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Volume 71, Issue 4
Displaying 1-8 of 8 articles from this issue
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ORIGINALS
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Kazuhiko HANASHIRO, Jun MOTOMURA, Masanori SUNAGAWA2022 Volume 71 Issue 4 Pages 309-320
Published: 2022
Released on J-STAGE: December 16, 2022
JOURNAL FREE ACCESSLiver steatosis (also known as fatty liver) is strongly associated with single nucleotide polymorphisms (SNPs) in the patatin-like phospholipase domain containing3 (PNPLA3) gene. The relationship between liver steatosis and PNPLA3 SNP was investigated in the northern part of Okinawa (Yambaru) in light of a report indicating that Okinawa Prefecture has the highest prevalence of liver steatosis in Japan. Abdominal ultrasonography was performed in 178 patients at health check-ups to evaluate liver steatosis based on hepatorenal contrast. The steatosis ratio was higher in males (39.5%) than in females (18.6%; p=0.0020). Among the 178 patients, 74 were selected for PNPLA3 SNP analysis, including 36 with and 38 without liver steatosis, with matching for age and sex between the groups. In the PNPLA3 SNP analysis, the ratios of the TT, GT/TG, and GG alleles were 16.2%, 58.1%, and 25.7%, respectively. Women with liver steatosis had a higher body mass index (p=0.0003) and body fat percentage (p<0.0001) than women without liver steatosis and those with the GG allele had a significantly higher body fat percentage (41.0±6.5%) than those with the TT allele (29.8±7.1%; p=0.0203). Multiple logistic regression revealed a significant relationship between liver steatosis and number of risk alleles G (adjusted odds ratio: 4.549; p=0.0073) as well as body fat percentage (adjusted odds ratio: 1.085; p=0.0329). Furthermore, the higher prevalence of risk alleles (G) in the PNPLA3 gene in Okinawa than in other regions possibly explains the higher prevalence of liver steatosis in Okinawa. Thus, effectively utilizing abdominal ultrasonography in health check-ups, detecting liver steatosis at an early stage, and then providing advice on lifestyle improvements is crucial.View full abstractDownload PDF (905K) -
: A Case of Collaboration Involving the Anan-cho Council of Social Welfare in an Aging, Depopulated VillageMorihito GOUDA2022 Volume 71 Issue 4 Pages 321-331
Published: 2022
Released on J-STAGE: December 16, 2022
JOURNAL FREE ACCESSThis study used a modified grounded theory approach to analyze a case of agriculturewelfare collaboration involving the Anan-cho Council of Social Welfare in order to reveal the process by which the agriculture-welfare collaboration shifted from practical action to intermediate support. A diagram of 14 concepts and 4 categories was developed based on the analysis results. Further, the results were presented in the form of a narrative using the following concepts and categories. In the agriculture-welfare collaboration implemented by the Anan-cho Council of Social Welfare in an aging, depopulated village, [assessment of the village community] was conducted first through activities such as <making visits to the village> and then starting to provide [agricultural support to help residents continue to live at home]. At the same time as <completion of the agricultural support project>, there was a shift in activities [from the support for elderly residents who live at home to the support for individuals with disabilities to find employment] through <practical agricultural activities at the facility run by the Anan-cho Council of Social Welfare>. Then, <matching of activities at a welfare facility for individuals with disabilities with activities to cultivate traditional vegetables> was conducted for the [achievement of a community-based inclusive society] through <coordination of social resources with individuals with disabilities and local residents>. Our results suggest that the agriculturewelfare collaboration implemented by the Anan-cho Council of Social Welfare offered support for independent living in the aging, depopulated village, by which “welfare capability in the community” was enhanced by utilizing “the community's capabilities in welfare”, and that the “driving force of welfare in the community” was generated by combining those capabilities, leading to the achievement of a community-based inclusive society, albeit in a small scale, in a depopulated village.View full abstractDownload PDF (889K)
CASE REPORTS
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Hiroshi NAKANO, Eisei ENDO, Akira MATSUISHI, Masashi KANAZAWA2022 Volume 71 Issue 4 Pages 332-336
Published: 2022
Released on J-STAGE: December 16, 2022
JOURNAL FREE ACCESSAn 85-year-old woman was transported to our hospital because of nausea and abdominal pain. Contrast-enhanced computed tomography revealed type IV hiatal hernia with incarcerated necrotic transverse colon. Emergency laparotomy was performed. When the incarcerated stomach and transverse colon were returned to the abdominal cavity, the transverse colon was resected and anastomosed due to necrosis. After the hiatal defect was closed, the Toupet method was also performed. No regurgitation or obstruction was observed after the operation, and the patient was discharged 63 days postoperatively. Here we report this rare case of intestinal necrosis due to type IV hiatal hernia and review the literature.View full abstractDownload PDF (1921K) -
Cellulitis Due to Umbilical Compression Material for Adhesive Strapping Therapy for Umbilical HerniaGenki TSUJI, Azuma IKARI, Michio SUZUKI, Tetsuo KUBOTA2022 Volume 71 Issue 4 Pages 337-341
Published: 2022
