著者

Stephen West Nishkantha Arulkumaran Phillip W. Ind Charles D. Pusey

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.52, no.1, pp.5-13, 2013 (Released:2013-01-01)

参考文献数

72

被引用文献数

13 51 4

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Diffuse alveolar haemorrhage (DAH) is a serious complication of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). A literature review was performed to ascertain the diagnostic features, treatment, and outcome of this rare but serious condition. Haemoptysis and dyspnoea are common but non-specific features. Chest radiography is usually abnormal, and high-resolution computerised tomographic scanning is more sensitive. Increased uptake of inhaled carbon monoxide and reduced clearance of C15O on lung function testing is suggestive of intra-alveolar blood. Fiberoptic bronchoscopy and bronchoalveolar lavage are useful when a super-added infection is suspected. Concurrent renal disease is common and contributes to the morbidity and mortality. Treatment should be individualised, and it is based on glucocorticoid and cyclophosphamide induction with azathioprine maintenance. The role of plasmapheresis is unclear, and is currently being evaluated. Patients are at risk of disease and treatment-related long-term complications. Ongoing research into the most efficacious therapeutic regimens associated with the least side effects is especially important.

著者

Satoshi Maeda Akira Tamura Hirofumi Zaizen Naohiko 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.53, no.15, pp.1721-1721, 2014 (Released:2014-08-01)

被引用文献数

8

著者

清野 裕

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.4, pp.713-716, 2009 (Released:2012-08-02)

参考文献数

9

著者

伊藤 聡

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.99, no.8, pp.1871-1877, 2010 (Released:2013-04-10)

参考文献数

10

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関節リウマチの治療に生物学的製剤が導入され,劇的な効果をあげている.我が国では4製剤が認可され,それぞれの特徴を考慮して使用されている.生物学的製剤は,神経Behçet病,多発性/皮膚筋炎,血管炎症候群などの,膠原病,膠原病関連疾患における神経・筋障害においても使用が開始され,有効例も報告されている.しかし,保険適用外であり,報告された症例数も少ないため,使用にあたっては,十分なインフォームドコンセントが必要である.

著者

荒川 泰行

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.87, no.3, pp.480-485, 1998-03-10 (Released:2008-06-12)

参考文献数

5

著者

Yasunori 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.53, no.7, pp.815-815, 2014 (Released:2014-04-01)

参考文献数

1

被引用文献数

1 1

著者

Shunichiro Hanai Takeo Sato Katsuya Nagatani Seiji Minota

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.5, pp.521-522, 2014 (Released:2014-03-01)

参考文献数

2

被引用文献数

5

著者

Wen-Cheng Liu Chih-Weim Hsiang Hsian-He Hsu Wei-Chou Chang

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.5, pp.523-523, 2014 (Released:2014-03-01)

参考文献数

2

著者

Satoshi Kutsuna Kayoko Hayakawa Norio Ohmagari

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.167-168, 2014 (Released:2014-01-15)

参考文献数

2

被引用文献数

1

著者

井田 弘明

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.97, no.2, pp.438-447, 2008 (Released:2012-08-02)

参考文献数

17

被引用文献数

2 2

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自己炎症疾患(autoinflammatory disease)は,自己炎症症候群(autoinflammatory syndrome)とも呼ばれる新しい疾患概念である.繰り返す全身性の炎症を来す疾患で,多くは発熱がみられ,関節·皮膚·腸·眼などの部位の炎症を伴う.症状としては,感染症や膠原病に類似しているが,病原微生物は同定されず,また,自己抗体や抗原特異的T細胞も検出されない.近年,Toll-like受容体や細胞内のNLRファミリー蛋白の分子機構の解明が進み,また,これらの分子が,一部の遺伝性周期熱症候群の疾患遺伝子でもあったことから,自己炎症疾患の概念が提唱され,現在注目されている.欧米の疾患と思われていた遺伝性周期熱症候群は,本邦でも存在が確認され,不明熱の鑑別疾患に挙げる必要性がでてきている.本稿では,自己炎症疾患の概念,分類を紹介するとともに,各疾患の臨床像と病因を簡単に解説した.

