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Lifelong education for dietitians in Japan is based mainly on competencies according to years of experience. Because learning content differs depending on the desired position and specialty, training programs that reflect the individual learning needs of public health dietitians are needed. This study aimed to assess the individual learning needs of public health dietitians via years of experience in health promotion. In 2021, an online survey of public health dietitians involved in health promotion in prefectures, designated cities, and other municipalities throughout Japan was conducted. Years of experience in health promotion were categorized as early (

Flipped learning has been applied in various fields, including medical professional education. E-learning is compatible with flipped learning; however, it is considered to be unsuitable for providing training on surgical techniques. In this study, we retrospectively examined the ligation performance of online students who underwent training with flipped learning incorporated into e-learning.We conducted a retrospective study of the ligation practices of online students at the Department of General Surgery from March 2020 to June 2021. The subjects included 134 fourth- and fifth-year medical students from Gunma University School of Medicine. We conducted mid-term checks on the 8th day of practice and an examination on the 19th day. Two instructors independently evaluated and calculated scores using the original Global Rating Scale of Gunma University. We also conducted a questionnaire survey on the ligation practice of online students.The total average score of the three tasks was 12.4 for Instructor 1 and 12.0 for Instructor 2. All students had a passing score. The questionnaire survey showed that 70% of the students were trained in ligation at the time of the first evaluation.Our online training materials and training methods enabled the acquisition of ligation skills by students who had not previously received ligation training.

Low serum alanine aminotransferase activity and high aspartate aminotransferase (AST)/ALT ratio may be associated with high mortality in older people. We aimed to confirm this in an 8-year retrospective cohort study. Clinical data for 5,958 people aged 67–104 years were analyzed for their relationships with all-cause mortality using artificial intelligence (AI; Prediction One [Sony Network Communications Inc.]) and conventional statistical analysis (SAS Enterprise Guide [SAS Institute Inc.]). In total, 1,413 (23.7%) participants died during the study. Auto-AI analysis with five rounds of cross-validation showed that AST/ALT ratio was the third largest contributor to mortality, following age and sex. Serum albumin concentration and body mass index were the fourth and fifth largest contributors, and the individual serum ALT and AST activities were the seventh and tenth largest contributors. Conventional survival analysis showed that ALT, AST, and AST/ALT ratio as continuous variables were all associated with mortality (adjusted hazard ratios (95% confidence intervals): 0.98 (0.97–0.99), 1.02 (1.02–1.03), 1.46 (1.32–1.62), respectively; all p

We investigated whether genetic susceptibility to tuberculosis (TB) influences lung adenocarcinoma development among never-smokers using TB genome-wide association study (GWAS) results within the Female Lung Cancer Consortium in Asia. Pathway analysis with the adaptive rank truncated product method was used to assess the association between a TB-related gene-set and lung adenocarcinoma using GWAS data from 5512 lung adenocarcinoma cases and 6277 controls. The gene-set consisted of 31 genes containing known/suggestive associations with genetic variants from previous TB-GWAS. Subsequently, we followed-up with Mendelian Randomization to evaluate the association between TB and lung adenocarcinoma using three genome-wide significant variants from previous TB-GWAS in East Asians. The TB-related gene-set was associated with lung adenocarcinoma (p = 0.016). Additionally, the Mendelian Randomization showed an association between TB and lung adenocarcinoma (OR = 1.31, 95% CI: 1.03, 1.66, p = 0.027). Our findings support TB as a causal risk factor for lung cancer development among never-smoking Asian women.

This study examines the efficacy of the Japanese version of the Program for the Education and Enrichment of Relational Skills (PEERS), which focuses on improving social functioning through making friends and maintaining good relationships for adolescents with autism spectrum disorder (ASD) without intellectual disabilities. Originally developed in the United States, PEERS is one of the few evidence-based social skills training programs for youth with ASD. The present study shows that with linguistic and cultural modifications, PEERS is effective in improving social functioning for adolescents with ASD in Japan. Positive results were found specifically in the areas of socialization, communication, knowledge of social skills, autistic mannerisms, and behavioral and emotional problems. In addition, most treatment gains were maintained at a 3-month follow-up assessment. These findings suggest that the Japanese version of PEERS is beneficial across multiple socio-emotional and behavioral domains for adolescents with ASD.

