自治医科大学紀要　第28巻

1-10 原著論文 Original Article JPN 　 ケアと情念 Care and Pathos 加藤,直克 Kato,Naokatsu 自治医科大学ドイツ語・哲学研究室 Department of German & Philosophy Jichi Medical School For almost 20 years the word 'care' has found a great variety of uses in various fields, including medicine, nursing, counseling, education, religion, cosmetics etc. We can now easily find a new employment of 'care' in our everyday life. This wide range of the use of 'care' might be ascribed to the fact that it could meet the essential and various demands of modern life and human relations. But as the diversity of its employment grows, the meaning of 'care' is becoming inevitably ambiguous. This ambiguity may have both a negative and positive sense. On the one hand it is because 'care' might have essentially no original core meaning. On the other hand it may have a profound and symbolic core meaning which couldn't easily be understood, but would reflect the way of human life in the postmodern world. So it seems to be at least necessary to try to find its core meaning, if possible. The most popular meaning of 'care' is the act of helping or service (caring). But we can't say that every kind of help deserves to be called 'care'. In this article the author tries to show that 'care' contains 'pathos' as the core ingredient. The Greek word 'pathos' has almost the same meaning as 'emotion'. And the problem of emotion like 'emotional labor' or 'emotional control' in the act of care (caring) has recently been widely discussed in the field of care work. But 'pathos' seems to have a more profound and wider implication than 'emotion'. 'Emotion' is surely one of the most important ingredients of 'care'. But it may not be an inevitable one. On the contrary, 'pathos' may underlie every act of care. Thus we can understand why 'care' is used so much in the postmodern age, namely from the end of the 20th to the beginning of the 21st century, when 'nihilism' prevailed worldwide. Care / Pathos / Emotion / Mayeroff / Reality / Actuality

11-16 原著論文 Original Article JPN 　 当科における成人ALLに対する地固め療法としてのHyper-CVAD/High-dose MTX-Ara-C療法の治療成績 Consolidation therapy of adult acute lymphoblastic leukemia with Hyper-CVAD/high dose MTX-Ara-C 小原,陽子 / 森,政樹 / 永嶋,貴博 / 佐藤,一也 / 外島,正樹 / 大嶺,謙 / 桐戸,敬太 / 高徳,正昭 / 室井,一男 / 小松,則夫 / 永井,正 / 小澤,敬也 Obara,Y. / Mori,M. / Nagashima,T. / Sato,K. / Toshima,M. / Omine,K. / Kirito,K. / Takatoku,M. / Muroi,K. / Komatsu,N. / Nagai,T. / Ozawa,K. 自治医科大学血液科 / 自治医科大学血液科:自治医科大学輸血・細胞移植部 / 自治医科大学血液科:自治医科大学輸血・細胞移植部 / 自治医科大学血液科 / 自治医科大学血液科 / 自治医科大学血液科 / 山梨大学医学部血液内科 / 自治医科大学血液科 / 自治医科大学血液科:自治医科大学輸血・細胞移植部 / 山梨大学医学部血液内科 / 自治医科大学血液科 / 自治医科大学血液科:自治医科大学輸血・細胞移植部 Department of Medicine, Division of Hematology, Jichi Medical School / Deparment of Medicine, Division of Hematology, Jichi Medical School:Division of Cell Transplantation and Transfusion, Jichi Medical School / Department of Medicine, Division of Hematology, Jichi Medical School:Division of Cell Transplantation and Transfusion, Jichi Medical School / Department of Medicine, Division of Hematology, Jichi Medical School / Department of Medicine, Division of Hematology, Jichi Medical School / Department of Medicine, Division of Hematology, Jichi Medical School / Department of Medicine, Division of Hematology, Yamanashi University / Department of Medicine, Division of Hematology, Jichi Medical School / Department of Medicine, Division of Hematology, Jichi Medical School:Division of Cell Transplantation and Transfusion, Jichi Medical School / Department of Medicine, Division of Hematology, Yamanashi University / Department of Medicine, Division of Hematology, Jichi Medical School / Department of Medicine, Division of Hematology, Jichi Medical School:Division of Cell Transplantation and Transfusion, Jichi Medical School 成人急性リンパ性白血病(acute lymphoblastic leukemia:ALL)は,強力な多剤併用化学療法によって寛解導入率は80-90%と高いものの,治療継続中の再発率も高く,長期生存率は35-40%と十分満足できる成績とは言えないのが現状である。現時点では,寛解例を早期に造血幹細胞移植へ移行していくことが,長期の無病生存率を向上させうる治療戦略であると期待されている。我々は,第一寛解を維持し,早期の造血幹細胞移植を施行することを目的とし,地固め療法としてHyper-CVAD/High dose-MTX-Ara-C療法(H-CVAD/HD-MA療法)を2000年以降に導入した。今回,当科での成人ALLに対する治療を後方視的に検討したところ,観察期間50ヶ月で無病生存率42.0%,全生存率85.0%と良好な成績が得られた。従って,H-CVAD/HD-MA療法は成人ALL治療において有用であると評価した。 We considered the outcome of adult acute lymphoblastic leukemia (ALL) patients treated with Hyper-CVAD (cyclophosphamide, vincristine, Adriamycin, and dexamethazone)/high dose MTX-Ara-C (methotrexate and cytarabine) as consolidation therapy. Between 1994 and 2004, twenty-seven ALL patients received standard induction therapy, and 23 achieved complete remission. Of the 23 patients, 12 were treated with Hyper-CVAD/high dose MTX-Ara-C (H-CVAD/HD-MA) regimen as consolidation therapy; of these patients, 7 (58%) underwent allogeneic stem cell transplantations. As a result, all but 1 of these 12 patients survived, especially 8 (67%) survived without the relapse of ALL. The other 11 patients who achieved CR were treated with other regimens. And three (27%) underwent allogeneic stem cell transplantations. Of these patients, 2 (18%) survived without relapse ; unfortunately, 6 (67%) died. The H-CVAD/HD-MA group produced better outcomes in both disease free survival (42.0% versus 12.0%, p=0.02) and overall survival (85.0% versus 24.0%, p=0.01) compared with the others. There were no significant differences in the treatment-related toxicity between the two groups. We concluded that H-CVAD/HD-MA regimen is beneficial and safe for ALL patients, and they give the patients to the chance of stem cell transplantation to the patients. 急性リンパ性白血病 / 地固め療法 / Hyper-CVAD/High dose-MTX-Ara-C療法

17-23 原著論文 Original Article ENG 　 潰瘍性大腸炎に対するHand-Assisted Laparoscopic Surgeryの有用性 Advantages of Hand-Assisted Laparoscopic Surgery for Ulcerative Colitis 堀江,久永 / 岡田,真樹 / 小島,正幸 / 鯉沼,広冶 / 永井,秀雄 / 小西,文雄 Horie,Hisanaga / Okada,Masaki / Kojima,Masayuki / Koinuma,Koji / Nagai,Hideo / Konishi,Fumio 自治医科大学消化器一般外科 / 自治医科大学消化器一般外科 / 自治医科大学消化器一般外科 / 自治医科大学消化器一般外科 / 自治医科大学消化器一般外科 / 自治医大大宮医療センター外科 Department of Surgery, Jichi Medical School / Department of Surgery, Jichi Medical School / Department of Surgery, Jichi Medical School / Department of Surgery, Jichi Medical School / Department of Surgery, Jichi Medical School / Department of Surgery, Jichi Medical School Omiya Medical Center 潰瘍性大腸炎に対するHand-Assisted Laparoscopic Surgery (HALS)の有用性を検討するため,1999年から2004年までに第一期目の手術にHALSにてtotal colectomyが施行された一連の潰瘍性大腸炎患者14例(HALS group)の手術時間,出血量,術後合併症などを1981年から1999年までに通常の開腹手術(conventional procedure)でtotal colectomyが施行された一連の潰瘍性大腸炎患者13例(CP group)のそれらとretrospectiveに比較した。年齢,性別,発症から手術までの罹患期間,プレドノゾロン(PSL)の総投与量,分割手術の方法について2群間に違いは認められなかった。手術時間は2群間で統計学的有意差は認められなかった。術中出血量はHALS群が有意に少なかった。HALSから開腹手術に移行した症例は1例であった。開腹移行の理由は,腹腔内脂肪が非常に多く左手を腹腔内に入れて操作をする際にworking spaceの確保が困難であったこと,炎症が漿膜まで強く及んでおり結腸が後腹膜に強固に癒着していたことであった。HALS群が有意に早く経口摂取が可能であった。術後の入院期間はHALS群が短い傾向が認められたが統計学的有意差は認められなかった。術後の合併症については,創感染と腸閉塞の発生率について2群で差は認められなかった。よって潰瘍性大腸炎手術に対するHALSは技術的困難性が比較的少なく,術後の消化管機能の回復も早いため,腹腔内脂肪が多量にある症例や,炎症が強く漿膜まで及んでいる症例を除けば,安全で適切な手術と考えられた。 To ascertain the advantages of hand-assisted laparoscopic surgery (HALS) for ulcerative colitis, the present retrospective study compared a series of 14 patients with ulcerative colitis who underwent total colectomy by HALS at the first stage operation during the period between 1999 and 2004 (HALS group) and a series of 13 patients who underwent total colectomy using the conventional procedure at the first stage operation (CP group). No significant differences existed between the two groups for age, gender, duration from onset to surgery, total prednisolone dose, staged surgery methods or operative time. However, volume of intraoperative bleeding was significantly lower for the HALS group than for the CP group. Conversion to open colectomy occurred in one HALS patient. This was because the amount of intra-abdominal fat was very large, resulting in the difficulty of securing a working space for the necessary intra-abdominal procedures using the left hand, and the inflamed serosal membrane had caused strong adhesion of the colon to the retroperitoneum. The length of time to initiate oral intake was significantly shorter for the HALS group than for the CP group. Duration of postoperative hospital stay tended to be shorter for the HALS group, however the difference was not significant. As far as postoperative complications were concerned, no significant intergroup differences were identified in the incidences of wound infection and bowel obstruction. These findings suggest that, except for patients with large amounts of intra-abdominal fat or severe serosal inflammation, HALS offers a safe and effective treatment for ulcerative colitis, as relatively few technical difficulties are present and postoperative recovery of bowel function is rapid. hand-assisted laparoscopic surgery / ulcerative colitis / total colectomy

