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A 62-year-old man was transported to the emergency medical center because of blunt chest trauma combined with multiple trauma after a car accident.He complained of severe back pain.Contrast-enhanced computed tomography revealed left hemopneumothorax with multiple left rib fractures,a scapular fracture,lung contusion,liver injury,right renal injury,and acute aortic dissection.Although open surgical repair and endovascular stent grafting were considered,primarily nonoperative manage-ment of the thoracic aortic injury under blood pressure control was selected because of the multiple trauma,type B aortic dissection,and oral administration of two antiplatelet drugs.The patient’s hemodynamic and respiratory conditions remained stable in the intensive care unit,and the aortic dissection improved.We herein report a rare case of blunt thoracic aortic injury with oral administra-tion of antiplatelet drugs resulting in multiple trauma and acute aortic dissection treated nonoperatively.

症例は62歳,男性.既往歴は特記すべきものなし.仕事中にプレス機が破裂し鉄片が無数に四肢・体幹に飛\nび散ったため当院に救急搬送された. 来院時所見ではバイタル等は問題なく, 鉄片による損傷部位は両上肢\nおよび腹部前面であり, 血流障害, 神経障害はなかった. CT およびレントゲン所見で鉄片異物は内臓に達し\nているものはなく, 明らかな血腫形成もなかった. 直ちに透視下で異物除去術を試みたが, 異物は辺縁不正で\n創部より斜めに侵入しており, 筋層深く存在した. 周囲組織に損傷を与えぬように, また可能な限り創部を小\nさくするため, 創部よりの異物除去を試みネオジム磁石を用いた. 鉄片は直径1 cmの市販のネオジム磁石を\n清潔操作下で示指先端に入れ,創部より2つの鉄片除去に成功した.ネオジム磁石を用いた四肢・体幹の鉄片\n除去術は,美容上および手術侵襲を少なくする上で有用であった.

Background: Focused assessment with sonography for trauma (FAST) is useful for detecting hemoperitoneum \n(HE) in trauma patients in the emergency room (ER), but, patients’condition cannot be \nevaluated adequately by FAST alone. CT is useful for the diagnosis of multiple trauma, but has certain \ndrawbacks. We evaluated the utility of mutidetector computed tomography(MDCT) as the initial tool \nfor proper diagnosis and treatment planning of multiple trauma patients. Method: We retrospectively \nanalyzed 128 cases treated in ER of Gunma University Hospital between April 1, 2005 and December 31, \n2006, and they were hospital patients were hospitalized with blunt multiple trauma. We analyzed the \nsensitivity, specificity, and accuracy of FAST, compiled MDCT finding, lifesaving treatment, and \noutcome. Result: Eight patients were FAST positive, and 7 of the 8 were scanned by MDCT. There \nwere 120 patients were FAST negative patients, 23 of the 120 were MDCT-negative, despite visceral \ninjury, however 9 of the 120 had visceral injury by MDCT findings. Damage control surgery without \nMDCT was performed in one case, but the patient died after surgery. Six of the patients in the \nHE-positive group had really HE. One of the 6 died while a waiting surgery, transcatheter arterial \nembolization (TAE) was performed in three patients, and one person out of the 3 died. The course of \nthe remaining 2 patients was monitored, and they are alive. A patient in the HE-negative group with \nbladder rupture required surgery. There were 120 patients in the FAST-negative group. One of the 6 \npatients in the HE-positive subgroup died while a waiting surgery. One patient required chest and \npericardial drainage. TAE was performed in 2 patients, and the remaining 6 were monitored and are \nalive. There were 23 FAST-negative patients patients who had visceral injury. Five of them required \nchest drainage, one received TAE, 17 were monitored, and all of the 23 are alive. There were 14 cases \nof pelvic fracture alone, and all of them were FAST-negative. One patient required surgery for open \nfemoral fracture, TAE was performed in three, 10 monitored, all 14 are alive. Only one patient \ndeveloped shock during MDCT. The others underwent scanning safely. Conclusion: MDCT is a \nbetter tool for the diagnosis of blunt multiple trauma of the trunk than CT, because the scanning time\nis shorter.

