信州医学雑誌
Online ISSN : 1884-6580
Print ISSN : 0037-3826
ISSN-L : 0037-3826
54 巻, 6 号
選択された号の論文の19件中1~19を表示しています
巻頭言
綜説
原著
  • 岩下 具美, 二木 智子, 関口 幸男, 今村 浩, 手塚 理絵, 飯ケ濱 実, 岡元 和文
    2006 年 54 巻 6 号 p. 379-386
    発行日: 2006/12/10
    公開日: 2014/06/09
    ジャーナル フリー
    Ventricular fibrillation (VF) is the main cause of sudden cardiac arrest. Because the mortality rate of patients with VF is extremely time-dependent, it is essential to perform defibrillation without delay. The automated external defibrillator (AED) is an instrument that laypeople can use anytime and anywhere. We surveyed the installation of AEDs in the 138 hospitals in Nagano Prefecture, and received 113 replies from the 138 hospitals. Fifty-nine hospitals (52%) have installed AEDs. Out of these 59, 28 hospitals experienced 31 events of cardiopulmonary arrest in which AEDs were used in 24 of the events (77%). Ten of 13 patients with VF (77%) were successfully defibrillated. The more the installation rate of AEDs increases and AEDs are popularized, the more likely is the mortality rate to decrease.
  • 角田 美穂, 高橋 徹, 篠山 大明, 中村 伸治, 岡田 八束, 今井 淳子, 鷲塚 伸介, 原田 謙, 野見山 哲生, 天野 直二
    2006 年 54 巻 6 号 p. 387-393
    発行日: 2006/12/10
    公開日: 2014/06/09
    ジャーナル フリー
    The psychiatric diagnosis recorded in documents is often inconsistent with that in the medical record. The object of this study was, by comparing the true diagnoses and those recorded in documents, to investigate the issue of how the diagnosis is presented to the patient and how the psychiatric diagnosis may influence the patient and society. We examined the documents in the medical records of 2350 psychiatric outpatients at the psychiatric department of Shinshu University Hospital from December,1998 to May, 2005. We classified the documents as public or private. The public documents are those submitted to public organizations, such as application forms for a handicapped pension. The private documents are those submitted to schools, offices, insurance companies, etc. such as hospitalization certificates. Patients with depression were mostly recorded as “depression” or “depressive state” in both public and private documents. Patients with schizophrenia usually were recorded as schizophrenia in public documents and “neurosis”, “neurasthenia”, “autonomic disorder”, or “depressive states” in private documents. Hesitation about telling the true diagnosis to the patient, and the influence of the written diagnosis upon the society around the patient may have contributed to the discrepancies between the true diagnoses and the recorded diagnoses in private documents.
ショートレクチャー
症例
  • 丸山 雅史, 小松 健一, 浜野 英明, 越知 泰英, 宮林 秀晴, 青木 雄次, 吉澤 要, 川 茂幸, 清澤 研道
    2006 年 54 巻 6 号 p. 395-399
    発行日: 2006/12/10
    公開日: 2014/06/09
    ジャーナル フリー
    A 30-year-old woman was admitted because of severe thirst and polyuria at 21 weeks of gestation. After fetal demise, she developed disturbance of consciousness. Laboratory examinations showed hyperglycemia, ketoacidosis, low urinary C-peptide concentration, an almost normal HbA1c level, undetectable diabetes-related autoantibodies, and high serum pancreatic amylase. These findings indicated fulminant type 1 diabetes mellitus. Hyperamylasemia and diffuse swelling of the pancreas associated with peri-pancreatic effusion on computed tomography indicated severe acute pancreatitis. After intensive therapy by infusion of fluid, insulin and nafamostat, she recovered and was discharged with insulin supplementation. Fulminant type 1 diabetes mellitus, especially pregnancy-associated fulminant type 1 diabetes mellitus, needs to be recognized because of its abrupt onset during pregnancy and the poor prognosis for the fetus.
ショートレクチャー
症例
  • 浦川 雅己, 池野 龍雄, 古澤 徳彦, 市川 英幸
    2006 年 54 巻 6 号 p. 401-405
    発行日: 2006/12/10
    公開日: 2014/06/09
    ジャーナル フリー
    We report a case of afferent loop obstruction after distal gastrectomy. A 49-year-old woman with upper abdominal pain was admitted to our hospital. She had a past history of distal gastrectomy combined with Billroth II reconstruction without Braun anastomosis for gastric carcinoma and bilateral oophorectomy for ovarian metastases 10 months before this admission. Laboratory findings showed a high level of serum amylase and abdominal CT revealed severe dilatation of the afferent loop. Judging from these findings, we diagnosed this case as afferent loop obstruction after distal gastrectomy and performed emergency surgery. Torsion of the afferent loop made the intestinal tract lapse into necrosis, and partial resection of about 20cm of the intestinal tract including the necrotic lesion was done.
    Exact preoperative diagnosis of afferent loop obstruction is very difficult as in this case. A high level of serum amylase and a characteristic CT with dilatation of the afferent loop may be useful diagnostic findings for this disease. In addition, it is said that too long or too short an afferent loop may cause this disease and Braun anastomosis may prevent it from occurring. In this case, a long afferent loop might have been the cause of the disease, and Braun anastomosis might have better been done to prevent it.
ショートレクチャー
症例
  • 久保 直樹, 飯島 智, 小出 直彦
    2006 年 54 巻 6 号 p. 407-410
    発行日: 2006/12/10
    公開日: 2014/06/09
    ジャーナル フリー
    Esophageal hiatus hernia presenting with an upside down stomach with volvulus in which the entire stomach is prolapsed is rare. An 80-year old woman complaining of long-standing appetite loss since was referred to the hospital because of an abnormal shadow on the mediastinum on medical examination. A chestX-ray showed a gastric bubble in the posterior mediastinum. An upper gastrointestinal series revealed that the gastric body and antrum had migrated into the mediastinum with organoaxial gastric volvulus. We diagnosed this as upside down stomach caused by organoaxial gastric volvulus and esohageal hiatus hernia, and performed surgery. Upon laparotomy, the prolapsed stomach was reduced into the intraperitoneal cavity, and repair of the esophageal hiatus and gastropexy were performed according to Hillʼs procedure. After operation the patient became free of symptoms.
    We makes special reference of the Japanese literature on this disease entity.
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