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Background: In coronary angiography (CAG), fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are widely measured for evaluating physiological ischemia and indication for percutaneous coronary intervention (PCI). On the other hand, the progress of ultrasonic devices and techniques have enabled the evaluation of coronary blood flow by non-invasive transthoracic echocardiography. Although, its application is limited to left anterior descending coronary artery (LAD). Objective: To investigate the correlation between the evaluation of physiological ischemia by catheterization and the evaluation of flow velocities by transthoracic echocardiography. Methods: In patients who underwent CAG for diagnosing angina, physiological evaluation of coronary blood flow was performed using pressure wire in LAD lesions. Transthoracic coronary echocardiography was also performed to evaluate the coronary blood flow velocity in the same lesions. Results: The peak diastolic flow velocity of the stenotic portion (V-stn) and the ratio of peak diastolic flow velocities of the stenotic and the reference portions (V-stn/V-ref) showed higher correlation efficient (r) values with FFR (r=0.561, p1m/s or V-stn/V-ref >3 had FFR

目的: 急性腹症の診療におけるCTの有用性を検討した. 対象・方法: 急性腹痛で入院した91例を対象として, 緊急CT群70例, 緊急CT非施行21例に分類した. さらに緊急CT群を腸閉塞29例, 急性虫垂炎および急性虫垂炎と鑑別すべき疾患群36例, 消化管穿孔4例, その他1例に分類し, 緊急CT群の入院時診断の正診率を検討した. 結果: 緊急CT群の最終診断は腸閉塞では癒着性イレウス16例, 大腸癌5例, 外ヘルニア3例, その他5例, 急性虫垂炎・鑑別を要する疾患では急性虫垂炎25例, 大腸憩室炎3例, 骨盤腹膜炎3例, 卵巣出血2例, その他3例, 消化管穿孔では上部2例, 下部2例であった. 緊急CT群の入院時診断の感度, 特異度, 正診率はそれぞれ91.1%, 100%, 91.4%であった. 緊急CT群の腸閉塞, 急性虫垂炎および急性虫垂炎と鑑別すべき疾患群, 消化管穿孔の入院時診断の正診率はそれぞれ96.5, 88.9, 75.0%であった. 緊急CT群で正確な入院時診断ができなかった症例は6例で, 盲腸周囲膿瘍3例, 急性虫垂炎1例, 宿便性S状結腸穿孔1例, 胃石小腸嵌頓1例であった. 後方視的にCTを評価すると4例は入院時診断が可能であった. 考察: 急性腹症の診断において緊急CTは腸閉塞・虫垂炎の鑑別, 微量の遊離ガスの検出, 消化管穿孔の穿孔部位の推定に有用であった. また, 緊急CTは急性腹症の治療方針の決定に有用であった.

開発した高圧熱水抽出装置を用いてイワシ鱗からゼラチンの抽出を行い，ゼラチンの抽出挙動および抽出ゼラチンの性状について検討した．本方法による抽出では抽出管のフィルターに目詰まりは認められず安定した抽出を水だけで行うことができた．抽出管出口温度が温度領域143-153℃以上において加水分解反応が顕著になり，抽出管入口温度225℃ 8分間（抽出管出口温度156-202℃）の抽出でほとんどのイワシ鱗コラーゲンが溶出することが分かった．抽出物中のタンパク質はほぼゼラチンであり，数パーセントのアパタイトと考えられる灰分が含まれていた．またアミノ酸の顕著な熱分解は認められなかった．抽出されたゼラチンの分子量はGPC曲線のピーク地点で443kDa付近から6.5kDa付近となっており，抽出温度が高くなるほど低くなった．入口温度225℃で400-1000mLの画分では，分子量分布の狭いペプチド領域のゼラチンが得られた．

We report a successfully treated case of thoracic penetrating injury caused by a kitchen knife. A 52-year-old woman, stabbed in the right thorax by a kitchen knife was transported into our hospital. The kitchen knife was deeply lodged in the right thorax, and the sound of air leaking was heard at the entrance of the wound. However, the patient was hemodynamically stable. Emergency computed tomography (CT) revealed that the kitchen knife had entered the right thorax across the rib and right lung and was lodged near the vertebrae without causing any cardiovascular injury. The patient was immediately transferred to the operating room. On thoracotomy, the knife was found to have penetrated the tenth ribs and right lower lobe, and it had reached the eighth rib. Right lower lobectomy with removal of the kitchen knife was then conducted. The postoperative course was uneventful. Thus, CT was useful to evaluate the presence of injuries in heart and great vessels and to start operation promptly in our present case.

