Shiga University of Medical Science Hospital
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コウレイ パーキンソンビョウ カンジャ ト レジスタンス ウンドウ ： シンタイ キノウ オヨビ メンタル ヘルス ジショウ カンレン デンイ P300 ニ タイスル エイキョウ : ヨビ ケンキュウ
No full textConsidering the aging population in Japan, an exercise program is recommended for the local elderly people. Of particular interest is the effect of muscle resistance exercise (RE) on physical and mental functions, especially in elderly patients with Parkinson disease (PD), which is characterized by the deterioration of the aforementioned functions. In a pilot study with elderly male PD patients (n = 6; age, 76.7 ± 1.86 years) at Hoehn-Yahr stage 2 or 3, we investigated the effects of an exercise program based on a BAB study design comprising muscle RE (twice a week) on motor skills, performance in activities of daily living (ADL), recognition ability, mood, and quality of life (QOL). To elucidate neurophysiological backgrounds, we analyzed changes in P300, which is a complex event-related potential induced in association with information processing. Nonparametric tests were used for statistical analysis of all data. The exercise program was shown to have selective benefits for balance ability by improving leg strength and Geriatric Depression Scale score (all p < 0.05). No significant effects were demonstrated for other measurement items, including PD symptoms or performance in ADL (Unified Parkinson’s Disease Rating Scale), cognitive function (Mini Mental State Examination), health-related QOL (36-item short-form health survey), and P300 wave. Previous reviews and meta-analyses have presented data that provide evidence to imply exercises as being beneficial to physical functioning, concurring with our findings. However, according to recent studies, rehabilitation only with simple physiotherapy is insufficient for PD patients. PD patients reportedly require intervention to reverse their mental state and lifestyle. Although this study indicated no clear improvement in ADL, cognitive function, QOL, and P300 in the PD patients that can be attributed to the exercise program with RE, occupational therapy for PD patients is obviously important to mental and physical function
トクハツセイ ケッショウバン ゲンショウセイ シハンビョウ カンジャ ニ タイシ γ-グロブリン タイリョウ リョウホウ シコウゴ ニ バッシ オ オコナッタ 1レイ
No full textThe idiopathic thrombocytopenic purpura (ITP) does not accept the clear underlying disease that can become the cause and the internal use of the drug, and the ingurgitation of the platelet aggravates it by an appearance of the antiplatelet autoantibody and is a disease to produce thrombopenia. Therefore the bloody measures of the patients with ITP are very likely to be the intraoperative and postoperative bleeding. We extracted teeth under high-dose gamma-globulin therapy for patient with ITP.
It was 39,000/µl, and, at the time of the first medical examination, the number of the platelets of the patient did not accept more than number of the platelets 50,000/µl recommended on the occasion of tooth extraction. Therefore, for five days from the first day after hospitalization to the fifth day, we gave an intravenous drip containing four bottles of Kenketu glovenin○R-I for I.V. injection 5000mg infusions with 30 ml/h. At the time of tooth extraction, we made a hemostasis floor considering the possibility that it became hard to stop bleeding. Because the number of the platelets was 63,000/µl and became more than 50,000/µl, we extracted teeth after eight days of hospitalization.
