同: drugs

WordNet

use recreational drugs (同)do drugs
administer a drug to; "They drugged the kidnapped tourist" (同)dose
a substance that is used as a medicine or narcotic
use a computer mouse to move icons on the screen and select commands from a menu; "drag this icon to the lower right hand corner of the screen"
proceed for an extended period of time; "The speech dragged on for two hours" (同)drag_on, drag out
the phenomenon of resistance to motion through a fluid (同)retarding force
clothing that is conventionally worn by the opposite sex (especially womens clothing when worn by a man); "he went to the party dressed in drag"; "the waitresses looked like missionaries in drag"
the act of dragging (pulling with force); "the drag up the hill exhausted him"
something tedious and boring; "peeling potatoes is a drag"
something that slows or delays progress; "taxation is a drag on the economy"; "too many laws are a drag on the use of new land"
to lag or linger behind; "But in so many other areas we still are dragging" (同)trail, get behind, hang back, drop behind, drop_back
move slowly and as if with great effort
persuade to come away from something attractive or interesting; "He dragged me away from the television set"
pull, as against a resistance; "He dragged the big suitcase behind him"; "These worries were dragging at him"
a substance that exerts some force or effect
a businessman who buys or sells for another in exchange for a commission (同)factor, broker
any agent or representative of a federal agency or bureau (同)federal agent
a representative who acts on behalf of other persons or organizations
an active and efficient cause; capable of producing a certain effect; "their research uncovered new disease agents"

PrepTutorEJDIC

『薬』,薬品,薬剤 / 『麻薬』,麻酔剤 / 〈人〉‘に'薬(特に麻酔剤)を与える / 〈飲食物〉‘に'(麻酔薬・毒薬などの)薬を混ぜる
〈重い物〉‘を'『引きずる』(haul) / 《副詞[句]を判って》…‘を'引っ張ってゆく / (網などで)(…を捜して)〈川・湖など〉‘の'底をさらう《+『名』+『for』+『名』》 / …‘を'だらだらと引き延ばす《+『out』+『名,』+『out』》 / (地面に)『引きずる』《+『along』》 / 〈物が〉重そうに動く;のろのろ進む / だらだらと長引く《+『on』(『out』)》 / 〈C〉〈U〉引っ張ること,引きずること / 〈C〉物事を遅らせる原因になる人(物);(…の)足手まとい,じゃま物《+『on』(『upon』)+『名』》 / 〈C〉水の底を探る物(探り錨,引き網など) / 〈C〉引きずられる物(重いまぐわ,犬ぞりなど) / 〈U〉《a~》(航空機の)抗力 / 《a~》《俗》退屈な人(物,事)
『代理人』;周旋人 / 働き(作用)を起こすもの;作用物,薬剤 / (政府機関,特にFBI,CIAなどの)部員,機関員

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/09/08 14:22:21」(JST)

wiki en

[Wiki en表示]

Caffeine, contained in coffee and other beverages, is the most widely used psychoactive drug in the world. 90% of North American adults consume the substance on a daily basis.^[1]

Alcohol is a commonly consumed drug. The global alcoholic drinks industry was worth nearly $1 trillion in 2013.^[2] Beer is the third-most popular drink worldwide, after water and tea.^[3]

Cigarettes, containing nicotine, are one of the world’s most widely consumed drugs.^[4]

A drug is, in the broadest of terms, a chemical substance that has known biological effects on humans or other animals.^[5] Foods are generally excluded from this definition, in spite of their physiological effects on animal species.^[6]^[7]^[8]

In pharmacology, a drug is "a chemical substance used in the treatment, cure, prevention, or diagnosis of disease or used to otherwise enhance physical or mental well-being."^[6] Pharmaceutical drugs may be used for a limited duration, or on a regular basis for chronic disorders.^[9]

Psychoactive drugs are chemical substances that affect the function of the nervous system, altering perception, mood or consciousness.^[10] Alcohol, nicotine, and caffeine are the most widely consumed psychoactive drugs worldwide.^[11]

Recreational drugs are drugs that are not used for medicinal purposes, but are instead used for pleasure.^[12] Common recreational drugs include alcohol, nicotine and caffeine, as well as other substances such as opiates and amphetamines.

Some drugs can cause addiction and habituation ^[13] and all drugs can cause side effects.^[14] Many drugs are illegal for recreational purposes and international treaties such as the Single Convention on Narcotic Drugs exist for the purpose of legally prohibiting certain substances.

