A primary aorto-duodenal fistula associated with an inflammatory abdominal aortic aneurysm: a case report.

Primary aorto-enteric fistula (PAEF)is a serious complication of abdominal aortic aneurysm(AAA). We report a patient with PAEF associated with inflammatory AAA who underwent emergent surgery. A 52-year-old male presented with recurrent hematemesis. A computer tomography scan showed a sealed rupture of the AAA adjacent to the duodenum. At surgery, a coin-sized PAEF was noted. The aorta was replaced with a Dacron graft in situ . Histological examination revealed the characteristics of an inflammatory AAA. The postoperative course was uneventful, and there has been no evidence of infection during a follow-up period of 3 years. We discuss the etiologic and surgical considerations regarding this unusual entity.</p

Therapists' Roles and Effects at the Community Care Center (Clinical Report)

介護保険におけるリハビリテーションは訪問リハビリテーション及び通所リハビリテーションの2つのサービス種類に特徴付けられている。制度開始から3年が経過した現在においてもその供給量や内容については不足しているのが現状である。 東京都における通所介護事業所では、介護保険以前より老人保健法に基づいた機能訓練事業を実施していたり、介護保険移行後も継続的リハビリテーションサービスを実施しているところもある。 当事業所である文京区立向丘高齢者在宅サービスセンターにおいても、開所した平成7年4月よりPT・OTの人員配置を行い、リハビリテーションサービスを実施している。今回実際の通所介護サービスにおけるリハビリテーションサービスの内容とPT・OTの業務を整理し、その効果についてまとめた結果、利用者の個別性や稼働率の向上や要介護状態の進行防止において、一定の効果が予想される結果が得られた

Economic Effects of Physical Therapy Interventions in the Facility of Health Care Services for the Elderly

個別理学療法を行っている介護老人保健施設における理学療法の効果を経済的側面からみた。要介護度,厚生省(当時)の「障害老人の日常生活自立度」(以下寝たきり度)及び「痴呆性老人の日常生活自立度」(以下痴呆度)から直接費用削減効果を推計した。また排泄状況について入所判定時,入所時,理学療法施行後を比較検討しオムツ使用量より間接費用削減効果をみた。理学療法法施行後では寝たきり度(p<0.05)は改善した。要介護度に置き換えてみると1施設(75人定員)1日当たり,17710円の削減となる。また終日オムツ利用者数も改善し(p<0.05)これらの人が夜間のみオムツ使用したとすると1施設(75人定員)1日あたり7164円の削減となる。なお,必要な理学療法期間は半年以内であろうと推定できThe report analyzed the effects of physical therapy interventions in facilities of health care services for the elderly from the economic standpoint. First, a direct reduction in expenses was estimated by care degree, Independence Degree of Daily Living in the Handicapped Elderly (bed-ridden degree) and Independence Degree of Daily Living in the Elderly with Dementia (dementia degree), presented by the Ministry of Health and Welfare at that time. Second, the excretory condition was compared among at the time of evaluation for admission, at admission, and after physical therapy intervention, for the purpose of estimating an indirect reduction in expenses caused by a decrease in diapers used. After physical therapy intervention, bed-ridden degree was significantly improved (p<0.05). Calculating this in terms of care degree, a reduction of expenses was 17,710 Japanese yen per facility (75beds) per day. The number of persons who used diapers throughout the day was significantly decreased (p<0.05). A reduction of 7,164 Japanese yen per facility (75beds) per day will be realized provided that persons who need diapers all day only use them at night. The necessary period of physical therapy intervention was considered within 6 months for the elderly in facilities of health care services

A Dipeptidyl Peptidase-4 Inhibitor, Des-Fluoro-Sitagliptin, Improves Endothelial Function and Reduces Atherosclerotic Lesion Formation in Apolipoprotein E–Deficient Mice

