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Effects of Enhanced Recovery After Surgery protocol for right colectomy
Get PDF右側結腸手術の周術期管理に，Enhanced Recovery After Surgeryプロトコル（ERAS）を導入したので短期成績を報告する。2014年６月から2017年10月に行われた右側結腸手術症例をERAS群，2010年１月から2014年５月の症例を従来群とし，後方視的に検討した。ERAS群では，機械的前処置の省略，術直後の胃管抜去，早期経口摂取開始を新たに採用した。ERAS群182例（腹腔鏡103例，開腹79例），従来群202例（腹腔鏡84例，開腹118例）であった。腹腔鏡手術では，ERAS群と従来群で手術関連因子，術後合併症に差は認めなかった。開腹手術では，表層性の創部感染の発生率はERAS群で有意に高かった（ERAS群12.7％：従来群2.5％）が，Clavien-Dindo分類２以上の術後合併症はERAS群で有意に低かった（ERAS群3.8％：従来群18.6％）。右側結腸手術において当科のERASプロトコルは安全に導入可能である。departmental bulletin pape
比較的早い経過で多発肺転移を示し経過中にTIA様症状を来した副甲状腺癌の一例
Get PDF44歳男性。大腿骨頸部骨折を機に前医にて高Ca 血症（13.7 mg/dl ），intact-PTH高値（1910 pg/ml），および甲状腺右葉後下方に4cm大の腫瘤性病変を指摘され，当科に紹介された。99mTc-MIBIシンチグラムで前頸部腫瘤性病変と前縦隔リンパ節と異常集積を認め，副甲状腺癌を疑い初回手術を施行した。摘出標本の組織診断は副甲状腺癌であった。術後約３カ月に縦隔内残存病変又はリンパ節転移が疑われ，縦隔腫瘍摘除・肺部分切除術を施行したが，その６カ月後に両側肺に多発肺転移を疑う多数の小結節が出現した。再手術は困難と判断し，Ca値コントロール目的でシナカルセトおよびデノスマブの投与を行った。初回術後９カ月に一過性の左半身脱力を認め，頭部MRI検査にて多発微小梗塞が確認され，Trousseau症候群に起因するTIAを疑った。その後高Ca血症が増悪し，初回手術後15カ月に急性膵炎を併発し死亡に至った。副甲状腺癌は比較的稀な疾患であり，Trousseau症候群に起因するTIA併発の報告もないため貴重な症例と考えた。departmental bulletin pape
Life satisfaction for rural practice in both own and partner’s home prefectures
Get PDFIntroduction: Physicians reported poor life satisfaction (LS). Satisfaction with work–life balance also affects a physician’s career. Medical students of Jichi Medical University (JMU) are bound by a contract to practice under rural settings for several years after graduation. Among these students, there are couples who are both graduates. Thus, support for those in charge of rural practice is expected. This study aimed to explore factors related to LS in one’s own or partner’s home prefectures.
Methods: A cross-sectional observation study was carried out, in which designated questionnaires were sent to 210 medical graduates (105 couples) from JMU between 2006 and 2010 who were engaged in rural practice. The main outcome was LS measured using the visual analog scale. LS of own or partner’s home prefecture was compared in terms of concerns, and supporters.
Results: The response rate was 67%. The median of LS of own and partner’s home prefecture was 70 and 74, respectively. The major concern was “difficulty in receiving support from parents” (40%). The major supporter was “partner” (85%). “trouble with human relations” was related to lower LS in either home prefecture. Concerns, such as “inconvenience”, “community acceptance”, and “relationship with Kenjinkai”, were also related to lower LS in partner’s home prefecture but not in one’s own home prefecture. “Boss” acting as a good supporter was related to high LS in one’s own home prefecture.
Conclusions: Good human relations are associated with LS in both own and partner’s home prefectures. In partners’ home prefectures, more factors are related to LS of physicians assigned to rural community. It may also be effective to involve the support of bosses.departmental bulletin pape
Cavernous hemangioma in the mediastinum： A case report focusing on multimodal image findings.
Get PDFA 50-year-old female was admitted to Jichi Medical University Saitama Medical Center with a mediastinal tumor suspected on thoracic computed tomography (CT). The CT showed a well-demarcated, nodular lesion in the left anterior mediastinum, which was adjacent to the aortic arch. A contrast-enhanced dynamic CT study revealed spotty enhancement in the peripheral part of the tumor in the arterial phase; subsequently, the contrast effect progressively spread throughout the tumor in the delayed phase.
On magnetic resonance imaging (MRI), the tumor had a homogeneously hyperintense signal on T2-weighted image. Diffusion-weighted image demonstrated high intensity in the tumor with a high apparent diffusion coefficient. A neurogenic tumor was suspected, and surgery was performed without a definitive preoperative diagnosis. The tumor was removed and was histologically diagnosed as a cavernous hemangioma.
Here, we report the multimodality imaging findings of a patient with a cavernous hemangioma in the mediastinum. When a cavernous hemangioma is on the differential diagnosis of a mediastinal tumor, dynamic CT or MRI studies should be considered to facilitate making a preoperative diagnosis.departmental bulletin pape
がん性疼痛の新規治療薬としてのoxytocinの有用性に関する研究〜oxytocinがμ opioid receptorに与える影響について〜
Get PDF自治医科大学博士（医学）平成30年度doctoral thesi
The prevalence of prolonged grief disorder in late-life depression and its clinical features in Japan
Get PDFBackground: Prolonged grief disorder (PGD), a new category related to bereavement, is a prolongation of grief and is distinct from depression, although its symptoms such as depressive state and a strong desire to die resemble those of depression. Until the concept of PGD was raised, many clinicians did not recognize PGD and regarded it as a form of depression. Here we examined the prevalence of PGD among older inpatients with and without PGD following their bereavement, and we analyzed the patients' clinical features.
Methods: We examined all depressive patients >50 years old who were admitted to the psychiatric ward of Jichi Medical University Hospital between January 2009 and December 2014. The concomitant depression with PGD was assessed based on the proposed diagnosis of persistent complex grief disorder in DSM-5 and the Brief Grief Questionnaire.
Results: Twenty-eight individuals (75.7%) consented to participate. The prevalence of PGD with depression was 57.1%. All individuals had lost a close relative. Suicide death, sudden death and death from chronic disease among the deceased relatives were more frequent in the PGD group than the non-PGD group. The rate of females, somatic symptoms in a limited body area, the use of tricyclic antidepressants or tetracyclic antidepressants, and lower number of educational years were more prevalent in the PGD group compared to the non-PGD group. The mean Global Assessment of Functioning (GAF-F) score at discharge was significantly lower in the PGD group.
Conclusions: PGD was prevalent in the patients with late-life depression following the death of a close relative. The development of PGD appears to be affected by both the death of a close relative and the cause of that relative's death. Clinicians should be aware of the possibility of concomitant PGD with depression, especially among older patients who respond poorly to antidepressant treatments.departmental bulletin pape
An analysis of two open reading frames (ORF3 and ORF4) of rat hepatitis E virus genome using its infectious cDNA clones with mutations in ORF3 or ORF4
No full text自治医科大学博士（医学）平成29年度thesi
アシルCoAコレステロールアシルトランスフェラーゼ（ACAT1）欠損マウスの皮膚黄色腫と動脈硬化病変形成におけるインフラマソームの役割に関する研究
Get PDF自治医科大学博士（医学）平成29年度doctoral thesi