岡山医学会Acta Medica Okayama0030-15581087-81996第27回 岡山リウマチ研究会287291ENHajimeInoueNo potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-15581087-81996当院における新しい在宅ケア支援システムについて281285ENKenichiTakaiToshikoIkedaMisaMiyasatoYokoYamaneTetzuzoKaneshigeHarumiKitanosakoYasuhiroKanemasaWe established a system to serve aged and disabled people within their neighborhood area. This system consists of visiting nursing service and an institutional care unit, both of which were directed by a managing bureau called the “Life assistance bureau”. This bureau investigates the needs of patients, negotiates with the government, supervises members and is authorized to plan budget and personnel affairs. Activities in one representative case handled by this bureau are reported.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-15581087-81996訪問看護におけるチームケアの取り組み275280ENKenichiTakaiSachikoOhtaToshikoIkedaMisaMiyasatoTetzuzoKaneshigeTakakoKawaiYasumiHarutaHarumiKitanosakoKayoTakahashiThe process of establishing a network between several professions involved in the home care nursing system is reported. This system gave satisfactory support to patients in their home. The frequency of visits by occupational therapists was 45%, 44% for case workers, 44% for visiting nurses from our hospital, 7% for pharmacists, and 3% for dieticians other than doctors and community nurses. For patients residing outside the Okayama Central Hospital areas, the frequency of visits by assistants was 13%, 7% for day care units, and 6% for public health nurses other than doctors and community nurses. Co-operative involvement in the care management of patients was beneficial to the home care nursing system because the needs of patients could be more easily met by members of different professions and opinions from different perspectives improved the quality of patient care. The quality of care management was evaluated and two cases are described.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-15581087-81996高齢者の死亡前医療費に関する決定要因の定量的分析267274ENShinichiTaniharaThis study evaluated medical expenses during the last seven months of life in elderly patients aged seventy and over in a rulal town in Okayama prefecture from January 1992 to March 1995, using data from death certificates and medical fee claim records of the elderly. The findings were as follows : 1. The monthly expenses increased toward the last month of life. 2. In the multiple regression model, five independent variables (length of hospital stay, malignant disease, cerebral vascular desease, place of death, services of a visiting nurse) accounted for about 60% of the variance in medical expenses during the last seven-month period. 3. Inflation of medical expenses of the elderly during the premortem period of life was mainly related to long-term hospitalization. 4. In analysing medical expenses, controlling various factors related to long-term hospitalization was found to be important.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-15581087-81996ドパミン受容体とドパミントランスポーターの遺伝子多型に基づいた精神分裂病の分子遺伝学的研究253266ENKojiYamaguchiFour studies on variants of the D2 receptor gene (Ser→Cys), Bal 1 polymorphism in D3, 48-nucleotide repeat polymorphism in D4, and 40-nucleotide repeat polymorphism in the dopamine transporter gene were carried out in patients with schizophrenia (n＝73), mood disorder (n＝11), neurological disease (n＝41) and controls (n＝29). Each polymorphism was typed by amplification of genomic DNA by PCR and agarose gel electrophoresis. Eight individuals were heterozygous for Cys/Ser 311 of D2 and three of these eight were schizophrenia patients and two of the three had family histories of the illness. Two patients with schizophrenia were homozygous for the mutant form of D3 and showed a stuporous state at disease onset. It was detected that four-fold and two-fold repeats in D4, and ten-fold, nine-fold and seven-fold repeats in the dopamine transporter gene. There was no evidence of association between any of these variants and reactivity to pharmacotherapy for schizophrenia.