著者

伊勢 孝之 高木 恵理 岩瀬 俊 楠瀬 賢也 山口 浩司 八木 秀介 山田 博胤 添木 武 若槻 哲三 佐田 政隆

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.6, pp.1175-1179, 2015-06-10 (Released:2016-06-10)

参考文献数

8

被引用文献数

1

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心臓サルコイドーシスの標準的治療はステロイドであるが,ステロイドを投与中であっても再燃を認めることも多く,またステロイドの多岐にわたる副作用も問題となることが多い.症例は70歳代,女性.心臓サルコイドーシスの診断でプレドニンを維持量5 mg/日で加療されていた.定期検査で施行した心電図で陰性T波,前壁心尖部に新規の左室壁運動異常を認めた.FDG-PET,Gaシンチグラフィーで壁運動異常部位に一致して集積を認め,心臓サルコイドーシスの再燃と判断した.本症例では,ステロイドの副作用として糖尿病,肥満,白内障などを認めており,ステロイド増量が躊躇され,メトトレキサートの併用を開始した.メトトレキサート開始後,特に副作用を認めず,心電図ならびに左室壁運動異常の改善が認められた.ステロイド投与で再燃を認める心臓サルコイドーシス症例にはメトトレキサート併用も考慮すべきであると考えられた.

著者

小泉 忠史 古家 乾 馬場 英 定岡 邦昌 関谷 千尋 服部 淳夫

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.6, pp.1167-1174, 2015-06-10 (Released:2016-06-10)

参考文献数

6

被引用文献数

2 3

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症例は60歳代,インド国籍の男性.2カ月前からの水様性下痢で12 kgの体重減少を認めたため,当科を初診した.初診5日後には脱水による腎機能の悪化を認め,入院となった.血液検査,検便検査,大腸内視鏡検査では特記すべき所見はなく,CT検査では膵の軽度の萎縮を認めた.薬剤等によるcollagenous colitisやceliac spurue,膵外分泌機能不全による下痢を考え加療するも,症状の改善を認めなかった.下痢が出現する約1年半前にオルメサルタンの内服が開始となっていたため,同剤によるenteropathyを疑い,同剤を休薬したところ,水様性下痢は速やかな改善を認めた.重症の下痢症の原因の1つとして記銘すべき疾患と思われた.

著者

Haiyan Wan Zhao Hu Jinhong Wang Shimei Zhang Xiangdong Yang Tao Peng

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.11, pp.1433-1437, 2016-06-01 (Released:2016-06-01)

参考文献数

13

被引用文献数

8

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Objective There are many adverse reactions due to clindamycin, but kidney diseases (acute kidney injury, AKI) are uncommon. However, in recent years, the rate of clindamycin-induced kidney diseases has increased. We analyzed 50 patients with clindamycin-induced kidney diseases retrospectively, and investigated the characteristics of these kidney diseases in order to provide a reference for rational clinical drug use and to reduce drug-induced organ damage. Methods We investigated 50 patients diagnosed with clindamycin-induced kidney diseases retrospectively at the Department of Nephrology, Shandong University Qilu Hospital, from January 2009 to December 2013. The parameters included in our study were age, sex, clinical manifestations, efficacy and prognosis. Results All patients were diagnosed with clindamycin-induced kidney diseases within 48 hours of the application of clindamycin at 1.0-2.0 g/day. The patients included 29 women and 21 men. Most of the enrolled patients were 20-59 years old. Fifty-one patients were diagnosed with AKI stage 3 upon admission. Thirty-three had episodes of gross hematuria, but fever, skin rash and eosinophilia were rare. Urine analysis revealed mild proteinuria and severe tubular dysfunction. In the majority of patients, AKI was severe and required renal replacement therapy, but renal function in all patients had recovered significantly two months after discharge. Conclusion Clindamycin-induced AKI is largely reversible and is associated with episodes of gross hematuria. Clinicians should use clindamycin rationally and reduce the incidence of adverse reactions.

