Therapeutic Research

Volume 37, Issue 3, 2016
Volumes & issues:
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INFORMATION:日本循環器学会 第16回プレスセミナー 全身の動脈硬化を包括的に診る
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TOPICS:第1回小児希少難病支援フォーラム日本とアジアの子どもたちのために
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- 基調講演
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Series:呼吸ケア・フロントランナー呼吸ケアに関わるメディカルスタッフのためのニュース
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個々のCOPD患者さんの病態に適した,PPR-OTとは/個々の患者さんの病態を把握した上での呼吸リハ/患者さんの意思をくみ取ったプログラムを考える/自宅での安全で自立した生活につながる指導を/生活安全領域(safe range)内で呼吸ケアを行うことの重要性
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Symposium:日本多施設共同コーホート(J-MICC)研究10周年記念シンポジウム
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日本のゲノムコーホート研究の未来
37巻3号(2016);View Description
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2005 年にがん特定領域研究事業として開始された「日本多施設共同コーホート(J–MICC)研究」が10 周年を迎え,次の10 年を見据えての記念シンポジウムが開催された。J–MICC 研究に携わってきたメンバーや疫学研究の重鎮・リーダー的存在である専門家が一堂に会し,疫学研究の歴史やJ–MICC の歩み,今後の展開などが語られた。シンポジウムは,J–MICC 研究の主任研究者である田中英夫氏(愛知県がんセンター)による開会の挨拶から始まり,来賓の挨拶,その後,第1 部,2 部,3 部の形で進行し,3 部の後半では若手研究者によるパネルディスカッションが行われた。約4 時間のシンポジウムは中味がぎっしりと詰まり,研究者たちの熱い思いにあふれ,J–MICC 研究の今後がおおいに期待される内容であった。
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Symposium:第49回ペーシング治療研究会
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- 一般演題
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植込み8日目に深吸気時に心室リードの脱落をきたした1例
37巻3号(2016);View Description
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Lead dislodgement usually occurs in the first few days after the procedure. We report a case of pacemaker lead dislodgement because of deep breath on the eight day. A 83 years old male was admitted to our hospital after syncope. Complete AV block was seen and DDD pacemaker was implanted. After operation on spine position, atrial and ventricular leads had enough curve while deep breath. On the next day chest X –ray on standing position showed straightened lead. Until seventh day no pacing failure happened and both leads had good pacing and sensing characteristics as before. But on the eight day, he lost consciousness after especially deep breath and pacing failure occurred. Reoperation and repositioning of the lead were performed for dislodged ventricular lead. We have to be careful to unnecessary deep breath avoiding lead dislodgement. -
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ペースメーカー植込み後に行った大動脈弁置換術および三尖弁形成術により心機能が軽快し,心室リードの変形・断線を来した1例
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The case was an 86–year–old woman. She underwent aortic valve replacement in 2001 and dual chamber pacemaker implantation for sick sinus syndrome in 2005. A ventricular lead was fixed to the right ventricular outflow tract. She was hospitalized for heart failure in February 2008. Echocardiography detected moderate aortic regurgitation, moderate mitral regurgitation, and moderate to severe tricuspid regurgitation. She underwent aortic valve replacement again in October 2008. The impedance and threshold of the ventricular lead gradually deteriorated. A programmer check revealed a fracture of the ventricular lead. We implanted a new ventricular lead and replaced a generator in 2014. Fluoroscopy showed hinge motion at the tip of the ventricular lead. -
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シングルチャンバーのVVIペーシングにおいて,blendセンサーがレートレスポンスに有用であった13歳女児例-小児に対する経静脈植込みの注意点と工夫-
37巻3号(2016);View Description
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Background:In transvenous cardiovascular implantable electronic device(CIED)implantations for children, we have to consider their growth and the rest of their life. This paper will outline a patient that we treated at our institute. Case: The patient was a 13–year –old girl who underwent ventricular septal defect closure at 4 months old. At that time, she suffered complete atrioventricular block induced by the surgical procedure. So she underwent an epicardial pacemaker implantation at 5 months old and had received VVIR pacing since then. After that, she was diagnosed with left ventricular noncompaction and began taking medicine. She was admitted to our institute following syncope due to pacing failure that was caused by incomplete lead fracture. After due consideration of her physique and growth, we performed a transvenous pacemaker implantation on her. We chose a generator that had a rate response function controlled by a blended sensor, because her heart responses controlled by an accelerometer had not been satisfactory despite her low left ventricular ejection fraction. The blended sensor dramatically improved her heart rate responses. In addition to this, we considered remote monitoring system, lead management and the longevity of a generator. Conclusion:In transvenous CIED implantations for children, the selection of generators or leads is often limited due to their small bodies and growth. However, transvenous CIED implantations for children can be more satisfactory if we devise a method or way of implantation based on each patient’s situation. -
