2024-03-29T00:34:56Zhttp://ginmu.naramed-u.ac.jp/dspace-oai/request
oai:ginmu.naramed-u.ac.jp:10564/3752017-06-11T23:20:26Zhdl_10564_1519表紙、目次、投稿規定、奥付(Vol.48 No.4)表紙目次投稿規定奥付奈良医学会2008-07-24T00:33:04Z2008-07-24T00:33:04Z1997-08-31OtherOthers217369 bytesapplication/pdf奈良医学雑誌 Vol.48 No.40469555013450069http://hdl.handle.net/10564/37504695550AN00180974奈良医学雑誌484jpnpublisher
oai:ginmu.naramed-u.ac.jp:10564/3762017-05-29T06:07:21Zhdl_10564_1519心房性二段脈に生理的ペーシングが奏功したALアミロイドーシスの1例A CASE OF AL AMYLOIDOSIS TREATED WITH PHYSIOLOGICAL PACING TO CONTROL ATRIAL BIGEMINY中嶋, 民夫橋本, 俊雄坂口, 泰弘椎木, 英夫土肥, 和紘籠島, 忠AL amyloidosisdual chamber pacingpacemakersick sinus syndromeA case of AL amyloidosis with sick sinus syndrome (SSS) is reported. The
patient was a 68-year-old female, who had been treated with a VVI pacemaker for SSS
from the age of 64. When she was 65years old, she suffered from palpitation which
gradually subsided. Electrocardiograms during palpitation showed bigeminal cycles.
Electrophysiological tests suggested that the bigeminy was a right ventricular pacing
rhythm followed by supravetricular premature beats. They did not respond to any antiarr-
hythmic drugs. Her laboratory data revealed anemia, elevated erythrocyte sedimentation
rate, mild renal dysfunction and M-protein. Myocardial biopsy, renal biopsy and bone
marrow aspiration were performed, and she was diagnosed as having AL amyloidosis. We
employed a DDD pacemaker to control the atrial contractions, and she was relieved from
the palpitations. Some considerations of pacemaker treatment with AL amyloidosis are
described herein.奈良医学会2008-07-24T00:37:55Z2008-07-24T00:37:55Z1997-08-31ArticleDepartmental Bulletin Paper1857481 bytesapplication/pdf奈良医学雑誌 Vol.48 No.4 p.183-1890469555013450069http://hdl.handle.net/10564/37604695550AN00180974奈良医学雑誌484183189jpnpublisher
oai:ginmu.naramed-u.ac.jp:10564/3772017-06-11T23:20:26Zhdl_10564_1519USEFULNESS OF INTRAVENOUS CONTRAST ECHOCARDIOGRAPHY FOR THE DETECTION OF A RUPTURED SITE OF SINUS OF VALSALVA ANEURYSMFujimoto, ShinichiTomoda, YoshioUemura, ShiroMizuno, ReikoDohi, KazuhiroNakano, Hiroshicontrast echocardiographysinus of Valsalva aneurysmA sinus of Valsalva aneurysm rupture into the right atrium was detected by
intravenous contrast echocardiographic negative jet, although transthoracic color Doppler
flow mapping suggested that the rupture communicated with the right ventricle.奈良医学会2008-07-24T00:44:47Z2008-07-24T00:44:47Z1997-08-31ArticleDepartmental Bulletin Paper5500949 bytesapplication/pdf奈良医学雑誌 Vol.48 No.4 p.190-1930469555013450069http://hdl.handle.net/10564/37704695550AN00180974奈良医学雑誌484190193engpublisher
oai:ginmu.naramed-u.ac.jp:10564/3782017-05-29T06:06:37Zhdl_10564_1519X線学的に1年以上遡及的経過観察が可能であった大腸癌症例の検討RETROSPECTIVE INVESTIGATION OF MISSED COLORECTAL CANCER畑, 倫明藤井, 久男石川, 博文森田, 敏裕寺内, 誠司榎本, 泰三中野, 博重吉川, 周作稲次, 直樹colorectal cancerdoubling timenatural historyWe report eleven cases overlooked in the initial barium enema. Nine of
them had advanced colorectal cancers and two had early colorectal cancers at the time of
resection. Initial images of nine advanced colorectal cancers were all sessile tumors and
those of two early colorectal cancers were pedunculated or subpedunculated form. Thus,
most advanced colorectal cancers may originate from sessile tumor. We also calculate
