http://hdl.handle.net/10564/1539 2000-08 2026-04-10T15:42:01Z http://hdl.handle.net/10564/615 タイトル: エンドトキシン吸着療法が著効した急性閉塞性化膿性胆管炎による敗血症性ショックの1例 著者: 増井, 一弘; 植田, 史朗; 相澤, 茂幸; 植山, 徹; 福島, 英賢; 畑, 倫明; 村尾, 佳則; 奥地, 一夫; 宮本, 誠司; 栗山, 茂樹; 竹内, 洋司; 菊池, 英亮; 中山, 雅樹; 松村, 雅彦; 福井, 博; 西尾, 健治 抄録: We present here a case of septic shock caused by acute obstructive suppur- ative cholangitis treated successfully with endotoxin absorption therapy. A 75-year-old man was admitted to our hospital due to high-grade fever and right hypochondralgia. His consciousness was not alert and incontinence was observed. Abdominal ultrasonography revealed that the stone was incarcerated into the common bile duct. Furthermore, he exhibited the Reynolds pentad. He was, therefore, diagnosed as having acute obstructive suppurative cholangitis. Although he was treated with endoscopic naso-biliary drainage, he did not recover from septic shock. Therefore, endotoxin adsorption therapy using a column containing polymyxin B immobilized fiber (PMX) was applied. Serum levels of endotoxin and inflamation-related mediators, such as interleukin-6 (IL-6), IL-8, IL-10, tumor ne- crosis factor-α, plasminogen activator inhibitor and adrenomedullin, were decreased markedly at the completion of the PMX treatment. Furthermore, hemodynamics were also improved markedly by the PMX treatment. Our experience indicates that endotoxin adsorption therapy using PMX is useful for the treatment of septic shock caused by acute obstructive suppurative cholangitis. 2000-08-30T15:00:00Z http://hdl.handle.net/10564/614 タイトル: 悪性リンパ腫の精査中に発見され鑑別診断が困難であった頚部嚢胞性リンパ管腫の1例 著者: 赤羽, たけみ; 栗山, 茂樹; 増井, 一弘; 吉川, 正英; 小嶌, 秀之; 吉治, 仁志; 中谷, 敏也; 福井, 博 抄録: We report a case of cervical cystic lymphangioma that was found during the examination of malignant lymphoma and difficult to differentiate from malignant lymphoma. A 68-year-old man with chronic hepatitis type C developed a subcutaneous mass at his posterior cervical region and this slow-growing tumor was resected and diagnosed histologically as non-Hodgkin lymphoma (diffuse mixed, B cell type). Although no other superficial lymph nodes were palpable, ultrasonography (US) of the neck revealed a low echoic mass of 40mm×30mm in diameter at the left supraclavicular fossa. The computed tomography (CT) also showed an inhomogeneously enhanced mass at the same region. On magnetic resonance imaging (MRI), T1-weighted image showed a low intensity mass and T2-weighted image showed a high intensity mass. The mass was enhanced inhomogeneously by systemic infusion of gadolinium. Therefore, the differential diagnosis from malignant lymphoma was difficult. The mass was resected and finally diagnosed as cystic lymphangioma. Cervical lymphangioma is rare among adults. Because US, CT and MRI examinations cannot provide definite information, the final diagnosis is usually made by histological examination of the resected specimens. In this case, the mass was found at the supra- clavicular fossa near the malignant lymphoma. Therefore, the histological differential diagnosis from malignant lymphoma was extremely important. 2000-08-30T15:00:00Z http://hdl.handle.net/10564/613 タイトル: Primary stenting 後に2度の亜急性血栓性閉塞を発症したと考えられる急性心筋梗塞の1例 著者: 竹田, 育弘; 川本, 篤彦; 中嶋, 民夫; 佐々木, 弥寿延; 上村, 史朗; 山野, 繁; 橋本, 俊雄; 土肥, 和紘 抄録: A 61-year-old man was admitted to our hospital with an acute myocardial infarction. Emergency coronary angiography revealed complete occlusion in seg. 6 of left anterior descending artery (LAD). Primary PTCA was performed; however, dissection occurred at the site of balloon inflation. Although two Gianturco-Rubin Ⅱ stents were implanted at the sites of dissection, dissection did not disappear. On the 9th hospital day, subacute thrombosis (SAT) occurred in seg. 6. Occluded LAD was revasculized by PTCA, but dissection was present at seg. 6 and seg. 7. Palmaz-Shatz stent was implanted to seg. 6, but dissection in seg. 7 did not disappear. On the 14th hospital day, recurrence of SAT was clinically suspected, and alteplase was administered intravenously. Coronary angiogra- phy performed on the 61st day revealed no significant stenosis in the LAD, but indicated aneurysm formation in seg. 6. Remaining dissection after stent implantation may have provoked two occurrences of SAT in this case. 2000-08-30T15:00:00Z http://hdl.handle.net/10564/612 タイトル: 遅発した外傷性心タンポナーデの1例 著者: 木田, 順富; 山野, 繁; 中嶋, 民夫; 川本, 篤彦; 中谷, 秀隆; 橋本, 俊雄; 土肥, 和紘 抄録: A case of delayed cardiac tamponade after chest trauma is reported. A 57 -year-old man was admitted to a local hospital because of chest wall contusion in a traffic accident. Fifty-five days after discharge, the patient developed dyspnea on effort and was admitted to our hospital. A chest radiograph showed cardiomegaly. Electrocardiogram showed no ST-T changes. Echocardiogram revealed massive pericardial effusion without asynergy of left ventricular wall movement. Pericardiocentesis was performed, which drained 760 ml of bloody fluid. No evidence of acute pericarditis, metastatic pericardial disease or uremic pericaditis was found and post-cardiac injury syndrome was suspected. Delayed pericardial effusion, which is part of post-cardiac injury syndrome, usually occurs 2-4 weeks after chest trauma. Because the interval between the chest trauma and pericar- dial fluid accumulation in this case was unusually long, we report the case and review the previous reports of post-traumatic cardiac tamponade. 2000-08-30T15:00:00Z