症例は73歳の男性で, 2004年8月上旬, 突然の心窩部痛を主訴に受診した. 腹部CTにて遊離ガス像, 腹水を認め, 消化管穿孔の診断を得た. 上部消化管内視鏡検査にて穿孔を伴う巨大な胃潰瘍を認め, 緊急開腹術を施行した. 胃下部前壁に穿孔, 後壁に膵穿通を有する広範な胃潰瘍を認めた. 幽門側胃切除術, Roux-en-Y再建を施行した. 穿通部は遺残し, 焼灼した. 摘出標本では胃下部小彎を中心に70×43mmの潰瘍を認めた. 病理検査では穿孔潰瘍の遠位側を中心に約2/3周の深達度mのIII型早期胃癌 (充実型低分化腺癌) を認めた. 総合所見はT1, N0, H0, P0, CY0, M0, stage IA, 根治度Bであった. 胃粘膜にHelicobacter pyloriを認めた. 術後53日目に軽快退院した. 術後7か月を経過したが再発を認めていない. 早期胃癌の穿孔は比較的まれであるが, 自験例は穿孔・膵穿通を呈する広範な消化性潰瘍形成を認めたまれな症例と思われた.

症例は81歳の男性で, 脳梗塞後遺症にて老人保健施設に入所中であった. 嘔吐, 著明な腹部膨満のため当科を受診した. 腹部X線にて胃拡張著明, 腹部造影CTにて上腸間膜動脈により十二指腸が圧迫され, 胃・十二指腸第3部までの拡張あり, 空腸の拡張を認めず. また, 門脈内ガス像を認めた. 上腸間膜動脈性十二指腸狭窄による急性胃十二指腸拡張, 門脈ガス血症と診断し, 経鼻胃管留置により保存的治療を開始した. 誤嚥性肺炎を認めたが, 徐々に全身状態の改善を認めた. 第5病日の腹部造影CT で胃十二指腸拡張・門脈ガスは消失し, 3D-CTでは上腸間膜動脈の分岐角度の狭小化を認めた. 上部消化管造影検査では十二指腸第3部での造影剤の途絶と口側腸管の拡張を認めた. 咀嚼・嚥下障害あり, 経管栄養開始後, 第19病日に転院した. 保存的治療のみで軽快した門脈ガス血症, 急性胃拡張を伴う上腸間膜動脈性十二指腸狭窄症はまれであり, 文献的考察を加えて報告する.

症例は75歳の男性で, 1週間の便秘と腹痛を主訴に当院救急外来を受診した.左下腹部に軽度の腹膜刺激症状を認めた.腹部造影CTにてS状結腸から直腸に多量の糞便の貯留を認めたが, 穿孔所見なく経過観察とした.翌日, 炎症反応著増, 腹部造影CTにて直腸壁外への糞便の漏出を認め, 宿便性大腸穿孔による汎発性腹膜炎の診断にて緊急開腹術を施行した.上部直腸に4.0cmの穿孔, 腸間膜内への糞便漏出を認め, Hartmann手術を施行した.術後に多臓器不全, 創感染, 腹腔内感染を来したが改善した.中枢神経症状が持続し, 臨床症状, 頭部CTにてBinswanger病の診断を得た.臨床症状が安定したため, 術後80日目に近医へ転院した.痴呆症状を有する高齢者では自覚症状が乏しいことがあり, 便秘を伴う突然の腹痛では宿便性大腸穿孔も念頭におき早期診断・早期治療を行うことが肝要である.

