※一部利用できない機能があります
| 1.
論文 |
論文
|
Okazaki, Mitsuyoshi ; Makino, Isamu ; Kitagawa, Hirohisa ; Nakanuma, Shinichi ; Hayashi, Hironori ; Nakagawara, Hisatoshi ; Miyashita, Tomoharu ; Tajima, Hidehiro ; Takamura, Hiroyuki ; Ohta, Tetsuo ; 岡崎, 充善 ; 牧野, 勇 ; 北川, 裕久 ; 中沼, 伸一 ; 林, 泰寛 ; 中川原, 寿俊 ; 宮下, 知治 ; 田島, 秀浩 ; 高村, 博之 ; 太田, 哲生
概要:
金沢大学医薬保健研究域医学系<br />We herein report a case of anaplastic carcinoma of the pancreas with remarkable intraductal tumor gr
…
owth into the main pancreatic duct. A 76-year-old male was referred to our hospital for treatment of a pancreatic tumor. Preoperative examinations revealed a poorly defined tumor in the main pancreatic duct in the body of the pancreas, accompanied with severe dilatation of the main pancreatic duct, which was diagnosed as an intraductal papillary-mucinous neoplasm. We performed distal pancreatectomy and splenectomy. The pathological examination revealed that the tumor consisted of a mixture of anaplastic carcinoma (giant cell type) and adenocarcinoma in the pancreas. There was a papillary projecting tumor composed of anaplastic carcinoma in the dilated main pancreatic duct. The patient is now receiving chemotherapy because liver metastasis was detected 12 mo after surgery. In this case, we could observe a remarkable intraductal tumor growth into the main pancreatic duct. We also discuss the pathogenesis and characteristics of this rare tumor with specific tumor growth. © 2014 Baishideng Publishing Group Co., Limited. All rights reserved.
続きを見る
|
||||
| 2.
論文 |
論文
|
中沼, 伸一 ; 萱原, 正都 ; 中川原, 寿俊 ; 伊藤, 博 ; 田島, 秀浩 ; 藤田, 秀人 ; 北川, 裕久 ; 藤村, 隆 ; 太田, 哲生 ; Nakanuma, Shinichi ; Kayahara, Masato ; Nakagawara, Hisatoshi ; Ito, Hiroshi ; Tajima, Hidehiro ; Fujita, Hideto ; Kitagawa, Hirohisa ; Fujimura, Takashi ; Ohta, Tetsuo
概要:
金沢大学附属病院肝胆膵・移植外科<br />症例は30歳の男性で，体重120 kg，BMI 41の高度肥満であった．重症急性膵炎と診断され当院に紹介された．CTでは両側胸水，膵実質の不明瞭化，後腎傍腔に及ぶ滲出液が認められた（Grade I
…
V）．また，SIRS，急性循環不全の状態であった．入院後4病日，炎症反応の持続とCTにて膵頭部の血流障害が認められ，感染性膵壊死と判断し，necrosectomyを行った．腸管・組織浮腫のため，閉腹によるabdominal compartment syndromeが危ぐされたため，術後zipper techniqueとして衣類圧縮用袋を腹壁に固定し，腹腔内洗浄を伴うplanned necrosectomyを継続し，残存膵壊死組織の除去を行った．退院1年目の現在，患者は職場復帰している．衣類圧縮用袋を用いたzipper techniqueは高度肥満を有する感染性膵壊死の術後に有用な処置と考えられ若干の文献を加え報告する．<br />A severely obese 30-year-old male (BMI 41) weighing 120 kg and referred based on a diagnosis of severe acute pancreatitis was found in computed tomography (CT) to have bilateral hydrothorax, unclear pancreatic parenchyma, and exudate spreading to the posterior pararenal spacer (Grade IV). He also had SIRS and acute circulatory failure. On hospital day 4, persistent inflammatory reactions and a CT finding of pancreatic-head necrosis were noted. Based on a diagnosis of infectious pancreatic necrosis, he underwent necrosectomy. It was difficult to close the abdominal wall because of intestinal and tissue edema. Postoperatively, we attached a vacuum storage bag to the abdominal wall by a zipper. The planned necrosectomy, accompanied by intraperitoneal lavage, was continued to remove residual pancreatic necrotic tissue. No sign of abdominal compartment syndrome was noted. The patient has been discharged and resumed his previous work. The zipper technique and vacuum storage bag thus proved useful in providing postoperative care to a patient with infectious pancreatic necrosis accompanied by severe obesity.
