Faculty Profiles - YANAI Hiroyuki

Papers - YANAI Hiroyuki

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Obstructive jaundice at the initial presentation in small-cell lung cancer. International journal

Nobuaki Ochi, Nagio Takigawa, Masayuki Yasugi, Etsuji Ishida, Hirofumi Kawamoto, Akihiko Taniguchi, Daijiro Harada, Eiko Hayashi, Hiroko Toda, Hiroyuki Yanai, Mitsune Tanimoto, Katsuyuki Kiura

International medical case reports journal 3 9 - 12 2010

Language：English

Obstructive jaundice sometimes may develop in association with advanced small-cell lung cancer (SCLC); however, SCLC initially presenting with obstructive jaundice is rare. This report presents the cases of two SCLC patients with obstructive jaundice at the initial diagnosis. A 64-year-old male presented with obstructive jaundice due to a tumor at the head of the pancreas. He was diagnosed with SCLC by transbronchial biopsy from a lung tumor in the left upper lobe. Another 74-year-old male was admitted with jaundice due to a tumor in the porta hepatis. He was also diagnosed with SCLC by a fine-needle aspiration biopsy of a lung tumor in the left lower lobe. Both cases were successfully treated with systemic chemotherapy after endoscopic retrograde biliary drainage.

Frequent downregulation or loss of CD79a expression in plasma cell myelomas: potential clue for diagnosis. Reviewed International journal

Takehiro Tanaka, Kouichi Ichimura, Yasuharu Sato, Katsuyoshi Takata, Toshiaki Morito, Maiko Tamura, Eisaku Kondo, Nobuya Ohara, Hiroyuki Yanai, Masaharu Sakai, Satoru Takahashi, Tadashi Yoshino

Pathology international 59 ( 11 ) 804 - 8 2009.11

Language：English

Plasma cell myeloma is a frequent hematogeneous disorder that occurs mainly in older people. Not only bone marrow smears but also clots and/or biopsied specimens are often taken for confirmation of pathological diagnosis. Some specimens show sheet-like plasma cell proliferation associated with immunoglobulin monotype on immunohistology, which readily leads to diagnosis, but many samples do not clearly show light-chain restriction. The aim of the present study was therefore to examine CD79a expression because some samples had reduced expression or none at all. The immunoreactivity of CD79a was categorized into three groups: positive, weakly positive and negative, compared with scattering non-neoplastic plasma cells in the same specimen. Out of 100 specimens of plasma cell myeloma, 48% were positive for CD79a, 15% were weakly positive, and 37% were negative. In contrast, overexpression of cyclinD1 was detected in 26% of examined samples. CD79a-negative cases had a significantly lower percentage of positive staining for cyclinD1 than CD79a-positive or weakly positive cases. Clinicopathological data showed that CD79a-negative expression was associated with decreased platelet numbers in patients. The present study indicates that downregulation or loss of CD79a and/or overexpression of cyclin D1, observed in 59% of neoplastic plasma cell samples, could provide a strong diagnostic clue without regard to the results of immunoglobulin light-chain restriction.

DOI： 10.1111/j.1440-1827.2009.02448.x

A case of immunotactoid glomerulopathy exhibiting nephrotic syndrome successfully treated with corticosteroids and antihypertensive therapy Reviewed

Masaru Kinomura, Yohei Maeshima, Ryo Kodera, Hiroshi Morinaga, Daisuke Saito, Kazushi Nakao, Hiroyuki Yanai, Kenei Sada, Hitoshi Sugiyama, Hirofumi Makino

CLINICAL AND EXPERIMENTAL NEPHROLOGY 13 ( 4 ) 378 - 384 2009.8

Language：English Publishing type：Research paper (scientific journal) Publisher：SPRINGER

