著者

Yukie Yamamura Manabu Nonaka

出版者

The Medical Association of Nippon Medical School

雑誌

Journal of Nippon Medical School (ISSN:13454676)

巻号頁・発行日

vol.86, no.2, pp.117-121, 2019-04-26 (Released:2019-05-24)

参考文献数

10

被引用文献数

1 2

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Sialorrhea is often treated with anticholinergic agents, but they can have undesirable side effects such as drowsiness, sedation, and constipation. Effective medication that acts selectively on the salivary glands is needed. We report the case of a patient with sialorrhea who was successfully treated by the combined use of pirenzepine and solifenacin (M1 and M3 muscarinic receptor antagonists, respectively). The patient was a 51-year-old man with mean unstimulated and stimulated salivary flow rates per 10 min of 6.1 mL and 41.7 mL, respectively (both were measured three times). 99mTcO4− salivary gland scintigraphy revealed characteristic spontaneous saliva secretion without stimulation. He was treated with Scopolia extract, escitalopram, solifenacin succinate, and the combined administration of solifenacin succinate and pirenzepine. A statistically significant decrease was observed from the pre-medication unstimulated and stimulated salivary flow rates only following the combined administration of solifenacin and pirenzepine. The major muscarinic receptor subtype expressed in the salivary glands is M3; however, M1 is also present. A study using knockout mice demonstrated that the presence of either M1 or M3 receptors was sufficient for salivation. Thus, the combined use of selective M1 and M3 antagonists could provide a good treatment option for sialorrhea.

著者

Kiyonori Furukawa Takashi Tajiri Hideyuki Suzuki Yoshihiro Norose

出版者

The Medical Association of Nippon Medical School

雑誌

Journal of Nippon Medical School (ISSN:13454676)

巻号頁・発行日

vol.72, no.3, pp.149-154, 2005 (Released:2005-07-27)

参考文献数

7

被引用文献数

16 20

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Purpose: To examine whether sterile water and brushes are necessary for hand washing before surgery. Method: Twenty-two operating room nurses were randomly divided into two groups as follows: 11 nurses who used 7.5% povidone iodine (PVI group) and another 11 nurses who used 4% chlorhexidine gluconate (CHG group) to wash their hands using the rubbing method. All the nurses were examined for bacterial contamination of their hands before and after surgical hand rubbing. We used tap water to wash the hands at the sink used for washing surgical instruments in the operating room and non sterilized plastic brushes. Results: No bacteria were detected in the tap water. Before washing the hands, the number of bacteria detected was 5.0×103 cfu/H in the PVI group and 4.0×103 cfu/H in the CHG group, which were similar in both groups. After washing the hands, the median value of the bacteria decreased to 8.7×102 cfu/H in the PVI group and 0 cfu/H in the CHG group. Conclusions: Sterile water and brushes are not necessary for preoperative scrubbing up. When using tap water for surgical hand washing, 1) the hand-rubbing method should be used; 2) a quick-alcohol-based disinfectant scrub should be used; 3) the concentration of free chloride in the water should be maintained at over 0.1 PPM; 4) the bacterial contamination of the water should be checked; and 5) the faucet should be routinely cleaned and sterilized.

著者

井上 重喜

出版者

The Medical Association of Nippon Medical School

雑誌

日本医科大学雑誌 (ISSN:00480444)

