type: misc

label: url

en: 【最新の骨粗鬆症学(第2版)-骨粗鬆症学の最新知見-】続発性骨粗鬆症の診断と治療 抗悪性腫瘍薬に伴う骨粗鬆症

en: 日本臨床

ja: 日本臨床


en: 【最新の骨粗鬆症学(第2版)-骨粗鬆症学の最新知見-】続発性骨粗鬆症の診断と治療 抗悪性腫瘍薬に伴う骨粗鬆症(解説)


en: 【骨髄腫と類縁疾患-全身をみわたす診断・治療】Overview 多発性骨髄腫の発症・進展機序

en: <文献概要>▼多発性骨髄腫(MM)はゲノム不安定性や遺伝子プロモーターのメチル化などのepigeneticな制御の異常に加え多段階の分子遺伝学的異常により,意義不明の単クローン性ガンマグロブリン血症(MGUS)を経て発症・進展する.▼MMの発症原因は不明であるが,疫学調査により性差,地域差,人種差,遺伝学的要因,被曝歴,年齢との関連が示唆されている.▼全ゲノム解析やマウスモデル,腸内細菌叢の解析などからMMのさまざまな発症機序が推測されている.

en: Internal Medicine

ja: 臨床雑誌 内科


en: 【腎臓症候群(第3版)-その他の腎臓疾患を含めて-】各種病態にみられる腎障害 造血器疾患 多発性骨髄腫

en: Nihon Rinsho. Japanese Journal of Clinical Medicine

ja: 日本臨牀


en: 【骨粗鬆症 最新の知見に基づいた治療薬の考え方・使い方】薬剤性骨粗鬆症に対するマネジメントの勘所 がん治療に伴う骨粗鬆症

en: <Key Points>◎がん治療およびがん治療の支持療法に使用する多くの薬剤が直接または間接的に骨吸収を亢進し骨喪失を来す．◎特に内分泌療法や造血幹細胞移植などのがん治療では急速に骨喪失がもたらされる．◎がん治療に伴う骨粗鬆症はQOLの低下や予後の悪化を来す．◎がんの治療と並行しがん治療に伴う骨粗鬆症に対する適切なスクリーニングと予防および治療を行う．(著者抄録)

en: The Journal of Practical Pharmacy

ja: 薬局


en: 【続発性骨粗鬆症-診断と対策-】移植医療と骨粗鬆症

ja: 【続発性骨粗鬆症-診断と対策-】移植医療と骨粗鬆症

en: 移植医療によって臓器不全の予後は飛躍的に向上しつつあるが，その一方で移植後の合併症の予防，対策の重要性が増している．骨粗鬆症とそれによる骨折は，移植医療における頻度の高い合併症であるが，その実態の解析は十分ではない．移植前の患者個々の背景因子や原疾患の病態，治療に伴う骨障害に加え，移植医療に伴うカルシニューリン阻害薬，ステロイドなどの免疫抑制薬の長期投与など，種々の要因が影響し，移植後骨粗鬆症が発症する．ビスフォスフォネートやビタミンDなどを早期から投与することにより，骨折を防ぎ移植後のQoLを維持することが重要である．(著者抄録)

en: THE BONE

ja: THE BONE


en: 骨病変/局所病変の管理 (特集 多発性骨髄腫診療の新時代を迎えて--診断と治療に吹き込む「新しい風」) -- (多発性骨髄腫の合併症の管理)

en: 骨髄腫骨病変は，患者のQOLを大幅に低下させるだけでなく，放置すれば高カルシウム血症や脊髄圧迫などをきたし予後を悪化させる．・全身の骨単純X線写真(skeletal survey)で骨病変を評価する．MRIやPET/CTは病変の検出感度が高いため，これらを組み入れた評価が有用である．・骨病変の治療は，抗腫瘍療法が基本であるが，補助療法としてビスホスホネートの点滴投与を反復する．顎骨壊死や腎障害に対する予防策を行う．また，局所の疼痛に対し放射線照射や椎体形成術などが有用である．・高カルシウム血症は，進行例に出現する緊急性を要する病態である．初期には特徴的な症状がなく消化器症状や脱水症状からはじまり，腎不全や意識障害をきたす．(著者抄録)

en: 内科

ja: 内科


en: Development of adult T-cell leukemia/lymphoma during immunosuppressive Therapy for human T-cell leukemia virus type 1 associated arthropathy

