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Get PDF【緒言】丹毒は，発熱とともに皮膚に出現する浮腫性紅斑を主症状とする真皮の化膿性炎症性疾患であるが，歯性感染症が原因と考えられる顔面丹毒の報告は少ない． 今回われわれは，右側上顎前歯の根尖性歯周炎が原因と疑われた顔面丹毒の1例を経験したので報告する．
【症例】患者は67歳の女性. 右側顔面の腫脹を主訴に当科を紹介され受診した．初診時所見として, 右側眼窩下部から右側頬部, 右側顎下部にかけて境界明瞭な紅斑と腫脹を認め，右側上顎3番に根尖性歯周炎を認めた．当初, 右側上顎3番の根尖性歯周炎に起因する頬部蜂窩織炎と診断し, 切開排膿術を施行したが, 排膿を認めなかったことから, 鑑別疾患として丹毒を疑い, 皮膚科対診を行ったところ, 顔面丹毒との臨床診断を得た. 抗菌薬投与後も右側頬部の腫脹および右側上顎3番部の違和感が消失しなかったため, 右側上顎3番の根管開放を行ったところ, 消炎を認め, 第11病日に右側顔面の紅斑は消失した. 約2ヵ月経過した現在, 再発なく経過は良好である．Erysipelas is a pyogenic inflammatory disease of the dermis characterized by erythema with edema appearing on the skin with fever. However, there have been few reports of facial erysipelas caused by dental infection. In this report, we describe a case of erysipelas of the face that was suspected to have been caused by periodontitis of the right maxillary canine tooth.
The patient was a 67-year-old woman. She was referred to our department because of right-sided facial swelling. At the time of initial examination, erythema and swelling with well-defined borders were observed from the lower right orbit to the right cheek and lower right side of the jaw. We initially diagnosed her disease as buccal cellulitis caused by periodontitis of the right maxillary canine tooth and therefore performed incisional drainage. However, because there was no drainage of pus, we suspected erysipelas as a differential diagnosis. After consultation with a dermatologist, the patient was diagnosed with facial erysipelas. The swelling in the right cheek area and discomfort in the right maxillary canine tooth persisted after administration of antibacterial drugs; therefore, we created a root canal opening in the right maxillary canine tooth. Eleven days after symptom onset, the erythema on the right side of the face disappeared. After about 2 months, the patient was doing well without any recurrence.departmental bulletin pape
Impact of administering umbilical cord-derived mesenchymal stem cells to cynomolgus monkeys with endometriosis
Get PDFPurpose:
This study aimed to explore whether umbilical cord-derived mesenchymal stem cells (UC-MSCs) could be used as a therapeutic resource for endometriosis.
Methods:
Of seven cynomolgus monkeys with endometriosis, five were administered UC-MSCs (intervention group) and two were administered saline (control group). First, intravenous US-MSC treatment was administered for three months. Second, weekly intravenous US-MSC administration combined with monthly intraperitoneal US-MSC administration was conducted for 3 months. Finally, weekly intraperitoneal US-MSC administration was conducted for 3 months. The dose of UC-MSCs was set to 2 × 106 cells/kg for all administration routes. Laparoscopic findings and serum cancer antigen 125 (CA125) levels were also evaluated. The Revised American Society for Reproductive Medicine classification was used for laparoscopic evaluation.
Results:
Laparoscopic findings showed exacerbation of endometriosis after intraperitoneal UC-MSC administration, although no changes were observed in the control group. Intravenous UC-MSC administration decreased the level of CA125 in all monkeys; however, the difference was not significant. Intraperitoneal UC-MSC administration significantly exacerbated endometriosis compared with intravenous administration (p = 0.02).
