著者

鈴木 則宏

出版者

一般社団法人 日本内科学会

雑誌

日本内科学会雑誌 (ISSN:00215384)

巻号頁・発行日

vol.106, no.Suppl, pp.98a-102a, 2017-02-20 (Released:2018-02-20)

参考文献数

9

著者

金子 祐子

出版者

一般社団法人 日本内科学会

雑誌

日本内科学会雑誌 (ISSN:00215384)

巻号頁・発行日

vol.104, no.10, pp.2149-2156, 2015-10-10 (Released:2016-10-10)

参考文献数

8

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Sjögren症候群(Sjögren syndrome:SS)は唾液腺炎,涙腺炎を主体とする臓器非特異的全身性自己免疫疾患である.原発性である一次性と他の膠原病に合併する二次性に分類されるが,本邦での有病率は約0.05%と推定され,圧倒的に女性に多い.腺症状のみならず,間質性肺炎,間質性腎炎,末梢神経障害などの腺外症状の出現や,原発性胆汁性肝硬変との合併など,多彩な臓器障害を合併し得る.長らく対症療法のみで対応する疾患という認識が強かったが,近年新しい分類基準,ESSDAI(EULAR Sjögren's Syndrome Disease Activity Index)といった疾患活動性評価基準が作成され,さらに免疫抑制薬や生物学的製剤などの新しい治療薬による病態にアプローチした治療が試みられている.今後の発展が期待される疾患である.

著者

林 伸和

出版者

一般社団法人 日本内科学会

雑誌

日本内科学会雑誌 (ISSN:00215384)

巻号頁・発行日

vol.106, no.2, pp.279-282, 2017-02-10 (Released:2018-02-10)

参考文献数

3

著者

岸本 寿男 濱野 雅子 磯田 美穂子 藤原 香代子 松岡 保博 服部 妙子 藤井 理津志 岡 弘子 筒井 みちよ 木田 浩司

出版者

一般社団法人 日本内科学会

雑誌

日本内科学会雑誌 (ISSN:00215384)

巻号頁・発行日

vol.104, no.9, pp.2011-2019, 2015-09-10 (Released:2016-09-10)

参考文献数

10

著者

宮下 修行

出版者

一般社団法人 日本内科学会

雑誌

日本内科学会雑誌 (ISSN:00215384)

巻号頁・発行日

vol.100, no.12, pp.3490-3496, 2011 (Released:2013-04-11)

参考文献数

10

被引用文献数

1

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従来,わが国では市中肺炎診療は主に入院治療が一般的であった.しかし新しい抗菌薬や診断試薬の開発はめざましく,医療費削減(医療費の適正化)の社会的要請から今後は欧米と同様に外来治療がさらに推進され,入院期間の短縮が求められる.さらに耐性菌の出現や蔓延を抑止するため適性抗菌薬使用を考慮しなければならない.その対策として医療の効率化と質の向上を目指したガイドラインは,貴重な参考資料となる.

著者

吉良 潤一

出版者

一般社団法人 日本内科学会

雑誌

日本内科学会雑誌 (ISSN:00215384)

巻号頁・発行日

vol.105, no.5, pp.894-904, 2016-05-10 (Released:2017-05-10)

参考文献数

40

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多発性硬化症(multiple sclerosis:MS)は,若年成人を侵す神経難病では最も多く,中枢神経髄鞘を標的とする自己免疫疾患と考えられているが,証明はできていない.近年,再発や新規病巣の出現を抑制できる疾患修飾薬が次々と開発され,日本でも4種類が臨床応用されるようになった.最初の疾患修飾薬であるインターフェロンベータ(interferon beta:IFNβ)は多面的な作用機序を有し,再発抑制は30%程度に過ぎなかった.しかし,最近では切れ味のよい分子標的薬が開発され,顕著に再発は抑えられるようになった.それでもなお,障害の慢性的な進行を抑制できると証明された疾患修飾薬は開発されておらず,大きな課題として残されている.

著者

滝川 一

出版者

一般社団法人 日本内科学会

雑誌

日本内科学会雑誌 (ISSN:00215384)

巻号頁・発行日

vol.96, no.9, pp.1876-1882, 2007 (Released:2012-08-02)

参考文献数

8

被引用文献数

2 2

著者

河野 雄平

出版者

一般社団法人 日本内科学会

雑誌

日本内科学会雑誌 (ISSN:00215384)

巻号頁・発行日

vol.104, no.2, pp.260-267, 2015-02-10 (Released:2016-02-10)

参考文献数

10

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高血圧患者の10%以上は二次性高血圧であり,診療においてはその可能性を念頭に置くべきである.特に重症高血圧や急な発症,若年発症の高血圧では可能性が高い.二次性高血圧の大部分は適切な診断と治療により良好な血圧コントロールが得られ,高血圧の治癒が期待できる場合も少なくない.治療抵抗性高血圧は降圧薬の3剤併用でもコントロール不良の高血圧で,服薬アドヒアランスや生活習慣,白衣現象,二次性高血圧,治療薬などの要因を考慮し,適切に対処することが重要である.薬物治療では,十分量の降圧薬を多剤併用し,利尿薬を含めることが原則となる.

