胎盤における甲状腺ホルモントランスポーターの発現と早産児甲状腺機能の関連に関する検討

雑誌掲載

Sequential changes in pathophysiology of systemic inflammatory response in a disseminated neonatal herpes simplex virus (HSV) infection

AuthorBACKGROUND: Disseminated neonatal herpes simplex virus (HSV) infection causes a typical systemic inflammatory response syndrome and has a high mortality rate. However, the validity of anti-inflammatory intervention against this condition remains unknown. OBJECTIVES: We sought to demonstrate the sequential changes in the pathophysiology of disseminated neonatal HSV infections. STUDY DESIGN: The HSV serum copy number as well as high-mobility group box 1 (HMGB1) and cytochrome c concentrations, which predict the severity and mortality rate of sepsis, were sequentially evaluated in a patient with disseminated neonatal HSV infection caused by HSV-2. RESULTS: As the patient presented with evidence of hyper-inflammation and severe illness, we empirically undertook anti-inflammatory intervention that included the administration of prednisolone, high-dose immunoglobulin, and blood exchange therapy in addition to high-dose acyclovir (ACV) therapy. The patient survived without significant neurological sequela. We found that (1) the serum concentrations of both HMGB1 and cytochrome c were extremely high, (2) temporal increases in these biomarkers were observed after admission, and (3) interestingly, the increase in HMGB1 level preceded that of cytochrome c. These results suggested that the pathophysiology of this condition changed sequentially in a dramatic manner, and the timing of our anti-inflammatory intervention was prior to the transition of pathological status from hyper-inflammation to massive apoptosis. CONCLUSIONS: Anti-inflammatory intervention may only be effective if it is undertaken during the early phase of disseminated neonatal HSV infections

心の健康問題と成長曲線との関連について

出版社版平成16年に経験した倦怠感や頭痛,腹痛により不登校となった8例の成長曲線を記録し,どの段階で身長・体重増加率に変化が生じるかを検討した.心の健康問題が明らかにあった6例のうち,5例では身体症状が出現する前から体重増加率の減少があり,表向きの理由の背景には学業不振や両親の不和などが潜んでいた.しかし,6例とも身長増加率の低下はなかった.心の健康問題が明らかではない2例では,身体症状が出現する以前の成長曲線に問題はなかった.不登校児に対しても,成長曲線に変化が出現した時期を示して病歴の聴取やカウンセリングを行うことは隠されたライフイベントを探ることに有用であると考えられ

当院における脳低温療法施行症例の臨床的検討

雑誌掲載版当院で脳低温療法導入後5年間に脳低温療法を行った10例について検討した。予後良好6例,予後不良4例で,10例中8例は重篤な有害事象なく脳低温療法を施行できた。予後による比較ではSarnat分類II度とIII度で差を認めた他,院外出生児,高乳酸血症遷延例で予後不良の傾向が認められた。様々な予後の症例が含まれる中等度〜重度の低酸素性虚血性脳症児から脳低温療法適応症例を的確に判断できる指標はまだなく,その確立は今後の重要な課題である。また院外出生仮死児のさらなる予後改善のためには,広域な医療圏をカバーする迅速な新生児搬送体制の整備や新生児蘇生法の普及も重要と思われた