気管　　　

WordNet

membranous tube with cartilaginous rings that conveys inhaled air from the larynx to the bronchi (同)windpipe
one of the tubules forming the respiratory system of most insects and many arachnids
relating to or resembling or functioning like a trachea
several small veins from the trachea (同)vena trachealis

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気管

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2017/04/04 20:39:15」(JST)

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The trachea, colloquially called the windpipe, is a cartilaginous tube that connects the pharynx and larynx to the lungs, allowing the passage of air, and so is present in almost all air-breathing animals with lungs. The trachea extends from the larynx and branches into the two primary bronchi. At the top of the trachea the cricoid cartilage attaches it to the larynx. This is the only complete ring, the others being incomplete rings of reinforcing cartilage. The trachealis muscle joins the ends of the rings and these are joined vertically by bands of fibrous connective tissue – the annular ligaments of trachea. The epiglottis closes the opening to the larynx during swallowing.

The trachea develops in the second month of development. It is lined with an epithelium that has goblet cells which produce protective mucins. An inflammatory condition, also involving the larynx and bronchi, called croup can result in a barking cough. A tracheotomy is often performed for ventilation in surgical operations where needed. Intubation is also carried out for the same reason by the inserting of a tube into the trachea. From 2008, operations have transplanted a windpipe grown by stem cells, and synthetic windpipes; their success is however doubtful.^[1]

Structure

The trachea of an adult has an inner diameter of about 1.5 to 2 centimetres (0.6 to 0.8 in) and a length of about 10 to 11 centimetres (4 to 4 in).^[2] It begin at the bottom of the larynx, and ends at the carina, the point where the trachea branches into left and right main bronchi.^[2] The trachea begins level with the sixth cervical vertebra and the carina is found at the level of the fifth thoracic vertebra (T5),^[2] opposite the sternal angle and can be positioned up to two vertebrae lower or higher, depending on breathing.

The trachea is surrounded by rings of hyaline cartilage; these rings are incomplete and C-shaped, except for the first ring, called the cricoid cartilage. The cricoid cartilage is attached to the top of the trachea and acts as the bottom of the larynx. There are fifteen to twenty rings in total, separated by narrow intervals. These reinforce the front and sides of the trachea to protect and maintain the airway.

In front of the rings lies connective tissue and skin. Several other structures pass or sit over it; the jugular arch, which joins the two anterior jugular veins, sits in front of the upper part of the trachea. The sternohyoid and sternothyroid muscles stretch along its length, and the thyroid gland sits below this; with the isthmus of the gland overlying the second to fourth rings.^[2]

The first tracheal ring is broader than the rest, and often divided at one end; it is connected by the cricotracheal ligament with the lower border of the cricoid cartilage, and is sometimes blended with the next cartilage down. The last cartilage is thick and broad in the middle, due to its lower border being prolonged into a triangular hook-shaped (uncinate) process, which curves downward and backward between the two bronchi. It ends on each side in an imperfect ring, which encloses the commencement of the bronchus. The cartilage above the last is somewhat broader than the others at its center.

Two or more of the cartilages often unite, partially or completely, and they are sometimes bifurcated at their extremities. The rings are generally highly elastic but they may calcify with age.

The trachealis muscle connects the ends of the incomplete rings and contracts during coughing, reducing the size of the lumen of the trachea to increase the rate of air flow.^[3] The esophagus lies posteriorly to the trachea, adjoining along the tracheoesophageal stripe. Circular horizontal bands of fibrous tissue called the annular ligaments of trachea join the tracheal rings together. The cartilaginous rings are incomplete to allow the trachea to collapse slightly so that food can pass down the esophagus. A flap-like epiglottis closes the opening to the larynx during swallowing to prevent swallowed matter from entering the trachea.

The sternohyoid and sternothyroid muscles lie on top of the upper part of the trachea
The thyroid gland also lies on top of the trachea, and lies below the cricoid cartilage. The isthmus of the thyroid, which connects both wings, lies directly in front, whereas the wings lie on the front and stretch to the side.

