著者

Toshiharu Ueno Koichi Kikuchi Ryo Hazue Koki Mise Keiichi Sumida Noriko Hayami Tatsuya Suwabe Junichi Hoshino Naoki Sawa Kenji Arizono Shigeko Hara Kenmei Takaichi Takeshi Fujii Kenichi Ohashi Yoshifumi Ubara

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.55, no.20, pp.2993-2999, 2016-10-15 (Released:2016-10-15)

参考文献数

13

被引用文献数

1 3

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A 58-year-old man was referred to our institution for an evaluation of nephrotic range proteinuria. Renal biopsy showed a marked expansion of the mesangial matrix and thickening of glomerular basement membrane (GBM) in periodic acid-silver methenamine (PAM). Immunofluorescence (IF) revealed strong staining for the monoclonal kappa light chain. EM demonstrated massive subendothelial and mesangial dense deposits. As a result, light chain deposition disease (LCDD) was diagnosed. Melphalan and prednisolone (MP) therapy was started, which was continued for 10 years with minimal complications. Serial evaluations of renal histology revealed the resolution of nodular lesions and the glomeruli became nearly normal. MP therapy can therefore be an effective therapeutic option for LCDD if it is continued over the long term.

著者

Nobutaka Doba Yasuharu Tokuda Keiichirou Saiki Toshio Kushiro Masumi Hirano Yoshihiro Matsubara Shigeaki Hinohara

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.55, no.19, pp.2785-2792, 2016-10-01 (Released:2016-10-01)

参考文献数

24

被引用文献数

24

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Objective It has been increasingly recognized in various clinical areas that self-efficacy promotes the level of competence in patients. The validity, applicability and potential usefulness of a new, simple model for assessing self-efficacy in the elderly with special reference to frailty were investigated for improving elderly patients' accomplishments. Methods The subjects of the present study comprised 257 elderly people who were members of the New Elder Citizen Movement in Japan and their mean age was 82.3±3.8 years. Interview materials including self-efficacy questionnaires were sent to all participants in advance and all other physical examinations were performed at the Life Planning Center Clinic. Results The internal consistency and close relation among a set of items used as a measure of self-efficacy were evaluated by Cronbach's alpha index, which was 0.79. Although no age-dependent difference was identified in either sex, gender-related differences in some factors were noted. Regarding several parametric parameters, Beck's inventory alone revealed a significant relationship to self-efficacy in both sexes. Additionally, non-parametric items such as stamina, power and memory were strongly correlated with self-efficacy in both sexes. Frailty showed a significant independent relationship with self-efficacy in a multiple linear regression model analysis and using Beck's inventory, stamina, power and memory were identified to be independent factors for self-efficacy. Conclusion The simple assessment of self-efficacy described in this study may be a useful tool for successful aging of elderly people.

著者

Masayuki Goto Masahito Sato Hitoshi Kitazawa Yasushi Komatsu Koichi Fuse Minoru Takahashi Masaaki Okabe Akira Yamashina Yoshifusa 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.54, no.10, pp.1223-1226, 2015 (Released:2015-05-15)

参考文献数

23

被引用文献数

1 4

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A 41-year-old man developed sustained monomorphic ventricular tachycardia (VT) with a left bundle branch block and inferior axis pattern during treadmill exercise concomitantly with unmasking of the typical Brugada electrocardiography (ECG) pattern. The typical ECG phenotype was provoked by a class IC drug. VT was not inducible with programmed electrical stimulation, but premature ventricular beat and non-sustained VT with the same morphology increased in frequency with isoproterenol treatment. Additionally, atrioventricular nodal reentrant tachycardia (AVNRT) was induced by electrical stimulation and VT and AVNRT were treated by radiofrequency catheter ablation.

著者

Keisuke Suzuki Masayuki Miyamoto Tomoyuki Uchiyama Tomoyuki Miyamoto Takeo Matsubara Koichi Hirata

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.55, no.18, pp.2713-2716, 2016-09-15 (Released:2016-09-15)

参考文献数

15

被引用文献数

7

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We herein report an elderly patient with a history of restless legs syndrome (RLS) who developed unpleasant sensations in the lower abdomen and perineum. The patient' s symptoms occurred during the evening and at rest and forced the patient to void, resulting in some symptom relief. Urological examinations and spinal magnetic resonance imaging findings were unremarkable. The adjunctive use of rotigotine resolved her symptoms. The symptoms were considered to be "restless bladder". Further studies are required to elucidate whether restless bladder is an identical condition to the clinical entities of other RLS variants or whether it represents an unusual feature of RLS.

