2024-03-29T13:19:19Zhttp://ginmu.naramed-u.ac.jp/dspace-oai/request
oai:ginmu.naramed-u.ac.jp:10564/4862017-06-11T23:20:26Zhdl_10564_1529表紙、目次、投稿規定、奥付(Vol.50 No.1)表紙目次投稿規定奥付奈良医学会2008-10-09T06:53:32Z2008-10-09T06:53:32Z1999-02-28OtherOthers3080000 bytesapplication/pdfJournal of Nara Medical Association Vol.50 No.113450069http://hdl.handle.net/10564/48613450069AA11252383Journal of Nara Medical Association501jpnpublisher
oai:ginmu.naramed-u.ac.jp:10564/4872017-09-06T05:05:40Zhdl_10564_1529ネフローゼ症候群を合併した糖尿病性腎症の臨床経過と予後CLINICAL COURSE AND PROGNOSIS OF PATIENTS WITH DIABETIC NEPHROPATHY AND NEPHROTIC SYNDROME金内, 雅夫川野, 貴弘辻本, 伸宏藤本, 隆椎木, 英夫土肥, 和紘diabetic nephropathyprognosisrenal biopsyThe aim of this study was to assess the clinical course and prognosis of
diabetic nephropathy as confirmed by renal biopsy associated with nephrotic syndrome in
patients with non-insulin-dependent diabetes mellitus (NIDDM). We conducted a retro-
spective study of 20 patients with NIDDM and nephrotic syndrome who had undergone
renal biopsy between 1982 and 1997, and who were observed for at least 6 months until
maintenance hemodialysis was started, or until death intervened. The mean duration of
follow-up was 30 (range 9-72) months. At the initial renal biopsy, nearly all the patients
exhibited advanced, diffuse glomerular lesions with various stages of nodular and vascular
lesions. Eight patients required maintenance hemodialysis between 11 and 57 months (mean
36 months) after the renal biopsy; 3 patients died before hemodialysis was initiated; 3
patients were admitted for treatment of congestive heart failure ; 2 patients were lost to
follow-up, and 4 patients were alive with stable renal function. The prognosis of NIDDM
and nephrotic syndrome is poor, as 11 (55%) of our 20 patients required maintenance
hemodialysis or died within a mean period of 3 years after the initial renal biopsy.奈良医学会2008-10-09T06:58:15Z2008-10-09T06:58:15Z1999-02-28ArticleDepartmental Bulletin Paper706672 bytesapplication/pdfJournal of Nara Medical Association Vol.50 No.1 p.1-513450069http://hdl.handle.net/10564/48713450069AA11252383Journal of Nara Medical Association50115jpnpublisher
oai:ginmu.naramed-u.ac.jp:10564/4882017-05-29T06:06:51Zhdl_10564_1529上位頸髄硬膜外電気刺激による局所脳血流と脳波変化に関する実験的検討EFFECT OF STIMULATION OF THE DORSAL ASPECT OF THE CERVICAL SPINAL CORD ON LOCAL CEREBRAL BLOOD FLOW and LECTROENCEPHALOGRAM IN THE CAT井上, 正純Cervical spinal cord stimulationlaser Doppler flowmetrylocal cerebral blood flowCurrently there is considerable interest in electrical stimulation of the
dorsal aspect of the cervical spinal cord as a potentially effective therapy for persistent
vegetative patients. Despite the clinical attempts, the mechanism of spinal cord stimulation
(SCS) remains obscure and there are scarce experimental data available regarding suitable
conditions for SCS. To investigate this issue, the authors assessed change in local cerebral
blood flow (LCBF) and electroencephalogram (EEG) in the cat following SCS.
In 31 adult cats under isoflurane anesthesia, an electrode for SCS was implanted epidural-
ly to the midline of the C2-C3 segment. Stimulation was performed at 25 Hz and 0.1 msec
for 30 min. These animals were divided into five groups by the stimulation voltage : (1) 2
V (n=7), (2) 4V (n=7), (3) 6V (n=7), (4) 4V with intravenous injection of muscarinic
cholinergic agents - atropine sulfate (n=5), and (5) sham-operated control (n=5) without
stimulation. LCBF was measured by laser Doppler flowmetry through bilateral small burr
holes at the parietal area during and 60 min after stimulation. All data from the EEG,
electrocardiogram (ECG) and CBF monitors were collected sequentially by the MacLab
system.
At 2 V, LCBF increased only during SCS, then returned to the pre-stimulated level, while
the increase continued until the end of the experiment at 4 and 6V. The increase in LCBF
was not affected by atropine sulfate. EEG showed spike and wave or polyspikes after SCS
in 2 animals of the 6V group, but not in the 2V and 4V groups, and moreover a moderate
increase of the background activity at only 4V.
