巻号一覧
86 巻 (2012)
- 6 号 p. 715-
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- 3 号 p. 274-
- 2 号 p. 103-
- 1 号 p. 1-
前身誌
86 巻, 3 号
選択された号の論文の7件中1～7を表示しています
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原著
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壱岐市におけるA（H1N1）pdm09 の流行江田 邦夫, 大田黒 滋, 松嶋 喬, 品川 敦彦, 池松 秀之, 柏木 征三郎2012 年 86 巻 3 号 p. 274-281
発行日: 2012/05/20
公開日: 2013/04/12
ジャーナル フリー長崎県壱岐市（人口約30,000 人の島）におけるA（H1N1）pdm09 の流行状況を調査した．流行は，2009 年8 月に始まり2010 年3 月に終ったが，流行が始まる以前より市医師会では対策委員会を立ち上げていた．流行開始後各医療機関ではインフルエンザと診断した患者について，その日のうちに保健所にFax で連絡した．保健所はその報告患者数を毎日集計し，流行状況により医師会は学校長及び教育委員会と協議し，学級・学年閉鎖，休園・休校を行った．本市での流行は，ピークが分散し2 峰性となったが，これらの措置が迅速かつ徹底して行われたためと考えられた．
A（H1N1）pdm09 ウイルスの罹患者は2,024 例で全人口の6.6％であった．年齢群別の人口における罹患率は10～19 歳が最も高く849 例（26.8％），ついで0～9 歳の594 例（21.3％）で，19 歳以下が全罹患者の71.3％を占めた．60 歳以上の高齢者の罹患率はきわめて低かった．A（H1N1）pdm09 ウイルスの抗体保有状況をみるため，流行終息後の2010 年9 月21 日～11 月15 日までに一般住民358 例の採血を行い，A（H1N1）pdm 09 ウイルスのHI 価を測定した．HI 価≧1 : 40 は全体の57.3％で，7～49 歳までが約70％と高率であった．これらのHI 価≧1 : 40 の要因を検討したが，最も多いのはワクチン接種，次いでA（H1N1）pdm09 罹患で，不顕性感染は11.7％と低かった．
以上から，壱岐市でのA（H1N1）pdm09 の流行について，
1．罹患率は全人口の6.6％であった．
2．罹患者の71.3％は19 歳以下であり，高齢者の罹患率はきわめて低かった．
3．流行に対して学級・学年閉鎖，休園・休校が有効であり，2 峰性となった．抄録全体を表示PDF形式でダウンロード (766K)
症例
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感染性心内膜炎による敗血症性肺塞栓症福光 研介, 鈴木 雄二郎2012 年 86 巻 3 号 p. 282-286
発行日: 2012/05/20
公開日: 2013/04/12
ジャーナル フリーA 30-year-old woman was admitted to our hospital with high fever and chest pain. She had a ventricular septal defect, but was asymptomatic and had not undergone surgical repair. She also had had atopic dermatitis since childhood that had not been adequately treated. Chest computed tomography showed multiple peripheral nodules and infiltrates in both lungs. A transthoracic echocardiogram detected vegetation on the wall of the right ventricle, and Staphylococcus aureus was cultured from a peripheral blood sample. She was diagnosed as having a septic pulmonary embolism associated with right-sided infective endocarditis caused by S. aureus. She was treated with Cefazolin, resulting in gradual improvement of laboratory and chest radiographic findings. Recent studies have revealed that atopic dermatitis is one of the risk factors for infective endocarditis. In this case, uncontrolled atopic dermatitis might have caused the right-sided infective endocarditis.抄録全体を表示PDF形式でダウンロード (484K) -
加藤 博史, 柳澤 如樹, 佐々木 秀悟, 細田 智弘, 菅沼 明彦, 今村 顕史, 味澤 篤2012 年 86 巻 3 号 p. 287-290
発行日: 2012/05/20
公開日: 2013/04/12
ジャーナル フリーWe report a case of a 45-year-old Japanese man with AIDS-associated Kaposiʼs sarcoma (KS) involving skin, liver, and lungs. Antiretroviral therapy was started in conjunction with pegylated liposomal doxorubicin (PLD). A clinical response was observed initially, but symptoms recurred following cessation of medication. The chemotherapeutic agent was changed to paclitaxel (PTX), since the therapeutic response to PLD was reduced and the total dose reached the maximum dose of 500mg/m2. The patient had a good response to PTX and tolerated the medication well. Symptoms did not recur after completing 8 courses of chemotherapy. PTX should be considered as an alternative agent in treating KS when there are problems with the use of PLD.抄録全体を表示PDF形式でダウンロード (469K) -
副腎不全を伴ったパラコクシジオイデス症吉村 幸浩, 立川 夏夫, 大澤 孝行, 小菅 葉子, 亀井 克彦2012 年 86 巻 3 号 p. 291-294
発行日: 2012/05/20
公開日: 2013/04/12
ジャーナル フリーParacoccidioidomycosis (PCM) is the most common systemic fungal disease in central-south America,but is rare in Japan. We experiensed a case of PCM in a patient, who came from Bolivia and presented with mouth pain and reduced dietary intake but no fever. Adrenal insufficiency was diagnosed with extremely high serum adrenocorticotropic hormone (ACTH) and was resolved with hormone supplementation. The PCM was treated with trimethoprim-sulfamethoxazole which was switched to itraconazole and improvement was achieved.抄録全体を表示PDF形式でダウンロード (564K) -
成人インフルエンザ脳炎の1 例岩永 直樹, 中村 茂樹, 田中 章貴, 福田 雄一, 今村 圭文, 宮崎 泰可, 泉川 公一, 掛屋 弘, 山本 善裕, 柳原 克紀, 早 ...2012 年 86 巻 3 号 p. 295-299
発行日: 2012/05/20
公開日: 2013/04/12
