PREFRONTAL ACTIVATION DURING EMOTIONAL EXPERIENCE AS MEASURED BY NIRS

To investigate brain activation in the prefrontal cortex (PFC) during emotional experiences, we examined blood oxygenation changes of healthy female volunteers by using multi-channel Near Infrared Spectroscopy (NIRS). Results directly confirmed that the PFC was activated during emotional tasks suggesting that the levels of oxy-Hb increased significantly larger in negative periods compared with positive or neutral in the bilateral dorsolateral PFC. There is a possibility that this brain area is associated with the regulation of negative emotion. Our results suggest that it may be possible to evaluate emotional changes using NIRS sensitively

Hipotermia associada à anestesia geral e fatores de risco envolvidos: uma revisão integrativa

INTRODUÇÃO:A hipotermia intraoperatória é definida como a temperatura central menor que 36°C, em pacientes com anestesia geral. Essa situação frequentemente está associada com fatores adversos como infecção pós-operatória, eventos cardiovasculares, hemorragia perioperatória e necessidade de transfusão. OBJETIVOS: Avaliar a hipotermia pós anestesia geral e elucidar os fatores de risco associados. METODOLOGIA: Trata-se de uma revisão integrativa na base de dados PUBMED utilizando os descritores “RISK AND HYPOTHERMIA AND ANESTHESIA AND GENERAL’’ para artigos publicados entre 2019 e 2024. RESULTADOS: A hipotermia intraoperatória (HI) possui uma prevalência de 39,8%, os neonatos e lactentes são estatisticamente mais associados à HI. Fatores como a temperatura ambiente do centro cirúrgico inferior a 26°C e a administração de mais de 1 litro de líquido ao paciente durante a cirurgia são fatores preditivos à hipotermia. Por outro lado, pacientes que possuem idade mais avançada (>66 anos) apresentam baixo limiar de vasoconstrição, facilitando diretamente a instalação do quadro hipotérmico nessa faixa etária. Além disso, o grau da cirurgia e complicações prévias como baixa temperatura corporal pré-operatória e combinação de anestesias locais e regionais também possuem grande significância na HI. CONCLUSÃO: A hipotermia apresenta alta prevalência nas cirurgias com anestesia geral, sendo os neonatos e lactantes os mais afetados. Cuidados pré-operatórios são fundamentais na prevenção

成人看護実習における技術到達度の学生の認識

成人看護実習において学生が看護基本技術の到達度をどのように認識しているのかを明らかにすることを目的に実態調査をおこなった。その結果、1)日常生活の援助技術では「一人でできる」水準に達している学生が多かった。しかし、水準に達していない項目では繰り返し経験する必要性が示唆された。2)診療の補助技術では「経験なし」とする学生が多かったため、「見学」の機会を調整する必要性が示唆された。本研究により今後の成人看護技術教育への方法が示唆された

看護観形成と臨地実習における今後の課題

本研究では、成人看護実習前後の学生に同意を得た44名を対象に、現時点での「看護に対する考え」をレポートとして記述してもらった。その結果から以下のことが明示された。1.学生が記述した看護観は、段階的には区分はできたが、深まりに困難性を感じた。2.患者との関わり場面において、その時々の学生の感じたことや具体的内容は読み取りにくい部分が認められた。3.学生の体験したことをその時々で討議し共有し、次のステップへ積み上げる体制づくりが必要である。そのため、実習中における学生の『看護観すくいあげ展開構造図』を示した。今後これを用いながら日々の学生への実習展開における学習指導過程の強化を図り、看護に対する考えを深化する関わりをしたい

乳児期の食道内pHモニタリングの胃食道逆流症の評価における胃内pHの影響(東京女子医科大学附属第二病院小児科開局30周年記念論文集)

食道内pHモニタリング(pH検査)は,現在,胃食道逆流症(GER)の評価法として最も信頼度が高いが,乳児では哺乳による影響で胃内pHが高い傾向にあり,GERの評価に影響を及ぼすといわれている.我々はGER症状を有する乳児81例について,日常生活と同じ授乳法でpH検査を施行しGERも評価しているが,その際の胃内pHの影響について検討した.これらの症例には消化管造影,内圧検査も施行した.[結果](1)胃内pH<4の時間率は,乳児期の月齢に従って上昇する.(2)日常生活と同じ授乳法で行ったpH検査のGERの評価は,胃内pHに影響されなかった.(3)胃排出能遅延は,81例中15例に認められたが,胃内pHとの関連は認められなかった.(4)pH検査にてGER陰性であった36例中20例は消化管造影によるGERは陽性,内圧検査にて下部食道括約筋(LES)圧の異常値は24例,食道蠕動異常は18例に認めた.これらの症例には,当科のGERの治療プロトコールに従って治療を行い,全例,症状は軽快した.[結論]乳児では,哺乳により胃内pHは変動するものの,日常生活と同じ授乳法によるpH検査は,そのGERの評価が,胃内pH<4の時間率に関係することなく,乳児におけるGERの評価に有用であった.しかしGERの病態を把握するためには,pH検査のみでなく,内圧検査や放射線学的検査も行い,胃食道機能の全体的な評価をすることが必要であると思われた.Prolonged intraesophageal pH monitoring has become the preferred test to quantify acid gastroesophageal reflux (GER). We have performed this procedure concurrent with a regular feeding schedule as patients experienced symptoms in a similar environment. Hence, milk feedings tended to buffer gastric acidity, we attempted to investigate the influence of gastric pH on the evaluation of esophageal pH monitoring. Gastric and esophageal pH were simultaneously recorded by two separate pH electrodes for more than 20 hours in 81 infants (0～11 months) with GER symptoms. Radiological evaluations of GER and gastric emptying with barium and manometric studies were also performed in these infants. The results of this study indicate that: 1) Percentage of time with gastric pH < 4 increases with age in infancy. 2) Gastric pH is statistically not related to the evaluation of GER on esophageal pH monitoring. 3) Significantly delayed gastric emptying occurred in 15 out of the cases studied, however, gastric pH is not related to the delay. 4) In 36 cases that GER was negative on pH monitoring, GER was documented during radiological study in 20 cases, the abnormalities of lower esophageal sphincter (LES) pressure showed in 24 cases, and esophageal dysmotilities occurred in 18 cases on manometric study. These cases with abnormal findings were successfully treated followed by our treatment protocol for GER. In conclusion, prolonged esophageal pH monitoring with regular feeding is independent of the gastric acidity in infancy, and the method is useful to evaluate pathological GER. However, radiological and manometric studies, in addition to pH monitoring, should be required to evaluate the total gastresophageal function

