Wakari Hospital

Background: Cow's milk allergy is known to result in decreased body height; accordingly, the aim of this study was to investigate whether termination of milk avoidance leads to an increase in body height. Methods: Between 2010 and 2011, 253 children with food allergies who were ≥2 years of age visited our outpatient department; 195 had height data available from approximately 1 year after their initial food allergy diagnosis and were included in the study. The height standard deviation scores (HtSDs) were calculated using data from the 2000 Japanese National Physical Growth Survey Report for Infants and Children, and changes in height were then retrospectively evaluated using clinical records. Results: The mean age of the 195 patients was 5.8 ± 3.0 years. The mean HtSDs increased significantly from -0.19 ± 0.99 at diagnosis to -0.12 ± 1.02 (p = 0.025) 1 year later for all children. The HtSDs of 110 cases had increased, but the HtSDs of 85 cases had decreased 1 year after the initial diagnosis. The only significant factor related to increased HtSD was tolerated milk allergy 1 year after the initial diagnosis (p = 0.004). Conclusions: Terminating the avoidance of cow's milk might lead to growth in height, although a prospective study with a larger sample size is needed to confirm these results.

今回, RFA後に胸壁播種をきたした再発肝細胞癌の1例を経験した.症例は83歳の男性で1999年11月に肝細胞癌 (S6-7) に対する肝後区域切除術後, 2001年7月に肝S8に再発を認めPEIを施行した. 2003年7月に肝S8に12mmの再発を認め, cool-tip型電極によるRFAを行った. 2003年12月頃よりPIVKA-IIの上昇と,右胸壁RFA穿刺部位に無痛性腫瘤を認め徐々に増大した.造影下USにて腫瘤は動脈相にて腫瘍血管と強い濃染を認め後期血管相まで濃染され胸壁穿刺経路播種と診断した. 2004年4月2日に胸壁再建を伴う腫瘤摘出術を施行し,病理組織学的検査では中分化型肝細胞癌であった. RFAによる穿刺経路播種について文献的考察を加え報告する.

症例は53歳,女性.平成8年に腹腔鏡下胆嚢摘出術(胆嚢結石症)を受けた際の術前CTで右横隔膜下腫瘍を指摘されたが放置.平成15年9月に手術希望にて入院.既往歴には腹腔鏡下胆嚢摘出術以外に虫垂切除術(S39),帝王切開術(S60),子宮筋腫摘出術(H5)がある.術前CT・MRIで横隔膜腫瘍と診断し,手術を行った.手術は小開胸下に腫瘤から約1cm離して横隔膜の切離を行った.その際肝S8との癒着があり,肝浸潤と判断して肝を一部合併切除した.病理診断は横隔膜膿瘍であった.肝実質内には膿瘍形成はなかった.また細菌培養でE. coliが検出された.横隔膜膿瘍は検索しえた限りでは報告がなく,非常に稀な疾患と考えられた.今回の症例における明らかな原因は不明であった.

脱水, 電解質異常を呈し肛門外に腫瘤脱出, 嵌頓した直腸絨毛腺腫の1例を経験したので報告する. 症例は76歳の女性で, 全身倦怠感, 脱水, 電解質異常, 腎機能障害 (Na125mEq/l, K 2.1mEq/l, Cl 88mg/l, BUN 57.9U/l, CREA 1.36mg/dl) にて入院になった. 脱水, 電解質異常の補正により全身倦怠感, 腎機能障害は改善した. 症状改善後に2年前から認めていた“脱肛”の嵌頓を生じた. 嵌頓腫瘤は手拳大で柔らかく絨毛状を呈し, 表面は浮腫状で多量の粘液の付着と一部出血を認めた. 大腸内視鏡検査にて, 腫瘍は歯状線直上より口側直腸に径10cmの3/4周を占め, 生検の結果絨毛状腺腫と診断された. 腫瘍径の大きさより悪性化の可能性も考えられ, 切除線を歯状線におく超低位前方切除術を行った. 病理組織学的所見では, Tubuo-villous adenoma with severe atypiaで悪性病変は認めず, 断端は陰性であった. 術後脱水, 電解質異常の再発は認めていない.

A series of small bowel neoplasms, benign, primary malignant and metastatic, representing the total local experience of a fourteen-year period, is reviewed. The problems of diagnosis and management are presented and discussed. Argentaffin carcinoma is the most frequently encountered primary malignant tumour. The mode of presentation is considered to be related to the biological behaviour of the various tumours rather than to bear upon the attendant prognosis. It is apparent from our observations that knowledge of the epidemiology of these lesions must still be considered deficient.