Etymology

In English, the noun "drug" is thought to originate from Old French "drogue", possibly deriving later into "droge-vate" from Middle Dutch meaning "dry barrels", referring to medicinal plants preserved in them.^[15] The transitive verb "to drug" (meaning intentionally administer a substance to someone, often without their knowledge) arose later and invokes the psychoactive rather than medicinal properties of a substance.^[16]

Medication

Nexium is a proton pump inhibitor. It is used to reduce the production of stomach acid.

A medication or medicine is a drug taken to cure and/or ameliorate any symptoms of an illness or medical condition, or may be used as preventive medicine that has future benefits but does not treat any existing or pre-existing diseases or symptoms.

Dispensing of medication is often regulated by governments into three categories—over-the-counter (OTC) medications, which are available in pharmacies and supermarkets without special restrictions, behind-the-counter (BTC), which are dispensed by a pharmacist without needing a doctor's prescription, and prescription only medicines (POM), which must be prescribed by a licensed medical professional, usually a physician.

In the United Kingdom, BTC medicines are called pharmacy medicines which can only be sold in registered pharmacies, by or under the supervision of a pharmacist. These medications are designated by the letter P on the label.^[17] The range of medicines available without a prescription varies from country to country.

Medications are typically produced by pharmaceutical companies and are often patented to give the developer exclusive rights to produce them. Those that are not patented (or with expired patents) are called generic drugs since they can be produced by other companies without restrictions or licenses from the patent holder.

Spiritual and religious use

Flowering San Pedro, a psychotropic cactus that has been used for over 3,000 years.^[18] Today the vast majority of extracted mescaline is from columnar cacti, not vulnerable peyote.^[19]

The spiritual and religious use of drugs has been occurring since the dawn of our species. Drugs that are considered to have spiritual or religious use are called entheogens. Some religions are based completely on the use of certain drugs. Entheogens are mostly hallucinogens, being either psychedelics or deliriants, but some are also stimulants and sedatives.

Self-improvement

Nootropics, also commonly referred to as "smart drugs", are drugs that are claimed to improve human cognitive abilities. Nootropics are used to improve memory, concentration, thought, mood, learning, and many other things. Some nootropics are now beginning to be used to treat certain diseases such as attention-deficit hyperactivity disorder, Parkinson's disease, and Alzheimer's disease. They are also commonly used to regain brain function lost during aging. Similarly, drugs such as steroids improve human physical capabilities and are sometimes used (legally or not) for this purpose, often by professional athletes.

Recreational drug use

Cannabis is another commonly used recreational drug.^[20]

Recreational drugs use is the use of a drug (legal, controlled, or illegal) with the primary intention of altering the state of consciousness through alteration of the central nervous system in order to create positive emotions and feelings.

Some national laws prohibit the use of different recreational drugs, and medicinal drugs that have the potential for recreational use are often heavily regulated. On the other hand, there are many recreational drugs that are legal in many jurisdictions and widely culturally accepted. There may be an age restriction on the consumption and purchase of legal recreational drugs. Some recreational drugs that are legal and accepted in many places include alcohol, tobacco, betel nut, and caffeine products, and in some areas of the world the legal use of drugs such as khat is common.

Administering drugs

Drugs, both medicinal and recreational, can be administered in a number of ways, or routes. Many drugs can be administered via more than one route.

Bolus is the administration of a medication, drug or other compound that is given to raise its concentration in blood to an effective level. The administration can be given intravenously, by intramuscular, intrathecal or subcutaneous injection.
Inhaled, (breathed into the lungs), as an aerosol or dry powder. (This includes smoking a substance)
Injected as a solution, suspension or emulsion either: intramuscular, intravenous, intraperitoneal, intraosseous.
Insufflation, or snorted into the nose.
Orally, as a liquid or solid, that is absorbed through the intestines.
Rectally as a suppository, that is absorbed by the rectum or colon.
Sublingually, diffusing into the blood through tissues under the tongue.
Topically, usually as a cream or ointment. A drug administered in this manner may be given to act locally or systemically.^[21]
Vaginally as a suppository, primarily to treat vaginal infections.