25-35 原著論文 Original Article ENG 　 胃癌・大腸癌に対する吊り上げ式腹腔鏡補助下手術 : 地域病院での経験 Gasless laparoscopy-assisted surgery for gastric and colorectal cancer in a small rural hospital 俵藤,正信 / 笹沼,英紀 / 宇井,崇 / 尾本,和 / 千葉,英男 / 大平,猛 / 大塚,紳 / 熊野,秀俊 / 関口,忠司 / 永井,秀雄 Hyodo,Masanobu / Sasanuma,Hideki / Ui,Takashi / Omoto,Yawara / Chiba,Hideo / Ohdaira,Takeshi / Ohtsuka,Shin / Kumano,Hidetoshi / Sekiguchi,Chuuji / Nagai,Hideo 自治医科大学医学部 / 自治医科大学医学部 / 自治医科大学医学部 / 自治医科大学医学部 / 自治医科大学医学部 / 自治医科大学医学部 / 那須南病院外科:自治医科大学消化器一般外科 / 自治医科大学医学部 / 那須南病院外科 / 自治医科大学消化器一般外科 Department of Surgery, Jichi Medical School Hospital / Department of Surgery, Jichi Medical School Hospital / Department of Surgery, Jichi Medical School Hospital / Department of Surgery, Jichi Medical School / Department of Surgery, Jichi Medical School Hospital / Department of Surgery, Jichi Medical School Hospital / Department of Surgery, Nasu-Minami Hospital:Department of Surgery, Jichi Medical School Hospital / Department of Surgery, Jichi Masadichl School / Department of Surgery, Nasu-Minami Hospital / Department of Surgery, Jichi Medical School Hospital 那須南病院は,吊り上げ式腹腔鏡下胆嚢摘出術の経験をもとに吊り上げ式腹腔鏡補助下胃癌・大腸癌手術を1999年から開始した。早期胃癌に対し幽門側胃切除12例と胃部分切除2例,大腸癌に対し回盲部切除1例,右半結腸切除8例,横行結腸切除2例,左半結腸切除1例,S状結腸切除4例,前方切除2例,大腸全摘1例,結腸部分切除1例を施行した。癒着や出血による開腹移行は3例であった。術者の腹腔鏡補助下手術経験は少なかったが,出血量は少なく手術時間も短時聞で,重篤な術後合併症も認めなかった。胃癌症例は全例無再発生存,大腸癌症例では2例の再発を認めているが全例生存中である。吊り上げ式補助下胃・大腸切除術術は小開腹創が利用でき開腹手術に準じた手術法なので,鏡視下手術の経験の少ない外科医や施設でも可能であり,気腹による心肺合併症の心配もないので高齢者に対しても適していると思われる。また開腹手術用の器具が利用可能で経済的にも優れている。 The laparoscopic approach to gastric or colorectal cancer is recognized as an alternative to open surgery, but it is often difficult in small hospitals because of a lack of laparoscopic experience and facilities. Based on 10 years experience of gasless laparoscopic cholecystectomy, we began gasless laparoscopy-assisted surgery via mini-laparotomy for gastric and colorectal cancer in a small rural hospital, Nasu-Minami Hospital, from 1999. Twelve distal gastrectomies and 2 partial gastrectomies were performed for early gastric cancer. One iliocecal resection, 8 right hemicolectomies, 2 transverse colectomies, one left hemicolectomies, 4 sigmoidectomies, 2 anterior resections, one total colectomy, and one partial resection were performed for colorectal cancer without seroserous invasion. One case of gastrectomy and 2 cases of colectomy were converted to open surgery because of adhesion and bleeding. The surgeons were beginners in this operation, but had sufficient experience of open surgery and laparoscopic cholecystectomy. The perioperative course was satisfactory with a small amount of blood loss and a short operative time. The postoperative course was fair except for wound infections, which were dramatically improved by wound protector devices. All the patients survived, but two patients recurred in colon cancer group. The gasless laparoscopy-assisted approach is suitable for less experienced surgeons and hospitals because of its similarity to open surgery utilizing mini-laparotomy. It is gentle for patients because of reduced cardiopulmonary and other organs distress by pneumoperitoneum, and is economical because of reusable instruments which are used for open surgery. In conclusion, gasless laparoscopy-assisted surgery for gastric and colorectal cancer is feasible and useful as a minimally invasive operation. Gasless / laparoscopy / gastric / colorectal / cancer

37-42 原著論文 Original Article JPN 　 シベレスタットナトリウム水和物(Sivelestat sodium hydrate)の人工心肺後炎症反応および肺障害に対する効果 Effects of neutrophil elastase inhibitor (Sivelestat sodium hydrate) on Systemic Inflammatory Response and Acute Lung Injury in Cardiopulmonary Bypass 上西,祐一朗 / 相澤,啓 / 坂野,康人 / 大木,伸一 / 齊藤,力 / 加藤,盛人 / 小西,宏明 / 三澤,吉雄 Kaminishi,Yuichiro / Aizawa,Kei / Sakano,Yasuhito / Oki,Shin-ichi / Saito,Tsutomu / Kato,Morito / Konishi,Hiroaki / Misawa,Yoshio 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門 Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical School / Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical School / Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical School / Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical School / Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical School / Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical School / Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical School / Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical School 好中球エラスターゼ阻害剤であるシベレスタットナトリウムが人工心肺後の全身性炎症反応や肺障害を抑制しうるか検討した。待期的開心術13症例を無作為にシベレスタットナトリウム投与群と非投与群に分け,シベレスタットナトリウムは麻酔導入時から人工心肺開始後24時間まで0.2mg/kg/hrで持続静注した。患者背景で2群間に有意差はなく,血液ガス,好中球エラスターゼ,IL-8,TAT,PTF F1-2,D-dimer,PIC,トロポニンT,CPK-MBを計測したが,計測項目すべてにおいて麻酔導入時,集中治療室帰室時,術翌日いずれも2群間の有意差は認めなかった。投与量不足のためシベレスタットナトリウムが効果を発現するにいたらなかった可能性,あるいは待期手術の人工心肺が低侵襲である可能性が考えられた。術後炎症や肺障害が高率に予測される侵襲の大きな手術症例を対象に再検討する必要がある。 A serine protease, neutrophil elastase is a potent cytotoxic enzyme and plays a pivotal role in systemic inflammatory responses and acute lung injury associated with cardiopulmonary bypass. This study assesses the effects of the specific inhibition of neutrophil elastase by a potent neutrophil elastase inhibitor (Sivelestat sodium hydrate). We hypothesized that Sivelestat attenuates inflammatory, thrombotic, and fibrinolytic responses and reduces acute lung injury associated with cardiopulmonary bypass. Thirteen patients undergoing elective valvular heart surgery were divided into two groups : the Sivelestat group (n=6) ; Sivelestat was administered continuously (0.2mg/kg/h) before, during and after cardiopulmonary bypass (24 hours) ; and the control group (n=7) ; no drugs were used. As markers of systemic inflammation, thrombosis, fibrinolysis, and myocardial injury, neutrophil elastase, interleukin-8 (IL-8), thrombin-antithrombin complex (TAT), prothrombin fragment F1.2 (F1.2), D-dimer, α2-plasmin inhibitor-plasmin complex (PIC), troponin-T, creatine kinase (CK)-MB were measured at 3 points : anesthetic induction, termination of cardiopulmonary bypass, and 24 hours after starting cardiopulmonary bypass. The PaO_2/FiO_2 ratio (P/F ratio) was used to assess postoperative pulmonary function. All patients tolerated surgery without acute lung injury ; there were no significant differences between the two groups in any one of the measured parameters. The present study did not demonstrate significant reduction in systemic inflammatory response and acute lung injury associated with cardiopulmonary bypass in elective valvular heart surgery, and this lack of significant effect might come from the Sivelestat dosage or severity of the insult of the background disease or cardiopulmonary bypass. シベレスタットナトリウム水和物 / 全身性炎症反応 / 人工心肺 / Sivelestat sodium hydrate / Inflammatory Response / Cardiopulmonary bypass

