全身麻酔下集中治療児の環境調査

To investigate positive inhibitory measures against severe caries thought to develop in nursing infants, we examined the nursing environment of intensive care infants under general anesthesia at Matsumoto Dental College\u27s Department for dental treatment from January 1989 through December 1993

Involvement of oxidative stress and mucosal addressin cell adhesion molecule-1 (MAdCAM-1) in inflammatory bowel disease

The pathophysiology of inflammatory bowel disease involves excessive immune effects of inflammatory cells against gut microbes. In genetically predisposed individuals, these effects are considered to contribute to the initiation and perpetuation of mucosal injury. Oxidative stress is a fundamental tissue-destructive mechanisms that can occur due to the reactive oxygen species and reactive nitrogen metabolites which are released in abundance from numerous inflammatory cells that have extravasated from lymphatics and blood vessels to the lamina propria. This extravasation is mediated by interactions between adhesion molecules including mucosal addressin cell adhesion molecule-1 and vascular cell adhesion molecule-1 on the surface of lymphocytes or neutrophils and their ligands on endothelial cells. Thus, reactive oxygen species and adhesion molecules play an important role in the development of inflammatory bowel disease. The present review focuses on the involvement of oxidative stress and adhesion molecules, in particular mucosal addressin cell adhesion molecule-1, in inflammatory bowel disease

乳房撮影における吸収物質内の線質について

In order to evaluate the x-ray quality in each material, we obtained the values from one to five half-value layer with aluminum, bakelite, polymethyl methacrylate resin and BR-12 phantom, and investigated the change of x-ray quality (from first to fifth half-value layer) according to the attenuation in their materials. The un-homogeneity factor to first half-value layer in BR-12 phantom was slightly low than that in aluminum, and especially was not as high as that in aluminum for the ratio of fifth half-value layer to first half-value layer. X-ray quality passed through the breast may be higher than that of the breast surface because of the transmission in the breast tissue. So the subject contrast would be decreasing. The thickness of the breast under compression in the clinical practice correspond to about four or five half-value layer. Therefore the x-ray quality must be evaluated by BR-12 phantom, being composed nearly with the breast

慢性膵炎患者の全消化管通過に関する研究

Abnormalities of whole gut transit could contribute to the maldigestion and　digestive symptoms of chronic pancreatitis patients. Whole gut transit was measured by radiopaque markers method. Fifteen chronic pancreatitis patients (2 females, 13 males; age range 40-78 years) and 17 controls (4 females, 13 males, 32-73 years) were studied. Additionally, we also looked for evidence of autonomic neuropathy in the chronic pancreatitis patients by using cardiovascular tests. In chronic pancreatitis, whole gut transit was shorter than controls. These abnormalities were not influenced by the degree of autonomic neuropathy. We conclude that whole gut transit is shorter in chronic pancreatitis patients.慢性膵炎の患者の自覚症状や消化不良には消化管の通過異常が関与している可能性がある｡慢性膵炎患者15例と対象群17例で全消化管通過を測定した｡さらに慢性膵炎患者は自律神経機能について評価した｡全消化管通過は慢性膵炎患者は対象群より早いことが示された｡しかしその機序として推定された自律神経機能異常の有無では全消化管通過に差は認められず,慢性膵炎の消化管機能異常の原因は自律神経異常ではないと推定された

Effect of the Nature of Subsequent Environment on Oxytocin and Cortisol Secretion in Maltreated Children

