Objective: To evaluate whether decreased abdominal air pressure and continuous administration of muscle relaxants may help relieve severe postoperative shoulder pain.Design: Retrospective cohort study.Settings: Single-
Spaces in Mies's interior montages have the character either Miesian“flowing space”or“unitary space”, and in these montages both spaces indicate different expression especially in the relation between inside space and outside one. On the one hand, in montages for flowing space outside space is deprived of its aspects as outside space and becomes the extension of the interior space, and there is no outside space as the “otherness” to the interior space. On the other hand, in the montage that expresses unitary space has the outside space that symbolizes the outside as otherness and consist a schematic contrast between inside space as abstract space and outside space as space of otherness.
To investigate the effect of oral glucose intake on gastric motility, we measured gastric myoelectrical activity and gastric emptying on two test conditions: 1) glucose intake and 2) water intake in the same 10 healthy male volunteers (20 to 29 years old). Gastric motility was evaluated with cutaneous-recorded electrogastrography (EGG) for 30 min both on fasting and after glucose or water intake, while gastric emptying was measured using acetaminophen-absorption method. There were no significant changes in EGG dominant frequency after water intake, but the frequency increased significantly after glucose intake. A postprandial dip (i.e., a transient decrease in frequency immediately after the food intake) was observed in 3 subjects after water intake and in 8 subjects following glucose intake. The EGG power ratio was significantly larger after glucose than water intake, with delayed gastric emptying in the former case. These results suggest that glucose is one of the components responsible for postprandial gastric motility.
Although it is well-known that 2% lidocaine has an effective action for preventing propofol-induced pain, it has been unclear whether or not lidocaine of the concentration below 2% has the effective action similar to 2% lidocaine. One-hundred and thirty-two patients were randomly assigned to one of the six groups according to concentration and dosage of lidocaine administered at the time of the initiation of propofol infusion. Groups I and II received 1 ml and 2 ml of 1% lidocaine, respectively; Groups III and IV were given 1 ml and 2 ml of 0.5% lidocaine, respectively; Group V received 2 ml of 2% lidocaine; Group VI was administered 1 ml of normal saline as a control. There were no significant differences in patients' profiles and alterations of hemodynamics during anesthetic induction among the six groups. Number of patients complaining of a pain during induction was more in Group VI with significance (P < 0.0001) and number of patients complaining of uncomfortableness was also more with significance (P < 0.0001). Incidence of propofol-induced pain and degree of satisfaction with anesthetic induction were similar among the groups receiving lidocaine. Even 0.5% lidocaine may have the same effective action as 2% lidocaine for preventing the pain on injection of propofol.
A 35-year-old woman (gravida 1, para 0) underwent termination of pregnancy (ToP) at 12 weeks of gestation. One month after ToP, she experienced significant vaginal bleeding and the mass with blood flow was identified on imaging. The presence of a placental polyp with arteriovenous malformation (AVM) was suspected on transvaginal sonography and MRI. Since the bleeding had ceased when she visited our hospital, we decided to treat the placental polyp with AVM with gonadotropin-releasing hormone (GnRH) antagonist therapy instead of surgery. Two months after GnRH antagonist treatment, the mass and blood flow in the uterus disappeared. Menstruation resumed 1 month after the completion of treatment. In our case, we were able to successfully treat placental polyps with AVM using GnRH antagonist therapy.
We treated four pregnancy cases positive for antiphospholipid antibodies (APLs) who had experienced recurrent second trimester fetal or neonatal losses using a Japanese modified Chinese herbal medicine, Sairei-to, low dose aspirin and adrenocorticosteroid hormone. The clinical courses of their new pregnancies in conjunction with the dynamic changes in their APL titers are described in this paper, and the possible efficacy of this treatment is discussed. The concept that autoimmune abnormalities, especially positive APLs, are generative factors for a range of reproductive failures, such as recurrent abortions, intrauterine growth retardation, intrauterine fetal death and preeclampsia, is now attracting a great deal of attention in the fields of reproductive immunology and perinatal medicine (Yasuda et al., 1995). The main mechanisms in the generation of reproductive failures are considered to be direct damage to chorionic villi by APLs during the period of placentation (Rote et al., 1998), as well as the formation of thrombi intervillous spaces (Arakawa et al., 1999). Considering these mechanisms of the reproductive failure generation by APLs, the application of immune suppressive therapy in combination with anti-coagulation therapy should be reconsidered as a treatment option. In this context, we treated four pregnancy cases positive for APLs who had experienced recurrent second trimester fetal or neonatal losses using a Japanese modified Chinese herbal medicine, Sairei-to, low dose aspirin and an adrenocorticosteroid hormone.
肺血栓塞栓症(PTE)は従来本邦では頻度が少ないと思われていたが,生活様式の欧米化によってその頻度が増える傾向にある。2002年に示されたEAST (Eastern Association for the Surgery of Trauma)治療ガイドラインワークグループによる外傷患者における静脈血栓塞栓症(VTE)予防のための治療ガイドラインでは頭部外傷患者を除く出血のリスクが許容できるハイリスクのすべての外傷患者に低分子ヘパリン(LMWH)の使用を強く考慮すべきとしている。本邦における外傷患者に対するVTE予防法の現状を知るために,全国の救命救急センター及び救急指導施設に対してアンケート調査を行った。対象は全国の救命救急センターおよび日本救急医学会指導医指定施設(175施設)で,調査内容はVTEの経験の有無,基準を設けたVTE予防の有無,その基準と予防法とした。有効回答率は39%。回答施設の内,VTEの経験があったのは57.4%。基準を設けたVTE予防法を行っていたのは44.1%,行っていなかったのが55.9%であった。VTE予防を行っていたのは,VTEの未経験施設のうち37.5%, VTEの経験施設のうち47.1%であった。ハイリスクグループの基準として挙げられているのは床上安静例(体位交換禁止)が82.1%,筋弛緩剤使用下の人工呼吸例が64.3%,下肢牽引例が53.6%。 VTE予防法としてはfoot pumpが最も多く75%で,次にヘパリンの使用25%であった。LMWHの使用は極めて少なかった。近年,本邦でもVTEの予防指針案が作成されているが,救命救急センターや日本救急医学会指導医指定施設においてもDVT/PTE予防の認識が不十分であった。骨盤骨折や多発外傷の患者はVTEの高リスクであり,積極的に抗凝固療法に取り組むべきである。LMWHをはじめとした抗凝固薬の使用を含めたガイドライン策定によるVTE予防策の普及啓発が必要と思われた。
