Jichi Medical University Institutional Repository
Not a member yet
1006 research outputs found
Sort by
Low-dose bevacizumab did not reduce epistaxis in patient with hereditary hemorrhagic telangiectasia : a case report
Get PDFA 74-year-old man with refractory epistaxis and melena was diagnosed with hereditary hemorrhagic telangiectasia （HHT）. Frequent epistaxis required gauze packing, electrocautery, and blood transfusion. Ileocecal resection did not reduce melena. To control both epistaxis and melena, off-label administration of bevacizumab was planned and approved by the ethical committee at Fukushima Medical University. However, after three courses of low-dose bevacizumab （2 mg/kg, every 3 weeks）, the frequency of epistaxis and melena were not reduced. Thus, bevacizumab administration was discontinued.departmental bulletin pape
Rheumatoid arthritis development after 23-valent pneumococcal polysaccharide vaccination（PPSV23）
Get PDF症例は72歳男性。当院リウマチ外来受診１か月前に前医で肺炎球菌ワクチン（23価肺炎球菌多糖体ワクチン：PPSV23）の接種を左上腕外側に受け，翌日に接種部位の腫脹と両股関節痛を生じた。翌々日，近医整形外科を受診し，C反応性蛋白（CRP）値9.0 mg/dLの炎症所見を指摘されたが，リウマチ因子（RF）陰性であった。接種５日後に両肩関節と両膝痛を自覚し，次第に寝返りやベッドからの起き上がりが困難となった。接種２週後に左手関節の痛みと腫れを生じ，当院内科を紹介受診した。ワクチンの副反応が疑われロキソプロフェンを処方されたが関節痛は改善せず，当院リウマチ外来を受診した。左手及び両足に浮腫と多数の圧痛関節を認め，RFは弱陽性ながら陽転化しており，ワクチン接種を契機とし新たに関節リウマチ（RA）を発症したと考えた。プレドニゾロン（PSL）内服治療（15 mg/日）を開始し，CRP値および病勢は次第に低減した。PSLはメトトレキサート併用のもと漸減中止され，RAの臨床的寛解は維持された。departmental bulletin pape
Toward the development of a support tool for a National Health Insurance data health plan
Get PDF国民健康保険（国保）ではデータヘルス計画の下で，地域の保健事業を実施することが求められてい
る。本計画の推進に際しては，職域で既に導入されているinformation and communication technology式
のポータルサイトのような事業計画支援ツールが必要になる可能性がある。今回，国保データヘルス計
画の策定と運用に関する支援ツールの開発の方向性を考案するために，自治体へのヒアリング調査と有
識者による検討を行った。ヒアリング調査の結果から，計画の策定に関する体制と技術，計画進行時の
管理，計画の標準化が課題として整理された。これらの解決には，課題や指標の設定と評価，進捗管
理，引継ぎが定式化され，他自治体の取組を共有でき，負担なく効率的に使える支援ツールが有用にな
る。既に実施されている国民健康保険団体連合会による支援を補完したり，重点的に取り組まれている
保健事業向けのツールを作成したりすることも考慮点である。今後，支援ツールの試作に進みたい。departmental bulletin pape
Simulation using patient-specific hollow three-dimensional models for percutaneous closure of patent ductus arteriosus in adult： Complete republication
Get PDFBackground and Objective：It is challenging to accurately predict the shape and stability of occlusion devices during percutaneous closure of patent ductus arteriosus （PDA） in adults. In this study, we evaluate the utility of percutaneous closure simulation of PDA in adults using patient-specific hollow threedimensional（3D） models created from computed tomography data.
Methods：The study was conducted on four adult patients with PDA, whose age ranged from 54 to 75 years. While three were type E as per the Krichenko classification, one was type D. We created a transparent silicone hollow model using a solid model, which was printed by a personal 3D printer from contrast-enhanced multi-detector computed tomography data, as a mold. All processes were carried out at our institution. Before actually performing percutaneous closure of PDA, we simulated procedures using these models and investigated the shape and stability of AMPLATZER™ Duct Occluder/AMPLATZER™ Vascular Plug deployed in them.
Results：Briefly, the time and cost required to create a hollow 3D model were about 3 days and 10,000 Japanese Yen, respectively. It was very easy to recognize the shape and stability of deployed devices in these models because the devices were clearly visible from outside. In fact, these models could be picked up by hands and observed from various angles, which was helpful in selecting optimum devices for closure.
Conclusions：The transparent silicone hollow models are an excellent simulator of percutaneous closure of PDA, especially in adults.departmental bulletin pape