doubling time (DT) of the tumors, radiologically. Average DT of nine advanced cancers
is 10.0 months and that of two early cancers is 48.5 months. DT of the advanced cancers
is significantly shorter than DT of the early cancers. Considering this fact, DT of the
cancers may be shorter when they grow. On the other hand, we discuss DT of the advanced
cancers focusing on the duration from the initial examination to the operation (described as
"duration" hereinafter). When the duration becomes longer, it may include the period of the
early stage of the cancer, in which DT of the tumor is considered long. Therefore, DT may
express differences depending on the duration. In our cases, three advanced tumors with
durations of less than two years show shorter DT (average 4.8 months) than the other
advanced tumors. Thus, if DT is shortening with the cancers' growth, actual DT of
advanced cancers might be shorter than calculated DT. With the above-mentioned assump-
tion, we should understand that DT of a recurrent cancer after operation might be getting
shorter than that of an original tumor before operation.奈良医学会2008-07-24T00:55:29Z2008-07-24T00:55:29Z1997-08-31ArticleDepartmental Bulletin Paper4382880 bytesapplication/pdf奈良医学雑誌 Vol.48 No.4 p.194-1990469555013450069http://hdl.handle.net/10564/37804695550AN00180974奈良医学雑誌484194199jpnpublisher
oai:ginmu.naramed-u.ac.jp:10564/3792017-05-29T06:06:52Zhdl_10564_1519強度屈折矯正におけるエキシマレーザー照射による家兎角膜屈折矯正手術効果についてTHE INFLUENCE OF EXCIMER LASER PHOTOREFRACTIVE KERATECTORY ON HIGH REFRACTIVE CORRECTION IN RABBIT EYES竹谷, 太原, 嘉昭excimer laserphotorefractive keratectomyhigh refractive correctionWe studied the influence of excimer laser photorefractive keratectomy on
high intended refractive corrections compared with moderate and low in 26 rabbits' eyes.
Intended refractive corrections were-12 diopter (D), -6D, and -3D. The changes of haze,
corneal depth, and corneal curvature were measured to 180 days. Haze disappeared in all
rabbits by 180 days. The rates of post-operative corneal curvature compared with intended
corneal curvature were not singnificant between 30 days and 90 days in all corrections.
Ablation depths and corrections were reduced over -6D correction. We consider the
incidence of low ablation depth and low correction.奈良医学会2008-07-24T00:59:24Z2008-07-24T00:59:24Z1997-08-31ArticleDepartmental Bulletin Paper720025 bytesapplication/pdf奈良医学雑誌 Vol.48 No.4 p.200-2060469555013450069http://hdl.handle.net/10564/37904695550AN00180974奈良医学雑誌484200206jpnpublisher
oai:ginmu.naramed-u.ac.jp:10564/3802017-05-29T06:06:37Zhdl_10564_1519選択的IgM欠損症の1症例A CASE OF SELECTIVE IMMUNOGLOBULIN M DEFICIENCY米田, 諭鶴薗, 卓也山根, 佳子中谷, 敏也岩澤, 秀西村, 公男吉川, 正英小嶌, 秀之福井, 博IgM deficiencyprimary immunodeficiencyWe report a case of selective IgM deficiency not associated with malig-
nancies or autoimmune disorders. A 26-yr-old male was admitted because of acute
bronchopneumonia. Cefmetazole was effective for the disease. He, however, seemed to
have an impaired immunity against infections. Six and 3 months before this admission, he
had been hospitalized with acute pleuritis. In addition, he had more histories of recurrent
infections; 3 hospitalizations for pneumonia at 16, 20 and 21years of age, twice for
pyelonephritis at 17 and 27 years of age and once for acute sinusitis at 8years of age.
