チョウオンパ ガイド カ センコツ コウマク ガイ ブロック : センコツ トノ カイボウガク テキ ケントウ

仙骨硬膜外ブロックは外科手術の麻酔あるいは慢性疼痛の除痛手段に対して用いられる.従来のランドマーク法による仙骨硬膜外ブロックは小児では容易で安全であるとされているが,成人では70〜80%の成功率とされている.本研究では超音波ガイド下仙骨硬膜外ブロックを成人患者50症例で施行してその有用性を検討した.結果は全症例にてブロックは成功した.さらに超音波ガイド下仙骨硬膜外ブロックの成功率と安全性をより高くするために仙骨裂孔(仙骨角)の形態変異を観察し,得られた超音波画像の関係を検討した.Caudal epidural block is often used in patients for anesthesiaand chronic pain. Caudal epidural block with surfacelandmark guidance has been generally considered simpleand safe to perform especially in child patients. However,the success rate of the block in adults has been 70-80 % inthe literature. This study was aimed to determine the clinicalefficacy of caudal epidural block using ultrasound in 50patients. All the blocks were performed successfully. In addition,to increase both success rate and safety of ultrasoundguided caudal block, an anatomical study of thesacral hiatus( sacral cornu) has been performed to demonstratethe type and frequency of the shape variations tocompare with ultrasound imagings

ドッキョウ イカ ダイガク デ ハジメテ ノ ノウシ カラノ ゾウキ テキシュツ ジュツ ノ マスイ ケイケン

獨協医科大学で初めての脳死下臓器摘出術の麻酔を経験した.ドナーは50歳代の女性で,くも膜下出血による脳死であり,麻酔および摘出術は特に問題なく終了した.臓器摘出術の麻酔管理の主な要点は,各摘出臓器の機能を最大限に維持するための適切な循環および呼吸管理である.本症例におけるわれわれの経験は近い将来,獨協医科大学で行われるであろう臓器摘出術及び移植術の麻酔管理に有益な情報になると考えられた.We report the anesthetic management of the first case ofthe brain death for organ donation in Dokkyo Medical University.The donor was brain death after subarachnoidhemorrhage. Anesthesia and surgical procedure were doneuneventfully. The aims of anesthetic management are tomaintain optimal organ perfusion. We believe that this firstexperience will be helpful for the anesthetic management ofthe organ transplantation patient in the future of DokkyoMedical University

Consensus-based identification of factors related to false-positives in ultrasound scanning of synovitis and tenosynovitis

<div><p></p><p>Introduction</p><p>We aimed to identify causes of false-positives in ultrasound scanning of synovial/tenosynovial/bursal inflammation and provide corresponding imaging examples.</p><p>Methods</p><p>We first performed systematic literature review to identify previously reported causes of false-positives. We next determined causes of false-positives and corresponding example images for educational material through Delphi exercises and discussion by 15 experts who were an instructor and/or a lecturer in the 2013 advanced course for musculoskeletal ultrasound organized by Japan College of Rheumatology Committee for the Standardization of Musculoskeletal Ultrasonography (JCR-CoSMUS).</p><p>Results</p><p>Systematic literature review identified 11 articles relevant to sonographic false-positives of synovial/tenosynovial inflammation. Based on these studies, 21 candidate causes of false-positives were identified in the consensus meeting. Of these items, 11 achieved a pre-defined consensus (≥ 80 %) in Delphi exercise and were classified as follows: I. Gray-scale assessment (A. Non-specific synovial findings, B. Normal anatomical structures which can mimic synovial lesions due to either their low echogenicity or anisotropy); II. Doppler assessment (A. Intra-articular normal vessels, B. Reverberation). Twenty-four corresponding examples with 49 still and 23 video images also achieved consensus.</p><p>Conclusions</p><p>Our study provides a set of representative images that can help sonographers to understand false-positives in ultrasound scanning of synovitis and tenosynovitis.</p></div