著者

Yutaro Akiyama Shinichiro Morioka Yuji Wakimoto Akira Kawashima Kohei Kanda Ayako Okuhama Tetsuya Suzuki Yusuke Miyazato Hidetoshi Nomoto Satoshi Ide Takato Nakamoto Keiji Nakamura Masayuki Ota Yuki Moriyama Saho Takaya Kota Yamada Maho Taguchi Erika Sugito Shinji Izuka Kenji Ishiguro Toshiaki Kobayashi Wataru Miyake Shuji Kubota Masahiro Ishikane Noriko Kinoshita Kei Yamamoto Mugen Ujiie Satoshi Kutsuna Kayoko Hayakawa Sho Saito Norio Ohmagari

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.5614-20, (Released:2020-11-02)

参考文献数

7

被引用文献数

2

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Objective In fever clinics screening coronavirus disease (COVID-19), there could be patients with life-threatening diseases that physicians should not overlook. We exploratorily investigated the final diagnosis among non-COVID-19 hospitalized patients who visited the fever clinic. Methods This was a retrospective, observational, and single-centered study conducted in the National Center for Global Health and Medicine (NCGM), Tokyo, Japan. We conducted a retrospective chart review of patients who visited the fever clinic in the NCGM from 11 March 2020 to 24 April 2020. Patients Patients who met the following clinical criteria visited the fever clinic in the NCGM: (1) body temperature >37.5°C, (2) any symptoms consistent with COVID-19 or (3) referral from local healthcare facilities. In the fever clinic, all patients who met the above criteria had severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test with nasopharyngeal swab specimens. Patients with severe symptoms or an unstable condition were sent to an outpatient clinic for infectious diseases for further evaluation and treatment. Results Among 1,470 patients who visited the fever clinic, 84 patients were hospitalized, and 45 of them were diagnosed as having COVID-19. Among the remaining 39 non-COVID-19 patients, there were nine patients with life-threatening diseases. The life-threatening diseases included acute heart failure, septic shock, pneumocystis pneumonia, peritonsillar abscess, and necrotizing fasciitis. Conclusion Physicians should evaluate each patient carefully while considering other life-threatening conditions even in such a COVID-19 pandemic era.

著者

Kazuo DAN

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.44, no.10, pp.1025-1026, 2005 (Released:2005-11-18)

参考文献数

11

被引用文献数

44 58 32

著者

Soichiro Suzuki Shotaro Naito Yoshiyuki Numasawa Mizuho Asada Norikazu Shoji Moko Zeniya Daiei Takahashi Hidehiko Sato Soichiro Iimori Naohiro Nomura Eisei Sohara Tomokazu Okado Yasuyoshi Ishiwata Masashi Nagata Tatemitsu Rai Takanori Yokota Shinichi Uchida

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.58, no.12, pp.1775-1779, 2019-06-15 (Released:2019-06-15)

参考文献数

23

被引用文献数

23

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Encephalopathy is a rare side effect of cephalosporin treatment. We herein present a case of encephalopathy induced by ceftriaxone, a third-generation cephalosporin, in a patient with renal failure. An 86-year-old woman on maintenance hemodialysis received ceftriaxone for Helicobacter cinaedi bacteremia. Her mental status deteriorated during antibiotic treatment, and an electroencephalogram revealed triphasic waves predominantly in the frontal area. Her consciousness improved after the discontinuation of the antibiotic due to the suspicion of ceftriaxone-induced encephalopathy. This is the first reported case of encephalopathy associated with high plasma and cerebrospinal fluid ceftriaxone concentrations, and provides significant evidence for a causal relationship between the administration of ceftriaxone and the onset of encephalopathy.

著者

Tomoko Tajiri Chisako Wada Hirotsugu Ohkubo Norihisa Takeda Kensuke Fukumitsu Satoshi Fukuda Yoshihiro Kanemitsu Takehiro Uemura Masaya Takemura Ken Maeno Yutaka Ito Tetsuya Oguri Akio Niimi

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.4746-20, (Released:2020-07-21)

参考文献数

17

被引用文献数

11

---

Acute eosinophilic pneumonia (AEP) is an acute respiratory illness with diffuse pulmonary infiltrates and pulmonary eosinophilia. While the etiology of AEP remains unclear, a relationship between cigarette smoking and AEP onset has been suggested. The use of heated tobacco products (HTPs) has been growing, but the impact of these products on our health is not fully understood. We herein report a case of AEP that developed after switching from conventional cigarette to HTP smoking. The patient's condition improved after the cessation of HTP smoking and corticosteroid treatment initiation. In cases of AEP, physicians should consider HTPs use as a possible cause.

