The NMR Spectroscopic Evaluation of Immobility of a Crowd of Porphyrin Rings Combined with Dendritic Poly(L-lysine)s

Since the dendritic poly(L-lysine)s combining eight to thirty-two free base-porphyrins showed split circular dichroism at the Soret band in toluene/N,N-dimethylformamide (9/1, v/v), the immobility of porphyrin rings was evaluated by 1H NMR measurements in terms of the peak width at half-height and spin-lattice relaxation time

A case with difficulty in airway management nevertheless switching from emergency tracheostomy to cricothyrotomy

深頸部膿瘍は時に急速な喉頭浮腫を来たし窒息に至ることもある救急疾患である．深夜に救急外来を受診し手術室にて気道確保中に窒息をきたし，院内コードブルー発動を経て救命し得た深頸部膿瘍の1例を経験したので報告する．症例は60代男性．増悪する咽頭痛，軽度の呼吸苦を主訴に当院へ救急搬送された来院後より次第に呼吸苦が増悪し，甲状軟骨内側の膿瘍および高度の喉頭浮腫を認め，気管切開による気道確保を計画した．術中，窒息が切迫した状態となり迅速に気道を確保するために輪状甲状膜切開に術式を切り替えた．しかし，呼吸苦から体動が多く不穏となりまた体動・出血に伴い窒息に至り，徐々に血中酸素飽和度が低下していった通常の手術続行が不可能となった段階で院内コードブルーを要請し，人員を集め，輪状甲状間膜切開・気道確保に成功した最終的には後遺症なく救命が可能であった

A case report on refractory ulcerative stomatitis associated with acute lymphoblastic leukemia

症例は難治性潰瘍性口内炎を契機に判明した急性リンパ性白血病の 1 例である．患者は 60 歳台，女性．下口唇に難治性潰瘍を認め紹介となった．血液検査にて汎血球減少を認めたため，血液疾患を疑った．骨髄検査にて，Ph 染色体陰性急性 B 細胞性リンパ性白血病と診断され，初診の 4 日後からステロイド療法が開始された．なお，下口唇生検の病理組織には明らかな白血病細胞の浸潤は認めなかった．口腔症状が白血病の初発症状となることがあり，これを主訴に受診した白血病患者を早期診断することは大変重要である．しかし，口腔病変の原因は多彩であり，さまざまな科が対応することが多く，各科が連携して診療にあたることが重要と考える．We herein report a case on refractory ulcerative stomatitis associated with acute lymphoblastic leukemia. The female patient in her 60s showed refractory ulcer on her lower lip ; and the referral was made. Since pancytopenia was found by a blood test, hematologic disease was suspected. Bone marrow examination presented the diagnosis of Philadelphia chromosome-negative B-cell acute lymphoblastic leukemia. Based on this diagnosis, steroid therapy had been initiated from four days after the first visit. On biopsy of lower lip, the pathological tissue did not show obvious infiltration of leukemia cells. Since oral manifestation may sometimes be an initial symptom of leukemia, an early diagnosis on leukemia patient with main complaint of oral symptom is critically important. Oral lesions, however, have various causes, and it thus often requires care of various clinical department. Based on this, it is considered to be important to implement treatment with cooperation among each clinical department

Computed Tomography Findings for Diagnosing Follicular Thyroid Neoplasms

Since no diagnostic method has been established to distinguish follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA), surgery has been the only way to reach a diagnosis of follicular neoplasm. Here we investigated the computed tomography (CT) features of follicular neoplasms, toward the goal of being able to identify specific CT features allowing the preoperative differentiation of FTC from FTA. We retrospectively analyzed the cases of 205 patients who underwent preoperative CT of the neck and were histopathologically diagnosed with FTC (n=31) or FTA (n=174) after surgery between January 2002 and June 2016 at several hospitals in Japan. In each of these 205 cases, non-enhanced and contrast-enhanced CT images were obtained, and we analyzed the CT features. On univariate analysis, inhomogeneous features of tumor lesions on contrast-enhanced CT were more frequently observed in FTC than in FTA (p=0.0032). A multivariate analysis identified inhomogeneous features of tumor lesions on contrast-enhanced CT images as an independent variable indicative of FTC (p=0.0023). CT thus offers diagnostic assistance in distinguishing FTC from FTA

Idiopathic first bite syndrome improved by Rikkosan : A case report

ファーストバイト症候群（first bite syndrome：以下、FBS）は、食事開始時に耳下腺部痛を生じ数回の咀嚼により徐々に軽快することを特徴とする。手術既往や腫瘍性疾患がない FBS は特発性 FBS と分類される。特発性 FBS に対する治療法として少数ではあるが立効散の内服が報告されており、本症例でも立効散が奏功した。特発性 FBS の治療法は未確立であり、有害事象の少ない立効散は食事療法と並んでまず考慮すべき治療法であると考える。First bite syndrome (FBS) is characterized by severe paroxysmal pain in the parotid region at the first bite of a meal, which gradually decreases as mastication continues. When FBS occurs with no history of head and neck surgery and no evidence of a tumor, it is classified as idiopathic. The effectiveness of Rikkosan has been reported by several studies, and we also experienced a case in which idiopathic FBS improved with Rikkosan. There is no established treatment method for idiopathic FBS. Rikkosan, which is associated with few adverse events, should be considered as a first-line treatment, along with diet therapy