当院における経皮的心肺補助装置の導入状況と予後について： 症例集積研究

京都府立医科大学附属北部医療センター循環器内科京都府立医科大学附属北部医療センター臨床工学科Department of Cardiovascular Medicine, North Medical Center, Kyoto Prefectural University of MedicineDepartment of Clinical Engineering, North Medical Center, Kyoto Prefectural University of Medicine経皮的心肺補助は、重症心不全（急性心筋梗塞、心筋症、劇症型心筋炎など）、開心術後の低拍出症候群、大血管手術（胸部下行大動脈瘤、胸腹部大動脈瘤）による補助循環や重症呼吸不全などの病態に用いられているが、近年救急医療の現場、とくに心肺停止患者への適用が急増している。しかしながら、装置が高価であることや導入にマンパワーを要する治療法であることから、導入をためらっている施設も少なくない。また、適用基準や使用方法についても各施設によってさまざまである。経皮的心肺補助装置は2008 年に当院に導入され、2018 年3 月までの約10 年間で16 例に用いられた。年齢の中央値は65.5 歳で、男性が12 例だった。原因疾患として急性冠症候群/ 急性心筋梗塞が11 例、劇症型を含む心筋炎が4 例だった。そのうち2 例は現在も当院外来に通院中であり、長期生存率は12.5% であった。高齢化率の高い丹後医療圏におけるPCPS の適用基準にまつわる問題点を挙げ、使用の心得を記述し、京都府下の病院におけるPCPS 導入状況を俯瞰する

仮性動脈瘤による静脈圧排が原因と考えられた下肢浮腫の1例

京都府立医科大学附属北部医療センター循環器内科Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine North Medical Center症例は７３歳女性。安静時胸痛を認め、不安定狭心症を疑い、冠動脈造影検査にて３枝病変を認めた。カテーテル治療を選択し、左大腿動脈より６Fr シースを挿入し、経皮的冠動脈ステント留置術を施行した。止血デバイスを用い止血を行い、穿刺部に問題なく術翌日に退院した。退院7 日後より左下肢の腫脹を認め、血管エコー検査にて穿刺部に仮性動脈瘤を認めた。カテーテル後の下肢浮腫の原因として仮性動脈瘤に留意すべきと考える

Pneumonia Caused by Severe Acute Respiratory Syndrome Coronavirus 2 and Influenza Virus: A Multicenter Comparative Study

Background: Detailed differences in clinical information between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia (CP), which is the main phenotype of SARS-CoV-2 disease, and influenza pneumonia (IP) are still unclear. Methods: A prospective, multicenter cohort study was conducted by including patients with CP who were hospitalized between January and June 2020 and a retrospective cohort of patients with IP hospitalized from 2009 to 2020. We compared the clinical presentations and studied the prognostic factors of CP and IP. Results: Compared with the IP group (n = 66), in the multivariate analysis, the CP group (n = 362) had a lower percentage of patients with underlying asthma or chronic obstructive pulmonary disease (P < .01), lower neutrophil-to-lymphocyte ratio (P < .01), lower systolic blood pressure (P < .01), higher diastolic blood pressure (P < .01), lower aspartate aminotransferase level (P < .05), higher serum sodium level (P < .05), and more frequent multilobar infiltrates (P < .05). The diagnostic scoring system based on these findings showed excellent differentiation between CP and IP (area under the receiver operating characteristic curve, 0.889). Moreover, the prognostic predictors were different between CP and IP. Conclusions: Comprehensive differences between CP and IP were revealed, highlighting the need for early differentiation between these 2 pneumonias in clinical settings

Impact of relative dose intensity (RDI) in CHOP combined with rituximab (R-CHOP) on survival in diffuse large B-cell lymphoma

<p>Abstract</p> <p>Background</p> <p>Recently, maintaining higher relative dose intensity (RDI) of chemotherapeutic drugs has become a widespread practice in an attempt to achieve better outcomes in the treatment of aggressive lymphoma. The addition of rituximab to chemotherapy regimens has significantly improved outcome in diffuse large B-cell lymphoma (DLBL). However, it is unknown if higher RDI in chemotherapy when combined with rituximab leads to a better outcome in aggressive B-cell lymphoma.</p> <p>Methods</p> <p>We retrospectively evaluated the impact of the RDI of initial chemotherapy (consisting of cyclophosphamide, doxorubicin, vincristine and prednisolone with rituximab (R-CHOP) on outcome in 100 newly diagnosed DLBL patients.</p> <p>Results</p> <p>A multivariate Cox regression model showed that RDI trended towards a significant association with mortality [hazard ratio per 0.1 of RDI = 0.8; 95% confidence interval 0.6–1.0; <it>P </it>= 0.08]. Additionally, on multivariate logistic analysis, advanced age was a significant factor for reduced RDI.</p> <p>Conclusion</p> <p>Our data suggest that in DLBL patients, mortality was affected by RDI of R-CHOP as the initial treatment, and the retention of a high RDI could therefore be crucial.</p

The Japanese Clinical Practice Guideline for acute kidney injury 2016

Acute kidney injury (AKI) is a syndrome which has a broad range of etiologic factors depending on different clinical settings. Because AKI has significant impacts on prognosis in any clinical settings, early detection and intervention are necessary to improve the outcomes of AKI patients. This clinical guideline for AKI was developed by a multidisciplinary approach with nephrology, intensive care medicine, blood purification, and pediatrics. Of note, clinical practice for AKI management which was widely performed in Japan was also evaluated with comprehensive literature search