JaLCDOI 10.18926/11698
タイトル(別表記) Diabetic complications in the advanced stage of chronic pancreatitis.
フルテキストURL 061_079_088.pdf
著者 越智 浩二| 立花 英夫| 松本 秀次| 妹尾 敏伸| 田中 淳太郎| 原田 英雄|
抄録 慢性膵炎が進行すると膵内外分泌不全に対する治療が主体となる。かつては膵疾患に由来する糖尿病(膵性糖尿病)においては糖尿病性合併症の発症が少ないとされていたが,慢性膵炎の長期経過観察例の増加とともにその頻度が一次性糖尿病にくらべて必ずしも低くないことが指摘されるようになった。そこで今回,厚生省難治性膵疾患調査研究班「慢性膵炎の新しい治療法の開発」小委員会の研究活動の一環として膵性糖尿病の治療法を再検討することになったのを機会に,その手始めに野性糖尿病の合併症に関する従来の報告を整理した。その結果,一次性糖尿病の場合にくらべて,細小血管症(網膜症,腎症,神経障害)はほぼ同程度であるが軽症例が多いこと,大血管症(心筋梗塞,脳硬塞,動脈硬化症)は少ないことが示唆された。そのほか,膵性糖尿病の合併症の発症に関与すると考えられる諸因子についても概説した。
抄録(別表記) Exocrine dysfunction (maldigestion) and endocrine dysfunction (diabetes) are malll clinical features in the advanced stage of chronic pancreatitis. Diabetic complications were previously considered to be infrequent in diabetes secondary to chronic pancreatitis (pancreatic diabetes). However, the recent improvement in life expectancy and closer observation of the clinical course of patients with chronic pancreatitis have revealed that diabetic complications are not infrequent in pancreatic diabetes as compared with primary diabetes mellitus and that diabetes is one of the most important prognostic factors in chronic pancreatitis. We, therefore, reviewed recent articles on the topics before beginning a national survey of diabetic complications in patients with pancreatic diabetes. It has been suggested that : (1) diabetic microangiopathy (retinopathy, nephropathy and peripheral neuropathy) is almost as frequent in secondary diabetes as in primary diabetes, although the severity is less in secodary diabetes : (2) peripheral neuropathy is frequent in alcoholic chronic pancreatitis : (3)macroangiopathy (myocardial infarction, cerebral thrombosis, atherosclerosis) is less frequent in pancreatic diabetes. We also discussed various factors which may precipitate the diabetic complications.
キーワード 膵性糖尿病 (Pancreatic diabetes) 慢性膵炎 (Chronic pancreatitis) 合併症 (Complications)
出版物タイトル 環境病態研報告
発行日 1990-09
61巻
開始ページ 79
終了ページ 88
ISSN 0913-3771
言語 Japanese
論文のバージョン publisher
NAID 120002313469
JaLCDOI 10.18926/11674
タイトル(別表記) Development of stepping measurement device for evaluation of and training in walking
フルテキストURL 061_123_128.pdf
著者 松本 秀次| 越智 浩二| 田中 淳太郎| 立花 英夫| 妹尾 敏伸| 原田 英雄| 壷井 圭一| 三宅 啓文| 木村 郁郎|
抄録 急性膵炎の回復後その発症原因の検索において発見された小膵癌の3例を報告し,膵炎の発症原因の一つとして膵癌を常に念頭におく必要があることを強調した。またスクリーニング検査および精査において小膵癌を診断する手順について考察を加えた。症例1は初回発作の回復後に,症例2および症例3は再発発作の回復後に急性膵炎の発症原因の検索を目的に紹介された。いずれの症例においても血清腫瘍マーカーは正常植を示し,腹部USおよびCTは腫瘍から尾側の膵管の拡張を示したが腫瘍そのものは描出はできなかった。症例1ではERCP像から膵体部癌を強く疑い,症例2と症例3ではERCP像と細胞診陽性所見から膵頭部癌と確診し,手術を行った。腫瘍の最大径は症例1では0.9cm,症例2では1.5cm,症例3では2.0cmであり,いずれも転移を認めず根治切除可能であった。
抄録(別表記) Although gait training equipment such as the bicycle ergometer and treadmill exists for patients whose walking ability is high, there is no appropriate gait training mehtod or training instrument for patients whose walking ability has become impaired, who often use a cane or walker, etc. in the course of daily life. In the case of gait training for persons whose walking ability involves impaired locomotion, there is always the danger of a fall. Consequently, a caregiver is required, and the effect of the training is cut by half because the patient's anxiety