Lung adenocarcinoma driven by somatic EGFR mutations is more prevalent in East Asians (30-50%) than in European/Americans (10-20%). Here we investigate genetic factors underlying the risk of this disease by conducting a genome-wide association study, followed by two validation studies, in 3, 173 Japanese patients with EGFR mutation-positive lung adenocarcinoma and 15, 158 controls. Four loci, 5p15.33 (TERT), 6p21.3 (BTNL2), 3q28 (TP63) and 17q24.2 (BPTF), previously shown to be strongly associated with overall lung adenocarcinoma risk in East Asians, were re-discovered as loci associated with a higher susceptibility to EGFR mutation-positive lung adenocarcinoma. In addition, two additional loci, HLA class II at 6p21.32 (rs2179920; P =5.1 × 10(-17), per-allele OR=1.36) and 6p21.1 (FOXP4) (rs2495239; P=3.9 × 10(-9), per-allele OR=1.19) were newly identified as loci associated with EGFR mutation-positive lung adenocarcinoma. This study indicates that multiple genetic factors underlie the risk of lung adenocarcinomas with EGFR mutations., 日本人に多いEGFR変異を持つ肺腺がんの罹りやすさを決める遺伝子領域発見－免疫を司るHLA遺伝子など6遺伝子領域が関与－. 京都大学プレスリリース. 2016-08-25.

Low serum alanine aminotransferase (ALT) activity and high aspartate aminotransferase (AST)/ALT ratio may be associated with high mortality in the elderly. We aimed to confirm this in an 8-year retrospective cohort study. Clinical data for 5958 people living in a city aged 67–104 years were analyzed for their relationships with all-cause mortality using artificial intelligence (AI) and conventional statistical analysis. In total, 1413 (23.7%) participants died during the study. Auto-AI analysis with five rounds of cross-validation showed that AST/ALT ratio was the third-largest contributor to mortality, following age and sex. Serum albumin concentration and body mass index were the fourth- and fifth-largest contributors. However, when serum ALT and AST were individually considered in the same model, the individual serum ALT and AST activities were the seventh- and tenth-largest contributors. Conventional survival analysis showed that ALT, AST, and AST/ALT ratio as continuous variables were all associated with mortality (adjusted hazard ratios (95% confidence intervals): 0.98 (0.97–0.99), 1.02 (1.02–1.03), and 1.46 (1.32–1.62), respectively; all p < 0.0001). In conclusion, both AI and conventional analysis suggest that of the conventional biochemical markers, high AST/ALT ratio is most closely associated with all-cause mortality in the elderly.

A rapid response system is required in a radiotherapy department for patients experiencing a critical event when access to an emergency department is poor due to geographic location and the patient is immobilised with a fixation device. We, therefore, rebuilt the response system and tested it through onsite simulations. A multidisciplinary core group was created and onsite simulations were conducted using a Plan-Do-Study-Act cycle. We identified the important characteristics of our facility, including its distance from the emergency department; the presence of many staff with little direct contact with patients; the treatment room environment and patient fixation with radiotherapy equipment. We also examined processes in each phase of the emergency response: detecting an emergency, calling the medical emergency team (MET), MET transportation to the site and on-site response and patient transportation to the emergency department. The protocol was modified, and equipment was updated. On-site simulations were held with and without explanation of the protocol and training scenario in advance. The time for the MET to arrive at the site during a 2017 simulation prior to the present project was 7 min, whereas the time to arrive after the first simulation session was shortened to 5 min and was then shortened further to 4 min in the second session, despite no prior explanation of the situation. A multidisciplinary project for emergency response with on-site simulations was conducted at an isolated radiation facility. A carefully planned emergency response is important not only in heavy ion therapy facilities but also in other departments and facilities that do not have easy access to hospital emergency departments.

