Dokkyo Medical University Repository / 獨協医科大学リポジトリ
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Labyrinthitis with Acute Otitis Media: Four Case Reports
Get PDFLabyrinthitis is a complication of acute otitis media, which may cause permanent hearing loss and impairment of balance. Therefore, early diagnosis and treatment are necessary. We report four cases of inner ear inflammation that spread from acute otitis media and resulted in hospitalization. All patients had otalgia and hearing loss, three had dizziness, but only one patient had obvious spontaneous nystagmus. All patients received steroid and intravenous or oral antimicrobial treatments within 10 days of onset. The average hearing levels of all patients improved, and the nystagmus resolved after treatment. Labyrinthitis following acute otitis media is rare; hearing loss and dizziness can lead to deterioration in the quality of life. Therefore, it is important to consider the risk of labyrinthitis when diagnosing acute otitis media and intervene early. In this study, we focused on the factors associated with improvements in hearing.journal articl
COVID-19-related pregnancy and neonatal cases at Nasu Red Cross Hospital
Get PDF当院で入院管理を要したCOVID-19に罹患した，または濃厚接触者と診断された妊婦と新生児の管理および転機について検討し，対応に難渋した例も提示した．調査期間は2020年4月から2023年1月末までの2年10か月間で，診療録をもとに後方視的に検討した．対象となった母子は18例で，妊婦の罹患例が9例，濃厚接触が4例，入院時に発熱を認め翌日LAMP法で陰性が判明した2例，分娩後に母の陽性が判明した3例であった．分娩形式は1例を除いて帝王切開であった．新生児は母および他の新生児と隔離し，陰圧の個室で管理した．母が陽性の場合は発症から8日目，濃厚接触者の場合は6日目に母のNEAR法での陰性を確認後に母子の面会を許可した．新生児はLAMP法またはNEAR法で全例陰性であり，母子感染はなかった．両親にカウンセリングを施行したところ，全例が隔離期間中は人工乳による栄養を選択した．児の在院日数は14.1±9.6日であった．退院後，当院の1か月健診に訪れた母子は17例で，混合ないし母乳栄養を開始していた母子は14例であった．母子の愛着形成に関し不安を残した症例はなかった．先天性異常を有する新生児の早期発見や，入院後発症への対応が困難であった．We reviewed the management and outcomes of pregnant women and newborns diagnosed or in close contact with coronavirus disease 2019 who required inpatient management at our hospital. Furthermore, we presented some difficult cases.
A retrospective review based on medical records was conducted for two years and 10 months from April 2020 to the end of January 2023. The following 18 cases of mothers and children were included in the study：nine cases of maternal morbidity, four cases of thick contact, two cases of fever on admission found negative by loop mediated isothermal amplification（LAMP）the next day, and three cases of mothers’ positivity after delivery. All but one case were delivered by cesarean section. The newborns were isolated from the mother and other newborns and managed in a private room with negative pressure. Mothers and newborns were allowed to see each other after confirmation of the mother’s negative result by the NEAR method on the eighth day after onset if the mother was positive or on the sixth day if the mother was a close contact. All neonates tested negative on LAMP or NEAR, and there was no mother-to-child transmission. Parents were counseled, and all parents opted for artificial breastfeeding during the isolation period. The children stayed in the hospital for 14.1±9.6 days. After discharge from the hospital, 17 mothers and their children visited our clinic for one-month checkups and 14 mothers and their children had started mixed feeding or breast-feeding. There were no cases of mother-child attachment. Early detection and handling of congenital anomalies among newborns after hospitalization were difficult.journal articl
Changing from a Dipeptidyl Peptidase (DPP)-4 Inhibitor to Oral Semaglutide in Patients with Poorly Controlled Type 2 Diabetes Mellitus: An Observational Study
Get PDFAims: The aim of the present study was to evaluate the effect of changing from a dipeptidyl peptidase (DPP)-4 inhibitor to oral semaglutide on glycemic control, as reflected by hemoglobin A1c (HbA1c), occasional plasma glucose (PG) and glycoalbumin (GA), and body weight (BW) in routine clinical practice.
Patients and Methods: A search of electronic medical records was performed for patients treated with a DPP4 inhibitor for diabetes mellitus and who were then changed to oral semaglutide because of relatively poor glycemic control from December 2021 to March 2022. A total of 19 patients met these inclusion criteria. Data for these patients were evaluated until the end of August 2022.
Results: HbA1c and occasional PG were significantly decreased compared to baseline (the time of changing treatment) at 4 months and at the final visit (a mean of about 6 months). GA was significantly decreased from baseline at 1 month, 4 months, and at the final visit. BW was also significantly decreased from baseline at 4 months and the final visit. There were no statistically significant changes in low-density lipoprotein cholesterol (LDL-C), triglyceride (TG) or estimated glomerular filtration rate (eGFR).