続きを見る
|
||||
| 3.
論文 |
論文
|
Nakanuma, Shinichi ; Miyashita, Tomoharu ; Hayashi, Hironori ; Tajima, Hidehiro ; Takamura, Hiroyuki ; Makino, Isamu ; Oyama, Katsunobu ; Nakagawara, Hisatoshi ; Fushida, Sachio ; Ohta, Tetsuo ; 中沼, 伸一 ; 宮下, 知治 ; 高村, 博之 ; 林, 泰寛 ; 田島, 秀浩 ; 牧野, 勇 ; 尾山, 勝信 ; 中川原, 寿俊 ; 伏田, 幸夫 ; 太田, 哲生
概要:
金沢大学附属病院肝胆膵・移植外科<br />Objectives: Continuous thrombocytopenia after liver transplant is associated with a less favorable
…
prognosis, but this pathogenesis remains unclear. We focused on the consumption of platelets in the allograft. We assessed platelet consumption in allografts, and evaluated the pathology of platelet aggregation in an allograft tissue and its involve-ment in clinical outcomes.Materials and Methods: We took biopsy specimens from 20 patients. To examine the localization of platelet aggregation, CD42b was assayed immuno-histochemically, and its level of expression correlated with clinical data and outcomes.Results: Platelet aggregation in zone 3 was 70%, compared with 30% in zone 1 and 50% in zone 2. Platelets were found mainly as extravasated platelet aggregates in local microenvironments. Patients were stratified according to the extent of extravasated platelet aggregates in zone 3 into extravasated platelet aggregate-negative and -positive groups. Graft weight/recipient body weight ratio with the extravasated platelet aggregate-positive group was significantly lower than that of the extravasated platelet aggregate-negative group. Platelet count after surgery was lower, while total bilirubin and prothrombin time/international normalized ratio were higher in the extravasated platelet aggregate-positive than they were in the extravasated platelet aggregate-negative group.Conclusions: Extravasated platelet aggregates in the zone 3 of allograft tissue cause the consumption of platelets and continuous thrombocytopenia after transplant, and may be the clinical marker for deterioration of graft function. Platelet activation and degranulation following the release by platelets of some negative regulators may be involved partially in liver damage.
続きを見る
|
||||
| 4.
論文 |
論文
|
Nakanuma, Shinichi ; Takamura, Hiroyuki ; Shoji, Masatoshi ; Hayashi, Hironori ; Tajima, Hidehiro ; Nakagawara, Hisatoshi ; Miyashita, Tomoharu ; Kitagawa, Hirohisa ; Tani, Takashi ; Ohta, Tetsuo ; 中沼, 伸一 ; 高村, 博之 ; 林, 泰寛 ; 田島, 秀浩 ; 中川原, 寿俊 ; 宮下, 知治 ; 北川, 裕久 ; 太田, 哲生
概要:
金沢大学附属病院肝胆膵・移植外科<br />Liver transplant is a treatment for familial amyloid polyneuropathy. Few cases of ABO-incompatible
…
living-donor liver transplant for familial amyloid polyneuropathy exist. The outcome of an ABO-incompatible living-donor liver transplant has improved recently, using local infusion therapy and rituximab prophylaxis. Here, we describe a successful ABO-incompatible living-donor liver transplant in a patient with familial amyloid polyneuropathy in whom disease progression ceased at 2 years’ follow-up. Additionally, no evidence of acute or chronic rejection, or adverse events of the immuno-suppressive therapy, was seen. As a postoperative complication, fatty changes in the grafted liver because of malnutrition or adverse events of corticosteroids were confirmed by a liver biopsy taken early after transplant. The main cause of malnutrition was considered to be gastrointestinal dysfunction caused by familial amyloid poly-neuropathy. Therefore, before deterioration of digestive function, liver transplants should be considered for familial amyloid polyneuropathy. This case suggests that an ABO-incompatible living-donor liver transplant may provide greater opportunities for familial amyloid polyneuropathy patients.
続きを見る
|
||||
| 5.
