Search

pdf, 看護師の身だしなみに関する患者の見解について、外来患者を対象に調査した。調査項目は、ユニフォームの印象について4項目（シミや汚れ、臭いの有無、着こなし、清潔感）と、看護師に望む服装と身だしなみについて13項目（ユニフォームの色、シミや汚れ、薬品や汗などの臭い、下着、スカート丈、ストッキング、髪型、髪の色、化粧、アクセサリー、口臭や体臭、洗濯・クリーニング）の合計17項目とし、3件法で回答を求めたほか自由記述の欄を設けた。調査票を配布し回収できた127名を解析対象（平均年齢49.8歳±標準偏差17.2歳）とし、単純集計とＸ²検定またはFisherの直接確率検定を行った結果、ユニフォームに対して患者が抱いていた印象は、清潔度や着こなしなどに関しておおむね良好であった。ユニフォームの色については「白以外でもよい」との回答が過半数を占めたほか、スカート丈や化粧、髪型、髪の色などの項目で、従来に比較すると看護師の自由を許容する割合が漸増していた。しかし、香水や口臭、薬品・汗などの臭気が付いたユニフォームの着用など臭いに関する項目や、アクセサリー・マニキュアに関する見解は好意的ではなく、経年的な変化はみられなかった。また、シミや汚れの付いたユニフォームの着用も容認できないとする意見が過半数を占めた。これらの結果から、患者は看護師に職業人としての清潔感のある身だしなみを求めていることが明らかになった。

Summary Background Colorectal depressed tumours have a tendency to invade deeper mucosal layers and metastasize in the lymph nodes, despite their small size. Aim To investigate the clinical and endoscopic characteristics of depressed early colorectal cancers (intramucosal and submucosal adenocarcinoma) compared with non-depressed early cancers. Methods Five hundred and seventy consecutive early colorectal cancers obtained through endoscopic resection or surgical operation were studied. Early cancers were endoscopically classified as either the depressed or non-depressed type. The age and gender of the patients as well as the size and distribution of the cancers were compared between types. The tumour locations were classified into three groups: caecum to transverse colon (right colon), descending to sigmoid colon (left colon) and rectum. Results Patients were similar with respect to age and gender. The mean size of the depressed type was smaller than that of the non-depressed type (mean 8.4 mm vs. 13.3 mm; P

Background: Previously, we reported that most gastrointestinal tumors could be distinguished with the Light-Induced Fluorescence Endoscopy for GastroIntestine system (LIFE-GI system) using a fiberscope. However, the quality of the fiberscopic images was inferior compared with videoscopic images. Therefore, we developed a new Auto-Fluorescence Imaging (AFI) videoscope system (manufactured by Olympus Corp.). Methods: We evaluated the clinical usefulness of the AFI videoscope system for the detection of colonic neoplasms. Using this system, we observed 168 colonic polyps. Results: Images obtained by AFI provided better brightness than autofluorescence fiberscopic images and lesion margins were clearly evident. It demonstrated excellent recognition capability to a small lesion that was difficult to be detected by conventional observation. Sensitivity was 89% and specificity 81%, with specificity higher than that of the autofluorescence fiberscopic images. Conclusions: This newly developed AFI videoscope system will be useful for the detection of colonic neoplasms.

Background EGD with conscious sedation is a safe procedure, but complications such as hypoxia can occur. The efficacy and safety of low-dose flunitrazepam (0.25 mg) was compared with a standard dose of flunitrazepam (0.5 mg) for moderate sedation during EGD. Methods In a randomized, double-blind, placebo-controlled trial, 75 outpatients (40 men, 35 women, mean age 45 [11] years) undergoing screening EGD were randomly assigned to one of 3 treatment arms: 0.25 mg of flunitrazepam (F0.25 group), 0.5 mg of flunitrazepam (F0.5 group), or placebo (normal saline solution), each administered intravenously. Patient tolerance was scored by using self-assessment questionnaires with visual analogue scales. Cardiopulmonary complications were assessed by monitoring blood pressure, heart rate, oxygen saturation, and the electrocardiogram during the procedure. Results The patient tolerance scores in the F0.25 and F0.5 groups, respectively 2.1 (2.1) and 2.3 (2.5), were significantly lower than that for the placebo group (6.5 [3.0]); there was no significant difference between F0.25 and F0.5. Cardiopulmonary complications in the F0.25 group were significantly lower than in the F0.5 group. Oxygen desaturation (oxygen saturation p = 0.2438). Conclusions Patient tolerance of EGD with low-dose flunitrazepam (0.25 mg intravenously) was similar to that with a standard dose (0.5 mg intravenously) and significantly better than in the placebo group. Oxygen desaturation was observed only in the group that received the standard dose, suggesting that sedation with low-dose flunitrazepam is efficacious and safe for EGD.

