日本医科大学医学会雑誌
Online ISSN : 1880-2877
Print ISSN : 1349-8975
ISSN-L : 1349-8975
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選択された号の論文の42件中1~42を表示しています
特集〔日本医科大学先端医学研究所Cutting Edge Research〕
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綜説
  • 新井 正徳
    2021 年 17 巻 4 号 p. 172-181
    発行日: 2021/10/30
    公開日: 2021/11/27
    ジャーナル フリー

    Increased intra-abdominal pressure (IAP) results in intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). ACS is a condition that causes multiorgan disorders such as respiratory, circulatory, and renal function due to a rapid increase in IAP, and is fatal if decompression is not performed promptly. The main causes of acute elevation of IAP include intra-abdominal or retroperitoneal bleeding, intestinal or retroperitoneal edema, packing by damage control surgery, and ascites. Diagnosis is obtained by measuring intra-bladder pressure and the presence or absence of organ dysfunction, and treatment is appropriate fluid infusion, medical treatment to reduce IAP, surgical decompression and open abdomen management. Initially, most reports of ACS were on surgical diseases; however, in the ICU, it has been reported that IAH also occurs relatively frequently in medical diseases. In addition, IAP has been identified as a predictor of mortality and multiple organ dysfunction. The definition of IAH/ACS and clinical practice guidelines were published in 2006 and revised in 2013, and are currently recognized as important pathophysiological conditions mainly in the critical care. This section describes the history, definition, pathophysiology, diagnosis, and treatment of ACS.

症例報告
  • 田辺 雄次郎, 柳原 剛, 吉田 圭志, 板橋 寿和, 伊藤 保彦
    2021 年 17 巻 4 号 p. 182-185
    発行日: 2021/10/30
    公開日: 2021/11/27
    ジャーナル フリー

    Nephrotic syndrome is known to cause hypercoagulation due to various factors. Steroid therapy is considered the main treatment for nephrotic syndrome. However, this can increase the risk of developing venous thromboembolism, prompting caution in its use. Here, we report a case of venous thromboembolism in a 13-year-old girl with acute renal failure. This developed during catheter insertion into the right internal jugular vein for hemodialysis. We initiated direct oral anticoagulant therapy. Ultrasound was used to monitor the jugular vein. Throughout the course of treatment, the venous thrombosis gradually disappeared. This study highlights the importance of considering prophylactic anticoagulant therapy in patients with nephrotic syndrome who have an increased risk of venous thromboembolism during central venous catheter placement.

  • 濱本 光, 竹下 輝, 佐野 透美, 上春 光司, 橋本 康司, 田嶋 華子, 早川 潤, 宮尾 昌樹, 高橋 翼, 右田 真
    2021 年 17 巻 4 号 p. 186-190
    発行日: 2021/10/30
    公開日: 2021/11/27
    ジャーナル フリー

    Malrotation is the incomplete rotation of the intestine during the fetal period. We report a case of midgut volvulus due to intestinal malrotation in a 4-year-boy. The patient was hospitalized for abdominal pain and non-biliary emesis. Biliary emesis was observed on the second day, and intestinal obstruction was suspected. Enhanced abdominal computed tomography showed that the positions of the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) were reversed left and right (SMV rotation sign), with swirling of the SMV around the SMA (whirlpool sign). The diagnosis was midgut volvulus with abnormal intestinal rotation. Emergency Ladd surgery was performed on the same day. Since surgery, the patient has not re-twisted and is in good condition. The majority of such patients are diagnosed within the first year of life with symptoms of biliary emesis and bowel obstruction. Although midgut volvulus is rare in young children, it is necessary to consider the possibility.

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