著者

Keizo HIRAYAMA

出版者

一般社団法人 日本内科学会

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.39, no.4, pp.283-290, 2000 (Released:2006-03-27)

参考文献数

66

被引用文献数

63 159

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This disease is characterized by initially progressive muscular weakness and wasting of the distal upper limb(s) in young people predominantly in men, followed by a spontaneous arrest within several years. This disease has been thought to be separate from motor neuron diseases, yet some authors still consider the illness a variant of motor neuron disease. However, the pathological evidence of ischemic changes in the lower cervical anterior horn should facilitate differentiation of the disorder from degenerative motor neuron disease. Recent radiological investigations proved compressive flattening of the lower cervical cord due to forward displacement of the cervical dural sac and spinal cord induced by neck flexion. These findings suggest that sustained or repeated neck flexion may cause ischemic changes in the cervical anterior horn. Application of a cervical collar to minimize neck flexion prevents progressive muscular weakness in an early stage of the disease.(Internal Medicine 39: 283-290, 2000)

著者

Makoto Hibino Tetsuri Kondo

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.56, no.2, pp.197-201, 2017-01-15 (Released:2017-01-15)

参考文献数

13

被引用文献数

12

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Although the influenza vaccine is relatively safe and effective, serious complications can develop in rare cases. We encountered two cases of interstitial pneumonia that developed after vaccination during the 2014-2015 influenza season. Overall, nine cases, including the two presented here, have been recorded in PubMed and the Cochrane library; eight patients were treated with corticosteroids, and all nine survived, suggesting a good prognosis. Interstitial pneumonia is rare; however, we found an increase in its incidence after 2009. Therefore, clinicians must be aware of the possibility of this complication and duly educate all patients in advance.

著者

Hiroki Namikawa Koichi Yamada Hiroki Fujimoto Ken-Ichi Oinuma Yoshihiro Tochino Yasuhiko Takemoto Yukihiro Kaneko Taichi Shuto Hiroshi Kakeya

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.56, no.14, pp.1807-1815, 2017-07-15 (Released:2017-07-15)

参考文献数

37

被引用文献数

18

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Objective In recent years, infection caused by extended-spectrum beta-lactamase (ESBL)-producing organisms has become an important issue. However, comparative studies of the bacteremia caused by ESBL Enterobacteriaceae and non-ESBL Enterobacteriaceae are extremely rare in Japan. This study aimed to assess the risk factors and prognosis of patients with bacteremia due to ESBL Escherichia coli (E. coli). Methods The medical records of 31 patients with ESBL E. coli bacteremia and 98 patients with non-ESBL E. coli bacteremia who had been admitted to Osaka City University Hospital between January 2011 and June 2015 were retrospectively reviewed. The patient backgrounds, risk factors for infection, and prognosis were evaluated. Results The male-to-female ratio, mean age, underlying disease, leukocyte count, and C-reactive protein (CRP) level did not differ between the patients in the ESBL E. coli bacteremia and non-ESBL E. coli bacteremia groups. The mean Sequential Organ Failure Assessment (SOFA) score for patients with ESBL and non-ESBL E. coli bacteremia were 3.6 and 3.8, respectively. Further, the mortality did not differ between the two groups (9.7% vs 9.2%). However, the independent predictors associated with ESBL E. coli bacteremia according to a multivariate analysis were the use of immunosuppressive drugs or corticosteroids (p=0.048) and quinolones (p=0.005) prior to isolation. The mortality did not differ between the carbapenem and tazobactam/piperacillin (TAZ/PIPC) or cefmetazole (CMZ) groups for the patients with ESBL E. coli bacteremia. Conclusion Whenever we encountered patients with a history of immunosuppressive drug, corticosteroid, quinolone administration, it was necessary to perform antibiotic therapy while keeping the risk of ESBL E. coli in mind.

著者

浜田 英里 岡本 憲省 奥田 文悟 中村 俊平 川尻 真和 小原 克彦 三木 哲郎 大塚 奈穂子

出版者

一般社団法人 日本内科学会

雑誌

日本内科学会雑誌 (ISSN:00215384)

巻号頁・発行日

vol.94, no.11, pp.2379-2381, 2005-11-10 (Released:2008-06-12)

参考文献数

10

被引用文献数

1 1

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尿閉を呈した脳脊髄髄膜炎2症例の臨床的特徴を検討した.いずれも感冒症状後に意識障害や脊髄症・神経根症を伴って発症し,ステロイドが有効であった点,髄液の細胞蛋白の上昇がみられた点などからウイルス感染を契機とした急性散在性脳脊髄炎(ADEM)と診断した.ステロイドを中心とした治療により神経徴候と尿閉は比較的速やかに改善した.尿閉の成因として無菌性髄膜炎に伴う急性仙髄神経根障害とそれに随伴した一過性の括約筋障害(Elsberg症候群)が考えられた.

