著者

横山 亮 中島 大成 津久田 享三 宇津 典明 宮越 一穂

出版者

公益財団法人 日本心臓財団

雑誌

心臓 (ISSN:05864488)

巻号頁・発行日

vol.43, no.11, pp.1484-1487, 2011 (Released:2013-02-05)

参考文献数

7

被引用文献数

1

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症例は51歳, 男性. 2009年7月ころより安静時, 労作時に胸部圧迫感を認めたため, 当院循環器内科受診. 運動負荷心電図施行中, 胸部症状を認めたため, 試験を中止し, ニトログリセリンを舌下投与したが, 下壁誘導にてST上昇と症状の持続を認めたため, 緊急冠動脈造影検査を施行. 器質的冠動脈狭窄は認めず, 運動誘発性冠攣縮性狭心症と診断した. 入院後, 冠拡張薬内服し安静時, 運動時とも症状は出現しなくなったため, 退院となった. 労作性狭心症の鑑別診断の1つとして留意すべき疾患であると考えられた.

著者

宮越 一穂 霜田 求

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.25, pp.129-130, 2007-10-18 (Released:2018-02-01)

著者

宮越 一穂

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.24, pp.132, 2006-10-24 (Released:2018-02-01)

著者

宮越 一穂 棚橋 賓

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.20, pp.223-225, 2002-11-10 (Released:2018-02-01)

著者

宮越 一穂

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.18, pp.174-181, 2000-12-15 (Released:2018-02-01)

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This discussion is focused on the patient's body in routine, popular, or standard medicine, such as hypertension, hyperlipidemia, diabetes mellitus, or atherosclerosis. Medicine related to extraordinary treatment such as organ transplantation, research, and denial from the patient to be treated based upon his/her age and so on, are beyond the limits of this discussion. Since ancient times, medicine has been a method to relieve a patient's pain and suffering. Modern medicine has made new discoveries in many diseases and their pathological mechanisms, as well as many new discoveries in the physiological aspects of the human body. It has recently shed new light on cells, molecules, and genes. We are however left with many unknown diseases. Medical methodology treats a patient as an object, objectively and scientifically. However, it should be a priority to treat a patient as a person, and to respect his/her patient's rights and human dignity. The doctor should explain the diagnosis, pathophysiology, risk factors and the hygiene, treatments, alternate therapies, prognosis, etc., to the patient. My answer to this question, what do I think about the patient's body?, is that the patient's body belongs to the patient, for the time being. The human body, however, is a nature in itself. In the studies of the human body as a nature, there are still many far beyond human intelligence. Although a patient is ill with some disease, he/she has his/her own lifestyle as a human being. We, physicians and patients, should not forget the natural aspect of the patient's body or his/her own lifestyle.

著者

宮越 一穂

出版者

日本医学哲学・倫理学会

雑誌

医学哲学 医学倫理 (ISSN:02896427)

巻号頁・発行日

vol.15, pp.48-63, 1997-09-20 (Released:2018-02-01)

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From America and Europe, there is a great abundance of reports of large-scale randomized clinical trials on various medical problems. They have brought important findings to medical practice. Such knowledge is available in all over the world, including Japan. However, in Japan, we have little experience of randomized multicenter clinical trials, and only a very small number of patients have participated in these studies during the initial period. There are still many diseases and many patients with intractable pathophysiological conditions, and many requests to relieve them or to improve their health, using high-level technology. Why do megatrials fail in Japan? While some have indicated that Japanese physicians have paid scant attention to or have had no experience of large-scaled, multicenter, double-blind, prospective, or randomized clinical trials. I would rather point out the following : we have the health insurance for all Japanese ; the coverage is for anyone, anytime, anywhere in the country, and for any type of conventional treatment ; so most Japanese individuals have little pressure to develop or to resolve medical problems. However, since the consultation time is only about three minutes, the physician does not have enough time to explain details on the clinical trial, therefore the condition of informed consent is poor in Japan. In addition, the peer review system has little tradition and there is no neutral powerful agent as the FDA. Consequently patients are not confident in physicians and the Japanese health care system in general.