著者

Taito Miyake Hajime Sanada Takahiro Yamano Kaori Yamaguchi

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1040-22, (Released:2023-05-10)

参考文献数

22

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Antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) predominantly affects small vessels. Almost all AAV patients are positive for myeloperoxidase- or proteinase 3-ANCA, and ANCA plays a crucial role in the pathogenesis of AAV. We herein report an ANCA-negative AAV patient with pauci-immune necrotizing glomerulonephritis and plasma cell-rich tubulointerstitial nephritis who was complicated with pleuritis and digital ischemia. ANCA-negative AAV is a rare clinical entity that is difficult to diagnose, and pleuritis and digital ischemia are rare manifestations of AAV. An early diagnosis and appropriate treatment are important, as any delay in the diagnosis may worsen the prognosis.

著者

Mizuki Asako Hitomi Matsunaga Kazumasa Oka Shuji Ueda

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.61, no.15, pp.2397, 2022-08-01 (Released:2022-08-01)

参考文献数

2

被引用文献数

3

著者

Ken Kanazawa Shogo Suzuki Tatsuro Inaba Shinichiro Koga Koichiro Kuwabara

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1405-22, (Released:2023-04-07)

参考文献数

14

被引用文献数

1

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Biliary pseudolithiasis is a ceftriaxone (CTRX)-induced complication, but the risk in cases of elderly type 1 diabetes mellitus (T1DM) is unclear. Case 1: A 78-year-old woman with T1DM complicated by diabetic autonomic neuropathy was admitted with pneumonia and treated with CTRX. On day 8, biliary pseudolithiasis and cholecystitis were observed. Case 2: an 80-year-old woman with T1DM was suspected of having a urinary tract infection and treated with CTRX. After a week, she developed asymptomatic biliary pseudolithiasis with gastroparesis. CTRX-associated biliary pseudolithiasis was thus noted in these cases of elderly T1DM. CTRX should be cautiously administered, especially in elderly T1DM patients with diabetic autonomic neuropathy.

著者

Shin-ichiro Ohmura Yusuke Ohkubo Ryuhei Ishihara Yoshiro Otsuki Toshiaki Miyamoto

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.61, no.22, pp.3453-3457, 2022-11-15 (Released:2022-11-15)

参考文献数

28

被引用文献数

5

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Coronavirus disease 2019 (COVID-19) vaccines have been delivered worldwide to prevent the spread of the disease, and almost all Japanese have received the mRNA vaccines "BNT162b2" (Pfizer-BioNTech) or "mRNA-1273" (Moderna). These vaccines have shown efficacy and safety with only minor adverse drug reactions. However, some patients develop severe adverse drug reactions, including autoimmune reactions. In addition, systemic vasculitis, mainly small-vessel vasculitis, following COVID-19 vaccination, has been reported. However, only a few investigators have reported medium-vessel vasculitis following vaccination. We herein report a case of medium-vessel vasculitis presenting with myalgia as the initial clinical manifestation following COVID-19 Moderna vaccination.

著者

Chiharu Aizawa Masahiro Okabe Daisuke Takahashi Makoto Sagasaki Mao Watanabe Toshinari Fujimoto Yuuki Yoshioka Ai Katsuma Ai Kimura Daisuke Miyamoto Nana Sato Ken Okamoto Kimiyoshi Ichida Yoichi Miyazaki Takashi Yokoo

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.0678-22, (Released:2023-02-08)

参考文献数

31

被引用文献数

1

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Exercise-induced acute kidney injury (EIAKI) is frequently complicated with renal hypouricemia (RHUC). In patients with RHUC, limiting anaerobic exercise can prevent EIAKI. However, it is challenging to reduce exercise intensity in athletes. We herein report a 16-year-old Japanese football player with familial RHUC with compound heterozygous mutations in urate transporter 1 (URAT1) who presented with recurrent EIAKI. As prophylaxis (hydration during exercise) could not prevent EIAKI, febuxostat was initiated. EIAKI was not observed for 16 months despite exercising intensively. Hence, non-purine-selective xanthine oxidoreductase inhibitors may decrease the incidence of EIAKI in athletes with RHUC.