The present data suggest that SCS at 4V can provide appropriate microcirculatory
enhancement with less harmful influence which continues to increase 30 min after SCS,
although the exact mechanism should be elucidated continuously. Within the limitation of
animal experiments, this study could provide the logical basis for determining the condition
of SCS.奈良医学会2008-10-10T01:29:03Z2008-10-10T01:29:03Z1999-02-28ArticleDepartmental Bulletin Paper868202 bytesapplication/pdfJournal of Nara Medical Association Vol.50 No.1 p.6-1313450069http://hdl.handle.net/10564/48813450069AA11252383Journal of Nara Medical Association501613jpnpublisher
oai:ginmu.naramed-u.ac.jp:10564/4892017-05-29T06:06:51Zhdl_10564_1529虚血性心疾患患者への抗血小板療法としてのアスピリンの投与と消化性潰瘍の発症との関連についてPEPTIC ULCER IN PATIENTS WITH ISCHEMIC HEART DISEASE ON CHRONIC ANTI-PLATELET THERAPY WITH ASPIRIN松倉, 康夫上村, 史朗川本, 篤彦坂口, 泰弘山野, 繁藤本, 眞一橋本, 俊雄土肥, 和紘aspiringastric ulcerischemic heart diseaseRecently, many patients with ischemic heart disease (IHD), including
myocardial infarction, angina pectoris, and patients with coronary stent implantation, are
receiving chronic aspirin therapy in expectation of its anti-platelet effects. It is well known
that, in patients with rheumatic disease on chronic aspirin therapy, aspirin-induced peptic
ulcer is frequent and limits its clinical usefulness. In this study, we studied 482 IHD patients
after coronary intervention to evaluate the incidence and characteristics of peptic ulcer in
patients with IHD. Of these patients, 93% were taking aspirin chronically, and the total
incidences of gastric ulcer were 1.8% in male patients and 1.2% in female patients.
Among patients with chronic aspirin therapy, elderly patients (≧65 y/o) and patients with
past history of peptic ulcer had high incidence of gastric ulcer. The prophylactic anti-ulcer
treatment did not affect the occurrence of ulcer. The incidence of gastrointestinal bleeding
did not correlate with the type of coronary intervention. Therefore, we should pay careful
attention to drug-induced gastric ulcer in elderly patients and patients with past history of
peptic ulcer during chronic asprin therapy for IHD.奈良医学会2008-10-10T01:33:19Z2008-10-10T01:33:19Z1999-02-28ArticleDepartmental Bulletin Paper537600 bytesapplication/pdfJournal of Nara Medical Association Vol.50 No.1 p.14-1813450069http://hdl.handle.net/10564/48913450069AA11252383Journal of Nara Medical Association5011418jpnpublisher
oai:ginmu.naramed-u.ac.jp:10564/4902017-05-29T06:06:51Zhdl_10564_1529地域における食事指導の血清総コレステロールに対する効果に関する介入研究AN INTERVENTION STUDY OF THE EFFECT OF CHOLESTEROL-LOWERING DIETARY COUNSELING ON LEVELS OF SERUM LIPIDS鄭, 燕dietary cholesterolserum cholesteroldietary counselingintervention studyTo determine the effect of cholesterol-lowering dietary counseling on levels
of serum lipids, a 48-week randomized intervention study was conducted between June 1996
and May 1997 in Nara. A total of 70 Japanese women aged 40-64 years, who had 181-294
mg/dl serum total cholesterol levels but did not receive cholesterol-lowering drug treat-
ment, were randomly assigned to two groups (first intervention group, 35 subjects and
second intervention group, 35 subjects) to receive a 24-week intervention in rotation. The
intervention program included three 40-minute cholesterol-lowering dietary counseling
sessions, and three 2 and a half-hour lectures related to diet and cholesterol. Changes in
dietary intakes and serum lipid levels by the intervention were examined by the paired t-
test, and factors that relate to changes in serum lipid levels were analyzed using the
stepwise multiple regression. After the interventions, significant reductions in intakes of
dietary cholesterol, energy and fat were observed in the two intervention groups. During
the same periods, serum total cholesterol levels decreased significantly by 4% for both
groups, from 238.3 mg/dl to 227.9 mg/dl in the first intervention group, and from 237.9 mg
/dl to 228.4 mg/dl in the second intervention group, and these changes were found to be
related with reductions of dietary cholesterol intakes. Serum HDL cholesterol levels
increased significantly in the two groups during the first 24-week period (June 1996-
December 1996), but no significant relationship between changes in dietary intakes and
serum HDL cholesterol change was observed. Significant reduction of serum triglyceride
level was observed only in the first intervention group after the dietary counseling, and this
change was shown to be associated with reduction of energy percentages of fat intake. The
results indicated that the 24-week cholesterol-lowering dietary intervention program was
effective for reducing serum total cholesterol, but its influence on levels of serum HDL
cholesterol and triglyceride should be further investigated.奈良医学会2008-10-10T01:36:49Z2008-10-10T01:36:49Z1999-02-28ArticleDepartmental Bulletin Paper1928200 bytesapplication/pdfJournal of Nara Medical Association Vol.50 No.1 p.19-3213450069http://hdl.handle.net/10564/49013450069AA11252383Journal of Nara Medical Association5011932jpnpublisher
oai:ginmu.naramed-u.ac.jp:10564/4912017-05-29T06:06:51Zhdl_10564_1529在宅中高年障害者の心理良好さに対する機能訓練事業の効果IMPACT OF A COMMUNITY-BASED ACTIVITIES PROGRAM ON PSYCHOLOGICAL WELL-BEING IN THE FRAIL ELDERLY松田, 亮三community-based activities programcommunity rehabilitationmorale scalenon-randomized controlled trialTo determine the impact of a community-based activities program (consist-
ing of handicraft work, light exercise, group work etc.) on psychological well-being in the
frail elderly, 82 subjects aged 40 and over with physical impairments were given the
Philadelphia Geriatric Center Morale Scale (PMS). They were given the PMS again
several months after the baseline study. Among them, 56 were participants (PA) of the
program and 26 were not (NP).
