Language：English   Publisher：International Journal of Urology  

Intraductal carcinoma of the prostate, a unique histopathologic entity that is often observed (especially in advanced prostate cancer), is characterized by the proliferation of malignant cells within normal acini or ducts surrounded by a basement membrane. Intraductal carcinoma of the prostate is almost invariably associated with an adjacent high-grade carcinoma and is occasionally observed as an isolated subtype. Intraductal carcinoma of the prostate has been demonstrated to be an independent poor prognostic factor for all stages of cancer, whether localized, de novo metastatic, or castration-resistant. It also has a characteristic genetic profile, including high genomic instability. Recognizing and differentiating it from other pathologies is therefore important in patient management, and morphological diagnostic criteria for intraductal carcinoma of the prostate have been established. This review summarizes and outlines the clinical and pathological features, differential diagnosis, molecular aspects, and management of intraductal carcinoma of the prostate, as described in previous studies. We also present a discussion and future perspectives regarding intraductal carcinoma of the prostate.

DOI： 10.1111/iju.15299

Web of Science

Scopus

PubMed

Language：English   Publisher：Nagoya Journal of Medical Science  

Androgen receptor signaling inhibitors combined with androgen deprivation therapy have become the standard of care for metastatic castration-sensitive prostate cancer (mCSPC), regardless of tumor volume or risk. However, survival of approximately one-third of these patients has not improved, necessitating further treatment escalation. On the other hand, for patients with oligometastatic mCSPC, there is an emerging role for local radiation therapy. Although data remain scarce, it is expected that treatment of both primary tumor as well as metastasis-directed therapy may improve survival outcomes. In these patients, systemic therapy may be de-escalated to intermittent therapy. However, precise risk stratification is necessary for risk-based treatment escalation or de-escalation. In addition to risk stratification based on clinical parameters, research has been conducted to incorporate genomic and/or transcriptomic data into risk stratification. In future, an integrated risk model is expected to precisely stratify patients and guide treatment strategies. Here, we first review the transition of the standard treatment for mCSPC over the last decade and further discuss the newest concept of escalating or de-escalating treatment using a multi-modal approach based on the currently available literature.

DOI： 10.18999/nagjms.86.2.169

Scopus

PubMed

Language：English   Publisher：Medicine (United States)  

Rationale: The purpose of this case report is to describe a case of successful early rehabilitation intervention for simultaneous liver and kidney transplantation (SLKT). Patient concerns: A 51-year-old Japanese man was diagnosed with Caroli disease 27 years ago. Hemodialysis was introduced due to end-stage renal disease 17 years ago. Diagnoses: After successful SLKT, the patient was extubated on postoperative day (POD) 1, liberated from dialysis on POD 4, and discharged from the intensive care unit on POD 9. Interventions: Supervised rehabilitation was started on POD 2, and the patient was able to walk 100 m on POD 9. Electrical muscle stimulation therapy was started to improve muscle weakness in both legs on POD 16, and aerobic exercise using a cycle-ergometer was started on POD 24. Outcomes: The 6-minute walking distance improved from 324 m on POD 14 to 501 m on POD 28. The patient could walk 4000 to 5000 steps per day at hospital discharge, and was discharged home on POD 32. There were no adverse events, including worsening hepatic or renal function, during the rehabilitation period. One month after discharge, the patient was able to perform 30 to 40 minutes of aerobic exercise every day, and returned to work 5 months after discharge. Lessons: This case shows that early rehabilitation intervention immediately after SLKT safely and rapidly improved physical performance without adverse events. The results in the present case suggest that regular physical assessment and appropriate interventions with a variety of exercise modalities can contribute to improved physical performance in SLKT patients.

