著者

Norihiro Nagamura Sayaka Ueno Hirofumi Fujishiro Hideyuki Oonuma

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.2, pp.145-149, 2014 (Released:2014-01-15)

参考文献数

28

被引用文献数

3 12

---

A 52-year-old woman presented to our hospital due to elevated liver enzyme levels and hypereosinophilia. Liver biopsy specimens revealed chronic hepatitis with abundant eosinophils and immunoglobulin G4(IgG4)-positive plasma cell infiltration. Systemic lymphadenopathy, including that involving the hepatic hilar lymph nodes, was observed on computed tomography, and the cervical lymph node biopsy specimens exhibited lymphoid follicular hyperplasia and IgG4-positive plasma cell infiltration. It is sometimes difficult to distinguish hypereosinophilic syndrome (HES) from IgG4-related disease, as some of the clinical findings overlap. The numerous areas of eosinophilic infiltration observed in the liver indicated a diagnosis of HES in our case.

著者

Toru Hashimoto Kimika Arakawa Yuko Ohta Takaichi Suehiro Noriko Uesugi Masaru Nakayama Takuya Tsuchihashi

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.46, no.5, pp.241-245, 2007 (Released:2007-03-01)

参考文献数

22

被引用文献数

5 10

---

A 60-year-old woman was admitted because of multiple bone pain. Examination revealed hypophosphatemic osteomalacia and acquired Fanconi syndrome. Further exploration revealed monoclonal gammopathy of undetermined significance (MGUS) excreting urinary Bence Jones protein (kappa light chain). Renal biopsy showed non-specific tubulointerstitial nephritis, yet neither crystalline inclusions in the cytoplasm of the tubular epithelium nor myeloma casts nor amyloid deposits were found. She was treated with supplementation by phosphate, alkali agents, and vitamin D, and responded well to the treatment symptomatically and biochemically. MGUS was observed without chemotherapy. Myeloma had not developed after 10 months follow-up.

著者

Takumu Hasebe Koji Sawada Shunsuke Nakajima Shigeaki Maeda Masami Abe Yasuaki Suzuki Takaaki Ohtake Chitomi Hasebe Mikihiro Fujiya Yutaka Kohgo

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.1, pp.29-33, 2014 (Released:2014-01-01)

参考文献数

17

被引用文献数

1

---

A 70-year-old Japanese man was hospitalized for expanding purpura and chronic disseminated intravascular coagulation (DIC) caused by decompensated liver cirrhosis. As there are no effective treatments for chronic DIC caused by liver cirrhosis, we decided to administer recombinant human soluble thrombomodulin (rhsTM) after he provided informed consent. The DIC was rapidly improved; however, the purpura and coagulopathy recurred after two months, and repeated rhsTM treatments were required. The rhsTM treatment sufficiently controlled the coagulopathy for two years, without any complications, including bleeding. This is the first report demonstrating that rhsTM can be administered safely and repeatedly to a patient with decompensated liver cirrhosis, and that it appears to be associated with a favorable outcome.

著者

Akira Sato Michio Sata Kenji Ikeda Takashi Kumada Namiki Izumi Yasuhiro Asahina Yukio Osaki Kazuaki Chayama Shuichi Kaneko Akito Sakai Morikazu Onji Yoichi Hiasa Takumi Omura Itaru Ozeki Osamu Yokosuka Shuichiro Shiina Mariko Itsubo Shuhei Nishiguchi Katsuharu Hirano Tatsuya Ide Shotaro Sakisaka Takahiro Yamasaki Isao Hidaka Masatoshi Tanaka Soo Ryang Kim Takafumi Ichida

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.52, no.24, pp.2701-2706, 2013 (Released:2013-12-15)

