Acta Medica Nagasakiensia
Print ISSN : 0001-6055
62 巻, 2 号
Acta Medica Nagasakiensia
選択された号の論文の6件中1~6を表示しています
ORIGINAL ARTICLES
  • Tamotsu Kuroki, Amane Kitasato, Tota Kugiyama, Takanori Hirayama, Ryo ...
    2019 年 62 巻 2 号 p. 43-47
    発行日: 2019年
    公開日: 2019/07/26
    ジャーナル フリー
    Postoperative delirium is one of the most common and important complications in patients who have undergone surgery. Although the precise mechanism of postoperative delirium is unclear, several risk factors have been reported. Here we investigated candidate risk factors for postoperative delirium after liver resection. This retrospective analysis included 112 consecutive patients who underwent an elective liver resection. Preoperative and intraoperative parameters were analyzed for their potential as risk factors of postoperative delirium. Thirty-one patients (27.7%) developed postoperative delirium. A multivariate analysis showed that advanced age (odds ratio [OR] = 1.189, 95% confidence interval [95%CI] = 1.081–1.309, p <0.001), the abdominal wall fat index (AFI) (OR 14.904, 95%CI 3.072–72.319, p <0.001), and non-laparoscopic surgery (OR 5.496, 95%CI 1.237–24.413, p=0.025) were independent risk factors for postoperative delirium. The AFI had a high OR for postoperative delirium. The area under the receiver-operating characteristic (ROC) curve was 0.806 (95%CI, 0.713–0.896) with a calculated optimal cut-off value of 1.0. The AFI is thus the most useful predictor for postoperative delirium after liver resection. Elderly patients with a higher AFI (>1.0) and open liver resection are associated with an increased risk of postoperative delirium.
  • Wataru Tarumi, Chizu Kumagai, Kazuyuki Shinohara
    2019 年 62 巻 2 号 p. 49-54
    発行日: 2019年
    公開日: 2019/07/26
    ジャーナル フリー
    The current studies have shown that some menopausal symptoms are due to a reduction in testosterone levels. However, testosterone replacement therapy is not the best option for menopausal women because possible occurrence of side effects due to testosterone replacement therapy cannot be ignored. Therefore, in order to explore a possibility that olfactory exposure to essential oils increase testosterone release in menopausal women, we measured salivary testosterone concentration before and after olfactory stimulation by the essential oils.  This experiment was conducted in a laboratory dedicated to odor exposure experiments and in a ventilate laboratory at Nagasaki University. In order to minimize the influence of visual stimuli on the subjects, the room lighting was turned off and light from the outside was shielded by a curtain.  Perimenopausal women (n = 15 per essential oil) were exposed first to propylene glycol or dipropylene glycol as a control and then to 1 of 10 essential oils (geranium, rose otto, orange sweet, lavender, neroli, frankincense, jasmine absolute, ylang ylang, roman chamomile, and clary sage) dissolved in propylene glycol or dipropylene at 2 l/min for 20 minutes on each experimental day. We measured the testosterone concentrations in saliva before and after each odor exposure in these perimenopausal women.  The results of this study demonstrate that olfactory stimulation by jasmine absolute, roman chamomile, and clary sage essential oils increased salivary testosterone. The clinical significance of this should be examined an empirical study in the future.
