Abstract

Crohn's disease (CD) causes gastrointestinal symptoms (i.e., diarrhea and abdominal pain), systemic symptoms (i.e., fatigue, anemia, weight loss, and fever), and perianal fistulas that produce anal pain. Because of the frequent occurrence of diarrhea and ulcers in the rectum, CD is often exacerbated by perianal abscesses and/or fistulas. Perianal fistulizing CD (PFCD) has an unknown etiology and recurring symptoms such as pain and discharge, which seriously affects the patient's quality of life (QOL). In the past, radical surgery was performed for PFCD, but due to the risk of anal sphincter impairment, conservative therapy using antibiotics and immunosuppressive medications is currently the first treatment option. PFCD management has greatly improved with the use of biologics such as the antitumor necrosis factor alpha (TNF-α) antibodies infliximab and adalimumab. In this review, the results of the administration of anti-TNF-α (certolizumab pegol), anti-interleukin-12/23 (ustekinumab), and anti-α4β7 integrin antibodies (vedolizumab) were evaluated. Our investigation showed that these medications may be effective for maintenance therapy to prevent the recurrence of anal fistulas. In addition to biologics, molecular target drugs and even regenerative medicine using mesenchymal stem cells have been introduced to further expand the treatment options for consideration by medical personnel. We herein discuss the management of PFCD by focusing on studies conducted in the United States and Europe where researchers used recommended guidelines and consensus statements to evaluate the efficacy of each medication and published their findings in peer-reviewed journals.

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Abstract

Purpose
To establish if it is appropriate to treat the inguinal lymph node (LN) of anal canal adenocarcinoma (ACA) as the intermediate LN according to the Japanese classification.

Methods
The characteristics of 346 ACA patients were examined from the nationwide registry. The effect of LN dissection was evaluated using the therapeutic value index (TVI). Furthermore, the prognostic classification ability of N factors and stage was evaluated using Akaike’s information criterion (AIC), the concordance index (C-index), and the 5-year overall survival (OS) rate.

Results
The rate of metastasis of the inguinal LN was 7.5% and the TVI was 3.05. Evaluation using AIC and the C-index showed better results when the inguinal LN was treated as the intermediate LN. The 5-year OS rate for 66 patients with perirectal or intermediate LN metastasis, 7 with inguinal LN metastasis, and 13 with inguinal and perirectal or intermediate LN metastasis were 49.2%, 68.6%, and 47.6%, respectively. When inguinal LN metastases were treated as N3, the 5-year OS rates were 66.7% for those with T1N3 and T2N3 disease, and 49.2% for those with T3N3 disease.

Conclusions
The inguinal LN of ACA was evaluated and staged as the intermediate LN to devise an appropriate treatment strategy.

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要約

目的：人間ドックでは多くの多血症が認められる．まれではあるが真性多血症（polycythemia vera: PV）が存在する可能性もあるが詳細は不明である．このため，人間ドックでの多血症の実態調査を実施した．

方法：2018年から2022年に受診し，ヘモグロビン（Hb）またはヘマトクリット（Ht）を検査された27,222例を対象とした．WHOのPV新診断基準（2016年）と旧基準（2008年），さらに日本人間ドック・予防医療学会のHb判定基準Dを適用して比較検討した．

結果：HbまたはHt値が旧WHO診断基準を満たした例は48例（ 0.2％）であったが，新WHO基準のHbまたはHt値には2,383例（ 8.8％）が該当した．日本人間ドック・予防医療学会のHb判定基準D該当例は193例（ 0.7％ ）と 旧 WHO基準該当の比率に近かった．新WHO基準を用いた多変量解析では，男性，BMI 25kg/m2以上，喫煙の3因子が関連し，97.8％がこれらの1つ以上を有したが，2.2％はどの因子も有さなかった．うち17例が二次検査を受け，1例でJAK2遺伝子の検索，同例を含めた2例でエリスロポエチンの測定が行われたが，いずれも異常は認められなかった．

結論：人間ドックで認められる赤血球増加症のほとんどは喫煙者およびストレス多血症であると考えられる．一方，PV確定のための二次検査受診例はまれであり，PV早期発見のための二次検査を効率的に行う戦略の確立が必要である．

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抄録
当院にて2019年度で治療した肛囲膿瘍の①臨床的背景②経肛門的超音波検査の有用性について検討を行った．

結果：①肛囲膿瘍の約80％が肛門腺由来の膿瘍であった．②肛囲膿瘍の切開排膿前の正診率（切開排膿後の根治手術所見を最終診断とした診断的中率）は，指診（74％）と比較し，経肛門的超音波検査（99％）が有意に高く有用であった．

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