西村 雄宏

PURPOSE: This pilot study evaluated indocyanine green-guided near-infrared fluorescence (ICG-NIRF) imaging of testicular blood flow to predict long-term testicular atrophy after testicular torsion (TT) surgery. METHODS: The subjects of this retrospective study were patients who underwent surgery for TT at our hospital between December, 2020 and July, 2022. After detorsion, testicular blood flow was evaluated by ICG-NIRF imaging and classified into three categories: fluorescence detected, no fluorescence detected, and fluorescence detected only in the tunica albuginea vessels. Testicular volume was measured by ultrasonography up to 12 months after surgery to evaluate long-term outcomes. RESULTS: Twelve patients were included in this analysis. We found a 100% correlation between the absence of ICG-NIRF signals and subsequent testicular atrophy. In three patients without an ICG-NIRF signal, the median testis size 12 months postoperatively was significantly smaller (16.5% of the contralateral testis; range 13-20%) than that in six patients with an ICG-NIRF signal (96%; 89-115%) (p = 0.013). Mild atrophy (74.5%; 73-76%) was also observed in the three patients for whom an ICG-NIRF signal was detected only in the tunica albuginea vessels. CONCLUSIONS: Our pilot study highlights the potential of ICG-NIRF imaging as a prognostic tool for guiding surgical decision-making for patients with TT, by predicting postoperative testicular atrophy.

当院で新生児期に胸腔鏡下先天性横隔膜ヘルニア(CDH)修復術を行った7例(男児2例、女児5例)について検討した。当院ではCPSSで6～7点を手術の適応基準としており、1例は4点で基準を外れていたが、SIMVで換気が保たれていること、一酸化窒素の使用がなく、手術室に移動できることから、胸腔鏡手術は可能と判断した。いずれの症例も開胸・開腹に移行することなく、安全に胸腔鏡下CDH修復術を完遂できたが、1例で術中に針の出し入れによる肺損傷から気胸がみられ、胸腔ドレーン留置により改善した。尚、術後合併症は全例で認められなかった。

UNLABELLED: Invariant natural killer T (iNKT) cells play an essential role in antitumor immunity by exerting cytotoxicity and producing massive amounts of cytokines. iNKT cells express invariant T-cell receptors (TCR) to recognize their cognate glycolipid antigens such as α-galactosylceramide (α-GalCer) presented on CD1d. We recently reported that iNKT cells recognize CD1d-negative leukemia cell line K562 in a TCR-dependent manner. However, it remains controversial how iNKT cells use TCRs to recognize and exhibit cytotoxic activity toward CD1d-negative tumors cells without CD1d restriction. Here, we report that iNKT cells exerted cytotoxicity toward K562 cells via a carried over anti-Vα24 TCR mAb from positive selection by magnetic bead sorting. We found that addition of the anti-Vα24Jα18 TCR mAb (6B11 mAb) rendered iNKT cells cytotoxic to K562 cells in an FcγRII (CD32)-dependent manner. Moreover, iNKT cells treated with 6B11 mAb became cytotoxic to other CD32+ cell lines (U937 and Daudi). In addition, iNKT cells treated with 6B11 mAb suppressed K562 cell growth in a murine xenograft model in vivo. These data suggest that anti-iNKT TCR mAb treatment of iNKT cells can be applied as a therapeutic strategy to treat CD32+ cancers such as leukemia, lymphoma, and lung cancer. SIGNIFICANCE: Our findings unveiled that iNKT cells recognize and kill CD1d-negative target tumors via the anti-iNKT TCR mAb bound to CD32 at the tumor site, thereby bridging iNKT cells and CD1d-negative tumors. These findings shed light on the therapeutic potential of anti-iNKT TCR mAbs in NKT cell-based immunotherapy to treat CD1d-negative CD32+ cancers.

