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1-8 総説 Review
JPN
急性胆嚢炎に対する手術時期,ランダム化比較試験のメタアナリシス
Early versus delayed cholecystectomy for acute cholecystitis
: a meta-analysis of randomized controlled trials
四方,哲 / 野口,善令 / 福井,次矢
Shikata,Satoru / Noguchi,Yoshinori / Fukui,Tsuguya
京都府立医科大学消化器外科 / 藤田保健衛生大学医学部一般内科 / 京都大学大学院医学研究科臨床疫学
Department of Surgery, Division of Digestive Surgery, Kyoto Prefectural
University of Medicine, Graduate School of Medical Science /
Division of General Internal Medicine, Department of Medicine,
Fujita Health University School of Medicine / Department of General
Medicine, and Clinical Epidemiology, Kyoto University Graduate
School of Medicine
目的:急性胆嚢炎に対する腹腔鏡下胆嚢摘出術,開腹胆嚢摘出術の至適手術時期を検討する。方法:急性胆嚢炎に対する早期と待機的手術を比較したランダム化比較試験をMEDLINEとコクランライブラリにて検索した。主要評価項目は死亡率と合併症率とした。結果:10編の研究(4編は腹腔鏡下胆嚢摘出術,6編は開腹胆嚢摘出術)が検索された。死亡率の統合リスク差では,開腹胆嚢摘出術では早期が有利であった。合併症率の統合リスク差では,開腹胆嚢摘出術,腹腔鏡下胆嚢摘出術ともに早期と待機群に差は無かった。腹腔鏡下胆嚢摘出術における術式変更率では早期と待機群に差は無かった。早期群は待機群に比べ有意に平均入院日数は短かった。結論:死亡率,合併症率,術式変更率,平均入院期間などの点で,急性胆嚢炎に対し胆嚢摘出術を待機的に施行するメリットはない。急性胆嚢炎患者に対しては早期に胆嚢摘出術を施行すべきである。
Objective To determine the optimal timing of laparoscopic cholecystectomy
and open cholecystectomy for acute cholecystitis. Summary Background
Data The benefits of early cholecystectomy have been shown in
several reports, but other reports have demonstrated an association
between early cholecystectomy and increase in morbidity. Methods
Randomized controlled trials that compared early with delayed
cholecystectomy for acute cholecystitis were retrieved by systematically
searching MEDLINE and the Cochrane Library for studies published
from 1996 through 2003. Outcomes of primary interest were mortality
and morbidity. Results The 10 included trials (4 trials of laparoscopic
and 6 trials of open procedures) comprised 1014 participants
: 534 were assigned to the early group and 480 were assigned
to the delayed group. Combined risk difference of mortality showed
early favor among open procedures (RD-0.02 ; 95% CI -0.44 to
-0.00), but no differences were observed among laparoscopic procedures
and among all procedures. Combined risk difference of morbidity
showed no differences among open procedures and laparoscopic
procedures. Combined risk difference of conversion rate showed
no difference in included laparoscopic studies (RD-0.40 ; 95%
CI-0.13 to 0.49). The combined total hospital stay was shorter
in the early group than in the delayed group (-2.7 days in laparoscopic,
-10.2 days in open) ; this was statistically significant. Conclusions
This meta-analysis has clarified that there is no advantage point
in delayed cholecystectomy for acute cholecystitis on the basis
of the outcomes in mortality, morbidity, conversion rate, and
the mean hospital stay. Early cholecystectomy should be performed
on patients with acute cholecystitis.
急性胆嚢炎 / 胆嚢摘出術 / 手術時期 / ランダム化比較試験 / メタアナリシス Acute cholecystitis
/ RCT / Meta-analysis
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9-17 原著論文 Original
Article JPN
自治医科大学医動物学教室で3年間(2000-2002)に経験した寄生虫・衛生動物関連症例の検討
Consultation cases referred to the Division of Medical Zoology,
Jichi Medical School, from 2000 to 2002
松岡,裕之 / 新井,明治 / 吉田,栄人 / 平井,誠 / 石井,明
Matsuoka,Hiroyuki / Arai,Meiji / Yoshida,Shigeto / Hirai,Makoto
/ Ishii,Akira
自治医科大学医学部感染・免疫学講座医動物学部門 / 自治医科大学医学部感染・免疫学講座医動物学部門 / 自治医科大学医学部感染・免疫学講座医動物学部門
/ 自治医科大学医学部感染・免疫学講座医動物学部門 / 自治医科大学医学部感染・免疫学講座医動物学部門
Division of Medical Zoology, Department of Infection and Immunity,
Jichi Medical School / Division of Medical Zoology, Department
of Infection and Immunity, Jichi Medical School / Division of
Medical Zoology, Department of Infection and Immunity, Jichi
Medical School / Division of Medical Zoology, Department of Infection
and Immunity, Jichi Medical School / Division of Medical Zoology,
Department of Infection and Immunity, Jichi Medical School
自治医科大学医動物学教室で3年間(2000-2002)に照会を受けた,寄生虫・衛生動物関連症例について検討を行なった。照会総件数は106件で,学内から63件(59.4%),学外から43件(40.6%)であった。うち実際に寄生虫が感染していた症例は38件であった。頻度の高かった疾患は,回虫症9例,日本海裂頭条虫症7例,イヌ(ネコ)回虫症5例などであった。輸入寄生虫症と考えられた症例として,熱帯熱マラリア(東チモール),三日熱マラリア(インドネシア,南米),回虫症(ネパール),イヌ回虫症(米国),肝吸虫症(中国),無鉤条虫症(タイ国)など計7症例があった。衛生動物関連症例は14件あり,ムカデ咬症,ヒルの眼瞼寄生などを新規に経験した。
We accepted 106 consultation cases of medical zoological subjects
from January 2000 to December 2002. Among them, 63 (59.4%) cases
were from Jichi Medical School Hospital including Omiya Medical
Center, and 43 cases (40.6%) were from other hospitals and clinics.
Thirty-eight cases were parasitic diseases including 9 cases
of ascariasis, 7 cases of diphyllobothriasis, 5 cases of toxocariasis.
Imported cases were one case of falciparum malaria from East
Timor, two cases of vivax malaria from Indonesia and South America,
one case of ascariasis from Nepal, one case of toxocariasis from
the USA, one case of clonorchiasis from China, and one case of
taeniasis from Thailand. Fourteen cases were medical entomological
concerns such as tick bite, centipede bite, pubic louse, leech
infestation on conjunctiva, etc.
寄生虫・衛生動物疾患 / ブラストシスチス / 大腸内視鏡 / ムカデ咬症 / ヒル眼瞼寄生
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19-27 原著論文 Original
Article JPN
ショウキョウ抽出液の眼瞼周囲部しわに対する予防および改善効果
A clinical effect of Zingiber officinale (L.) Rose on facial
wrinkles and skin elasticity
塚原,和枝 / 中川,秀己 / 大槻,マミ太郎 / 森脇,繁 / 藤村,努 / 武馬,吉則 / 芋川,玄爾
Tsukahara,Kazue / Nakagawa,Hidemi / Ohtsuki,Mamitaro / Moriwaki,Shigeru
/ Fujimura,Tsutomu / Takema,Yoshinori / Imokawa,Genji
自治医科大学皮膚科学教室 / 東京慈恵会医科大学皮膚科学教室 / 自治医科大学皮膚科学教室 / 花王株式会社生物科学研究所
/ 花王株式会社生物科学研究所 / 花王株式会社生物科学研究所 / 花王株式会社生物科学研究所
Department of Dermatology, Jichi Medical School / Department
of Dermatology, Jikei Medical School / Department of Dermatology,
Jichi Medical School / Biological Science Laboratories, Kao Corporation
/ Biological Science Laboratories, Kao Corporation / Biological
Science Laboratories, Kao Corporation / Biological Science Laboratories,
Kao Corporation
我々は既にショウキョウ抽出液が線維芽細胞エラスターゼ活性を阻害し,光老化動物モデルへの塗布により,真皮弾性線維の直線性を維持し,皮膚弾力性の低下を抑え,しわ形成を抑制することを報告している。今回,本ショウキョウ抽出液のヒト眼瞼部位への,しわ,皮膚弾力性および角層水分量に及ぼす影響を検討した。被験者には,平均年齢37.6歳の健常な日本人男性20名を用いた。ハーフフェイス・二重盲検法にて1%ショウキョウ抽出液配合処方およびプラセボ処方を1日2回,12ヶ月間塗布した。しわへの効果を検証するために,塗布開始前および12ヶ月後にしわの目視評価,レプリカ採取,皮膚弾力性測定,角層水分量測定を行った。レプリカは画像解析によるしわの定量に用いた。今回の結果により,本ショウキョウ抽出液の1年間の塗布によって男性被験者において角層水分量の変化を伴わずに,眼瞼周囲部の皮膚弾力性の低下を抑制し,しわの形成を予防,改善することが明らかになった。
We previously reported that extract of Zingiber Officinale (L.)
Rose after removing irritant components inhibits fibroblast derived
elastase activity, and its topical application to animal skin
after UVB irradiation inhibits wrinkle formation and decrease
in skin elasticity and maintains the linearity of dermal elastic
fibers. In this study, the clinical effects of this extract on
wrinkles, skin elasticity and the water content of the stratum
corneum were evaluated in areas around the eyes in humans. The
subjects were 20 healthy Japanese male volunteers, mean age 37.6
years. Either a preparation containing a 1% extract of Zingiber
officinal (L.) Rose or placebo was topically applied by the half-face
and double blind methods twice daily for 12 months. Before, as
well as 12 months after the initiation of topical application,
wrinkles were visually assessed, replicas were collected, and
skin elasticity and the water content of the stratum corneum
were measured. The replicas were used for the measurement of
wrinkles by image analysis. After 1 year of topical application,
while the wrinkle score and the image analysis area ratio (%)
of wrinkles, significantly increased in eye corner and lower
eyelid areas on the placebo side, it significantly decreased
in each area on the extract side. Skin elasticity evaluated in
terms of Ur/Uf, a parameter of aging, significantly decreased
after 1 year on the placebo side alone, and its decrease was
inhibited on the extract side. The water content of the stratum
corneum did not differ between the extract and placebo sides
throughout the measurement period. These results demonstrate
that this extract of Zingiber officinale (L.) Rose inhibits the
decrease in skin elasticity and thereby prevents and improves
human wrinkle formation in the area around the eye corner by
inhibiting fibroblast-derived elastase activity without changing
the water content of the stratum corneum.
光老化 / しわ / ショウキョウ / エラスターゼ / Photoaging / Wrinkle / Zingiber
officinale (L.) Rose / Elastase
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29-34 原著論文 Original
Article JPN
体外循環非使用および心筋保護下冠状動脈バイパス術における非侵襲性の比較検討
Postoperative systemic inflammatory response in coronary artery
bypass patients : a comparison of on-pump with cardioplegic arrest
vs. off pump surgery
齊藤,力 / 小西,宏明 / 三澤,吉雄 / 加藤,盛人 / 上沢,修 / 大木,伸一 / 上西,祐一朗 / 坂野,康人
/ 高橋,英樹 / 相澤,啓 / 田口,昌延 / 布施,勝生
Saito,T. / Konishi,H. / Misawa,Y. / Kato,M. / Kamisawa,O. / Oki,S.