In the case of the tooth extraction of the ITP patient, we think that it is important to consult doctors of hematology and to perform appropriate pre-treatment, to give local hemostasis treatment for possibility of the intraoperative and postoperative bleeding, to prepare for a suture and an electric scalpel, a gelatine sponge for hemostasis, a hemostasis floor appropriately
イガク カンゴガク エノ コウガクテキ シュホウ ノ オウヨウ トクベツ キコウ
No full text 本学では、20年間MRを中心とした研究に従事し、その後の7年間看護学科に在籍した。2テスラ、7テスラの動物実験用MR装置では、MR画像とMRスペクトロスコピーの研究を行い、MR信号の高速・高感度検出のために、動物サイズや目的核種に合わせて信号検出コイルを自作し、撮像プログラムやデータ処理プログラムを改良するなど、ソフト・ハード両面から取り組みを行った。オープンMR装置では、臨床各科と連携して、安全で効果的な低侵襲手術を遂行するため、新しいMR対応手術機器、ナビゲーションソフトウェアの開発を行った。また指定した標的を自動追尾するMR対応穿刺支援ロボットを製作し、肝腫瘍症例23例に対して臨床応用を行い、良好な結果を得た。看護学科では、オープンMR装置による坐位での骨盤MR画像を用いた尿失禁研究に参画した。いずれの研究においても工学的手法が大きな役割を果たした
イリョウテキ ケア オ ヒツヨウ ト スル コドモ ノ オヤ エノ タイイン シエン : リョウシン エノ インタビュー カラ ビョウトウ カンゴシ ノ ヤクワリ オ カンガエル ケンキュウ ホウコク
No full text医療的ケアが必要な子どもの親への退院支援における病棟看護師の役割について明らかにするため、両親3組にインタビュー調査を行った。その結果、以下のことが明らかになった。1.両親は重症心身障害のある子どもと生活することを選択する、2.両親は同じ境遇の家族と情報を共有する、3.両親は子どもの成長や社会資源で奮起する、4.両親は在宅療養にむけてゆきとどいた看護を実感する、5.両親は入院中から在宅ケア技術習得を心掛ける、6.両親は在宅ケアの技術支援を期待する、7.両親は在宅ケアの負担を軽減できないことに悩む。以上より、病棟看護師の役割として考えられたことは、家族の在宅療養に対する思いを共有し、家族とともに在宅療養を目指すこと、また、退院後に長く続く生活を想定した、その家族の在宅ケア方法を入院中から家族とともに見出すことである
ワガ クニ デ オコナワレテキタ ボニュウ ホイク シュウリョウジ ノ ニュウボウ ケア ノ レキシ : キンダイ ノ ブンケン カラノ イチコウサツ ケンキュウ ホウコク
No full text出産後、母親が継続してきた母乳哺育を終えようとする際に、乳汁うっ滞に伴う乳房痛、うっ滞性乳腺炎などの乳房トラブルを発症することがある。今回、母乳哺育終了時に行われてきた伝承的な乳房ケアを明らかにするため文献研究に取り組んだ。近代の文献から、母乳哺育終了の考え方は時代とともに変化してきたが、徐々に直接授乳回数を減らしていくという終了方法は現在と相通じるものがあり、多くの乳房ケアが近代から現在まで変わらず伝承的に受け継がれてきたものであることがわかった。しかし、これらの乳房ケアは経験に基づく知見が多く、ケアの科学的根拠は示されてこなかった。乳房トラブルを起こすことなく母乳哺育を終了するための支援は重要であり、伝承的に受け継がれてきた乳房ケアについて、今後助産学研究における研究課題として、科学的根拠を検証する必要性が示唆された
ブンベン マジカ ニ シンダンサレ，ブンベンジ タイリョウ シュッケツ オ キタシタ キュウセイ ゼンコツズイキュウセイ ハッケツビョウ (APL) ガッペイ ニンシン
No full textAcute promyelocytic leukemia（APL）occupies approximately about 10～15% of acute myeloblastic leukemia. After the introduction of all-trans retinoic acid（ATRA）therapy, the prognosis of APL has been dramatically improved. However, APL still remains life-threatening, because disseminated intravascular coagulation（DIC）occurs in large portions of patients with this disease. Here we report a case of the pregnant woman who was diagnosed with APL in the third trimester, and had no time to receive ATRA therapy before delivery. We managed this patient, although she suffered from massive post-partum hemorrhage due to severe hypo-fibrinogenaemia.
A pregnant woman noticed purpuras on the trunk and upper extremities after the gestational age of 30 weeks. At the gestational age of 37 weeks, she had severe nasal bleeding continuing for an hour, and the blood test revealed pancytopenia. When she was referred to our hospital, DIC was accompanied with pancytopenia. Bone marrow aspiration was performed to obtain diagnosis, and the result showed 88% abnormal promyelocytes with fine heavy granules and fagotts. The findings were compatible with APL. Immediately after the admission, spontaneous labor began and she delivered 2978 g of a male infant. After the delivery of the placenta and the suture of the vaginal laceration, massive post-partum hemorrhage continued and the vaginal wall hematoma developed. Severe hypo-fibrinogenaemia persisted despite FFP replacement. Two hours after the delivery, the amounts of bleeding reached to 3,200 g. With the use of 2 g of fibrinogen concentrate, we conducted suture under general anesthesia, and finally the bleeding decreased. Then, the patient was treated by ATRA therapy and chemo-therapy. Three months later she had gained complete remission from APL.
This case shows that fibrinogen concentrate is useful to control huge postpartum hemorrhage in APL patients with hypo-fibrinogenaemia due to DIC