外科的に切除しえた, 肝硬変を伴う維持透析患者に発症した右腎癌下大静脈腫瘍塞栓の1例

症例は54歳, 男性。1900年, CGNにて血液透析導入となった。2005年2月に肉眼的血尿が出現。CTにて右腎癌を指摘され, 3月9日当科紹介。当科にて施行したCTでは直径7cm大の右腎腫瘍とともに下大静脈内の肝静脈流入部まで達する腫瘍塞栓を認めた。右腎腫瘍, 下大静脈塞栓, T3bN0M0 stage IIIの診断で4月28日, 根治的右腎摘除ならびに腫瘍塞栓摘除術を施行した。手術時間4時間28分, 出血量1, 400ml, 摘出標本は重量800g, 病理所見はrenal cell carcinoma, G2, pT3bであった。術前の凝固系検査は異常を認めなかったが, 肝硬変が原因と考えられる出血時間の延長と血小板数の低下を認めたため, 周術期は血小板輸血などにて対応した。術後経過は良好で, 後出血などの術後合併症もなく, 術後18日目に退院した。現在IFNα投与にて後療法を施行中であるが, 再発を認めていない。透析患者における下大静脈腫瘍塞栓を伴う腎癌に対して外科的治療を施行した症例についての報告例については比較的少なく, 文献的考察も含めて報告する。(著者抄録)A 54-year-old man who had been under hemodialysis therapy for 16 years presented with gross hematuria at our department in February 2005. Imaging findings revealed right renal tumor of8.2 cm in diameter. In addition, the tumor extended into inferior vena cava at the level of the hepatic vein. There were no findings of distant metastasis. Right radical nephrectomy and thrombectomy were performed on April 2006. Histopathological analysis showed that the tumor was renal cell carcinoma of clear cell type, grade 2. Postoperative course was uneventful, and the adjuvant therapy with interferon alpha was initiated. He has been free from recurrence for 22 months after surgery

Pengaruh Komunikasi Terapeutik Perawat Terhadap Kepuasan Pasien Di Rawat Jalan RSUD Jogja

The Objective of this study is to know influence of nurse therapeutic communication to satisfaction of patients satisfaction in RSUD Yogyakarta. The study was a quantitative research methods such as surveys of descriptive inferential research with cross sectional approach. Number of samples in this research is 285 sample in inpatient and 140 in emergency room. The instrument used a questionnaire. Analysis of data using multiple linear regression. This study show that there is the influence of therapeutic communication nurse to satisfaction of outpatients and Emergency room in RSUD Yogyakarta, and orientation phase is a phase that most influence on patient satisfaction. The most influential to therapeutic communication is termination stage

EFFECTS OF ALCOHOL ON DENTIN FORMATION IN HAMSTER AND RABBIT INCISOR

Although no effect on den tin formation was seen following voluntary alcohol consumption in the hamster for a period of 11 weeks, the dentin that was formed and calcified during the several days after abrupt withdrawal of alcohol was weakly stainable with hematoxylin. Similar qualitative changes of a lesser degree were also observed in the dentin formed after repeated administration of an intoxicating dose of alcohol. It was suggested that the effects of alcohol on the dentin formation were causally related to the non-specific stress induced by an intoxicating dose of alcohol and / or the withdrawal of alcohol

Comparison of three prognostic and predictive scores in 10 patients with COVID-19 pneumonia caused by nosocomial infection