ジャーナル フリーA 73-year-old man was admitted to our hospital with a high fever and left paresis. A rapid diagnosis test was positive for influenza A was positive by rapid diagnosis test and diffusion-weighted MRI imaging of the brain showed a high intensity lesion of the right cerebral peduncle. The patient was therefore diagnosed as having influenza A virus infection complicated with lacunar infarction. In spite of initial treatment with oseltamivir and anticoagulant therapy, he lost consciousness eight hours after admission. The high intensity lesion of the cerebral peduncle enlarged and new lesions in the thalamus, hippocampus and calcarine cortex were detected with brain MRI. Additionally, an electroencephalographic study showed an entire slow wave and as the other causative pathogens of central nerve system infection were not detected, the likely diagnosis was influenza-associated encephalitis. We administered a high dose of intravenous immunoglobulin since the low-grade fever and mild unconscious state had continued in spite of the treatment with methylprednisolone pulse therapy. His consciousness was restored and body temperature became normal immediately. We could confirm the efficacy of our treatment by measurement of IL-6 levels in the serum and cerebrospinal fluid during the entire clinical course. In conclusion, a high dose of intravenous immunoglobulin therapy might be one of the effective treatments for influenza-associated encephalitis.抄録全体を表示PDF形式でダウンロード (564K) -
S.maltophilia 出血性肺炎森 美奈子, 北川 智也, 佐々木 裕哉, 山本 和代, 大中 貴史, 米澤 昭仁, 今田 和典2012 年 86 巻 3 号 p. 300-305
発行日: 2012/05/20
公開日: 2013/04/12
ジャーナル フリーA 63-year-old man had been treated with intensive chemotherapy for acute myeloid leukemia. On the 49th hospital day, he had febrile neutropenia after the second course of induction chemotherapy. On the 53rd hospital day, he presented with hemoptysis and developed acute respiratory failure requiring ventilator support within several hours. On the 54th hospital day, the patient died with hemorrhagic respiratory infection. Stenotrophomonas maltophilia was detected in bacterial cultures of his blood, bronchoalveolar lavage, and sputum. To our knowledge, nine cases of fatal hemorrhagic pneumonia causedby S. maltophilia have been reported in the literature. All the patients had hematological neoplasms and were severely neutropenic after one or two intensive chemotherapy regimens. They died shortly (within 3 days) after the onset of the hemorrhagic pneumonia. Management of the infection caused by S. maltophilia is hampered by high-level intrinsic resistance to multiple antibiotics and the increasing occurrence of acquired resistance to co-trimoxazole and fluoroquinolones. It would be important to keep in mind that hemorrhagic respiratory infection caused by S. maltophilia may lead to a fulminant and lethal course in severely neutropenic patients with hematological neoplasms and to recognize which antibiotic agents are more sensitive to S. maltophilia in each institution.抄録全体を表示PDF形式でダウンロード (660K) -
水痘再感染による水痘肺炎・VZV 髄膜炎の1 例山下 裕之, 上田 洋, 高橋 裕子, 三森 明夫2012 年 86 巻 3 号 p. 306-309
発行日: 2012/05/20
公開日: 2013/04/12
ジャーナル フリーThe patient was a 74-year old male who presented with a skin rash, cough, and impaired consciousness. Adiffuse, systemic, dark red rash was observed and he was admitted. Varicella infection was diagnosed based on the varicella-zoster virus (VZV)-IgM levels. The extremely high VZV- IgG levels observed were unlikely to be present inaninitial infection and the infection was thought to be a reoccurrence. Diffuse nodular shadows measuring ≤5mm indiameter were observed on chest computed tomography (CT) ; this was consistent with the typical imaging findings of varicella pneumonia.
The cerebrospinal fluid (CSF) was positive for CSF VZV-IgM antibody, CSF VZV-PCR, and CSF antibody titer index. A diagnosisofvaricella meningitis was made. When both respiratory and neurological symptoms are observed inpatients with varicella infection, it is necessary to consider a combined diagnosis of varicella pneumonia and varicella meningitis/encephalitis and perform chest imaging and a CSF examination. Repeated asymptomaticre-infection isconsidered necessary in order to maintaina life long immunity to varicella ; however, the opportunities for asymptomaticre-infection are decreasing with the declining birth rate and trend toward small families. As a result, reoccurrences of varicella infection in the elderly are expected to increase with rapidlyincreasing longevity.抄録全体を表示PDF形式でダウンロード (329K)
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