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中华口腔医学会第六届全国口腔黏膜病学术会

作者： junichi shindo Kanagawa Dental College Japan

＜正＞ Many diseases appear on the oral mucosa. However, many of these etiology are left unknown, expect some infectious diseases and immunological disturbances. So it is impossible to make etiological classification, and we use the classification according to clinical findings: bullae, erythema, ulcer, white lesion, atrophy and *** we make diagnosis of these diseases from inspection. However, small number of malignant diseases are included in these benign diseases. Histopathologi-cal examination is important for this *** paper presents some cases to be difficult for differential diagnosis. Penphygus vulgaris and benign penphygoid are included in bullous diseases. Inearly stage it is impossible to differentiate these from clinical findings. It is determined that the bullae are observed within epithelial layers or basement membrane in histological *** erythematous diseases, we may not so often observe erythroplakia. However, it frequently advances to cancer. The authors have experiences of some cases diagnosed as erythroplakia at the first biopsy, and advancing to cancer at the next *** ulcer is very simple disease, however these ulcers are surrounded with induration. It resembles to cancerous ulcer. When decubital ulcer does not recover after usual treatment as the removal of stimulant or steroid ointment, biopsy is *** white lesions, it is well known that leukoplakia is precancerous lesion. Lichen planus is also reported to be able to advance to cancer. However, I have no experiences of these cases. The pseudomembrane of Candida albicans sometimes covers on the surface of cancer lesion. It is often the result of steroid treatment under the mistaken diagnosis of early *** stomatitis especially Plummer-Vinson syndrome is known as precancerous lesion. We have to observe carefully the atrophic stomatitis on middle aged woman with iron deficiency anemia. I have a case of them. It is known that some of papillo

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Investigation and prediction of enteral nutrition problems after percutaneous endoscopic gastrostomy

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World Journal of Gastroenterology 2009年第11期15卷 1367-1372页

作者： Shiro Yokohama Masaru Aoshima Yukiomi Nakade Junya shindo junichi Maruyama Masashi Yoneda Department of Gastroenterology Asahikawa Rehabilitation HospitalAsahikawa078-8801Japan Division of Gastro-enterology Department of Internal MedicineAichi Medical University School of MedicineAichi 480-1195Japan Department of Rehabilitation Asahikawa Rehabilitation HospitalAsahikawa 078-8801Japan Department of Internal Medicine Asahikawa Rehabilitation HospitalAsahikawa 078-8801Japan

AIM： To investigate and predict enteral nutrition problems after percutaneous endoscopic gastrostomy （PEG）. METHODS： We retrospectively analyzed data for 252 out of 285 patients who underwent PEG at our hospital from 1999 to 2008 after PEG were defined as： Enteral nutrition problems （1） patients who required ≥ 1 mo after surgery to switch to complete enteral nutrition, or who required additional parenteral alimentation continuously; or （2） patients who abandoned switching to enteral nutrition using the gastrostoma and employed other nutritional methods. We attempted to identify the predictors of problem cases by using a logistic regression analysis that examined the patients＇ backgrounds and the specific causes that led to their problems. RESULTS： Mean age of the patients was 75 years, and in general, their body weight was low and their overall condition was markedly poor. Blood testing revealed that patients tended to be anemic and malnourished. A total of 44 patients （17.5%） were diagnosed as having enteral nutrition problems after PEG. Major causes of the problems included pneumonia, acute enterocolitis （often Clostridium difficile-related）, paralytic ileus and biliary tract infection. A multivariate analysis identified the following independent predictors for problem cases：（1） enteral nutrition before gastrectomy （a risk reduction factor）; （2） presence of esophageal hiatal hernia; （3） past history of paralytic ileus; and （4） presence of chronic renal dysfunction. CONCLUSION： Enteral nutrition problems after PEG occurred at a comparatively high rate. Patient background analysis elucidated four predictive factors for the problem cases.

关键词： Percutaneous endoscopic gastrostomy Enteral nutrition Complication, Risk factor Predictor

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