著者

Woo Hyun Cho Hye Ju Yeo Seong Hoon Yoon SeungEun Lee Doo SooJeon Yun Seong Kim Ki Uk Kim Kwangha Lee Hye Kyung Park Min Ki Lee

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.54, no.18, pp.2307-2313, 2015 (Released:2015-09-15)

参考文献数

31

被引用文献数

2 17

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Objective High-flow nasal cannula (HFNC) therapy is an oxygen delivery system. However, evidence regarding the clinical applications of HFNC is still emerging. We herein evaluated the clinical predictors of HFNC therapy success for adult patients with acute hypoxemic respiratory failure. Methods We retrospectively reviewed the medical records of the subjects with acute hypoxemic respiratory failure supported by HFNC therapy in the medical intensive care unit between July 2011 and March 2013. Therapy success was defined as the avoidance of intubation. The patients' baseline characteristics and the serial changes in the respiratory parameters after HFNC therapy at 1 and 24 hours were measured. Results Of the 75 eligible patients, 62.7% successfully avoided intubation. Overall, HFNC therapy significantly improved the physiologic parameters, such as partial pressure of arterial oxygen (PaO2), saturation of arterial oxygen (SaO2), respiratory rate (RR), and heart rate (HR), throughout the first 24 hours. After the adjustment for the other clinical variables, Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), cardiogenic pulmonary edema, and PaO2 improvement at 1 and 24 hours were associated with therapy success. The overall intensive care unit (ICU) mortality was 25.3%. However, out of 37.3% of the patients who required intubation, the ICU mortality in this proportion of patients was 67.9%. The ICU mortality in the therapy failure group was associated with the use of a vasopressor and a limited PaO2 improvement at 1 hour. Conclusion HFNC therapy showed a good compliance and the improvement of the physiologic parameters in an adult population. The failure to improve oxygenation within 24 hours was a useful predictor of intubation. Among the failure group, the vasopressor use and failed oxygenation improvement were associated with ICU mortality.

著者

Nobuyuki Horita Naoki Miyazawa Takashi Yoshiyama Ryota Kojima Yoshiaki Ishigatsubo Takeshi Kaneko

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.54, no.18, pp.2315-2320, 2015 (Released:2015-09-15)

参考文献数

20

被引用文献数

5

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Objective In the 1950s, a high-dose (40-70 mg/kg/day) of pyrazinamide (PZA), was reported to cause drug-induced liver injury (DILI) at an unacceptable frequency. It remains unclear whether adding PZA (Z) at the currently accepted low-dose (20-25 mg/kg/day) for two months to a regimen of isoniazid (H) + rifampicin (R) + ethambutol (E) actually increases the risk of DILI. Method Smear-positive tuberculosis patients were treated with daily HRE or HRZE regimen under direct observation. We used three independent models. Model 1 was analyzed with a multivariate Cox-analysis using a pre-matched cohort. Next, propensity score matching was conducted using the nearest neighbor method with caliper of 0.03. Models 2 and 3 were analyzed by univariate and multivariate Cox-analyses, respectively, with the matched cohort. DILI was assessed based on the guidelines of the American Thoracic Society. Results We reviewed the records of 383 patents (male, n=260; female n=123; mean age, 64±20 years). Among these patients, 75 patients were treated with HRE and 308 were treated with HRZE. DILI occurred in the first two months in 24% (18/75) and 8% (24/308) of the HRE-treated and HRZE-treated cases, respectively. In all three of the models, DILI was less frequent in patients treated with the HRZE regimen: Model 1, HR of 0.30 (95% confidence interval (CI) 0.14-0.68, p=0.004); Model 2, HR of 0.37 (95%CI 0.14-0.96, p=0.041); and Model 3, HR of 0.34 (95%CI 0.12-0.94, p=0.038). Conclusion The addition of the currently accepted low dose (20-25 mg/kg/day) of PZA to the HRE regimen did not increase the incidence of DILI during the first two months of treatment.

著者

Shintaro Sagami Yoshitaka Ueno Shinji Tanaka Kenta Nagai Ryohei Hayashi Kazuaki Chayama

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.54, no.17, pp.2167-2172, 2015 (Released:2015-09-01)

参考文献数

21

被引用文献数

11

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A 52-year-old woman with ulcerative colitis was admitted to our hospital for an ulcerative colitis flare-up under salazosulfapyridine therapy. The symptoms improved with high-dose corticosteroids. After prednisolone was tapered to 10 mg, the frequency of diarrhea increased. The diarrhea was accompanied by joint pain and a skin ulcer with abscess formation, which was diagnosed to be pyoderma gangrenosum. The patient was started on adalimumab. A positive response to the adalimumab therapy was observed after 2 weeks, during which time the ulcerative skin lesion healed completely, however, colonic mucosal healing was achieved at 2 months. Therefore, adalimumab appears to be an effective therapeutic option for patients with ulcerative colitis-associated pyoderma gangrenosum.

