It is known that infants born to mothers with hyperglycemic disorders in pregnancy have a high risk of complications such as macrosomia, neonatal hypoglycemia, and hyperbilirubinemia. Strict treatments such as dietary andinsulin therapy are necessary to prevent these complications.We retrospectively examined 374 infants born to mothers with hyperglycemic disorders in pregnancy whowere treated with dietary and insulin therapy at our hospital over a six-year period from 2014 to 2019. First, thecomplications in the infants included preterm birth in 73 cases (19%), neonatal hypoglycemia in 115 cases (31%),hyperbilirubinemia in 59 cases (16%), and respiratory disorders in 56 cases (15%), as there was a high incidenceof neonatal hypoglycemia. Second, we conducted a univariate analysis to determine the association between theoccurrence of complications (neonatal hypoglycemia, hyperbilirubinemia, and respiratory disorders) in infantsborn to mothers with hyperglycemic disorders and 12 clinical factors. Third, we conducted a multivariate analysisusing each complication as the dependent variable and identified significant factors as independent variables. Wefound that the independent clinical factors associated with neonatal hypoglycemia were mothers’ body mass indexbefore pregnancy, the use of ritodrine hydrochloride during pregnancy, gestational age, and infants with small forgestational age (SGA); those associated with hyperbilirubinemia were gestational age and infants with SGA; andthose associated with respiratory disorders were gestational age.Our study demonstrates that gestational age plays a role in complications observed in infants born to motherswith hyperglycemic disorders in pregnancy who were strictly treated, such as dietary and insulin therapy, ratherthan glycated albumin and glycosylated hemoglobin levels.

The cranium of neonates and infants grows soft and large. During this process, the cranium undergoes a multifaceted deformation under the influence of physical pressure and gravity. This deformed cranial shape is calledpositional plagiocephaly and is distinguished from craniosynostosis. In recent years, the number of infants withpositional plagiocephaly has increased due to the recommendation of “back to sleep” to prevent sudden infantdeath syndrome. Our department has established an outpatient clinic for cranial deformity and has been conducting research and treatment of cranial deformity in neonates and infants. We clarified that the prevalence ofpositional plagiocephaly in healthy infants at 1 month of age is approximately 65% and that severe cases exist inapproximately 7% of these infants. Furthermore, 66% of those with severe positional plagiocephaly did not improve after 3 months of natural history. This result suggests the need for appropriate therapeutic intervention. Inaddition, it was possible to predict the severity of cranial deformity at 6 months of age at the severity of cranialdeformity at 1 month of age. The differences in severity at approximately 1 month of age were related to the subsequent natural course. This is a major challenge for neonatologists and pediatricians in the future.

The aim of this study was to compare the clinical significance of procalcitonin and presepsin levels in associationwith different bacterial species or cultures in sepsis cases that meet the Sepsis-3 criteria.Methods: We conducted a 2-year observational study of sepsis patients found to meet the Sepsis-3 criteria. Theparameters examined included age, the infection focus, the initial blood procalcitonin and presepsin levels, andthe SOFA score. The patients were divided into several groups based on bacterial cultures from blood specimensand fluid and tissue specimens taken from the infected sites.Results: Finally, 132 sepsis patients were investigated in the study period. The patients had a mean age of 73.3, amean SOFA score of 8.9, and mean blood procalcitonin and presepsin levels of 35.6 ng/ml and 1319.6 pg/ml,respectively. The patients were divided into a culture/positive group (n = 108) and a culture/negative group (n =24) based on the bacterial specimen cultures. The culture/positive group, which included duplicate cases, wasfurther divided into a blood/positive group (n = 63) and a local infection group (n = 86). No significant differencesin the SOFA score were observed among the culture groups. Blood procalcitonin was significantly lower in theculture/negative (p < 0.0001) and blood/negative groups (p < 0.0152). The blood presepsin level, however, didnot significantly differ between those groups.Conclusions: The blood procalcitonin levels in sepsis patients diagnosed according to the Sepsis-3 criteria maybe lower when the bacterial specimen cultures are negative. In such patients, reliance on procalcitonin alone forclinical guidance may lead to an underestimation of sepsis severity.

