尿閉解除後の肺塞栓/リアルに後輩に会う
・医学のCase Report読んでいると、「あら、まあ、こんなことがあるのね。」という感想を持つことがよくあります。今回は、尿閉がよくなったと思ったら肺塞栓が起こってしまったというお話↓
Pulmonary Embolism after Relief of Urinary Obstruction
Sumie Sakamoto, Sho Sasaki, Kazuhiro Okamura, Kiichiro Fujisaki
Intern Med 61: 1625, 2022
・拡張した膀胱が下大静脈を圧排して、それによって静脈に血栓ができて、その圧排が解除されて血栓が肺までいっちゃったということですね。尿閉解除後の血圧低下は血管迷走神経反射だけではなくて、こういう病態も考えないといけないのですね。しかし、なかなか思いつきません、少なくとも私は。
・あと、まったく関係無いですが、最新のNEJMに喘息の治療に関する論文が出ておりました。ちょっときょうみあるので早いうちに読んでおこうと思います。
Albuterol–Budesonide Fixed-Dose Combination Rescue Inhaler for Asthma
Alberto Papi, et al.
NEJM May 15, 2022 DOI: 10.1056/NEJMoa2203163
Abstract
BACKGROUND
As asthma symptoms worsen, patients typically rely on short-acting β2-agonist (SABA) rescue therapy, but SABAs do not address worsening inflammation, which leaves patients at risk for severe asthma exacerbations. The use of a fixed-dose combination of albuterol and budesonide, as compared with albuterol alone, as rescue medication might reduce the risk of severe asthma exacerbation.
METHODS
We conducted a multinational, phase 3, double-blind, randomized, event-driven trial to evaluate the efficacy and safety of albuterol–budesonide, as compared with albuterol alone, as rescue medication in patients with uncontrolled moderate-to-severe asthma who were receiving inhaled glucocorticoid-containing maintenance therapies, which were continued throughout the trial. Adults and adolescents (≥12 years of age) were randomly assigned in a 1:1:1 ratio to one of three trial groups: a fixed-dose combination of 180 μg of albuterol and 160 μg of budesonide (with each dose consisting of two actuations of 90 μg and 80 μg, respectively [the higher-dose combination group]), a fixed-dose combination of 180 μg of albuterol and 80 μg of budesonide (with each dose consisting of two actuations of 90 μg and 40 μg, respectively [the lower-dose combination group]), or 180 μg of albuterol (with each dose consisting of two actuations of 90 μg [the albuterol-alone group]). Children 4 to 11 years of age were randomly assigned to only the lower-dose combination group or the albuterol-alone group. The primary efficacy end point was the first event of severe asthma exacerbation in a time-to-event analysis, which was performed in the intention-to-treat population.
RESULTS
A total of 3132 patients underwent randomization, among whom 97% were 12 years of age or older. The risk of severe asthma exacerbation was significantly lower, by 26%, in the higher-dose combination group than in the albuterol-alone group (hazard ratio, 0.74; 95% confidence interval [CI], 0.62 to 0.89; P=0.001). The hazard ratio in the lower-dose combination group, as compared with the albuterol-alone group, was 0.84 (95% CI, 0.71 to 1.00; P=0.052). The incidence of adverse events was similar in the three trial groups.
CONCLUSIONS
The risk of severe asthma exacerbation was significantly lower with as-needed use of a fixed-dose combination of 180 μg of albuterol and 160 μg of budesonide than with as-needed use of albuterol alone among patients with uncontrolled moderate-to-severe asthma who were receiving a wide range of inhaled glucocorticoid-containing maintenance therapies. (Funded by Avillion; MANDALA ClinicalTrials.gov number, NCT03769090. opens in new tab.)
以下日記
・昨日5/16（月）は、5時29分起床。朝勉して午前中はZOOMで因果推論の勉強会。午後から出勤して回診、夜間診療。外来前に、ある治りが悪い患者さんのことで大病院の呼吸器科の先生に相談。自分の治療が間違ってないことと、困ったら受け入れてくれるというお話でホッとしました。帰宅は19時37分。ネコたちに餌屋ってお風呂入って夕食。寝床で↓を読み切りました。阿川佐和子のエッセイ、おもろいどす。
- 阿川 佐和子
- 文藝春秋
- 2021/04/06
・本日5/17（火）は5時44分起床。朝勉はせず朝食摂ってサッサと病院へ、7時半前着。病棟に寄って、朝礼出て午前外来。いつもになく外来が早く終わったので病棟へ。それから昼食とって13時過ぎ病院を出て鴨方駅へ。駅前駐車場に車止めて一路鹿田キャンパスへ。14時半頃大学について学務部へ、学位申請書類の「添削」を返してもらって疫学・衛生学教室へ。そこで書類訂正してから、cirtical appraisalへ参加。その後後輩何人かとご挨拶。（コロナが流行してから実際に後輩に会うことがありませんでした）その後寄り道もせず一路帰宅。なんと17時39分と明るいうちに帰宅完了。ネコたちに餌やって事務的な作業。夕食とって、英語の本訳して入浴。そしてこのブログを書いております。明日も早く起きてはやく病院に行きたいと思いますので、22時前に寝ます。今日は寝床で芥川龍之介ですね。
