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81.
Tomoya Ikeda Naoto Tani Tatsuya Hirokawa Kei Ikeda Fumiya Morioka Alissa Shida Yayoi Aoki Takaki Ishikawa 《Internal medicine (Tokyo, Japan)》2022,61(13):1999
A man in his 30s injected insulin several times into his abdomen and was found dead several hours later. Micropathological findings showed alveolar injury with hemorrhaging and cerebral parietal lobe nerve cell edema. Biochemical examinations showed that the blood insulin level was high, significantly so at the insulin injection sites. The blood glucose and C-peptide levels were low. The insulin level in the kidneys was low. In forensic medicine, a postmortem diagnosis of insulin subcutaneous injection is often difficult. When insulin injection is suspected, particularly high insulin levels can be expected at the insulin injection site, rather than in the blood. 相似文献
82.
Kenji Nakahama Hiroyasu Kaneda Koichi Ogawa Yoshiya Matsumoto Yoko Tani Tomohiro Suzumura Shigeki Mitsuoka Tetsuya Watanabe Kazuhisa Asai Tomoya Kawaguchi 《Internal medicine (Tokyo, Japan)》2022,61(7):1039
A 68-year-old Japanese man was diagnosed with lung adenocarcinoma stage IVB. We introduced a first-line chemotherapy of four cycles of carboplatin and pemetrexed and pembrolizumab, followed by pemetrexed and pembrolizumab maintenance therapy. Approximately four months after anticancer therapy, a small nodule appeared in the right peripheral S3 lesion. After five months, the nodule was confirmed as a Mycobacterium tuberculosis (TB) nodule. We initiated anti-TB therapy without stopping pembrolizumab, and the right S3 nodule shrank immediately. This report supports the concurrent use of anti-TB treatment with an immune checkpoint inhibitor when the TB infection area is limited. 相似文献
83.
Tetsuro Uchida Yoshinori Kuroda Atsushi Yamashita Mitsuaki Sadahiro 《Journal of cardiac surgery》2019,34(12):1673-1675
Currently, total arch replacement (TAR) using frozen elephant trunk (FET) technique is gaining popularity for various thoracic aortic pathologies. FROZENIX is the first commercialized open stent‐graft (OSG) in Japan, and it is a useful alternative to previously self‐made OSG. FROZENIX is easy to deploy compared with formerly launched OSGs. However, some challenges have been identified with FROZENIX. Herein, we present the cases of two patients in whom we encountered serious unexpected kinking of FROZENIX during TAR performed using FET, which was related to its structural property. The clinical course and the bailout are described. 相似文献
84.
N Kuroda N Yamanaka E Kawamura W Tanaka Y Kitayama M Imakita E Okamoto 《The Journal of surgical research》1999,85(2):279-285
BACKGROUND: The liver and portal circulation contribute to production and clearance of endothelin-1 (ET-1). This study was undertaken to investigate what variables relate to the dynamics of ET-1 in hepatic resection and its clinical implication. PATIENTS AND METHODS: On 20 patients with (n = 8) or without (n = 12) chronic liver disease who underwent hepatic resection, peripheral arterial and portal venous ET-1 were serially measured to determine a correlation with pre-, intra-, and postoperative variables. RESULTS: The preoperative factors with which the portal ET-1 showed a positive correlation were the indocyanine green retention rate at 15 min (ICG R15) and portal venous pressure. The ET-1 clearance, as calculated from the difference between the portal and the peripheral ET-1 concentrations, was also correlated with the ICG R15. The peripheral ET-1 elevated significantly in the patients with increasing intraoperative blood loss or hepatic inflow occlusion. An increase in the portal ET-1 was correlated with an elevation of portal venous pressure after hepatectomy. Postoperative increase in serum bilirubin was closely correlated with the peripheral ET-1 at closure. CONCLUSION: The peripheral and portal ET-1 are correlated with not only preoperative hepatic reserve and portal venous pressure but also invasiveness of hepatectomy and postoperative course. 相似文献
85.
86.
Ayuko Yamashita Mineaki Kitamura Yohei Tateishi Kenta Torigoe Kumiko Muta Yasushi Mochizuki Tsuyoshi Izumo Takayuki Matsuo Akira Tsujino Hideki Sakai Hiroshi Mukae Tomoya Nishino 《Internal medicine (Tokyo, Japan)》2022,61(8):1133
Objective The quality of life and activities of daily living (ADL) are generally poor among dialysis patients after intracerebral hemorrhaging, and their precise clinical course remains unclear. In addition, the association between the severity of cerebral hemorrhaging and the long-term prognosis in these patients has not been fully elucidated. This study aimed to evaluate the subsequent prognosis of hemodialysis patients who survived the acute phase of intracerebral hemorrhaging. Methods We included hemodialysis patients who were admitted to Nagasaki University Hospital between 2007 and 2015 for intracerebral hemorrhaging treatment. After excluding cases of in-hospital death, survivors were classified using the 5-point modified Rankin Scale (mRS), which specifically measures the ADL in patients with cerebrovascular diseases. The patients were followed up at the medical facilities to which they were transferred in the same medical zone until 2017. Results Out of 91 patients with cerebral hemorrhaging (65±11 years old, 66% men, hemodialysis duration 108±91 months), 62 survived until discharge. Twenty-one patients died during observation, largely due to infectious diseases, such as sepsis and pneumonia (n=16, 76%). Compared to patients with mRS 0-4 (n=31), those with mRS 5 (n=31) showed a significantly poorer prognosis. The hazard ratio adjusted for age and antiplatelets was 13.7 (95% confidence interval: 3.88-63.7, p<0.001). Conclusion Hemodialysis patients with intracerebral hemorrhaging who were bedridden showed poor outcomes. The major causes of death were infections. Therefore, these patients should be carefully monitored for infections in order to improve their prognosis. 相似文献
87.
