Successful Treatment of Long-Term Severe Progressive Interstitial Pneumonia with Low-Dose Corticosteroid and Azathioprine in a Patient with Diffuse Systemic Sclerosis

For progressive interstitial pneumonia (progressive IP) that accompanies diffuse systemic sclerosis (diffuse SSc), no treatment guidelines have yet been established, and it is a complication with a poor prognosis. We herein report a case in which combination therapy of a low-dose corticosteroid and low-dose azathioprine was performed for progressive SSc-IP in a 64-year-old female whose respiratory function was severely damaged for a long period of time and for whom improvement was achieved. The beneficial effect has continued for 3 years with no side effects being observed during the course

School-based participatory health education for malaria control in Ghana: engaging children as health messengers

<p>Abstract</p> <p>Background</p> <p>School children have been increasingly recognized as health messengers for malaria control. However, little evidence is available. The objective of this study was to determine the impact of school-based malaria education intervention on school children and community adults.</p> <p>Methods</p> <p>This study was conducted in the Dangme-East district of the Greater Accra Region, Ghana, between 2007 and 2008. Trained schoolteachers designed participatory health education activities and led school children to disseminate messages related to malaria control to their communities. Three schools and their respective communities were chosen for the study and assigned to an intervention group (one school) and a control group (two schools). Questionnaire-based interviews and parasitological surveys were conducted before and after the intervention, with the intervention group (105 children, 250 community adults) and the control group (81 children, 133 community adults). Chi-square and Fisher's Exact tests were used to analyse differences in knowledge, practices, and parasite prevalence between pre- and post-intervention.</p> <p>Results</p> <p>After the intervention, the misperception that malaria has multiple causes was significantly improved, both among children and community adults. Moreover, the community adults who treated a bed net with insecticide in the past six months, increased from 21.5% to 50.0% (<it>p </it>< 0.001). Parasite prevalence in school children decreased from 30.9% to 10.3% (<it>p </it>= 0.003). These positive changes were observed only in the intervention group.</p> <p>Conclusions</p> <p>This study suggests that the participatory health education intervention contributed to the decreased malaria prevalence among children. It had a positive impact not only on school children, but also on community adults, through the improvement of knowledge and practices. This strategy can be applied as a complementary approach to existing malaria control strategies in West African countries where school health management systems have been strengthened.</p