/ Kaminishi,Y. / Sakano,Y. / Takahashi,H. / Aizawa,K. / Taguchi,M.
/ Fuse,K.
自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門
/ 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門
/ 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門
/ 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門
Division of Cardiovascular Surgery, Department of surgery, Jichi
Medical School / Division of Cardiovascular Surgery, Department
of surgery, Jichi Medical School / Division of Cardiovascular
Surgery, Department of surgery, Jichi Medical School / Division
of Cardiovascular Surgery, Department of surgery, Jichi Medical
School / Division of Cardiovascular Surgery, Department of surgery,
Jichi Medical School / Division of Cardiovascular Surgery, Department
of surgery, Jichi Medical School / Division of Cardiovascular
Surgery, Department of surgery, Jichi Medical School / Division
of Cardiovascular Surgery, Department of surgery, Jichi Medical
School / Division of Cardiovascular Surgery, Department of surgery,
Jichi Medical School / Division of Cardiovascular Surgery, Department
of surgery, Jichi Medical School / Division of Cardiovascular
Surgery, Department of surgery, Jichi Medical School / Division
of Cardiovascular Surgery, Department of surgery, Jichi Medical
School
2002年1月から2003年9月までの連続単独冠状動脈バイパス術101例のうち,緊急手術8例を除き術後経過21日以内で退院した72例を対象として,体外循環非使用下冠状動脈バイパス術(OPCAB)症例36例と体外循環使用心筋保護下冠状動脈バイパス術(CCAB)症例36例の2群に分類し,全身炎症反応症候群(SIRS)基準関連項目による評価から非侵襲性について検討した。OPCAB群とCCAB群との比較では,バイパスヵ所数(2.4ヵ所,3.1ヵ所),手術時間(290分,332分),抜管までの時間(14.1時間,27.1時間),発熱日数(1.0日,1.9日)で有意差を認めた。冠状動脈バイパス術周術期におけるSIRS基準関連項目による評価は,薬物,人工呼吸器などの影響があり,心拍数,呼吸数での評価には限界があるものの,多数を占める順調経過群においては,術後発熱日数からOPCABの低侵襲性が示された。
To assess the harmless procedure for inflammatory response in
coronary artery bypass surgery between with off-pump and with
conventional cardioplegic arrest under cardiopulmonary bypass,
we sought to investigate the clinical outcome and data included
SIRS (systemic inflammatory response syndrome) criteria. From
Jan. 2001 to Sept. 2003, 101 consecutive patients received isolated
coronary artery bypass in our hospital. We selected the patients
who were discharged by the 21 st postoperative day except emergent
cases. In the excluded cases, only one of the emergent cases
surrendered to severe cardiogenic shock with preoperative PCPS
died postoperatively by sustained low output syndrome to multiple
organ failure in the hospital. About remained 72 patients, 36
patients with scheduled elective off-pump coronary artery bypass
(OPCAB) group and 36 patients with scheduled elective conventional
coronary artery bypass with cardioplegic arrest on cardiopulmonary
bypass (CCAB) group were compared with postoperative clinical
data each other about the view point of systemic inflammatory
response syndrome (SIRS). As SIRS criteria, the respiratory rate
criteria was substituted the duration of postoperative intubation
time as the marker of respiratory stress expediently. In the
clinical results, the OPCAB group were anastomosed rather small
amount of graft sites than CCAB group (2.4vs. 3.1sites), shorter
operation time (290vs. 332min.), shorter duration of pyrexia
higher than 38.0℃ (1.0vs. 1.9days) (p <0.05), shorter postoperative
intubation time (14.1vs. 27.1 hours) (p<0.05). There were
no statistical difference about the amount of days analyzed WBC
count over 12, 000/μL (1.4vs. 1.0days), and the duration of heart
rate over 90/min (4.3vs. 5.9days) because of small amount of
numbers, or effect of drugs indicated preoperatively. In conclusion,
we presumed the OPCAB makes no better effect but shorter postoperative
pyrexia on inflammatory changes than CCAB for a standpoint of
SIRS criteria in the cases, such as discharged until 21st postoperative
day.
冠状動脈バイパス術 / 体外循環非使用 / 体外循環使用 / 全身炎症反応症候群 coronary artery bypass
grafting / off-pump / on-pump / systemic inflammatory response
syndrome
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35-43 原著論文 Original
Article ENG
ハイドロキシアパタイト顆粒を大腿骨髄腔に充填使用したセメントレス人工股関節手術の成績
Results in Cementless Total Hip Arthroplasty Using Hydroxyapatite
Granules to Fill the Femoral Medullary Cavity
坂口,亮人 / 関矢,仁 / 刈谷,裕成 / 星野,雄一
Sakaguchi,Makoto / Sekiya,Hitoshi / Kariya,Yusei / Hoshino,Yuichi
自治医科大学整形外科 / 自治医科大学整形外科 / 自治医科大学整形外科 / 自治医科大学整形外科
Department of Orthopaedic Surgery, Jichi Medical School / Department
of Orthopaedic Surgery, Jichi Medical School / Department of
Orthopaedic Surgery, Jichi Medical School / Department of Orthopaedic
Surgery, Jichi Medical School
当教室では1988年よりハイドロキシアパタイト顆粒を骨髄腔内ステム周囲に充填使用するセメントレス人工股関節手術を行ってきた。今回平均6.4年経過した38例44股関節(手術時平均63.7歳)についてX線評価と臨床成績の評価を行った。subsidenceは2股4.5%に認めた。Radiolucent
lineはゾーン1,3,4で13.6%〜18.2%に認めたが,いずれもステム周囲全周には及ばず,経時的に拡大しなかった。osteolysisは1股のみに認めた。カップのポリエチレンの摩耗は年間0.18±0.14mmであった。JOAスコアは,平均で術前48.8点,最終観察時86.1点であった。ステム周囲のRadiolucent
lineの出現が少なく,臨床成績も良好であった。臼蓋ポリエチレンの摩耗がHAの使用により増加することはなかった。この方法はTHAの長期成績を向上させる可能性がある。
Since 1988, we have been performing cementless total hip arthroplasty
(THA) using hydroxyapatite (HA) granules to fill the femoral
medullary cavity around the stem. We evaluated roentgenographic
and clinical results in 38 patients (44 hips) who were mean 63.7
years old at the time of surgery and followed up for mean 6.4
years. Stem subsidence was observed in 2 hips (4.5%). Radiolucent
lines around the stem were observed in zones 1, 3, and 4 however
the frequency was relatively low with the value of 13.6% to 18.2%
respectively. Furthermore the width was ≦1mm, and there was no
progression over time and in no case was there radiolucency around
the entire stem. Osteolysis around the stem was observed in only1hip
in zone 7. The annual wear rate of the polyethylene cup ranged
from 0.02mm to 0.81mm (mean, 0.18±0.14mm) . The JOA score (mean)
improved from 48.5 before surgery to 86.1 at final examination.
Thus radiological assessment as well as clinical interim results
of this new procedure was satisfactory as compared with the reported
studies.
cementless total hip arthroplasty / hydroxyapatite granules
/ radiolucent line / wear rate
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45-53 原著論文 Original
Article ENG
粗鬆骨における脊椎後方固定手術の力学的強度に関する研究
A biomechanical evaluation of posterior spinal instrumentation
applied for osteoporotic bone
高田,尚 / 税田,和夫 / 関矢,仁 / 中間,季雄 / 刈谷,裕成 / 星野,雄一
Takada,Hisashi / Saita,Kazuo / Sekiya,Hitoshi / Nakama,Sueo /
Kariya,Yusei / Hoshino,Yuichi
自治医科大学整形外科 / 自治医科大学整形外科 / 自治医科大学整形外科 / 自治医科大学整形外科 / 自治医科大学整形外科
/ 自治医科大学整形外科
Department of Orthopaedic Surgery, Jichi Medical School / Department
of Orthopaedic Surgery, Jichi Medical School / Department of
Orthopaedic Surgery, Jichi Medical School / Department of Orthopaedic
Surgery, Jichi Medical School / Department of Orthopaedic Surgery,
Jichi Medical School / Department of Orthopaedic Surgery, Jichi
Medical School
椎弓根スクリューシステムは,脊椎圧迫骨折に対する治療法であるが,骨粗鬆や脊椎後彎が著しい例では,固定性に問題がある。脊椎短縮術は後彎を矯正するため,従来は困難な症例にも適応可能な術式だが,力学的検討がなされていない。システムの固定強度に影響を与えると考えられる後彎角度,骨密度との関係を明らかにするために力学的試験をおこなった。新鮮屍体脊椎13例を用いて後彎した粗鬆骨脊椎モデルを作製し,椎弓根スクリューシステムを設置し,その固定強度を検討した。また,脊椎の骨密度と後彎角度,椎弓根スクリューの引き抜き強度も測定した。システムの固定強度は骨密度と正の,後彎角度とは負の相関があった。後彎角度と骨密度からシステムの固定強度を推定する回帰式固定強度(N)=-20.42×後彎角度(度)+1048×骨密度(g/cm^2)+1014を得た。直接,臨床に適用するには限界があるが,各要素の関係を理解し,手術時の許容後彎角を推定する上で有用と考えた。
In the osteoporotic spine, it is difficult to ensure posterior
fixation using a pedicle screw system., and unscrewing pedicle
is a serious problem. A solution must include a posterior column-shortening
procedure that can change the spinal alignment in the sagittal
plane. However, no biomechanical study has examined the relationship
between the stability of a pedicle screw system and alignment
after a shortening procedure. The purpose of this study is to
clarify the relationships among the strength of a pedicle screw
system, the degree of osteoporosis, and spinal alignment after
a column-shortening procedure. An experimental model was created
simulate the spine in which of kyphosis developed after a compression
fracture of a vertebral body. Biomechanical tests were performed
using a universal testing machine. We used 13 cadaveric spines
for the study. In each, we created amodel of a kypotic spine
by removing wedge-shaped bones of various sizes from anterior
part of the spinal body of T12, we created the model of kyphotic
spine. We attached pedicles screws to T10, L1 and L2, then, connected
the screws with rods to complete the model of the posterior fixation
in a kyphotic patients in clinical conditions. Then, we measured
the yield strength by applying an axial load to the model. We
also measured the pull-out strength of the pedicle screws, and
we used D X A to measure bone density. Yield strength of the
pedicle screw system showed negative correlation with angle of
kyphosis, and positive correlation with bone density. From this
study, we calculated the regression formula : Yielding strength
(N)=-20.42x[angle of kyphosis (degree)]+1048x[bone density (g/cm^2)]+1014
Although this formula was calculated in vitro study, it might
be helpful to consider the relationship among the yielding strength,
the degree of kyphosis and the bone density.
