http://hdl.handle.net/10564/1479 2010-12 2026-04-09T00:09:29Z http://hdl.handle.net/10564/1489 タイトル: 第130回奈良医学会 : 学会記事 2010-12-30T15:00:00Z http://hdl.handle.net/10564/1488 タイトル: 胃転移巣の免疫染色にて診断した原発性肺腺癌の1例 著者: 瓦谷, 英人; 美登路, 昭; 辻本, 達寛; 豊原, 眞久; 白井, 勇作; 山尾, 純一; 福井, 博; 中山, 雅樹 抄録: We report a rare case of gastric metastasis from primary lung adenocarcinoma. A 64-year-old woman with a liver tumor had been admitted to our hospital for further examinations of a liver tumor. Chest CT showed lung tumor on the right upper lobe， and esophagogastroduodenoscopy showed verrucous erosion on the greater curve of the fornix. The histopathology of the liver tumor and the verrucous erosion revealed differentiated adenocarcinoma. The immunohistochemistry of both lesions were positive for TTF-1 and CK-7，and negative for CK-20，by which both liver and stomach lesions were diagnosed as metastases from the primary lung adenocarcinoma. She received chemotherapy，however she died 14 months after diagnosis. When the verrucous erosion on upper side of the stomach is found in a patient with malignant tumor in other organs，it should be considered as a metastatic tumor. Therefore histological examination is strongly recommended. 2010-12-30T15:00:00Z http://hdl.handle.net/10564/1487 タイトル: 腎細胞癌術後16年目に膵転移をきたした1例 著者: 榎本, 泰典; 森田, 剛平; 武田, 麻衣子; 高野, 将人; 赤堀, 宇広; 笠井, 孝彦; 野々村, 昭孝 抄録: A 66-year-old woman was admitted to our hospital because of a pancreatic tumor detected by ultrasonography. She had undergone left nephrectomy for renal cell carcinoma (RCC) 16 years before. Abdominal CT and angiography showed hypervascular two masses in the head and tail of the pancreas，about 25mm and 10mm in size， respectively，suggesting primary neuroendocrine tumors of the pancreas. Under a diagnosis of primary neuroendocrine tumors of the pancreas，pancreatoduodenectomy and distal pancreatectomy were performed. Careful histological examination of the resected specimen revealed metastatic tumors from RCC, which were diagnosed as the clear cell type. Metastatic carcinoma to the pancreas is uncommon. Pancreatic metastasis from an RCC is exceptional，but may occur many years after the initial diagnosis and treatment of the primary tumor. Surgical therapy in patients whose metastatic pancreatic lesions are amenable to resection results in better palliation and improved survival. The result suggests the need for aggressive surgery for this type of carcinoma. The histologic analysis of pancreatic masses in patients with a history of resected primary RCC is important，because neuroendocrine carcinoma most closely resembles metastatic RCC on CT images. 2010-12-30T15:00:00Z http://hdl.handle.net/10564/1486 タイトル: 当院における緩和ケアセンターの開設が緩和ケアサポート活動実績にもたらした効果 著者: 山崎, 正晴; 高橋, 正裕; 太田, 豊作; 金井, 恵美; 伊豆原, 知恵; 古家, 仁 抄録: The Palliative Care Support Team at Nara Medical University Hospital has provided a clinical consu1tation service since February 2007 that was integrated with a Palliative Care Center (PCC) in May 2009. The framework for establishing the PCC was 1) to open a palliative care outpatient clinic， 2) to design a reservation system that corresponds to the introduction of medical support requests，3) to place nurses certified in palliative care and 4) to co-ordinate support to engage in medical activities.　The present study examines the impact of opening the PCC on administrative outcomes for palliative care support activities in a medical university hospital. We compared the hospital medical database from February 2007 to April 2009 (before the PCC opened) with that from May to December 2009 (after the PCC opened). We found that the median number of requests for palliative care support increased from 4.0 to 14.5 per month，ρ＜0.0001，the median consultation interval per patient decreased from 3.7 to 2.5 days，ρ = 0.04 and the ratio of outpatients increased from 2.0% to 46.4%，ρ＜0.0001. The median Palliative Prognostic Index decreased from 5.0 to 3.5，ρ＜.0001. These findings indicate that establishment of the PCC has positively contributed to palliative care support activities by creating easier access to requests，generating more frequent consu1tations and providing earlier intervention by palliative care specialists. 2010-12-30T15:00:00Z