43-49 原著論文 Original Article ENG 　 血液悪性腫瘍患者における歯性感染症に関する研究 : 白血病患者に対する根管治療の必要性について Odontogenic Infections and Septicemia in Immunocompromised Patients with Hematologic Malignancies : Assessment of the need for root canal treatment in patient with leukemia 小佐野,仁志 / 松本,浩一 / 星,健太郎 / 草間,幹夫 Osano,Hitoshi / Matumoto,Koichi / Hoshi,Kentaro / Kusama,Mikio 自治医科大学大宮医療センター歯科口腔外科:自治医科大学歯科口腔外科学講座 / 自治医科大学歯科口腔外科学講座 / 自治医科大学歯科口腔外科学講座 / 自治医科大学大宮医療センター歯科口腔外科:自治医科大学歯科口腔外科学講座 Department of Dentistry, Omiya Medical Center, Jichi Medical School:Department of Dentistry, Oral and Maxillofacial Surgery, Jichi Medical School / Department of Dentistry, Oral and Maxillofacial Surgery, Jichi Medical School / Department of Dentistry, Oral and Maxillofacial Surgery, Jichi Medical School / Department of Dentistry, Omiya Medical Center, Jichi Medical School:Department of Dentistry, Oral and Maxillofacial Surgery, Jichi Medical School 我々は,根尖性歯周炎が白血病の化学療法後に生じる骨髄機能の低下時に,生体にどのような影響を及ぼしたかをレトロスペクティブに調査し,化学療法前の根管治療の必要性について検討した。(結果)発熱の日数及び,好中球減少の日数は各々8.5日と7.3日と1週間を越え,やはり感染のリスクが高いことが明らかとなった。化学療法に先立ち根管治療を要した症例が1例あった。他の5例は症状はなく,全症例が化学療法前には症状が認められなかった。化学療法後の急性症状は,全症例で認められなかった。抗生剤は全例で,広範囲の抗菌力を有する薬剤が投与され,このことが急性炎症の発現を防止した一因と考えられた。(結論)自覚症状がない根尖性歯周炎は,抗菌スペクトラムの広い抗生物質の点滴静注を併用することで化学療法前に必ずしも治療しなくても重篤な感染症を発症しない可能性が示唆された。 Myelosuppressive chemotherapy for acute leukemia develop several oral infections. The purpose of this study is to evaluate possibility of systemic infection from apical periodontitis during treatment for acute leukemia. The subjects consisted of 6 patients with acute leukemia who had treated between January 1997 and October 1998 were reviewed retrospectively. This population included 5 male patients and a female patient ranging age from 37 to 64 years, of whom 5 chronic apical periodontitis and 1 acute transformation of chronic apical periodontitis. Several clinical criteria were used to determine whether infectious complications developing. The results were as follows : 1. The mean number of days that the patients had a temperture greater than 37.5℃ and had leukocyte counts were less than 1000/μl were 8.5 days. 2. The mean number of days that the patients had a neutrophil counts less than 500/μl were 7.3 days. 3. No patient revealed odontogeneic acute reaction after the chemotherapy. 4. All patients were administered several antibiotics which possess wide range of antibacterial activity. Taken together, these results suggest that asymptomatic apical periodontitis does not increase the incidence of infectious complication during antileukemic chemotherapy with the administration of antibiotics which possess wide range of antibacterial activity.

51-62 原著論文 Original Article JPN 　 軽度高脂血症,軽度耐糖能障害を伴った狭心症患者のテスト食前後の血管内皮機能,血液流動性および,それに対するEPA(エイコサペントエン酸エチル)の効果の検討 Effects of eicosapentaenoic acid (EPA) on hemorheological behavior and endothelial function during postprandial hyperlipidemia and hyperglycemia in patients with stable effort angina pectoris 梅本,富士 / 安,隆則 / 荒尾,憲司郎 / 石田,岳史 / 池田,奈保子 / 久保,典史 / 黒木,昌寿 / 斎藤,宗靖 / 川上,正舒 Umemoto,Tomio / Yasu,Takanori / Arao,Kenshirou / Ishida,Takeshi / Ikeda,Nahoko / Kubo,Norifumi / Kuroki,Masatoshi / Saitou,Muneyasu / Kawakami,Masanobu 自治医科大学付属大宮医療センター総合診療科I / 自治医科大学付属大宮医療センター総合診療科I / 自治医科大学付属大宮医療センター総合診療科I / 自治医科大学付属大宮医療センター総合診療科I / 自治医科大学付属大宮医療センター総合診療科I / 自治医科大学付属大宮医療センター総合診療科I / 自治医科大学付属大宮医療センター総合診療科I / 自治医科大学付属大宮医療センター総合診療科I / 自治医科大学付属大宮医療センター総合診療科I Department of Internal Medicine I, Omiya Medical Center, Jichi Medical School / Department of Internal Medicine I, Omiya Medical Center, Jichi Medical School / Department of Internal Medicine I, Omiya Medical Center, Jichi Medical School / Department of Internal Medicine I, Omiya Medical Center, Jichi Medical School / Department of Internal Medicine I, Omiya Medical Center, Jichi Medical School / Department of Internal Medicine I, Omiya Medical Center, Jichi Medical School / Department of Internal Medicine I, Omiya Medical Center, Jichi Medical School / Department of Internal Medicine I, Omiya Medical Center, Jichi Medical School / Department of Internal Medicine I, Omiya Medical Center, Jichi Medical School 食事摂取が血管内皮機能と血液流動性に与える影響と,それらに対するエイコサペンタエン酸エチル(EPA)の効果を検討した。対象は労作性狭心症13例と正常対照群の男性6例で,テスト食(脂肪40g,680kcal)摂取前,摂取二時間後に血糖・脂質値,血管内皮機能(上腕阻血後反応性充血時前腕血流量),Microchannel array flow analyzerによる全血通過時間を測定した。その後疾患群にEPA1800mg/日を投与し,二日後,六ヶ月後に上記測定を再施行した。結果は,血管内皮機能,全血通過時間ともテスト食による影響を受けなかった。疾患群では食前後とも血管内皮機能は有意に低下していたが,全血通過時間は差異を認めなかった。EPAの内服は,血管内皮機能,血液流動性両者に影響を与えなかった。 Postprandial hyperlipidemia and hyperglycemia have been reported to lead to coronary atherosclerosis via endothelial dysfunction. Hemorheological deterioration is also an atherogenic factor. We examined the short-term and long-term effect of EPA on endothelial function and hemor-heological behavior before and after a single test meal in patients with stable effort angina pectoris (AP). Thirteen patients with AP (66±7years) who met the criteria of fasting plasma glucose<126mg/dl, HbAlc<6.5%, fasting TG<250mg/dl, and LDL<200mg/dl and six normal control subjects (53±8 years, men) were studied. We measured forearm blood flow (FBF) by strain-gauge plethysmography during reactive hyperemia, whole blood transit time (WBTT) using a microchannel array flow analyzer, and plasma levels of glucose, insulin and lipids before and 2 hours after a single test meal (680 Cal, 40g fat). All the measurement protocol was repeated two days and six months after administration of EPA (1800mg/day). In the results, four patients dropped out because of onset of unstable angina or coronary artery bypass graft operation or abdominal discomfort, and one patient stopped taking EPA during the treatment. Both groups showed no significant abnormality in fasting glucose and lipids. In the AP group, total cholesterol, LDL-cholesterol, triglycerides and fibrinogen were higher than in the control, both before and after the meal, whereas blood glucose and insulin were higher in the AP group only after the meal. FBF in the AP group was significantly lower than in the control both before and after the meal. WBTT showed no significant difference between the two groups. EPA treatment did not improve lipid and glucose profiles. EPA did not change FBF or WBTT. In summary, our test meal did not affect endothelial function and hemorheological behavior both in the healthy subjects and the AP patients and EPA did not show any effect on these parameters even after 6 months' administration. 血管内皮機能 / 血液レオロジー / 食事負荷 / エイコサペンタエン酸エチル / Endothelial function / Blood rheology / Fat diet / Eicosapentaenoic acid

