Mitsunobu Akashi

A Case of Gastric Cancer with Malignant Acanthosis Nigricans.

症例は60歳女性。主訴は頸部, 項部, 腋窩部, 腹部, 陰部, 鼠径部の色素沈着および掻痒感で, 皮膚生検にて黒色表皮腫と診断された。上部消化管内視鏡検査にて胃体上部後壁にBorrmannIII型進行胃癌を認めた。胃全摘術を施行したが, 術後1年9か月後に癌性腹膜炎にて死亡した。黒色表皮腫は悪性腫瘍の合併率が高く, 特に胃癌との合併が多く報告されている。皮膚症状は胃癌の発見につながるもので, 黒色表皮腫に対しては, 特に胃癌の合併を念頭に置いた定期検診を行うべきであると考える。

Present Situation and Future Theme of Zoonosis.

I chose this subject for the chairmans lecture without a moments hesitation. During the four years at the graduate school, I studied virology and enjoyed a wide range of researches from molecular biology and electron microscopy to field work on the wintering of Japanese encephalitis viruses, etc. Then, I was engaged in research in the field of tropical medicine in Kenya, Africa. Half a year after I returned to Japan, still obsessed by Africanism, I came to Oita on a three-year contract.I found Oita blessed with nature and rich in wonderful food, However, the first thing I came across here was a parasite that is much larger than viruses. It was Paragonimus which would infect humans not through crab meat but raw boar meat. I also discovered the 12th case in Japan of pulmonary dirofilariasis in the human lungs that is an infection with filaria immitis. Later, I had opportunities to diagnose a variety of zoonosis, but I realized wrong diagnosis had been made for each of those infections. I came to Oita as a doctor of pulmonary medicine, but living in Africa had changed my view of life and my clinical view. In Africa, illesses were greatly affected by the natural environment and socio-economic factors in local areas.To present my experiences in discovering rare diseases in local areas, to talk about how I discovered them, and to mention the present situation and future themes are thought to be suitable for the Rural Medicine Congress which will be held in Kyushu for the first time in 22 years.In Japan, we have to keep zoonosis always in mind, when making diagnoses, because of an increasing number of people going overseas, the pet boom, the gourmet boom, the increase in imported foods, etc.Also zoonses, both new and reviving ones, are told to break our by unusual changes in this modern society. Now is the time to reexamine agriculture in Japan. I believe this is the task for people who are associated with the cause of rural medicine.