「case 78 (Acute Otitis Extrna)」の編集履歴（バックアップ）一覧はこちら

「case 78 (Acute Otitis Extrna)」(2007/01/23 (火) 00:35:25) の最新版変更点

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<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"><span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
<font size="3">急性化膿性限局性外耳道炎</font></span></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 8.9pt; TEXT-INDENT: -8.9pt; mso-char-indent-count: -.85">
<font size="3"><span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
外耳道軟骨部</span> <span lang="EN-US"><font face=
"Century">(</font></span><span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">外側</span><span lang="EN-US"><font face="Century">1/3)</font></span>
<span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
に分布する毛嚢</span><span lang="EN-US"><font face=
"Century">,</font></span> <span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
皮脂腺</span><span lang="EN-US"><font face="Century">,</font></span>
<span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
耳垢腺</span><span lang="EN-US"><font face="Century">,</font></span>
<span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
汗腺などに細菌感染を起こして生じる急性化膿性炎症</span><span lang="EN-US"><font face="Century">.</font></span>
<span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
機械的刺激</span> <span lang="EN-US"><font face=
"Century">(</font></span><span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">耳掻きなど</span><span lang="EN-US"><font face="Century">)</font></span>
<span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
や水泳・薬剤などの刺激が誘因</span><span lang="EN-US"><font face=
"Century">.</font></span></font></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 8.9pt; TEXT-INDENT: -8.9pt; mso-char-indent-count: -.85">
<font size="3"><span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
起炎菌は主にブドウ球菌</span><span lang="EN-US"><font face=
"Century">,</font></span> <span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
緑膿菌</span><span lang="EN-US"><font face="Century">,</font></span>
<span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
アスペルギルス</span><span lang="EN-US"><font face=
"Century">,</font></span> <span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
カンジダ</span><span lang="EN-US"><font face=
"Century">.</font></span></font></p>
<p class="MsoNormal" style=
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<font size="3"><span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
症状</span><span lang="EN-US"><font face="Century">:</font></span>
<span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
耳痛</span><span lang="EN-US"><font face="Century">.</font></span>
<span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
外耳道皮膚は発赤・腫脹</span><span lang="EN-US"><font face=
"Century">.</font></span> <span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
ときに外耳道閉塞</span><span lang="EN-US"><font face=
"Century">.</font></span> <span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
疼痛は特に摂食痛が激しい</span><span lang="EN-US"><font face=
"Century">.</font></span> <span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
耳珠の圧迫・耳介の牽引・開口などによって耳痛増強</span>
<span lang="EN-US"><font face="Century">(</font></span><span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">軟骨部の痛みの特徴</span><span lang="EN-US"><font face="Century">).</font></span>
<span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
数日後に自潰</span><span lang="EN-US"><font face=
"Century">,</font></span> <span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
排膿して軽快</span><span lang="EN-US"><font face=
"Century">.</font></span></font></p>
<p class="MsoNormal" style=
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<font size="3"><span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
診断</span> <span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
以下の点に注意して中耳炎や乳突洞炎を除外</span><span lang=
"EN-US"><font face="Century">; (1)</font></span> <span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
耳珠圧迫痛</span><span lang="EN-US"><font face="Century">,</font></span>
<span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
耳介牽引痛あり</span><span lang="EN-US"><font face="Century">, (2)
(</font></span><span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">外耳道完全閉塞がなければ</span><span lang="EN-US"><font face="Century">)</font></span>
<span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
難聴なし</span><span lang="EN-US"><font face="Century">, (3)</font></span>
<span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
耳漏が膿性</span> <span lang="EN-US"><font face=
"Century">(</font></span><span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">膿粘性ではない</span><span lang="EN-US"><font face="Century">),
(4)</font></span> <span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
鼓膜に所見はない</span><span lang="EN-US"><font face=
"Century">.</font></span></font></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 8.9pt; TEXT-INDENT: -8.9pt; mso-char-indent-count: -.85">
<font size="3"><span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
治療</span><span lang="EN-US"><font face="Century">:</font></span>
<span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
抗菌薬入りの軟膏を塗布</span><span lang="EN-US"><font face=
"Century">,</font></span> <span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
あるいは圧迫タンポンに軟膏を塗布し外耳道に挿入</span><span lang="EN-US"><font face="Century">.<br></font></span></font></p>
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</p>
<p class="MsoNormal" style=
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<span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
<font size="3">シナリオの注釈</font></span></p>
<p class="MsoNormal" style=
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<font size="3"><span lang="EN-US"><font face="Century">Medication History:
Asterizole </font></span> <span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
