4/3（火）
◆今日の気持ち
（膠原病科 1週目）
・電子カルテが初めてな研修医3人＆レジデント1人ではじめてのオーダーを出したとき、感動の声がでた。…おもしろかった
・小さなデータを徹底的に詰めていく。膠原病のあり方は面白い
・新人研修、特にマナー講習はほんとうに無駄だった…。ホテルオークラ関係ということだったけれど、公演料・参加している職員の時給、などを計算すると50万円くらいは無駄がでてたと思う。やめてほしいものだ…
●今の目標
・内科感覚を取り戻す
●今日の新患・診断
・強直性脊椎炎 AS
・RA IP 誤嚥性肺炎
・サルコイドーシス
●今日の病院滞在時間
8時〜23時
●今日行ったこと・見たこと・知ったこと
・血小板減少
消費 …アレルギー（薬・ITP など）
感染症（細菌→DIC、ウイルス）
HPS 血球貪食症候群
脾腫
産生減少 …肝疾患、骨髄疾患（ウイルス感染なども）
・Koebner phenomenon
外から刺激を受けると、疾患固有の現象が皮膚に生じること
・AOSD
除外診断するべきもの。だから、腫瘍随伴症候群（特にALL）をこれとしてしまうことも…
・PSL 5mg = mPSL 4mg と換算
・PR /min と表現！
・ステロイドの副作用のひとつ、偽脳腫瘍
→良性頭蓋内圧亢進症
頭痛・嘔吐・うっ血乳頭などの頭蓋内圧亢進が見られるが、脳腫瘍も明らかな異常も見られない脳血流量増加・脳浮腫・髄液還流異常によるのか？ 圧倒的に、肥満な女性に多い
・ネフローゼ治療
カンカイに導入できたら、PSL 10〜15mgでの維持を目指す
4型のevidenceしかない。5型の治療は…
・FK506（タクロリムス） …LNに今年適応になった
・IgG補充 300〜600mg/kg
アナフィラキシーがおきやすいのでゆっくりと
２〜３週が半減期
免疫抑制やるなら事前にあげておかないと…
・Schober test
腰を曲げてどれくらい伸びるか
・ASにMTX ほとんどevidenceない
・震戦
パーキンソニズム？ 甲状腺？
・関節チェック
腫脹は〇、疼痛は×
コメント
What a lovely day for a 4404996! SCK was here
投稿者: 4404996 | 2011年03月31日 21:22
What a lovely day for a 3654624! SCK was here
投稿者: 3654624 | 2011年03月31日 22:46
What a lovely day for a 2592618! SCK was here
投稿者: 2592618 | 2011年03月31日 23:35
What a lovely day for a 1100995! SCK was here
投稿者: 1100995 | 2011年04月01日 01:39
What a lovely day for a 3587781! SCK was here
投稿者: 3587781 | 2011年04月02日 19:27
Today, I went to the beach front with my children. I found a sea shell and gave it to my 4 year old daughter and said "You can hear the ocean if you put this to your ear." She put the shell to her ear and screamed. There was a hermit crab inside and it pinched her ear. She never wants to go back! LoL I know this is completely off topic but I had to tell someone!
投稿者: ipod touch free | 2011年04月03日 09:05
Someone Sometimes with visits your blog regularly and advised it to me to read too. The way of writing is excellent and the content is top-notch. Thanks for the information you provide the readers!
投稿者: Solar Energy for home | 2011年04月04日 21:44
Buying AUTO INSURANCE? New, FREE service compares quotes to get you the best and cheapest policy. Buy Car Insurance
投稿者: Dakota Rolark | 2011年04月05日 02:55
Some genuinely interesting information, well written and broadly speaking user friendly .
投稿者: Laine Furnia | 2011年04月05日 07:17
This is a great blog. Thanks for all of your effort and also the info you give.
投稿者: Solar Panels For Home | 2011年04月05日 14:25
Hey compaﾃｱero, realmente tenido gusto este poste. Can' t parece conseguirlo para dar formato a la derecha en Internet Explorer, se dobla todo para arriba, pero no trabaja muy bien en Firefox tan ninguna preocupaciﾃｳn.
投稿者: cleaners | 2011年04月06日 09:49
Couldnt be written any better. Reading this post reminds me of my old room mate! He always kept talking about this. I will forward this article to him. Pretty sure he will have a good read. Thanks for sharing!
投稿者: hawaii vacation all inclusive | 2011年04月06日 16:25
Nice post. I was checking continuously this blog and I'm impressed! Very useful information particularly the last part :) I care for such information a lot. I was looking for this certain info for a long time. Thank you and best of luck.
投稿者: program tv | 2011年04月06日 20:06
First off I want to say wonderful blog! I had a quick question that I'd like to ask if you don't mind. I was interested to know how you center yourself and clear your mind prior to writing. I've had a difficult time clearing my mind in getting my thoughts out. I truly do enjoy writing but it just seems like the first 10 to 15 minutes are wasted simply just trying to figure out how to begin. Any recommendations or tips? Many thanks!
投稿者: free ipod touch | 2011年04月12日 13:12
Good job over again. I am looking forward for more updates!
投稿者: biżuteria | 2011年04月13日 19:13
What a lovely day for a 1613763! SCK was here
投稿者: 1613763 | 2011年04月14日 00:01
I've recently been thinking the similar point myself recently. Glad to see someone on the same wavelength! Nice article.
投稿者: practice tests | 2011年04月14日 03:08
I think that is one of the such a lot significant info for me. And i'm satisfied reading your article. However want to commentary on few basic things, The web site taste is great, the articles is really nice : D. Excellent activity, cheers
投稿者: dog lover | 2011年04月14日 15:09
I have read a few of the articles on your website now, and I really like your style of blogging. I added it to my favorites blog site list and will be checking back soon. Please check out my site as well and let me know what you think.
投稿者: reliable hosting | 2011年04月14日 15:31
Interesting , how would I use this?
投稿者: Pflegetipps fﾃｼr Uhren | 2011年04月15日 20:54
Heya this is a excellent article. I'm going to e-mail this to my pals. I stumbled on this while browsing on google I'll be sure to come back. thanks for sharing.
投稿者: buy viagra online no prescription | 2011年04月16日 09:31
Valuable info. Lucky me I discovered your web site accidentally, and I'm stunned why this accident did not took place earlier! I bookmarked it.
投稿者: bench press shirt | 2011年04月16日 09:36
Here窶冱 a comment. Great advice =) Thanks
投稿者: Juan Curless | 2011年05月30日 05:31
The publish is unquestionably the freshest on this treasured topic. I concur collectively with your conclusions and may eagerly look forward to your future updates. Saying thanks received窶冲 simply be passable, for the nice lucidity in your writing.
投稿者: naked muscle women | 2011年06月02日 09:19
Let me start by saying great publish. Im not certain if it has been talked about, but when using Chrome I can never get the entire internet site to load without refreshing many times. Could just be my computer. Thanks.
投稿者: charice pempengco latest news | 2011年06月08日 04:08
I窶囘 come to go along with with you here. Which is not something I typically do! I really like reading a post that will make people think. Also, thanks for allowing me to speak my mind!
投稿者: Chet Archilla | 2011年06月09日 10:51
That is my initial time i pay a visit to here. I identified a lot of entertaining stuff within your blog, specially its discussion. From the tons of feedback on your articles, I guess I am not the just one getting every one of the satisfaction right here! Keep up the great function.
投稿者: waterjet cutting machine | 2011年06月10日 17:34