力学試験 / 椎弓根スクリューシステム / 粗鬆骨 / 引き抜き強度 biomechanical evaluation
/ pedicle screw system / osteoporotic bone
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55-63 原著論文 Original
Article ENG
HELLP症候群と血液濃縮 : 尿量/補液量比による評価
Hemoconcentration in patients with HELLP syndrome : evaluation
using urine-to-fluid ratio
桑田,知之 / 松原,茂樹 / 大口,昭英 / 萩原,秀文 / 泉,章夫 / 渡辺,尚 / 鈴木,光明 / 水上,尚典
Kuwata,Tomoyuki / Matsubara,Shigeki / Ohkuchi,Akihide / Hagiwara,Hidefumi
/ Izumi,Akio / Watanabe,Takashi / Suzuki,Mitsuaki / Minakami,Hisanori
自治医科大学産婦人科 / 自治医科大学産婦人科 / 自治医科大学産婦人科 / 自治医科大学産婦人科 / 自治医科大学産婦人科
/ 自治医科大学産婦人科 / 自治医科大学産婦人科 / 北海道大学生殖発達医学
Department of Obstetrics and Gynecology, Jichi Medical School
/ Department of Obstetrics and Gynecology, Jichi Medical School
/ Department of Obstetrics and Gynecology, Jichi Medical School
/ Department of Obstetrics and Gynecology, Jichi Medical School
/ Department of Obstetrics and Gynecology, Jichi Medical School
/ Department of Obstetrics and Gynecology, Jichi Medical School
/ Department of Obstetrics and Gynecology, Jichi Medical School
/ Department of Obstetrics and Gynecology, Hokkaido University
School of Medicine
目的:帝王切開後のHELLP症候群褥婦では,HELLP症候群のない褥婦に比べて,分娩後尿量が少ない可能性がある。尿量/補液量比を用いて,これを評価することが本研究の目的である。方法:帝王切開が行われた17名のHELLP症候群褥婦(分娩週数;35±2.8週,平均±標準偏差)と23名のHELLP症候群のないコントロール褥婦(37.5±2.7週)を研究対象とした。分娩周辺期に低血小板血症(12万/μ1以下),高AST血症(50IU/L),高LDH血症(700IU/L)の3つを同時に示し,かつ出血傾向や他臓器不全などの臨床症候を示さない婦人を今回検討対象のHELLP症候群とした。手術室入室時から産褥まで尿量と補液量をモニターし,さらに血算を測定評価した。成績:コントロールに比し,HELLP症候群婦人では1)分娩当日および分娩翌日の尿量/補液量比は小さく(HELLP
vs control:dayO ; 0.21±0.13vs 0.65±0.18,day1 ; 0.89±0.45 vs1.30±0.35),2)分娩前Hb(HELLP
vs control:13.3±1.5vs 10.7±1.5g/dL)およびHt (HELLP vs contro1:39.1±4.4vs
32.1±3.9%)は高値であった。HELLP症候群婦人に認められたこの高Hb・高Htは産褥3日目には8.5±1.6mg/dLおよび26.4±5.8%にまで低下した。結論:コントロール褥婦に比べHELLP症候群褥婦では,尿量は補液量に比し少量である(尿量/補液量比は小さい)。臨床症候を示さず血液データのみから診断されたHELLP症候群婦人では血液濃縮が存在する可能性がある。
Aim : The objective of this study was to determine whether the
urine volume is disproportionately small relative to the amount
of fluid replaced in postpartum patients with hematologically-detectable
HELLP syndrome. Methods : We conducted a retrospective observational
study in 17 patients with HELLP syndrome and 23 control patients,
all of whom underwent cesarean section. We confined the study
population to women who showed laboratory data characteristic
of HELLP syndrome and did not exhibit clinical manifestation
of coagulopathy or multiorgan failure. We monitored the postpartum
volumes of the urine and fluid replaced, and analyzed the ratio
of urine volume/replaced fluid volume. The pre- and post- operative
hemoglobin concentration (Hb) and hematocrit value (Ht) were
also monitored. Results ; Compared to controls, patients with
HELLP syndrome exhibited a significantly1) smaller urine-to fluid
ratio on the day of delivery (0.21±0.13vs. 0.65±0.18) and on
postoperative day1 (0.89±0.45vs. 1.30±0.35), and also2) higher
preoperative Hb (13.3±1.5g/dL vs.10.7±1.5g/dL) and Ht (39.1±4.4
%vs. 32.1±3.9%). The high Hb and Ht observed in HELLP patients
gradually decreased to 8.5±1.6g/dL and 26.4±5.8%, respectively,
without bleeding by postoperative day3. Conclusions ; Compared
to control women, patients with hematologically-detectable HELLP
syndrome passed a smaller volume of urine that was disproportionate
to the fluid replaced. This observation suggests that antenatal
patients with hematologically-detectable HELLP syndrome suffer
from severe hemoconcentration.
HELLP syndrome / hemoconcentration / fluid replacement / urine
output
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65-69 原著論文 Original
Article JPN
当院における泌尿器科領域内での重複癌についての検討
Multiple primary cancers limited to the urological field
黒川,真輔 / 寺内,文人 / 鈴木,一実 / 徳江,章彦
Kurokawa,Shinsuke / Terauchi,Fumihito / Suzuki,Kazumi / Tokue,Akihiko
自治医科大学泌尿器科 / 自治医科大学泌尿器科 / 自治医科大学泌尿器科 / 自治医科大学泌尿器科
Department of Urology, Jichi Medical School / Department of Urology,
Jichi Medical School / Department of Urology, Jichi Medical School
/ Department of Urology, Jichi Medical School
今回われわれは,当院における泌尿器科領域内での重複癌について検討した。過去5年間に当科で入院治療した尿路性器系重複癌33例を対象として検討した。重複癌33例は,泌尿器科領域内ではすべて二重癌であった。重複癌33例の内訳は,腎細胞癌を含むもの6例,腎盂尿管癌を含むもの4例,膀胱癌を含むもの26例,前立腺癌を含むもの29例,精巣腫瘍を含むもの1例であり,重複癌症例の組み合わせは膀胱癌と前立腺癌の重複が24例と最も多かった。前立腺癌29例中9例は偶発癌であった。2つの癌の発生間隔については,33例中同時性が24例,異時性が9例であった。前立腺癌の増加に伴い重複癌における前立腺癌の割合がさらに増加することが予想される。
We analyzed the clinical features of multiple primary cancers
arising from the urogenital organs. Of patients who were treated
at our hospital for the past 5 years, 33 patients had multiple
genitourinary cancers, and all of them were double cancers limited
to the urological field. The double cancers included renal cell
carcinoma in 6 cases, renal pelvic-ureteral cancer in 4 cases,
bladder cancer in 26 cases, prostate cancer in 29 cases, and
testicular tumor in 1 case. The highest rate of double cancer
was bladder cancer and prostate cancer in 24 cases, while incidental
prostate cancer was found in 9 cases. 24 cases had synchronous
tumors, and 9 cases had metachronous prostate cancer. The occurrence
of prostate cancer has recently increased ; therefore, the double
cancers including prostate cancer will increase more and more
in the future.
重複癌 / 臨床統計 Multiple primary cancer / Clinical analysis
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71-77 原著論文 Original
Article JPN
下斜筋後転術の手術成績
Surgical outcome of recession of the inferior oblique muscle
牧野,伸二 / 酒井,理恵子 / 保沢,こずえ / 近藤,玲子 / 川崎,知子 / 坂庭,敦子 / 杉山,華江 /
平林,里恵 / 山本,裕子
Makino,Shinji / Sakai,Rieko / Hozawa,Kozue / Kondo,Reiko / Kawasaki,Tomoko
/ Sakaniwa,Atsuko / Sugiyama,Hanae / Hirabayashi,Rie / Yamamoto,Hiroko
自治医科大学眼科学教室 / 自治医科大学眼科学教室 / 自治医科大学眼科学教室 / 自治医科大学眼科学教室 / 自治医科大学眼科学教室
/ 自治医科大学眼科学教室 / 自治医科大学眼科学教室 / 自治医科大学眼科学教室 / 自治医科大学眼科学教室 Department
of Ophthalmology, Jichi Medical School / Department of Ophthalmology,
Jichi Medical School / Department of Ophthalmology, Jichi Medical
School / Department of Ophthalmology, Jichi Medical School /
Department of Ophthalmology, Jichi Medical School / Department
of Ophthalmology, Jichi Medical School / Department of Ophthalmology,
Jichi Medical School / Department of Ophthalmology, Jichi Medical
School / Department of Ophthalmology, Jichi Medical School
下斜筋後転術を行った29例を対象に上下偏位に対する手術効果を大型弱視鏡を用いて検討した。術前の下斜筋の最大作用方向での上下偏位量は12.4°±4.4°(5.0°〜22.0°),術前の正面位での上下偏位量は9.3°±5.0°(1.0°〜23.0°)であった。術後の上下偏位は術後1カ月で安定した値を維持し,最大作用方向における手術効果は9.1°±5.4°(0°〜20.0°),正面位における手術効果は4.8°±4.3°(-2.5°〜17.0°)であった。術前の上下偏位量と手術効果の間には正の相関があった(r=0.734,p<0.0001)。
We evaluated the surgical effect of recession of the inferior
oblique muscle in 29 patients with vertical strabismus using
a major amblyoscope. The preoperative vertical deviation was
12.5±4.4° (5.0°〜22.0°) in the field of maximum action movement
of the inferior oblique muscle and 9.3±5.0° (1.0〜23.0°) in the
primary position. As a result, the improvement in the vertical
deviation was 9.1±5.4° (0゜〜20°) and 4.8±4.3° (-2.5〜17.0°), respectively.
There was a statistically significant correlation between the
preoperative vertical deviation and the improvement of the vertical
deviation (r=0.734, P<0.0001).
下斜筋後転術 / 上下斜視 / 手術成績 / 大型弱視鏡
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79-86 原著論文 Original
Article ENG
口腔心身症に対するparoxetineの効果
The efficacy of paroxetine for oral psychosomatic diseases
小佐野,仁志 / 松本,浩一 / 土屋,欣之 / 草間,幹夫
Osano,Hitoshi / Matsumoto,Koichi / Tsuchiya,Yoshiyuki / KUSAMA,Mikio
自治医科大学歯科口腔外科学講座 / 自治医科大学歯科口腔外科学講座 / 自治医科大学歯科口腔外科学講座 / 自治医科大学歯科口腔外科学講座
Department of Dentistry, Oral and Maxillofacial Surgery, Jichi
Medical School / Department of Dentistry, Oral and Maxillofacial
Surgery, Jichi Medical School / Department of Dentistry, Oral
and Maxillofacial Surgery, Jichi Medical School / Department
of Dentistry, Oral and Maxillofacial Surgery, Jichi Medical School
従来,口腔心身症に対する治療においては,その高い効果から三環系抗うつ薬が用いられてきたが,抗コリン作用による口渇や眠気などの副作用のため十分な投与量が得られない症例をしばしば経験してきた。今回われわれは,口腔心身症の症例に対して三環系抗うつ薬と作用機序が異なる選択的セロトニン再吸収阻害薬であるparoxetineを投与し,その効果について検討した。対象は,当科を受診した口腔心身症と診断された8例(全て女性)で,内訳は舌痛症5例,口腔乾燥症,唾液異常感症と非定型顔面痛が各1例であった。効果判定は,疼痛を主訴とした6例に対してはvisual
analogue scales(VAS)を用い,全例にたいしてClinical Global Impression score
(CGI)を用いた。8例全てに症状の改善を認めた。副作用は,重篤なものはなく,2例に軽度の頭痛,嘔吐,眠気が認められたがいずれも特に処置を必要とせず回復した。Paroxetineは口腔心身症に対して効果的であることが示唆されたが,心身症はプラセボが効きやすい疾患でもあるため,今後さらに症例を増やし検討を続ける必要があるものと思われた。
In this investigation, we evaluated a population of patients
(8 females) with glossodynia, depressive xerostomia, atypical
facial pain, and abnormal sensation of the saliva who received
treatment with oral administration of paroxetine at the department
of dentisty, oral and maxillofacial surgery in our university.The
effect of paroxetine on pain in the tongue or in the face were
measured using the visual analogue scales (VAS) in 6 patients.