Development

In the fourth week of development of the human embryo as the respiratory bud grows, the trachea separates from the foregut through the formation of tracheoesophageal ridges which fuse to form the tracheoesophageal septum and this separates the future trachea from the oesophagus and divides the foregut tube into the laryngotracheal tube. Before the end of the fifth week, the trachea begins to develop from the laryngotracheal tube which develops from the laryngotracheal groove. The first part of the cephalic region of the tube forms the larynx, and the next part forms the trachea.

The trachea is no more than 4mm diameter during the first year of life, expanding to its adult diameter by late childhood. The trachea is more mobile and of more variable length, deeper, and smaller in children.^[2]

Histology

10 X Photograph of a histological sample of a human trachea coloured with H&E stain

Cross-section

The trachea is lined with a layer of pseudostratified ciliated columnar epithelium. The epithelium contains goblet cells, which are glandular, modified simple columnar epithelial cells that produce mucins, the main component of mucus. Mucus helps to moisten and protect the airways.^[4] Mucus lines the ciliated cells of the trachea to trap inhaled foreign particles that the cilia then waft upward toward the larynx and then the pharynx where it can be either swallowed into the stomach or expelled as phlegm. This self-clearing mechanism is termed mucociliary clearance.^[5]

Clinical significance

Inflammation

Inflammation of the trachea is known as tracheitis. When the trachea is inflamed as well as the larynx and bronchi, this is known as croup, which often causes a distinct, barking cough.

Intubation

Tracheal intubation refers to the insertion of a catheter down the trachea. This procedure is commonly performed during surgery, in order to ensure a person receives enough oxygen when sedated. The catheter is connected to a machine that monitors the airflow, oxygenation and several other metrics. This is often one of the responsibilities of an anesthetist during surgery. The epiglottic vallecula is an important anatomical landmark for carrying out this procedure. In an emergency, or when tracheal intubation is deemed impossible, a tracheotomy is often performed to insert a tube for ventilation, usually when needed for particular types of surgery to be carried out so that the airway is kept open for sufficient time. Another less invasive method is used when a procedure can be carried out more quickly, or in an emergency situation, and this is a cricothyrotomy.

Congenital disorders

Tracheal agenesis,^[6] is a rare birth defect in which the trachea fails to develop. The defect is usually fatal though sometimes surgical intervention has been successful.

A tracheoesophageal fistula is a congenital defect in which the trachea and esophagus are abnormally connected.

Sometimes as an anatomical variation one or more of the tracheal rings are completely formed. These O rings are smaller than the normal C-shaped and can cause narrowing of the trachea resulting in breathing difficulties. An operation called a slide tracheoplasty can be performed which opens up the rings and rejoins them as wider rings shortening the length of the trachea.^[7] Slide tracheoplasty is said to be the best option in treating tracheal stenosis.^[8]

Mounier-Kuhn syndrome is a very rare congenital disorder of an abnormally enlarged trachea.

Other

A tracheo-oesophageal puncture is a surgically created hole between the trachea and the esophagus in a person who has had a total laryngectomy, (removal of larynx). The purpose of the puncture is to restore a person’s ability to speak after the vocal cords have been removed.
Tracheomalacia (weakening of the tracheal cartilage)
- Tracheal collapse (in dogs)
Tracheobronchial injury (perforation of the trachea or bronchi)
A chondrolaryngoplasty commonly called a tracheal shave is the shaving of the cricoid cartilage in order to reduce it to lessen the prominence of the Adam's apple. It is often carried out in transgender surgery.

