Dokkyo Medical University Repository / 獨協医科大学リポジトリ
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Genetic Abnormalities in Pseudohypoaldosteronism Type II and Hypertensive Disorders
Full text linkPseudohypoaldosteronism type II (PHAII) is an inherited disorder that presents with salt-sensitive hypertension, hyperkalemia, and metabolic acidosis. Genetic mutations in WNK4 (with no lysine kinase 4) and WNK1 (with no lysine kinase 1) were reported as causative genes of PHA II in 2001 by positional cloning of patient families. Through analysis of the molecular pathogenesis of PHA II, WNK constitutes a novel salt reabsorption and blood pressure regulatory signaling pathway in the kidney. In addition, KLHL3 and CUL3, components of the KLHL3-Cullin3 E3 ubiquitin ligase complex, have been newly identified as causative genes of PHA II in 2012 by next generation sequencing (NGS). WNK1 and WNK4 are ubiquitinated as substrates of the KLHL3-Cullin3 ubiquitin E3 ligase complex. Disease-causing genetic mutations in WNK4, KLHL3, and Cullin3 all cause PHAII by a common mechanism of impaired WNK4 ubiquitination and increased intracellular WNK4 protein levels. GWAS (genome-wide association study) and NGS have emerged as powerful tools to identify genes related to the pathogenesis of hypertension. The uromodulin gene (UMOD) is one of such candidates obtained from GWAS, which has been reported to be associated in a number of renal diseases.journal articl
Treatment with Low-Profile Visualized Intraluminal Support Junior Device (LVIS Jr.) for Distal Middle Cerebral Artery Ruptured Dissecting Aneurysm
Full text linkBackground: Dissecting aneurysms of the distal middle cerebral artery (MCA) are rare, and endovascular treatment is yet to be established.
Case Description: The present report describes the case of a 33-year-old male patient who presented with a ruptured dissecting aneurysm of the MCA M2 segment of the superior trunk. The patient underwent a low-profile visualized intraluminal support junior (LVIS Jr.) stent placement because hypoplasia of the superficial temporal artery made bypass surgery unfeasible and severe spasm of the MCA M1 was observed. We decided to only utilize stent deployment in the dissecting vessel due to insufficient space for inserting coils. At 2, 6, and 20 days after stent deployment, follow-up angiography showed minor dilatation within the dissecting aneurysm without in-stent thrombosis. Approximately 2.5 months later, dual antiplatelet agent therapy was reduced to single antiplatelet agent therapy. Follow-up angiography at 74 days after stent placement revealed complete occlusion of the aneurysm and patency of the parent artery.
Conclusions: In cases of hypoplasia of the superficial temporal artery and severe spasm of the parent artery, LVIS Jr. placement may be a suitable alternative treatment for distal MCA ruptured dissecting aneurysms.journal articl
Neurological Prognosis of Neuroblastoma Diagnosed by Opsoclonus-Myoclonus-Ataxia：A Case Report