The Clinical Global Impression of Change scale (CGI-C) was recorded
at each visit. The final dose of paroxetine ranged from 10-20mg.
The baseline values of pain on VAS were (mean) 76.7%. The mean
percentage changes of VAS at endpoint were-87.7%. Paroxetine
was effective on CGI-C in all cases, consisting of Very much
improved in 6 patients, Much improved in 2 patients. Paroxetine
has similar in efficacy to tricyclic antidepressants and lower
incidence of side effects. However, the placebo often shows the
effect for the patients with psychosomatic disease, further investigation
is necessary to examine the efficacy.
口腔心身症 / パロキセチン / SSRI oral psychosomatic disease / paroxetine
/ SSRI antidepresant
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87-95 原著論文 Original
Article ENG
超音波造影剤を用いた乳癌組織型,乳管内伸展の検討
Clinical Examination of Pathological Type and Intraductal Spread
of Breast Cancer by Microbubble Contrast-Enhanced Color Doppler
Ultrasonography : Initial experience
竹元,伸之 / 甲斐,敏弘 / 秋池,功 / 溝上,智子 / 小野口,晃 / 小西,文雄
TAKEMOTO,Nobuyuki / KAI,Toshihiro / AKIIKE,Isao / MIZOKAMI,Tomoko
/ ONOKUCHI,Akira / KONISHI,Fumio
自治医科大学附属大宮医療センター総合医学II / 自治医科大学附属大宮医療センター総合医学II / 自治医科大学附属大宮医療センター臨床検査科
/ 自治医科大学附属大宮医療センター臨床検査科 / 自治医科大学附属大宮医療センター臨床検査科 / 自治医科大学附属大宮医療センター総合医学II
Departments of Surgery, Omiya Medical Center, Jichi medical School
/ Departments of Surgery, Omiya Medical Center, Jichi medical
School / Clinical Laboratory Medicine, Omiya Medical Center,
Jichi Medical School / Clinical Laboratory Medicine, Omiya Medical
Center, Jichi Medical School / Clinical Laboratory Medicine,
Omiya Medical Center, Jichi Medical School / Departments of Surgery,
Omiya Medical Center, Jichi medical School
(目的)乳癌組織型,乳管内進展に関して超音波造影剤(以下レボビスト)併用ドプラ法を行い検討したので報告する。(対象)2001年7-12月に手術を施行した原発性乳癌19症例でTis1例,T15例,T210例,T3以上3例。組織型は硬癌7例,乳頭腺管癌10例,その他2例。(方法)腫瘤内血流の出現最適条件下でレボビストを1,500mg/5ml静注し5分間の観察を行った。(結果)血流パターンは(1)plunging
sign58%,(2)surrounding sign21%,(3)血流が観察されない症例16%。レボピスト使用で(1)(2)は79%に血流の増加を、また53%に強度の増加を認めたが,(3)では殆ど変化は認められなかった。乳頭腺管癌では70%に強度の血流増加を認めたが,硬癌では29%であった。硬癌成分が増加すると造影効果は低下を示し,硬癌成分High,Very
low間では有意差を認めた(p<0.01)。乳管内伸展に血流増加を認めたのは1例のみであった。(結語)通常USで減衰型でない腫瘤像でも,レボビストで血流の増加を認めない症例では硬癌成分の合併は考慮すべきである。レボビスト併用で術前乳癌組織型推定率が上昇しうる可能性が示されたが,乳癌の乳管内伸展の診断には寄与しなかった。
(Objective) To assess the possibility of preoperatively diagnosing
the pathological type of breast cancer by color Doppler ultrasonography
using Levovist, an ultrasound contrast agent. (Subjects) Subjects
were 19 female patients (aged 37 to 75 years) with primary breast
cancer who underwent surgery between July and December 2001.
Staging was 1 case of Tis, 5 cases of T1, 10 cases of T2, and
3 cases of T3 and above. As to pathological type, there were
7 cases of scirrhous carcinoma, 10 cases of papillo-tubular carcinoma,
1 case of lobular carcinoma, and 1 case of ductal carcinoma in
situ. (Methods) Under optimal conditions for detecting intratumoral
blood flow, 1, 500mg/5ml of Levovist was administered intravenously,
and color Doppler ultrasonography was performed without moving
the probe. (Results) Intratumoral blood flow patterns, assessed
by B-mode ultrasonography, were as follows : (1) "plunging"
was the dominant pattern in 11 patients (58%) ; (2) "surrounding"
was the dominant pattern in 4 patients (21%) ; and (3) no intratumoral
blood flow was seen in 3 patients (16%). When Levovist was used
in cases with results (1) and (2), intratumoral blood flow increased
in 15 patients (79%) and increased markedly in 10 patients (53%).
However, very little change was seen in the 4 individuals with
no intratumoral blood flow. While a marked increase in intratumoral
blood flow was seen in 7 of the 10 patients with papillo-tubular
carcinoma (70%), it was only observed in 2 of the 7 patients
with scirrhous carcinoma (29%). As to the relationship between
scirrhous ratio and Levovist enhancement, the tendency was that
the greater the scirrhous ratio, the lower the Levovist enhancement,
and there was a significant difference between "high"
and "very low" cases (p<0.01). A high scirrhous
ratio correlated with vascular resistance, namely increased PI,
and decreased Vmax and Vmin. Furthermore, Levovist increased
blood flow in an area with suspected intraductal spread only
in one patient. (Conclusions) Even if US findings do not suggest
attenuation (according to Kasumi's classification), when Levovist
does not increase intratumoral blood flow, it is necessary to
consider the presence of scirrhous carcinoma, and as a result,
the use of Levovist could improve preoperative estimation of
the pathological type of breast cancer. However, the use of Levovist
had no effect on the preoperative diagnosis of intraductal spread
of breast cancer.
Ultrasonography / Microbubble / Pathological type / Intraductal
spread / Scirrhous ration
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97-103 症例報告 Case
Report JPN
LDL吸着療法とシクロスポリンAの併用で寛解した膜性腎症によるネフローゼ症候群の1例
A case of nephrotic syndrome in which partial remission was achieved
by the combination of LDL apheresis and cyclosporin A administration
奥田,康輔 / 桜井,俊宏 / 石井,恵里子 / 浅野,泰 / 草野,英二
Okuda,Kousuke / Sakurai,Toshihiro / Ishii,Eriko / Asano,Yasushi
/ Kusano,Eiji
自治医科大学付属病院腎臓科 / 小山市民病院腎臓内科 / 自治医科大学付属病院腎臓科 / 自治医科大学付属病院腎臓科
/ 自治医科大学付属病院腎臓科
Division of Nephrology, Jichi Medical School / Department of
Nephrology, Oyama Municipal Hospital / Division of Nephrology,
Jichi Medical School / Division of Nephrology, Jichi Medical
School / Division of Nephrology, Jichi Medical School
LDL吸着療法(LDL-A)とシクロスポリンA(CyA)の併用によって寛解が得られた膜性腎症(MN)によるネフローゼ症候群(NS)の1症例を経験した。症例:72歳,男性。2000年11月,全身浮腫にて小山市民病院を受診し,NSと診断された。腎生検にてMN(stageI)と診断された。尿蛋白(UP)は10.1g/日認め,プレドニゾロン(PSL)30mgより投薬を開始したが治療抵抗性で,2001年1月,CyA100mgの投与開始し,一旦UPは1.4g/日まで減少した。しかし同年9月,UPは9.5g/日と再増加したためCyAlOOmg併用下に計4回のLDL-Aを施行した。治療2ヶ月後からUP1〜2g/日まで減少し,不完全寛解となった。難治性ネフローゼ症候群にLDL-Aを行い,それまで効果の少なかったCyAに対する反応性が改善し,寛解へ導ける可能性があることが示唆された。
We report a case of nephrotic syndrome (NS) in which partial
remission was achieved by LDL apheresis (LDL-A) and cyclosporin
A (CyA) administration. Case : The patient was a 72-year-old
man who was admitted to Oyama Municipal hospital in November,
2000 for treatment of NS. He was diagnosed with membranous nephropathy
on the basis of a renal biopsy examination finding. His urinary
protein (UP) level was 10.1g/day before starting treatment. Prednisolone
was administered at 30mg/day, but his UP level did not decrease.
Treatment with CyA at 100 mg/day was therefore started in January
2001. His UP level decreased to 1.4g/day, but increased to 9.5g/day
again in September. The patient underwent four sessions of LDL-A
combined with CyA. Incomplete remission, with UP level of 1〜2g/day,
was achieved after 2 months of LDL-A. We concluded that CyA is
effective for treatment of steroid-resistant nephrotic syndrome
in combination with LDL-A, which rapidly reduces the level of
serum LDL.