The long-axis in-plane approach is amenable to ultrasound-guided central venous catheterization. However, the long-axis in-plane approach is considered difficult to learn because the needle should remain visible in the ultrasound beam during the procedure. We developed a novel competency-based modular system to acquire the skills for the long-axis in-plane approach. The purpose of this study is to evaluate the efficacy of this system. The study was approved by the local ethics committee. Participants performed ultrasound guided venous catheterization (pre-test), attended a 2-hour hands-on session with the teaching system and were then evaluated again (posttest). The teaching system is a simulator device consisting of an ultrasound probe, a simulated vessel, a needle, and an endoscope connected to a computer to visualize the image inside the simulated vessel. The success rate, visualization of the needle tip, and puncture accuracy were measured before and after training. The puncture accuracy was determined by evaluating the distance of the needle tip and needle shaft from the center of a simulated vessel. Primary outcomes were the success rate and the puncture accuracy. The secondary outcome was needle tip visualization. McNemar test was used to analyze success rate and needle tip visualization. Tukey test was used to analyze puncture accuracy. A P value

Generalized epilepsy with febrile seizures plus (GEFS+) is characterized by childhood-onset epilepsy syndrome. It involves febrile seizures and a variety of afebrile epileptic seizure types within the same pedigree with autosomal-dominant inheritance. Approximately 10% of individuals with GEFS+ harbor SCN1A, a gene mutation in one of the voltage-gated sodium channel subunits. Considerably less common are focal epilepsies including focal seizures with impaired consciousness. We report vagus nerve stimulation (VNS) in a 6-year-old girl with GEFS+ who exhibited drug-resistant generalized tonic-clonic seizures and focal seizures with impaired consciousness.

To propose a new strategy to prevent communication errors caused by unread radiology reports. Medical emergencies were prefixed with triple stars on radiology reports, and the attending physician was contacted by telephone. Semi-emergencies (medical issues needing addressing within 2 weeks) were prefixed with double stars. Two weeks later, the duty radiologist would search the double-starred reports, and reviewed relevant patient charts to confirm that the information had been appropriately understood and acted upon. If not, the duty radiologist contacted the referral physician by telephone. One year after implementing this strategy, we retrospectively evaluated 1-year worth of data for all the reports of CT, MRI, nuclear medicine and ultrasonography (April 2018 to March 2019). Three hundred and twenty-one reports were double starred (0.52% of 62,143 reports, 1.32 reports/day), and transmission of relevant information was incomplete in 23 cases (7.17%). Causes of incomplete transmission were (1) reports not being opened (n = 17), (2) relevant information on reports being overlooked (n = 5), and (3) the wrong report being opened (n = 1). Sixty-five reports contained triple stars (0.10%, 0.27 reports/day). The proposed strategy may be effective in preventing communication errors in radiology reports with important findings requiring semi-emergency clinical action.

We treated a 64-year-old woman with high blood pressure. Catecholamine metabolite levels were elevated in the blood and urine. CT revealed a densely stained tumor on the right side of the descending aorta dorsal to the inferior vena cava. PET-CT revealed abnormal accumulation of (18) F-fluorodeoxyglucose, and (123) I-meta-iodo-benzylguanidine uptake was apparent on scintigraphy. The tumor was determined to be a paraganglioma located on the border between the thoracic and abdominal cavities, and laparoscopic tumorectomy was performed. The patient was placed in the left lateral position. The right lobe of the liver was turned over, and we cut the diaphragm to expose the front of the tumor. We resected the straight artery flowing in from the aorta and removed the tumor safely. Herein, we describe the removal of a paravertebral paraganglioma located in the border of the thoracic and abdominal cavities with a laparoscopic transabdominal-transdiaphragmatic approach.