著者

Yayoi Ueda Shoji Asakura Sae Wada Takashi Saito Tomofumi Yano

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.9136-21, (Released:2022-05-31)

参考文献数

15

被引用文献数

12

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A patient with follicular lymphoma treated with obinutuzumab and bendamustine experienced prolonged coronavirus disease-2019 (COVID-19). One month after the symptoms transiently improved, the patient experienced exacerbated COVID-19 symptoms. The patient recovered from COVID-19 with remdesivir and dexamethasone and was discharged 77 days after the disease onset. The patient completed a primary series of SARS-CoV-2 vaccinations on day 176, but the anti-spike protein IgG was not detected later. A careful observation to detect any subsequent relapse of COVID-19 symptoms is necessary in immunocompromised patients. Chemotherapy should be based on the disease status and type of lymphoma.

著者

Shinei Kato Nobuaki Yoshikura Akio Kimura Takayoshi Shimohata

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.0371-22, (Released:2022-10-05)

参考文献数

15

被引用文献数

7

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We encountered a 55-year-old woman with possible autoimmune encephalitis associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant. She was not vaccinated against coronavirus disease 2019 (COVID-19). Consciousness disturbance, myoclonic-like movements and gait disturbance occurred 10 days after the COVID-19 symptom onset. Her neurological symptoms improved two days after methylprednisolone pulse therapy. Cerebrospinal fluid (CSF) was negative for SARS-CoV-2 reverse transcription-polymerase chain reaction, the CSF-to-serum albumin quotient was mildly elevated, and interleukin 6 and 8 levels were normal in serum but mildly elevated in CSF. Omicron variant infection may increase blood-brain barrier permeability and intrathecal inflammation, causing autoimmune encephalitis.

著者

Teruhiko Imamura Koichiro Kinugawa

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.0277-22, (Released:2022-10-05)

参考文献数

14

被引用文献数

2

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Metabolic syndrome, including diabetes mellitus, obesity, and dyslipidemia, is associated with the development and progression of metabolic dysfunction-associated fatty liver disease. Therapeutic strategies, particularly optimal medical therapies, for treating metabolic dysfunction-associated fatty liver disease remain unestablished. We encountered a 37-year-old man with obesity (body mass index 39.0), metabolic dysfunction-associated fatty liver disease, and nephrotic syndrome due to obesity-related focal segmental glomerulosclerosis. Combination therapy using pemafibrate and dapagliflozin, together with body weight reduction, ameliorated his hypertriglyceridemia, hyperglycemia, hepatic injury, and proteinuria. Combination therapy using selective peroxisome proliferator-activated receptor α modulator and sodium-glucose cotransporter 2 inhibitor, together with body weight reduction, might be a promising dual-medical strategy for ameliorating metabolic dysfunction-associated fatty liver disease.

著者

Akira Kitajima Takuya Kishi Kohei Yamanouchi Yoshitaka Hirooka Shuji Toda Ayako Takamori Kazuma Fujimoto Chie Kishi Yoshiyuki Tomiyoshi

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.0040-22, (Released:2022-09-13)

参考文献数

13

被引用文献数

3

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Objective We analyzed adverse events retrospectively during a three-year follow-up of patients undergoing hemodialysis at the dialysis center of our general hospital that can treat comprehensive diseases and conducted an exploratory study focusing on the risk factors that determine the prognosis of hemodialysis patients. Methods A total of 132 hemodialysis patients at our dialysis center as of June 2017 were included in the study. Data on event incidence, including death and various clinical indicators, were collected in the electronic medical record for three years until June 2020. Results Between June 2017 and June 2020, 33 of the 132 patients died. The mortality group had a lower body mass index (BMI) and a longer duration of hemodialysis already carried out with more preexisting upper gastrointestinal (GI) bleeding, infections, ischemic heart disease (IHD), and malignancy than the survival group. Furthermore, the mortality group took more warfarin, aspirin, proton pump inhibitors and less H2 blockers than the survival group. Occurrence of upper or lower GI bleeding was similar between the mortality and survival groups. In a univariate analysis for mortality, the odds ratio was significantly higher for a low BMI (<18), long duration of hemodialysis, history of upper GI bleeding, and presence of IHD. Multivariable-adjusted odds ratios for mortality were significantly higher for cases with a history of upper GI bleeding and BMI <18. Conclusion A history of upper GI bleeding and low BMI may be poor prognostic factors of hemodialysis patients. Careful management of upper GI bleeding and a low BMI are required during the initiation of hemodialysis.

