kobayashi takashi

We investigated 2,152 patients with gallbladder polyps detected by ultrasonographic mass screening at our institution. Nine underwent cholecystectomy later, when polyps had enlarged. Seven others, most with larger polyps, underwent cholecystectomy shortly after polyp detection. Characteristics were compared between these 2 surgical groups. In patients with surgery upon enlargement, mean polyp diameter at the time of cholecystectomy was 12.9 mm and the mean polyp growth rate was 2.6 mm/year. Ultrasonographically, these polyps most often showed homogenous echo patterns resembling liver parenchyma. Pathological diagnoses were cholesterol polyps in 7; papillary hyperplasia in 1; and tubular adenoma in 1. In patients with surgery immediately upon detection, the mean polyp diameter was 13.1 mm. Ultrasonographically, these polyps often showed homogenous echo patterns that included small cystic structures. Pathological diagnoses included 5 cholesterol polyps, 1 inflammatory polyp, and 1 carcinoma in situ. The polyp diameter at detection in the immediate surgery group was significantly greater than that in the group with surgery upon enlargement. Single polyps were significantly more prevalent in immediate surgery patients than in the other group. Careful follow-up is required in patients monitored for polyp showing homogenous echo patterns resembling liver parenchyma, in which polyps are enlarged prior to surgery, considering that this group may include tubular adenoma or carcinoma in situ.

高齢化社会を迎え心疾患や脳血管疾患が増加し、その予防や治療目的で抗凝固薬や抗血小板薬が用いられる機会が多くなり、これらの薬剤は時に消化管出血の原因となることが危惧される。今回、高齢者における食道出血性病変について81症例(Mallory-Weiss症候群20例・逆流性食道炎37例・食道潰瘍15例、うち42例が65歳以上の高齢者)を対象に抗凝固薬・抗血小板薬との関連性について検討した。その結果、抗凝固薬或いは抗血小板薬を処方されていたのは14例(28.6%)で全例高齢者であり、出血によりヘモグロビンが10g/dl以下をきたしていたのはこの14例で、4例に対しては輸血を要し、またこの14例は1例を除き何らかの心疾患や脳血管疾患の既往を有していた。以上より、これらの薬剤投与中には消化管出血の可能性があることを患者・家族に説明して注意を促すことが必要と考えられた。