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タイトル A case suggesting the efficacy of camostat mesilate in preventing recurrent pneumonia after total gastrectomy<数学・自然科学>
別タイトル
胃切除術後の繰り返す肺炎の予防にメシル酸カモスタットの有効性が示唆された1例
著者
瀧波, 慶和 (TAKINAMI, Yoshikazu)
Faculty of Education, Saitama University, Department of Emergency Medicine, Tannan Regional Medical Center
内山, 崇 (UCHIYAMA, Takashi)
Department of Emergency Medicine, Tannan Regional Medical Center
熊野, 貴規 (KUMANO, Takanori)
Department of Internal Medicine, Tannan Regional Medical Center
伊藤, 義幸 (ITO, Yoshiyuki)
Department of Internal Medicine, Tannan Regional Medical Center
伊藤 重二 (ITO, Shigeji)
Department of Internal Medicine, Tannan Regional Medical Center
[出版社版]
出版者 埼玉大学教育学部
日付
出版年: 2015 - 2015
作成日: 2015-10-09
更新日
上位タイトル
埼玉大学紀要. 教育学部 (Journal of Saitama University. Faculty of Education). Vol.64, No.2  (2015. ) ,p.251- 255
識別番号
ISSN
18815146
抄録 A 56-year-old man with a history of total gastrectomy for gastric cancer at age 44 visited the internal medicine department of our hospital because of a slight fever (> 37℃ ), chills and cough since the previous night. His white blood cell count was 44,200 cells/μl and C-reactive protein level was 8.4 mg/dl. Plain chest radiography showed opacity in the right upper lung field. Based on these findings, he was diagnosed with pneumonia and hospitalized. He responded to intravenous ceftriaxone sodium hydrate (2 g/day) for 8 consecutive days, and was discharged on hospital day 9. Coughing started again 2 weeks after discharge and he visited our department again 10 days after noticing the cough. Plain chest radiography showed opacity in the right lower lung field and he was diagnosed and hospitalized for the second time with pneumonia 48 days after discharge. He was discharged on hospital day 9 but visited our department again with a complaint of nighttime heartburn 9 days after the second discharge. Bile reflux after total gastrectomy was suspected as the cause of the recurrent pneumonia and oral administration of camostat mesilate (300 mg/day) was started. Although this treatment alleviated the condition, his adherence to the regimen gradually declined 9 months after the second discharge. He visited our department for a third time complaining of fever and coughing 15 months after the second discharge. Pneumonia in the left middle lung field was treated by a 7-day oral course of levofloxacin hydrate (500 mg/day). The importance of oral camostat mesilate was stressed to the patient and instructions on lifestyle changes were given to prevent reflux esophagitis. The patient has not had heartburn or cough since, and recurrence of pneumonia appears to have been prevented. This case suggests that silent aspiration due to esophageal reflux and aspiration pneumonia should be suspected in cases of recurrent fever without cough or sputum after total gastrectomy.
キーワード
total gastrectomy
esophageal reflux
recurrent pneumonia
camostat mesilate
言語
eng
資源タイプ text
ジャンル Departmental Bulletin Paper
著者版フラグ publisher
Index
/ Public / 埼玉大学 / 教育学部
/ Public / ジャンル別 / 研究紀要 / 埼玉大学 / 教育学部紀要
/ Public / 主題別 / 医歯薬学 / 内科系臨床医学
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