about falling is exacerbated. Slow stepping affords strengthening and balance training of the leg muscles for patients whose walking ability has become low, and walking ability is improved. However,whether such training appropriately carries out stepping and the degree of the effect of such training has not been evaluated. Therefore, we have developed a stepping measturement device that monitors stepping for evaluation and training of walking ability. This system consists of two mat switches for stepping, a measuring circuit for stepping detection, and a book-sized personal computer with a PC card-type AD converter. This system can detect a left or right single stance phase and a double stance phase relative to the ON, OFF condition of the mat switch. After measurement, the following items are analyzed and displayed : ・number of steps, ・average time of double stance phase, ・the average time of single stance phase, and so on. Finally, we measured the stepping of subjects whose walking ability is low, and showed the relationship between daily walking conditions and stepping conditions. The effectiveness of this system was considered in light of the results.
キーワード 小膵癌 (Small pancreatic cancer) 膵癌の早期発見 (Early diagnosis of pancreatic cancer) 急性膵炎 (Acute pancreatitis)
出版物タイトル 環境病態研報告
発行日 1990-09
61巻
開始ページ 123
終了ページ 128
ISSN 0913-3771
言語 Japanese
論文のバージョン publisher
NAID 120002313750
JaLCDOI 10.18926/11668
タイトル(別表記) カンジダ特異的IgG(4)抗体と気管支喘息
フルテキストURL 062_001_004.pdf
著者 谷崎 勝朗| 貴谷 光| 岡崎 守宏| 御舩 尚志| 光延 文裕| 高取 明正| 奥田 博之| 原田 英雄|
抄録 Serum levels of Candida-specific IgG(4) antibodies were examined in 66 patients with bronchial asthma, relating to patient age and asthma severity. 1. The levels of Candida-specific IgG(4) antibodies were the highest in patients with 60+years of age, compared to the levels in cases with 0-39 and 40-59 years of age. 2. In cases with 40-59 years of age, the levels of Candida-specific IgG(4) were significantly higher in cases with long-term steroid therapy (severe intractable asthma) than in cases without steroid regimen. The results suggest that increased levels of Candida-specific IgG(4) were observed in relation to patient age and asthma severity.
抄録(別表記) 66例の気管支喘息症例を対象に,血清中カンジダ特異的lgG(4)抗体を測定し,その血中レベルと年齢および喘息の重症度との関連について検討を加えた。1.血清カンジダ特異的IgG(4)値は,0~39才,40~59才の年齢層にくらべ,60才以上の年齢層において高く,年齢によりその値が変動することが 示唆された。2.40~59才の年齢層では,血清カンジダ特異的IgG(4)は,ステロイド非使用例にくらべ,ステロイド依存性重症難治性喘息症例で有意の高値を示し,この年齢層では,カンジダ特異的IgG(4)抗体がその発症病態に関連している可能性が示唆された。以上,カンジダ特異的IgG(4)抗体の上昇は,高年齢層の症例(60才以上)では全般的に,また40~59才の年齢層で重症型喘息症例において観察されることが明らかにされた。
キーワード Candida (カンジダ) Sepcific IgG(4) (特異的IgG(4)) Bronchial asthma (気管支喘息) Aging (加齢) Asthma severity (喘息重症度)
出版物タイトル 環境病態研報告
発行日 1991-08
62巻
開始ページ 1
終了ページ 4
ISSN 0913-3771
言語 English
論文のバージョン publisher
NAID 120002313495
JaLCDOI 10.18926/11666
タイトル(別表記) Trial of a mass screening survery for detecting early pancreatic cancer
フルテキストURL 062_005_010.pdf
著者 松本 秀次| 越智 浩二| 田中 淳太郎| 妹尾 敏伸| 原田 英雄|
