岡山医学会雑誌
Online ISSN : 1882-4528
Print ISSN : 0030-1558
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129 巻, 2 号
選択された号の論文の16件中1～16を表示しています
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平成28年度岡山医学会賞紹介記事
原著
  • 糖尿病患者の「治療に伴うストレス認知尺度」の開発
    住吉 和子, 川田 智恵子, 岡本 辰夫, 大橋 睦子, 實金 栄, 高林 範子, 太湯 好子, 金 外淑, 和田 淳, 四方 賢一, 中嶋 ...
    2017 年 129 巻 2 号 p. 93-99
    発行日: 2017/08/01
    公開日: 2017/09/01
    DOIhttps://doi.org/10.4044/joma.129.93
    ジャーナル フリー
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     The purpose of this study was to establish a measurement scale for “stress recognition in receiving treatment” in patients with diabetes. A self-completed questionnaire was distributed to 149 type-2 diabetes outpatients in March-May 2015 after authorization from Okayama Prefectural University and the ethics committee of the hospital.
     The “stress recognition in receiving treatment” scale was designed as a second-order factor model consisting of 14 items and the following four factors : the respondent's sense of (1) the burden of being sick, (2) the burden on interpersonal relationships, (3) the burden of treatment, and (4) the burden of medical expenses.
     Stress recognition in treatment means recognition of being stressed in the burdens related to the illness, interpersonal relationships, treatment and medical expenses.
     The suitability of the questionnaire data was then evaluated with a structural equation model. The suitability of the factor model to the data satisfied the statistically acceptable standards as Comparative Fit Index (CFI) ＝0.931, Root Mean Square Error of Approximation (RMSEA) ＝0.096, Tucker-Lewis Index (TLI) ＝0.946.
     As the construct validity was not examined by the scale created in this study or by existing scale, it was verified by using the degrees of mental healthiness and HbA1c that were proved to be associated with the sense of burden.
     In addition, the construct validity of the questionnaire was supported by a significant correlation between the Japanese version of the WHO-Five Well-being Index (S-WHO-5-J) and the patients' HbA1c levels. The use of this measure is expected to contribute to the early detection of a decline in a diabetic patient's activities of daily living and to the early confirmation of patients' support status.
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短報
  • 岡山県健診受診者の慢性腎臓病 （CKD） 認知度 ～2015年度～
    内田 治仁, 杉山 斉, 宮崎 雅史, 和田 淳, 四方 賢一, 柏原 直樹, 槇野 博史
    2017 年 129 巻 2 号 p. 101-105
    発行日: 2017/08/01
    公開日: 2017/09/01
    DOIhttps://doi.org/10.4044/joma.129.101
    ジャーナル フリー
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     Public education programs about chronic kidney disease (CKD) have been performed in Okayama, Japan for the past 10 years. The present study investigated the perception of CKD in a general population in Okayama. In October and November 2015, a questionnaire survey was distributed by 12 medical centers in five medical districts in Okayama prefecture. A total of 7,022 respondents who underwent their physical checkup at these centers answered the questionnaire. In response to a questionnaire item asking about the respondent's familiarity with the term “CKD,” only 4% of the respondents answered “know it well” and 10% answered “unfamiliar.” In contrast, in response to a questionnaire item asking about the respondent's familiarity with “chronic kidney disease,” 27% answered “know it well” and 38% answered “unfamiliar.” The leading avenue by which the respondents learned about CKD/chronic kidney disease was television, followed by newspapers, magazines, and a family doctor or nurse. The leading component which the respondents considered essential for the diagnosis of CKD/chronic kidney disease was proteinuria. A stratified analysis demonstrated a higher recognition of “CKD” or “chronic kidney disease” in the medical districts in northern Okayama prefecture compared to southern Okayama prefecture. These results indicated that the awareness of CKD in Okayama prefecture is still inadequate. Many people did not appear to realize that the term “CKD” represents “chronic kidney disease”. Further continuous public education efforts are required to enlighten people about CKD/chronic kidney disease.