Background: Most cancers and adenomas of the GI tract are easily detected by light-induced fluorescence endoscopy (LIFE-GI). However, some tumors are poorly visualized by using this technique. To investigate whether the spraying of noradrenaline on the lesion provides better visualization of the boundaries of neoplasms, the conventional and LIFE-GI endoscopic observations were made before and after spraying of nonadrenaline. Methods: Seven patients with gastric cancers were studied. After a conventional fiberscopic examination, a LIFE-GI procedure was performed, and then 20 mL of 0.02% noradrenaline solution was sprayed on the lesion. Results: The normal mucosa became paler than the tumor after spraying noradrenaline, thereby clarifying the tumor boundary in the LIFE-GI image. Conclusions: The combined use of pharmacoendoscopy with LIFE-GI is useful in the detection of gastric malignant tumors because it enhances the boundaries of these lesions.

Autofluorescence spectra of neoplastic tissues have been reported to be significantly different from those of normal tissues when excited by blue or violet light. From this concept, a light-induced autofluorescence endoscopic imaging system for gastrointestinal mucosa (LIFE-GI; Xillix, Canada and Olympus, Japan) has been newly developed and the clinical evaluation of the prototype system has been conducted in hospitals in Canada, Netherlands and Japan.We examined the clinical usefulness of the prototype LIFE-GI system for the detection of gastrointestinal cancer and high and low grade dysplasia. The LIFE-GI system was also applied to the early detection of remnant lesions after endoscopic treatment of early gastric cancer and to the detection of laterally spreading superficial colonic tumors.This system has potential application for the diagnosis of dysplastic lesions and early cancers in the gastrointestinal tract as an adjunct to ordinary white light endoscopy. This system, which needs no administration of a photosensitive agent, may be suitable as a screening method for the early detection of neoplastic tissues.

We carried out a retrospective study of 71 patients with congenital non-hemolytic hyperbilirubinemia who had been treated at our institution over the 25 years from 1965 to 1990. Twenty patients had Gilbert's syndrome, 1 had Crigler-Najjar syndrome, 1 had new type unconjugated hyperbilirubinemia, 21 had Dubin-Johnson syndrome, and 28 had Rotor's syndrome. We also reviewed 20 patients with constitutional indocyanine green (ICG) excretory defect. The study focused on the hepatic transport of serum bilirubin, bromsulfophthalein (BSP), and ICG. In Dubin-Johnson syndrome, a defect appeared in late-stage transport, while uptake and storage capacity were normal. In Rotor's syndrome, defects were found in the early stage, and storage capacity was reduced, while excretion into bile was slightly suppressed. A secondary rise in serum ICG was seen in 5 of the 10 patients with Dubin-Johnson syndrome. The transport defect in Gilbert's syndrome was unclear. It could not be considered to be homogeneous, but it may exist at multiple sites, from the conjugation with serum proteins to excretion into bile. Following phenobarbital administration, the ICG secondary rise in the 5 patients with Dubin-Johnson syndrome disappeared, and ICG was rapidly cleared from blood. However, in patients with Dubin-Johnson syndrome, BSP clearance in serum did not show any change before and after phenobarbital administration. ICG excretion in patients with constitutional ICG excretory defect was due only to the impairment o ICG transport, and the defect was suggested to be hepatic uptake. These results indicate that studies of the hepatic transport of bilirubin, BSP, and ICG are useful for determining the etiological factors involved in congenital hyperbilirubinemia and constitutional ICG excretory defect.

当科において経験した原発性胆汁性肝硬変症(PBC)を合併した膠原病および自己免疫疾患8例について文献的考察を加え検討を行った.原疾患の内訳はシェーグレン症候群(SjS) 5例,慢性関節リウマチ(RA) 3例,進行性全身性硬化症(PSS) 5例, CREST症候群1例, Mixed connective tissue disease(MCTD) 1例,慢性甲状腺炎2例であった.全例いわゆる無症候性PBCで,血清ALP, IgMの上昇が特徴的であった.甲状腺ホルモンを投与した2例では血清ALPの低下を認めPBCに対する有効性が示唆された.各種自己抗体の検索の結果,抗セントロメア抗体(ACA)は50%に検出され, PBCに特異的とされる抗M2抗体は全例に検出された.膠原病患者において肝機能障害,抗ミトコンドリア抗体(AMA)を認めた場合, PBCを疑い積極的に検査を進めることが必要と思われた.

