論文

© 2019 Japan Pediatric Society Background: The optimum enteral (EN) and parenteral nutrition (PN) regimens during acute management of congenital diaphragmatic hernia (CDH) remain unclear. We examined the effects of EN and PN on weight gain in CDH patients. Methods: A multicenter retrospective cohort study of neonates with CDH (born 2006–2010; n = 105) who survived to discharge was conducted. Patients were divided as receiving PN ≥ or <50 kcal/kg/day at 1 week of age, and EN ≥ or <60 kcal/kg/day at 2 weeks of age. Changes in bodyweight at 30, 60, and 90 days of age were compared. Results: The higher EN group (n = 39) had greater mean weight gain than the lower EN group (n = 66; 90 days: 2,501 g, 95% CI: 2,294–2,710 g vs 1,706 g, 95% CI: 1,553–1,861 g; P <0.001). When patients received lower EN, the higher PN group (n = 24) had greater mean weight gain than the lower PN group (n = 42; 90 days: 1,768 g, 95% CI: 1,574–1,961 g vs 1,411 g, 95% CI: 1,264–1,558 g; P = 0.004). Conclusion: The amount of EN in the acute phase of CDH management is essential for weight gain during infancy. When patients are intolerant to adequate EN, supportive PN is also essential.

OBJECTIVE: A solitary pulmonary lesion in patients with a history of malignancy may be either primary lung cancer or a metastatic lung tumor or benign nodule. We retrospectively examined the preoperative predictive factors for determining the type of pathology. METHODS: We used an exact logistic regression analysis to identify radiological and clinical predictors of primary lung cancer. The study included 187 patients who underwent pulmonary resection for a solitary pulmonary lesion and had received previous treatment for a malignancy. RESULTS: There were 107 patients with primary lung cancer, 74 with metastatic lung tumors, and 6 with benign lesions. The previous malignancy included colorectal cancer in 71 patients. A disease-free interval exceeding 5 years and ground-glass opacity were found in 27.0% (20/74) and 1.4% (1/74) of metastatic lung tumors, respectively. Multivariate logistic regression analysis demonstrated that spiculation [adjusted odds ratio (a-OR), 1.74; 95% confidence interval (CI), 1.09-2.86], pleural indentation (a-OR 1.99, 95% CI 1.24-3.29), and ground-glass opacity (a-OR 5.28, 95% CI 2.61-13.1) on high-resolution computed tomography, maximum standardized uptake value (a-OR 1.14, 95% CI 1.02-1.29), current and former smokers (a-OR 1.96, 95% CI 1.21-3.30), and previous malignancy other than colorectal cancer (a-OR 2.02, 95% CI 1.26-3.37) were associated with primary lung cancer. CONCLUSIONS: A combination of radiological findings, smoking history, and type of previous malignancy can improve the ability to predict primary lung cancer in the presence of a solitary pulmonary lesion that appears after previous treatment for a malignancy.