高気圧酸素治療下の酸素動態,代謝に関する検討

高気圧酸素治療(HBO)の有効性の機序を検討することを目的とし,近赤外線法(near infrared spectroscopy: NIRS)を利用し,同時に全身的酸素動態の測定には経皮的ガス分圧モニターを利用した.著者らは新たにプローベを改造しHBO下のNIRSによる酸素動態の測定を可能とした.従って近赤外線法によるHBO下の酸素動態,代謝の検討は本研究が嚆矢となるものである.対象は20～67(平均40.7±15.4)歳,男性21例,女性2例で治療時間は2気圧で60分間である.治療開始前よりNIRSで右前腕部組織中の酸化ヘモグロビン(Oxy-Hb),還元型ヘモグロビン(Deoxy-Hb),総ヘモグロビン(Total-Hb),チトクロームaa3 (Cyt.Oxi.)を測定し,同時に経皮酸素分圧(PtcO_2),二酸化炭素分圧(PtcCO_2)も測定した.治療前後に左大腿動脈より血液を採取し酸素分圧(PaO_2),二酸化炭素分圧(PaCO_2),pH,重炭酸イオン(HCO_3^-),Base excess(BE)を検討した.治療開始前,治療中,治療後の各測定機器の測定値より酸素動態,代謝の変化を検討した.NIRSは開始前をa群,ピーク時をb群とし,経皮ガス分圧測定法はHBO開始前をc群,ピーク時をd群,減圧終了直後をe群とし,動脈血分析は開始直前をf群と減圧終了直後をg群とし検討した.結果,a群,b群間でOxy-Hb,Total-Hb,Cyt.Oxi.は有意に増加,Deoxy-Hbは有意に減少,PtcO_2はc群とd群,e群間で有意に増加,PtcCO_2はc群とd群,e群間で有意に減少,f群,g群間でPaO_2,pHは有意に増加,PaCO_2は有意に減少,BE,HCO_3^-は有意差を認めなかった.HBO下では酸化型チトクロームaa3の増加を認めた.これは,恒常状態で還元型チトクロームaa3が存在するという報告を支持するものであり同治療下ではOxy-Hb,Total-Hbも増加しており組織レベルで酸素代謝が亢進していると考えられた.また同治療中にPaO_2の著明な上昇とPaCO_2の低下を認めるが酸塩基平衡には影響の少ない治療法であった.To investigate the mechanism of the hyperbaric oxygenation (HBO) therapy efficacy, we assessed oxygen dynamics and metabolism during HBO therapy (60 hours at 2 ATA) by near infrared spectroscopy (NIRS) and percutaneous blood gas partial pressure monitoring in 21 men and 2 women aged 20～67 years (mean: 40.7±15.4). Oxyhemoglobin (Oxy-Hb), deoxyhemoglobin (Deoxy-Hb), total hemoglobin (Total-Hb), and cytochrome aa3 (Cyt.Oxi.) were recorded at intervals of 10 seconds from the rest period preceding HBO therapy until the measurements stabilized during rest after decompression. Percutaneous blood gas partial pressure (PtcO_2), carbon dioxide partial pressure (PtcCO_2), oxygen partial pressure (PaO_2), carbon dioxide partial pressure (PaCO_2), pH, bicarbonate ion concentration (HCO_3^-), and base excess (BE) were also determined. The Oxy-Hb, Total-Hb, and Cyt.Oxi. levels were significantly elevated and the Deoxy-Hb levels were significantly reduced during the stable period preceding HBO therapy and the peak stable time during therapy. PtcO_2 significantly increased and PtcCO_2 significantly decreased during the stable period before HBO therapy, the peak stable period during therapy, and immediately after the end of decompression. PaO_2 and pH were significantly elevated and PaCO_2 was significantly reduced immediately before the start of HBO therapy and immediately after the end of decompression. There were no significant differences in BE or HCO_3^- at any of the times measured. In conclusion, the oxidized Cyt.Oxi. levels increased during HBO, substantiating a report on the dominance of reduced Cyt.Oxi. under homeostatic conditions. The elevated Oxy-Hb and Total-Hb levels appear to reflect enhancement of oxygen metabolism at the tissue level. HBO therapy appears to have little effect on acid-base equibrium, although it markedly increased the PaO_2 levels and decreased the PaCO_2 levels

A Patient with Systemic Lupus Erythematosus Complicated by Neurological Symptoms of Toluene Poisoning

We report a patient with systemic lupus erythematosus complicated by toluene poisoning. She had erythema, alopecia, arthralgia, and various neurological symptoms. Laboratory findings showed leukocytopenia, low levels of complements, and anti-dsDNA antibody. However, normal interleukin-6 level and IgG index of cerebrospinal fluid and brain magnetic resonance imaging and single photon emission computed tomography findings suggested that her neurological symptoms were caused by metabolic disorder but not neuropsychiatric systemic lupus erythematosus. Erythema, alopecia, and arthralgia improved rapidly after administration of prednisolone and tacrolimus, whereas neurological symptoms improved only gradually. Because of a history of exposure to toluene, her neurological symptoms were considered to be due to toluene poisoning. The differentiation of toluene poisoning from neuropsychiatric systemic lupus erythematosus based on symptoms is difficult because both induce various neuropsychiatric disorders. Laboratory findings of cerebrospinal fluid, radiological findings, and medical interview were useful for differentiation of toluene poisoning from neuropsychiatric systemic lupus erythematosus