The rotary motor enzyme F1-ATPase (F1) is a catalytic subcomplex of FoF1-ATP synthase that produces most of the ATP in respiring cells. Chemomechanical coupling has been studied extensively for bacterial F1 but very little for mitochondrial F1. Here we report ATP-driven rotation of human mitochondrial F1. A rotor-shaft γ-subunit in the stator α3β3 ring rotates 120° per ATP with three catalytic steps: ATP binding to one β-subunit at 0°, inorganic phosphate (Pi) release from another β-subunit at 65° and ATP hydrolysis on the third β-subunit at 90°. Rotation is often interrupted at 90° by persistent ADP binding and is stalled at 65° by a specific inhibitor azide. A mitochondrial endogenous inhibitor for FoF1-ATP synthase, IF1, blocks rotation at 90°. These features differ from those of bacterial F1, in which both ATP hydrolysis and Pi release occur at around 80°, demonstrating that chemomechanical coupling angles of the γ-subunit are tuned during evolution.

Ultrasound-guided central venous catheterization may cause lethal mechanical complications intraoperatively. We developed a novel device to prevent such complications. It works as a needle guide to supplement the operator's skill. We evaluated the utility of this device in terms of the success rate and visualization of the needle tip while penetrating the target vessel using a simulator.This study was approved by the local ethics committee. The new device - an optical skill-assist device - has a slit and a mirror in the center. The operator can see the needle's reflection in the mirror through the slit and can thus ensure that the needle is directed in line with the ultrasound beam. Participants were recruited by placing an advertisement for a hands-on seminar on ultrasound-guided vascular access. They received hands-on training on the in-plane approach for 2 hours. Pre-test and post-test without the device and an additional test using the device were performed to evaluate the proficiency of ultrasound-guided vascular access. An endoscope inserted into the simulated vessel was used to detect the precise location of the needle tip in the vessel.The primary outcomes were the success rate of the procedure. The secondary outcome was visualization of the needle tip while penetrating the simulated vessel. The chi-squared test was used for comparing the success rate and needle tip visualization between the different tests. P < .05 was considered to indicate significant differences.Forty-two participants were enrolled in this study. The success rate did not increase after the simulation training (P = .1). Using the optical skill-assist device, the rate improved to 100%. There was a significant difference in success rate between the pre-test and additional test using the optical skill-assist device (P = .003). Needle tip visualization significantly improved with the use of the optical skill-assist device compared to the pre-test (P < .001) and post-test (P = .001).Simulation training improved participants' skill for ultrasound-guided vascular access, but the improvement depended on each participant. However, further, improvement was achieved with the use of the optical skill-assist device.The optical skill-assist device is useful for supplementing the operator's skill for ultrasound-guided central venous catheterization.

The mesenteric vessels have many branching patterns. This study clarified the anatomic relationship between the superior mesenteric vein (SMV), the right colic artery (RCA), and the ileocolic artery (ICA) using 3-dimensional computed tomography (3D-CT). The relationship between the RCA and the right colic vein (RCV) was also examined.Between April 2006 and July 2011, all patients with colorectal cancer underwent multidetector computed tomography (MDCT) before laparoscopic surgery. The 100 most recent consecutive cases were analyzed. 3D-CT images were made by combining arterial angiography, venous angiography, colonography, tumor, lymph node, and duodenal images.The RCA branched from the SMA in 37 cases (37%); of these, 21 had an ICA that crossed anterior to the SMV and 16 had an ICA that crossed posterior. When the ICA crossed anterior to the SMV, all had an RCA that crossed anterior to the SMV, and no posterior RCA was seen. Furthermore, the RCV joined the SMV in 10 cases (27%) and the gastrocolic trunk in 27 cases (73%).Our study clarified the anatomic variety of the vessels in right-sided colon cancer. Preoperative 3D-CT is useful for understanding the anatomy to ensure a safe, precise operation.

