毎週木曜日5:30PMから30分間、Clinical Problem-Solvingを素材にクリニカル・パールを拾い集めます。

Chicago Med I-3 "Fallback"

タイトルの "Fallback" は、「頼みの綱」としての "Surgical Navigation Advanced Platform" と御主人にプレドニゾロンを盛ってまで軍役から「退却」してもらおうとした奥様の犯罪とを掛けたのでしょうか。奥様の嘘を暴いた Dr. Daniel Charles のセリフ。

To lie well, you have to loosen up.

You know, make eye contact, stuff like that.



Chicago Med I-2 "iNO"



“What’s the difference between doctors and God? God knows he’s not a doctor.”

それに対して、医者は出来ることと出来ないことの区別する分別がつけられない、ということを言いたいのでしょう。深読みをすれば、タイトルの "iNO" は "I KNOW" と掛けたのか?






【日時】 毎週月曜日 17:00〜17:30 次回は、4月17日(月)とします。

【課題】 従来は、気になったところの抜粋を持ち寄って頂きましたが、


【当日】 各人が持ち寄った要約をワークショップ形式で、


【事後】 まとめたテキストを FromTextToSpeech.com のサービスを利用し、





第50回:"Wasting Away"

今回の "Wasting Away" というタイトルは、「衰弱する」と「浪費する」という2つの意味を掛けたタイトルでした。その意味を汲めば、難しい日本語だが、「枯槁憔悴(ここうしょうすい)」という訳にでもなりましょうか。

Word Count:3224語 (Time:  16'06'', 200 wpm)



  • The administration of calcitriol is also indicated to increase phosphate levels through several mechanisms. This approach was successful in our patient, with resolution of her pain, muscle weakness and wasting, and electrolyte abnormalities and amelioration of the bone loss caused by urinary electrolyte wasting.
  • Phosphate redistribution into bone occurs in the “hungry bone” syndrome, in which the decrease in parathyroid hormone levels after parathyroidectomy for primary hyperparathyroidism leads to the rapid deposition of calcium and phosphate (in the form of hydroxyapatite) into undermineralized bone within an expanded remodeling space.
  • Her HBV infection increases her risk of polyarteritis nodosa, which could explain the fatigue, weight loss, weakness, and abdominal pain.
  • The clinical manifestations of hypophosphatemia are rarely apparent until phosphate levels fall below 1 mg per deciliter. Common symptoms and signs include fatigue, proximal myopathy, dysphagia, ileus, and impaired cardiac contractility. There may be involvement of the central nervous system, which can result in irritability, delirium, or coma. Hemolysis and impaired granulocyte function have also been described. Finally, chronically low serum phosphate levels lead to a reduction in bone-mineral deposition, which can lead to rickets in childhood and osteomalacia in adulthood. Rickets is associated with stunted linear growth and bone deformities. In adulthood, bone deformities are rare, but widespread bone pain may occur. Gait abnormalities attributable to pain with weight-bearing ambulation are common.

Chicago Med I-1 "Derailed"

昨日から放映が始まった "Chicago Med"、"ER" 後、なかなか気に入る医療ドラマが現れなかったが、今回は期待が持てそう。時代的には、ERのグリーン先生のお嬢さんが メディカル・スクール4年生のサラ・リースといったところか。(もちろん別ドラマ、別人なのだが)



Leñador 1: ¡Ay muerte mala! ¡Deja para el amor la verde rama!

あぁ、不幸な死よ! 愛に緑の枝を接げよ!


第49回:"Histology Rings True"

今回は、"ring true"という熟語と"fibirin ring granuloma"という組織パターン名を掛けたタイトルでした。その意味を汲めば、「実質臓器が語る真実」という訳にでもなりましょうか。

Word Count:2927語 (Time:  10'16'', 285 wpm)



  • Jaundice and dark urine raise suspicion for cholestasis, which can be intrahepatic (caused by infection or lymphoma, for example) or extrahepatic (caused by choledocholithiasis, for example). Given the patient’s fever, the first priority is to rule out obstruction of the biliary tree and cholangitis. Jaundice and dark urine (hemoglobinuria) also occur in cases of acute intravascular hemolysis, such as autoimmune hemolytic anemia, malaria, or Clostridium perfringens bacteremia.
  • Fibrin-ring granulomas are characterized by granulomatous inflammation with a central fat vacuole and surrounding ring of fibrin. They are suggestive but not pathognomonic of Q fever; in one series, 10 of 23 patients (43%) with fibrin-ring granulomas were shown to have this infection. Fibrin-ring granulomas have also been described in visceral leishmaniasis, toxoplasmosis, EBV hepatitis, and allopurinol hypersensitivity.
  • ANA has been reported in 12 to 35% of patients with Q fever, and anti–smooth muscle antibodies have been reported in 30 to 65%. Rheumatoid factor, antineutrophil cytoplasmic antibodies, and anti–double-stranded DNA antibodies have also been reported in some patients.

第48回:"Unfolding the Diagnosis"

 今回は、Ménétrier病。その胃襞を伸ばすが如く、診断もその背景のウイルス感染まで展開しましょうということなのでしょう。今年2月23日号のNEJM誌金沢医科大学発生発達医学部門 犀川太教授と秋田千里助教の報告があり、そのCT画像の胃は、まるで女性が身につけるシュシュのような印象的写真でした。

Word Count:2387語 (Time:  13'09'', 182 wpm)



  • Our patient presented with a clinical picture of viral infection and severe epigastric pain. Because he had ingested high doses of NSAIDs to control his fever, NSAID-induced gastritis was initially suspected as the cause of his abdominal pain. However, the finding of severe hypoalbuminemia was not easily explained by either viral infection or his NSAID use. The identification of this abnormality led to reconsideration of the working diagnosis and a shift from a “probability approach” (identifying the most likely diagnosis) to a “causal reasoning” approach (looking for clinical conditions that could underlie this finding as well as the other presenting symptoms and signs).
  • Ménétrier's disease affects men more often than women and is most common between 40 and 55 years of age. Clinical manifestations of the disease include epigastric pain, weight loss, nausea, vomiting, gastrointestinal bleeding, diarrhea, and protein-losing gastropathy. Hypoalbuminemia is present in 20 to 100% of patients, according to a different series; this feature helps distinguish Ménétrier's disease from the Zollinger–Ellison syndrome.