著者

Kazuaki Jindai Yoshiki Kusama Yoshiaki Gu Hitoshi Honda Norio Ohmagari

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.4760-20, (Released:2020-07-21)

参考文献数

66

被引用文献数

3

---

The Ministry of Health, Labour and Welfare has published the Manual of Antimicrobial Stewardship (1st edition) in June 2017 to improve the prescribing practice of antimicrobials for immunocompetent adult and pediatric (both school-aged and older children) patients. Due to the increasing demand for further promoting outpatient antimicrobial stewardship, we conducted a literature and national guideline review to identify the area of need. The results of our review revealed a high antimicrobial prescription rate in the Japanese pediatric population. Furthermore, although the Japanese clinical guidelines/guidance covered the fields of almost all infectious diseases, no system exists to estimate the incidence and treatment patterns of important infectious diseases such as asymptomatic bacteriuria, skin and soft tissue infections, and dental practices in Japan. Therefore, addressing the issues of both establishing surveillance systems and the implementation of guidelines/guidance can be the next step to promote further outpatient antimicrobial stewardship.

著者

Yuki Miyamoto Hiroyuki Ohbe Miho Ishimaru Hiroki Matsui Kiyohide Fushimi Hideo Yasunaga

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.4308-19, (Released:2020-04-23)

参考文献数

13

被引用文献数

4

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Objective Carbazochrome sodium sulfonate (CSS) has been routinely used to treat bleeding; however, no study has examined the effect of CSS for gastrointestinal bleeding. Therefore, we aimed to investigate the effect of CSS for colonic diverticular bleeding. Methods We performed a nationwide observational study using the Japanese Diagnosis Procedure Combination inpatient database. We identified patients who were admitted for diverticular bleeding from July 2010 to March 2018. Patients who received CSS on the day of admission were defined as the CSS group, and those not receiving CSS were defined as the control group. The primary outcome was in-hospital mortality. Secondary outcomes were length of stay, total costs, and blood transfusion within 7 days of admission. Propensity score matching analyses were performed to compare outcomes between the two groups. Results A total of 59,965 patients met our eligibility criteria. Of these, 14,437 (24%) patients received CSS on the day of admission. One-to-one propensity score matching created 14,379 matched pairs. There was no significant difference in the in-hospital mortality between the CSS and control groups (0.6% vs. 0.5%, respectively; odds ratio: 0.96; 95% confidence interval: 0.72-1.29). The length of stay was longer in the CSS group than in the control group (11.4 vs. 11.0 days, respectively; difference: 0.44; 95% confidence interval: 0.14-0.73). There were no significant differences in the total costs or the proportion of patients receiving blood transfusion between the groups. Conclusions CSS may not reduce in-hospital mortality, length of stay, total costs, or the need for blood transfusion in patients with colonic diverticular bleeding.

著者

Yuki Baba Seiji Kawano Yoshiyasu Kono Toshihiro Inokuchi Hiromitsu Kanzaki Masaya Iwamuro Keita Harada Sakiko Hiraoka Yoshiro Kawahara Hiroyuki Okada

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.3628-19, (Released:2020-02-05)