INTRODUCTION We adopted the use of Penrose drains and Endo Close to secure a good surgical field during laparoscopic pancreatectomy. METHODS We used a Penrose drain with threads ligated on both ends to suspend the stomach. We then pulled the threads out of the body from the side of the trocar or from besides the xiphisternum by using Endo Close. In most cases, 2 Penrose drains were used to retract the stomach. When the greater omentum on the left side of the cardia still blocks the surgical field, we sewed the posterior wall of the stomach onto the dome of the diaphragm. RESULTS The use of 2 Penrose drains and Endo Close were effective to retract the stomach in most cases. However, in 3 cases, we needed to additionally sew the stomach onto the diaphragm to fully open up the field. CONCLUSION This is a simple and effective method to ensure a good surgical field.

Aim The present study was carried out to clarify tube feeding utilization and the prevalence of swallowing difficulty among residents in geriatric long-term settings, and to elucidate the implementation of swallowing assessment at four different types of facilities in Japan. Methods We mailed a questionnaire to a total of 4334 facilities. Results We received responses from 1137 (26.2%) facilities, including 440 (29.0%) from 1517 nursing homes, 275 (29.2%) from 941 long-term care facilities, 205 (18.1%) from 1134 sanatorium medical facilities and 217 (29.2%) from 742 rehabilitation hospitals. The number of tube-fed residents per 100 beds in each facility was 11.6 at the nursing homes, 7.4 at the long-term care facilities, 36.3 at the sanatorium medical facilities and 7.9 at the rehabilitation facilities. The number of residents per 100 beds with swallowing difficulty was 23.7 in the nursing homes, 15.6 in the long-term care facilities, 19.2 in the sanatorium medical facilities and 15.4 in the rehabilitation hospitals. The percentages of facilities that assessed swallowing difficulty were 31.8% of the nursing homes, 63.0% of the long-term care facilities, 77.9% of the sanatorium medical facilities and 91.7% of the rehabilitation hospitals. Conclusion A large number of residents using a feeding tube and with difficult swallowing were observed in geriatric long-term settings without adequate evaluation of swallowing function. Geriatr Gerontol Int 2014; 14: 577–581.

Background Behavioural and psychological symptoms of dementia (BPSD) are very common among older people, and previous studies showed that BPSD affects eating behaviour negatively, possibly resulting in undernutrition. In a previous study, we constructed a set of 11 items based on direct observations of older people with dementia during mealtime and named them ‘SSADE: signs and symptoms accompanying dementia while eating’. Aims This study aimed to conduct a factor analysis to clarify the structure of the set of 11 SSADE items and to analyse the relationship of the SSADE with nutritional status. Methods We sampled 259 older people from 14 institutional facilities in Japan. To assess the status of the SSADE, we quantified each item according to its frequency and severity, using a 5-point scale. We also collected information regarding characteristics and nutritional status (body mass index [BMI], dietary intakes, body weight change, serum albumin level). We performed an exploratory factor analysis on the SSADE. In addition, associations between grouped factor scores and nutritional status were analysed. Results Exploratory factor analysis indicated four factors. ‘Hypoactivity’ including ‘dietary agnosia’ and ‘drowsiness’ correlated negatively with BMI and serum albumin levels. ‘Hyperactivity’ including ‘agitation’, ‘delusion’, ‘wandering’ and ‘eating too rapidly’ correlated negatively with BMI. ‘Obsessiveness’ including ‘food refusal’ and ‘fad eating’ correlated negatively with BMI, dietary intake and body weight change. ‘Aberrant behaviours’ including ‘eating apraxia’, ‘pica’ and ‘stealing food’ correlated positively with dietary intake. Conclusion The identified factors of the SSADE were related to nutritional status, which may suggest acceptable factorial validity. Implications for practice We expected the SSADE to contribute to the prevention and improvement of undernutrition, through the development of a concrete strategy for nutritional care planning by professional teams including dietitians in long-term care facilities.

