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函館稜北病院総合診療科抄読会B面

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。

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)

参加人数:4名+1名(文書参加)

引用箇所:

  • 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.