膵頭十二指腸切除術後の肝内外門脈閉塞に伴う 消化管出血に対して上腸間膜静脈－下大静脈シャント手術を 施行した一例

　症例は，80歳男性．17年前に下部胆管癌に対して膵頭十二指腸切除術を施行した．後治療として胆 管断端に対する放射線治療を追加し，無再発で経過していた．2年前に肝内外門脈閉塞症を発症し， その後難治性の消化管出血が出現するようになった．上下部消化管内視鏡検査で出血源を特定できず， 造影CTで挙上空腸に静脈瘤形成を認めたため同部位からの静脈性出血と診断した．繰り返す輸血を必要としたため，根治的治療として上腸間膜静脈－下大静脈シャント手術を施行した．術後は速やか に消化管出血が改善し輸血は不要となった．合併症として高アンモニア血症を認めたが，保存治療にて改善した．難治性の肝内外門脈閉塞症に対する上腸間膜静脈－下大静脈シャント手術は有効な治療 の一つと考えられた

Ceramic restoration using a dental CAD/CAM CEREC 3D system

Ten commercial soft lining materials were selected to be representative of the types currently available including plasticised acrylic, silicone and fluorine-containing materials. These have been investigated in terms of their tensile, tear and hardness properties. With the exception of tear strength, where silicone materials had the lowest values, there appeared to be no correlation between material type and property. All but two of the materials had hardness values in the range of 30.3 to 43.7. The general conclusion was that the materials selected showed a large variability in the properties investigated. Regarding clinical aspects of some soft lining materials used for acrylic resin denture bases, it was appeared that colour change and deterioration occurred

高齢者嚥下調整食の開発に向けた自然薯のレオロジー解析

少子高齢化を迎えた我が国において、高齢者の低栄養状態や誤嚥性肺炎を回避し、生活の質の向上のために、良質な高齢者嚥下調整食の開発は必須である。最近、私達は、自然薯が、炎症性脂質メディエーターのプロスタグランジン（PG）E2 の合成を抑制し、抗炎症・抗腫瘍効果を有することを明らかにした。本研究では、自然薯のレオロジー特性を解析し、安全な高齢者嚥下調整食の物性指標と比較するために、厚生労働省の基準（Ⅰ（嚥下難易度 重度）〜Ⅲ（軽度））にそったテクスチャー測定とレオメータによる動的粘弾性の測定を行った。自然薯生すりおろしはテクスチャー項目の「硬さ」と「凝集性」には優れていたが「付着性」が基準外で、30% 自然薯粉末はいずれの指標においても基準 II に該当した。また、動的粘弾性では、生よりも10-30% 自然薯粉末の方が増粘剤として適する値を示した。以上の結果から、自然薯粉末を利用した嚥下食の開発に可能性を見出した。　In Japan, decreasing birthrate and aging of society are promoted, and therefore a development of quality dysphagia diet is necessary for an avoidance of undernutrition and aspiration pneumonitis in elderly people. Recently, we found that Dioscorea japonica suppressed prostaglandin E2 synthetic pathway and prevented inflammation and carcinogenesis in mouse squamous cell carcinoma of the skin. Dioscorea japonica with such high food functionality will be useful for a quality dysphagia diet. The aims of this study regarding Dioscorea japonica were an analysis of the rheological property and a comparison with that of safety dysphagia diet. We performed Texture Profile Analysis (TPA) on the basis of the standard specified by Ministry of Health, Labour and Welfare (level I-III for dysphagia diet), and analyzed the rheological property by a rheometer. In TPA, the grated raw Dioscorea japonica was very suitable in “hardness” and “aggregability” and was unsuitable in “adherability” for person with dysphagia. The 30% adjusted Dioscorea japonica powder had level II of the standard specified by Ministry of Health, Labour and Welfare. In the rheological analysis, 10-30% adjusted Dioscorea japonica powder had compatibility as the thickener for dysphagia better than the grated raw Dioscorea japonica. These results suggested the ability of Dioscorea japonica for the development of dysphagia diet.

信州大学医学部附属病院において分離されたStaphylococcus属の薬剤感受性

For empiric therapy against bacterial infections,it is most important to select antibiotics on the basis of statistical analyses of drug-resistance of the bacteria isolated in a hospital or a region. In this study, we examined the drug resistance of Staphylococcus species isolated at Shinshu University Hospital during the 4-year period from 2001 through 2004. Methicillin-resistant strains comprised 37.3% of the total number of Stapylococcus aureus, 73.5% of Stapylococcus epidermidis, 80.9% of Stapylococcus haemolyticus, 41.8% of Stapylococcus capitis, 45.7% of Stapylococcus hominis, 87.9% of Stapylococcus saprophyticus, 40.3% of Stapylococcus lugdunensis, 32.4% of Stapylococcus warneri, and 63.6% of Stapylococcus simulans. Methicillin resistance differed among the departments or the wards,but there was no distinct trend for resistance to increase among each Staphylococcus species. All Staphylococci were susceptible to vancomycine, and almost all were to arbekacin surfate. 65.7% of methicillin-susceptible Stapylococcus aureus and 62.4% of methicillin-susceptible Stapylococcus epidermidis were resistant to penicillin G. The methicillin-resistance rate may be important in selecting antibiotics for the treatment of patients infected with any Staphylococcus species.Article信州医学雑誌 53(4): 209-220(2005)journal articl