Administration of phalloidin in vivo to rats causes marked changes in the distribution of actin and myosin in hepatocytes, which accompanies reduced bile flow. We have found that in hepatocytes treated with phalloidin for 3 and 7 days, cellular myosin content increased about 1.5-fold and 4.7-fold, respectively. In addition, total cell protein content and several marker enzyme activities were also elevated by 30-120% depending on the duration of phalloidin treatment. These observations allow us to speculate that phalloidin somehow elicits inhibition of cellular protein degradation, which results in the increase of these protein levels. To examine this possibility further, we analyzed leupeptin-induced density shift of phagolysosomes. In normal liver, the injection of leupeptin/E64c caused an increase in the density of both heterolysosomes and autolysosomes, due to retarded digestion of sequestered proteins as a result of the inhibition of lysosomal cathepsins. Accumulation, in these denser autolysosomes, of lactic dehydrogenase, pyruvate kinase, aldolase, and myosin was demonstrated by enzyme assays and immunoblot analysis. In the phalloidin-treated liver, the increase in the density of autolysosomes and the accumulation of above cytoplasmic enzymes were markedly inhibited. However, phalloidin did not affect the shift in the density of heterolysosomes. From these data, we concluded that autolysosome formation was specifically hindered in phalloidin-treated rat hepatocytes, which results in the reduction of autophagic protein degradation and eventual increase in intracellular protein levels.

われわれは伊東細胞の細胞骨格蛋白としてアクチンの他にデスミンを見いだし,細胞質のデスミンを標的として四塩化炭素,異種血清,あるいはエタノールの投与により作製した実験的肝線維化における伊東細胞の動態を検討したが,今回は最小局所肝障害として27G注射針による0.05mlの生食水注入,27G注射針のみ,あるいは同じ太さのガラス棒の穿刺を行い,障害箇所における線維の形成と伊東細胞の動態を観察した.これら3群における変化は基本的に類似し,まず肝細胞の壊死部周囲に胞体の腫大した伊東細胞が出現し,次いで細胞分裂により細胞数が増加して線維化が認められ始め,細胞突起は線維と同一の方向性を示し,細胞突起を伸展結合させて線維束を形成し,線維性隔壁が完成したが,この時期に細胞数は減少した.これらの結果は肝線維化における伊東細胞の意義を明らかにしたものであり,筋線維芽細胞との関連を示したものと考えられた.

Alterations of actin and myosin were observed by the effects of cytochalasin B (CB) and phalloidin (Ph) using primary cultured rat hepatocytes. The morphology of cells was observed by phase contrast microscopy and actin was observed by fluorescent microscopy using DACM-HMM. Myosin was observed by immunofluorescence techniques using anti-rat liver myosin antibody. In normal controls, after a 3hour incubation, actin and myosin were both intensely observed in the region along the plasma membrane, especially around the bile canaliculi. After a 24hour incubation, hepatocytes spread and actin and myosin were observed around the bile canaliculi, and appeared as filamentous patterns in the cytoplasm. In the CB group, hepatocytes did not spread even after 24hours, and actin and myosin were identified as granules around the widely dilated bile canalicli. Filamentous patterns of actin and myosin were not observed in the cytoplasm. In the Ph group, cytoplasmic vacuoles and protrusions from the cell membrane were observe. The hepatocytes did not spread even after a 24 hour incubation. Actin and myosin were identified as granules in the region along the plasma membrane, especially around the bile canaliculi. Present studies show that actin and myosin distribute almost to the same place in the hepatocytes and the integrity of each component of the cytoskeleton is important for normal cellular function.

