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Background/Aims: There is lack of definitive evidence about the association between erythropoiesis-stimulating agent (ESA) responsiveness in the pre-dialysis phase and mortality. Therefore, we conducted a hospital-based, retrospective, cohort study to assess the predictive value of ESA response for prognosis in incident hemodialysis patients. Methods: A total of 108 patients without preexisting cardiovascular disease who had been started on maintenance hemodialysis were studied. ESA responsiveness just before starting dialysis was estimated using an erythropoietin resistance index (ERI). The endpoint was defined as all-cause death. Results: During a mean follow-up period of 3.1 ± 1.6 years, 18 (17%) patients died. Overall, the multivariate Cox regression analysis revealed that the log-transformed ERI remained an independent predictor of all-cause death after adjustment using a propensity score (hazard ratio 2.25, 95% CI 1.25–4.06). Conclusions: Among incident hemodialysis patients, hyporesponsiveness to ESA may be associated with mortality.

Background and Aims There are several reports showing on the relationship between electrocardiographic (ECG) findings and prognosis in dialysis patients. We recently reported that among various ECG findings, T-wave of lead aVR (aVRT) amplitude revealed the strongest and significant association with cardiovascular disease (CVD) events and all-cause mortality in prevalent dialysis patients (Ther Apher Dial, 2017). We also reported that BNP level was significantly associated with CVD-related mortality and all-cause mortality in our cohort study (Ren Fail, 2018; Sci Rep, 2019). On the other hand, BNP levels have been reported to be higher among elderly and women and lower in people with higher body mass index. However, there is no report showing the correlation between NT-proBNP and ECG findings. Method From our Miyazaki Dialysis Cohort, we extracted patients who had both ECG findings and NT-proBNP data and did not have atrial fibrillation. We examined the relationship between log NT-proBNP level and various ECG findings using Spearman analysis as a cross-sectional study. Results We analyzed 519 hemodialysis patients (44.1% women, mean age was 66.1 years old, median dialysis vintage was 105 months) without atrial fibrillation. Diabetes mellitus was the underlying disease in 25.0% and a history of CVD was found in 25.2% of all patients. Median and IQR (25-75 percentile) of NT proBNP was 4150 (1980-8960). Log NT-proBNP level was significantly correlated with aVRT magnitude (mV), electrical left ventricular high voltage (mV), QTc time (ms), and T-wave amplitude of I lead (mV) (r=0.289, p Conclusion Although some ECG findings and BNP level are factors associated with CVD events and death, there was also a significant correlation between these two factors. There has been no report showing the relationships between these two factors, and it may be useful in considering BNP levels in dialysis patients.

We challenged to identify the cutoff value of cTnT in chronic kidney disease (CKD) patients by point of care assessment way. A single center, prospective cross-sectional study was planned and performed. 201 consecutive patients who were visited emergency room for chest symptoms were enrolled in this study. All patients were performed routine practice for differential diagnosis of chest symptom by cardiologist. Simultaneously, semiquantitative measurement of cTnT was performed using same blood sampling on the blind condition to cardiologists for this study. Study patients were divided into four groups according to the estimated glomerular filtration rate (eGFR), CKD1-2, CKD3, CKD4-5, and CKD5D. Usefulness of semiquantitative measurement for diagnosing ACEs was investigated in each group. 77 (38%) of total patient was diagnosed as acute coronary events (ACEs). About 50% of patients were showing cTnT level less than 0.03 ng/mL. The cTnT level over 0.1 ng/mL was found in 30% of total subjects. Mean quantitative value of cTnT was 0.29 ± 0.57 ng/mL in total subjects. Estimated cutoff value in CKD3 patients was 0.088 ng/mL with a sensitivity of 59.3% and specificity of 80.0%. Interestingly, the cutoff values of CKD1-2, CKD4-5, and CKD5D were 0.047, 0.18, and 0.27 respectively, which are half, two times, and three times of CKD3 cutoff value 0.088. The specificities of four cutoff values in each CKD group were showing over 80%, which is higher than sensitivity, respectively. In CKD patients, semiquantitative, point of care assessment of cTnT could be a useful tool for screening for ACEs.