巻号頁・発行日

vol.2, pp.a1-a16, 1931

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現今ノ醫學界デ寵兒ノ如キ觀ヲナセル『輸血』ハ特ニ"Verblutung"即チ失血ノ際ノ補血法トシテ最モ有效ナルモノノ一ツデアル事ハ誰レモノ熟知シテ居ル所デアル。ソノ失血ガ如何樣ナ失血デアロウトモ、例ヘバ外傷性出血―外出血及ビ内出血―。或ハ病的出血―濾出性出血、破綻性出血、滲出性出血―等ノ際ニ起ル失血、又ハ出血ニヨリテ第二次的ニ起ル急性貧血ノ如キ場合ニモ必要缺クベカラザルハ再言ヲ要シナイ。然シナガラ總テノ場合ニ輸血ガ行ハレ得ルデアロウカ特ニ速急ヲ要スル外傷性出血ニヨル失血ノ際ニ丁度ソノ必要トスル型ノ血液ガアレバヨイガ、寧ロ異型ニ相遇スル場合ノ方ガ多イト假定シテオカネバナラナイ。又假令同型デアツテモ給血者タリ得ヌ場合モアロウシ、特ニ戰爭ノ場合等ニハ、殆ド不可能ノ場合ノ方ガ多イデアロウ。<BR>斯カル場合ニ最近マデ行ハレテ居タ補血法トシテハ生理的食鹽水ノ注入法デ、コレニハ靜脈注入法、皮下注入法、飲用法、灌腸法、腹腔内注入法等、種々ノ方法ガアルガ、特ニコノ場合、靜脈内注入法デアルガ、コノ靜脈内注入法ハ勿論コレモ失ハレタル血液ヲ補フ意味ニ於テハ適當ト云ハネバナラナイガ、コノ食鹽水ヲ靜脈内ニ注入スルト血管壁ニ於ケル滲透壓ニ變化ガ起リ、ソノ結果滲透作用ニヨツテ、血管壁ヨリ濃度ノ低下サレタル血液及ビ生理的食鹽水ガ組織中ニ流出サレル事トナル。故ニ結局ハアマリ面白カラザル結果ヲ齎ラスモノデアル。<BR>所ガ歐洲大戰爭ノ時ニコノ方面ノ研究ガ自ラ必要トサレ、ソノ結果コノ滲透作用ヲ防グ爲メニ「アカシャゴム溶液」ヲ用フル事ガ始メラレタ、コレモ勿論靜脈内注入デ、コレハ單ナル食鹽水ノ注射ヨリ確カニ有效ナル結果ヲ齎ラシタモノデアル、然シナガラ創傷失血ノ際ニ"Wund-Schock"ヲ伴フ如キ場合ニ今迄ノ食鹽水ノ注入ニシロ、「アカシヤゴム溶液」ノ注入ニシロ、コノ「シヨツク」ヲ防グ事ハ效少ナキニ失シタ恨ガアツタ。<BR>一般ニ"Wund-Schock"ノ場合即其直後ニ於テハ血液中ノ糖分ハドウ變化スルデアラウカ、云フマデモナク"Wund-Schock"ノ場合ニハ、血糖量ハ増加シテ行クモノデアル。コレハ生物體ノ防禦力ヲ支持スル爲メノ現象デアルコノ血糖量ノ變化ニ着眼シテ失血ノ際ノ"Wund-Schock"ヲ防グ爲メニ新ナル方法ヲ考エテミタ。即チ單獨ニ用テモ相當效果ノアル「アカシヤゴム溶液」ニ葡萄糖溶液ヲ加ヘタ液ヲ實驗的ニ試ミテミタ。<BR>コレハ今迄「アカシヤゴム溶液」ノミノ場合ヨリ遙カニ有效ナル結果ヲ齎ス事ヲ知ツタノデアル。故ニ輸血ニ次グベキ補血溶液トシテ、又輸血ノ出來ザル場合ニ於テ最モ效力ノアルモノデアルコトヲ本實驗ニヨリ知リ得タノデアル。<BR>實驗ノ結果、コノ溶液ハ6%ノ「アカシヤゴム溶液」ニ8%ノ割合ニ葡萄糖溶液ヲ混ジタ液ヲ用フルノヲ最良トシテヰル。

著者

Akiko Ishiwata Kazumi Kimura

出版者

The Medical Association of Nippon Medical School

雑誌

Journal of Nippon Medical School (ISSN:13454676)

巻号頁・発行日

vol.83, no.2, pp.87-92, 2016-04-15 (Released:2016-05-16)

参考文献数

32

被引用文献数

1 2

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Posterior cortical atrophy (PCA) is a rare neurodegenerative disorder that has cerebral atrophy in the parietal, occipital, or occipitotemporal cortices and is characterized by visuospatial and visuoperceptual impairments. The most cases are pathologically compatible with Alzheimer's disease (AD). We describe a case of PCA in which a combination of imaging methods, in conjunction with symptoms and neurological and neuropsychological examinations, led to its being diagnosed and to AD being identified as its probable cause. Treatment with donepezil for 6 months mildly improved alexia symptoms, but other symptoms remained unchanged. A 59-year-old Japanese woman with progressive alexia, visual deficit, and mild memory loss was referred to our neurologic clinic for the evaluation of right homonymous hemianopsia. Our neurological examination showed alexia, constructional apraxia, mild disorientation, short-term memory loss, and right homonymous hemianopsia. These findings resulted in a score of 23 (of 30) points on the Mini-Mental State Examination. Occipital atrophy was identified, with magnetic resonance imaging (MRI) showing left-side dominance. The MRI data were quantified with voxel-based morphometry, and PCA was diagnosed on the basis of these findings. Single photon emission computed tomography with 123I-N-isopropyl-p-iodoamphetamine showed hypoperfusion in the corresponding voxel-based morphometry occipital lobes. Additionally, the finding of hypoperfusion in the posterior associate cortex, posterior cingulate gyrus, and precuneus was consistent with AD. Therefore, the PCA was considered to be a result of AD. We considered Lewy body dementia as a differential diagnosis because of the presence of hypoperfusion in the occipital lobes. However, the patient did not meet the criteria for Lewy body dementia during the course of the disease. We therefore consider including PCA in the differential diagnoses to be important for patients with visual deficit, cognitive impairment, and cerebral atrophy in the parietal, occipital, or occipitotemporal cortices. A combination of imaging methods, including MRI and single photon emission computed tomography, may help identify probable causes of PCA.

