Dokkyo Medical University Repository / 獨協医科大学リポジトリ
Not a member yet
2844 research outputs found
Sort by
A 13-Year-Old Boy with Group A Streptococcal Infection Complicated by Acute Fasciitis and Rhabdomyolysis
Full text link症例は生来健康な13 歳男子で，発熱，右大腿部痛，暗赤褐色尿を主訴に来院した．血液検査では高クレアチンキナーゼ血症は認めなかったが，炎症反応上昇とミオグロビン尿が確認された．画像検査で筋膜炎の所見があり，壊死性軟部組織感染症の診断スコアは高値だった．急性筋膜炎と横紋筋融解兆候の併発と判断し，A群溶血性連鎖球菌感染症が発症の契機と考えられ，抗菌薬加療のみで退院した．早期の画像診断と抗菌薬加療が奏功して，保存的に治療を進めることができた．感染症に伴う四肢の発赤や疼痛が認められた場合には，早期にMRI を含む画像検査を実施し，臨床症状の推移を確認しながら適切な抗菌薬治療を進めることが重要である．We report a 13-year-old boy who was admitted to our hospital with erythema on both upper extremities, right thigh pain, muscle weakness, redness, and dark red urine. The patient was previously healthy, and GAS （group A streptococcus） infection was the trigger for the onset of the disease. An MRI was performed early, and treatment with appropriate antibiotics and fluid replacement was started. Blood examinations showed elevated white blood cell, serum CRP, and procalcitonin, and myoglobinuria was confirmed. However, elevation of serum creatine kinase was not detected. Thigh CT and MRI showed fascial thickening and high signal intensity on T2-weighted images, suggesting the possibility of necrotizing soft tissue infection. We diagnosed him as having acute fasciitis and signs of rhabdomyolysis. Antibiotics were continued, and the clinical symptoms improved on the 15th day after admission. In this case, early imaging diagnosis and antibiotic treatment were successful, and we were able to proceed with conservative treatment. If redness or pain in the lower limbs is observed during the GAS infection, it is important to perform imaging tests including MRI at an early stage and proceed with appropriate antibiotic treatment.journal articl
Association between Enteral Nutrition and Chylous Ascites and Perioperative Management after Pancreaticoduodenectomy
Full text linkWe aimed to investigate whether chylous ascites is associated with enteral nutrition and postoperative complications in pancreaticoduodenectomy and assess perioperative management and treatment methods. This retrospective observational study included 98 patients who underwent pancreaticoduodenectomy between 2020 and 2022. The associations between enteral nutritional supplements and the occurrence of chylous ascites and between postoperative infectious complications and pancreatic leakage among patients with chylous ascites were compared. Chylous ascites occurred in 3/27 (11%), 5/5 (100%), and 18/66 (27%) of patients who received ELENTALⓇ, ISOCAL SupportⓇ, and HINEXⓇ, respectively (P 3a were observed in 8/26 (30.7%) patients in Group A and 34/72 (47.2%) in Group B. Group A had a lower frequency of pancreatic leakage (P = 0.03) and a similar rate of infectious complications (P = 0.25). The time to improvement in milk and chylous ascites was similar in the groups using no food, ELENTALⓇ, and octreotide (3 days [1-10 days]) and in the groups using a fat-restricted diet and ELENTALⓇ (4.5 days [4-5 days]). Chylous ascites was not associated with any serious postoperative complications. Lipid intake is a risk factor for chylous ascites. Lipid restriction enabled treatment without special drugs and with continued oral intake and enteral nutrition.journal articl
Prelacrimal Approach to Maxillary Sinus Lesions:A Surgical Perspective
Full text linkThe prelacrimal approach has emerged as a minimally invasive, nasal function-preserving technique for accessing maxillary sinus. It enables direct visualization and resection of diseases located in the anterior and medial regions of the maxillary sinus, which areas are often difficult to reach using conventional endoscopic sinus surgery or the Caldwell-Luc procedure. Among prelacrimal approaches, endoscopic modified medial maxillectomy (EMMM) stands out for preserving key nasal structures, including the inferior turbinate, nasolacrimal duct, and pyriform aperture. This approach is particularly effective for managing inverted papilloma, offering low recurrence rates. Comparative studies and case series have demonstrated its superiority to traditional methods, with the added benefit of maintaining nasal morphology and function. Nonetheless, attention must be paid to the risk of recurrence, emphasizing the importance of meticulous surgical technique and long-term follow-up. Beyond inverted papilloma, the prelacrimal approach has been successfully applied to a range of maxillary sinus diseases. In recent years, its role has expanded further as a minimally invasive corridor to the skull base diseases, broadening its scope of clinical applications.journal articl
Histological Characterization of Epithelial Cell Populations in Respiratory Epithelial Adenomatoid Hamartoma
Full text linkBackgrounds: Clinically, respiratory epithelial adenomatoid hamartoma (REAH) is often indistinguishable from nasal polyps on endoscopic examination. However, its clinical management differs substantially, as REAH typically requires complete surgical excision. Despite increasing recognition of the lesion, its pathogenesis and underlying cellular composition remain poorly understood.
