照井 慶太

小児において急性虫垂炎は代表的な腹部救急疾患である。しかし, その診断は必ずしも容易ではなく, 正確な術前病型診断を得るのは難しい。小児虫垂炎に対して, 術後病理診断をもとに術前超音波病型診断の有用性の検討を行った。手術を行った151症例中 (カタル性2例, 蜂窩織炎性66例, 壊疽性83例), 術前カタル性と診断された2症例は病理診断もカタル性で, 正診率は100%であった。壊疽性, 蜂窩織炎性いずれの正診率も約90%で, ともに比較的良好な正診率を得ているが, 約10%の症例で病型診断が異なっていた。蜂窩織炎性以上の術前病型診断で手術を行いカタル性であった症例は1例のみでカタル性に対しては, 正確な病型診断を下し, 無用な手術を避けるという意味では術前超音波診断は, 十分な診断率を有していた。また術前虫垂炎の診断で手術を行い, メッケル憩室の捻転であった症例も認められた。

We report that serial diffusion weighted imaging (DWI) is clinically useful in an epilepsy patient. A 63-year-old man was admitted in an emergency with status epilepticus and consciousness disturbance. CT scan and conventional MRI showed no abnormal area. DWI revealed the focal lesion as high intensity area in the parietooccipital area. Also, periictal EEG showed a focal epileptiform discharge in the same area. DWI was repeated for 5 consecutive days. The size of high intensity area seen on DWI decreased day by day. It therefore seemed reasonable to conclude that the high intensity area in the DWI in this case was the epileptogenic focus. The change in DWI findings in epilepsy is similar to the findings in cerebral ischemia. However, the mechanisms resulting in these finding may be different from those associated with ischemia. In status epilepticus, the metabolism is markedly increased, resulting in depletion of energy reserves in the later stage. This will result in impaired ion exchange pump functions and swelling of neuronal and glial cells. Serial DWI can be useful diagnostic method for localization of the focus in the evaluation of cases with epilepsy.