著者

Yusuke Yata Michihiro Hosojima Hideyuki Kabasawa Tomomi Ishikawa Ryohei Kaseda Noriaki Iino Yoshiki Suzuki Akihiko Saito 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.56, no.19, pp.2555-2562, 2017-10-01 (Released:2017-10-01)

参考文献数

24

被引用文献数

10

---

Objective The administration of glucocorticoids usually causes a mild increase in fasting glucose levels and a greater dose-dependent increase in postprandial values in patients without pre-existing diabetes mellitus. Patients with persistent hyperglycemia due to glucocorticoid therapy sometimes require insulin therapy, which might result in increased weight gain and more episodes of hypoglycemia, some of which are severe. On the other hand, scant evidence is available on the efficacy of oral hypoglycemic agents in treating glucocorticoid-induced diabetes. In this study, we evaluated the efficacy of dipeptidyl peptidase (DPP)-4 inhibitors in patients with glucocorticoid-induced diabetes by continuous glucose monitoring (CGM). Methods We examined the glycemic profiles using CGM at baseline and 1-4 weeks after initiating DPP-4 inhibitor treatment in patients with newly developed glucocorticoid-induced diabetes. Results Eleven patients who had been diagnosed with kidney disease or other diseases with renal involvement were recruited for the present retrospective study. After starting DPP-4 inhibitors, the mean and standard deviation (SD) of the glucose level, and the mean amplitude of glycemic excursion (MAGE) were significantly improved in comparison to baseline. Furthermore, the area over the curve (AOC) for the glucose levels <70 mg/dL was not increased in comparison to baseline after the initiation of DPP-4 inhibitor treatment. The results indicate that the treatment of patients with glucocorticoid-induced diabetes using DPP-4 inhibitors can minimize the risk of hypoglycemia and reduce glucose variability. Conclusion DPP-4 inhibitors are potentially useful for blood glucose control in patients with glucocorticoid-induced diabetes.

著者

Yoshihisa Fukuda Yusuke Higuchi Kanae Shinozaki Yuji Tanigawa Taro Abe Nobuyoshi Hanaoka Sunao Matsubayashi Tomomi Yamaguchi Tomoki Kosho Koji Nakamichi

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

pp.8758-16, (Released:2017-09-15)

参考文献数

25

被引用文献数

7

---

Ehlers-Danlos syndrome, hypermobility type (EDS-HT) is unexpectedly common and is associated with a high rate of gastrointestinal manifestations. We herein report the first documented case of mobile cecum associated with EDS-HT. A 21-year-old woman with repeated right lower abdominal pain was initially diagnosed with EDS-HT. Abdominal examinations performed in the supine position, such as CT and ultrasonography, showed no gross abnormalities. In contrast, oral barium gastrointestinal transit X-ray images obtained with changes in the patient's body position revealed position-dependent cecal volvulus with mobile cecum. She was finally discharged with a dramatic resolution of her symptoms after laparoscopic cecopexy for mobile cecum.

著者

Kazuya Nagasaki Harumi Gomi

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.17, pp.2379-2379, 2017-09-01 (Released:2017-09-01)

被引用文献数

2

著者

平井 潤 山岸 由佳 三鴨 廣繁

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.103, no.11, pp.2657-2665, 2014-11-10 (Released:2015-11-10)

参考文献数

20

---

カルバペネム耐性腸内細菌科細菌(carbapenem-resistant Enterobacteriaceae:CRE)はカルバペネム系抗菌薬に耐性を獲得した腸内細菌科細菌の総称で,ヒトの腸管に生息する腸内細菌が耐性を持つという点が重要である.ほとんどの耐性遺伝子がプラスミド伝播性であるため,他の細菌や種を超えて薬剤耐性が伝播する可能性があり,治療には多剤耐性菌用の薬剤であるチゲサイクリンやコリスチンの使用が必要な症例もある.現時点では本邦での検出頻度は低いが,アウトブレイク事例も認めるため,今後の動向には注意する.

著者

Marie Murakawa Kazumoto Shibuya Yukari Sekiguchi Satoshi Kuwabara

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.13, pp.1747-1748, 2017-07-01 (Released:2017-07-01)

参考文献数

2

被引用文献数

2

著者

Kenichiro Sato Noritoshi Arai Aki Omori-Mitsue Ayumi Hida Akio Kimura Sousuke Takeuchi

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

pp.8394-16, (Released:2017-08-01)

