巻号一覧
53 巻, 4 号
December
選択された号の論文の5件中1～5を表示しています
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REVIEWS
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Annette L. Williams, Andra L. Blomkalns, W. Brian Gibler原稿種別: Others
専門分野: Others
2004 年 53 巻 4 号 p. 203-209
発行日: 2004年
公開日: 2005/06/17
ジャーナル フリーEmergency Medicine is a relatively young specialty in the United States as well as in other parts of the world. It was only 36 years ago, in 1968, that the American College of Emergency Physicians was founded. Two years later, the University of Cincinnati in Cincinnati, Ohio, USA launched the first Emergency Medicine Residency Training Program. Until the inception of this program, staffing of “Emergency Rooms” consisted largely of physicians who were not trained in the specialty of Emergency Medicine. Emergency Medicine Residency training programs fulfill the need to have Emergency Medicine trained physicians staffing Emergency Departments. There are three and four year training formats for Emergency Medicine in the United States. The University of Cincinnati program is a full four-year program, which teaches residents to master the many diagnostic, procedural, and interpersonal skills required of Emergency Medicine physicians. Diagnostic skills must encompass the pathology affecting all organ systems in all age groups and both sexes. Procedural skills include airway management, vascular access, cavity access, and wound repair. Interpersonal skills are demanding as well, requiring leadership/management of the Emergency Department care team, immediate patient rapport, and dealing with patient/family grief. The Residency Review Committee of the Accreditation Council for Graduate Medical Education (ACGME) ensures that all programs have a structured curriculum complete with both didactic and bedside teaching, as well as structured methods for evaluation of both residents and faculty. According to manpower studies, a great need still exists for Emergency Physicians in many United States hospitals, particularly in rural communities.抄録全体を表示PDF形式でダウンロード (80K) -
Lawrence L. Horstman, Wenche Jy, Joaquin J. Jimenez, Carlos Bidot, Yeo ...原稿種別: Others
専門分野: Others
2004 年 53 巻 4 号 p. 210-230
発行日: 2004年
公開日: 2005/06/17
ジャーナル フリーAnalysis of circulating cell-derived microparticles (MP) is becoming more refined and clinically useful. This review, stemming from lectures given at Tokyo late 2003, does not repeat prior reviews but focusses on new horizons. A major theme is the rising recognition of platelets and their MP (PMP) as key mediators of inflammation/immunity. Among the major concepts developed are that (i) many so-called soluble markers of inflammation are in reality MP-bound; (ii) PMP and other MP appear to serve important signaling and immune functions including antigen presentation. In conclusion, MP analysis is poised to enter the mainstream of clinical testing, measuring specific antigens rather than gross levels. However, more research is needed to decisively establish their functions, and international standards are needed to allow comparing results from different laboratories.抄録全体を表示PDF形式でダウンロード (352K) -
Barbro B Johansson原稿種別: Others
専門分野: Others
2004 年 53 巻 4 号 p. 231-246
発行日: 2004年
公開日: 2005/06/17
ジャーナル フリーResearch during the last decades has greatly increased our understanding of brain plasticity, i.e. how neuronal circuits can be modified by experience, learning and in response to brain lesions. Currently available neuroimaging techniques that make it possible to study the function of the human brain in vivo have had an important impact. Cross-modal plasticity during development is demonstrated by cortical reorganization in blind or deaf children. Early musical training has lasting effects in shaping the brain. Albeit the plasticity is largest during childhood, the adult brain retains a capacity for functional and structural reorganization that earlier has been underestimated. Resent research on Huntington's disease has revealed the possibility of environmental interaction even with dominant genes. Scientifically based training methods are now being applied in rehabilitation of patients after stroke and trauma, and in the sensory retraining techniques currently applied in the treatment of focal hand dystonia as well as in sensory re-education after nerve repair in hand surgery. There is evidence that frequent participation in challenging and stimulating activities is associated with reduced cognitive decline during aging. The current concept of brain plasticity has wide implication for areas outside neuroscience and for all human life.抄録全体を表示PDF形式でダウンロード (286K)
ORIGINAL ARTICLE
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Masaru Suzuki, Akira Imai, Masanori Honda, Kenji Kobayashi, Shujiro Oh ...原稿種別: Others
専門分野: Others
2004 年 53 巻 4 号 p. 247-250
発行日: 2004年
公開日: 2005/06/17
ジャーナル フリーObjective: Door-to-CT-completion interval (DCI) for acute ischemic stroke patients is one of the clinical indicators of quality assurance in an emergency room (ER). The aim was to clarify whether the critical pathway improves the DCI for acute stroke patients in the ER. Methods: The pathway describes each step in patient evaluation in sequence from the patient's arrival in the ER until the brain CT is completed. Whether to use the pathway when evaluating individual patients is left to the discretion of the physician. After excluding 8 cases with insufficient data, 52 cases diagnosed with acute stroke (29 males, 69.9±12.4 y/o) in the ER between January and February 2003 were retrospectively identified. A logistic regression analysis was used to assess the impact of application of the pathway on achievement of an acceptable DCI (<25 min). Results: The pathway was applied in 21.2% of the cases included in the study, and the median DCI was reduced from 48 minutes to 22 minutes as a result (P=0.02). Comparing them with the DCI, the probability values for ambulance use, consciousness disturbance, history of stroke, and application of the pathway in univariate analyses were less than 0.10. These variables were entered into the logistic analysis, which that indicated application of the pathway was the strongest variable related to acceptable DCI (OR: 10.92, 95% CI: 1.22 to 97.96). Conclusion: Application of the pathway was associated with an improvement of the DCI. Use of the pathway will improve the quality of the process of care in the ER.抄録全体を表示PDF形式でダウンロード (61K)
CASE REPORT
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Jun Iwamoto, Tsuyoshi Takeda, Yoshihiro Sato原稿種別: Others
専門分野: Others
2004 年 53 巻 4 号 p. 251-255
発行日: 2004年
公開日: 2005/06/17
ジャーナル フリーA case of osteogenesis imperfecta (OI), which was successfully treated with alendronate is reported. A 41-year-old premenopausal woman with OI type I, who had frequently been experiencing fragile fractures, consulted our clinic because of back pain associated with spinal osteoporosis. She had experienced heart surgery (aortic valve replacement) due to aortic regurgitation 5 years before her first consultation with our clinic. After the surgery, she had been taking warfarin 3 mg/day, and this treatment was continued during our follow-up period. She was treated with alendronate (5 mg/day, daily) for 18 months. The bone mineral density of the lumbar spine (L2-L4) measured by dual energy X-ray absorptiometry (Norland XR-36) increased for 18 months, and back pain markedly decreased. The urinary cross-linked N-terminal telopeptides of type I collagen and serum bone-specific alkaline phosphatase, osteocalcin, and undercarboxylated osteocalcin levels also markedly decreased. No new fragile vertebral or non-vertebral fractures were observed during the 18 months of treatment. This report provides evidence indicating that treatment with oral alendronate may have the potential to decrease bone turnover, improve the lumbar BMD, reduce back pain, and prevent new fragile fractures in premenopausal women with OI type I.抄録全体を表示PDF形式でダウンロード (73K)
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