植込み後5 ヵ月で心室pacingの頻度増加にて心不全となり,CRT–Pの追加となった1例
37巻3号(2016);View Description
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A 78–year –old woman was implanted with a pacemaker because of sick sinus syndrome after catheter ablation of paroxysmal atrial fibrillation. Initially it was considered only atrial pacing was needed to just sustain a narrow QRS. The pacing mode was changed from AAI to DDIR and antiarrhythmic drugs were prescribed for an atrial tachycardia occurring after four months. She was admitted to a nearby hospital for a heart failure exacerbation after 1 month. It was believed that mitral regurgitation (MR) caused by an increasing frequency of ventricular pacing had worsened. It was considered that the CRT–P upgrade performed at our hospital worsened the heart failure due to MR.Echocardiography confirmed that the MR had increased more during the ventricular paced rhythm than during the intrinsic QRS. At a later date in order to add a left ventricular lead, we changed the pacing mode for the CRT–P. The MR then decreased with the CRT–P, and made satisfactory progress. The change in the left ventricular contraction pattern associated with right ventricular pacing, was one factor that would not seem to have been predicted an increase in the MR. -
Standard CRT pacingに反応の悪い患者のProvisional multi –point –pacingの有効性について
37巻3号(2016);View Description
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遠隔モニタリングシステム管理の落とし穴
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67 year –old Japanese female with sarcoidosis and complete atrio –ventricular block status post ICD implantation had been followed by remote monitoring system(RMS) every week and at ICD clinic every four month. ICD(TELIGEN, Boston Scientific) was set at DDD 50/110. At ICD clinic she complained of faintness for a few seconds only after she ate food or kept a certain posture for a long time. RMS revealed no ventricular arrhythmia and showed good lead status with 1% of atrial pacing and 90% of ventricular pacing with frequent PVCs. Her 12 leads ECG showed atrial sensing followed by ventricular pacing without any problem, so we did not check ICD manually at clinic. Although her complaint was considered to be vasovagal or gastrointestinal, her gastrointestinal evaluation showed no abnormality. Four month later at ICD clinic she kept complaining of the same symptom and this time her ECG showed only one beat of atrial pacing after single PVC, which was not followed by any ventricular event. RMS this time again showed no ventricular arrhythmia and good lead status with 1 % of atrial pacing and 90% of ventricular pacing and frequent PVCs. During manual ICD check, we made her drink water or change position to provoke the same symptom, which revealed no abnormality. When we started to check atrial lead pacing threshold, however, it revealed the markers of atrial pacing and ventricular sensing without any ventricular event. Because of atrial pacing spike, crosstalk inhibition happened and ventricular pacing was inhibited. Integrated bipolar lead used for a short female patient was suspected to be the cause of crosstalk inhibition. We lengthened ventricular blanking after atrial pacing from 65 ms to 85 Zms, changed the sensitivity of ventricle, decreased lower rate to prevent unnecessary atrial pacing, and decreased atrial output to eliminate crosstalk inhibition. After the adjustment, her symptom diminished. Although RMS is usually useful for the early detection of device trouble, this case had the opposite effect because of the omission of manual checking. Since this phenomenon was difficult to judge only by RMS, we should carefully listen to the patients and not to hesitate manual check even though RMS showed no abnormality. -
当院での条件付きMRI対応デバイス治療戦略
37巻3号(2016);View Description
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We can implant MRI –conditional pacemaker from October 2012 in Japan. A total of 467 patients underwent pacemakers new implantation from October 2012 to June 2015. Among them, 409 patients (87.6%) were performed MRI –conditional pacemakers implantation. We performed 54 times of MRI scanning in 37 patients with MRI –conditional pacemaker. All MR scanning were completed safely. Pacemaker malfunction, inhibition of pacemaker output or induction of arrhythmias was not observed.
