バセドウ ビョウ ト ハカイセイ コウジョウセン エン ノ ショシンジ ニオケル ジンソク カンベツホウ

[目的]バセドウ病 (GD) と破壊性甲状腺炎 (DT) の迅速鑑別法にはTSHレセプター抗体の有無,甲状腺エコー検査,遊離T3/T4 (FT3/FT4),総T3/T4比 (T3/T4),総ALP (T-ALP),甲状腺血流が有用とされている.そのうち最も鋭敏な指標となりうる項目を検討した.[方法]2007年から未治療で当科を受診したGD:15名,無痛性甲状腺炎(PT):8名,亜急性甲状腺炎( SAT):10名( DT:18名) を対象として,FT3/FT4,T3/T4,T-ALP,上甲状腺動脈平均血流速度( mean velocity STA) を測定した.[結果]年齢:GD51.2± 18.8歳,DT49.3±21.0歳,FT3/FT4:GD3.3±1.0,DT2.9±1.9,T3/T4:GD15.9±4.7,DT15.2± 3.3,T-ALP( U/l):GD431.3 ±196.6,DT299.1±163.2,mean velocitySTA( cm/s):GD65.0±8.7,DT41.0± 7.0,(P < 0.0001).[結論]今回の検討ではmean velocity STA がGD とDT の鑑別に最も有用であった.It is important to make a rapid differentialdiagnosis of Graves\u27Diseases (GD) and Destructive Thyroiditis(DT). However, it is often difficult to make a distinctionwithout measurement of radioactive iodine uptake(RAIU). Instead of measurement of RAIU, measuringFreeT3/FT4ratio (FT3/FT4), totalT3/T4ratio (T3/T4),total alkaline phosp hatase activity( T-ALP), blood flow inthe thyroid, is useful for differential diagnosis. We searchedfor the parameters is most sensitive parameter for rapiddifferential diagnosis.Patients and Methods:We investigated on 33 patientswith untreated hyperthyroidism (15 with GD and 18 withDT). When 33 patients were first seen in our hospital, wemeasured FT3/FT4, T3/T4, T-ALP, and mean velocity inthe superior thyroid arteries( STA).Results:In comparison between GD and DT, mean velocitySTA was significantly increased in patients with GD.In the group of GD, FT3/FT4 and T-ALP tend to be higherin patients with GD but without statistical significance.Conclusion:Mean velocity STA might be the most sensitiveparameter for rapid differential diagnosis of GD andDT

Effect of Poly (ADP-ribose) Polymerase Inhibitors on Hypoadiponectinemia Caused by Chronic Blockade of Nitric Oxide Synthesis in Rats

Oxidant stress-induced activation of poly (ADP-ribose) polymerase (PARP) contributes to the pathogenesis of various cardiovascular diseases. Adiponectin is an adipocyte-derived anti-atherogenic protein. In the present study, we investigated the role of PARP in the development of hypoadiponectinemia caused by chronic blockade of nitric oxide synthesis with N^ω-nitro-L-arginine methyl ester (L-NAME) in rats. Decreased production of NO and increased production of O_2^- were observed in aortas from L-NAME-treated rats. Plasma adiponectin levels and adiponectin mRNA levels within adipose tissue were markedly decreased in L-NAME-treated rats. Concurrent administration of potent PARP inhibitors, INO-1001 or PJ34, with L-NAME did not restore plasma adiponectin levels or fat adiponectin mRNA levels. Thus, the cardiovascular protective effects of PARP inhibitors are not associated with adiponectin levels. Therefore, drugs which increase adiponectin levels may be beneficial alongside PARP inhibitors in the treatment of cardiovascular disease