Objective Therapies for chronic kidney disease have changed greatly over the last decade. The aim of this study was to examine the changes in the clinical characteristics and carotid atherosclerosis of patients with end-stage kidney disease (ESKD) over the last 9 years. Methods A cross-sectional study of 150 consecutive patients with ESKD who had initiated maintenance dialysis between January 2005 and December 2013 was conducted. The patients' mean age was 68 ± 13 years. The group comprised 73% men, and 63% of the patients had diabetic nephropathy. The carotid artery-intima media thicknesses and the plaque scores (PS) were measured using carotid artery ultrasonography within 3 months of dialysis initiation. Changes in the patients' carotid atherosclerosis and clinical characteristics over the years were examined by categorizing the patients into 3 groups representing 3-year intervals based on when dialysis was initiated. Results The PS declined from 12.8 to 5.4 ( P = 0.001). Low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol levels declined over the 9-year period ( P = 0.005 and P = 0.006, respectively), and the ratio of statin users increased markedly from 24% to 54% ( P = 0.001). Univariate regression analysis identified a positive correlation between the PS and LDL-C (r = 0.281; P = 0.01), and a strong positive correlation was found between the PS and LDL-C after adjusting for various risk factors for atherosclerosis. Conclusion Carotid atherosclerosis in patients with ESKD has decreased over the past 9 years, which may be a consequence of improvements in dyslipidemia management.

Background/Aims: An upright T-wave in lead aVR (aVRT) has recently been reported to be associated with cardiovascular death and mortality among the general population and patients with prior cardiovascular disease (CVD). However, evidence for the predictive ability of aVRT in patients with chronic kidney disease is lacking. Therefore, a hospital-based, prospective, cohort study was conducted to evaluate the predictive ability of an upright aVRT for the short-term prognosis in incident hemodialysis patients. Methods: Among 208 patients who started maintenance hemodialysis, 79 with preexisting CVD (CVD cohort) and 129 with no history of CVD (non-CVD cohort), were studied. An upright and non-upright aVRT were defined as a wave with a positive deflection in amplitude of ≥0 mV and a negative deflection in amplitude of Results: Overall, the prevalence of an upright aVRT was 22.6% at baseline. During the mean follow-up period of 2.1 ± 1.0 years, 33 deaths occurred. Cumulative survival rates at 3 years after starting dialysis in patients with an upright and non-upright aVRT were 50.0 and 80.7%, respectively, in the CVD cohort and 92.0 and 91.3%, respectively, in the non-CVD cohort. In the CVD cohort, multivariate Cox regression analysis showed that an upright aVRT was an independent predictor of death after adjusting for confounding variables. Conclusion: Among Japanese hemodialysis patients at high risk for CVD, an upright aVRT seems to be useful for predicting death.

Aims/Introduction: To reveal whether visit-to-visit variability in HbA1c is associated with higher risk of cardiovascular disease (CVD) in patients with type 2 diabetes. Materials and Methods: The study was conducted on 689 Japanese patients with type 2 diabetes [295 women, 394 men; mean (±standard deviations (SD)) age 65 ± 11 years]. Variability in HbA1c was evaluated as the intrapersonal SD of serial measurements of HbA1c during the follow-up period for at least 12 months. Patients were divided into quartiles according to the SD of HbA1c, and the primary endpoint was defined as incident CVD. Cox’s proportional hazards model was used to calculate hazard ratios (HR) and 95% confidence intervals (CI). Results: During a median follow-up period of 3.3 years (range 1.0–6.3 years), 26 ± 14 measurements of HbA1c were obtained per patient and 61 episodes of incident CVD were recorded. The 5-year cumulative incidence of CVD in patients across the first, second, third, and fourth quartiles of SD in HbA1c was 4.9, 8.7, 17.1, and 26.2%, respectively (P

