著者

山岡 稔

出版者

松本歯科大学学会

雑誌

松本歯学 (ISSN:03851613)

巻号頁・発行日

vol.22, no.3, pp.233-244, 1996-12-31

---

Bacterial resistance to antimicrobial agents increases rapidly outside as well as in hospitals. Antimicrobials may remove sensitive organisms from the bacterial flora, but they also foster the establishment of a resistant strain, not only inducing infection by bacteria which had not previously been considered pathogens, but also preventing spontaneous healing. Although necrotizing fasciitis has been seen in the past 20 years throughout the world, it remains unclear which cases are attributable to new forms of infectious disease because no data are available on their incidence. Regional clusters of cases of necrotizing fasciitis in England and Norway suggest the differential geographic distribution of certain bacteria with high toxicity, such as beta-hemolytic Streptococcus (mainly invasive group A Streptococcus). For the most part, gram-negative rods and anaerobes were simultaneously isolated from tissue fluid cultures. Necrotizing fasciitis occurs within 24 hours after the onset of cellulitis. The progression of necrotizing fasciitis is usually rapid, resulting in widespread gangrene of the subcutaneous fat and fascia around the scalp and into the deep neck spaces. Crepitus, cutaneous anesthesia due to gas bubbles in the soft tissues, and foul-smelling gray watery discharge are found. Some cases are seen as post-operative infection after maxillofacial surgery. Frequently, septic shock, mediastinitis and multiple organ failure are associated with necrotizing fasciitis, leading to a fatal outcome. Some patients have a history of systemic diseases, particularly those associated with compromised status, accounting for the increased risk of necrotizing fasciitis. In some cases, however, there is no such history. This suggests that the toxicity of the bacteria influences the onset of this disease in addition to the widely accepted risk factor of compromised host. Computed tomography can be diagnostic when there is evidence of gas bubbles in the deep tissue even in the absence of crepitation, foetor, and anesthesia of the skin. Abnormally elevated C-reactive protein concentration is a sensitive quantitative measure of the inflammatory response associated with necrotizing fasciitis. Necrotizing fasciitis requires prompt surgical referral for immediate debridement to reduce necrotic tissue and expose anaerobes to oxygen, followed by antibiotics such as clindamycin. The precription of antibiotics alone is not helpful because of the ischaemic focus in necrotic tissue. One of our patients developed septicemia, but all of our patients including the one with septicemia recovered fully without skin grafting. Our findings point to the clinical significance of the computed tomographic findings and débridement associated with eradication of gas bubbles. The patient without objective findings may be misdiagnosed as having a form of cellulitis, such as Ludwigs angina. Any patient with cellulitis should be referred for an early surgical evaluation to prevent the development of the disease and dyspnea due to pharyngeal edema. Prompt evaluation and surgical treatment might reduce the overall mortality in necrotizing fasciitis. It was recently noted that invasive streptococcal infection is associated with a substantial risk of transmission in households and health care institutions. Infections seen throughout the world should be continuously and carefully reviewed.

著者

芦谷 啓吾 山岡 稔 小林 威仁 今枝 博之 中元 秀友 宮川 義隆

出版者

一般社団法人 日本内科学会

雑誌

日本内科学会雑誌 (ISSN:00215384)

巻号頁・発行日

vol.107, no.2, pp.269-275, 2018-02-10 (Released:2019-02-10)

参考文献数

16

---

33歳,男性.1週間持続する発熱と咽頭痛を主訴に地域の病院を受診した.細菌性咽頭炎の診断で抗生物質を投与されたが改善せず,単純CT検査で肝脾腫,脾臓の出血性梗塞を認め,当院に転院した.Epstein-Barr virus (EBV)関連抗体であるvirus capsid antigen(VCA)-IgMが陽性,EBV DNA定量が4.7×103 copies/106 cellsと上昇していることから,伝染性単核球症に合併した脾梗塞と診断した.伝染性単核球症の発症中に,ループスアンチコアグラントが一過性に陽性となり,脾梗塞発症への関与が疑われた.

著者

大崎 篤史 芦谷 啓吾 大庫 秀樹 山岡 稔 市村 隆也 李 治平 永田 耕治 茅野 秀一 宮川 義隆 山本 啓二 中元 秀友 今枝 博之

出版者

一般社団法人 日本消化器内視鏡学会 関東支部

雑誌

Progress of Digestive Endoscopy (ISSN:13489844)

巻号頁・発行日

vol.87, no.1, pp.160-161, 2015-12-12 (Released:2016-01-06)

参考文献数

10

---

A 60-oyear-oold male visited a clinic because of gastric discomfort. This symptom was temporarily improved by a proton pump inhibitor, but it was worsened by discontinuation of the drug. He was referred to our hospital. Esophagogastroduodenoscopy showed an elevated lesion with multiple whitish small granular protrusions in the duodenal second portion, occupying two thirds of the circumference. The lesion was diagnosed to be a follicular lymphoma by histopathological examination including immunostaining of the biopsy specimens. He was admitted to our hospital. Abdominal CT scan showed no lymph node metastasis. Capsule endoscopy of the small intestine showed lymphoid follicles in the distal ileum in addition to the duodenal lesion. Bone marrow aspiration showed no invasion of lymphoma cells. This case was diagnosed as stage I according to the Lugano international conference classification. He underwent monotherapy using rituximab four times. However, the lesion did not respond. Therefore, radiotherapy was added which induced regression of the duodenal lesion. Follow-oup capsule endoscopy did not show any lesion in the distal ileum. As long-term outcome after treatment for duodenal follicular lymphoma is not known, strict observation is considered to be necessary.

著者

安田 浩一 古澤 清文 奥田 大造 堀口 文嗣 長谷川 貴史 山岡 稔

出版者

Japanese Society of Oral and Maxillofacial Surgeons

雑誌

日本口腔外科学会雑誌 (ISSN:00215163)

巻号頁・発行日

vol.41, no.6, pp.546-548, 1995-06-20 (Released:2011-07-25)

参考文献数

9

---

Two cases of gas gangrene in the maxillofacial region and neck that developed after odontogenic infection are reported. Case 1, a 35-year-old man, developed gas gangrene after removal of the mandibular right third molar. In case 2, a 61-year-old man, gas gangrene occurred after apical periodontitis of the mandibular right second premolar. Both cases were treated by digitally opening the site where computed tomography (CT) revealed extension of gas bubbles early after the onset of symptoms and surgical debridement with antibiotics. CT was useful in monitoring the location of gas bubbles to permit opening of the progressive large focus in multiple spaces of maxillofacial region and neck. Digital preparation of the fascia was useful for opening the focus in the early stage of the disease.