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5/7〜5/19

非常に忙しくて記録が長くできていなかった…
最近診た疾患、勤務時間、学んだことのメモを振り返ってみる

●診た疾患
・RA、SLE, ループス腎炎 →rituximab

●勤務時間
5/7 8時〜23時半
5/8 7時半〜とまり
5/9 とまり〜とまり
5/10 とまり〜23時
5/11 7時〜22時
5/12 8時〜18時

●ふりかえり
・腫瘍・膿瘍に拡散強調画像
・MTX →IP
 リスクファクター
 年齢、DM、アレルギー、肺疾患、タバコ、低Alb・栄養
 0.5%
・ABPA
 アスペルギルスに対して…。血管炎が喘息から発症
・発ガン率
 DM →6倍に。PM →2倍に
 特に卵巣がんの発症率のみ10倍に
・DM、PM、Jo-1陽性だと熱でやすい
・カリニ
 免疫抑制するとコロナイズしやすい→PCR特異度低い
 BFだと感度90%に
・IPの予後
 …%VCが関与。10%の差があると…
・SScにPSLは、強皮症腎を引き起こす、とされる。日本人にはおこりにくいが
・喘息の診断に…
 ステロイドをwash outした後に、吸入改善テスト
 IgE
・膠原病で聞くべきROS
 レイノー、日光過敏症、口内炎、関節炎
・SS →無菌性髄膜炎
・コルヒチン
 好中球の遊走を抑える(細胞骨格にはたらく) →ベーチェットにきく
・進行性多巣性白質脳症
 JCウイルスによる
・高安病、UC、MDL、3つ、合併しやすい
・皮膚症状
 きっちり旅行歴きかないと…
・水痘
 顔にもでる、水泡を伴う紅斑をみたら、一発
・虫刺され
 ひどかったら蜂窩織炎うたがっとかないと…
・PSL
 肝代謝されやすいから点滴なら1.5倍いれないと
・amyopatic DM
二年間、が山場
・DC
 きっちり心臓包めば200でOK
・ステロイドパルス
 3日間やっても副作用はほとんどない
・Steinblocker分類 …リウマチの分類
 T →骨変化なし
 U →変形なし
 V →強直なし
 W →あり
・RA 外来でチェックすべきは
 RAが陽性であれば、RAは活動性を示す
 IgG
 ESR
・APS
 リツキサンで治療は注意…
・SSc
 コラーゲンの増加。分厚くなっていく
 血管内皮細胞も分厚くなっていく
 レイノーは母指にはできない
 T-cell(Th2)が線維芽細胞にとりつき、刺激 
 全身SSc健付着部に聴診器あてておとをきく
  Scl-70  …30%で陽性
 CREST
  セントロメア 70%で陽性
 localized scleoderma
デルマトームにそったもの …顔にでると…
 変化:浮腫→硬化→薄く
   浮腫、のときしかステロイドきかない
   真皮がむくむ
   消化器がむくむと… 吸収不良症候群、気腹症、平滑筋の萎縮と線維化
 RS3PE
  両手がパンパンにはれる。関節痛もある
 NEAZ nonepisodic angio edema
片手がパンパンにはれて、関節炎・痛みなし
 クインケ浮腫
  たらこ唇 NEAZと同じ病態
 
 SScで頭痛と血圧上昇が急にでてきたら… 腎性溶血性貧血でたら… 腎!
 SRC リスク
   Diffuse, 急速な経過、4年以内のSSc、抗RNAポリメラーゼ
   ステロイドで後押し
  ANA 90%
  Ku …SSc、DMのオーバーラップ
・MTX & LC
  アルコールのリスクがとてもたかい!
・マイスリー、アモバン
 依存なく使いやすい
・タクロリムス
 腸管を経ると吸収20%のみ。だいたい
・DVT
 大腿の太さ、左右差>3cmで感度90%
・CIDP
 ギランバレーみたいに麻痺性に…
 慢性炎症性脱髄性多発ニューロパチー
・BNP、FDPは、カットオフポイントが大切…
  感度をとるか、特異度をとるか…
・C4
 遺伝的に低い人もいるのでSLEの評価のとき注意
・ACE
 Crをあげる。でも害はない。輸出、がひろくなるから糸球体の負荷がちいさくなりからあまりでなくなるため
 SLEだと見かけ上の蛋白へって予後よくなる
・巨大Plt
 Pltにとっての網状RBC
・ヘパリンの出血リスク
 健常人、では1.3%
・LCのPltは…脾臓にtrapされる

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