Dokkyo Medical University Repository / 獨協医科大学リポジトリ
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Novel Approach to Upper Extremity Ischemia: Radial Artery Bypass Surgery in the Anatomical Snuff Box for Upper Extremity Critical Ischemia Leading To Hand Gangrene: A Case Report
Get PDFThe patient was a 72-year-old man who underwent bypass surgery from the ulnar artery to radial artery in the anatomic snuff box with a small saphenous vein graft for right fourth finger gangrene caused by prolonged wound healing due to chronic limb threatening ischemia of the upper extremity. Postoperative transection of the necrotic finger was performed successfully to protect the upper extremity. Cases of chronic limb threatening ischemia of the upper extremity are rare, and there have been limited studies regarding revascularization of the forearm. We present on this case with a review of literature and describe the unique surgical method we performed during the surgery.journal articl
Comparison of long fusion terminating at lower lumbar versus the sacrum and ilium in corrective surgery for adult spinal deformity: a propensity score analysis
Get PDF獨協医科大学博士（医学）令和5年度doctoral thesi
Investigating the effects of weather on headache occurrence using a smartphone application and artificial intelligence: A retrospective observational cross-sectional study
Get PDF獨協医科大学博士（医学）令和5年度doctoral thesi
Details of patients hospitalized with COVID-19 in a university-affiliated core hospital and the changes in anti-SARS-CoV-2 antibody titers of the physicians exclusively responsible for their treatment
Get PDF獨協医科大学博士（医学）令和5年度doctoral thesi
A case of Laparoscopic Intraperitoneal Onlay Mesh Repair for Re-recurrent Inguinal Hernia after the Removal of an Infected Mesh
Get PDF患者は 83 歳，男性．初発，再発左鼠径ヘルニアに対して Mesh-Plug 法によるヘルニア修復術を施行された． 再発に対する手術後 4 か月目にメッシュの感染を来し，メッシュ除去が施行された．しかし，メッシュ除去後 9 か月目にヘルニア再々発を発症し，Intraperitoneal Onlay Mesh repair（以下 IPOM）を施行された．術後経過は良好で 3 回目の再発や再感染は認めていない．ヘルニア門およびその周囲の高度な瘢痕化を認める症例には IPOM が有用であると考えられた．An octogenarian man was referred to our hospital because of a mesh infection with purulent discharge occurring four months after a mesh-plug repair for both a left inguinal direct hernia and its recurrence. The infected mesh was completely removed, but a re-recurrent inguinal hernia was confirmed 9 months after the surgery. Laparoscopic intraperitoneal onlay mesh repair（IPOM）was performed for the re-recurrent inguinal hernia because of the severe postoperative adhesion and scarring of the hernia orifice and surrounding area. No further recurrence occurred. We believe that laparoscopic IPOM is a useful procedure for the treatment of complicated re-recurrent inguinal hernia after the removal of an infected mesh.journal articl
Submucosal Anorectal Malignant Melanoma Treated with Robot-assisted Abdominoperineal Resection: A Case Report
Get PDFIntroduction: Anorectal malignant melanoma is a rare disease, accounting for approximately 0.4-1.6% of all malignant melanomas. The prognosis is poor due to aggressive metastasis. Case presentation: We report a case of 73-year-old woman who presented with rectal bleeding in whom colonoscopy revealed an anorectal polyp in black-toned color. The pathological diagnosis of biopsy specimens was malignant melanoma and other examinations showed no evidence of lymph node or distant metastases. Robot-assisted abdominoperineal resection combined with lymph node dissections including lymph nodes along the inferior mesenteric artery, superior rectal artery, and bilateral inguens was performed. The patient was discharged on the postoperative day 21 without any adverse events. Pathological diagnosis revealed malignant melanoma cells invaded a submucosa, with no evidence of lymph nodes metastases. As of 25 months after tumor resection, no recurrence of anorectal malignant melanoma has been identified. Discussion: The present case showed that robot-assisted surgery would be a feasible and safe surgical approach in the treatment of anorectal malignant melanoma.journal articl
Effects of Switching from Insulin Glargine 100 to Insulin Glargine 300 on Glycemic Control and Treatment Satisfaction In Japanese People with Type 1 and Type 2 Diabetes
Get PDFAims: To investigate how switching from insulin glargine U-100 (Gla-100) to insulin glargine U-300 (Gla-300) affects glycemic control and treatment satisfaction in Japanese people with type 1 and 2 diabetes.
Methods: We enrolled 152 outpatients with diabetes (type 1, n = 29; type 2, n = 123) being treated with basal-bolus therapy (BBT; n = 95) or basal only using as insulin therapy (n = 57) with Gla-100 and switched them all to Gla-300. The dose of Gla-300 was initially the same as that of Gla-100 and was then titrated up. We investigated changes in hemoglobin A1c (HbA1c), body weight, glargine insulin dose over three months, and diabetes treatment satisfaction questionnaire scores over three months.
Results: Three months after patients had switched to Gla-300, HbA1c and body weight had not changed significantly. In the whole group, the basal dose of Gla-300 insulin was significantly higher than that of Gla-100 (14.2 ± 8.1 vs 13.7 ± 7.9 units, respectively; P < 0.001). Separate analyses of the BBT and Basal only groups showed that in both the BBT and the Basal only group, the basal insulin dose was significantly higher with Gla-300 than with Gla-100. Patient treatment satisfaction scores did not change significantly after switching to Gla-300. In the BBT group, hypoglycemia was less frequent with Gla-300.
Conclusions: HbA1c, body weight, and treatment satisfaction were similar with Gla-100 and Gla-300. In people treated with BBT, Gla-300 may be associated with less frequent hypoglycemic episodes.journal articl
Pediatric Atopic Dermatitis
Get PDF小児アトピー性皮膚炎の治療は今パラダイムシフトを迎えている．「皮膚の炎症」だけではなく「かゆみ」も重要な症状であり，それらが及ぼす患児およびその家族への疾病負荷は多岐にわたる．難治性のアトピー性皮膚炎患者にとっては，分子標的薬の全身治療は疾病負荷を軽減し，人生を変えることさえ期待できるものといっても過言ではない．2024年9月現在小児アトピー性皮膚炎に対して生物学的製剤としてネモリズマブ，デュピルマブ，レブリキズマブ，JAK阻害薬としてウパダシチニブ，アブロシチニブ，バリシチニブが保険適応を有している．これらの登場により，小児アトピー性皮膚炎を診療する医師にもより高度な専門性が求められるようになってきた．本稿では，小児アトピー性皮膚炎がもたらす患児とその家族への影響，そして全身治療に関する現在の知見を概説する．journal articl