http://hdl.handle.net/10564/1538 2000-06 2026-04-10T15:42:02Z http://hdl.handle.net/10564/605 タイトル: 心室頻拍にメチルプレドニゾロン・パルス療法が奏功した心サルコイドーシスの1例 著者: 木田, 順富; 中嶋, 民夫; 山本, 広光; 坂口, 泰弘; 椎木, 英夫; 橋本, 俊雄; 土肥, 和紘; 藤本, 眞一 抄録: A 63-year old woman was admitted because of ventricular tachycardia and congestive heart failure. A chest radiograph showed cardiomegaly and bilateral hilar lymphadenopathy. Echocardiogram showed diffuse left ventricular hypokinesis, dilated left ventricle and thinning of the interventricular septum. On gallium scintigram gallium was accumulated in the heart, especially in the left ventricle. Although endomyocardial biopsy revealed non-specific fibrosis, cardiac sarcoidosis was clinically suspected. On the 10th day of the addmission, multiple episodes of sustained ventricular tachycardia appeared. As it was refractory to lidocaine infusion, methylpredonisolone pulse therapy was initiated, which abated ventricular tachycardia. Corticosteroid was gradually tapered off and ventricular tachycardia never recurred. Methylpredonisolone pulse therapy could be a therapeutic option for cardiac sarcoidosis with fatal arrhythmia even if histological evi- dence of cardiac sarcoidosis is absent. 2000-06-29T15:00:00Z http://hdl.handle.net/10564/604 タイトル: Swan-Ganzカテーテルによる肺動脈損傷の1例 著者: 中谷, 秀隆; 土肥, 直文; 林, 照剛; 藤田, 泰三; 橋本, 俊雄; 土肥, 和紘; 酢谷, 俊夫; 平井, 純 抄録: An accidental rupture of the pulmonary artery is reported in a 72-year-old woman. On November 8, 1997, she was admitted for acute myocardial infarction. Marked ST segment elevation in Ⅰ, aVL, Ⅱ, aVF and V2 from V6 were evident by electrocardiogra- phy. Cardiac catheterization showed a normal coronary artery with left ventricular failure. During the procedure, the patient received an initial bolus injection of 10,000 IU of heparin. A size 7 Fr Swan-Ganz catheter was inserted without difficulty. Mean pulmonary artery wedge pressure was 14 mmHg. After catheterization, immediately after the balloon was inflated for a PAWP measurement at the bedside, the patient developed a cough followed by massive hemoptysis. The possibility of a pulmonary artery rupture was considered. Protamine was injected through the distal port of the pulmonary artery catheter. After 2 hours, the patient had no further hemoptysis. Pulmonary artery rupture due to the use of a Swan-Ganz catheter is rare, with an estimated 0.001 to 0.47% incidence rate. Because such a rupture is fatal in almost 50% of cases, it is important to prevent such complications during the use of Swan-Ganz catheters. 2000-06-29T15:00:00Z http://hdl.handle.net/10564/603 タイトル: 高度の肺高血圧を合併した高齢者慢性肺動脈血栓閉塞症の1例 著者: 那須, 賢哉; 松倉, 康夫; 藤井, 厚史; 西田, 育功; 藪田, 育男; 野中, 秀郎; 山野, 繁; 土肥, 和紘 抄録: A 76-year-old female was admitted to our hospital because of dyspnea on effort. She had suffered from hypertension for nine years and had a sudden onset of dyspnea a year and five months before admission. A chest reontgenogram showed marked enlargement of the cardiac shlhouette. Chest enhanced CT study revealed that an embolism in the right main pulmonary artery had caused stenosis. However, pulmonary angiographic study suggested that embolism was questionable. The pulmonary arterial pressure was 100 /30 mmHg and the right ventricular pressure was 112/10 mmHg Lung scan test showed mismatched defects between abnormal perfusion scanning and normal ventilation scanning. Venous ultrasound imaging revealed thrombosis in the popliteal vein. The patient was diagnosed as having chronic pulmonary embolism due to deep vein thrombosis. She had been taking warfarin as anticoagulant thrapy. We believe this was a case of chronic pulmonary embolism. In elderly patients with sudden onset of dyspnea, chest enhanced CT study is necessary for the accurate diagnosis of chronic pulmonary embolism. 2000-06-29T15:00:00Z http://hdl.handle.net/10564/602 タイトル: 胸骨前再建術を施行された脳梗塞患者に再建胃管より腸瘻を造設した1例 著者: 後一, 肇; 丸山, 直樹; 山路, 國弘; 川野, 貴弘; 西浦, 公章; 小泉, 和昭; 紀川, 伊敏; 南, 繁敏; 小川, 修二; 法田, 浩一 抄録: A 61-year-old man, who was operated for esophageal cancer at the age of 60, was admitted to our hospital because of poor consciousness. After admission, he was treated by percutaneous endoscopic gastrojejunostomy (PEGJ) at a gastric tube because of aspiration pneumonia. After PEGJ placement, he did not suffer from aspiration pneumonia and was discharged from our hospital. Percutaneous endoscopic gastrostomy (PEG) is a very useful method but can not be performed on the patient with the partial or total resected stomach. Percutaneous endoscopic jejunostomy (PEJ) is performed on these patients, but the procedure is difficult for a general endoscopist. Therefore we think that it is easy and safe for a general endoscopist to perform PEGJ on the patient whose stomach is recostruct- ed with a gastric tube through anthethorax after resection of esophageal cancer. 2000-06-29T15:00:00Z