著者

Ryusuke Yoshimi

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1657-18, (Released:2018-08-24)

参考文献数

9

被引用文献数

7

著者

Hiroaki Okada Manabu Wada Hiroyasu Sato Yoshitaka Yamaguchi Haruko Tanji Katsuro Kurokawa Toru Kawanami Toshiyuki Takahashi Takeo Kato

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.52, no.23, pp.2665-2668, 2013 (Released:2013-12-01)

参考文献数

16

被引用文献数

6 19

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We report the case of a 48-year-old woman presenting with an elevated serum creatine kinase level (hyperCKemia) associated with an initial attack of neuromyelitis optica (NMO). The patient initially showed general fatigue with fever. Laboratory findings showed hyperCKemia and subsequently she developed a slight weakness of both lower limbs and reduced vision. Autoantibodies against aquaporin 4 were found in her serum, and a retrospective examination of viral titers indicated a possible coxsackie virus group A10 infection. The present case suggests that hyperCKemia-mediated disease onset is involved in some patients with NMO, and furthermore, it may be related to muscular destruction associated with viral infection.

著者

Takako SAEKI Kensuke SUZUKI Hajime YAMAZAKI Syoji MlYAMURA Hiroshi KOIKE Hideo MORISHITA Fumitake GEJYO

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.42, no.10, pp.1011-1015, 2003 (Released:2006-03-27)

参考文献数

32

被引用文献数

6 10

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Although pheochromocytoma in a patient with endstage renal disease (ESRD) is considered extremely rare, we recently encountered 4 ESRD patients with pheochromocytoma. Three were symptomatic, and in the fourth patient the tumor was discovered as an adrenal incidentaloma. Plasma catecholamine levels were significantly increased in two patients. In each case, 131I-MIBG scintigraphy showed accumulation of the radionuclide in the adrenal tumor, which was identified by MRI or CT scanning, and adrenalectomy was conducted without serious complications. Although paroxysmal hypertension is a common symptom in patients with ESRD, pheochromocytoma must be eliminated by careful evaluation.(Internal Medicine 42: 1011-1015, 2003)

著者

Fraisse Thibaut Crouzet Julien Lachaud Laurence Durand Anne Charachon Sylvie Lavigne Jean Philippe Sotto Albert

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.50, no.18, pp.1935-1940, 2011

被引用文献数

12 5

---

<b>Objective</b> Candiduria is a common finding in the growing population of very old patients that has not been previously studied. The objective was to study candiduria in the population aged 85 and over, including an estimation of the incidence, factor of acquisition, and evaluation of treatment and mortality.<br> <b>Methods</b> retrospective monocentric study.<br> <b>Materials</b> medical charts of patients aged of 85 and over who have candiduria diagnosed at Nimes University Hospital.<br> <b>Results</b> The prevalence of candiduria in the hospitalized very old patients was 8.9%. More than half of strains isolated were <i>C. albicans</i> (59%). Mean age was 89.7 years old with 53 women and 20 men. Urinary catheter (55%) and prior antibiotic use (67%) were commonly found. Fifteen patients with candiduria were treated, consistently with fluconazole. Patients treated had higher Mini Mental Test score than the others. A high C-reactive protein level, Mac Cabe score or Charlson's score >7 were associated with 6 months mortality.<br> <b>Conclusion</b> Episodes of candiduria in oldest old were associated with frailty and vulnerability of the patient. The medical decision for antifungal treatment is usually difficult to make but it did not seem to influence mortality.<br>

著者

Mikio Shiba Yasuo Sugano Yoshihiko Ikeda Hatsue Ishibashi-Ueda Takahiro Ohara Takuya Hasegawa Hideaki Kanzaki Toshihisa Anzai

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.55, no.7, pp.751-754, 2016 (Released:2016-04-01)

参考文献数

11

被引用文献数

2 5

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A 74-year-old man, who had a history of a mitral valve replacement for rheumatic heart disease (RHD) 30 years previously, was admitted with progressive heart failure. Massive calcification was observed around the left atrium on multidetector CT, in addition to a late gadolinium enhancement (LGE)-positive layer adjacently outside of the calcification on MRI. He underwent a second mitral valve replacement for the prosthetic valve failure. Pathohistological analyses of a tissue section of the left atrial wall from a surgical specimen revealed lymphocyte and macrophage infiltration that coincided with the LGE-positive layer on MRI, suggesting the existence of sustained active inflammation even after the long period of RHD.