LDL吸着療法 / シクロスポリンA / ネフローゼ症候群 / 膜性腎症
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105-110 症例報告
Case Report JPN
有機溶剤暴露に起因すると考えられた急性肝障害の2例
Two cases of acute hepatic injury following transient exposure
to an organic solvent
大竹,俊哉 / 井戸,健一 / 礒田,憲夫 / 長嶺,伸彦 / 小野,和則 / 佐藤,慎 / 砂田,富美子 / 永江,玄太
/ 砂田,圭二郎 / 宮田,知彦 / 菅野,健太郎 / 金井,信行
Ootake,Toshiya / Ido,Kenniti / Isoda,Norio / Nagamine,Nobuhiko
/ Ono,Kazunori / Sato,Shin / Sunada,Fumiko / Nagae,Genta / Sunada,Keijiro
/ Miyata,Tomohiko / Sugano,Kentaro / Kanai,Nobuyuki
自治医科大学消化器内科 / 自治医科大学消化器内科 / 自治医科大学消化器内科 / 自治医科大学消化器内科 / 自治医科大学消化器内科
/ 自治医科大学消化器内科 / 自治医科大学消化器内科 / 自治医科大学消化器内科 / 自治医科大学消化器内科 / 自治医科大学消化器内科
/ 自治医科大学消化器内科 / 自治医科大学病理学
Division of Gastro-enterology Dept. of Internal Medicine, Jichi
Medical School / Division of Gastro-enterology Dept. of Internal
Medicine, Jichi Medical School / Division of Gastro-enterology
Dept. of Internal Medicine, Jichi Medical School / Division of
Gastro-enterology Dept. of Internal Medicine, Jichi Medical School
/ Division of Gastro-enterology Dept. of Internal Medicine, Jichi
Medical School / Division of Gastro-enterology Dept. of Internal
Medicine, Jichi Medical School / Division of Gastro-enterology
Dept. of Internal Medicine, Jichi Medical School / Division of
Gastro-enterology Dept. of Internal Medicine, Jichi Medical School
/ Division of Gastro-enterology Dept. of Internal Medicine, Jichi
Medical School / Division of Gastro-enterology Dept. of Internal
Medicine, Jichi Medical School / Division of Gastro-enterology
Dept. of Internal Medicine, Jichi Medical School / Department
of Pathology, Jichi Medical School
有機溶剤一過性暴露後に急性肝障害の病態を示した2例を経験した。症例1は48歳男性。トルエンを一回使用した後に発熱・嘔吐が認められ来院。著明な肝機能障害が認められ入院した。他疾患が除外され,病歴よりトルエンによる急性肝障害と診断。経過は良好で入院10日目で退院した。入院9日目に施行した肝生検では肝細胞再生の所見が認められた。症例2は25歳女性。数回トリクロロエチレンを短時間使用した後,眼球の黄染を自覚し来院。肝機能障害が認められ入院した。他疾患が除外され,病歴および尿中トリクロロ酢酸の検出よりトリクロロエチレンによる急性肝障害と診断した。経過は良好で入院24日目で退院した。入院17日目に施行した肝生検では胆汁うっ帯を伴う肝細胞障害の所見が認められた。いずれの症例も有機溶剤への暴露が一過性で,かつ急性肝障害のみの病態を示した稀な症例と考えられた。
We encountered 2 patients developing acute hepatic injury following
transient exposure to an organic solvent. Patient 1 was a 48-year-old
man who developed fever and vomiting after a single use of toluene,
and visited our hospital. Severe hepatic dysfunction was noted,
and he was hospitalized. After exclusion of other diseases, acute
hepatic injury due to tolue ne was diagnosed based on his history.
The clinical course was uneventful, and he was discharged on
the 10th hospital day. A liver biopsy performedon the 9th hospital
day showed findings of liver cell regeneration. Patient 2 was
a 25-year-old woman who noted yellow staining of the eyes after
a brief use of trichloroethylene several times, and visited our
hospital. Hepatic dysfunction was noted, and she was hospitalized.
After exclusion of other diseases, acute hepatic injury due to
trichloroethylene was diagnosed based on her history, and the
detection of trichloroacetic acid in the urine. The clinical
course was uneventful, and she was discharged on the 24 th hospital
day. A liver biopsy performed on the 17th hospital day showed
findings of liver cell injury and cholestasis. The two cases
are considered rare because exposure to an organic solvent was
transient and acute hepatic injury alone developed.
トルエン / トリクロロエチレン / 一過性暴露 / 急性肝障害 Toluene / Trichloroethylene
/ Transient exposure / acute hepaticinjury
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111-114 症例報告
Case Report JPN
腎嚢胞に合併した腎管状乳頭状腺腫の1例
Renal cyst associated with renal adenoma : a case report
黒川,真輔 / 小林,実 / 徳江,章彦 / 高屋敷,典生
Kurokawa,Shinsuke / Kobayashi,Minoru / Tokue,Akihiko / Takayashiki,Norio
自治医科大学泌尿器科 / 自治医科大学泌尿器科 / 自治医科大学泌尿器科 / 自治医科大学病理
Department of Urology, Jichi Medical School / Department of Urology,
Jichi Medical School / Department of Urology, Jichi Medical School
/ Department of Pathology, Jichi Medical School
症例は73歳,男性。甲状腺癌の既往があり,当院に定期的に通院していた。腹部CT検査にて右腎上極に直径1.5cmの腫瘤を認め,当科入院となった。右腎血管造影検査ではhypovascular
tumorの像を示した。右腎腫瘍の診断にて右腎部分切除術を施行した。肉眼的には嚢胞状腫瘤で,病理組織学的には嚢胞壁の一部に管状乳頭状腺腫を認めた。腎腺腫は,病理解剖や摘出腎の病理検索などで偶然発見されることが多く,本症例のごとく臨床的に発見されることは稀である。腎嚢胞に合併した腎腺腫としては,自験例は本邦17例目である。
We report a case of renal cyst associated with renal adenoma.
A 73-year-old man with a history of thyroid cancer underwent
a follow-up computed tomography (CT). A small renal tumor (1.5cm
in diameter) was revealed at the upper portion of the right kidney,
and he was referred to our department. Right renal angiography
showed a hypovascular feature of the tumor. Although we suspected
a benign tumor at most, right partial nephrectomy was performed
because of a slight chance of malignancy. Pathological findings
showed a small renal cyst associated with renal tubulopapillary
adenoma. Renal adenoma is mostly found incidentally at autopsy
or in pathological evaluation of resected kidneys, while the
tumor was discovered clinically in the present case. This is
the seventeenth domestic case of renal cyst associated with renal
adenoma.
腎腺腫 / 管状乳頭状腺腫 Renal adenoma / Tubulopapillary adenoma
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115-119 症例報告
Case Report JPN
Anderson法による先天眼振の手術成績
Surgical outcome of Anderson's procedure for congenital nystagmus
牧野,伸二 / 酒井,理恵子 / 佐々木,誠 / 青木,由紀 / 保沢,こずえ / 近藤,玲子 / 川崎,知子 /
坂庭,敦子 / 杉山,華江 / 平林,里恵 / 山本,裕子
Makino,Shinji / Sakai,Rieko / Sasaki,Makoto / Aoki,Yuki / Hozawa,Kozue
/ Kondo,Reiko / Kawasaki,Tomoko / Sakaniwa,Atsuko / Sugiyama,Hanae
/ Hirabayashi,Rie / Yamamoto,Hiroko
自治医科大学眼科学教室 / 自治医科大学眼科学教室 / 自治医科大学眼科学教室 / 自治医科大学眼科学教室 / 自治医科大学眼科学教室
/ 自治医科大学眼科学教室 / 自治医科大学眼科学教室 / 自治医科大学眼科学教室 / 自治医科大学眼科学教室 / 自治医科大学眼科学教室
/ 自治医科大学眼科学教室
Department of Ophthalmology, Jichi Medical School / Department
of Ophthalmology, Jichi Medical School / Department of Ophthalmology,
Jichi Medical School / Department of Ophthalmology, Jichi Medical
School / Department of Ophthalmology, Jichi Medical School /
Department of Ophthalmology, Jichi Medical School / Department
of Ophthalmology, Jichi Medical School / Department of Ophthalmology,
Jichi Medical School / Department of Ophthalmology, Jichi Medical
School / Department of Ophthalmology, Jichi Medical School /
Department of Ophthalmology, Jichi Medical School
先天眼振に対してAnderson法により手術を施行した。症例は28歳の男性と4歳の男児である。いずれも眼振は左方視で増強し,静止位は右方約30゜にあり,顔を左に向けて右方視する頭位異常を伴っていた。そのため,頭位異常を改善する目的で右眼外直筋後転6mm,左眼内直筋後転6mmのAnderson法による手術を行った。術後の静止位は右方約5°になり,頭位の改善が得られた。本術式は眼振に対する初回手術として有用であった。
The surgical outcome of Anderson's procedure for congenital nystagmus
is reported. We treated a 28-year-old male and a 4-year-old boy
with congenital nystagmus. A 30-degree compensatory face turn
to the left as a null position was present preoperatively in
these patients. Both patients underwent 6mm recession of the
right lateral rectus muscle and 6mm recession of the left medial
muscle in one session (Anderson's procedure). The abnormal head
position remarkably improved within 5 degrees of normal after
surgery. Anderson's procedure was considered to be effective
as a first surgical procedure for treating congenital nystagmus.
先天眼振 / Anderson法手術 / 静止位 / 頭位異常
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121-125 症例報告
Case Report JPN
アンギオテンシンII受容体拮抗薬の関与が疑われた術中難治性低血圧の1例
Refractory hypotension after induction of anesthesia in a patient
treated with an angiotensin receptor antagonist
岡田,修 / 井上,荘一郎 / 中川,雅史 / 瀬尾,憲正
Okada,Osamu / Inoue,Soichiro / Nakagawa,Msasi / Seo,Norimasa
自治医科大学麻酔科・集中治療学講座 / 自治医科大学麻酔科・集中治療学講座 / 自治医科大学麻酔科・集中治療学講座
/ 自治医科大学麻酔科・集中治療学講座
Department of Anesthesiology and Intensive Care, Jichi Medical
school / Department of Anesthesiology and Intensive Care, Jichi
Medical school / Department of Anesthesiology and Intensive Care,
Jichi Medical school / Department of Anesthesiology and Intensive
Care, Jichi Medical school
A case of refractory hypotension due to losartan (angiotensin
II receptor antagonist, angiotensin receptor blocker, ARB) is
reported. Fifty-two year old fireman was scheduled for the elective
operation for open correction of his right fractured upper arm.
He had been treated hypertension with losartan, doxazosin and
seriprorol. Preoperatively the patient took these pills. After
induction of anesthesia, the patient was turned to left lateral
decubitus position. On the left lateral position, he suffered
from refractory hypotension in spite of large volume of fluid
replacement and large doses of ephedrine. There were no signs
of hypovolemia or myocardial ischemia. The operation was postponed
and re-scheduled on the next day. On the second anesthesia, the
patient preoperatively took no medication of these anti-hypertensive
drugs and the anesthesia was uneventful. These clinical findings
suggest that ARB may induce the refractory hypotension and the
careful pre-anesthetic evaluation of circulatory status is necessary
in the patient with chronically treated by ARB.
