http://hdl.handle.net/11665/2636 2020-12-25 Tue, 24 Jun 2025 02:56:59 GMT 2025-06-24T02:56:59Z http://hdl.handle.net/11665/2689 タイトル: 奥付等 著者: 岡野, 創造 Thu, 24 Dec 2020 15:00:00 GMT http://hdl.handle.net/11665/2689 2020-12-24T15:00:00Z http://hdl.handle.net/11665/2688 タイトル: Behcet 病に伴う器質化肺炎の一例 著者: 高田, 直秀; 西川, 圭美; 太田, 登博; 吉岡, 秀敏; 五十嵐, 修太; 小林, 祐介; 後藤, 健一; 中村, 敬哉; 江村, 正仁 抄録: 症例は 61 歳男性．1995 年 37 歳時に口腔内アフタ，陰部潰瘍，ブドウ膜炎，結節性紅斑を認め完全型 Beh?et 病と診断され コルヒチン 1 mg/日と tocilizumab の治療を受けており，寛解状態で経過していた．2019 年 10 月 1 日に咳嗽，喀痰の増加を主 訴に近医を受診し，胸部 CT にて両側のびまん性多発粒状影を認めた．当初は細菌性肺炎が疑われ，抗生剤加療を行ったが不 応であったため，10 月 21 日に精査加療目的に当院へ転院となった．転院後に抗酸菌を含めた喀痰検査を行ったが起因菌は同 定されず，免疫学的検査でも異常を認めなかった．気管支鏡検査を行ったが，原因となる細菌は認められなかった．経気管支 肺生検で泡沫細胞の集簇とフィブリンの析出を認め，元々の完全型 Beh?et 病の既往もあり，Beh?et 病に関連した器質化肺炎 と診断し，ステロイド投与を開始したところ，呼吸状態，肺陰影ともに改善を認めた．Beh?et 病に器質化肺炎を合併する報告 は少なく , まれな病態と考えられる．; A 61-year-old man was diagnosed with complete Beh?et's disease with oral aphthae, genital ulcer, uveitis, and erythema nod osum at the age of 37 in 1995, and was treated with colchicine 1 mg / day and Tocilizumab in remission. On October 1, 2019, he visited a nearby doctor with a complaint of increased cough and sputum, and chest CT showed diffuse multiple granular shadows on lungs. Initially, bacterial pneumonia was suspected. He was treated with antibiotics but was unresponsive, so he was transferr ed to our hospital on October 21 for the purpose of detailed examination and treatment. After the transfer, a sputum test including acid-fast bacillus was performed, but the causative bacteria were not identified. Bronchoscopy did not reveal any abnormalities in immunological examination. Transbronchial lung biopsy showed aggregation of foam cells and precipitation of fibrin. Patients who were originally diagnosed with Behcet's disease were diagnosed with organized pneumonia associated with Behcet's disease, and when steroids were started, both respiratory status and lung shadows improved. There are reports of Behcet's disease associat ed with the organization of pneumonia. It is considered a rare condition. Thu, 24 Dec 2020 15:00:00 GMT http://hdl.handle.net/11665/2688 2020-12-24T15:00:00Z http://hdl.handle.net/11665/2676 タイトル: 術前化学療法によって腫瘍縮小化が図られ，有効な治療を完遂し得た 子宮頸部類内膜腺癌の 1 例 著者: 大井, 仁美; 坪内, 万祐子; 山田, 惇之; 山本, 櫻; 小木曽, 望; 山田, 義治; 山本, 浩之; 藤原, 葉一郎; 楢林, 正流; 平田, 希美子; 大津, 修二 抄録: 子宮頸癌や腟癌の組織型は扁平上皮癌が多く，腺癌は比較的少ない．また，腺癌は扁平上皮癌に比して化学療法や放射線療 法の感受性が低いことから，進行期がⅠ期・Ⅱ期では手術療法が放射線療法よりも予後が良好であるとの報告がある．今回 我々は，腫瘍の主座が腟円蓋部にあり手術摘出が困難と考えられた腺癌に対し，術前化学療法（neoadjuvant chemotherapy： NAC）を施行することによって腫瘍の縮小化が図られ，その後手術摘出を完遂し得た症例を経験した． 症例は 48 歳，子宮腟部から腟腔内に突出する約 6㎝の低分化腺癌を認めた．子宮頸癌もしくは腟癌を疑い，NAC 施行後に 広汎子宮全摘術を施行した．摘出標本の病理検査結果は子宮頸部類内膜癌で，腟，直腸表面への浸潤を認めた．多臓器に浸潤 する子宮頸癌や腟癌にはしばしば同時化学放射線療法 (concurrent chemoradiotherapy：CCRT) が行われるが，腺癌の場合， より根治性の高いとされる手術療法を行うための選択肢の一つとして NAC が有効である可能性が示唆された．; Most of the malignant tumors located at the uterine cervix and vagina are squamous cell carcinoma. The treatment of each tumor is surgery or concurrent chemoradiotherapy (CCRT) decided by the tumor size and cancer stage. Adenocarcinoma of the uterine cervix and vagina is rare and less sensitive to radiation therapy and chemotherapy compared to squamous cell carcinoma. This report presents a case of large adenocarcinoma located at the uterine cervix and vagina that had invaded the serosa of the rectum, and was treated with neoadjuvant chemotherapy (NAC) and surgery. A 48-year-old multiparous woman presented with metrorrhagia Pelvic magnetic resonance imaging (MRI) revealed a 59mm× 62mm tumor located at the posterior wall of the vagina, uterine cervix and surface of the rectum. After NAC a complete resection was performed, and a pathological examination revealed to be an endometrioid carcinoma of the uterine cervix. Large and highly invaded vaginal and cervical tumors are often treated with CCRT. NAC, however, is a therapeutic option when the tumor is adenocarcinoma. Thu, 24 Dec 2020 15:00:00 GMT http://hdl.handle.net/11665/2676 2020-12-24T15:00:00Z http://hdl.handle.net/11665/2675 タイトル: 当院における糖尿病受診中断予防の取り組み 著者: 近藤, 有里子; 細尾, 真奈美; 和田, 英美子; 安威, 徹也; 小暮, 彰典 抄録: 糖尿病患者における受診中断は合併症進行のリスクであり，その対策として再受診勧奨が有効と言われている．当科では 2016 年4 月より外来通院中の糖尿病患者のうち希望者に未受診時の再受診勧奨を開始した．24 か月後の受診中断率は3.3％で， 再受診勧奨の連絡に応答があった者の8 割が再受診しており，この取り組みは受診中断抑制に一定の効果を認めた．95％の患 者が未受診時の連絡を希望しており，漏れなく確実に連絡を行える体制を作り，積極的に再受診を勧めることが重要である．; Missing a doctor’s appointment may result in interruption of diabetic care and promote the development of complications in patients with diabetes. An effective preventive measure has been said to be to contact and encourage the patients to revisit their doctor. In April 2016, we began to contact the outpatients who had given their consent to encourage them to revisit our hospital when they missed an appointment. After 24 months, the interruption rate became 3.3%, and 80% of those who were contacted did revisit their doctor. Thus the effort was found to be effective. Ninety-five percent of the patients wished to be contacted after they missed their appointment for consultation. It is important to create a fail-free system to contact and remind all patients not to miss their next appointment for uninterrupted diabetic care. Thu, 24 Dec 2020 15:00:00 GMT http://hdl.handle.net/11665/2675 2020-12-24T15:00:00Z