医学部

AA型アミロイドーシスを合併したCrohn病の一例を経験した.症例は73歳女性.発熱,下痢症状の改善がないため紹介入院となった.入院時の腹部単純X線写真では著明な大腸拡張像を認め,腹部骨盤CTでも回腸から結腸にかけての浮腫状の壁肥厚と腸管周囲に膿瘍の形成,回腸の拡張像を認めた.十二指腸粘膜の内視鏡下生検を施行したところ,組織学的にAA型アミロイドーシスと診断された.大腸内視鏡検査では異常所見はなかった.小腸X線二重造影検査にて,小腸の管状狭窄と拡張,潰瘍瘢痕,類円形の潰瘍が多発していた.AA型アミロイドーシスを合併したCrohn病の診断のもとに入院･加療を行った.絶食と抗生剤点滴で腸管安静をはかると下痢などの症状は改善し,食事を流動食から固形食に変えると症状の増悪を認めた.Crohn病は栄養療法で寛解導入され,その後維持された.消化管アミロイドーシスの消化器症候もなく4年間経過良好である.

症例は46歳男性.近医の腹部エコーで膵尾部近傍に腫瘤を認めたため当科へ紹介された.腹部CTで小腸間膜根部に約50mm大の低吸収域の腫瘤性病変を認めた.腹部MRIではT1強調像で低信号,T2強調像で高信号の多房性腫瘍を認めた.悪性の可能性も否定できず,診断的意味も含め,外科的切除を施行した.腫瘍は表面平滑,弾性軟で,他の周囲臓器への癒着は認めなかった.腫瘍は組織学的に嚢胞状リンパ管腫と診断した.リンパ管腫は小児の頭頚部に好発する良性腫瘍であるが,成人の腸間膜に発生したリンパ管腫はまれであるため報告する.

We held medical seminars for high-school students who hope to become physicians to increase their motivation and to encourage them to enter Yamaguchi University. The seminars were held two or three times a year at hospitals in six locations in Yamaguchi prefecture between 2011 and 2014, and consisted of observation of facilities in hospitals, physician lectures, experience of medical practice, and Q&A sessions with physicians and medical students. A total of 210 high-school students participated in 11 seminars. The questionnaires for the participants showed 89.9% of the participants rated the seminars“very good”and 91.4% responded,“my motivation was strengthened”.Of the seminar participants, 20 of 69 high-school graduates entered the Yamaguchi University School of Medicine. The follow-up survey showed that the percentage of medical school students studying at Yamaguchi University was 69.0% (20/29) for seminar participants and 45.5% (46/101) for non-seminar participants. The results suggest that the medical seminars were as effective as expected in encouraging high-school students to become physicians and to enter Yamaguchi University.

The purpose of this study was to compare demographic trends in the aging of the Japanese and Brazilian populations on the basis of health indicator data collected by the statistics bureaus of the Japanese and Brazilian governments. The demographic and health indicator data from surveys by the Statistics Bureaus of the Japanese and Brazilian governments and other sources were obtained from websites. The data showed that Japan has an aging population, that the number of elderly persons in Japan is increasing and that the Government of Japan has a plan to address future demands for health resources by this aging population, whereas Brazil has a rapidly population aging but no plan for its future health services. Brazil may need to increase the number of hospitals and hospital beds and develop a medical care plan for the elderly within its Unified Health System.

Hepatocellular carcinoma (HCC) has a poor prognosis even after curative surgery, due to the high frequency of early intrahepatic recurrence (IHR). Conventional staging systems are almost completely inadequate, and need to be complemented by novel tools. To this end, many investigators have performed DNA microarray analysis on the basis of genome-wide information. However, so far, few studies have been able to truly account for the clinical efficacy of DNA microarray analysis in HCC. To address this dilemma, we used a supervised learning method with information of 7070 genes from 33 HCC samples, to construct a 12-gene predictor for early IHR, and then evaluated its predictive performance in 27 independent HCC samples. Our 12-gene predictor correctly predicted early IHR or non-recurrence in 25 (93%) of the 27 independent samples. This predictive value is higher than that of any other system currently available, suggesting that our system can serve as a robust tool for accurate prediction of early IHR of HCC. I emphasize in this mini-review that, although there are some technical issues to resolve prior to clinical use, DNA microarray technology can provide molecular basis to initiate “bench to bedside” translation, which cannot be easily reached with other methods.

Application of cell therapy using stem cell into intractable diseases has been noted as the medicine in the next generation taking the place of organ transplantation. Bone marrow cells have been focused as a candidate of the source of this therapy. Liver failure is a terminal state of all advanced liver diseases and thousands of patients are dying of decompensated liver cirrhosis in every year in Japan. Liver transplantation must be the strongest weapon to relieve those patients. However, particularly in Japan, liver transplantation has not been popularized. In this sense, we thought of autologous bone marrow cells transplantation for decompensated liver cirrhosis. Basic studies using animal model revealed that transplanted bone marrow cells into syngenic mouse suffering from liver cirrhosis migrated into the damaged liver and transdifferentiated to the hepatocytes. Based upon the animal studies, clinical trial of this new cell therapy supported by the Ministry of Health, Labor and Welfare is ongoing. It is early to estimate this therapy. However, free from liver failure has been observed in some cases.