岡山医学会雑誌
Online ISSN : 1882-4528
Print ISSN : 0030-1558
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129 巻, 1 号
選択された号の論文の15件中1～15を表示しています
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平成27年度岡山医学会賞紹介記事
総説
原著
  • 骨盤臓器脱に対するTVM手術前後の性機能に関する検討
    松本 裕子
    2017 年 129 巻 1 号 p. 17-22
    発行日: 2017/04/03
    公開日: 2017/05/01
    DOIhttps://doi.org/10.4044/joma.129.17
    ジャーナル フリー
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    　We prospectively assessed sexual function before and after a tension-free vaginal mesh (TVM) procedure for pelvic organ prolapse (POP). From April 2007 to March 2009, a total of 42 patients, who reported having an active sex life preoperatively underwent TVM for POP. Female sexual function was evaluated with the self-reporting, multiple-domain Female Sexual Function Index(FSFI). We administered the FSFI to all of the patients before and at 3, 6, and 12 months after surgery. The mean age at surgery was 61.3±7.1 years. Before the TVM surgery, the FSFI score was very low (12.5±9.0). The total FSFI score was improved significantly at 12 months after surgery (17.4±7.7). The Arousal, Lubrication and Orgasm domains were significantly improved at 12 months after surgery. POP appears to have a significant negative impact on female sexual function. Our findings indicate that TVM for POP improved sexual function in a group of Japanese women with POP.
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  • アントラキノンの長期連用，及び摂取中止が大腸粘膜に与える影響
    岩野 英二, 岩室 雅也, 岡田 裕之
    2017 年 129 巻 1 号 p. 23-30
    発行日: 2017/04/03
    公開日: 2017/05/01
    DOIhttps://doi.org/10.4044/joma.129.23
    ジャーナル フリー
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    　Anthraquinone, an anthracene derivatives, is widely used as a purgative medicine. The long-term use of anthraquinone is known to cause melanosis coli and elevated lesions in the colon. However, the clinical course of patients who take anthraquinone over a long term and those who discontinue the drug has not been fully investigated. Here we investigated 22 patients who had colonic mucosal changes (i.e., melanosis coli and elevated lesions) who had been taking anthraquinone for at least one year and discontinued it. We classified the elevated lesions into two subtypes: the small-lesion, which included multiple small nodules that were < 2 mm in dia., and the large-lesion, which included a single or multiple nodules of ≥ 2-mm dia. We used colonoscopy to investigate the changes of colonic lesions between before and after the discontinuation of anthraquinone. The results indicated that the nodules of the small-lesion group were lymphoid follicle hyperplasia. In the large-lesion group, adenoma was most frequently observed (n＝118), followed by hyperplastic polyp (n＝52) and inflammatory changes with edema (n＝22). Melanosis coli and elevated lesions were decreased or invisible after the discontinuation of anthraquinone. Our findings thus suggest that the long-term use of anthraquinone may cause some type of elevated lesions due to chronic inflammation. It is recommended that the use of anthraquinone be limited to a short term.
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短報
  • チーム医療による術後せん妄発症予防についての検討
    小田 幸治, 大栁 貴惠, 山口 恵, 馬場 華奈己, 江角 悟, 千田 真友子, 井上 真一郎, 川田 清宏, 岡部 伸幸, 山田 了士
    2017 年 129 巻 1 号 p. 31-34
    発行日: 2017/04/03
    公開日: 2017/05/01
    DOIhttps://doi.org/10.4044/joma.129.31
    ジャーナル フリー
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    　We launched our Psychiatry Liaison Team in the Department of Neuropsychiatry of Okayama University Hospital in 2009. Since nearly half of all new cases had suffered delirium, we subsequently launched our Delirium Control Team in 2011.
    　The main purposes of the Delirium Control Team are to prevent the occurrence of delirium through early interventions by various medical staff, and to educate co-medical staff about delirium care. In this article, we present the recent activities and future outlook of both the Psychiatry Liaison Team and the Delirium Control Team.
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症例報告
  • 抗菌化学療法で保存的に閉鎖した放線菌症による難治性皮膚直腸膀胱瘻の1例
    桂 佑貴, 松川 啓義, 加藤 卓也, 杉原 正大, 小島 康知, 塩崎 滋弘
    2017 年 129 巻 1 号 p. 35-39
    発行日: 2017/04/03
    公開日: 2017/05/01
    DOIhttps://doi.org/10.4044/joma.129.35
    ジャーナル フリー
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    　The patient was a 35-year-old Japanese man diagnosed with appendicitis with abscess formation. An appendectomy was performed, but a refractory surgical wound infection developed, and eventually a cutaneous-rectovesical fistula was detected. In a review of the first-time CT scan, a small high-density construction resembling a bone from a fish was detected in the ileum. The histopathological examination revealed granules of actinomyces. These findings suggested that abdominal actinomycosis due to intestinal mucosal breakage by the fish bone caused the secondary appendicitis, and that after the appendectomy, residual actinomyces caused the cutaneous-rectovesical fistula.
    　After the diagnosis, total parenteral nutrition and a long-term administration of antibiotics improved the patient's clinical symptoms, and the fistula closed within a month. Antibiotics were administered for 6 months, and there has been no recurrence for 6-1/2 years. Because actinomycosis is difficult to diagnose based on the typical clinical features, a direct identification of the infecting organism from a tissue sample or from sulfur granules is required for the definitive diagnosis. Actinomyces is also known to cause fistula formation, and intestinal penetration caused by a fish bone may indicate abdominal actinomycosis. A rectovesical fistula requires surgical intervention in most cases, but in cases caused by abdominal actinomycosis, such a fistula may be cured by conservative therapy, as in our patient's case. It is important to consider the possibility of actinomycosis when a refractory rectovesical fistula is observed.
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  • 40年経過した食道アカラシア術後の食道拡張・下部食道狭窄症に対して胸腔鏡下食道亜全摘が著効した1例
    桂 佑貴, 白川 靖博, 田邊 俊介, 前田 直見, 野間 和広, 藤原 俊義
    2017 年 129 巻 1 号 p. 41-44
    発行日: 2017/04/03
    公開日: 2017/05/01
    DOIhttps://doi.org/10.4044/joma.129.41
    ジャーナル フリー
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    　When planning surgery for achalasia, it is important to plan for adequate myotomy and prevention of reflux. However, achalasia may recur if the procedure was inadequate or in patients with a long-term course. The present case is a 68-year-old woman who underwent myotomy of the lower esophageal sphincter 40 years ago, but recently reported difficulty in swallowing. Dilatation of the thoracic esophagus and stenosis of the abdominal esophagus were identified by examination, and the patient was diagnosed with recurrence of achalasia. After percutaneous endoscopic gastrostomy was performed to recover nutritional status, thoracoscopic esophagectomy was carried out. The patient's post-operative course was uneventful and oral intake was enabled. At the time of writing, there has been no re-recurrence. There is no standard therapy for post-operative recurrence of achalasia. We believe that thoracoscopic esophagectomy for the recurrence of achalasia is a safe and minimally invasive alternative to conventional surgery.
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