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Diagnostic contribution by the radiographer：A case of superior mesenteric artery dissection in a rural hospital
Get PDFA 59-year-old man presented with sudden onset of severe epigastric pain at the emergency room of a rural hospital. The emergency physician ordered abdominal computed tomography （CT）, and a radiographer （non-physician） notified the physician that the Hounsfield units in the lumen of the superior mesenteric artery（ SMA） were elevated. A contrast-enhanced CT study was then added and revealed SMA dissection. The patient was transferred to a tertiary hospital. On the same day, rupture of the middle colic artery occurred. Massive blood transfusion and emergent surgery were life-saving. Appropriate transfer of a seriously ill patient to the referral hospital based on a correct diagnosis is crucial in rural medicine. In Japan, CT is deployed even in rural areas, although remote image interpretation systems are not yet functioning sufficiently. The real-time interpretation of CT images by the radiographer can contribute to the diagnosis of critical disorders, especially in emergencies occurring in rural area.departmental bulletin pape
Acinar Cell Cystadenoma の一例
Get PDF症例は53歳男性，膵嚢胞を指摘され当院へ紹介。腹部造影CTで膵尾部に15cm大の造影効果のない単房性嚢胞を認めた。腹部MRIではT1強調画像で低信号，T2強調画像で高信号であり，主膵管との交通は指摘できなかった。超音波内視鏡検査でも充実性成分や血流はなかった。以上より膵漿液性嚢胞性腫瘍を考え，膵体尾部切除術を施行。病理所見にて，嚢胞壁は異型のない腺房細胞で裏装され，trypsin染色に陽性を示した。Ki-67 proliferative indexは１％未満であり，acinar cell cystadenoma（ACA）の診断に至った。本症例は他疾患にて13年前に腹部造影CTを撮像され，膵臓には病変は指摘されておらず，後天的に発生し経時的に増大したと考えられる。ACAは稀な膵臓の上皮性良性腫瘍であるため，臨床的特徴，疫学，自然史等の詳細の更なる集積が必要と考えられる。departmental bulletin pape
REPEAT PANCREATICOGASTROSTOMY AFTER GASTROPANCREATIC ANASTOMOTIC DEHISCENCE：A CASE REPORT
Get PDF症例は79歳，男性。胆管炎で入院し十二指腸乳頭部癌の診断となったが，偽膜性腸炎による腎前性腎不全・低栄養を併発し手術を延期した。バンコマイシン投与で軽快後に，亜全胃温存膵頭十二指腸切除術・膵胃吻合を施行した。術後８日目にドレーンAMY高値と混濁を認め術後膵液瘻International Study Group on Pancreatic Surgery（以下，ISGPS）GradeBと診断し，絶食とドレナージによる保存的治療を施行した。しかし，術後1か月に完全膵液外瘻となり一時退院の上，外来管理にて栄養状態の改善を図り術後９ヶ月目完全膵液外瘻に対し再膵胃吻合術を施行した。合併症なく術後経過良好で退院となった。膵頭十二指腸切除術前の偽膜性腸炎には注意が必要で，治療後に栄養状態をみながら手術時期を決定する必要がある。膵縫合不全における再膵吻合は，膵空腸吻合が選択されることが多いが，膵胃吻合は有用な方法である。本例のように，膵胃吻合縫合不全後に再膵胃吻合を施行した報告例はなく，考察を加え報告する。departmental bulletin pape
Limited administration of the tyrosine kinase inhibitor,imatinib mesylate of in a case of intra-abdominal recurrencn of gastrointestinal stromal tumors
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Syphilitic Meningitis in a Human Immunodeficiency Virus-Negative Woman
Get PDFThe“ Stop! Syphilis Project” was started in Japan in 2018.
A 29-year-old woman was admitted with fever, acute onset of posterior cervical pain, urodynia, and positive signs of meningeal irritation. Three months before admission, her heterosexual partner had been diagnosed with primary symptomatic syphilis with induration, but her initial serological screening tests for syphilis [rapid plasma reagin （RPR） test and Treponema pallidum hemagglutination （TPHA） test] were negative. She presented with a painless genital lesion at 2 months before the current hospitalization and
with skin rashes at 1 month before hospitalization； however, these were not recognized as symptomatic for syphilis. Additionally, urodynia appeared at 2 weeks before admission； the patient underwent serological rescreening for syphilis, which tested positive （RPR： 128-fold, TPHA： 640.0 titer unit）, and posterior cervical pain appeared at 10 days before hospitalization. After emergent hospitalization, she was diagnosed with syphilitic meningitis without human immunodeficiency virus infection. Antimicrobial treatment with penicillin G was continued for 2 weeks, after which the fever, posterior cervical pain, urodynia, and rash subsided, and the patient was discharged on hospital day 16. On day 187 after starting treatment, RPR was 8-fold and TPHA was 262.4 titer unit.
This case report highlights the fact that for the timely detection and appropriate treatment of syphilis,primary care physicians should recommend a repeated RPR test with incubation period taken into account,even in the absence of symptoms and even if initial screening results are negative.departmental bulletin pape