Effects of Intravenous Diltiazem on Supraventricular Tachyarrhythmias

The effects of intravenous diltiazem on supraventricular tachyarrhythmias were studied in 16 patients : 6 with paroxysmal supraventricular tachycardia using an accessory pathway retrogradely, 6 with atrial fibrillation, 3 with atrial flutter and 1 with chronic atrial tachycardia. Diltiazem (0.1 or 0.2 mg/kg) was administered intravenously over 5 minutes. Termination of paroxysmal supraventricular tachycardia was achieved in 6 out of 10 episodes during or just after the injection. Diltiazem slowed the ventricular conduction from 2 : 1 to 4 : 1 in atrial flutter, but sinus rhythm was not restored in either case. Diltiazem increased the ventricular response through an accessory pathway in a patient with atrial fibrillation associated with Wolff-Parkinson-White syndrome. Atrial rate in a case of chronic atrial tachycardia did not change significantly. There were no adverse clinical effects. It is concluded that diltiazem is effective in slowing ventricular rate in atrial fibrillation and flutter and in terminating paroxysmal supraventricular tachycardia. However, diltiazem may be contraindicated in atrial fibrillation associated with Wolff-Parkinson- White syndrome

Simulation of I-V Hysteresis Branches in An Intrinsic Stack of Josephson Junctions in High TcT_c Superconductors

I-V characteristics of the high T$_c$ superconductor Bi$_2$Sr$_2$Ca$_1$C$_2$O$_8$ shows a strong hysteresis, producing many branches. The origin of hysteresis jumps is studied by use of the model of multi-layered Josephson junctions proposed by one of the authors (T. K.). The charging effect at superconducting layers produces a coupling between the next nearest neighbor phase-differences, which determines the structure of hysteresis branches. It will be shown that a solution of phase motions is understood as a combination of rotating and oscillating phase-differences, and that, at points of hysteresis jumps, there occurs a change in the number of rotating phase-differences. Effects of dissipation are analyzed. The dissipation in insulating layers works to damp the phase motion itself, while the dissipation in superconducting layers works to damp relative motions of phase-differences. Their effects to hysteresis jumps are discussed.Comment: 18 pages, Latex, 8 figures. To be appear in Phys.Rev.B Vol.60(1999

シンキン バイヨウ ケンサ ニオケル カンジダ ノ ケンシュツ ニ エイキョウ スル リンショウテキ ヨウイン ノ ケントウ : コウクウ カンソウ ノ カンレン ニツイテ

In order to analyze the clinical factors affecting the fungal culture test, we examined the oral mucosae of 89 individuals with various complaints: pain, xerostomia etc. The subjects, age ranged from 36 to 87 years (mean age: 64.8 ± 11.8). Based on the fungal culture, 56 patients were found Candida-positive, and the remaining 33 patients were Candida-negative. The mean ages of the Candida-positive and -negative groups, respectively, were 67.4 ± 12.0 and 60.5 ± 10.3 years old, with the Candida-positive group being significantly older than Candida-negative group. The Candida-positive group showed a smaller amount of salivary secretion (10.9 ± 5.3 ml/10 min) than the Candida-negative group (13.8 ± 6.0 ml/10 min); this difference was also statistically significant. Patients with Candida infection suffered from different diseases and conditions, including hypertension, gastrointestinal disease, and xerostomia. The above findings suggest that one of the factors in the fungal culture test is dry mouth. Specifically, old age, dry mouth, chronic disease or medication leading to dry mouth were the clinical factors affecting the fungal culture test. However, neither the Candida species detected in the fungal culture nor the clinical appearance of the oral mucosa influenced these clinical features

ガク カンセツショウ カンジャ ニオケル MR ガゾウ ショケン ト リンショウ ショケン ノ ヒカク ケントウ

Two hundred eighteen (28.4%) of 768 patients with temporomandibular disorders (TMD), who visited the Clinic for Temporomandibular Disorders, Tokushima University Medical and Dental Hospital during the period of January 2006 through December 2007, were examined using magnetic resonance (MR) imaging. The present study assessed clinico-statistically the correlation between MR images and the clinical findings of 157 patients with complete registered data in our TMD reporting system. The following findings were obtained: 1. MR imaging showed anterior disk displacement in 125 joints (67.9%), rotational disk displacement in 45 joints (24.5%), and sideways disk displacement in 13 joints (7.1%). 2. Joint effusion (JE) was found in 42.7% of 157 patients; 48.0% in females and 23.5% in males. In addition, anterior or rotational disk displacement was observed in 97% of patients with JE. Furthermore, condyle bone change was significantly higher in joints with than without JE. 3. The appearance of JE was significantly higher on the symptomatic side than the asymptomatic side, but tenderness of the temporomandibular joint (TMJ) area or the value of the visual analog scale (VAS) regarding pain and problems in daily life was not related to the presence of JE

Clinico-statistical study of HIV patients in clinical dental departments at Tokushima University Hospital

HIV 感染症診療は，免疫不全の原因治療と免疫不全に伴う日和見感染症の管理が2 本柱とされる．日和見感染症の管理という観点から，口腔衛生管理は重要で歯科医師の果たす役割は大きい．われわれは，徳島大学病院歯科診療科を受診した31 例のHIV 感染者の臨床統計的検討を行い，今後増加すると予想されるHIV感染者に対する歯科医療の留意点について考察した．症例は男性29 例，女性2 例で，平均年齢は31.7 ± 12.4歳であった．感染経路は血液製剤による感染が8 例，性感染による感染が23 例であった．31 例中3 例で抗HIV 療法が導入されていなかった．HIV 感染者の合併症の保有率は高く，血友病群ではHCV 感染症（75.0%），C 型肝硬変（37.5%）が多く，性感染症群では梅毒（30.4%），HBV 感染症（21.7%）が多かった．歯科診断では歯周病，う蝕が多かったが，31 例中7 例に口腔粘膜疾患を認めた．歯科治療内容は抜歯処置15 例，歯周治療12 例，修復治療5 例の順に多かった．血友病群の抜歯の際は血液凝固製剤を術前・術後に補充して抜歯を行った． HIV 感染者の歯科医療は，医科と連携し患者個々のHIV 感染症の病態や合併症を把握し，日和見疾患のリスク因子である口腔感染症を治療し，予防する必要がある．そして，患者にHIV 感染症と口腔症状の関連性と定期的な歯科治療の必要性を説明し，患者にあわせた無理のない口腔衛生指導を行いながら，長期的なメインテナンスが必要であると考えられた．To prevent opportunistic infectious disease in HIV patients with immunodeficiency, oral management is important. In order to identify focal points in dental treatment, we studied the 31 HIV patients（ 29 males and 2 females, mean age 31.7±12.4 years） who visited the clinical dental departments of Tokushima University Hospital from 1981 to 2016. Among the 31 cases, 3 cases did not start antiretroviral therapy （ART）. The HIV patients were classified by infection route, producing a hemophilia group （8 cases） and sexually transmitted disease group（ 23 cases）. Clinical complications were different in these two groups: complications in the hemophilia group included hepatitis C virus （HCV） infection （75.0%） and hepatitis C-related cirrhosis （37.5%）, whereas in the sexually transmitted disease group complications included syphilis （30.4%） and hepatitis B virus （HBV） infection （21.7%）. There were many dental caries and periodontal diseases found in the patients. On the other hand, oral mucosal diseases were observed in seven of 31 cases. Dental treatment consisted of tooth extraction in 15 cases, periodontal treatment in 12 cases, and caries treatment in 5 cases. Blood coagulation formulation was supplied during tooth extraction in the hemophilia group. Careful attention must be given according to the condition of each HIV patient during dental treatment, and the risk of opportunistic infection caused by oral infection must be treated and prevented

Study of the preparation with sodium picosulfate and PEG intestinal lavage solution for total colonoscopy.

Total colonoscopyの前処置における被検者の負担軽減と良好な腸管洗浄を得る目的で,50例の大腸内視鏡検査において,前日の食事制限せず, sodium picosulfate 20mℓ前夜服用,検査当日PEG腸管洗浄液1ℓ以上服用する前処置法の有用性について検討した。本前処置法によってPEG腸管洗浄液平均1230mℓの服用により,50例中48例で観察可能な腸管洗浄が得られ,PEG腸管洗浄液の服用量の減量が可能であった｡腹痛,嘔気,腹鳴などの症状出現例は認めたが,重篤な副作用は認めなかった｡腸管洗浄度の点で,高齢者の大腸内視鏡検査の前処置として有用である｡以上よりSodium Picosulfate 20mℓをPEG腸管洗浄液と併用することにより,優れた腸管洗浄度を得られると同時にPEG腸管洗浄液服用量の減量か可能であり,total colonoscopyの前処置として有用であることが示された。The following results were obtained from a total colonoscopic study of 50 patients who received preparation with 20mℓ of sodium picosulfate (Laxoberon®) and PEG intestinal lavage solution (Niflec®) prior to the examination. (l) The present method in combination with a mean of 1230mℓ of PEG intestinal lavage solution allowed colonic cleaning for which observation was available in 48 of 50 patients. (2) With this method. no adverse reactions were observed except for mild abdominal pain, nausea, and rugitus in a few patients. (3) This method was particularly as a preparation for colonoscopic examination in elderly patients. Thus, we conclude that preparation with 20mℓ of sodium picosulfate and PEG intestinal lavage solution is useful for colonoscopic examination

Clinical evaluation of an endoscopic image filing system, Olympus SDF-3

光ディスクとパーソナルコンピュータを組み合わせた内視鏡画像ファイリングシステムは電子内視鏡の画像の保存･管理,検索･再生などに威力を発揮する｡今回,われわれはオリンパス社製内視鏡ファイリングシステムSDF-3を使用する機会を得たので,その有用性や問題点の検討を行った｡有用性としては,①内視鏡画像を検査終了後直ちに再生し,再検討できる,②多数の項目についての検索や統計処理が可能である,③限られたスペース内で大量の画像データの一括保存･管理が可能であるなどが挙げられる｡一方,問題点としては,①内視鏡再生画像は画質が劣化する,②検索機能を十分に活用するにはかなり煩雑な人力操作を必要とする,③光ディスクの清掃が必要であるなどがあげられる｡本内視鏡ファイリングシステムに今後必要な改良点やその展望についても合わせて考案を加えた。Olympus SDF-3, an endoscopic image　filing system using an electronic endoscope in　conjunction with a personal computer and an　optical disk, has been recently developed. We evaluated the usefulness of this filing system with 449 cases of gastroduodenal endoscopy. As a result, we have found that this filing system has following advantages : (1) one can review endoscopic images immediately after endoscopic examinations ; (2) previously documented endoscopic image can be searched and reviewed in a short time ; (3) statistical analysis of documented cases is facilitated. However, it has some disadvantages as well to be improved : (1) quality of endoscopic images is deteriorated in the process of filing ; (2) putting patients' data into the filing system is time-consuming ; (3) frequent cleaning of an optic disk is required. This endoscopic image filing system needs to be further developed and refined

A Case of Perforated Sigmoid Diverticulitis in Which Gram Staining of Ascitic Fluid Was Useful for Diagnosis

An 85-year-old woman was admitted to our hospital for steroid therapy for relapsing nephrotic syndrome. During hospitalization, she complained of sudden epigastric pain at night. Although there were signs of peritoneal irritation, CT showed a large amount of ascitic fluid, but no free intraperitoneal gas. Gram staining of ascitic fluid obtained by abdominal paracentesis showed Gram-negative rods, which raised a strong suspicion of gastrointestinal perforation and peritonitis. Therefore, emergency surgery was performed. Exploration of the colon showed multiple sigmoid diverticula, one of which was perforated. The patient underwent an emergency Hartmann's procedure. Imaging studies failed to reveal any evidence of gastrointestinal perforation, presenting a diagnostic challenge. However, a physician performed rapid Gram staining of ascitic fluid at night when laboratory technicians were absent, had a strong suspicion of gastrointestinal perforation, and performed emergency surgery. Gram staining is superior in rapidity, and ascitic fluid Gram staining can aid in diagnosis, suggesting that it should be actively performed. We report this case, with a review of the literature on the significance of rapid diagnosis by Gram staining

A Novel Plasmid Carrying Capsule Gene Cluster Found in Lactococcus garvieae Isolated from Filefish

Lactococcus garvieae is recognized as a crucial bacterial pathogen of freshwater and marine fish species. It has been divided into two serological phenotypes, namely KG? and KG+. Difference of the two phenotypes is owing to the presence or absence of polysaccharide capsule, and a phenotypic change from KG? to KG+ occurs during stocking of isolates for a long period or by repeated subculturing. We found that the phenotypic change occurred more readily in L. garvieae isolates from cultured filefish, thread-sail filefish Stephanolepis cirrhifer and black scraper Thamnaconus modestus, than those from other fish species. Thus we studied the gene cluster for capsular polysaccharide biosynthesis (capsule gene cluster) of a filefish isolate, strain BSLG13015, and revealed that the strain possessed the same capsule gene cluster as those from other fish species, but that it was integrated in a newly identified plasmid. The plasmid, a size of 31,654 bp and circular, was named pBSLG13015. It was detected in all of KG? filefish isolates but not in KG+ filefish isolates or L. garvieae from other fish species. It is highly probable that the easier change from KG? to KG+ in L. garvieae filefish isolates is attributed to the loss of the plasmid

トクシマ ダイガク ビョウイン セイシンカ シンケイカ ニュウイン カンジャ ニ タイスル コウクウ ケア ノ イギ

For patients with mental diseases, safe food-intake and the maintenance of good oral hygiene become difficult due to a decline in the ability of daily livings. In addition, a majority of patients suffer from the lack of reflection of both deglutition and cough as well as clinical silent aspiration, resulting from the extrapyramidal symptom (EPS) caused by antipsychotics. In this clinical study, we evaluated the oral environment in 10 inpatients with psychiatry neurology, and examined the usefulness of professional oral care. They were divided into 2 groups: the physical restriction group (restriction group) and the non-physical restriction group (control group), followed by the estimation of the conditions of oral hygiene and the days accompanied by fever, one of the symptoms of aspiration-related pneumonia, before and after professional oral care intervention. As a result, restriction group had poor oral hygiene condition as compared to the control group. After professional oral care intervention, oral hygiene condition was significantly improved in the restriction group, and reached to the same levels as in the control group. The days with fever were 7.3 and 5.0 days per month in the restriction group before and after the intervention, respectively. In the control group, those were 0.6 and 0 day per month before and after intervention, respectively. The cause of the difference in days with fever between 2 groups was considered to be the effect of clinical silent aspiration by EPS induced by antipsychotics. The professional oral care contributed to the improvement of the oral hygiene in inpatients with psychiatry neurology, resulting in the reduction of aspiration-related pneumonia. Therefore, the role of dentistry in the field of psychiatry neurology would be inevitable in the future