http://hdl.handle.net/10564/1526 1998-10 2026-04-09T03:39:55Z http://hdl.handle.net/10564/475 タイトル: 精神分裂病に下垂体性巨人症を合併した1症例 : プロモクリプチン併用についての考察 著者: 森川, 将行; 飯田, 順三; 岸本, 年史; 伊藤, 直人; 畑, 和也; 南, 尚希; 中井, 貴 抄録: Bromocriptine is an ergot alkaloid derivative that possesses both dopamine agonist and antagonist activity. This biphasic action has allowed bromocriptine to be used for many psychiatric disorders. We describe a rare case of schizophrenia with pituitary gigantism, whose psychiatric symptoms were improved by concomitant bromocriptine therapy with neuroleptics. The patient (a 30-year-old single female) had been suffering from schizophrenia during the past 12 years. In remission, she was employed in accounting. At age 25, brain CT scanning revealed a pituitary tumor, but operation was not indicated. At age 30, she discontinued neuroleptics by herself. As a result, she had a relapse and entered a psychiatric hospital for the first time. Her psychiatric symptoms were auditory hallucination, delusion of persecution, reference and control, and depersonalization. Neurological symptoms were not present. Serum growth hormone ranged from 4 to 13.6 ng/ml (normal 0.6-3.7 ng/ml). Brain MRI scanning also revealed a pituitary tumor, of a size less than 1 centimeter and localized in sella turcica. Bromperidol improved her symptoms for the most part, but depersonalization continued obstinately. After a while, she was started on bromocriptine 2.5mg daily together and increased gradually. At 7.5mg daily her depersonalization began to be reduced and then at 15 mg daily it disappeared. Through the course of treatment, there were no side effects of bromocriptine therapy. Generally at low doses bromocriptine acts on the presynaptic autoreceptor as antagonist activity, while at higher doses, bromocriptine works directly on the postsynaptic receptor as agonist activity. However in this case the effective dose was a moderate dose, 15 mg daily ; finally bromocriptine may act as antipsychotic action. Concomitant bromocriptine therapy with neuroleptics were useful in schizophrenia with pituitary gigantism. 1998-10-30T15:00:00Z http://hdl.handle.net/10564/474 タイトル: 敗血症におけるadrenomedullinの意義 著者: 植田, 史朗 抄録: The author measured the plasma levels of adrenomedullin (AM), a novel vasodilating peptide, in 12 patients with severe sepsis and 27 patients with septic shock, with 13 healthy volunteers as controls. Plasma levels of AM in sepsis (severe sepsis 48.3±12.1 fmol/mL ; septic shock, 203.5±32.8) were significantly elevated as compared with those in controls (5.1±0.2). The patients with septic shock showed higher levels of plasma AM than those with severe sepsis. Subsequently, we measured the plasma levels of some mediators such as tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-8, plasminogen activator inhibitor (PAI)-1 and thrombomodulin (TM) in patients with severe sepsis and septic shock to compare with severity of illness. Plasma levels of AM and TNF-α in septic shock correlated with hemodynamic variables characterized hyperdynamic state. Plasma AM, TNF-α and IL-8 levels correlated positively with Acute Physiology and Chronic Health Evaluation (APACHE)-Ⅱ score, multiple organ failure score. Plasma AM, IL-8 and PAI-1 levels correlated with prognosis. These observations suggest that plasma AM level might serve as a useful marker of severity in septic shock. Furthermore, we examined mononuclear cells derived from four septic patients for the expression of AM messenger RNA (mRNA) by using the reverse transcription-polymerase chain reaction method. AM mRNA was expressed in the mononuclear cells from septic patients, but not in those from healthy subjects, suggesting that mononuclear cells costitute one of the sources to elevate plasma AM level in sepsis. These data showed that AM may play an important role in the pathophysiology of sepsis. 1998-10-30T15:00:00Z http://hdl.handle.net/10564/473 タイトル: 遺伝性運動感覚性ニューロパチータイプⅠの臨床遺伝学的検討 著者: 村田, 加代子 抄録: We investigated 12 Japanese patients whose diagnosis was hereditary motor sensory neuropathy type Ⅰ (HMSN Ⅰ) from clinical and pathological findings. We compared the genetic findings with their clinical features, MRI findings of the nerve roots, nerve biopsy findings, electrophysiological studies, and magnetic stimulation studies. So far as we investigated, PMP-22 gene duplication was detected in one half of the patients while no genetic changes of PMP-22 or P0 were observed in the other. Enlargement of peripheral nerves and nerve roots was remarkable in patients without abnormalities of PMP-22 or P0, while some of them showed signs of radiculopathy or myelopathy. In patients with PMP-22 gene duplication, there was a significant correlation between the age at onset and MCV. This fact indicated that patients with younger onset and slower MCV had more severe symptoms. Though HMSN Ⅰ is thought to be heterogeneous, we could detect significant features between clinical and electrophysiological findings according to the analysis of PMP-22 duplication. 1998-10-30T15:00:00Z http://hdl.handle.net/10564/472 タイトル: インスリン非依存型糖尿病患者における副腎アンドロゲンとテストステロン 著者: 金内, 雅夫; 川野, 貴弘; 中嶋, 美鐘; 辻本, 伸宏; 土肥, 和紘 抄録: Adrenal androgens have recently received much attention regarding their anti-diabetic effects. We investigated the serum levels of dehydroepiandrosterone sulfate (DHEA-S) and testosterone in 68 men with non-insulin-dependent diabetes mellitus (NIDDM) and in 31 non-diabetic men. Compared with non-diabetic men, men with NIDDM had significantly lower levels of DHEA-S and testosterone. Serum levels of DHEA-S showed a significant negative correlation with age and were also inversely related to the severity of diabetic nephropathy. However, no correlations were observed between serum levels of DHEAs and fasting plasma glucose, HbA1c, serum total cholesterol concentration or serum triglyceride concentration. Our results suggest that diabetes and aging have detrimental effects on adrenal androgens, and that lower levels of adrenal androgens are also associated with the severity of diabetic nephropathy, but not with glycemic control or dyslipidemia. 1998-10-30T15:00:00Z