著者

一山 智

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.1761-1772, 2015-09-10 (Released:2016-09-10)

参考文献数

6

著者

石原 賢一

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

巻号頁・発行日

vol.104, no.12, pp.2490-2497, 2015

被引用文献数

1

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<p>戦後,1949年の学制改革で新制大学が発足して以降,大学入試において常に医学部医学科(以下,「医学部」)は最難関であった.しかし,入試の中身をみると,教科試験中心だった入試から面接が重視されるようになり,共通一次試験導入で教科数が絞り込まれた個別(2次)試験は,近年は教科数が増加し,重視されるようになった.さらに,「地域枠」や「特定診療科枠」といった受験生の出身地を限定したり,入学時点で将来の進路の決定をせまったりする入試方式も生まれている.医学部入試の変遷を辿るとともに,今後予定されている大学入試改革で医学部入試が受ける影響についても言及したい.</p>

著者

河野 修興

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.2163-2168, 2009 (Released:2012-08-02)

参考文献数

15

著者

Hideharu Hagiya Koji Miyawaki Norihisa Yamamoto Hisao Yoshida Akihiro Kitagawa Tadafumi Asaoka Hidetoshi Eguchi Yukihiro Akeda Kazunori Tomono

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.8774-16, (Released:2017-09-25)

参考文献数

17

被引用文献数

13

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Ceftriaxone is a widely used third-generation cephalosporin showing advantageous pharmacokinetic properties and a broad antimicrobial spectrum. We herein report a case of ceftriaxone-induced neurotoxicity in a 56-year-old man on hemodialysis. Seven days after initiating high-dose ceftriaxone, the patient developed impaired consciousness along with facial myoclonus and sporadic phonation. The symptoms clearly disappeared shortly after withdrawal of the drug. Ceftriaxone is considered a safe antibiotic for patients with renal insufficiency, since it is excreted via both haptic and renal pathways. Physicians should note that antibiotic-associated encephalopathy may develop in patients administered ceftriaxone, especially in those complicated with renal dysfunction.

著者

田中 耕太郎

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.103, no.9, pp.2252-2260, 2014-09-10 (Released:2015-09-10)

参考文献数

25

著者

Hidetomo Maruyoshi Natsue Maruyoshi Motone Hirosue Komei Ikeda Masaaki Shimamoto

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.8234-16, (Released:2017-08-10)

参考文献数

19

被引用文献数

7

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We herein report an 87-year-old woman who was taking clonazepam at 1.5 mg/day. She was hospitalized with an old cerebral infarction complicated with symptomatic epilepsy, dementia, dyslipidemia, and chronic cholecystitis. Electrocardiogram revealed severe bradycardia at 31 beats/min. The bradycardia disappeared on day 3 after clonazepam withdrawal, although the serum clonazepam level had been within normal limits. She was diagnosed with clonazepam-associated bradycardia, which was likely related to the potential calcium channel-blocking properties of clonazepam. Because of age-related pharmacokinetic and pharmacodynamic changes, the adverse effects of clonazepam should be considered, especially in disabled elderly individuals with multiple comorbidities.

著者

久保 千春

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.93, no.3, pp.589-594, 2004-03-10 (Released:2008-06-12)

参考文献数

6

著者

Shigeo Godo Yu Kawazoe Hiroshi Ozaki Motoo Fujita Daisuke Kudo Ryosuke Nomura Hiroaki Shimokawa Shigeki Kushimoto

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.2603-2609, 2017-10-01 (Released:2017-10-01)

参考文献数

23

被引用文献数

5

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Thyroid storm is a life-threatening disorder that remains a therapeutic challenge. Although β-blockers are the mainstay for treatment, their use can be challenging in cases complicated by rapid atrial fibrillation and decompensated heart failure. We present a case of thyroid storm-associated atrial fibrillation and decompensated heart failure complicated by gastrointestinal dysfunction secondary to diffuse peritonitis that was successfully managed by a switching therapy, in which the continuous intravenous administration of landiolol was changed to bisoprolol via transdermal patch, in the acute phase treatment. This switching therapy may offer a promising therapeutic option for this potentially lethal disorder.