The differential diagnosis of solitary pulmonary nodules (SPNs) using radiological features in patients with breast cancer is vital yet difficult. The nature of SPNs, of these patients, as well as the role of surgery in the diagnosis and treatment were evaluated. Thirty consecutive patients, who underwent surgery for an SPN between 2002 and 2011 subsequent to curative surgery for breast cancer were retrospectively evaluated. The overall survival and disease-free survival periods were estimated using the Kaplan-Meier method. The Student’s t-test and the χ2 test were performed to compare percentages and the mean values, respectively. The values were considered statistically significant at P

Reconstruction after esophagectomy may represent a serious problem when a previous gastric resection has been performed. The colon is frequently usedbut the marginal artery is of insufficient caliber to maintain the viability of a transposed colon. Three‑dimensional computed tomography(3D -CTprovides abundant information about a patients anatomy without requiring an arterial puncture. We present a case in which 3D-CT was used. A 68‑year‑old man who had previously undergone a gastrectomy was diagnosed with esophageal cancer.3D-CT showed that the left colic artery was straight and long and had a solitary branch from the inferior mesenteric artery. The vascular pedicle of the left colon was found during the operation to be in accord with the 3D-CT evaluation. The patient underwent a transthoracic esophagectomyfollowed by reconstruction using left colon interposition. No anastomotic leakage or necrosis of the reconstructive colon occurred.(Kitakanto Med J 2012;62: 143~146)

The C-terminal two α-helices of the ε-subunit of thermophilic Bacillus F(o)F(1)-ATP synthase (TF(o)F(1)) adopt two conformations: an extended long arm ("up-state") and a retracted hairpin ("down-state"). As ATP becomes poor, ε changes the conformation from the down-state to the up-state and suppresses further ATP hydrolysis. Using TF(o)F(1) expressed in Escherichia coli, we compared TF(o)F(1) with up- and down-state ε in the NTP (ATP, GTP, UTP, and CTP) synthesis reactions. TF(o)F(1) with the up-state ε was achieved by inclusion of hexokinase in the assay and TF(o)F(1) with the down-state ε was represented by εΔc-TF(o)F(1), in which ε lacks C-terminal helices and hence cannot adopt the up-state under any conditions. The results indicate that TF(o)F(1) with the down-state ε synthesizes GTP at the same rate of ATP, whereas TF(o)F(1) with the up-state ε synthesizes GTP at a half-rate. Though rates are slow, TF(o)F(1) with the down-state ε even catalyzes UTP and CTP synthesis. Authentic TF(o)F(1) from Bacillus cells also synthesizes ATP and GTP at the same rate in the presence of adenosine 5'-(β,γ-imino)triphosphate (AMP-PNP), an ATP analogue that has been known to stabilize the down-state. NTP hydrolysis and NTP-driven proton pumping activity of εΔc-TF(o)F(1) suggests similar modulation of nucleotide specificity in NTP hydrolysis. Thus, depending on its conformation, ε-subunit modulates substrate specificity of TF(o)F(1).

症例は84歳女性で, 平成22年1月, 頻回の嘔吐と発熱のため近医に入院した. 精査の結果, 食道裂孔ヘルニアに起因する通過障害による誤嚥性肺炎と診断された. 食道裂孔ヘルニアは混合型で巨大であり, CT上胃と膵尾部が縦郭内に脱出していた. 禁飲食とし補液と抗生剤で加療した. 禁飲食により嘔吐はすぐに軽快したが, 食事を開始すると嘔吐し肺炎を繰り返した. また, 肺炎のため長期臥床を余儀なくされ, 廃用症候群となりリハビリテーションを必要とした. その間は, 経口での水分摂取のみを行った. 同年3月, 自力で短時間の歩行が可能となり, 酸素投与も必要なくなったため手術目的で当科に転院した. 手術は腹腔鏡下で噴門形成術 (Nissen法) を行った. 術後経過は良好で, 手術翌日から離床を開始し, 第2病日より食事を開始し, 第10病日に退院となった. 今回, 高齢者の食道裂孔ヘルニアに対し合併症なく安全に腹腔鏡下噴門形成術を行い, 頻回におこった誤嚥性肺炎の予防に有用であった症例を経験したので報告する.