Laboratory findings revealed a very low level of serum IgM, 10 mg/dl, while serum IgG and
IgA were within normal limits, 805 mg/dl and 239 mg/dl, respectively. Interestingly serum
IgD was elevated as high as 102 mg/dl. On microfluorometric analysis of peripheral blood
lymphocytes (PBLs), the number of B lymphocytes bearing pan-B markers such as CD 19,
CD 20 and CD 21 was decreased, while that of CD 4⁺ or CD 8⁺ T cells and the CD 4/CD 8
ratio was normal. As for the number of B lymphocytes bearing surface immunoglobulin
(sIg), the number of sIgM⁺ B lymphocytes was decreased. Responses of PBLs to both
phytohemoagglutinin and concanavalin A were normal, but those to pokeweed mitogen and
staphylococcus aureus Cowan strain I seemed to be suppressed. In the present report, we
also discuss the cases of primary selective IgM deficiency documented in the literature.奈良医学会2008-07-24T01:04:42Z2008-07-24T01:04:42Z1997-08-31ArticleDepartmental Bulletin Paper1979248 bytesapplication/pdf奈良医学雑誌 Vol.48 No.4 p.207-2110469555013450069http://hdl.handle.net/10564/38004695550AN00180974奈良医学雑誌484207211jpnpublisher
oai:ginmu.naramed-u.ac.jp:10564/3812017-05-29T06:06:52Zhdl_10564_1519全身性エリテマトーデスの心筋障害と疾患活動性との関連 : 負荷201 Tl心筋シンチグラムによる検討RELATION BETWEEN MYOCARDIAL DAMAGE AND DISEASE ACTIVITY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS BY EXERCISE 201TL SCINTIGRAPHY葛本, 雅之disease activity indexexercise thallium-201 scintigraphymyocardial damagesystemlc lupus erythematosusMyocardial damage in patients with systemic lupus erythematosus (SLE)
was evaluated using exercise thallium-201 myocardial scintigraphy, and the relationship
between myocardial damage and disease activity of SLE was examined. Twenty-seven
patients (26 women and 1 man, mean age 43 years), in whom extramural coronary artery
lesions were excluded by coronary angiogram or presumed to be excluded by exercise
electrocardiogram, were enrolled in this study.
The mean duration of disease and the mean duration of corticosteroid therapy in these
patients were 94 and 77months, respectively. Exercise thallium-201 scintigraphy was
perforined twice (mean interval, 30months) to evaluate the progression of myocardial
damage. Myocardial ischemia as an index of myocardial damage was evaluated by visual
analysis and ischemic score (IS). The changes in myocardial ischemia were categorized
into 3 groups: improved, unchanged or worsened. The disease activity of SLE was
determined by the SLE Disease Activity Index (SLEDAI), and the changes in this index
were classified into the same three categories, as evaluated every six months between the
two scintigraphic examinations.
Disease activity was significantly correlated with myocardial ischemia (p<0.05), and
with myocardial ischemia as diagnosed by ΔIS (difference in ischemic score between the
first and second thallium-201 scintigrams : p<0.005). But neither the duration of disease
nor the duration of corticosteroid therapy was correlated with IS at the first scintigraphy.