Introduction: A nosocomial outbreak of coronavirus disease (COVID-19) occurred in the Toda Chuo General Hospital in Toda City, Saitama Prefecture, Japan in December 2020. The purpose of this study was to compare the accuracy of three prognostic indices for predicting the outcome of COVID-19 in patents with COVID-19 pneumonia. Patients and methods: Patients in the Department of Urology and Transplant Surgery at Toda Chuo General Hospital with nosocomially acquired COVID-19 confirmed by a positive polymerase chain reaction test were included in the study. We used the COVID-GRAM, International Severe Acute Respiratory and Emerging Infections Consortium’s World Health Organization 4C Mortality Score, and COVID-19 Registry Japan to independently predict the prognoses of 10 patients and identify common prognostic factors. All three indices include age, dyspnea, and comorbidities as prognostic factors. Results: Ten patients were included in the study, of which two patients died. According to the COVID-GRAM both patients were “high risk,” whereas the 4C Mortality Score predicted “high risk” and “very high risk.” Conclusion: The prognostic scores of all three indices were useful for predicting illness severity. Resumen: Objetivos: En diciembre de 2020 se produjo un brote nosocomial de enfermedad por coronavirus (COVID-19) en el Hospital General Toda Chuo de la ciudad de Toda, prefectura de Saitama, Japón. El propósito de este estudio fue comparar la exactitud de tres índices pronósticos para predecir el resultado de COVID-19 en pacientes con neumonía por COVID-19. Métodos: Se incluyeron en el estudio pacientes del Departamento de Urología y Cirugía de Trasplantes del Hospital General Toda Chuo con COVID-19 adquirida por vía nosocomial confirmada por una prueba de reacción en cadena de la polimerasa positiva. Se utilizaron los índices COVID-GRAM, International Severe Acute Respiratory and Emerging Infections Consortium's World Health Organization 4C Mortality Score y COVID-19 Registry Japan para predecir de forma independiente el pronóstico de 10 pacientes e identificar factores pronósticos comunes. Los tres índices incluyen la edad, la disnea y las comorbilidades como factores pronósticos. Resultados: Se incluyeron en el estudio 10 pacientes. Dos pacientes fallecieron. Según el COVID-GRAM ambos pacientes eran de ''alto riesgo'', mientras que el 4C Mortality Score predijo ''alto riesgo'' y ''muy alto riesgo''. Conclusión: Las puntuaciones pronósticas de los tres índices fueron útiles para predecir la gravedad de la enfermedad

Mild rhabdomyolysis after renal transplantation

We present a kidney transplantation patient who developed rhabdomyolysis. The patient was initially immunosuppressed with tacrolimus, mycophenolate mofetil, steroids, and chimeric CD25 monoclonal antibody. He complained of severe precordial and appendicular pain on 25th day after the operation. The patient developed rhabdomyolysis manifested as a rise in serum creatine phosphkinase (CPK) and elevation of urinary myoglobulin at approximately the same time as his symptoms. Although he was switched from tacrolimus to cyclosporine (CYA), his muscle pain and levels of serum CPK did not improve. However, dividing the daily total amount of the calcinuerin inhibitors into more frequent doses in order to reach lower serum levels resolved the rhabdomyolysis. Therefore, we conclude that his rhabdomyolysis might be a dose-related problem of calcineurin inhibitor

Renal protective effect of antiplatelet therapy in antiphospholipid antibody-positive lupus nephritis patients without antiphospholipid syndrome.

We sought to evaluate the effect of antiplatelet therapy in addition to conventional immunosuppressive therapy for lupus nephritis (LN) patients positive for antiphospholipid antibodies (aPL) without definite antiphospholipid syndrome (APS).Patients with biopsy-proven LN class III or IV were retrospectively evaluated. We selected patients positive for anticardiolipin antibody (aCL) or lupus anticoagulant (LA) who did not meet the criteria for a diagnosis of APS. The patients were divided into two subgroups according to whether antiplatelet therapy was received. The cumulative complete renal response (CR) rate, relapse-free rate, and change in estimated glomerular filtration rate (eGFR) over 3 years after induction therapy were calculated.We identified 17 patients who received antiplatelet therapy and 21 who did not. Baseline clinicopathological characteristics and immunosuppressive therapy did not show a significant difference between the two groups except for a higher incidence of LN class IV in the treatment group (p = 0.03). There was no difference in cumulative CR rate, relapse-free rate, or eGFR change between these subgroups. However, when data on LA-positive patients were assessed, an improvement in eGFR was found (p = 0.04) in patients receiving antiplatelet treatment.Addition of anti-platelet therapy was associated with an improvement of eGFR in LA-positive patients with LN class III or IV