Okara was hydrolyzed in subcritical water to increase the inhibitory activity of angiotensin I-converting enzyme (ACE) and soluble dietary fiber (SDF) content. The IC50 of okara and subcritical water-treated okara (SC-okara) for ACE were 11.2 and 4.7 mg/ml, respectively, showing that SC-okara had about 2.4-fold higher inhibitory activity than okara. The SDF content in okara and SC-okara were 3.4 and 17.1%, respectively, showing that SC-okara had about 5-fold higher SDF content than okara. Powdered SC-okara or okara was fed to spontaneously hypertensive rats (SHR) at the level of 5% in a 1% NaCl (control) diet for 28 days. On the 14th and 28th days, the SHRs of the SC-okara group showed significantly lower systolic blood pressure compared to the control group. Thus, hydrolysis of okara by subcritical water is an effective technology for increasing ACE inhibitory activity and SDF content, which cause the hypotensive action.

小麦フスマを亜臨界水処理することで食物繊維含有量がどのように変化するのか検討した.亜臨界水処理の結果,未処理時に比べ,水溶性食物繊維含有量が倍増した.また,亜臨界水処理した小麦フスマ(SC-WB)および処理前の小麦フスマ(WB)を高コレステロール飼料に5%添加した場合にSDラットの脂質代謝にどのような影響を及ぼすのか検討した.血清コレステロール,HDL-コレステロール,リン脂質ではSC-WB群,WB群ともにコントロール群に比べ有意な低下は観察されなかった.一方,血清中性脂肪濃度,腸管膜脂肪組織重量については,SC-WB群,WB群がコントロール群に比べ有意に低下した.しかしながらSC-WB群とWB群とでは有意差は認められなかった.

We focused on heat shock protein 70 (HSP70) as a marker of viability in hepatic warm ischemia-reperfusion. Segmental hepatic warm ischemia was produced in rats for 15, 30, 60, 90, 120, or 180 min. Liver sections were evaluated at 30, 60, and 120 min of reperfusion. Expression of HSP70 and messenger RNA (mRNA), apoptosis, and apoptosis-associated genes such as Bcl-2 and Bax were studied. Expression of HSP70 and mRNA was augmented as warm ischemia was prolonged, but was markedly suppressed in livers with more than 120 min of ischemia. The highest accumulation of HSP70 was observed in the nucleus. In livers subjected to longer duration of warm ischemia, necrosis and apoptosis were evident and Bcl-2 mRNA expression and Bcl-2/Bax protein ratio were markedly diminished. Apoptosis may be related to the process of cellular injury induced by warm ischemia-reperfusion. Expression of HSP70 and the Bcl-2 family can be effective markers of viability in hepatic warm ischemia-reperfusion.

可溶化コラーゲンフィルムに種々の溶媒中でメタクリル酸メチル (MMA) の無触媒光グラフト重合を行った結果著しい溶媒効果が認められ, コラーゲンに対する膨潤能の高いメタノール>エタノール>プロパノール>アセトン=トルエンの順にグラフト率が高い傾向であった. メタノールを溶媒にしてMMA, メタクリル酸n-ブチル (BMA), メタクリル酸2-ヒドロキシエチル (HEMA), ポリスチレン (PSt), および酢酸ビニル (VAc) をグラフト重合すると, VAcを除いて高グラフト率のフィルムが得られた. グラフトフィルムのDSC測定, 動的粘弾性挙動, およびグラフトフィルムから酸でコラーゲンを除去したグラフトポリマーのSEM写真から, MMA, BMA, HEMAグラフトフィルムではポリマーがコラーゲンフィルムに細かく分散した構造であることが示唆された. いずれのグラフトフィルムでも, 高グラフト率にもかかわらず片表面の約0.4μm以上の厚さでコラーゲンが保持されており, 湿潤強度も大幅に向上できたことから十分医用材料としての使用が可能であると考えられた.

Objectives : This study was undertaken to examine the morphological influence of microwave tissue coagulation on the intrahepatic main vessels (both the hepatic vein and the portal vein). We have tried to confirm the harmlessness of microwave tissue coagulation to the intrahepatic main vessels.Methods : The adult mongrel dogs underwent the liver coagulation near the intrahepatic main vessel using the microwave tissue coagulator. The liver tissue was punctured and irradiated by the 15 mm needle electrode with a microwave energy of 60 watts for 30 seconds and then the electrode was charged with a dissociating electric current for 20 seconds. Group A : The distance was 5 mm from the tip of electrode to the intrahepatic main vessel wall. Group B : The tip of electrode attached to the intrahepatic main vessel wall. Just and on the seventh day after the operation, we obtained the coagulated liver tissue and the vessel wall specimens through sacrifices and they were histologically examined (hematoxylin-eosin stain, elastica van Gieson stain, and using scanning electron microscope).Results : Group A : The coagulation of 5 mm diameter from the vessel wall have not injured them at all. Group B : The tunica adventitia was partially injured and the other layers (tunica media and tunica interna) were slightly degenerated, each layers were discriminated. The seventh day after the operation, the vessel wall which was not destroyed and the bleeding was not observed.Conclusions : Results of this study suggests that the microwave tissue coagulation may be useful and harmless, if it is used on the 5 mm far from the intrahepatic main vessel. The bleeding was not observed, even if the tip of the electrode attaches to the intrahepatic main vessel wall.