参考文献数

16

被引用文献数

10

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Objective With the advent of capsule endoscopy (CE) and double-balloon endoscopy (DBE), the diagnosis and treatment of obscure gastrointestinal bleeding (OGIB) have markedly progressed. However, rebleeding sometimes occurs and is difficult to diagnose and treat. The aim of the present study was to investigate the clinical features of OGIB and risk factors for rebleeding in our hospital. Methods A total of 195 patients who underwent CE and/or DBE for OGIB in our hospital from January 2009 to July 2016 were included in the present study. We analyzed 168 cases of small intestinal OGIB, after excluding 27 cases of extra small intestinal bleeding. The clinical characteristics and risk factors related to rebleeding were retrospectively studied. Results Among the 168 patients who were included in the analysis, 95 patients (56.5%) were male. The mean age was 64.5 years (range, 8 to 87 years). Hypertension (31.0%) was the most frequent comorbidity, followed by chronic kidney disease (19.0%). The final diagnoses were ulcerative lesions (n=50, 29.8%), vascular lesions (n=30, 17.9%), tumors (n=7, 4.2%), and diverticula (n=2, 1.2%). The bleeding source was undetermined in the remaining 79 cases (47.0%). Rebleeding was confirmed in 29 cases (17.3%). In a univariate analysis, chronic kidney disease, vascular lesions, and overt previous bleeding were significantly associated with the risk of rebleeding. A multivariate analysis showed that chronic kidney disease, vascular lesion, and overt previous bleeding were significantly associated with the risk of rebleeding. Conclusion Patients with OGIB with overt previous bleeding, vascular lesions, and/or chronic kidney disease had a higher risk of rebleeding.

著者

Yasuharu Tokuda Seishirou Miyagi

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.46, no.23, pp.1885-1891, 2007 (Released:2007-12-03)

参考文献数

57

被引用文献数

2 8

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Among the various diagnostic strategies of chronic obstructive pulmonary disease (COPD), physical diagnosis is the quickest and requires no extra cost. Rapid physical diagnosis of COPD in primary care practice can lead to earlier actions of preventive measures and counseling for patients. Further, rapid physical diagnosis of COPD in an emergency department is also crucial for timely use of potentially lifesaving therapy specific for COPD patients. In this review, we will present a broad scope of physical findings for rapid physical diagnosis of COPD.

著者

Angel Torralba-Morón Maria Urbanowicz Carolina Ibarrola-De Andres Guadalupe Lopez-Alonso Francisco Colina-Ruizdelgado Juan-Manuel Guerra-Vales

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.55, no.18, pp.2595-2599, 2016-09-15 (Released:2016-09-15)

参考文献数

18

被引用文献数

4 9

---

Endometriosis is a quite common pathology, however, intestinal endometriosis is a rare condition, which typically occurs with chronic symptoms. Its acute presentation is very infrequent. We herein report four cases of intestinal endometriosis, in which the clinical debut occurred acutely: two as an acute small bowel obstruction and two as a small bowel perforation. None of the cases had a preoperative diagnosis of endometriosis. The interest of these cases lies in this exceptional form of presentation, such as a surgical acute abdomen. Therefore, intestinal endometriosis should be taken into account in the differential diagnosis of an acute obstructive or perforative process of the small or large bowel.

著者

Shohei Yoshida Hayato Tada Tetsuo Nishikawa Tamami Nakagawa-Kamiya Takuya Nakahashi Kenji Sakai Kenji Sakata Masa-aki Kawashiri Masahito Yamada Masayuki Takamura

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.3870-19, (Released:2019-12-26)

参考文献数

11

---

Transcatheter aortic valve implantation (TAVI) is widely accepted as the treatment for patient with severe aortic stenosis (AS) whose prognosis may be over one year; however, there is no consensus concerning extremely high-risk patients whose prognosis may not exceed one year. We herein report a highly frail patient with severe AS complicated with transthyretin-type cardiac amyloidosis who had a very poor prognosis. Given his condition, we treated him by percutaneous antegrade balloon aortic valvuloplasty (A-BAV) instead of TAVI. A-BAV may be a beneficial option for treating extremely high-risk severe AS patients, including those with cardiac amyloidosis.

著者

Hideharu Hagiya Ryohei Kokado Akiko Ueda Hideo Okuno Daiichi Morii Shigeto Hamaguchi Norihisa Yamamoto Hisao Yoshida Kazunori Tomono

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.58, no.18, pp.2621-2625, 2019-09-15 (Released:2019-09-15)

