について述べた。症例数は20例で、女性8 名、男性1 2名で若干男性に多かった。発症年齢は若年成人と55歳以上の比較的高齢者が多く、30~55歳の壮年には少ない。急性のもの(広義のGBS)は17例でうち3例はFisher症候群(MFS)であった。他の3例は慢性炎症性脱髄性多発神経炎(CIDP)と考えられた。8割以上（15/17例)の症例で先行感染がみられ感冒様症状が最も多く全症例の約半数を占めていた。重症度ははEⅡ度が2 名、Ⅲ度が6 名で、Ⅳ度が10名と最も多く、2名は呼吸停止( V 度) により人工呼吸が行われた。肺活量が60%未満に低下したものは17例中6例(35.3%)とやや高率であった。抗ガングリオシド抗体は13例中9例(69.2%)に陽性であった。治療は3例は症状が軽微で特異的治療は行わず、他は主に血液浄化療法(DFPP、IAPP)を行い3例はDFPPのみ、5例はIAPPのみ、8例は両者を併用していた。1例はガンマグロプリン大量静注療法(IVIg)を行った。予後はl例は重篤な、2例は軽微な後遺症を残し、CIDPを含む他の17例はほぼ完全に回復した。死亡例はなかった