著者

Shinji Izuka Bunki Natsumoto Hirofumi Shoda Keishi Fujio

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.0084-22, (Released:2022-07-22)

参考文献数

2

著者

Naoto Kuroda Anna Suzuki Kai Ozawa Nobuhiro Nagai Yurika Okuyama Kana Koshiishi Masafumi Yamada Yoshihiko Raita Yosuke Kakisaka Nobukazu Nakasato Makoto Kikukawa

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.9291-21, (Released:2022-06-07)

参考文献数

44

---

Objective This cross-sectional national study determined which educational approaches are associated with the effectiveness of online clerkship for medical students. Method A survey was conducted for medical students at 78 medical schools in Japan from May 29 to June 14, 2020. It comprised the following aspects: (a) participants' profiles, (b) number of opportunities to learn from each educational approach (lecture, medical quiz, assignment, oral presentation, observation of a physician's practice, clinical skill practice, participation in interprofessional meetings, and interactive discussions with physicians) in online clerkship, (c) frequency of technical problems, and (d) educational outcome measurement (satisfaction, motivation, knowledge acquisition, skill acquisition, change in self-study time, and understanding of the importance of medical care team). Results Of the 2,640 respondents, 2,594 (98.3%) agreed to cooperate. Ultimately, 1,711 matched our inclusion criteria. All educational approaches but assignments were positively associated with satisfaction and motivation. All educational approaches excluding assignment submission and interprofessional meeting were positively associated with knowledge acquisition. Observation, practice, and interprofessional meeting were positively associated with skill acquisition. Only assignment submission was positively associated with the change in self-study time. Educational approaches excluding medical quizzes were positively associated with understanding the importance of the medical care team. Technical problems were negatively associated with motivation, knowledge acquisition, and skill acquisition. Conclusions Educators should implement various educational approaches, especially observation and practice, even in online clinical clerkship. They also need to minimize the technical problems associated with the Internet, as they reduce the effectiveness of online clerkship.

著者

Naoto ISHIKAWA Takuroh IMAMURA Kouji NAKAJIMA Junichi YAMAGA Hiroaki YUCHI Masaaki OOTSUKA Haruhiko INATSU Toshihiro AOKI Tanenao ETO

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.40, no.9, pp.901-904, 2001 (Released:2006-03-27)

参考文献数

18

被引用文献数

23 28

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A 17-year-old male who had been diagnosed with ulcerative colitis was prescribed 80 mg prednisolone and 1, 500 nig 5-aminosalicylic acid (5-ASA) per day. Two weeks after initiating therapy, he was referred to our hospital for evaluation of chest pain and high fever. Electrocardiography (ECG) showed ST elevation in limb and precordial leads. Chest pain with high fever and ECG changes were resolved after 5-ASA was discontinued. Three weeks later, the administration of a low dose of 5-ASA was associated with the immediate recurrence of pericarditis associated with chest pain, suggesting a hypersensitive reaction to 5-ASA in this patient.(Internal Medicine 40: 901-904, 2001)

著者

Yukihiro Umeda Miwa Morikawa Masaki Anzai Yasuyuki Sumida Maiko Kadowaki Shingo Ameshima Takeshi Ishizaki

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.49, no.21, pp.2333-2336, 2010 (Released:2010-11-01)

参考文献数

14

被引用文献数

15 34

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We report a case of acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) after pandemic influenza (H1N1) vaccination. A 57-year-old man, who had been diagnosed with IPF in September 2008, was admitted to our hospital in December 2009 because of aggravation of dyspnea and fever two days after H1N1 vaccination. Chest computed tomography showed diffuse bilateral ground-glass opacities superimposed on preceding reticular opacities. We diagnosed AE-IPF. Corticosteroid and cyclophosphamide were effective. Although the efficacy of influenza vaccination in patients with chronic lung diseases is well established, physicians should keep in mind that influenza vaccination has the potential to cause AE-IPF.