Background The impact of serum lipid abnormalities on the progression of diabetic kidney disease (DKD) remains conflicting. Furthermore, gender differences in the association between dyslipidaemia and outcome of DKD are largely unknown. We therefore conducted this single-centre observational cohort study to clarify gender differences in the association between serum lipid profiles and the progression of DKD. Methods Seven hundred and twenty-three Japanese type 2 diabetes mellitus (T2DM) patients with normoalbuminuria or microalbuminuria, 280 women and 443 men, with a mean (± SD) age of 63 ± 11 years were studied. The endpoint was the progression to a more advanced stage of albuminuria. For statistical analyses, Cox proportional hazard model analyses were conducted. Results During the mean follow-up period of 4.3 years, 62 of 477 patients with normoalbuminuria and 69 of 246 patients with microalbuminuria reached the endpoint. A significant interaction between high-density lipoprotein (HDL) cholesterol and gender was detected (P(interaction) = 0.04); therefore, separate analyses were conducted for men and women. Overall, in men, the univariate Cox proportional hazard model revealed that higher triglycerides and lower HDL cholesterol levels were significantly associated with higher risk of reaching the endpoint. In the multivariate Cox proportional hazard model, only HDL cholesterol levels remained as an independent predictor of the endpoint (hazard ratio 0.391, P = 0.01). In women, no serum lipid parameters were associated with the endpoint. Conclusions Lower HDL cholesterol levels seem to be associated with the progression of DKD in men but not in women.

Purpose A retrospective investigation of patients presenting with renal pelvic and ureteral cancer was performed. This study focused on the prognostic factors and frequency of subsequent bladder cancer following surgical treatment. Materials and methods Forty-five patients presenting with transitional cell carcinoma, who had undergone nephroureterectomy at the Department of Urology, Okayama Central Hospital, from March 1990 to November 2000, were reviewed. Various factors were evaluated according to survival and non-bladder cancer occurrence rates. The Kaplan-Meier method was used in the analyses. Results Patients consisted of 33 males and 12 females (mean age was 71.7). Seventeen patients exhibited renal pelvic cancer, 25 cases displayed ureteral cancer and three subjects presented with multiple cancers. Eleven patients had received treatment for precedent or coexistent superficial bladder cancer by transurethral resection. The overall 5-year survival rate was 71.9%. Ten patients died as a result of the disease; in all cases, lymph node or distant metastasis had progressed. Pathological T factor, tumor grade and pN factor demonstrated a significant effect on survival; however, sex, age, tumor localization and incidence of subsequent bladder cancer had no influence on survival. The 5-year non-bladder cancer occurrence rate was 38.8%; additionally, all subsequent bladder cancer was disclosed within three years. Tumor multiplicity exclusively in the upper urinary tract significantly affected occurrence of bladder cancer. T factor and tumor grade revealed no correlation to occurrence. Conclusions Adjuvant chemotherapy for prevention of clinical metastasis should be considered in cases involving pT3 or higher stage, grade 3, or in instances of pathologically confirmed lymph node metastasis. The significant occurrence of subsequent bladder cancer in the case of tumor multiplicity suggested that prophylactic therapy such as intravesical BCG instillation or chemotherapy might be beneficial.

好酸球性胃腸炎および仙骨前面骨盤腔に発生した侵襲性血管粘液腫を同時に合併した症例を経験したので報告する.症例は49歳の男性で主訴は腹痛.末梢血で白血球が14,400/mm3,好酸球が34%, lgE280U/mlと高値であった.胸部CTでは右胸水と食道壁の肥厚を認め,腹部骨盤部CTは小腸壁の肥厚と腹水を認め、会陰部から骨盤腔に境界明瞭な径9cmの充実性腫瘤を認めた.骨盤部MRIは膀胱と精嚢の背側にT1強調画像で低輝度, T2強調画像で不均一な高輝度を示す腫瘤を認め周囲とは明瞭であった.穿刺した胸腹水は多数の好酸球を認め細胞診ではclass 2で,骨盤腔腫瘍の針生検では線維成分の多い筋成分としか診断が得られなかった.腹水と骨盤腔腫瘍との関係ははっきりしないまま全麻下で腹会陰式骨盤腫瘍切除術と浮腫のある小腸を一部切除した.骨盤腫瘍は弾性軟で割面はゼラチン様で大きさ17×13.5×8cmであった.病理組織所見は骨盤腔腫瘍の組織は多様性の線維粘液組織の多い侵襲性血管性粘液腫で,小腸は粘膜下から漿膜にかけて好酸球浸潤を認める好酸球性胃腸炎のpredominant subserosal layer disease typeと考えられた.自験例は術後2年5カ月が経過するが現在両疾患とも再発は認めておらず,術後好酸球増多症は自然緩解した.病理学的には侵襲性血管粘液腫に好酸球浸潤を認めなかったことより,好酸球性胃腸炎と侵襲性血管粘液腫との因果関係ははっきりしなかったが,極めて稀な2疾患が同時に認められたものと判断した.今後長期にわたる充分な経過観察が必要と思われる.