  • Makiko Yamasaki, Shuhei Abe, Kiyonori Miura, Hideaki Masuzaki
    2019 年 62 巻 2 号 p. 55-61
    発行日: 2019年
    公開日: 2019/07/26
    ジャーナル フリー
    Aim: Self-sampling devices for oncogenic human papillomavirus (HPV) testing may be useful for improving participation in cervical cancer screening. The aim of this study was to investigate the effects of HPV self-sampling devices for non-attenders, who have not participated in regular cervical cancer screening. Methods: To determine whether HPV self-sampling devices improve participation in cervical cancer screening on a remote island, non-attenders aged 20–49 years were included in this study. Participation was defined as returning a self-sampling device and/or participating in a conventional cytology-based cervical cancer screening. From April 2014 to May 2015, written informed consent for participation in this study was obtained from 249 of 2,986 non-attenders in the Goto Islands and randomly assigned to the “re-call” group (n=124) or the self-sampling group (n=125). Results: The participation (by returning the HPV self-sampling device and/or attending a cervical cancer screening) rate was 12.1% (n = 15) in the “re-call” group and 76.0% (n = 95) in the self-sampling group. Only 50% of HPV-positive women (n=5) underwent cytological testing, and abnormal cytological findings were detected in two cases. For these two patients with abnormal cytology, carcinoma in situ was detected and treated. Conclusions: Offering HPV self-sampling devices may improve participation in cervical cancer screening on remote islands in Japan.
CASE REPORT
  • Kazuo To, Toshio Shiraishi, Ayako Fukushima, Takaaki Nakatsukasa, Yuma ...
    2019 年 62 巻 2 号 p. 63-68
    発行日: 2019年
    公開日: 2019/07/26
    ジャーナル フリー
    A 46-year-old woman was admitted to our hospital and was diagnosed with a gastric submucosal tumor at the medical examination. Upper endoscopic examination revealed a submucosal tumor in the lower body of the stomach. Abdominal computed tomography (CT) revealed a large tumor of dimensions 51 × 32 mm in the lower body of the stomach with a mixed appearance: a solid part exhibiting a contrast effect and a cystic part exhibiting no contrast. Endoscopic ultrasonic fine needle aspiration biopsy (EUS-FNAB) was performed, and a gastrointestinal stromal tumor (GIST) was diagnosed by immunohistopathological examination. Laparoscopic surgery with five ports was performed for resection. After securing the safety margin the tumor was resected circumferentially using an ultrasonically activated device (USAD). Resection entailed a significant portion of the gastric wall. During surgery, a support yarn hooked in the minor axis direction, and the defect was closed using an automatic suturing device three times. According to the third edition of the GIST clinical practice guidelines, indications for laparoscopic resection of GISTs over 5 cm have been relaxed. It was considered that careful laparoscopic resection would be possible even though this was a large GIST exceeding 5 cm.
  • Yushi Kawaguchi, Nozomi Iwanaga, Tohru Michitsuji, Chieko Kawahara, Yo ...
    2019 年 62 巻 2 号 p. 69-72
    発行日: 2019年
    公開日: 2019/07/26
    ジャーナル フリー
    An octogenarian female who developed edema in the lower extremities and exertional dyspnea was admitted to our hospital. A diagnosis of lung carcinoma was made from radiographic images and lung biopsy findings. Along with abnormal lung shadows, persistent pyrexia, elevated serum C-reactive protein levels, and progressive kidney dysfunction were also observed. The findings of the myeloperoxidase-antineutrophil cytoplasmic antibody led to a diagnosis of microscopic polyangiitis together with lung and kidney symptoms. Physicians should be aware that microscopic polyangiitis and lung adenocarcinoma may develop concomitantly.
  • Takeshi Watanabe, Fujinobu Tanaka, Yuji Oishi, Ryota Oku, Kenji So
    2019 年 62 巻 2 号 p. 73-76
    発行日: 2019年
    公開日: 2019/07/26
    ジャーナル フリー
     Recurrent nerve (inferior laryngeal nerve) injury in thyroid surgery is a very severe and serious complication that impairs patient’s quality of life and it is one of the major complications in thyroid surgery. If the recurrent nerve can be detected during the surgery, injury can be prevented. We report a case of a woman with right non-recurrent inferior laryngeal nerve (NRILN) branching from the vagus nerve directly at the level of the right thyroid upper lobe in thyroid surgery.  NRILN is a very rare anatomic variation and is associated with aberrant right subclavian artery (ARSA). In such cases, preoperative contrast-enhanced computed tomography should be monitored closely to avoid injuring this nerve.
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