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Uterine lavage for residual menstrual blood and chronic endometritis led to successful conception: A case report
Get PDF帝王切開瘢痕症候群では、子宮内の月経血貯留を生じ、続発性不妊の原因となることが知られるが、月経血貯留が不妊に関与する機序については明らかにされていない。慢性子宮内膜炎は着床障害や反復流産に関与し、抗菌薬治療の効果が明らかになっている。我々は、月経血貯留・子宮内膜炎に対し、子宮内洗浄後に人工授精（以下IUI）を行い、妊娠成立した例を経験した。症例は36歳。26歳で子宮頸癌に対し広汎子宮頸部摘出術を施行後、28歳で第1子を得たが、その後反復流産および続発性不妊を生じていた。IUI 3回目で妊娠したが流産し、その後IUIを2回行うも妊娠に至らなかった。頸管狭窄に伴う月経血貯留を生じており、子宮鏡および内膜生検にて慢性子宮内膜炎と診断した。月経血貯留および子宮内膜炎に起因する子宮内環境悪化が着床障害の原因と考え、卵胞期に子宮内洗浄を施行したところ、IUIで2回連続して妊娠成立した。しかし、1回目は6週で流産し、2回目は16週で破水し死産となった。子宮内洗浄は貯留月経血や炎症性メディエーターを物理的に除去することで子宮内環境を改善し、妊娠率を改善する可能性がある。Cesarean scar syndrome causes menstrual blood retention in the uterus and is known to be a cause of secondary infertility, but the association between menstrual blood retention and infertility has not been clarified. Chronic endometritis is associated with implantation failure and repeated miscarriages, and antimicrobial therapy has been shown to be effective. We experienced a case of successful conception after intrauterine lavage for residual menstrual blood and chronic endometritis. The patient was a 36-year-old woman who had undergone radical trachelectomy for stage IB1 cervical cancer at 26 years old and delivered a live infant 2 years later but had subsequently suffered repeated miscarriages and secondary infertility. One pregnancy was achieved through five cycles of intrauterine insemination (IUI), but it ended in miscarriage. Given that we detected residual menstrual blood due to cervical stenosis, and hysteroscopy and an endometrial biopsy revealed chronic endometritis, implantation failure due to deterioration of the intrauterine environment was suspected. Prior to IUI, intrauterine lavage was performed in the follicular phase, which resulted in two consecutive successful conceptions: the first miscarried at 6 weeks, and the second resulted in a stillbirth due to premature rupture of the membranes at 16 weeks. Uterine lavage may improve the intrauterine environment by physically removing residual menstrual blood and inflammatory mediators, thereby improving conception rates.journal articl
Distinguishing analgesic drugs from non-analgesic drugs based on brain activation in macaques with oxaliplatin-induced neuropathic pain
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
Term newborns with relatively low tissue oxygen saturation levels soon after birth are predisposed to neonatal respiratory disorders in low-risk, elective cesarean sections
Get PDF浜松医科大学博士（医学）doctoral医学系研究科thesi
Comparison of the postoperative changes in trunk and lower extremity muscle activities between patients with adult spinal deformity and age-matched controls by using surface electromyography
Get PDFStudy Design:
A prospective study
Objective:
To investigate the paravertebral and lower extremity muscle activities using surface electromyography (S-EMG) in patients with adult spinal deformity (ASD) comparing with those of age-matched controls.
Summary of Background Data:
Although the paravertebral muscle is greatly involved in ASD pathology, little is known about the contribution of lower extremity muscle on maintaining standing posture.
Methods:
Fourteen patients with ASD (1 man, 13 women; mean age, 67.1 years) who underwent corrective fusion surgery with at least 2 years of follow-up and age-matched controls (1 men, 7 women; mean age, 69.3 years) were enrolled. The muscle activities of the thoracic and lumbar erector spinae (TES and LES), external oblique (EO), gluteus maximus (GM), rectus femoris (RF), and biceps femoris (BF) were recorded in the upright and anterior flexion positions using S-EMG pre-operatively and 1 year post-operatively.