論文 |
論文
|
中沼, 伸一 ; 森, 和弘 ; 岩田, 啓子 ; 経田, 淳 ; 佐藤, 就厚 ; 安居, 利晃 ; Nakanuma, Shinichi ; Mori, Kazuhiro ; Iwata, Keiko ; Tsuneda, Atsushi ; Sato, Nariatsu ; Yasui, Toshiaki
概要:
金沢大学附属病院肝胆膵・移植外科<br />患者は70 歳，男性．腹部食道癌に対して胸腔鏡下食道亜全摘，胸骨後胃管再建，頸部吻合を施行した．第2 病日に右胸腔ドレーンより腸液色の排液を認め，CT，上部消化管透視にて胃管穿孔と診断し，再手術を
…
行った．頸部吻合より肛門側約10 cm に胃管穿孔を認めた．胃管切除は手術侵襲が大きいと判断し，消化管内視鏡の先端を穿孔部へ通し，把持鉗子を腹腔内に進め，大網を把持して胃管内まで吊上げ，クリップにて胃壁に固定した．再手術後，ドレーン排液量は漸減し，穿孔部は再生組織に覆われた．食道癌術後胃管穿孔に対して胃管切除が選択できない場合，穿孔部の大網被覆と穿孔部周囲のドレナージは有効な場合もあると考えられたため，若干の考察を加えて報告する．<br />A 70 -year-old man underwent retrosternal gastric tube reconstruction following subtotal esophagectomyfor advanced abdominal esophageal cancer. On the second post-operative day, drained fluid changed to intestinaljuice. Computed tomography and gastrointestinal fluoroscopy showed perforation of the gastric tube. Wethen performed emergency surgery, and laparotomy was redone. During surgery, gastrointestinal endoscopydemonstrated gastric tube perforation at 10 cm from the anastomosis of stomach to cervical esophagus. Itwas too invasive to perform the resection of gastric tube, so we pulled the greater omentum into the stomachthrough the perforation site and fastened with clips（ omental patch method）. The drainage then graduallydecreased, and the perforation healed with regenerating epithelium. The omental patch method and drainageproved useful to treat gastric tube perforation following esophagectomy, and should be considered if resectionof the gastric tube is difficult.
続きを見る
|
||||
| 6.
論文 |
論文
|
中沼, 伸一 ; 木南, 伸一 ; 尾山, 勝信 ; 舟木, 洋 ; 藤田, 秀人 ; 二宮, 致 ; 伏田, 幸夫 ; 藤村, 隆 ; 萱原, 正都 ; 太田, 哲生
概要:
症例は58歳の女性で,多発性骨髄腫の化学療法中にCTにて胃体上部の壁肥厚と壁内に多数の嚢胞性病変を指摘された.胃透視検査では体上部から穹窿部に境界不明瞭な壁の硬化を認め,胃内視鏡検査所見は胃体上部後壁を中心とした境界不明瞭な丈の低い結節状隆
…
起を呈していた.組織診は高分化型の腺癌であった.多発性胃粘膜下嚢腫を伴ったBorrmann IV型の進行胃癌と診断し手術を施行した.癌は体上部から穹窿部全体に浸潤し,漿膜露出と腹膜播種も認めた.病理組織学的検査所見は明瞭な腺腔形成を示す高分化型の腺癌で繊維化を伴いびまん浸潤していた.免疫染色検査ではMUC2陰性,MUC5AC・MUC6陽性で胃型であった.高分化型のBorrmann IV型胃癌はまれである.本症例では拡張した癌腺管と,境界不明瞭で丈の低い結節状隆起を示した内視鏡像が特異であり,前者は高分化型Borrmann IV型癌に,後者は胃型の分化型癌に関係した性質と考えられた. A 58-year-old woman admitted for multiple myeloma and treated with chemotherapy was found in Abdominal computed tomography (CT) to have showed wall thickening in the upper gastric body, together with multiple cystic lesions at the same site. Barium enema studies showed wall hardening with unclear margins in the upper gastric body and fundus. Endoscopy showed a low protruding nodular lesion with unclear margins on the posterior wall of the upper gastric body. Endoscopic biopsy indicated well-differentiated adenocarcinoma, yielding A diagnosis of Borrmann type 4 advanced gastric cancer with diffuse heterotopic multiple cysts. The tumor was found to have spread from the upper gastric body to the fundus, with serosal penetration and peritoneal dissemination. The Pathological diagnosis was well-differentiated adenocarcinoma invading all layers diffusely forming large glandular cavities and scirrhous changes. Immunohistochemical staining showed tumor cells to be positive for MUC5AC and slightly positive for MUC6 but negative for MUC2. Based on these findings, the definitive diagnosis was gastric phenotype. Borrmann type 4 advanced gastric cancer consisting of well-differentiated adenocarcinoma alone is rare. Our case suggested two characteristic features: large carcinomatous glandular cavities such as gastric cysts related to well-differentiated adenocarcinoma of Borrmann type 4 advanced gastric cancer, and an endoscopic picture of a low protruding nodular lesion with unclear margins related to differentiated carcinoma with a gastric phenotype.