参考文献数

32

被引用文献数

4 14

---

Objective We attempted to elucidate the clinical features of chronic hepatitis C patients who develop hepatocellular carcinoma (HCC) after achieving a sustained viral response (SVR) to interferon (IFN) therapy. Methods The clinical features of 130 patients at 19 hospitals who developed HCC after obtaining an SVR were retrospectively reviewed. Results Overall, 107 (82%) of the 130 patients were men, with 92 (71%) being ≥60 years of age and 76, 38 and 16 developing HCC within 5, 5-10 and 10-16.9 years after IFN therapy, respectively. Before receiving IFN therapy, 92 (71%) patients had cirrhosis and/or a low platelet count (<15×104 cells/μL). Lower albumin (<3.9 g/dL) and higher alpha fetoprotein (AFP) (≥10 ng/mL) levels were identified in a multivariate analysis to be independent variables of the development of HCC within five years after IFN therapy. Among 4,542 SVR patients, HCC occurred in 109 (2.4%) during a 5.5-year follow-up period, thus resulting in an occurrence rate of 4.6% for men and 0.6% for women. Conclusion SVR patients with lower albumin or higher AFP levels require careful assessments to prevent early HCC development after IFN therapy. HCC occurrence within >10 years of IFN therapy is not uncommon, and the risk factors remain uncertain, thus suggesting that all SVR patients should undergo long-term follow-up examinations for HCC development.

著者

Serdal Ugurlu Erkan Caglar Tijen Erdem Yesim Eda Tanrikulu Gunay Can Pinar Kadioglu

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.4, pp.205-209, 2008 (Released:2008-02-15)

参考文献数

27

被引用文献数

3 8

---

Objective To determine the characteristics of thyroid nodules by using fine needle aspiration (FNA) biopsy and ultrasonography. Patients and Methods FNAs of 1,004 patients with thyroid nodules between 2000 and 2007 were evaluated retrospectively. The surgical records of 101 of the patients were available and reviewed. The Odds ratios for nodule characteristics were calculated individually. Results The sensitivity of FNA was 66.7% and the specifity was 95.2%. Positive predictive value was 72.7% and negative predictive value was 93.7%. Our diagnostic accuracy was 90.5%. Solitary nodules, irregular margins and microcalcifications were associated with increased risk of malignancy with Odds ratios 3.61 (95% CI: 1.25-10.42; p= 0,017); 5.44 (95% CI: 1.76-16.78; p= 0,003) and 39.29 (95% CI 8.32-185.47; p< 0.001) respectively. Macrocalcification, age, gender and thyroid status were not associated with increased risk of malignancy. Conclusion Our data suggest that FNA is a reliable, reproducible and valid method to evaluate thyroid nodules and ultrasonographic features, especially microcalcification is a very important predictor of malignancy.

著者

Yoshiaki Kaneko Tadashi Nakajima Tadanobu Irie Masahiko Kurabayashi

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.52, no.19, pp.2287-2288, 2013 (Released:2013-10-01)

参考文献数

2

被引用文献数

1

著者

Shinji Teramoto Norihito Hida Hiroaki Ishikawa Nobuyuki Hizawa

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.52, no.19, pp.2289-2290, 2013 (Released:2013-10-01)

参考文献数

2

被引用文献数

1 1

著者

Kazuhide Higuchi Takashi Joh Koji Nakada Ken Haruma

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.52, no.13, pp.1447-1454, 2013 (Released:2013-07-01)

参考文献数

23

被引用文献数

5 14

---

Objective Proton pump inhibitors (PPIs) are widely used as the mainstay of treatment for erosive reflux esophagitis, based on the excellent results obtained in clinical trials. However, the endoscopic remission rates in patients treated with PPIs in actual clinical settings have not been fully assessed. We conducted a nationwide survey to evaluate the effectiveness of PPIs based on endoscopic findings in real-world clinical settings. Methods This was a multicenter retrospective study conducted among 41 Japanese institutions. Endoscopic findings before and after PPI therapy were collected from the medical records of patients diagnosed with Los Angeles grade A-D reflux esophagitis who had been treated with a PPI for at least eight weeks before undergoing a second endoscopy. The remission rates of erosive esophagitis, defined as the percentage of patients with grade N or M findings following PPI therapy, were calculated. Results Data for 541 patients were analyzed. At first endoscopy, 45.5%, 30.3%, 15.9% and 8.3% of patients were diagnosed with grade A, B, C and D esophagitis, respectively. The mean duration of PPI therapy was 410 days, and the mean remission rate was 61.6%. The remission rate was significantly lower in the patients with more severe erosive esophagitis based on the LA grade before PPI therapy. Conclusion This study revealed that approximately 40% of the patients did not achieve remission of erosive esophagitis following PPI therapy for a mean of 1.1 years. This suggests the necessity of providing careful follow-up using periodic endoscopy and appropriately selecting PPI therapy.