Results:
Compared with controls, patients showed a significantly higher muscle activity in the LES and BF at rest in a standing position. After corrective fusion surgery, the muscle activity of LES decreased and that of RF increased (p<0.05), and the changes reached the level of the controls. When the posture changed from upright to anterior flexion, the controls showed increased muscle activity of the BF, whereas the patients showed decreased muscle activity of the TES and RF and increased muscle activity of the BF. Post operatively, muscle activity of the TES, LES, GM, and BF increased and that of the RF decreased.
Conclusions:
ASD patients required a higher activity of the lower extremity and trunk muscles to maintain a standing position compared to the age-matched controls. Significant increase of the GM, BF, and TES muscle activities during anterior bending suggest the presence of mechanical stress concentration caused by fixed lumbar spine.journal articl
A family case of hypokalemic periodic paralysis with a missense mutation in CACNA1S
Get PDF運動翌日や特に誘因なく脱力，嚥下困難を示し，父方の大家族歴から，低カリウム性周期性四肢麻痺と診断した12歳女子例を経験した．CACNA1Sに父由来のミスセンス変異（c.4097T>G,p.Met1366Arg）が同定された．同一家系内でも，ミオパチー型から周期性四肢麻痺のみを示す型まで臨床症状に多様性が見られた．周期性四肢麻痺では，原因遺伝子により，誘因や治療法が異なるため，遺伝子診断による治療方針の決定が重要である．journal articl
Pregnancy with fetal growth restriction and massive subchorionic hematoma following Fontan operation: A case report
Get PDFFontan手術の進歩により、Fontan術後妊娠は増加している。Fontan術後妊娠における高率な周産期合併症が報告されているが、症例数が少なく管理方針は確立していない。
32歳、1妊0産。無脾症候群、単心室症に対し9歳時に両大静脈肺動脈吻合手術（Fontan、Total cavopulmonary connection : TCPC）を行った。31歳時に妊娠を許可され自然妊娠に至る。妊娠16週以降、絨毛膜下血腫を継続して認めた。妊娠19週に262g（-1.5 SD）の胎児発育不全（FGR）と診断し、妊娠24週に586g（-2.2 SD）とFGRが進行し入院管理とした。妊娠26週に前期破水となった。抗菌薬などの集学的アプローチにも関わらず、妊娠継続が困難となり妊娠29週1日に帝王切開術を施行し、1157gの男児を出産した。
Fontan術後妊娠はFGRを始めとする様々な産科合併症が併発することが考えられ集学的な対応が必要となる。Advances in Fontan operation have improved patient outcomes and led to an increasing number of pregnancies in women with Fontan circulation. Although a high occurring rate of perinatal complications has been reported in pregnancies among women with Fontan circulation, management strategies have not been established owing to the paucity of research.
We report the case of 32-year-old primigravida who had undergone the Fontan operation with an extracardiac total cavopulmonary connection (TCPC) at the age of 9 years for asplenia (right isomerism) and single ventricle. At the age of 31, she conceived naturally. Subchorionic hematoma was observed continuously from 16 weeks of gestation. She was diagnosed with fetal growth restriction (FGR) with 262g (-1.5 SD) weight of fetus at 19 weeks of gestation. At 24 weeks of gestation, the estimated fetal weight was 586g (-2.2 SD). She was admitted to the hospital for close observation of fetus and maternal bed rest. At 26 weeks of gestation preterm premature rupture of membranes (PPROM) was occurred. Despite multidisciplinary approach, it became difficult to administration of antimicrobial agents was challenging owing to hypersensitivity reactions. A cesarean section was performed at 29+1 weeks of gestation and she gave birth to a boy weighing 1157g. She was discharged from the hospital on the 12th postoperative day without any complications.
Owing to the special circulatory dynamics in patients with Fontan circulation, placental circulation is suspected to be impaired. This leads to various obstetrical complications including FGR and subchorionic hematoma.