refractory hypotension / angiotensin II receptor antagonist
/ anesthesi
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127-133 症例報告
Case Report JPN
骨格性下顎前突・開咬症例に対し外科的に上顎咬合平面後方部を圧下した上下顎同時移動手術症例
A case report of skeletal class III and open bite with surgical
depression of the posterior part of the occlusal plane by two-jaw
surgery
笹栗,健一 / 佐藤,貞雄 / 小林,優 / 久保田,英朗 / 神部,芳則 / 草間,幹夫Sasaguri,Kenichi
/ Sato,Sadao / Kobayashi,Masaru / Kubota,Eiro / Jinbu,Yoshinori
/ Kusama,Mikio
自治医科大学歯科口腔外科学講座:神奈川歯科大学成長発達歯科学講座 / 神奈川歯科大学成長発達歯科学講座 / 神奈川歯科大学顎顔面外科学講座
/ 神奈川歯科大学顎顔面外科学講座 / 自治医科大学歯科口腔外科学講座 / 自治医科大学歯科口腔外科学講座
Department of Dentistry, Oral and Maxillofacial Surgery, Jichi
Medical School:Department of Craniofacial Growth & Development
Dentistry, Kanagawa Dental College / Department of Craniofacial
Growth & Development Dentistry, Kanagawa Dental College /
Department of Oral and Maxillofacial Surgery, Kanagawa Dental
College / Department of Oral and Maxillofacial Surgery, Kanagawa
Dental College / Department of Dentistry, Oral and Maxillofacial
Surgery, Jichi Medical School / Department of Dentistry, Oral
and Maxillofacial Surgery, Jichi Medical School
患者は,11歳11ヶ月の男性で,反対咬合・前歯部開咬を主訴に来院した。下顎骨の過成長による骨格的反対咬合の診断にて,12歳1ヶ月より上下前歯部にmulti
bracket appliance(M.B.A.)を装着し,上下顎前歯歯軸のコントロールを行うと共に,protractorを用いて上顎骨の成長促進,下顎骨の成長抑制を約3年間行った。しかしながら,被蓋の改善が得られなかったため,やむを得ず一時装置をすべて除去し,全身成長終了後,外科的に咬合の改善を行うこととした。17歳1ヶ月,再診断の結果全身成長が終了しつつあると判断し,術前矯正治療をM.B.A.を用いて開始した。術前矯正終了後,光造形モデルを用いたmodel
surgeryの検討から,上顎骨はLe FortI型骨切り術による咬合平面の後方挙上と,前方移動を行った。下顎骨は,上顎骨の移動量に合わせて両側下顎枝矢状分割法による後方移動を行った。術後は,術後矯正治療により緊密な咬合が構築され,良好な結果が得られたので,若干の文献的考察を加え報告する。
The patient was an 11-year, 11-month-old male who had the chief
complaint of progenia and anterior open bite. We diagnosed his
case as skeletal mandibular protrusion because of the excess
growth of the mandible. We had applied both a multi bracket appliance
(MBA) in order to control the inclination of the incisors and
a protractor to promote the growth of the maxilla and to suppress
the growth of the mandible for approximately 3 years since he
was 12 years, 1 month old. However, the ideal over jet and over
bite hadn't been established ; we decided to remove all the appliances
at once and improve the occlusion surgically after the whole
body growth had finished. When he was 17 years, 1 month old,
the growth was completed ; we reexamined his case, after which
we started to apply an MBA as a preoperative orthodontic treatment.
After the preoperative orthodontic treatment had finished examined
with model surgery by using laser lithography methods, the Le-Fort
I procedure was performed to elevate the posterior part of the
occlusal plane and moveif forward. Moreover, sagittal splitting
ramus osteotomy was carried out on both sides and set back for
repositioning of the maxillary and mandibular bone fragments.
We established the constitution of the ideal occlusion by postoperative
orthodontic treatment ; thus, we would report this case with
some reference-consideration.
光造形モデル / 上下顎同時移動手術 / Three-dimensional model / Two-jaw surgery
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135-143 症例報告
Case Report ENG
原発性肺動脈平滑筋肉腫 : 4年間の生存を得た1切除例
Primary Pulmonary Artery Leiomyosarcoma : a Case of 4-year Survivor
after Surgical Treatment
石田,博徳 / 安達,秀雄 / 岡田,晋一郎 / 村田,聖一郎 / 石田,岳史 / 山田,茂樹 / 小西,文雄
Ishida,Hironori / Adachi,Hideo / Okada,Shinichiro / Murata,Seiichirou
/ Ishida,Takeshi / Yamada,Shigeki / Konishi,Fumio
自治医科大学附属大宮医療センター一般・消化器・呼吸器外科 / 自治医科大学附属大宮医療センター心臓血管外科 / 自治医科大学附属大宮医療センター一般・消化器・呼吸器外科
/ 自治医科大学附属大宮医療センター心臓血管外科 / 自治医科大学附属大宮医療センター総合診療科 / 自治医科大学附属大宮医療センター病理
/ 自治医科大学附属大宮医療センター一般・消化器・呼吸器外科
Departments of Surgery, Omiya Medical Center, Jichi Medical School
/ Departments of Cardiovascular Surgery, Omiya Medical Center,
Jichi Medical School / Departments of Surgery, Omiya Medical
Center, Jichi Medical School / Departments of Cardiovascular
Surgery, Omiya Medical Center, Jichi Medical School / Departments
of General Internal Medicine, Omiya Medical Center, Jichi Medical
School / Departments of Pathology, Omiya Medical Center, Jichi
Medical School / Departments of Surgery, Omiya Medical Center,
Jichi Medical School
肺動脈肉腫は稀で致命的な疾患である。54歳女性で,左主肺動脈の完全閉塞と肺動脈主幹部から右肺動脈の狭窄を来す血管内肉腫の症例を報告する。体外循環下に,右室-右肺動脈の人工血管置換,左肺全摘術を行った。最終病理診断は平滑筋肉腫であった。術後4年8ヶ月で再発死亡するまでは,自宅での日常生活が可能であった。できる限り完全切除を試みることで,早期の突然死を回避でき,比較的長期の生存が得られる可能性がある。
Pulmonary artery sarcoma is a rare and usually fatal tumor. We
report a case of a 54-year-old female with an intraluminal sarcoma
which occluded the left pulmonary artery and narrowed the right
pulmonary artery and pulmonary trunk. Under cardiopulmonary bypass,
the patient underwent resection of the right pulmonary artery
and pulmonary artery trunk including the tumor, pulmonary artery
reconstruction, and left pneumonectomy. Final pathologic diagnosis
was leiomyosaroma. The patient survived at home for 4 years 8
months, until she died of tumor recurrence. Radical surgical
resection under cardiopulmonary bypass probably improves symptoms
and prolongs postoperative survival.
肺動脈肉腫 / 平滑筋肉腫 / 肺動脈血栓塞栓症 / 手術 / 生存 / pulmonary artery sarcoma
/ leiomyosarcoma / pulmonary thromboembolism / surgery / survival
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145-154 症例報告
Case Report ENG
経膣的切除術を施行した直腸gastrointestinal stromal tumorの1例
A case of gastrointestinal stromal tumor of the rectum resected
by the transvaginal approach
楠本,祥子 / 早田,邦康 / 首藤,介伸 / 小西,文雄
Kusumoto,Yoshiko / Soda,Kuniyasu / Shuto,Yukinobu / Konishi,Fumio
自治医科大学附属大宮医療センター消化器・一般外科 / 自治医科大学附属大宮医療センター消化器・一般外科 / 自治医科大学附属大宮医療センター消化器・一般外科
/ 自治医科大学附属大宮医療センター消化器・一般外科
Department of Surgery, Omiya Medical Center, Jichi Medical School
/ Department of Surgery, Omiya Medical Center, Jichi Medical
School / Department of Surgery, Omiya Medical Center, Jichi Medical
School / Department of Surgery, Omiya Medical Center, Jichi Medical
School
症例は71歳女性。下血を主訴に近医を受診し,精査加療目的に当科に入院した。直腸指診で,直腸前壁に表面平滑な硬い腫瘤を触知した。大腸内視鏡検査では,肛門縁より約3cmの位置に中心に潰瘍を伴う粘膜下腫瘍を認めた。生検組織標本の病理組織学的検査および免疫染色にてgastrointestinal
stromal tumor(GIST)と診断し,経膣的腫瘍切除術および回腸瘻造設術を施行した。膣後壁に縦切開を加え,更にその下端に横切開を置き,膣壁を直腸膣中隔より剥離した。次いで腫瘍より約1cm離して直腸壁を腫瘍周囲より切離し腫瘍を摘出した。55mm×45mm×35mm大の灰白色,軟な充実性腫瘍で,病理組織学的には紡錘形細胞の増殖を認め,免疫染色にてS-100蛋白,α-smooth
muscle actin陰性,CD34,c-kit陽性でGISTと診断した。直腸GISTの本邦報告例は自験例を含め47例であるが,経膣的切除は本症例の他には1例にしか施行されていない。今回我々は,直腸GISTに対する経膣的切除の適応と手技についての考案を加えて本症例を報告する。
A 71-year-old woman was admitted to our hospital with a chief
complaint of bloody stool. Digital examination revealed a hard
mass with a smooth surface protruding from the anterior wall
of the rectum. Colonoscopy demonstrated a submucosal tumor with
a mucosal ulceration located about 3cm from the anal verge. Biopsy
specimens were examined histopathologically and immunohisto-chemically.
The tumor was diagnosed as gastrointestinal stromal tumor (GIST).
The patient underwent tumor resection by the transvaginal approach,
and an ileostomy on the right side of the abdomen was constructed.
The tumor, which measured 55mm×45mm×35mm, was solid and white
with a slightly grayish color and soft consistency. Microscopic
examination revealed fascicular proliferation of spindle-shaped
tumor cells. In immunohistochemical studies, tumor cells were
diffusely positive for CD 34 and c-kit protein, and were negative
for S-100 protein, a-smooth muscle actin and desmin. The tumor
was diagnosed as GIST of the rectum. To our knowledge, 41 cases
of rectal GIST have been reported in Japan, but only in one of
these was resected by the transvaginal approach. We describe
a case of rectal GIST resected by transvaginal approach, with
reference to GIST in the literature.
gastrointestinal stromal tumor / rectum / transvaginal approach
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155-160 症例報告
Case Report ENG
内視鏡的胃瘻造設術後に皮膚結腸瘻をきたした一例
Colocutaneous fistula as a complication of percutaneous endoscopic
gastrostomy
石窪,力 / 古川,泰司 / 相原,弘之 / 合原,進二 / 竹井,真一郎 / / 有馬,美和子 / 多田,正弘
Ishikubo,Tsutomu / Furukawa,Taiji / Aihara,Hiroyuki / Gohara,Shinji
/ Takei,Shin-ichiro / Shuto,Chio / Arima,Miwako / Tada,Masahiro
飯能市立病院内科 / 飯能市立病院外科 / 飯能市立病院外科 / 飯能市立病院内科 / 飯能市立病院内科 / 飯能市立病院外科
/ 埼玉県立がんセンター消化器科 / 埼玉県立がんセンター消化器科
Department of Internal Medicine, Hanno City Hospital / Department
of Surgery, Hanno City Hospital / Department of Surgery, Hanno
City Hospital / Department of Internal Medicine, Hanno City Hospital
/ Department of Internal Medicine, Hanno City Hospital / Department
of Surgery, Hanno City Hospital / Department of Gastroenterology,
Saitama Cancer Center / Department of Gastroenterology, Saitama
Cancer Center
多発性脳梗塞の74歳女性にpull法による内視鏡的胃瘻造設術(PEG)を施行した。5ヶ月後、PEGチューブが事故的に抜去され入院となった。チューブ再挿入後造影したところ、横行結腸が造影され皮膚結腸瘻と診断された。保存的治療で瘻孔は自然に閉鎖し、腹膜炎は発症しなかった。経皮的経食道胃管挿入術を施行後退院とした。PEG造設1週間後の造影検査でPEGチューブの先端は横行結腸ガス像の辺縁にあった。PEG造設直後に腹膜炎を発症しなかったことも考えると、本症例では造設時の横行結腸誤穿刺よりは、横行結腸壁がBumperと腹壁の間に挟まれて慢性的に瘻孔を形成したという方が考えやすいと思われた。稀ではあるがBumperで胃壁を腹壁に固定する際に腸管を挟み込むことの予測、予防は難しく、本合併症は一定の頻度で起こりえるものと考えられ、初回のチューブ交換時には念頭に置く必要がある。
We present an unusual complication of percutaneous endoscopic
gastrostomy (PEG), colocutaneous fistula. The patient was a 74-year-old
woman with multiinfarct dementia. PEG tube was placed by the
standard "pull" technique without difficulty. Colocutaneous
fistula was discovered five months later, during the procedure
of replacement of the tube following inadvertent tube removal.
