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Premenopausal torsion of an enlarged uterus with leiomyomas associated with ovarian cyst torsion: A case report
Get PDF今回、閉経前に筋腫を伴う腫大子宮の捻転を卵巣嚢腫茎捻転と共に発症した一例を経験した。症例は47歳、0妊0産。腰背部痛を主訴に当院に救急搬送された。造影CTおよび単純MRIで筋腫を伴う腫大子宮の頸部が渦巻き状を呈していた。それとは別に6cm大の造影効果不良な卵巣腫瘍も認めた。子宮捻転ないし卵巣嚢腫茎捻転を疑い、緊急試験開腹術を施行した。子宮は成人頭大に腫大し、頸部を軸に540度捻転していた。右付属器も捻転して暗赤色に変性していた。腹式単純子宮全摘術、両側付属器摘出術を施行した。病理診断は多発子宮筋腫と両側卵巣の成熟奇形腫であった。術後9日目に退院した。筋腫を伴う腫大子宮捻転は閉経後に発症することが多いが、閉経前での発症もあり得る。診断の遅れは重篤化を引き起こす可能性がある。筋腫を伴う腫大子宮を認める急性腹症では、卵巣嚢腫を認める場合でも、子宮捻転は念頭に置くべき疾患と考えられた。We report a case of torsion of the enlarged uterus with leiomyomas in a premenopausal woman associated with ovarian cyst torsion. A 47-year-old nulli-gravid woman was admitted with lower back pain in emergency. Contrast enhanced CT and plain MRI images showed a whorled structure in the cervix of an enlarged uterus with leiomyomas. There was also a poorly enhancing ovarian tumor measuring 6cm. An emergency laparotomy was performed in the preoperative diagnosis of uterine torsion or ovarian cyst torsion. The uterus was enlarged to the size of adult head, twisted 540 degrees around the axis of the cervix. The right ovary was also twisted. A total abdominal hysterectomy with bilateral salpingo-oopherectomy was performed. The hystopathological diagnosis was multiple leiomyomas and the mature cystic teratoma in both ovaries. The patient was discharged on post-operative day nine. Torsion of an enlarged uterus with leiomyomas is common in postmenopausal women but it can also occur in premenopausal women. Delay in diagnosis can cause severe consequences. Uterine torsion should be considered in the case of acute abdomen with enlarged uterus with leiomyomas, even if she is accompanied by ovarian cyst.journal articl
A retrospective study of perinatal short-term outcomes in pregnancy after fresh and frozen-thawed embryo transfer
Get PDF凍結融解胚移植は新鮮胚移植に比較して癒着胎盤や分娩時異常出血のリスクが増えることが報告されている。当院で胚移植後に妊娠した症例の周産期短期アウトカムを新鮮胚移植と凍結融解胚移植に分けて検討した。2014年3月から2018年12月に当院で胚移植後に妊娠し当院で分娩した症例 (早産、多胎を除く) を対象に、後方視的に診療録から臨床情報を抽出した。統計解析はノンパラメトリック検討を用いた。症例数は新鮮胚移植群8例、凍結融解胚移植群 (全例ホルモン補充周期) 37例であった。分娩週数ならびに分娩方法に有意差を認めなかった。一方で、癒着胎盤や妊娠高血圧症候群を合併した症例は新鮮胚移植群では認められなかったものの、凍結融解胚移植群ではそれぞれ7例、11例であった。分娩時出血量について、癒着胎盤の症例で増加したことが一因となり凍結融解胚移植群 (中央値880mL) は新鮮胚移植群 (中央値450mL) より有意に多かった。児出生体重は初産婦に限定すると凍結融解胚移植群で新鮮胚移植群よりも大きかった。凍結融解胚移植を行った症例では周産期管理として妊娠高血圧症候群ならびに癒着胎盤による分娩時異常出血に注意する必要がある。Frozen-thawed embryo transfers (ET) have been reported to increase the risk of placenta accreta and postpartum hemorrhage compared with fresh ET. We compared the short-term perinatal outcome after frozen-thawed ET with that after fresh ET in our hospital. We reviewed reproductive and obstetric clinical information from medical records of patients who became pregnant after ET between March 2014 and December 2018 and delivered at our hospital, excluding preterm and multiple pregnancy. We used nonparametric analysis for statistical analysis. The number of the cases was eight in the fresh ET group, and 37 in the frozen-thawed ET group during hormonal replacement cycles. Placenta accreta and hypertensive disorders of pregnancy were not observed in the fresh ET group, while they were seen in 7 and 11 cases in the frozen-thawed ET group, respectively. The bleeding amount during delivery was significantly larger in the frozen-thawed ET group (median 880mL) than in the fresh ET group (median 450mL), partly due to an increase in the number of patients with placenta accreta in the former group. Neonatal birth weight was higher in the frozen-thawed ET group, when excluding the multiparous cases. Postpartum hemorrhage due to placenta accreta and hypertensive disorders of pregnancy may occur in patients who become pregnant after frozen-thawed ET.journal articl
Desorption ionization using through-hole alumina membrane offers higher reproducibility than 2,5-dihydroxybenzoic acid, a widely used matrix in Fourier transform ion cyclotron resonance mass spectrometry imaging analysis
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
Maternal uniparental isodisomy of chromosome 4 and 8 in patients with retinal dystrophy; SRD5A3-congenital disorders of glycosylation and RP1-related retinitis pigmentosa
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
MIHARI project, a preceding study of MID-NET, adverse event detection database of Ministry Health of Japan －Validation study of the signal detection of adverse events of drugs using export data from EMR and medical claim data
Get PDF浜松医科大学博士（医学）doctoral医学系研究科We studied the effectiveness of the direct data collection from electronic medical records (EMR) when it is used for monitoring adverse drug events and also detection of already known adverse events. In this study, medical claim data and SS-MIX2 standardized storage data were used to identify four diseases (diabetes, dyslipidemia, hyperthyroidism, and acute renal failure) and the validity of the outcome definitions was evaluated by calculating positive predictive values (PPV). The maximum positive predictive value (PPV) for diabetes based on medical claim data was 40.7% and that based on prescription data from SS-MIX2 Standardized Storage was 44.7%. The PPV for dyslipidemia was 50% or higher under either of the conditions. The PPV for hyperthyroidism based on disease name data alone was 20?30%, but exceeded 60% when prescription data was included in the evaluation. Acute renal failure was evaluated using information from medical records in addition to the data. The PPV for acute renal failure based on the data of disease names and laboratory examination results was slightly higher at 53.7% and increased to 80?90% when patients who previously had a high serum creatinine (Cre) level were excluded. When defining a disease, it is important to include the condition specific to the disease; furthermore, it is very useful if laboratory examination results are also included. Therefore, the inclusion of laboratory examination results in the definitions, as in the present study, was considered very useful for the analysis of multi-center SS-MIX2 standardized storage data.doctoral thesi