References

^ Richard Lovett (2005-09-24). "Coffee: The demon drink?". Retrieved 2014-05-01.
^ http://www.forbes.com/sites/robertlaura/2013/12/26/will-your-retirement-home-have-a-liquor-license/
^ Nelson, Max (2005). The Barbarian's Beverage: A History of Beer in Ancient Europe. Abingdon, Oxon: Routledge. p. 1. ISBN 0-415-31121-7. Retrieved 21 September 2010.
^ According to the statistic of the Food and Agriculture Organization the production quantity in 2006 of coffee was 7.8 million tonnes and of tobacco was 6.7 million tonnes.
^ "Drug." Merriam Webster: Concise Encyclopedia
^ ^a ^b "Drug." Dictionary.com Unabridged (v 1.1), Random House, Inc., via dictionary.com. Retrieved on 20 September 2007.
^ "Drug Definition". Retrieved 2014-05-01.
^ "Drug - Definition". Retrieved 2014-05-01.
^ "Drug." The American Heritage Science Dictionary, Houghton Mifflin Company, via dictionary.com. Retrieved on 20 September 2007.
^ "CHAPTER 1 Alcohol and Other Drugs". ISBN 0-7245-3361-3 http://www.nt.gov.au/health/healthdev/health_promotion/bushbook/volume2/chap1/sect1.htm. Missing or empty |title= (help)
^ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181622/
^ "Recreational Drug". The Free Dictionary. Retrieved 16 March 2015.
^ Fox, Thomas Peter; Oliver, Govind; Ellis, Sophie Marie (2013). "The Destructive Capacity of Drug Abuse: An Overview Exploring the Harmful Potential of Drug Abuse Both to the Individual and to Society". ISRN Addiction 2013. doi:10.1155/2013/450348. Retrieved 15 April 2015.
^ "MHRA Side Effects of Medicines." MHRA Side Effects of Medicines,
^ Harper, Douglas. "drug". Online Etymology Dictionary.
^ Tupper, K.W. (2012). Psychoactive substances and the English language: "Drugs," discourses, and public policy. Contemporary Drug Problems, 39(3), 461-492.
^ "Glossary of MHRA terms - P". MHRA. Retrieved 2008-11-05.
^ http://www.mescaline.com/sanpedro/
^ http://www.iucnredlist.org/details/151962/0
^ Lingeman, Drugs from A-Z A Dictionary, Penguin ISBN 0-7139-0136-5
^ "?".

External links

DrugBank, a database of 4800 drugs and 2500 protein drug targets

UpToDate Contents

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1. アルコールおよびその他の薬物の有害な使用のスクリーニング screening for unhealthy use of alcohol and other drugs
2. 成人における薬物中毒への一般的アプローチ general approach to drug poisoning in adults
3. 成人における抗癌剤の投与 dosing of anticancer agents in adults
4. 処方剤の誤用：疫学、予防、同定、およびマネージメント prescription drug misuse epidemiology prevention identification and management
5. Unipolar major depression in adults: Augmentation of antidepressants with stimulants and stimulant-like drugs

English Journal

Nano-Hydroxyapatite/Chitosan/Konjac Glucomannan Scaffolds Loaded with Cationic Liposomal Vancomycin: Preparation, In Vitro Release and Activity against Staphylococcus aureus Biofilms.

Ma T, Shang BC, Tang H, Zhou TH, Xu GL, Li HL, Chen QH, Xu YQ.SourceKunming General Hospital of Chengdu Military Region, 212 Daguanlu Road, Kunming 650032, Yunnan, P. R. China; Third Military Medical University, Chongqing 400037, P. R. China.
Journal of biomaterials science. Polymer edition.J Biomater Sci Polym Ed.2012;22(12):1669-1681.
The objective of this study was to design a novel artificial bone scaffold for the therapy and prevention of refractory bacterial infections. Porous nano-hydroxyapatite/chitosan/konjac glucomannan (n-HA/CS/KGM) scaffolds were loaded with cationic liposomal vancomycin (CLV) to form a novel complex dr
PMID 21605505

Active Targeting Behaviors of Biotinylated Pluronic/Poly(Lactic Acid) Nanoparticles In Vitro through Three-Step Biotin-Avidin Interaction.

Xiong XY, Gong YC, Li ZL, Li YP, Guo L.SourceSchool of Life Science, Jiangxi Science & Technology Normal University, Nanchang 330013, P. R. China. xyxiong@gmail.com.
Journal of biomaterials science. Polymer edition.J Biomater Sci Polym Ed.2012;22(12):1607-1619. Epub 2010 Aug 6.
In order to prepare targeted drug carriers, previously a biotin group has been attached by our group to the end of Pluronic F87/poly(lactic acid) and Pluronic P85/poly(lactic acid) block co-polymers to obtain B-F87-PLA and B-P85-PLA, respectively. In this paper, the active targeting properties of B-
PMID 20699057

Indentation Creep Reservoirs for Drug-Eluting Poly(L-Lactic Acid) Scaffolds.