参考文献数

10

被引用文献数

1 24

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Objective The importance of antimicrobial stewardship is increasingly highlighted in this age of antimicrobial resistance. A better comprehension of adverse drug events (ADEs) can promote the appropriate use of antibiotics. We aimed to quantify the incidence of ADEs associated with broad-spectrum systemic antibiotics in a hospital setting. Methods We conducted a six-month prospective, observational study at Osaka University Hospital to describe the incidence of ADEs in patients hospitalized in general wards undergoing treatment with broad-spectrum antibiotics [carbapenems, piperacillin/tazobactam (PIPC/TAZ), and anti-methicillin-resistant Staphylococcus aureus agents]. The occurrence of ADE was defined as any cardiac, gastrointestinal, hepatobiliary, renal, neurologic, hematologic, dermatologic, or musculoskeletal manifestation after 48 hours or more of systemic antibiotic therapy. Results The 3 most frequently prescribed antibiotics were PIPC/TAZ (242 cases), meropenem (181 cases), and vancomycin (92 cases). Of 689 patients, 118 (17.1%) experienced ADEs, including gastrointestinal (6.4%), hepatobiliary (4.2%), dermatologic (2.5%), and renal (2.3%) manifestations. Patients treated with PIPC/TAZ, meropenem, doripenem, vancomycin, daptomycin, and teicoplanin developed ADEs at rates of 20.7%, 16.0%, 15.4%, 19.6%, 11.8%, and 10.9%, respectively. Conclusion Our study provides a quantitative value for the incidence of ADEs associated with broad-spectrum antibiotics in clinical practice. To optimize patient safety, clinicians need to be aware of the risks associated with antibiotic administration.

著者

Keisuke Kamada Takeshi Matsuda Satoshi Konno Hideaki Oka

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.3698-19, (Released:2019-12-13)

被引用文献数

2

著者

Satoshi Kutsuna Norio Ohmagari

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.53, no.15, pp.1727, 2014 (Released:2014-08-01)

参考文献数

1

被引用文献数

1 1

著者

Masaki Ohya Yuko Iwashita Satoko Kunimoto Shuto Yamamoto Toru Mima Shigeo Negi Takashi Shigematsu

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.58, no.18, pp.2595-2603, 2019-09-15 (Released:2019-09-15)

参考文献数

28

被引用文献数

7

---

Objective This follow-up survey report describes medication adherence and patient preferences, beliefs, and expectations of maintenance hemodialysis treatment in Japan. Methods This patient-reported questionnaire-based survey was conducted in six regions in Japan from September 2016 to November 2016. Patients The questionnaire was provided to 700 patients (50-79 years old) on maintenance hemodialysis for >3 years who were members of the Japan Association of Kidney Disease Patients. Patients were randomly selected by a stratified sampling method based on patient distribution observed from the Japanese Society for Dialysis Therapy Renal Data Registry. Results A total of 524 (74.9%) complete patient questionnaires were evaluated; the mean (SD) age was 66.6 (7.2) years (men, 63.4%) with a dialysis vintage of 16.9 (9.1) years. Adherence was high for all types of medications: between 76.7% for phosphate binders and 95.7% for antidiabetic medications. The most common reason for a missed dose was forgetting to take medication [52.5% (117/223)]. Patient preference for oral medication was as low as 0.9% (1/110), 9% (31/345), and 2.9% (2/69) for patients who felt mental burden, felt no mental burden, and neither, respectively, with their current treatment regimen. In addition, 37.8% (198/524) of patients responded that the elimination of 1 medication (1 tablet) would reduce their mental burden. Conclusion The results of this survey show that overall medication adherence is high in Japanese patients on maintenance hemodialysis. While many patients perceive an absence of mental burden, they still prefer to avoid oral medication when possible.

著者

Keisuke Matsuo Takashi Ishiguro Takatomo Najama Yoshihiko Shimizu Yasuhito Kobayashi Makoto Mutou

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.58, no.16, pp.2367-2372, 2019-08-15 (Released:2019-08-15)

参考文献数

19

被引用文献数

15

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A 62-year-old man presented to our hospital for the further evaluation and treatment of his back pain, general fatigue, and dyspnea, which had developed 4 days after the 29th administration of nivolumab to treat his lung cancer. Based on his clinical history, elevated serum cardiac enzyme values, and cardiac magnetic resonance (CMR) imaging and myocardial biopsy findings, he was diagnosed with myocarditis induced by nivolumab. Corticosteroid therapy improved his condition, and CMR performed on hospital day 11 also showed remarkable improvement. Although nivolumab-induced myocarditis is rare, cardiologists should consider it when encountering patients treated with such a drug for malignant disease.