Conclusions:
This study revealed that intraperitoneal UC-MSC administration exacerbates endometriosis in a nonhuman primate model of the disease.journal articl
フククウキョウヨウ ICGケイコウホウ デ チョウカン ケツリュウ オ ハンダンシタ コウヤクセイ チョウヘイソク ノ 6レイ
Get PDF絞扼性腸閉塞の手術における腸管の血流評価でIndocyanine Green（以下，ICGと略記）蛍光法の有用性が報告されている．当院では腹腔鏡用ICG蛍光法のVISERA ELITEⅡ®（OLYMPUS）を導入しており，腹腔鏡画像上でICG蛍光法の観察が可能である．絞扼性腸閉塞の手術で腹腔鏡用ICG蛍光法を使用した症例について報告する．
2019年4月～2022年12月の期間に当院で腹腔鏡用ICG蛍光法を施行した絞扼性腸閉塞の症例は6例であった．平均年齢は72.3±13.9歳，発症から手術までの平均時間は19.3±1.7時間，平均手術時間は85.5±10.9分，平均在院日数は19.8±3.5日であった．4例で腸管を温存しており，2例で腸管を切除した．術後合併症は１例のみ誤嚥性肺炎を認めたが，全例が遅発性壊死や穿孔を発症せず退院した．
腹腔鏡用ICG蛍光法は絞扼腸管を温存する判断の一助となる可能性がある．腹腔内で手術を完遂できる症例では小開腹することなくICG蛍光法で血流を評価できる点が利点と考えられた．There is a report on the evaluation of blood flow in a strangulated intestine during surgery for strangulated bowel obstruction using the ICG fluorescence image. We have introduced the laparoscopic ICG fluorescence image. This allows the ICG fluorescence image to be performed on laparoscopic screen. We will discuss cases of laparoscopic ICG fluorescence image used in a surgery for strangulated bowel obstruction.
Six cases were performed in our hospital from April 2019 to December 2022. The mean age was 72.3 ± 13.9 years, the mean time from onset to surgery was 19.3 ± 1.7 hours, the mean operative time was 85.5 ± 10.9 minutes, and the mean hospital stay was 19.8 ± 3.5 days. 4 patients had their strangulated bowel tract preserved and 2 patients had it resected. Only one patient developed aspiration pneumonia as a postoperative complication. All six patients did not develop delayed necrosis or perforation of strangulated intestine.
We believe that the laparoscopic ICG fluorescence image could assist in the decision to preserve the strangulated bowel tract. In cases that can be completed laparoscopically, the advantage of laparoscopic ICG fluorescence image is that we can evaluate blood flow of strangulated intestine without a small laparotomy and extraperitoneal traction.departmental bulletin pape
O-GlcNAc modification is essential for physiological adipose expansion induced by high-fat feeding
Get PDF滋賀医科大学博士（医学）American journal of physiology. Endocrinology and metabolism. 2023 Jul 1;325(1):E46-E61.令和5年度thesi
Epidemiology of Acute Aortic Dissection in a General Population of 1.4 Million People in Japan
Get PDF滋賀医科大学博士（医学）Circulation journal. 2023 Aug 25;87(9):1155-1161. d令和5年度thesi
Factors predicting oral and maxillofacial fractures after falling and factors predicting the duration of treatment
Get PDF滋賀医科大学博士（医学）Dental traumatology. 2023 Oct;39(5):418-424.令和5年度thesi
Clinical utility of the BIWACO score for patients with atrial fibrillation after percutaneous coronary intervention
No full text滋賀医科大学博士（医学）Heart Vessels. 2023 Jan;38(1):96-105.令和5年度thesi
Complete remission of diabetes with a transient HDAC inhibitor and insulin in streptozotocin mice
Get PDFDespite the growing epidemic worldwide, diabetes is an incurable disease. We have been focusing on why diabetes manifests refractoriness to any therapy. We recently found that abnormal bone marrow-derived cells (BMDCs), namely, Vcam-1+ST-HSCs, was a key mechanism for diabetic complications. We then hypothesize that those aberrant BMDCs sustainedly impair pancreatic β cells. Here we show that eliminating abnormal BMDCs using bone marrow transplantation results in controlling serum glucose in diabetic mice, in which normoglycemia is sustained even after cessation of insulin therapy. Alternatively, abnormal BMDCs exhibiting epigenetic alterations are treated with an HDAC inhibitor, givinostat, in diabetic mice. As a result, those mice are normoglycemic along with restored insulin secretion even following the cessation of both insulin and givinostat. Diabetic cell fusion between abnormal BMDCs and resident cells is significantly blocked by the combination therapy in the pancreatic islets and thymus while surgical ablation of the thymus completely eliminates therapeutic protection in diabetic mice. In conclusion, diabetes is an epigenetic stem cell disorder with thymic disturbances. The combination may be applied to patients aiming at complete remission from diabetes in clinical medicine.journal articl