We report a case of immunotactoid glomerulopathy (ITG) with cerebral hemorrhage and hypocomplementemia, with successful therapeutic outcome following the corticosteroids and antihypertensive treatment. A 70-year-old man presented with facial edema in October 2006. One day prior to his referral, he experienced speech disturbance, headache, and vomiting, and on the next day he was referred to our hospital. The laboratory examination revealed massive proteinuria (11.3 g/day) and hematuria. The total serum hemolytic complement (CH50) was decreased to 23 U/ml and C4 component was decreased to 7.5 mg/dl, whereas C3 component remained within normal limits (82 mg/dl). Brain computed tomography scan showed high-density lesions in the left parieto-occipital area suggesting subcortical cerebral hemorrhage. Renal biopsy revealed diffuse subendothelial PAS-positive depositions. Immunofluorescence studies revealed intensive deposition of IgG, IgA, C3, C1q, Fibrinogen, and kappa light chain with granular pattern in the capillary and mesangial area. Electron microscopic examination revealed regularly arranged microtubular deposits, appearing as 21-33 nm in diameter. Based on these findings, this patient was diagnosed as ITG complicated with cerebral hemorrhage and hypocomplementemia. He received oral prednisolone (30 mg/day), resulting in reduction of proteinuria, improvement of hypocomplementemia, and prevention of renal functional deterioration. This case demonstrates that accurate diagnosis of ITG may result in successful therapeutic outcome.

DOI： 10.1007/s10157-009-0166-6

Infusion of Hypertonic Saline into the Lung Parenchyma during Radiofrequency Ablation of the Lungs with Multitined Expandable Electrodes: Results Using a Porcine Model Reviewed

Tatsuhiko Iishi, Takao Hiraki, Hidefumi Mimura, Hideo Gobara, Taichi Kurose, Hiroyasu Fujiwara, Jun Sakurai, Hiroyuki Yanai, Tadashi Yoshino, Susumu Kanazawa

ACTA MEDICA OKAYAMA 63 ( 3 ) 137 - 144 2009.6

Language：English Publishing type：Research paper (scientific journal) Publisher：OKAYAMA UNIV MED SCHOOL

The present study was performed to clarify the effect of hypertonic saline infusion into the lung parenchyma on radiofrequency ablation (RFA) of the lungs. A total of 20 ablation zones were created in 3 pigs. The ablation zones were divided into 3 groups. Group 1 (n = 6) consisted of ablation zones created by applying smaller radiofrequency (RF) power without saline infusion; group 2 (n = 5) zones were created by applying greater RF power without saline infusion; and group 3 (n = 9) zones were created by applying greater RF power with saline infusion. The techniques of saline infusion included administration of hypertonic saline 1 ml before RFA, followed by continuous administration at a rate of 1 ml/min during the first 2 min after the initiation of RFA. The ablation parameters and coagulation necrosis volumes were compared among the groups. Group 3 had a tendency toward smaller mean impedance than group 1 (p = 0.059) and group 2 (p = 0.053). Group 3 showed significantly longer RF application time than group 2 (p = 0.004) and significantly greater maximum RF power than group 1 (p = 0.001) and group 2 (p = 0.004). Group 3 showed significantly larger coagulation necrosis volume (mean, 1,421 mm(3)) than group 2 (mean, 858 mm(3), p = 0.039) and had a tendency toward larger necrosis volume than group 1 (mean, 878 mm(3), p = 0.077). Although this small study had limited statistical power, hypertonic saline infusion during RFA appeared to enlarge coagulation necrosis of the lung parenchyma.

