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手関節伸展荷重時の遠位橈尺関節の3次元動態解析
Get PDFPURPOSE: To assess the wrist joints of healthy volunteers in extended and loaded states versus the unloaded state by using computed tomography (CT) to analyze the in vivo 3-dimensional movements in the distal radioulnar joint (DRUJ). METHODS: The dominant arms of 9 volunteers with healthy wrists were studied. We mounted a compression device onto the elbows in an inverted position. A 0-kg and 7-kg load each was applied during low-dose radiation CT imaging and a bone model was produced. We marked the insertion sites for the 4 radioulnar ligaments stabilizing the DRUJ: palmar superficial radioulnar ligament (PS-RUL), dorsal superficial radioulnar ligament (DS-RUL), dorsal deep radioulnar ligament (DD-RUL), and palmar deep radioulnar ligament (PD-RUL). Using Marai's method, each ligament was virtualized and the length of each simulated ligament was measured. We also computed the 3-dimensional displacement and corresponding rotation of the distal ulna where it comes into contact with the radius in the sigmoid notch. RESULTS: The lengths of palmar ligaments (PS-RUL and PD-RUL) increased significantly under loaded conditions, and although not significant, the length of dorsal ligaments (DS-RUL and DD-RUL) tended to increase. When the wrist was loaded, the ulna rotated toward the open palmar side. CONCLUSIONS: The length of simulated radioulnar ligaments increased when the wrist joint was loaded in an extended position. This kinematic movement of DRUJ separation under a loading condition is different from physiological active movement. CLINICAL RELEVANCE: The 3-dimensional kinematic analysis revealed that palmar radioulnar ligaments were stretched during axial loading, suggesting that a tear of the palmer ligament can result from a fall on an outstretched hand.博士（医学）・甲第704号・平成31年3月15日© 2019 by the American Society for Surgery of the Hand. All rights reserved
当院で経験した膵上皮内癌の細胞学的検討
Get PDF膵上皮内癌の細胞学的所見について検討した。対象は摘出術が施行された上皮内癌(High-gradePanIN)症例のうち術前にENPD細胞診が行われた8例、および良性病変13例を用いた。細胞像の評価基準は細胞診ガイドライン2015年版(消化器)を参照し、膵液細胞診への応用が可能な「貯留胆汁細胞診の判定基準」に準拠した。その結果、上皮内癌群では細胞集塊の判定基準3項目(不規則な重積、核の配列不整、集塊辺縁の凹凸不整)全てを満たす細胞集塊を全例で認めた。個々の細胞の判定基準3項目(核の腫大、核形不整、クロマチンの異常)を全て満たしたのは6例で、核の腫大を除く2項目は全例で認められた。良性病変群では細胞集塊および個々の細胞の判定基準それぞれ3項目を全て満たした細胞集塊は認められず、特に核の飛び出しを伴った集塊辺縁の凹凸不整は全例で認めなかったことから、両者を鑑別する上で重要な所見である可能性が示唆された
頚椎症性脊髄症症例における頚椎アライメント評価 : 坐位頚椎レントゲンと立位全脊椎レントゲンは等しく有用か?
Get PDFStudy Design: Retrospective review of medical charts and radiographic data. Objectives: We aimed to clarify the differences in cervical alignment findings between sitting cervical lateral radiographs and standing whole-spine lateral radiographs with clavicle positioning in cervical spondylotic myelopathy (CSM) patients. Methods: We retrospectively evaluated the radiographs of 50 consecutive patients who underwent cervical surgery for CSM in our hospital. Cervical sagittal alignment was evaluated based on the C0-2 angles and C2-7 Gore and Cobb angles. Head position was evaluated in terms of the center of gravity of the head to C7 (CGH-C7) angle and the McGregor angle (ie, the angle between the McGregor line and a horizontal line). The T1-slope was also evaluated. Results: The mean values of the CGH-C7 angle and T1-slope were significantly lower, while the mean value of the McGregor angle was significantly higher on whole-spine lateral radiographs with clavicle positioning than on sitting cervical lateral radiographs. The mean values of the C0-2 and C2-7 angles did not differ significantly between the 2 radiographic positioning approaches. Conclusions: Using whole-spine lateral radiographs with clavicle positioning may result in a significantly lower T1-slope and a posterior tilt of the head. In the absence of a compensatory change in cervical alignment, clavicle positioning may force patients to adopt an upward gazing position of the head. These compensatory mechanisms should be considered while evaluating cervical alignment on whole-spine lateral radiographs with clavicle positioning. Surgical planning should take into account the effect of posture on the radiographic appearance of cervical alignment.博士（医学）・甲第702号・平成31年3月15日© The Author(s) 2018. Creative Commons Non Commercial No Derivs CC BY-NC-ND: This article is distributed under the terms of the Creative Commons Attribution-Non
Commercial-NoDerivs 4.0 License (http://www.creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of
the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open
Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage)
UTILITY OF BLOOD UREA NITROGEN AND CREATININE MEASUREMENT FOR DIAGNOSIS OF FATAL HYPOTHERMIA.
