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Background : We retrospectively investigated the status, including radiological outcomes, of reduction manipulation for dorsally displaced fracture of the distal radius to assess the need for the technique. / Methods : Of 256 patients with dorsally displaced fracture of the distal radius in electronic medical records, this study included 59 patients aged ≧17 years who could be followed up for at least 3 months after the injury. Patients with an open fracture were excluded. The mean age at the time of injury was 66.2 years. The mean follow-up period after injury was 6 months. We examined the number of patients treated with reduction manipulation (Group Y) and those without reduction manipulation (Group N), number of patients undergoing surgery, redisplacement rates and the radiological outcomes in each group....

Receiver operating characteristics curve analysis for the optimal cutoff of the most tumor shrinkage rate relative to baseline. (PPTX 53â kb)

We had found previously that calcitonin treatment (elcatonin once a week for 10 weeks) results in significant decreases in blood pressure. The aim of the present study was to determine whether these effects were due to a cumulative effect of elcatonin or could be elicited by treatment with a single dose. To this end, we recruited 62 patients (eight men, 54 women; mean age 83 years; range 67-101 years) with a chief complaint of lower back pain to the present study and examined changes in blood pressure following administration of the first dose of elcatonin. All subjects in the study had been hospitalized either at our institution or an affiliated hospital. After acute phase symptoms had settled, subjects received 1 U (1mL), i.m., elcatonin S20. Blood pressure was measured the day before the first scheduled treatment and on the day of treatment. Both systolic and diastolic blood pressure decreased from 2 h after administration, and dropped significantly 4 and 6 h after administration. Therefore, elcatonin decreased blood pressure without first having to be accumulated in the body. There are several possible explanations for the results, including effects mediated by changes in concentrations of calcitonin gene-related peptide and calcium ions, as well as involvement of the parasympathetic nervous system. In conclusion, calcitonin inhibits bone resorption and pain, lowers blood pressure, and is easy to use in elderly patients who exhibit age-related increases in blood pressure.

A 76-year-old female patient with diabetes was referred to our hospital for evaluation of a 1-week history of left abdominal pain with loss of appetite. Laboratory data showed markedly elevated neutrophils. Abdominal X-ray showed massive gas and fluid collection in the left pararenal space, resembling an intestinal obstruction. Abdominal computed tomography revealed renal parenchymal gas and fluid and led to the correct diagnosis of emphysematous pyelonephritis. Based on these findings, this patient was immediately transferred to the intensive care unit. She underwent emergent ne-phrectomy and was discharged 28 days after surgery without complications.（Kitakanto Med J2013；63：141～145）

症例は 49歳,男性. 2008年 2月血尿と頻尿を主訴に泌尿器科を受診し膀胱頂部に腫瘍を指摘された.直腸癌膀胱浸潤の診断で当科に紹介となり,直腸前方切除,膀胱部分切除を行った.病理結果は高分化腺癌 (tub1) SI (膀胱),int,INFb,ly1,v0,N1,H0,M0,P0stageaで膀胱切除断端は陰性であった.術後 1年 9ヶ月で血尿が出現し,腹部 CTで膀胱底部から前立腺に連続する腫瘍を認めた.膀胱癌を疑い膀胱鏡による生検を行ったが生検結果は高分化腺癌であった.直腸癌の再発と診断し,膀胱前立腺全摘術,両側側方リンパ節郭清を施行した.摘出標本では前回の膀胱切除部は瘢痕組織のみで残存腫瘍はなく,それとは連続しない反対側の膀胱底部を中心に腫瘍を認めた.病理組織学的には腫瘍細胞は膀胱粘膜面からの浸潤増殖であり膀胱内播種による再発と考えられた.

