著者

Takahiro Matsuo Osamu Takahashi Kazuyo Kitaoka Hiroko Arioka Daiki Kobayashi

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.5872-20, (Released:2020-12-07)

参考文献数

52

被引用文献数

20

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Objectives We examined the prevalence of burnout among resident doctors and its relationship with specific stressors. Methods We conducted a nationwide, online, cross-sectional survey in Japan with 604 resident doctors in 2018-2019. Participants and Materials Participants completed the Maslach Burnout Inventory-General Survey to evaluate burnout and provided details of their individual factors and working environmental factors. Chi-square tests and t-tests were conducted for categorical and continuous variables, respectively. The association between burnout and resident-reported causes of stress, ways of coping with stress, number of times patient-safety incidents were likely to occur, and individuals who provide support when in trouble was analyzed using logistic regression analyses after controlling for confounding variables. Results A total of 28% met the burnout criteria, 12.2% were exhausted, 2.8% were depressed, and 56.9% were healthy. After adjusting for sex, postgraduate years, type of residency program, marital status, number of inpatients under residents' care, number of working hours, number of night shifts, number of days off, and resident-reported causes of stress-excessive paperwork (odds ratio [OR]: 2.24, 95% confidence interval [CI]: 1.32-3.80), excessive working hours (OR: 2.75, 95% CI: 1.24-6.04), low autonomy (OR: 3.92, 95% CI: 2.01-7.65), communication problems at the workplace (OR: 2.24, 95% CI: 1.05-4.76), complaints from patients (OR: 6.62, 95% CI: 1.21-36.1), peer competition (OR: 2.22, 95% CI: 1.25-3.93), and anxiety about the future (OR: 2.13, 95% CI: 1.28-3.56)-were independently associated with burnout. The burnout group had more reported patient-safety incidents that were likely to occur per year (>10) (OR: 2.65, 95% CI: 1.01-6.95) and a lack of individuals who could provide support when in trouble (OR: 1.83, 95% CI: 1.01-3.34) than the non-burnout group. Conclusions This study described the prevalence of burnout among residents who responded to our survey. We detected an association between burnout and resident-reported causes of stress, patient-safety incidents, and a lack of individuals who provide support when in trouble. Further interventional studies targeting ways to reduce these concerns are warranted.

著者

Yu Kurahara Yoshinobu Matsuda Kazunari Tsuyuguchi Akihiro Tokoro

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.9013-21, (Released:2022-02-26)

参考文献数

15

被引用文献数

4

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Objective The incidence and clinical importance of delirium in COVID-19 have not yet been fully investigated. The present study reported the prevalence of delirium in patients with COVID-19 and identified the factors associated with delirium and mortality. Methods We performed an observational, retrospective study of patients diagnosed with COVID-19 at the Kinki-Chuo Chest Medical Center. Univariate and multivariate logistic regression analyses were used to explore delirium risk factors. Patients or Materials All consecutive patients diagnosed with COVID-19 at the Kinki-Chuo Chest Medical Center. Results We identified 600 patients [median age: 61.0 (interquartile range: 49.0-77.0) years old], of whom 61 (10.2%) developed delirium during their stay. Compared with patients without delirium, these patients were older (median age 84.0 vs. 56.0 years old, p <0.01) and had more comorbidities. Based on a multivariate analysis, age, dementia, severe disease, and lactate dehydrogenase (LDH) levels were independent risk factors for developing delirium. For every 1-year increase in age and 10-IU/L increase in LDH, the delirium risk increased by 10.8%-12.0% and 4.6%-5.7%, respectively. There were 15 (24.6%) in-hospital deaths in the group with delirium and 8 (1.6%) in the group without delirium (p <0.01). Delirium was associated with an increased mortality. Conclusion Delirium in patients with COVID-19 is prevalent and associated with poor clinical outcomes in Japan. Despite difficulties with COVID-19 patient care during the pandemic, physicians should be aware of the risk of delirium and be trained in its optimal management.