ObjectivesThe aim of this study was to investigate the antiatherogenic effects of the dipeptidyl peptidase-4 inhibitor, des-fluoro-sitagliptin (DFS).BackgroundThe new class of anti–type 2 diabetes drugs, dipeptidyl peptidase-4 inhibitors, improves glucose metabolism by increasing levels of active glucagon-like peptide (GLP)-1.MethodsEndothelial function was examined by acetylcholine-induced endothelium-dependent vasorelaxation using aortic rings and atherosclerotic lesion development in the entire aorta in apolipoprotein E–deficient mice fed a high-fat diet with or without DFS, and the antiatherogenic effects of DFS were investigated in cultured human macrophages and endothelial cells. Plasma levels of active GLP-1 were measured in patients with or without coronary artery disease.ResultsDFS significantly improved endothelial dysfunction (89.9 ± 3.9% vs. 79.2 ± 4.3% relaxation at 10−4 mol/l acetylcholine, p < 0.05) associated with increased endothelial nitric oxide synthase phosphorylation and reduced atherosclerotic lesion area (17.7% [15.6% to 25.8%] vs. 24.6% [19.3% to 34.6%], p < 0.01) compared with vehicle treatment. In cultured human macrophages, DFS significantly increased GLP-1-induced cytosolic levels of cyclic adenosine monophosphate compared with GLP-1 alone, resulted in inhibiting phosphorylation of c-jun N-terminal kinase and extracellular signal-regulated kinase 1/2 and nuclear factor-kappa B p65 nuclear translocation through the cyclic adenosine monophosphate/protein kinase A pathway, and suppressed proinflammatory cytokines (i.e., interleukin-1-beta, interleukin-6, and tumor necrosis factor-alpha) and monocyte chemoattractant protein-1 production in response to lipopolysaccharide. DFS-enhanced GLP-1 activity sustained endothelial nitric oxide synthase phosphorylation and decreased endothelial senescence and apoptosis compared with GLP-1 alone. In the human study, fasting levels of active GLP-1 were significantly lower in patients with coronary artery disease than those without (3.10 pmol/l [2.40 to 3.62 pmol/l] vs. 4.00 pmol/l [3.10 to 5.90 pmol/l], p < 0.001).ConclusionsA DPP-4 inhibitor, DFS, exhibited antiatherogenic effects through augmenting GLP-1 activity in macrophages and endothelium

Multi-disciplinary Team Approached for Swallowing and Feeding Disturbed Cases

これは、リハビリテーション専門医、小児神経専門医、作業療法士、理学療法士が、乳児から高齢者までの重度心身障害児、神経難病、脳血管障害後遺症などのクライアントが食べ物の取り込み、咀嚼、嚥下に困っている事害を前に、それぞれの摂食・嚥下障害の原因の究明や治療の模索を約20年にわたり記録したものをまとめたものである。 報害する内害は機能障害学につながる運動病態学と考えている。主としてビデオによる観察、表面筋電図による運動解析、ビデオフルオグラフィーなどを用いて運動病態を解析し,それぞれの実際の記録を遭遇した時間に沿って用いた。Our multi-disciplinary team of rehabilitation doctors, oaediatric neurological doctors, occupational therapists and physical therapists have been studying the problems of feeding, sucking, chewing and swallowing in neurologically affected clients for over 20 vears. We commonly use surface EMG and video-fluorography to examine these phenomena more closely, and have observed several abnormal movements in severely affected clients whilst eating. This report outlines the interdisciplinary experiences of our team when dealing with the problems of feeding, sucking, chewing and swallowing in clients with severe neurological disorders

Study of Kinetic and Electromyography of Dream Plastic Ankle Foot Orthoses while Walking and Stair Descending

本研究の目的は、「装具なし」、「プラスチック製短下肢装具」(以下、P-AFO)、「摩擦制動継手付短下肢装具 (ドリームブレース : Dream Plastic Ankle Foot Orthoses)」(以下、DP-AFO) 装着の3条件で、装具装着側下肢の力学的および筋電図学的解析を行うことである。インフォームド・コンセントの得られた健常成人を対象に、一側下肢の足部に装具を装着し、平地歩行および階段降り動作を行った。使用機器は、三次元動作解析装置および床反力計を使用し、装具装着側下肢の関節角度、関節モーメントの測定および筋電図の記録を行った。解析は、装具装着側下肢が床面および階段面に接地している区間を3条件で比較検討した。その結果、ドリームブレースは、正常歩行に近似した関節角度、関節モーメントおよび筋活動を再現していることが明らかになった。The purpose of this study was to investigate a kinetic and electromyogram analysis of the Dream Plastic Ankle Foot Orthoses (DP-AFO) while walking and descending staircases. One healthy adult participated in this study. DP-AFO was attached to one of the legs of the subject, assuming that the limb was affected. The movement was measured with 3D motion analysis system (VICON 512) and force plates (AMTI). We compared the state of the limb, when the foot was touching the floor or the stair. As a result, it was clarified that the DP-AFO reproduces the joint angle, the joint moment, and the EMG activities of normal walking