著者

高林 克日己 末石 真 冨岡 玖夫 今泉 照恵 吉田 尚 杉山 隆夫 木村 亮 井坂 茂夫 島崎 淳

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.74, no.11, pp.1579-1585, 1985-11-10 (Released:2008-06-12)

参考文献数

14

被引用文献数

3 10

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全身性エリテマート一デス(SLE)にまれながら間質性膀胱炎を合併することが最近示され,これはlupus cystitis (ループス膀胱炎)と呼ばれている.今までにこのループス膀胱炎の本邦におけるまとまつた報告はなかつたが,われわれは最近4例のループス膀胱炎と思われる症例を経験した.いずれも中年女性で,頻尿などの膀胱症状を訴えて発症し,亜急性に進行して水腎症に至つている.これらの患者はまたいずれにも悪心・嘔吐・下痢などの消化器症状を合併していた.うち1例はステロイド療法・腎瘻造設術後も腸管運動の低下からイレウスを繰り返し,消化管出血により死亡した. 1例は腎瘻造設後にネフローゼ症候群が出現しSLEと診断された.他の2例はループス膀胱炎と診断後,ステロイド療法により膀胱・消化器症状の改善をみた.本疾患はまれではあるが,膀胱の他消化器症状を合併するなど特有の臨床像をもつたSLEのsubgroupの一つと考えられる.しかし既知の特定の自己抗体との相関は認められなかつた.また1例で消化管粘膜下の血管にimmune depositsを認めたが,膀胱では明らかな血管炎はみられなかつた.この疾患は初期には他覚的所見に乏しく,診断が遅れる傾向があるが,早期治療により症状の改善が期待できることから,膠原病患者の膀胱症状に遭遇した際には,念頭におかなければならない疾患と考えられる.

著者

Taro Shibuki Hiroharu Kawakubo Kojiro Kawachi Toshihiko Mizuta

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.11, pp.1447-1447, 2017-06-01 (Released:2017-06-01)

参考文献数

1

被引用文献数

1

著者

萩原 弘一

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.95, no.6, pp.1036-1041, 2006-06-10 (Released:2009-03-27)

参考文献数

6

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我々は, 効率的な疾患遺伝子同定法であるホモ接合指紋法 (homozygosity fingerprinting法) により, 肺胞微石症責任遺伝子を同定した. 責任遺伝子 (SLC34A2) はII型肺胞上皮細胞に発現するリンの運搬蛋白をコードしていた. 肺胞の表面は, リン脂質を主成分とする表面活性物質に覆われている. 古い表面活性物質は, 肺胞マクロファージによる消化後, II型肺胞上皮細胞上のSLC34A2により肺胞腔から除去される. 肺胞微石症では, SLC34A2機能喪失により, 肺胞腔内のリンイオン除去が障害された結果, 微石が生じると考えられる.

著者

Issei Tokimatsu Katsumi Shigemura Tomohiro Kotaki Hiroki Yoshikawa Fukashi Yamamichi Tadashi Tomo Soichi Arakawa Masato Fujisawa Jun-ichi Kadota

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.11, pp.1315-1319, 2017-06-01 (Released:2017-06-01)

参考文献数

19

被引用文献数

4

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Objectives To investigate the efficacy of oral moxifloxacin (MFLX) as a treatment for pneumonia in hemodialysis (HD) patients and the pharmacokinetic (PK) profile of MFLX after oral administration. Methods Thirteen adult patients who required HD due to chronic renal failure were enrolled in the present study, which was performed to investigate the treatment of community-acquired pneumonia in HD patients. A standard dose of MFLX (400 mg, once daily) was administered. The therapy was continued, discontinued, or switched to another antibiotic depending on the response of the pneumonia to MFLX. A population PK model was developed using the post-hoc method. Results In total, 13 HD patients with pneumonia (male, n=7; female, n=6) were enrolled in the present study. The evaluation on the 3rd day showed that treatment was successful in 11 patients (84.6%) and that 10 patients were cured (76.9%). In the one case in which MFLX treatment failed, the patient was cured by switching to ceftriaxone (CTRX) (2 g, intravenously) plus levofloxacin (LVFX) (250 mg, orally). The causative bacterium in this male patient was P. aeruginosa. It did not display resistance to fluoroquinolones. One patient had liver dysfunction due to MFLX. The estimated PK parameters of MFLX were as follows: AUC0→24, 61.04±17.74 μg h/mL; Cmax, 5.25±1.12 μg/mL; and Ctrough, 1.15±0.45 μg/mL. The PK parameters of MFLX among the patients in whom adverse events occurred or in whom a cure was not achieved did not differ from those of the other patients to a statistically significant extent. Conclusion MFLX showed good efficacy and safety in HD patients with community-acquired pneumonia and the results of the PK analysis were favorable. Further prospective studies with larger numbers of patients will be needed to draw definitive conclusions.

