著者

湯浅 直樹 石川 達也 徳岡 健太郎 北川 泰久 高木 繁治

出版者

日本神経学会

雑誌

臨床神経学 (ISSN:0009918X)

巻号頁・発行日

vol.48, no.6, pp.422-425, 2008 (Released:2008-06-25)

参考文献数

14

被引用文献数

1

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症例は17歳男性である.1歳1カ月の頃左上下肢麻痺が出現し,某大学病院へ搬送され原因不明の急性小児片麻痺と診断された.麻痺は約2週間で改善し,原因不明のまま以後再発なく経過していた.17歳になり頭部外傷で当院へ搬送された.頭部CT施行したところ,右放線冠~基底核にかけて陳旧性脳梗塞をみとめたため精査をおこなった.その結果,メチレンテトラヒドロ還元酵素(MTHFR)欠損(V/V型)による高ホモシステイン血症と診断された.MTHFR欠損は先天性アミノ酸代謝異常の新生児マススクリーニングで検出されないため,診断が遅れることがあり注意を要する.

著者

中村 浩規 横山 晴子 矢口 武廣 鈴木 優司 徳岡 健太郎 渡邊 昌之 北川 泰久 山田 安彦

出版者

公益社団法人 日本薬学会

雑誌

YAKUGAKU ZASSHI (ISSN:00316903)

巻号頁・発行日

vol.131, no.3, pp.445-452, 2011-03-01 (Released:2011-03-01)

参考文献数

15

被引用文献数

4 4

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In this study, we investigated the effect of histamin H2 receptor antagonist (H2RA) or proton pump inhibitor (PPI) for the prevention of upper gastrointestinal lesions associated with low-dose aspirin. We carried out a retrospective study of 2811 patients who had been prescribed low-dose aspirin (Bayaspirin® 100 mg) for more than 30 days at Tokai University Hachioji Hospital from 2006 to 2008. We classified them into three groups: aspirin alone group (n=1103), aspirin with H2RA group (n=844) and aspirin with PPI group (n=864). Patients who developed upper gastrointestinal lesions were diagnosed with gastric ulcer, duodenal ulcer, gastritis or duodenitis by gastroscopy. We then compared the incidence of upper gastrointestinal lesions among the groups. The incidence in aspirin alone group, aspirin with H2RA group and aspirin with PPI group was 2.54%, 1.54% and 1.04%, respectively; that of aspirin with PPI group being significantly lower (p<0.05). Additively, the odds ratio (OR) of aspirin with H2RA group and aspirin with PPI group was 0.60 (95% confidence interval [95%CI]: 0.31-1.17) and 0.40 (95% CI: 0.19-0.86) as compared with aspirin alone group, respectively. The upper gastrointestinal lesions were developed within two years in all groups. Our results suggest that the combined administration of low-dose aspirin and PPI is effective for the prevention of upper gastrointestinal lesions associated with low-dose aspirin. Also, the pharmacists should be especially careful for upper gastrointestinal lesions development within two years after administration of low-dose aspirin, regardless of combined whether H2RA or PPI.

著者

北川 泰久 大熊 壮尚 徳岡 健太郎

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.102, no.8, pp.1907-1915, 2013-08-10 (Released:2014-08-10)

参考文献数

10

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頭痛は日常診療の中で,最も多い神経症状である.近年,病態生理の解明と共に,片頭痛に対するトリプタンをはじめ,新しい治療法もいくつか出てきている.日本の頭痛医療は欧米に比べて,慢性頭痛に対する疾患としての重要性,専門的な治療の必要性がまだ十分に理解されていない.ここでは頭痛治療トピックスについて概説した.最近,日本神経学会・日本頭痛学会から発刊された慢性頭痛の診療ガイドライン2013を参照されたい.

著者

鈴木 優司 横山 晴子 添田 真司 徳岡 健太郎 渡邊 昌之 北川 泰久 山田 安彦

出版者

公益社団法人 日本薬学会

雑誌

YAKUGAKU ZASSHI (ISSN:00316903)

巻号頁・発行日

pp.13-00193, (Released:2014-01-18)

参考文献数

11

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Low-dose aspirin-induced gastrointestinal lesions are becoming an important problem in clinical practice. In our investigation of such adverse effects, we obtained 4 important findings considered useful for physicians, as follows; 1) even when aspirin was given at a dose, the incidence rate of gastrointestinal lesions was higher than with other NSAIDs, 2) the odds ratios for gastrointestinal lesions induced by aspirin with a histamine H2 receptor antagonist and proton pump inhibitor were 0.6 and 0.4, respectively, as compared with aspirin alone, 3) it is difficult to administer aspirin, which exerts an antiplatelet effect, without inducing gastrointestinal lesions, and 4) these gastrointestinal lesions appears early, especially within 2 years after administration. We distributed a questionnaire to 41 physicians to confirm our findings, and compared high (n=20) and low (n=21) frequency aspirin prescription groups. The recognition rate of points 1 and 3 noted above in the high group was significantly elevated as compared to the low group, whereas there no significant difference in regard to the information in point 4 between the groups and the rate of recognition was low. Moreover, only 27% of the surveyed physicians were familiar with all 4 points. Prior to receiving this information, 17% of the physicians gave no related instructions their patients, which was reduced to 0% after receiving this information. Furthermore, 98% of those surveyed found the information to be useful. Our results suggest that these 4 points of information regarding potential adverse gastrointestinal effects of low-dose aspirin are useful for physicians.