著者

Hyung Koo Kang Sang-Won Um Byeong-Ho Jeong Kyung Jong Lee Hojoong Kim O Jung Kwon Joungho Han

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.55, no.9, pp.1061-1066, 2016 (Released:2016-05-01)

参考文献数

20

被引用文献数

1 8

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Objective Most small-cell lung cancers (SCLCs) are located within the central aspect of the chest and manifest as a mediastinal or hilar lymphadenopathy. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) makes it possible to perform mediastinal and hilar nodal examinations. The purpose of this study was to evaluate the performance of EBUS-TBNA in the diagnosis of SCLC. Methods The diagnostic performances of EBUS-TBNA and/or transesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-FNA-B/E) were calculated using the standard definitions. Patients The study consisted of a retrospective review of the medical records for all patients with histologically proven SCLC who previously underwent EBUS-TBNA and/or EUS-FNA-B/E from May 2009 to September 2014. Results The analysis was based on 161 patients and 299 aspirated specimens. The patient group included 144 males (89%); the median age was 66 years. EBUS-TBNA and/or EUS-FNA-B/E were performed in 239 mediastinal nodes, 39 hilar/interlobar nodes, and 21 lung parenchymal lesions. The median short diameter of the biopsied lesions was 17 mm. The overall sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of EBUS-TBNA and/or EUS-FNA-B/E on a per-person basis were 97.4%, 100%, 60%, 100%, and 97.5%, respectively. The corresponding values on a per-lesion basis were 91.8%, 100%, 73.0%, 100%, and 93.3%, respectively. There were no serious complications related to EBUS-TBNA. Conclusion In our series of patients with SCLC, EBUS-TBNA had an excellent diagnostic yield in the evaluation of mediastinal, hilar and lung parenchymal lesions. Thus, EBUS-TBNA could be a useful and safe diagnostic method with which to evaluate patients with SCLC.

著者

Hideharu Hagiya Masaya Iwamuro Takehiro Tanaka Kou Hasegawa Yoshihisa Hanayama Maya Kimura Fumio Otsuka

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.55, no.13, pp.1769-1774, 2016-07-01 (Released:2016-07-01)

参考文献数

27

被引用文献数

1 11

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A 74-year-old man who had been administered trimethoprim-sulfamethoxazole for three weeks suffered from drug-induced hypersensitivity syndrome/drug rash with eosinophilia and systemic symptoms (DIHS/DRESS). In the early stage of the clinical course, he developed renal dysfunction. A renal biopsy showed granulomatous tubulointerstitial nephritis accompanying the proliferation of human herpes virus (HHV)-6 in tubular epithelial cells. With corticosteroid therapy, the systemic rash and renal function gradually improved. The present patient is the second case of DIHS/DRESS demonstrating a possible reactivation of HHV-6 in the renal tissue. The clinical role of viral reactivation in DIHS/DRESS must be further elucidated.

著者

Masashi Yoshimitsu Takeshi Sawada Takeshi Kobayashi Masakazu Yamagishi

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.55, no.13, pp.1815-1815, 2016-07-01 (Released:2016-07-01)

参考文献数

2

被引用文献数

1 4

著者

Shiko Gen Ryuichi Usui Takaya Sasaki Kanako Nobe Aya Takahashi Keisuke Okudaira Naofumi 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.55, no.10, pp.1327-1329, 2016 (Released:2016-05-15)

参考文献数

8

被引用文献数

2

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A 79-year-old man on hemodialysis was hospitalized for further investigation. Early gastric cancer was diagnosed by gastrointestinal endoscopy and endoscopic submucosal dissection (ESD) was performed. Fever and abdominal pain thereafter developed, and a severe inflammatory response was observed on a blood test. Contrast computed tomography (CT) showed ulcer-like projections and soft tissue surrounding the aorta, from the celiac to left renal artery. An infected aneurysm was diagnosed. Although infected aneurysms developing after laparoscopic cholecystectomy or biopsy of contiguous esophageal duplication cyst have been reported, those developing after ESD have not. When fever and abdominal pain develop after ESD, an infected aneurysm should be considered and contrast CT performed.

