Ryo Shinhara

Surgical methods and clinical results of subfascial endoscopic perforator surgery in Japan

Objectives To clarify the surgical methods and the clinical results of subfascial endoscopic perforator surgery in Japan. Methods This study included 1287 limbs of 1091 patients who underwent subfascial endoscopic perforator surgery in 14 hospitals. Simultaneous saphenous vein treatment was performed in 1079 limbs (83.8%), and 118 limbs (9.2%) had deep venous lesions. The venous clinical severity score was calculated before and 6 to 12 months after surgery. The ulcer healing rate and ulcer recurrence rate were calculated cumulatively. Results Preoperative venous clinical severity score was significantly decreased from 10.0 ± 6.6 to 3.1 ± 3.4 (P < .0001) postoperatively. The primary ulcer healing rate was 96.2% (332/345 C6 limbs) at an average follow-up of 47.7 months, and the ulcer recurrence rate was 12.0% (49/393 C5, C6 limbs) at the average follow-up of 46.0 months after the ulcer healed. Conclusion These results indicate that subfascial endoscopic perforator surgery is an alternative to improve the long-lasting disease severity and/or clinical outcome.

Significance of variation in plasma calcitonin and administration of elcatonin to hemodialysis patients

透析患者に対しカルチトニン (CT) 製剤 (elcatonin, ECT) を長期にわたって投与し骨性状の改善に有効であることを報告してきた. しかし内因性CTの透析患者における変動及びCT製剤投与との関係は未だ明確でなかった. 今回, 血清CT値を測定しその変動及びECT投与との関係を検討した.ECT長期投与12例の投与前血清CT値は98.9±31.2pg/mlであったが, 投与6年後には低下8例 (49.6±11.1), 不変3, 上昇1と低下傾向を示し, その傾向はALP高値群で著明であった. 非投与症例の血清CT値は男: 78.8±46.1, 女: 56.3±26.4と女性が低かった (P<0.01). C-PTHは透析歴, ALP値と有意の正の相関を認めたが, 血清CT値は透析歴, ALP値, C-PTHとまったく相関を認めず, ALP高値・低値及び糖尿病・非糖尿病に分けて検討しても差は見られなかった.ECT投与は透析患者の骨病変の進行を抑制していると考えられ有効であると言える. また6年間のECT連続投与によっても, ECT抗体産生は認められなかったが, 血清CT値は低下傾向を示しており内因性CTの分泌抑制がおこっている可能性が考えられた. また慢性透析患者の血清CT値は, 常に正常範囲内に存在しており, PTHとは完全に独立して変動するものと考えられた.