平成27年度衝撃波シンポジウム (2016年3月7日-9日. 熊本大学 黒髪南地区）熊本市, 熊本県, Symposium on Shock Waves in Japan, FY2015 (March 7-9, 2016. Kumamoto University), Kurokami Chuo-ku, Kumamoto, Japan, 資料番号: SA6000049081, レポート番号: 2C2-1【若】

平成27年度衝撃波シンポジウム (2016年3月7日-9日. 熊本大学 黒髪南地区）熊本市, 熊本県, Symposium on Shock Waves in Japan, FY2015 (March 7-9, 2016. Kumamoto University), Kurokami Chuo-ku, Kumamoto, Japan, 資料番号: SA6000049082, レポート番号: 2C2-2

A 61-year-old man with an aneurysm of the common and deep femoral arteries underwent successful vascular reconstruction.The patient presented with localized pain and a rapidly enlarging pulsatile mass in the femoral triangle.A graft was placed from the left common femoral artery to the left superficial and deep femoral arteries.No ischemic symptoms or thrombosis developed postoperatively.Successful reconstruction with a graft is rare in this situation,with less than 30 cases reported in Japan to date.This type of aneurysm is characterized by rapid enlargement and severe atherosclerotic changes.Ischemic complications may occur after surgical treatment of a ruptured deep femoral artery aneurysm.We recommend reconstruction using the saphenous vein or a vascular prosthesis,as there have been some reports of patients requiring leg amputation following ligation of the deep femoral artery.

In Japan, we have experienced the particle therapy for more than ten years. The Japan Clinical Study Group of Particle Therapy (JCPT) studied the achievements of the Japanese particle therapy from 2002 to 2010. Our study group covered the all Japanese particle therapy institutions. The aim of the paper is to disclose the status of the Japanese particle therapy and to analyze the change of the number of the therapy., Particle Therapy Co-Operative Group Meeting ５０

Purpose/Objective(s): In Japan, we have experienced the particle therapy for more than ten years. The Japan Clinical Study Group of Particle Therapy (JCPT) studied the achievements of the Japanese particle therapy from 2002 to 2009. Our study group covered the all Japanese particle therapy institutions. The aim of the paper is to disclose the status of the Japanese particle therapy and to analyze the change of the number of the therapy. \nMaterials/Methods: The JCPT member consisted of the eight particle therapy institutions. Each hospital was (1) Southern Tohoku Proton Therapy Center, (2) Proton Medical Research Center, University of Tsukuba, (3) Division of Radiation Oncology, National Cancer Center, (4) Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, (5) Proton Therapy Division, Shizuoka Cancer Center Hospital, (6) The Wakasa Wan Energy Research Center, (7) Hyogo Ion Beam Medical center and (8) Gunma University. The JCPT office gathered each institution's annual report and analyzed the number of treatments. Particle therapy was divided into a proton therapy and a carbon ion therapy. We analyzed the disease, gender and age distributions. \nResults: The number of particle therapy treatment from 2002 to 2009 reached 10,782. Each annual number of particle therapy was 520 (244 proton:p, 276 carbon:c) in 2002, 794 (474 p, 320 c) in 2003, 1082 (699 p, 383 c) in 2004, 1276 (803 p, 473 c) in 2005, 1453 (827 p, 626 c) in 2006, 1712 (923 p, 789 c) in 2007, 1712 (781 p, 931 c) in 2008, 2233 (1278 p, 955 c) in 2009. The number of patients according to the primary lesion ranged 198 (164 p, 34 c) for CNS tumors, 1448 (815 p, 633 c) for Head and Neck tumors, 1241 (742 p, 499 c) for lung tumors, 112 (77 p, 35 c) for upper digestive organ tumors, 1257 (947 p, 310 c) for liver tumors, 151 (42 p, 109 c) for pancreas tumors, 73 (8 p, 65 c) for gynecological tumors, 2509 (1770 p, 739 c) for prostate tumors, 659 (118 p, 541 c) for bone and soft tissue tumors, 246 (44 p, 202 c) for recurrent rectal tumors and 1275 (438 p, 837 c) for other or unclassified tumors. The treatment for prostate cancer was a major target. The gender distribution of the patients treated by the particle therapy was 7933 for male and 2849 for female. The male patients were almost three times as many as the female patients. \nConclusions: This paper reports the activity of Japanese particle therapy for 8 years. We think that the analysis of the particle therapy is very important for the radiation oncology. We will be able to realize the desirable co-operation between the JCPT hospitals and establish the Japanese database concerned with the proton and carbon ion therapy. This study was supported by Grants-in-Aid for Scientific Research (2009-Gan Ippan-008) from the Ministry of Health, Labor and Welfare of Japan., ASTRO ５２nd Annual Meeting

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