Multidisciplinary approach is necessary in pregnancies with Fontan circulation.journal articl
Case report of perforation between a peritoneal inclusion cyst and intestinal tract improved by conservative treatment
Get PDFPeritoneal inclusion cyst（PIC: 腹膜封入嚢胞）とは、術後の癒着や腹膜の炎症により腹膜の液体吸収機能が低下した結果、限局性に液体貯留が生じた状態を指す。手術療法を施行しても約30-50%と高確率で再発することが知られており、症状がなく悪性を疑う状態でなければ経過観察となることが多い。今回我々は、PICと腸管との間に瘻孔を形成した症例を経験したので報告する。56歳、G0P0、下腹部腫瘤感を主訴に当科を受診した。16cm大の充実性腫瘤とCA125の軽度上昇を認め、卵巣癌の術前診断で腹式単純子宮全摘、両側付属器切除、大網部分切除、骨盤・傍大動脈リンパ節郭清、虫垂切除術を施行した。最終病理診断は明細胞癌（stage IC3）であった。術後TC（PTX+CBDCA）療法を6コース施行し、化学療法終了後のCTで骨盤内に長径11cm大の嚢胞性病変を認めPICが疑われた。その後、外来経過観察中に38度台の発熱があり再診となった。炎症反応の亢進と、CTでPICと回腸との瘻孔形成を認めた。抗菌薬と絶食の保存的加療のみで軽快し、その後PICの消失を確認した。現在最終CTから半年経過し、著変なく経過観察中である。PICが存在する場合、発熱や腹痛などの症状を認めた時はPICによる腸管穿孔を鑑別の一つとして考慮する必要があると考えられた。Peritoneal inclusion cyst (PIC) refers to a condition in which fluid retention occurs locally as a result of decreased peritoneal fluid absorption function due to postoperative adhesions and peritoneal inflammation. The rate of recurrence is high at 30-50% even after surgical treatment, and it is often followed up unless there is no symptom and malignancy is suspected. We report a case of fistula formation between PIC and the intestinal tract. A 56-year-old woman, G0P0, visited our department with a complaint of a feeling of a mass in the lower abdomen. A 16-cm solid tumor and slight increase in CA125 were observed, and abdominal total hysterectomy + bilateral salpingo-oophorectomy + partial omental resection + pelvic and paraaortic lymph node dissection + appendectomy were performed under a diagnosis of ovarian cancer. The final pathological diagnosis was clear cell carcinoma (stage IC3). Six courses of postoperative TC therapy were performed and CT after the end of chemotherapy revealed a cystic lesion with a major axis of 11cm in the pelvis, suggesting PIC. During the outpatient follow-up, she developed 38-degree fever and revisited the hospital. CT demonstrated PIC and ileal fistula formation. Antibiotics and conservative treatment by fasting management led to the disappearance of PIC. Six months have passed since the last CT and the patient is being followed up without significant changes. In the presence of PIC, if symptoms, such as fever and abdominal pain, are observed, intestinal perforation by PIC should be considered.journal articl
Impact of antifibrotic therapy on lung cancer development in idiopathic pulmonary fibrosis
Get PDFPatients with idiopathic pulmonary fibrosis (IPF) are at a high risk for lung cancer (LC). Antifibrotic therapy slows disease progression and possibly prolongs survival. However, whether antifibrotic therapy affects LC-development in IPF patients remains unknown. This multi-centre retrospective study evaluated 345 IPF patients. The incidence and prevalence of LC were significantly lower in IPF patients receiving antifibrotic therapy than those not. Subsequently, LC-related mortality was significantly lower in IPF patients receiving antifibrotic therapy. These results suggest that antifibrotic therapy was possibly associated with a reduced risk of LC-development in IPF patients, which may be partly associated with its survival benefit.journal articl
血球成分除去療法
Get PDF通巻第1210号In the intestinal mucosa of inflammatory bowel disease, leukocytes are excessively activated, affecting the progress and persistence of inflammation. Cytapheresis is a treatment method that improves intestinal inflammation in patients with inflammatory bowel disease by removing these activated leukocytes from the blood. It is a safe treatment method with fewer side effects than other drug therapies involving steroids and immunosuppressants; recently, it was speculated that cytapheresis might have a previously unknown effect in improving the diminished effect of biologics such as infliximab. In the future, it is necessary to formulate more effective treatment regimens and their positioning in treatment algorithms based on evidence.journal articl