Other animals

Allowing for variations in the length of the neck, the trachea in other mammals is, in general, similar to that in humans. Generally, it is also similar to the reptilian trachea.^[9]

Vertebrates

In birds, the trachea runs from the pharynx to the syrinx, from which the primary bronchi diverge. Swans have an unusually elongated trachea, part of which is coiled beneath the sternum; this may act as a resonator to amplify sound. In some birds, the tracheal rings are complete, and may even be ossified.^[9]

In amphibians, the trachea is normally extremely short, and leads directly into the lungs, without clear primary bronchi. A longer trachea is, however, found in some long-necked salamanders, and in caecilians. While there are irregular cartilagenous nodules on the amphibian trachea, these do not form the rings found in amniotes.^[9]

The only vertebrate to have lungs, but no trachea, is Polypterus, in which the lungs arise directly from the pharynx.^[9]

Invertebrates

Tracheal system of dissected cockroach. The largest tracheae run across the width of the body of the cockroach and are horizontal in this image. Scale bar, 2 mm.

The tracheal system branches into progressively smaller tubes, here supplying the crop of the cockroach. Scale bar, 2 mm.

The invertebrate trachea refers to the open respiratory system composed of spiracles, tracheae, and tracheoles that terrestrial arthropods have to transport metabolic gases to and from tissues.^[10] The distribution of spiracles can vary greatly among the many orders of insects, but in general each segment of the body can have only one pair of spiracles, each of which connects to an atrium and has a relatively large tracheal tube behind it. The tracheae are invaginations of the cuticular exoskeleton that branch (anastomose) throughout the body with diameters from only a few micrometres up to 0.8 mm. The smallest tubes, tracheoles, penetrate cells^{[citation needed]} and serve as sites of diffusion for water, oxygen, and carbon dioxide. Gas may be conducted through the respiratory system by means of active ventilation or passive diffusion. Unlike vertebrates, insects do not generally carry oxygen in their haemolymph.^[11] This is one of the factors that may limit their size.

A tracheal tube may contain ridge-like circumferential rings of taenidia in various geometries such as loops or helices. In the head, thorax, or abdomen, tracheae may also be connected to air sacs. Many insects, such as grasshoppers and bees, which actively pump the air sacs in their abdomen, are able to control the flow of air through their body. In some aquatic insects, the tracheae exchange gas through the body wall directly, in the form of a gill, or function essentially as normal, via a plastron. Note that despite being internal, the tracheae of arthropods are shed during moulting (ecdysis).^{[citation needed]}

Artificial trachea

Several bioengineering approaches have been tested to repair and replace the trachea.^[12]

Society and culture

In 2008, a Colombian woman, Claudia Castillo (30), received a trachea transplant using her own stem cells.^[13]

Between 2011 and 2014 Paolo Macchiarini of the Karolinska University Hospital performed eight operations in which he generated an artificial trachea from a person's stem cells; four of them at Karolinska, three in Russia, and one in Illinois.^[1] In January 2016 the Swedish television station Sveriges Television broadcast a three part documentary about Macchiarini that suggested that Macchiarini did not obtain informed consent from these people, six of whom died.^[1] Macchiraini had been a "media darling" and had been seen as a pioneer in the field.^[1] In February 2016 Karolinska announced it would not renew his contract when it expired in November 2016 and that it would open an investigation of Macchiarini's work and publications.^[1]

Additional images

Trachea.
The tracheobronchial lymph glands.
Coronal section of larynx and upper part of trachea.
Microscopic cross section of human trachea.
Larynx helps in the passage of air.

External links

Histology at vetmed.wsu.edu
Atlas image: rsa3p2 at the University of Michigan Health System - "Larynx and trachea, lateral view"
"Cat Respiratory System " at kent.edu