ja: リウマチ様関節炎に対する免疫抑制療法中に発症した成人T細胞性白血病/リンパ腫の1例

en: A 64-year-old woman presented with lower leg edema, fever, and bilateral joint pain, involving the wrists, fingers, and knees, in April 201X. Serological test results were negative for rheumatoid factor, antinuclear antibody, and anti-cyclic citrullinated peptide antibody. A diagnosis of remitting seronegative symmetrical synovitis with pitting edema syndrome, a type of seronegative rheumatoid arthritis, was made and prednisolone was administered. The joint pain was refractory to prednisolone therapy. In February, 201X+2, the patient presented with right cervical lymphadenopathy. The CT scan revealed swelling of the cervical, axillary, and inguinal lymph nodes bilaterally and rapidly enlarged. In April, 18F-fluorodeoxyglucose PET/CT scan showed an abnormal collection in the enlarged lymph nodes. The patient subsequently developed hoarseness with dyspnea and attended our department. Blood test results showed high levels of lactate dehydrogenase (547U/L) and soluble interleukin‐2 receptor (34200 IU/L) and were positive for anti-human T-cell leukemia virus type1 (HTLV‐1) antibody. Biopsy of the right cervical lymph node showed proliferation of abnormal lymphoid cells positive for CD3, CD4, and CD25 and negative for CD7. Monoclonal integration of HTLV‐1 proviral DNA was detected in the lymph node. A diagnosis of adult T-cell leukemia/lymphoma (ATLL), lymphoma type was made. The pain involving multiple joints was attributed to HTLV‐1associated arthropathy. Immunosuppressive therapy for HTLV‐1 carrier status may have played a role in the development of ATLL.

en: Shikoku Acta Medica

ja: 四国医学雑誌


en: Clinical evaluation of pharmacist interventions in patients treated with anti-methicillin-resistant Staphylococcus aureus agents in a hematological ward

en: The therapeutic effects of anti-methicillin-resistant Staphylococcus aureus (MRSA) agents, vancomycin (VCM), teicoplanin (TEIC), and arbekacin (ABK), depend on their concentrations in blood. Therefore, therapeutic drug monitoring (TDM) is important when these antibiotics are used. In the hematological ward at Tokushima University Hospital, pharmacists have ordered the measurement of blood VCM, TEIC, and ABK concentrations to promote the use of TDM in accordance with an agreed protocol since 2013. Moreover, the infection control team includes several medical disciplines and has advised on the optimal treatment using VCM, TEIC, and ABK since 2013. This study aimed to investigate the clinical effectiveness of these pharmacist interventions. We retrospectively studied 145 cases in which patients were treated with VCM, TEIC, or ABK between January 2012 and December 2013 in the hematological ward at Tokushima University Hospital. The patients were divided into a control group (71 cases) and an intervention group (74 cases), and their clinical outcomes were compared. The rate of achievement of effective drug concentrations significantly increased in the intervention group (74%), compared to the rate in the control group (55%). Moreover, univariate and multivariate Cox proportional hazard regression revealed that pharmacist intervention and appropriate concentrations of anti-MRSA agents were independent factors associated with reduced hospitalization periods in patients with lymphoma. Our study revealed that proactive pharmacist intervention may improve the therapeutic effect of anti-MRSA agents in hematology ward patients.

en: Biological & Pharmaceutical Bulletin

ja: Biological & Pharmaceutical Bulletin


en: Human immunodeficiency virus-positive secondary syphilis mimicking cutaneous T-cell lymphoma.

en: Malignant syphilis or lues maligna is a severe form of secondary syphilis that was commonly reported in the pre-antibiotic era, and has now reemerged with the advent of the human immunodeficiency virus (HIV) epidemic. However, the characteristic histopathological findings of malignant syphilis remain controversial. The aim of this case report was to clarify the clinical and histopathological findings of HIV-positive malignant secondary syphilis. A Japanese man in his forties complained of fever, skin lesions, headache, and myalgia without lymphadenopathy during the previous 4 weeks. The skin lesions manifested as erythematous, nonhealing, ulcerated papules scattered on his trunk, extremities, palm, and face. Although the skin lesions were suspected to be cutaneous T-cell lymphomas on histological analyses, they lacked T-cell receptor Jγ rearrangement; moreover, immunohistochemical analyses confirmed the presence of spirochetes. The patient was administered antibiotics and anti-retroviral therapy, which dramatically improved the symptoms. On the basis of these observations of the skin lesions, we finally diagnosed the patient with HIV-associated secondary syphilis that mimicked cutaneous T-cell lymphoma. The patient's systemic CD4+ lymphocyte count was very low, and the infiltrate was almost exclusively composed of CD8+ atypical lymphocytes; therefore, the condition was easily misdiagnosed as cutaneous lymphoma. Although the abundance of plasma cells is a good indicator of malignant syphilis on skin histological analyses, in some cases, the plasma cell count may be very low. Therefore, a diagnosis of malignant secondary syphilis should be considered before making a diagnosis of primary cutaneous peripheral T-cell lymphoma or lymphoma associated with HIV infection.

en: Diagnostic Pathology

ja: Diagnostic Pathology