コウジョウセン クリーゼ 20レイ ノ チリョウ ト ヨゴ : コウジョウセン クリーゼ シンダン キジュン オ モチイタ ケントウ

日本甲状腺学会から甲状腺クリーゼの診断基準が2008 年に発表された.2004 年4 月から2009 年3月に当院で臨床的に甲状腺クリーゼと診断,治療した20 症例を,その診断基準にあてはめ,治療と予後等について解析した.基礎疾患は全例バセドウ病だった.誘因として服用不規則や中断が9 例,感染症6 例,糖尿病性ケトアシドーシス3 例,情動ストレス2 例,脳血管障害1 例,外傷1 例だった.診断基準で確定診断例が15例,疑い例が1 例,除外症例が4 例だった.症状では中枢神経症状が疑い・確定診断例では11 例,脈拍130/分以上は12 例認められたが,除外例では認められなかった.治療としてはチアマゾールが全症例に使用されていた.ヨードは13 例,b ブロッカーは17 例,ステロイドは12 例の症例で使用されており全例救命できた.服用不規則や中断,感染症が誘引となりやすく,症状では中枢神経症状・脈拍が特にクリーゼの診断には重要と考えられた.後遺症を残す重症例は6 例で全て新診断基準によって確定診断された症例であり,新診断基準は予後への有用性も期待できると考えられた.The Japan Thyroid Association established diagnosticcriteria for thyroid crisis in 2008. Using these criteria, weanalyzed 20 cases clinically diagnosed as thyroid crisis andtreated in our hospital from April 2004 to March 2009. Allpatients had Basedow\u27s disease at the basal disease. Thecauses were irregular compliance or interruption of treatment(9 cases), infection (6 cases), diabetic ketoacidosis (3cases), emotional stress( 2 cases), stroke( 1 case), and trauma(1 case). Fifteen cases were confirmed as thyroid crisis,1 case was suspected as thyroid crisis, and 4 cases were rejectedas thyroid crisis according to the diagnostic criteria.Central nervous symptoms were observed in 11 cases, andtachycardia (over 130 beats/min) in 12 cases in the definitiveand suspicious cases, although there were no centralnervous symptoms or tachycardia in the excluded cases.Thiamazole was administered to all patients. In addition, iodine(13 cases), b -blocker (17 cases), and corticosteroids(12 cases) were administered. All patients were recovered.Irregular internal use, stopping treatment, and infectionwere likely to induce thyroid crisis. In paticular, centralnervous symptoms and tachycardia were important factorsfor diagnosis. As 6 serious cases with aftereffect were diagnosedas definitive cases of thyroid crisis according to thenew criteria, these new criteria may be useful to predictthe prognosis

ホンガク ニオケル シンリョウ サンカガタ リンショウ ジッシュウ ニ カンスル コウサツ : モデル・コア・カリキュラム ノ ドウニュウ ト シンリョウ サンカガタ リンショウ ジッシュウ ノ アリカタ

獨協医科大学では,医学教育モデル・コア・カリキュラムに準じた診療参加型臨床実習を実施する予定である.平成16年度以降の臨床実習形式は46週と従来より長くなり,診療参加型となる.これを円滑に導入するためには,臨床実習開始以前から学生の準備教育を充実させ,コ・メディカルを含めた実習にかかわるすべてのスタッフに,臨床実習の意義を徹底させることが必要である.現実的な問題点として,現状では実習教育にたずさわる教員数の絶対的な不足が挙げられ,マンパワーの補充を目的とした組織的な対応を早急に検討することが望まれる.(本論文は,第8回医学教育ワークショップCグループの発表内容を中心に加筆検討を加えたものである.)In introducing clinical clerkship incorporating a core curriculum at Dokkyo University School of Medicine, its problems and concrete plans were evaluated. For smooth introduction of this plan, improving the preliminary education of students before the beginning of clinical training and assuring the understanding of all the staff members involved in clinical training including co - medicals about its significance were considered to be necessary. As a practical problem, a lack of instructors who can be involved in clinical training was raised, and prompt evaluation of systematic measures to increase the staff was strongly recommended