参考文献数

18

被引用文献数

5

---

Objective To identify the prehospital factors predicting the performance of tracheal intubation (TI) at the emergency department (ED) in patients with convulsive seizure or epilepsy. Methods We performed a retrospective analysis of seizure patients who underwent TI at the ED soon after arrival. The clinical variables obtained in the prehospital setting were reviewed. Patients The study population included consecutive adult patients who were transported to an urban tertiary care ED due to convulsive seizure between August 2010 and September 2015. Results Among the 822 eligible patients, 59 patients (7.2%) underwent TI at the ED. Four independent prehospital predictors were identified using multivariate analysis: age ≥50 years (+1 point), meeting the definition of convulsive status epilepticus (+4 points), and an on-scene heart rate of ≥120 bpm (+1 point) led to a higher likelihood of TI, while a higher on-scene (alert or confused) level of consciousness (-3 points) led to a lower likelihood of TI. The derived prediction rule (the sum of all points) had good predictive performance with an area under the curve of 0.88 (95% confidence interval: 0.79-0.97), a sensitivity of 0.62, a specificity of 0.91, and a positive likelihood ratio of 10.6, when the cut-off value was set to 5 points. Conclusion We constructed a simple prehospital prediction rule to help predict the need for TI in seizure patients, even in the prehospital phase. This may possibly lead to the more effective management of seizure patients in the ED.

著者

堤 久 大田 雅嗣

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.95, no.10, pp.2021-2025, 2006-10-10 (Released:2009-03-27)

参考文献数

5

被引用文献数

1 1

---

加齢に伴い赤血球諸値の低下をみるが, 高齢者では貧血の定義を男女一律にヘモグロビン濃度11g/dl以下とするのが実際的である. 高齢者では, 自覚症状に乏しかったり貧血らしからぬ症状を呈することも多い. 貧血の原因としては, 消化管出血による鉄欠乏性貧血, 慢性炎症に伴う二次性貧血, 腎性貧血などが多く骨髄異形成症候群も重要である. 貧血の治療は原因療法が基本だが, 輸血療法を行う場合は心不全の予防などの配慮を要する.

著者

髙田 和生

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.12, pp.2498-2508, 2015-12-10 (Released:2016-12-10)

参考文献数

8

---

アクティブラーニングとは,大人数講義と対照をなす教育アプローチであり,後者が教育者側の情報伝授効率を高めるのに対して,前者は学習者が新たに受領した情報について何らかの活動に従事することにより,それら情報の高次レベルでの修得を可能にする.大人数講義とは排他的ではなく相補的関係にあり,大人数講義を数分間中断して個人やペアで何らかの認知タスクに取り組ませるという小規模なものから始められる.その有効性は実証研究でも証明されつつあり,膨大な医学情報量と過密化するカリキュラムの中で学ぶ医学生の学習支援のために,今後導入拡大が求められている.

著者

Yurie Hirata Shinji Kamei Fuminori Tatsumi Masashi Shimoda Akihito Tanabe Junpei Sanada Yoshiro Fushimi Shintaro Irie Tomoatsu Mune Kohei Kaku Hideaki Kaneto

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.12, pp.1527-1529, 2017-06-15 (Released:2017-06-15)

参考文献数

11

被引用文献数

1

---

Succinic acid cibenzoline (CZ) is an antiarrhythmic agent often used for the treatment of tachyarrhythmia. However, hypoglycemia should be avoided in the treatment of diabetes. We herein report two late-stage elderly subjects who experienced a severe and prolonged hypoglycemic coma after the usage of CZ. These cases suggest that, when CZ is administered to elderly subjects with renal dysfunction and/or frailty, we should be aware of the possibility that this medicine may induce hypoglycemia and should adjust the dose as appropriate and monitor the concentration of CZ to avoid severe hypoglycemia.

著者

Takashi Shimizu Shosuke Akita Yoshinori Harada Eri Oguro Yasutaka Okita Minoru Shigesaka Hidetoshi Matsuoka Takuro Nii Satoru Teshigawara Eriko Kudo-Tanaka Soichiro Tsuji Masato Matsushita Shiro Ohshima Yoshihiko Hoshida Jun Hashimoto Yukihiko Saeki

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.10, pp.1243-1246, 2017-05-15 (Released:2017-05-15)

参考文献数

21

被引用文献数

6

---

A 72-year-old man presented with persistent oligoarthritis and positive results for rheumatoid factor and was suspected of having rheumatoid arthritis (RA). However, the musculoskeletal ultrasonography (MSUS) findings were not consistent with those of typical RA. He had undergone surgery for carpal tunnel syndrome, which allowed both histopathological and microbiological examinations to be performed. A synovial tissue culture was positive for Sporothrix schenckii, and he was diagnosed with sporotrichal tenosynovitis. He received anti-fungal therapy, and the sporotrichal tenosynovitis resolved. This case suggests that MSUS is a useful modality, and sporotrichal tenosynovitis, though rare, should be considered in the differential diagnosis of RA.