著者

下田 義男

出版者

The Medical Association of Nippon Medical School

雑誌

日本医科大学雑誌 (ISSN:00480444)

巻号頁・発行日

vol.5, no.2, pp.173-183, 1934

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以上私ハ強迫性神經症者ノ一治驗例ヲ擧ゲ,其ノ本態竝ビニ治癒機制ニ就テ若干ノ分析考察ヲ加ヘテ見タ。今茲ニソノ要點ヲ再摘シテ見ルト,<BR>1. 本例患者ハ12歳癩病恐怖ヲ主徴候トシテ發病,爾來8年間症状ハ漸次増惡遂ニ現實的生活ノ積極的部分ヲモ犠牲トスルニ至ツタ強迫觀念症患者デアルガ,治療開始以來20日餘デ治癒ノ域ニ達シタモノデアル。<BR>1. 強迫神經症ノ本態ハ一定ノ基調的性格ニ何等カノ外部的原因ノ加ツタモノト認メラレル。<BR>1. 本症ノ基調的性格トシテハ,先ヅ性格ノ概念ヲ人ノ組織生物學的根據ノ上ニ立ツ氣質ニ後天的諸條件ノ影響シテ構成セラレルモノトスルト,本例患者ノ性格ヲ分析的ニ考察シタ結果ニ依レバ,クレツチユメルノ乖離性氣質ニ見ラレル「自己内生活」的傾向ト偏執病者ノ有スル偏執的傾向ニ精神幼稚性ノ加ツタモノトシテ説明スルコトガ可能デアル。カカル性格ハ理論的ニハ本症ノ基調的性格トシテ適切デハアルガ,他ニモ普遍的實在的デアル事ヲ證スルタメニハ更ニ多數例ノ觀察ニ俟ツノヲ妥當トスル。<BR>1. 本症ノ發生機制ニ就テハ,探索ヲ意識範圍ニ限局スル場合殆ンド説明不可能デアル。精神分析派ノ説明ニハ聽クベキ所多イト考ヘラレルガ未グ終極的結論ハ此方面カラモ得ラレナイ<BR>1. 本症ノ治癒機制ハ「矛盾」ノ體驗的認識ガ性格構成ノ後天的部分ニ或ル修正ヲ齎ラシ,之レガ強靱ナ意志ト俟ツテ症状ノ解消ヲ來スモノト考ヘラル。故ニ本症ニ在ツテハ治癒ハ基調性格ヲ遺シテノ症状ノ消失デアリ。此ノ意味ニ於テ比較治癒ナル語ガ適當デアルト考ヘラレル。擱筆ニ當リ御校閲下サツタ齋藤玉男先生,御鞭韃下サツタ長澤米藏先生及ビ種々御配慮下サツタ森崎院長,杉尾副院長ニ深甚ノ感謝ノ意ヲ表スルモノデアル。

著者

中西 修

出版者

The Medical Association of Nippon Medical School

雑誌

日本医科大学雑誌 (ISSN:00480444)

巻号頁・発行日

vol.20, no.6, pp.566-569, 1953

著者

Hiroki Yamaguchi

出版者

The Medical Association of Nippon Medical School

雑誌

Journal of Nippon Medical School (ISSN:13454676)

巻号頁・発行日

vol.74, no.3, pp.202-209, 2007 (Released:2007-07-12)

参考文献数

35

被引用文献数

10 17

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Dyskeratosis congenita (DKC) is a bone marrow failure (BMF) with characteristic physical anomalies, and is typically diagnosed in childhood. Some forms of DKC are known to be caused by mutations occurring in DKC1, telomerase RNA component (TERC), and telomerase reverse transcriptase (TERT). These genes are the main constituents of the telomerase complex that plays a role in replicating telomeres and stabilizing them against shortening. Mutations in these genes could shorten telomeres and impair the proliferative capacity of hematopoietic stem cells, eventually causing DKC. Recently, mutations in TERC and TERT have been reported in some cases of aplastic anemia (AA) and myelodysplastic syndrome (MDS). These cases are considered to be atypical forms of DKC that develop slowly in adulthood without characteristic physical anomalies. Genetic tests are essential in diagnosing this late-presenting DKC and determining the appropriate treatment. This article reviews mutations in the telomerase complex and their connections with DKC and bone marrow failures.