DOI： 10.1097/MD.0000000000035324

Open Access

Web of Science

Scopus

PubMed

Language：Japanese   Publisher：一般社団法人 日本移植学会  

<p>サイトメガロウイルス(CMV)感染症は最も頻度が高く重要な移植後ウイルス感染症である。治療にはまずガンシクロビル(GCV)、バルガンシクロビル(VGCV)が使用されるが、今回移植後GCV耐性CMV感染となり、ホスカルネットナトリウムにて治癒した2例を経験したので報告する。症例1:50代男性。X-17年より血液透析導入。Caroli病による頻回の胆管炎で入院を繰り返していた。ドナーは50代女性。原疾患は脳出血。脳死下肝腎同時移植施行。S-Cre1.00mg/dl前後で安定し、特記合併症なく術後約一か月で退院となった。CMV抗体陽性。術後7か月後、CMV感染となりVGCV内服開始。内服開始後もCMV感染の改善見られず、GCV耐性が判明しホスカルネットナトリウム投与開始。特記合併症なく治癒した。症例2:40代男性。X年、悪性高血圧による慢性腎不全にて血液透析導入。母親をドナーとした生体腎移植施行。S-Cre2.00mg/dl前後で安定し、特記合併症なく術後約一か月で退院となった。レシピエントCMV抗体陰性、ドナーCMV抗体陽性であったためVGCV予防内服を開始した。術後6か月後、CMV感染となりVGCV内服を治療量へ増やした。内服開始後もCMV感染の改善見られず、GCV耐性が判明しホスカルネットナトリウム投与開始。特記合併症なく治癒した。今回、移植後GCV耐性CMVに対してホスカルネットナトリムを使用し、特記問題なく治癒した症例を経験したので若干の文献的考察を加えて報告する。</p>

DOI： 10.11386/jst.58.supplement_s274_2

CiNii Research

Language：Japanese   Publisher：一般社団法人 日本移植学会  

<p>【目的】日本透析医学会の統計調査では慢性維持透析患者107 人（0.043％）が腎移植ドナーとしての腎提供ありと回答した。名古屋大学の生体腎移植ドナーの予後を調査した。</p><p>【方法】対象は1998年以降に名古屋大学で生体腎移植のため腎提供したドナー167名。内2020～22年に受診した138名の最終診察時のCKD重症度分類を調査した。受診がない29名について背景を調査した。</p><p>【結果】生体腎移植ドナーのGFR区分はG2:18名（13.0％）、G3a:74名（53.6％）、G3b:44名（31.9％）G4:2名（1.5％）、蛋白尿区分はA1:103名（74.6％）、A2:25名（18.1％）、A3:5名（3.6％）、未測定5名（3.6％）であった。G4の1名は73歳男性で腎提供前の2回の実測Ｃｃｒ平均は126.15ｍＬ/分であったが腎提供後に高血圧を合併し、腎提供後15年以上の経過で大動脈瘤手術を受けていた。残る1名は80歳女性で腎提供前の実測GFRは113.9で、腎提供後も10年以上安定していたが、急性腎障害後に腎機能が低下した。A3の4名では、腎提供前の高血圧合併2名、肥満1名だった。</p>

DOI： 10.11386/jst.58.supplement_s248_3

CiNii Research

Authorship：Lead author   Language：Japanese  

Language：Japanese   Publisher：一般社団法人 日本移植学会  

<p>レシピエント：40代男性。間質性肺炎のため、X-5年に脳死下両側肺移植施行後。免疫抑制剤としてMMF、TacER、Pred.内服中。徐々に腎機能悪化し、X-1年に血液透析導入。妹をドナーとした生体腎移植目的に当科受診。血液型不一致。AB 2mismatch　DR　1mismatch、CDC　T(-)Bw(-)Bc(-)、FCXM　T(-)B(-)、PRA screening　classⅠ(-)classⅡ(-)、導入免疫抑制剤：TacER+MMF+Pred.+BXM。右腸骨窩生体腎移植術施行。手術時間：3時間52分。外腸骨静脈-腎静脈、外腸骨動脈-腎動脈を吻合。尿管膀胱吻合は粘膜下トンネル3cm作成、Lich-Gregori法で縫合。術後速やかに腎機能発現し、S-Cre1.3mg/dl前後で推移。術後7か月拒絶反応なく、腎機能安定し経過している。両側肺移植後に生体腎移植を施行し、術後経過良好であったので若干の文献的考察を加え報告する。</p>

DOI： 10.11386/jst.57.supplement_s371_2

CiNii Research

Event date： 2024.2

Presentation type：Oral presentation (general)