＜論文紹介：NEJM 2019;381:1059-1067.他＞

1456

NEJMがとても役立ちますよ、ということを以前お話ししましたが、
最新号の“Case Records of the MGH”を紹介します。

「Case 28-2019: A 22-Year-Old Woman with Dyspnea and Chest Pain.（NEJM 2019;381:1059-1067.）」

とても深いですね。
鑑別疾患や本病態の解説は学ぶところが多いです。


ついでに、最近のNEJM論文も紹介します。

「CLINICAL PROBLEM-SOLVING: A Terminal Event.（NEJM 2019;381:970-976.）」

画像的にも臨床的にも大変興味深く、勉強になる症例です。
実臨床で、かなり困って二転三転しているのがよくわかります。



「ORIGINAL ARTICLE: Inhaled GM-CSF for Pulmonary Alveolar Proteinosis.（NEJM 2019;381::923-932.）」

日本発の原著論文です。
軽症～中等症の肺胞蛋白症に対するGM-CSF吸入治療に関して検討されています。

Pulmonary alveolar proteinosis is a disease characterized by abnormal accumulation of surfactant in the alveoli. Most cases are autoimmune and are associated with an autoantibody against granulocyte–macrophage colony-stimulating factor (GM-CSF) that prevents clearing of pulmonary surfactant by alveolar macrophages. An open-label, phase 2 study showed some therapeutic efficacy of inhaled recombinant human GM-CSF in patients with severe pulmonary alveolar proteinosis; however, the efficacy in patients with mild-to-moderate disease remains unclear.

In this randomized, controlled trial, inhaled recombinant human GM-CSF was associated with a modest salutary effect on the laboratory outcome of arterial oxygen tension, and no clinical benefits were noted.





他のNEJM関連は、こちら。
（かなり数がたまったので今後はリンクははりません。ご了承ください。
内容を記載しますので、ご関心があればリンク先アドレスをコピペしてご参照ください。）

（https://ocu-radiology.jp/news/news-2464/）：
Pregnant woman with Acute suppurative appendicitis and periappendicitis.
Pheochromocytoma and Paraganglioma.
Drug-Induced Liver Injury.
New Guidelines for Statistical Reporting in the Journal.

（https://ocu-radiology.jp/news/news-2436/）：
Leber’s hereditary optic neuropathy.
Kelch-like Protein 11 Antibodies in Seminoma-Associated Paraneoplastic Encephalitis.
Intestinal tuberculosis.

（https://ocu-radiology.jp/news/news-2403/）：
Anaplastic carcinoma arising in association with intestinal-type mucinous carcinoma of the ovary.
（いわゆる　Mucinous cystic tumours with mural nodules）
West Nile virus encephalitis/West Nile virus meningoencephalitis.

（https://ocu-radiology.jp/news/news-2371）：
Systemic lupus erythematosus.
Contrast-Associated Acute Kidney Injury.
Mesenchymal Hamartoma of the Liver and DICER1 Syndrome.
Metastatic postpubertal immature teratoma.
Machine Learning in Medicine.

（https://ocu-radiology.jp/news/news-2148/）：
Idiopathic pulmonary fibrosis.
Pulmonary alveolar proteinosis.
Mucinous Ovarian Carcinoma.
Ocular syphilis.

（https://ocu-radiology.jp/news/news-2115/）：
Herpes simplex virus lymphadenitis, Chronic lymphocytic leukemia.
Perforation of the sigmoid colon by a foreign body (toothpick) that caused a fistula to the right common iliac artery.
Powassan virus encephalitis.

（https://ocu-radiology.jp/news/news-2037/）：
Papulonecrotic tuberculid (cutaneous tuberculosis).
Hepatobiliary Tuberculosis.
Sudden death caused by pulmonary fat embolism in a patient with miliary tuberculosis.

（https://ocu-radiology.jp/news/news-1974/）：
眼窩領域Granulomatosis with polyangiitis, Susac’s syndrome.
Clostridium perfringens bacteremia with a hepatic abscess.
Osteoblastic and Osteolytic Spine Metastases by Using SWI.

（https://ocu-radiology.jp/news/news-1921/）：
The t(6;11) TFEB translocation variant of renal-cell carcinoma.
比較的新しい病理組織概念でUncommonな腎腫瘤の復習.

（https://ocu-radiology.jp/news/news-1901/）：
Pulmonary adenocarcinoma, hypercoagulable state with nonbacterial thrombotic endocarditis.
BK Virus–Progressive Multifocal Leukoencephalopathy.

（https://ocu-radiology.jp/news/news-1843/）：
Anti–N-methyl-d-aspartate (NMDA) receptor encephalitis.
The drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, associated with human herpesvirus 6.
Acute Viral Encephalitis. 特にarbovirus encephalitisについて.

（https://ocu-radiology.jp/news/news-1793/）：
Vitamin C deficiency (scurvy).“bachelor scurvy”
Vitamin B6, folate, zinc, and selenium deficiencies.
Alcohol-use disorder.
Multiple vitamin deficiencies.

（https://ocu-radiology.jp/news/news-1681/）：
Polyarteritis nodosa. HBVとの関連.

（https://ocu-radiology.jp/news/news-1605/）：
Membranous nephropathy, PLA2R type. IgG4との関連性など.
Idiopathic Pulmonary Fibrosis.

（https://ocu-radiology.jp/news/news-1588/）：
Giant-cell myocarditis.
Takotsubo cardiomyopathy and catecholamine-induced crisis due to pheochromocytoma.
Fulminant Myocarditis with Combination Immune Checkpoint Blockade.

（https://ocu-radiology.jp/news/news-1462/）：
Homocystinuriaの様々な表現型：Cystathionine β-synthase deficiency, Methylenetetrahydrofolate reductase deficiency.
Primary Sjögren’s Syndrome.
Antibody-Mediated Encephalitis.

（https://ocu-radiology.jp/news/news-1374/）：
Immune-Related Adverse Events Associated with Immune Checkpoint Blockade.
Multiple Sclerosis. Neuromyelitis Optica Spectrum Disorders.
Adenovirus infection, disseminated.

（https://ocu-radiology.jp/news/news-1253/）：
Biotin–thiamine–responsive basal ganglia disease.

（https://ocu-radiology.jp/news/news-1109/）：
好酸球増多症（Eosinophilia）について.

（https://ocu-radiology.jp/news/news-897/）：
Copper deficiency. Zincとの関連.

（https://ocu-radiology.jp/news/news-891/）：
Takayasu’s arteritis.
Atypical immunoblastic reaction that was consistent with primary Epstein–Barr virus infection.

（https://ocu-radiology.jp/news/news-783/）：
NEJMの紹介、Case Recordsの変遷についての私見.