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小児腫瘍で最も多い前駆Ｂリンパ芽球性白血病で死亡した1例を経験したので報告する．2歳女児，特記すべき既往はない．呼吸不全で病院に搬送されたが，4時間後に死亡した．死亡2週間前に39℃台の発熱があったが，自然療法の薬草で改善した．1週間前には黄疸がみられるようになり，死亡当日に状態が悪化した．搬送時の病院での採血で白血球数の著明な上昇がみられたため，急性白血病を疑われた．司法解剖の結果，死因は前駆Ｂ...リンパ芽球性白血病と判明した．医学の進歩により，小児のリンパ芽球性白血病の90％程度は診断から5年以上生存している．しかしながら，死者の両親は西洋医学より補完代替療法（自然療法）を好んでおり，死者が産まれてから健康診断や予防接種で病院に連れて行ったことがなかった．死者が通常の医療を受けていれば，5年生存率は60％を超えていたと考えられ，両親の動機によらず，本事例は医療ネグレクトと考えられた．
We report the case of 2-year-old girl who died of precursor B-cell acute lymphoblastic leukaemia(ALL), the most common cancer in children. She had no remarkable medical history. She was transferred to a hospital because of respiratory distress and died 4 hours after arrival. Two weeks before death, she had a fever of 39℃, which subsided after the administration of a naturopathic herbal remedy. She developed jaundice 1 week before death, and her condition worsened on the day of death. Laboratory test results on admission showed a markedly elevated white blood cell count. Accordingly, the cause of death was suspected to be acute leukaemia. Forensic autopsy revealed the cause of death to be precursor B-cell ALL. With advancements in medical technology, the 5-year survival rate of children with ALL is nearly 90%. However, in this case, the deceasedʼs parents preferred complementary and alternative medicine (i.e., naturopathy) to evidence-based medicine and had not taken her to a hospital for a medical check-up or immunisation since she was an infant. Thus, if she had received routine medical care, she would have a more than 60% chance of being alive 5 years after diagnosis. Therefore, we conclude that the parents should be accused of medical neglect regardless of their motives.続きを見る
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