DOI： 10.18926/AMO/31848

Immunohistochemical staining of liver grafts with a monoclonal antibody against HCV-Envelope 2 for recurrent hepatitis C after living donor liver transplantation Reviewed

Hiroshi Sadamori, Takahito Yagi, Hiromi Iwagaki, Hiroaki Matsuda, Susumu Shinoura, Yuzo Umeda, Nobuya Ohara, Hiroyuki Yanai, Tetsuya Ogino, Noriaki Tanaka

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 24 ( 4 ) 574 - 580 2009.4

Language：English Publishing type：Research paper (scientific journal) Publisher：WILEY-BLACKWELL PUBLISHING, INC

We evaluated the expression of hepatitis C virus (HCV) antigen on liver grafts by immunohistochemical staining (IHS) using IG222 monoclonal antibody (mAb) against HCV-envelope 2 (E2).
The study material was 84 liver biopsy specimens obtained from 28 patients who underwent living donor liver transplantation (LDLT) for HCV infection. The biopsy samples were examined histopathologically, and by IHS using IG222 mAb against HCV-E2. Serum HCV-RNA level was measured in all patients. The IHS grades were compared among the three groups classified according to the time elapsed from LDLT (at 1-30, 31-179 and >= 180 days post-LDLT) and among four post-transplant conditions, including acute cellular rejection (ACR).
Immunoreactivity to IG222 was detected in 78.6% of the specimens obtained during the first month after LDLT, and there were no significant differences on the IHS grades between the three groups classified according to the time elapsed from LDLT. The IHS grades were significantly stronger in definite recurrent HCV (n = 12) and probable recurrent HCV (n = 7) than in definite ACR (n = 7) and other complications (n = 8). There were no significant differences in serum HCV-RNA levels among the four post-transplant conditions. There was no significant correlation between the IHS grades using IG222 mAb and serum HCV-RNA levels when data of 84 liver biopsy specimens were analyzed.
Constant HCV-E2 expression was observed in liver biopsy specimens obtained 1 month or longer. The strong HCV-E2 expression on liver grafts were associated with recurrent hepatitis C after LDLT, but the serum HCV-RNA levels were not.

DOI： 10.1111/j.1440-1746.2008.05638.x

A case of small early cancer of sigmoid colon, which recurred with liver metastasis 18 months after surgical resection Reviewed

Keita Harada, Jun Kato, Koji Takemoto, Toshio Uraoka, Sakiko Hiraoka, Hiroyuki Yanai, Kazuhide Yamamoto

Journal of Japanese Society of Gastroenterology 106 ( 5 ) 660 - 667 2009

Language：Japanese Publishing type：Research paper (scientific journal)

A 74-year-old man was referred to our hospital with positive fecal occult blood test. Colonoscopic examination revealed a 7-mm 0-Is type polyp in the sigmoid colon. Endoscopic mucosal resection for this lesion completely removed the lesion and the histologic diagnosis was well differentiated adenocarcinoma. Cancer cells invaded the submucosa to a depth of 900μm, and vascular invasion was found. Therefore, the patient underwent additional surgical resection with lymph node dissection. During follow-up, however, serum CEA increased beyond the normal limit 18 months after surgical operation, and a 15-mm single liver metastasis was found through enhanced CT scan abdominal imaging, the FDG-PET scan, and ultrasonography. We have to pay attention to metachronous liver metastasis especially when the vascular invasion is suspected in the resected sample, even if the lesion is completely removed.

切除18ヵ月後に肝転移をきたした径7mmのS状結腸早期癌の1例

原田馨太, 加藤順, 竹本浩二, 浦岡俊夫, 平岡佐規子, 柳井広之, 山本和秀

日本消化器病学会雑誌 106 ( 5 ) 660 - 667 2009

Language：Japanese Publisher：(一財)日本消化器病学会

症例は74歳男性。便潜血陽性に対する精査目的の大腸内視鏡検査にて、S状結腸に径7mm大のO-Is型腫瘍を指摘され、内視鏡的粘膜切除術を施行した。切除標本の病理組織学的診断は高分化腺癌で、粘膜下浸潤と脈管侵襲が認められたため、追加切除を行った。しかし術後18ヵ月目にCEAの上昇を認め、腹部造影CT、FDG-PET、超音波エコー検査にて15mmの単発肝転移による異時性再発を診断された。(著者抄録)

DOI： 10.11405/nisshoshi.106.660

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2009&ichushi_jid=J01118&link_issn=&doc_id=20090518090006&doc_link_id=10024850990&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F10024850990&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

