Therapeutic Research

Volume 33, Issue 7, 2012
Volumes & issues:
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Symposium:第24回神奈川心不全研究会
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- 一般演題
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1.慢性血栓塞栓性肺高血圧症による右心不全に対して肺動脈バルーン拡張術とエンドセリン受容体拮抗薬およびPDE5 阻害薬の併用が有効であった症例
33巻7号(2012);View Description
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4.甲状腺機能亢進症に合併した肺高血圧症の1 例
33巻7号(2012);View Description
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The patient was a 56 –year–old man. He presented to a local clinic with pedal edema. Echocardiography showed preserved left ventricular systolic function and the enlarged right side of the heart (estimated right ventricular systolic pressure, 68.1 mmHg). He was thus diagnosed with pulmonary hypertension and referred to our hospital for detailed evaluation in October 2011. The patient had a previous medical history of chronic atrial fibrillation. Imaging examinations, including computed tomographic pulmonary angiography and ventilation/perfusion scintigraphy, showed no specific findings. Then, Swan–Ganz catheterization was performed for the assessment of pulmonary function, resulting in obvious pulmonar y hypertension (pulmonar y arterial pressure, 66/14/31mmHg). The cardiac index was 7.41 L/min/m2, suggesting that the patient should have hyperdynamic state. The hematological evaluation resulted in hyperthyroidism with positive anti –thyroglobulin antibody, anti–thyroid peroxydase antibody and thyroid stimulation hormone receptor antibody. Thyroid echography also revealed thyromegaly and increased blood flow to the thyroid gland. Although the patient was suspected Basedow disease, thyroid scintigraphy revealed a pattern of silent thyroiditis. The patient still remains under treatment with potassium iodide. No specific cause of pulmonar y hypertension can be found except hypethyroidism. Here, we present a case in which we identified hyperthyroidism while searching the etiology of pulmonary hypertension. -
5.妊娠を契機に発症した無痛性甲状腺炎による肺高血圧症に対しTadalafil が著効した1 例
33巻7号(2012);View Description
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Patient:A 27–year–old female. Chief complaint:Breathing difficulty after delivery. History of present illness:The patient was referred to our hospital with increased thyroid–stimulating hormone(TSH; 5.221μU/mL)in the 5th week of pregnancy. She had breathing difficulty on effort in the 3rd trimester pregnancy, although, she could deliver the baby without any problems in the 38th week of pregnancy. Four days later, she suffered from critical breathing difficulty, which triggered hypoxemia. The increased right heart load on the electrocardiograms and the estimated right ventricular systolic pressure of 50 mmHg on the echocardiograms suggested that the patient should have pulmonary hypertension. The result of hematology in the 2nd trimester pregnancy was within the normal ranges(TSH 0.84μU/mL, triiodothyronine [T3] 2.6 pg/mL, thyroxin [T4] 1.1 ng/dL), however, these values were exacerbated after delivery(TSH 0.007μU/mL, T3 9.0 pg/mL, T4 2.4 ng/dL), suggesting that she also have hyperthyroidism. Thyroid scintigraphy identified silent thyroiditis. These findings supported that silent thyroiditis induced by pregnancy caused pulmonary arterial hypertension. The patient was immediately treated with bosentan according to the treatment algorism in pulmonar y hyper tension, but no significant effect was observed. Then, tadalafil was additionally administered, resulting in obvious improvement in pulmonar y arterial pressure on the echocardiograms and normalized electrocardiograms. Since medical treatment sufficiently improved breathing difficulty, home oxygen therapy was not required thereafter. Discussion:Tadalafil inhibits cGMP specific phosphodiesterase type 5(PDE–5), which reduces cGMP concentrations in the pulmonar y vascular smooth muscle; thus lowering pulmonary arterial pressure. Only a handful of case reports have reported the effective use of tadalafil in Japan. This case report presents a new insight into the treatment of pulmonary hypertension. -
