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< がっかりだよ，ハリソン | メイン | 金貨の作り方 >
2008.10.11 23:30 |  診療  |  その他（医療関連）  |  ミチバ  | 推薦数 : 1

後腹膜線維症・・・逆引き薬の副作用辞典ないかしら？

・以前2004年5月1日のランセットに，石綿が後腹膜線維症のリスクファクターですよといった論文が載っていることをこのブログで書きました．

・改めて，後腹膜線維症について教科書の記載を調べてみました．医学書院の医学大辞典では，特発性が多いと書かれていますが，個別の原因は書かれていません．私の持っている朝倉書店の内科学（第八版）には，牽引に後腹膜線維症がありません．新臨床内科学（第八版）には，腎・尿路疾患の所（1402ページ）に，「突発性後腹膜線維症は原因不明のまれな疾患で，中年以降の男性に多い．」という記載があります．「突発性」は「特発性」の誤植でしょう．標準泌尿器科学（第７版）には，牽引に載っていません．さて，期待のハリソンはどうか？牽引でretroperitoneal fibrosisをみると，４カ所ありました．まずは，DISEASES OF THE AORTA:ETIOLOGY AND ASSOCIATED FACTORSという一覧表にあり．次に，急性腎不全の原因（Postrenal ARF）の一覧表にあり．同様にCOMMON MECHANICAL CAUSES OF URINARY TRACT OBSTRUCTIONという一覧表と本文での説明．それから，sclerosing chlangitisの合併症としての記載．残念ながら独立して，後腹膜線維症自体の記述はありませんでした．忍者部隊月光の最後の手段の拳銃と同様(何言ってんだか，分かります？），UpToDateをみてみると．すばらしいっ！高い金はらっているだけあると思いました．きちんと独立した記載があり，原因がいっぱい挙げられています．下の表は，その引用．

 Examples
DrugsMethysergide, pergolide, bromocriptine, ergotamine, methyldopa, hydralazine, analgesics, β-blockers
Malignant diseasesCarcinoid, Hodgkin's and non-Hodgkin's lymphomas, sarcomas, carcinomas of the colon, prostate, breast, stomach
InfectionsTuberculosis, histoplasmosis, actinomycosis
RadiotherapyTesticular seminoma, colon carcinoma, pancreatic carcinoma
SurgeryLymphadenectomy, colectomy, hysterectomy, aortic aneurysmectomy
Others

Histiocytoses, Erdheim-Chester disease, amyloidosis, trauma, barium enema

 

 

 

 

・しかーしっ！何で，アスベストが無いんじゃっ！不満だーっ！

・Be cool と自分に言いかせて．．．今回何で後腹膜線維症のことを書こうと思ったかというと，厚生労働省医薬食品局安全対策課から，『「使用上の注意」の改訂について』という文書が回ってきたからです．その中に，メシル酸ジヒドロエルゴトキシン，カベルゴリン，メシル酸ベルゴリドという薬に副作用として後腹膜線維症が報告されていると言った記載があったからです．恥ずかしながら，薬剤で後腹膜線維症が起こるとは，知りませんでした．（じつは，UpToDateで見ていたが，完全に失念していた）・・・知ったら知らせるという「専門家の基本的態度の原則」（私が，勝手に命名）により，ブログの記事にしてみました．こういった薬を飲んでいる方が，背部痛，下肢浮腫，腎機能障害等現れたら，後腹膜線維症も考えましょう．

・余談ですが，自己免疫性膵炎も後腹膜線維症を合併するのですが，上記UpToDateの表には載っていませんが，autoimmune pancreatitisの項には載っています．ハリソンには，AUTOIMMUNE PANCREATITISの項がありますが，後腹膜線維症に関する記載は見受けられません．

・調べると言えば，この標題の，「逆引き薬の副作用辞典」というのは，こういうのがあったらいいと思うのです．もし，既存に存在したら，教えていただきたいと思います．後腹膜線維症をおこす薬剤が他にどんなのがあるかと思っても，案外，これが調べにくいのです．（UpToDateをみると，成る程，他の薬剤でもあるなと，わかりますが）咳とか，腹痛とか症状をいれたら，それを起こす薬剤の一覧がパッとでるような，websiteがあったら良いなと，ドラえもんの歌の様に思うのです．

・ときどき，訳のわからないこと書きましたが，当直開けなので許しておうせーっ．

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