著者

赤司 浩一

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

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.News4-News4, 2015-04-10 (Released:2016-04-10)

著者

Keita Fujikawa Yushiro Endo Akinari Mizokami Kosuke Takahashi Maiko Tabuchi Kazuo Ohba Hideki Nakamura Atsushi Kawakami

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.1375-1378, 2016 (Released:2016-05-15)

参考文献数

19

被引用文献数

8

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A 36-year-old Japanese woman with intestinal Behcet's disease was admitted to our hospital due to a recurrent ileocecal ulcer. Because infliximab (IFX) showed secondary failure, IFX was switched to adalimumab (ADA). After the third injection of ADA, she was unexpectedly 4-weeks pregnant. ADA was continued until 20 gestational weeks. Remission of the disease activity was maintained during pregnancy, and the birth was uneventful. The ileocecal ulcer disappeared after her delivery. ADA was detected in the umbilical blood after 119 days from the last infusion. The placental transition and timing of neonatal vaccination should be considered in cases of pregnancy with TNF antibody therapy.

著者

Karin Takeda Masaya Oda Takemichi Okada Hitoshi Yamazaki Makoto Ohbu Masaaki Watanabe Hiroaki Yokomori

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.1293-1297, 2016 (Released:2016-05-15)

参考文献数

12

被引用文献数

1 3

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A 64-year-old man seeking treatment for a common cold was admitted to our hospital due to symptoms of general fatigue and liver dysfunction. A thorough history review revealed that the patient had recently started taking an over-the-counter (OTC) drug. Drug-induced lymphocyte stimulation tests were positive. Serum markers for autoimmune hepatitis (AIH) were particularly elevated. Liver biopsy revealed spotty necrosis and ceroid-pigmented Kupffer cells and piecemeal necrosis with multiple plasma cells. He responded to corticosteroids, thus suggesting the presence of an immune-mediated component associated with the liver injury. Liver injury after using OTCs should be included in the differential diagnosis for chronic hepatitis with features of AIH.

著者

Hiroaki Tanaka Satoshi Ambiru Takeharu Kawaguchi Yasumasa Sugita Chika Kawajiri Yuhei Nagao Takenori Shimura

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.1287-1292, 2016 (Released:2016-05-15)

参考文献数

23

被引用文献数

2

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Objective The use of intravenous in-line filters is effective for the mechanical removal of large particles, precipitates, bacteria, fungi, large lipid globules, and air. However, the routine use of in-line filters remains controversial. Many patients with hematological diseases frequently suffer from bloodstream infections (BSIs) with fatal outcomes. Methods The year before cessation of an in-line filter was defined as the "filter period" and the year after its cessation was defined as the "non-filter period." The number of central line-associated bloodstream infections (CLABSIs), which are defined through surveillance, the catheter utilization rate, the number of patient deaths within 7 days after removal of the central venous catheters (CVCs), and the overall survival rate following CVC insertion were measured. Results During both periods, 84 patients had a total of 140 CVCs with a total number of catheter days of 3,407. There were 10 CVCs with CLABSIs, and the overall CLABSI rate was 2.9/1,000 catheter days, including 4 CVCs with CLABSIs (2.5/1,000 catheter days) during the filter period and 6 CVCs with CLABSIs (3.3/1,000 catheter days) during the non-filter period. The CLABSI rate, catheter utilization rate, and mortality did not differ significantly between the two periods. The only independent variable that was found to be significantly associated with the development of CLABSIs was a neutrophil count of <500×106/L (p<0.05). Conclusion Our study revealed that the cessation of in-line filters from CVCs does not significantly influence the incidence of BSIs and mortality in patients with hematological disease. To confirm our results, however, a large-scale randomized controlled study is warranted.