著者

平野 勉

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.12, pp.2812-2818, 2007 (Released:2012-08-02)

参考文献数

26

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多くの慢性腎臓病(CKD)には脂質異常症が続発するが,その成因にはアルブミン尿と腎機能低下の要因が複雑に関連する.CKDにおける脂質代謝異常が腎疾患を悪化させるリスクとなることのみならず冠動脈疾患のリスクであることが指摘されている.強力なLDLコレステロール低下薬であるスタチンは腎機能低下を抑制し,タンパク尿を軽減させることがメタ解析で示されている.強力なトリグリセリド低下とHDLコレステロール増加作用を有するフィブラートはタンパク尿を低下させる可能性があるが,腎機能低下症例では排泄が遅延するため慎重に投与すべきである.様々な脂質代謝改善薬の腎機能に対する影響をみたも小規模の臨床研究はあるが,脂質低下療法がどの程度タンパク尿を改善し,どの程度腎機能の保持に寄与するかについては大規模で長期的な介入試験の集積が必要である.

著者

Shoji Kikui Takao Takeshima

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.9091-17, (Released:2017-09-06)

参考文献数

10

被引用文献数

1

著者

Yasuo Ito Takashi Mitsufuji Yoshio Asano Tomokazu Shimazu Yuji Kato Norio Tanahashi Yuichi Maruki Fumihiko Sakai Toshimasa Yamamoto Nobuo Araki

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.8865-17, (Released:2017-09-06)

参考文献数

13

被引用文献数

9

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Objective Naratriptan has been reported to reduce the frequency of cluster headache. The purpose of this study was to determine whether naratriptan is effective as a prophylactic treatment for cluster headache in Japan. Methods We retrospectively reviewed all 43 patients with cluster headache who received preventive treatment with naratriptan from April 2009 to April 2015. The International Classification of Headache Disorders, 3rd Edition (beta version) (ICHD-3 beta) was used to diagnose cluster headache. This study was conducted at 3 centers (Department of Neurology, Saitama Medical University; Saitama Neuropsychiatric Institute; Saitama Medical University International Medical Center). Patients were recruited from these specialized headache outpatient centers. Naratriptan was taken before the patient went to bed. Results The study population included 30 men (69.8%) and 13 women (30.2%). Twenty-two cases received other preventive treatments (51.2%), while 21 cases only received naratriptan (48.8%). Among the 43 cases, 37 patients (86.0%) achieved an improvement of cluster headache on naratriptan. Conclusion Naratriptan has been suggested as a preventive medicine for cluster headache because of the longer the biological half-life in comparison to other triptans. The internal use of naratriptan 2 hours before attacks appears to achieve a good response in patients with cluster headache.

著者

横井 徹

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.5, pp.1021-1023, 2007 (Released:2012-08-02)

参考文献数

1

著者

Tetsuro Konishi Kaori Hayashi Hiroshi 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.56, no.16, pp.2119-2123, 2017-08-15 (Released:2017-08-15)

参考文献数

12

被引用文献数

3

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Objective We attempted to clarify the factors related to the aggravation of depression in patients with subacute myelo-optico-neuropathy (SMON) caused by clioquinol intoxication more than 35 years previously. Methods We investigated changes in the depressive mental states that occurred with aging in 19 Japanese SMON patients (mean age, 78.3 years; range, 66-89 years) according to their scores on the Japanese version of the Zung Self-rating Depression Scale (SDS), which were obtained 3-10 years previously and their current scores. The depressive state was further evaluated using simultaneous semi-structured interviews. Results The depressive mental states of 6 patients, whose current total SDS scores had increased by ≥10% in comparison to the previous score, were considered to have been aggravated with aging. The mean current total SDS score of these six patients was significantly higher than the mean score of the 13 patients whose conditions were not aggravated. Among the 20 SDS questionnaires, the patients whose conditions were aggravated showed significantly higher scores in diurnal variation, sleep disturbance and weight loss. The semi-structured interviews revealed that physical disabilities due to the sequelae of SMON, a lack of acceptance of SMON, and a decline in social activities were important factors in the aggravation of their depressive mental states with aging. Conclusion The maintenance of social activities with public support was important for coping among Japanese SMON patients with a depressive mental state, especially those who could not walk independently or who could not go outside freely without assistance.

著者

Yuya Aotsuka Akiyuki Uzawa Kazutaka Nishimura Kazuho Kojima Mika Yamaguchi Takahiro Makino Kazuo Nakamichi Masayuki Saijo 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.55, no.12, pp.1645-1647, 2016-06-15 (Released:2016-06-15)

参考文献数

13

被引用文献数

11

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Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease that favors the cerebrum and typically occurs in immunosuppressed patients. We herein report the case of a 66-year-old man with PML, idiopathic CD4+ T lymphocytopenia (ICL), and chronic renal failure. Cranial magnetic resonance imaging (MRI) showed a crescent-shaped lesion in the left cerebellum, brainstem, and middle cerebellar peduncle. Although the patient did not present with HIV infection, collagen diseases, or tumors, JC virus DNA was detected in the cerebrospinal fluid. Clinicians should consider PML and ICL in the differential diagnosis if the patient develops progressive ataxia and a crescent-shaped cerebellar lesion on MRI.