Frequent p16 inactivation by homozygous deletion or methylation is associated with a poor prognosis in Japanese patients with pleural mesothelioma Reviewed

Naruyuki Kobayashi, Shinichi Toyooka, Hiroyuki Yanai, Junichi Soh, Nobukazu Fujimoto, Hiromasa Yamamoto, Shuji Ichihara, Kentaro Kimura, Kouichi Ichimura, Yoshifumi Sano, Takumi Kishimoto, Hiroshi Date

LUNG CANCER 62 ( 1 ) 120 - 125 2008.10

Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER IRELAND LTD

This study examined the p16 expression status and the P16 gene deletion and methylation status in specimens from Japanese patients with malignant pleural mesothelioma (MPM). lmmunohistochemical staining for p16 protein and fluorescence in situ hybridization for the P16 gene were performed using specimens from 30 Japanese patients with primary MPM. The methylation status of the P16 gene was examined in 13 patients whose frozen tumor specimens were available using a methylation-specific PCR assay. Among the 30 patients, the toss of p16 protein expression was observed in 24 patients (80.0%). Twenty-one patients had homozygous deletions, and 9 patients retained the P16 gene. None of the patients with P16 homozygous deletions exhibited p16-positive expression, and 3 patients who retained the P16 gene did not exhibit p16-positive expression. Aberrant P16 methylation was present in two patients with an intact P16 gene but without p16 expression. These results suggest that either a homozygous deletion or methylation is responsible for P16 inactivation. Regarding the prognosis, patients with p16-negative expression had a significantly shorter survival. time than those with p16-positive expression (P=0.040). Our study showed that P16 inactivation by homozygous deletions or methylation is a frequent event in Japanese patients with MPMs, relating to poor prognosis. Homozygous deletion is the major cause of P16 inactivation, but methylation also lead to the inactivation of P16 when the P16 alleles are retained. (C) 2008 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.lungcan.2008.02.013

Orbital exenteration after transarterial embolization in a patient with Wyburn-Mason syndrome: Pathological findings Reviewed

Toshihiko Matsuo, Hiroyuki Yanai, Kenji Sugiu, Susumu Tominaga, Yoshihiro Kimata

JAPANESE JOURNAL OF OPHTHALMOLOGY 52 ( 4 ) 308 - 313 2008.7

Language：English Publishing type：Research paper (scientific journal) Publisher：SPRINGER TOKYO

Background: We present the pathological findings at orbital exenteration in a patient with Wyburn-Mason syndrome who underwent transarterial embolization.
Case: A 31-year-old man with a 10-year history of gradual exacerbation of left exophthalmos and left cheek swelling was found to have facial and orbital arteriovenous malformations on the left side. There was no vascular malformation in the brain. The feeding arteries derived from the left internal maxillary artery, facial artery, and ophthalmic artery. He underwent several courses of transarterial embolization of the feeding arteries from the left internal maxillary artery and then from the facial artery, resulting in no reduction of the arteriovenous malformation. He finally elected to undergo ophthalmic artery embolization in the expectation of a reduction and with the understanding that he would lose sight in his left eye. Two years later, he requested lid-sparing orbital exenteration and reconstruction with cutaneous flap transfer and prosthesis for cosmetic reasons.
Observations: Pathologically, orbital vascular channels of varying sizes were filled with embolizing glue and had degenerating vascular wall cells surrounded by inflammatory cell infiltration. The central retinal artery in the optic nerve was also filled with the embolizing glue, and the retina lost the ganglion cell layer and inner nuclear layer but maintained the outer nuclear layer and outer segments.
Conclusions: Marked anastomoses and hence incomplete embolization among the feeding arteries of facial and orbital vascular malformations in Wyburn-Mason syndrome do not respond well to attempts at feeding vessel embolization, which result in unsuccessful closure of the malformation.