Objectives: To characterize and compare the distribution of major epithelial cell types―basal, secretory, and ciliated cells―in the surface and submucosal regions of REAH, chronic rhinosinusitis with nasal polyps (CRSwNP), and control sinonasal tissues.
Methods: Formalin-fixed, paraffin-embedded tissue specimens were collected from healthy controls (uncinate process), CRSwNP patients (nasal polyps), and REAH patients (olfactory cleft masses). Immunofluorescence staining was performed using markers for basal cells (Cytokeratin 5 (CK5)), differentiated cells (Cytokeratin8 (CK8)), secretory/goblet cells (Mucin 5AC (MUC5AC)), and ciliated cells (acetylated α-tubulin (α-tubulin)).
Results: No significant differences were observed in the architecture of the surface epithelium among the groups. However, the submucosal regions demonstrated distinct profiles: CRSwNP lacked epithelial elements; control tissues showed CK8-positive, MUC5AC-negative secretory glands without basal or ciliated cells; and REAH tissues exhibited submucosal glands containing CK5-positive basal cells, CK8- and MUC5AC-positive secretory/goblet cells, and α-tubulin -positive ciliated cells. This composition closely resembled surface respiratory epithelium.
Conclusions: REAH demonstrates a unique submucosal epithelial profile, characterized by the coexistence of basal, secretory/goblet, and ciliated cells, in contrast to control and CRSwNP tissues. These findings support the classification of REAH as a hamartomatous lesion and highlight the diagnostic value of identifying these specific epithelial cell subtypes.journal articl
LVSEM Observation of Epoxy Resin-embedded Urinary Sediment Facilitates the Diagnosis of Fabry Disease
Full text linkThe presence of mulberry bodies in urinary sediment is an indicator of Fabry disease but may be easily overlooked in routine urine testing. Therefore, I recommend the application of low-vacuum scanning electron microscopy (LVSEM) to urinary sediments embedded in epoxy resin. The advantages of this method are as follow: first, that blocks of urinary sediment embedded in epoxy resin can be stored for a long time; second, the samples can be screened for mulberry bodies using light microscopy with toluidine blue staining; third, the epoxy resin blocks can be directly observed with LVSEM, which allows for a clearer view of mulberry bodies; and fourth, ultrathin sections can be observed by transmission electron microscopy to reveal the zebra pattern. The direct observation of urinary sediment embedded in epoxy resin can facilitate the diagnosis of Fabry disease.journal articl
Advances in Obstetric Care and Future Prospects
Full text link過去20 年間にわたり，産科医療は確実に進歩してきた．出生前診断の技術向上，子宮収縮抑制剤による妊娠期間延長，新生児医療の進展，胎児の生理・病理に関する研究の発展など，臨床技術ならびに研究のレベルは着実に向上してきた．近年では，胎内治療における技術の進歩も顕著である．また，日本産科婦人科学会による『産科診療ガイドライン』の普及により，最新の知見に基づいた診療の標準化が進んでいる．さらに，産科救急は一般救急に統合され，妊産婦死亡症例検討会や母体救命システム普及協議会が発足するなど，産科救急診療体制の改革も進んでいる．一方で，産科医療には依然として多くの社会的課題が存在している．産科医師の不足と地域間格差，過酷な労働環境，周産期医療システムや医療連携システムの不備，深刻な少子化，高齢妊娠や合併症妊娠の増加，特定妊婦などの社会的ハイリスク妊婦の増加，分娩施設の減少など，解決すべき問題は多岐にわたっている．これらの課題を解決するためには，産科医の確保と定着，労働環境の改善，周産期医療システムの整備，医療連携の強化など，国全体での多面的な対応が必要である．Over the past two decades, obstetric care has made
steady progress. Advances in prenatal diagnostic techniques, the use of tocolytic agents to prolong pregnancy, developments in neonatal care, and growing research into fetal physiology and pathology have all contributed to the continuous improvement of both clinical practices and research. In recent years, notable progress has also been made in the field of in utero therapy. Furthermore, the widespread adoption of the Obstetric Clinical Practice Guidelines by the Japan Society of Obstetrics and Gynecology has promoted the standardization of care based on the latest evidence. Obstetric emergency care has also undergone reform, becoming integrated with general emergency services, alongside the establishment of review committees for maternal deaths and the launch of initiatives such as the Council for the Promotion of Maternal Life-Saving Systems. On the other hand, obstetric care in Japan still faces numerous social challenges. These include a shortage and uneven distribution of obstetricians, harsh working conditions, deficiencies in perinatal and inter-facility coordination systems, a serious decline in birth rates, an increase in advanced maternal age and high-risk pregnancies with complications, a growing number of socially vulnerable expectant mothers, and the centralization of delivery facilities. Addressing these issues will require a comprehensive national response, including the recruitment and retention of obstetricians, improvement of working conditions, enhancement of perinatal care systems, and the strengthening of medical coordination.journal articl