症例は68歳の男性で，食道癌で右開胸・開腹胸腹部食道亜全摘，3領域リンパ節郭清，胸骨後結腸再建術を施行した．術後9日目に突然腹痛と頻呼吸が出現した．腹部CTで門脈ガス血症と腸管気腫を認め，緊急手術を施行した．Treitz靭帯より20cmから120cmの空腸，盲腸から90cm口側に及ぶ回腸に血流障害を認め，同部を切除した．腸管吻合は施行せず，人工肛門を作成し手術を終了した．再手術後4日目のCTでは門脈ガスは消失し，腸管壊死の所見も認めなかった．再手術後12日目に腸管吻合を伴う人工肛門閉鎖術を施行し，救命しえた．門脈ガス血症は腸管壊死やイレウスなどに合併する比較的まれな病態であり，腸管壊死に伴う例の予後は不良と報告されている．今回，我々は食道癌術直後に門脈ガス血症を呈した非閉塞性腸管虚血症例を救命しえたので文献的考察を加えて報告する．

【目 的】 教室で行ってきた腹腔鏡下胃切除の術式の変遷と短期成績を提示し, 腹腔鏡下胃切除の有用性を検討する. 【方 法】 2006年4月～2010年5月末までに胃癌に対し当科で行われた腹腔鏡下胃切除116例を対象とし, 手術方法や成績について検討した. 【結 果】 導入当初は幽門側胃切除, 幽門保存胃切除は腹腔鏡補助下で行い, 胃全摘と噴門側胃切除は用手補助腹腔鏡下で行っていたが, 2009年からは全ての術式を完全腹腔鏡下で行っている. 術後Stage IA, IBの短期成績は IAで77例中1例が他病死し, IBで18例中1例が再発生存中である. 完全腹腔鏡下胃切除32例の平均手術時間は338分で, 出血量は104g, 在院日数は10.9日で, 術後合併症は2例 (6.3％) であった. 【結 語】 胃癌手術で腹腔鏡手術は年々増加し, 術式は変遷して現在は完全腹腔鏡下に行っている. 合併症は比較的少なく, 短期成績も比較的良好であるので, 今後標準手術となりうる可能性がある.

【目 的】 腹腔鏡補助下胃切除では, 術中に病変の局在を診断し, 適切な術式を決定することが困難である. そこで術前3D-CTの有用性について検討した. 【方 法】 内視鏡を用い病変にクリップで印を付けた後, 動脈相と門脈相のCTを0.5mm間隔で撮影し, 3D-CTを作成した. 【結 果】 術前の3D-CTで胃周囲血管との位置関係まで含めた胃癌の局在が描出できた. 5 mm程度以上のリンパ節が描出可能であった. また, 術式の決定 (幽門側胃切除か幽門保存胃切除か) に有用で, 症例によっては胃切除の際の切離線決定に有用であった. 【結 語】 3D-CTを用いれば至適な胃切除範囲・リンパ節郭清範囲を決定できるので, より安全かつ過不足のない適切な手術が行える可能性がある.

症例は29歳の男性で，既往歴は結節性硬化症と腎血管筋脂肪腫であった．発熱があり近医を受診し，抗生剤と解熱剤を投与されるも改善せず当院を紹介された．全身検索で明らかな感染源を認めなかったが，38度以上の発熱が続いていた．血液検査は炎症反応以外に特異的所見がなかった．CTでは肝S8に7cm，S6に1cmの腫瘤を認め，半年前より増大していた．MRIではT1低信号T2高信号で，肝細胞相で欠損を認めた．生検で血管筋脂肪腫と診断された．PET-CTで高度集積を示し，大きさが増大しているため，悪性化が否定できず肝右葉切除を施行した．切除標本では被膜のない充実性腫瘍で，2つの腫瘍とも同様の性状であった．病理組織学的には紡錘形胞体を有する腫瘍細胞が線維束を形成し，リンパ球や形質細胞浸潤を伴っていた．免疫染色でhuman melanoma black-45，CD31，vimentin，α-smooth muscle actinが陽性で，炎症細胞浸潤を伴う血管筋脂肪腫と診断した．