References

^ ^a ^b ^c ^d ^e "Karolinska Institute has 'lost confidence' in Paolo Macchiarini, says it won't renew his contract". KI. 2016-02-04. Retrieved 2016-02-07.
^ ^a ^b ^c ^d ^e Gray's Anatomy 2008, p. 1000.
^ Ross, Michael. Histology a text and atlas (5th ed.). Wojciech Pawlina. p. 617.
^ Mescher AL, "Chapter 17. The Respiratory System" (Chapter). Mescher AL: Junqueira's Basic Histology: Text & Atlas, 12e: http://www.accessmedicine.com/content.aspx?aID=6182422.
^ Antunes, MB; Cohen, NA (February 2007). "Mucociliary clearance--a critical upper airway host defense mechanism and methods of assessment.". Current opinion in allergy and clinical immunology. 7 (1): 5–10. doi:10.1097/aci.0b013e3280114eef. PMID 17218804.
^ Chiu, T.; Cuevas, D.; Cuevas, L.; Monteiro, C. (1990). "Tracheal agenesis". Southern Medical Journal. 83 (8): 925–930. doi:10.1097/00007611-199008000-00018. PMID 2200137.
^ "Slide tracheoplasty". http://www.cincinnatichildrens.org/health/s/slide-tracheoplasty/. External link in |website= (help); Missing or empty |url= (help); |access-date= requires |url= (help)
^ Xue, B; Liang, B; Wang, S; Zhu, L; Lu, Z; Xu, Z (January 2015). "One-stage surgical correction of congenital tracheal stenosis complicated with congenital heart disease in infants and young children.". Journal of cardiac surgery. 30 (1): 97–103. doi:10.1111/jocs.12418. PMID 25109422.
^ ^a ^b ^c ^d Romer, Alfred Sherwood; Parsons, Thomas S. (1977). The Vertebrate Body. Philadelphia, PA: Holt-Saunders International. pp. 336–337. ISBN 0-03-910284-X.
^ Wasserthal, Lutz T. (1998). Chapter 25: The Open Hemolymph System of Holometabola and Its Relation to the Tracheal Space. In "Microscopic Anatomy of Invertebrates". Wiley-Liss, Inc. ISBN 0-471-15955-7.
^ Westneat, Mark W.; Betz, Oliver; Blob, Richard W.; Fezzaa, Kamel; Cooper, James W.; Lee, Wah-Keat (January 2003). "Tracheal Respiration in Insects Visualized with Synchrotron X-ray Imaging". Science. 299 (5606): 558–560. doi:10.1126/science.1078008. PMID 12543973.
^ Delaere, P; Van Raemdonck, D (March 2016). "Tracheal replacement.". Journal of thoracic disease. 8 (Suppl 2): S186–96. PMC 4775267. PMID 26981270.
^ "The top health stories of 2008 - CNN.com". CNN. 2008-12-26. Retrieved 2010-05-27.

Books

editor-in-chief, Susan Standring ; section editors, Neil R. Borley; et al. (2008). Gray's anatomy : the anatomical basis of clinical practice (40th ed.). London: Churchill Livingstone. ISBN 978-0-8089-2371-8.
Britton, the editors Nicki R. Colledge, Brian R. Walker, Stuart H. Ralston ; illustated by Robert (2010). Davidson's principles and practice of medicine. (21st ed.). Edinburgh: Churchill Livingstone/Elsevier. ISBN 978-0-7020-3085-7.

Ligaments

UpToDate Contents

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1. 気管の放射線学 radiology of the trachea
2. 麻酔のための気道管理の手技およびデバイス：声門上気道デバイス（ラリンジアルマスク） techniques and devices for airway management for anesthesia supraglottic devices including laryngeal mask airways
3. 成人における気管挿管の失敗 the failed airway in adults
4. フローボリューム曲線 flow volume loops
5. 成人における中枢気道閉塞の臨床症状、診断的評価およびマネージメント clinical presentation diagnostic evaluation and management of central airway obstruction in adults

English Journal

Bacteriological and pathological studies of egg peritonitis in commercial layer chicken in Namakkal area.

Srinivasan P, Balasubramaniam GA, Murthy TR, Balachandran P.SourceDepartment of Veterinary Pathology, Veterinary College and Research Institute, Namakkal, Tamil Nadu State, India. Electronic address: srinipat2004@yahoo.com.
Asian Pacific journal of tropical biomedicine.Asian Pac J Trop Biomed.2013 Dec;3(12):988-94. doi: 10.1016/S2221-1691(13)60191-4.
OBJECTIVE: To detect the various bacteriological agents and pathological changes in commercial layer chicken affected with egg yolk peritonitis in Namakkal region of India.METHODS: A total of 6 572 layer chicken from 85 commercial farms were subjected for the study, out of which 1 715 showed various
PMID 24093792

Contributions of the S2 spike ectodomain to attachment and host range of infectious bronchitis virus.

