著者

FUKUDA Ryuki ICHIKAWA Yukinobu TAKAYA Masatoshi OGAWA Yoshiaki MASUMOTO Akira

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.33, no.12, pp.733-738, 1994

被引用文献数

3 20

---

We determined the circadian variations and prednisolone (PSL)-induced alterations of circulating lymphocyte subsets in 10 healthy adults by two-color flow cytometry using monoclonal antibodies to various lymphocyte subsets in order to collect fundamental data for monitoring of the subsets in clinical practice. This study first examined the changes of CD5+ B cells, γδ+ or γδ- T cells, activated (HLA-DR+) CD4+ or CD8+ cells, CD11b+ or CD11b-CD8+ cells, and natural killer (NK) cell subsets (CD16+CD57-, CD16+CD57+, CD16-CD57+), in addition to other subsets described before. Compared with the base line values obtained at 9:00 (AM) on day 1, lymphocytes, total B cells, CD5+ B cells, total T cells, γδ- T cells, CD4+ cells, activated CD4+ cells, CD45RA-CD4+ cells, and activated CD8+ cells were significantly increased at 20:00 (PM). However, the numbers of CD45RA+CD4+ cells, CD11b+ or CD11b-CD8+ cells and three NK cell subsets did not show significant circadian variations. After oral PSL (30 mg), which was given at 7:00 (AM) on day 2, lymphocytes and almost all lymphocyte subsets, except for CD16+CD57- cells, were significantly decreased; these changes recovered between 13 and 26 hours after PSL administration. The circadian variations and PSL-induced alterations of lymphocyte subsets were relatively comparable, but PSL administration cause a decrease in a wider range of lymphocyte subsets including relatively corticosteroid-resistant subsets such as CD45RA+CD4+ cells, CD8+ cell and NK cell subsets. Thus, these alterations of lymphocyte subsets should be taken into account in the evaluation of patients with immunologic abnormalities, especially those receiving PSL treatment.<br>(Internal Medicine 33: 733-738, 1994)

著者

Shintaro Yanagimoto Michiko Haida Matsunobu Suko

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.12, pp.1631-1634, 2012 (Released:2012-06-15)

参考文献数

23

被引用文献数

2

---

People living in Japan were affected in various ways after the Great East Japan earthquake of March 11, 2011. A 52-year-old female asthma patient not directly affected by the disaster experienced a decrease in peak expiratory flow (PEF) immediately after the earthquake. Despite increasing the inhaled and oral corticosteroid doses, her PEF did not recover. One month later, her PEF level abruptly returned to normal with minimal medications, which were previously ineffective, and the asthma-related symptoms vanished. The stabilization of her state of mind and actual social state seemed to be a part of the reason for the patient's recovery.

著者

Kenichiro Yaita Takumitsu Suzuki Yukihiro Yoshimura Natsuo Tachikawa

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.3231-3232, 2012 (Released:2012-11-15)

参考文献数

2

被引用文献数

2 2 2

著者

Yuji Hirai Toshio Yoshihara Toshiko Motoji Kyoichi Totsuka

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.20, pp.2989-2990, 2012 (Released:2012-10-15)

参考文献数

2

著者

Taro Shimizu Yasuharu Tokuda

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.49, no.12, pp.1051-1057, 2010 (Released:2010-06-15)

参考文献数

80

被引用文献数

30 91

---

Necrotizing fasciitis (NF) is a necrotizing soft tissue infection that can cause rapid local tissue destruction, necrosis and life-threatening severe sepsis. Predisposing conditions for NF include diabetes, malignancy, alcohol abuse, and chronic liver and kidney diseases. NF is classified into two categories (types 1 and 2) based on causative microorganisms. The initial clinical picture of NF mimics that of cellulitis or erysipelas, including fever, pain, tenderness, swelling and erythema. The cardinal manifestations of NF are severe pain at onset out of proportion to local findings, hemorrhagic bullae and/or vital sign abnormality. In such cases, NF should be strongly suspected and immediate surgical intervention should be considered, along with broad-spectrum antimicrobials and general supportive measures, regardless of the findings of imaging tests.

著者

Daisuke Danno Keita Kawabata Hisao Tachibana

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.10, pp.1195-1198, 2012 (Released:2012-05-15)

参考文献数

7

被引用文献数

1 1 1

---

Objective Although a lot of people have recently reported headaches provoked after watching 3-D videos, the clinical features of the so-called "3-D headache" have not been clarified. In this study, we investigated the clinical features of headaches provoked after watching 3-D videos. Methods We conducted a questionnaire survey by email to cases who described headaches caused by watching 3-D videos on a Weblog. We established the diagnostic criteria for 3-D headaches, which are as follows for a definite 3-D headache: A) Provoked after watching 3-D videos, but was never provoked by 2-D videos, B) Never experienced previously, C) Unclassifiable by the ICHD-II. A possible 3-D headache was one that met the criteria of A) and B) the same as above, C) Classified as a "probable" subform by the International Classification of Headache Disorders-2nd Edition (ICHD-II). Results We received answers from 16 cases (5 males, 11 females, average age of 35.8 years old). Eleven of the 16 cases had experienced an entirely new type of headache after watching 3-D videos. Of these 11 cases, 5 were diagnosed as having a definite "3-D headache". The other 6 cases were diagnosed as having possible 3-D headaches. The remaining 5 of 16 cases were suspected to be attacks of primary headaches that the cases were accustomed to having experienced. The common characteristics of the 5 definite 3-D headaches were that they were bilateral and non-pulsating, and the duration was from 10 minutes to 24 hours. The intensity of the 3-D headache was as follows; severe in 2 cases, moderate in 2 cases, and mild is one case. Three of the 4 cases with moderate to severe headache had nausea. Conclusion The headaches provoked after watching 3-D videos include not only the attacks of primary headaches but also the headache attacks unclassifiable by the ICHD-II.

著者

Hiromasa Tsuda Kozue Tanaka

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.15, pp.2031-2034, 2012 (Released:2012-08-01)

参考文献数

7

被引用文献数

5 9

---

We report two cases of isolated unilateral pupil-sparing partial fascicular oculomotor paresis. Patient 1 was a 72-year-old man who developed left-sided palsy of the inferior rectus muscle (IR), medial rectus muscle (MR), superior rectus muscle (SR), inferior oblique muscle (IO), and levator palpebrae superioris (LP) due to infarction of the left paramedian thalamic artery. Patient 2 was a 70-year-old woman who developed right-sided palsy of MR, SR, IO and LP due to infarction of the right superior paramedian mesencephalic artery. These results suggest that the fibers to IR may be located in the most rostral portion of the oculomotor fascicles.

著者

Seiya Shimoda Rieko Goto Noboru Furukawa Kaku Tsuruzoe Junji Kawashima Shinsuke Iwashita Takako Maeda Shinji Ichimori Kenshi Ichinose Kenro Nishida Eiichi Araki

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.51, no.16, pp.2091-2096, 2012 (Released:2012-08-15)

参考文献数

33

被引用文献数

3 4

---

Objective Several studies have assessed the efficacy of angiotensin receptor blockers (ARBs) on peripheral insulin sensitivity using the euglycemic hyperinsulinemic clamp technique in hypertensive subjects. However, these subjects were mostly non-diabetic, and some studies showed that ARB treatment did not improve insulin sensitivity. Thus, it is still uncertain whether ARBs could improve insulin sensitivity in subjects with hypertension and diabetes. Therefore, we evaluated the effect of olmesartan on peripheral insulin sensitivity in subjects with type 2 diabetes and hypertension using M/I value during the euglycemic-hyperinsulinemic clamp technique. Methods We enrolled 10 Japanese subjects with type 2 diabetes and hypertension who had never taken antihypertensive agents. Their blood pressure, fasting plasma glucose level, HbA1c and glucose utilization rate during euglycemic-hyperinsulinemic clamp (M/I value) were examined before and after 6 months of treatment with 10-20 mg/day olmesartan (mean: 13.0 mg/day). Results Blood pressure decreased significantly from 156/88 mmHg before starting olmesartan to 135/76 mmHg after 6 months of olmesartan treatment. The mean M/I value increased significantly from 6.33±3.19 (mg/kg/min/mU/L) × 100 to 8.11±4.20 (mg/kg/min/mU/L) × 100. Peripheral insulin sensitivity improved in eight out of ten subjects. Fasting glucose levels and HbA1c levels also decreased significantly. Conclusion These results indicate that olmesartan improves glucose metabolism by improving the peripheral insulin sensitivity in subjects with type 2 diabetes.

著者

Takashi NAGAI Makoto IMAMURA Shuuzou MISUMI Masatomo MORI

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.41, no.7, pp.566-570, 2002 (Released:2006-03-27)

参考文献数

14

被引用文献数

16 21 16

---

A 53-year-old woman was admitted because of hypertension and diabetes mellitus. Elevated diastolic blood pressure, hypertensive retinopathy and renal dysfunction indicated malignant hypertension. Adrenocorticotropic hormone (ACTH) and cortisol levels were high although there were no Cushingoid features.One mg dexamethasone administration decreased neither ACTH nor cortisol levels. Brain magnetic resonance imaging revealed a left pituitary tumor (7 mm × 6 mm). Upon removal, the tumor showed positive ACTH staining by immnohistochemistry, and was diagnosed as pituitary ACTH-secreting adenoma (Cushing's disease). Her blood pressure, renal function, blood glucose and hormone levels subsequently improved. Malignant hypertension and deteriorated diabetes mellitus may have been due to subclinical Cushing's disease.(Intrenal Medicine 41: 566-570, 2002)

著者

Masao Iwagami Kanae Kubo Ryoichi Tanaka Kimito Kawahata Akiko Okamoto Noboru Hagino Kazuhiko Yamamoto

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.50, no.20, pp.2413-2416, 2011 (Released:2011-10-15)

参考文献数

14

被引用文献数

3 8

---

We present the first documented case of thrombotic thrombocytopenic purpura (TTP) with severe hypertension complicated by polymyositis and systemic sclerosis sine scleroderma. TTP developed in the progressive phase of visceral fibrosis in the absence of skin thickening. ADAMTS13 activity was not useful for the diagnosis of TTP. Although TTP and scleroderma renal crisis (SRC) share similar findings of thrombotic microangiopathy, severe thrombocytopenia with multiple organ injuries and hemorrhagic manifestations suggested TTP rather than SRC. The patient's condition improved dramatically with plasmapheresis.

著者

Akitake Suzuki Naoki Asazuma Eigo Kikuchi Takeshi Kawanobe Yoshihiko Horimoto Ryuichi Yokobari Shigeru Kotake Takahiro Okai

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.51, no.7, pp.813-816, 2012 (Released:2012-04-01)

参考文献数

9

被引用文献数

10 10 4

---

Although antiphospholipid antibody syndrome (APS) is an autoimmune condition that is primarily characterized by arterial or venous thrombosis or pregnancy morbidity and the presence of antiphospholipid antibodies (aPL), recent reviews have introduced non-thromboembolic manifestations. We describe the case of a 58-year-old woman with vegetation on the aortic valve, whose initial presentation of APS abruptly developed into diffuse pulmonary hemorrhage. Despite consecutive plasma exchange procedures and the administration of corticosteroids and high-dose intravenous immunoglobulin, multiple brain infarctions developed, and the patient died of pneumonia. Although anecdotal, this case might serve as a useful example of the non-standard complications of fulminant APS.

著者

Ayami Ochi Takashi Takei Kayu Nakayama Chihiro Iwasaki Daigo Kamei Yuki Tsuruta Ari Shimizu Shunji Shiohira Takahito Moriyama Mitsuyo Itabashi Toshio Mochizuki Keiko Uchida Ken Tsuchiya Motoshi Hattori Kosaku Nitta

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.51, no.7, pp.759-762, 2012 (Released:2012-04-01)

参考文献数

15

被引用文献数

17 21

---

We present two cases with steroid-resistant nephrotic syndrome (SRNS) and two cases with steroid-dependent nephrotic syndrome (SDNS) due to focal segmental glomerulonephritis (FSGS) who were treated with a single dose of rituximab (375 mg/m2). Although the two cases with SRNS showed no response, the two cases with SDNS achieved complete remission. The patients in whom the peripheral B-cell counts subsequently increased after the administration of rituximab demonstrated a relapse. Rituximab may be an effective treatment agent for SDNS with FSGS and the peripheral B-cell count may be a useful marker in such patients for preventing disease relapse.

著者

Yusuke Fukuda Shin-ichiro Miura Keijiro Saku

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.51, no.4, pp.441-442, 2012 (Released:2012-02-15)

参考文献数

1

被引用文献数

1 1

著者

Kojiro Sato Toshihide Mimura

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.51, no.4, pp.451, 2012 (Released:2012-02-15)

著者

Kohno Shigeru Seki Masafumi Watanabe Akira the CAP Study Group

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.50, no.11, pp.1183-1191, 2011-06-01

被引用文献数

36

---

Objective The Japanese Respiratory Society (JRS) last revised the guidelines for community-acquired pneumonia (CAP) in adults in 2005. These guidelines proposed new criteria (A-DROP) to assess the severity of pneumonia and to differentiate between typical bacterial pneumonia and atypical pneumonia. The goal of the present study was to evaluate the utility of the A-DROP criteria for these described purposes. Methods An observational survey was conducted between July 2006 and March 2007, and patients with CAP were prospectively surveyed using consecutive enrollment methods. Patients In total, 1,875 patients from 200 medical facilities throughout Japan were analyzed. Results The JRS 2005 A-DROP system was a good indicator of mortality in the patient population, and these results were significantly correlated with the Pneumonia Severity Index (PSI) of the Infectious Disease Society of America (IDSA). Among the various factors characterized, 'SpO2 of 90% or less (PaO2 of 60 Torr or less)' was the strongest predictor of mortality. In terms of the differential diagnosis between typical bacterial and atypical pneumonia, five of six JRS 2005 items were strongly and significantly correlated with a diagnosis of atypical pneumonia. Conclusion The JRS 2005 A-DROP system was accurate and clinically useful for the assessment of the severity of pneumonia and for the differentiation between typical bacterial pneumonia and atypical pneumonia.

著者

Satoshi Kurisu Ichiro Inoue Takuji Kawagoe Masaharu Ishihara Yuji Shimatani Takaki Hata Yasuharu Nakama Yasufumi Kijima Eisuke Kagawa

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.45, no.10, pp.703-704, 2006 (Released:2006-06-15)

被引用文献数

6 5

著者

Takashi Kajiya Atsushi Kuroda Daisuke Hokonohara Chuwa Tei

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.45, no.13, pp.827-829, 2006 (Released:2006-08-01)

参考文献数

8

被引用文献数

2 3

---

An 87-year-old man with heart failure caused by severe anemia was referred to our hospital. Gastroenteroscopy revealed the existence of several parasites in the duodenum. Examination of the stool by a formalin-ethyl acetate concentration technique detected hookworm eggs. After a single dose of pyrantel pamoate, his symptoms including dyspnea on exertion and edema diminished. And also hemoglobin and B-type natriuretic peptide (BNP) had improved dramatically. Hookworm infection is an extremely rare cause of heart failure, and furthermore this parasitic infection is not common in advanced countries. We suggest the possible relationship between parasite infection and organic foods.

著者

Hajime Fukuyama Tadashi Ishida Hiromasa Tachibana Hiroaki Nakagawa Masahiro Iwasaku Mika Saigusa Hiroshige Yoshioka Machiko Arita Toru Hashimoto

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.1917-1922, 2011 (Released:2011-09-15)

参考文献数

22

被引用文献数

3 12

---

Objective Several scoring systems have been derived to identify patients with severe community-acquired pneumonia (CAP). Recently, España et al (Am J Respir Crit Care Med 174:1249-1256, 2006) developed a clinical prediction rule that predicts hospital mortality, the need for mechanical ventilation, and risk for septic shock. We assessed the performance of this rule and compared it with other published scoring systems. Methods A prospective study was conducted of patients with CAP who were hospitalized at our hospital from April 2007 till May 2009. Clinical and laboratory features at presentation were recorded and used in order to calculate España rule, the pneumonia severity index (PSI), CURB-65, A-DROP, the 2007 Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) prediction rule and SMART-COP. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were compared for adverse outcomes. We also assessed the association of the España rule criteria and adverse outcomes. Results A total of 505 patients were enrolled in the study. The overall in-hospital mortality rate was 6.5%, and 6.3% of patients were admitted to the intensive care unit (ICU). Sixty-two (12.3%) patients were defined as having severe CAP (in-hospital death or need for mechanical ventilation or septic shock). España rule achieved highest sensitivity and NPV in predicting severe CAP. When ICU admission was the outcome measure, the IDSA/ATS rule and SMART-COP were regarded to be good predictors. Conclusion España rule performed well in identifying patients with severe CAP. As a result, each of the severity scores has advantages and limitations for predicting adverse outcomes.

著者

Kazumi KATSUMATA Kazuo KATSUMATA

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.4, pp.344-345, 2004 (Released:2005-02-04)

参考文献数

5

被引用文献数

1 1

著者

Hideto Kameda Hitoshi Tokuda Fumikazu Sakai Takeshi Johkoh Shunsuke Mori Yuji Yoshida Noboru Takayanagi Hirofumi Taki Yoshinori Hasegawa Kazuhiro Hatta Hisashi Yamanaka Makoto Dohi Shu Hashimoto Hidehiro Yamada Shinichi Kawai Tsutomu Takeuchi Kazuhiro Tateda Hajime Goto

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.50, no.4, pp.305-313, 2011 (Released:2011-02-15)

参考文献数

25

被引用文献数

27 60

---

Objective Acute-onset diffuse interstitial lung disease (AoDILD) in patients with rheumatoid arthritis (RA) has been a serious concern, especially for those under treatment with biological agents which may affect the presentation and outcome of AoDILD, including Pneumocystis pneumonia (PCP). Therefore, we conducted a retrospective, multi-center study of AoDILD in RA patients receiving biological agents. Methods Patients who developed AoDILD while receiving biological agents (infliximab, etanercept, adalimumab and tocilizumab) were enrolled in the study. Definite PCP was defined as patients who showed either P. jirovecii organisms in their respiratory samples by microscopic examination, or positive tests for both P. jirovicii DNA-PCR with respiratory samples and an elevated serum 1,3-β-D-glucan level above the cut-off value. Probable PCP was defined as either a positive test for P. jirovicii PCR or an elevated serum β-D-glucan level. Chest HRCT findings were evaluated and scored by two board-certified radiologists. Results The final diagnoses for 26 patients examined were definite PCP for 13 patients, probable PCP for 11, and methotrexate-associated pneumonitis in 2 patients. Definite and probable PCP cases were clinically indistinguishable. Generalized, diffuse ground-glass opacity (GGO) is the characteristic HRCT finding in patients with definite or probable PCP, which was different from our previous findings in RA patients, mostly without biologics, showing GGO distributed in a panlobular or multilobular manner. The clinical outcome was favorable by treatment with trimethoprim-sulfamethoxazole and glucocorticoids. Conclusion The possibility of PCP should be intensively investigated in RA patients developing AoDILD while receiving biological agents.