著者

Kei Nakashima Masafumi Misawa Ayumu Otsuki Kentaro Narita Yoshihito Otsuka Kosei Matsue Masahiro Aoshima

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.61, no.5, pp.623-632, 2022-03-01 (Released:2022-03-01)

参考文献数

27

被引用文献数

2

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Objective Acute pulmonary lesions (APLs), defined as an acute infiltrate or nodular lung field, are a major complication in patients with haematological diseases. Recently, endobronchial ultrasonography with a guide-sheath (EBUS-GS) was established as a useful technique for diagnosing pulmonary lesions. This study aimed to evaluate the efficacy and safety of EBUS-GS for managing APLs in patients with haematological diseases. Methods Our single-centre, retrospective, observational, single-arm, descriptive study enrolled 22 consecutive adult (>20-year-old) patients with haematological diseases and concomitant APL who underwent EBUS-GS between January 2011 and June 2016 at Kameda Medical Center, Chiba, Japan. The primary endpoint was the contribution of EBUS-GS to clinical decision-making. Secondary endpoints were an adequate tissue collection rate, diagnostic yield, complication rate, and 30-day mortality. Results The median patient age was 70 years old, and 63.6% were men. Acute myeloid leukaemia was the most frequent underlying disease, accounting for 54.5% of patients. The contribution of EBUS-GS to clinical decision-making was recognised in 11 (50.0%) patients. Adequate tissue collection was achieved in 21 (95.5%) patients. The aetiology of the APL was identified in 9 (40.9%) patients. No complications, including severe haemorrhaging and pneumothorax, were observed in any patients, and the 30-day mortality rate was 0%. Conclusion EBUS-GS may be a suitable diagnostic option for APL in patients with haematological diseases. Further larger-scale and randomised controlled trials are needed to confirm our results.

著者

Hisatoshi Okumura Hidetaka Ishino Daisuke Yokoi Masami Matsumura

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.8619-21, (Released:2021-12-28)

参考文献数

20

被引用文献数

4

---

Palmar fasciitis and polyarthritis syndrome (PFPAS) is a rare paraneoplastic rheumatic disease with characteristic features. We herein report a 77-year-old man with lung adenocarcinoma and contralateral pulmonary metastasis receiving chemotherapy who presented with progressive symmetrical flexion contractures associated with palmar fascial thickening and arthritis of both hands and shoulders. He was diagnosed with PFPAS as paraneoplastic manifestations. Salazosulfapyridine was not effective, but 15 mg/day of oral prednisolone improved his symptoms. Physicians should consider PFPAS and rule out malignancy in patients with arthritis in the extremities and flexion contractures associated with palmar fascial thickening.

著者

Masayuki Aiba Yutaka Tsutsumi Jun Nagai Takahiro Tateno Shinichi Ito

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.7758-21, (Released:2021-07-17)

参考文献数

16

被引用文献数

5

---

A 71-year-old woman was admitted for the treatment of diffuse large B-cell lymphoma of the ileum. She had been taking lansoprazole but was switched to vonoprazan due to epigastric discomfort. Three weeks after starting vonoprazan intake, she had a convulsive seizure, and a blood test showed hypomagnesiemia. The cause of hypomagnesemia was considered to be malabsorption of magnesium from the intestinal tract associated with vonoprazan. After discontinuation of vonoprazan, the magnesium level quickly recovered, and the seizures did not relapse. It is important to consider the risk of hypomagnesemia in patients taking vonoprazan, even for a short period of time.

著者

Masaru Okamoto Yu Wakunami Kyoji Hashimoto

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.61, no.1, pp.119-122, 2022-01-01 (Released:2022-01-01)

参考文献数

13

被引用文献数

7

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Hypomagnesemia caused by a proton pump inhibitor (PPI) was first reported in 2006. We herein report a case of hypomagnesemia due to the long-term use of vonoprazan, a potassium-competitive acid blocker (P-CAB). A 66-year-old man was admitted to our hospital complaining of disturbance of consciousness with evidence of hypomagnesemia noted on blood testing. The long-term use of vonoprazan was considered the cause of his hypomagnesemia, so it was discontinued, after which the hypomagnesemia improved. Hypomagnesemia can be induced not only by PPI treatment but also following the long-term use of P-CAB.