続きを見る
|
||||
| 7.
論文 |
論文
|
齋藤, 裕人 ; 尾山, 勝信 ; 伏田, 幸夫 ; 柄田, 智也 ; 岡本, 浩一 ; 中沼, 伸一 ; 木下, 淳 ; 牧野, 勇 ; 中村, 慶史 ; 林, 泰寛 ; 井口, 雅史 ; 中川原, 寿俊 ; 宮下, 知治 ; 藤田, 秀人 ; 田島, 秀浩 ; 高村, 博之 ; 二宮, 致 ; 北川, 裕久 ; 藤村, 隆 ; 太田, 哲生
概要:
We report a case of gastric adenosquamous carcinoma producing granulocyte-colony stimulating factor (G-CSF). A 60-year-o
…
ld man was admitted to our hospital complaining of upper abdominal pain. Endoscopic examination revealed a large type 5 advanced gastric cancer with bleeding from the low body of stomach to the antrum, accompanied with para-aortic and mesenteric lymph node metastasis. He had marked leukocytosis, and serum levels of G-CSF were elevated. Histological diag-nosis of the biopsy specimen was adenosquamous carcinoma producing G-CSF. We attempted combination chemotherapy with docetaxel, cisplatin and S-1 (DCS). After 1 course of treatment, the primary lesion was reduced in size. However, the size of the metastatic lymph node was larger. Chemotherapy was not effective enough, and the patient died 3 months after ending chemotherapy. 症例は60歳、男性。上腹部痛を主訴に受診。上部消化管内視鏡で胃体下部から前庭部の小弯後壁に易出血性の5型胃癌を認め、画像所見で傍大動脈・腸間膜リンパ節転移を認めた。生検にて腺癌成分と扁平上皮癌成分の混在を認めた。来院時より白血球数が著明に増多し、血清G-CSF高値、生検組織の免疫組織染色で腫瘍組織のG-CSF発現を認めた。以上よりG-CSF産生胃腺扁平上皮癌と診断し、化学療法（DCS (docetaxel/ cisplatin/ S-1併用)療法）を1コース行ったところ原発巣の縮小を認めたが、転移リンパ節の増大を認めた。急激な病状悪化により3ヶ月の経過で死亡した。
続きを見る
|
||||
| 8.
論文 |
論文
|
中沼, 伸一 ; 萱原, 正都 ; 中川原, 寿俊 ; 伊藤, 博 ; 田島, 秀浩 ; 藤田, 秀人 ; 北川, 裕久 ; 藤村, 隆 ; 太田, 哲生
概要:
症例は30歳の男性で,体重120kg,BMI41の高度肥満であった.重症急性膵炎と診断され当院に紹介された.CTでは両側胸水,膵実質の不明瞭化,後腎傍腔に及ぶ滲出液が認められた(Grade IV).また,SIRS,急性循環不全の状態であった
…
.入院後4病日,炎症反応の持続とCTにて膵頭部の血流障害が認められ,感染性膵壊死と判断し,necrosectomyを行った.腸管・組織浮腫のため,閉腹によるabdominal compartment syndromeが危ぐされたため,術後zipper techniqueとして衣類圧縮用袋を腹壁に固定し,腹腔内洗浄を伴うplanned necrosectomyを継続し,残存膵壊死組織の除去を行った.退院1年目の現在,患者は職場復帰している.衣類圧縮用袋を用いたzipper techniqueは高度肥満を有する感染性膵壊死の術後に有用な処置と考えられ若干の文献を加え報告する. A severely obese 30-year-old male (BMI41) weighing 120kg and referred based on a diagnosis of severe acute pancreatitis was found in computed tomography (CT) to have bilateral hydrothorax, unclear pancreatic parenchyma, and exudate spreading to the posterior pararenal spacer (Grade IV). He also had SIRS and acute circulatory failure. On hospital day 4, persistent inflammatory reactions and a CT finding of pancreatic-head necrosis were noted. Based on a diagnosis of infectious pancreatic necrosis, he underwent necrosectomy. It was difficult to close the abdominal wall because of intestinal and tissue edema. Postoperatively, we attached a vacuum storage bag to the abdominal wall by a zipper. The planned necrosectomy, accompanied by intraperitoneal lavage, was continued to remove residual pancreatic necrotic tissue. No sign of abdominal compartment syndrome was noted. The patient has been discharged and resumed his previous work. The zipper technique and vacuum storage bag thus proved useful in providing postoperative care to a patient with infectious pancreatic necrosis accompanied by severe obesity.