Get PDFDiagnosis of fatal hypothermia using biochemical markers from blood obtained post mortem has not been fully studied. The objective of this study was to investigate biochemical markers useful for diagnosis of fatal hypothermia. We investigated 573 cases that were autopsied within 72 hours of death in our laboratory between January 2015 and February 2018. Right cardiac blood, left cardiac blood and the femoral vein were used as blood sampling sites. Levels of troponin T, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen (BUN), creatinine (Cr), creatine kinase (CK), and CK-MB in the blood, and blood and urinary myoglobin (Mb) were measured. Mb staining of kidney specimens was also performed. Although BUN and Cr levels did not differ from their respective clinical reference values, very high levels of the other markers compared with their respective reference values were observed. BUN and Cr values did not differ among the right cardiac, left cardiac, and femoral vein blood. The BUN value of right cardiac blood in patients who died due to fatal hypothermia was significantly higher than that in patients who died due to burns, heart disease, suffocation, hemorrhagic shock, drowning, and trauma; however, the Cr value for fatal hypothermia was not different from that for other causes of death. Also, the BUN/Cr ratio was significantly higher for fatal hypothermia than for other causes of death. The positive rates of Mb staining in the kidney were as follows: fatal hypothermia, 75%; drowning, 56.7%; drug addiction, 53.3%; trauma, 51.4%; burning death, 47.4%; heart disease, 34.8%; and suffocation, 23.1%. In addition, the amount of urine in the urinary bladder was higher in cases of fatal hypothermia than that in cases of other causes of death. These results suggest that a high BUN value and high BUN/Cr ratio are useful for diagnosis of fatal hypothermia; the increase in BUN value may not be due to acute renal failure caused by rhabdomyolysis but may be due to a decrease in renal blood flow caused by extrarenal factors such as dehydration or circulatory failure.博士（医学）・甲第708号・平成31年3月15
第IX(a)因子および第X因子に対する二重特異性抗体であるエミシズマブはin vitroで第XI因子欠乏血漿における凝固機能を増強する
Get PDFEssentials Emicizumab mimics factor (F)VIIIa cofactor function, augments the intrinsic tenase activity. We assessed the emicizumab-driven hemostatic function in FXI-deficient plasmas. Emicizumab improved the coagulation potentials in severe FXI-deficient plasma. Emicizumab may provide a possibility for clinical application in patients with FXI deficiency. SUMMARY: Background Patients with factor (F)XI deficiency commonly present with markedly prolonged activated partial thromboplastin times (APTT), although bleeding phenotypes are heterogeneous. Emicizumab, a bispecific monoclonal antibody to FIX/FIXa and FX/FXa, mimics FVIIIa cofactor function on phospholipid (PL) surfaces. Antibody reactions were designed, therefore, to augment mechanisms during the propagation phase of blood coagulation. Aim To assess emicizumab-driven hemostatic function in FXI-deficient plasmas. Methods and Results Standard ellagic acid (Elg)/PL-based APTTs of different FXI-deficient plasmas (n = 13; FXI activity, < 1 IU dl-1 ) were markedly shortened dose dependently by the presence of emicizumab. To further analyze the effects of emicizumab, clot waveform analysis (CWA) in FXI-deficient plasmas with emicizumab, triggered by tissue factor (TF)/Elg demonstrated improvements in both clot times, reflecting the initiation phase, and coagulation velocity, which represents the propagation phase. Emicizumab also enhanced the TF/Elg-triggered thrombin generation in FXI-deficient plasmas dose-dependently although the degree of enhancement varied in individual cases. Thrombin generation with either FVII-deficient plasma or FIX-deficient plasma treated with anti-FXI antibody showed little or no increase by the co-presence of emicizumab, suggesting that the accelerated thrombin generation in FXI-deficient plasmas by emicizumab should depend on the FIXa-involved coagulation propagation initially triggered by FVIIa/TF. The ex vivo addition of emicizumab to whole blood from three patients with severe FXI deficiency demonstrated modest, dose-dependent improvements in Ca2+ -triggered thromboelastograms (NATEM mode). Conclusion Emicizumab appeared to improve coagulation function in severe FXI-deficient plasma, and might provide possibilities for clinical application in patients with FXI deficiency.博士（医学）・乙第1427号・平成31年3月15日© 2018 International Society on Thrombosis and HaemostasisThis is the pre-peer reviewed version of the following article: [https://onlinelibrary.wiley.com/doi/full/10.1111/jth.14334], which has been published in final form at [http://dx.doi.org/10.1111/jth.14334]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions
