シガ イカ ダイガク イガクブ フゾクビョウイン ノ シュウジュツキ コウクウ キノウ カンリ ノ リンショウテキ トウケイ 2002ネン

滋賀医科大学医学部附属病院歯科口腔外科では2014年より, 周術期患者の口腔機能管理を目的とした「オーラルマネジメントシステム」を稼働した. 2015年には, 患者に快適, 安心, 安全な周術期医療を提供することを目的として, 多職種からなる「周術期チーム」が発足し, 当科はチームの一員として口腔機能管理を担っている. 今回われわれは, 2015年4月１日から2022年3月31日までの７年間の年度毎の全身麻酔手術件数, 周術期口腔機能管理依頼件数の推移と周術期口腔機能管理依頼率(1年間の全身麻酔手術件数に対する周術期口腔機能管理依頼件数の割合), 依頼件数の多かった診療科について臨床的検討を行った. 当院の2021年度の全身麻酔手術件数は4158件, 依頼件数は1931件, 依頼率は46.3%であり, オーラルマネジメントシステムを導入した2015年度より年々増加を認めていた. 診療科毎の依頼件数は消化器外科, 耳鼻咽喉科が多かった. 当科の院内啓蒙活動や周術期口腔機能管理により術後合併症のリスクが低下する報告が増えたことにより, 医科の周術期口腔機能管理の認知が高まり, 依頼件数, 依頼率の増加につながったと考える. 診療科毎の依頼件数に関しては, 歯科口腔領域と関係の深い診療科の依頼が多いと考えられた. 周術期チームが発足してから, 他職種連携は密となり, 依頼件数, 依頼率の増加を認めたが, 周術期口腔機能管理が, 術後合併症の予防を示すエビデンスはまだないため今後の課題と考えている.The Department of Oral Surgery of Shiga University Hospital launched the "Oral Management System" for the purpose of managing oral functions of perioperative patients, in 2014. "Perioperative team" consisting of members from various professions was established in 2015, with the aim of providing comfortable, safe, and secure perioperative care to patients. Our department is responsible for the management of oral functions. In this study, we conducted a clinical review of the number of general anesthesia cases per year, the number of requests for perioperative oral function management, the rate of requests for perioperative oral function management (the ratio of the number of requests for perioperative oral function management to the number of general anesthesia cases per year), and the departments with high number of requests for perioperative oral function management during the seven years from April 1, 2015, to March 31, 2022. The number of general anesthesia surgeries in our hospital in 2021 was 4158, and the number of requests was 1931, for a request rate of 46.3%. The number of requests had been increasing every year since 2015, when the oral management system was introduced. The number of requests per department was higher in the departments of gastroenterological surgery and otorhinolaryngology. The number of requests and the request rate increased. Because we consider that the awareness of perioperative oral functional management in the medical department has increased due to our hospital\u27s educational activities and an increase in the number of reports showing that perioperative oral function management reduced postoperative complications. After the perioperative team was established, the collaboration among other departments became closer, and the number of requests and the request rate increased. However, there is still no evidence that perioperative oral function management prevents postoperative complications, and this is an issue for the future

