５．資 本 金
⑴ 自己資本金 6,885,913,966
⑵ 借入資本金
イ 企 業 債 19,243,634,794
借 入 資 本 金 合 計 19,243,634,794
資 本 金 合 計 26,129,548,760
６．剰 余 金 ⑴ 資本剰余金
イ 受 贈 財 産 評 価 額 324,002,160 ロ 補 助 金 1,079,051,810 ハ 負 担 金 13,547,406,389 ニ 寄 附 金 3,000,000
資 本 剰 余 金 合 計 14,953,460,359 ⑵ 欠 損 金
イ 当年度未処理欠損金 8,084,446,505
欠 損 金 合 計 8,084,446,505
剰 余 金 合 計 6,869,013,854
資 本 合 計 32,998,562,614
負 債 資 本 合 計 35,309,214,098
区 分 算 式 平成24年度 平成23年度 平成22年度
１. 平 均 在 院 日 数
（こころのケア科 除く）
在 院 患 者 数 1/2（新入院患者数＋退院患者数）
日 13.9
日 14.5
日 15.2
２. 病 床 利 用 率
（一般病床）
入 院 患 者 数 ×100
許 可 病 床 数
％ 88.1
％ 84.2
％ 86.5
３. 入院患者１人１日当たり
収 入 額
入 院 収 益 額 入 院 患 者 延 数
円 55,120
円 52,981
円 51,756
４. 外来患者１人１日当たり
収 入 額
外 来 収 益 額 外 来 患 者 延 数
円 13,713
円 12,908
円 12,034
５. 剖 検 率 解 剖 数
×100 院内死亡患者数
％ 4.4
％ 3.9
％ 2.7
６. 100 床 当 た り 職 員 数 職 員 数（年度末）
×100 許可病床数（年度末）
人 126.0
人 116.6
人 116.3
７. 100 床 当 た り 医 師 数 医 師 数（年度末）
×100 許可病床数（年度末）
人 19.5
人 17.9
人 17.9
８. 100床当たり看護師数 看 護 師 数（年度末）
×100 許可病床数（年度末）
人 81.5
人 76.3
人 76.3
９. 100床当たり器械備品額
（年 度 末）
器械備品額（減価償却累計額控除額）
×100 許 可 病 床 数
千円 388,509
千円 347,519
千円 341,485
10. 人 件 費 率 給 与 費 ×100
医 業 収 益
％ 47.7
％ 49.0
％ 49.7
11. 流 動 比 率 流 動 資 産 ×100
流 動 負 債
％ 381.1
％ 340.9
％ 277.7
12. 総 資 本 利 益 率 当 年 度 純 利 益 ×100
1/2（期首総資産＋期末総資産）
％ 1.1
％ 0.6
％ 0.1 ⑸ 主な経営財務分析
Ⅵ 研究・業績
国際学会発表
⑴ 一般外科部長 平松和洋 （10
thWorld Congress of the International Hepato-Pancreato-Biliary Association）
Could preoperative chemotherapy for colorectal liver metastases contribute to preserve major vessels in liver resection?
Hiramatsu kazuhiro, Natsume seiji, Kato takehito
Department of general surgery, Toyohashi Municipal Hospital, Toyohashi, Japan
【Introduction】
Current chemotherapy might amplify the chance of curative hepatectomy for colorectal liver metastases. Once the resection is scheduled, tumorous major vessel invasion often limits the extent of liver resection. The aim of this study is to observe the effects of chemotherapy for colorectal liver metastases in perivascular area of major vessels which is major limiting factor in liver resection.
【Method】
Among 91 cases of liver resections for colorectal liver metastases since January 2006 till November 2011, because of tumorous involvement, liver resections with major vessels, including three major stems of hepatic veins and central (more than segmental) glissonean pedicles, were investigated.
Sufficient pathological observations were possible in 10 cases. The type of hepatectomies were 6 major hepatectomies, one left lateral sectorectomy and 3 partial resections. Observed major vessels were 2 right anterior glissonean pedicles, 2 left lateral superior segmental glissonean pedicles, one right anterior superior glissonean pedicle, one left portal pedicle, 2 right hepatic veins, 2 left hepatic veins and 2 middle hepatic veins. The effect of chemotherapy were investigated on comparing their computed tomography (CT) images with their histological effect. Tumor regressions were observed on CT as the difference at its longer diameter before and after chemotherapy. Also the distances between tumors and targeting major vessels before and after chemotherapy were measured on CT. The histological residual tumor existence and tumor regression effects were observed. The regression effects were classified into 4 grades as percentage area of fibrosis in the residual tumor area according to the method proposed by Dworak et al.