Full text linkOpsoclonus-myoclonus-ataxia 症候群（以下OMAS）合併神経芽腫の1 例を経験した．症例は11 か月女児，不規則な眼球運動，四肢の不随意運動，座位保持の不安定さを主訴に当院を受診した．原因検索のために腹部超音波検査を行ったところ，左副腎に腫瘤を認め，OMAS と診断した．腫瘍生検を行い神経芽腫の診断となった．化学療法後に，腫瘍摘出術を行った．免疫療法は行わなかったが，時間をかけてOMAS 症状は改善した．基礎疾患の治療のみで症状の回復を観察できた貴重な症例であると考えられた．We report a case of neuroblastoma complicated with opsoclonus-myoclonus-ataxia syndrome （OMAS）. An 11-month-old girl visited our hospital complaining of irregular eye movements, involuntary movements of limbs, and instability in sitting position. An abdominal ultrasound was performed to determine the cause, and a mass was found in the left adrenal gland, and was diagnosed with OMAS. A tumor biopsy revealed a diagnosis of neuroblastoma. After chemotherapy, a tumor removal surgery was performed. Although immunotherapy was not administered, OMAS symptoms improved over time. This was considered to be a rare case in which recovery from symptoms was observed simply by treating the underlying disease.journal articl
A Case of a 5-Year-Old Boy with Kawasaki Disease Who had Prolonged Fever and Parotitis, in Whom Neck Ultrasonography was Useful for Diagnosis
Full text link流行性耳下腺炎との鑑別が必要であった川崎病の5 歳男児の症例を経験した．本症例では，発症初期に耳下腺部の腫脹から流行性耳下腺炎が疑われたが，後に川崎病診断基準を満たす症状が現れ，最終的に川崎病と診断された．この症例は，頸部超音波検査所見にて耳下腺実質の内部不均一な所見を認め耳下腺炎を合併していた．発熱の遷延する耳下腺炎を診察する場合は，頸部超音波検査で耳下腺とリンパ節所見の有無を確認することが川崎病の早期治療介入と冠動脈瘤形成リスク軽減のために重要である．We experienced a case of a 5-year-old boy with Kawasaki disease that required differentiation from mumps. In this case, mumps was suspected early in the course due to swelling in the parotid gland area. Parotitis was confirmed based on the findings of the cervical ultrasonography, which showed heterogeneous internal parenchyma of the parotid gland. However, the patient was finally diagnosed with Kawasaki disease after the patient developed symptoms fulfilling the diagnostic criteria of Kawasaki disease. This case underscores the importance of cervical ultrasonography in patients presenting with prolonged parotitis and fever to diagnose Kawasaki disease earlier.journal articl
Survey of Health Literacy, Health Behaviors, and Health Support Needs of Women Working in the Medical Field
Full text link【目的】 医療系就労・就学女性は，健康に関する知識を有することから，自らの健康保持・増進のための行動をとりやすいことが予測される．しかし，その実態や健康行動及び健康支援ニーズは明らかにされていない．本研究の目的は，医療系就労・就学女性のヘルスリテラシーと健康行動及び健康支援ニーズを明らかにすることである．
【方法】 関東圏内の大学病院および医療系大学等に所属する，18～49 歳の女性を対象に調査を行った．調査項目は，性成熟期女性のヘルスリテラシー尺度（以下，ヘルスリテラシー），健康に関する行動，所属先に希望するサポートと教育に関するニーズとした．健康に関する行動とヘルスリテラシーの関連を分析し，健康に関する行動，所属先のサポートと教育に関するニーズは単純集計を行った．
【結果】 693 名のデータを分析した結果，ヘルスリテラシーの得点は61.3±14.3 であり，一般女性よりも高かった．運動習慣があると回答した女性のほうが，有意にヘルスリテラシーが高値であった．自ら健康を維持する方法は，「寝る」が就労女性（84.8％），就学女性（90.8％）双方とも，最も多かった．ニーズについて，所属先に希望するサポートは，就労女性は「適切な人員配置」（51.6％）が最も多く，就学女性は「生理休暇」（62.7％）が最も多かった．希望する健康教育については，就労女性は「女性特有の症状」（42.0％）が最も多く，就学女性は「PMS や月経随伴症状等の月経に関する症状と対処」（48.6％）が最も多かった．
【結論】 医療系就労・就学女性の健康を維持・増進していくためには，就労前からのヘルスリテラシーを高める教育や支援とともに，無理なく就業が継続できるような職場環境の整備，相談できる体制の整備の必要性が示唆された．departmental bulletin pape
Literature Review on the Perspective of Visiting Nurses Capturing the Life of Home Care Patients
Full text link【目的】 国内文献において訪問看護師が在宅療養者の生活を捉える視点を明らかにする．
【方法】 訪問看護師が在宅療養者の生活を捉えている内容が記述された文献を研究対象とした．データの収集方法は，検索年代は絞らず，医学中央雑誌Web 版で検索できた原著論文について文献タイトルおよび抄録から研究対象が訪問看護師ではない文献，訪問看護師が捉える在宅療養者の生活について記述されていない文献を除外し，最終的に抽出された論文を分析対象論文とした．分析対象論文を熟読しレビューマトリックス表を作成した．訪問看護師が捉える在宅療養者の生活について記載された内容について抽出し，意味内容の類似性を複数の研究者で検討し質的帰納的に分析した．
【結果】 国内文献において訪問看護師が在宅療養者の生活を捉える視点を明らかにすることを目的に文献検討を行った結果，以下のことが明らかとなった．1 つ目は，訪問看護師が捉える「生活」に関する研究は継続的に取り組まれておらず，「生活」の定義づけがなされていなかった．2 つ目は，国内文献にみる訪問看護師が捉える在宅療養者の生活の視点は，【療養者・家族の価値観】，【セルフケア能力】，【家族の介護力】，【住居環境】，【健康状態・ADL/IADL】，【家族関係】，【活用している社会資源】，【経済の状況】，【災害時の備え】であった．
【結論】 国内文献にみる訪問看護師は，家族を含めた視点や身体状態を生活の中で捉える視点，療養者や家族の価値観を大切にする視点を持っていた．訪問看護師が在宅療養者の「生活」を捉える視点の研究は十分ではなく，今後は訪問看護師へのインタビュー等により，訪問看護師が捉える在宅療養者の「生活」の視点について研究を進める必要がある．その様な継続的な研究の取り組みにより看護基礎教育において教育の一貫性への一助となり，更に訪問看護師の在宅療養者の生活モニタリングの指標に示唆を得る可能性がある．departmental bulletin pape
