脳神経外科速報
Volume 26, Issue 6, 2016
Volumes & issues:
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目次
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Techniques & Arts
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【Special Interview】 外科学の根幹は手術である―すべては「患者さんのために」
26巻6号(2016);View Description Hide Description手術を指導するときは時間を優先します.「この手術は3時間で終わるはず」という場合には3時間与えて,それを過ぎたらどんな状況でも「はい終わり,交代」.いくら良い手術でも時間をかけた手術は患者さんや周りのスタッフを含め,みんなに迷惑をかけることになりますから.術中,動脈瘤が破れても,すぐに手出しせず,ゆっくり5つ数えます.術者がこれを乗り越えるか,乗り越えないか,見極める.それが彼らの成長につながります.(松本健五) -
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【脳外科手術リカバリーの極意 私の工夫】 間脳下垂体病変術後の水電解質異常―ナトリウム濃度を中心とする間脳下垂体術後,水電解質管理
26巻6号(2016);View Description Hide Description
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Current Knowledge
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【専門医に求められる最新の知識:脳腫瘍】 膠芽腫に対する免疫療法のup to date
26巻6号(2016);View Description Hide Descriptionがんの領域で発展が著しい免疫療法について,グリオーマの次世代の標準治療の候補と位置付け,その現況を要約した.免疫療法の原理と中枢神経系の免疫環境を総括し,すでに中枢神経系は免疫寛容臓器ではないことを述べた.主には膠芽腫において世界で広く行われている「がん関連抗原を標的とした免疫療法」である樹状細胞ワクチン,自家腫瘍ワクチン,ペプチドワクチン療法の臨床試験結果を記述したが,その他の免疫療法のモダリティーであるエフェクター細胞療法やチェックポイント阻害療法についても言及した.グリオーマ免疫療法時代の幕開けに際し,現在の課題と将来の展望を述べたが,なかでも有望視される複合的な免疫療法について「何をどのように組み合わせるか」が重要であることを強調した. -
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Journal in Journal 【脳卒中速報】
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【本音と主観で語る 脳血管内治療に用いるデバイスの基礎知識】 血栓回収デバイスの比較―Solitaire FR,TrevoProVue Retriever,ReVive SE,Penumbra System 5MAX ACE
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【超実践!脳卒中に用いる薬の基礎知識】 エダラボン
26巻6号(2016);View Description Hide Description① エダラボンは急性期脳梗塞患者の神経症候を改善する効果がある.② エダラボンはt-PA療法との併用において,出血性合併症軽減や再開通率向上に寄与する可能性がある.③ エダラボンはALSの治療薬としても認可され,その効果が期待されている. -
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Contribution
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【投稿論文:Case Report】 上皮成長因子受容体(EGFR)遺伝子変異陽性肺腺癌による髄膜癌腫症の2例
26巻6号(2016);View Description Hide DescriptionLeptomeningeal metastasis (LM) of non-small cell lung carcinoma (NSCLC) is related to an unfavorable outcome; however, epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) have been reported to provide a relative long-term survival rate in patients with EGFR mutations. We report our experience of surgical interventions as a multidisciplinary treatment for LM and review the literature. Case 1: A 67 year-old man underwent right upper lobectomy and adjuvant chemotherapy for lung adenocarcinoma in September 2002. He was diagnosed as LM, and soon a VP shunt was placed for treatment of his severe headache due to hydrocephalus in November 2013. After surgery, headache and gait disturbance improved and morphine was discontinued. As EGFR mutation showed positive, erlotinib was started and revealed a relative long-term effective. Then, He received pemetrexed and afatinib after exacerbation of LM and expired 23 months after the diagnosis of LM. Case 2: A 55 year-old woman underwent right middle lobectomy with adjuvant chemotherapy for her lung adenocarcinoma in March 2010. She underwent craniotomy due to a left frontal brain metastasis in March 2013. In June, she received erlotinib immediate after the diagnosis of LM. We placed an Ommaya reservoir for further intraventricular chemotherapy, but wound infection occurred from severe skin rash by erlotinib happened to her, and the reservoir was removed. She returned to work during administration of pemetrexed and afatinib. As LM gradually exacerbated, she died 25 months after the diagnosis of LM. Efficacy of EGFR-TKIs for brain metastasis or LM of NSCLC has been reported in the literature and may provide a relative long-term survival after proper treatment of LM. Our report showed that VP/LP shunt for the treatment of hydrocephalus was effective to improve patient’s quality of life (QOL) and might be an important multidisciplinary treatment of LM. The risk of peritoneal metastasis following VP/LP shunt isconsidered to be low in combination with EGFR-TKIs. Complication of skin rash caused by EGFR-TKIs is common, and we suggest surgery should precede the administration of EGFR-TKIs to prevent a possibility of surgical infection. We report the efficacy and adverse events of surgical interventions, using VP shunt or Ommaya reservoir placement as a multidisciplinary treatment for the treatment of LM. Further studies are necessary to de-termine the indication and timing of surgical interventions.
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Lecture & General Information
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【World Report:海外脳外科最新事情】 ドイツ臨床留学記:その⑥ International Neuroscience Institute Hannover①
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【Clinical Essay:PC,スマホ,タブレットを使いこなせ!!日常診療に役立つIT】 iPhone/iPadを使い倒そう!─スマートフォンやタブレット端末をきれいに使おう─
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【World Report:海外脳外科最新事情】 International Fellowship for Young Neurosurgeons at Fujita Health University
26巻6号(2016);View Description Hide DescriptionThe fellowship gave me more than I actually had expected. It provided best neurovascular training and helped me a lot to understand basic points of neurovascular surgery. I had a great experience in Japan. I learnt a lot from my Japanese mentors, friend and I hope I can use it for better patient care in my country. Although staying away from my country and my family was difficult, I felt we had many similarities with Japanese people in a manner and language. Having opportunity to learn some Japanese, I even found out that grammar of language was very close to our language. I wish to keep in touch with my Japanese friends and mentors as frequent as possible and wish professor Kato and her team good luck and the best of success. Arigato gozaimashita! -
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その他
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Lecture & General Information
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その他
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