Abdominal CT showed the fistula tract penetrating right in the
middle of the intestinal wall of the transverse colon. In the
course of conservative treatment, the fistula healed spontaneously.
There were no symptoms or findings associated with peritonitis.
As the reinsertion of PEG tube was considered to involve a great
risk of repeated injury in the transverse colon, percutaneous
trans-esophageal gastrotubing was applied and the patient left
the hospital. In abdominal X-ray of gastrografin contrast study
at a week after the initial tube placement, the internal bumper
of the tube slightly overlapped the inferior border of the transverse
colon. When these X-ray findings were combined with the above
abdominal CT findings, it was indicated that the marginal part
of the transverse colon was tucked in between the bumper of PEG
tube and the abdominal wall, and prolonged pressure against the
intestinal wall resulted in the formation of colocutaneous fistula.
This event is unpredictable, but is likely in elderly and pediatric
patients whose mesenteries and gastrocolic ligaments are lax.
Frequency of occurrence is thus considered to remain. in a certain
percentage, though it should be very low.
colocutaneous fistula / percutaneous endoscopic gastrostomy
/ intestinal injury / complication
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161-165 症例報告
Case Report ENG
長時間の前傾姿勢が契機となり発症した上腸間膜動脈症候群の1例
Superior mesenteric artery syndrome caused by maintaining anteflexion
posture-a case report
石窪,力 / 合原,道二 / 古川,泰司 / 相原,弘之 / 竹井,真一郎 / 多田,正弘 Ishikubo,Tsutomu
/ Gohara,Shinji / Furukawa,Taiji / Aihara,Hiroyuki / Takei,Shin-ichiro
/ Tada,Masahiro
飯能私立病院内科 / 飯能私立病院内科 / 飯能私立病院外科 / 飯能私立病院外科 / 飯能私立病院内科 / 埼玉県立がんセンター消化器
Department of Internal Medicine, Hanno City Hospital / Department
of Internal Medicine, Hanno City Hospital / Department of Surgery,
Hanno City Hospital / Department of Surgery, Hanno City Hospital
/ Department of Internal Medicine, Hanno City Hospital / Department
of Gastroenterology, Saitama Cancer Center
症例は24歳男性。食後の嘔気,嘔吐を主訴として受診した。それらの症状はゲームソフト開発会社に就職し,モニターを見ながら行なう長時間の前屈姿勢での作業をするようになってから出現した。上部消化管造影では上腸間膜動脈と腹部大動脈の分岐部と思われる部位での十二指腸水平脚の直線状な途絶,造影剤の逆蠕動などの所見を認め,上腸間膜動脈症候群と診断した。腹部超音波検査では腹部大動脈と上腸間膜動脈の角度は8°と狭小化しており,その診断の裏づけとなった。本症例では元々ズボンのベルトをきつく巻く習慣があった。前屈姿勢ではベルトによる腹壁への圧迫が更に強くなり,その状態が長時間持続したことが本症を発症した契機となったと思われた。絶食,補液で症状は消失し,食事再開後も再燃はなかった。長時間の前屈姿勢を止めるように指導したところ,6ヶ月経過した現在でも本症の再燃は認めていない。
A 24-year-old man complained post-prandial nausea and vomiting.
The symptoms appeared after he started his work to develop computer
games and he tended to slouch or lean forward to view work the
monitor. Radiological and ultrasonic findings showed duodenal
obstruction due to narrowing of the angle between the superior
mesenteric artery (SMA) and the aorta, and a diagnosis of SMA
syndrome was made. His habit to sit in an anteflexion posture
for a long time was noticeable as a major trigger. Compression
against the outside of the abdominal wall by the waistband was
considered to be involved in the pathogenesis.
superior mesenteric artery syndrome / duodenal obstruction /
high intestinal obstruction / anteflexion
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167-172 報告 Research
Report JPN
当院の医師による不適切なABO式血液型判定の解析
Analysis of incorrect ABO blood typing by doctors in Jichi Medical
School Hospital
永嶋,貴博 / 山本,千鶴 / 森,政樹 / 小澤,敬也 / 室井,一男
Nagashima,Takahiro / Yamamoto(Kawano),Chizuru / Mori,Masaki /
Ozawa,Keiya / Muroi,Kazuo
自治医科大学附属病院輸血・細胞移植部 / 自治医科大学附属病院輸血・細胞移植部 / 自治医科大学附属病院輸血・細胞移植部
/ 自治医科大学附属病院輸血・細胞移植部 / 自治医科大学附属病院輸血・細胞移植部
Division of Cell Transplantation and Transfusion, Jichi Medical
School Hospital / Division of Cell Transplantation and Transfusion,
Jichi Medical School Hospital / Division of Cell Transplantation
and Transfusion, Jichi Medical School Hospital / Division of
Cell Transplantation and Transfusion, Jichi Medical School Hospital
/ Division of Cell Transplantation and Transfusion, Jichi Medical
School Hospital
1989年度から2002年度までの,当院における医師による不適切なABO式血液型検査(血液型判定ミス)を解析した。血液型判定ミスの件数は1997年まで増加し最大108件を記録したが,以後減少し2002年では53件となった。血液型判定ミスの頻度(ABO式血液型検査件数に占める血液型判定ミスの件数)も同様な変化を示した。血液型判定ミスの主な原因は,ABO式血液型検査における検査または判定時のミスだった。どの期間においても一定の頻度で検体の取り違えが認められた。血液製剤使用の適正化の指針,レジデントに対する輸血再教育(講習や実習),インシデント・アクシデントレポートが血液型判定ミスの減少に貢献したと考えられる。
From 1989 to 2002, we analyzed incorrect ABO blood typing by
doctors in Jichi Medical School Hospital. The number of incorrect
ABO blood typing increased to a maximum of 108 in 1997 and then
decreased to 53 in 2002. The percentage of incorrect ABO blood
typing ([incorrect ABO blood typing numbers/ABO blood typing
numbers]×100) showed a similar change in this period. The main
cause of incorrect ABO blood typing was a technical error. A
sampling error was shown at a constant frequency in this period.
It is suggested that the guideline on rationalization of blood
products, the training of ABO blood typing for residents and
the incident and accident report system will lead to a decrease
in incorrect ABO blood typing.
ABO式血液型検査 / 血液型判定ミス / インシデント・アクシデントレポート / 輸血再教育
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173-181 報告 Research
Report JPN
デンマークでの脳死肝移植システムと現状
Cadaveric liver transplantation in Denmark
俵藤,正信 / 石橋,敏光 / 安田,是和 / 永井,秀雄 / 三上,公次 / 山内,靖
Hyodo,Masanobu / Ishibashi,Toshimitsu / Yasuda,Yoshikazu / Nagai,Hideo
/ Mikami,Koji / Yamauchi,Yasushi / Noergaard Larsen,Peter / Kirkegaard,Preben
自治医科大学消化器一般外科 / 自治医科大学消化器一般外科 / 自治医科大学消化器一般外科 / 自治医科大学消化器一般外科
Department of Surgery, Jichi Medical School, Department of Surgery
C, University of Copenhagen / Department of Surgery, Jichi Medical
School, Department of Surgery C, University of Copenhagen / Department
of Surgery, Jichi Medical School, Department of Surgery C, University
of Copenhagen / Department of Surgery, Jichi Medical School,
Department of Surgery C, University of Copenhagen
デンマークでは1990年10月から脳死肝移植が開始され2003年8月までに390症例に対し448回の肝移植が施行されている。デンマークは小国ゆえに他の北欧4国とともにScandiatransplantを組織し,ドナー臓器の相互利用を行いながら移植医療を維持している。ただし近年は小児を中心にドナー不足が深刻になってきており,生体肝移植も施行されてきている。脳死肝移植はすでに確立した医療として定着しており,コーデイネーターを中心に効率的なシステムが構築され看護師・麻酔科医等のスタッフも充実している。デンマーク肝移植症例の特微は緊急例ではパラセタモール中毒が,待期例ではアルコール性肝硬変が多いことである。当教室員2名が2年で経験した脳死肝移植は70例で緊急11例・待期59例であるが,緊急例ではパラセタモール中毒・待期例ではアルコール性肝硬変が最多であった。肝移植にかかる医療費の患者自己負担は無料であり,疾病構造とともに医療経済の違いを感じた。
A total of 448 liver transplantations have been performed for
390 patients in Denmark since October 1990. Denmark, a small
country with a small population of more than 5 million, has participated
in the transplantation network, Scandiatransplant, composed of
5 Nordic nations maintaining mutual organ donations. Due to a
lack of cadaveric donors, living related liver transplantation
has started recently, especially for children. Cadaveric liver
transplantation is being managed efficiently, not only by physicians
and surgeons but also by coordinators, nurses, anesthesiologists,
and paramedics. The number of staff members is much greater than
in Japanese institutes. Paracetamol intoxication and alcoholic
liver cirrhosis represent general indications in an urgent and
an elective transplantation, respectively. Two surgeons from
Jichi Medical School experienced 70 cadaveric cases that consisted
of 11 urgent (4 paracetamol intoxication) and 59 elective (17
alcoholic liver cirrhosis) transplants. Thus, there is a marked
difference from the Japanese circumstance in the underlying diseases
for liver transplantation. Another surprising fact in Denmark
is that all transplantations are covered by medical insurance.