Childhood maltreatment (CM), including abuse and neglect is a crucial factor that distorts child development. CM is associated with alterations in numerous brain regions, and may be associated with neuropeptide hormonal dysregulation. This study aimed to investigate differences in secretion patterns of cortisol (CT) and oxytocin (OT) among children who experienced CM, children living in residential care facilities and in unstable environments. Among 38 maltreated children, 23 (mean age = 12.2 years, SD = 3.0) were categorized as Settled and 15 (mean age = 13.1 years, SD = 2.2) as Unsettled. Twenty-six age- and gender-matched (mean age = 12.6 years, SD = 2.1), typically developing (TD) children were also included. Clinical and psychological assessments, including IQ and trauma evaluations were conducted for all participants. Age, gender and full-scale IQ were used as covariates in hormone analysis. Two saliva samples were collected, one on awakening, the other at bedtime. There were significant differences in the awakening CT levels of the Unsettled group, and in bedtime OT levels in the Settled group as compared with TD children, and between CM groups. Furthermore, there was a significant difference in trauma-symptomatic depression scores between the Settled and Unsettled CM group. These results suggest that CT diurnal secretions tend to be reactive to current stress rather previous experience. OT diurnal secretions are presumably hyper-regulated for coping with the environment to survive and thrive. By measuring salivary CT/OT diurnal patterns, hormonal dysregulation of CM children living in Settled environments and Unsettled environments was indicated

A Complicated Case of Tacrolimus-Induced Rapid Remission after Cesarean Section in the Early Third Trimester for Refractory Severe Ulcerative Colitis Flaring in the Initial Period of Gestation

A 36-year-old woman who had been diagnosed with ulcerative colitis at the age of 17 years was referred to our hospital because of severe abdominal pain and repeated bloody diarrhea that persisted during pregnancy despite combination therapy with high-dose corticosteroids and weekly granulocyte and monocyte adsorptive apheresis (GMA). She underwent combination therapy consisting of high-dose corticosteroids, intensive GMA (two sessions per week) and vancomycin, which was used to eradicate Clostridium difficile, under total parenteral nutrition control until the estimated weight of her fetus reached 1,000 g. This combination therapy was partially successful, resulting in almost complete disappearance of abdominal pain and a marked decrease in stool frequency. However bloody diarrhea persisted and the patient developed anemia and hypoalbuminemia and was unable to prolong her gestation time. Cesarean section was conducted at 28 weeks of gestation without any congenital abnormalities or neurological defects. Oral administration of tacrolimus was begun 7 days after cesarean section, which was followed by rapid induction of remission. Corticosteroids were then gradually tapered off. Tacrolimus is one therapeutic option after cesarean section in pregnant patients who do not respond well to GMA and high-dose corticosteroids for persistent active ulcerative colitis

Event-Related Desynchronization and Corticomuscular Coherence Observed During Volitional Swallow by Electroencephalography Recordings in Humans

Swallowing in humans involves many cortical areas although it is partly mediated by a series of brainstem reflexes. Cortical motor commands are sent to muscles during swallow. Previous works using magnetoencephalography showed event-related desynchronization (ERD) during swallow and corticomuscular coherence (CMC) during tongue movements in the bilateral sensorimotor and motor-related areas. However, there have been few analogous works that use electroencephalography (EEG). We investigated the ERD and CMC in the bilateral sensorimotor, premotor, and inferior prefrontal areas during volitional swallow by EEG recordings in 18 healthy human subjects. As a result, we found a significant ERD in the beta frequency band and CMC in the theta, alpha, and beta frequency bands during swallow in those cortical areas. These results suggest that EEG can detect the desynchronized activity and oscillatory interaction between the cortex and pharyngeal muscles in the bilateral sensorimotor, premotor, and inferior prefrontal areas during volitional swallow in humans

Case Report: Event-Related Desynchronization Observed During Volitional Swallow by Electroencephalography Recordings in ALS Patients With Dysphagia