【Result】
Effects of regression of tumor size on CT were no CR case, 2 cases in PR, 1 case in NC, 2 cases in PD. The number of patients of each histological tumor regression were grade4 ,0 and grade3 ,1, grade2 ,1, grade1 ,4, and grade0 ,4. Patients with major vascular invasion were considered apart before and after chemotherapy in 5 cases of 10 overall on CT. However, pathologically residual tumor nests were still seen in contact with major vessels in 4 of 5 cases, whose tumor seemed got apart from the major vessels after chemotherapy on CT.
【Conclusion】
Tumor regressions of colorectal liver metastasis involving major vessels after chemotherapy on CT might not necessarily mean possible preservation of their major vessels. Therefore, the way of liver resection for colorectal liver metastasis could be decided mostly at first imaging diagnosis even in the era of strong agents of chemotherapy.
⑵ リウマチ科部長 平野裕司 （Annual European Congress of Rheumatology 2012 in Berlin）
A COMPARATIVE STUDY OF CLINICAL COMPOSITE MEASURES
(DAS28,SDAI,CDAI,BOOLEAN) USING PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH ANTI-TNF AGENTS
Y. Hirano 1,*, Y. Oishi 1, K. Yamauchi 1
1Rheumatology, Toyohashi Municipal Hospital, Toyohashi, Japan
Background: in addition to familiar DAS28, SDAI and CDAI have been routinely used in the clinical studies or in clinical setting. New remission criteria have been also developed. These new movement in the treatment of rheumatoid arthritis (RA) cause a little chaos in real-world clinical setting. What should we physicians use in the evaluation of a patient in front of us?
Objectives: The aim of this study is to compare four composite measures (DAS28-ESR, DAS28-CRP, SDAI, CDSI) and new remission criteria (Boolean) in patients with RA treated with anti-TNF agents and to determine the characteristics of each measure. Two sets of cut-off point were used in case of DAS28-CRP. One is original cut-off points (5.1,3.2,2.6) and the other is developed by Tokyo women s university (4.1,2.7,2.3) in Japan. The latter is called DAS28-CRP (IORRA).
Methods: 153 RA patients treated with anti-TNF agents (130 female and 23 male) were included in this retrospective study. Disease activity was evaluated using four composite measures at the time of starting anti-TNF agents and at the time of last observation and compared with each other. The rate of remission was also evaluated at the time or last observation.
Results: The rates of high disease activity (HDA) were 85.6% using DAS28-CRP (IORRA), 75.2%
using DAS28-ESR, 62.5% using SDAI, 61.8% using CDAI and 56.2% using DAS28-CRP at the time of starting anti-TNF therapy in all cases (n=153). There were significant differences in the rate of HAD among every couple except for SDAI, CDAI and DAS28.
The rates of low disease activity (LDA) were 77.5% using SDAI, 76.6% using SDAI, 73.8% using CDAI, 60.3% using DAS28-CRP (IORRA) and 45.0% using DAS28-ESR at the time of last visit in only cases who continued anti-TNF therapy (n=111). There were significant differences in the rate of LDA among every couple except for SDAI, CDAI and DAS28. The rates of remission were 19.8%
using Boolean-4, 21.6% using Boolean-3, 24.3% using CDAI.25.2% using SDAI,34.2% using DAS28-ESR, 46.8% using DAS28-CRP (IORRA) and 59.5% using DAS28-CRP at the time of last visit in only cases continuing anti-TNF therapy (n=111). Patients who achieved Boolean-4 remission (n=22) were significantly young, had significantly short RA duration and used significantly fewer prednisolone and more MTX compared with patients who did not achieved Boolean-4 remission (n=89).
