@article{oai:niigata-u.repo.nii.ac.jp:02000705,
 author = {今井, 邦英 and Imai, Kunihide and 西川, 太郎 and Nishikawa, Taro and 小林, 茂 and Kobayashi, Shigeru and 石川, 忍 and Ishikawa, Shinobu and 本間, 毅 and Honma, Takeshi and 塩谷, 雄二 and Shiotani, Yuji and 八木, 和徳 and Yagi, Kazunori},
 issue = {10-12},
 journal = {新潟医学会雑誌},
 month = {Dec},
 note = {Even if the histology of the brain tumor were benign, the prognosis of the patient suffering from it would be poor according to the location in the intracranial portion. Moreover, histologically low grade glioma often perform malignant transformation resulting in the high grade glioma, while the patient is treated. Finally the patient would be dead. Concerning the glioma, tumor cell usually invades the brain outside the margin which seems to be one between the normal brain and tumor. In addition, we must suppress the neurological deficits by the subtotal evacuation as strongly as possible. Therefore, it is actually impossible for us to evacuate the tumor totally. If the glioma locates on the brain stem which is the life center or does on the parietal lobe of the dominant hemisphere which has the another side of the motor area and the language center including Broca area, it is more difficult for us to remove the tumor completely without neurological deficits. Especially in the case of the latter, after the operation (subtotal resection) the patient would manifest complete paralysis of the upper and lower limbs and the total aphasia. Therefore, when the patient suffering from the high grade glioma which locates on the parietal lobe of the dominant hemisphere often would hesitate the standard therapy including operation, chemotherapy, radiation, immunotherapy. For example, the presented case 1 rejected the standard therapy in addition to the multidisciplinary one while she was alert without the disorientation. On the other hand, case 2 has undergone the standard therapy with serious neurological deficits and admitted on our institute for the palliative treatment. Under the systemic condition, we find difficulties in the treatments of them. In any case, the patient and their family members do not desire undergoing the multidisciplinary treatments including central venous hyperalimentation (IVH) or tube nutritional support (TNS) but intravenous drip (DIV). Then, we sometimes experience the unexpected and suddenly appeared problems such as Cushing ulcer (Case 1) or the aspiration pneumonia (case 2). We studied from the presented two cases that the patients must be treated as a man not only to avoid discomforts but also be done with the welfare and authority until the they would die even if on the palliative treatments., 脳腫瘍は，例え，病理学的に良性であったとしても，発生母地となる局在によって，生命あるいは，神経学的に予後不良となる場合が，しばしば認められる。更に，組織型が，神経膠腫(glioma)の場合，high gradeはもちろん，当初，low gradeであっても，経過中に悪性転化を繰り返し，最終的にはhigh grade glioma(以下HGG)となって，致死的となる場合が少なくない。脳実質から発生するgliomaの場合，画像で認められる脳との境界線よりも外側の，一見，正常と思われる脳実質にも，腫瘍細胞は浸潤しており，神経学的な脱落症状を最小限に抑えなければならいという制約もあるため，腫瘍組織を全摘出することは，事実上，不可能である。したがって，gliomaの局在が生命中枢である脳幹や言語中枢(言葉の理解，発話)，計算，論理的思考，運動中枢を司る優位半球(通常は左側)，に認められる場合は，摘出術はさらに困難を極め，特に，後者の場合，術後，高度の右片麻痺および全失語となることが，予想されるため，患者本人およびその家族は，摘出術を受ける躊躇うケースが，しばしば，認められる。症例の中には，術後の神経学的脱落症状を考慮し，当初より，摘出術を含む標準治療を拒否するもの(症例1)や標準治療後，高度の神経学的脱落症状を呈し，緩和ケアに回ってくるケースなど(症例2)，対応に苦慮する場合がしばしば，認められる。いずれの症例も，緩和ケアにおいては，治療に関して，集学的な内容を希望せず，敢えて，高カロリー輸液(central venous hyperalimentation)も避けて，末梢血管からの輸液のみを行う場合が，しばしば，ありえる。その際に，事前に，ある程度，想定はしていても，いきなりの発症をみる注意すべき全身的合併症を経験することも，しばしばである。著者らは，緩和ケアとはいえ，一人の人間である患者が，苦痛を回避するだけでなく，安寧と尊厳を持って，最期を迎えらえるよう，尽力すべきことを，教訓として得た．},
 pages = {229--235},
 title = {優位半球頭頂葉に主座を置くhigh grade glioma，標準治療後の緩和ケアにおける致死的全身合併症に関する2症例の検討},
 volume = {135},
 year = {2021}
}