著者

Satoshi Konno Yoshihiro Matsuno Shingo Ichimiya Masaharu Nishimura Yoshikazu Kawakami

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1241-18, (Released:2018-10-17)

参考文献数

12

被引用文献数

3

---

In 1982, we reported a case of retroperitoneal fibrosis (RPF) exhibiting various clinical manifestations. Our current understanding of immunoglobulin G4 (IgG4)-related disease led us to consider it as a possible diagnosis because all of the patient's clinical features could be explained by this disease entity. To confirm our hypothesis, we re investigated the histopathological findings of resected specimens that had been stored for 35 years postoperatively. Typical pathological findings together with predominant IgG4+ plasma cell infiltration confirmed a potential diagnosis of IgG4-related RPF. Furthermore, we observed positive immunohistochemical staining for several molecules associated with T regulatory and T follicular helper cells.

著者

Tomoki Kokubun Masayoshi Oikawa Yasuhiro Ichijo Yoshiyuki Matsumoto Tetsuro Yokokawa Kazuhiko Nakazato Yoshiyuki Sato Shinya Takase Hiroharu Shinjo Hitoshi Yokoyama Hitoshi Suzuki Shu-ichi Saitoh Yasuchika Takeishi

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.57, no.11, pp.1597-1600, 2018-06-01 (Released:2018-06-01)

参考文献数

16

被引用文献数

3

---

A 40-year-old man was transferred to our hospital following an isolated horse kick injury to the anterior chest wall. The case showed bi-fascicular block, severe tricuspid valve regurgitation due to ruptured chordae tendineae of the anterior leaflet, moderate mitral valve regurgitation due to prolapse of mitral anterior leaflet, and hypokinetic motion of the inferior septal wall. Both tricuspid and mitral insufficiency were completely repaired by a surgical operation. Fortunately, these injuries were not fatal in this case, but the comprehensive assessment of cardiac damage and careful observation are important for managing patients with cardiac injury.

著者

Saori Yamamoto Tasuku Nagasawa Koichiro Sugimura Atuhiro Kanno Shunsuke Tatebe Tatsuo Aoki Haruka Sato Katsuya Kozu Ryo Konno Kotaro Nochioka Kimio Sato Hiroaki Shimokawa

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.0959-18, (Released:2018-10-17)

参考文献数

16

被引用文献数

7

---

Anderson-Fabry disease (AFD) is a rare X-linked disorder caused by deficient activity of the lysosomal enzyme α-galactosidase A (α-GAL A). We herein report 10 cases of AFD in 5 families (3 men and 7 women) that were found to have a specific common mutation in R301Q (G-to-A transition in exon 6 [codon 301] resulting in the replacement of a glutamine with an arginine residue). We evaluated their clinical characteristics, residual enzymatic activity, and plasma concentrations of globotriaosylsphingosine (Lyso-Gb3). Although all 10 cases had cardiac and renal manifestations in common, their clinical manifestations were markedly divergent despite the same genetic abnormality.

著者

Takeshi Kawashita Mikio Nakajima Richard H. Kaszynski Masamitsu Shirokawa Tomotsugu Nakano Koji Ochiai Yoshitaka Inoue Hideaki Goto

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1041-18, (Released:2018-09-12)

参考文献数

12

被引用文献数

1

---

A 28-year-old man with type 1 diabetes mellitus was admitted for shock and coma due to diabetic ketoacidosis. Despite aggressive treatment and management of the patient's underlying clinical issues, the patient remained in a comatose state. Further investigations revealed an excess consumption of psychotropic agents; however, there was no evidence of an insulin overdose. Physicians should be aware that, in patients who are highly dependent upon insulin, an overdose of psychotropic agents can lead to hypoxic-ischemic brain injury.