著者

Yoshito Homma Masashi Watanabe Koji Inoue Tomonori Moritaka

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.59, no.14, pp.1773-1775, 2020-07-15 (Released:2020-07-15)

参考文献数

12

被引用文献数

17 30

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The novel coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2, has spread worldwide from China. There are no case reports from Asia of COVID-19 with facial paralysis and olfactory disturbance. We herein report a case of COVID-19 pneumonia in a Japanese woman who showed facial nerve palsy and olfactory disturbance.

著者

Mio Masuda Osamu Tomonaga

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.8134-21, (Released:2021-10-12)

参考文献数

44

被引用文献数

1

---

Objective The stress brought on by changes in social conditions due to COVID-19 is diverse. However, there have been no studies examining the relationship between the type of stress felt by an individual due to such changes in social conditions and the degree of change in HbA1c, prompting us to conduct this study. Methods We conducted a collaborative study at two diabetes clinics. A total of 1,000 subjects responded to the questionnaire. Data on HbA1c and body weight before and after the declaration of the state of emergency were collected. Results We conducted a questionnaire on some stressors, but when comparing the two groups with respect to whether or not they felt stress from each item, only "school closures for children," seemed to be associated with a significant difference in the amount of change in HbA1c. In the stressed group, i.e. the group of parents who experienced stress due to their children's schools being closed, the HbA1c value changed from 7.30±0.78 to 7.30±1.13 (p=0.985). By contrast, in the unstressed group, the HbA1c value significantly decreased from 7.28±0.98 to 7.06±0.85 (p<0.001). In addition, as a result of comparing the amount of change between the 2 groups, a significant decrease was observed in the unstressed group compared with the stressed group (p=0.032). There was no significant difference in body weight change between the two groups. Conclusion Stress that cannot be avoided by one's own will, such as school closures for children, may affect glycemic control.

著者

Tetsuaki Ban Shin-ichiro Fujiwara Rui Murahashi Hirotomo Nakajima Takashi Ikeda Sae Matsuoka Yumiko Toda Shin-ichiro Kawaguchi Shoko Ito Takashi Nagayama Kento Umino Daisuke Minakata Hirofumi Nakano Kaoru Morita Masahiro Ashizawa Chihiro Yamamoto Kaoru Hatano Kazuya Sato Ken Ohmine Yoshinobu Kanda

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.8184-21, (Released:2021-09-11)

参考文献数

19

被引用文献数

3

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Objective Peripherally inserted central catheters (PICCs) are widely used in patients with hematologic malignancies. However, the risks of PICC-related complications during chemotherapy for acute myeloid leukemia (AML) are not fully understood. Methods We conducted a retrospective review of 128 adult patients with AML who received induction therapy by way of PICC insertion between 2012 and 2019. Results The median duration of PICC insertion was 30 days. The incidence rate of catheter-related bloodstream infection (CRBSI) was 2.4% at 30 days, and women were more likely to suffer from CRBSI than men. Local reactions at the insertion site were observed in 56 patients; however, these events did not predict CRBSI. The incidence rates of catheter-related thrombosis (CRT) were 1.6% at 30 days. Obesity put patients at an increased risk for CRT. Unexpected PICC removal occurred in 59 patients, and women were at a higher risk of catheter removal than men. Conclusion Low PICC-related complication rates, possibly associated with high rates of catheter removal, were observed during intensive chemotherapy for AML. Women and obese patients require careful monitoring of their PICC. Procedures to achieve appropriate PICC removal without increasing the complication rate need to be considered.

著者

Goichi Beck Rika Yamashita Chizu Saeki Takuya Ogawa Mikito Shimizu Hideki Mochizuki

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.4601-20, (Released:2020-05-26)

参考文献数

23

被引用文献数

1

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We herein report a 56-year-old Japanese woman who had been diagnosed with hereditary angioedema. She experienced progressing muscle weakness and pain in the upper and lower extremities. Blood tests revealed a marked increase in creatine kinase levels; however, myositis-specific autoantibodies were not detected. Serum C1-inhibitor activity and C4 levels were low. A muscle biopsy showed mild muscle fiber necrosis and C5b-9 deposition in the endomysial capillary vessel walls and sarcolemma, mimicking necrotizing myopathy. These results suggest that C1-inhibitor deficiency induces myositis-like symptoms through the activation of the complement pathway and deposition of the membrane attack complex in the muscles.