Promkuntod N, Wickramasinghe IN, de Vrieze G, Gröne A, Verheije MH.SourcePathology Division, Department of Pathobiology, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3584 CL Utrecht, The Netherlands.
Virus research.Virus Res.2013 Nov 6;177(2):127-37. doi: 10.1016/j.virusres.2013.09.006. Epub 2013 Sep 13.
The spike protein is the major viral attachment protein of the avian coronavirus infectious bronchitis virus (IBV) and ultimately determines viral tropism. The S1 subunit of the spike is assumed to be required for virus attachment. However, we have previously shown that this domain of the embryo- an
PMID 24041648

Simvastatin treatment showed no prophylactic effect in influenza virus-infected mice.

Glück B, Schmidtke M, Walther M, Meerbach A, Wutzler P.SourceInstitute of Virology and Antiviral Therapy, Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany. Brigitte.Glueck@med.uni-jena.de
Journal of medical virology.J Med Virol.2013 Nov;85(11):1978-82. doi: 10.1002/jmv.23682. Epub 2013 Aug 7.
Simvastatin, a cholesterol-lowering drug, is reported to have immunomodulatory properties that attenuated acute lung injury independent of their major lipid lowering effects. Based on these reports, simvastatin is expected to be used for influenza prophylaxis and treatment. The present study evaluat
PMID 23926054

Bimodal concentration-response of nicotine involves the nicotinic acetylcholine receptor, transient receptor potential vanilloid type 1, and transient receptor potential ankyrin 1 channels in mouse trachea and sensory neurons.

Kichko TI, Lennerz J, Eberhardt M, Babes RM, Neuhuber W, Kobal G, Reeh PW.SourceInstitute of Physiology and Pathophysiology (T.I.K., J.L., M.E., R.M.B., P.W.R.) and Institute of Anatomy I (W.N.), Friedrich-Alexander-University, Erlangen, Germany; Institute of Pathology, University of Ulm, Ulm, Germany (J.L.); Department of Biophysics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania (R.M.B.); Department of Anesthesiology and Intensive Care, Hannover Medical School, Hannover, Germany (M.E.); and Altria Client Services, Inc., Richmond, Virginia (G.K.).
The Journal of pharmacology and experimental therapeutics.J Pharmacol Exp Ther.2013 Nov;347(2):529-39. doi: 10.1124/jpet.113.205971. Epub 2013 Aug 7.
High concentrations of nicotine, as in the saliva of oral tobacco consumers or in smoking cessation aids, have been shown to sensitize/activate recombinant transient receptor potential vanilloid type 1 (rTRPV1) and mouse TRPA1 (mTRPA1) channels. By measuring stimulated calcitonin gene-related peptid
PMID 23926288

Japanese Journal

Molecular and antimicrobial analyses of non-classical Bordetella isolated from a laboratory mouse

Journal of Veterinary Medical Science advpub(0), 2016
NAID 130005119389

全身麻酔下大腿骨人工骨頭置換術の抜管直後に発現した舌腫脹

麻酔 64(10), 1088-1090, 2015-10
NAID 40020609924

スネアループが摘出に有用であった歯冠補綴物による気道異物の2例

気管支学 : 日本気管支研究会雑誌 37(5), 550-555, 2015-09-25
NAID 110009989141

一時的なシリコンステント留置が有効であった気管気管支原発MALTリンパ腫の1例

気管支学 : 日本気管支研究会雑誌 37(5), 514-520, 2015-09-25
NAID 110009989135

Related Pictures

★リンクテーブル★

リンク元	「100Cases 33」「気管」「tracheary」「tracheal」「tracheal tube」
拡張検索	「intratracheally」

「100Cases 33」

Trachea
	Conducting passages.
Details
Artery	tracheal branches of inferior thyroid artery
Vein	brachiocephalic vein, azygos vein accessory hemiazygos vein
Identifiers
Latin	Trachea
MeSH	A04.889
FMA	7394
	Anatomical terminology [edit on Wikidata]

　　[★]

☆case33　頭痛と混乱

■glossary

accompany

vt.