著者

Rina Ando Hirotaka Iwaki Tomoaki Tsujii Masahiro Nagai Noriko Nishikawa Hayato Yabe Ikuko Aiba Kazuko Hasegawa Yoshio Tsuboi Masashi Aoki Kenji Nakashima Masahiro Nomoto on behalf of the Parkinson's Disease Safe Driving Study Group of Japan

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.9653-17, (Released:2018-02-28)

参考文献数

22

被引用文献数

4

---

Objective We conducted a study to obtain information that could be used to provide Parkinson's disease (PD) patients with appropriate advice on safe driving. Methods Consecutive PD patients who visited our office were studied. Among these patients, those who had experienced driving after being diagnosed with PD were interviewed by neurologists and a trained nurse to investigate their previous car accidents, motor function, cognitive function, sleepiness, levodopa equivalent dose (LED), and emotional dysregulation. The rates of major car accidents before and after the onset of PD were compared. Results Fifteen patients had experienced a major car accident resulting in human injury or serious property damage since the onset of PD. When the rates of major car accidents before and after the onset of PD were compared, the ratio was 4.3 (95% CI 1.9-9.7). The incidence of accidents after the onset of PD was correlated with age, disease duration, LED, the cognitive function (MMSE, MoCA-J), but not the motor symptom score (UPDRS part III at the time of the study). The Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP) score was also higher in patients with major car accidents. Conclusion The severity of symptoms (Hoehn-Yahr classification), cognitive function, and disease duration were expected to be risk factors for car accidents. However, the motor symptom score (UPDRS part III) was not associated with the incidence of major car accidents. In addition to a low cognitive function and the severity of symptoms, the QUIP score might be an independent factor that can be referenced when advising PD patients to refrain from driving.

著者

Haruki Koike Ryoji Nishi Shohei Ikeda Yuichi Kawagashira Masahiro Iijima Naoki Atsuta Tomohiko Nakamura Masaaki Hirayama Hidenori Ogata Ryo Yamasaki Jun-ichi Kira Masahisa Katsuno Gen Sobue

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.0455-17, (Released:2018-02-28)

参考文献数

27

被引用文献数

6 11

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We herein report a woman with chronic inflammatory demyelinating polyneuropathy (CIDP) in whom positivity for anti-neurofascin 155 antibodies was revealed 23 years after the onset of neuropathy. The patient initially reported numbness in the face at 50 years of age and subsequently manifested features compatible to typical CIDP. Steroid administration initiated at 54 years of age ameliorated her neuropathic symptoms. Although the nerve conduction indices at 59 years of age deteriorated, those at 68, 72, and 73 years of age showed a gradual recovery. The deterioration and subsequent restoration of compound muscle action potential amplitudes was the most dramatic, suggesting that a conduction block can be reversed earlier than other electrophysiological indices.

著者

Kazuhiro Ota Toshihisa Takeuchi Kouki Kodama Haruhiko Ozaki Satoshi Harada Yuichi Kojima Sadaharu Nouda Masahiro Goto Kazuhide Higuchi

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.57, no.3, pp.343-344, 2018-02-01 (Released:2018-02-01)

参考文献数

7

被引用文献数

1 3

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Although S-1 chemotherapy is used widely as postoperative adjuvant chemotherapy for gastric cancer, some patients experience diarrhea during treatment. The patient was a 39-year-old woman who underwent distal gastrectomy for gastric cancer and who had started S-1 chemotherapy as postoperative adjuvant chemotherapy 1 week before her presentation. She experienced severe diarrhea immediately after starting the course of S-1 tablets. Capsule endoscopy revealed severe S-1-induced enteritis with extensive mucosal injury in the ileum and red intestinal fluid due to the oozing of blood in the ileum. After reducing the dosage of S-1, her diarrhea became milder, and she was able to continue S-1 chemotherapy.

