sasaki hitomi

47歳女。1年前に無症候性肉眼的血尿を認め、近医内科を受診するも精査されなかった。今回、1ヵ月前から39℃の発熱、右腰部痛を発症し前医を再診し、右腎盂腎炎の診断でシプロフロキサシン内服薬を2週間投与された。一旦は症状改善したが、再燃したため当科紹介となった。胸腹部造影CTで右腎実質の非薄化と水腎症、および腎盂尿管移行部で壁肥厚と狭窄を認めた。右膿腎症の診断で抗菌薬を投与するも発熱が続き、尿路悪性腫瘍の可能性が否定できないため、腎盂悪性腫瘍に準じ一期的に腎尿管全摘除術・膀胱部分切除術を施行した。病理組織所見よりurothelial carcinomaと診断した。術後は速やかに解熱し、術前に認めていた右胸水は消失したが、大動脈下大静脈間リンパ節の腫大は残存し、右腎盂癌と診断して術後22日目よりGC療法を4コース施行した。2コース終了後にリンパ節腫大は消退し、術後2年経過した現在も再発の兆候はなく外来にて経過観察中である。

A 47-year-old woman who was diagnosed with right pyelonephritis by a local physician, but failed to respond to antimicrobial chemotherapy, was referred to our hospital. Here, the diagnosis of right pyonephrosis was confirmed byabdominal computed tomography(CT). Retrograde pyelography(RP) revealed a severe stricture at the ureteropelvic junction, and it was considered difficult to advance a guidewire through the stricture. Urine cytologywas pseudo-positive ; thus, the possibilityof a malignant tumor of the urinarytract could not be ruled out. Therefore, right nephroureterectomywas performed. The final, histopathological diagnosis was urothelial carcinoma, (G2, pT3). After surgery, the signs and symptoms of the infection were rapidlyameliorated ; however, swelling of the lymph-nodes between the aorta and vena cava was observed, which was considered to be metastasis. Therefore, 4 courses of gemcitabine ＋cisplatin therapywere administered, which resulted in complete resolution of the lymph-node swelling. The patient has remained free of recurrence for 2 years after surgery.

<p>  Pelvic organ prolapse (POP) and vesicovaginal fistula (VVF) are female benign pelvic floor diseases which can be treated by surgery. Robot-assisted laparoscopic surgery was performed on 5 cases of POP and 1 case of VVF in our hospital.</p><p>  POP cases : An average age of 5 cases was 63.6 y.o and 2 patients had hysterectomy before robot assisted laparoscopic sacrocolpopexy (RSC). In 3 cases, RSC was performed after subtotal hysterectomy. Consol time of RSC was 206.2 minutes on average. After 1 year, there is no recurrence of symptom in all patients. VVF case : A 51 y.o female suffered from total urinary incontinence after hysterectomy visited us. A 20 mm fistula between bladder and vagina was found by cystoscopy. Robot-assisted laparoscopic repair of VVF was administered for fisterectomy and reconstruction of bladder and vagina wall (Consol time was 120 minutes). The patient discharged on the 7th postoperative day and keeps urinary continence.</p>

© 2017 Elsevier Inc. Background Kidney transplant recipients are at increased risk of developing cancer in comparison with the general population. To effectively manage post-transplantation malignancies, it is essential to proactively monitor patients. A long-term intensive screening program was associated with a reduced incidence of cancer after transplantation. This study evaluated the usefulness of the gene expression profiling of peripheral blood samples obtained from kidney transplant patients and adopted a screening test for detecting cancer of the digestive system (gastric, colon, pancreas, and biliary tract). Study Design and Method Nineteen patients were included in this study and a total of 53 gene expression screening tests were performed. The gene expression profiles of blood-delivered total RNA and whole genome human gene expression profiles were obtained. We investigated the expression levels of 2665 genes associated with digestive cancers and counted the number of genes in which expression was altered. A hierarchical clustering analysis was also performed. The final prediction of the cancer possibility was determined according to an algorithm. Results The number of genes in which expression was altered was significantly increased in the kidney transplant recipients in comparison with the general population (1091 ± 63 vs 823 ± 94; P = .0024). The number of genes with altered expression decreased after the induction of mechanistic target of rapamycin (mTOR) inhibitor (1484 ± 227 vs 883 ± 154; P = .0439). No cases of possible digestive cancer were detected in this study period. Conclusion The gene expression profiling of peripheral blood samples may be a useful and noninvasive diagnostic tool that allows for the early detection of cancer of the digestive system.

2012年に藤田保健衛生大学に臓器移植科が開設され、完全後腹膜鏡下ドナー腎採取術を導入した。2012年10月から2015年9月までに39例のドナー腎採取を施行し、その間、以下の改良点を加えた。A.3ポート操作から単孔式コンパート 脈管切離を残すのみとなった段階で、1stポート創と2ndポート創を延長し、GelPortを装着、単孔式にコンパートして腎を採取する。同法は(1)筋繊維走行に沿って解放するため筋肉は切離しない(2)温阻血時間の短縮が見込まれる利点がある。温阻血時間は5.9±4.3分から2.7±0.7と有意に短縮され、疼痛緩和から術後入院期間も6.3±1.3日から5.5±0.7と有意に短縮された。B.3D video systemの導入 導入により平均出血量は2D視野で76.7±84.5gであったのに対し、3D視野で36.1±29.6と減少した。(著者抄録)