DOI： 10.1007/s10384-008-0563-5

Duodenal follicular lymphomas share common characteristics with mucosa-associated lymphoid tissue lymphomas Reviewed

Y. Sato, K. Ichimura, T. Tanaka, K. Takata, T. Morito, H. Sato, Y. Sato, E. Kondo, H. Yanai, N. Ohara, T. Oka, T. Yoshino

JOURNAL OF CLINICAL PATHOLOGY 61 ( 3 ) 377 - 381 2008.3

Language：English Publishing type：Research paper (scientific journal) Publisher：B M J PUBLISHING GROUP

Background: Follicular lymphomas occasionally arise in the extra-nodal organs and are frequently found in the duodenum. They are often localised tumours with multiple polyps around the ampulla of Vater.
Aims: To examine a IgH/bcl-2 hybrid gene and VH gene to investigate the nature of the lymphoma cells and how they differ from nodal follicular lymphomas and MALT lymphomas.
Methods: Of 40 patients reported previously, 35 with duodenal follicular lymphoma were studied in detail with respect to clinicopathological characteristics.
Results: 37/40 patients were in clinical stage I (n= 30) or stage II (n= 7). Clonal immunoglobulin gene rearrangement was detected in 53.3% of examined cases, and rearrangement of IgH/bcl-2 gene at the major break point was detected in 27% of cases. Three of 8 examined cases were VH4 (38%); 2 out of them were VH4-34. As VH4 deviation is one of the common characteristics of MALT lymphomas and 2/3 were identical, duodenal follicular lymphomas have a similar aetiology to MALT lymphomas. Clinical course was also similar to that of MALT lymphomas.
Conclusions: Results suggest that duodenal follicular lymphomas have intermediate characteristics of MALT lymphomas and nodal follicular lymphomas.

DOI： 10.1136/jcp.2007.049825

A rare tumor in the adrenal region: Neuron-specific enolase (NSE)-producing leiomyosarcoma in an elderly hypertensive patient Reviewed

Junko Goto, Fumio Otsuka, Ryo Kodera, Tomoko Miyoshi, Masaru Kinomura, Hiroyuki Otani, Yukari Mimura, Toshio Ogura, Hiroyuki Yanai, Yasutomo Nasu, Hirofumi Makino

ENDOCRINE JOURNAL 55 ( 1 ) 175 - 181 2008.2

Language：English Publishing type：Research paper (scientific journal) Publisher：JAPAN ENDOCRINE SOC

A 73-year-old Japanese woman was referred for examination of right flank pain and progressive hypertension. Abdominal CT incidentally detected a right adrenal mass 8 cm in size. The tumor exhibited isodensity by CT and contained high-intense lesion by T2-weighted MRI. Scintigraphy with I-131-metaiodobenzylguanidine and I-131-adosterol showed no abnormal uptake by whole body scan. Positron emission tomography scan with F-18-2-fluoro-D-deoxyglucose demonstrated an exclusive uptake in the right adrenal mass. Adrenocortical hormone levels and catecholamine secretion were within normal range; however, the level of serum neuron-specific enolase (NSE) was found to be markedly high. After controlling systemic blood pressure with an alpha 1-blocker, the right adrenal tumor was surgically removed, along with the right kidney and inferior vena cava which adhered to it. The tumor was pathologically proven to be leiomyosarcoma, which was immunohistochemically positive with a-smooth muscle actin and negative with CD57, S-100 and c-kit proteins. Notably, NSE protein was massively expressed in the resected tumor. After surgery blood pressure was controlled with regular medication and serum NSE levels have since normalized. The possibility of leiomyosarcoma should be kept in mind in adrenal incidentalomas with rapid growth and atypical radiological images. Our findings suggest that circulating NSE levels may be clinically useful for early detection of recurrence.