Pandey A, Aswath P.SourceMaterials Science and Engineering Department, 500 West First Street, Room 325, The University of Texas at Arlington, Arlington, TX 76019, USA.
Journal of biomaterials science. Polymer edition.J Biomater Sci Polym Ed.2012;22(12):1591-1606. Epub 2010 Jul 26.
The indentation creep behavior of poly(L-lactic acid) (PLLA) thin and thick films was examined. The creep rate was found to be strongly dependent on applied stress, as well as on the thickness of the PLLA film with creep rates being much larger in thin films compared to thick ones at lower stresses,
PMID 20663280

Japanese Journal

玄米発酵食品による油症原因物質の体外排泄促進

長山淳哉,戸髙尊,平川博仙,梶原淳睦,飯田隆雄,柴田智子,辻博,岩崎輝明,Nagayama Junya,Todaka. Takashi,Hirakawa Hironori,Kajiwara Jumboku,Iida Takao,Shibata Satoko,Tsuji Hiroshi Iwasaki Teruaki,ナガヤマジュンヤ,トダカタカシ,ヒラカワヒロノリ,カジワラジュンボク,イイダタカオ,シバタサトコ,ツジヒロシ,イワサキテルアキ
福岡医学雑誌 102, 123-129, 2011-04-25
Forty two years have passed since the outbreak of Kanemi rice oil poisoning, namely, Yusho in the western Japan. However, even now the Yusho patients have been still suffering from several objective a …
NAID 120003075303

胎児性油症関連物質の時系列的濃度変化 : ダイオキシン様PCBsとPCBs

長山淳哉,戸髙尊,平川博仙,堀就英,梶原淳睦,吉村健清,Nagayama Junya,Todaka Takashi,Hirakawa Hironori,Hori Tsuguhide,Kajiwara Jumboku,Yoshimura Takesumi,ナガヤマジュンヤ,トダカタカシ,ヒラカワヒロノリ,ホリツグヒデ,カジワラジュンボク,ヨシムラタケスミ
福岡医学雑誌 102, 116-122, 2011-04-25
… Therefore, we considered due to heavy exposure to PCDFs some drug metabolizing enzymes such as aryl hydrocarbon hydroxylase were induced and excretion of the related agents to fetal Yusho were enhanced from the bodies of Yusho group. …
NAID 120003075302

胎児性油症原因物質の時系列的濃度変化 : PCDDs とPCDFs

長山淳哉,戸髙尊,平川博仙,堀就英,梶原淳睦,吉村健清,Nagayama Junya,Todaka Takashi,Hirakawa Hironori,Hori Tsuguhide,Kajiwara Jumboku,Yoshimura Takesumi,ナガヤマジュンヤ,トダカタカシ,ヒラカワヒロノリ,ホリツグヒデ,カジワラジュンボク,ヨシムラタケスミ
福岡医学雑誌 102, 109-115, 2011-04-25
… Therefore, we considered due to high exposure to PCDFs some drug metabolizing enzymes such as aryl hydrocarbon hydroxylase were induced and the excretion of PCDFs and PCDDs were enhanced from the bodies of Yusho group. …
NAID 120003075301

Related Pictures

★リンクテーブル★

リンク元	「100Cases 76」「100Cases 14」「100Cases 34」「agent」「薬物」
拡張検索	「immunosuppressive drug」「pro-drug」

「100Cases 76」

　　[★]

☆case76　頭痛

■glossary

傾眠 drowsiness 正常、病的の区別なく眠り込む場合に用いられる

意識不鮮明　 confusion 周囲に対する認識や理解は低下し、思考の清明さや、記憶の正確さが失われる

錯乱　 confusion　夢幻様状態より見当識障害と思考の滅裂が見られる状態(PSY.40)

MA = Master of Arts 文学修士

　The Master of Arts (BrE: MA, UsE: M.A.) is awarded in Arts, Humanities, Theology and Social Sciences (Wikipedia)

graduate student 大学院生

rousable adj. 覚醒できる、目を覚ますことができる

rouse vt. ～の目を覚まさせる、呼び起こす。喚起する、鼓舞する、奮起させる。(感情を)起こさせる、かき立てる

lateralize vt. (生理)(大脳が)(左右半球に心的機能差がある、左右差がある。(器官・機能・活動などが)大脳の(左右いずれかの)片側優位下にある。(医学)(障害などが)大脳の片半球にあると診断される

