著者
石川 理恵 井関 雅子 古賀 理恵 山口 敬介 稲田 英一
出版者
日本疼痛学会
雑誌
PAIN RESEARCH (ISSN:09158588)
巻号頁・発行日
vol.31, no.3, pp.156-165, 2016-09-30 (Released:2016-10-16)
参考文献数
16
被引用文献数
1

Introduction: In a retrospective study on patients with zoster–associated pain, we reported the patients were associated with various neuropathic pain components and high VAS values regardless of their disease stages. In the present study, we prospectively followed another group of patients to evaluate those components in each of the stages.    Subjects: The subject group was comprised of 76 patients who first visited our clinic between June 2013 and January 2015 with their onsets of zoster–associat­ed pain within 30 days of the first visits.    Methods: Two neuropathic pain screening questionnaires including the Neuropathic Pain Screening Questionnaire (Japan–Q) and the Pain DETECT Questionnaire (PDQ) were used to track the patients for six months. The questionnaires and Visual Analogue Scale (VAS) evaluations were conducted at each of the acute stage (up to 30 days from the onset), the subacute stage (one to three months) and the chronic stage (the fourth month and after).    Results: Sixty–four patients remained in the subject group throughout the course of the study. The median values of the scores at the acute: subacute: chronic stages were 12 : 4 : 3 for Japan–Q, 15 : 9 : 7 for PDQ and 71.5 : 27.5 : 9.5 for VAS (mm). The numbers of patients with neuropathic pain components more strongly manifested at those stages were 53 (68%) : 14 (18%) : 10 (13%) for Japan–Q scores of 9 or higher and 61 (78%) : 35 (45%) : 21 (27%) for PDQ of 11 or higher. The correlation coefficients between the Japan–Q scores and VAS at the stages were 0.38 : 0.38 : 0.46 while the same between the PDQ scores and VAS were 0.42 : 0.29 : 0.44 indicating moderate correlations at the chronic stage of the pain with both of the questionnaires.    Discussion: While dermatitis and neuritis are common complications of herpes zoster, the fact that the patients experiencing intense pain in the acute phase exhibit neuropathic pain components may suggest the severity of neuritis is more manifested than the other complication. Although the patients diagnosed in our clinic in their acute stages exhibited high scores for the neuropathic pain components and VAS, both declined over time suggesting early intervention by pain specialists may be useful in achieving good therapeutic outcomes, even though spontaneous remission may not be completely ruled out.
著者
則行 敏生 奥道 恒夫 木村 厚雄 赤山 幸一 古賀 理恵 武島 幸男
出版者
日本肺癌学会
雑誌
肺癌 (ISSN:03869628)
巻号頁・発行日
vol.44, no.1, pp.25-30, 2004-02-20
被引用文献数
1

背景.悪性胸膜中皮腫は比較的稀な腫瘍であり,画像所見,胸水所見からの診断は困難なことが多い.好酸球性胸水を呈したgranulocyte-macrophage colony-stimulating factor (GM-CSF),granulocyte colony-stimulating factor(G-CSF)産生性悪性胸膜中皮腫の1例を報告する.症例.65歳,男性,2002年7月29日右胸背部痛のため当院入院となった.胸水,血液検査,胸部CT所見より好酸球性胸水(胸膜炎)と考えられ,ステロイド内服による診断的治療が施行されたが症状の進行を認めたため,9月17日胸腔鏡下胸膜生検を施行し,悪性胸膜中皮腫(二相型)と診断した.また,経過を通じて白血球,好酸球増多を認め,血清G-CSFは50pg/dl と高値であり,抗GM-CSF抗体,抗G-CSF抗体による免疫染色では腫瘍細胞のほとんどの細胞質と約5%の細胞質にそれぞれ陽性像を認めたことよりGM-CSFおよびG-CSF産生性腫瘍と診断した.腫瘍の進行,全身状態の悪化を認め,11月27日在院死となった.剖検で悪性胸膜中皮腫の壁側臓側胸膜,心外膜,横隔膜,腹膜,小腸,大腸への進展を認めた.結論.炎症反応陽性,治療抵抗性難活性胸水を認めた場合,悪性胸膜中皮腫も疑い早期に胸腔鏡下生検で確定診断を行うことが必要であると考えられた.