PURPOSE: This study evaluated the abdominal aortic diameter in high-risk neuroblastoma (NB) patients and the risk of aortic narrowing following intensive treatment. METHODS: We measured the aortic diameter at four specific levels of the abdominal aorta (diaphragmatic crus, celiac axis, and the root of the superior (SMA) and inferior (IMA) mesenteric arteries) on contrast CT scans. The control group consisted of 56 children with non-oncologic disorders, while the NB group included 35 patients with high-risk abdominal NB. We used regression analysis of age and aortic diameter to determine the regression formula for each level in each group and performed intergroup comparisons using t-test. RESULTS: We evaluated a total of 160 contrast-enhanced CTs performed in the 35 eligible cases. The aortic diameter of pretreated NB patients was not significantly different from the controls. After receiving any treatment, the aortic diameter was significantly smaller in the NB group (p < 0.01 each). Patients who underwent radical surgery, particularly gross total resection (n = 26), had smaller aortic diameters at all levels compared to controls (p < 0.01 each). Patients treated with radiotherapy (RT) had smaller aortic diameters than controls. External beam radiotherapy (EBRT) patients (n = 24) had smaller aortic diameters at all levels except the celiac axis (crus, SMA, IMA; p < 0.01 each), and intraoperative radiotherapy (IORT) ± EBRT patients (n = 5) had smaller aortic diameters at all levels (p < 0.01 each). CONCLUSION: Patients with NB may experience impaired development of the abdominal aorta after multimodal therapy, particularly after RT. Close observation and long-term follow-up is essential to monitor for catastrophic vascular complications. LEVEL OF EVIDENCE: LEVEL III.

2004年1月～2020年12月の間に、腹腔鏡下虫垂切除術を施行した15歳以下の非穿孔性症例を対象に、適切な抗菌薬投与方法について検討した。2017年12月以降に新たな周術期抗菌薬剤投与プロトコール(非穿孔性の場合、感染巣を完全除去できれば術後抗菌薬投与を行わない、など)を定め(導入後)、術者判断で投与期間を決定していた2004年1月～2017年11月(導入前)の治療成績と比較した。腹鏡下虫垂切除術を行った非穿孔例254例を解析対象とした。その結果、導入後は有意に手術時間が短く、虫垂摘出時の回収パウチ使用が少なかった。術後抗菌薬投与は、導入前の190/190例から導入後の6/64例に有意に減少し、6日以上の入院も導入前の92例に対し、導入後は7例と有意に減少した。術後合併症の発生リスクは導入前の14例(7%)に対し、導入後は11例(17%)と増加した。創感染発生リスクのみが導入後に有意に上昇していた。

The clinical features and risk factors of acute appendicitis in infants are unclear. Our aim was to evaluate the association between anthropometrics and the occurrence of infantile appendicitis. This was a retrospective study of infants (<6 years of age) and school-age children (6-10 years of age) of Asian ethnicity who required hospitalization for appendicitis at our two participating institutions between 2004 and 2018. The Z-score for height, body weight, and body mass index (BMI) was compared between the two groups, as well as between patients presenting with perforated and non-perforated appendicitis. The analysis included data from 73 infants and 362 school-age children. Z-scores were greater in infants than in school-age children for height (0.37 versus -0.03, p = 0.003) and body weight (0.12 versus -0.36, p = 0.023), with no between-group difference for the Z-score of BMI. There was no difference in Z-scores for height, weight, and BMI between the perforated and non-perforated appendicitis infant groups. Infants presenting with acute appendicitis were characterized by a larger physique but with normal proportion. This trend was not observed in school-age children. Therefore, larger infants presenting with abdominal pain should be screened for appendicitis.

狭義の先天性胆道拡張症(congenital biliary dilatation:CBD)の画像診断では、胆管径と形態学的特徴を加味した胆管拡張と、膵・胆管合流異常(pancreaticobiliary maljunction:PBM)の明示が不可欠である。加えて詳細な治療方針の決定に際しては、肝内胆管の拡張と狭窄、併存悪性病変の有無とその拡がり、narrow segmentの距離、胆道の分岐形態、結石・蛋白栓の有無と存在箇所、肝動脈と総胆管の位置関係などの情報も重要である。検索手段としてUS、直接造影(ERCP、PTC、術中胆道膵管造影(IOCP))、MRCP、DIC-CT、EUS、MD-CTなどがある。胆管径は胆道内圧を上昇させ得る直接造影で評価すべきでないが、複雑な膵管胆道(合流)形態を把握するには逆にそれが有用である。広義のCBDでは病態が不明な点も残っており、とくに有症状例では詳細な画像検索がすすめられる。各種画像検査の選択と施行にあたっては、患者の年齢、全身状態、悪性病変の併存率や各検査の特徴を十分に把握しておく必要がある。(著者抄録)

漏斗胸に対する手術としてRavitch法を施行した20例、胸骨挙上法(SCE)を施行した7例を対象に、手術成績を比較検討した。その結果、Ravitch法と比べSCEでは有意に手術時間が短く、出血量も少量で、入院期間の短縮を認めた。合併症はRavitch法で肺損傷を1例、SCEで胸膜損傷を1例、創感染を1例に認めた。両術式とも患者の満足度は高かった。