乳頭浮腫 papilledema 原因を問わず視神経乳頭が腫脹している状態

うっ血乳頭 choked disc 脳圧亢進による乳頭浮腫

■症例

24歳、男性　精神学の修士過程を専攻している大学院生

主訴：激しい頭痛

現病歴：頭部全体に痛みがある。2回嘔吐。傾眠と錯乱が認められるようになった。明るい光を嫌う()he finds bright lights uncomfortable。

既往歴：病気の既往はない。アレルギーはない。タバコ1日10本。アルコール24 unit/week(缶ビール(350ml)13.7本/週)。薬は服用してない。

家族歴：彼女と同居。3歳と4歳の子供がいる。

・診察 examination

　見た感じ紅潮しており、調子が悪そう。体温：39.2℃。項部硬直あり(he has stiffness on passice flexion of his neck)。皮疹なし。副鼻腔に圧痛なし。鼓膜所見は正常。脈拍：120/分。血圧：98/74 mmHg。心血管系、胸部、腹部に異常所見なし(normal)。意識レベル低下。命令に応じて覚醒する(JCS10？)。局所神経症状認めない。眼底所見正常

・検査 investigation

　血液検査

　　白血球：上昇。血清 Na：低下。血清尿素：上昇。血清クレアチニン：上昇。血液培養：検査中

　画像検査

　　胸部X線：異常所見なし。頭部 CT：正常

　心電図：洞性頻脈

　腰椎穿刺

　　髄液所見：混濁。白血球：増多。蛋白：増多。糖：低下(普通の人の血糖100mg/dLと考える。→　1g/L　→　1/180　mol/L　→　5.56 mmol/L。グラム染色：結果待ち

■Q

　診断、鑑別診断、管理

■A

　細菌性髄膜炎、髄膜炎・クモ膜下出血、経験的抗菌薬投与・

■解説

(第1パラグラフ)細菌性髄膜炎

・(症状)突然発症。激しい頭痛、嘔吐、錯乱、羞明、項部硬直

・低血圧、白血球増多、腎機能低下　→　ウイルス性よりむしろ細菌性の感染を示唆する。　←　重症敗血症～敗血症ショックかな？(私見)

・(髄膜炎菌の種類)

＜テーブル挿入　髄膜炎＞

・(疫学)HIM. 2621 (多分、全患者中(←私見))

　Streptococcus pneumoniae ～50%

　Neisseria meningitidis ～25%、

　group B streptococci ～15%

　Listeria monocytogenes ～10%

　Haemophilus influenzae type B <10%

・Neisseria meningitidisは全身性の脈管の皮疹(点状出血、紫斑)が特徴的(generalized vasculitic rash)

(第2パラグラフ)鑑別診断

・激しい頭痛

　・the most severe headaches are experienced in meningitis, subarachnoid hemorrhage and classic migraine.

　　・meningitis：単回の発作(single episode)。症状は時間単位で出現。

　　・subarachnoid hemorrhage：単回の発作(single episode)。突然発症(突発完成？)。硝子体出血を認めることがある。

　　・classic migraine：繰り返す(数回/年～1回/週。平均月2回。発作は4-72時間継続)

・髄膜刺激：急性に発熱をきたした多くの病態でみられる(acute febrile conditions)。特に子供。　←　そうなの？

・頚部硬直：頚部や脊椎の局所感染症でも起こる。　←　パーキンソン病などによる筋トーヌスの異常亢進も除外しよう

・他の髄膜炎：脳脊髄液所見で鑑別する

(第3パラグラフ)経験的治療

・(細菌性)髄膜炎が疑われたら、確定診断する前に適切な抗菌薬を投与(empirical treatment)。　→　数時間の経過で死亡することがある。

・ペニシリンアレルギーがなければ、ceftriaxoneかceftaximeの静脈内投与が一般的な治療法

(第4パラグラフ)腰椎穿刺

・乳頭浮腫がない、あるいは占拠性病変を示唆する片側性の神経徴候(lateralized neurological signs)がある患者では(CTの結果を待たずに)腰椎穿刺をすぐにやるべき(CASES)　←　どういう事？