著者

Takaaki Ishiyama Toshinori Takada

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.54, no.16, pp.1959-1960, 2015 (Released:2015-08-15)

参考文献数

7

著者

Toshio Naito Keito Torikai Masafumi Mizooka Fujiko Mitsumoto Kenji Kanazawa Shiro Ohno Hiroyuki Morita Akira Ukimura Nobuhiko Mishima Fumio Otsuka Yoshio Ohyama Noriko Nara Kazunari Murakami Kouichi Mashiba Kenichiro Akazawa Koji Yamamoto Mika Tanei Masashi Yamanouchi Shoichi Senda Susumu Tazuma Jun Hayashi

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.54, no.16, pp.1989-1994, 2015 (Released:2015-08-15)

参考文献数

26

被引用文献数

7 8

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Objective Although inflammatory markers, such as the white blood cell (WBC) count, erythrocyte sedimentation rate (ESR) and levels of C-reactive protein (CRP) and procalcitonin, are widely used to differentiate causes of fever of unknown origin (FUO), little is known about the usefulness of this approach. We evaluated relationships between the causes of classical FUO and the levels of inflammatory markers. Methods A nationwide retrospective study including 17 hospitals affiliated with the Japanese Society of Hospital General Medicine was conducted. Patients This study included 121 patients ≥18 years old diagnosed with "classical FUO" (axillary temperature ≥38.0°C at least twice over a ≥3-week period without elucidation of the cause on three outpatient visits or during three days of hospitalization) between January and December 2011. Results The causative disease was infectious diseases in 28 patients (23.1%), non-infectious inflammatory disease (NIID) in 37 patients (30.6%), malignancy in 13 patients (10.7%), other in 15 patients (12.4%) and unknown in 28 patients (23.1%). The rate of malignancy was significantly higher for a WBC count of <4,000 /μL than for a WBC count of 4,000-8,000 /μL (p=0.015). Among the patients with a higher WBC count, the rate of FUO due to NIID tended to be higher and the number of unknown cases tended to be lower. All FUO patients with malignancy showed an ESR of >40 mm/h. A normal ESR appeared to constitute powerful evidence for excluding a diagnosis of malignancy. In contrast, the concentrations of both serum CRP and procalcitonin appeared to be unrelated to the causative disease. Conclusion The present study identified inflammatory markers that should be considered in the differential diagnosis of classical FUO, providing useful information for future diagnosis.

著者

Shojiro Minomo Kazunobu Tachibana Kazunari Tsuyuguchi Masanori Akira Masanori Kitaichi Katsuhiro Suzuki

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.54, no.5, pp.491-495, 2015 (Released:2015-03-01)

参考文献数

10

被引用文献数

2

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Summer-type hypersensitivity pneumonitis includes a spectrum of granulomatous lung diseases that result from the inhalation of Trichosporon species in the summer. Hot tub lung is a granulomatous lung disease caused by the inhalation of water aerosols containing non-tuberculous mycobacteria. We herein describe a case of hot tub lung that deteriorated during the winter season. Every winter, the patient's symptoms, laboratory findings and chest images worsened. Genetically identical Mycobacterium avium strains were detected in his sputum and bathtub. The circulation of bathtub water during the winter months only exacerbated his symptoms in the winter.

著者

Akemi Okui Yoshihiko Soga Susumu Kokeguchi Motoko Nose Reiko Yamanaka Nobuchika Kusano Manabu Morita

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.54, no.14, pp.1809-1814, 2015 (Released:2015-07-15)

参考文献数

21

被引用文献数

1 5

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The detection of infective endocarditis (IE) of oral origin has been previously discussed. However, there are few reports confirming this infection using molecular biological techniques. We herein describe the case of a 67-year-old man who developed IE. Blood culture samples and strains obtained from the gingival and buccal mucosa showed 100% identity to Enterococcus faecalis JCM 5803 on sequencing of 16S rRNA gene fragments. A random amplification of polymorphic DNA (RAPD) analysis showed the same pattern for these samples, thus confirming the identity of E. faecalis isolates in the blood and oral mucosa. Our observations provide novel information regarding the level of identity between IE pathogens and oral bacteria.

