Search

Solitary fibrous tumor (SFT) of the retroperitoneal space is rare. We report a case of retroperitoneal tumor, diagnosed as SFT. A 69-year-old woman presented with right lower abdominal swelling, and was referred to our hospital with suspicion of right renal tumor. Abdominal ultrasound and computerized tomography (CT) showed a mass (about 15 x 14 x 10 cm) in the right abdomen. The tumor was thought to be right renal rumor, and right radical nephrectomy was performed. In the excised specimen the tumor was not connected to gastrointestinal tract, peritoneum, or right kidney. The histological and immunohistochemical examination of the specimen revealed SFT. The tumor has malignant potential with partially increased mitotic activity and cellularity in the histological examination. The patient is healthy and without evidence of recurrence or metastasis 26 months from surgery., 後腹膜solitary fibrous tumor(SFT)は稀な疾患である。症例は69歳, 女性。右下腹部の腫瘤を主訴に近医を受診, 右腎腫瘍が疑われ当科紹介となった。腹部超音波およびCT検査にて右腹部に15×14×10cm程の充実性腫瘤を認めた。右腎腫瘍と考えられ, 右根治的腎摘除術を施行した。腎と一塊に腫瘍を摘出したが, 摘出標本にて腎との連続性はなく, 後腹膜腫瘍と判断された。病理組織検査にてsolitary fibrous tumorと診断された。術後26ヵ月経過し, 現在再発の徴候なく外来通院中である。(著者抄録)

3施設において局所前立腺癌と診断し恥骨後式前立腺全摘除術が施行され, 医療費の計算できた69例を対象に, 1年間にかかる費用を計算し医療経済的効果を検討した.全体の平均の医療費は1436千円, 入院費用は1228千円で全体の約85%を占めていた.そのうち手術は450千円で, 外来費用は208千円であった.更にadjuvant therapyをしていない63例についてneoadjuvant療法施行群(n=27)と未施行群(n=36)に分けて比較してみると, 外来では主に投薬及び注射料においてneoadjuvant施行群が有意に費用がかかっていた.また, 手術・麻酔料や入院管理料をふくめた入院費合計においてもneoadjuvant施行群が高額になっていた.診断時の前立腺特異抗原(PSA)値と内分泌療法の関係をみると, PSA値が高い程, neoadjuvant療法を施行している傾向がみられた.医療費はPSAが高くなるほど有意に高額であった.クリニカルパス(パス)を使用していないA, B各施設別及びパスを使用しているC施設においてパス使用前後の在院日数を比較した結果, A施設, B施設は各々27.8日, 35.4日であった.C施設ではパス導入前は37.0日であったのに対し, パス導入後は16.6日と56%の短縮を認めた.このC施設での医療費の検討では, パス導入前1897千円, パス導入後は1133千円と40%の削減となった, We assessed the 1-year charges in the group of patients undergoing radical prostatectomy and the changes in hospital costs and resource use following implementation of a clinical care path. A total of 69 consecutive men treated with radical prostatectomy for clinically localized prostate cancer were enrolled in the study. Hospital and outpatient records were analyzed for each patient in regard to preoperative, operative and postoperative charges of a 12-month period. Parameters included number of encounters, diagnostic and therapeutic interventions, hospitalization and operative charges, and follow-up visits, diagnostic tests and interventions for 1 year. The mean first-year cost of treatment with radical prostatectomy for localized prostate cancer was 144 x 10(4) yen. The increases in the first-year cost with higher prostate specific antigen (PSA) level for the diagnosis level appeared to primarily be associated with increased inpatient resource use and greater use of hormonal therapy. Length of the stay in a hospital significantly influenced the first-year cost. After implementation of the radical prostatectomy care path hospital costs decreased by 30% (66 x 10(4) yen vs 46 x 10(4) yen), total costs decreased 40% (190 x 10(4) yen vs 113 x 10(4) yen) and length of hospital stay decreased by 56% (37.0 vs 16.6). The first-year costs with radical prostatectomy are influenced greatly by the hormonal therapy and the number of hospital days. By standardizing preoperative and postoperative management for patients undergoing radical prostatectomy, significant savings can be achieved toward shorter hospital stays and lower hospital costs.

