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Conservative Management may be an Option: Three Cases of Perforated Duodenal Diverticulum
No full textJournal Article十二指腸憩室は無症状のまま経過する場合が多く，穿孔することは比較的稀である．当院で3例の十二指腸憩室穿孔を経験し，手術治療および保存的治療を行ったため，経過を報告する．症例は全例腹痛を主訴に来院し，腹部CT検査で十二指腸憩室穿孔と診断した．手術治療をした2症例は憩室切除および全層縫合し，Witzel法で経胃的に十二指腸減圧チューブを留置した．症例3は傍十二指腸乳頭憩室穿孔のため，手術侵襲は過大であると判断し，抗菌薬と経鼻胃管による十二指腸内減圧を併せて保存的治療を選択した．
十二指腸憩室穿孔の治療に明確な基準は無いが手術治療が基本である．一方，近年ではCT検査による画像診断が進んだ結果，早期診断と早期治療が可能となり，保存的治療が奏功する例も散見する．当院での治療経験と若干の文献的考察を加え報告する．journal articl
Child-Pugh Classification using Magnetic Resonance Imaging using Gadoxetic Acid-based Contrast Agent Compared with Indocyanine Green and 99mTc-galactosyl-human Serum Albumin Liver Scintigraphy
No full textJournal ArticleThis study evaluated liver function using gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) to improve assessment of patients with liver tumors compared to Child-Pugh classification (CPC). Materials and methods: The liver function of 59 patients was assessed to determine the indication for heavy ion therapy. Clinical and laboratory assessments, including 99mTc-GSA liver scintigraphy and indocyanine green retention index (ICGR15), were performed for liver function assessment. EOB-MRI was performed on T1W1 images both before and after Gd-EOB-DTPA administration and hepatobiliary phase images were acquired 20-min post-injection. Liver parenchymal enhancement ratio (LER) was measured based on liver-to-spleen (L/Sp) ratios calculating the average liver intensity divided by spleen intensity. Results: The mean LER values on MRI were 138.2±12.8 (133.9-142.5), 115.7±11.6 (110.0-121.5), and 93.2±15.8 (73.6-112.9) in CPC-A, -B and -C, respectively. From the correlation between the LER on MRI and ICGR15 and parameters of 99mTc-GSA liver scintigraphy, LER on MRI was highly significantly correlated with ICGR15 (r=-0.67; p<0.0001). Discussion: This study demonstrated that LER values on EOB-MRI could classify liver function and had high correlation with CPC and ICGR15.journal articl
Three Cases with Esophageal Hiatal Helnia Shownig Upside Down Stomach
No full textJournal Article症例1は76歳女性で，主訴は逆流症状と食思不振．胃癌に合併した食道裂孔ヘルニアで，ESD困難であり，幽門側胃切除，食道裂孔縫縮術を行った．症例2は78歳女性，主訴は嘔気嘔吐．胃体部の縦隔内への脱出を認め，通過障害に対し手術を行った．逆流症状を認めていなかったため噴門形成を行わず，食道裂孔縫縮術を行った．症例3は68歳女性で，主訴は継続的な嘔吐で，通過障害を認めた．逆流性食道炎の既往があり，噴門形成とメッシュを用いた食道裂孔縫縮術を行った．いずれの症例も胃の軸捻転を伴い胸腔内にほぼ全胃が陥入しており，比較的稀なupside down stomachを呈した食道裂孔ヘルニアに対しての手術を経験したので若干の文献的考察を加えて報告する．journal articl
A Possible Novel Mechanism of Action of Genistein and Daidzein for Activating Thyroid Hormone Receptor-Mediated Transcription.
Get PDF群馬大学博士（医学）Thesis or Dissertation学位記番号：医博甲1771doctoral thesi
体育授業における教師の笑顔表出と授業評価の関連性の検討 ：学習者の「楽しさの体験」の評価に着目して
No full textDepartmental Bulletin Paperdepartmental bulletin pape