著者

Kinya Hisanaga

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.8227-21, (Released:2021-10-05)

参考文献数

33

被引用文献数

4

---

Behçet disease and its related disorder, Sweet disease, are multifactorial disorders whose susceptibility loci have been identified in the genes of various immunological factors aside from human leukocyte antigens. The neurological involvement of these diseases, including encephalitis, myelitis, and meningitis, referred to as neuro-Behçet disease (NBD) and neuro-Sweet disease (NSD) respectively, is sometimes difficult to diagnose, especially when the characteristic mucocutaneous symptoms do not precede neurological symptoms or when characteristics of both diseases are present in a single patient. NBD and NSD constitute a spectrum of diseases that are differentiated according to the combination of risk factors, including the genetic background. Encephalitis, myelitis, and meningitis similar to NBD or NSD can be diagnosed as spectrum disorders, even if the characteristic mucocutaneous symptoms fail to be detected. Understanding these conditions as a disease spectrum may help elucidate the disease pathogenesis and assist in the development of therapeutic agents.

著者

Masatomo Ogata Satoru Morikubo Naohiko Imai Yugo Shibagaki Masahiko Yazawa

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.8285-21, (Released:2021-10-19)

参考文献数

13

被引用文献数

2

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Serum tonicity is defined by the serum concentrations of sodium (sNa) and glucose, which can promote free water movement across intra/extracellular compartments. Rapid changes in serum tonicity can cause brain damage. We herein report an educational case of a patient with hyponatremia (sNa: 112 mEq/L) concomitant with acute alcoholic pancreatitis. The cause of hyponatremia was considered complex. Pseudo- and trans-locational natremia was secondary to hyperglycemia (721 mg/dL) and hypertriglyceridemia (1768 mg/dL), respectively, and true hypotonic hyponatremia. Regarding sNa correction, rapid correction was suspected. However, this was safely managed by monitoring tonicity (not sNa or osmolarity), thereby avoiding brain damage.

著者

Fumika Azuma Kazuya Nokura Tetsuharu Kako Mari Yoshida Shinsui Tatsumi

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.7635-21, (Released:2021-10-12)

参考文献数

31

被引用文献数

1

---

A 57-year-old woman presented with optic neuritis with repeated clinical symptoms of focal demyelination of the cerebral white matter and brain stem for 14 years. At the end of the patient's course, the clinical signs mimicked secondary progressive multiple sclerosis, but whether it was caused by interferon administration or neuromyelitis optica spectrum disorders (NMOSD)-or a combination of both or others-was unclear. Histopathological findings indicated the etiology to be NMOSD, with no apparent plaque in spinal cord specimens. This case suggests that an accurate clinical diagnosis requires serum anti-aquaporin 4 antibody measurements as well as an autopsy examination.

著者

Kazumasa Oura Keita Taguchi Mao Yamaguchi Oura Ryo Itabashi Tetsuya Maeda

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.7735-21, (Released:2021-07-30)

参考文献数

30

被引用文献数

2

---

Takayasu's arteritis is an inflammatory disease of unknown etiology that causes stenosis, occlusion, or dilatation of the aorta and its major branches, the pulmonary arteries, and the coronary arteries. The incidence of extracranial carotid artery aneurysm in patients with Takayasu's arteritis is reportedly 1.8%-3.9%. We herein report a patient with Takayasu's arteritis who presented with transient left hemiplegia immediately after neck massage. Carotid ultrasonography revealed a thrombus within the fusiform aneurysm on the right common carotid artery. We speculated that fragmentation from the intra-aneurysmal thrombus was caused by neck massage.

著者

Richard Birrer Yasuharu Takuda Tsuyoshi Takara

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.46, no.14, pp.1063-1070, 2007 (Released:2007-07-17)

参考文献数

42

被引用文献数

92 157

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Background Dramatic transient elevation in serum concentrations of hepatic enzymes occurs in some patients following a hypo-perfusion state. This entity is variously termed "shock liver" or "ischemic hepatitis", since the pathogenesis is considered to be ischemia. However, hypotension or shock is not always present. Methods We analyzed the medical records of 293 patients (322 episodes) who had a hypoxic state and were admitted to the critical care units of two general hospitals over a 13-year period. Results Hepatic injury was identified in about 1% of patients in critical care admissions. In addition to hypotension, the causes for hepatic injury were a low flow state secondary to congestive heart failure and hypoxia from sepsis or respiratory failure and hypoxemia from a variety of etiologies. These values were mostly normalized within several days when the hypoxic etiology was corrected and a serious co-morbid state did not intervene. Conclusion Marked elevation of hepatic enzymes can be identified not only in patients with hypotension, but also in normotensive patients in hypoxic state. Thus, the condition is appropriately termed hypoxic hepatopathy.