63-70 原著論文 Original Article ENG 　 内視鏡的痔核結紮硬化療法の有用性 Endoscopic hemorrhoidal ligation and sclerotherapy without anesthesia : Report of an initial experience 瑞木,亨 / 俵藤,正信 / 近藤,泰雄 / 志村,国彦 / 永井,秀雄 Zuiki,Toru / Hyodo,Masanobu / Kondo,Yasuo / Shimura,Kunihiko / Nagai,Hideo 猿島赤十字病院外科:自治医科大学消化器一般外科 / 自治医科大学消化器一般外科 / 猿島赤十字病院外科:自治医科大学消化器一般外科 / 猿島赤十字病院外科:自治医科大学消化器一般外科 / 自治医科大学消化器一般外科 Department of Surgery, Sashima Red-Cross Hospital:Department of Surgery, Jichi Medical School Hospital / Department of Surgery, Jichi Medical School Hospital / Department of Surgery, Sashima Red-Cross Hospital:Department of Surgery, Jichi Medical School Hospital / Department of Surgery, Sashima Red-Cross Hospital:Department of Surgery, Jichi Medical School Hospital / Department of Surgery, Jichi Medical School Hospital 痔核手術の疼痛軽減・麻酔副作用の回避・在院日数短縮を目的に内視鏡的痔核結紮硬化療法(EHLS)を導入した。今回その有効性について従来行なってきた外科的痔核治療と比較し検討した。検討項目は手術時間,在院日数,麻酔合併症を含めた術後合併症の頻度,術後疼痛の程度,アンケートによる患者の満足度である。従来の外科的痔核治療は,痔核結紮切離法7例・ゴム結紮法9例・レーザー治療5例でいずれも麻酔下で施行されており,この21例を"他治療"群とした。EHLSは23例に計27回施行されていた。EHLS群と"他治療"群の患者背景に差は認めなかった。手術時間と在院日数はEHLS群で有意に短かった。麻酔合併症を含めた術後合併症頻度はEHLS群で有意に少なく,術後疼痛の程度もEHLS群で有意に軽度であった。アンケートによる患者の満足度調査では両群とも十分な満足度が得られていた。麻酔を必要としない内視鏡的痔核結紮硬化療法(EHLS)は,低侵襲でありコスト面でも優れ,また患者満足度も高く有用な外科的痔核治療であると考えられた。 We introduced endoscopic hemorrhoidal ligation and sclerotherapy (EHLS) without anesthesia to relieve postoperative anal pain of conventional methods and to avoid adverse effects of anesthesia, shortening the postoperative hospital stay. We evaluated its effectiveness and usefulness compared with other surgical hemorrhoidal treatments under anesthesia, in terms of operative time, hospital stay, incidence of postoperative complications, and severity of anal pain. Postoperative satisfaction was also investigated using questionnaires. Twenty-one patients were treated with ligation-excision (7 cases), rubber band ligation (9 cases), and laser therapy (5 cases), which were all together designated as "other operations" group. Twenty-three patients underwent EHLS 27times. There were no significant differences in the backgrounds between EHLS and "other operations" groups. The operative time and hospital stay in EHLS were significantly shorter than those of "other operations". The incidence of postoperative complications including anesthetic sequelae was higher in the "other operations" group. Postoperative anal pain after EHLS was much slighter than after other operations. Patients in both groups were satisfied with their postoperative situation. In conclusion, EHLS without anesthesia seems to be a beneficial treatment for internal hemorrhoids in terms of low invasiveness and patients' satisfaction similar to the conventional surgery. Hemorrhoid / Anesthesia / Endoscopic hemorrhoidal ligation and sclerotherapy (EHLS)

71-76 症例報告 Case Report ENG 　 早期に進行した母体Anti-Ro/SSA抗体陰性の先天性房室ブロックの1例 Rapid progression of congenital heart block with negative maternal anti-Ro/SSA antibody 齋藤,真理 / 白石,裕比湖 / 保科,優 / 飯野,真由 / 市橋,光 / 桃井,真里子 / 高橋,英樹 / 上西,裕一郎 / 加藤,盛人 Saito,Mari / Siraishi,Hirohiko / Hoshina,Masaru / Iino,Mayu / Ichihashi,Ko / Momoi,Mariko Y. / Takahashi,Hideki / Kaminishi,Yuichiro / Kato,Masato 自治医科大学小児科 / 自治医科大学小児科 / 自治医科大学小児科 / 自治医科大学小児科 / 自治医科大学小児科 / 自治医科大学小児科 / 自治医科大学小児科 / 自治医科大学小児科 / 自治医科大学小児科 Department of Pediatrics, Jichi Medical School / Department of Pediatrics, Jichi Medical School / Department of Pediatrics, Jichi Medical School / Department of Pediatrics, Jichi Medical School / Department of Pediatrics, Jichi Medical School / Department of Pediatrics, Jichi Medical School / Department of Pediatrics, Jichi Medical School / Department of Pediatrics, Jichi Medical School / Department of Pediatrics, Jichi Medical School 4か月間に完全房室ブロックに至った先天性房室ブロックの児を経験した。一般に母体anti-Ro/SSA抗体陽性の先天性房室ブロックの児は,完全房室ブロックへ進行する率が高く,また完全房室ブロックへの進行が早いと報告されているが,本児では Anti-Ro/SSA抗体は母児とも陰性だった。Anti-Ro/SSA抗体陰性の先天性房室ブロックでも,早期に完全房室ブロックに進行する例があり,頻回の電気生理学的な評価が必要と考えられた。 Severe congenital heart block is strongly associated with maternal anti-Ro/SSA antibody. However, we experienced an infant with negative maternal anti-Ro/SSA antibody who had showed progression of severe congenital heart block. A 2-month-old infant with 2 : 1 second-degree heart block progressed to 4 : 1 heart block within a month. At 6 months of age, he was administrated to our hospital because of frequent vomiting and loss of body weight. His ECG showed complete heart block. A VVI pacemaker was implanted under the diagnosis of severe heart failure due to congenital complete heart block. During a one-year follow-up, he has been free from cardiac events. Frequent electrophysiologic examinations are mandatory for an infant with progressive heart block. atrioventricular block / infant / a pacemaker implantation

77-82 症例報告 Case Report JPN 　 手術術式選択に苦慮した,進行直腸癌に合併した後腹膜脂肪肉腫の1例 A CASE OF RETROPERITONEAL LIPOSARCOMA WITH ADVANCED RECTAL CANCER 伊澤,祥光 / 堀江,久永 / 岡田,真樹 / 瑞木,亨 / 安田,是和 / 永井,秀雄 IZAWA,Yoshimitsu / HORIE,Hisanaga / OKADA,Masaki / ZUIKI,Tohru / NAGAI,Hideo 自治医科大学消化器一般外科 / 自治医科大学消化器一般外科 / 自治医科大学消化器一般外科 / 自治医科大学消化器一般外科 / 自治医科大学消化器一般外科 / 自治医科大学消化器一般外科 Department of Surgery, Jichi Medical School Hospital / Department of Surgery, Jichi Medical School Hospital / Department of Surgery, Jichi Medical School Hospital / Department of Surgery, Jichi Medical School Hospital / Department of Surgery, Jichi Medical School Hospital / Department of Surgery, Jichi Medical School Hospital 今回我々は手術術式選択に苦慮した,進行直腸癌に合併した後腹膜脂肪肉腫症例を経験した。症例は64歳,男性。進行直腸癌と診断され当科入院となり,腹部造影CT,MRI検査で左後腹膜に長径20cmの脂肪肉腫の合併が認められた。後腹膜脂肪肉腫は局所再発率が高いため,周囲臓器を含めた完全切除が必要であるが,他臓器癌との合併では,癌の予後と脂肪肉腫の予後とを考慮した手術術式の選択が必要である。本症例では,予後規定因子は進行直腸癌と考え,後腹膜腫瘍は切除しない方針で手術に臨んだ。しかし,術中,後腹膜腫瘍の存在が低位前方切除術の障害と判断され,切除を余儀なくされた。後腹膜腫瘍の境界は明瞭であった。精巣動静脈のみ腫瘍に癒着していたため合併切除した。病理診断は高分化型脂肪肉腫であった。直腸癌は2型の高分化型腺癌でstage III aであった。術後1年6ヶ月の現在,両腫瘍の再発は認めていない。 We experienced a case of retroperitoneal liposarcoma with an advanced rectal cancer. A 64-year-old male was admitted to our hospital diagnosed with an advanced rectal cancer. Abdominal enhanced CT was performed for screening of metastasis, and a 20cm low density tumor in the left retroperitoneal space was detected. The tumor was diagnosed to be retroperitoneal liposarcoma by the CT and MRI, because the density and intensity of the tumor was the same as fat. The treatment of retroperitoneal liposarcoma requires complete resection with adjacent organs, because of its high local recurrence rate. But, it was not clear that wide resection of the retroperitoneal tumor with adjacent organs was suitable for the case with advanced rectal cancer. Therefore, we planned curative surgery (low anterior resection) for the advanced rectal cancer but no resection of the retroperitoneal tumor, because the advanced rectal cancer would mostly influence the prognosis of this case. However, we were forced to excise the retroperitoneal tumor, disturbing the low anterior resection. The retroperitoneal tumor was well circumscribed, and the left seminal vessels adhered to the tumor. The left seminal vessels were excised with the tumor without the resection of any other adjacent organs. The pathological diagnosis of the retroperitoneal tumor was well differentiated liposarcoma. The rectal cancer was type 2 and well differentiated adenocarcinoma, and its clinical stage was III a. There has been no recurrence of liposarcoma and rectal cancer 18 months after the surgical operation. 後腹膜脂肪肉腫 / 進行癌 / 直腸癌