脳死肝移植 / パラセタモール中毒 / アルコール生肝硬変
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183-197 報告 Research
Report JPN
口腔癌に対する機能温存手術と術後の口腔機能検査およびリハビリテーション
Surgery for preservation of function in oral cancer and evaluation
of oral function and rehabilitation after surgical treatment
松本,浩一 / 篠崎,泰久 / 土屋,欣之 / 星,健太郎 / 伊藤,弘人 / 野口,忠秀 / 小佐野,仁志 / 神部,芳則
/ 若林,宣江 / 鈴木,祐子 / 本多,ムツ子 / 草間,幹夫
Matsumoto,Koichi / Shinozaki,Yasuhisa / Tuchiya,Yoshiyuki / Hoshi,Kentaro
/ Ito,Hiroto / Noguchi,Tadahide / Osano,Hitoshi / Jinbu,Yoshinori
/ Wakabayashi,Nobue / Suzuki,Yuko / Honda,Mutuko / Kusama,Mikio
自治医科大学歯科口腔外科学講座 / 自治医科大学歯科口腔外科学講座 / 自治医科大学歯科口腔外科学講座 / 自治医科大学歯科口腔外科学講座
/ 自治医科大学歯科口腔外科学講座 / 自治医科大学歯科口腔外科学講座 / 自治医科大学歯科口腔外科学講座 / 自治医科大学歯科口腔外科学講座
/ 自治医科大学歯科口腔外科学講座 / 自治医科大学歯科口腔外科学講座 / 自治医科大学歯科口腔外科学講座 / 自治医科大学歯科口腔外科学講座
Department of Dentistry, Oral and Maxillofacial Surgery, Jichi
Medical School / Department of Dentistry, Oral and Maxillofacial
Surgery, Jichi Medical School / Department of Dentistry, Oral
and Maxillofacial Surgery, Jichi Medical School / Department
of Dentistry, Oral and Maxillofacial Surgery, Jichi Medical School
/ Department of Dentistry, Oral and Maxillofacial Surgery, Jichi
Medical School / Department of Dentistry, Oral and Maxillofacial
Surgery, Jichi Medical School / Department of Dentistry, Oral
and Maxillofacial Surgery, Jichi Medical School / Department
of Dentistry, Oral and Maxillofacial Surgery, Jichi Medical School
/ Department of Dentistry, Oral and Maxillofacial Surgery, Jichi
Medical School / Department of Dentistry, Oral and Maxillofacial
Surgery, Jichi Medical School / Department of Dentistry, Oral
and Maxillofacial Surgery, Jichi Medical School / Department
of Dentistry, Oral and Maxillofacial Surgery, Jichi Medical School
口腔癌術後患者は口腔機能障害が出現することが多く,そのため口腔機能を正確に把握するための口腔機能評価が必要となる。また,それに基づく機能回復のための再建手術やリハビリテーションが重要である。当科で行っている口腔機能の評価法を紹介する。嚥下機能については,反復唾液嚥下テスト,水飲みテスト,VF検査を施行。長期的な総合評価は,摂食・嚥下能力のgrade表を用いる。咀嚼機能については,デンタルプレスケール,山本咬度表にて検査している。構音機能は,田口の5段階尺度,発語明瞭度検査を施行している。また,器官運動能力として口唇,舌,頬粘膜,頸部,肩の運動を評価している。その他,触覚,味覚を含めた知覚検査も行う。術後のリハビリテーションは,嚥下機能訓練については,器官運動能力評価を行い,頚部と腕のストレッチなどの間接訓練から開始する。反復唾液嚥下テスト,水飲みテスト,頚部聴診法,さらにVF検査にて誤嚥の有無を確認した上で,直接訓練を開始する。嚥下練習食より開始,徐々に食事形態を上昇させていく。
Patients with oral cancer occasionally have oral functional disorders
after surgical treatment. For that reason, it is necessary to
accurately evaluate oral function. We perform reconstructive
surgery and rehabilitation based on the results of the evaluation.
Here we present a procedure for evaluation of oral function after
surgical treatment. Our tests for such evaluations involve swallowing,
chewing, speech, anatomical movement ability, and perception.
Selected tests for swallowing function are the water swallow
test, repeated saliva swallow test, and videofluoroscopic examination
of swallowing. As long term criteria for swallowing function,
grading of swallowing and eating are used. For chewing function,
the dental prescale and occlusal force of Yamamoto are used.
To evaluate speech function, we chose the 5-grade criteria according
to Taguchi and the 100-syllable Japanease speech intelligibility
test. We measure the movement of lips, tongue, cheeks, neck,
and shoulders to evaluate anatomical movement ability. Moreover,
we examined the sense of touch and taste to evaluate perception.
At the beginning of rehabilitation, we begin with indirect training
on organ movement, then perform rehabilitation by stretching
the neck and shoulders for patients with functional disorders
after surgical treatment. Direct training is started after confirmation
of the absence of aspiration by water swallow test, repeated
saliva swallow test, videofluoroscopic examination of swallowing,
and swallowing sound detection. At the beginning of direct training,
patients eat a simple meal of soft foods to practice swallowing.
After that, food with an increasingly more challenging consistency
is introduced in increments.
機能温存手術 / 口腔機能 / リハビリテーション Surgery for preservation of function
/ Oral function / Rehabilitation
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199 平成15年度自治医科大学研究奨励金研究成果報告 JPN
小脳依存性運動学習でのCa^<++>依存型プロテインキナーゼCサブタイプの機能的役割
首藤,文洋
自治医科大学生理学講座神経脳生理学部門
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200 平成15年度自治医科大学研究奨励金研究成果報告 JPN
生活習慣病の地域特異性に対する分子遺伝学的解析
熊田,真樹
自治医科大学地域医療学センター人類遺伝学部門
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200-201 平成15年度自治医科大学研究奨励金研究成果報告 ENG
AAV-mediated interleukin(IL)-10 gene transfer prevents heart
failure in Dahl salt-sensiive rats
Maeda,Yoshikazu / Sarukawa,Mutsuko / Yoshioka,Toru / Ito,Takayuki
/ Shimada,Kazuyuki
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201-202 平成15年度自治医科大学研究奨励金研究成果報告 JPN
腸上皮化生の発生メカニズム,特に転写因子CDX1,CDX2の発現解析,遺伝子異常の解明(平成15年度自治医科大学研究奨励金研究成果報告)
江田,証
自治医科大学内科学講座消化器内科学部門
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202-203 平成15年度自治医科大学研究奨励金研究成果報告 JPN
遺伝性脊髄小脳変性症の原因蛋白aprataxinの相互作用蛋白の単離と機能解析
嶋崎,晴雄
自治医科大学内科学講座神経内科学部門
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203-204 平成15年度自治医科大学研究奨励金研究成果報告 JPN
DNAチップを用いた骨髄間葉系幹細胞の分化制御機構の解明(平成15年度自治医科大学研究奨励金研究成果報告)
宮里,彰
自治医科大学内科学講座血液学部門
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204-205 平成15年度自治医科大学研究奨励金研究成果報告 JPN
胃癌患者におけるTS-1隔日投与法の有用性と臨床薬理学的研究(平成15年度自治医科大学研究奨励金研究成果報告)
細谷,好則 / 荒井,渉
自治医科大学消化器・一般外科 / 自治医科大学消化器・一般外科
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205-206 平成15年度自治医科大学研究奨励金研究成果報告 JPN
シベレスタットナトリウム水和物(ELASPOL)の人工心肺後全身性急性炎症反応(とくに急性肺障害)における効果(平成15年度自治医科大学研究奨励金研究成果報告)
上西,祐一朗 / 相澤,啓 / 坂野,康人 / 大木,伸一 / 齊藤,力 / 加藤,盛人 / 小西,宏明 / 三澤,吉雄
自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門
/ 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門
/ 自治医科大学外科学講座心臓血管外科学部門 / 自治医科大学外科学講座心臓血管外科学部門
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206 平成15年度自治医科大学研究奨励金研究成果報告 ENG
The prevention of organ injuries by the inhibition of leukocyte
activation The prevention of organ injuries by the inhibition
of leukocyte activation
Sato,Yukio / Goto,Yukinobu / Sato,Shoko / Endo,Shunsuke /
Sohara,Yasunori
Division of Thoracic Surgery, Department ofSurgery, Jichi
Medical School:University of Tsukuba, Institute of Clinical Medicine
/ University of Tsukuba, Institute of ClinicalMedicine / University
of Tsukuba, Institute of ClinicalMedicine / Division of Thoracic
Surgery, Department of Surgery, Jichi Medical School / Division
of Thoracic Surgery, Department of Surgery, Jichi Medical School
The use of granulocyte-colony stimulating factor (G-CSF) for
the recovery from neutropenia has been established; however,
acute lung injury due to G-CSF induced polymorphonuclear leukocytes
(PMN) activation is a serious complication. This study was designed
to compare the activation of PMN with single bolus administration
and continuous administration of G-CSF. Healthy volunteers (age,
33.8±1.4 years, n=6) received a single bolus injection of 50
micrograms/m^2 of G-CSF (SI; n=6) or continuous subcutaneous
injection of 50 micrograms/m^2 of G-CSF for 24 hrs (CI; n= 6),
and were followed for 48 hrs. Circulating leukocyte counts, markers
of activation on PMN, and circulating levels of G-CSF, IL-6 and
PMN elastase were measured. SI rapidly increased serum G-CSF
levels that peaked at 4hrs, whereas CI gradually increased G-CSF
levels, which remained at a steady level from 8 to 24hrs. SI
caused a rapid decrease in PMN counts at 0.5hr followed by sustained
increase to peak at 12hrs. CI gradually increased PMN counts,
which peaked at 24hrs, but the peak values were not significantly
different between the groups. SI induced activation of PMN, which
was characterized by increased expression of CD11b, decreased
expression of L-selectin, and increased F-actin content, lead
to increases in serum IL-6 and PMN elastase level. Such changes
were all attenuated with CI (p< 0.05). We conclude that continuous
subcutaneous injection of G-CSF resulted in a similar marrow
response as a single injection but yielded reduced PMN activation.
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206-207 平成15年度自治医科大学研究奨励金研究成果報告 JPN
筋強直性ジストロフィーの分子病態とSIX5標的遺伝子
佐藤,滋
自治医科大学細胞生物研究部
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207-208 平成15年度自治医科大学研究奨励金研究成果報告 JPN
子宮内膜症とアレルギー反応 : 発生・進展メカニズムに基づく疼痛治療ターゲットの研究
藤原,寛行 / 今野,良 / 鈴木,光明
自治医科大学産科婦人科学教室 / 自治医科大学大宮医療センター婦人科 / 自治医科大学産科婦人科学教室
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209 平成15年度自治医科大学大学院研究奨励賞研究成果報告 JPN
サルES細胞由来神経幹細胞を用いた疾患モデル動物への移植治療
永田,三保子
自治医科大学大学院地域医療学系精神・神経・筋骨格疾患学
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209-210 平成15年度自治医科大学大学院研究奨励賞研究成果報告 JPN
静脈麻酔薬の作用メカニズムにおけるNMDA受容体の関与
佐藤,友紀
自治医科大学大学院地域医療学系麻酔・救急・集中治療医学
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210-211 平成15年度自治医科大学大学院研究奨励賞研究成果報告 JPN
霊長類の小脳による随意眼球運動制御の神経機構の解明
平松,敬人
自治医科大学大学院地域医療学系精神・神経・筋骨格疾患学
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211 平成15年度自治医科大学大学院研究奨励賞研究成果報告 JPN
腹膜播種を標的とした卵巣癌遺伝子治療に関する基礎的研究
竹井,裕二
自治医科大学大学院地域医療学系生殖・発達医学
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211-212 平成15年度自治医科大学大学院研究奨励賞研究成果報告 JPN
インターロイキン : 10の体内発現による動脈硬化の抑制化の抑制(平成15年度自治医科大学大学院研究奨励賞研究成果報告)
吉岡,徹
自治医科大学大学院地域医療学系循環器・呼吸器疾患学
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212-213 平成15年度自治医科大学大学院研究奨励賞研究成果報告 JPN
脳神経分化に伴い発現調節を受ける神経性RNA結合タンパク質(Drb1)の機能解析(平成15年度自治医科大学大学院研究奨励賞研究成果報告)
野崎,靖之
自治医科大学大学院地域医療学系生殖発達医学
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