Dokkyo Medical University Repository / 獨協医科大学リポジトリ
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Additive effectiveness of acrylonitrile-co-methallyl sulfonate surface-treated membranes in treatment of pneumonia: A propensity score-matched retrospective cohort study
Get PDF獨協医科大学博士（医学）令和4年度doctoral thesi
Current Management of Chronic Kidney Disease in the Elderly Patients
Get PDFThe number of elderly people aged 65 and over is increasing all over the world. In parallel, the number of elderly patients with chronic kidney disease (CKD) is also increasing, especially in the advanced stages. Clinical trials that evaluate treatment for CKD usually exclude patients over the age of 80. Therefore, it is difficult to apply the current treatments recommended for younger CKD patients to the elderly. It is really necessary to include the elderly in CKD clinical trials in the future so that we can generate evidence-based therapies for this group. In addition, new therapies for treating and slowing the progression of CKD are needed for all age groups. CKD is a very common clinical problem in older patients and is associated with increased morbidity and mortality. As life expectancy continues to improve around the world, there is a rising prevalence of comorbidities and risk factors such as hypertension, diabetes, and dyslipidemia predisposing to a high burden of CKD in the elderly. Thus, this review seeks to explore the epidemiology of CKD and discuss the current management of CKD in the elderly. We have outlined the key points of CKD treatment, but unfortunately, there are few studies on outcomes specific to elderly CKD patients.journal articl
Utility of Self-expandable Metallic Stents for Gastrointestinal Obstruction Due to Malignant Tumor
Get PDFSelf-expandable metallic stents (SEMS) are used to alleviate symptoms of gastrointestinal tract obstruction. In this study, patients who underwent SEMS placement in our department were investigated, and the improvement of gastrointestinal passage disorders in cases of esophageal cancer, gastric cancer, and colon cancer was examined. This was a retrospective, noninvasive, observational study of patients with impaired food passage associated with gastrointestinal obstruction from a malignant tumor who underwent SEMS placement from June 2020 to December 2021. The impaired passage was evaluated before, 48 hours after, and 7 days after SEMS placement using the appropriate scoring systems based on the placement site (esophagus, gastroduodenum, or large intestine), and the patients were divided into an effective group and a non-effective group depending on the changes in the scores. The subjects were 64 patients (44 men, 20 women; mean age 73.2 ± 10.5 (47-97) years). Of the total patients, the SEMS effective group included 38 (59.4%), and the non-effective group included 26 (40.6%). No significant differences in age and sex were seen between the two groups. By the site of SEMS placement, the effective group had 11/19 patients (57.9%) in the esophagus, 11/25 patients (45.8%) in the gastroduodenum, and 16/20 patients (80.0%) in the colon. There were more patients in the effective group with the placement site in the colon (p = 0.0499). By the cause of gastrointestinal obstruction, no differences were seen with primary tumor, compression from adjacent tumor, or peritoneal dissemination. This study showed the short-term effectiveness of SEMS placement, but longer term studies are needed.journal articl
Nasal Bleeding from a Ruptured Aneurysm of the Internal Carotid Artery Treated with Endovascular Coil Embolization
Get PDFNasal bleeding can be generally controlled with only intranasal treatment. However, bleeding from large vessels, such as maxillary and internal carotid arteries, is difficult to control only by intranasal treatment, and endovascular treatment is required. Especially nasal bleeding from a ruptured internal carotid artery aneurysm is extremely rare and requires urgent treatment. The patient visited our hospital for sudden nasal bleeding, but the bleeding spontaneously stopped when the patient was first seen. When the blood clot in the natural ostium of the left sphenoid sinus was inhaled at an outpatient situation, massive pulsatile bleeding occurred and continued. The venous route was secured, extracellular fluid was rapidly administered, and tracheal intubation was performed. With computed tomography and angiography examination, the patient was diagnosed with nasal hemorrhage secondary to a ruptured aneurysm in the left internal carotid artery, and the bleeding was controlled by placing endovascular stents and coil in the left internal carotid artery. From the experience of this case, if nasal bleeding occurs around the sphenoidal sinus ostium, clinicians should consider the possibility of nasal bleeding from a ruptured aneurysm of the internal carotid artery and the appropriate treatment should be managed after detailed examinations.journal articl
