Volume 33,
Issue 10,
2012
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榊原カンファレンス:チーム医療の実際
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Source:
Therapeutic Research 33巻10号, 1441-1454 (2012);
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Symposium:第13回肺高血圧治療研究会
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一般演題
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Source:
Therapeutic Research 33巻10号, 1469-1471 (2012);
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Source:
Therapeutic Research 33巻10号, 1472-1474 (2012);
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Source:
Therapeutic Research 33巻10号, 1475-1476 (2012);
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Source:
Therapeutic Research 33巻10号, 1477-1479 (2012);
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Source:
Therapeutic Research 33巻10号, 1480-1482 (2012);
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Source:
Therapeutic Research 33巻10号, 1483-1483 (2012);
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Source:
Therapeutic Research 33巻10号, 1484-1486 (2012);
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Source:
Therapeutic Research 33巻10号, 1487-1492 (2012);
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Source:
Therapeutic Research 33巻10号, 1493-1496 (2012);
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Source:
Therapeutic Research 33巻10号, 1497-1498 (2012);
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Source:
Therapeutic Research 33巻10号, 1499-1501 (2012);
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Source:
Therapeutic Research 33巻10号, 1502-1502 (2012);
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Source:
Therapeutic Research 33巻10号, 1503-1505 (2012);
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Source:
Therapeutic Research 33巻10号, 1506-1507 (2012);
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Source:
Therapeutic Research 33巻10号, 1508-1509 (2012);
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Source:
Therapeutic Research 33巻10号, 1510-1511 (2012);
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胆道閉鎖等の肝疾患に伴う肺動脈性肺高血圧(門脈肺高血圧;portopulmonary hypertension,以下 PPHTN)に対する根本的治療として肝移植が検討されるが,肺血圧が高い場合は周術期死亡率が高く,移植術の禁忌とされてきた。しかし,epoprostenol(以下 PGI2)治療の後,移植術が成功すれば PPHTN についても良好な予後が期待される。一方,全例に PGI2が著効するわけではない。これまで当院では,中等度以上の PPHTN の患者 10 例に対し,PGI2で肺高血圧をコントロールした後,生体部分肝移植を施行した。一方,PGI2を導入したにも関わらず移植の適応となるまで改善しなかった症例も存在する。これら 5症例につき検討した。症例数が少ないこともあり,血行動態等に移植成功例との明らかな差異を指摘できなかったが,生体部分肝移植後に発症した PPHTN 症例の割合が多く,注目された。
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要望演題:肝門脈疾患によるPAHの治療経験
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Source:
Therapeutic Research 33巻10号, 1512-1514 (2012);
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Source:
Therapeutic Research 33巻10号, 1515-1515 (2012);
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Source:
Therapeutic Research 33巻10号, 1516-1518 (2012);
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Source:
Therapeutic Research 33巻10号, 1519-1520 (2012);
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Source:
Therapeutic Research 33巻10号, 1521-1522 (2012);
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胆道閉鎖症等の肝疾患に伴う肺動脈性肺高血圧(門脈肺高血圧;portopulmonary hypertension,以下 PPHTN)に対する根本的治療として,肝移植が検討される。ただし,肺血圧が高い場合は周術期死亡が高いため,以前は移植の禁忌とされており,今なお禁忌と考える施設もある。しかし,epoprostenol(以下 PGI2)で治療することにより移植が可能となる症例も存在するため,われわれは PGI2で積極的に治療したうえで肝移植を目指す方針としている。実際当院では平成 11 年以降,重度の PPHTNを伴う肝疾患の患者 10 例に対して PGI2で肺高血圧をコントロールした後,生体部分肝移植を施行した。1 名を術後早期に失ったが,9 名が生存し,うち 7 名では肺高血圧が改善するなどにより PGI2から離脱できた。これらの症例および当院での治療戦略につき報告する。
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シンポジウム:各種の肺高血圧症治療における診断のポイント
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Source:
Therapeutic Research 33巻10号, 1523-1525 (2012);
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Source:
Therapeutic Research 33巻10号, 1526-1528 (2012);
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Source:
Therapeutic Research 33巻10号, 1529-1531 (2012);
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Source:
Therapeutic Research 33巻10号, 1532-1534 (2012);
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Source:
Therapeutic Research 33巻10号, 1535-1537 (2012);
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Review
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Source:
Therapeutic Research 33巻10号, 1541-1545 (2012);
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原著
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Source:
Therapeutic Research 33巻10号, 1547-1550 (2012);
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In 21 cases of geriatric uncontrolled hypertensive with diabetes and others, theyhave obtained equivalent blood pressure-lowering effects by switching from high dose valsartan to normal dose olmesartan without HbA1c worsened and so on. For excellent antihypertensive and organ protective effects, olmesartan might be expected to give more economic efficiency than other ARBs.
