<原著>副腎腫瘤の臨床的検討

We reviewed the records of 13 patients with adrenal masses operated on over a ten-year period to clarify clinical characteristics of adrenal tumors. Tumors were found incidentally in seven of nine patients with primary adrenal tumors (78%); however, three of these seven patients (43%) proved to have shown symptoms related to adrenal hyperfunction when re-e、raluated. Other adrenal tumors (metastatic in three patients and inflammatory in one) were found without any symptoms referable to the tumors. In nine of 13 patients (69%), tumors were discovered by computerized tomography (CT). All patients with primary tumors have been gotten free of disease postoperatively. In contrast, although all three patients with metastatic adrenal tumors underwent resection of all known disease tissue, they died of the recurrence of malignancies within 10 months. This study suggests that a number of functional adrenal tumors are possibly left undiagnosed until found incidentally, and that CT is the most powerful tool to detect adrenal tumors. Our data did not support surgical intervention in cases of metastatic adrenal tumors.副腎腫瘤の臨床的特徴を明らかにするために過去10年間に当科で手術された13例を検討した. 原発性腫瘍9例中2例は臨床症状より原発性アルドステロン症を疑われ副腎腫瘍を発見されているが, 残りの7例(78%)は偶然腫瘍が発見された, いわゆる incidentaloma であった. しかしながら, retrospective にみるとこの7例中3例(43%)で副腎機能亢進によると考えられる症状を呈していた. 転移性腫瘍3例, histoplasma による肉芽腫1例は全て無症状であった. 13例中9例(69%)はCTにより, 2例は超音波, 1例は血管造影, 1例は scintigraphy によりそれぞれ病変を発見され, CT で副腎腫瘤を指摘できなかったのは1例のみであった. 13例中11例は経腹的に, 2例 は開胸開腹で手術されたが, 術後合併症は1例に創感染を認めたのみであった. 原発性腫瘍例は全例術後再発を認めていないが, 転移性腫瘍の3例は全例, 術後10ヶ月以内に再発死した. 以上の結果は機能性副腎腫瘍でも偶然発見されるまで診断されない場合が多いことを示唆しており, 臨床症状を注意深く検討し常に副腎腫瘍の可能性を考慮にいれることが肝要であると考えられる. また, 今回の結果より CT が副腎腫瘤の診断において重要な位置を占めるものと考えられた. なお, 転移性副腎腫瘍に対する手術療法は今回の検討ではそれを積極的に支持する結果は得られず, 今後さらに検討を要する問題と思われる

<症例>胃癌手術 (脾摘術合併胃全摘術) 後の門脈血栓症の1例

A 48-year-old woman underwent total gastrectomy, splenectomy, and distal pancreatectomy with en bloc regional lymph node dissection for gastric carcinoma. Dull pain in the right upper quadrant and the back developed postoperatively. Contrast-enhanced computed tomography and ultrasonography disclosed portal vein thrombosis (PVT). Heparin and urokinase were given in conjunction with antbiotics. This treatment resulted in clinical improvement, but failed to achieve complete thrombolysis. Cavernous transformation of the portal system was confirmed. Although PVT after splenectomy has been reported mainly in patients with hematological disorders, our case suggests that splenectomy for en bloc node dissection in gastric carcinoma is a possible cause of PVT.門脈血栓症は肝硬変や肝癌の患者で時に認められる病態であるが, 術後の門脈血栓症は稀であり, そのほとんどが脾腫に対する脾摘術後に発生している. 我々は胃癌根治術に伴う脾摘術後に門脈血栓をきたした症例を経験したので報告する. 症例は48才の女性で, 胃体上部後壁を中心とする5型胃癌に対し, 胃全摘術, 脾摘術, 膵尾側切除術を行なった. 病変は組織学的には低分化腺癌, 深達度ss, No, Po, Ho の stage I b で, 摘出した脾重量は 150g であった. なお, 術前の出血凝固系検査には異常を認めなかった. 術後18日目より右上腹部から背部の鈍痛が出現し, 白血球数, CRP, 血清アルカリフォスファターゼ値も上昇してきた. 術後19日目の造影CTで, 門脈, 上腸間膜静脈がほとんど造影されず, 門脈から上腸間膜静脈におよぶ血栓形成が考えられた. 抗生剤の投与とともにただちにへパリンの持続静注とウロキナーゼ投与を併用したところ, 臨床症状や検査所見は軽快した. ただし, 血栓は完全に消失せず, その後の腹部血管造影では側副血行路としての肝十二指腸間膜内の静脈拡張, いわゆるcavernous transformation が認められた. へパリン, ウロキナーゼの投与からワーファリン内服に切り替え, 患者は術後66日目に退院した. 現在, 術後2年経過したが, 食道静脈瘤の出現や消化管出血などの門脈血栓, 門脈圧充亢進に起因すると思われる症状は認めていない. 我々の症例は, 進行胃癌根治術の際にしばしは合わせ行われる脾摘術後にも門脈血栓症の出現する可能性があることを示唆しており, そのような手術を受けた患者が術後原因不明の腹部症状や白血球増加を来たした時には門脈血栓症も疑い精査を進める必要があると考えられる