著者

Eri Katsuyama Ken-ei Sada Noriko Tatebe Haruki Watanabe Takayuki Katsuyama Mariko Narazaki Koichi Sugiyama Katsue S. Watanabe Hiroshi Wakabayashi Tomoko Kawabata Jun Wada Hirofumi Makino

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.991-994, 2016 (Released:2016-04-15)

参考文献数

16

被引用文献数

8

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Idiopathic intracranial hypertension (IIH) is a syndrome of increased intracranial pressure and presents as an intractable headache, vomiting, and ophthalmologic manifestations. We herein report the case of a young girl who presented with bilateral abducens nerve palsy due to IIH as the onset of systemic lupus erythematosus (SLE). The patient was successfully treated with corticosteroid therapy. Our case lacked the typical symptoms of IIH, such as headache or nausea; therefore, it is necessary to carefully determine the cause of bilateral abducens nerve palsies. The development of IIH in SLE patients is a rare occurrence, but this manifestation should not be overlooked.

著者

Kazuhiro Tada Kenji Ito Aki Hamauchi Koji Takahashi Renya Watanabe Ai Uchida Yasuhiro Abe Tetsuhiko Yasuno Katsuhisa Miyake Yoshie Sasatomi Hitoshi Nakashima

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.969-973, 2016 (Released:2016-04-15)

参考文献数

26

被引用文献数

1 6

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Clopidogrel was administered to a 67-year-old Japanese man to prevent the recurrence of cerebral infarction. Twelve weeks later, he was admitted to our hospital with acute renal failure, hemolytic anemia and thrombocytopenia, and was diagnosed with clopidogrel-induced thrombotic microangiopathy. Clopidogrel was immediately discontinued and corticosteroid and plasma exchange therapy were administered simultaneously. Thereafter, the patient's condition gradually improved. The patient had a decreased serum complement C3 level. This suggests that the activated alternative pathway is related to thrombotic microangiopathy (TMA). TMA is a critical drug-associated adverse reaction that clinicians should always be vigilant about, because clopidogrel is widely prescribed.

著者

Sayoko Kinoshita Kyoichi Wada Sachi Matsuda Takeshi Kuwahara Haruki Sunami Takuma Sato Osamu Seguchi Masanobu Yanase Takeshi Nakatani Mitsutaka Takada

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.719-724, 2016 (Released:2016-04-01)

参考文献数

25

被引用文献数

2 4

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Objective The purpose of this study was to investigate the possible interaction between warfarin and linezolid in patients with a left ventricular assist system (LVAS) for the treatment of severe heart failure. Methods Patients with LVAS who were treated with linezolid for the treatment of infections from January 2003 to March 2013 were identified from medical records. The impact of linezolid on the clotting function, as well as the dose of warfarin during the first 10 days of linezolid therapy, was investigated. The mean prothrombin time-international normalized ratio (PT-INR) and mean doses of warfarin during 7 days before and 10 days after the initiation of linezolid therapy were calculated for individual patients. The PT-INR per mg of WF dose on the previous day (X) was calculated. The warfarin dose, PT-INR, and warfarin sensitivity index (WSI) value before and after the initiation of linezolid were compared to evaluate the impact of linezolid on the effect of warfarin. Results Sixteen patients were enrolled in the study. Although the mean PT-INR increased from 3.74 to 4.06, no significant difference was observed (p=0.05). A significant difference was observed in the mean dose of warfarin before and after the initiation of linezolid administration, with a decrease from 3.23 to 2.69 mg/day (p=0.001). In contrast, the mean WSI value significantly increased from 1.37 to 1.82 (p=0.014). After 10 days of linezolid administration, the mean X values increased over the baseline value by 31.7%. Conclusion These findings suggest that co-administration of linezolid results in increased PT-INR in patients with LVAS treated with warfarin.

著者

Toshikazu Ozeki Rui Kawato Mitsuru Watanabe Shun Minatoguchi Yukari Murai Akihiro Ryuge Koji Takasugi Takuya Hamada Yukako Oyama Atsushi Nomura Tatsuhito Tomino Hideaki Shimizu Yoshiro Fujita

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.775-778, 2016 (Released:2016-04-01)

参考文献数

15

被引用文献数

1 8

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A 72-year-old woman with a history of type 2 diabetes mellitus was brought to the ER with metformin-associated lactic acidosis. She received continuous hemofiltration and hemodialysis, but the laboratory analyses showed no improvement. She died 11 hours after admission. Metformin is minimally bound to proteins and is readily dialyzable, but a prolonged period of dialysis is required, because metformin has a very large distribution volume and is distributed to multiple compartments. The peak blood metformin level was 432 mg/L in this case, which is one of the highest metformin concentrations ever reported, and eight hours of hemodialysis were not sufficient to reduce the serum level.

