Therapeutic Research

Volume 35, Issue 2, 2014
Volumes & issues:
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Symposium:The Sanford Guide“熱病”Forum in Yokohama 2013
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Symposium:第40 回関西高血圧研究会
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- 一般演題
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褐色細胞腫と原発性アルドステロン症の各1 例
35巻2号(2014);View Description
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We report effective diagnoses and treatments in two cases with adrenal incidentaloma. The first male case aged 38 years was suffered from hypertension and right adrenal incidentaloma(14 cm and 11 cm in diameter)through CT, MRI and PET‒CT, who showed slightly higher levels of adrenaline, noradrenaline and vanilmandelic acid of 24 hour urine, in despite of normal ranges of blood catecholamines. Right adrenal tumor adhered with renal tissue was removed surgically, accompanying with right nephrectomy. Normotension continued postoperatively without any drug. The second female case aged 52 years showed hypertension, hypokalemia(2.5mEq/L), high concentration of plasma aldosterone(400.7 pg/mL, normal range:29.9‒158 pg/mL), hyporeninemia(<0.2 ng/mL/hr), alkalosis and small adrenal adenoma through abdominal CT. Right adenoma with high secretion of aldosteron was confirmed by both selective adrenal venous sampling and adrenal scintigraphy, indicating primary aldosteronism. Right adrenal adenoma was removed by laparoscopic adrenalectomy, resulting in near normotension without drugs involving spironolactone. Furthermore, microscopic findings of adrenal tissues were consist with the above diagnoses in the two cases. -
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Symposium:第47 回ペーシング治療研究会
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- 一般演題(看護部門)
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2.甲状腺機能亢進症に伴う発作性心房細動患者の救急受診に対しCareLink® ExpressTMが有用であった1 例
35巻2号(2014);View Description
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- 一般演題(技士部門)
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2.Battery がRemaining Longevity のMinimum 表示より早期に低下した1 症例
35巻2号(2014);View Description
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6.Non‒Competitive Atrial Pacing(NCAP)アルゴリズム作動により設定心拍数に満たない心拍変動を認めた1 例
35巻2号(2014);View Description
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8.ペーシングシステムアナライザ,ペースメーカーでのP 波高値が十分な安全域を取れているにもかかわらずアンダーセンシングを起こした1 例
35巻2号(2014);View Description
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原著
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2 型糖尿病患者におけるシタグリプチンの諸種臨床指標に対する包括的改善効果
35巻2号(2014);View Description
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DPP‒4 阻害薬であるシダグリプチン50 mgで加療を行った2 型糖尿病患者193 例において,後ろ向きに諸種臨床指標のデータをサンプルして,その推移を統計学的に検討した。HbA1cは,3 ヵ月後には有意な低下を認め(p=0.0005),以後24 ヵ月後まで安定していた。血圧は,収縮期血圧130 mmHg 以上の群で15 ヵ月後に有意な低下を認め(p=0.044),拡張期血圧85 mmHg 以上の群では6 ヵ月後に有意な低下を認めた(p=0.002)。LDL‒cholesterol (LDL‒C)は,12 ヵ月後に有意な低下を認めたが(p=0.04),スタチン投与の有無や体重減少の有無による変化率の比較では有意差を認めなかった。体重,HDL‒C,eGFR,単核球数および好酸球数に有意な変化は認めなかった。シタグリプチンは,血糖,血圧ならびに脂質を改善させる効果を有しており,2 型糖尿病の包括的な管理に有用な薬剤であることが推察された。 -
循環器医による糖尿病合併高血圧の降圧療法の現状
35巻2号(2014);View Description
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目的:循環器医による糖尿病(DM)合併高血圧薬物療法の現状を明らかにする。方法:札幌医科大学第二内科およびその関連施設の循環器医を対象に,外来受診の高血圧連続20 例についてケースカード調査を行い,DMの合併の有無で対比した。結果:3186 例が解析対象となり,そのうちDM 合併例は830 例であった。DM の有無にかかわらずCa 拮抗薬(CCB)の処方率は71.9%(DM 非合併例),73.1%(DM 合併例)と最多で,アンジオテンシン受容体拮抗薬(ARB)がおのおの62.1%,71.6%とそれに続いた。アンジオテンシン変換酵素(ACE)阻害薬とARB を併せたレニン・アンジオテンシン(RA)系抑制薬処方率はDM 合併例では85.0%とCCB の処方率をしのいだ。利尿薬の使用率はDM非合併例の23.0%に比してDM合併例では31.4%と有意に大であった。平均薬剤使用数はDM非合併例の1.94 剤に比してDM 合併例では2.29 剤と多かったが,主治医判定による血圧コントロール良好例はDM非合併例の63.9%に比してDM合併例で53.7%と低値であった。RA 系抑制薬,CCB,利尿薬の3 剤併用はDM 合併例では24.0%に達していたが,主治医判定のコントロール良好率は42.2%に留まった。まとめ:DM 合併例では,大多数の症例が良好な降圧を得るためにRA 系抑制薬とCCBが使用されていた。利尿薬は,糖代謝に対する影響を考慮しても良好な降圧の観点からはむしろ積極的に使用され,これら3 剤の併用も約20%であったが,コントロール良好例は半数に届かず,DM 合併高血圧の治療の困難性が再確認された。 -