著者

Kayoko Ozeki Takahisa Furuta Michio Asano Tatsuya Noda Mieko Nakamura Yosuke Shibata Eisaku Okada Toshiyuki Ojima

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.1729-1734, 2016-07-01 (Released:2016-07-01)

参考文献数

43

被引用文献数

3

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Objective Recently, the number of patients receiving Helicobacter pylori eradication treatment has dramatically increased in Japan, although the eradication rate has gradually decreased. Patient characteristics could affect the eradication rate. Our aim in this study was to investigate the association between failed first-line eradication therapy and hay fever. Methods We researched 356 patients who visited a pharmacy adjacent to the Internal Medicine clinic with a prescription for first-line H. pylori eradication treatment and investigated whether the patients had hay fever using a questionnaire. We separated these patients into 2 groups based on the success or failure of eradication according to the clinical data and performed a logistic regression analysis to investigate the influence of hay fever on first-line eradication failure. Results The eradication rate of patients with and without hay fever was 65.6% and 77.7%, respectively. The adjusted odds ratios according to which patients with hay fever would fail eradication therapy gradually lowered with increasing patient age [≤50 years, odds ratio (OR) 6.81, p=0.089; 51-60 years, OR 2.75, p=0.145; 61-70 years, OR 1.60, p=0.391; >70 years, OR 1.02, p=0.979]. A significant relationship was found for all patients (OR 1.88, p=0.047) and the age group ≤70 years (OR 2.31, p=0.024). Conclusion Patients with hay fever have difficulty with first-line eradication, especially younger patients. The existence of clarithromycin-resistant bacteria is suspected, and other factors may also be involved. When a hay fever sufferer receives first-line treatment, eradication might be difficult and other treatment may be required.

著者

Hiroaki Satoh Tetsuya Ohira Masato Nagai Mitsuaki Hosoya Akira Sakai Tsuyoshi Watanabe Akira Ohtsuru Yukihiko Kawasaki Hitoshi Suzuki Atsushi Takahashi Gen Kobashi Kotaro Ozasa Seiji Yasumura Shunichi Yamashita Kenji Kamiya Masafumi Abe

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.15, pp.1967-1976, 2016-08-01 (Released:2016-08-01)

参考文献数

23

被引用文献数

2 31

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Objective The Great East Japan Earthquake and the Fukushima Daiichi nuclear disaster forced the evacuation of residents and led to many changes in the lifestyle of the evacuees. A comprehensive health check was implemented to support the prevention of lifestyle-related disease, and we analyzed changes in lipid metabolism before and after these disasters. Methods Subjects included Japanese men and women living near the Fukushima Daiichi nuclear power plant in Fukushima Prefecture. Annual health checkups, focusing on metabolic syndromes, were conducted for persons ≥40 years of age by the Heath Care Insures. Results A total of 27,486 subjects underwent a follow-up examination after the disaster, with a mean follow-up of 1.6 years. Following the disaster, the prevalence of hypo-high-density lipoprotein (HDL) cholesterolemia increased significantly from 6.0% to 7.2%. In the hypo-HDL cholesterolemia group, the body mass index (BMI), blood pressure, and LDL-C level increased significantly in men after the disaster. On the other hand, in the normal HDL-C level group, the BMI, blood pressure, glucose and lipid metabolism, and liver function were adversely affected. The decrease in HDL-C was significantly greater in evacuees than non-evacuees in the normal HDL-C level group. Furthermore, a multivariate logistic regression analysis showed that the evacuation was significantly associated with the incidence of hypo-HDL cholesterolemia. Conclusion This is the first study to evaluate how the evacuation affected the incidence of hypo-HDL cholesterolemia and led to an increase in cardiovascular disease. This information may be important in the follow-up and lifestyle change recommendations for evacuees.