著者

Motoaki Sano

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.2870-19, (Released:2019-06-07)

参考文献数

17

被引用文献数

9

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It has become clear that sodium glucose cotransporter (SGLT)-2 inhibitors not only do not increase the incidence of cardiovascular events but they also reduce the duration of hospitalization for heart failure in type 2 diabetic (T2DM) patients. The administration of SGLT2 inhibitor in T2DM patients with hypertension and a fluid retention tendency lowers the blood pressure and mitigates fluid retention. It also reduces the heart rate in T2DM patients with a fast heart rate. As an explanation for the multifaceted effects of SGLT2 inhibitors on hemodynamics, we hypothesize that these agents act on the inter-organ communication pathway, which modulates the sympathetic nerve activity to the cardiovascular system.

著者

Atsushi Goto Mitsuhiko Noda Manami Inoue Maki Goto Charvat Hadrien

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.55, no.14, pp.1827-1830, 2016-07-15 (Released:2016-07-15)

参考文献数

17

被引用文献数

1 39

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Diabetes mellitus, especially type 2 diabetes, has been a major concern among health issues for Japanese policy requiring serious address. In this regard, the increasing number of people with diabetes in Japan over the past few decades has been regarded as a fundamental and evident problem. We herein clarify that the crude diabetes prevalence is likely to have increased mainly as a result of changes in the population distribution, namely, aging of the general population in Japan. We also predict the future trend for the number of people with diabetes according to available concrete evidence in this review.

著者

Fumihiro Asano Naofumi Shinagawa Takashi Ishida Akifumi Tsuzuku Motoko Tachihara Kenya Kanazawa Noriyuki Yamada Satoshi Oizumi Hiroshi Moriya

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.54, no.9, pp.1021-1025, 2015 (Released:2015-05-01)

参考文献数

19

被引用文献数

6 28 4

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Objective Bronchoscopy using radial-endobronchial ultrasound (R-EBUS) and virtual bronchoscopic navigation (VBN) is a promising method for diagnosing peripheral pulmonary lesions. We previously performed a randomized comparative trial (RCT) (i.e., VBN combined with EBUS RCT) involving patients with 30-mm or smaller peripheral pulmonary lesions and found that the addition of VBN to R-EBUS improved the diagnostic yield. In the present study, we performed a retrospective subanalysis in order to identify patients for whom VBN is useful. Methods The per-protocol population (194 cases) of the VBN combined with EBUS RCT was divided into subgroups based on the lesion size, lung lobe containing the lesion, lesion location, presence or absence of involved bronchi (bronchus sign) on thin-section CT and whether the lesion was detected on posterior-anterior (P-A) radiographs. The difference in the diagnostic yield between the VBN-assisted (VBNA) and non-VBN-assisted (NVBNA) groups was investigated. Results Within the bronchus sign-positive subgroup, the diagnostic yield in the VBNA and NVBNA groups was 94.4% (68/72) and 77.8% (56/72), respectively, showing a significantly higher yield in the VBNA group (p=0.004; odds ratio: 4.9). The yield was particularly high for lesions smaller than 20 mm (94.6% vs. 70.7%; p=0.006), lesions located in the peripheral third of the lung field (95.1% vs. 71.4%; p=0.005) and lesions invisible on P-A radiographs (90.0% vs. 41.7%; p=0.026). Conclusion VBN improves the diagnostic yield when combined with R-EBUS to assess lesions exhibiting involved bronchi on CT images.

著者

Emi Mashima Yu Sawada Manabu Yoshioka Motonobu Nakamura

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.9714-17, (Released:2018-03-30)

被引用文献数

1

著者

Kengo Maeda Tomoyuki Shiraishi

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.57, no.5, pp.745-750, 2018-03-01 (Released:2018-03-01)

参考文献数

13

被引用文献数

2

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Japanese people born before World War II learned Japanese kana (Japanese syllabograms) writing in a style that is not currently used. These individuals had to learn the current style of kana orthography after the war. An 85-year-old man was taken to our hospital by his family who were surprised by his diary. It was written with kanji (Japanese ideograms) and katakana using the prewar style. A neuropsychological examination revealed impaired recall of hiragana. Neuroimaging studies revealed atrophy of the left fronto-parietal lobe and hypoperfusion of the left frontal lobe. His allographic agraphia might have resulted from the disturbance of the current style of kana orthography.