Aim The medical management of patients with chronic kidney disease(CKD) has changed within the past 20 years. We speculate that this change has resulted in a decrease in the prevalence of atherosclerotic cardiovascular disease in patients with CKD. The aim of the present study was to analyze changes in the prevalence of coronary artery disease(CAD) in patients newly started on hemodialysis, as well as trends in clinical factors and medications over the past two decades. Methods This single-center cross-sectional study examined data for 315 consecutive patients starting hemodialysis(age, 64±12 years; men, 73%; diabetic nephropathy, 57%) between January 1993 and December 2010. All patients were routinely screened for CAD within three months of starting hemodialysis, regardless of whether ischemic heart disease was suspected. The patients were categorized into six groups based on the date of the initial dialysis session in order to compare the historical prevalence of unidentified CAD(uCAD) in association with the clinical factors. In addition, we performed a subgroup analysis among 222 patients without known cardiac disease. Results The prevalence of uCAD gradually declined from 69% to 25% over 18 years(p＜0.001 for trend). The mean high-density lipoprotein cholesterol(HDL-C) concentration increased(p＜0.001 for trend), while the median C-reactive protein(CRP) level decreased over time. In parallel with these trends, the proportion of statin users significantly increased over time(p＜0.001 for trend). The use of erythropoiesis-stimulating agents(ESAs) and renin angiotensin aldosterone system inhibitors(RAS-Is) also increased during the same period(both p＜0.001 for trend). A univariate logistic regression analysis identified a significant association between the prevalence of uCAD and the use of ESAs(OR: 0.565, p=0.016) or RAS-Is(OR: 0.501, p=0.004). In addition, a lower BMI, lower HDL-Clevel and higher CRP level were found to be closely associated with uCAD, independent of confounding variables. The findings for the new dialysis patients without cardiac disease were similar. Conclusions The prevalence of uCAD in patients with end-stage kidney disease has remarkably decreased over the past two decades. Major improvements in the medical management of CKD may modify the prevalence of coronary atherosclerosis.

われわれは胃多発癌と直腸癌の重複癌症例に対し1期的根治術を施行しえた.症例は56歳の男性.便通異常を主訴に来院, 直腸指診にて腫瘤を触知し, 大腸内視鏡検査にて限局隆起型進行癌を認めた.生検にて中分化型腺癌との診断をえた.術前検査中の胃内視鏡検査にて, 早期多発胃癌を発見した.1期的根治術可能と考え, 胃全摘術+第1群リンパ節の郭清および直腸癌に対して低位前方切除術+リンパ節郭清を施行した.術後約1年の現在健在であり, 特記すべき腹部症状もない.胃と大腸の重複癌はまれではないが, 胃癌が早期多発癌であった点はまれである.

It is unclear whether albuminuria and reduced glomerular filtration rate (GFR) independently increase the risk of incident stroke and coronary artery disease (CAD) in Japanese patients with diabetes. We investigated the independent effects of albuminuria and estimated GFR (eGFR) on the first occurrence of stroke and CAD in patients with type 2 diabetes mellitus (T2DM). We studied 1002 T2DM patients with eGFR (ml min−1 per 1.73 m2) ⩾15 and had no previous cardiovascular disease (CVD) history. GFR was estimated using the modified three-variable equation for the Japanese. Patients were divided into four eGFR categories: ⩾90, 60–89, 30–59 and 15–29. The end point was an incident stroke and CAD events. The Cox proportional hazard model was used to calculate hazard ratio and 95% confidence interval. During a mean follow-up period of 5.2±2.1 years, 72 episodes of stroke and 90 of CAD were observed. Multivariate Cox analysis revealed no significant association between the eGFR category and incident stroke. The stroke hazard ratio (95% confidence interval) in reference to patients with an eGFR ⩾90 was 0.78 (0.40–1.56) for patients with an eGFR of 60–89, 1.47 (0.70–3.10) for patients with an eGFR of 30–59 and 1.14 (0.39–3.35) for patients with an eGFR of 15–29. Reduced eGFR was a significant risk factor for CAD, with hazard ratios (95% confidence interval) for patients with an eGFRs of 60–89, 30–59 and 15–29 at 1.81 (1.01–3.57), 2.03 (1.04–4.40) and 3.01 (1.13–8.02), respectively. Reduced eGFR is independently associated with incident CAD but not stroke in Japanese patients with T2DM.