・局在性の神経徴候(localized neurological sign)がある場合はまずCTを撮るべき(CASES)。　→　the dangers of coning　←　鉤ヘルニアの事？

(第5パラグラフ)細菌性髄膜炎の管理

・診断：CSF 検査(グラム染色、髄液培養(確定診断、感受性試験)

・管理

　・意識が低下しているのでそれなりの看護(must be nursed)。アヘン剤による鎮痛。生理食塩水による低ナトリウム血症の補正。低血圧を補正するために inotrope(a drug with positive inotropic effects, e.g. dobutamine, digitalis, milrinone )も必要かもしれない。(100CASES)

　・感受性のある抗菌薬の投与(大量静注、髄液移行性の高いもの)、髄液所見の正常化・CRP 陰転後、1週間抗菌薬を投与して治療を終了。対症療法として脳圧亢進には高張脳圧降下薬(マンニトールなど)を投与。(IMD.1042)

(第6パラグラフ)家族構成を考えた治療

・(意訳)誰が3-4歳の世話をしていたのか分からないけど、子供も検査すべき。髄膜炎菌か原因菌が不明だったら、リファンピシンによる予防的治療と髄膜炎球菌に対する予防接種をすべき。　←　日本ではどうなんでしょうか。

□350ml アルコール5%

350x0.05/10=1.75 unit

■莢膜を有し、髄膜炎を起こす細菌　→　莢膜を有することで血液中で補体などを介した貪食を免れ、血行性にクモ膜下腔まで到達しうる。

・Streptococcus pneumoniae

・Haemophilus influenzae type b

・Neisseria meningitidis

■敗血症

・定義

　感染症による全身性炎症反応症候群(SIRS)をセプシス(sepsis, 広義の敗血症？)とする

　感染症の病原体は、一般細菌(グラム陽性菌・陰性菌)、真菌、寄生虫、ウイルスなど

　皮膚や粘膜の傷とか、種々の臓器にある感染巣から、細菌がリンパ流から血中に入り、全身に播種されて、新たに転移性の感染巣をつくり、重篤な全身症状を引き起こす。

・全身性炎症反応症候群の診断基準

　下記項目のうち2項目以上が当てはまる

　　1. 体温>38℃ or 体温<36℃

　　2. 心拍数>90bpm

　　3. 呼吸数>20回/min or PaCO2<32mmHg

　　4. (白血球数>12,000/ul or 白血球数<4,000/ul) or ( 幼若好中球>10% )　←　ここでいう幼若好中球とは桿状好中球のことである。

・敗血症の周辺疾患概念

　1. 全身性炎症反応症候群 systemic inflammatory response syndrome SIRS

　　発熱や白血球増加などの全身の炎症の徴候によって特徴づけられる病態(SIRSの診断基準に合致する病態)

　2. 敗血症 sepsis

　　SIRSが感染の結果である場合

　3. 重症敗血症 severe sepsis

　　主要臓器障害を伴う敗血症

　4. 敗血症性ショック septic shock

　　輸液投与に不応性の低血圧を伴う重症敗血症

　5. 多臓器機能障害症候群 multiorgan dysfunction syndrome MODS

　　2つ以上の主要臓器の機能異常

　6. 多臓器不全 multiorgan failure MOF

　　2つ以上の主要臓器の不全状態

■参考文献

HIM = Harrison's Principles of Internal Medicine 17th Edition

PSY = 標準精神医学第3版

CASES = 100 Cases in Clinical Medicine Second edition

IMD = 内科診断学第2版

「100Cases 14」

　　[★]

☆case14　複視

■glossary

diplopia n. 複視

筋力低下、筋無力、筋脱力 muscle weakness, muscular weakness

sunken

vt. sinkのpp.

adj.

沈没した、沈んだ、水中の

沈下した、一段低いところにある

落ち込んだ、くぼんだ

3,4-ジアミノピリジン 3,4-diaminopyridine 3,4-DAP K+チャネル阻害薬;ランバート・イートン筋無力症治療

■症例

43-year-old woman

cheif complaint: diplopia

present history: diplopia and holding her head up ; more marked in the evenings, for the last 3 months. difficulty of chewing. voice has become quieter. weight loss (3kg / 6months). non-smoker. drinks about 15 units/week. no regular medication.

past history: no significant previous medical illnesses.

family history: lives with her husband and three children.