PMX-DHP治療前後における近赤外線分光法による組織酸素代謝の変化と評価

PMX-DHP (direct hemoperfusion with polymyxin B immobilized fiber)は1994年にエンドトキシン吸着療法として日本で認可された治療法であり,現在敗血症症例を中心に広く臨床応用されているが,その臨床的有効性の評価および機序については今も議論のあるところである.筆者らは当センターでPMX-DHPを施行した敗血症症例に対し,近赤外線法(NIRS)を用いて測定可能なcytochrome a,a3 (Cyt a,a_3),酸化ヘモグロビン(Oxy-Hb),還元型ヘモグロビン(Deoxy-Hb),総ヘモグロビン(Total Hb)をPMX-DHP前後で比較することにより,細胞レベルでの組織酸素代謝と血液量の再分布の変化を検討した.対象は東京女子医科大学救命救急センター集中治療室に入室し,PMX-DHPを施行した18症例である.近赤外線装置は前額部,前腕部の2ヵ所に装着し,PMX-DHPを中心に約3時間連続して計測した.また,全身の組織酸素代謝の指標としてSwan-Ganz catheterを使いVO_2 (oxygen consumption), DO_2 (oxygen delivery), O_2EI (oxygen extraction index), SVRI (systemic vascular resistance index), SvO_2 (mixed venous oxygen saturation)を測定し,血液検査からはblood lactate concentration, base excess, IL-6を測定した.前腕部の近赤外線法による結果はPMX-DHP前後でCyt a, a_3(p<0.05), Oxy-Hb (p<0.01), Deoxy-Hb(p<0.05), TotalHb (p<0.01),すべてに有意差をもって増加した.前額部の前頭葉の近赤外線法による結果は,PMX-DHP前後でCyt a,a_3, Oxy-Hbに変化はなく,Deoxy-Hb (p<0.01), TotalHb (p<0.01)は,有意差をもって減少した.また,VO_2, DO_2, O_2EI, SVRI, SvO_2, blood lactate concentration, base excess, IL-6はPMX-DHPの前後での有意差は認めなかった.結論としてPMX-DHPにより全身の組織酸素代謝の指標に変化を認めなかった.しかし近赤外線法による測定結果は前腕骨格筋での血液量は増加し,さらにミトコンドリア内における電子伝達系の酸素代謝は亢進した.また前頭葉の血液量の分布はPMX-DHPにより改善された.これらの結果はPMX-DHPの有効性を示唆していると考えられた.Near-infrared spectroscopy (NIRS) is a continuous, non-invasive measurement to relatively evaluate tissue oxygen delivery and cellular aerobic metabolism. In the present study, to more understand the therapeutic efficacy of direct hemoperfusion with polymixin B-immobilized fibers (PMX-DHP), we investigated changes of tissue oxygenation by using NIRS and compared before and after PMX-DHP treatment. We measured oxygenated hemoglobin (Oxy-Hb), deoxygenated hemoglobin (Deoxy-Hb), total hemoglobin (Total Hb) and cytochrome a,a_3 (Cyt a,a_3) at forehead and forearm using NIRS. Data obtained by using a Swan-Ganz catheter was used to derive systemic VO_2 (oxygen consumption), DO_2 (oxygen delivery), O_2EI (oxygen extraction index), SVRI (systemic vascular resistance index) and SvO_2 (mixed venous oxygen saturation). At forearm, Cyt a,a_3 significantly increased after PMX-DHP (p<0.05). At forehead, there were no changes of Cyt a,a_3 (p=0.39) between before and after PMX-DHP. And there were no significant changes in VO_2, DO_2, O_2EI, SVRI, SvO_2 blood lactate concentration, base excess and IL-6. After PMX-DHP treatment, Oxy-Hb, Deoxy-Hb, Total Hb and Cyt a,a_3 increased at the forearm. But at forehead, Cyt a,a_3 was unchanged. This result suggests PMX-DHP could increase blood volume and tissue oxygen metabolism in skeletal muscles in septic shock