application/pdf

Lignin-carbohydrate complexes (LCCs) have been extracted from tropical hard wood of Albizia fakata (L.) Back, by a modified Bjorkman method. After extraction of milled wood lignin (MWL) from the hard wood, LCCs were isolated by successive extraction of the residual wood meal with water (LCC-WE) and 4% NaOH (LCC-AE). NMR and methylation analysis of the LCCs indicated that carbohydrate moiety of LCC-AE was composed of 4-O-methyl-glucuronoxylan while polyose component of LCC-WE consisted of glucomannan and xylan. Analysis of neutral fraction from LCC-WE revealed that this LCC contained β-1,4-linked xylan chain bearing no glucuronic acid residue. In addition, it has been clarified by DDQ-oxidation that the glucuronoxylan was directly bound to the lignin through C-2 and C-3 positions of xylose unit by ether linkage., この論文は国立情報学研究所の学術雑誌公開支援事業により電子化されました。

1984～1987年の間に検討した前立腺癌200例中, 本剤経口投与開始から1年以上継続観察し得た96例について検討した.96例中33例では主治療に本剤を用い, 63例では本剤治療前に他の薬物が用いられていた.12例は本剤単独で, 84例は合併療法であった.初回治療38例, 維持療法37例, 再燃時治療11例, その他10例であった.本剤の効果判定可能67例では, 著効10例, 有効16例, やや有効15例, 無効26例であった.1, 3及び5年生存率はそれぞれ92.6%, 66.0%, 及び46.3%であった.22例で副作用がみられ, 中3例で投与を中止した, Two hundred patients with prostatic cancer were enrolled in our previous study between 1984 and 1987. In this study, 96 patients of them were observed for 1 year or more after oral administration of Estracyt (estramustine sodium phosphate). Of these 96 cases, 33 patients were treated with Estracyt as primary treatment and 63 patient had been treated with other treatments before Estracyt treatment. Twelve patients were treated only with Estracyt and 84 patients also received other treatments. Thirty-eight patients were on primary therapy, 37 patients were on maintenance therapy, and 11 patients were on primary therapy, 37 patients were on maintenance therapy, and 11 patients were on the re-activated stage therapy and 10 patients were others. In conclusion, among the 67 cases in which the due judgement of the effect was possible, Estracyt was markedly effective in 10 cases (14.9%), effective in 16 cases (23.9%), slightly effective in 15 cases (22.4%) and ineffective in 26 cases (38.8%). The survival rate was 92.6% at the first year, 66.0% at the third year and 46.3% at the fifth year in the follow-up study. Adverse reactions were observed in 22 cases (22.9%), among which the administration was discontinued in 3 cases.

この論文は国立情報学研究所の学術雑誌公開支援事業により電子化されました。

この論文は国立情報学研究所の学術雑誌公開支援事業により電子化されました。

To evaluate the use of free/total prostate-specific antigen ratio (fPSA/tPSA ratio) in improving the early diagnosis of prostate cancer.fPSA/tPSA ratio in the serum was analyzed prospectively in 187 men with tPSA ranging between 4.0 and 20.0 microg/L. All of them underwent ultrasound-guided sextant prostatic biopsies. Sensitivity, specificity, positive and negative predictive values were calculated by SPSS 10.0 software.Prostate cancer detection rates were 18.1% and 22.5% when tPSA was within the ranges of 4.0-10.0 g/L and 10.0-20.0 g/L respectively. fPSA/tPSA ratio was more significant than tPSA in all the men. When the cut-off value of fPSA/tPSA ratio was set at 0.25, 90.5% and 87.5% of cancers could be detected; and 26.7% and 11.3% of biopsies could be avoided within the tPSA ranges of 4.0-10.0 g/L and 10.0-20.0 g/L, respectively.The use of fPSA/tPSA ratio can improve prostate cancer detection and reduce unnecessary biopsies when tPSA is within the range of 4.0-10.0 microg/L and 10.0-20.0 microg/L.

この論文は国立情報学研究所の学術雑誌公開支援事業により電子化されました。