DOI： 10.1507/endocrj.K07E-020

A novel variant apolipoprotein E Okayama in a patient with lipoprotein glomerulopathy Reviewed

Masaru Kinomura, Hitoshi Sugiyama, Takao Saito, Akira Matsunaga, Ken-ei Sada, Motoko Kanzaki, Yuki Takazawa, Yohei Maeshima, Hiroyuki Yanai, Hirofumi Makino

NEPHROLOGY DIALYSIS TRANSPLANTATION 23 ( 2 ) 751 - 756 2008.2

悪性転化を示したnuclear palisadingを伴う隆起性皮膚線維肉腫の1例 Reviewed

大森昌子, 柳井広之, 荻野哲也, 松川昭博, 吉野正

診断病理 25 ( 2 ) 72 - 76 2008

Language：Japanese Publisher：(一社)日本病理学会

症例は59歳女性。左膝窩部の皮膚から皮下組織におよぶ8×6cm大の腫瘍が存在し、腫瘍切除術が施行された。組織学的には、通常型の隆起性皮膚線維肉腫(dermatofibrosarcoma protuberans;DFSP)の領域から移行して明瞭なnuclear palisadingを示す部分が散在性に認められた。いずれの領域もCD34はびまん性に強陽性を示した。また線維肉腫に相当する高悪性度肉腫の領域が存在し、その部分ではCD34が減弱〜陰性化していた。Nuclear palisadingを示すDFSPから発生した稀なfibrosarcomaの1例を報告する。(著者抄録)

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唾液腺導管癌の組織型を呈した耳下腺多形腺腫由来癌の1手術例

松浦博夫, 高田晋一, 江草憲太郎, 南波由紀, 柳井広之

広島市立広島市民病院医誌 24 4 - 7 2008

Risk factors for recurrence and unfavorable prognosis in patients with stage I non-small cell lung cancer and a tumor diameter of 20 mm or less Reviewed

Naruyuki Kobayashi, Shinichi Toyooka, Junichi Soh, Kouichi Ichimura, Hiroyuki Yanai, Hiroshi Suehisa, Shuji Ichihara, Masaomi Yamane, Motoi Aoe, Yoshifumi Sano, Hiroshi Date

JOURNAL OF THORACIC ONCOLOGY 2 ( 9 ) 808 - 812 2007.9

Language：English Publishing type：Research paper (scientific journal) Publisher：LIPPINCOTT WILLIAMS & WILKINS

Background: The purpose of this study was to identify risk factors for disease recurrence and unfavorable prognosis after surgical resection for stage I non-small cell lung cancer in patients with tumor diameters of <= 20 mm.
Methods: One hundred sixty-three patients who had pathologic stage I non-small cell lung cancer with tumor diameters <= 20 mm and who had undergone a lobectomy with mediastinal lymph node dissection were retrospectively reviewed. The relationships between clinicopathologic factors and clinical outcomes, including recurrence and survival, were then examined. The clinicopathologic factors examined in this study were age, sex, smoking status, preoperative serum carcinoembryonic antigen level, pathologic tumor size, histologic subtype, histologic grade, and visceral pleural invasion.
Results: Among the clinicopathologic factors that were examined, the histologic grade of the carcinoma status was significantly related to a high risk of recurrence when analyzed using univariate (p = 0.01) and multivariate analyses (p = 0.049). Regarding survival, patients with poorly differentiated carcinomas showed a significantly unfavorable overall survival (p < 0.001), disease-specific survival (p = 0.003), and disease-free survival (p = 0.002) compared with patients with well-/moderately differentiated carcinomas according to univariate analyses. A Cox proportional hazards model indicated that a poorly differentiated carcinoma status was the only independent factor for an unfavorable overall survival (p = 0.02), disease-specific survival (p = 0.046), and disease-free survival (P = 0.04).
Conclusions: Poor differentiation of tumor was the only risk factor for recurrence and an unfavorable prognosis for stage I non-small cell lung cancer patients with tumor diameters of <= 20 mm.