The diagnostic accuracy of endoscopic ultrasound-shear wave elastography in multiple pancreatic regions for chronic pancreatitis based on the Rosemont criteria
No full textPurpose:
Although endoscopic ultrasound (EUS) has been widely used for diagnosing chronic pancreatitis (CP), the assessment of fibrosis using the Rosemont criteria (RC) is generally subjective. Shear wave elastography using EUS (EUS-SWE) has been advocated as an objective approach to evaluating pancreatic fibrosis; however, it is unknown which pancreatic region should be selected for measurement. This study aims to compare the diagnostic accuracy in diagnosing CP by measurement site.
Methods:
Fifty patients with CP or suspected CP who underwent EUS-SWE were retrospectively analyzed. As per the RC, they were classified into two groups: CP and non-CP. Pancreatic stiffness was evaluated by measuring the velocities of the shear wave (Vs) in addition to determining the relevant cutoff value of Vs for diagnosing CP. The correlation between Vs and RC, and the RC factors affecting pancreatic stiffness were evaluated.
Results:
In the CP group, the Vs were notably higher in all regions (P < 0.001). The Vs for diagnostic accuracy of CP were highest in the body [area under the curve (AUC): 0.87]. A significant correlation was seen between the number of RC and Vs in all regions, with the correlation coefficient being highest in the pancreatic body (rs = 0.55). Multivariate analysis revealed that lobularity with honeycombing was an independent factor for pancreatic stiffness (P = 0.02).
Conclusion:
The pancreatic body is a suitable region for assessing pancreatic stiffness using EUS-SWE. Additionally, quantifying Vs is a valuable objective indicator for diagnosing CP.journal articl
Long term observation of de novo adipogenesis using novel bioabsorbable implants with larger size in a porcine model
Get PDFIntroduction:
The regeneration of adipose tissue in patients after breast cancer surgery would be desirable without the use of growth factors or cells to avoid potential recurrence and metastasis. We reported that prolate spheroidal-shaped poly-L-lactic acid (PLLA) mesh implants of approximately 18-mm polar diameter and 7.5-mm greatest equatorial diameter containing collagen sponge (CS) would be replaced by regenerated adipose tissue after implantation, thereby suggesting an innovative method for breast reconstruction. Our study aimed to evaluate the adipose tissue regeneration ability of implant aggregates in a porcine model.
Methods:
We prepared implant aggregates consisting of thirty PLLA mesh implants containing CS packed in a woven poly (glycolic acid) bag. The implant aggregates were inserted under the mammary glands in the porcine abdomen for a year. Single and double groups were classified by inserting either one or two implant aggregates on each side of the abdomen, respectively.
Results:
In both groups, the volume of the implant aggregates decreased over time, and the formation of adipose tissue peaked between 6 and 9 months. Histologically, the formation of adipose tissue was confirmed in the area that was in contact with native adipose tissue.
Conclusions:
Our implant aggregates could induce the autologous adipose tissue after long term implantation in vivo, without the use of any growth factor or cell treatment, presenting a potential novel method of breast reconstruction.journal articl