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-15581087-81996心室細動下両心バイパス型人工心臓における循環及び内分泌動態の検討241252ENHironobuNakayamaHemodynamic and hormonal changes were studied in 13 sheep whose entire circulation was maintained by a biventricular bypass system with a pair of pusher-plate type blood pumps. Ventricular fibrillation was induced and pneumatically driven pumps placed outside the body kept the animals alive for 2-48 days (average: 11 days). Pump output and aortic pressure stayed within physiological ranges, but central venous pressure was elevated from 5 to 10-13 oHg after surgery. Serum levels of antidiuretic hormone, cortisol and insulin were stabilized soon after surgery. Adrenaline level and renin activity did not change significantly. For unknown reasons, the noradrenaline level showed a temporary increase after a week. Atrial natriuretic peptide (ANP) increased significantly 5 days after surgery. There were significant drops in triiodothyronine (T(3)) and thyroxine (T(4)) levels after surgery with gradual recovery afterward to 40% and 50% of the control levels, respectively. These results suggested that the biventricular bypass system maintained hemodynamic conditions similar to those maintained by the natural heart, although ANP, T(3) and T(4) values were changed.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-15581087-81996動脈圧波形の形状変化に対する周波数解析による検討225240ENTomohikoSaitoIt is known that the shape of arterial blood pressure waveform reflects the hemodynamic status, but quantitative analyses of waveform are seldom reported. In this study, the arterial pressure wave was recorded with an intra-arterial catheter and pressure transducer, converted to digital data, and stored in a computer. The data were analyzed by two methods of spectrum analyses, i.e., fast Fourier transform (FFT for both power spectrum and phase information) and the autoregressive model (ARM). Pressure waveforms during normotension were compared with pressure waveforms during hypotension induced by vasodilators (sodium nitroprusside and nitroglycerin) in the human study, and by the vasodilators, hemorrhage or 3% isoflurane in the animal study. Reconstruction of waveforms by inverse FFT was also performed, and compared with the original waveforms. FFT is more useful than ARM for analysis of data with known frequencies, such as respiratory and heart rates. Using inverse FFT, the wave can be reconstructed by the base frequency (heart rate) to 4th harmonic data with an error margin of less than 2%. The amplitude and phase information of heart rate frequency up to its 4th harmonic, and amplitude of respiratory frequency, were found to be the essential parameters to describe the shape of the arterial pressure waveform.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-15581087-81996開心術後における Macrophage Colony-Stimulating Factor と急性相反応物質の血中動態について215223ENHirokazuChikakiyoTo clarify the phathophysiological role of macrophage colony stimulating factor (M-CSF) in the healing processes of inflammation, we studied chronological changes in serum concentrations of M-CSF and other reactants during the acute phase of inflammation in patients who underwent open heart surgery, since these patients showed a precise point of tissue damage. The number of neutrophilic leukocytes increased in the very early postoperative stage, reached a peak 48 h after surgery and declined to the basal level at day 14. The chronological changes in serum C-reactive protein level after surgery were similar to these of neutrophic leukocytes. Serum M-CSF concentrations increased gradually, reached a peak 7 days after surgery and remained at that level until day 14. Based on these phenomena, it is assumed that M-CSF plays a pathophysiological role in the healing processes of an inflammation. Measurement of the serum concentration of M-CSF would be useful for evaluating the process of inflammation.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-15581087-81996尿路感染症治療における Granulocyte Colony-Stimulating Factor (G-CSF) の有用性に関する基礎的検討203214ENKazuhiroHataThe priming effects of granulocyte colony stimulating factor (G-CSF) on neutrophil function and anti-pseudomonal activity were examined under various osmotic conditions created with urea and NaCL (280mOsm., 400mOsm., 800mOsm.) in vitro. Consequently, the prophylactic effect of G-CSF on post-operative urinary tract infection after transurethral resection of the prostate were examined experimentally. As a result, neutropil chemiluminescence was significantly enhanced by G-CSF under physiological osmotic conditions. However, enhancement was not observed under hyperosmotic conditions as in the urine. Similarly, the anti-pseudomonal activity of human neutrophils was not enhanced by G-CSF under hyperosmotic condition. However, whole blood chemiluminescence in patients after transurethral resection of the prostate was significantly enhanced by the administration of G-CSF. Moreover, postoperative urinary tract infection, considered an infection of the submucosal layer, was not obsereved, suggesting that the neutrophil priming effect occurred in the submucosal layer not in the urinary tract.No potential conflict of interest relevant to this article was reported.