83-87 症例報告 Case Report ENG 　 冠状動脈バイパス術中に大動脈近位側自動吻合器 : (PAS-Port proximal anastomosis system)不具合の1例 Misdeployment of a staple in the PAS-Port proximal anastomosis system : Report of a case 齊藤,力 / 三澤,吉雄 / 相澤,啓 / 小西,宏明 / 大木,伸一 / 上西,祐一朗 / 坂野,康人 / 加藤,盛人 / 田口,昌延 / 篠原,貴子 / 布施,勝生 Saito,Tsutomu / Misawa,Yoshio / Aizawa,Kei / Konishi,Hiroaki / Oki,Shin-ichi / Kaminishi,Yuichiro / Sakano,Yasuhito / Kato,Morito / Taguchi,Masanobu / Shinohara,Takako / Fuse,Katsuo 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門 Division of Cardiovascular Surgery, Jichi Medical School / Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical School / Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical School / Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical School / Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical School / Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical School / Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical School / Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical School / Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical School / Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical School / Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical School 症例は74歳の男性,心筋梗塞後不安定狭心症で冠状動脈バイパス術を施行した。術前より肺高血圧を合併していたため体外循環使用心拍動下手術を行った。術野からのechoは行わなかったが,術前胸部単純CT検査や術中経食道超音波検査では明らかな大動脈病変を認めなかった。術中,大動脈近位側自動吻合器(PAS-Port proximal anastomosis system)を使用したところ,9枚のouter flangeのうちひとつが開放しない状態となった。吻合部位からの出血は認めなかったが,吻合部を6-0 polypropylene糸結節にて8針補強した。経過中本件に関連する有害事象は出現しなかった。術後78日目に術後造影検査を行ったが特に吻合部には狭窄などの所見は認められなかった。技術の進歩に伴い自動吻合器などを臨床使用する機会が増加しているが,不具合が不意に発生した場合,その事態への対応を考慮しておく必要があることを常に認識しておかねばならない。 We report a case of 74-year-old man who underwent coronary artery bypass grafting utilizing the PAS-Port proximal anastomosis system. Misdeployment of a staple occurred at the proximal anastomosis; one of the nine outer flanges was invaginated in the aortotomy and partially opened. There was no bleeding at the anastomosis site, so a 6-0 polypropylene monofilament interrupted suture was applied to ensure an encircular stitch for reinforcement of the anastomosis. Postoperative angiography showed no adverse findings at the anastomosis. Though we concluded that this misdeployment did not place the patient at additional risk, we need to take notice using new devices and consider rescue methods in situations arising from technical mistakes. coronary artery bypass grafting / PAS-Port proximal anastomosis system / misdeployment / proximal anastomosis

89-93 症例報告 Case Report JPN 　 下直筋後転鼻側水平移動を行った外傷性滑車神経麻痺の1例 Nasal transposition and recession of the inferior rectus muscle to treat traumatic trochlear palsy 牧野,伸二 / 木野内,理恵子 / 保沢,こずえ / 近藤,玲子 / 川崎,知子 / 坂庭,敦子 / 杉山,華江 / 平林,里恵 Makino,Shinji / Kinouchi,Rieko / Hozawa,Kozue / Kondo,Reiko / Kawasaki,Tomoko / Sakaniwa,Atsuko / Sugiyama,Hanae / Hirabayashi,Rie 自治医科大学眼科学教室 / 自治医科大学眼科学教室 / 自治医科大学眼科学教室 / 自治医科大学眼科学教室 / 自治医科大学眼科学教室 / 自治医科大学眼科学教室 / 自治医科大学眼科学教室 / 自治医科大学眼科学教室 Department of Ophthalmology, Jichi Medical School / Department of Ophthalmology, Jichi Medical School / Department of Ophthalmology, Jichi Medical School / Department of Ophthalmology, Jichi Medical School / Department of Ophthalmology, Jichi Medical School / Department of Ophthalmology, Jichi Medical School / Department of Ophthalmology, Jichi Medical School / Department of Ophthalmology, Jichi Medical School 外傷性滑車神経麻痺に対して下直筋後転鼻側水平移動術を施行した。症例は交通外傷によるくも膜下出血の既往のある76歳の女性。回旋偏位は第一眼位で外方回旋12°と大きく,それによる回旋複視を訴えていた。非患眼である右眼の下直筋後転術と鼻側に一筋幅水平移動を行った。術後,回旋偏位は消失し,自覚症状も改善した。本術式は手技も比較的容易で,回旋斜視に対する第一選択術式として有用であった。 A 76-year-old woman with traumatic trochlear palsy complained of torsional diplopia in the left eye due to 12 degrees of excyclotropia in primary position. Nasal transposition of one muscle width combined with recession of the inferior rectus muscle was performed in the right eye. The excylotropia in primary position resolved completely, and the torsional diplopia improved remarkably postoperatively. Nasal transposition and recession of the inferior rectus muscle was easy and effective for the treatment of torsional strabismus. 滑車神経麻痺 / 回旋斜視 / 垂直筋水平移動術 Trochlear palsy / Torsional strabismus / Horizontal transposition of the vertical muscle

95-100 症例報告 Case Report ENG 　 症例報告 : 強皮症,腹臥位と難治性低血圧 Scleroderma, The Prone Position and Profound Hypotension : A Case Report 宮之原,利男 / 瀬尾,憲正 / Waechter,Jason Miyanohara,Tishio / Seo,Norimasa / Waechter,Jason 自治医科大学麻酔科学・集中治療医学講座 / 自治医科大学麻酔科学・集中治療医学講座 / 自治医科大学麻酔科学・集中治療医学講座 Department of Anesthesiology and Critical Care Medicine, Jichi Medical School / Department of Anesthesiology and Critical Care Medicine, Jichi Medical School / Department of Anesthesiology and Critical Care Medicine, Jichi Medical School 目的:全身性硬化症(強皮症)の患者において高度の低血圧をきたした症例を報告する。臨床経過:59歳,男性。全身性硬化症による下肢の虚血性病変に対し,骨髄よりの単球分離採取術が予定された。循環器系及び呼吸器系の合併症を有しており,経口プロスタサイクリンを内服中であった。プロポフォールで導入後,腹臥位にて手術を行った。腹臥位中,難治性の低血圧が発生した。手術終了後,仰臥位に戻すと血圧は回復した。結論:本症例は低血圧の診断及び低血圧の原因の発見が共に遅れる結果となった。本症例の低血圧の原因としては,全身性硬化症による血管収縮による血管床減少状態に麻酔薬による血管拡張と腹臥位での下大静脈の圧迫による静脈還流の低下が最も考えられた。全身性硬化症患者の麻酔においては,血管収縮により循環血液量が減少していることを考慮して十分な補液後に慎重な体位変換が必要であると考えられた。 Purpose : This case report describes a case of profound hypotension in a patient with a diagnosis of systemic sclerosis (scleroderma). Clinical Features : A 59 year old Japanese diagnosed with scleroderma was scheduled for self bone marrow harvest and monocyte plantation to the affected skin in his hands. The patient suffered from cardiovascular and respiratory comorbidities and was taking oral prostacyclin. The hypotension correlated with the onset and offset of the prone position during the anesthesia. Conclusions : This case is an example of profound hypotension of a patient with a diagnosis of scleroderma in the prone position. The diagnoses of both hypotension and the cause of hypotension were delayed. The etiology of the patient's hypotension was thought to be mostly caused by reduced venous return to the heart due to relative hypovolemia by vasospastic phenomena with scleroderma and improper positioning leading to IVC compression in the prone position. This case indicates that preoperative adequate volume replacement and proper positioning are imperative to maintain the circulatory status during anesthesia in the prone position for a patient diagnosed as scleroderma. 低血圧 / 合併症 / 麻酔 / 強皮症 / 腹臥位 / hypotension / complication / anesthesia / scleroderma / prone position

101-107 症例報告 Case Report JPN 　 統合失調症により,治療中に精神療法的関与を必要とした舌癌の1例 A case of tongue cancer requiring psychiatric therapy for schizophrenia 松本,浩一 / 小佐野,仁志 / 松村,俊男 / 岩田,和彦 / 岡崎,翼 / 岡島,美朗 / 阿部,隆明 / 丹波,嘉一郎 / 草間,幹夫 Matsumoto,Koichi / Osano,Hitoshi / Matsumura,Toshio / Iwata,Kazuhiko / Okazaki,Tsubasa / Okajima,Yoshio / Abe,Takaaki / Tanba,Kaichiro / Kusama,Mikio 自治医科大学歯科口腔外科学講座 / 自治医科大学歯科口腔外科学講座 / 自治医科大学歯科口腔外科学講座 / 自治医科大学精神医学講座 / 自治医科大学精神医学講座 / 自治医科大学精神医学講座 / 自治医科大学精神医学講座 / 自治医科大学総合診療部 / 自治医科大学歯科口腔外科学講座 Department of Dentistry, Oral and Maxillofacial Surgery, Jichi Medical School / Department of Dentistry, Oral and Maxillofacial Surgery, Jichi Medical School / Department of Dentistry, Oral and Maxillofacial Surgery, Jichi Medical School / Department of Psychiatry, Jichi Medical School / Department of Psychiatry, Jichi Medical School / Department of Psychiatry, Jichi Medical School / Department of Psychiatry, Jichi Medical School / Division of General Practice Center for Community Medicine, Jichi Medical School / Department of Dentistry, Oral and Maxillofacial Surgery, Jichi Medical School 統合失調症を有する舌癌の治療にあたり精神医学的アプローチを必要とした1例を経験した。患者:34歳男性。主訴:舌の疼痛。病理組織学的診断:舌扁平上皮癌。12月4日一般病棟の個室に入院。入院下に癌の告知を行い,本人が希望する治療法を選択した。最終的に手術療法が必要になる旨も伝えた上で化学療法2クール施行したところ,腫瘍の大きさは縮小,中心部に硬結を残すのみとなった。本人の承諾が得られたので,全身麻酔下で舌部分切除術を施行した。術後の舌の変形は軽度で運動障害はなく,構音障害,摂食障害とも認めていない。告知前後と手術前は,特に陽性症状(幻覚,妄想)が多くみられた。また,入院期間全体を通じて不眠症状を認めた。いずれの症状も抗精神薬の追加により対処可能だった。初回手術9ヵ月後にオトガイ下リンパ節に後発転移を認め,右側頸部郭清術および術後放射線外照射を施行した。術後の経過は良好で再発は認めていない。 We present the experience of treatment of a patient with tongue cancer who required psychiatric therapy for schizophrenic symptoms. The patient was a 34-year-old male who first visited our hospital in November 2003, with the chief complaint of pain in the tongue. The histopathological diagnosis was squamous cell carcinoma. He was admitted to a private room of the general ward in December 2003. During the hospitalization, he was told of the diagnosis of cancer. He was notified of the cancer after hospitalization. We presented him with options for therapeutic methods and allowed him to select the treatment. After he was told that ultimately surgery would be necessary, two courses of chemotherapy were administered. The tumor diminished in size and an induration remained only in its central region. After informed consent had been obtained, we performed partial resection of the tongue under general anesthesia. Postoperatively the tongue showed slight deformation but no movement disorder. Neither dysarthria nor eating disorder was evident. Symptoms positive for schizophrenia were often noticed, particularly around the time when the cancer was disclosed and during the immediate preoperative period. He also showed symptoms of insomnia throughout the hospitalization period. All these symptoms were satisfactorily dealt with by administering increasing dosages of psychotropic drugs. Nine months after the initial operation, postoperative metastasis was found in the submental lymph nodes. Right neck dissection was performed and postoperative external irradiation was administered. Postoperatively he has been in very good condition and has shown no recurrence. 統合失調症 / 舌癌 / 機能温存手術 / Schizophrenia / Oral cancer / Conservative operation