Conclusion: These results of the present study show that changing from a DPP4 inhibitor to oral semaglutide significantly improved glycemic control, as reflected by HbA1c, occasional PG and GA, and led to a significant reduction in BW after an observational period of over 4 months.journal articl
An Exploratory Study on the Development of Drug-induced Renal Hyperpotassemia in General Anesthetized Rats
Get PDFManagement of hyperpotassemia is important in a perioperative period. Decreased renal-potassium excretion is a major mechanism of hyperpotassemia. However, current therapeutics for renal hyperpotassemia are not specific to the target site. Thus, we develop an animal model of renal hyperpotassemia for use in evaluation of candidate drugs. Nine-week-old male Wistar-Imamichi rats were intubated after anesthesia and attached to a ventilator. Heart rate and arterial blood pressure were continuously measured. After continuous infusion (c.i.) of normal saline for 30 min amiloride was given bolus infusion (36 μg/kg) followed by c.i. of KCl (0.3, 0.6, 0.9 mmol/kg) and amiloride (10.8 μg/kg) for 75 min. Blood pH was measured before and after co-administration of KCl and amiloride. Serum potassium concentration and urinary potassium excretion were measured every 15 min by collecting arterial blood and urine via indwelling catheters. Changes in serum potassium concentration from a value immediately before the co-administration of KCl and amiloride were expressed as Δpotassium. An increase in the Δpotassium was dose-dependent and greater in the KCl 0.6 and KCl 0.9 compared with the control (P = 0.024, 0.0003, respectively). It was also greater in the KCl 0.6 and amiloride than KCl 0.6 (P = 0.016). The blood pH was not changed among the groups. Blood pressures and heart rates tended to decrease, and urine volume tended to increase in all groups. In conclusions, we developed a renal hyperpotassemia model in the general anesthetized rats with a stable pH which could minimize potassium fluctuations. This model can be applied for evaluation of the candidate drugs for renal hyperpotassemia.journal articl
Effect of Remifentanil on Cardiac Autonomic Activity Changes during Electroconvulsive Therapy: A Randomized Controlled Trial
Get PDFElectroconvulsive therapy (ECT) leads to remarkable hemodynamic changes. Heart rate variability (HRV), which comprises high frequency (HF) or low frequency (LF), is an index of cardiac autonomic regulation. In the present study, we examined the effects of remifentanil on HRV changes during ECT. After obtaining approval from the ethics committee of Dokkyo Medical University Hospital, we randomly allocated 42 patients who were scheduled to undergo ECT with American Society of Anesthesiologists physical status I or II to group R (n = 21), which received remifentanil (1 μg/kg) as pretreatment, or group C (n = 21), which did not receive pretreatment. After the induction of general anesthesia, we recorded the LF/HF ratio and HF ratio every minute during ECT. Statistical analysis was performed using two-way analysis of variance. Immediately (T0) and 1 min (T1) after convulsion, heart rate, systolic and diastolic blood pressures were significantly lower in group R than in group C. The LF/HF ratio in group R was significantly lower than that in group C (group C: T0; 28.6 ± 24.3, T1; 20.1 ± 18.6, group R: T0; 16.1 ± 9.7, T1; 11.2 ± 9.9, p < 0.05). No significant difference was noted in the HF ratio between both groups. Pretreatment with remifentanil suppresses hemodynamic and cardiac autonomic activity changes during electroconvulsive therapy.journal articl
Endoscopic Ultrasound-guided Fine Needle Aspiration is Useful to Diagnose Pancreatic Metastases from Renal Cell Carcinoma
Get PDFA patient for whom the diagnosis of a pancreatic metastasis from renal cell carcinoma was made with endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is presented. The patient was a 77-year-old man. Three years after resection of renal cell carcinoma (T3bN0M1 Stage 4), a lung metastasis was found on computed tomography (CT) scan, and chemotherapy scheduled. Tests were positive for HBc antibodies on preoperative screening, and abdominal ultrasound showed a well-defined, hypoechoic mass in the head of the pancreas. EUS-FNA was performed for definitive diagnosis. The pathological results were consistent with metastasis to the pancreas from the previous renal cell carcinoma. In diagnosing a pancreatic metastasis from renal cell carcinoma, contrast-enhanced CT scan and angiography are useful to differentiate the lesion from pancreatic cancer, but contrast studies cannot always be performed because of renal dysfunction, contrast agent allergies, or other reasons. Even when contrast studies are performed, it is difficult to differentiate pancreatic metastases from renal cell carcinoma and pancreatic neuroendocrine tumors, and histological diagnosis is generally considered necessary.journal articl
