http://hdl.handle.net/10564/1557 2003-06 2026-04-10T15:42:26Z http://hdl.handle.net/10564/113 タイトル: 超音波断層検査で偶然発見された胃の有茎性壁外発育型Gastrointertinal stromal tumor(GIST)の1例 著者: 辰巳, 満俊; 西沼, 亮; 安川, 十郎 抄録: A 55-year-old woman was admitted to our hospital complaining of epigastral distress. Endoscopy of the gastro-intestinal tract revealed no remarkable finding, but a tumor was detected near the kidney by abdominal ultrasonography. Computerized tomography revealed that the tumor had a lower density than that of the liver, and was enhanced by CE/CT. Operative findings showed that the tumor had grown out of the gastric wall with a short peduncle derived from the posterior wall of the stomach. It was diagnosed as a gastrointestinal stromal tumor with exogastric pedunculated development. Pathological examination revealed that the tumor had little symptom of malignancy such as frequent mitosis, and that it was connected to the muscular layer of the gastric wall by the thin peduncle. Immunohistdlogical study confirmed that the tumor was the smooth muscle type of GIST because of the positive expression of CD34, c-kit and αSMA. 2003-06-29T15:00:00Z http://hdl.handle.net/10564/112 タイトル: Intra-Day Variation of Urinary Nuclear Matrix Protein 22 著者: Fukui, Yoshihisa; Samma, Shcui; Yamaguchi, Akira; Aoki, Katsuya; Shimizu, Azuhiro 抄録: Nuclear Matrix Protein 22 (NMP22), a urinary tumor marker for urothelial cancers, is directly released into the urine from the nucleus after cell death, Accordingly, values of NMP22 do not requlre adjustment using other substances such as urinary creatinine. On the other hand, its values might vary according to urine concentration. This study investigated the intra-day variation in the urinary level of NMP22. NMP22 and urinary creatinine were measured in a 24-hour urine sample and 4 spot urine samples obtained from 20 inpatients (10 with bladder cancer, and 10 with non-urothelial cancer or benign tumors). The spot urine samples were collected at 6 a.m., 10 a.m., 2p.m. and 9 p.m. There were no significant differences in NMP22 values between the 24-hour and spot samples in all patients. Out of 10 bladder cancer patients, 6 had positive 24-hour samples. Among these 6 patients, only 3 had 4 positive spot samples (>12.O U/ml): one had 3 positive samples, and 2 had one positive sample. Among the controls, only one patient with renal cancer had a positive 24-hour sample. Only 3 controls, 2 With prostatic cancer and one with renal cancer, had a single positive spot sample. The highest margin between the maximum and minimum levels in the 4 spot samples was 237.8 U/ml in the bladder cancer patients and 16.6 U/ml in the controIs. When the ratios of NMP22 and urinary creatinine values for the 24-hour to spot samples were calculated in each patient, a significant correlation was observed between the ratios of NMP22 and urinary creatinine (r=0.575, p<0.001). The urinary level of NMP22 shows intra-day variation and might be affected by the extent of the concentration of urine samples. The measurement results must be judged with this in mind, especially when judging the results around the cut-off value. 2003-06-29T15:00:00Z http://hdl.handle.net/10564/110 タイトル: 早期胃癌に対する内視鏡的胃粘膜切除（EMR）後の胃切除症例の検討 著者: 阪口, 晃行; 渡辺, 明彦; 山本, 克彦; 石川, 博文; 山田, 高嗣; 大槻, 憲一; 横谷, 倫世 抄録: Sixteen cases were treated with salvage gastrectomy after endoscoplc mucosal resection (EMR) for early gastric cancer in Nara Prefectural Nara Hospital from 1996 to 2002. The residual cancer cells and lymph node metastases were pathologlcally evaluated in comparing the findings of EMR-specimens. The reasons for salvage gastrectomy are described below. Twelve cases were treated for 'positive surgical margin'. Two cases that were not proved 'negative surglcal margin' in the EMR-specimens were underwent salvage gastrectomy for remnant cancer at 4 and 9 months after EMR. Although one case was 'negative surglcal margin', salvage gastrectomy was performed because of the patient's choice. One case was a recurrent case after curative EMR. In resected specimens, remnant cancer cells were observed in 12 of all 16 cases (75.0％), 11 of 14 cases that were not proved 'negative surgical margin' (78.6％) in the EMR specimens. Lymph node metastasis was not found in all cases. Although one case was mucosal cancer with 'positive surgical margin' in EMR-specimens, salvage gastrectomy was not performed because no cancer cells were observed by follow-up gastrofiberscopy in the EMR-scar and the patient's choice. In this case, the follow-up gastrofiberscopy at 9 months after EMR proved cancer cells and laparoscopy assisted distal gastrectomy was perfomed. The surgical specimen pathlogically showed submucosal invasion. Laparoscoplc gastrectomy as minimally invasive surgery was performed in 6 of 16 cases. In conclusion, surgical operation should be performed as soon as possible for remnant and recurrent gastric cancer after EMR and if possible, laparoscoplc operations would be a good choice. 2003-06-29T15:00:00Z http://hdl.handle.net/10564/109 タイトル: 当科での食道癌手術における器械吻合導入後の成績 著者: 阪口　, 晃行; 渡辺, 明彦; 山本, 克彦; 石川, 博文; 山田, 高嗣; 大槻, 憲一; 横谷, 倫世 抄録: We have utilized a circular stapler for intra-thoracic anastomosis (ITA) after radical esophagectomy since July 1999, and moreover, for cervical anastomosis (CA) since July 2001. In this study，we evaluate the usefulness of esophagogastric anastomosis with a circular stapler. Subjects were 28 esophageal patients who underwent esophagectomy followed by esophagogastric anastomosis with a circular stapler in the period from July 1999 to February 2003. Esophagogastric anastomosis with a circular stapler was performed by end to side anastomosis. Subjects consisted of 20 cases undergoing ITA and 8 cases undergolng CA. The incidences of anastomotic leakage were 15.0％ and 12.5％, respectively. The cases with anastomotic leakage were treated with a conservative therapy and cured. The incidences of anastomotic stenosis in ITA and CA were 15.0％ and 12.5％, respectively. Anastomotic stenosis occurred from one to six months after operation in the cases without anastomotic leakage. One or two balloon dilatation could not relieved in 3 of the 4 cases with anastomotic stenosis. Anastomotic bleeding was not found. There was only one case with severe reflex esophagitis in ITA. We are almost satisfied with these results. Therefore, it was thought that esophagogastric anastomosis with a circular stapler isuseful. 2003-06-29T15:00:00Z