著者

Manabu Hayashi Kazumichi Abe Masashi Fujita Ken Okai Atsushi Takahashi Hiromasa Ohira

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.57, no.17, pp.2451-2458, 2018-09-01 (Released:2018-09-01)

参考文献数

32

被引用文献数

15

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Objective Hyponatremia is closely associated with the pathophysiology of cirrhosis. However, the association between the serum sodium level and the response to tolvaptan is unclear. This study evaluated the factors related to the tolvaptan response and the prognosis in cirrhosis patients with ascites and hyponatremia. Methods We retrospectively reviewed the clinical records of cirrhosis patients hospitalized for treatment with tolvaptan. The associations of patient baseline characteristics with the tolvaptan response after one week and of the characteristics after one-month tolvaptan treatment with the prognosis were analyzed. Results We analyzed 83 cirrhosis patients with ascites, including 34 patients with hyponatremia. The response rates to tolvaptan in patients with serum sodium <130 mEq/L, 130-135 mEq/L, and >135 mEq/L were 20%, 66%, and 58%, respectively (p=0.22). The serum sodium level was associated with the response to tolvaptan [odds ratio=1.18; 95% confidence interval (CI) =1.02-1.37; p=0.029]. In patients with hyponatremia, the serum sodium level after 1-month tolvaptan treatment was increased compared to baseline (132 mEq/L vs. 136 mEq/L, p=0.006), and an increasing serum sodium level was associated with a lower risk of mortality (hazard ratio=0.85; 95% CI=0.75-0.97; p=0.016). The survival rate was higher in patients with an increase in the serum sodium level after 1 month than in patients with a decreased serum sodium level (p=0.023). Conclusion Tolvaptan treatment was effective in cirrhosis patients with ascites and hyponatremia, but a low serum sodium level was associated with non-responsiveness to tolvaptan. An increased serum sodium level after one-month tolvaptan treatment may positively influence the mortality risk in cirrhosis patients with hyponatremia.

著者

Kiyohito Hayashi Taizo Tasaka Toshinori Kondo Yuichi Ishikawa Makoto Goto Yoshiko Matsuhashi Yoshito Sadahira Takashi Sugihara Wada Hideho

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.0317-17, (Released:2018-08-24)

参考文献数

28

被引用文献数

4

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Werner syndrome (WS) confers a high risk of the development of neoplasias, including hematological malignancies, and curative treatment for these malignancies is difficult to achieve. A 44-year-old man with myelodysplastic syndrome was admitted to our hospital. He was diagnosed with mutation-proven WS. He underwent cord blood transplantation (CBT) following fludarabine, busulfan, and melphalan administration. A chimerism analysis of his marrow blood on day 62 showed a donor pattern >95%, which confirmed engraftment. The patient lived for 15 months while maintaining remission of MDS without treatment-related toxicity. Our case shows that CBT can be a treatment modality for WS patients with hematological malignancies.

著者

Taku Sugawa Takaaki Murakami Daisuke Yabe Riko Kashima Makiko Tatsumi Shinobu Ooshima Erina Joo Keiko Wada Atsushi Yoshizawa Toshihiko Masui Yuji Nakamoto Yuki Yamauchi Yuzo Kodama Yoshiki Iemura Masahito Ogura Akihiro Yasoda Nobuya Inagaki

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1173-18, (Released:2018-08-10)

参考文献数

22

被引用文献数

10

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The delayed diagnosis of insulinoma remains a clinical issue. One of the main causes of such a delay is hypoglycemia unawareness. A 53-year-old woman fell unconscious during postprandial exercises. Flash glucose monitoring (FGM) systems revealed glucose profiles with fasting hypoglycemia, which facilitated the clinical diagnosis of insulinoma even though she was unaware of her hypoglycemia. The preoperative comparison of the blood glucose values provided by FGM with those obtained from capillary blood were consistent. Thus, FGM may have potential utility in revealing the presence of insulinoma-induced hypoglycemia.

著者

Yasuyoshi Shikama Jun-ichi Kitazawa Nobuo Yagihashi Osamu Uehara Yuuji Murata Nobuhisa Yajima Ryuichi Wada Soroku Yagihashi

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.49, no.5, pp.397-401, 2010 (Released:2010-03-01)

参考文献数

9

被引用文献数

43 111

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A 60-year-old woman diabetic patient presented with a subcutaneous mass in right lower abdominal quadrant where recombinant human insulin or insulin analogue had been injected for 16 years. Her diabetes has been insulin resistant with insufficient blood glucose control. The mass was extirpated under the suspicion of neoplasm but it was found to consist of diffuse deposition of eosinophilic amorphous materials mixed with inflammatory change. Congo-red staining demonstrated positive red color and yielded green birefringence by polarized microscopy. Pre-digestion with potassium permanganate was incomplete to quench positive Congo-red stains. Immunostains with insulin antibody were positive for this deposition but not so with amylin or AA or AL amyloid. Thus, the mass was considered to be localized amyloidosis composed of iatrogenic A-Ins type amyloid. Thus, the case suggested that her insulin resistance, i.e. refractoriness of insulin treatment, may be ascribed to poor penetration of injected insulin and human insulin itself or its analogue is amyloidogenic to form a local mass.