複数の動脈硬化危険因子を有する患者に対する高純度EPA 製剤の効果および治療効果判定の指標としてのEPA/AA 比の有用性
35巻2号(2014);View Description
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Background:Sevaral studies suggested that serum EPA/AA ratio could be one of the risk factors of cardiovascular events. However, few study reported that serum EPA/AA ratio could be the indicator of therapy effect of atherosclerosis. Methods:Forty six dyslipidemia patiets with multiple artery atherosclerotic risk factors were treated on EPA(1800 mg/day)added after statin therapy. In addition to serum lipids, high‒sensitive CRP(hs‒CRP), adiponectin and serum EPA/AA ratio, as a marker of atherosclerosis, carotid intima‒media thickness(IMT)and cardio‒ankle vascular index(CAVI) were measured before and after EPA treatment. Multiple linear regression analysises were performed to assess the association between IMT and other parameters. Results:During the study period of 12 months, maxIMT, CAVI, hs‒CRP and adiponectin showed significant improvement(p<0.0001, p<0.0001, p<0.05, p<0.01, respectively). Multiple linear regression analysises revealed that only the increase of EPA/AA ratio associated with improvement of maxIMT(p=0.0405). Conclusion:The observasion suggests that EPA can inhibit the development of atherosclerosis and the increase of EPA/AA ratio can be the indicator of therapy effect of atherosclerosis with EPA. -
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症例
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Effects of Demeclocycline in an Elderly Patient with Syndrome of Inappropriate Secretion of Antidiuretic Hormone(SIADH)
35巻2号(2014);View Description
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Antidiuretic hormone(ADH) secretion is abnormal or alters serum osmolality inpatients with syndrome of inappropriate secretion of antidiuretic hormone (SIADH),of which the causes and treatment remain undetermined. We treated SIADH using a classical approach followed by demethylchlortetracycline(demeclocycline). A 75–year–old hypertensive, diabetic man sustained a brain contusion. Computed tomography showed a skull fracture and subarachnoid hemorrhage, and MRI revealed a cystic pituitary tumor. Blood findings indicated traumatic syndrome of inappropriate secretion of antidiuretic hormone(SIADH). Saline infusion and NaCl intake returned Na and Cl levels to near normal. However, the patient’s clinical status deteriorated with increasing ADH concentrations. Sodium levels were corrected with diuretics and fluid replacement. Antihypertensive, antiarrhythmic, gastrointestinal drugs were administered along with demeclocycline(450 mg/day) and drinking water was restricted. C–reactive protein(CRP)levels remained low(0.02 mg/dL) under this regime and demeclocycline was tapered to 150mg/day. The patient resumed premorbid activities after about four months and continued treatment as an outpatient. The most recent Na, Cl and K values were normal (137, 102 and 4.7 mEq/L respectively). Demeclocycline prevents infections of the central nervous system by promoting antidiuretic hormone(ADH) secretion and reducing urine output; it also has antidiuretic action. However, the causes and treatment of this condition remain largely unknown and neither clinical trials nor double–blind controlled studies have assessed the actual mechanism(s) of demeclocycline action. Thus, the effects of demeclocycline remain questionable. We plan to investigate more effective agents against SIADH.
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