Tomoya Matsuhashi Alexander W. Hooke Kristin D. Zhao John W. Sperling Scott P. Steinmann Kai-Nan An 《Clinical biomechanics (Bristol, Avon)》2013,28(9-10):961-966
BackgroundThe humeral head and glenoid cavity are not perfectly spherical, nor do they have matching radii of curvature. We hypothesized that glenohumeral stability is dependent on axial humeral rotation.MethodsSeven cadaveric shoulders were investigated. For each test, the humeral head was translated relative to the glenoid in 2 directions (starting from neutral), anterior and anteroinferior. Contact forces and lateral humeral displacement were recorded. Joint stability was quantified using the stability ratio and energy to dislocation. The humerus was set in 60° of abduction for all tests. Testing was performed in neutral rotation and 60° of external rotation.FindingsThe force displacement curves differed between rotations. In both displacement directions, the peak translational force occurred with less displacement in neutral rotation than in external rotation. The stability ratio and energy to dislocation in the anteroinferior direction were greater than in the anterior direction for both rotation positions. While there were no significant differences in the stability ratio or energy to dislocation between rotation conditions at complete dislocation, the energy required to move the humeral head 10% of the glenoid width was significantly greater with the arm in neutral rotation.InterpretationThe energy to dislocation, a new parameter of dislocation risk, and the stability ratio, indicate that the glenohumeral joint is more stable in the anteroinferior direction than the anterior direction. During initial displacement, axial rotation of the humeral head contributes to glenohumeral geometrical stability. However, humeral head rotation does not have a significant effect when looking at complete dislocation. 相似文献
88.
Shoichiro Hirose M.D. Hideo Honjou Hikohito Nakagawa Keigo Nishimura Yoshitaka Kuroda Masahiko Tsuji Atsuo Miwa Masanobu Kitagawa 《Journal of gastroenterology》1989,24(5):481-487
Clinical and pathological characteristics of scirrhous carcinoma of the stomach were studied in 106 cases treated by gastrectomy
between 1973 and 1983. The male to female ratio was 0.58. The percentage of scirrhous carcinomas to all gastric carcinomas
resected in the same period was three times higher in females than males. The age distribution of the patients suggested that
there were two peaks in the forties and sixties in the male, and in the thirties and fifties in the female. The incidence
of scirrhous carcinoma in all types of gastric carcinoma was significantly higher in the twenties, thirties and forties compared
to the lowest incidence in the seventies. In the female group the primary lesion had a tendency to be adjacent to the fundic
gland area and to avoid intestinal metaplasia. In the male the opposite was recognized. Cancer nests with single cells or
only several cells were common in this type of carcinoma. These findings suggest that there might be two biologically different
scirrhous carcinomas both in the male and the female, the appearance of single carcinoma cells might be favored by female
sex hormones and young ages, and not only the original gastric mucosa but also mucosa with intestinal metaplasia could be
precursors of single carcinoma cells. 相似文献
89.
Nakamura K Funabashi N Miyauchi H Aminaka M Uehara M Ueda M Murayama T Hori Y Nakayama T Daimon M Kuroda N Kobayashi Y Komuro I 《International journal of cardiology》2008,127(3):437-441
We report the case of a 38-year-old Asian man with a pericardial hemangioma on the left main coronary artery. The patient presented initially at our hospital after cardiopulmonary resuscitation following an episode of ventricular fibrillation (VF). Because of spontaneous coved-type ST segment elevation on the higher intercostal space V1 to V2 in a 12-lead electrocardiogram, documented VF in the absence of structural heart disease, and a family history of sudden death, he was diagnosed with Brugada syndrome. Transesophageal echocardiography showed a smooth-surfaced mass with well-demarcated borders, directly above the left main coronary artery. Computed tomography confirmed the presence of the mass, which showed no enhancement at early phase, but did demonstrate homogenous enhancement at delay phase by contrast material. There were no findings from either the nuclear medicine or the tumor marker investigations which indicated that the mass located just above the main coronary arteries was malignant. Therefore, taken together, these findings suggested that the tumor might be a pericardial hemangioma. The relationship between the location of the hemangioma just above the left main coronary artery and the occurrence of VF was not clear, i.e. whether the presence of the hemangioma caused the stimulation of the left main coronary artery and as a result, led to the spasm of the left main coronary artery and the occurrence of VF. Furthermore, as the tumor did not extend into any of the adjacent structures, such as the coronary arteries or the right ventricular outflow tract, surgical resection was not performed; instead, the patient received a dual chamber implantable cardioverter-defibrillator. 相似文献
90.
Akihiko?Inoue Toru?Hifumi Yasuhiro?Kuroda Naoki?Nishimoto Kenya?Kawakita Susumu?Yamashita Yasutaka?Oda Kenji?Dohi Hitoshi?Kobata Eiichi?Suehiro Tsuyoshi?Maekawa 《Critical care (London, England)》2018,22(1):352