DOI： 10.1097/JTO.0b013e31814617c7

Intraductal tubular adenoma, pyloric gland-type, of the pancreas Reviewed

H. Fukatsu, H. Kawamoto, K. Tsutsumi, H. Kato, K. Hirao, N. Kurihara, T. Ogawa, E. Ishida, Y. Okamoto, H. Okada, K. Sakaguchi, H. Yanai

ENDOSCOPY 39 ( Suppl 1 ) E88 - E89 2007.2

小児のトルコ鞍部に発生した肉芽腫性病変の一例.

神原啓和, 市川智継, 茶山公祐, 宮村能子, 大森昌子, 柳井広之, 伊達勲

瀬戸内脳神経外科懇話会会誌 15 20 - 24 2007

非定型奇形腫様／ラブドイド腫瘍 atypical teratoid/rhabdoid tumor (AT/RT)の１例. Reviewed

大森昌子, 柳井広之, 荻野哲也, 井上智, 市川智継, 松川昭博, 吉野正

診断病理 24 ( 1 ) 115 - 120 2007

Language：Japanese Publisher：(一社)日本病理学会

非定型奇形腫様/ラブドイド腫瘍(atypical teratoid/rhabdoid tumor(AT/RT))はrhabdoid cellの出現を特徴とした中枢神経に発生する胎児性腫瘍で予後はきわめて不良である。症例は生後6ヵ月、女児。頭囲の拡大、発達遅延を認め、近医にて水頭症を指摘された。腫瘍は松果体部、中脳被蓋部、第四脳室にかけて存在し、脊髄に播種性病変が存在した。組織学的に腫瘍はprimitive neuroectodermal tumor(PNET)様の小型未熟細胞の充実性増殖が主体をなし、小範囲にrhabdoid cellや索状配列を示す領域が存在した。AT/RTと診断し、腫瘍摘出後化学療法が施行されたが、5ヵ月後水頭症が悪化し死亡した。(著者抄録)

救命しえた劇症型好酸球性心筋炎の１例.

大郷恵子, 圓光賢希, 草野研吾, 桜木悟, 永瀬聡, 中村一文, 柳井広之, 大森昌子, 大家政志, 難波靖治, 津田佳穂, 大江透

心臓 39 ( Suppl.3 ) 112 - 117 2007

Language：Japanese Publisher：(公財)日本心臓財団

症例は19歳、男性。主訴は胸苦・胸痛。2006年4月29日午前2時ころ、胸苦・胸痛のため近医を受診、心電図上広範囲のST-T変化を認め急性心膜炎の疑いで入院となった。30日午前4時ころより血圧低下がみられたためdopamine点滴を開始され当科転院となった。転院時、血圧80mmHg、脈拍130/分で、奇脈、III音、頸静脈怒張を認めた。心エコーでの左室壁厚増大とびまん性の高度壁運動低下(左室駆出率23.8%)、多量の心嚢液貯留、CPKの上昇などから劇症型心筋炎による心原性ショックと診断した。機械的循環補助を行った上で、心臓カテーテル検査により冠動脈疾患を否定し、右室心内膜心筋生検を施行した。5月2日好酸球性心筋炎との組織診断によりステロイド投与を開始した。そのころより心機能の急速な回復がみられ、補助循環が離脱可能となった(離脱時に脳出血を合併)。その後ステロイドを漸減中止したが好酸球性心筋炎の再発やLoeffler心内膜炎への移行は認めていない。原因検索の結果、イヌ回虫に対する抗体が陽性であり、寄生虫感染に関連した好酸球性心筋炎と考えられた。今回著者等は劇症型心筋炎がイヌ回虫感染に伴う好酸球性心筋炎によるという稀な1例を経験し、ステロイド投与と機械的循環補助により救命しえたので報告する。(著者抄録)

DOI： 10.11281/shinzo1969.39.Supplement3_112

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TUR-BT前後におけるFollow up尿細胞診の意義について.

佐藤正和, 平本直美, 有安早苗, 山鳥一郎, 柳井広之, 吉野正

日本臨床細胞学会岡山支部会誌 26 29 - 31 2007

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