抗ヒスタミン薬</span><span lang="EN-US"><font face=
"Century">.</font></span> <span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
日本では使用中止</span><span lang="EN-US"><font face=
"Century">.</font></span></font></p>
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</p>
<p class="MsoNormal" style=
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<span lang="EN-US"><font face="Century" size="3">PROBLEM</font></span></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 8.9pt; TEXT-INDENT: -8.9pt; mso-char-indent-count: -.85">
<font size="3"><span lang="EN-US"><font face="Century">3.</font></span>
<span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
クロラムフェニコールの副作用</span> <span lang=
"EN-US"><font face="Century">(</font></span><span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">内用の場合</span><span lang="EN-US"><font face="Century">)
</font></span> <span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
重大なもの</span> <span lang="EN-US"><font face=
"Century">[JAPIC</font></span><span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">より</span><span lang="EN-US"><font face="Century">]<br></font></span></font></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 17.9pt; TEXT-INDENT: -9pt; mso-para-margin-left: .85gd">
<font size="3"><span lang="EN-US"><font face="Century">(1)</font></span>
<span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
再生不良性貧血</span> <span lang="EN-US"><font face=
"Century">(</font></span><span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">頻度不明</span><span lang="EN-US"><font face="Century">):</font></span>
<span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
再生不良性貧血が現れることがあるので，血液検査を行うなど，観察を十分に行い，血液に異常が認められた場合には直ちに中止し，適切な処置を行う</span><span lang="EN-US"><font face="Century">.</font></span></font></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt 18pt; TEXT-INDENT: -8.95pt">
<font size="3"><span lang="EN-US"><font face="Century">(2) Gray syndrome
(</font></span><span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">頻度不明</span><span lang="EN-US"><font face="Century">):</font></span>
<span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
腹部膨張に始まる嘔吐，下痢，皮膚蒼白，虚脱，呼吸停止等が現れる</span><span lang="EN-US"><font face="Century">.</font></span>
<span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
低出生体重児</span><span lang="EN-US"><font face=
"Century">,</font></span> <span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
新生児には投与しない</span><span lang="EN-US"><font face=
"Century">.<br></font></span></font></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 17.9pt; TEXT-INDENT: -9pt; mso-para-margin-left: .85gd">
<font size="3"><span lang="EN-US"><font face=
"Century">(3)</font></span><span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">視神経炎</span>
<span lang="EN-US"><font face="Century">(</font></span><span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">頻度不明</span><span lang="EN-US"><font face="Century">),</font></span>
<span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
末梢神経炎</span> <span lang="EN-US"><font face=
"Century">(</font></span><span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">頻度不明</span><span lang="EN-US"><font face="Century">):</font></span>
<span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
長期投与により</span><span lang="EN-US"><font face=
"Century">,</font></span> <span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
視神経炎又は末梢神経炎が現れることがあるので</span><span lang="EN-US"><font face="Century">,</font></span>
<span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
観察を十分に行い</span><span lang="EN-US"><font face=
"Century">,</font></span> <span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
視覚の異常，四肢のしびれや異常感等が認められた場合には直ちに中止し</span><span lang="EN-US"><font face="Century">,</font></span>
<span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
適切な処置を行う</span><span lang="EN-US"><font face=
"Century">.</font></span></font></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 8.9pt; TEXT-INDENT: -8.9pt; mso-char-indent-count: -.85">
<font size="3"><span lang="EN-US"><font face="Century">4. (1)</font></span>
<span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
まず手洗い</span><span lang="EN-US"><font face="Century">,
(2)</font></span> <span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
薬液出口が耳に触れぬよう</span><span lang="EN-US"><font face=
"Century">, (3)</font></span> <span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
薬滴が外耳道の途中で止まったら少し頭を振る</span><span lang="EN-US"><font face="Century">,
(4)</font></span> <span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
耳を上方へ向けて投与する</span><span lang="EN-US"><font face=
"Century">, (5)</font></span> <span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
タンポンを使用する方法もある</span><span lang="EN-US"><font face=
"Century">.</font></span></font></p>
<p class="MsoNormal" style=
"MARGIN: 0mm 0mm 0pt 8.9pt; TEXT-INDENT: -8.9pt; mso-char-indent-count: -.85">
<font size="3"><span lang="EN-US"><font face="Century">13. (1)</font></span>
<span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
薬による治療に加えて</span><span lang="EN-US"><font face=
"Century">,</font></span> <span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
清潔に保つことが重要</span><span lang="EN-US"><font face="Century">.
(2)</font></span> <span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
自己管理が必要であるので患者に対する教育が重要</span><span lang="EN-US"><font face="Century">.
(3)</font></span> <span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
一般的に局所薬としてネオマイシンやクロラムフェニコールを用いるべきではない</span><span lang="EN-US"><font face="Century">.
(4)</font></span> <span style=
"FONT-FAMILY: &quot;ＭＳ 明朝&quot;; mso-ascii-font-family: Century; mso-hansi-font-family: Century">
抗菌薬全身投与は周囲の組織に感染が広がったときのみ</span><span lang="EN-US"><font face="Century">.</font></span></font></p>
<p class="MsoNormal" style="MARGIN: 0mm 0mm 0pt"></p>