Desorption ionization using through-hole alumina membrane offers higher reproducibility than 2,5-dihydroxybenzoic acid, a widely used matrix in Fourier transform ion cyclotron resonance mass spectrometry imaging analysis
Get PDF浜松医科大学博士（医学）doctoral医学系研究科Rationale: DIUTHAME (desorption ionization using through-hole alumina membrane), a recently developed matrix-free ionization-assisting substrate, was examined for reproducibility in terms of mass accuracy and intensity using standard lipid and mouse brain sections. The impregnation property of DIUTHAME significantly improved the reproducibility of mass accuracy and intensity compared with 2,5-dihydroxybenzoic acid (DHB).
Methods: Frozen tissue sections were mounted on indium tin oxide-coated glass slides. DIUTHAME and DHB were applied to individual sections. Subsequently, a solution of a phosphatidylcholine standard, PC(18:2/18:2), was poured onto the DIUTHAME and matrix. Finally, the samples were subjected to laser desorption ionization coupled with Fourier transform ion cyclotron resonance mass spectrometry. The reproducibility was tested by calculating the mean ± standard deviation values of mass errors and intensities of individual ion species.
Results: Analysis of the PC(18:2/18:2) standard showed significantly (p<0.01) lower mass error for DIUTHAME-MS than for MALDI-MS. Endogenous PC(36:4) analysis in mouse brain section also showed significantly (p<0.05) lower mass errors for DIUTHAME-MS. Furthermore, we investigated the mass error of some abundant lipid ions in brain sections and observed similar results. DIUTHAME-MS displayed lower signal intensity in standard PC analysis. Interestingly, it offered higher signal intensities for all the endogenous lipid ions. Lower fluctuations of both mass accuracies and signal intensities were observed in DIUTHAME-MS.
Conclusions: Our results demonstrated that DIUTHAME-MS offers higher reproducibility for mass accuracies and intensities than MALDI-MS in both standard lipid and mouse brain tissue analyses. It can potentially be used instead of conventional MALDI-MS and mass spectrometry imaging analyses to achieve highly reproducible data for mass accuracy and intensity.doctoral thesi
Development and Use of a Kinetical and Real-Time Monitoring System to Analyze the Replication of Hepatitis C Virus
Get PDF浜松医科大学博士（医学）doctoral医学系研究科In microbiological research, it is important to understand the time course of each step in a pathogen’s lifecycle and changes in the host cell environment induced by infection. This study is the first to develop a real-time monitoring system that kinetically detects luminescence reporter activity over time without sampling cells or culture supernatants for analyzing the virus replication. Subgenomic replicon experiments with hepatitis C virus (HCV) showed that transient translation and genome replication can be detected separately, with the first peak of translation observed at 3?4h and replication beginning around 20h after viral RNA introduction into cells. From the bioluminescence data set measured every 30min (48 measurements per day), the initial rates of translation and replication were calculated, and their capacity levels were expressed as the sums of the measured signals in each process, which correspond to the areas on the kinetics graphs. The comparison of various HuH-7-derived cell lines showed that the bioluminescence profile differs among cell lines, suggesting that both translation and replication capacities potentially influence differences in HCV susceptibility. The effects of RNA mutations within the 50 UTR of the replicon on viral translation and replication were further analyzed in the system developed, confirming that mutations to the miR-122 binding sites primarily reduce replication activity rather than translation. The newly developed real-time monitoring system should be applied to the studies of various viruses and contribute to the analysis of transitions and progression of each process of their life cycle.doctoral thesi
Distribution of evoked delayed potential and delayed potential in a patient with subendocardial inferior infarction and transmural postero-lateral infarction: A case report
Get PDF発行年：2022年9-10月A 47-year-old man with transmural posterolateral myocardial infarction (MI) and subendocardial inferior MI underwent catheter ablation for monomorphic ventricular tachycardia (VT). Right ventricular extra stimulation could unmask evoked delayed potentials in the subendocardial infarction area without delayed potentials in the sinus rhythm. Extra stimulation mapping for VT is useful for hidden VT substrates, particularly in the subendocardial infarction area.journal articl