自己免疫性肝炎をはじめとして各種肝疾患において,その発症や進展に免疫学的機序の関与することが推側されている.近年汎T細胞膜抗原の一つであるCD5を保持するB細胞(CD5 B細胞)と自己免疫との関連性が注目されているが,われわれは種々の肝疾患におけるその出現率を検討した結果,慢性肝炎,肝硬変,自己免疫性肝炎で増加が見られ,さらにB型の慢性活動性肝炎に高率に出現し,またnonA nonB型肝炎例でも炎症の持続する例に増加する傾向がみられ,特に血中自己抗体陽性例で著明な増加がみられたことから,CD5 B細胞はウイルス肝炎の慢性化や自己免疫機構による病態の進展に深く関与するものと考えられた.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. In large GISTs, cystic degeneration, necrosis and focal hemorrhage that occur inside the tumor can result in gastrointestinal bleeding. We describe a case of a 74-year old male with GIST of the stomach accompanied with a giant abscess that penetrated the gastric lumen. The patient experienced undiagnosed fever for two months prior to hospitalization. Gastrointestinal endoscopy, X-ray series and computed tomography of the patient's abdomen revealed a gastric submucosal tumor in the fornix, with a fistula to the gastric lumen that was inundated with a great deal of pus. The mass was diagnosed as a GIST from biopsy specimens. The patient was treated by endoscopic drainage of the abscess and intravenous administration of antibiotics. Eventually, a partial gastrectomy was performed. He was also administered Imanitib mesylate as adjuvant therapy. He was followed up for 2 years and no metastasis or recurrence was recognized at the follow-up examinations. This is the first report of a patient with clearly diagnosed GIST with endoscopic evidence of an abscess penetrating into the gastric lumen.

EGD with conscious sedation is a safe procedure, but complications such as hypoxia can occur. The efficacy and safety of low-dose flunitrazepam (0.25 mg) was compared with a standard dose of flunitrazepam (0.5 mg) for moderate sedation during EGD.In a randomized, double-blind, placebo-controlled trial, 75 outpatients (40 men, 35 women, mean age 45 [11] years) undergoing screening EGD were randomly assigned to one of 3 treatment arms: 0.25 mg of flunitrazepam (F0.25 group), 0.5 mg of flunitrazepam (F0.5 group), or placebo (normal saline solution), each administered intravenously. Patient tolerance was scored by using self-assessment questionnaires with visual analogue scales. Cardiopulmonary complications were assessed by monitoring blood pressure, heart rate, oxygen saturation, and the electrocardiogram during the procedure.The patient tolerance scores in the F0.25 and F0.5 groups, respectively 2.1 (2.1) and 2.3 (2.5), were significantly lower than that for the placebo group (6.5 [3.0]); there was no significant difference between F0.25 and F0.5. Cardiopulmonary complications in the F0.25 group were significantly lower than in the F0.5 group. Oxygen desaturation (oxygen saturation90%) was noted in two of 25 patients in the F0.5 group. Post-procedure drowsiness was observed in two of 24 (8.3%) patients in the F0.25 group and 3 of 21 (14.3%) in the F0.5 group (p = 0.2438).Patient tolerance of EGD with low-dose flunitrazepam (0.25 mg intravenously) was similar to that with a standard dose (0.5 mg intravenously) and significantly better than in the placebo group. Oxygen desaturation was observed only in the group that received the standard dose, suggesting that sedation with low-dose flunitrazepam is efficacious and safe for EGD.

As a medical application of optoelectronic technology, an instrument to measure liver function was developed. For the estimation of liver function, Indocyanine green (ICG) is widely used as a tracer clinically. A description of an instrument for noninvasive measurement of ICG clearance and the results of the clinical evaluation of about 470 patients are presented. In in vivo measurement, to solve the problem of changing blood volume, the authors propose a novel calibration method before ICG injection. Using this instrument, called an ICG clearance meter, the value of ICG tests correlated well with the values calculated from the conventional blood sampling methods. >

We report a patient--a 42-year-old man--who had suffered from recurrent duodenal ulcer for about 20 years. Successful curative therapy for Helicobacter pylori infection was performed for 2 weeks with new triple omeprazole, anoxicillin, clarithromycin (OAC) treatment in October 1995, and cure of the infection was repeatedly confirmed by histology, culture, and the 13C urea breath test. One month after the curative therapy, recurrence of a small duodenal ulcer was observed and in February another duodenal ulcer and reflux esophagitis occurred, with severe symptoms, despite the continuous administration of ranitidine. None of the examinations to reconfirm cure of the infection revealed the presence of H. pylori. As the patient experienced continual psychological stress and smoked more frequently during the recurrent episode and had not used nonsteroidal anti-inflammatory drugs, stress and smoking appeared to play important roles in the relapse of duodenal ulcer in this patient after cure of H. pylori infection.