Image / Graph:
䋨䋦䋩
㪫㪿㪼㩷㪩㪸㫋㪼㩷㫆㪽㩷㪩㪼㫄㫀㫊㫊㫀㫆㫅
㪏㪇㪅㪇 㪍㪇㪅㪇 㪋㪇㪅㪇 㪉㪇㪅㪇 㪇㪅㪇
㪈㪐㪅㪏 㪉㪈㪅㪍 㪉㪋㪅㪊 㪉㪌㪅㪉 㪊㪋㪅㪉 㪋㪍㪅㪏 㪌㪌㪅㪇 㪌㪐㪅㪌
㪙㫆㫆㫃㪼㪸㫅㪄㪋 㪙㫆㫆㫃㪼㪸㫅㪄㪊 㪚㪛㪘㪈 㪪㪛㪘㪈 㪛㪘㪪㪉㪏㪄 㪜㪪㪩
㪛㪘㪪㪉㪏㪄㪚㪩㪧 䋨㪠㪦㪩㪩㪘䋩
㫄㪟㪘㪨 㪛㪘㪪㪉㪏㪄 㪚㪩㪧
Conclusions: Although SDAI and CDAI were stringent among the definitions of remission, they were also lenient among the definitions of LDA. Although LDA is alternative goal in T2T strategy, it is unclear which measure should be used in case of LDA. DAS28-ESR was most stringent among the definitions of LDA. Boolean-4 was most stringent among the criteria of remission. This study suggested that early intervention with MTX and biologics was one of the methods ahead to remission defined by Boolean-4.
⑶ 消化器内科 松原 浩 （Asian Pacific Digestive Week 2012）
Usefullness of contrast-enhancement transabdominal ultrasonography for diagnosing gallbladder diseases by dynamic quantitative evaluation
Hiroshi MATSUBARA1), Fumihiro URANO1), Shozo OKAMURA1), Yoshiki HIROOKA2), Hidemi GOTO3)
1) Department of Gastroenterology, Toyohashi municipal hospital.
2) Department of Endoscopy, Nagoya University Hospital.
3) Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine.
Aims: We conducted this study to compare the diagnostic usefulness of contrast-enhanced transabdominal ultrasonography (CE-US) for the differential diagnosis of GB diseases with or without dynamic quantitative evaluation preparing time-intensity curves (TIC) using second-generation ultrasound contrast agent (SonazoidⓇ,Daiichi-Sankyo, Tokyo, Japan).
Patients and methods: Total of 15 patients (8 GB carcinoma (GBCA) and 7 GB cholesterol polyps (GBCP); pathological evidences were obtained in all cases through surgery.) were analyzed by TIC at our institute before April 2010 (Group A). Forty-three patients (12 GB adenomyomatosis (ADM), 11 GB debris (GBS), 18 GBCP, 1 GB hyperplasic polyp (GBH) and 1 with GB adenomatous polyp (GBA)) who underwent CE-US between April 2010 and October 2011 were investigated (Group B).
After the CE-US procedure for 5minutes, TICs were made using software built into the ultrasound system. The lesions in the Group A were analyzed by TIC-based quantitative evaluation. On the other hand, in the Group B, characteristic findings on CE-US images were defined as follows, clearer manifestations of Rokitansky‐Aschoff sinuses or non-vascular masses in the GB leading to the diagnosis of ADM and GBS, respectively, and others were diagnosed by TIC basis. This study was approved by the Institutional Review Board of our institute.
Result: The echo brightness (EB) reduction rate from the peak only at 5 minutes after the injection of contrast agents was significantly greater in GBCP than GBCA(p＜0.001). On the basis of CE-US characteristic findings, 12 lesion was diagnosed as ADM and 11 lesion as GBS. Two of 20 lesions which were not ADM and GBS, were diagnosed as GBCA by TIC. The diagnostic sensitivity, specificity, and accuracy of the CE-US were 95.1, 100, and 92.9%, respectively.
Conclusions: CE-US with TIC increased the diagnostic accuracy for GB diseases.
⑷ 産婦人科 寺西佳枝 （The 28
thAnnual Meeting of ESHRE）
Abstract of Selected Oral Presentation; 28th Annual Meeting of the European Society of Human Reproduction and Embryology (ESHRE), Istanbul, TURKEY, July 1-4, 2012
Predictive availability of morphokinetics of cleavage stage embryos for live-birth or early pregnancy loss using time-lapse cinematography
Teranishi Y., Ando H., Takayanagi T., Suzuki N, Moroi H., Mukai M.
Center for Reproductive Medicine and Surgery, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan
Introduction: Time-lapse observation provides detailed morphokinetic parameters as well as precise morphological grading. This study was conducted to evaluate the morphokinetics of cleavage stage embryos as a predictor of live-birth or early pregnancy loss.