7.重症大動脈弁狭窄症に合併したたこつぼ型心筋症の1 例
33巻7号(2012);View Description
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An 80s –year –old female with peak aortic jet velocity of 4.64m/s had been recommended to receive an aortic valve surgery due to severe aortic stenosis. Then she was admitted to our hospital with complaining dyspnea. Her electrocardiogram showed ST segment elevations in leads V1–V5, troponin T was positive and her echocardiogram showed a hypokinesis of left ventricular wall from mid to apex. Soon an emergent coronary angiography was performed due to a diagnosis of acute coronary syndrome but it showed almost normal coronary arteries. She was admitted in a department of intensive care unit and received intravenous carperitide and isosorbide dinitrate etc. continuously and she was recovered. Her peak aortic jet velocity on admission was decreased to 3.75m/s and then it was increased to 4.92m/s again concomitant with an improvement of a left ventricular wall motion. She was transferred to another hospital and received an aortic valve replacement surgery successfully. -
8.僧帽弁腱索断裂による僧帽弁閉鎖不全の急性うっ血性心不全で僧帽弁形成術を施行するまでのブリッジにトルバプタンが奏効した2 例
33巻7号(2012);View Description
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- 特別講演
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Symposium:第10回DPB・難治性気道疾患研究会
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- 一般演題
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- 要望演題
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- 特別講演
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Ⅱ.連続切片による DPB における呼吸細気管支領域の立体構築
33巻7号(2012);View Description
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The lesions of 20 autopsied cases of diffuse panbronchiolitis(DPB)were seriallysectioned and reconstruction was made focusing on the region from the terminal to the respiratory bronchioles. Morphological changes in the regions of the respiratory bronchioles were classified into three types by the presence and the size of the intraluminal granulation tissue. The walls of the respiratory bronchioles were thickened with cell infiltration and granulation tissue in all foci(28 in total), and 26 foci showed intraluminal granulation tissue whereas only 2 foci did not exhibit intraluminal plugs. Xanthoma cells were mostly observed in the interstitial tissue of the alveolar ducts, sacs, and septal walls distal to the stenotic sites as well as in the alveolar spaces in the marked cases. - 特別発言
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原著
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Beneficial Effect of the Angiotensin I I Receptor Blocker Olmesartan on Insulin Resistance
33巻7号(2012);View Description
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We investigated the effects of the angiotensin I I receptor blocker olmesartan oninsulin resistance in 14 hypertensive patients with obesity(6 men, 8 women;mean age 50.7±6.9 years, mean BMI 28.8±2.1, mean±SD). All subjects were treated with 20 mg of olmesartan for 3 to 5 months. BMI, blood pressure(BP), heart rate(HR), fasting plasma glucose(FPG), fasting serum immunoreactive insulin(F-IRI), HbA1c(NGSP), insulin resistance index as assessed by homeostasis model assessment(HOMA-R), serum adiponectin, plasma renin activity(PRA)and serum aldosterone were measured before and after 3 to 5 months of treatment. Olmesartan treatment lowered BP, F-IRI, HOMA-R andserum aldosterone and increased serum adiponectin and PRA significantly. No clinically significant changes in BMI, HR, FPG and HbA1c were observed during treatment. We conclude that olmesartan improves insulin resistance in hypertensive patients with obesity. -