著者

Yuko Tada Ippei Kanazawa Masakazu Notsu Ken-ichiro Tanaka Nobuaki Kiyohara Motofumi Sasaki Toshitsugu Sugimoto

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.55, no.10, pp.1275-1278, 2016 (Released:2016-05-15)

参考文献数

16

被引用文献数

1 4

---

Objective We herein conducted a retrospective study to evaluate the long-term efficacy and safety of sitagliptin treatment in elderly patients with type 2 diabetes mellitus. Methods We analyzed the changes in glycemic control in 112 Japanese type 2 diabetes patients over 65 years of age treated with 50 mg/day sitagliptin. Hemoglobin A1c (HbA1c) levels, liver and kidney functions, and usage of hypoglycemic agents were recorded for 24 months. Results HbA1c levels were significantly decreased, and the significance of HbA1c reduction was maintained during the observation period [from 7.7±1.1% to 7.2±0.7% (p Conclusion Sitagliptin treatment continually decreases the HbA1c level for 24 months and is useful to reduce the dose of sulfonylurea in elderly patients with type 2 diabetes.

著者

Mineto Ota Hideyuki Iwai Kaori Imai Mari Kamiya Yoko Yoshihashi-Nakazato Nobuyuki Miyasaka Hitoshi Kohsaka

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.55, no.10, pp.1367-1370, 2016 (Released:2016-05-15)

参考文献数

16

被引用文献数

7

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We report the findings of a 46-year-old man, who presented with fever and renal dysfunction while undergoing treatment for Crohn's disease with infliximab (IFX). Remittent fever and renal dysfunction with urinary casts developed and lasted for 3 weeks without deterioration of Crohn's disease. Renal biopsy revealed acute tubulointerstitial nephritis (ATIN). After the discontinuation of IFX, his fever and renal abnormalities resolved. We herein report the first known case of ATIN associated with IFX.

著者

Keita Kirito Minoru Sakamoto Nobuyuki Enomoto

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.55, no.10, pp.1341-1344, 2016 (Released:2016-05-15)

参考文献数

19

被引用文献数

21

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Ruxolitinib is a useful treatment option for myelofibrosis since it effectively resolves splenomegaly and constitutional symptoms. After the widespread use of ruxolitinib outside of clinical trials, a series of case reports indicated a potential risk of ruxolitinib-associated opportunistic infections, including the reactivation of the hepatitis B virus (HBV). We herein report the case of a polycythemia vera patient who showed an elevation of HBV-DNA viral DNA with an elevation of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) after the initiation of ruxolitinib. Anti-viral therapy with entecavir was immediately started and the HBV viral load thereafter decreased with an improvement of the liver function. Physicians should thus be aware of the potential risk of ruxolitinib-associated HBV reactivation.

著者

Takamasa Tanaka Haru Kato Takushi Fujimoto

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.55, no.8, pp.999-1000, 2016 (Released:2016-04-15)

参考文献数

8

被引用文献数

1 5

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A 64-year-old woman developed diarrhea after taking clindamycin for a dental infection. We diagnosed her with Clostridium difficile infection (CDI) and performed fecal microbiota transplantation (FMT) as the initial therapy using colonoscopy on an outpatient basis. The frequency of her bowel movements decreased from 10 times per day to two times per day three days after the procedure. The key component of FMT is to restructure the protective microbiome of the natural intestinal flora. We consider that FMT could be used as an effective first-line therapy for CDI if the efficacy and safety of this procedure is established in the future.

著者

Yutaka Nagata Tetsuo Watanabe Kazuhiko Nagasaka Masaaki Yamada Minoru Saito Toshinori Yazaki Kenichi Komatsu Mika Sano Koji Asano Chikao Ando Norihide Taniuchi

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.55, no.6, pp.573-581, 2016 (Released:2016-03-15)