著者

Yasuharu Tokuda Masahiro Koizumi Gerald H. Stein Richard B. Birrer

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.48, no.7, pp.537-543, 2009 (Released:2009-04-01)

参考文献数

33

被引用文献数

6 10

---

Objective To derive and validate a clinical prediction model with high sensitivity for differentiating aseptic meningitis (AM) patients from bacterial meningitis (BM) patients. Methods We developed the model using the derivation cohort in a community rural hospital in Okinawa and assessed its performance using the validation cohort in a metropolitan urban hospital in Tokyo. There were 66 (39.5%) and 5 (17.9%) adult patients with BM among the derivation (n=167) and the validation cohort (n=28), respectively. Recursive partitioning analysis was used to determine the important classification variables and to develop a sensitive model to safely exclude BM. Results The model produced high- and low-risk groups based on the following: 1) Gram stain, 2) CSF neutrophil percent ≤15%, 3) CSF neutrophil count ≤150 cells/mm3, and, 4) mental status change. Among the derivation cohort, there were 65 patients with BM in the high-risk group (n=76), while only one patient with BM was noted (sensitivity, 99%) in the low-risk group (n=91). Among the validation cohort, there were 5 patients with BM in the high-risk group (n=7), while no patient was classified with BM (sensitivity, 100%) in the low-risk group (n=21). Conclusion This simple and sensitive model might be useful to safely identify low-risk patients for BM who would not require antibiotic treatment.

著者

Satoshi Murao Takaaki Kiuchi

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.57, no.13, pp.1945-1946, 2018-07-01 (Released:2018-07-01)

参考文献数

2

被引用文献数

1

著者

Minami Taki Yoshio Shimojima Ayako Nogami Takuhiro Yoshida Michio Suzuki Koichi Imaoka Hiroki Momoi Norinao Hanyu

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.57, no.2, pp.273-277, 2018-01-15 (Released:2018-01-15)

参考文献数

10

被引用文献数

14

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Sepsis caused by a Capnocytophaga canis infection has only been rarely reported. A 67-year-old female with a past medical history of splenectomy was admitted to our hospital with fever and general malaise. She had been bitten by a cat. She showed disseminated intravascular coagulation and multi-organ failure because of severe sepsis. On blood culture, characteristic gram-negative fusiform rods were detected; therefore, a Capnocytophaga species infection was suspected. A nucleotide sequence analysis revealed the species to be C. canis, which was newly identified in 2016. C. canis may have low virulence in humans; however, C. canis with oxidase activity may cause severe zoonotic infection.

著者

Tetsuaki Shoji Hidenori Mizugaki Yasuyuki Ikezawa Megumi Furuta Yuta Takashima Hajime Kikuchi Houman Goudarzi Hajime Asahina Junko Kikuchi Eiki Kikuchi Jun Sakakibara-Konishi Naofumi Shinagawa Ichizo Tsujino Masaharu Nishimura

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.57, no.12, pp.1769-1772, 2018-06-15 (Released:2018-06-15)

参考文献数

17

被引用文献数

2

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This report describes the case of a 66-year-old man with non-small cell lung cancer and venous thromboembolism (VTE). Unfractionated heparin (UFH) was initially used to control VTE before chemotherapy. However, switching UFH to warfarin or edoxaban, a novel oral anticoagulant (NOAC), failed. Chemotherapy was then administered to control the tumor which was thought to have been the main cause of VTE, which had been treated by UFH. After tumor shrinkage was achieved by chemotherapy, we were able to successfully switch from UFH to edoxaban. Controlling the tumor size and activity enabled the use of edoxaban as maintenance therapy for VTE.