著者

谷本 和紀 入交 重雄 関 雅之 葛城 有希子 山田 豊 木下 真孝 三島 伸介 倭 正也

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.866-873, 2016-05-10 (Released:2017-05-10)

参考文献数

4

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71歳,男性.前腕および下腿の皮膚硬化を自覚し,近医を受診した.全身性強皮症を疑われて当院を紹介された.皮膚硬化を認めたが,四肢末梢の皮膚は保たれ,抗核抗体や各種自己抗体は陰性であり,全身性強皮症(systemic sclerosis:SSc)と合致しない点も認められた.皮膚生検を施行し,病理組織学的にはSScと矛盾しない結果であった.経過中に皮膚のgroove signを認め筋膜炎脂肪織炎症候群(fasciitis-panniculitis syndrome:FPS)を疑い,皮膚から筋まで一塊(en bloc)に生検を施行し,FPSの確定診断に至った.非典型的なSSc疑似症例では,FPSも鑑別診断に挙げる必要がある.

著者

谷本 安 高橋 清

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.12, pp.3103-3113, 2009 (Released:2012-08-02)

参考文献数

24

被引用文献数

1 1

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重症難治性喘息は,ステロイド薬等でも制御しがたい強い気道炎症や,不十分・不適切な治療によりリモデリングを起こして治療に反応しにくい場合,合併症による修飾で喘息症状が管理しにくい場合等,複雑な病態の重複がある.近年吸入ステロイド薬(ICS)等の改善・普及により重度の難治性喘息は著減したが,各ガイドラインの定義によっては1%から10%程度を占める.その治療は,ICSの早期導入と十分量の使用,各種合併症への対策が大切であり,近年開発された抗IgE抗体療法の併用がかかる患者への福音として期待される.

著者

Koichi Yamada Hiroki Namikawa Hiroki Fujimoto Kiyotaka Nakaie Etsuko Takizawa Yasuyo Okada Akiko Fujita Hiroyoshi Kawaguchi Yasutaka Nakamura Junko Abe Yukihiro Kaneko 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.7, pp.781-785, 2017-04-01 (Released:2017-04-01)

参考文献数

27

被引用文献数

21

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Objective Coagulase-negative staphylococci are among the most frequently isolated microorganisms in blood cultures. The aim of this study was to assess [1] the clinical characteristics of methicillin-resistant, coagulase-negative staphylococci bacteremia and [2] the susceptibility of the isolated bacteria to glycopeptides. Methods We retrospectively reviewed the medical records of 70 patients from whom methicillin-resistant coagulase-negative staphylococci had been isolated at Osaka City University Hospital between January 2010 and December 2013. We evaluated the patients' background, severity and prognosis of the disease, and the susceptibility of the isolated methicillin-resistant coagulase-negative staphylococci to glycopeptides. Results Out of the 70 patients tested, 28 (40.0%) had leukemia, and 36 (51.4%) had been treated for febrile neutropenia. Infection with Staphylococcus epidermidis accounted for 78.6% of patients. Thirty-nine cases (55.7%) were related to intravascular catheters, and 39 (55.7%) were treated using teicoplanin as a first-line therapy. The 30-day mortality rate was 4.3%. Regarding susceptibility, 20% of all isolates were non-susceptible to teicoplanin. According to multivariate analyses, it was observed that premedication using glycopeptides was independently associated with teicoplanin non-susceptibility (p=0.03; hazard ratio = 5.64; 95% confidence interval, 1.16-26.76). Conclusion Our results suggest that clinicians must use glycopeptides appropriately to prevent the development of further antibiotic resistance in methicillin-resistant coagulase-negative staphylococci.

著者

Masato Sawamura Atsushi Komatsuda Masaru Togashi Hideki Wakui Naoto 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.56, no.6, pp.631-636, 2017-03-15 (Released:2017-03-17)