This test of the technical feasibility of extracting heat from the earth of a volcanic zone and delivering it to water-utilizing heat pipes was conducted at Tsukahara Hot Spring in Kyushu, Japan, in July 1992. The temperature distributions of the heat pipes and the surrounding earth were analyzed through an equivalent thermal network-a three-dimensional circuit of thermal resistances and capacitors taking account of the mass transfer—and did not show much agreement with the experimental data. The calculated values of the heat transport, taking account of the mass transfer, agreed well with the experimental ones in the steady state, assuming the thermal conductivity of the earth. But a discrepancy arose in the unsteady state during startup. There are many problems to be overcome in this area of natural phenomena. Earth more than 0.15 m away from the heat pipe was not affected during the test.

可溶化コラーゲンフィルムをメタクリル酸メチル (MMA) 溶液に接触させて光照射したところ, フィルム内部で無触媒で効率よく重合し, 容易にグラフトフィルムを得た. このグラフトフィルムは多量のpoly (MMA) を含むが, 片表面の深さ約0.4μmまではpoly (MMA) が見られずコラーゲンのみであり, 水に膨潤し親水性であるうえ, グルタルアルデヒド架橋フィルムよりも湿潤強度も高いことがわかった.

We tried to duplicate the shape of occlusal surface of artificial tooth using the CAD/CAM technique and to replace the occlusal surface of the plastic tooth of denture with gold alloy.The present CAD/CAM system was composed of the three-dimensional shape measurement system (XYZAX PA 400 A, Tokyo Seimitsu Co. Ltd.), the personal computer (PC 98, NEC), and the computer aided engraving machine (CAMM-2, Roland D. G.).The contour of occlusal surface of the molar artificial tooth was measured by stepping at 0.5mm intervals. Measured points were interpolated with the spline function to obtain as smooth a surface as possible. Those data were used to cut a methacrylic plate to a pattern of occlusal surface (acrylic pattern). To examine the accuracy of duplication, the space between the acrylic pattern and the plaster core of the artificial tooth was evaluated. The space was represented as the thickness of silicone rubber and measured by using the optical magnifier (Profile projector V-12, Nikon). The thickness ranged from 70μm to 290μm. It was suggested that a CAD/CAM system like the present one is useful to duplicate the occlusal surface of an artificial tooth.More accurate duplication requires some improvements in the intervals of measuring the contour and cutting the acrylic plate.

2, 2'-アゾビス [ (ヒドロキシメチル) プロピオニトリル] (AHPN) を用いたスチレンのラジカル重合の動力学的研究を行った. 0℃で光重合することにより連鎖移動反応及び不均化停止を抑え, 効率よくポリスチレン末端に水酸基を導入できた。このポリスチレンはブロック共重合のマクロモノマーとして期待される.

This technical feasibility test of extracting heat from the earth of a volcanic zone and delivering it to the water utilizing heat pipes was conducted at Tsukahara Hot Spring in Kyushu, Japan in July, 1992. The temperature distributions of the heat pipe and its neighboring earth were analyzed through an equivalent thermal network –a three dimensional circuit made of thermal resistances and capacitors taking account of the mass transfer– and did not show much agreement with the experimental data. The calculated values of the heat transport, taking account of the mass transfer agreed well with the experimental ones in the steady state. But a discrepancy arose in the unsteady state during startup. The earth which was more than 0.15 meters away from the heat pipe did not change under the present test condition.