続きを見る
|
||||
| 9.
論文 |
論文
|
岡本, 浩一 ; 田島, 秀浩 ; 太田, 哲生 ; 中沼, 伸一 ; 林, 泰寛 ; 中川原, 寿俊 ; 大西, 一朗 ; 高村, 博之 ; 北川, 裕久 ; 伏田, 幸夫 ; 谷, 卓 ; 藤村, 隆 ; 萱原, 正都
概要:
Angiotensin II (Ang II) plays an important role in stromal fibrosis and tumor progression in cancer tissues. Now we inve
…
stigated the role of Ang II in the cross-interaction between intrahepatic cholangiocarcinoma (ICC) cells and hepatic stellate cells (HSCs). The concentrations of Ang II in ICC tissues were significantly higher than those of hepatocellular carcinoma and normal liver. The expression of Ang II type 1 receptor (AT-1) in ICC specimens, two ICC cell lines, and HSC cell line, LI-90 was demonstrated by immunostain and Western blot. The proliferative activity of ICC cells and HSCs added Ang II dose-dependently increased and telmisartan inhibited the proliferative effects in MTT assay. HSCs added Ang II showed a higher expression of α-smooth muscle actin (α-SMA) compared with control cells. Telmisartan also inhibited the activation of HSCs added Ang II. Ang II in ICC tissues may play a pivotal role in tumor growth and stromal fibrosis and Ang II receptor blocker will be a potential therapy in cancer tissue expressing AT-1.
続きを見る
|
||||
| 10.
論文 |
論文
|
寺川, 裕史 ; 牧野, 勇 ; 正司, 政寿 ; 中沼, 伸一 ; 酒井, 清祥 ; 林, 泰寛 ; 中川原, 寿俊 ; 宮下, 知治 ; 田島, 秀浩 ; 高村, 博之 ; 二宮, 致 ; 北川, 裕久 ; 伏田, 幸夫 ; 藤村, 隆 ; 尾山, 武 ; 井上, 大 ; 小坂, 一斗 ; 蒲田, 敏文 ; 太田, 哲生
概要:
症例は56歳, 男性. 検診にて膵頭部腫瘍を指摘され, 当科紹介となった. 腹部USでは膵頭部に多房性嚢胞性病変を認め, 内部は多彩なエコー輝度が混在するモザイク状であった. CTでは膵外に突出する境界明瞭な多房性嚢胞性病変として描出され,
…
嚢胞壁および隔壁に造影効果を認めた. MRIにおいては自由水の信号と比較してT1強調像ではより高い信号, T2強調像ではより低い信号, 拡散強調像ではより高い信号を呈しており, 粘調度や蛋白成分の高い内容物の存在が示唆された. 年齢, 性別, 画像所見およびCA19-9高値などを総合的に評価し, lymphoepithelial cyst (LEC)を第一に疑った. 他の膵嚢胞性疾患が否定できないため切除生検としての腫瘍核出術を施行し, 病理学的にLECと診断した. 詳細な画像検査に加え, 性別やCA19-9値などを総合的に評価することにより, 膵LECを疑うことが可能であると考えられた.
続きを見る
|