著者

Morihiko Oya Takao Tanimoto Takayuki Yamamoto Yukiya Hakozaki

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.54, no.14, pp.1803-1808, 2015 (Released:2015-07-15)

参考文献数

30

被引用文献数

8

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A 33-year-old previously healthy man injured his gums and subsequently developed dyspnea and fever. A chest X-ray showed nodules and infiltrates in both lungs, and the patient was initially diagnosed with pneumonia and administered meropenem hydrate, although his symptoms did not improve. A blood culture identified Fusobacterium necrophorum, and thrombophlebitis in the internal jugular vein of the neck was observed on computed tomography and ultrasound scans. We replaced the meropenem with clindamycin, sulbactam/ampicillin and metronidazole, and the patient's symptoms improved.

著者

Norihiko Ohashi Takenori Okada Mio Uchida Michitaka Amioka Mai Fujiwara Shunichi Kaseda

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.54, no.14, pp.1761-1763, 2015 (Released:2015-07-15)

参考文献数

10

被引用文献数

17

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Left ventricular thrombus (LVT) after acute myocardial infarction (AMI) is a risk factor for embolic complications. Although warfarin has traditionally been used to treat LVT, it has relevant disadvantages that limit its use. We herein describe the case of a 78-year-old man with AMI who had a history of paroxysmal atrial fibrillation. Following 10 days of urgent coronary reperfusion therapy, transthoracic echocardiography revealed a moderately sized LVT in the apex, which subsequently disappeared after 18 days of treatment with dabigatran. This case demonstrates that dabigatran may represent an alternative to warfarin as a therapeutic option in patients with LVT after AMI.

著者

Shuwa Minami Tomotaka Kawayama Masao Ichiki Mamoru Nishiyama Yoshiko Sueyasu Rumi Gohara Masaharu Kinoshita Hideyuki Koga Tomoaki Iwanaga Hisamichi Aizawa

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.47, no.6, pp.503-509, 2008 (Released:2008-03-17)

参考文献数

21

被引用文献数

2 2

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Background There is insufficient evidence for the efficacy of a transdermal tulobuterol patch (TP), although combination therapy with bronchodilators is recommended for chronic obstructive pulmonary disease (COPD). Objective A randomized, controlled crossover study was conducted to evaluate the clinical efficacy and safety of the TP in 16 patients with COPD. Slow-release theophylline was used as a control drug. Methods Following a 2-week run-in period, patients were randomly allocated to two groups by the envelope method; they then received the TP and theophylline for 4 weeks each by the crossover method. Pulmonary function tests, peripheral blood examination, and electrocardiography were performed before and after each treatment period. Patients recorded in diaries their symptom scores, numbers of administrations of inhaled β2 agonists, and presence/absence of adverse reactions. Results Patients receiving TP exhibited significant improvement in the number and ease of sputum expectorations and in cough frequency score and wheezing severity score compared with baseline (p<0.05); the corresponding improvement in patients receiving theophylline was non-significant. Assessment of quality of life by the St. George's Hospital Respiratory Questionnaire revealed that treatment with TP was associated with significant improvement in symptoms, impact, and total scores compared with baseline (p<0.05); theophylline gave only a non-significant improvement in total score. Neither drug caused significant changes in the results of physiological examinations or in pulse or blood pressure. There was no difference in safety between the treatments. Conclusion Treatment of COPD patients with TP is more effective than with theophylline.

著者

Kazutoshi Fujibayashi Hirohide Yokokawa Toshiaki Gunji Noriko Sasabe Mitsue Okumura Kimiko Iijima Tomomi Haniu Teruhiko Hisaoka Hiroshi Fukuda

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.54, no.7, pp.717-723, 2015 (Released:2015-04-01)

参考文献数

27

被引用文献数

1 5

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Objective The aim of this study was to investigate the associations between the incidence of diabetes and the accumulation of markers of impaired glucose metabolism; i.e., pre-diabetes. Methods This retrospective cohort study recruited 1,631 men without diabetes at baseline who attended more than two routine health check-ups at our institution between 2006 and 2012. The participants were divided into four groups based on the number of markers of impaired glucose metabolism exhibited at the initial examination. The following markers of impaired glucose metabolism were defined as risk factors for diabetes: a fasting plasma glucose level of ≥110 mg/dL, 2-hour plasma glucose level of ≥140 mg/dL and glycated hemoglobin (HbA1c) value of ≥6.0% (42 mmol/moL). The risk of developing diabetes was assessed using a multivariate analysis. Results The median examination interval was 1,092 days. The incidence of diabetes rose in association with the number of markers. The subjects with two markers displayed a multivariate-adjusted odds ratio (OR) for diabetes of 19.43 [95% confidence interval (CI): 9.70-38.97] and the subjects with three markers displayed an OR of 48.30 (95% CI: 20.39-115.85) compared with the subjects with one or no markers. Conclusion The present results demonstrate the impact of accumulating markers of impaired glucose metabolism on the risk of developing diabetes. Anti-diabetes intervention strategies should aim to comprehensively assess an individual's risk of developing diabetes at the pre-diabetes stage.