下垂体神経内分泌腫瘍 (pituitary neuroendocrine tumor;PitNET) に対し内視鏡下経蝶形骨洞手術を受ける患者にとって，術前に入院期間が分かることは有益である．そこで我々は，2015 年 4 月から 2023 年 3 月までの間に自施設にて手術を行なった PitNET 症例 72 例を後方視的に解析することで，入院期間ならびに入院期間が長期化する原因について検討した．対象症例の年齢の中央値は 52.0 歳，男女比は 1：1．初発の非機能性 PitNET が47 例，再発の非機能性 PitNET が 11 例，初発の機能性PitNet が 14 例であった．手術時間の中央値は 148.0 分，術前の腫瘍長径の中央値は 25.0 mm，Knosp grade の中央値は 3 であった．18 例が下垂体卒中を合併しており，10 例に術前からホルモン補充がなされていた．28 例で術中に髄液漏を認め，19 例で被膜外の全摘出が行われた．術後髄液漏 2 例，残存腫瘍内出血 1 例，摘出不良 1例に対し，同一入院内で再手術が行われた．髄膜炎は 2例，SIADH は 5 例で認められ，それぞれ 3 ～ 4 および6 ～ 7 日目に発症し，いずれも 9 ～11 日目に治療を終了した．術後に持続的なホルモン補充療法が行われた症例は 22 例であった．PitNET 以外に入院期間中に治療を要した疾患として，動眼神経麻痺，脳梗塞，肺炎，肝機能障害があった．術後入院期間（中央値 12.0 日）と，患者背景，腫瘍の大きさや浸潤度，再手術や合併症例について解析したところ，年齢との間に有意な相関関係が認められた ( p < 0.01)．また，同一入院内に再手術を行っていること ( p < 0.01)，および，入院中に PitNET 以外に治療を要した疾患があったこと ( p < 0.01) が有意に術後入院期間を延長させた．これらの結果から，高齢でなく，PitNET 以外に治療を要する疾患がない症例は，再手術を要する術後合併症が生じなければ，術後 11 日目までに退院を許可できる可能性が示唆された．

【背景】外傷後に細胞外液中にグルタミン酸とアデノシン三リン酸 (adenosine triphosphate: ATP) が放出されることが報告されている．しかし，外傷におけるグルタミン酸と ATP の放出や両物質の相互作用に明確な報告はなされていない．この相互作用を明らかにすることにより，二次性脳損傷の病態解明の一助となり得ると考えた．【方法】Stab wound injury モデルを作製し，非薬物投与群，アピレース群，テトロドトキシン群の 3 群に分けて，細胞外液中のグルタミン酸濃度と ATP 濃度を測定した．コントロール群とアピレース群ではモデル作製 3 日，7日，28 日後に脳検体を摘出した．モデル作製 3 日後の脳検体を用いて細胞死の程度を評価した．さらに，テトロドトキシンを用いて神経細胞活動や神経細胞興奮を抑制した際の ATP 放出を検討した．【結果】細胞外液中グルタミン酸値と ATP 値は，コントロール群と比較してアピレース群，テトロドトキシン群で有意に低い値を示した．細胞死の程度も同様の結果であった．glial fibrillary acidic protein，CD11b の発現量は，すべての時点においてコントロール群と比較してアピレース群で有意に低い値を示した．【結語】アピレース投与により ATP が抑制された状態では，グルタミン酸放出も抑制され，更に細胞死も抑制された．この相互作用の解明は，二次性脳損傷の改善につながる重要な知見であると考えられた．

症例は 37 歳女性．難治性高血圧症の原因精査で行った頭部 MRI にて下垂体腫瘍を疑われて当院へ紹介された．血中のホルモン基礎値は，adrenocorticotropic hormone (ACTH, 70.6 pg/ml) およびコルチゾール (26.5 μg/dl)が異常高値であり，中心性肥満を認めた．診断を確実なものとすべく静脈洞サンプリングを行ったところ，中枢と末梢における静脈血中の ACTH の値に差が見られず，クッシング病に矛盾する所見であった．しかし，その他の各種内分泌学的負荷試験の結果は全てクッシング病の診断基準を満たしており，全身他臓器の検索にて他の病変が指摘できなかった．静脈サンプリングの結果が偽陰性であると判断し，クッシング病の術前診断のもと，内視鏡下経蝶形骨洞手術を行った．術中に腫瘍性病変を確認できたため摘出し，下垂体神経内分泌腫瘍すなわちクッシング病と診断した．術後 ACTH およびコルチゾールの値は正常化した．本症例は手術によりクッシング病の確定診断が得られ，静脈サンプリングの結果は偽陰性であったと判断された．静脈サンプリングは極めて稀に偽陰性になることがあり，注意が必要である．本稿においてその原因や対策について考察する．