著者

土居 浩 中村 精紀 望月 由武人 徳永 仁 吉田 陽一 大橋 元一郎 井田 正博

出版者

日本脊髄外科学会

雑誌

脊髄外科 (ISSN:09146024)

巻号頁・発行日

vol.23, no.2, pp.211-217, 2009 (Released:2017-05-11)

参考文献数

14

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Spontaneous spinal cerebrospinal fluid (CSF) leaks are an increasingly recognized cause of intracranial hypotension. Comprehensive diagnostic criteria encompassing the varied clinical and radiographic manifestations of spontaneous intracranial hypotension are not available. In this report the authors review the diagnosis of the point of cerebrospinal fluid leak. The major presenting symptoms include postural headaches, nausea, vomiting, and diplopia. Often, there is no history of traumatic injury. The most common cranial magnetic resonance (MR) imaging features include pachymeningeal gadolinium enhancement. MR myelography is a non invasive method to detect CSF leakage, however, extradural hyperintensity on MR myelography is non-specific for CSF. Fat-saturated T2-weighted imaging and post contrast T1-weighted imaging should be added to confirm CSF leakage. On spinal MR images, meningeal cysts and extradural venous plexus are frequently misdiagnosed as CSF leakage. In cases in which symptoms are severe and refractory to less invasive measures, surgical intervention is indicated. Recently, some authors reported the identification of upper cervical epidural fluid collections as a false localizing sign in patients with spontaneous intracranial hypotension (SIH) and this has provided significant insight into the selection of management options. However, herein we report on true C1-2 CSF leakage. We examined a group of consecutive patients with 25 SIH and 13 posttraumatic CSF hypovolemia and investigated clinical, MRI, CT myelography, and radioisotope findings and therapeutic outcomes of this syndrome.

著者

内海 美保 徳永 仁 山岡 由美子 高村 徳人

出版者

一般社団法人日本医療薬学会

雑誌

医療薬学 (ISSN:1346342X)

巻号頁・発行日

vol.36, no.9, pp.657-666, 2010 (Released:2012-03-15)

参考文献数

11

被引用文献数

7 3

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In order to clarify the status of clinical skills education in the faculties of pharmaceutical sciences at pharmacy schools in Japan,we carried out a questionnaire survey of such faculties at 74 schools in Japan.The results revealed that 67.9% of the pharmacy schools were providing clinical skills education such as that regarding physical assessment and assessment of vital signs.As for the amount of time spent in education on clinical skills,the median lecture time was 225 minutes and the median practical training time was 540 minutes.The ranking of lecture content was :[1]basic knowledge related to vital signs,[2]basic knowledge related to electrocardiography,[3]basic knowledge related to clinical laboratory test results,[4]pathophysiology and symptomatology and[5]Procedures for using assessment equipment,and the ranking of practical training :[1]primary or secondary emergency medical care,[2] assessment of vital signs,[3]electrocardiography measurements and analysis,[4]auscultation,[5]nursing and patient care.The ranking for equipment available at pharmacy schools was :[1]stethoscope (availability rate 50.9%),[2]mercury sphygmomanometer (41.5%),[3]AED trainer (24.5 %),[4]electrocardiograph (22.6%),[5]pulse oxymeter (20.8%).Based on the results of our survey,it is felt that clinical skills education in pharmaceutical science courses will enhance the professional capabilities of pharmacists,and enable them to make greater contributions in various fields including emergency medical care and home medical care.

著者

土居 浩 中村 精紀 望月 由武人 徳永 仁 吉田 陽一 大橋 元一郎 井田 正博

出版者

日本脊髄外科学会

雑誌

脊髄外科 (ISSN:09146024)

巻号頁・発行日

vol.23, no.2, pp.211-217, 2009

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<p>  Spontaneous spinal cerebrospinal fluid (CSF) leaks are an increasingly recognized cause of intracranial hypotension. Comprehensive diagnostic criteria encompassing the varied clinical and radiographic manifestations of spontaneous intracranial hypotension are not available. In this report the authors review the diagnosis of the point of cerebrospinal fluid leak. The major presenting symptoms include postural headaches, nausea, vomiting, and diplopia. Often, there is no history of traumatic injury. The most common cranial magnetic resonance (MR) imaging features include pachymeningeal gadolinium enhancement. MR myelography is a non invasive method to detect CSF leakage, however, extradural hyperintensity on MR myelography is non-specific for CSF. Fat-saturated T2-weighted imaging and post contrast T1-weighted imaging should be added to confirm CSF leakage. On spinal MR images, meningeal cysts and extradural venous plexus are frequently misdiagnosed as CSF leakage. In cases in which symptoms are severe and refractory to less invasive measures, surgical intervention is indicated. Recently, some authors reported the identification of upper cervical epidural fluid collections as a false localizing sign in patients with spontaneous intracranial hypotension (SIH) and this has provided significant insight into the selection of management options. However, herein we report on true C1-2 CSF leakage. We examined a group of consecutive patients with 25 SIH and 13 posttraumatic CSF hypovolemia and investigated clinical, MRI, CT myelography, and radioisotope findings and therapeutic outcomes of this syndrome.</p>

著者

菊池 由莉恵 戎井 理 大野 敬三 徳永 仁夫 明坂 和幸 上田 晃久 西原 永潤 窪田 純久 宮内 昭

出版者

一般社団法人 日本内科学会

雑誌

日本内科学会雑誌 (ISSN:00215384)

巻号頁・発行日

vol.106, no.11, pp.2425-2431, 2017-11-10 (Released:2018-11-10)

参考文献数

7

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31歳,女性.Basedow病の診断で抗甲状腺薬を投与されていたが,甲状腺機能正常化せず,当院受診.syndrome of inappropriate secretion of thyroid stimulating hormone(SITSH)の状態で,TR(thyroid hormone receptor)β1遺伝子解析の結果,甲状腺ホルモン不応症と診断し,抗甲状腺薬を中止した.甲状腺ホルモン不応症の約3分の1の症例がBasedow病と間違えられ,適切でない治療を受けておりSITSH所見を診た際は,甲状腺ホルモン不応症を念頭に置く必要がある.

著者

徳永 仁 髙村 徳人 松岡 俊和 佐藤 圭創 瀬戸口 奈央 緒方 賢次 佐藤 圭創 緒方 賢次 瀬戸口 奈央

出版者

九州保健福祉大学

雑誌

基盤研究(C)

巻号頁・発行日

2012-04-01

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病棟、薬局、在宅およびドラッグストアを想定した薬効の評価や副作用の早期発見のトレーニングを目的とする薬学生・薬剤師のためのフィジカルアセスメント(PA)学習教材を作成した。基礎学習(スライド形式・動画形式)と症例学習からなり、基礎学習ではPAの基本解説と心音、肺音および腸音の正常または異常の聴診できる。症例学習では患者アバターに対して客観的または主観的な身体学的所見の情報、バイタルサインや臨床検査値を加えることにより、薬剤師としての受診勧奨、他医薬品への処方変更、薬効・副作用の確認もバーチャルで可能となった。患者対応から症状回復までが体験できるこれまでにない有益な教材が開発できたと考えている。