著者

Yasuhiro Kiyonaga Keisuke Maeshima Chiharu Imada Miwa Haranaka Koji Ishii Hirotaka Shibata

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.53, no.11, pp.1209-1213, 2014 (Released:2014-06-01)

参考文献数

39

被引用文献数

1 11

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We herein report the case of an 84-year-old man with steroid-dependent adult-onset Still's disease (AOSD) whose daily steroid dose was successfully tapered after etanercept treatment. The corticosteroids worked well initially, and the patient went into remission promptly; however, he suffered a relapse due to steroid tapering. Because treatment with cyclosporine and methotrexate was ineffective, reducing the steroid dose was difficult, and the corticosteroids induced myopathy and diabetes. However, steroid tapering was accomplished in combination with etanercept therapy, and the patient's steroid-induced side effects disappeared. Etanercept should therefore be considered as a steroid-sparing treatment option in patients with steroid-responsive, steroid-dependent AOSD.

著者

Yoshiro Sakai Tetsuya Naito Chiyoko Arima Miho Miura Liang Qin Hidenobu Hidaka Kenji Masunaga Tatsuyuki Kakuma Hiroshi Watanabe

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.54, no.5, pp.459-464, 2015 (Released:2015-03-01)

参考文献数

12

被引用文献数

4 10

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Objective Warfarin is known to interact with many drugs; however, there are currently no descriptions of an interaction with linezolid in the literature. It was recently brought to our attention, however, that several warfarin-medicated patients have experienced an increase in the prothrombin time international normalized ratio (PT-INR) following the administration of linezolid. We therefore performed a retrospective survey in order to investigate the possibility of an interaction between warfarin and linezolid. Methods The survey items included age, gender, underlying disease, type of surgery, type of infectious disease, duration of linezolid administration, laboratory values and the dose of warfarin. The PT-INR was observed over time before treatment and at days 4 or 5 and 10, completion and one week after the end of concomitant therapy. Patients The subjects included six patients who were recovering from recent heart-related surgery. Results The PT-INR increased from 1.62±0.32 before concomitant linezolid administration to 3.00±0.83 at day 4 or 5 after concomitant administration (p<0.01) and significantly decreased from 1.65±0.45 at the completion of the regimen to 1.26±0.1 one week later (p<0.05). With respect to the relationship between the dose of warfarin and the PT-INR in five cases, the PT-INR increased following concomitant linezolid treatment in all cases. Conclusion Although it has been reported that linezolid does not influence the metabolism or protein binding of warfarin, our data showed potential drug interactions between warfarin and linezolid. Our data suggest that PT-INR monitoring after the completion of concomitant warfarin and linezolid therapy is important.

著者

Takeshi Yoshida Natsumi Fujisaki Ryo Nakachi Takeshi Sueyoshi Shugo Suwazono Masahito Suehara

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.53, no.20, pp.2373-2376, 2014 (Released:2014-10-15)

参考文献数

10

被引用文献数

8

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A 76-year-old man came to our hospital complaining of hiccups and vomiting lasting for five days. A neurological examination showed dysfunction of cranial nerves V, VII, VIII, IX and X on the left side. Cerebrospinal fluid polymerase chain reaction for varicella zoster virus-DNA was positive. The patient responded well to treatment with intravenous acyclovir and steroids. To the best of our knowledge, this is the first case report of zoster sine herpete presenting with persistent hiccups and vomiting. It is important to keep in mind that herpes zoster can present with symptoms that closely resemble those of intractable hiccups and nausea of neuromyelitis optica. Early detection of the virus is critical for making appropriate treatment decisions.