Dysphagia is a severe disability affecting daily life in patients with amyotrophic lateral sclerosis (ALS). It is caused by degeneration of both the bulbar motor neurons and cortical motoneurons projecting to the oropharyngeal areas. A previous report showed decreased event-related desynchronization (ERD) in the medial sensorimotor areas in ALS dysphagic patients. In the process of degeneration, brain reorganization may also be induced in other areas than the sensorimotor cortices. Furthermore, ALS patients with dysphagia often show a longer duration of swallowing. However, there have been no reports on brain activity in other cortical areas and the time course of brain activity during prolonged swallowing in these patients. In this case report, we investigated the distribution and the time course of ERD and corticomuscular coherence (CMC) in the beta (15-25 Hz) frequency band during volitional swallow using electroencephalography (EEG) in two patients with ALS. Case 1 (a 71-year-old man) was diagnosed 2 years before the evaluation. His first symptom was muscle weakness in the right hand; 5 months later, dysphagia developed and exacerbated. Since his dietary intake decreased, he was given an implantable venous access port. Case 2 (a 64-year-old woman) was diagnosed 1 year before the evaluation. Her first symptom was open-nasal voice and dysarthria; 3 months later, dysphagia developed and exacerbated. She was given a percutaneous endoscopic gastrostomy. EEG recordings were performed during volitional swallowing, and the ERD was calculated. The average swallow durations were 7.6 ± 3.0 s in Case 1 and 8.3 ± 2.9 s in Case 2. The significant ERD was localized in the prefrontal and premotor areas and lasted from a few seconds after the initiation of swallowing to the end in Case 1. The ERD was localized in the lateral sensorimotor areas only at the initiation of swallowing in Case 2. CMC was not observed in either case. These results suggest that compensatory processes for cortical motor outputs might depend on individual patients and that a new therapeutic approach using ERD should be developed according to the individuality of ALS patients with dysphagia

A case of eosinophilic gastroenteritis with stenosis in the colon

大腸に全周性狭窄をきたした好酸球性胃腸炎の1例を報告した｡症例は54才の女性で,腹痛と下痢を主訴に来院した｡上部消化管検査では異常を認めなかったが,下部消化管造影検査と大腸内視鏡検査で横行結腸の全周性狭窄を認め,生検にて大腸粘膜の好酸球浸潤を認めた｡貝料理の摂取にて腹痛発作が出現したが,原因抗原は同定できなかった｡貝類の摂取を避けることにより,症状は消失し,末梢血液中の好酸球増多は消失した｡本邦ではこれまでに124例 の報告があるが,大腸に全周性の狭窄をきたす症例は稀であり,文献的考察を加え報告する｡We report a case of eosinophilic gastroenteritis with a stenosis in the transverse colon. A patient, 54 year-old-woman, presented to our clinic with abdominal pain and diarrhea. Esophagogastric endoscopy and biopsy were normal. Contrast barium enema examination and colonic endoscopy showed a stenotic segment in the transverce colon. Biopsy specimens obteind from the stenotic segment revealed moderate eosinophilic infiltration in the colonic mucosa. Oral intake of sea shells exacerbated her symptoms. Avoiding sea shells has resulted in the disappearance of symptoms and peripheral blood eosinophilia. The present case was discussed in comparison with the 124 cases heretofore reported in Japan

Low-Intensity Resistance Training with Moderate Blood Flow Restriction Appears Safe and Increases Skeletal Muscle Strength and Size in Cardiovascular Surgery Patients:A Pilot Study

We examined the safety and the effects of low-intensity resistance training (RT) with moderate blood flow restriction (KAATSU RT) on muscle strength and size in patients early after cardiac surgery. Cardiac patients (age 69.6 +/- 12.6 years, n = 21, M = 18) were randomly assigned to the control (n = 10) and the KAATSU RT group (n = 11). All patients had received a standard aerobic cardiac rehabilitation program. The KAATSU RT group additionally executed low-intensity leg extension and leg press exercises with moderate blood flow restriction twice a week for 3 months. RT-intensity and volume were increased gradually. We evaluated the anterior mid-thigh thickness (MTH), skeletal muscle mass index (SMI), handgrip strength, knee extensor strength, and walking speed at baseline, 5-7 days after cardiac surgery, and after 3 months. A physician monitored the electrocardiogram, rate of perceived exertion, and the color of the lower limbs during KAATSU RT. Creatine phosphokinase (CPK) and D-dimer were measured at baseline and after 3 months. There were no side effects during KAATSU RT. CPK and D-dimer were normal after 3 months. MTH, SMI, walking speed, and knee extensor strength increased after 3 months with KAATSU RT compared with baseline. Relatively low vs. high physical functioning patients tended to increase physical function more after 3 months with KAATSU RT. Low-intensity KAATSU RT as an adjuvant to standard cardiac rehabilitation can safely increase skeletal muscle strength and size in cardiovascular surgery patients.</p