These results indicate that control of SLE disease activity may be critical in the treatment of myocardial damage resulting from vascular lesions, especially intramyocardial
small-artery disease, in patients with SLE.奈良医学会2008-07-24T01:10:14Z2008-07-24T01:10:14Z1997-08-31ArticleDepartmental Bulletin Paper5219335 bytesapplication/pdf奈良医学雑誌 Vol.48 No.4 p.212-2270469555013450069http://hdl.handle.net/10564/38104695550AN00180974奈良医学雑誌484212227jpnpublisher
oai:ginmu.naramed-u.ac.jp:10564/3822017-06-11T23:20:26Zhdl_10564_1519CURRENT STATUS OF ELDERLY DIABETIC PATIENTS ON MAINTENANCE HEMODIALYSIS IN NARA PREFECTUREKanauchi, MasaoKawano, TakahiroDohi, Kazuhiroactivities of daily living (ADL)diabetes mellitusthe elderlyhemodialysisThe clinical characteristics of elderly hemodialysis patients with diabetes
mellitus (DM) were compared with those with non-diabetic renal diseases (NDM). The
subjects were 432 patients over 65 years of age undergoing maintenance hemodialysis at 28
dialysis centers in Nara Prefecture. The presence or absence of 8 different co-morbid
illnesses was ascertained for each study patient. These conditions included congestive heart
failure (CHF), ischemic heart disease (IHD), cerebrovascular disease (CVD), peripheral
vascular disease (PVD), serious infections, severe visual disturbance, malnutrition and
dementia. The prevalence of complications related to CHF, IHD, CVD, PVD, and severe
visual disturbance was significantly higher in DM than in NDM. Activities of daily living
(ADL) status was also evaluated. Degree of conditions of ADL was divided into four
classes : no disability, needs assistance, wheelchair use, and bedridden. Disability of ADL
was observed in 34.9% of DM patients and 22.3% of NDM patients (p<0.01). The mean
numbers of co-morbid illnesses in the no disability and bedridden classes were significantly
higher in DM than in NDM. We conclude that cardiovascular complications and visual
disturbance are the main causes of disability in elderly diabetic patients undergoing
hemodialysis.奈良医学会2008-07-24T01:15:08Z2008-07-24T01:15:08Z1997-08-31ArticleDepartmental Bulletin Paper560880 bytesapplication/pdf奈良医学雑誌 Vol.48 No.4 p.228-2330469555013450069http://hdl.handle.net/10564/38204695550AN00180974奈良医学雑誌484228233engpublisher
oai:ginmu.naramed-u.ac.jp:10564/3832017-05-29T06:06:52Zhdl_10564_1519脳梗塞に加えて心筋梗塞を4回発症したホモシステイン血症の1例A CASE OF HOMOCYSTEINEMIA COMPLICATED BY CEREBRAL INFARCTION AND RECURRENT MYOCARDIAL INFARCTION高岡, 稔山野, 繁川本, 篤彦佐々木, 弥寿延橋本, 俊雄土肥, 和紘cerebral infarctionhomocysteinemiamyocardial infarctionreinfarctionWe report a 50-year-old man with homocysteinemia who had a cerebral
infarction and recurrent myocardial infarction. His coronary risk factors were smoking
and homocysteinemia. A cerebral infarction had occurred when he was 34 years old, and his
first myocardial infarction occurred in 1988. Coronary angiography performed at Nara
Medical University on the first admission in 1989 showed a 50% stenosis in the mid-left
anterior decending artery (LAD) and a 75% stenosis in the distal-left circumflex artery
(LCX). The latter lesion was dilated to a 25% stenosis by percutaneus transluminal
coronary angioplasty (PTCA). A second myocardial infarction occurred in 1990. The mid
-LAD showed a total occlusion and was dilated to a 25% stenosis by PTCA. A third
myocardial infarction occurred in 1995. Again, the mid-LAD had a total occlusion and was
dilated to a 25% stenosis by PTCA. There was no history of recent angina pectoris, but
the patient had a fourth myocardial infarction in 1996. A total occlusion was dilated in the
LCX (seg 15). This lesion was dilated to a 25% stenosis by PTCA.
This was a rare case of homocysteinemia complicated by cerebral infarction and recur-
rent myocardial infarction.奈良医学会2008-07-24T01:20:38Z2008-07-24T01:20:38Z1997-08-31ArticleDepartmental Bulletin Paper3547509 bytesapplication/pdf奈良医学雑誌 Vol.48 No.4 p.234-2390469555013450069http://hdl.handle.net/10564/38304695550AN00180974奈良医学雑誌484234239jpnpublisher
oai:ginmu.naramed-u.ac.jp:10564/3842017-05-29T06:06:38Zhdl_10564_1519治療抵抗性本態性高血圧の1例A CASE OF RESISTANT ESSENTIAL HYPERTENSION西谷, 喜治中谷, 晃高岡, 稔原, 知里中島, 孝夫井澤, 鉄之土肥, 和紘真矢, キヨミessential hypertensionresistant hypertensionA 42-year-old woman was admitted to our hospital for a thorough examina-
tion and treatment of her hypertension on July 23rd, 1996. She had been admitted to our
hospital in 1994 and 1995 for close examination and had been diagnosed as having essential
hypertension. Test results excluded the possibility of secondary hypertension.