ジュツゴ ニ ゼッセンブ エシ オ ミトメタ コウテイガン ノ 1レイ

　口底癌の部分切除による様々な術後合併症がある中で, 今回われわれは口底癌術後の舌尖部に壊死を認めた１例を経験したので文献的考察を加えて報告する. 　患者は76歳男性で, 口底部の腫瘤を自覚し当科へ紹介され受診した. 右側口底部に長径16 mm×短径14 mmの表面粘膜粗造,無痛性の外向性腫瘤を認めた. 病理組織学的診断の結果, 高分化型扁平上皮癌と診断された. 全身検索を行い, 右側口底癌 T2N0M0の診断のもと, 全身麻酔下に口底部悪性腫瘍切除術を施行した. 術中, 舌深動脈が切除範囲に含まれたため, 結紮切断した. 術後5日目より, 舌尖部の色調が暗赤色から淡黄色へ, 術後9日目よりさらに褐色へと変化を認めた. 舌尖部への血流障害により部分壊死が生じたと考えられ, 術後14日目に局所麻酔下で舌尖部壊死組織のデブリードマンを行い, 舌形成術を施行した. 術後１ヶ月経過し, 舌尖部は色調の改善を認めた．舌の味覚障害, 知覚異常および摂食・嚥下障害は改善傾向であった. 今後注意深く経過観察を行う必要があると考えられる.Various postoperative complications are associated with the partial resection of carcinoma of the floor of the mouth. Here we report the case of a patient who developed necrosis of the tongue tip after undergoing a surgery for carcinoma of the floor of the mouth and discuss this based on a literature review. A 76-year-old male was referred to our department after he noticed a mass on the floor of his mouth. A painless, exophytic mass with rough surface mucosa—16 mm on the long axis and 14 mm on the short axis—was found on the right side of the floor of the mouth. Histopathological assessments led to the diagnosis of a well-differentiated squamous cell carcinoma. Systemic assessments were performed, and the tumor was diagnosed as T2N0M0 basal cell carcinoma. The tumor was resected under general anesthesia. During surgery, it was ligated and cut as the deep lingual artery was within the resection area. Since postoperative day 5, the color of the tongue tip started changing from dark red to light yellow and then started turning brown since postoperative day 9. Impaired blood flow to the tongue tip might have resulted from partial necrosis. On postoperative day 14, debridement of the necrotizing tissue was performed under local anesthesia, which was followed by glossoplasty. The color of the tongue improved after 1 month of surgery. Furthermore, tongue dysgeusia, paresthesia, and eating and swallowing disorders showed a tendency to improve. Careful follow-up is necessary in the future

Haplotype-based analysis of genes associated with risk of adverse skin reactions after radiotherapy in breast cancer patients.

PURPOSE: To identify haplotypes of single nucleotide polymorphism markers associated with the risk of early adverse skin reactions (EASRs) after radiotherapy in breast cancer patients. METHODS AND MATERIALS: DNA was sampled from 399 Japanese breast cancer patients who qualified for breast-conserving radiotherapy. Using the National Cancer Institute-Common Toxicity Criteria scoring system, version 2, the patients were grouped according to EASRs, defined as those occurring within 3 months of starting radiotherapy (Grade 1 or less, n = 290; Grade 2 or greater, n = 109). A total of 999 single nucleotide polymorphisms from 137 candidate genes for radiation susceptibility were genotyped, and the haplotype associations between groups were assessed. RESULTS: The global haplotype association analysis (p < 0.05 and false discovery rate < 0.05) indicated that estimated haplotypes in six loci were associated with EASR risk. A comparison of the risk haplotype with the most frequent haplotype in each locus showed haplotype GGTT in CD44 (odds ratio [OR] = 2.17; 95% confidence interval [CI], 1.07-4.43) resulted in a significantly greater EASR risk. Five haplotypes, CG in MAD2L2 (OR = 0.55; 95% CI, 0.35-0.87), GTTG in PTTG1 (OR = 0.48; 95% CI, 0.24-0.96), TCC (OR = 0.48; 95% CI, 0.26-0.89) and CCG (OR = 0.50; 95% CI, 0.27-0.92) in RAD9A, and GCT in LIG3 (OR = 0.46; 95% CI, 0.22-0.93) were associated with a reduced EASR risk. No significant risk haplotype was observed in REV3L. CONCLUSION: Individual radiosensitivity can be partly determined by these haplotypes in multiple loci. Our findings may lead to a better understanding of the mechanisms underlying the genetic variation in radiation sensitivity and resistance among breast cancer patients

Real GDP in pre-war East Asia: a 1934–36 benchmark purchasing power party comparison with the U.S.

This article provides estimates of purchasing power parity (PPP) converters for expenditure side GDP of Japan&sol;China, Japan&sol;U.S. and China&sol;U.S. in 1934-36 through a detailed matching of prices for more than 50 types of goods and services in private consumption and about 20 items or sectors for investment and government expenditure. Linking with the earlier studies on the price levels of Taiwan and Korea relative to Japan, we derive the mid-1930s benchmark PPP adjusted per capita income of Japan, China, Taiwan and Korea at 32, 11, 23, and 12 percent of the U.S. level respectively. These estimates correct the consistent downward bias in East Asian income levels based on market exchange rate conversions. Compared with Angus Maddison's estimates based on the 1990 benchmark back-projection, our current-price based result are 18 and 44 percent lower for Japan and Korea, and 4 and 10 percent higher for Taiwan and China respectively in the mid-1930s. We develop a preliminary theoretical and empirical framework to examine the possible source of the biases in the back-projection method. The article ends with a discussion on historical implications of our findings on the initial conditions and long-term growth dynamics in East Asia. Copyright � 2007 The Authors; Journal compilation � International Association for Research in Income and Wealth 2007.