抄録 早期膵癌を発見するためのスクリーニング法を確立するため,1986年6月1日から1990年6月30日までの期間のprospective studyを行った。対象は,人間ドックを目的として来院した患者を主とする三朝分院の外来患者1,748名である。一次スクリーニング検査として,血清アミラーゼ,エラスターゼI,腹部超音波検査(US)を施行し155名の要精検者が得られ,要精検率は8.9%であった。155名の要精検者に,二次検査として,USの再精査,ERCP,腹部CTを施行した。その結果,早期膵癌患者1名,進行膵癌患者4名を発見し,膵癌発見率は0.29%と良好な成績であった。加えて,一次スクリーニングの検査項目を限定することによりcost-benifitを改善することができた。発見された膵癌患者の3名は60歳代であった。また,年代別要精検率は加齢とともに上昇した。1年以後にfollow-up検査を受けた患者の数は641名でfoilow-up率は36.7%であり,そのなかから膵癌は発見されなかった。60歳代のfollow-up率は40歳以上60歳未満のそれにくらべて有意の低値をとった。早期膵癌の見逃しを少なくするためには,今後,60歳代を中心とする患者のfollow-up率をさらに高めることが必要である。
抄録(別表記) To find an effective mass screening method for detecting early pancreatic cancer among asymptomatic populations and patients with vague abdominal symptoms, a prospective study was attempted on 1748 patients who came to Medical Clinic of Misasa Branch Hospital, Okayama University Medical School mostly for a routine annual chek-up from June 1, 1986 through June 30, 1990. These patients underwent first-step screeing tests including serum amylase, elastase I and routine abdominal ultrasonography (US). Consequently 155 patients (8.9% of the total 1748 patients) showed abnormal findings and underwent secondstep tests including US, ERCP and computed tomography. Final diagnosis was early pancreatic cancer in one patient and advanced pancreatic cancer in four. Three of the 5 patients with pancreatic cancer were in their sixties. Detection rate of pancreatic cancer (0.29%) in this series was satisfactory as compared with the results of previous reports with US alone. The rate of second-step examination increased with age. Six hundred and forty-one patients (36.7% of the 1748 patients) underwent follow-up examinations more than one year after the previous test. No pancreatic cancer was detected in the 641 patients. The rate of follow-up examination in patients in their sixties was significantly lower than in those in their forties or fifties. It is important to improve the follow-up rate in patients in their sixties, because they are at a high risk for pancreatic cancer as suggested by the present study.
キーワード 膵集検 (Mass screening for pancreatic cancer) 膵癌の早期診断 (Early diagnosis of pancreatic cancer) 早期膵癌 (Small pancreatic cancer)
出版物タイトル 環境病態研報告
発行日 1991-08
62巻
開始ページ 5
終了ページ 10
ISSN 0913-3771
言語 Japanese
論文のバージョン publisher
NAID 120002313927
JaLCDOI 10.18926/11664
タイトル(別表記) A dietary survey in patients with chronic pancreatitis
フルテキストURL 062_011_015.pdf
著者 林下 加奈枝| 越智 浩二| 原田 英雄| 田中 淳太郎| 田熊 正栄| 増井 悦子| 谷崎 勝朗| 松本 秀次| 妹尾 敏伸| 出石 通博|
抄録 食事療法は慢性膵炎治療の基本として重要であるが,その具体的な内容についてはあまり明確にされていない。今回,筆者らは慢性膵炎例の食事に関する全国調査の一部を担当したので,その成績を報告し,問題点と対策について考察した。対象は慢性膵炎間欠期の患者56名(男44名,女12名)である。(1)エネルギー摂取量では1日1,400kcal以下が16名(29%)にみられ,肥満度80~90%が7名および80%以下が9名という栄養状態と考え合わせて,食事の回数を増やしてでも摂取エネルギーの改善をはかる必要がある。(2)蛋白質および脂質摂取量についても同様な成績であり,消化酵素剤を投与しながら量的,質的な改善をはかる必要がある。(3)糖質については質的改善をはかる必要がある。(4)ビタミンとミネラルも不足傾向にあった。野菜の摂取不足が顕著であった。(5)診断確定後も禁酒できない患者が男17名(39%),女1名(8%)にみられ,その指導が重要な課題である。
抄録(別表記) Importance of diet therapy has been emphasized in chronic pancreatitis. However, concrete measures and programs of the diet therapy have remained to be studied. Therefore, Intractable Pancreatic Disease Study Group recently carried out a nation-wide questionnaire survey on the diets in patients with chronic pancreatitis under the auspIces of the Ministry of Health and Welfare. Attendant physicians were requested to report the nutritional states of their patients and the kinds and amounts of foods taken by their patients