ホゾンテキ ニ チリョウ シエタ モンミャク ケッセン オ ガッペイ スル ジョウチョウカン マク ジョウミャク ケッセンショウ ノ 1レイ

症例は47歳の男性. 40℃の発熱と頭痛が出現し近医を受診.一時症状は軽快したが,再び発熱が出現し前医入院となった.入院後の腹部CT検査及び腹部超音波検査により上腸間膜静脈血栓症と診断され,精査加療を目的に当院に転院となった.厳重な経過観察の下に抗菌薬投与と抗血栓および抗凝固療法による保存的治療を行い,これにより第4病日には症状の改善が得られた.本症例は後にプロテインC欠乏症と診断され,感染と脱水が影響して門脈血栓に及ぶ上腸間膜静脈血栓症が引き起こされたものと考えられた.今回我々は保存的に治療しえた門脈血栓を合併する上腸間膜静脈血栓症の一例を経験したので報告した.The patient was a 47-year-old male who had presented with a fever of 40℃ and headaches. He was treated by antibiotics at a local hospital under the diagnosis of the common cold. But progress of symptoms was temporary, so he was admitted to the hospital. Based on the findings of an abdominal CT and US after the admission, he was diagnosed as superior mesenteric vein thrombosis (SMVT) and transferred to our hospital on the 25th day of his illness. Antibiotics, together with antithrombotics and anticoagulant agents, were carefully administered as the treatment. As a result, symptoms were improved on the fourth day of admission to our hospital. This case was detected later to be associated with protein C deficiency. We speculated that portal vein thrombosis complicated with SMVT had occurred following infection and dehydration. We reported a case of SMVT with portal vein thrombosis, which was effectually treated with conservative therapy

Mucosal cytokine network in inflammatory bowel disease

Inflammatory bowel disease (IBD), ulcerative colitis (UC) and Crohn’s disease (CD) are characterized by ongoing mucosal inflammation in which dysfunction of the host immunologic response against dietary factors and commensal bacteria is involved. The chronic inflammatory process leads to disruption of the epithelial barrier, and the formation of epithelial ulceration. This permits easy access for the luminal microbiota and dietary antigens to cells resident in the lamina propria, and stimulates further pathological immune cell responses. Cytokines are essential mediators of the interactions between activated immune cells and non-immune cells, including epithelial and mesenchymal cells. The clinical efficacy of targeting TNF-α clearly indicates that cytokines are the therapeutic targets in IBD patients. In this manuscript, we focus on the biological activities of recently-reported cytokines [Interleukin (IL)-17 cytokine family, IL-31 and IL-32], which might play a role through interaction with TNF-α in the pathophysiology of IBD

Poorer Prognosis of Idiopathic Pleuroparenchymal Fibroelastosis Compared with Idiopathic Pulmonary Fibrosis in Advanced Stage

Objective. Idiopathic pleuroparenchymal fibroelastosis (IPPFE) is a rare disease characterized by predominant upper lobe pulmonary fibrosis of unknown etiology. However, the prognosis of IPPFE has not been discussed. We investigated the clinical characteristics and prognostic factors of IPPFE and idiopathic pulmonary fibrosis (IPF). Methods. We performed a retrospective cohort study on 375 consecutive idiopathic interstitial pneumonia patients between April 2004 and December 2014. Among them, we diagnosed IPPFE and IPF patients using high-resolution computed tomography radiological criteria. Results. Twenty-nine IPPFE patients (9 males, 20 females) and 67 IPF patients (54 males, 13 females) were enrolled. IPPFE patients were significantly more likely to be females and nonsmokers and had lower body mass index, lower values of predicted percentage of forced vital capacity (%FVC), and a higher residual volume-to-total lung capacity ratio than IPF patients. Survival analysis revealed that they had significantly poorer prognosis than IPF patients in GAP (gender, age, and physiology) stages II + III. %FVC and GAP index independently predict mortality in patients with IPPFE. Conclusions. Patients with IPPFE showed poorer prognosis in the advanced stage than patients with IPF. %FVC and GAP index are independent predictors of survival in patients with IPPFE