Published papers

Systemic lupus erythematosus (SLE) is a known risk factor for malignant lymphoma. A woman in her 40s with SLE who was receiving treatment with mycophenolate mofetil (MMF) and belimumab presented to our emergency department complaining of abdominal pain of sudden onset. Physical examination revealed abdominal muscle guarding and contrast-enhanced computed tomography (CT) of the abdominopelvic region revealed intra-abdominal free gas and thickening of the small intestinal wall. We performed emergency surgery, and intraoperative exploration revealed a small bowel perforation: a perforation of the jejunum was observed 40 cm distal to the ligament of Treitz, and partial resection of the small intestine and functional end-to-end anastomosis were performed. Postoperative histopathology led to the diagnosis of other iatrogenic immunodeficiency-associated lymphoproliferative disorders associated with MMF, specifically Epstein-Barr virus-positive diffuse large B-cell lymphoma. Chemotherapy was initiated postoperatively, but the patient developed a second bowel perforation 40 cm distally to the previous surgical site. In patients with SLE, the possibility of gastrointestinal perforation associated with malignant lymphoma and the potential for incomplete tumor resection during initial surgery must be considered.

 There are various surgical techniques for skin grafts, among which grafting with artificial dermis has been suggested to enhance the skin function and esthetics. Artificial dermis usually takes a few weeks to be engrafted and is generally followed by split-thickness skin grafts (STSG). The sandwich technique using artificial dermis is relatively new, in which meshed STSG is covered by the artificial dermis during the same surgery. To elucidate the clinical effects of the sandwich technique, a multicenter prospective observational study was planned and initiated. Expected favorable effects of the sandwich technique include: 1) shortening the treatment period for deep skin wounds, compared with historical artificial dermis grafting that is followed by STSG, and 2) decreasing the donor-site area for extensive skin wounds, compared with the limited ratio of meshed STSG. Considering that many cofounding factors exist when determining the surgical technique for skin grafts, the appropriate selection of covariates and optimal methods for the evaluation of outcomes were discussed prior to study initiation. The current study will hopefully generate the background knowledge necessary for a randomized controlled trial.

＜Point(1)＞敗血症において,ステロイド治療の適応を説明できる.＜Point(2)＞敗血症に投与するステロイドの種類・量を説明できる.＜Point(3)＞IVIGとはどんな治療薬なのかを説明できる.＜Point(4)＞敗血症において,IVIGの適応を説明できる.(著者抄録)

＜文献概要＞Point ◎プロトロンビン複合体はビタミンK拮抗薬の抗凝固作用を抑制する目的として使用され,少ない容量負荷で迅速な効果発現が可能である.◎プロトロンビン複合体はワルファリン服用中の急性重篤出血あるいは緊急手術・処置を行う際に保険適用となるが,容量負荷を避けたい患者や迅速な凝固能の回復が望ましい場面に良い適応となる.◎イダルシズマブとアンデキサネット アルファは直接経口抗凝固薬(DOAC)の拮抗薬であるが,イダルシズマブはダビガトランのみ,アンデキサネット アルファはリバーロキサバン,アピキサバン,エドキサバンに対して有効である.◎トラネキサム酸は外傷患者や周術期での効果が示されてきた止血薬剤であるが,消化管出血などの内科領域の出血性疾患ではその効果は確立していない.

＜ここがポイント!＞▼医療関連感染症は医療行為を介して罹患する感染症のことであり,いまだ高い有病率を認め,患者の健康のみならず社会への経済的影響も重大である.▼医療関連感染症を防ぐ手段として,正しい方法で行う手指衛生は非常に重要である.▼手指衛生に用いる消毒薬の種類を認知し,適切な種類と濃度をもって手指衛生を実施することが重要である.▼消毒薬を使用する際には,消毒薬への感受性低下の可能性を認識し,適切な濃度と量を用いることを意識する.▼消毒薬を用いた手指衛生を実施すべきタイミングを理解し,診療中に正しく実施することが重要である.(著者抄録)