著者

Masayuki Amano Taro Shimizu

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.79-82, 2014 (Released:2014-01-15)

参考文献数

21

被引用文献数

14 90

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Emphysematous cystitis (EC) is a rare form of complicated urinary tract infection, its characteristic feature being gas within the bladder wall and lumen. Patients with EC present with variable clinical manifestations ranging from asymptomatic to severe sepsis. EC is typically observed in elderly women with severe diabetes mellitus. Escherichia coli and Klebsiella pneumoniae are often isolated from urine cultures. Imaging methods, such as plain conventional abdominal radiography and computed tomography, are pivotal for obtaining a definitive diagnosis of EC. Most cases can be treated with a combination of antibiotics, bladder drainage and glycemic control. EC is potentially life-threatening, with a mortality rate of 7%. Early medical intervention can contribute to achieving a favorable prognosis without the need for surgical intervention. In this review, we provide a comprehensive description of the clinical characteristics of EC.

著者

Tomoki Taniguchi Yuta Inoue Mitsuru Itoh Mayumi Tomita Tadashi Kamata Noriyuki Iehara

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.60, no.11, pp.1737-1742, 2021-06-01 (Released:2021-06-01)

参考文献数

29

被引用文献数

2

---

A patient with recurrent plasmacytoma with massive ascites exhibited vancomycin intoxication and cefepime-induced encephalopathy due to renal dysfunction. The ascitic accumulation of these drugs was suspected because of the refractory intoxicated state. To remove these drugs that had accumulated in the blood and ascites, abdominal drainage was performed in addition to online hemodiafiltration. If patients with renal dysfunction and massive ascites develop vancomycin intoxication and cefepime-induced encephalopathy that cannot be improved by drug discontinuation, physicians should suspect ascitic accumulation and evaluate the ascitic concentration. Furthermore, if a high accumulation in massive ascites occurs, physicians should perform abdominal drainage along with blood purification.

著者

Ayana Okamoto Tomohiro Watanabe Ken Kamata Kosuke Minaga Masatoshi Kudo

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.58, no.11, pp.1533-1539, 2019-06-01 (Released:2019-06-01)

参考文献数

28

被引用文献数

6 29

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Autoimmune pancreatitis (AIP) is now considered a pancreatic manifestation of a newly proposed disease condition, IgG4-related disease (IgG4-RD). IgG4-RD is characterized by enhanced IgG4 antibody responses and multiple organ involvements. Recent epidemiological studies have addressed the incidence of cancer in patients with AIP and/or IgG4-RD. Surprisingly, a significant number of AIP patients were detected with cancer at or within one year of the diagnosis of AIP. Furthermore, around 50% of all cancers detected in AIP patients comprised mainly 3 types (gastric, lung, and prostate cancer). Thus, AIP appears to be associated with cancer of other organs rather than the pancreas itself, which suggests that AIP is not a pre-cancerous condition of the pancreas. Moreover, the simultaneous occurrence of cancer and AIP in many patients has led to the establishment of an attractive concept that AIP might sometimes arise from co-existing cancers as a paraneoplastic syndrome.

著者

Masaki Tago Toru Oishi Seijiro Makio Shu-ichi Yamashita

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.7096-21, (Released:2021-05-07)

参考文献数

2

被引用文献数

3

著者

Naoto Ishimaru Jun Ohnishi Hiroyuki Seto Yohei Kanzawa Nobuya Sano Saori Kinami

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.5606-20, (Released:2020-09-30)

参考文献数

20

被引用文献数

1

---

A 23-year-old man had an 8-day history of fatigue and dry cough and papulo-nodular reactions on his extensive tattoos. Chest radiography revealed several small granular shadows, and a transbronchial lung biopsy showed non-caseating epithelioid cell granuloma. A skin biopsy of the tattooed area showed histiocytic infiltrates with phagocytized tattoo pigment. Antibody tests for hepatitis C virus were positive. The patient was successfully treated with corticosteroid therapy, and after inflammation was suppressed, he received delayed anti-viral therapy. Sarcoidosis should be considered as a concurrent condition if papules are presented on the tattoos of patients with hepatitis C.

