著者

本田 芳大 武田 和也 岡崎 鈴代 中村 恵 天野 雄太 山根 有希子 端山 昌樹 前田 陽平 愛場 庸雅 猪原 秀典

出版者

日本鼻科学会

雑誌

日本鼻科学会会誌 (ISSN:09109153)

巻号頁・発行日

vol.60, no.4, pp.522-530, 2021 (Released:2021-12-20)

参考文献数

22

---

副鼻腔真菌症の大部分は予後良好な非浸潤型副鼻腔真菌症であるが,まれに免疫が低下した患者において重症化し,致死的となる浸潤型副鼻腔真菌症が知られている。今回,われわれはびまん性大細胞型B細胞性リンパ腫(DLBCL)の化学療法中,骨髄抑制期に発症した副鼻腔炎に対し上顎洞開放を行い,その後より急速に進行した浸潤型副鼻腔真菌症を経験した。症例は69歳女性。DLBCLに対する化学療法施行後,骨髄抑制期に発熱性好中球減少症となった。経過中に右眼痛とCT検査にて右上顎洞に新規陰影の出現を認め,紹介受診となった。初診時,副鼻腔真菌症を疑い外来にて上顎洞開放を行った。上顎洞内に菌塊を認めたため除去し,明らかな菌塊の残存がないことを確認して,軟膏ガーゼを挿入した。第4病日にガーゼを抜去し,鼻内を観察すると,右鼻腔内全体に白色の粘膜病変を認め,真菌の増殖が疑われた。第5病日には右鼻腔粘膜の広範な黒色壊死を認めた。その後のCT検査にて下直筋の腫脹と眼窩内脂肪織の濃度上昇を認め,眼窩内浸潤が疑われた。内視鏡下鼻副鼻腔手術を行い,抗真菌薬全身投与継続の方針とした。その後,眼球運動障害は残存するものの明らかな増悪はなく,鼻腔内所見も著変なく経過し,第98病日に転院となった。骨髄抑制が遷延した状態で上顎洞を開放し,ガーゼパッキングを行ったことが広範な真菌浸潤をきたす一因となった可能性があり,骨髄抑制時の処置・手術にはその後の管理を含め細心の注意を払う必要があると考えられた。

著者

平山 世志衣 天野 雄太 大内 康弘 本藤 祐樹

出版者

日本LCA学会

雑誌

日本LCA学会誌 (ISSN:18802761)

巻号頁・発行日

vol.11, no.4, pp.348-358, 2015 (Released:2015-11-17)

参考文献数

28

---

We created a self-directed e-learning program for high school environmental education. The learners are expected to understand their indirect contribution to environmental problems such as global warming or energy consumption through this program. Life cycle thinking (LCT) is a key concept to link learners’ daily activities to the environmental problems. The advantage of e-learning is that it makes possible to provide schools with an opportunity of environmental education without much extra preparation required for school teachers. This feature of e-learning is especially important for LCT based education, because the concept of LCT is usually unknown by most of school teachers. The program created is composed of two parts. In the first part, learners study the LCT concept using visual materials that describe the life cycle environmental impacts of pro-environmental behaviors, such as local production for local consumption and reuse tableware. In the second part, learners calculate the life cycle energy of their own belongings using the dedicated LCA software named ‘Energy Consumption in Your Bag?!’. These learning materials can be down-loaded from the website prepared for the e-learning. Approximately 500 high-school third graders studied using this self-directed e-learning program, individually during the summer break. Their teachers’ role was to provide students with the follow-up quizzes to confirm what they had learned. The result of the self-assessment survey conducted after the e-learning showed that more than half of the learners became concerned about LCA. Moreover, there was the tendency that their concern to environmental problems was higher than that of the previous third graders in the same school. Furthermore, we analyzed the learners’ impression statements written after the e-learning, and found that the learners who began to be concerned about LCA tended to describe more about their daily lives in their impression statements than those who were not or less interested in LCA did.