著者

Hiroaki Araie Ippei Sakamaki Yasufumi Matsuda Katsunori Tai Satoshi Ikegaya Kazuhiro Itoh Shinji Kishi Kana Oiwa Miyuki Okura Toshiki Tasaki Naoko Hosono Takanori Ueda Takahiro Yamauchi

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.18, pp.2407-2413, 2017-09-15 (Released:2017-09-15)

参考文献数

31

被引用文献数

3

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Objective We retrospectively compared the clinical efficacy and toxicity of rituximab (R)-THP-COP (pirarubicin, cyclophosphamide, vincristine, and prednisolone) with that of R-CHOP (rituximab, adriamicin, cyclophosphamide, vincristine, and prednisolone) in previously untreated old patients with diffuse large B-cell lymphoma (DLBCL). Patients and Methods Patients admitted to our institution between 2004 and 2013 were examined. The patients received either R (375 mg/m2, day 1)-THP-COP (pirarubicin 50 mg/m2 day 1, cyclophosphamide 750 mg/m2 day 1, vincristine 1.4 mg/m2 day 1, and prednisolone 100 mg day 1-5) or R-CHOP (adriamicin 50 mg/m2 day 1, cyclophosphamide 750 mg/m2 day 1, vincristine 1.4 mg/m2 day 1, and prednisolone 100 mg day 1-5). The doses of chemotherapeutic agents were adjusted depending on the patient's age and associated complications. The treatment was performed for 6 to 8 cycles. Results Among 74 patients with DLBCL (median 76, range 65-90 years; male 39, female 35), 29 received R-THP-COP, while 45 received R-CHOP. The overall response rates were 94.6% (complete response 86.4%, partial response 8.1%). The 2-year overall and progression-free survival rates were 77.6% and 68.5% for the R-THP-COP regimen and 79.2% and 78.9% for R-CHOP, respectively. No significant differences were found between these two regimens regarding the clinical efficacies. The most frequent adverse event was neutropenia (72.4% for the R-THP-COP regimen, 88.9% for the R-CHOP regimen). The cardiac function as evaluated by ejection fraction values was not impaired in either regimen. Conclusion R-THP-COP was effective and safe as an alternative to R-CHOP.

著者

Yukitoshi Sakao Takeshi Sugiura Takayuki Tsuji Naro Ohashi Hideo Yasuda Yoshihide Fujigaki Akihiko Kato

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.14, pp.1485-1490, 2014 (Released:2014-07-15)

参考文献数

34

被引用文献数

1 13

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Objective The goal of this study was to clarify the clinical manifestation of hypercalcemia due to hypoadrenalism in hemodialysis (HD) patients. Methods We retrospectively analyzed the clinical characteristics of five HD patients who had presented with hypercalcemia due to adrenal insufficiency (age: 69±7 [58-75] years old, time on HD: 13±11 [2-32] years). We conducted corticotropin-releasing hormone (CRH) and adrenocorticotropic hormone (ACTH) stimulation tests. We also examined serum bone turnover markers before and after glucocorticoid replacement. Results All patients had critical illnesses at the onset of hypercalcemia. They had at least one symptom, such as eosinophilia, hypoglycemia, or fever. The prevalence of hypercalcemia due to adrenal insufficiency was 1.3% in maintenance HD patients on admission. The causes of adrenal insufficiency were isolated ACTH deficiency, pituitary apoplexy, pituitary atrophy, glucocorticoid withdrawal syndrome, and unilateral adrenalectomy. Serum calcium (Ca) levels corrected by serum albumin were maximally increased to 12.9 to 14.3 mg/dL in four anuric HD patients and mildly elevated to 10.4 mg/dL in a patient with residual diuresis. Their basal serum cortisol levels ranged from <1.0 to 15.4 μg/dL. Single CRH injections failed to increase serum cortisol in any of the patients. Glucocorticoid replacement acutely normalized serum Ca and decreased levels of carboxy-terminal telopeptide of type I collagen, a marker of bone resorption. Conclusion Adrenal insufficiency could therefore be an occult cause of hypercalcemia in anuric HD patients who are critically ill.