中等度以上腎機能低下患者に対するフェブキソスタットの有効性と認容性の検討
33巻7号(2012);View Description
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Background:Chronic kidney disease(CKD)is a common disease and risk factor of cardiovascular diseases. Hyperuricemia is one of the important factors to worsen CKD. However, there is no available drugs to lower the uric acid levels sufficiently in CKD patients. The aim of this study is to examine the efficacy and safety of febuxostat in CKD patients with moderate to severe renal dysfunction.Methods:Forty CKD patients with hyperuricemia were enrolled and febuxostat was prescribed newly or in place of allopurinol or benzbromalone. The maximum daily dose was 40 mg for the patients with 30≦estimated glomerular filtration rate(eGFR)<60 mL/min/1.73 m2 and 20 mg for those with eGFR<30. The primary efficacy end-point was reduction to and maintenance of serum urate levels<6.0 mg/dL. Six month follow-up was preformed and the effect and tolerability of febuxostat was observed. Results:By using febuxostat, hyperuricemia was reduced significantly without severeside effects. Six mg/dL urate level achievement ratio increased from 5%to 50%, even though, among the other unachieved 20 patients, 13 patients had not received maximum dailydose. Seven mg/dL achievement ratio went up from 20%to 87.5%. Uric acid excretion was also decreased significantly and renal function was maintained.Conclusion:Febuxostat can be an effective and safe drug to treat hyperuricemia in patients with modetate to severe renal dysfunction. New target level for uric acid will be determined for CKD patients. -
総合病院精神科でのメラトニン受容体作動薬ラメルテオンの使用経験―好適症例に関する検討―
33巻7号(2012);View Description
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ラメルテオンは初めてのメラトニン受容体アゴニストとして開発され,不眠症治療薬として使用されている。いままでよく使われていたベンゾジアゼピン系薬物とは異なる作用機序をもち,より生理的な睡眠をもたらすことができる薬物として期待されている。今回,ラメルテオンのより効果的な臨床治療の対象・方法を検討するために,われわれが外来・病棟治療で奏効した症例をケースシリーズとして報告した。症例は若年者例4例(行動起因性睡眠不足症候群3例,概日リズム障害・睡眠相後退型1例),高齢者例5例(精神生理性不眠症2例,せん妄3例)であった。検討の結果,ラメルテオンの好適症例としては,①生活リズムの乱れによる不眠・睡眠リズム障害,②身体合併症を有し薬物忍容性の低い高齢者の不眠,③高齢者のせん妄,などが挙げられると考えられた。 -
原発性骨粗鬆症患者に対するエルデカルシトール0.75μg/日とアルファカルシドール 1.0μg/日の前腕骨骨密度増加効果の比較
33巻7号(2012);View Description
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血液透析患者に対する貧血治療におけるダルベポエチン アルファからエポエチンベータペゴル投与変更後再度ダルベポエチンアルファに変更した症例の検討
33巻7号(2012);View Description
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血液透析患者における腎性貧血治療に対して持続型エリスロポエチンであるダルベポエチンアルファ(DA)からエポエチンベータペゴル(C. E. R. A.)に変更した際,ヘモグロビン(Hb)濃度が1.0 g/dL以上低下した症例が14例中6例に認められた。Hb濃度を上げるためC. E. R.A.の増量ではなく変更前の投与量であるDAに戻したところ速やかにHb濃度は回復した。血清フェリチン値は,DAからC. E. R. A.への変更により上昇傾向を示したことから鉄利用の低下が貧血進行の原因と考えられた。DAからC. E.R. A.に変更後Hb濃度の低下した症例ではDAに戻すことで速やかに目標Hb濃度に復することが示された。 -
Is Korean Red Ginseng a Medicine Which Regulates Heart Rhythm?
33巻7号(2012);View Description
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It is well known that medical ginseng not only improve hemodynamics but also maintain homeostasis in human by regulating autonomic-endocrine system. The author was always thinking medical ginseng, specifically Korean red ginseng(KRG), maybe improves sinus node function and prevents various arrhythmias. Simultaneously the author was thinking KRG improves tachyarrhythmia by suppressing excess activity of sinus node and ectopic excitement. On the other hand, in bradyarrhythmia, KRG is thought to recover suitable rhythm by recovering triggered activity of damaged sinus node. In this study, the author aimed to prove an efficacy of KRG on treatment of arrhythmias through severalexperiences in routine clinical work. As the result, it became clear that KRG improves both of tachycardic and bradycardic arrhythmia. The author concluded from this experience even if uses it as main agent or additional one, KRG have a useful value as one procedure to treat arrhythmia that is refractory to standard treatment.
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