逆流性食道炎（RE）と胃食道逆流症（GERD）症状の関連性が糖尿病の有無で変化するかを健診受診者を対照群として比較検討した．スクリーニング目的で上部消化管内視鏡を施行した糖尿病患者88名と非糖尿病者263名を対象とし，自答式問診票を用いてGERD症状を認めた者をsymptomatic GERDと診断した．REの頻度は糖尿病患者で有意に高かったが，symptomatic GERDの頻度は両群に差を認めなかった．非糖尿病者ではsymptomatic GERDの有無でRE有病率に差が認められたが，糖尿病患者では認められなかった．糖尿病患者では非糖尿病者と比較し，胃酸逆流が生じてもsymptomatic GERDが顕在化しにくくなる可能性が示唆された．

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症例：84歳女性．主訴：食欲不振，意識レベル低下．既往歴：末期腎不全，甲状腺機能低下症，2型糖尿病，難聴．現病歴：以前より甲状腺機能低下症を指摘されていたが，服用できていなかった．近医診察にて食欲不振，意識レベル低下を認めた．原因として甲状腺機能検査異常を認め，全身状態が悪く入院加療目的で当院紹介となった．検査所見：JCS 10，TSH 681.7 μIU/mL，fT4 0.40 ng/mL，総CK 170 U/L，pH7.33，Na 124 mEq/L，Cr 3.85 mg/dL，eGFR 9 ml/min/1.73 m²．臨床経過：末期腎不全ではあるが，透析治療は拒否されていた．検査所見より，粘液水腫昏睡と診断し，レボチロキシンNa水和物25 μg経口投与から開始，中心静脈カテーテルにて経静脈栄養を行った．入院約3カ月にて，回復退院となった．考察：粘液水腫昏睡の過去の日本の6例の報告では，高齢者が多い印象であった．レボチロキシンNa水和物25～50 μg内服から開始する症例が多く，治療法について本症例と類似していたが，本症例のような高齢で高度な腎不全を伴う症例は認めなかった．また，ガイドラインのない症例の治療方針決定においては，本人に寄り添い，意思を何度も確認することがより重要と考えた．結論：今回，我々は透析を希望されない末期腎不全高齢者の症例における粘液水腫性昏睡の1例を経験した．治療や経過について，貴重な症例と考え，報告する．

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The objective of this study was to construct a finite element (FE) model which can accurately simulate the rebound behaviour of a ball including a spin axis for a golf impact, and to investigate the effect of centre of gravity (CoG) of a clubhead on the ball rebound, by conducting an FE analysis on a ball colliding with a simplified club. The club was constructed by holding the simplified clubhead in a locking ring fitted onto a steel shaft. The club model with linear elasticity was constructed. A ball model with hyperelasticity and viscoelasticity was constructed using solid elements. Impact experiments were also conducted to devise a method for calculating a spin rate and axis using a rotation matrix and to also confirm the accuracy of the FE model. The simulated results closely matched the experimental results. The ball rebound was analysed using the constructed model by varying positions of the height and depth of the CoG. The rebound angle and backspin tended to depend on the height of the CoG and the variation seemed to be influenced by the tangential force on the impact face. In the toe and heel impact cases, the deviation angle and sidespin tended to increase with the depth of the CoG. A component of impact force, which led to a generation of the sidespin, was identified from the relationship between the variation of the sidespin and positions of the depth of the CoG.

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症例1は93歳男性．50歳時より2型糖尿病のため近医通院中であったが，80歳頃より突発する腹痛・腹満を頻回に自覚し数カ所の病院を救急受診していた．症例2は84歳女性．70歳時より2型糖尿病のため近医通院中であったが，80歳頃より突発する腹痛・腹満・嘔吐を認め当院を受診していた．これらの症例は詳細なCT画像の検討により胃軸捻転症と診断するに至った．さらに本疾患は開腹や腹腔鏡手術で治療されることが多いが，本2症例は捻転を防止するため胃瘻の造設で胃壁を固定した．これにより経口摂取再開後も再発を認めず，胃瘻の造設は手術に代わる有効な治療法と考えられた．胃軸捻転症は稀な疾患であるため，本疾患が念頭にない場合は画像をみても診断に至らない事が多い．また当院で経験した2症例とも2型糖尿病を合併していた．糖尿病患者で突発する腹痛や腹満といった症状を認めた場合，本疾患の可能性も念頭におくべきであると考え報告する．

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千葉体育学会／山梨体育・スポーツ科学学会／兵庫体育・スポーツ科学学会／山陰体育学会／広島体育学会

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The influences of the parameters, i.e., the friction coefficient between the club head and golf ball, the eccentricity and inclination of the head to the target direction and the surface shape of the head, on the release velocity, spin velocity and trajectory of the ball after impact, are investigated. A computer program that analyzes the dynamic contact problem with friction is constructed, and the impact phenomenon between the head and ball is numerically analyzed using this program. The influences of the parameters described above are investigated quantitatively. It is shown that backspin is the result of friction between the head and ball, sidespin is the result of eccentricity or inclination of the head, which is called the gear action, and the surface shape of the head influences the trajectory of the ball after impact, which is called the round effect.

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The rotation of the golf-club around the long-axis of the shaft may be generated by two mechanisms. The 1^<st> mechanism is the angular impulse exerted by the golfer around the long-axis of the shaft directly. The 2^<nd> mechanism is the change in the orientation of the long-axis of the shaft with respect to the angular momentum of the golf-axis of the shaft in golf swing. A golfer performed 5-trials of "place shot" toward target away from 2m of the golfer. The electromagnetic tracking device was used to measure the three-dimensional motion of the golf-club. The angular velocity around the shaft was 1938±211°/s in the direction of "closed face" at ball impact. The angular velocity attributed to 1^<st> mechanism was 3543±378°/s in direction of "opened face", on the other hand the angular velocity attributed to 2^<nd> mechanism was 5400±312°/s in direction of "closed face" at impact. These results suggest that the angular impulse exerted by the golfer around the long-axis of the shaft be important to control the direction of the face.

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