岡山医学会雑誌
Online ISSN : 1882-4528
Print ISSN : 0030-1558
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127 巻, 1 号
選択された号の論文の18件中1～18を表示しています
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平成25年度岡山医学会賞紹介記事
原著
  • 岡山大学勤務医師による非常勤勤務を通した地域医療支援の現状調査
    勅使川 早苗, 岩瀬 敏秀, 金森 達也, 川畑 智子, 佐藤 勝, 片岡 仁美
    2015 年 127 巻 1 号 p. 13-17
    発行日: 2015/04/01
    公開日: 2015/05/01
    DOIhttps://doi.org/10.4044/joma.127.13
    ジャーナル フリー
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      We investigated the situation of how physicians at Okayama University support local medical institutions by serving as a part-time worker, and analyzed the difference between the five medical districts of Okayama prefecture and other prefectures. Many physicians (actual number of physicians, full-time equivalent number of physicians) served in the southeastern region of the Okayama prefecture (339, 82.2). On the other hand, fewer physicians (42, 11.4) served in Takahashi・Niimi in the northwestern region of Okayama. Many physicians also served in Hiroshima prefecture (193, 48.8), Hyogo prefecture (109, 26.7), and the four prefectures of Shikoku Island (81, 23.6).
      It has been clarified that many physicians at Okayama University are working on a part-time basis to support local and community medical institutions in the wide area of Okayama prefecture, Hiroshima prefecture, Hyogo prefecture and the four prefectures of Shikoku Island.
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症例報告
  • 憩室切除と輪状咽頭筋切開術を行ったZenker憩室症の１例
    二宮 卓之, 金谷 信彦, 勝田 浩, 田中屋 宏爾, 青木 秀樹, 竹内 仁司
    2015 年 127 巻 1 号 p. 19-23
    発行日: 2015/04/01
    公開日: 2015/05/01
    DOIhttps://doi.org/10.4044/joma.127.19
    ジャーナル フリー
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      Zenker's diverticulum is a very rare disease among gastorointestinal diverticulum. We report a case of Zenker's diverticulum successfully treated with diverticulectomy and cricophalyngial myotomy. A 71-year-old male complained of aspirating water for two years. He was diagnosed as Zenker's diverticulum. Due to his severe symptoms, the operation was performed in an open-neck approach. The left recurrent laryngeal nerve was identified and preserved. An incision was made in the diverticulum wall, and the internal diameter of normal cervical esophagus was measured. The diverticulum was then excised with an automatic suture device in the minor axis direction of the esophagus. A cricopharyngeal myotomy was conducted, because this muscle was fibrotic and stiffened. The patient's symptoms disappeared after the operation. Diverticulectomy and cricopharyngeal myotomy through an open-neck approach is a safe and reliable method that follows, direct access to the diverticulum and recurrent laryngeal nerve.
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  • 家族性大腸腺腫症（FAP）に合併した同時性５多発大腸癌に対してリンパ節郭清を伴う腹腔鏡下大腸全摘術を施行した１例
    加藤 大, 大石 正博, 小寺 正人, 山村 方夫, 池田 秀明, 水野 憲治, 山下 裕
    2015 年 127 巻 1 号 p. 25-29
    発行日: 2015/04/01
    公開日: 2015/05/01
    DOIhttps://doi.org/10.4044/joma.127.25
    ジャーナル フリー
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      A 49-year-old Japanese man visited our hospital with chief complaints of difficulty with and bleeding during defecation. After a detailed examination, he was diagnosed with familial adenomatous polyposis (FAP) with multiple (five) colorectal cancers. The tumors were located in the right-sided, left-sided, and sigmoid colon, and the lower rectum. Regional lymph node involvement was observed, but no metastasis to other organs was detected. We, therefore, performed a laparoscopic total colectomy with superior mesenteric artery (SMA) and inferior mesenteric artery (IMA) lymph node dissection. We were able to perform minimally invasive and cosmetically acceptable surgery using laparoscopy instead of highly-invasive open abdominal surgery. Our search of the literature revealed no reported cases of laparoscopic total colectomy with lymph node dissection for FAP with multiple colorectal cancers, making the present case the first to be reported in the literature.
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  • 恥骨上腹壁瘢痕ヘルニアに対して腹腔鏡下修復術を施行した１例
    中野 敢友, 井谷 史嗣, 淺海 信也, 大川 広, 吉本 匡志, 伊藤 雅典, 門田 一晃, 黒瀬 洋平, 日置 勝義, 石井 龍宏, 貞 ...
    2015 年 127 巻 1 号 p. 31-34
    発行日: 2015/04/01
    公開日: 2015/05/01
    DOIhttps://doi.org/10.4044/joma.127.31
    ジャーナル フリー
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      Laparoscopic repair of a suprapubic hernia typically carries a high risk of recurrence, because fixation of the mesh in the peripubic area is difficult. We herein report a patient undergoing laparoscopic repair of a suprapubic hernia, along with a description of the surgical techniques employed.
      A 78-year-old woman visited our hospital with a chief complaint of swelling at the median hypogastric incision site after surgery for an ovarian cyst performed at age 25 years. Laparoscopic examination revealed the hernia orifice to be 3.5×3.0 cm in size and that the distance between the caudal margin of the hernia orifice and the pubis was 2.5 cm. Parietex composite mesh was used for fixation through all layers of the abdominal wall with non-absorbable sutures and tack fixation. On the pubic side, after the pubis had been exposed by separating it from the bladder, we performed mesh fixation through all layers of the abdominal wall immediately above the pubis with the sutures placed inside the mesh, combined with tack mesh fixation directly to the pubis. This procedure enabled definite fixation of the mesh. Six days after surgery, she was discharged without complications. To date, two years and five months after surgery, no recurrence has been observed.
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  • 胆嚢十二指腸瘻に対し合併症なく手術を行えた発作性夜間血色素尿症の１例
    加藤 卓也, 松川 啓義, 塩崎 滋弘, 藤 智和, 藤原 康宏, 二宮 基樹
    2015 年 127 巻 1 号 p. 35-39
    発行日: 2015/04/01
    公開日: 2015/05/01
    DOIhttps://doi.org/10.4044/joma.127.35
    ジャーナル フリー
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      In cases of paroxysmal nocturnal hemoglobinuria (PNH), attention must be paid to potential complications such as thrombosis and hemolysis due to perioperative stress and infection from complement activation. Here we present the case of a 61-year-old Japanese woman with PNH. We made the diagnosis of PNH when she was 28 years old, and we administered repeated steroid medication and erythrocyte transfusion. The patient's cholecystocholedocholithiasis with a cholecystoduodenal fistula was diagnosed based on a survey of the right hypochondriac pain. We performed endoscopic nasobiliary drainage (ENBD) for the prophylaxis of perioperative infection, plus a cholecystectomy and fistulectomy. There were no complications, including hemolysis attack, infection, thrombosis with irrigation erythrocyte transfusion, steroid cover, or the need for heparin administration during the perioperative period. The reduction of the complement activation is necessary in the perioperative management of PNH patients. The prevention of the development of acidosis and hypoxemia, the selection of washed red blood cells, steroid use, appropriate infection measures and thrombosis prophylaxis are all important for the prevention of complications.
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