乳児期の食道内pHモニタリングの胃食道逆流症の評価における胃内pHの影響(東京女子医科大学附属第二病院小児科開局30周年記念論文集)

食道内pHモニタリング(pH検査)は,現在,胃食道逆流症(GER)の評価法として最も信頼度が高いが,乳児では哺乳による影響で胃内pHが高い傾向にあり,GERの評価に影響を及ぼすといわれている.我々はGER症状を有する乳児81例について,日常生活と同じ授乳法でpH検査を施行しGERも評価しているが,その際の胃内pHの影響について検討した.これらの症例には消化管造影,内圧検査も施行した.[結果](1)胃内pH<4の時間率は,乳児期の月齢に従って上昇する.(2)日常生活と同じ授乳法で行ったpH検査のGERの評価は,胃内pHに影響されなかった.(3)胃排出能遅延は,81例中15例に認められたが,胃内pHとの関連は認められなかった.(4)pH検査にてGER陰性であった36例中20例は消化管造影によるGERは陽性,内圧検査にて下部食道括約筋(LES)圧の異常値は24例,食道蠕動異常は18例に認めた.これらの症例には,当科のGERの治療プロトコールに従って治療を行い,全例,症状は軽快した.[結論]乳児では,哺乳により胃内pHは変動するものの,日常生活と同じ授乳法によるpH検査は,そのGERの評価が,胃内pH<4の時間率に関係することなく,乳児におけるGERの評価に有用であった.しかしGERの病態を把握するためには,pH検査のみでなく,内圧検査や放射線学的検査も行い,胃食道機能の全体的な評価をすることが必要であると思われた.Prolonged intraesophageal pH monitoring has become the preferred test to quantify acid gastroesophageal reflux (GER). We have performed this procedure concurrent with a regular feeding schedule as patients experienced symptoms in a similar environment. Hence, milk feedings tended to buffer gastric acidity, we attempted to investigate the influence of gastric pH on the evaluation of esophageal pH monitoring. Gastric and esophageal pH were simultaneously recorded by two separate pH electrodes for more than 20 hours in 81 infants (0～11 months) with GER symptoms. Radiological evaluations of GER and gastric emptying with barium and manometric studies were also performed in these infants. The results of this study indicate that: 1) Percentage of time with gastric pH < 4 increases with age in infancy. 2) Gastric pH is statistically not related to the evaluation of GER on esophageal pH monitoring. 3) Significantly delayed gastric emptying occurred in 15 out of the cases studied, however, gastric pH is not related to the delay. 4) In 36 cases that GER was negative on pH monitoring, GER was documented during radiological study in 20 cases, the abnormalities of lower esophageal sphincter (LES) pressure showed in 24 cases, and esophageal dysmotilities occurred in 18 cases on manometric study. These cases with abnormal findings were successfully treated followed by our treatment protocol for GER. In conclusion, prolonged esophageal pH monitoring with regular feeding is independent of the gastric acidity in infancy, and the method is useful to evaluate pathological GER. However, radiological and manometric studies, in addition to pH monitoring, should be required to evaluate the total gastresophageal function.東京女子医科大学附属第二病院小児科開局30周年記念論文

A MALE CASE OF KALLMANN'S SYNDROME : FERTILITY INDUCED BY GONADOTROPIN (hCG/hMG) THERAPY

A 24-year-old male patient with Kallmann's syndrome who fathered two children after gonadotropin therapy is reported here. He was diagnosed with Kallmann's syndrome because of hypothalamic hypogonadism associated with anosmia. The gonadotropin therapy was initiated which involved treatment with human chorionic gonadotropin (hCG) and human menopausal gonadotropin (hMG). After 3 years of treatment, his secondary sexual characteristics developed to near the adult level and sperm were detected in his semen. Although pulsatile luteinizing hormone releasing hormone (LH -RH) injection using a mini-pump was tried for 4 months, it did not maintain the plasma testosterone at normal levels. At 29 y the patient was switched to gonadotropin therapy. His sperm count reached 6×10(6/mm3, and his wife became pregnant ; they had a female baby. His second child was born when the patient was 32 y. The sequence of the KAL gene was normal in all 14 exons of the patient's DNA. Here we describe the clinical benefits of gonadotropin therapy and LH-RH therapy