著者

Tomohiro Koga Kanako Takano Yoshiro Horai Satoshi Yamasaki Hideki Nakamura Akinari Mizokami Koichi Ohshima Atsushi Kawakami

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.52, no.16, pp.1839-1843, 2013 (Released:2013-08-15)

参考文献数

15

被引用文献数

3

---

A 21-year-old man was admitted to our hospital with a fever, erythema, cervical lymphadenopathy and pancytopenia. A diagnosis of Sweet's syndrome (SS) with Kikuchi's disease (KD) and hemophagocytic syndrome (HPS) was made based on the results of a bone marrow aspiration along with the results from biopsy specimens of the brachial skin and a cervical lymph node. The expression of retinoic acid-inducible gene-I (RIG-I) in the skin epidermal basal layer as well as in a cervical lymph node was revealed through immunohistochemistry. He successfully entered remission through treatment with prednisolone. This findings of this case indicate that when SS with KD presents as HPS, it may suggest an association with an RIG-I-related innate immunity.

著者

Hiroto Kinoshita Reiko Kunisaki Hisae Yamamoto Reikei Matsuda Tomohiko Sasaki Hideaki Kimura Katsuaki Tanaka Makoto Naganuma Shin Maeda

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.52, no.17, pp.1855-1862, 2013 (Released:2013-09-01)

参考文献数

23

被引用文献数

8 39

---

Objective To investigate the short- and long-term efficacy and safety of infliximab (IFX) in intestinal Behçet's disease (BD) patients in a retrospective cohort study. Methods Among 43 consecutive patients with intestinal BD presenting at the same clinic, 15 with active disease and receiving standard treatment were given IFX infusions (5 mg/kg body weight) every eight weeks. The patients were clinically and endoscopically evaluated before treatment, then assessed after 10 weeks, 12 months and 24 months for a clinical response, defined as a significant improvement in intestinal symptoms and a reduced C-reactive protein (CRP) level. Results At week 10, 12 patients (80%) exhibited a response to IFX, with eight (53%) in remission with no intestinal symptoms and normal CRP levels. A response to IFX was maintained in seven of the 11 patients (64%) available at 12 months and in four of the eight patients (50%) available at 24 months. Of the seven patients receiving prednisolone at entry, five responders had their steroid doses reduced. Fulminant intestinal BD was predictive of an absence of response to IFX. The adverse effects comprised one infusion reaction and one case of fever, most likely related to IFX. Conclusion IFX is effective and safe in patients with refractory intestinal BD.

著者

Tokihisa KIMURA

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.39, no.12, pp.1002-1003, 2000 (Released:2006-03-27)

参考文献数

13

被引用文献数

6 10

著者

Kei Suzuki Akiko Nakamura Tomoyuki Enokiya Yoshiaki Iwashita Eri Tomatsu Yuichi Muraki Toshihiro Kaneko Masahiro Okuda Naoyuki Katayama Hiroshi Imai

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.52, no.14, pp.1641-1645, 2013 (Released:2013-07-15)

参考文献数

20

被引用文献数

4 13

---

We herein report the first case of septic arthritis caused by rmpA-positive hypermucoviscous community-acquired K. pneumoniae that followed urosepsis in a 65-year-old Japanese woman. The patient responded well to drainage of the abscesses and treatment with cefazolin. Although this virulent phenotype of K. pneumoniae has been primarily reported in Hong Kong, we confirmed that 18/50 isolates obtained in our hospital over the past five years displayed the hypermucoviscous phenotype. Therefore, clinicians should consider the possibility of an increasing prevalence of rmpA-positive hypermucoviscous K. pneumoniae infection in Japan and be particularly vigilant for invasive clinical manifestations, even in patients with urinary tract infections.