A New Approach for Measuring Circumferential Resection Margin (CRM) in Resected Specimen of Locally Advanced Rectal Cancer
Full text linkEvaluation of the circumferential resection margin (CRM) of locally advanced rectal cancer is an important prognostic factor for predicting local recurrence rate and distant metastasis and is currently the standard practice mainly in Western countries. In Japan, however, CRM assessment is not commonly performed and thus has not been sufficiently studied. Therefore, we aimed to evaluate CRM using a histopathological specimen processing method developed independently by our department. Ten patients with locally advanced rectal cancer who underwent surgery between January 2022 and March 2024 were included in the study. Although preoperative treatment was given to all the 10 patients, CRM was measurable in all cases using this method. As a result, one patient was found to be CRM-positive. The average number of lymph nodes dissected was 14, and the average distal margin (DM) was 20 mm, which was comparable to those of the current pathological specimen processing method. It is imperative to establish the global standard CRM assessment method in Japan. This also should be done in a way that aligns with the current guidelines for specimen processing methods outlined in the Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma (JCCRC). Our method was able to minimize the burden on pathologists and lower gastrointestinal surgeons as much as possible while enabling more accurate CRM measurement. In the future, it will be necessary to accumulate more cases, identify potential problems, and prospectively evaluate the effectiveness of this method in a multicenter collaborative study.journal articl
Comparisons in Postoperative Outcomes and Complications between Baerveldt Glaucoma Implant and Ahmed Glaucoma Valve Implanted Eyes in Japanese Patients with Refractory Glaucoma
Full text linkThe aim of the study is to compare postoperative outcomes and complications between Baerveldt Glaucoma Implant (BGI) and Ahmed Glaucoma Valve (AGV) implanted eyes with refractory glaucoma. This study included 48 eyes of 46 patients (BGI group) and 56 eyes of 52 patients (AGV group) who underwent BGI and AGV implantation, respectively, for the treatment of refractory glaucoma. Changes in intraocular pressure (IOP), medication score, and complications were evaluated postoperatively and compared between the BGI and AGV groups. The IOPs were significantly reduced after surgery in both groups, with significantly lower IOPs at 12, 18 and 24 months in the BGI group than in the AGV group (P < 0.05). Medication scores were significantly reduced postoperatively in both groups, with the AGV group having significantly lower scores than the BGI group at 1 week and 1 month (P < 0.05). Choroidal detachment caused by hypotony (P < 0.0005), additional glaucoma surgeries (P < 0.05) and tube exposure including Hoffman elbow due to the melting of the scleral flap (P < 0.01) were observed more frequently in the BGI group than in the AGV group. Prolapse or plate exposure caused by loosening of sutures was significantly more common in the AGV group (P < 0.05). BGI and AGV implantation effectively reduced the IOP and medication scores in eyes with refractory glaucoma, with subsequently lower IOP in the BGI group. The BGI group required more medication than the AGV group in the early postoperative period. These implantations have characteristic complications related to the nature of each device.journal articl