109-115 症例報告 Case Report ENG 　 皮膚基底細胞癌肝転移の1切除例 Hepatic metastasis by a facial basal cell carcinoma of the skin 温井,剛史 / 遠山,信幸 / 宮崎,国久 / 住永,佳久 / 山田,茂樹 / 小西,文雄 Nukui,Takefumi / Toyama,Nobuyuki / Miyazaki,Kunihisa / Suminaga,Yoshihisa / Yamada,Shigeki / Konishi,Fumio 自治医科大学附属大宮医療センター外科 / 自治医科大学附属大宮医療センター外科 / 自治医科大学附属大宮医療センター外科 / 自治医科大学附属大宮医療センター外科 / 自治医科大学附属大宮医療センター病理 / 自治医科大学附属大宮医療センター外科 Department of Surgery, Jichi Medical School, Omiya Medical Center / Department of Surgery, Jichi Medical School, Omiya Medical Center / Department of Surgery, Jichi Medical School, Omiya Medical Center / Department of Surgery, Jichi Medical School, Omiya Medical Center / Department of Pathology, Jichi Medical School, Omiya Medical Center / Department of Surgery, Jichi Medical School, Omiya Medical Center 症例は77歳男性。76歳時に局所再発及び左頸部リンパ節転移に対し切除術,皮弁形成術を行った。病理所見は基底細胞類似の組織中に,角化を伴う扁平上皮癌の像を認め基底細胞癌と診断された。その後77歳時に眩暈,嘔気がありジギタリス中毒の診断にて当院入院となる。その際に施行した腹部CTにて肝S7に3cm大のbull's eye lesionを呈する腫瘤を指摘された。肝生検所見を前医皮膚標本と比較したところ基底細胞癌肝転移と診断され外科転科となり肝部分切除を施行した。病理診断では腫瘍は内部が高度壊死を呈しbasalloid,扁平上皮癌への分化を示し基底細胞癌の肝転移であった。患者は肝部分切除後11ヶ月目にBCC多発肝転移のために亡くなっている。基底細胞癌は顔面に好発し局所侵襲性は強いが転移はまれとされている。 A patient with basal cell carcinoma who had undergone surgical resection of the primary lesion was discovered to have a liver metastasis. Complete resection of the primary lesion and lymphadenectomy had been performed nine years previously, and the liver tumor was an incidental finding doing hospitalization for digitalis intoxication. The needle-biopsy specimen of the liver revealed basaloid carcinoma, and partial liver resection was perfomed. Eleven months postoperatively multiple liver metastases were detected, and the patient died at another hospital of wide-spread liver metastasis. To our knowledge, basal cell carcinoma mainly develops in the skin of the faciel and tends to exhibit extensive local invasion. Hematogenous metastasis, however, is rarely seen in this type of skin cancer. 皮膚基底細胞癌 / 肝転移 Basal cell carcinoma / liver metastasis

117-123 症例報告 Case Report ENG 　 嚢胞性膵腫瘍と鑑別困難であったforegut cystの一例 A foregut cyst mimicking a cystic pancreatic tumor-report of a case 飯島,裕生 / 野田,弘志 / 住永,佳久 / 兵頭,隆史 / 山田,茂樹 / 小西,文雄 Iijima,Yuki / Noda,Hiroshi / Suminaga,Yoshihisa / Hyodo,Takashi / Yamada,Shigeki / Konishi,Fumio 自治医科大学付属大宮医療センター外科 / 自治医科大学付属大宮医療センター外科 / 自治医科大学付属大宮医療センター外科 / 自治医科大学付属大宮医療センター病理 / 自治医科大学付属大宮医療センター病理 / 自治医科大学付属大宮医療センター外科 Department of Surgery, Omiya Medical Center, Jichi Medical School / Department of Surgery, Omiya Medical Center, Jichi Medical School / Department of Surgery, Omiya Medical Center, Jichi Medical School / Department of Pathology, Omiya Medical Center, Jichi Medical School / Department of Pathology, Omiya Medical Center, Jichi Medical School / Department of Surgery, Omiya Medical Center, Jichi Medical School 術前診断に苦慮したforegut cystの1例を経験したので文献的考察を加えて報告する。症例は30歳の女性,主訴は左側腹部鈍痛であった。腹部超音波,CT検査,超音波内視鏡では膵尾部と連続する辺縁明瞭な腫瘤が存在し,内部はcystic partとsolid partの混在が認められた。また,血液検査ではCA19-9の上昇がみられた。ERCPでは膵管に拡張はなく嚢胞との交通も認めなかった。以上より膵臓原発のsolid and pseudopapillary tumorを第一に考え,開腹手術を行った。術中所見で腫瘍は膵尾部とは連続性がなく腹腔内腫瘍として腫瘍摘出術を行った。術後の病理組織診断はforegut cystであった。また,病理組織ではCA19-9染色で重層扁平上皮,気管支上皮,嚢胞内容物に陽性所見が認められた。腹腔内にみられるforegut cystは極めて稀であるが,鑑別診断として挙げる必要があると考えられる。 We reported a rare case of foregut cyst with bronchial and small bowel ephithelium. In this case there was a difficulty in differentiating from pancreatic tumor. The patient was a 30 year-old female with a complaint of left abdominal pain. Abdominal ultrasonography, CT scan and endoscopic ultrasonography revealed a tumor that was located in the body and the tail of the pancreas. And solid parts and cystic parts were present within the tumor. The elevation of serum CA19-9 level was observed. Endoscopic retrograde cholangio-pancreatography did not show abnormalities in the pancreatic duct. With the findings of the imaging examinations stated above, firstly, solid-pseudopapillary tumor of the pancreas was suspected. Therefore, we performed laparotomy, but there was no continuity between the tumor and the pancreas. And the resection of the tumor was carried out without difficulties. Histological examination of the resected specimen revealed both bronchial and small bowel epithelium, in the absence of ectodermal structures. The diagnosis was a foregut cyst, which is a type of benign developmental anomalies arising in the primitive foregut. Immunohistochemical staining of CA19-9 showed a positive staining in the stratified squamous epithelium, bronchial epithelium and the fluid within the cystic structures. Cystic developmental anomalies of the foregut are mostly seen cranial to the diaphragm, and it is rare to see such anomalous cystic lesions caudal to the diaphragm. In conclusion, although foregut cyst of the location in this case is rare, it should be considered as one of the differential diagnosis of the retroperitoneal organs including pancreas. foregut cyst / CA19-9 / retroperitoneum