Chronic kidney disease (CKD) is an important risk factor for cardiovascular disease in patients with diabetes. The relationship between renal manifestations of CKD (albuminuria and decreased glomerular filtration rate) and silent cerebral infarction (SCI) has attracted attention; however, most studies examined the effects of components of CKD on prevalence of SCI. We sought to assess the relationship between SCI and the development and progression of nephropathy in type 2 diabetic patients. We studied 366 type 2 diabetic patients with normoalbuminuria (urinary albumin-to-creatinine ratio [ACR]30 mg g(-1), N=246) or microalbuminuria (ACR=30-299 mg g(-1), N=120). SCI was defined by cranial MRI. The primary end point was progression from normo- to microalbuminuria or from micro- to macroalbuminuria. The cumulative incidence of the primary end point was estimated using the Kaplan-Meier method. Risk estimates for reaching the end point were calculated using Cox proportional hazard model analyses. During a median follow-up period of 3.9 years, 23 normoalbuminuric and 24 microalbuminuric patients reached the primary end point. Patients with SCI (N=171) had a greater incidence of reaching the end point than those without SCI (N=195, P=0.020 by the log-rank test), with a hazard ratio of 2.02 (95% confidence interval=1.09-3.72, P=0.025) in the multivariate Cox regression model. Although the common pathogenesis of SCI and albuminuria in diabetic patients is still unclear, SCI may be a predictor of progression of nephropathy in type 2 diabetic patients.

Although chronic kidney disease is a risk factor for cardiovascular disease it is unclear whether diabetic patients with a reduced glomerular filtration rate (GFR), independent of (micro)albuminuria, carry an increased risk of stroke. We therefore investigated the independent effect of estimated GFR (eGFR) on stroke events in patients with type 2 diabetes mellitus (T2DM). We studied T2DM patients with an eGFR >or=15 ml min(-1) per 1.73 m(2), who had no history of stroke. Patients were divided into four categories by the eGFR at baseline for comparison: >or=90, 60-89, 30-59 and 15-29 ml min(-1) per 1.73 m(2). The end point was an incident stroke event. The Cox proportional hazard model was used to calculate the hazard ratio (HR) and 95% confidence interval (CI). The study included a total of 1300 T2DM patients (546 women and 754 men) with a mean (+/-s.d.) age of 63+/-13 years. During a mean follow-up period of 3.7+/-1.4 years, 91 patients experienced an incident stroke event. Although a lower eGFR was associated with an increased stroke risk using a univariate model, statistical significance disappeared after adjusting for other risk factors including albuminuria. The HR (95% CI) was 0.75 (0.40-1.41, P=0.373), 0.99 (0.50-1.95, P=0.964) and 0.91 (0.36-2.28, P=0.844) for patients with eGFRs of 60-89, 30-59 and 15-29 ml min(-1) per 1.73 m(2), respectively, compared with patients with an eGFR >or=90. Clinical albuminuria remained a significant risk factor for stroke, and the adjusted HR compared with normoalbuminuria was 2.40 (1.46-3.95, P=0.001). In conclusion, the association between reduced GFR and stroke events in patients with T2DM is likely to be mediated by albuminuria.

Abdominal trauma remains in a severe disease in which delayed diagnosis and treatment lead to lifethreatening condition.We have experienced a case of omental necrosis due to blunt trauma, manifesting the signs of peritonitis. Diagnosis and post-traumatic observation were successfully performed by CT and US.Omental necrosis is a rare disease and its operative indication can not be easily decided. In this case elective surgery was carried out 3 weeks after diagnosis. It is emphasized that the differentiating diagnosis from other diseases is of most important, especially for trauma-caused ones.