参考文献数

22

被引用文献数

3 16

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Objective Mesenteric phlebosclerosis (MP) is a disease characterized by calcification of the mesenteric vein, which causes chronic mesenteric ischemia. Recently, the long-term intake of gardenia fruit ('Sanshishi' in Japanese) has been attracting attention as a possible cause. Usually, only advanced, severe MP cases get reported. However, we suspected that some latent cases of this disease may exist. We performed this study in order to determine the prediagnostic cases at our outpatient departments of herbal (Kampo) medicine, with particular attention paid to the initial changes, such as any slight color change of the colon, as shown in colonoscopy. Methods We recommend colonoscopy and computed tomography (CT) scans for patients with a long-term history of taking herbal medicines containing gardenia fruit. Clinical examinations were performed upon receiving patients' consent from December 2013 to November 2014. Results Of the 103 patients who took gardenia fruit long-term, 29 agreed to be checked for MP. 14 patients underwent colonoscopy. Four patients were confirmed to have MP due to the presence of fibrotic deposition of the colonic membrane on histological inspection. Twenty-one patients underwent abdominal CT screening. Characteristic calcification of the mesenteric vein was observed on CT scans in 2 patients. All 4 MP patients took Kampo formulas containing gardenia fruit for more than 6.8 years. The other patients did not develop MP, despite long-term gardenia fruit intake. Conclusion We detected the latent and undiagnosed MP cases. All diagnoses were made while paying careful attention to any slight changes in colonoscopy and CT scans.

著者

Kenji Tsuda Kazuaki Sudo Goro Goto Makiko Takai Tatsuo Itokawa Takahiro Isshiki Naoko Takei Tetsuya Tanimoto Tsunehiko Komatsu

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.55, no.4, pp.347-352, 2016 (Released:2016-02-15)

参考文献数

32

被引用文献数

29

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Objective Adherence to rehabilitation exercise is much lower in patients with hematologic malignancies (22.5-45.8%) than in patients with solid tumors (60-85%) due to the administration of more intensive chemotherapeutic regimens in the former. Virtual reality exercise can be performed even in a biological clean room and it may improve the adherence rates in elderly patients with hematologic malignancies. Thus, in this pilot study, we aimed to investigate the feasibility and safety of virtual reality exercise intervention using Nintendo Wii Fit in patients with hematologic malignancies receiving chemotherapy. Methods In this feasibility study, 16 hospitalized patients with hematologic malignancies aged ≥60 years performed virtual reality exercise for 20 minutes using the Nintendo Wii Fit once a day, five times a week, from the start of chemotherapy until hospital discharge. The adherence rate, safety, and physical and psychological performances were assessed. Results The adherence rate for all 16 patients was 66.5%. Nine patients completed the virtual reality exercise intervention with 88 sessions, and the adherence rate was 62.0%. No intervention-related adverse effects >Grade 2, according to National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0, were observed. We noted maintenance of the physical performance (e.g., Barthel index, handgrip strength, knee extension strength, one-leg standing time, and the scores of timed up and go test and Instrumental Activities of Daily Living) and psychosocial performance (e.g., score of hospital anxiety and depression scale). Conclusion Virtual reality exercise using the Wii Fit may be feasible, safe and efficacious, as demonstrated in our preliminary results, for patients with hematologic malignancies receiving chemotherapy.

著者

Yukihiro Kimura Ayano Ito Kanyu Miyamoto Norihiro Suga Naoto Miura Tomomichi Kasagi Yuka Yamagishi Hiroshige Mikamo Hirokazu 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.55, no.2, pp.165-168, 2016 (Released:2016-01-15)

参考文献数

20

被引用文献数

3

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A 79-year-old man on continuous ambulatory peritoneal dialysis (CAPD) developed abdominal pain and cloudy peritoneal fluid two days after colonoscopy that revealed multiple diverticula. The white blood cell count was 9,000 cells/μL, C-reactive protein level was 6.86 mg/dL, and the white blood cell count of the peritoneal fluid was 7,800 cells/μL, suggesting acute peritonitis. Empiric therapy consisting of cefazolin and ceftazidime slowly improved the patient's symptoms. The initial microbiological examination of the peritoneal fluid demonstrated Morganella morganii. He was changed from CAPD to hemodialysis. It is important to consider M. morganii peritonitis in patients with colonic diverticula.

著者

Hiroaki Nakagawa Hiroshi Wada Takashi Hajiro Taishi Nagao Emiko Ogawa Atsushi Hatamochi Toshihiro Tanaka Yasutaka Nakano

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.24, pp.3181-3184, 2015 (Released:2015-12-15)

参考文献数

15

被引用文献数

16

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A 17-year-old teen was hospitalized with bilateral pneumothorax. After the bilateral lungs were expanded using catheter tubes, he fully recovered and he was discharged from our hospital. He had a history of colon perforation. Ehlers-Danlos syndrome (EDS) was suspected due to the combination of colon perforation and pneumothorax, and EDS type IV was confirmed after a genetic study identified a c.1511g>a mutation in the COL3A1 gene. This is the first report of bilateral pneumothorax caused by EDS type IV. Clinicians should consider EDS type IV in the differential diagnosis for bilateral pneumothorax in conjunction with distinct previous histories and radiological findings.

