膵疾患における膵液中CA19-9値測定の診断的意義に関する研究

取得学位 : 博士（医学）, 学位授与番号 : 医博乙第1156号, 学位授与年月日：平成4年2月5日,学位授与年：199

The exacerbation risk prediction by fractional exhaled nitric oxide in younger and elder children with bronchial asthma

The usefulness of the Fractional exhaled nitric oxide (FeNO) measurements for asthma exacerbation risk prediction in asthmatic children is controversial. Fifty-seven asthmatic children who were regularly treated and had previously been stable for at least 3 months were enrolled. The asthma excerbations risk prediction by the FeNO levels and age contribution on it were investigated. As analyzed all the patients, FeNO cut off value for the significant risk of asthma exacerbation was 36.9 ppb (risk odds was 5.1 [95% C.I., 1.8 to 15.0], chi square valve = 9.0, p=0.0028). However, sensitivity and specificity were not adequate for predicting asthma exacerbation (Sensitivity, 77.8%; Specificity, 59.9%; Area under the curve [AUC], 0.674). These parameters were improved only when 6-10 year old children were assessed (FeNO threshold=39.9 ppb, risk odds=10.2 [3.1 to 33.1], chi square valve 14.8, p=0.0001); Sensitivity, 80.8%; Specificity, 71.8%; AUC, 0.758). High value of FeNO is a risk factor for the asthma exacerbation, and FeNO measurement may be more useful for asthma control in younger children than elder asthmatic children

Sulfamethoxazole / Trimethoprim confer no change on the clinical course of Kawasaki disease

Kawasaki disease (KD) is one of the most common vasculitis in childhood, but its etiology is still unknown. We hypothesized that Sulfamethoxazole / Trimethoprim (S/T) would inhibit overproduction of cytokine due to heat shock protein produced by intestinal bacteria in patients with KD and improve the clinical course of KD indirectly. We have conducted a prospective study to assess the usefulness of S/T for KD. For patients with KD (S/T group, N=23), we use S/T in addition to the standard treatment in the guidelines such as intravenous immunoglobulin (IVIG) and moderate dose aspirin. The control group (non S/T group, N=32) is patients with KD treated with the standard treatment in the guidelines. The baseline characteristics did not demonstrate notable differences between the two groups. We compare duration of fever, rate of initial IVIG failure, the day of illness membranous desquamation appeared, and the occurrence of coronary artery lesion (CAL) between two groups. Membranous desquamation appeared rather earlier in S/T group than in non S/T group (11.4±3.0 day of illness vs 12.9±3.5 day of illness, P=0.078), but there was no statistically significant difference. Duration of fever (39±59 hours vs 42±57 hours, P=0.41), rate of initial IVIG failure (26% vs 31%, P=0.30), and number of CAL (8.6% vs 9.3%, P=0.87) were found no significant difference between two groups. These data indicated that the use of S/T in acute phase of KD didn\u27t improve any clinical course of KD

Endoscopic characteristics and usefulness of endoscopic dilatation of anastomotic stricture following pancreaticojejunostomy: case series and a review of the literature

The incidence of pancreatitis induced by anastomotic stricture following pancreaticodigestive tract anastomosis as a late-onset adverse event has been reported to be 3% or lower, but some cases repeatedly relapse and are difficult to treat. Endoscopic identification and treatment of the anastomotic site are considered to be difficult, and only a small number of cases have been reported. We present three cases with recurrent pancreatitis induced by anastomotic stricture following pancreaticojejunostomy applied after pancreaticoduodenectomy. We successfully identified the anastomotic site and performed endoscopic dilatation of the anastomotic stricture, and pancreatitis has not recurred. We characterized endoscopic features of the anastomotic site, understanding of which is essential to identify the site, and investigated useful techniques to identify the site and perform cannulation for pancreatography. Furthermore, we showed the safety and usefulness of endoscopic dilatation for anastomotic stricture following pancreaticojejunostomy according to our three cases and a review of the literature