We report a case of lipoma of the retroperitoneum, which is so rare that only about 60 cases have been reported in Japan so far. A 22-years-old woman was seen with the complaint of right hypochondral discomfort. Since the graphic studies including computed tomography and ultrasonography made a diagnosis of lipoma of the retroperitoneum, the tumor was resected. Histopathologically it was a lipoma. Lipoma of the retroperitoneum is easily diagnosed by echography or CT, but has difficulties in treating, because it is possibly accompanied by recurrence and a morphorogical change to sarcoma. On resection of lipomas, surgeons should pay attentions for these possibilities.

In a recent 6-year period we have treated five patients with villous adenoma of the colon. This paper describes a discussion of the association of this condition with cancer of the colon and its therapeutic guideline. It was found three (60%) out of these five patients with villous adenoma were complicated by cancer of the colon. Three (0.9%) out of 349 patients with cancer of the colon who had undergone surgery were diagnosed as having villous adenoma. The main signs and symptoms of this condition included prolapse of the tumour mass from the anal annulus, dysfunction of bowel movement, and secretion of mucous. The guideline for surgical treatment was to keep the area of excision localized so as to avoid excessive surgical invasion. The villous adenoma and the cancerous tissue were excised en block followed by a perioperative pathological diagnosis. It was concluded that this degree of excision might be adequate if the tumour invasion was retained within mucosal layer. We hope to treat a further number of such patients, therefore be able to provide an adequate postoperative follow-up and establish more appropriate therapeutic guidelines.

Background: International guidelines have recommended making a screening for coronary heart disease (CHD) at the initiation of dialysis therapy. However it remains unclear whether the screening has an advantage for the prognosis of dialysis patients. Aim: The aim of this study is to explore the influence of screening for CHD at the starting of dialysis on the survival for new dialysis patients. Methods: Between January 1993 and December 2010, 358 ESKD patients without cardiac disease started chronic dialysis at our hospital and were enrolled into a preliminary database. Among 358 patients, 222 ESKD patients (62%) were underwent a screening regardless of a suspicion of CHD within 3 months of starting dialysis by SPECT or CAG. Then to minimize the selection bias for performing the screening, a propensity-matched analysis was performed. Finally 204 ESKD patients (102 screening group vs. 102 non-screening group) were selected. The survivals for all cause of death and cardiac death were compared between two groups in propensity matched patients. Results: During the follow-up period, 75 all cause of deaths and 26 cardiac deaths were observed. Figure shows the Kaplan-Meier survival curves for all cause of death and cardiac death. The screening had a beneficial effect for all cause of death (HR: 0.50, p=0.004) in univariate analysis. After adjusting for age, sex, diabetes, serum creatinin level, the beneficial effect remained significant and independent (HR: 0.50, p=0.007). For cardiac death, the screening also had an advantage in univariate analysis (HR: 0.24, p=0.025) and multivariate analysis (HR: 0.50, p=0.007) after adjusting for age, sex, diabetes, serum creatinin level. ![Figure][1] The Kaplan-Meier survival curves Conclusions: Screening for CHD at the stating dialysis could play a role for improving of prognosis in ESKD patients. [1]: pending:yes

Culture of stones and electrical microscopic observation were performed with stones collected from forty-eight patients who underwent surgery for urolithiasis. Thirty-six strains of bacteria in the stones obtained form stone culture were classified as nineteen strains of bacteria deriving from primary infection stones (Group A-I) and seventeen strains of bacteria deriving from metabolic stones (Group A-M). As for their ability to produce urease and glycocalyx, they were studied in comparison with forty-nine strains of stone surface-adhering bacteria (Group B). Glycocalyx producing ability was examined by the provisional quantitative toluidine blue assay and safranine straining method. As for the electrical microscopic observation, formation of biofilm bacterium was observed in all twenty cases of primary infection stones and in thirteen cases (46.4%) of twenty-eight cases of metabolic stones. Urease producing ability per stone was 6/14 (43.9%) in Group A-I, 4/13 (30.8%) in Group A-M and, 4/32 (12.5%) in Group B. There was a significant difference (p < 0.05) between Group A-I and Group B. Similarly for the glycocalyx producing ratio (toluidine blue assay), the values were 9/14 (64.3%) in Group A-I, 11/3 (84.6%) in Group A-M and 10/32 (31.3%) in Group B. As for the glycocalyx producing ration (safranine method), the values were 10/14 (71.4%) in Group A-I, 9/13 (69.2%) in Group A-M and 9/32 (28.1%) in Group B. As for the glycocalyx producing ability, Group A-I and Group A-M both showed significantly higher production ratios compared to Group B for both toluidine blue method and safranine method.(ABSTRACT TRUNCATED AT 250 WORDS)