著者

Junichi Hirahashi Norio Hanafusa Takehiko Wada Makoto Arita Keiichi Hishikawa Matsuhiko Hayashi Masaomi Nangaku

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.2377-2382, 2015 (Released:2015-09-15)

参考文献数

17

被引用文献数

7

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Immunoglobulin (Ig) A nephropathy is a prevalent form of primary glomerulonephritis, which leads to end-stage renal failure in a significant proportion of patients. Immunotherapy, including steroid use, is widely used to induce disease remission; however, it can cause serious side effects. We herein report 3 cases of progressive IgA nephropathy and their successful treatment with a combination of aspirin and eicosapentaenoic acid (EPA) without the use of steroids. The precise mechanism responsible for the combination therapy is still unknown; however, aspirin may potentiate the production of anti-inflammatory lipid mediators derived from EPA. Further clinical trials are required to substantiate this treatment regimen.

著者

Hiroshi Ureshino Toshihiko Ando Kensuke Kojima Hidekazu Itamura Shunichi Jinnai Kazuko Doi Koichi Ohshima Kazuya Kurogi Masaharu Miyahara Shinya 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.54, no.24, pp.3205-3208, 2015 (Released:2015-12-15)

参考文献数

25

被引用文献数

1 12

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Rituximab treatment may cause or exacerbate Kaposi's sarcoma (KS) in patients with human immunodeficiency virus (HIV)-associated multicentric Castleman's disease. Despite the widespread use of rituximab, rituximab-induced KS has not yet been reported in HIV-negative patients with diffuse large B cell lymphoma (DLBCL). We herein report a case of KS that developed after undergoing rituximab-containing chemotherapy in an HIV-negative patient with DLBCL. An 84-year-old man who received rituximab-containing chemotherapy for the treatment of DLBCL developed severe infection, and subsequently KS. Our observations indicate that serious infections under rituximab treatment may trigger KS. KS should therefore be considered when skin tumors appear in lymphoma patients receiving rituximab-containing chemotherapy.

著者

Yuichi Makino Chikayoshi Tani Naoyuki Miyokawa Ryota Yoshimoto Katsutoshi Mizumoto Kohei Eguchi Daisuke Fujishiro Satoru Kodama Atsushi Kobayashi Keiji Komura Kensaku Okamoto Hiroyuki Furukawa Masakazu Haneda

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.22, pp.2851-2855, 2015 (Released:2015-11-15)

参考文献数

16

被引用文献数

1 4

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A 47-year-old woman with a 2-year history of rheumatoid arthritis (RA) undergoing methotrexate treatment developed a perforated ulcer in the ileum for which she underwent emergency surgery. A histological analysis of the extirpated specimen presented a possible Epstein-Barr virus (EBV) infection in the ulcerative lesion without a feature of lymphoproliferative disorder. Interestingly, the patient's serological tests with a paired serum diagnosed a primary EBV infection. The present case emphasizes the importance of being aware of severe enteritis as a possibility for patients with RA, for an accurate diagnosis.

著者

Hideharu Hagiya Hiroko Ogawa Yusuke Takahashi Kosuke Kimura Kan Hasegawa Fumio Otsuka

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.21, pp.2775-2777, 2015 (Released:2015-11-01)

参考文献数

13

被引用文献数

9

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We herein present a rare case of Actinomyces turicensis bacteremia that was caused by pyometra. The patient was successfully treated with transvaginal drainage and antibiotic therapy. A literature review in MEDLINE showed that there have been only 8 previously reported cases of A. turicensis bacteremia. This infection frequently occurs in patients with visceral abscesses, and blood culture examinations usually reveal a polymicrobial pattern. However, the prognosis of such patients has been reported to generally be benign. Due to difficulties in performing bacterial identification and the wide-spectrum clinical pictures associated with this bacteremia, no comprehensive understanding of the clinical features of each Actinomyces species has yet been established.