(人)と同行する、(人)に随行する。(もの)に付随する。～と同時に起こる。～に加える(添える、同封する)(with)

slurred n. 不明瞭

強直間代痙攣 tonic-clonic convulsion

　意識消失とともに全身の随意筋に強直痙攣が生じ(強直痙攣期tonic convulsion)、次いで全身の筋の強直と弛緩とが律動的に繰り返される時期(間代痙攣期clonic convulsion)を経て、発作後もうろう状態を呈する一連の発作。

■症例

28歳、女性　黒人　南アフリカ　手術室看護師　ロンドン住在

主訴：頭痛と混乱

現病歴：過去3週間で頭痛が続いており、ひどくなってきた。現在も頭痛が持続しており、頭全体が痛い。友人曰く「過去六ヶ月で体重が10kg減っていて、最近、混乱してきたようだ」。発話は不明瞭。救急室にいる間に強直間代痙攣を起こした。

・診察 examination

やせている。55kg。38.5℃。口腔カンジダ症(oral candidiasis)。リンパ節腫脹無し。心血管、呼吸器系、消化器系正常。痙攣前における神経検査では時間、場所、人の見当識無し。神経局所症状無し(no focal neurological sign)。眼底両側に乳頭浮腫有り。

・検査 investigation

血算：白血球増多

血液生化学：ナトリウム低下

CT：供覧

■キーワード＆着目するポイント

・口腔カンジダ症(oral candidiasis)

・頭痛、精神症状、強直間代痙攣

・眼底両側に乳頭浮腫

・CT 所見

・低ナトリウム血症は二次的なもの

■アプローチ

・口腔カンジダ症(oral candidiasis)　→　細胞免疫低下状態(DM、免疫抑制、AIDSなど) or 常在細菌叢の攪乱(長期の抗菌薬の使用)

　・The occurrence of thrush in a young, otherwise healthy-appearing person should prompt an investigation for underlying HIV infection.(HIM.1254)

　・More commonly, thrush is seen as a nonspecific manifestation of severe debilitating illness.(HIM.1254)

・精神症状、強直間代痙攣　→　一次的、あるいは二次的な脳の疾患がありそう

・頭痛　→　漠然としていて絞れないが、他の症状からして機能性頭痛ではなく症候性頭痛っぽい。

・眼底両側に乳頭浮腫　→　脳圧亢進の徴候　→　原因は・・・脳腫瘍、ことにテント下腫瘍と側頭葉の腫瘍、クモ膜下出血、脳水腫など、そのほか、眼窩内病変、低眼圧などの局所的要因、悪性高血圧、血液疾患、大量出血、肺気腫などの全身的要因 (vindicate本のp342も参考になる)

　・頭痛と脳圧亢進　→　頭蓋内圧占拠性病変、脳炎(IMD.274)

・CT 所見　→　ringformの病変、脳浮腫、脳圧亢進

・低ナトリウム血症　→　脳ヘルニアに続発して起こることがあるらしい。実際には下垂体にトキソプラズマによる病変が形成されることにより起こりうる。

・そのほか出身地、体重減少もHIVを疑わせる点

パターン認識でHIV + 精神症状 + てんかん発作(強直間代痙攣) + 脳圧亢進 + CT 所見 = 一番ありそうなのはToxoplasma gondiiによるトキソプラズマ脳症 cerebral toxoplasosis (トキソプラズマ脳炎 toxoplasmic encephalitis)

■Toxoplasma gondii

　原虫　胞子原虫類

(感染予防学 080521のプリント、CASES p,92、HIM p.1305-)