著者

Yasushi Ito Susumu Mitsutani

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.49, no.23, pp.2645-2646, 2010 (Released:2010-12-01)

参考文献数

1

著者

Ichiro WAKABAYASHI Kunihiro SAKAMOTO Hidehisa MASUI Sachiko YOSHIMOTO Akihisa KANAMARU Eizo KAKISHITA Hiroshi HARA Masashi SHIMO-OKA Kiyoyasu NAGAI

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.33, no.4, pp.198-203, 1994 (Released:2006-03-27)

参考文献数

22

被引用文献数

10 17

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A case control study was performed with 142 leukemia patients and 284 controls matched for age and sex. Occupation, birth order, past medical history, and drinking and smoking habits were compared in these two groups. Persons born first or fourth were found to have a higher incidence of leukemia. History of a fracture was one of the risk factors for acute leukemia, and a history of gastroduodenal ulcer was a risk factor for chronic leukemia. This may suggest that extensive exposure to X-rays in diagnosis and treatment is a risk factor for leukemia. There was a significant dose-response relationship between the amount of smoking and the incidence of acute nonlymphocytic leukemia, but not between the amount of alcohol consumption and the incidence of leukemia. Thus, smoking was one of the risk factors for acute leukemia.(Internal Medicine 33:198-203, 1994)

著者

Taiji Tsunemi Yuki Sakai Koichi Tsunoda Yasuhiro Irie Yoshiaki Wada

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.45, no.22, pp.1315-1317, 2006 (Released:2006-12-15)

参考文献数

9

被引用文献数

4 7

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The patient was hospitalized due to rapidly undulant fever and sore throat. Empirical antibiotic therapy was started, however, headache also occurred. Lumbar puncture disclosed polynuclear leukocyte-predominant pleocytosis indicating that the patient suffered from bacterial meningitis. The antibiotics therapy was increased, however, consciousness became impaired and erythema multiforme-like skin lesions appeared. T2-weighted brain magnetic resonance imaging showed high signal intensity in the brainstem. HLA testing revealed B54 and Cw1. The patient presented futures of Behçets disease at the same time as those of Sweets syndrome and it was difficult to distinguish between the two diseases. Administration of prednisolone showed remarkable effect.

著者

Shinji Abe Arata Azuma Hiroshi Mukae Takashi Ogura Hiroyuki Taniguchi Masashi Bando Yukihiko Sugiyama

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.12, pp.1487-1491, 2012 (Released:2012-06-15)

参考文献数

21

被引用文献数

23 88

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Objective The prognosis of idiopathic pulmonary fibrosis (IPF) patients with acute exacerbation (AE) is reported to be extremely poor. Several clinical studies suggest that direct hemoperfusion with polymyxin B-immobilized fiber (PMX) may have beneficial effects on AE in patients with interstitial pneumonia (IP). The aim of this multicenter retrospective analysis was to investigate whether PMX treatment could provide improvement of oxygenation and survival benefits in IPF patients with AE. Methods We conducted a retrospective study of 160 IP patients (including 73 IPF) with AE treated by PMX at 18 institutions in Japan. PMX treatment was carried out twice. The total hemoperfusion time of PMX treatment was, on average, 12 hours. Data concerning oxygenation on PMX treatment and survival after AE were collected and analyzed. Results In IPF patients with AE, arterial oxygen tension (PaO2)/inspiratory oxygen fraction (FiO2), (P/F) ratio was significantly improved at the end of the 2nd treatment with PMX (173.9±105.4 to 195.2±106.8 Torr, p=0.003). White blood cell count was significantly reduced at the end of the 2nd treatment (13,330±7,002 to 9,426±5,188 /mm3, p<0.001). These clinical changes were also observed on analysis of all 160 IP patients with AE. The one- and three-month survival rates of IPF patients after AE were 70.1% and 34.4%, respectively. Conclusion PMX treatment may improve oxygenation and survival in IPF patients with AE. Prospective, controlled trials of PMX treatment for IPF with AE are warranted to verify this potential benefit.

著者

田港 朝彦

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.8, pp.1570-1577, 2000-08-10 (Released:2008-06-12)

参考文献数

19

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厳格な血糖コントロールは,細小血管合併症の発症,進展を抑制する.しかし,前増殖網膜症,増殖網膜症を有する例に血糖降下療法を開始する場合には, HbAlcが極めて高い場合, HbAlc 8.0%までは速やかに下げても良いが,それ以後は緩徐に血糖を下げて,低血糖を起こさないなどの配慮が要る.長期間放置例や,糖尿病罹病治療歴が不明の初診患者の場合も同様である.また,治療開始前から治療中の眼科医との緊密な連係が必須である.その他,高血圧,高脂血症,喫煙,肥満などのリスクファクターを取り除くこと,などが重要である.