著者

松島 敏春

出版者

一般社団法人 日本内科学会

雑誌

日本内科学会雑誌 (ISSN:00215384)

巻号頁・発行日

vol.91, no.10, pp.2965-2969, 2002-10-10 (Released:2008-06-12)

著者

原 寿郎

出版者

一般社団法人 日本内科学会

雑誌

日本内科学会雑誌 (ISSN:00215384)

巻号頁・発行日

vol.102, no.Suppl, pp.111a-111a, 2013 (Released:2014-06-19)

著者

Kenichiro Yaita Yoshiro Sakai Jun Iwahashi Kenji Masunaga Nobuyuki Hamada Hiroshi Watanabe

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.7, pp.739-743, 2016 (Released:2016-04-01)

参考文献数

20

被引用文献数

1 6

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Objective To clarify the characteristics of post-travel consultation services in Japan, particularly in the provinces, we analyzed our post-travel patients in the travel clinic of Kurume University Hospital located in Kurume City (a regional hub City in southwestern Japan). Methods Sixty post-travel patients visited our clinic between April 2008 and October 2014 and participated in this study: 55 were Japanese and five were foreign. We summarized and compared the characteristics of the patients after dividing the Japanese participants into long-term travelers (>14 days) and short-term travelers (≤14 days). The foreign travelers were described in a separate analysis. Results Of the 55 Japanese travelers, the mean age (± standard deviation) was 37.3 ± 16.3 years, and 36 patients (65%) were men. Southeast Asia was the major destination (30/55, 55%), and business was stated as the major reason for travel (16/55, 29%). Post-exposure rabies prophylaxis (16/55, 29%) was the most common purpose for the consultations. There were 34 participants (62%) who were classified as short-term travelers. Fewer of the short-term travelers stated receiving pre-travel consultations compared with long-term travelers (11% vs. 79%, p=0.0002). The five foreign travelers included one dengue fever patient and two malaria patients. Conclusion Most post-travel Japanese patients visited our clinic were short-term travelers who had not received any pre-travel consultation. One of the most common complaints, post-exposure rabies prophylaxis, could have been avoided to some extent by appropriate pre-travel consultations. The results of this study suggest that pre-travel consultations should therefore be encouraged for both long- and short-term travelers.

著者

Hiroe Sato Junichiro James Kazama Akira Murasawa Hiroshi Otani Asami Abe Satoshi Ito Hajime Ishikawa Kiyoshi Nakazono Takeshi Kuroda Masaaki Nakano Ichiei Narita

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.121-126, 2016 (Released:2016-01-15)

参考文献数

33

被引用文献数

3 34

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Objective Rheumatoid arthritis (RA) is a chronic inflammatory disease accompanied by periarticular and systemic osteoporosis. Fibroblast growth factor 23 (FGF23), which is mainly produced by osteocytes, circulates to the kidneys and regulates bone metabolism. We herein assessed serum FGF23 and its relationship to inflammation and osteoporosis in patients with RA. Methods Sixty-one patients with RA were included. Serum concentrations of FGF23 were determined using a sandwich enzyme-linked immunosorbent assay. Results The mean (± standard deviation) serum FGF23 concentration was 34.9±9.2 (range, 21.0-61.0) pg/mL. The serum FGF23 level was significantly and positively correlated with the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels, disease activity score-28 based on the ESR (DAS-28 ESR) and DAS-28 CRP (r=0.261, p=0.044, r=0.280, p=0.029, r=0.409, p=0.001 and r=0.421, p=0.001, respectively). The serum matrix metalloproteinase-3 level was also significantly and positively correlated with the serum FGF23 level (r=0.331, p=0.015). Concentrations of type I collagen cross-linked N-telopeptide in the serum was significantly correlated with the serum FGF23 level (r=0.272, p=0.034). Neither the bone mineral density in the femoral neck nor lumbar was significantly correlated with the serum FGF23 level. Serum phosphate, calcium, 25-hydroxy vitamin D, and intact parathyroid hormone were not related to the serum FGF23 level. Conclusion In patients with RA, serum FGF23 is correlated with inflammation, the disease activity of RA, and bone absorption markers. Serum FGF23 may be associated with abnormal bone absorption related to RA inflammation. Further studies are necessary to clarify the mechanism underlying this association.

著者

山中 伸弥

出版者

一般社団法人 日本内科学会

雑誌

日本内科学会雑誌 (ISSN:00215384)

巻号頁・発行日

vol.98, no.9, pp.2141-2145, 2009 (Released:2012-08-02)

参考文献数

6

著者

Kazuki Yokota Naoya Igaki

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.2041-2044, 2012 (Released:2012-08-01)

参考文献数

16

被引用文献数

12 38

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A dipeptidyl peptidase (DPP)-4 inhibitor, commonly used to treat patients with type 2 diabetes, has caused concern because of immune system side effects. We report a 48-year-old woman with type 2 diabetes who was diagnosed with rheumatoid arthritis (RA) after continued polyarthritis and an increase in rheumatoid factor up to 86 IU/mL after three months of treatment with sitagliptin, a DPP-4 inhibitor. The shared epitope (SE)-containing human leukocyte antigen (HLA)-DRB1 alleles, which are important predisposing factors for RA, were positive. RA might have been triggered by sitagliptin due to a predisposing condition.