・診察 examination

looks well.

organ systems: normal; cardiovascular, respiratory, and abdominal systems.

muscle power; grossly normal. decrease after testing a movement repetitively.

motor function: normal; tone, coordination, reflexes and sensation.

bilateral ptosis. exacerbated by prolonged upward gaze

eye: normal; pupillary reflexes, eye movements, and funduscopy

■答え

diagnosis: myathenia gravis

differential diagnoses:

CASES

上位and/or下位運動ニューロン motor neurone disease　運動ニューロン疾患：線維束性攣縮。進行例では筋力低下

筋 muscular dystrophy　筋ジストロフィー：ある種の筋肉が選択的に筋力低下する。家族歴がある。

筋 dystrophia myotonica　強直性筋ジストロフィー：咬筋、側頭筋、胸鎖乳突筋の筋萎縮、四肢遠位端の筋萎縮。顔貌が特徴的(前頭部脱毛、無表情、窪んだ頬)。家族歴ある。筋電図が診断に有用(急降下爆撃音)。

筋 polymyositis　多発筋炎：普通は皮疹と関節痛が出現。CKが上昇。筋生検が診断に有用

筋 myopathy　ミオパチー：甲状腺中毒性ミオパチー、甲状腺機能低下症によるミオパチー、クッシング症候群によるミオパチー、アルコール性のミオパチー

神経筋接合部？ non-metastatic associations of malignancy (paraneoplastic syndrome(傍腫瘍性症候群 = 腫瘍随伴症候群)のこと)：胸腺腫の症例の10%に重症筋無力症がみられる。ランバート・イートン筋無力症症候群は小細胞癌と関連がある。

HIM.2674

神経筋接合部 congenital myasthenia syndrome　先天性筋無力症症候群
神経筋接合部 drug-induced myasthenia　薬剤性筋無力症

Treatment with penicillamine (used for scleroderma or rheumatoid arthritis) may result in true autoimmune MG, but the weakness is usually mild, and recovery occurs within weeks or months after discontinuing its use.

　重症筋無力症の誘発：ペニシラミン(強皮症や関節リウマチの治療に用いられる)。

　　mildだし、薬剤の中断で改善する。

Aminoglycoside antibiotics or procainamide can cause exacerbation of weakness in myasthenic patients; very large doses can cause neuromuscular weakness in normal individuals.

　重症筋無力症の悪化：アミドグリコシド系抗菌薬、プロカインアミド

　　MGの患者の筋脱力が悪化する。

神経筋接合部 Lambert-Eaton myasthenic syndrome　ランバート・イートン筋無力症症候群：全身の筋肉が冒されるが、特に下肢の近位筋が冒される。MGと同じように～70%の患者で脳神経所見(眼瞼下垂、複視など)が認められる。MGと違うのは(1)反射が消失・減弱すること、(2)自律神経系の変化(口渇、勃起不全)を生じる、(3)神経刺激検査で漸増(waxing)が見られることである。病因は神経筋接合部のP/Q type calcium channelsに対する抗体の出現であり、85%の患者で見いだされる。治療はMGのように血漿交換や免疫抑制薬が使われる。3,4-DAPやpyridostigmineは症状に対する治療のために用いる。前者は運動神経の終末部でカルシウムチャネルをブロックし活動電位を延長させる。後者はアセチルコリンエステラーゼを阻害してシナプスにおける神経伝達物質の濃度を上げる。
精神疾患 neurasthenia　神経衰弱症：歴史的な用語。器質的な障害を伴わない筋無力症のような脱力を伴う症候群。患者は筋脱力や疲労を訴えてやってくる。筋肉の検査では器質的変化は認めないが"jerky release"あるいは"give-away weakness"が認められる。患者の主訴は反復動作による筋力低下よりむしろ疲労や感情鈍麻である。
内分泌疾患 hyperthyroidism　甲状腺機能亢進症：MGが疑われる患者にはthyroid function testをルーチンにやる。甲状腺機能異常は筋無力症の筋力低下を大きくすることがある。
神経筋接合部 botulism　ボツリヌス症：ボツリヌス毒素はシナプス前膜からの神経伝達物質の開口分泌を妨げる。症状はbulbar weakness (複視、構音障害、嚥下困難)。感覚障害はない。深部腱反射は初期には保たれている。進行すれば反射は見られなくなる。筋脱力は全身性。呼吸困難に陥ることがある。精神状態は正常。自律神経症状(麻痺性イレウス、便秘、urinary retention、瞳孔の散大、瞳孔の反応性低下、口渇)。確定診断は血清中の毒素の検出だけど、見つかることはまれ。神経伝導検査(nerve conduction studies)：compound muscle action potentials (CMAPs)の低下。高頻度の刺激で振幅が増加。治療：intubation for airway protection、呼吸補助、aggressive inpatient supportive care(e.g., nutrition, DVT prophylaxis)。馬の抗毒素を検査結果が帰ってくる前に投与する(？)。
上位運動ニューロン intracranial mass lesions　頭蓋内占拠病変：複視はintracranial mass lesionが外眼筋の神経を圧迫することにより生じる。
筋 progressive external ophthalmoplegia　進行性外眼筋麻痺：外眼筋の筋脱力を伴う。四肢の近位筋の筋力低下やそのほかの全身症状を伴うことがある。ミトコンドリアの異常を有する。

