Nagasaki Rousai Hospital

This fourth edition of the Japanese Clinical Practice Guidelines for Prostate Cancer 2023 is compiled. It was revised under the leadership of the Japanese Urological Association, with members selected from multiple academic societies and related organizations (Japan Radiological Society, Japanese Society for Radiation Oncology, the Department of EBM and guidelines, Japan Council for Quality Health Care (Minds), Japanese Society of Pathology, and the patient group (NPO Prostate Cancer Patients Association)), in accordance with the Minds Manual for Guideline Development (2020 ver. 3.0). The most important feature of this revision is the adoption of systematic reviews (SRs) in determining recommendations for 14 clinical questions (CQs). Qualitative SRs for these questions were conducted, and the final recommendations were made based on the results through the votes of 24 members of the guideline development group. Five algorithms based on these results were also created. Contents not covered by the SRs, which are considered textbook material, have been described in the general statement. In the general statement, a literature search for 14 areas was conducted; then, based on the general statement and CQs of the Japanese Clinical Practice Guidelines for Prostate Cancer 2016, the findings revealed after the 2016 guidelines were mainly described. This article provides an overview of these guidelines.

症例は38歳，男性．飲酒後の心窩部痛と嘔吐を主訴に当院に救急搬送され，アルコール性重症急性膵炎の診断にて入院となった．急性膵炎に対する全身集学的治療により救命し得たが，1ヶ月後のCT検査では膵尾部から後腹膜にかけて拡がる広範囲な膿瘍の出現を認めた．経胃瘻孔ステントを留置し，経胃内視鏡的ネクロセクトミーを行ったが膿瘍腔が大きく，頻回に内視鏡的ネクロセクトミーを施すも改善せず，外科的治療を導入した．ハイブリッド手術室で膿瘍腔をCTガイド下にマーキングしつつ膿瘍腔に直接腹腔鏡ポートを挿入し，経後腹膜アプローチによる腹腔鏡下ネクロセクトミー及びドレーン留置手術を施行した．膿瘍腔の縮小が得られ，術後78日目に自宅退院となった．重症急性膵炎後の巨大な膵被包化壊死に対して腹腔鏡下ネクロセクトミーが有用であったため，当科で施行した工夫と共に報告する．

PurposeTo investigate the clinical practices of diagnosing multicystic cervical lesions as a means to develop a more appropriate diagnostic algorithm for gastric-type adenocarcinoma (GAS) and its precursors.MethodsClinical information for 159 surgically treated patients for multicystic disease of the uterine cervix was collected from 15 hospitals. We performed a central review of the MRI and pathological findings. The MRI findings were categorized into four types including two newly proposed imaging features based on the morphology and distribution of cysts, and the diagnosis accuracy was assessed. Among the four MRI types, types 1 and 2 were categorized as benign lesions that included LEGH; type 3 were precancerous lesions (with an assumption of atypical LEGH); and type 4 were malignant lesions.ResultsThe central pathological review identified 56 cases of LEGH, seven with GAS, four with another form of carcinoma, and 92 with benign disease. In clinical practice, over-diagnosis of malignancy (suspicion of MDA) occurred for 12/19 cases (63.2%) and under-diagnosis of malignancy occurred for 4/11 (36%). Among the 118 patients who had a preoperative MRI and underwent a hysterectomy, type 3 or 4 MRI findings in conjunction with abnormal cytology were positively indicative of premalignancy or malignancy, with a sensitivity and specificity of 61.1% and 96.7%, respectively.ConclusionsAlthough the correct preoperative diagnosis of cervical cancer with a multicystic lesion is challenging, the combination of cytology and MRI findings creates a more appropriate diagnostic algorithm that significantly improves the diagnostic accuracy for differentiating benign disease from premalignancy and malignancy.

The relationship between microgenia and obstructive sleep apnea syndrome is well known. 27-year-old woman. She underwent a combination of Le Fort I with horseshoe osteotomies and mandibular distraction osteogenesis and genioplasty. She was satisfied with the aesthetics of her face, with an AHI of 7.8/h.

A 67-year-old Japanese woman with a history of contact with a COVID-19 patient presented with a one-day history of fever, malaise, and dyspnea, and was hospitalized with a positive nasopharyngeal swab test for SARS-CoV-2 LAMP. Chest CT revealed bilateral patchy infiltrates. The patient was treated with remdesivir and dexamethasone and supplemental oxygen supplied via a nasal cannula. The supplemental oxygen therapy was continued for 6 days, and the drug administration was completed on the 10th day of hospitalization. The patient was then scheduled to be discharged, when she developed severe hyponatremia with a serum Na level of 110 mEq/L, but no consciousness disorder.

スギ花粉症への錠剤による舌下免疫療法は年齢制限がないが2018年5月までは液剤により施行され, 適応は12歳以上であった. 過去の報告では小児と成人における服薬アドヒアランス, 臨床効果, 副反応等の臨床的検討が十分になされていない. 過去の調査で使われたアンケート結果より臨床上重要となる小児と成人の服薬アドヒアランス, 臨床効果, 副反応等の違いについて新たに統計学的解析を行ったので報告する. 対象は2014～2018年にシダトレン® を開始し, 治療を継続中のスギ花粉症患者のべ1,017例に各年度の花粉飛散シーズン終了後にアンケートを実施. ① 調査項目を小児と成人における服薬アドヒアランス, 舌下投与の負担感, 舌下免疫療法の効果とし, 調整項目を性別, 罹病期間として, ② 調査項目を併用薬の使用状況, 副反応, 治療全般の満足度とし, 調整項目を性別, 罹病期間, 服薬アドヒアランスとして多重ロジスティック回帰分析を施行. 結果は解析を施行した全シーズンにて小児と成人に統計学的有意差を認めない. 本研究はスギ花粉症に対する舌下免疫療法は小児においても成人と同様の効果を示すことを明らかにした. 副反応に関しては比較的軽いものではあるが, 1シーズン目に多く出現し, 特に女性に多いことが本研究から示された. 今後は治療後効果持続性の小児と成人における違いを解析することが望まれる.

Background: The clinical efficacy of Japanese cedar (JC) pollen SLIT tablets for allergic symptoms during Japanese cypress (JCY) pollen dispersal has been controversial in actual clinical settings. JC and JCY both belong to the Cupressaceae family and the major allergens of the two species have strong amino acid homology. The efficacy of JC pollen SLIT tablets against seasonal allergic rhinitis during the JC pollen and JCY pollen dispersal periods was investigated.

手指MP関節側副靱帯損傷は母指に多く，母指以外の指では頻度が少ないとされており，その愁訴は疼痛や不安定性が主である．指交叉を伴う示指MP関節側副靱帯損傷を経験したため報告する．症例は45歳女性，牛の手綱と柱に左示指が挟まれたため，自分で手を引き抜いて受傷．単純X線，CT検査では明らかな骨折等はなく保存療法を行った．経過観察中に指交叉が出現したため，MR検査を施行したところ，骨傷や介在物などはなく，MP関節橈側側副靭帯の断裂を認めた．受傷後5ヵ月後に手術を施行した．示指MP関節橈側側副靭帯は中手骨付着部で断裂し瘢痕状となっており，スーチャーアンカーで縫着したところ，指交叉は改善した．指交叉を生じた場合，指骨骨折を伴うことが多いが，明らかな骨折を認めない場合はMP関節側副靭帯損傷の可能性を念頭において治療することが必要と思われた．