Therapeutic Research

Background：For pacing therapy in children, relative shortening of leads accompanying growth, frequent exchanges due to lead life, thrombotic vein occlusion are anticipated and epicardial leads are often chosen. Recently, reports using transvenous leads are also commonly found, but adaptation has no definite view. We report a case of a 9 – year–old child with complete atrioventricular block, a height of 110 cm and a weight of 16.1 kg, that was implanted with transvenous pacemaker without any complications. Case：A 9–year –old boy with adrenoleukodystrophy. During hospitalization for bronchial asthma attacks, bradycardia with heart rate（HR） 30 bpm was observed without induction and diagnosed as complete atrioventricular block with 12 lead electrocardiogram. Atropine infusion and continuous infusion of isoproterenol （ISP） did not improve the bradycardia, HR 30 bpm advanced bradycardia was occasionally repeated. An percutaneous pacing catheter was inser ted, followed by a permanent ransvenous pacemaker implantation. The generator was Advisa MRI （Medtronic Inc.）, the ventricular lead was 4.1 Fr SelectSecure MRI SureScan 3830（Medtronic Inc.）, screwed–in to the right ventricular septum. The setting was VVI （lower rate 80 bpm）, and with good postoperative course. Discussion：In this case, MRI –compatible pacemaker was preferred for evaluation of the original disease, and we wanted to avoid thoracotomy surgery and generator placement in the abdomen because gastrostomy was planned. Due to the growth disorder caused by the original disease, transvenous pacing device implantation was chosen. Conclusion：In patients with growth disorders, intravenous device placement may be an active choice.

目的：レパグリニド（以下，本剤）が新たに投与された2 型糖尿病患者について，本剤投与開始後3 年間観察し，製造販売後の使用実態下における長期投与時の安全性および有効性を検討することを目的とした特定使用成績調査を実施した。方法：中央登録方式により，患者背景，本剤の投与状況，血糖降下薬を含む併用薬，有害事象，臨床検査値について調査した。結果：副作用は安全性評価対象症例3484例の6.57％に発現し，主な副作用は低血糖（3.21％）であった。低血糖以外に特徴的な副作用は認められず，3 年間の長期投与で副作用の発現割合の著しい増加は認められなかった。有効性評価対象症例2934 例のHbA1c 値は投与開始前の7.69±1.44％に対し，最終観察時（36 ヵ月後のデータが欠損もしくは投与中止により中途脱落した場合には最後に観察された値で補完）には7.05±1.20％に低下し，最終観察時の変化量は－0.64±1.46％であった。変化量は投与開始3 ヵ月後には－0.74±1.28％と低下がみられ，12 ヵ月後には－0.74±1.30％，24 ヵ月後には－0.76±1.29％，36 ヵ月後には－0.75±1.26％であった。結論：使用実態下での本剤の3 年間の長期投与において，新たな安全性の問題点は認められず，本剤の有効性に関しても特に懸念される点は認められなかった。

Objectives：Three types of drawing tests（cube copying test［CCT］, interlocking pentagon test［IPT］, and clock drawing test［CDT］）that can be administered in a short period of time（approximately two minutes）during an outpatient examination were performed. The relationship between the performance on these tests and the Mini‒Mental State Examination（MMSE）score, as well as the utility of the results in estimating cognitive decline, were evaluated. Methods：In a 14‒month period between April 2017 and May 2018, the three different drawing tests and MMSE were administered on the same day at our clinic in 57 patients with dementia of the Alzheimer type（10 men aged 81‒92, 86.0±3.3 years old on average；47 women aged 73‒98, 85.9±5.8 years old on average）. Performance for each of the three drawing tests was contrasted with results from the MMSE. The final judgment on the severity of dementia was determined by contrasting the number of patients （％）who were able to correctly complete the test against the MMSE score. Results：The sensitivity of the three drawing tests varied. The number of patients who were able to correctly complete the test started to decline from high MMSE scores starting with CDT as the most sensitive, followed by CCT, while IPT was the test where only patients with severe dementia were not able to complete the drawing correctly. In reference to the MMSE score, the drawing test performances were classified into three groups, where the MMSE ranges were 23‒18 for mild dementia, 17‒11 for moderate dementia, and 10‒0 for severe dementia. Conclusions：The drawing tests used in this study could be administered together over a short period of time. The tests are useful for understanding the severity of dementia in patients, moreover families and caregivers can also look at the drawings to understand the severity of the dementia.