著者

Hsin-Fu Lee Yen-Chen Lin Chia-Pin Lin Chun-Li Wang Chi-Jen Chang Lung-An Hsu

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.51, no.14, pp.1815-1820, 2012 (Released:2012-07-15)

参考文献数

40

被引用文献数

6 19

---

Objective We aimed to investigate the association between the ABO blood groups and the risk of coronary artery disease (CAD) and myocardial infartion (MI) in a young Taiwanese population. Methods We retrospectively recruited 277 consecutive subjects (men younger than 45 years and women younger than 55 years) who underwent coronary angiography (136 with documented CAD and 129 without CAD) at our center, between 2005 and 2008. Their ABO blood groups were determined using standard agglutination techniques. Results Patients with CAD showed a significantly different blood group distribution (O, 30.1%; A, 39.7%; B, 26.5%; AB, 3.7%) than that shown by the controls (O, 42.6%; A, 24.0%; B, 27.1%; AB, 6.2%; p=0.032). Patients with blood group A had a greater risk of CAD and MI than those with non-A blood groups (OR=2.08, 95% CI=1.23-3.54; OR=2.21, 95% CI=1.19-4.09, respectively). After adjustment for common cardiovascular risk factors such as age, gender, hypertension, cigarette smoking, diabetes mellitus, body mass index, family history of CAD, and lipid profiles; blood group A remained significantly associated with an increased risk of CAD and MI (OR=2.61, 95% CI 1.11-6.14, p=0.028; OR=3.53, 95% CI=1.21-10.29, p=0.021, respectively). Conclusion Our findings suggest that blood group A is an independent risk factor for CAD and MI in young people in Taiwan.

著者

Yuki Ohmoto-Sekine Makiko Ishihara Shiun Dong Hsieh Kazuhisa Amakawa Shigeko Hara Hiroshi Tsuji Rieko Ishimura Sugao Ishiwata Tetsu Yamaguchi Minoru Ohno Yasuji Arase

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.52, no.9, pp.977-980, 2013 (Released:2013-05-01)

参考文献数

16

被引用文献数

4 6

---

Kawasaki disease (KD) is one of the most important causes of coronary artery aneurysms in children and young adults. However, the natural course of the disease and the patient prognosis remain obscure. A 72-year-old asymptomatic man with undiagnosed KD underwent whole-heart magnetic resonance coronary angiography during a health checkup. The imaging disclosed giant aneurysms in the proximal portion of the right coronary artery and the left anterior descending artery. The patient was successfully treated with coronary artery bypass grafting. The present case suggests that there may be a substantial number of patients who have attained middle to old age with undiagnosed KD.

著者

Takahiko Kurasawa Hayato Nagasawa Eiko Nishi Hirofumi Takei Ayumi Okuyama Tsuneo Kondo Koji Nishimura Ryota Sakai Akiko Shibata Kentaro Chino Hiroe Ogawa Tatsuya Ito Koichi Amano Hitoshi 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.10, pp.1125-1130, 2013 (Released:2013-05-15)

参考文献数

30

被引用文献数

4 5

---

A substantial number of patients with lupus nephritis (LN) are refractory to conventional glucocorticoid (GC) treatment. Although many of these patients respond to immunosuppressive drugs such as intravenous cyclophosphamide (IVCY), azathioprine (AZA), mizoribine, tacrolimus, cyclosporine A (CSA) and mycofenolate mofetil (MMF), some remain refractory to such therapies. Recent studies of multi-target therapies have reported effective outcomes for immunosuppression following renal transplantation and refractory LN when therapy consists of two or more immunosuppressive drugs with different mechanisms of action. We herein report a case of LN unresponsive to IVCY that was successfully treated with the addition of tacrolimus and discuss the usefulness of multi-target therapy for LN.