切除胃癌総数879例中74例の固有筋層胃癌 (pm胃癌) について臨床病理学的に予後を中心に検討した.全体の治癒切除率は87.8%であり, 広範なリンパ節転移により切除不能となる症例が多かった. pm胃癌の5年生存率は80.1%であり, 再発形式はリンパ節再発癌性腹膜炎, 肝転移の順になっていた.リンパ節再発死亡はA領域, Borrmann 3型, n3 (+), pap, por, ly2, ly3, v0の症例が多くみられた.癌性腹膜炎再発は全例が静脈侵襲陽性であった.5年生存率が60%以下となった因子はBorrmann3型, 4型, 絶対非治癒切除, n2 (+) 以上, ly3, v3, stage IVであった.

Many cases of mammary cancer, except for special types, show a relatively favorable prognosis, in comparison with carcinoma of other organs. However, we recently encountered a case showing rapid growth and metastasis in which the period between onset and death was short, 13 months. The patient, a 29-year-old woman, first noted a small finger-tip-sized mass in her left breast, and visited a nearby hospital. In spite of therapy by hormone injection in hospital, the mass increased. About 3 months after onset, she visited our hospital. On the basis of a diagnosis of malignant tumor following biopsy, surgery with radiotherapy was undertaken, but the patient died from remote systemic metastasis about 8 months after surgery, i.e., about 13 months after onset. The pathological diagnosis was apocrine carcinoma. The results obtained from this case suggested that some cases of apocrine carcinoma have the potential to be highly malignent, requiring careful attention to the treatment.

Fifty-eight patients who underwent transcatheter hepatic artery embolization (TAE) were divided into two groups. Patients who had cholecystectomy before TAE were placed in group A (8 patients), and those without cholecystectomy in group B (50 patients). The two groups were compared for changes in liver function and complaints following TAE, in order to investigate the relation between side effects and gallbladder infarction. No differences in GOT, GPT and LDH following TAE were found between the two groups. In group B, γ-GTP and Al-p were elevated after TAE in 16 (32%) and 9 (18%) patients, respectively. Elevation of the two enzymes was not observed in any of the patients in group A. Patients in both groups showed high fever after TAE at a considerable frequency. Many patients in group B felt abdominal pain after TAE, but only one patient in group A felt abdominal pain. Eight patients in group A underwent cholecystectomy when curative operations were done after TAE, and six of them were found to have gallbladder infarction. A correlation between elevated serum γ-GTP and Al-p and gall-bladder infarction was supposed to exist. Preceding cholecystectomy seems to be useful in preventing complaints following TAE.

Guidelines have recommended that physicians screen for coronary artery disease (CAD) at the initiation of dialysis. The purpose of this study was to examine the effects of CAD screening at the initiation of dialysis on prognosis after starting dialysis This retrospective cohort study involved 224 consecutive incident dialysis patients without advanced cardiac disease. Pharmacological stress myocardial perfusion imaging (MPI) was performed to routinely screen incident dialysis patients within 3 months of starting dialysis therapy. The influence of MPI on prognosis after starting dialysis was explored by the propensity score adjustment method. The study outcome was defined as all-cause mortality and cardiac death. Of the 224 patients, 164 (73.2 %) underwent MPI screening at initiation of dialysis. During the median follow-up period of 5.5 years, 77 patients died, among whom 17 (22.1 %) cardiac deaths were observed. The patients who received MPI had a significantly higher survival rate for all-cause mortality and cardiac death compared with the patients without MPI (log-rank test, p