著者

Kayo Harada-Shirado Kazuhiko Ikeda Miki Furukawa Masumi Sukegawa Hiroshi Takahashi Akiko Shichishima-Nakamura Hiroshi Ohkawara Hideyoshi Noji Kinuyo Kawabata Shun-ichi Saito Hitoshi Ohto Kazuei Ogawa Yasuchika Takeishi

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.53, no.20, pp.2369-2371, 2014 (Released:2014-10-15)

参考文献数

18

被引用文献数

4 8

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A 44-year-old man whose platelet count had been at the lower limit of the normal range for years visited the urgent care department of our hospital for treatment of a high fever and severe fatigue. The influenza A virus was detected, and the patient therefore received the intravenous antiviral agent, peramivir. One week later, he developed systemic petechial rashes. A peripheral blood examination showed a markedly decreased platelet count (3.0×109 cells/L), and the bone marrow findings were compatible with a diagnosis of immune thrombocytopenia (ITP). Furthermore, a drug-induced lymphocyte-stimulating test was positive for peramivir. The thrombocytopenia slowly responded to treatment with oral prednisolone. This case suggests that neuraminidase inhibitors, including peramivir, can elicit or worsen ITP.

著者

Toshio Naito Nagako Kudo Akihiro Inui Naomi Matsumoto Naoto Takeda Hiroshi Isonuma Takashi Dambara Yasuo Hayashida

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.45, no.13, pp.833-834, 2006 (Released:2006-08-01)

参考文献数

5

被引用文献数

9 16 17

著者

Susumu CHIBA Kazumi YONEKURA Michio NONAKA Tomihiro IMAI Hiroyuki MATUMOTO Takuro WADA

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.43, no.1, pp.79-81, 2004 (Released:2005-01-07)

参考文献数

8

被引用文献数

8 23

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Juvenile muscular atrophy of the distal upper extremity (Hirayama disease) is a benign and non-progressive motor neuron disease. Application of a cervical collar is believed to prevent progression of symptoms in the early stages, but there is no effective therapy for the advanced disease. We found that tendon transfer improved the activities of daily living (ADL) of a patient with advanced Hirayama disease. An operative reconstruction can be valuable, even in patients with Hirayama disease who have developed impaired ADL due to extensive intrinsic hand muscle atrophy.

著者

Toshiki Nakajima Daisuke Kawabata Shuichiro Nakabo Aya Miyagawa-Hayashino Naoichiro Yukawa Hajime Yoshifuji Koichiro Ohmura Takao Fujii Tsuneyo Mimori

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.53, no.19, pp.2255-2258, 2014 (Released:2014-10-01)

参考文献数

15

被引用文献数

3 11

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A 75-year-old woman with rheumatoid arthritis (RA) presented with long-term painful erythema on the right upper arm and left elbow. The patient was diagnosed with intralymphatic histiocytosis (ILH) based on the biopsy findings. Because the patient was unresponsive to single-agent treatment with methotrexate, infliximab and etanercept, we switched to tocilizumab (TCZ) treatment, which induced remission of the ILH. Our case suggests that TCZ may be a treatment option for ILH in patients with RA.

著者

Nagaaki Katoh Akira Matsushima Masahiro Kurozumi Masayuki Matsuda Shu-ichi Ikeda

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.53, no.17, pp.1991-1995, 2014 (Released:2014-09-01)

参考文献数

27

被引用文献数

3 10

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A 52-year-old woman with a high serum alkaline phosphatase (ALP) level underwent a liver biopsy, which showed diffuse heavy deposition of Aκ amyloid, and was diagnosed as having immunoglobulin light chain (AL) amyloidosis. Although she received high-dose melphalan with stem cell transplantation and achieved a hematologic complete response (CR), her ALP level began to increase one year after treatment. Further examinations revealed that she was still in a CR state with dominant bone-type ALP, and re-biopsied liver specimens demonstrated marked regression of amyliod deposition, providing important evidence that the turnover of hepatic amyloid proteins can actually occur more rapidly than previously thought.

著者

Satoshi Murao Hiroaki Manabe Tetsuji Yamashita Takashi Sekikawa

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.47, no.11, pp.1013-1015, 2008 (Released:2008-06-02)

参考文献数

17

被引用文献数

6 14 10

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We report a 35-year-old man who was referred to our hospital with generalized convulsion and mixed acidosis presumably caused by abuse of SS-BRONTM tablets, an over-the-counter (OTC) antitussive medication sold in Japan. These tablets contain dihydrocodeine phosphate, methylephedrine, chlorpheniramine, and caffeine. Although it is difficult to discern which component caused these symptoms, it seems that dihydrocodeine phosphate or methylephedrine was involved in the addiction to SS-BRONTM and chlorpheniramine may have caused the generalized convulsion. It should be recognized that an OTC antitussive, which is quite easy to obtain, can be abused and subsequently induce serious intoxication.