次の各問いに対する答えを解答用紙に記入しなさい。
Ⅰ．前立腺癌に関する以下の文章を和訳しなさい。
Carcinoma of the prostate is predominantly a tumor of older men, which frequently responds to treatment when widespread and may be cured when localized. The rate of tumor growth varies from very slow to moderately rapid, and some patients may have prolonged survival even after the cancer has metastasized to distant sites such as bone. Because the median age at diagnosis is 72 years, many patients – especially those with localized tumors – may die of other illnesses without ever having suffered significant disability from the cancer. The approach to treatment is influenced by age and coexisting medical problems. Side effects of various forms of treatment should be considered in selecting appropriate management. Controversy exists in regard to the value of screening, the most appropriate staging evaluation, and the optimal treatment of each stage of the disease.
Ⅱ．周術期脳卒中に関する以下の文章を和訳しなさい。
The incidence of perioperative stroke depends on the type and complexity of the surgical procedure. The risk of stroke after general, noncardiac procedures is very low, whereas cardiac and vascular surgeries are associated with higher risks. Despite advances in surgical techniques and improvements in perioperative care, the incidence of perioperative strokes has not decreased, reflecting the aging of the population and the increased number of elderly patients with coexisting conditions who undergo surgery. Perioperative strokes result in a prolonged hospital stay and increased rates of disability, discharge to long-term care facilities, and death after surgery. Radiologic and postmortem studies indicate that perioperative strokes are predominantly ischemic and embolic. In a study of patients with stroke after coronary-artery bypass grafting （CABG）, hemorrhage was reported in only 1% of patients. Early postoperative embolism results especially from manipulations of the heart and aorta or release of particulate matter from the cardiopulmonary-bypass pump. Delayed embolism is often attributed to postoperative atrial fibrillation, myocardial infarction, and hypercoagulability resulting from surgical trauma and associated tissue injury. Several studies have shown activation of the hemostatic system and reduced fibrinolysis after surgery, as evidenced by decreased tissue plasminogen activator （t-PA） and increased levels of d-dimer immediately after surgery and up to 14 to 21 days postoperatively.
次の各問いに対する答えを解答用紙に記入しなさい。
Ⅰ．血管remodelingに関する以下の文章を和訳しなさい。
Chronic changes in arterial blood flow induce compensatory changes in arterial size, a response known as remodeling. Arterial remodeling occurs during normal growth and development and as a response to exercise. As originally described, arterial remodeling is a compensatory response that maintains the arterial lumen and blood flow during the formation of atherosclerotic lesions. The present study took advantage of a “natural experiment” to study arterial remodeling in humans. When the radial artery is harvested from the forearm for use as a bypass conduit during coronary bypass surgery, the ulnar artery remains as the sole supply of blood to the hand and is exposed to chronically increased blood flow. We measured remodeling of the ulnar artery before and after removal of the radial artery in 53 patients undergoing coronary bypass surgery. We observed a chronic increase in ulnar artery blood flow and outward remodeling of the artery. The response was blunted in cigarette smokers but did not relate to other risk factors. Remodeling was greatest in patients with the largest increases in flow and correlated with the function of the vascular endothelium. These findings are consistent with the idea that the endothelium acts as the primary sensor to changes in flow and coordinates the remodeling response. This study provides new insights into the causes and predictors of arterial remodeling in patients and is relevant to a variety of clinical situations, including angiogenesis, collateral formation, atherosclerosis, and restenosis after percutaneous intervention.
Ⅱ．転移性肺腫瘍に関する以下の文章を和訳しなさい。
Regardless of their route of entry into the lungs, pulmonary metastases present a common clinical problem. Early signs and symptoms may be varied or absent. Most patients have an identified primary cancer, but for those who do not, careful history and physical examinations are useful to determine a possible primary site, and only a few laboratory tests contribute to the evaluation. Imaging studies may be very useful to find multiple pulmonary metastases not seen on conventional radiographs and to better define lymphangitic or locally invasive disease. When the thorax is the only available site for obtaining tissue, a variety of techniques may be used, aided by immunohistochemical stains, to help identify the site of origin of the cancer. Treatment of pulmonary metastases is individualized and is highly dependent on the type of cancer. Patients having curable cancers are few. Treatment issues for these patients may include later resection of residual disease in the lungs for diagnostic and potentially therapeutic purposes. For most patients, palliative treatment is appropriate, employing both symptomatic and anticancer therapies. Surgical resection of metastases may be advisable for highly selected patients having isolated pulmonary metastases. Metastatic sarcomas are most often approached surgically, occasionally with long-term cure of patients. The lack of prospective data limits further application of surgical treatment.