Measurements of radial profile of isotope density ratio using bulk charge exchange spectroscopy

A bulk charge exchange spectroscopy (BCXS) system using a grism (grating prism) spectrometer has been applied to measure the profile of the deuterium (D) fraction in deuterium and hydrogen (H) mixture plasma in the Large Helical Device. The observed spectrum can be fitted with four Gaussian functions successfully by reduction of free parameters for the least-squares fit. The plasma flow velocity and ion temperature profile measured by charge exchange spectroscopy using carbon impurity are used for estimation of the wavelength shift of hot components to reduce the free parameter. The ion temperature is used to estimate the apparent wavelength shift due to the energy dependent emission cross section only and is not used to set the Doppler width for H and D in the fitting. The sensitivity of the evaluated D fraction on the velocity is increased for a higher D fraction. The error of the D fraction is calculated from the error in the fitted parameter and sensitivity on the velocity of the hot component. The difference in the profile and time trace of the D fraction with D pellet and H pellet injection was observed clearly by BCXS using a grism spectrometer

Polarization behavior of discrete multipath and diffuse scattering in urban environments at 4.5 GHz

The polarization behavior of the mobile MIMO radio channel is analyzed from polarimetric double-directional channel measurements, which were performed in a macrocell rural environment in Tokyo. The recorded data comprise non-line-of-sight, obstructed line-of-sight, and line-of-sight conditions. The gradient-based maximum-likelihood estimation framework RIMAX was used to estimate both specular and dense multipath components. Joint angular-delay results are gained only for the specular components. The dense multipath components, which may be attributed to diffuse scattering, can be characterized only in delay domain. Different characteristics describing the polarization behavior and power-weighted cross- and copolarization ratios for both types of components are introduced. Statistical analysis of long measurement track segments indicates global trends, whereas local analysis emphasizes specific behavior such as polarization dependency on angle of incidence in streets and under shadowing conditions. The results also underline the importance of modeling changing and transient propagation scenarios which are currently not common in available MIMO channel models

Isolation and characterisation of nanofibrillated cellulose from N36 Ananas comosus leaves via ball milling with green solvent

The production of valuable materials from biomass into nanosized become the principal focus of the developing industries on achieving green-based composite product, designed for extensive range of applications. This study principally, focused on discovering green method for the utilisation of N36 Ananas comosus leaves fibre (PALF) to highly potential material. Nanofibrillated cellulose (NFC) were successfully isolated from PALF by ball milling with presence of isopropyl alcohol. The effect of isopropyl alcohol and the milling time on nano fibrillation were analysed through characterisation of NFCs including Field Emission Scanning electron microscopy (FESEM), Xray diffraction (XRD), thermogravimetric analysis (TGA), Zeta-potential (ZP), Fourier transform infra-red (FTIR) and Particle size analysis (PSA). Comparatively, the 1:4─15 min NFC sample which milled for 15 mins with 1 mL of cellulose suspension and 4 mL of IPA, express desirable features in the concern of morphology, fibre size, yield, crystallinity, thermal stability, and homogeneity on disintegration of PALF fibre. High thermal degradation temperature of 323 ℃ and crystallinity index of 67%, reveal the potential on reinforcing to improve the composite’s thermal stability and mechanical properties. Moreover, it exhibits excellent surface morphology, stability with low self-agglomeration, and uniformity in defibrillation with fibre diameter of 25.84 ± 8.30 nm, zetapotential of − 32.31 ± 2.51 and PDI of 0.103. Besides, the high yield of NFC (>90%), increase the feasibility of NFC production. Hence, addition of IPA gives significant impact on defibrillation by disrupt the intermolecular hydrogen bond, so that less milling time is convenient on production of NFC without causes severe damage on other properties

Recovering value from waste: Development of G-Nanocellulose derived from ananas comosus leaves

Malaysia is known as one of the largest producers of pineapple in Asia, at the same time it created a large quantity of waste; Pineapple leave fibre (PALF) is the main waste of this industry. Due to lack of study in agricultural waste management, Normally, PALF is left on the plantation for nutrient cycling or being burnt, and this circumstance may lead to air pollution. PALF possess higher cellulose (81.27%) content; lower lignin (3.46%) content than other natural fibre