on three consecutive days. The nutritional state was evaluated by a body weight index calculated by the following formula:Body Weight Index (%) = Present Body Weight / Ideal Body Weight X 100. Daily nutritional intake (calorie, protein, fat, carbohydrate, and others) was calculated by dieticians according to the Food Exchange Table published by the Japanese Association of Diabetes. The present study constitutes a part of the group study. Patients consisted of 44 men and 12 women who fulfilled the diagnostic criteria proposed by the Japanese Society of Gastroenterology;20 men and 3 women had secondary diabetes mellitus. Following results and conclusions were obtained. (1) Average daily calorie intake of the patients was 1,759kcal as compared with 2,057kcal in the general population in Japan. Sixteen patients (28.6%) showed daily calorie intake less than 1,400 kcal and consequently poor nutritional states (6 patients with body weight indices less than 80% and 10 with 80-90%). It is important, therefore, to try to improve the daily calorie intake by increasing the frequency of diets in these patients. (2) Average daily intake of protein was 72.1 g (animal protein 38.1 g), only slightly less than 79.2 g (animal protein 41.7 g) in the general population. However, as many as 16 patients (28.6%) showed daily protein intake of less than 60 g and poor nutritional states as described above. It is important, therfore, to encourage patients to maintain the daily protein intake of more than 60 g by increasing the frequency of diets with oral administration of digestive enzymes. (3) Average daily intake of fat was 39.9 g (animal fat 23.8 g), approximately 20 g less than 58.3 g (animal fat 28.0 g) in the general population. As many as 17 patients (30.4%) showed daily fat intake of less than 30 g , and 16 of the 17 patients showed poor nutritional states as described above. It is important, therefore, to encourage patients to maintain the daily fat intake of more than 30 g (especially by increasing the amounts of vegetable oil) by increasing the frequency of diets with oral administration of digestive enzymes. (4) Average daily intake of carbohydrate was 278 g, almost equal to 289 g in the general population. However, many patients took as much as 48 g of carbohydrate in the from of cakes, plain sugar and alcohol beverages. Seventeen men (39%) and one woman (8%) had continued drinking alcohol beverages even after the diagnosis was made. It is important, therefore, to encourage patients to improve the quality of carbohydrate intake, although it is admittedly difficult to realize the ideal. (5) Intake of vitamins and minerals (especially calcium) also tended to be insufficient. Green vegetables were especially insufficient. (6) In conclusion, it is utmost important in chronic pancreatitis to perform periodical evaluation of nutritional intake and feed back the information to the treatment through a close patient-dietician-doctor relationship.
キーワード 慢性膵炎 (Chronic pancreatitis) 食事療法 (Diet therapy in chronic pancreatitis) 栄養状態 (Nutrition in chronic pancreatitis)
出版物タイトル 環境病態研報告
発行日 1991-08
62巻
開始ページ 11
終了ページ 15
ISSN 0913-3771
言語 Japanese
論文のバージョン publisher
NAID 120002313896