125-132 症例報告 Case Report ENG 　 肉腫型悪性腹膜中皮腫の1例 Sarcomatous malignant mesothelioma of the peritoneum : A case report 溝上,賢 / 宮崎,国久 / 首藤,介伸 / 能城,毅 Mizokami,Ken / Miyazaki,Kunihisa / Shuto,Yukinobu / Nojo,Takeshi 自治医科大学付属大宮医療センター外科 / 自治医科大学付属大宮医療センター外科 / 自治医科大学付属大宮医療センター外科 / 東京北社会保険病院放射線科 Department of Surgery, Jichi Medical School Omiya Medical Center / Department of Surgery, Jichi Medical School Omiya Medical Center / Department of Surgery, Jichi Medical School Omiya Medical Center / Department of Radiology, Tokyo Kita Social Insurance Hospital 悪性腹膜中皮腫はまれな疾患であり,予後不良とされる。我々は肉腫型悪性腹膜中皮腫の1例を経験したので報告する。症例は72歳女性,下腹部痛のため入院。発症前に既往疾患はなく,身体所見では腹水が示唆された。CTとMRIで腹水を認め,術前診断としては消化器癌による癌性腹膜炎を疑ったが,内視鏡検査では原発巣となるものは認められず,腹水細胞診でも診断に至らなかった。腹腔鏡検査が行われ,原発不明な進行した腹膜播種を認めた。腹膜全体に数ミリから3センチ大の結節が多数存在し,結節の一部を採取し終了した。腹膜結節の病理診断は,肉腫型の悪性腹膜中皮腫であった。腹腔鏡から4週間後に患者は呼吸不全で死亡した。本症例のように悪性腹膜中皮腫は診断に難渋することが多い。また,肉腫型の悪性腹膜中皮腫は予後不良とされており,我が国では20例を超える報告がなされている。 Malignant mesothelioma of the peritoneum is an uncommon and fatal disease. We report here a case of diffuse sarcomatous malignant mesothelioma of the peritoneum. A 72-year-old woman was admitted to our hospital because of lower abdominal pain. Results of the physical examination suggested massive ascites, and she had no history of any other illness preceding the onset of distention. Computed tomography scan and magnetic resonance imaging confirmed gross ascites. The preoperative diagnosis was peritonitis carcinomatosis probably due to gastrointestinal carcinoma, however endoscopic examinations and fine needle aspiration cytology failed to identify the cause of the condition. The patient was scheduled for diagnostic laparoscopy. A laparoscopic examination revealed extensive intraperitoneal dissemination of a malignant neoplasm without a recognizable primary site. During observation, multiple nodules from several millimeters to 3 cm in diameter were found throughout the peritoneum. Laparoscopic biopsy of the peritoneal nodule was performed. Pathologic studies of the peritoneal nodules showed a malignant methothelioma of the sarcomatous type. One month after laparoscopic examination, the patient died of respiratory failure. Diagnosis of malignant mesothelioma of the peritoneum is generally difficult. Sarcomatous malignant mesothelioma of the peritoneum is considered fatal. Over twenty such cases have been reported in this country. 悪性中皮腫 / 腹膜 / 腹腔鏡 / malignant mesothelioma / peritoneum / laparoscopy

133-140 症例報告 Case Report ENG 　 水酸化カリウム服用による腐蝕性食道炎の一手術例 Successful treatment for corrosive esophagitis and gastritis caused by potassium hydroxide Report of a case 高田,理 / 清崎,浩一 / 斎藤,正昭 / 櫻木,雅子 / 宮田,道夫 / 平林,慎一 / 小西,文雄 Takata,Osamu / Kiyozaki,Hirokazu / Sato,Masaaki / Sakuragi,Masako / Miyata,Michio / Hirabayashi,Shinichi / Konishi,Fumio 自治医科大学附属大宮医療センター外科 / 自治医科大学附属大宮医療センター外科 / 自治医科大学附属大宮医療センター外科 / 自治医科大学附属大宮医療センター外科 / 自治医科大学附属大宮医療センター外科 / 自治医科大学附属大宮医療センター外科 / 自治医科大学附属大宮医療センター外科 Department of surgery, Omiya Medical Center, Jichi Medical School / Department of surgery, Omiya Medical Center, Jichi Medical School / Department of surgery, Omiya Medical Center, Jichi Medical School / Department of surgery, Omiya Medical Center, Jichi Medical School / Tokyo North Social Insurance Hospital / Department of plastic surgery, Teikyo University Hospital / Department of surgery, Omiya Medical Center, Jichi Medical School 我々は水酸化カリウム服用による自殺企図後,食道全長全周にわたる高度の瘢痕性狭窄を来たした腐蝕性食道炎に対して手術施行し,良好なQOLの改善を得たので報告する。症例は32歳,男性。自殺企図にて多量のアルコールと睡眠剤と一緒に手のひら一杯の業務用配管清掃剤(水酸化カリウム含有)を服用した。10時間後に救急病院へ搬送され,直ちに胃洗浄され,次いで牛乳と伴に活性炭および下剤を投与され,一命をとりとめた。しかしながらアルカリ反応に引き続き起こる瘢痕性食道狭窄により摂食障害・栄養障害をきたした。そこで,縦隔鏡補助下経横隔膜食道切除術および遊離小腸移植による再建術を施行した。この術式は,腐蝕性食道炎に引き続き起こる高度の瘢痕性狭窄を来たした症例に対して安全で有益な手術方法であると考えられた。 We report a case of successful reconstructive operation of severe corrosive esophagitis, which developed for the full length of the esophagus. A 32-year-old man ingested a handful of potassium hydroxide with a large amount of alcohol and many hypnotic pills intending to commit a suicide. He was transferred to an emergency medical care center ten hours later. He underwent emergency procedures such as gastric lavage, infusion of activated carbon and laxative. And the patient survived. However, he had a severely corroded esophageal constriction due to alkaline reaction. He underwent mediastinoscopy assisted transhiatal esophagectomy and reconstruction using an isolated jejunal segment with vascular anastomosis. This operation was considered useful and safe for a corrosive narrowing and cicatricial stricture of the esophagus. Corrosive esophagitis / Suicide attempt / Alkaline solution Jejunal interposition reconstruction

141-148 症例報告 Case report ENG 　 腹腔内再発したgastrointestinal stromal tumor (GIST)の1症例におけるチロシンキナーゼ阻害剤(メシル酸イマチニブ)の短期投与 Limited administration of the tyrosine kinase inhibitor, imatinib mesylate, in a case of intra-abdominal recurrence of gastrointestinal stromal tumors 神山,英範 / 池谷,朋彦 / 河端,美則 / 星,永進 Kamiyama,Hidenori / Ikeya,Tomohiko / Kawabata,Yoshinori / Hoshi,Eishin 埼玉県立循環器・呼吸器病センター外科, 病理部 / 埼玉県立循環器・呼吸器病センター外科, 病理部 / 埼玉県立循環器・呼吸器病センター外科, 病理部 / 埼玉県立循環器・呼吸器病センター外科, 病理部 Departments of Surgery, Saitama Cardiovascular and Respiratory Center / Departments of Surgery, Saitama Cardiovascular and Respiratory Center / Departments of Surgery, Saitama Cardiovascular and Respiratory Center / Departments of Surgery, Saitama Cardiovascular and Respiratory Center 患者は62歳,女性。2002年7月左上腹部の腫瘤を主訴に当センターを受診した。18cm大の腹腔内腫瘍に対し,胃,横行結腸合併腫瘍切除術を施行。胃GIST(c-kit陽性)と診断された。2002年9月た腹腔内再発巣が出現,増悪し,2002年12月imatinib mesylateを400mg/日で開始。投与2週間後より発熱,体幹四肢の広範囲に掻痒を伴う斑状疹,眼周囲,口唇の浮腫が出現。2週間休薬後300mg/日で再開したが,同様の症状が出現し再開後5週間で中止した。2003年2月再発巣の著明な縮小(縮小率74%)を確認した。その後腫瘍の増大を認めなかったが,2003年12月再発巣が増悪し,2004年1月腫瘍切除術を施行。2004年6月他部位に再発が確認され,現在はsupportive careの状態である。今回の我々の報告のようなimatinib mesylate短期間投与後の投与再開不可能な症例の臨床経過は報告されていない。 We report the case of a 62-year-old woman with a gastrointestinal stromal tumor of the stomach. The patient underwent resection of the tumor, but an intra-abdominal recurrence was discovered 2 months after the operation. Because the recurring tumors gradually grew in size and number, the patient received treatment with imatinib mesylate ; however, the treatment lasted only 7 weeks due to severe cutaneous adverse reactions to the imatinib mesylate. After treatment with imatinib mesylate, a marked reduction of the intra-abdominal lesions was observed. The skin rash was improved by treatment with a topical steroid and an antihistamine medication. This report showed that seven-week administration of imatinib mesylate led a partial response for ten months in spite of imatinib mesylate discontinuance. gastrointestinal stromal tumor / imatinib mesylate / adverse reaction / limited administration

149-155 報告 Research Report JPN 　 欧米と日本の心臓リハビリテーションの現況 Cardiac Rehabilitation in Western countries and Japan 折口,秀樹 Origuchi,Hideki 九州厚生年金病院内科 Kyushu Kosei-Nenkin Hospital Department of Internal Medicine 当院の心臓リハビリテーションプログラムを充実させるため,国内外の心臓リハビリテーション施設を見学する機会を得た。その経験を基に欧米と日本の心臓リハビリテーションの現況について述べる。北米では施設中心型心臓リハビリテーションで発展してきており,心臓医または体育学部主導であった。とくに運動療法士の教育が充実し,そのレベルも高く救急処置にも精通していた。ドイツでは急性期,回復期,維持期と対応する施設が明確に機能分担していた。とくに維持期で全国に広がる心臓グループのシステムが特徴的である。日本では欧米に劣らない施設はあるが,維持期に対応するシステムがなく今後の課題である。近年世界的には心不全に対する心臓リハビリテーション,家庭でできる心臓リハビリテーションが注目を浴び,また,Prehabilitationと言う言葉で示される予防医学的な取り組みに重点が置かれている。 To improve the cardiac rehabilitation program of my hospital, I have visited famous cardiac rehabilitation centers in western countries and Japan. Through my experience, I will mention the differences in cardiac rehabilitation programs between western countries and Japan. In North America, cardiac rehabilitation programs are center based and divided into two types, directed by cardiologists or sports medicine departments. They have excellent systems to educate exercise therapists. In Germany, there are three types of cardiac rehabilitation programs which are called acute phase, recovery phase and maintenance phase cardiac rehabilitation. The maintenance phase cardiac rehabilitation of Germany is famous as "Herzgruppe". In Japan, there are a lot of excellent cardiac rehabilitation centers, but compared with Germany, the maintenance phase cardiac rehabilitation system is not developed. Cardiac rehabilitation in heart failure patients and home based cardiac rehabilitation is becoming popular in the world. The prevention of cardiovascular disease is the goal of cardiac rehabilitation programs.