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症例報告
  • Klebsiella pneumoniae を起因菌とした後腹膜膿瘍からの炎症波及により腹部大動脈破裂に至った一例
    山崎 賢士, 榊間 昌哲, 長倉 優花, 橋本 紘幸, 田代 傑, 三輪 真史, 米村 克彦
    2017 年 129 巻 2 号 p. 107-109
    発行日: 2017/08/01
    公開日: 2017/09/01
    DOIhttps://doi.org/10.4044/joma.129.107
    ジャーナル フリー
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     An 80-year-old Japanese man was admitted to our hospital in April 2016 with an acute high-grade fever and back pain. A systemic contrast-enhanced computed tomography scan disclosed a retroperitoneal abscess around his aorta. The blood culture revealed Klebsiella pneumoniae. Antibiotics (Cefotaxime 1 g i.v. q 6 hours) were administered, but the patient's symptoms worsened. The abscess then ruptured the aorta. An emergency surgical repair was done, and the patient recovered. Invasive Klebsiella pneumoniae syndrome has been detected in southeast Asia over the past two decades, and here we describe a rare case of a retroperitoneal abscess caused by Klebsiella pneumoniae that ruptured the aorta.
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  • 家族性大腸腺腫症術後20年後に小腸癌を発症した1例
    杉原 雄策, 川野 誠司, 原田 馨太, 高嶋 志保, 竹井 大介, 井口 俊博, 高原 政宏, 平岡 佐規子, 母里 淑子, 岸本 浩行, ...
    2017 年 129 巻 2 号 p. 111-114
    発行日: 2017/08/01
    公開日: 2017/09/01
    DOIhttps://doi.org/10.4044/joma.129.111
    ジャーナル フリー
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     A 58-year-old Japanese man visited a local clinic for the evaluation of a stomachache. He was diagnosed with intestinal obstruction. His medical history included a proctocolectomy at the age of 38 years, due to familial adenomatous polyposis (FAP). He was referred to our institution, where he underwent a computed tomography examination and endoscopy of the small intestine. The pathological diagnosis was adenocarcinoma. No invasive or metastatic lesions were observed. Therefore, partial resection of the ileum with lymphadenectomy and reconstruction of the ileostomy were performed. Pathological examination revealed that the tumor was type 2, pT3 (SS) , pN1, pPM0, pDM0, pRM0, INFb, ly1, v1, pEX0, PN0. Twenty-nine days after the surgery, the patient was diagnosed with lung metastasis and he underwent lung radiofrequency ablation. We suggest that long-term follow-up is necessary for patients after surgery for FAP, because of the risk of malignant disease developing in other organs.
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  • POEM (Per-Oral Endoscopic Myotomy) を施行した食道アカラシアの1例
    杉原 雄策, 原田 馨太, 加藤 諒, 山内 健司, 高嶋 志保, 竹井 大介, 井口 俊博, 高原 政宏, 川野 誠司, 平岡 佐規子, ...
    2017 年 129 巻 2 号 p. 115-121
    発行日: 2017/08/01
    公開日: 2017/09/01
    DOIhttps://doi.org/10.4044/joma.129.115
    ジャーナル フリー
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     Esophageal achalasia is a disorder of the lower esophageal sphincter muscle. Patients present with dysphagia, chest pain, vomiting, and aspiration. Esophageal achalasia had traditionally been treated with esophageal achalasia balloon dilatation and the Heller-Dor method, but in recent years, the use of per-oral endoscopic myotomy (POEM) has increased. Our patient, a 39-yr-old male, began experiencing dysphagia 4 years prior to his referral to our hospital. Based on the results of esophagogastroduodenoscopy, esophageal radiography and high-resolution manometry, we made the diagnosis of esophageal achalasia (Chicago classification type I) . After informed consent from the patient and his family and approval from our hospital's ethics committee were obtained, we performed a POEM. The patient was discharged on the 4th day post-surgery. At the 1-year post-operative examination, no worsening of symptoms and no relapse were observed. POEM is an excellent treatment method for esophageal achalasia from the perspective of therapeutic effect and prevention of invasion. We recommend that it be considered as the first-choice treatment for achalasia. However, accessibility to the procedure itself is limited due to the few adequately trained operators worldwide. POEM should thus be performed by an expert operator at a high-volume center.
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