PA consisted of 27 men and 29 women and NP consisted of 13 men and 13 women. The
average number of participation throughout the study period in PA was 2.66 (SD=2.04).
Among men, the PMS in PA increased from 9.4 to 10.0 (P=0.32) and the PMS in NP
decreased from 9.8 to 8.2 (P=0.08). Among women, the PMS in PA increased from 9.6
to 9.8 (P=0.81) and the PMS in NP decreased from 10.3 to 10.1 (P=0.75). Regression
analyses indicated that men less likely to decrease the PMS had participated in the program
and had lower PMS at baseline (P=0.01) and that women less likely to decrease the PMS
had used home nursing care and had lower PMS at baseline (P=0.002).
The findings suggest community-based activities programs should be expanded to pro-
mote psychological well-being in the frail elderly.奈良医学会2008-10-10T05:25:16Z2008-10-10T05:25:16Z1999-02-28ArticleDepartmental Bulletin Paper1241839 bytesapplication/pdfJournal of Nara Medical Association Vol.50 No.1 p.33-4113450069http://hdl.handle.net/10564/49113450069AA11252383Journal of Nara Medical Association5013341jpnpublisher
oai:ginmu.naramed-u.ac.jp:10564/4922017-05-29T06:06:51Zhdl_10564_1529尿閉を伴った幼児卵巣類皮嚢胞腫茎捻転の1手術例A CASE OF TORSION OF OVARIAN DERMOID CYST WITH URINARY RETENTION IN AN INFANT大山, 孝雄中野, 博重島野, 吉祐四宮, 洋一dermoid cysttorsionurinary retentionThe patient was a girl 2 years and seven months of age. Because of
vomiting, she was examined by a pediatrician on November 25, 1993. Her condition seemed
to improve a little, however on November 29, she suffered from fever and anuresis, and was
hospitalized in a surgical department. Physical examination revealed a distended abdomen
and tenderness in the abdomen, but no tumor. An ultrasound examination was performed
on the abdomen and a CT scan was performed on the pelvis. From the results of these tests,
the patient was diagnosed with torsion of tumor in the left ovary. Peritoneotomy was
performed and the result of the surgery showed that the tumor originated from the right
overy, and was incarcerated in the pelvic cavity, exerting pressure on the base of the
bladder. The tumor was 7×6×6cm in size, and contained hair balls and 15g of serum.
Pathohistologically, fatty tissues, as well as developed crinis and bone tissues were found.