157-167 報告 Research Report ENG 　 三宅島雄山噴火SO_2排出ガス短期曝露による呼吸器症状の検討 Respiratory symptoms associated with transient exposure to sulfur dioxide (SO_2) from Mt. Oyama volcano on Miyake Island south of Tokyo 宇野,秀之 / 堀口,兵剛 / 香山,不二雄 Uno,Hideyuki / Horiguchi,Hyogo / Kayama,Fujio 自治医科大学地域医療学センター環境医学部門 / 自治医科大学地域医療学センター環境医学部門 / 自治医科大学地域医療学センター環境医学部門 Center for Community Medicine, Division of Environmental Medicine, Jichi Medical School:Tokyo Metropolitan Government, Welfare and Health Office, Department of Medical Policy / Center for Community Medicine, Division of Environmental Medicine, Jichi Medical School / Center for Community Medicine, Division of Environmental Medicine, Jichi Medical School 三宅島にある雄山が2000年6月から噴火が始まり,それ以来全住民が避難となった。2002年には噴火は消退しているが,火山ガス(ほとんどSO_2)排出は当分続くであろう。2003年4月から3日間滞在型帰島プロジェクトが始まり,我々は2003年10〜12月にこのプロジェクトに参加した住民にアンケートを行った。アンケートには呼吸器症状(咳嗽,喀痰,喘鳴,息切れ)出現とそれらの症状を元々持っていたかどうかを含めた。さらに我々は島内6箇所の大気中SO_2濃度を知り,濃度により2つのグループに分けた。我々はSO_2大気汚染と呼吸器症状との関係を調査した。我々はまた最終的に性別,年齢,元々存在した呼吸器症状のような交絡因子を排除するため,それぞれの呼吸器症状を独立変数として類推評価した。結論として,大気中SO_2濃度がより高いときは70歳以上の高齢者では息切れの悪化に注意を払った方がよいのだろう。しかし,SO_2大気汚染は息切れ以外の呼吸器症状悪化に影響を与えていないのかも知れない。 The onset of volcanic activity of the Mt. Oyama volcano on Miyake Island in June 2000 prompted authorities to evacuate all of the inhabitants of the island. Despite the relative cessation of activity since the last eruption in 2002, it is thought that the emission of volcanic gas (principally S0_2) will continue for some time. We undertook a three-day rehabilitation project in April 2003 that included a survey of the inhabitants who participated this project during October and December 2003. This questionnaire included respiratory symptoms (cough, phlegm, wheeze and breathless) and pre-existing symptoms. In addition, we also measured ambient SO_2 concentrations in six regions of the island and divided the inhabitants into High and Low exposure groups after assaying atmospheric S0_2 concentration levels. We examined the relationship between SO_2 air pollution and respiratory symptoms. We also regarded respiratory symptoms as dependent variables in order to exclude confounding factors such as gender, age, and respec-tive pre-existing symptoms. In conclusion, we found that high ambient sulfur concentrations have the effect of causing breathlessness the elderly (age>70) when ambient concentrations are high. However, except for breathlessness, SO_2 air pollution was not observed to aggravate respiratory symptoms. respiratory symptoms / volcanic gas / SO_2 / self-administrated questionnaire

169　平成16年度自治医科大学医学部研究奨励金研究成果報告　JPN 　 血管性脳浮腫における脳血管壁細胞の制御 竹内,公一 自治医科大学医学部解剖学講座解剖学部門

169-170　平成16年度自治医科大学医学部研究奨励金研究成果報告　JPN 　 生薬由来物質のヘリコバクター・ピロリに対する抗菌活性の解析 林,俊治 自治医科大学医学部感染・免疫学講座細菌学部門

170-171　平成16年度自治医科大学医学部研究奨励金研究成果報告　JPN 　 神経調節性失神の病態解明についての研究 江口,和男 / 苅尾,七臣 / 富澤,英紀 / 石川,譲治 / 星出,聡 / 石川,鎮清 / 島田,和幸 自治医科大学医学部循環器内科 / 自治医科大学医学部循環器内科 / 自治医科大学医学部循環器内科 / 自治医科大学医学部循環器内科 / 自治医科大学医学部循環器内科 / 自治医科大学医学部循環器内科 / 自治医科大学医学部循環器内科

171-172　平成16年度自治医科大学医学部研究奨励金研究成果報告　JPN 　 好中球アポトーシスと好中球依存性慢性気道炎症に及ぼすマクロライド抗菌薬の影響 山沢,英明 自治医科大学医学部内科学講座呼吸器内科部門

172-173　平成16年度自治医科大学医学部研究奨励金研究成果報告　JPN 　 血液体液暴露事故による病院内職業感染防止のための新規器具の開発 外島,正樹 自治医大内科学講座血液学部門

173-174　平成16年度自治医科大学医学部研究奨励金研究成果報告　JPN 　 慢性骨髄性白血病における薬剤耐性機構の解明と分子標的薬による耐性克服法の開発 大嶺,謙 自治医大学医学部内科学講座血液学部門

174-175　平成16年度自治医科大学医学部研究奨励金研究成果報告　JPN 　 頭頸部腫瘍に対する多分割照射のQOL評価研究 柴山,千秋 自治医科大学医学部放射線医学講座

175-176　平成16年度自治医科大学医学部研究奨励金研究成果報告　JPN 　 ミトコンドリア異常症における細胞死分子機構とその抑制分子過程の解析 : 治療への応用 後藤,珠子 / 森,雅人 / 山形,崇倫 / 桃井,真里子 自治医科大学医学部小児科 / 自治医科大学医学部小児科 / 自治医科大学医学部小児科 / 自治医科大学医学部小児科

176-177　平成16年度自治医科大学医学部研究奨励金研究成果報告　JPN 　 新生児仮死児における胃食道逆流症の発生について : さらに呼吸機能・脳血流を使った検討 江上,聡 / 河原崎,秀雄 / 水田,耕一 / 桃井,真理子 / 本間,洋子 / 高橋,尚人 自治医科大学医学部移植外科 / 自治医科大学医学部移植外科 / 自治医科大学医学部移植外科 / 自治医科大学医学部小児科 / 自治医科大学医学部小児科 / 自治医科大学医学部小児科

177-178　平成16年度自治医科大学医学部研究奨励金研究成果報告　JPN 　 胸部大動脈手術周術期における,心房性不整脈の発生原因とその予防に関する研究 坂野,康人 / 三澤,吉雄 自治医科大学医学部外科学講座心臓血管外科部門 / 自治医科大学医学部外科学講座心臓血管外科部門

178　平成16年度自治医科大学医学部研究奨励金研究成果報告　JPN 　 エリスロポエチン産生線維芽細胞移植による急性脊髄損傷後の2次損傷抑制効果 木村,敦 / 村上,孝 / 袴田,陽二 / 星野,雄一 / 小林,英司 自治医科大学医学部整形外科:自治医科大学医学部臓器置換研究部 / 自治医科大学医学部臓器置換研究部 / 自治医科大学医学部臓器置換研究部 / 自治医科大学医学部整形外科 / 自治医科大学医学部臓器置換研究部

178-180　平成16年度自治医科大学医学部研究奨励金研究成果報告　JPN 　 肺の線維化におけるST2遺伝子の関与について 田島,俊児

181　平成16年度自治医科大学医学部研究奨励賞研究成果報告　JPN 　 器官形成を司るSixタンパク質の標的遺伝子同定と遺伝子制御ネットワーク 安藤,善一 自治医科大学医学部人間生物学系専攻

181-182　平成16年度自治医科大学医学部研究奨励賞研究成果報告　JPN 　 マウス間葉系幹細胞を用いた同種造血幹細胞移植後移植片対宿主病制御に関する研究 翁,家国 自治医科大学医学部地域医療学系専攻

182-183　平成16年度自治医科大学医学部研究奨励賞研究成果報告　JPN 　 活性型FKHRL1によるCML治療薬イマチニブ耐性克服に向けての基礎的検討 菊池,悟 自治医科大学医学部地域医療学系専攻

183-184　平成16年度自治医科大学医学部研究奨励賞研究成果報告　JPN 　 成人T細胞性白血病の大規模DNAチップ解析による病期進展機構解明 崔,永林 自治医科大学医学部人間生物学系専攻

184　平成16年度自治医科大学医学部研究奨励賞研究成果報告　JPN 　 大腸癌におけるDNA異常メチル化のゲノムワイドスクリーニング 鯉沼,広治 自治医科大学医学部地域医療学系専攻

184-185　平成16年度自治医科大学医学部研究奨励賞研究成果報告　JPN 　 ガラニン様ペプチドによるNPYニューロン刺激と脂肪嗜好性における役割 倉持,素樹 自治医科大学医学部地域医療学系専攻