Schizencephaly Type I : Magnetic Resonance Imaging and Single Photon Emission Computed Tomography Features

We report a case of type I schizencephaly diagnosed by magnetic resonance imaging in a 2-year- old boy with delayed speech and hemiplegia. Cerebral single photon emission computed tomography showed an abundant cerebral blood flow at the site of the cleft lesion. Single photon emission computed tomography thus may provide useful cerebral blood flow images in schizencephaly patients

Acute Necrotizing Encephalopathy of Childhood due to Influenza Type A Virus

A 1 year and 11 month-old boy developed convulsions and disturbance of consciousness after an antipyretic was administered. Influenza type A virus reaction was positive on rapid antigen test of nasal discharge. Although no significant abnormality was found by brain CT on admission, abnormal densities were observed in the bilateral thalami, brain stem and tegmentum on brain CT performed 12 hours later, so the patient was diagnosed with acute necrotizing encephalopathy (ANE) of childhood due to influenza type A virus. In spite of we diagnosed and performed methylprednisolone pulse and antithrombin III therapy in the early stage of this encephalopathy, which resulted in serious neurologic sequelae remaining. The clinical course of our case suggests that the early diagnosis and these treatments for ANE may not be effective. At present, we have no established therapy for this encephalopathy, so the vaccination is only a method for prevention of ANE due to influenza type A virus

サイタイケツ チュウ D4^+ サイボウ, NKサイボウ ノ キモカインリセプター CXCR3 ハツゲン ノ ケントウ

Th1細胞は造血幹細胞移植後の急性移植片対宿主病(graft-versus-hostdisease:GVHD)の発症に深く関与しているといわれている。今回我々はTh1細胞に発現するとされるキモカインリセプターの1つであるCXCR3を測定し,瞬帯血移植で急性GVHDがなぜ軽度なのかを検討した。臍帯血,成人末梢血と移植後患者末梢血中のリンパ球,NK細胞をモノクローナル抗体(抗CD4,抗CD8,抗CD56,抗HLA-DR,抗CD25)で染色し以下の結果を得た。CD^4+T細胞のCXCR3発現,HLA-DRの発現はいずれも末梢血よりも膀帯血の方が少なかった(p<0.05)。NK(CD56^+)細胞ではCXCR3,HLA-DR発現に有意差はなかった。IL-2で刺激したCD4^+T細胞でのCXCR3発現は培養後5日でも謄帯血では末梢血より発現が少なかった(p<0.05)。IL-2で刺激したNK細胞のCXCR3発現には両者に差がなかったが,HLA-DR発現は末梢血と比べて膀帯血で少なかった(p<0.05)。移植1ヶ月後の末梢血CD^+T細胞のCXCR3発現を膀帯血移植例と対照の同種骨髄移植例で比較すると膀帯血移植例で低値であった(p<0.05)。膀帯血のCD^+T細胞.NK細胞でのCXCR3発現の特徴は膀帯血移植で急性GVHDが発症しにくいということに関与していると考えたIn order to know why the development of acute graft-ver-sus-host-disease (aGVHD) is significantly milder after stem cell transplantation (SCT) using cord blood, we studied the CXCR3 expression on CD4^+T cells and NK (CD 56^+) cells, based on the fact that CXCR3 is one of the chemokine receptors on Th1 cells. Cord blood (CB) and peripheral blood (PB) from healthy volunTFFrs and patients who received SCT were treated with monoclonal antibodies against CD4, CD25, CD56, CXCR3, and HLA-DR and the antigen expression was analyzed using flow cytometry. The percentage of CXCR3 antigen on GB and PB CD4^+ T cells was 2.6 ± 1.4% and 30.8 ± 3.9%, respectively, demonstrating a significant difference (p < 0.05). However, that on GB and PB NK cells was not significantly different. CXCR3 expression on CB and PB CD4^+T cells stimulated by IL-2 for 72h and 120h was significantly different (p < 0.05), but that on NK cells was not significant. CXCR3 expression on CD4^+ T cells from patients who received allo-CB-SCT and allo-bone marrow transplantation from HLA-mismatched donor was significantly different at one-month post-SCT (p < 0.05). We concluded that the lower CXCR3 expression on GB CD^+T cells and absence of difference in CXCR3 expression on cord blood NK cells facilitated a milder aGVHD

ガクセイ アンケート チョウサ ニヨル コウギ ヒョウカ ト ソノ モンダイテン

近年,医学教育改革が目まぐるしく行われている.その中で,学生による講義評価が行われはじめているが,まだその報告は少ない.獨協医科大学では学年委員会が主体となって,講義・実習に対するアンケート調査を第1学年から第4学年まで行った.その結果,講義に対して「十分に満足している」という学生は,どの学年においても多くはなかった.さらに,「わかりやすい講義」をしている教員の共通点は,板書・プリント・シラパスを活用しているという点であった.実習に関しては,「基礎医学」に関わる実習に対しての評価が高かった.今後の医学教育において,学生の意見の反映がよりよい講義につながるものと考えられる.Extensive innovations in medical education have been carried out in recent years in our country. Although student evaluations of lectures have been conducted, there have been few reports on this issue. Thus, our committee consisting of representatives of every grade played a leading role in making and evaluating a questionnaire investigation of the lectures and the experiments. The investigation covered students from freshmen to seniors. We found that there were few students in each grade who were satisfied with the lectures. Students gave high marks to lecturers who wrote in detail on the blackboard, distributed well-organized documents, and made practical use of the syllabus. Experiments concerning the preclinical course were also well accepted. We consider that this sort of investigation will be influential in improving the quality of lectures