著者

森松 光紀

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.89, no.4, pp.678-684, 2000-04-10 (Released:2008-06-12)

参考文献数

5

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チックは,単一筋または複数の筋群に起こる,短時間の,すばやい,反復的・常同的運動である.一般に小児期から成人初期に発病し,やがて消失するか,半永久的に続く.心因性のこともあるが脳内伝達物質の異常とみなされる場合もある.後者の代表はトゥレット症候群である.治療はまず経過を観察し,社会生活上の困難を示すときは,ドパミン阻害薬を中心にした薬物治療を行う.ただし,完全抑制はしばしば困難である.

著者

Yuji Kikuchi Mayumi Yoshimi Tsuyoshi Takahashi

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.711-711, 2016 (Released:2016-03-15)

参考文献数

2

被引用文献数

4

著者

福井 次矢

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.87, no.10, pp.2122-2134, 1998-10-10 (Released:2008-06-12)

参考文献数

34

被引用文献数

4 5

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1990年代に入って提唱された「信頼できる最新データに基づいた,理に適った医療」であるevidencebased medicine (EBM)は, (1)臨床上の疑問点抽出, (2)信頼性の高い結果(エビデンス)を示す文献の効率の検索, (3)臨床疫学と生物統計学の原理に則った,文献の批判的吟味, (4)得られたエビデンスの患者への適用性の判断,という4段階の手順から成る. EBMの主な活用場面は, (1)個々の患者での疑問点への対応,それに(2)頻度の高い臨床上の疑問点についての診療ガイドライン作成,である. EBMに則った診療を行うことで,入院患者については確固としたエビデンスに基づいた臨床判断を下す頻度が高くなった,診療ガイドラインを用いることで医師の診療行為だけでなく患者アウトカムも改善した,などのデータが報告され,医学教育にも大きく取り入れられつつある.世界的な規模でEBMが普及することにより,客観的な臨床データを重視した患者指向の医療が,今後ますます求められることになろう.

著者

Yuki Nanke Tsuyoshi Kobasigawa Keiko Yoda Hisashi Yamanaka Shigeru Kotake

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.515-517, 2016 (Released:2016-03-01)

参考文献数

16

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Behçet's disease (BD) is a polysymptomatic and recurrent systemic vasculitis with a chronic course and unknown cause. We herein report a 27-year-old woman who had suffered from a recurrent fever and tonsillitis for nearly ten years with BD for who tonsillectomy was effective.

著者

橋本 修

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.Suppl, pp.124b-125a, 2015-02-20 (Released:2016-02-20)

著者

久保 惠嗣 松井 祥子

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.Suppl, pp.104a-104a, 2015-02-20 (Released:2016-02-20)

著者

川合 眞一

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.104, no.Suppl, pp.119a-119a, 2015-02-20 (Released:2016-02-20)

著者

Mariko Kobayashi Shinji Endo Yukako Hamano Mamiko Imanishi Daisuke Akutsu Akinori Sugaya Daisuke Ochi Toshikazu Moriwaki Ichinosuke Hyodo

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.127-130, 2016 (Released:2016-01-15)

参考文献数

16

被引用文献数

1 6

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Combination chemotherapy of mFOLFOX6 (5-fluorouracil, leucovorin, and oxaliplatin) plus panitumumab, a fully human monoclonal antibody against epidermal growth factor receptor (EGFR), is one of the standard treatments for metastatic colorectal cancer (mCRC) without KRAS mutation. A few reports suggested no need of dose adjustment of cetuximab, a similar chimeric anti-EGFR antibody, in patients with renal impairment. However, panitumumab combined with cytotoxic drugs for hemodialysis patients has not been reported. We herein report a case of a hemodialysis mCRC patient successfully treated with mFOLFOX6 and panitumumab combination therapy.