(1984年2月) patients with SLE, we must pay attention to; (1) whether they have fever or not; (2) distribution pattern of joint involvement, particularly whether wrists are involved or not; (3) duration of jioint symptoms and their reactivity to steroids; (4) whether they have vascu- litis or not; (5) significance of rheumatoid factors in both SLE and RA. 2) Vasculitis and rheumatoid factors are supposed to be related to the nature of arthro- pathy in SLE, and the relation between anti SS-A antibody and SLE arthropathy should he further investigated prospectively. 3) Hand-thermography showed that even arthralgia in SLE might indicate the presence of joint inflammation. A CLINICAL STUDY OF ACUTE HEMORRHAGIC COLITIS ASSOCIATED WITH ANTIBIOTIC THERAPY II. PSEUDOMEMBRANOUS COLITIS AND ACUTE HEMORRHAGIC COLITIS Koichi SUZUKI, Kazuhiro OBI, Tetsuji KITAHORA, Akira YOKOTA, Tadayoshi MORI and Toshiyoshi UTSUNOMIYA (Okura National Hospital, Tokyo) Yoichi KIRIHARA (Tachikawa National Hospital, Tokyo) During a six-year period we encountered 29 patients with acute hemorrhagic colitis following oral antibiotic therapy, especially with synthetic penicillins. As other type of antibiotic-associated colitis, the presence of pseudomembranous colitis was suggested from the standpoint of the roll of bacterial toxin. These two types of colitis show dissimilar symptoms and pathophysiological findings. To compare both types of colitis, we presented one case with typical pseudomembranous colitis, in which toxin producing Clostridium difficile was detected in feces. A 47 year old female was admitted with a two-week history of abdominal pain and diarrhea. Prior to admission she was treated with several antibiotics, ABPC, CEX, FOM and CET after intrauterine curretage becauae of endometritis. Sigmoidoscopic examination revealed inflammatory mucosa with numerous raised, flat and yellowish plaque in the rectum and the sigmoid colon. Microscopic examination showed mucosal necrosis covered with mucoid fibrinous exudate mixed with inflammatory cells. Clostridium difficile was isolated from mucous evacuation and toxigenicity was studied. Fecal sterile filtrates and bacterial culture extracts had cytotoxicity in tissue -120-
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(1984年2月)
patients with SLE, we must pay attention to; (1) whether they have fever or not; (2)
distribution pattern of joint involvement, particularly whether wrists are involved or not;
(3) duration of jioint symptoms and their reactivity to steroids; (4) whether they have vascu-
litis or not; (5) significance of rheumatoid factors in both SLE and RA.
2) Vasculitis and rheumatoid factors are supposed to be related to the nature of arthro-
pathy in SLE, and the relation between anti SS-A antibody and SLE arthropathy should
he further investigated prospectively.
3) Hand-thermography showed that even arthralgia in SLE might indicate the presence
of joint inflammation.
A CLINICAL STUDY OF ACUTE HEMORRHAGIC COLITIS
ASSOCIATED WITH ANTIBIOTIC THERAPY
II. PSEUDOMEMBRANOUS COLITIS AND ACUTE
HEMORRHAGIC COLITIS
Koichi SUZUKI, Kazuhiro OBI, Tetsuji KITAHORA,
Akira YOKOTA, Tadayoshi MORI and Toshiyoshi UTSUNOMIYA
(Okura National Hospital, Tokyo)
Yoichi KIRIHARA
(Tachikawa National Hospital, Tokyo)
During a six-year period we encountered 29 patients with acute hemorrhagic colitis
following oral antibiotic therapy, especially with synthetic penicillins.
As other type of antibiotic-associated colitis, the presence of pseudomembranous colitis
was suggested from the standpoint of the roll of bacterial toxin. These two types of
colitis show dissimilar symptoms and pathophysiological findings. To compare both types
of colitis, we presented one case with typical pseudomembranous colitis, in which toxin
producing Clostridium difficile was detected in feces.
A 47 year old female was admitted with a two-week history of abdominal pain and
diarrhea. Prior to admission she was treated with several antibiotics, ABPC, CEX, FOM
and CET after intrauterine curretage becauae of endometritis.
Sigmoidoscopic examination revealed inflammatory mucosa with numerous raised,
flat and yellowish plaque in the rectum and the sigmoid colon. Microscopic examination
showed mucosal necrosis covered with mucoid fibrinous exudate mixed with inflammatory
cells. Clostridium difficile was isolated from mucous evacuation and toxigenicity was
studied. Fecal sterile filtrates and bacterial culture extracts had cytotoxicity in tissue
-120-
(医 療 第38巻 第2号)
culture method (Hela cell) and vascular permeability effects for intestinal loop test and
skin test of the rabbit. Even though Clostridinm difficile was isolated from the solid
feces after colonic inflammation was subsided, toxigenicity could not be observed.
The clinical feature of pseudomembranous celitis is different from acute hemorrhagic
colitis which was reported previously by the authors, so the difference between both colitis
was discussed.
A STATISTICAL STUDY OF THE CESAREAN SECTION
Takashi SATO, Ryuichi KAKU, Eiki KAYAMA,
Eiki SO, Ryoko MORITA, Keiko HENMI
and Takashi WAGATSUMA
(National Medical Center Hospital, Tokyo)
A statistical analysis was done about the cesarean section in National Medical Center
Hospital in the period of 1976-80, and the changes during this period were examined.
1. Material and Method
The patients were admitted to this hospital in the period of 1976-50, and they delivered
babies by cesarean section. They were divided into small groups by several factors, and
the results were compared with the results during the period of 1970-74.
2. Result
In the peril of 1976-80 there were 3531 deliveries in this hospital. One hundred and
ninety-four of these deliveries were by cesarean section, the rate of cesarean section was
5.5% and this rate was reduced by half as compared with 11.2% during the period of 1970-74.
The most common indications were fetal distress, cephalo-pelvic disproportion and placenta
previa. The cases of previous cesarean section were greatly decreased as compared with
the cases during the period of 1970-74. The cases of primiparaous breech presentation and
old primipara were decreased, too. But the cases of fetal distress increased. The
methods of anesthesia were mainly inhalation anesthesia and this tendency was not changed.
3. Discussion
Since 1976, we reevaluated the indication for cesarean section in this hospital resulting
in the decreased rate of the cesarean section. In the previous cesarean section, the cases
of uterine rupture are uncommon and many cases are allowed to trial labor. So the cases
of vaginal delivery have increased. Because of the development and the spread of the
fetal monitoring, early detection of fetal distress has become possible. So the cases of
cesarean section by fetal distress have increased. Conversely, we can carefully observe
to delivery process and fetal condition of high risk pregnancy, e. g. old primipara, primi-
paraous breech presentation. So the cases, whose indication were old primipara or pri-