著者

舘田 一博

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.11, pp.2908-2914, 2013-11-10 (Released:2014-11-10)

参考文献数

2

被引用文献数

1 1

---

耐性菌の増加と蔓延が進行する中で,新しい抗菌薬の開発が進まない状況が深刻な問題となっている.米国では“2020年までに10薬剤の開発”をスローガンに,産官学の連携の中で抗菌薬開発促進の動きがみられている.その1例が2011年に施行されたGAIN法であり,この法律により耐性菌感染症に対する新しい治療薬に対して5年間の排他的(独占)販売期間の延長が認められた.日本でも,創薬促進検討委員会が立ち上がり,感染症関連学会,行政(厚生労働省,文部科学省,経済産業省),製薬企業との意見交換がスタートした.これまで世界標準の抗菌薬を多数創出してきた日本企業の知的・人的・物的リソースを生かす抗菌薬開発の環境整備が,今求められている.

著者

橋本 貢士 小川 佳宏

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.104, no.4, pp.697-702, 2015-04-10 (Released:2016-04-10)

参考文献数

10

---

肥満症の発症と進行には,遺伝因子である肥満関連遺伝子と,栄養や運動などの環境因子が密接に関与している.近年,次世代シークエンサーの登場により全身の遺伝子多型が網羅的かつ迅速に解析することが可能になり,新たな肥満関連遺伝子であるfat mass and obesity associated(FTO)遺伝子が同定された.また,環境因子による遺伝子発現制御機構であるエピジェネティクスの肥満症における新たな知見,特に,DNAメチル化による遺伝子発現制御機構の知見が急速に蓄積している.

著者

Youichi Yanagawa Kouichirou Nishi Naoyuki Kaneko

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.47, no.7, pp.659-661, 2008 (Released:2008-04-01)

参考文献数

18

被引用文献数

1 2

---

A 65-year-old woman with a sore throat and cough suddenly collapsed. She regained spontaneous circulation following resuscitation, but hypoxic encephalopathy was identified. Her vocal cords and the results of chest radiography were normal and no obstructive mass was identified in the neck on computed tomography (CT), but she demonstrated signs of obstructive upper airway. Bronchoscopy revealed tracheal stenosis. Chest CT showed tracheal compression by an esophageal tumor. Investigation of the trachea and surrounding organs by bronchoscopy and CT is important even when a patient with suspected respiratory arrest displays normal findings on chest radiography.

著者

Yusuke Miwa Ryo Takahashi Yuzo Ikari Airi Maeoka Shinichiro Nishimi Nao Oguro Tomoki Hayashi Mika Hatano Sakiko Isojima Ryo Yanai Tsuyoshi Kasama Yoichi Toyoshima Katsunori Inagaki Kenji Sanada

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.8, pp.903-906, 2017-04-15 (Released:2017-04-15)

参考文献数

15

被引用文献数

12

---

Objective Although previous studies have reported the prognostic factors for functional remission, no reports have cited the predictive factors. Our aim was to study the predictive factors for functional remission, which is a treatment goal in rheumatoid arthritis (RA), after receiving biological disease-modifying antirheumatic drugs (bDMARDs) treatment for six months. Methods The study consisted of 333 RA patients treated with bDMARDs for six months. The following patient characteristics were investigated: age, gender, disease duration, type of bDMARDs, baseline steroid and methotrexate dosage, and levels of serum rheumatoid factor, matrix metalloprotease, anti-cyclic citrullinated peptides antibody, tumor necrosis factor-α, and interleukin-6. In our evaluation, we used the Simplified Disease Activity Index (SDAI) for RA disease activity, health assessment questionnaire disability index (HAQ-DI) for activity of daily living, Short Form (SF)-36 for quality of life, and Hamilton Depression Rating Scale (HAM-D) or Self-rating Depression Scale (SDS) to determine the patients' depression status. The subjects were divided into two groups: patients with HAQ-DI≤0.5 and HAQ-DI>0.5 at 6 months. Results A univariate analysis comparing a group of RA patients without functional remission (n=68) showed that the patients with functional remission (n=164) had the following in common compared with those without remission: younger age, shorter disease duration, lower baseline steroid dosage, lower SDAI, lower HAQ-DI, higher SF-36, and lower HAM-D. Only lower HAQ-DI scores and "mental health" score on the SF-36 were detected using a logistic regression analysis. Conclusion These findings suggested that RA patients with lower HAQ-DI and lower depression scores at baseline were more likely to achieve functional remission using bDMARDs treatment than those without these variables.