PMX-DHP治療前後における近赤外線分光法による組織酸素代謝の変化と評価

PMX-DHP (direct hemoperfusion with polymyxin B immobilized fiber)は1994年にエンドトキシン吸着療法として日本で認可された治療法であり,現在敗血症症例を中心に広く臨床応用されているが,その臨床的有効性の評価および機序については今も議論のあるところである.筆者らは当センターでPMX-DHPを施行した敗血症症例に対し,近赤外線法(NIRS)を用いて測定可能なcytochrome a,a3 (Cyt a,a_3),酸化ヘモグロビン(Oxy-Hb),還元型ヘモグロビン(Deoxy-Hb),総ヘモグロビン(Total Hb)をPMX-DHP前後で比較することにより,細胞レベルでの組織酸素代謝と血液量の再分布の変化を検討した.対象は東京女子医科大学救命救急センター集中治療室に入室し,PMX-DHPを施行した18症例である.近赤外線装置は前額部,前腕部の2ヵ所に装着し,PMX-DHPを中心に約3時間連続して計測した.また,全身の組織酸素代謝の指標としてSwan-Ganz catheterを使いVO_2 (oxygen consumption), DO_2 (oxygen delivery), O_2EI (oxygen extraction index), SVRI (systemic vascular resistance index), SvO_2 (mixed venous oxygen saturation)を測定し,血液検査からはblood lactate concentration, base excess, IL-6を測定した.前腕部の近赤外線法による結果はPMX-DHP前後でCyt a, a_3(p<0.05), Oxy-Hb (p<0.01), Deoxy-Hb(p<0.05), TotalHb (p<0.01),すべてに有意差をもって増加した.前額部の前頭葉の近赤外線法による結果は,PMX-DHP前後でCyt a,a_3, Oxy-Hbに変化はなく,Deoxy-Hb (p<0.01), TotalHb (p<0.01)は,有意差をもって減少した.また,VO_2, DO_2, O_2EI, SVRI, SvO_2, blood lactate concentration, base excess, IL-6はPMX-DHPの前後での有意差は認めなかった.結論としてPMX-DHPにより全身の組織酸素代謝の指標に変化を認めなかった.しかし近赤外線法による測定結果は前腕骨格筋での血液量は増加し,さらにミトコンドリア内における電子伝達系の酸素代謝は亢進した.また前頭葉の血液量の分布はPMX-DHPにより改善された.これらの結果はPMX-DHPの有効性を示唆していると考えられた.Near-infrared spectroscopy (NIRS) is a continuous, non-invasive measurement to relatively evaluate tissue oxygen delivery and cellular aerobic metabolism. In the present study, to more understand the therapeutic efficacy of direct hemoperfusion with polymixin B-immobilized fibers (PMX-DHP), we investigated changes of tissue oxygenation by using NIRS and compared before and after PMX-DHP treatment. We measured oxygenated hemoglobin (Oxy-Hb), deoxygenated hemoglobin (Deoxy-Hb), total hemoglobin (Total Hb) and cytochrome a,a_3 (Cyt a,a_3) at forehead and forearm using NIRS. Data obtained by using a Swan-Ganz catheter was used to derive systemic VO_2 (oxygen consumption), DO_2 (oxygen delivery), O_2EI (oxygen extraction index), SVRI (systemic vascular resistance index) and SvO_2 (mixed venous oxygen saturation). At forearm, Cyt a,a_3 significantly increased after PMX-DHP (p<0.05). At forehead, there were no changes of Cyt a,a_3 (p=0.39) between before and after PMX-DHP. And there were no significant changes in VO_2, DO_2, O_2EI, SVRI, SvO_2 blood lactate concentration, base excess and IL-6. After PMX-DHP treatment, Oxy-Hb, Deoxy-Hb, Total Hb and Cyt a,a_3 increased at the forearm. But at forehead, Cyt a,a_3 was unchanged. This result suggests PMX-DHP could increase blood volume and tissue oxygen metabolism in skeletal muscles in septic shock