・疫学：西洋では30-80%の成人がトキソプラズマの感染の既往がある・・・うぇ(CASES)。日本では10%前後(Wikipedia)。

・生活環

　・終宿主：ネコ：ネコの小腸上皮細胞で有性・無性生殖　糞便にオーシストの排泄

　・中間宿主：ヒト.ブタを含むほ乳類と鳥類：無性生殖で増殖、シストの形成

　　　急性期の増殖盛んな急増虫体 tachyzoiteとシスト内の緩増虫体 bradyzoite

・病原、病因 phathogenesis

　・緩増虫体(bradyzoite)、接合子嚢(oocyst)

・感染経路

　1. オーシストの経口摂取

　2. 中間宿主の生肉中のシストの経口摂取

　3. 初感染妊婦からの経胎盤感染。既感染なら胎盤感染しないらしい(HIM.1306)

　(4)移植臓器、輸血。確率は低い(at low rate)(HIM.1306)

・病態

　1. 先天性トキソプラズマ症　congenital toxoplasmosis

　　　①網脈絡膜炎、 ②水頭症、 ③脳内石灰化、 ④精神・運動障害

　2. 後天性トキソプラズマ症　acquired toxoplasmosis

　　(1) 健常者

　　　・多くは不顕性感染。発熱、リンパ節腫脹、皮疹(rash)

　　　・(少数例)筋肉痛、暈疼痛、腹痛、斑状丘疹状皮疹(maculopapular rash)、脳脊髄炎、混乱(HIM.1308)

　　　・(まれ)肺炎、心筋炎、脳症、心膜炎、多発筋炎

　　　・網膜、脈絡叢に瘢痕や、脳に小さい炎症性の病変を残すことあり(CASES)。

　　　・急性感染の症状は数週間で消失　筋肉や中枢神経系に緩増虫体が残存

　　(2)HIV 感染者、臓器移植例、がん化学療法例

　　　シスト内緩増虫体→急増虫体→播種性の多臓器感染

　　　AIDSでは、トキソプラズマ性脳炎が指標疾患 AIDS-defineing illness(CASES)

・治療

　(日本)アセチルスピラマイシン、ファンシダール(感染予防学 080521)

■トキソプラズマ脳炎 toxoplasmic encephalitis、トキソプラズマ脳症 cerebral toxoplasosis

・症状

　発熱、頭痛、混乱ｍ、痙攣、認知の障害、局所神経徴候(不全片麻痺、歯垢、脳神経損傷、視野欠損、感覚喪失)(CASES)

・画像検査

　(CT,MRI)多発性、両側性、ring-enhancing lesion、特に灰白質-白質境界、大脳基底核、脳幹、小脳が冒されやすい(CASES)

・鑑別診断(臨床症状・画像診断の所見で)

　リンパ腫、結核、転移性脳腫瘍(CASES)

・病歴と画像所見からの鑑別診断

　リンパ腫、結核、転移性腫瘍

？

このCTがcerebral toxoplasmosisに特徴的かは不明

□最後に残る疑問

　AIDSでWBC(leukocyte)の数はどうなるんだろう？？？AIDSの初診患者ではWBCが低い人が多いらしいし()、HIVはCD4+ T cellとmacrophageに感染して殺すから、これによってB cellは減るだろうし、CD8+ T cellも若干減少するだろうからWBCは減るんじゃないか？！好中球はAIDSとは関係ない？好中球は他の感染症に反応性に増加している？ちなみに、好酸球は寄生虫(原虫)の感染のために増える傾向にあるらしい(HIMのどこか)。

葉酸拮抗剤である。

サルファ剤と併用され、抗トキソプラズマ薬、抗ニューモシチス・カリニ薬として相乗的に働く。

ST 合剤

SMX-TMP

スルファメトキサゾール・トリメトプリム合剤 sulfamethoxazole and trimethoprim mixture

□AIDSの定義(http://en.wikipedia.org/wiki/CDC_Classification_System_for_HIV_Infection_in_Adults_and_Adolescents)