著者

Koki Kawanishi Kensaku Shojima Masayuki Nishimoto Hiroko Abe Tetsuhiro Kakimoto Yuko Yasuda Takeshi Hara Jun Kato

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.8647-16, (Released:2017-09-06)

参考文献数

28

被引用文献数

6

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Objective Superior mesenteric artery (SMA) syndrome is characterized by the compression of the third segment of the duodenum between the SMA and aorta, resulting in duodenal obstruction. Because the symptoms of the syndrome are similar to those of functional dyspepsia (FD), this study aimed to examine whether or not patients with SMA syndrome were present among those diagnosed with FD. Methods Patients with an FD diagnosis underwent measurement of the angle and distance between the SMA and aorta by ultrasonography or computed tomography. Patients with an angle of ≤22° or with a distance of ≤8 mm between the SMA and aorta were diagnosed with SMA syndrome. Bacterial culture of the duodenal aspirate was also performed. Results Of the 46 FD patients, 5 (11%) met the criteria. All 5 were women with a body mass index significantly lower than the remaining 41 patients (18.7 vs. 24.0 kg/m2, p=0.003). In addition, all 5 patients had 105/mL or more bacteria in the duodenum. The symptoms of these five patients were treated through dietary and postprandial posture counselling with or without medication. Conclusion Patients with SMA syndrome were observed among underweight women diagnosed with FD. Their symptoms may be associated with bacterial overgrowth.

著者

Jun Shiraishi Yoshio Kohno Takeshi Nakamura Takashi Yanagiuchi Sho Hashimoto Daisuke Ito Masayoshi Kimura Akihiro Matsui Hirokazu Yokoi Masayasu Arihara Masayuki Hyogo Takatomo Shima Takahisa Sawada Satoaki Matoba Hiroyuki Yamada Akiyoshi Matsumuro Takeshi Shirayama Makoto Kitamura Keizo Furukawa on Behalf of the AMI-Kyoto Multi-Center Risk Study Group

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.9, pp.933-939, 2014 (Released:2014-05-01)

参考文献数

27

被引用文献数

2 16

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Objective The predictors of in-hospital outcomes after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) complicated with heart failure or cardiogenic shock at presentation remain unclear. Methods Using the AMI-Kyoto Multi-Center Risk Study database, the clinical background characteristics, angiographic findings, primary PCI results, and in-hospital prognoses were retrospectively compared between primary PCI-treated AMI patients with a Killip class status of ≥2 (Killip 2-4 patients, n=390) and those with a Killip class 1 status (Killip 1 patients, n=1,057). Results The Killip 2-4 patients were more likely to have a higher age and proportion of women and exhibited a higher prevalence of previous myocardial infarction, diabetes mellitus and chronic kidney disease or anemia on admission, lower systolic blood pressure (SBP) values on admission, a higher rate of multivessels or left main trunk as the culprit artery, a larger number of diseased vessels, a lower Thrombolysis In Myocardial Infarction (TIMI) grade in the infarct-related artery (IRA) before/after primary PCI and a significantly higher in-hospital mortality rate than the Killip 1 patients. According to a multivariate analysis, age was found to be an independent positive predictor of in-hospital mortality, while admission SBP was an independent positive predictor of in-hospital survival in both groups. In contrast, anemia on admission was found to be an independent predictor of in-hospital death, while the TIMI 3 flow in the IRA after PCI was found to be an independent factor for survival in the Killip 2-4 patients, but not the Killip 1 patients. Conclusion Anemia on admission and the final TIMI 3 flow in the IRA are critical determinants of in-hospital death in AMI patients with a Killip class status of ≥2 undergoing primary PCI.

著者

Tomoharu Suzuki Yasuharu Tokuda Hiroyuki Kobayashi

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.8769-16, (Released:2017-09-06)

参考文献数

7

被引用文献数

8

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Yellow nail syndrome (YNS) is characterized by yellowish nails, lymphedema, sinusitis, and pulmonary involvement and can be triggered by various underlying conditions, such as sinusitis or titanium exposure from an artificial joint or dental implant. Since YNS is potentially treatable, its timely diagnosis is important. The authors recently experienced a case of YNS in a patient who developed sinusitis, yellowish nails, bilateral edema of the extremities, and subclinical rheumatoid arthritis after the implantation of a cardiac pacemaker made from titanium. This case may be the first report of YNS induced by a titanium cardiac pacemaker.

著者

Naoyuki Nishimura Motowo Mizuno Muneaki Miyake Kazuhiro Matsueda

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.8812-17, (Released:2017-08-21)

参考文献数

1

被引用文献数

1