http://hdl.handle.net/10564/13 <p>Journal of Nara Medical Association（奈良医学雑誌）<br>奈良県立医科大学看護短期大学部紀要<br>奈良県立医科大学医学部看護学科紀要<br>HUMANITAS　奈良県立医科大学一般教育紀要</P> 2026-04-09T17:46:35Z http://hdl.handle.net/10564/4439 タイトル: 遺伝子組み換え型Fc融合第VIII因子製剤による免疫寛容導入療法を行ったインヒビター保有先天性血友病Aの３小児例 著者: 清水, 一貴; 古川, 晶子; 大砂, 光正; 下西, 成人; 中島, 由翔; 荻原, 建一; 野上, 恵嗣 抄録: Previous basic studies in vitro and in vivo have shown that recombinant Fe-fusion factor (F) VIII (rFVIIIFc) could induce and promote immunotolerance due to increasing the number of regulatory T cells, thereby reducing antigenicity to FVIII. Therefore, immune tolerance induction therapy (ITI) is expected to be effective in patients with hemophilia A and FVIII inhibitors (PwHAI) , aiming at eliminating the inhibitor. We experienced 3 pediatric cases of PwHAI including high responder on ITI using rFVIIIFc. Two of them had successful ITI and one had unsuccessful ITI, which appeared to be similar to the success rates reported in domestic and international studies. We suggest that ITI using rFVIIIFc would be useful. 2024-01-30T15:00:00Z http://hdl.handle.net/10564/4438 タイトル: 寒冷凝集素高値を呈したEvans症候群の小児例 著者: 杉村, 憲市; 渡壁, 麻依; 越智, 聡史; 石原, 卓; 荻原, 建一; 野上, 恵嗣 抄録: Evans syndrome (ES) is a disorder in which autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP) occur simultaneously or serially. Most AIHA in ES is warm-AIHA in which anti-RBC IgG antibodies are the main body causing hemolysis. In this report, we describe a case of ES diagnosed as warm-AIHA but with a markedly high level of cold agglutinin (CA), where cold-AIHA was ruled out. A 9-year-old girl presented to the clinic with headache and was pale. There was no past history or family history of autoimmune disease. On admission, she was markedly anemic and thrombocytopenic with a positive direct Coombs test. A bone marrow examination revealed increased erythroid cells and megakaryocytes. The CA titer was very high of 2,048-fold, but cold-AIHA was considered negative because of the absence of IgM elevation, improvement of anemia with steroid therapy, and absence of symptoms due to cold exposure. She was diagnosed as ES with warm-AIHA and ITP. To our best knowledge, this is the first case of ES with high titers of CA. Long-term follow-up into adulthood is important in children with ES because of the high incidence of subsequent autoimmune disease after remission, while the association of CA was unknown. 2024-07-30T15:00:00Z http://hdl.handle.net/10564/4437 タイトル: A case of postoperative wound infection caused by Mycobacterium wolinskyi 著者: Yamaguchi, Naoki; Koizumi, Yosuke; Inatomi, Shinichiro; Ito, Wataru; Sekine, Takahiro; Nishihara, Yuji; Furukawa, Ryutaro; Nishimura, Tomoko; Fukumori, Tatsuya; Imakita, Natsuko; Kasahara, Kei 抄録: A 69-year-old woman underwent a total hysterectomy for uterine cancer and was undergoing postoperative chemotherapy. One month after surgery, the patient developed a postoperative wound infection caused by methicillin-sensitive Staphylococcus aureus (MSSA) in her midline abdominal postoperative wound and was treated with antimicrobial agents. Three months after surgery, a fistula and serous exudate appeared in her midline abdominal postoperative wound and the patient was treated with oral minocycline and topical sodium fusidic acid ointment. Two weeks after starting treatment, exudate culture specimens were collected and a rapidly growing mycobacterium was detected, but its name could not be identified by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry. The rapidly growing mycobacterium detected was identified as Mycobacterium wolinskyi by analyses of the rpoB and hsp65 gene sequences. Based on the susceptibility, the patient was treated with minocycline and moxifloxacin for approximately 4 months, and her symptoms improved. In postoperative wound infections which do not respond well to treatment targeting common bacteria, it is important to include nontuberculous mycobacterium as a causative organism and to perform appropriate culture tests. 2024-07-30T15:00:00Z http://hdl.handle.net/10564/4436 タイトル: 解剖により病死と判明した車両火災の１例 著者: 井上, 伸; 田村, 修平; 蓮輪, 恭子; 工藤, 利彩; 勇井, 克也; 寺澤, 郁子; 粕田, 承吾 抄録: A woman in her 70s, with a history of lung c ancer, pancreatic cancer, and diabetes mellitus, was discovered deceased in the driver's seat of her car. She went out with her family in the morning but felt unwell and attempted to drive home. As she drove, the car burst into flames, prompting a passerby to call an ambulance. Her head and anterior surfaces of the extremities exhibited burns, with the thorax and abdomen showing III-IV degree burns on the anterior surface and I-II degree burns on the dorsal surface in some areas. There were fractures of the sternum, left clavicle, and bilateral ribs, and damage to the mesentery. Soot was observed in the trachea and bronchi, and examination revealed no traumatic changes in any viscera. The blood's carboxyhemoglobin (COHb) concentration was 15%. Histological examination indicated neutrophils in the blood vessels of the brain, heart, and liver, as well as neutrophil infiltration in the renal parenchyma. Consequently, the determined cause of death was a urinary tract infection. The chest severity rating, determined by the Abbreviated Injury Scale (AIS), was 6, signifying multiple rib fractures on both sides. The injury severity score (ISS), which is the sum of the squares of the highest AIS code in each of the three most severely injured body regions, was determined. The ISS score was 75 due to an AIS code of 6 for the chest. Generally, an ISS score of 25 or higher is associated with a high mortality rate. Consequently, even in the absence of the car fire, saving her life would have been challenging. Through this case, the importance of meticulous observation becomes evident, especially when histological examination is conducted during the autopsy of a burnt corpse. 2024-07-30T15:00:00Z