著者

Toshihiro Tsuruda Naoki Yoshikawa Motoaki Kai Masashi Yamaguchi Reiko Toida Tsuyoshi Kodama Kei Kajihara Takayuki Kawabata Takeshi Nakamura Koji Sakata Kinta Hatakeyama Toshihiro Gi Yujiro Asada Tetsuya Tono Kazuo Kitamura Ryuji Ikeda

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.5317-20, (Released:2020-09-19)

参考文献数

33

被引用文献数

15

---

We herein report the cytokine expression at different stages for three patients who developed cardiac complications after immune checkpoint inhibitor (ICI) therapy. Patient 1 with biopsy-proven myocarditis showed increased levels of interleukin (IL)-8, monocyte chemotactic and activating factor, and granulocyte macrophage colony-stimulating factor (GM-CSF) when he developed Takotsubo cardiomyopathy. Patient 2 with subclinical myocarditis showed predominant activation of IL-8 during the progressive clinical course. Patient 3 with cytokine-releasing syndrome showed substantial activations of IL-6, IL-8, GM-CSF, and interferon-γ. Our data suggest the development of unique cytokine activation in individual patients with cardiac complications after ICI therapy.

著者

Yu Fujiwara Takeshi Yamaguchi Minoru Nakane

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.60, no.1, pp.53-57, 2021-01-01 (Released:2021-01-01)

参考文献数

15

被引用文献数

5

---

Portal vein thrombosis (PVT) while using an angiogenesis inhibitor is relatively rare. A 70-year-old Asian man was diagnosed with PVT two months after initiating 5-fluorouracil/leucovorin, irinotecan, and bevacizumab therapy for rectal cancer with liver metastases. Because the metastases were small and shrinking, we suspected that the thrombosis might have been caused by bevacizumab-containing chemotherapy. We stopped bevacizumab and started apixaban, a direct oral anticoagulant (DOAC). Eight months later, the complete dissolution of the thrombus and recanalization of the portal vein were attained. Our case suggests that PVT can occur during bevacizumab-containing chemotherapy, and DOAC therapy might be beneficial for treating PVT in patients with cancer.

著者

Riku Arai Daisuke Fukamachi Masaki Monden Naotaka Akutsu Nobuhiro Murata Yasuo Okumura

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.60, no.1, pp.79-83, 2021-01-01 (Released:2021-01-01)

参考文献数

14

被引用文献数

5

---

Ophthalmic carteolol is often used to treat glaucoma. Elderly patients with atrial fibrillation (AF) and chronic kidney disease (CKD) are common among the super-elderly in Japan. Because these patients are exposed to polypharmacy, they are at a high-risk of adverse drug interactions. We herein report an elderly patient with CKD who suffered bradycardia shock after the combined use of carteolol eye drops and verapamil for glaucoma and paroxysmal AF. This case highlights the fact that eye drops have a similar systemic effect to oral drugs, and especially in elderly patients with polypharmacy, drug interactions can unwittingly lead to serious events.

著者

Yuki Yoshimatsu Kazunori Tobino Takafumi Kawabata Naoki Noguchi Ryo Sato Daisuke Motomura Takuto Sueyasu Kohei Yoshimine Saori Nishizawa Yoshihiro Natori

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.5752-20, (Released:2020-12-07)

参考文献数

12

被引用文献数

4

---

While aspiration pneumonia constitutes the majority of pneumonia cases in the elderly, it remains highly underdiagnosed. We experienced a case of recurrent pneumonia and chronic cough that was later diagnosed as aspiration pneumonia and diffuse aspiration bronchiolitis (DAB) due to recurrent hemorrhaging from an intramedullary cavernous malformation. The patient was finally diagnosed when life-threatening respiratory depression caused emergency attention. This is the first report of hemorrhaging from an intramedullary cavernous malformation diagnosed due to aspiration pneumonia and DAB. These findings highlight the importance of considering aspiration in cases with recurrent pneumonia or chronic chough. The underlying cause may be a life-threatening condition.