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原著
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シタグリプチンの使用経験―出雲地区における多施設共同研究より―
37巻3号(2016);View Description
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目的:シタグリプチンを1 年間投与した時の実臨床での使用成績を多施設共同研究により検証する。方法:島根県出雲地区の9 施設に通院中で既存の治療で十分な効果が得られていない2 型糖尿病患者にシタグリプチンを投与し,1 年以上観察できた57例を解析対象とした。シタグリプチン投与開始時(ベースライン時),投与3,6,9 および12 ヵ月後の外来受診時に問診,採血,採尿および身体測定などを行い,有効性および安全性を評価した。有効性の指標としてHbA1cおよび体重の推移を評価し,安全性は試験期間中の副作用発現を指標に評価した。結果:患者背景は平均年齢が64.2 歳,男性が31 例(54.4%)を占め,平均HbA1c が7.6%,BMI が24.9 kg/m2とやや肥満傾向にある2 型糖尿病患者が対象であった。HbA1c は,シタグリプチン投与3 ヵ月後には7.0±0.7%(平均±標準偏差)に有意に低下し(p<0.01),さらに投与6~12 ヵ月後に経時的に有意に低下して(p<0.01),12 ヵ月後のHbA1c は6.7±0.8%となりベースラインからの低下量は0.9%であった。一方,体重には投与12ヵ月後まで有意な変動は認められなかった。安全性については,試験期間中にシタグリプチン投与に起因すると判定される副作用発現は認めず,重篤な低血糖も発現しなかった。結論:多施設共同研究により,実臨床におけるシタグリプチンを2 型糖尿病患者に1 年間投与したときの有効性および安全性を検証しえた。 -
DPP‒4 阻害薬からミチグリニドカルシウム水和物/ボグリボース配合錠への切替えにおける有効性と安全性の検討
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Background:To date, a step‒up strategy from regimens including a dipeptidyl peptidase‒4(DPP‒4)inhibitor has not been established. Objective:This prospective cross‒over study was conducted in order to assess the efficacy and safety of a mitiglinide/voglibose fixed‒dose combination tablet in type 2 diabetic patients whose glycemic control is not adequate with administration of a DPP‒4 inhibitor for more than three months. Methods:In 31 diabetic patients whose HbA1c was 6.9% or higher with a DPP‒4 inhibitor, we switched their DPP‒4 inhibitor to a mitiglinide/voglibose fixed‒dose combination tablet for 3 months. Subsequently, the combination tablet was switched to the original DPP‒4 inhibitor, which was then administered for 3 months. The total observa tion period of each patient was 6 months. We evaluated the changes in HbA1c, glycoalbumin, 1,5‒anhydroglucitol (1,5‒AG), casual blood glucose, serum C peptide, and glucagon levels. Results:Switching to the combination tablet did not change the HbA1c level but caused a reduction in glycoalbumin level and an increase in 1,5‒AG level. After the switch to the original DPP‒4 inhibitor, HbA1c and glycoalbumin levels increased, and 1,5‒AG level decreased. After the DPP‒4 inhibitor was changed to the combination tablet, casual blood glucose, serum C peptide, and glucagon did not change. After the reversal to the original DPP‒4 inhibitor, blood glucose increased, but C peptide and glucagon did not change. Conclusion:The combination tablet showed a more favorable effect on glycoalbumin and 1,5‒AG than did the DPP‒4 inhibitor. This might reflect a greater improvement of postprandial hyperglycemia by the combination tablet. -
オルメサルタン メドキソミル錠を服用中の高血圧患者におけるオルメサルタンメドキソミル口腔内崩壊錠(OD 錠)官能評価の臨床研究
37巻3号(2016);View Description
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オルメサルタンメドキソミル口腔内崩壊錠(販売名:オルメテック® OD 錠,以下オルメサルタンOD 錠)の官能評価を目的として,研究を実施した。本研究はオルメサルタンOD 錠20mg 1 錠を単回投与する介入研究で,オルメサルタンメドキソミル錠(販売名:オルメテック® 錠,以下オルメサルタン錠)20 mg を2 週間以上服用している20 歳以上の高血圧患者30例を対象とし,患者本人から文書にて同意を取得した後に実施した。研究方法は,登録されたすべての患者に対しオルメサルタンOD 錠20 mg 1 錠を舌の上に置いて舌と上顎で挟ませ,舐めながら口に含ませて口腔内で咀嚼せずに,原形を留めなくなるまで崩壊させた後に,「お薬に関するアンケート」(10 項目)を実施し,評価した。本研究において,オルメサルタンOD 錠20mg の錠剤の大きさが「ちょうど良い」と回答した患者が90.0%を占めた。年齢別サブグループ解析では特に65 歳以上の高齢者において「飲みやすそう」81.8%,「便利になる」72.7%,「続けやすくなる」63.6%など服用感,利便性において良い印象となる結果が得られた。また,現在服用しているオルメサルタン錠を「飲み込みにくい」と思っていない患者が90%を占めるなかにあって,オルメサルタンOD 錠への「変更を希望する」患者は全体で40%を超え,65 歳以上の高齢患者では70%を超えた。以上より,オルメサルタンOD 錠は特に高齢高血圧患者において服薬アドヒアランスのさらなる向上が期待できる剤形であると考えられた。 -
かかりつけ薬局からみたアルツハイマー病と生活習慣病の関係
37巻3号(2016);View Description
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目的:アルツハイマー病と生活習慣病,特に高血圧症,糖尿病および高コレステロール血症の三疾患との関係を,かかりつけ薬局の処方箋情報から検討した。方法:かかりつけ薬局でアルツハイマー病薬を処方された症例で高血圧症治療薬(降圧薬),糖尿病治療薬(抗糖尿病薬),高コレステロール血症治療薬(スタチン)の処方頻度を調査した。結果:アルツハイマー病薬処方者(AD 群)は323 例(83.16±6.58 歳),対照としたパーキンソン病薬処方者(非AD 群)は78 例(78.28±8.95歳)であった。AD 群で降圧薬,抗糖尿病薬,スタチンを処方されているオッズ比(対非AD群)は,それぞれ,1.158(0.628~2.135,p=0.637),1.507(0.604~3.763,p=0.379),1.402(0.682~2.884,p=0.358)(年齢,性別で調整)であった。考察:アルツハイマー病では高血圧,糖尿病,高コレステロール血症が多いことが示唆された。
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