著者

Kiyoo Mori Kazunori Yamada Tetsuo Konno Dai Inoue Yoshihide Uno Michio Watanabe Miho Okuda Kotaro Oe Mitsuhiro Kawano 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.54, no.10, pp.1231-1235, 2015 (Released:2015-05-15)

参考文献数

17

被引用文献数

4 24

---

We herein report the case of a 65-year-old man with pericardial involvement associated with autoimmune pancreatitis. Chest CT imaging showed pericardial thickening. The patient responded to corticosteroid therapy, and the pericardial thickening resolved. Multiple organs are involved in immunoglobulin G4 (IgG4)-related disease (IgG4-RD); however, only a few cases of IgG4-related chronic constrictive pericarditis have been reported. To our knowledge, this is the first reported case of IgG4-RD with pericardial involvement at an early stage. This case indicates that recognizing pericardial complications in autoimmune pancreatitis is important and that CT imaging may be useful for obtaining the diagnosis and providing follow-up of pericardial lesions in cases of IgG4-RD.

著者

Toshiharu MATSUSHIMA

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.44, no.7, pp.687-687, 2005 (Released:2005-08-06)

参考文献数

2

被引用文献数

3 6

著者

Akihito Tanaka Hideki Ishii Yosuke Tatami Yohei Shibata Naohiro Osugi Tomoyuki Ota Yoshihiro Kawamura Susumu Suzuki Yoshimasa Nagao Tadashi Matsushita Toyoaki Murohara

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.333-337, 2016 (Released:2016-02-15)

参考文献数

23

被引用文献数

5

---

Objective Heparin is not recommended to be administered during the interruption of antiplatelet therapy for non-cardiac surgery. However, there are insufficient data to determine the value. The purpose of the present study was to evaluate the clinical results of the administration of unfractionated heparin during the interruption of antiplatelet therapy in non-cardiac surgery patients who had previously undergone drug-eluting stent (DES) implantation. Methods We retrospectively identified 210 elective non-cardiac surgical procedures that were performed with the administration of unfractionated heparin during interruption of all antiplatelet therapies in patients who had previously undergone DES implantation. Heparin was administered during the perioperative period in accordance with the local practice guideline at out institution. We examined the clinical outcomes within 30 days of surgery. Results The mean number of implanted DESs was 2.1±1.3. No major adverse cardiac events (including cardiac death, definite stent thrombosis, and non-fatal myocardial infarction) occurred in any of the 210 cases within 30 days of surgery. Four of the 210 cases (1.9%) required reoperation for bleeding within 30 days of surgery. Conclusion Our data showed the potential for the perioperative management with unfractionated heparin administration in Japanese patients who had previously undergone DES implantation who required non-cardiac surgery with the interruption of all antiplatelet therapies.

著者

Taku Harada Takanobu Hirosawa Kouhei Morinaga 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.56, no.6, pp.737-739, 2017-03-15 (Released:2017-03-17)

参考文献数

10

被引用文献数

11

---

A 40-year-old woman with bipolar disorder who was taking mirtazapine presented with mydriasis, abnormal diaphoresis, myoclonus and muscle rigidity after taking metocloplamide. Her medical history, which included the use of serotonergic agents, and the presence of symptoms including myoclonus and muscle rigidity were consistent with a diagnosis of serotonin syndrome (SS) according to the Hunter criteria. The symptoms diminished following three days of treatment with oral lorazepam and cyproheptadine and a reduced dose of mirtazapine. Metoclopramide is frequently used to various gastric symptom. Metoclopramide is not widely known to induce SS. This potentially fatal condition should be avoided by exercising care in the use of drugs that have the potential to cause drug-drug interactions.

著者

松居 喜郎 若狭 哲 大岡 智学 新宮 康栄

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.2, pp.238-244, 2016-02-10 (Released:2017-02-10)

参考文献数

12

---

活動期感染性心内膜炎(infective endocarditis:IE)に対する外科治療は,心不全や感染の制御,塞栓症の予防の観点から,適応,手術時期を判断し,感染組織の可及的切除により再感染を予防する.また,脳合併症を呈する場合には,梗塞後出血や新規発症のリスクを考慮に入れたうえで適切な手術時期を決定すべきである.大動脈弁位では弁周囲膿瘍が起こりやすく,周囲組織との解剖学的関係を十分理解し,郭清,再建を行う.僧帽弁位では弁形成の可能性を常に考慮すべきである.

著者

Kiyoshi Kitano Kiyoshi Furuta Shinichiro Kanai Yo-ichi Takei

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.5, pp.533-536, 2016 (Released:2016-03-01)

参考文献数

10

被引用文献数

2

---

A 41-year-old nurse was referred to our hospital with a fever and disturbed consciousness. She tested positive for influenza antigen. CT and MRI findings revealed low density and intensity areas in the right occipital and lateral lobes with remarkable brain edema, which led to a diagnosis of influenza encephalopathy. Influenza A antibodies in the serum were below the detection limit despite the patient receiving previous vaccination three months earlier. A PCR analysis revealed that the influenza HA gene was classified into clade 3C.2a, subclass AH3N2. The present case indicates the potential development of encephalopathy in adults under certain conditions.