Released on J-STAGE: December 16, 2022
JOURNAL FREE ACCESSAdhesive strapping therapy is widely used for umbilical hernia in infants and serious complications are rare. Here we report a case of a 2-month-old girl who developed cellulitis during adhesive strapping therapy with an umbilical compression material and required hospitalization. Five days after the start of adhesive strapping therapy, she presented to our hospital with a laceration, intense redness of the skin, induration, and drainage of pus at the compression site. Her white blood cell count was 13,200/μL (neutrophils 56%) and C-reactive protein level was 3.78 mg/dL. Ultrasonography showed hyper-echogenicity of the surrounding fatty tissue and blood flow signals, so cellulitis was diagnosed. Symptoms rapidly improved after 5 days of antibiotic treatment. Cellulitis during adhesive strapping therapy is rare but should be kept in mind as a potential complication.View full abstractDownload PDF (1725K) -
Emiri SUGIYAMA, Yasuharu TOKUYAMA, Hidenori OJIO, Mana KAWAJIRI, Kosuk ...2022 Volume 71 Issue 4 Pages 342-347
Published: 2022
Released on J-STAGE: December 16, 2022
JOURNAL FREE ACCESSA woman in her late 80s visited a local physician complaining of nausea, loss of appetite, and constipation. She was referred to our hospital for detailed examination. Computed tomography (CT) revealed that the entire stomach, pancreas, spleen, transverse colon, and small intestine were prolapsed into the mediastinum and left thoracic cavity through the esophageal hiatus, which was dilated. Moreover, the small intestine was narrowed at the hiatus and dilated in the abdominal cavity, presenting ileus. After diagnosing type IV esophageal hiatal hernia with upside-down stomach and starting conservative treatment, the ileus improved and oral intake was resumed. Subsequent CT showed continued prolapse of the pancreas, spleen, transverse colon, small intestine, and entire stomach, but CT taken 5 years earlier had shown similar findings of prolapse. Thus, we decided not to perform surgery and instead opted for close follow-up after discharge. The patient is well without any symptoms of obstruction as of 1.5 years after discharge.View full abstractDownload PDF (1824K) -
Naomi KIMURA, Yuta KATO, Minami HASHIMOTO, Keika YAMAUCHI, Emi KONDO, ...2022 Volume 71 Issue 4 Pages 348-356
Published: 2022
Released on J-STAGE: December 16, 2022
JOURNAL FREE ACCESSThe patient was a 68-year-old woman who was diagnosed with stage IIIA cervical cancer and pyometra. Concurrent chemoradiotherapy was planned. She was admitted to our hospital 3 weeks after the initial examination due to vaginal bleeding and worsening of lower abdominal pain. On hospital day 5, she developed a fever, and free gas in the peritoneal cavity and ascites were confirmed by contrast-enhanced computed tomography. Emergency surgery was performed for suspected generalized peritonitis attributed to perforation in the digestive tract or uterus. A large amount of purulent ascites and 2 perforations in the anterior wall of the uterus, but none in the digestive tract, were observed. Peritoneal lavage and drainage were performed, and a colostomy was created. The patient was managed in the intensive care unit until postoperative day 13 due to septic shock and acute renal failure. After the peritonitis resolved, radiation therapy alone was provided, and then chemotherapy was started to treat residual lesions. Pyometra recurred, and transvaginal drainage was performed to prevent perforation of the uterus. However, a few days later, a colouterine fistula and an enterocutaneous fistula developed simultaneously, and her general condition worsened. In advanced cervical cancer complicated by pyometra, various complications can develop that are difficult to manage (e.g., uterine perforation and fistula formation due to radiation enteritis and dermatitis).
This case demonstrates the importance of uterine drainage at appropriate timing, which can contribute to improved prognosis.View full abstractDownload PDF (5427K) -
Hajime ARIMA, Takatomo TESAKI, Kazushi OTA, Noriaki SEKIYA, Makoto OYA ...2022 Volume 71 Issue 4 Pages 357-362
Published: 2022
Released on J-STAGE: December 16, 2022
JOURNAL FREE ACCESSMushroom poisoning with Russula subnigricans can lead to severe rhabdomyolysis. Here we describe a case of severe mushroom poisoning that resulted in severe rhabdomyolysis with acute kidney injury, hypotension, and shock 12 h after oral ingestion of R. subnigricans. The patient's serum myoglobin was 6,475 ng/mL and his creatine phosphokinase (CK) level was 38,100 IU/L on admission. Although aggressive fluid resuscitation and on-line hemodiafiltration (OHDF) were initiated, vascular permeability and shock failed to improve. Continuous hemodiafiltration (CHDF) and OHDF was repeated, but their effects were limited. He later developed generalized edema, and his weight increased from 55 kg to 72.5 kg within 4 days. On day 5, his CK level reached 203,800 IU/L. He died 160 h after oral ingestion of R. subnigricans. CHDF and OHDF filter out circulating myoglobin, potassium, and some toxic substances released due to muscle cell disruption. Although OHDF was performed nearly 24 h a day in our patient, it failed to remove toxic intracellular components from muscle cells due to the severe R. subnigricans mushroom poisoning in this case.View full abstractDownload PDF (1220K)
REGIONAL MEETING
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2022 Volume 71 Issue 4 Pages 363-364
Published: 2022
Released on J-STAGE: December 16, 2022
JOURNAL FREE ACCESSDownload PDF (609K)
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