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4/15メモ

●脾臓摘出後
・見つけ次第肺炎球菌ワクチン投与
・アメリカガイドラインなら5年おき投与が原則
・日本の添付文書では再接種は認められていない
 理由は、「注射部位の疼痛、紅斑、硬結等の著しい副反応が起こる可能性があるため」
  …別に、アナフィラキシー並のことが想定されているわけではない。
・日本も脾臓摘出後なら肺炎球菌ワクチンは保健範囲内
・9年たっても効果は変わらないという報告もある

●便秘
・便秘の女性はまず痔をききだし、一ヶ月徹底的にポステリザン軟膏などで治療しろ。 …朝リラックスできない子どものいる母親とかなりやすいんだよね
・プリンペラン
 ナウゼリン …安全。けれど、毎日飲ませると錐体外路症状が…
・ラキソベロン 安全
 プルゼニドは習慣性あり、弛緩性便秘も惹起する
・弛緩性、痙攣性、直腸性、気質性、症候性、薬剤性 をきちんと見分けろ
・痙攣性(過敏性、IBS)は腹痛を伴うのが特徴
 兎糞状、も特徴
・納豆、は、コソウ菌含まれているし、繊維質多いし、いい! 毎食出してもOK
・乳酸菌はentercoccus

●気管支角
 右系の腫大を示す(左は無関係!)
 →角がひろがっていなかったら、左の疾患を考える

●BPPV経過
1〜2ヶ月治療にはかかるよ

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