参考文献数

14

被引用文献数

26

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Objective We performed a prospective study to determine the efficacy and safety of denosumab on bone metabolic indices and bone mineral density (BMD) in 29 patients receiving long-term glucocorticoids (GCs) who had clinical risk factors for fracture. Methods Among these patients, 16 had systemic lupus erythematosus (SLE), 6 RA, 4 other autoimmune diseases, and 3 renal diseases. All patients received donosumab 60 mg at baseline and 6 months. Serum N-terminal cross-linked telopeptide of type I collagen (NTX) and bone-specific alkaline phosphatase (BAP) levels were measured as bone metabolic indices. BMD at the lumbar spine (LSBMD) and femoral neck (FNBMD) were measured using dual energy X-ray absorptiometry and expressed as a percentage of the young adult mean (%YAM). Results Denosumab therapy significantly reduced serum NTX and BAP levels from baseline after 12 months (from 19.2 to 13.9 nmol BCE/L; from 11.9 to 9.2 U/L, respectively). In 18 patients treated with bisphosphonates before the start of denosumab therapy, the improvements in the LSBMD and FNBMD values were 1.5%YAM/year and 1.1%YAM/year, respectively. The LSBMD and FNBMD values were both significantly higher 12 months after denosumab therapy (3.5%YAM/year and 3.0%YAM/year, respectively). The LSBMD gain was significantly higher after denosumab therapy than during bisphosphonate therapy. No fractures were observed in any patients during denosumab therapy. Conlusion Denosumab is effective and safe in preventing bone resorption and BMD loss in patients treated with long-term GCs for inflammatory diseases. This is the first study showing a significant increase in not only LSBMD but also FNBMD in GC-induced osteoporosis after denosumab therapy.

著者

金井 隆典 水野 慎大 南木 康作 長沼 誠

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.Suppl, pp.111a-111a, 2016-02-20 (Released:2017-02-20)

著者

湊口 信也

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.9, pp.1826-1833, 2016

著者

山田 京志

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.3672-3676, 2011 (Released:2013-04-11)

参考文献数

2

著者

Masahiro Tahara Kazuhiro Yatera Kei Yamasaki Takeshi Orihashi Makoto Hirosawa Takaaki Ogoshi Shingo Noguchi Chinatsu Nishida Hiroshi Ishimoto Akihito Yonezawa Junichi Tsukada Hiroshi Mukae

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.1787-1791, 2016-07-01 (Released:2016-07-01)

参考文献数

13

被引用文献数

8

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A 37-year-old woman was admitted to a hospital due to a prolonged fever and a rash on her legs. She had systemic lymphadenitis and a skin abscess on her left leg. Pathological findings of a left leg skin biopsy revealed abscess formation with granulomatous dermatitis, Mycobacterium abscessus complex was cultured from the resected left supraclavicular lymph node, and disseminated M. abscessus complex infection was diagnosed. She was treated with combination treatment with antimicrobials and percutaneous drainage, and her clinical findings improved. Four months later, she developed acute lymphocytic leukemia. Leukemia is a risk factor for disseminated M. abscessus complex infection, even before developing leukemia.

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.9, pp.1937-1943, 2015-09-10 (Released:2016-09-10)

参考文献数

10

被引用文献数

1

著者

Shigeo Godo Yoshitaro Yoshida 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.4, pp.455-459, 2017-02-15 (Released:2017-02-15)

参考文献数

21

被引用文献数

6

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Biguanides are a drug of choice for the treatment of type 2 diabetes mellitus. Although they can cause lactic acidosis in susceptible patients with predisposing risk factors, the incidence of lactic acidosis is reported to be very low when they are used properly. We herein present a case of biguanide-associated severe lactic acidosis complicated with thiamine deficiency that was provoked without predisposing factors for thiamine deficiency. Diabetic patients taking biguanide may be predisposed to thiamine deficiency, even when there is no evidence of risk factors, and the high-dose administration of thiamine may be essential in the treatment of this otherwise under-recognized disorder.

著者

Yoshikatsu Nakai Shun'ichi Noma Mitsuo Fukusima Ataru Taniguchi Satoshi Teramukai

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.14, pp.1853-1857, 2016-07-15 (Released:2016-07-15)

参考文献数

31

被引用文献数

15

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Objective To evaluate some risk factors for cardiovascular diseases in feeding and eating disorders, the degree of lipid abnormalities was investigated in a large Japanese cohort of different groups of feeding and eating disorders, according to the Japan Atherosclerosis Society Guidelines for the Prevention of Atherosclerotic Cardiovascular Diseases 2012 (JAS Guidelines 2012). Methods Participants in the current study included 732 women divided into four groups of feeding and eating disorders: anorexia nervosa, restricting type (AN-R); anorexia nervosa, binge-eating/purging type; bulimia nervosa (BN); and binge-eating disorder (BED). We measured the serum levels of total cholesterol, high-density-lipoprotein (HDL) cholesterol, and triglyceride in these participants. Low-density-lipoprotein (LDL) cholesterol and non-HDL cholesterol levels were also calculated. Results The concentrations of LDL cholesterol and non-HDL cholesterol were widely distributed in all groups. When the LDL cholesterol risk was defined as ≥120 mg/dL and the non-HDL cholesterol risk as ≥150 mg/dL, according to the JAS Guidelines 2012, the proportion of LDL cholesterol risk ranged from 29.6% (BN) to 38.6% (AN-R), and the proportion of non-HDL cholesterol risk ranged from 17.8% (BN) to 30.1% (BED). Conclusion The present findings suggest the existence of LDL cholesterol risk and non-HDL cholesterol risk in all groups of eating disorders. Given the chronicity of this condition, the development of elevated concentrations of LDL cholesterol and non-HDL cholesterol at an early age may increase the risk of cardiovascular diseases.