According to the US CDC definition, one has AIDS if he/she is infected with HIV and present with one of the following:

A CD4+ T-cell count below 200 cells/μl (or a CD4+ T-cell percentage of total lymphocytes of less than 14%).

or he/she has one of the following defining illnesses:

01. Candidiasis of bronchi, trachea, or lungs
02. Candidiasis esophageal
03. Cervical cancer (invasive)
04. Coccidioidomycosis, disseminated or extrapulmonary
05. Cryptococcosis, extrapulmonary
06. Cryptosporidiosis, chronic intestinal for longer than 1 month
07. Cytomegalovirus disease (other than liver, spleen or lymph nodes)
08. Encephalopathy (HIV-related)
09. Herpes simplex: chronic ulcer(s) (for more than 1 month); or bronchitis, pneumonitis, or esophagitis
10. Histoplasmosis, disseminated or extrapulmonary
11. Isosporiasis, chronic intestinal (for more than 1 month)
12. Kaposi's sarcoma
13. Lymphoma Burkitt's, immunoblastic or primary brain
14. Mycobacterium avium complex
15. Mycobacterium, other species, disseminated or extrapulmonary
16. Pneumocystis carinii pneumonia
17. Pneumonia (recurrent)
18. Progressive multifocal leukoencephalopathy
19. Salmonella septicemia (recurrent)
20. Toxoplasmosis of the brain
21. Tuberculosis
22. Wasting syndrome due to HIV

People who are not infected with HIV may also develop these conditions; this does not mean they have AIDS. However, when an individual presents laboratory evidence against HIV infection, a diagnosis of AIDS is ruled out unless the patient has not:

undergone high-dose corticoid therapy or other immunosuppressive/cytotoxic therapy in the three months before the onset of the indicator disease
OR been diagnosed with Hodgkin's disease, non-Hodgkin's lymphoma, lymphocytic leukemia, multiple myeloma, or any cancer of lymphoreticular or histiocytic tissue, or angioimmunoblastic lymphoadenopathy
OR a genetic immunodeficiency syndrome atypical of HIV infection, such as one involving hypogamma globulinemia

AND

the individual has had Pneumocystis carinii pneumonia
OR one of the above defining illnesses AND a CD4+ T-cell count below 200 cells/μl (or a CD4+ T-cell percentage of total lymphocytes of less than 14%).

□AIDSのステージング

Revised World Health Organization (WHO) Clinical Staging of HIV/AIDS For Adults and Adolescents (2005)

http://en.wikipedia.org/wiki/WHO_Disease_Staging_System_for_HIV_Infection_and_Disease_in_Adults_and_Adolescents

■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

「気管」

　　[★]

英: trachea (Z), tracheal tube
ラ: trachea
関: 気管支、気管支の分岐、肺

解剖

長さ12cm、直径2cm (HIS.298)。
C6椎体-T5椎体 / C6椎体の下部より始まりT4-T5椎体で左右の気管支に分かれる。)
喉頭の輪状軟骨の直下から始まり主気管支が分岐するところに終わる。 (HIS.298)

粘膜

1呼吸上皮(粘膜上皮)：多列線毛上皮

a. 杯細胞 goblet cell 30%　粘液物質の分泌　ムチンmucin
b. 線毛細胞 ciliated cell 30%　核は基底部に存在　線毛と微絨毛
c. 基底細胞 basal cell 30% 丈の低い細胞、未分化細胞　
d. その他　刷子細胞、漿液細胞、DNES細胞　など

2. 粘膜固有層　疎性結合組織　膠原線維、弾性線維、気管腺（混合腺）
3. 粘膜下組織　密生結合組織　
4. 外膜気管軟骨馬蹄形（C字軟骨）後方に開いている。10-12個

Henry Gray (1825-1861). Anatomy of the Human Body. 1918.
Henry Gray (1825-1861). Anatomy of the Human Body. 1918.
Henry Gray (1825-1861). Anatomy of the Human Body. 1918.