著者

Kazuki Sakakura Norio Takayashiki Yasuharu Tokuda Hiroaki Satoh

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.52, no.8, pp.925-925, 2013 (Released:2013-04-15)

参考文献数

2

被引用文献数

5

著者

Toru Naganuma Keigo Dote Masaya Kato Shota Sasaki Kentaro Ueda Yasuyuki Kono Yoshikazu Watanabe Masato Kajikawa Haruko Yokoyama

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.48, no.6, pp.433-436, 2009 (Released:2009-03-16)

参考文献数

17

被引用文献数

3

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A 65-year-old man who had undergone retropubic prostatectomy for prostate adenocarcinoma presented with sudden dyspnea and chest pain. Contrast-enhanced multi-slice computed tomography (MSCT) revealed thrombi in the left internal jugular vein (IJV) and in branches of the right pulmonary artery. Ultrasonography showed that the thrombus which occluded the left IJV was hypoechoic and mobile. After beginning anticoagulant therapy, he again presented with dyspnea and transient hypotension. MSCT and ultrasonography showed that the IJV thrombus had moved and caused a new embolism of the left pulmonary artery branch. This is a rare case of a patient who experienced non-catheter-related thrombosis of the IJV.

著者

Masafumi Seki Naruhiko Ikari Seigo Yamamoto Yuhki Yamagata Kosuke Kosai Katsunori Yanagihara Tomoyuki Kakugawa Shintaro Kurihara Koichi Izumikawa Yoshitsugu Miyazaki Yasuhito Higashiyama Yoichi Hirakata Takayoshi Tashiro Shigeru Kohno

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.45, no.22, pp.1323-1326, 2006 (Released:2006-12-15)

参考文献数

22

被引用文献数

11 24 11

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A 77 years old woman who had a bite with eschar on her left arm, was admitted to emergency ward in our hospital, because of high fever, severe malaise, skin eruption, and consciousness disturbance beginning 5 days previously. She was diagnosed as Japanese spotted fever by seropositive of Rickettsia japonica (R. japonica) antibody, and successfully treated with fluoroquinolone, after minocycline hydrochloride had been proven ineffective. R. japonica-specific DNA was detected by PCR from the tick: Haemaphysalis hystricis larvae collected from a mountainous location in Fukuoka, Japan where the patient had been bitten.

著者

Itaru Hayakawa Junwa Kunimatsu Riri Watanabe Kazuo Kubota Atsuto Yoshizawa

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.24, pp.3431-3434, 2012 (Released:2012-12-15)

参考文献数

27

被引用文献数

2 2 1

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The early diagnosis and treatment of Takayasu arteritis (TA) is crucial to prevent the devastating complications of vascular insufficiency. This report describes a patient with a persistent fever in whom carotid artery tenderness led to a diagnosis of TA. This case suggests that carotid artery tenderness is a useful physical finding that warrants 2-deoxy-2-[Fluorine-18] fluoro-D-glucose positron emission tomography/computed tomography to confirm a diagnosis of early TA.

著者

Hideyuki Nagakura Masanori Nishikawa Nobuko Kusano Mari Saito Satoshi Morita Takeshi Kaneko Yoshiaki Ishigatsubo

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.22, pp.3115-3118, 2012 (Released:2012-11-15)

参考文献数

27

被引用文献数

1 3

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Objective The aim of this study was to determine the epidemiological characteristics of never-smoking patients with non-small cell lung cancer (NSCLC) detected with clinic-based screening programs, focusing on clinical risk factors and survival. Methods The medical records of NSCLC patients (n=285) diagnosed at Fujisawa City Hospital between April 2000 and December 2010 with lesions that were originally detected with clinic-based screening programs in Fujisawa City were reviewed to identify the clinicopathological variables and survival outcomes. Results Of the 285 NSCLC patients, 95 (33.3%) were never-smokers. A comparison between the never-smoking and ever-smoking patients revealed that the never-smokers included a significantly greater proportion of women and patients with adenocarcinoma (86.3% vs. 12.6%: p<0.001 or 94.7% vs. 55.8%: p<0.001, respectively). The overall survival rate of the never-smoking patients was significantly superior to that of the ever-smokers (p=0.004). In addition to smoking status, factors found to be significantly associated with the overall survival rate in univariate analyses were gender, stage, histology and first line treatment. A multivariate analysis revealed smoking status to be an independent prognostic factor in addition to stage and first line treatment. Conclusion The differences in the clinicopathological factors and survival outcomes between never-smoking and ever-smoking patients with NSCLC detected with clinic-based screening programs suggest that persuading people to never start smoking is important.