著者

Masaru Suzuki Takuro Shimbo Toshiharu Ikaga Shingo Hori

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.0825-18, (Released:2018-08-24)

参考文献数

14

被引用文献数

4 11

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Objectives Bath-related sudden cardiac arrests frequently occur in Japan. This study aimed to describe the actual incidence and characteristics of bath-related accidents, including non-fatal events, and to establish the etiology of bath-related sudden cardiac arrest. Methods This prospective cross-sectional observational study was conducted in Tokyo Metropolis and Saga and Yamagata Prefectures between October 2012 and March 2013. Emergency personnel enrolled events in this study when they recognized that activation of the emergency medical system was related to bathing. Surveillance cards were delivered and collected from the emergency personnel and attending physicians. Results In total, 4,593 events were enrolled (1,528 cardiac arrests, 935 survivors in need of help, 1,553 patients with acute illnesses, and 577 patients with injuries) in this study. In the group of survivors in need of help and with acute illness, consciousness disturbance and lethargy without any organic disease were recognized as the main symptoms. Acute coronary syndrome and stroke were infrequently diagnosed. Of the survivors, 30% had a body temperature above 38°C. Their consciousness level significantly correlated with their body temperature. Emergency personnel reported that 79% of sudden cardiac arrests were from victims whose faces were submerged in the tub water, while 18% of survivors had their faces submerged in the tub water. Conclusions This study revealed that accidents, including non-lethal events, frequently occur. The key symptoms were consciousness disturbance and lethargy characterized as a functional disorder and accompanied by an elevated body temperature. Those findings suggest that heat illness during hot water immersion causes drowning.

著者

Tatsuya Aoki Hajime Yamazaki Tadayuki Hashimoto Ryosuke Horitani Shunichi Fukuhara

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.6795-20, (Released:2021-06-19)

参考文献数

21

被引用文献数

2

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Objective The establishment of a department of general internal medicine (GIM) has been shown to improve the clinical outcomes among patients treated in GIM departments but the effect on practice patterns in other departments remains unclear. We evaluated the association between the establishment of a GIM department and the use of blood cultures, an indicator of quality of care of infectious diseases, in other departments. Methods This study was conducted between 2013 and 2017 in a community hospital which established a new GIM department in 2015, with a mandate to improve the quality of care of the hospital including infectious disease management. The primary outcome was the change in the number of blood culture episodes per calendar month in other departments before and after establishment of the GIM department. The secondary outcome was the change in the blood culture episodes per month, indexed to 1,000 patient-days, during the same time. Using 2015 as the phase-in period, interrupted time series analyses were used to evaluate the change in the outcome variables. Results In departments other than GIM, there were 284 blood cultures prior to the establishment of the GIM department (2013-2014) and 853 afterwards (2016-2017). The number of blood culture episodes in other departments increased by 10.7 (95%CI: 0.39-21.0, p=0.042) per calendar month after the establishment of the GIM department; blood culture episodes / calendar month / 1,000 patient-days increased by 0.55 (95%CI: 0.03-1.07 p=0.037). Conclusion These results indicate that a GIM department in a community hospital can improve the quality of care in other departments.

著者

Hiroshi Okada Keiji Yoshioka

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.49, no.19, pp.2113-2116, 2010 (Released:2010-10-01)

参考文献数

6

被引用文献数

7 9

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A 73-year-old woman was admitted to our hospital because of persistent fever, headache and fatigue for several weeks. On admission, she was diagnosed as having meningitis due to Mycobacterium intracellulare (M. intracellulare) detected in her cerebrospinal fluid (CSF) by polymerase chain reaction. Even though anti-tuberculous therapy improved her CSF findings, her condition was not restored. Brain MRI showed multifocal and asymmetrical increases in T2 signals involving white matter and cortical gray-white junction of cerebral hemispheres, cerebellum and brainstem. Based on the progression of clinical symptoms and radiological features, we diagnosed her illness as acute disseminated encephalomyelitis (ADEM) associated with meningitis due to M. intracellulare. Steroid therapy dramatically improved her condition. This is the first report of ADEM following meningitis due to M. intracellulare in a non-immunocompromized host.