1985年より群馬県及びその近郊の病・医院における未治療前立腺癌の登録作業を開始し, その資料をもとに, 1985～2000年の群馬県における前立腺癌の罹患数, 粗罹患率, 年齢調整罹患率, 年齢別罹患率, 臨床病期, 組織学的分化度の推移について検討した.群馬県における前立腺癌の罹患数及び粗罹患率(/10万人/年)の推移は, 各々1985年には114例, 12.0であったものが, 2000年には539例, 53.9と急激に増加した.年齢調整罹患率(/10万人/年)の推移について, 世界人口と1985年モデル人口の両方で年齢調整を行ったところ, 世界人口では, 1985年に8.3であったものが2000年には24.2に, 1985年モデル人口では, 各々13.1であったものが36.8と約3倍に増加した.80年代後半に対しての90年代前半, 90年代後半の年齢別罹患率の増加率については, 年代が進むにつれていずれの年齢層においても罹患率は増加した.各年齢における増加率は, 60歳代から70歳代前半の中間の年齢層において高い値を示した.臨床病期では, 年代共に病期A, Dが減り, 病期B, Cが増える傾向であった.組織学的分化度では, 年代によって明らかな分化度別割合の変化はみられなかった, Prostate cancer is the most common urogenital cancer, and is increasing rapidly. We performed an epidemiological study on prostate cancer in Gunma Prefecture, Japan. Registration of prostate cancer patients diagnosed at clinics and hospitals in and around Gunma Prefecture was started at Gunma University in 1985. The epidemiological characteristics of prostate cancer patients in Gunma Prefecture were analyzed by these data. The incidence and crude incidence rates have increased five-fold, from 114 and 12.0 in 1985 to 539 and 53.9 in 2000, respectively. The age-adjusted incidence rate (adjusted to the world population) was increased three-fold, from 8.3 in 1985 to 24.2 in 2000. The age-specific incidence rate showed an increase with age. The cancers in clinical stages A and D decreased, while those in stages B and C increased. No change in distribution was observed in pathological differentiation. Prostate cancer has increased rapidly during these 16 years in Gunma Prefecture. It is important to perform PSA testing aggressively in males age 50 or older, and detect prostate cancer in an early stage.

A 75-year-old male undergoing hemodialysis because of diabetic nephropathy was referred to our hospital complaining of high fever and swelling of the left kidney. Our initial clinical diagnosis was severe pyelonephritis. He was initially treated with intravenous antibiotics and his clinical symptoms subsequently improved but only temporarily. The high fever soon recurred, accompanied by progressive thrombocytopenia. His general condition deteriorated despite conservative treatment. He then underwent nephrectomy of the left kidney. However, the thrombocytopenia persisted and his general condition did not improve. The pathological diagnosis was malignant lymphoma (non-Hodgkin’s lymphoma, diffuse large Bcell type). He received chemotherapy, but his status rapidly deteriorated and he died 1.5 months after the operation. Primary renal malignant lymphoma is very rare, because the kidney lacks lymphatic tissue.

1)f-PSAとc-PSA測定系とも各抗原を特異的に測定し, t-PSA測定系はf-PSAとc-PSAを1:1の割合で測定していた. 2)f/t%とf/c%は共にPCaにおいてA1やB0のような早い病期からnon PCaと有意差が認められた. 3)t-PSAとc-PSA及びf/t%とf/c%のROC曲線における差は殆ど認められず, c-PSAの診断上の有用性はt-PSAと同等と思われた.f-PSA単独では有用性が認められなかった. 4)t-PSAが4～10ng/mlの検体においてはf/t%とf/c%がPSA-Dと同様に前立腺癌の診断に有効であった. 5)前立腺体積40ml以上でt-PSAが10ng/ml以下では癌でない確率が高い, We studied the clinical significance of serum prostate specific antigen (PSA) ratio: free-PSA/total-PSA and free-PSA/complex-PSA to discriminate between prostate cancer (PC) and prostate benign disease (non-PCa) by using total-PSA, alpha 1-antichymotrypsin complexed (complex)-PSA and free-PSA enzyme-linked immunosorbent assay (ELISA) kits newly developed at EIKEN Chemical Co, Ltd. Fre-PSA and complex-PSA ELISA kits demonstrated high sensitivity and specificity. Total-PSA ELISA kit also demonstrated equimolarity for free-PSA and complex-PSA. On the total-PSA range of 4-10 ng/ml, free-PSA/total-PSA% (f/t%) and free-PSA/complex-PSA% (f/c%) were very useful to discriminate between PCa and non-PCa by receiver operating characteristic curve analysis as well as PSA density (PSA-D) but not free-PSA level. F/t% and f/c% were even useful to discriminate early stage PCa (i.e. A1 or B0) from non-PCa by the Mann-Whitney U-test.