著者

Jun-ichi Oyama Toyoki Maeda Makoto Sasaki Kazuya Kozuma Ryuji Ochiai Ichiro Tokimitsu Sachiyo Taguchi Yoshihiro Higuchi Naoki Makino

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.49, no.23, pp.2553-2559, 2010 (Released:2010-12-01)

参考文献数

37

被引用文献数

13 32

---

Objective Several epidemiological investigations have reported that green tea reduces cardiovascular and cerebral vascular risks. Green tea catechins may improve peripheral endothelial dysfunction in smokers. The purpose of this study was to elucidate the beneficial effect of green tea catechins on the repair of endothelial dysfunction in smokers. Methods Thirty healthy male smokers divided into three groups ingested a green tea beverage containing 0 mg (control group), 80 mg (middle dose group) or 580 mg (high dose group) of green tea catechins (GTC) daily for two weeks, and endothelial-dependent vasodilatation was investigated by measuring forearm blood flow (FBF) response to reactive hyperemia (RH) by venous occlusion strain-gauge plethysmography. Results An acute effect was that the FBF response to RH significantly increased 2 hr after GTC intake in the high dose group. However, no increase was observed in the other groups. The chronic administration of GTC for one or two weeks ameliorated the FBF responses to RH in the high dose group. On the other hand, no significant increase was observed in the FBF responses to RH in the other groups. Moreover, the plasma concentration of 8-OHdG, IL-6, TNF-alpha, and soluble Fas decreased significantly for two weeks in the high dose group, however, the level of IL-1 beta remained unchanged over this period. Conclusion Green tea consumption over short and long periods appears to ameliorate endothelial dysfunction by scavenging free radicals with anti-inflammatory and anti-apoptotic properties in healthy male smokers.

著者

Takeshi Saraya Manami Inoue Hajime Takizawa Hajime Goto

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.52, no.9, pp.1003, 2013 (Released:2013-05-01)

参考文献数

2

被引用文献数

1 2

著者

Wei-Hsi Chen Tzu-Hui Li Lian-Hui Lee Chih-Cheng Huang

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.51, no.17, pp.2439-2441, 2012 (Released:2012-09-01)

参考文献数

11

被引用文献数

4 17

---

A nummular headache (NH) is a type of primary headache that results from cranial neuralgia without a known cause. We herein report the case of a woman who suffered two episodes of focal headache in the left parietal area with identical characteristics that were compatible with NH. During the recovery phase of the second NH episode, the pain resurged with shingles coinciding with the painful area. The patient's NH subsided in parallel with resolution of the shingles. These findings support a diagnosis of peripheral neuralgia with NH. Latent virus infections, such as Varicella-zoster virus, that frequently cause distal nerve damage in patients with zoster sine herpete may be associated with epicranial neuralgia and NH.

著者

Stavroula J. Theodorou Daphne J. Theodorou Yousuke Kakitsubata Judith E. Adams

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.51, no.22, pp.3225-3226, 2012 (Released:2012-11-15)

参考文献数

2

被引用文献数

3 12 3

著者

Motonori Nagasawa Yoshifumi Ubara Tatsuya Suwabe Masayuki Yamanouchi Noriko Hayami Keiichi Sumida Yoshinari Hattori Maki Tsukamoto Eriko Hiramatsu Eiko Hasegawa Junichi Hoshino Naoki Sawa Yuji Marui Michio Nakamura Shinji Tomikawa Kennmei Takaichi

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.51, no.24, pp.3401-3404, 2012 (Released:2012-12-15)

参考文献数

13

被引用文献数

2 5

---

We herein report an unusual case of spontaneous parathyroid gland rupture. A man was admitted with respiratory distress in September 2010. He had been receiving hemodialysis since 1995. He was diagnosed secondary hyperparathyroidism in 2006 and began receiving cinacalcet therapy in 2009. His intact parathyroid hormone (iPTH) level decreased, and massive traumatic bleeding occurred, following which rupture of the parathyroid gland was detected during surgery. The ruptured gland showed nodular hyperplasia. Previous reports have indicated that parathyroid bleeding is associated with glandular hypertrophy. This is the first report of parathyroid apoplexy occurring after suppression of elevated parathyroid function caused by cinacalcet therapy.