Method: We developed a new system of a built-in microscope incubator which can produce time-lapse images from up to 100 embryos at one time. Our Institute has applied single embryo transfer (SET) for all the fresh and frozen-thaw embryo replacement cycles using the time-lapse imaging incubator system. In addition, women who have conceived after embryo transfer give birth in our institute as a basic rule. Good quality embryos were selected based on the morphological assessment including the elimination of the embryos which showed abnormal first cleavage. Good quality embryos were cryopreserved at cleavage or blastocyt stage. For the current morphokinetic study, time-lapse photographs of transferred embryos in consecutive 401 fresh and 271 frozen SET cycles were analysed retrospectively.
Results: We found that various parameters such as time between disappearance of pronuclei and division to two cells (2 h 18 min ± 0 h 39 min, 2 h 14 min ± 0 h 29 min, 2 h 20 min ± 0 h 43 min) and time between division to 2 cells and division to 5 cells (25 h 26 min ± 4 h 11 min, 24 h 58 min ± 3 h 22 min, 26 h 10 min ± 5 h 29 min) are similar in the case of live birth (n = 115), early pregnancy loss (n = 54), and negative pregnancy test (n = 502), respectively.
Conclusion: Time-lapse images were useful in understanding of morphological changes. However, after selecting or deselecting on the basis of morphology, morphokinetic parameters appear to allow no additional advantage in selecting the best embryo to achieve live birth or in avoiding pregnancy loss.
＜呼吸器内科＞
№ 演 題 名 発表者及び
共同研究者 学会・研究会名 発表年月日 1 当院における超音波気管支鏡ガイド下針
生検 (EBUS-TBNA) 施行症例の検討 竹 山 佳 宏 第35回日本呼吸器内視鏡学会学術集会 2012/5/30 2 当院における超音波気管支内視鏡ガイド下
針生検 (EBUS-TBNA) 自験例56例の検討 佐 藤 和 秀 第35回日本呼吸器内視鏡学会学術集会 2012/5/30 3
2nd-lineとして
CBDCA+Pemetrexed+Bevacizumabと その維持療法が著効した乳房単独転移肺 癌の１例
佐 藤 和 秀 第10回日本臨床腫瘍学会学術集会 2012/7/27
4 乳癌治療中にニューモシスチス肺炎とク
リプトコッカス肺炎を重複発症した１例 寺田万紀子 日本内科学会
第218回東海地方会 2012/10/28 5 肺小細胞癌のびまん性肝転移により引き
起こされた劇症肝不全の２剖検例 三 竹 千 尋 第120回日本結核病学会東海地方学会／
第102回日本呼吸器学会東海地方学会 2012/11/10 6 胸膜癒着が有効であった特発性乳び胸の
１例 安 井 裕 智 第120回日本結核病学会東海地方学会／
第102回日本呼吸器学会東海地方学会 2012/11/10 7
高周波スネアとAPC (Argon Plasma Coagulation) により治療した気管内多形 腺腫 (Pleomorphic Adenoma) の１例
三 竹 千 尋 第44回日本呼吸器内視鏡学会中部支部
会 2012/12/8
8 気管内異物の２例 安 井 裕 智 第44回日本呼吸器内視鏡学会中部支部
会 2012/12/8
学会発表
＜消化器内科＞
№ 演 題 名 発表者及び
共同研究者 学会・研究会名 発表年月日 1 内視鏡的止血が困難であったDieulafoy