A Case of Anaplastic Carcinoma of the Pancreas that was Difficult to Differentiate from a Gastric Submucosal Tumor
Full text link患者は84 歳の男性．上腹部不快感を契機に腹部腫瘍を指摘された．上部消化管内視鏡と腹部超音波検査，造影CT が施行され胃粘膜下病変が疑われたが，膵原発の腫瘍が否定できなかった．超音波内視鏡下穿刺吸引法（EUS-FNA）を予定したが貧血の進行を認めたため，準緊急で手術が施行された．病理学的に膵退形成癌と診断された．胃粘膜下病変と膵退形成癌の鑑別が困難であることを改めて実感した貴重な症例と思われた．An 84-year-old man with upper abdominal discomfort
was found to have an abdominal tumor. Upper gastrointestinal endoscopy, abdominal ultrasonography, and contrast-enhanced computed tomography were performed, and a gastric submucosal tumor was suspected；however, the possibility of a primary pancreatic tumor could not be ruled out. Although endoscopic ultrasound-guided fine-needle aspiration was scheduled, progressive anemia led to semi-urgent surgery. The pathological diagnosis was anaplastic carcinoma of the pancreas. This is a valuable case that re-affirms the difficulties in differentiating between a gastric submucosal tumor and anaplastic carcinoma of the pancreas.journal articl
Early Rapid Weight Gain During Childhood and Cardiometabolic Risk
Full text linkDynamic changes in body weight have long been recognized as important indicators of risk for human health. Many observational studies have shown that rapid weight gain during infancy, including catch-up growth following low birth weight delivery or adiposity rebound in early childhood, predisposes a person to development of obesity, type 2 diabetes, and cardiovascular diseases (CVD) in later life. However, the mechanisms through which cardiometabolic risk factors develop are not fully understood. Furthermore, a consensus has not been established regarding which period of weight gain contributes to development of future CVD. Therefore, in this review, we evaluate recent evidence on the relationship between early rapid growth and future obesity and cardiometabolic risk as causes of CVD, with a focus on the differential significance of rapid weight gain in infancy and early childhood. Childhood growth during early infancy before 1 year of age may be related to future obesity, but emerging evidence also suggests that toddlers showing an increase in body mass index (BMI) before 3 years of age, a period normally characterized by decreased BMI, are prone to developing cardiometabolic risk. The recognition of this growth pattern may help to identify children who will have cardiometabolic risk and permit tailored interventions to prevent development of future CVD. This review considers the evidence for developmental origins of obesity and related cardiometabolic risk, and the mechanisms involved, with a focus on the relationship between rapid weight gain in early childhood and future cardiometabolic risk. In addition, based on the knowledge accumulated to date, we present proposals for effective preventive measures for future CVD starting from childhood.journal articl
Association of Number of Teeth with Cognitive and Physical Functions in Japanese Older Adults: A Cross-sectional Study
Full text linkThe relationship of the number of teeth with cognitive, physical, and oral functions in older adults has been widely investigated, but there are few studies with a cutoff of more than 20 and less than 20 teeth. This cross-sectional study examined the association of ≥ 20 teeth with physical and cognitive assessment scores, oral function, and subjective health status among older adults. Participants were 754 community-dwelling Japanese aged ≥ 65 years. Mean age was 78.5 ± 5.6 years and 21.6% were men. The following assessments were performed: handgrip strength, balance test, 5-m walk test, timed up and go test, Yamaguchi Kanji- Symbol Substitution Test (YKSST), repetitive saliva swallowing test (RSST), stretch cheek test, oral diado-chokinesis test, chewing strength test, number of remaining teeth, and subjective health status. There were 328 participants aged ≥ 80 years (43.5%), and 52.4% of them (n = 172) retained ≥ 20 teeth. Participants with ≥ 20 teeth had significantly better scores on the balance test, stretch cheek test, and YKSST, better masticatory strength, and a lower RSST score compared with those with < 20 teeth, after controlling for age and sex. Stepwise logistic regression analysis showed that having ≥ 20 remaining teeth was associated with younger age (OR = 0.967, P = 0.036), better balance test (OR = 1.010, P = 0.009), YKSST score (OR = 1.031, P < 0.001), and masticatory strength (OR = 1.252, P = 0.004). These findings suggest that older adults with ≥ 20 teeth have better cognitive, physical, and oral functions than those with fewer teeth.journal articl