Mito Red Cross Hospital

This retrospective cohort study aimed to emulate the ADVANCE trial population and directly compare the Endurant and Excluder using propensity score matching. Patients were included if endovascular aneurysm repair was performed for abdominal aortic aneurysm using either Endurant or Excluder at 10 hospitals in Japan between January 2012 and July 2022. Cases were selected according to the modified ADVANCE trial inclusion and exclusion criteria. To minimize selection bias and simulate a randomized controlled trial setting, propensity score matching was performed using patient and anatomical characteristics. The primary outcome measure was the proportion of patients with sac regression ≥ 5mm at 1year. The secondary outcome measures were rates of freedom from late complications, T1aEL, sac enlargement ≥ 5mm, and overall survival. Outcomes were first analyzed in patients within the instructions for use (IFU) and then in all matched patients including outside IFU patients. After matching, the within-IFU group included 124 pairs and the total cohort of 266 pairs. The primary outcome measures for Endurant and Excluder were met in 38.9% and 36.6% (p = 0.74) in the within-IFU group and 33.5% and 35.0% (p = 0.74) in the total cohort, respectively. No significant differences were observed in any secondary outcome measures. However, T2EL and use of additional proximal cuff were significantly more frequent for Excluder in both the within-IFU and total cohort. Furthermore, T1b and T5ELs occurred significantly more for Endurant in the total cohort. There were no significant differences in all clinical outcome measures between Endurant and Excluder. Level IV, multicenter retrospective cohort study.

Patients with histologically confirmed breast cancer who were scheduled to receive standard weekly paclitaxel (80mg/m2) or tri-weekly nab-paclitaxel (260mg/m2) at institutions in our multicenter group were eligible for this study. Sensory and motor PN were evaluated every 3weeks until PN improved for up to one year using patient-reported outcome. Between February 2011 and April 2013, 115 patients were enrolled, including 57 and 58 in the paclitaxel and nab-paclitaxel groups, respectively. The incidence of moderate or severe sensory PN was not significantly different between the two groups (p = 0.40). The incidence of moderate or higher motor PN was more frequent in the nab-paclitaxel group than in the paclitaxel group (p = 0.048). The median period for demonstrating PN were shorter in the nab-paclitaxel group than in the paclitaxel group (sensory, p = 0.003; motor, p = 0.001). The recovery of motor PN was slower in the nab-paclitaxel group than in the paclitaxel group (p = 0.035), while the recovery period of sensory PN was not statistically different. Nab-paclitaxel induced sensory PN sooner than paclitaxel, and no difference was observed in the severity and recovery duration between the two agents. Motor PN was more severe, started sooner, and improved over a longer period in the nab-paclitaxel-treated patients than in the paclitaxel-treated patients.

当院で2003年から2016年までに行った伏在静脈瘤に対して結紮術などを併用しないポリドカノールによるフォーム硬化療法単独の治療成績を報告する.抜去術や焼灼術の適応があると考えられても患者が手術を希望しない場合を主な治療対象とした.症例数は296例383肢(大伏在静脈338肢,小伏在静脈45肢)であった.再発のため後に手術を施行したのは28例28肢(7.3%)(抜去術4例,EVLA19例,RFA5例)であった.初回に硬化療法を行ってから再手術を施行するまでの期間は1–10年(中央値6年)であった.合併症は硬結や色素沈着が多いが,重篤なものはなかった.方法が簡便で費用が安いことから,再発率が高いことを説明したうえで患者が希望する場合は伏在静脈瘤に対して初回にフォーム硬化療法単独で治療することも選択肢の一つとして良いと考える.

Takayasu arteritis (TAK) is a rare vasculitis that often affects young women of childbearing age, and its management during pregnancy poses unique challenges. Limited data exist regarding the safety and efficacy of tocilizumab (TCZ), an interleukin-6 receptor antagonist, in the treatment of TAK during pregnancy. This case report presents a unique and valuable insight into the use of TCZ in pregnant patients with TAK. We report an 18-year-old female patient with TAK who was treated with TCZ during two pregnancies, resulting in positive maternal and neonatal outcomes. However, a newly identified descending aortic aneurysm was noted after the second delivery, highlighting the importance of careful monitoring of vascular lesions in patients with TAK receiving TCZ. Our findings suggest that TCZ has a high safety profile for both the mother and fetus; however, further research and close monitoring are essential for its use in pregnant patients with TAK.