69歳男.主訴は食欲不振, 顔面の発疹.入院時, 顔面全体, 後頸部及び手背に浮腫性紅斑を認めた.筋無力感があり, 立ち上がり困難であった.皮膚筋炎を合併した前立腺癌が疑われ, 経直腸エコー下系統的前立腺針生検及び大腿四頭筋生検を施行した.前立腺組織では8ヶ所中4ヶ所でpoorly-differentiated adenocarcinoma, Gleason score 5+5=10が検出され, 筋組織では筋肉の壊死と再生像といった筋炎の所見を認めた.また, 画像所見より前立腺癌(T4N1M1)と診断された.諸治療を行ったが全身状態悪化にて初診1年ヵ月後に死亡した.著者等が検索した限り, 前立腺癌と皮膚筋炎との合併症例は本邦では3例あるのみで, 本症例は4例目の報告であった, We report a case of dermatomyositis associated with prostatic carcinoma. A 69-year-old male was admitted to the Department of Internal Medicine with the chief complaint of general fatigue, appetite loss and facial anthema. Abdominal ultrasound demonstrated swollen periaortic lymph nodes and the margin of prostate was unclear. Prostatic carcinoma was suspected based on digital rectal examination, so he was admitted to our department. Serum prostate specific antigen level was 190 ng/ml. He was examined by a dermatologist because of deterioration of anthema. Dermatomyocitis was demonstrated by dermatoses (edema erythema at face, neck and limbs, nail fold thrombosis and poikiloderma), high serum level of creatine phosphokinase and a decrease in muscular strength (especially at the proximal musculus). There was no interstitial pneumonitis or malignancy of the digestive system. On needle biopsy of the prostate and quadriceps femoris muscle, prostatic carcinoma (poorly differentiated adenocarcinoma, Gleason score 5 + 5) and myositis were suspected. The stage of prostatic carcinoma was T4N1M1. The patient was treated by administration of diethylstilbestrol phosphate and prednisolone for prostatic carcinoma and dermatomyositis, respectively, but he died of multiple metastasis of the tumor 1 year and 5 months later. Dermatomyocitis is associated with malignancy more frequently than any other collagen disease. In Japan, it is frequently complicated by gastric, lung and mammory cancers, but rarely by prostatic carcinoma. To our knowledge, this is the fourth case of prostatic carcinoma associated with dermatomyocitis in Japan.

12歳男子.主訴は右陰嚢腫大.右精巣上体炎と診断し, PIPC及びISPの点滴静注を開始した.抗生剤投与後に次第に陰嚢内容の腫脹は軽快して14日目には白血球及びCRPは正常化した.予防的にCFTM-PIを処方したが運動後に右陰嚢腫脹が再出現した為CTM及びISPの点滴静注を開始した.抗生剤開始後, 次第に局所所見が改善した.以後, 予防的にEM及びTFLXの内服を続けていた.再度右陰嚢腫大が出現し右精巣上体炎の再発と診断された.PIPC及びISPの点滴静注開始後, 局所所見は改善したが, 今後も抗生剤による治療のみでは再発する可能性があった為, 右精巣上体摘出術を施行した.精巣上体は白膜など周囲組織と癒着しており, 特に尾部ではその癒着が著明であった.再発を繰り返したので尿路合併奇形の検素を行った.Voiding cystourethrography尿流量測定を行ったが異常所見は認めなかった, The patient was a 12-year-old boy, who was brought to our hospital with a chief complaint of swelling and pain in the right scrotum. Color Doppler ultrasonography showed blood flow in the right testis and increased blood flow at the right epididymis. Our diagnosis was right epididymitis, and the swelling of the scrotum was improved by antibiotics. Since there was recurrence, right epididymectomy was performed. Histological diagnosis was chronic epididymitis. Postoperative, screening for abnormalities in the urinary tract revealed no malformations. Recurrent epididymitis in a child without genitourinary malformations is a very rare pathology.

1985～89年の5年間に未治療の状態で発見された前立腺癌は730例であった.平均年齢は74.0歳, 来院時主訴は排尿障害が最も多く, 74.5%, 以下頻尿, 肉眼的血尿, 排尿時痛, 癌性疼痛の順であった.症状発現から初診まで1ヵ月以内38.2%と多く, 1年以上も22.9%であった.病期Dが45.7%と多く, 以下B, C, Aの順であった.分化度では中分化48.2%, 高分化, 低分化が約25%ずつであった.転移は骨が82.9%, その中でも腰椎55.2%, 以下肋骨, 腸骨, 胸椎, 坐骨の順であった.PAP, ALPは病期の進行と共に有意に(P, Prostatic cancer is one of the most common malignant tumors in the field of urology. The number of patients is increasing rapidly and its importance as a mortal disease is gathering attention. In 1985, we organized a registration system for prostatic cancer patients found in and around Gunma prefecture. In this study, we analyzed the clinical characteristics of the 730 patients registered from 1985 to 1989. The results were as follows. Mean age was 74.0 years old and the number of the patients was the greatest in the eighth decade. Voiding disturbance was the most common chief complaint, followed by pollakisuria, gross hematuria and miction pain. Stage and grade distribution were as follows. Stage A 16.2%, B 21.1%, C 17.0%, D 45.7%, well differentiated 27.4%, moderately differentiated 48.2% and poorly differentiated 24.5%, respectively. A statistically significant relationship between stage and grade was observed. Bone was the most common metastatic site. The highest incidence of bone metastasis was in lumbar vertebra, followed by ribs, ilium, thoracic vertebra and ischium. The value of PAP, ALP and ESR tended to be higher in high stage patients, and that of Hb was lower. Fifty two patients were detected by mass screening. Most of these patients were in an early stage. Most of the patients were treated by hormonal therapy. LH-RH agonists constituted 39.2% of the cases given hormonal therapy.