著者

Kenji Iwaku Fumiko Otuka Matsuo Taniyama

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.3, pp.335-339, 2017-02-01 (Released:2017-02-01)

参考文献数

28

被引用文献数

5

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The patient was 32-year-old man, who received olanzapine for schizophrenia and developed polyuria and thirst without drinking soft-drinks after 4 months. Five months after the initiation of treatment, he developed diabetic ketoacidosis (blood glucose: 490 mg/dL, HbA1c: 15.5%). He was diagnosed with type 1 diabetes (glutamic acid decarboxylase (GAD)-Ab: 5.6 U/mL, IA-2 Ab: 5.9 U/mL, fasting C-peptide: 0.12 ng/mL) and was put on intensive insulin therapy. At four months after the onset of 1A diabetes, he experienced a honeymoon phase that was sustained until the 40th month of treatment. We hypothesize that the administration of olanzapine to a patient with pre-type 1A diabetes induced marked hyperglycemia and accelerated the onset of type 1A diabetes.

著者

竹中 克斗 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.101, no.7, pp.1969-1976, 2012 (Released:2013-07-10)

参考文献数

10

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原発性骨髄線維症(PMF)は,造血幹細胞レベルで生じたJAK2遺伝子変異などの遺伝子異常により骨髄中で巨核球と顆粒球系細胞がクローナルに増殖する難治性疾患で,骨髄増殖性腫瘍に分類される.分化した異常クローン由来の巨核球や単球などからの増殖因子・サイトカインの産生によって骨髄間質細胞の増殖を来たし,骨髄の広範な線維化,骨硬化を生じる.その結果,無効造血や,末梢血での涙滴状赤血球の出現,白赤芽球症,髄外造血による巨脾などの特徴的な臨床症状を呈する.PMFは難治性で,平均生存期間が5年程度とされる.現時点では,PMFは,薬物療法による治癒は困難であり,同種造血幹細胞移植が唯一の根治的治療法である.移植非適応例では,造血のコントロール,合併症の予防,対症療法が主体であったが,2005年のJAK2V617F変異の発見以降,基本病態の解明が急速に進み,JAK2阻害薬などの分子標的薬の開発がすすめられている.

著者

藤田 拓男

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.79, no.9, pp.1125-1133, 1990-09-10 (Released:2008-06-12)

参考文献数

13

著者

Hirotaka Ebara Hideharu Hagiya Yuto Haruki Eisei Kondo Fumio Otsuka

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.137-142, 2017-01-15 (Released:2017-01-15)

参考文献数

31

被引用文献数

38

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Objective Stenotrophomonas maltophilia is an emerging nosocomial pathogen that causes fatal infections in critically ill or immunocompromised patients. S. maltophilia bacteremia (SMB) is a rare condition, and its clinical characteristics in Japanese settings are not well known. Methods The medical charts of patients with SMB were retrospectively reviewed at two medical facilities (Okayama University Hospital and Tsuyama Chuo Hospital) for seven years. The data were analyzed along with those previously reported from other Japanese facilities. Result A total of 181 patients (110 men and 71 women) were evaluated. The major underlying diseases included hematologic malignancy (36.5%), solid organ malignancy (25.4%), and neutropenia (31.5%). The recent use of carbapenem was seen in 56.9% of the cases in total, and more than one-third of the patients in our hospitals were treated with carbapenem at the onset of SMB. Of 28 (63.6%) of 44 cases treated for S. maltophilia, those who did not survive were more likely to have been treated with broad-spectrum antibiotics. A multivariate analysis revealed that a higher updated Charlson Comorbidity Index [odds ratio (95% confidence interval), 1.75 (1.11-2.75); p=0.015] and intubation [odds ratio (95% confidence interval), 12.6 (1.62-97.9); p=0.016] were associated with mortality in our cases. Pathogens were often resistant to ceftazidime but susceptible to minocycline, trimethoprim/sulfamethoxazole, and fluoroquinolones. The overall mortality rates within 30 and 90 days were 37.5% and 62.5%, respectively. Conclusion The clinical characteristics of SMB in Japanese cases were similar to those reported from other countries. Clinicians should be aware that breakthrough infection by S. maltophilia may occur during administration of carbapenem.

著者

Tomohiro Taniguchi Yuki Miyasako Hideyasu Hirosawa

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.24, pp.3689-3690, 2016-12-15 (Released:2016-12-15)