下腿潰瘍からの出血を伴った大伏在静脈瘤に対し，フォーム硬化療法単独による治療が奏功した症例を報告する．48歳（初診時），男性，インドネシア人．左下腿からの出血を主訴に当院を受診した．下腿前方に15×20 mm大の皮膚潰瘍を認め潰瘍部に凝血が付着し自然に止血された状態であった．超音波検査では左大伏在静脈の逆流を全長に認め血管径は10 mm程度であった．手術を勧めたが医療費の負担が少ない治療を強く希望した．このため，ポリドカノールによるフォーム硬化療法を行った．初日は3%を使用し，2日後，4日後，7日後に閉塞不十分な部位に1%を使用して追加治療した．初回治療から39日後の診察では静脈瘤ならびに潰瘍の縮小を確認できた．再発の懸念があることを説明し有事受診を指示した．5年後（53歳）に来院したが静脈瘤や潰瘍の再発は認めず軽度の色素沈着があるのみで，超音波検査でも大伏在静脈の縮小を確認できた．

The appropriate localization of gastrinoma is still difficult. We aimed to evaluate the diagnostic accuracy of selective arterial calcium injection (SACI) for localization of gastrinomas including multiple lesions. This retrospective study included ten patients with surgically proven gastrinomas (gastrinoma group) and six patients without any findings suggesting Zollinger-Ellison syndrome (non-gastrinoma group). For SACI, calcium gluconate was injected into the arteries supplying pancreas, duodenum, and liver. Blood samples from the hepatic vein were obtained before and 30, 60, and 120 seconds after each injection. The results were considered positive when the increase in serum immunoreactive gastrin (IRG) levels within 60 seconds of calcium gluconate injection were more than 80 pg/mL and more than 20% from baseline. We evaluated the efficacy of SACI by comparing the SACI responses with definitive locations diagnosed by clinical and histopathological findings. In the gastrinoma group, false-positive responses were confirmed in seven of the ten patients. False-negative response was observed in one of the feeding arteries of one patient with gastrinomas in multiple locations. Conversely, the greatest increase in serum gastrin levels from baseline at 30 seconds indicated the true-positive responses in all patients with gastrinomas. In the non-gastrinoma group, calcium gluconate injection into gastroduodenal artery evoked positive responses in five of the six patients. In conclusion, our data suggest the strongest gastrin response evoked by SACI indicates the definitive location in patients with gastrinomas. In contrast, SACI could not accurately locate multiple gastrin-secreting lesions due to poor specificity.

Diazoxide is recognized as an effective medical treatment for insulinoma. However, due to its adverse effects, such as fluid retention, it is sometimes difficult to employ diazoxide at an effective dose in clinical practice. This study aimed to clarify the clinical factors, which may affect efficacy and safety of the diazoxide treatment. We retrospectively evaluated the medical records of 20 patients with insulinoma including 4 malignant cases. The patients were divided into two groups according to the presence or absence of favorable outcomes or adverse effects, and the clinical features of both groups were compared. Diazoxide was effective and ineffective in each 9 patients, respectively. In other 2 cases, the efficacy could not be determined. In the effective group, all patients had benign insulinoma. Additionally, the tumor size determined by imaging test was tended to smaller than the ineffective group but not statistically significant when malignant cases were excluded (p = 0.065). Fluid retention was observed more frequently in females than in males (p = 0.025). Five patients displayed unacceptable thrombocytopenia within a few weeks after the administration of diazoxide. In these patients, the diazoxide dose was significantly higher than that in the other patients [400 mg/day (250-500 mg/day) vs. 225 mg/day (50-425 mg/day), p = 0.027]. These findings may be informative in determining the indication and dose of diazoxide against insulinoma. In addition, a careful evaluation of platelet count would be required for a few weeks after the initiation of diazoxide treatment.