昭和33年より25年間に当教室にて経験した下気道異物160例について, 統計的観察を行ない報告した.1) 150例中, 男性11例, 女性49例でほぼ2:1であった.2) 2才以下の乳幼児が123例で77%を占め, ことに1才児が89例と56%であった.3) ピーナッツ異物が109例 (68%) と圧倒的に多数を占めた.4) 異物の介在部位は, 左気管支61例, 右気管支58例, 気管26例, その他15例であった. 年令及び介在期間による介在側の左右差に大きな変化を認めなかった.5) 1週間以上の診断遅延例が, 47例 (29%) あった. 1ヵ月以上の長期異物介在例が9例あったが全例気管支鏡にて摘出することができた.6) ピーナッツ異物の予防の重要性を強調し,「2才以下の乳幼児にはピーナッツを与えてはいけない」ということの啓蒙の必要を述べた.

The relation between the maximum holding power ratio and the shear strength of the sea bed is discussed on the basis of experimental results of anchoring and sounding tests. Sounding tests have been performed with the device which is proposed in the present paper to measure the strength of the bed as the N-value.If the bed is in loose state as N

The purpose of this paper is to present a surgical method which is applicable for the treatment of atrophic rhinitis. The method consists of taking out the mucous membrane from the maxillary sinus and transplanting the mucous membrane freely to the inferior turbinate, the floor of the nasal cavity and the septum. The mucous membrane is separated carefully from the maxillary sinus by the Caldwell-Luc's method. The epithelial surface of the inferior turbinate and, if necessary, of the floor of the nasal cavity and of the septum are freshened by curettage. The mucous membranes in moderate size and shape are then put on the fresh wounds in the nasal cavity and fixed by suture and tam-ponade.After an interval of about 7 days the tampon is removed. The free mucous membrane graft readily adheres and the inferior turbinate becomes swollen and the nasal cavity becomes narrow. Edema and superficial crust which are found on the free graft after the operation in some cases disappear spontaneously in the period of 3 to 5 weeks. This operation brings about total absence or diminution of stinking smell, crusting, nasal discharge, nasal obstruction and headache in many cases. This surgical method is applicable alone or also in combination with some other technique such as submucosal bone graft or insertion of acrylic implant.

A case of oesophageal stenosis was reported. The patient was 1 year and 9 month old child. He drinked NaOH and was treated immediately with cortisone and antibiotics owing to avoid oesophageal stenosis. But, one month after, oesophageal stenosis appeared.Oesophageal stenosis was recovered by using “Dilatation Ohne Ende”

1. The actions of various sensory stimulation upon the induced wave of the olfactory bulb of a frog were studied.2. The induced waves were inhibited by the application of pain and warmth on the skin, light to the eye and sound to the ear. They were also inhibited by the application of sodium chloride, cane sugar, acetic acid and quinine solution onto the tongue.3. On the contrary, the induced waves were generally augmented by the application of touch and cold on the skin as well as distilled water on the tongue.4. These findings support the view that there are facilitatory and inhibitory fibers in the centrifugal nervous system from the higher brain centers to the olfactory bulb. The biological functions of these two fiber systems were considered.

An induced wave is produced in the olfactory bulb by applying odorous or electrical stimulation on the olfactory epithelium of the frog. The effect of various sensory stimulations on the induced wave was studied.As sensory stimuli, cutaneous, visual, gustatory and auditory stimuli were used.The following results and conclusions were obtained in these experiments:1) The induced waves were inhibited by the application of pain and warmth to the skin, light to the eye and sound to the ear. They were also inhibited by the application of sodium chloride, cane sugar, acetic acid and quinine solution on the tongue.2) The induced waves, on the other hand, were generally augmented by the application of touch and cold on the skin as well as distilled water on the tongue.3) These findings support the view that there are facilitatory and inhibitory fibers in the centrifugal nervous system from the higher brain centers to the olfactoly bulb.4) The biological function of these two fiber systems was considered. It is supposed that the inhibition found above occured because of the diversion of attention, whereas the augmentation was probably the result of the enhancement of general attention.

It is well known that naramysin, cyclohexiimid has a strong repellent action to the rat. It was intended to clarify which one of the two conceivable stimuli, the smell and the taste of the drug does a rat detest. It was concluded that the evasion of a rat to naramysin primarily originates in the taste of the drug, but once a rat experiences the detestable taste, it remembers the smell which works as a conditioning stimulus thereafter.