1 0 0 0 OA 可逆性脳梁膨大部病変を有する軽症脳炎脳症(MERS)を合併した川崎病の1例
- 著者
- 髙橋 健一郎 本間 哲 鈴木 恵子 加藤 文代 杉原 茂孝
- 出版者
- 東京女子医科大学学会
- 雑誌
- 東京女子医科大学雑誌 (ISSN:00409022)
- 巻号頁・発行日
- vol.87, no.Extra1, pp.E118-E124, 2017-05-31 (Released:2017-07-31)
- 参考文献数
- 30
We present a case of Kawasaki disease (KD) complicated by clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). A 2-year-old boy was brought to the emergency outpatient unit because of recurrent convulsions. He had experienced two episodes of KD at the age of 1 year. Both episodes had been treated with high dose intravenous immunoglobulin therapy (IVIG; 2 g/kg/day) and the patient had recovered from both episodes without any sequelae. He was diagnosed as having KD based on the presence of 5 out of 6 criteria. After hospitalization, the patient exhibited a persistent disturbance of consciousness and was diagnosed as having MERS based on the presence of enhanced signals in the splenium of the corpus callosum on the 3rd day of illness. Initial treatment with IVIG plus pulsed methylprednisolone (30 mg/kg/day×3 days) for MERS was started. However, a high fever recurred on the 7th day. Additional treatment with IVIG plus intravenous prednisolone (2 mg/kg/day) was started on the 8th day. The patient's body temperature normalized on the 9th day and maintenance therapy with prednisolone was continued until the 28th day. Despite some risk factors for coronary artery lesion, the patient was discharged without any sequelae because of twice IVIG and aggressive steroid therapy including steroid pulse therapy.
1 0 0 0 OA 小児1型糖尿病について知っておきたいこと
- 著者
- 杉原 茂孝
- 出版者
- 東京女子医科大学学会
- 雑誌
- 東京女子医科大学雑誌 (ISSN:00409022)
- 巻号頁・発行日
- vol.87, no.Extra1, pp.E11-E21, 2017-05-31 (Released:2017-07-31)
- 参考文献数
- 39
- 被引用文献数
- 1
Childhood-onset type 1 diabetes (T1D) is a relatively rare disease in Japan. In our department, we have around 50 patients with T1D. The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT) was established in 1994. Here, I will introduce the current issues surrounding T1D in the form of answers to eight questions.T1D is classified into T1A (autoimmune) and T1B (idiopathic). T1A is an autoimmune disease in which pancreatic β cells are destroyed by both genetic and environmental factors. Associations with HLA and other gene polymorphisms (SNP) have been reported. The incidence of childhood-onset T1D is reportedly increasing in Europe and the US, but not in Japan. Autoimmune thyroid disease has been shown to accompany T1D frequently. Insulin pump therapy (CSII) is useful and has recently become popular for the treatment of younger children. A carbohydrate counting (Carbocount) is recommended by international medical practice guide lines for T1D. A smooth transition of medical care is required from pediatric clinics to adult clinics. The goals of treatment for T1D are normal growth and development and self-reliance as an adult. For these goals to be reached, social and psychological support is needed.
1 0 0 0 OA 小児2型糖尿病に対するメトホルミン単独療法
- 著者
- 松浦 信夫 竹内 正弘 雨宮 伸 杉原 茂孝 横田 行史 田中 敏章 中村 秀文 佐々木 望 大木 由加志 浦上 達彦 宮本 茂樹 菊池 信行 小林 浩司 堀川 玲子 菊池 透
- 出版者
- 一般社団法人 日本糖尿病学会
- 雑誌
- 糖尿病 (ISSN:0021437X)
- 巻号頁・発行日
- vol.51, no.5, pp.427-434, 2008 (Released:2009-05-20)
- 参考文献数
- 25
小児において適応が認められていない,経口血糖降下薬メトホルミンの有効性,安全性を評価するために,臨床試験を行った.47名が試験に登録され,38名が試験を終了した.HbA1c値を指標とした主要評価項目では38名中30名(78.9%)が有効と判定された.HbA1c値,空腹時血糖など7項目を指標とした副次評価項目を経時的に比較検討した.試験開始前に比し12週,24週終了時でのHbA1c値,空腹時血糖は有意に低下した.乳酸値を含めた臨床検査値に異常なく,有害事象は47例中16例に,副作用は1例に認めたが,試験を中止するような重篤なものは認めなかった.