HIV キャリア ニンプ オヨビ シュッセイ シタ ジ ニ タイスル シュウサンキ カンリ : HIV キャリア ニンプ ヨリ シュッセイ シタ シンセイジ レイ オ ケイケン シテ

獨協医科大学総合周産期母子医療センターで経験したHIVキャリア妊婦の妊娠,分娩,および出生した児の新生児期,乳児期の経過について報告し,当院におけるHIV母子感染予防対策の管理指針について検討した.本例の周産期管理では,AIDS-Clinical-Trial-Group-076のプロトコールを参考とし,妊娠27週から母体にジドブジン400 mg/dayを投与した.分娩形式は選択的帝王切開とし,Level P4の感染対策管理のもと,妊娠35週5日に施行した.出生した児に対しては臍カテーテルよりガンマグロブリン製剤200 mg/kg×1回,およびジドブジンシロップ8 mg/kg分4を6週間投与した.児は生後1歳時にPA法によるHIV抗体検査を施行して陰性であり,母子感染は予防しえた.近い将来,当院においてHIVキャリア妊婦を周産期管理する件数は増加する可能性がある.HIV患者に対する突然の事態にも対応可能な体制を維持し続けることは,栃木県内におけるHIV患者診療拠点病院である本学の重要な役割である.HIV陽性妊娠の周産期管理においては,HIVキャリア妊婦を早期に発見し,NICUをはじめ各科専門家と協力して計画的な管理を励行することが重要である.We report pregnancy and delivery in pregnant HIV carriers and their children whom we encountered at the Perinatal medical center, Dokkyo University School of Medicine. We investigated management guidelines for the prevention of maternal and child infection with HIV in our hospital. For perinatal management in the present patient, 400 mg/day of zidovudine was administered from week 27 of pregnancy in reference to the AIDS-Clinical-Trial-Group-076 protocol. Concerning the mode of delivery, selective cesarean section was performed at week 35 and day 5 of pregnancy under level- P4 infection management. A single dose of gamma globulin preparation at 200 mg/kg and 4 doses of zidovudine syrup at 8 mg/kg were administered to the neonate through an umbilical catheter for 6 weeks. In the infant, the HIV antibody test with the PA method showed a negative reaction at the age of 1 year, so maternal and child infection could be prevented. In the future, perinatal management of increasing number of pregnant HIV carriers may be performed in our hospital. To maintain the system for managing patients infected with HIV is the important role of our university, a main hospital for the treatment of patients with HIV infection in Tochigi Prefecture. In the perinatal management of HIV-positive pregnancy, pregnant HIV carriers should be detected in the early stage, and strategic management including the NICU should be performed in cooperation with specialists from other departments

シンセイジ ニ タイスル ケイヒテキ チュウシン ジョウミャク (PCV) カテーテル ノ シヨウ ニツイテ : ソノ リテン ト ガッペイショウ

3年間に当院周産期センター新生児部門に入院し,経皮的中心静脈(PCV)カテーテルを使用した新生児は69例であった。これらの症例を対象とし,カテーテルの挿入理由,抜去理由,維持日数,合併症などについて後方視的に検討した。カテーテルの挿入理由は,超低出生体重児の輸液管理目的が最も多く,抜去理由は輸液が不要となった症例が最も多かった。カテーテルの平均維持日数は17.7日であった。カテーテルの留置中の合併症としては敗血症が4例(5.8%)であったが,カテーテル敗血症と診断したのは1例(1.4%)のみであった。その他に胸水貯留と横隔膜挙上の症例を計2例経験した。経皮的中心静脈カテーテルは,長期間にわたって留置が可能であり,合併症が少ないことから,新生児の輸液管理に非常に有用であると考えられた。We used percutaneous central venous catheters (PCV catheters) for 69 neonates, who entered our neonatal intensive care unit for recent 3 years. We retrospectively researched the reasons of insertion and removal of PCV catheters, and complications of the catheters. The catheters were inserted mainly for the maintenance of fluid administration of extremely low birth weight infants, and were removed mainly for the end of fluid administration. The catheters were maintained for 17.7 days on the average. The sepsis occurred in 4 infants (5.8%) during indwelling of PCV catheters, however, only one infant (1.4%) was diagnosed as the catheter-related sepsis. Expect for the sepsis, two infants complicated retention of pleural fluid or elevation of diaphragm. Our results disclosed that PCV catheter caused be use for the long-term indwelling of catheter for fluid administration, and had rare frequency of complications. We conclude that PCV catheter is very useful for the fluid administration of neonates