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論文
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Harada, Naoyuki ; Akuzawa, Nobuhiro ; Hayama, Toshimitsu ; Hasegawa, Noriko ; Seki, Hidenori ; Oku, Yuko ; Totsuka, Masayuki ; Hatori, Takashi ; Murakami, Jun ; Imai, Kunihiko ; Kitahara, Younosuke ; Miyao, Takeshi ; Kurihara, Souta ; Ohki, Kazunari ; Okamoto, Kouhei ; Suzuki, Kouichi ; Kubota, Yutaka ; Matsuo, Yasushige ; Kurabayashi, Masahiko
概要:
Journal Article<br />A 76-year-old female patient with diabetes was referred to our hospital for evaluation of a 1-week
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history of left abdominal pain with loss of appetite. Laboratory data showed markedly elevated neutrophils. Abdominal X-ray showed massive gas and fluid collection in the left pararenal space, resembling an intestinal obstruction. Abdominal computed tomography revealed renal parenchymal gas and fluid and led to the correct diagnosis of emphysematous pyelonephritis. Based on these findings, this patient was immediately transferred to the intensive care unit. She underwent emergent ne-phrectomy and was discharged 28 days after surgery without complications.（Kitakanto Med J2013；63：141～145）
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Mai, Tomizawa ; Takashi, Nagai ; Kazunori, Tonouchi ; Naoko, Tonooka ; Gen, Takahashi ; Mie, Kotake ; Ken, Masubuchi ; Takao, Ishizuka ; Kunihiko, Iizuka ; Yoshio, Umegae
概要:
application/pdf<br />Journal Article<br />A 72-year-old male diabetic patient was admitted due to autoimmune hemolytic a
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nemia (AIHA).\nWe started 1mg/kg weight of prednisolone daily and multiple daily insulin infusion for hyperglycemia.\nGall bladder cancer and early stage gastric cancer were then diagnosed. We removed the gall bladder\nand the spleen for treatment of AIHA without prednisolone for better control of diabetes mellitus. Five\nweeks later, endoscopic gastromucosal resection (EMR) was performed for gastric cancer. The patient\nsuffered from fever and respiratory failure after 4 days. Chest computed tomography showed consolidation,\nbronchial wall thickening and a ground glass appearance in bilateral lungs. Although the sputum\nand blood culture were negative,β-D-glucan and mannan antigen increased. Neutrophilia (87％)was\nshown. The WBC count had not increased (7300/μl) compared with the CRP elevation (21.8mg/dl).\nTherefore, we diagnosed overwhelming postsplenectomy infection syndrome followed by atypical pathogen\ninfection. We used ciprofloxacin and fosfluconazol, respirator at low tidal volume ventilation,\nsivelestat sodium hydrate and methylprednisolone for respiratory failure and regular insulin aiming for\na blood glucose range of from 80 to 140mg/dl. The patient subsequently recovered
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Nagai, Takashi ; Inoue, Chiharu ; Tonouchi, Kazunori ; Tonooka, Naoko ; Imamura, Makoto ; Kaneko, Katumi ; Honma, Manabu
概要:
application/pdf<br />Journal Article<br />A 49-year-old semi-conscious woman was admitted due to fever and dehydration.
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Disseminated\nintravascular coagulation (DIC), renal dysfunction and diabetic ketoacidosis were detected. Whole\nbody computed tomography showed multiple nodular lesions in bilateral lungs and kidneys indicating\nseptic emboli, and intrauterine lesions. We diagnosed multiple organ failure followed by intrauterine\ninfection due to untreated diabetes mellitus. Vaginal discharge and blood culture revealed Klebsiella\npneumoniae. We used multi-antibiotics for sepsis,respirator at low tidal volume ventilation,200mg of\nsivelestat sodium hydrate and 300mg of hydrocortisone for respiratory failure, gabexate mesilate and\nanti-thrombin III for DIC, transfusion for bleeding from uterus and regular insulin aiming for a blood\nglucose range of from 80 to 140mg/dl. When we extracted the myoma uteri,the patient’s fever subsided\nand the C-reactive protein became negative. Treating diabetes mellitus is important for the prevention\nof severe infection.
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Nagai, Takashi ; Imamura, Makoto ; Shimizu, Eri ; Mori, Masatomo
概要:
application/pdf<br />Journal Article<br />A 62-year-old man was administered pegylated interferon α-2a and ribavirin for
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chronic hepatitis\nC. He had come to our hospital for treatment of chronic hepatitis C and diabetic triopathy. After diet\nand insulin therapy blood glucose levels (HbA1c; 6.0-6.8％, glycosylated Alb ; 18.5-20％) were adequately\nmaintained for a year. However, AST and ALT levels ranged from 50 to 60 mU/ml by\nursodeoxycholic acid and Stronger Neo-Minophagen C. Although liver function improved after interferon\nand ribavirin combination therapy, visual acuity decreased due to diabetic retinopathy deterioration.\nAfter the end of interferon and laser photocoagulation therapy, visual acuity improved.
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Nagai, Takashi ; Imamura, Makoto ; Negishi, Tetuo ; Mori, Masatomo
概要:
application/pdf<br />Journal Article<br />A 49-year-old woman was admitted because of hyperglycemia. On a delivery at age 29 iron deficiency anemia was indicated. She was injected with 40mg of saccharated ferric oxide every two
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weeks until age 40. At age 35 menopause occurred. Serum ferritin increased (4,300ng/ml). An abdominal computed tomogram (CT) showed increased hepatic CT density. Iron deposition in the parenchymal cells of the liver was shown in a biopsy specimen. Secondary hemochromatosis was diagnosed. Her gonadotropin release decreased. After 30 months serum ferritin had decreased gradually to the normal range after daily 1,000mg injection of deferoxamine mesilate. Although the hepatic CT density decreased, gonadotropin release and insulin release were not improved.
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