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近赤外線スペクトロスコピィを用いた成人期注意欠如・多動症の前頭前野における血液動態反応の低下
Get PDFAIM: Recent developments in near-infrared spectroscopy (NIRS) have enabled non-invasive clarification of brain functions in psychiatric disorders. In pediatric attention-deficit hyperactivity disorder (ADHD), reduced prefrontal hemodynamic responses have been observed with NIRS repeatedly. However, there are few studies of adult ADHD by multi-channel NIRS. Therefore, in this study, we used multi-channel NIRS to examine the characteristics of prefrontal hemodynamic responses during the Stroop Color-Word Task (SCWT) in adult ADHD patients and in age- and sex-matched control subjects. METHODS: Twelve treatment-naïve adults with ADHD and 12 age- and sex-matched healthy control subjects participated in the present study after giving consent. We used 24-channel NIRS to measure the oxygenated hemoglobin (oxy-Hb) changes at the frontal lobes of participants during the SCWT. We compared the oxy-Hb changes between adults with ADHD and control subjects by t-tests with Bonferroni correction. RESULTS: During the SCWT, the oxy-Hb changes observed in the ADHD group were significantly smaller than those in the control group in channels 11, 16, 18, 21, 22, 23, and 24, corresponding to the prefrontal cortex. At channels 16, 21, 23, and 24 of the ADHD group, there were negative correlations between the symptomatic severity and the oxy-Hb changes. CONCLUSION: The present study suggests that adults with ADHD have reduced prefrontal hemodynamic response as measured by NIRS.博士（医学）・乙第1422号・平成30年11月30日© 2018 The Authors. Psychiatry and Clinical Neurosciences © 2018 Japanese Society of Psychiatry and NeurologyThis is the pre-peer reviewed version of the following article: [https://onlinelibrary.wiley.com/doi/full/10.1111/pcn.12643], which has been published in final form at [https://doi.org/10.1111/pcn.12643]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions
傾向スコアマッチング解析を用いた、全身麻酔術後の気管抜管後に発生する呼吸数変化を伴わない動脈血酸素飽和度低下の影響
Get PDFBACKGROUND: It has been suggested that oxygen desaturation may be paradoxically related to the absence of an abnormal respiratory rate (RR) during acoustic respiratory rate (RRa) monitoring in a postoperative setting. We retrospectively compared the incidence of desaruration in patients without an abnormal RR with that in patients with an abnormal RR using propensity scorer matching. We also explored the factors contributing to oxygen desaturation without an RR monitoring alert. METHODS: We used ≤ 8 h postoperative data of the first 935 patients. Outcomes of patients with and without critical RR changes (RR > 30 or 2 min) (critical RR change vs. noncritical RR change) were first compared according to oxygen desaturation levels (SpO₂ 10 s). Multivariate analysis was used to determine oxygen desaturation-associated explanatory factors. RESULTS: Propensity score matching yielded 259 patients without critical RR changes and 259 patients with critical RR changes, respectively. Oxygen desaturation rates were higher in patients without critical RR changes [noncritical RR change vs. critical RR change: 39/220 (15.1%) vs. 16/243 (6.2%)]. An odds ratio and 95% CI for the noncritical RR change was 2.56 (1.38-4.55, P = 0.002). A critical change in the RRa was not observed in 576 patients; of these, oxygen desaturation was observed in 76 (13.2%) patients. Surgery duration (OR, 1.018 per 10 min increase; 95% CI, 1.002 to 1.035) was independently associated with oxygen desaturation without critical RR change. CONCLUSION: Postoperative oxygen desaturation paradoxically occurred more frequently in patients without critical RR changes, whose RR was monitored by the RRa under oxygen therapy. The duration of surgery may explain the possibility of postoperative oxygen desaturation without an RRa device alert.博士（医学）・甲第679号・平成30年3月15日Copyright © 2017 by authors and Via Medica This work is licensed under the Creative Commons Attribution International License (CC BY-NC-ND 4.0). https://creativecommons.org/licenses/by-nc-nd/4.0/The definitive version is available at " http://dx.doi.org/10.5603/AIT.a2017.0038
術前診断できなかった耳下腺粘表皮癌の1例 : 術前診断は可能か
Get PDF背景: 粘表皮癌(MEC:Mucoepidermoid carcinoma)は唾液腺に好発する悪性腫瘍であり、扁平上皮細胞、粘液細胞及び中間細胞の3種の細胞を特徴とする。低悪性度から高悪性度と幅広い異型・悪性度を示すが、低悪性度の症例では細胞診断が困難であり、しばしば多形腺腫などと誤認される。症例: 70歳代女性の左耳下腺腫瘍。細胞診にて多形腺腫と判断し、耳下腺摘出術が施行された。切除標本では低異型度のMECと診断された。結論: 低悪性度のMECにおける細胞診断はしばしば困難である。しかし、多形腺腫やワルチン腫瘍などの頻度の高い疾患に特徴的な所見を得られない場合、その存在を念頭に置き、鑑別診断に挙げることが重要であると考えられた