■参考文献

HIM = Harrison's Principles of Internal Medicine 17th Edition

CASES = 100 Cases in Clinical Medicine Second edition

IMD = 内科診断学第2版

「100Cases 34」

　　[★]

☆case34　てんかん発作

■症例

23歳　アフリカ-カリブ系　女性　銀行の店員

主訴：てんかん発作

現病歴：強直間代発作を2回起こしたところを母親が目撃していた。娘の行動は次第におかしくなり、また娘は自分のことを話している声が聞こえていた(幻聴)。最近、頭痛を訴えていた。体重が減少し、脱毛があった。盗汗と主に足と手の小関節に及ぶflitting 関節痛を訴えていた。服用薬なし。タバコ1日5-10本、アルコール10 unit/week(缶ビール(350ml)6本弱)

既往歴：特記なし(medical or psychiatric history)

家族歴：

生活歴：

・身体診断

意識：眠そうだが痛みに反応。頚部硬直：なし。頭髪：薄く斑状。体温38.5℃。リンパ節：たくさんの部位で触知。

心拍：104/分、整。血圧：164/102 mmHg。心血管系、呼吸器系、腹部：異常なし。

神経所見：focal anormalityなし(局所性異常)。乳頭浮腫：認めず。

・検査

(血液生化学)

上昇：erythrocyte sedimentation rate、urea、creatinine

低下：hemoglobin、white cell count、platelet

正常：mean corpuscular volume、sodium、potassium、glucose

(腰椎穿刺)

上昇：leukocytes、CSF protein

正常：CSF glucose

(尿検査)

蛋白：＋＋＋。血尿：＋＋＋。赤血球：＋＋。赤血球円柱：あり。

(その他)

胸部X線：異常なし。ECG：洞性頻脈。頭部 CT：正常。CSF グラム染色：陰性(光顕レベルで細菌なし)

■glossary

fall out　(毛髪などが)抜ける

night sweat 盗汗、寝汗

tonic-clonic generalized seizure 全般性強直間代発作

flit　vi (鳥・蝶など)すいすい/ひらひら飛ぶ、飛び回る、飛翔する。(人が)軽やかに通る、行き交う。(時が)(飛ぶように)すぎる。(幻想など)去来する、よぎる、(表情が)かすめる

drowsy　adj. 眠い。眠そうな。眠気を誘う。ものうい。眠ったような

stiffness　n. 堅いこと、堅ぐるしさ、がんこさ

delirium tremens 振戦譫妄

hypertensive encephalopathy 高血圧性脳症

alopecia　脱毛症

African-Caribbean アフリカ-カリブ系

fit n.　(病気の)発作。引きつけ、痙攣。(感情の)激発、一時的興奮、気まぐれ

chorea n. 舞踏病

recreational drug 耽溺性があり乱用される脱法薬物

urgent adj. (物・事が)急を要する、緊急の、背拍質(pressing)。(～を)緊急に必要とする(in)。(S is ～ (with O1) for [in] O2)(人が)(O1(人)に)O2(物・事)をしつこく求める。(人に/～するように)催促する(for/to do)。(要求などが)執拗な。

□てんかん発作

・新規発生したてんかん発作の原因(ICU.805-806)

・薬物中毒(テオフィリンなど)

・薬物からの離脱(アルコールなど)

・感染症(髄膜炎、膿瘍など)

・頭部外傷

・虚血障害(虚血あるいはびまん性)

・占拠性病変(腫瘍あるいは血腫)

・代謝性障害(肝性脳症、尿毒症性脳症、敗血症、低血糖、低ナトリウム血症、低カルシウム血症など)

・合併症(ICU.805-806)