潰瘍の１例 三 竹 千 尋 第33回東三医学会 2012/3/3
2 カプセル内視鏡検査が有用であった小腸
出血の１例 小笠原康伸 第33回東三医学会 2012/3/3
3 急性膵炎後の膵仮性嚢胞に対して超音波
内視鏡下膵嚢胞ドレナージを施行した１例 宮 入 祐 一 第33回東三医学会 2012/3/3 4 Volume Navigationを用いた超音波診断
が有用であった２例 飛田恵美子 第33回東三医学会 2012/3/3
5 Infliximab二次無効クローン病に対する
adalimumabの治療成績 山 田 雅 弘 第98回日本消化器病学会総会 2012/4/21 6
Infliximab (IFX) 維持療法にて当院に紹 介されIFXが離脱可能であったCrohn病 の６例
廣 瀬 崇 第98回日本消化器病学会総会 2012/4/21
7
｢ワークショップ１超音波内視鏡の進歩−診 断と治療への応用｣−定量的評価Time-intensity curveを用いた造影超音波内視 鏡による膵腫瘤性疾患診断
松 原 浩
日本超音波医学会第85回学術集会 2012/5/25
8
｢ワークショップ46 C型慢性肝炎臨床２｣
Late responderに対するペグインターフェロ ンα2b・リバビリン72週投与の治療効果とcore とISDR変異，IL28B-塩基多型の関連ついて
の検討
浦 野 文 博
（共同演者） 第48回日本肝臓学会総会 2012/6/8
№ 演 題 名 発表者及び
共同研究者 学会・研究会名 発表年月日 9 成人で発症した大腸 hypoganglionosis
の１例 鈴 木 博 貴 第217回日本内科学会東海地方会例会 2012/6/16 10 メトトレキセート (MTX) が著効した小
腸大腸型クローン病の１例 樋 口 俊 哉 日本消化器病学会東海支部第116回例
会 2012/6/23
11
胃ESD (Endoscopic Submucosal
Dissection; 内視鏡的粘膜下層剥離術) に おける局注液の検討
田 中 浩 敬 日本消化器病学会東海支部第116回例
会 2012/6/23
12 悪性リンパ腫を合併したクローン病の一
例 芳 川 昌 功 日本消化器病学会東海支部第116回例
会 2012/6/23
13 食道ESD後の狭窄に対して食道ステント
を留置した１例 飛田惠美子 日本消化器病学会東海支部第116回例
会 2012/6/23
14 治療の経過中に潰瘍性大腸炎を発症した
２型と考えられる自己免疫性膵炎の１例 山 本 和 弘 日本消化器病学会東海支部第116回例
会 2012/6/23
15 非典型的な画像所見を呈した膵神経内分
泌腫瘍の一切除例 田 中 浩 敬 第43回日本膵臓学会大会 2012/6/28 16 主膵管と交通を認めた膵粘液性嚢胞腺癌
(MCC) の一切除例 藤 田 基 和 第43回日本膵臓学会大会 2012/6/29 17 主膵管の途絶を呈した膵神経内分泌腫瘍
(G1) の一例 松 原 浩 第43回日本膵臓学会大会 2012/6/29 18 十二指腸Paragangliomaの一例 松 原 浩 日本超音波医学会第33回中部地方会学
術集会 2012/9/9
19
Contrast-enhanced transabdominal US (CE-US) を用いた十二指腸乳頭部癌の有 用性
松 原 浩
（共同演者）
日本超音波医学会第33回中部地方会学
術集会 2012/9/9
20
瘻孔を介した胆道アプローチ
(rendezvous technique) をした膵IPMN の総胆管穿破の二例
藤 田 基 和 第48回日本胆道学会学術集会 2012/9/21
21
「パネルディスカッション２」胆嚢二次 検診における定量的評価を用いた造影腹 部超音波検査の有用性
松 原 浩 第54回日本消化器病学会大会（JDDW
2012 神戸） 2012/10/10 22 Colitic Cancerの一例 田 中 卓 第84回日本消化器内視鏡学会総会
（JDDW 2012 神戸） 2012/10/12 23 腸管気腫性嚢胞症を合併したマントル細
胞リンパ腫の一例 田 中 浩 敬 第84回日本消化器内視鏡学会総会
（JDDW 2012 神戸） 2012/10/13 24
シンポジウム１「自己免疫関連消化器疾患の 診断と治療」当院におけるtypeⅠ自己免疫性 膵炎の臨床的特徴と長期予後の検討
樋 口 俊 哉 日本消化器病学会東海支部第117回例
会 2012/11/17
25 術前に診断し得た混合型肝癌の１例 廣 瀬 崇 日本消化器病学会東海支部第117回例
会 2012/11/17
26 経過中に膵石を発生した自己免疫性膵炎
の一例 片 岡 邦 夫 日本消化器病学会東海支部第117回例
会 2012/11/17
27 胆管断端神経腫の一切除例 木 下 雄 貴 日本消化器病学会東海支部第117回例
会 2012/11/17
28 急性胆嚢炎に対し経乳頭的胆嚢ドレナー
ジを施行した２例 山 本 和 弘 第55回日本消化器内視鏡学会東海支部
例会 2012/12/1
29
Usefullness of Contrast-enhanced Transabdominal Ultrasonography for Diagnosing Gallbladder Diseases by Dynamic Ouantitative Evaluation
Hiroshi MATSUBARA
ASIAN PACIFIC DIGESTIVE
WEEK 2012 2012/12/6