From these findings, the tumor was was diagnosed as ovarian dermoid cyst. It is extremely
rare for ovarian dermoid cyst to occur in children, and in Japan, there have been few cases
of ovarian dermoid cyst in children under 7 years of age. Nonetheless, because of their age,
one must be careful when handling these cysts.奈良医学会2008-10-10T05:28:43Z2008-10-10T05:28:43Z1999-02-28ArticleDepartmental Bulletin Paper1181729 bytesapplication/pdfJournal of Nara Medical Association Vol.50 No.1 p.42-4513450069http://hdl.handle.net/10564/49213450069AA11252383Journal of Nara Medical Association5014245jpnpublisher
oai:ginmu.naramed-u.ac.jp:10564/4932017-06-11T23:20:26Zhdl_10564_1529A CASE OF CAROLI'S DISEASE ASSOCIATED WITH CHOLANGITIS, HEPATOLITHIASIS, AND POLYCYSTIC KIDNEY DISEASE : USEFULNESS OF THE MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHYNakagawa, YoshihitoOgawa, ShujiYabuta, IkuoHayashi, MotomuYoshida, HideakiFujimoto, ShinichiDohi, KazuhiroCaroli's diseasecholangitisMRCPpolycystic kidney diseaseCaroli's disease is a rare congenital condition characterized by cystic dilatation of the intrahepatic bile ducts. A 74-year-old man with chronic renal failure complicated by polycystic kidney disease presented with jaundice and fever. Ultrasonography, non-contrast computed tomography, and magnetic resonance cholangiopancreatography (MRCP) were performed. Contrast medium was not administered because of the renal failure due to polycystic kidney disease. MRCP provided cholangiographic images of the biliary system. No hepatic fibrosis was observed on liver biopsied specimens. Based・ on the cystic dilatation of the intrahepatic bile ducts, stone formation, cholangitis, absence of
hepatic cirrhosis, and association with cystic of the kidneys, a diagnosis Caroli's disease was
made.奈良医学会2008-10-10T05:33:25Z2008-10-10T05:33:25Z1999-02-28ArticleDepartmental Bulletin Paper962447 bytesapplication/pdfJournal of Nara Medical Association Vol.50 No.1 p.46-4913450069http://hdl.handle.net/10564/49313450069AA11252383Journal of Nara Medical Association5014649engpublisher
oai:ginmu.naramed-u.ac.jp:10564/4942017-05-29T06:06:51Zhdl_10564_1529内視鏡的に急性期および治癒期を観察し得た腸管出血性大腸菌O157 : H7による出血性腸炎の1例A CASE OF HEMORRHAGIC COLITIS DUE TO ENTEROHEMORRHAGIC ESCHERICHIA COLI O157 OBSERVED ENDOSCOPICALLY AT THE ACUTE AND HEALED STAGE池中, 康英櫻井, 伸也松下, 和広佐藤, 由美子諏訪, 好信松本, 真松本, 元嗣栗山, 茂樹岸田, 秀樹東野, 正玉川, 泰浩岡本, 新悟福井, 博hemorrhagic colitisenterohemorrhagic Escherichia coli O157endoscopyA 49-year-old woman was admitted to the hospital because of abdominal
pain and bloody diarhea. Emergent colonoscopy was performed due to continuous bloody
diarrhea on the following day after admission. Although edema, erosion, ulceration and
hemorrhage were observed from the sigmoid colon through the cecum, inflammatory
changes were more remarkable in the ascending colon with narrowing of the colon due to
severe edema. Apparent inflammatory changes were not seen in the terminal ileum.
Subsequently the stool culture was positive for Escherichia coli O157, resulting in the
diagnosis of hemorrhagic colitis due to Escherichia coli O157 infection. Biopsy specimens
revealed fibrin thrombosis in many vessels, closely similar to observations in ischemic
colitis. It is therefore indicated that differential diagnosis from ischemic colitis is impor-
tant. Her symptoms and inflammatory parameters improved with antibiotics without
causing hemolytic-uremic syndromes, and no inflammatory findings were observed by
colonoscopy performed on day 28 after the onset.奈良医学会2008-10-10T05:40:19Z2008-10-10T05:40:19Z1999-02-28ArticleDepartmental Bulletin Paper4986431 bytesapplication/pdfJournal of Nara Medical Association Vol.50 No.1 p.50-5413450069http://hdl.handle.net/10564/49413450069AA11252383Journal of Nara Medical Association5015054jpnpublisher
oai:ginmu.naramed-u.ac.jp:10564/4952017-05-29T06:06:52Zhdl_10564_1529褐色細胞腫と甲状腺髄様癌を合併したMEN-type Ⅱa : Sipple症候群の1例A CASE REPORT OF MEN-TYPE ⅡA : SIPPLE SYNDROME ASSOCIATED WITH PHEOCHROMOCYTOMA AND MEDULLARY CARCINOMA OF THE THYROID GLAND増田, 安政妻谷, 憲一植村, 天受大園, 誠一郎岡島, 英五郎平尾, 佳彦中谷, 敏也岡本, 新悟山中, 敏彰家根, 旦有pheochromocytomamedullary carcinoma of the thyroid glandMEN-type Ⅱasipple syndromeHere we report the details of a 53-year-old male patient with MEN-type
Ⅱa (multiple endocrine neoplasia type Ⅱa). He underwent extirpations of thyroid gland and
bilateral adrenaal glands. Pathological diagnosis revealed medullary carcinoma of the
thyroid gland and pheochromocytoma. Pathogenesis and management for this rare condi-
tion is discussed.奈良医学会2008-10-10T05:45:05Z2008-10-10T05:45:05Z1999-02-28ArticleDepartmental Bulletin Paper2642811 bytesapplication/pdfJournal of Nara Medical Association Vol.50 No.1 p.55-6113450069http://hdl.handle.net/10564/49513450069AA11252383Journal of Nara Medical Association5015561jpnpublisher