On admission, her blood presure was 220/140 mmHg. She was not overweight. A
regiment that restricted the intake of sodium was initiated and strictly observed by the
patient. From close examination, the possibilities of secondary hypertension (e. g. pheo-
chromocytoma, renovascular disease, hyperaldsteronism), office hypertension, and a drug
interaction were excluded. Control over her blood presure was attempted using a multitude
of medications ; however, her blood presure remained high.
We considered that this was an interesting case of resistant essential hypertension.奈良医学会2008-07-24T01:25:36Z2008-07-24T01:25:36Z1997-08-31ArticleDepartmental Bulletin Paper4107974 bytesapplication/pdf奈良医学雑誌 Vol.48 No.4 p.240-2450469555013450069http://hdl.handle.net/10564/38404695550AN00180974奈良医学雑誌484240245jpnpublisher
oai:ginmu.naramed-u.ac.jp:10564/3852017-06-11T23:20:26Zhdl_10564_1519MESENTERIC LIPOSARCOMA : A CASE REPORTTatekawa, YukihiroYoshikawa, TakashiShibaji, TakamuneAsao, YukioNakano, Hiroshigeliposarcomasmall bowel mesenteryWe report a case of a large liposarcoma arising from the small bowel
mesentery. A 63-year-old man was referred to our outpatient clinic with the chief com-
plaint of abdominal disterision in September 1995. The sense of the abdomirial distension
had progressed gradually over the previous six years. Computed tomography scan and
magnetic resonance imaging showed the main component of the mass was fatty tissue. The
clinical diagnosis was liposarcoma of unknown origin. Laparotomy showed that the yellow
-white, encapsulated mass was found in the small bowel mesentery. The excised tumor was
7700g in weight. The histological diagnosis was well-differentiated liposarcoma. The flow
cytometric DNA ploidy was aneuploidy. The patient received no adjuvant chemotherapy
and has been followed up without local reccurrence or metastasis for one year.奈良医学会2008-07-24T01:31:42Z2008-07-24T01:31:42Z1997-08-31ArticleDepartmental Bulletin Paper3800773 bytesapplication/pdf奈良医学雑誌 Vol.48 No.4 p.246-2500469555013450069http://hdl.handle.net/10564/38504695550AN00180974奈良医学雑誌484246250engpublisher
oai:ginmu.naramed-u.ac.jp:10564/3862017-05-29T06:06:38Zhdl_10564_1519腋窩リンパ節転移を初発とした乳癌の1例A CASE OF BREAST CARCINOMA PRESENTING AS METASTATIC AXILLARY LYMPH NODES楯川, 幸弘中谷, 勝紀石井, 久史朴, 秀一成清, 道博笠松, 稔中野, 博重occult breast carcinomaA 63-year-old woman who had noticed a right axillary mass was seen at the
hospital in January, 1993. On cytology she was suspected of having a malignancy and
underwent right axillary lymph nodes dissection. Pathologically it was metastatic
adenocarcinoma. Mammoechography, Ga scan, Ba enema or meal and abdominal CT were
done to search for an origin, but the origin Was unknown. Metastasis in the supraclavicular
lymph nodes was found in July, and then cleaning of lymph nodes of the neck and irradiation
therapy were performed. Another mass was found near the operative scar on right axilla
in January 1994, and pathological examination of the resected mass showed lymph node
metastasis of invasive ductal carcinoma. Three months later, a mass in D area of the right
breaSt was palpated and Auchincloss method was carried out. Pathologically it was
medullary carcinoma. Clinicopathologically this case was thought to be occult breast
carcinoma presenting as axillary lymph node metastasis. CEF therapy, and medication
with Tamoxifen and 5' DFUR were added postoperatively. The patient died because of
local recurrence of the right breast and lung metastasis in July 1996.奈良医学会2008-07-24T01:35:59Z2008-07-24T01:35:59Z1997-08-31ArticleDepartmental Bulletin Paper830140 bytesapplication/pdf奈良医学雑誌 Vol.48 No.4 p.251-2550469555013450069http://hdl.handle.net/10564/38604695550AN00180974奈良医学雑誌484251255jpnpublisher