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Source:
Therapeutic Research 33巻10号, 1551-1560 (2012);
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Anti-hypertensive treatment has been recommended in patients with chronic kidney disease(CKD)to prevent progression to end-stage kidney disease(ESKD),and calcium channel blocker(CCB)is one of the most common agent to treat hypertension. However, their long-term outcomes in case of treatment by CCB have not been elucidated. Thirtyeight CKD patients under treatment with CCB, benidipine were reviewed, and factors that might contribute to the progression to ESKD were assessed (mean follow-up:6.9±3.6 years). Systolic and diastolic blood pressure(BP)significantly decreased from 149.6/92.3 mmHg at baseline to 134.4/83.0 mmHg at 1 month, and anti-hypertensive effects continued afterwards(both, p<0.001). The rate of protein score≧2 significantly decreased from 36.8% at baseline to 18.4% at last visit(p<0.05). At baseline estimated glomerular filtration rate(eGFR)were 45.7±16.4 mL/min/1.73 m2. The progression rate to ESKD was 21.1%. Multivariate Cox regression analysis identified baseline eGFR as an independent factor influencing the progression to ESKD. The point of no return of baseline eGFR for progression to ESKD was estimated to be 25.0 mL/min/1.73 m2 by maximal χ2 test. This study showed that benidipine may prevent progression to ESKD in hypertensive patients with CKD, and should be started at the time of 25.0 mL/min/1.73 m2 eGFR or more, which was defined as the point of no return. We consider that early and optimum BP control by benidipine is advisable to prevent progression to ESKD for hypertensive patients with CKD, especially with mild or moderate renal dysfunction.
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Source:
Therapeutic Research 33巻10号, 1561-1568 (2012);
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Background:Fibrates bind to and activate the nuclear receptor PPARα. Fenofibrate is a PPARα–specific agonist, while bezafibrate has been reported to act by binding not only to PPARα, but also to PPARγ and δ. However, few studies have comparatively evaluated the effects of the two drugs in clinical practice. Subjects and Methods:Fenofibrate was switched to bezafibrate in 61 patients(43 males and 18 females) and the safety and effect of the drug switch on lipid(LDL–C, TG, HDL–C) and glucose metabolism(HbA1c) were evaluated after 20 weeks of the switch. Results:While no significant changes of the serum LDL–C and TG levels were observed after the switch to bezafibrate, significant increase of the serum HDL–C level from 49.5±1.7 mg/dL to 52.5±2.0 mg/dL was observed at 20 weeks after the switch. Moreover, the HbA1c level significantly decreased from 5.92±0.34% to 5.72±0.33% . The switch from fenofibrate to bezafibrate posed no problems in terms of safety. Conclusion:Although the effects of the two drugs on the serum LDL–C and TG were similar, bezafibrate appeared to exert more favorable effects on the serum HDL–C and glucose metabolism.
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Source:
Therapeutic Research 33巻10号, 1569-1573 (2012);
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Background:Poor glycemic control and elevated levels of inflammatory markers such as C–reactive protein(CRP) are associated with the increased risk for cardiovascular diseases in diabetic patients undergoing hemodialysis. Dipeptidyl peptidase –4(DPP–4) is a responsible enzyme that mainly inactivates glucagon –like peptide –1(GLP–1), a gut hormone secreted from L cells in the intestine in response to food intake. Since GLP–1 not only augments glucose –dependent insulin secretion from pancreatic β–cells, but also suppresses glucagon production and slows gastric emptying, DPP–4 inhibitors are now one of the widely used agents for the treatment of type 2 diabetes. However, whether there is some difference of clinical efficacy among DPP–4 inhibitors remains unclear. In this study, we compared the clinical effects of DPP–4 inhibitors in diabetic patients undergoing hemodialysis by switching from alogliptin to linagliptin. Methods:Four hemodialysis patients who had treated with alogliptin were enrolled. Clinical efficacy was compared by the replacement of alogliptin with linagliptin. Results:After switching to linagliptin, glycated albumin(21.6±1.1 vs 20.4±0.5% , p =0.08), serum levels of CRP(0.41±0.18 vs 0.08±0.02mg/dL, p = 0.054) and ferritin(175.4±71.4 vs 83.8±41.0ng/mL, p<0.05) were decreased. Moreover, replacement with linagliptin had a tendency to increase high –density lipoprotein(HDL) levels(51.0±5.8 vs 55.2±8.3mg/dL, p = 0.21). There was no difference among other parameters before and after the treatment of linagliptin. Conclusion:The present study suggested the clinical efficacy in switching from alogliptin to linagliptin in diabetic patients undergoing hemodialysis.
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Source:
Therapeutic Research 33巻10号, 1575-1581 (2012);
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Source:
Therapeutic Research 33巻10号, 1583-1591 (2012);
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Objective: To clarify the contribution of the pre-ejection period(PEP)to the pulse wave transit time(PWTT)while performing electrocardiography(ECG)as a novel continuous cardiac output monitoring method, the relations between each time component and blood pressure parameters and the stroke volume(SV)were evaluated. Methods: The circulatory dynamics of ten anesthetized mongrel dogs were varied with the administration of dobutamine, phenylephrine, nitroglycerin, blood removal, or deepening of isoflurane anesthesia. The times from the ECG R wave to the rise point of the femoral arterial pressure(FAP)wave and the aortic pressure(AOP)wave were calculated as m-PWTT and PEP, respectively; m-PWTT minus PEP was defined as a-PWTT. The intermittent bolus thermodilution cardiac output(ICO)was measured, and the SV was calculated. Results: For both the AOP and the FAP, the first quartile, median, and third quartile of the coefficients of determination between the m-PWTT and the pulse pressure(PP)were higher than those between the m-PWTT and other blood pressure parameters. The PEP and the m-PWTT were best correlated with the PP in the largest number of cases. The changes in the m-PWTT were best correlated and had the highest concordance rates with the changes in the SV. Conclusions: The inclusion of the PEP in the m-PWTT enhances the precision of cardiac output measurements. Using ECG as a novel continuous cardiac output monitoring method based on the PWTT has the advantages of being accurate as well as inexpensive, non-invasive, and easy to use.