著者

佐藤 一也 鳥本 悦宏 高後 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.97, no.7, pp.1611-1619, 2008 (Released:2012-08-02)

参考文献数

10

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末梢性T細胞リンパ腫は,リンパ腫の約10%を占める不均一な疾患単位の非Hodgkin T細胞性リンパ腫であり,病因も不明な点が多い.標準的治療法が未確立で,初回治療としてはCHOP療法等が選択されるが,治療効果は不十分で予後不良である.自家,同種造血幹細胞移植も行われるが有用性は明らかではない.生命予後の改善のためには,今後モノクローナル抗体等の新規治療法との併用治療も含めて,標準的治療法の確立が望まれる.

著者

Hiroshi Ureshino Toshihiko Ando Kensuke Kojima Hidekazu Itamura Shunichi Jinnai Kazuko Doi Koichi Ohshima Kazuya Kurogi Masaharu Miyahara Shinya Kimura

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.24, pp.3205-3208, 2015 (Released:2015-12-15)

参考文献数

25

被引用文献数

1 12

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Rituximab treatment may cause or exacerbate Kaposi's sarcoma (KS) in patients with human immunodeficiency virus (HIV)-associated multicentric Castleman's disease. Despite the widespread use of rituximab, rituximab-induced KS has not yet been reported in HIV-negative patients with diffuse large B cell lymphoma (DLBCL). We herein report a case of KS that developed after undergoing rituximab-containing chemotherapy in an HIV-negative patient with DLBCL. An 84-year-old man who received rituximab-containing chemotherapy for the treatment of DLBCL developed severe infection, and subsequently KS. Our observations indicate that serious infections under rituximab treatment may trigger KS. KS should therefore be considered when skin tumors appear in lymphoma patients receiving rituximab-containing chemotherapy.

著者

Yuichi Makino Chikayoshi Tani Naoyuki Miyokawa Ryota Yoshimoto Katsutoshi Mizumoto Kohei Eguchi Daisuke Fujishiro Satoru Kodama Atsushi Kobayashi Keiji Komura Kensaku Okamoto Hiroyuki Furukawa Masakazu Haneda

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.22, pp.2851-2855, 2015 (Released:2015-11-15)

参考文献数

16

被引用文献数

1 4

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A 47-year-old woman with a 2-year history of rheumatoid arthritis (RA) undergoing methotrexate treatment developed a perforated ulcer in the ileum for which she underwent emergency surgery. A histological analysis of the extirpated specimen presented a possible Epstein-Barr virus (EBV) infection in the ulcerative lesion without a feature of lymphoproliferative disorder. Interestingly, the patient's serological tests with a paired serum diagnosed a primary EBV infection. The present case emphasizes the importance of being aware of severe enteritis as a possibility for patients with RA, for an accurate diagnosis.

著者

吉田 富美菜 大楠 泰生 和田 篤 廣江 吉隆 矢野 英人 宮崎 敬大 石川 博之 中村 雅 望月 孝俊

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.2804-2806, 2014-11-10 (Released:2015-11-10)

参考文献数

4

被引用文献数

3

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症例は81歳,男性.低血糖を伴う一過性意識消失で救急搬送.血糖降下剤の内服なく,誘因として発作性心房細動に対し内服していたシベンゾリンコハク酸塩が疑われ,同剤を中止の上入院.第2病日に突然意識消失し,心電図モニター上Torsade de Pointes(TdP)を認めた.QT延長を認め,シベンゾリンによる副作用を疑ったが,同剤中止後も改善なし.コハク酸ソリフェナシン内服中止したところ改善.経過より同剤内服によるQT延長と推測された.

著者

Hideharu Hagiya Hiroko Ogawa Yusuke Takahashi Kosuke Kimura Kan Hasegawa 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.54, no.21, pp.2775-2777, 2015 (Released:2015-11-01)

参考文献数

13

被引用文献数

7

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We herein present a rare case of Actinomyces turicensis bacteremia that was caused by pyometra. The patient was successfully treated with transvaginal drainage and antibiotic therapy. A literature review in MEDLINE showed that there have been only 8 previously reported cases of A. turicensis bacteremia. This infection frequently occurs in patients with visceral abscesses, and blood culture examinations usually reveal a polymicrobial pattern. However, the prognosis of such patients has been reported to generally be benign. Due to difficulties in performing bacterial identification and the wide-spectrum clinical pictures associated with this bacteremia, no comprehensive understanding of the clinical features of each Actinomyces species has yet been established.

著者

田尻 久雄 丹羽 寛文

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.81, no.5, pp.617-621, 1992-05-10 (Released:2008-06-12)

参考文献数

5

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胃ポリープのなかで最も多く代表的なものは過形成性ポリープであり,内視鏡的ポリペクトミーの成績では83%を占める.そのなかで局在癌の頻度は3%であった.一方,胃腺腫の場合は発生頻度が低いものの,腺腫内の癌共存率が10%と高率にみられた.胃集検の意義は,無症状の有所見群を拾い上げることにあり,内視鏡による精密検査によってはじめて微細な変化を確診し得る.今後は,内視鏡胃集検がより普及していくことが望まれる.

著者

Woo Hyun Cho Hye Ju Yeo Seong Hoon Yoon SeungEun Lee Doo SooJeon Yun Seong Kim Ki Uk Kim Kwangha Lee Hye Kyung Park Min Ki Lee

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.18, pp.2307-2313, 2015 (Released:2015-09-15)

参考文献数

31

被引用文献数

2 17

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Objective High-flow nasal cannula (HFNC) therapy is an oxygen delivery system. However, evidence regarding the clinical applications of HFNC is still emerging. We herein evaluated the clinical predictors of HFNC therapy success for adult patients with acute hypoxemic respiratory failure. Methods We retrospectively reviewed the medical records of the subjects with acute hypoxemic respiratory failure supported by HFNC therapy in the medical intensive care unit between July 2011 and March 2013. Therapy success was defined as the avoidance of intubation. The patients' baseline characteristics and the serial changes in the respiratory parameters after HFNC therapy at 1 and 24 hours were measured. Results Of the 75 eligible patients, 62.7% successfully avoided intubation. Overall, HFNC therapy significantly improved the physiologic parameters, such as partial pressure of arterial oxygen (PaO2), saturation of arterial oxygen (SaO2), respiratory rate (RR), and heart rate (HR), throughout the first 24 hours. After the adjustment for the other clinical variables, Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), cardiogenic pulmonary edema, and PaO2 improvement at 1 and 24 hours were associated with therapy success. The overall intensive care unit (ICU) mortality was 25.3%. However, out of 37.3% of the patients who required intubation, the ICU mortality in this proportion of patients was 67.9%. The ICU mortality in the therapy failure group was associated with the use of a vasopressor and a limited PaO2 improvement at 1 hour. Conclusion HFNC therapy showed a good compliance and the improvement of the physiologic parameters in an adult population. The failure to improve oxygenation within 24 hours was a useful predictor of intubation. Among the failure group, the vasopressor use and failed oxygenation improvement were associated with ICU mortality.

著者

Nobuyuki Horita Naoki Miyazawa Takashi Yoshiyama Ryota Kojima Yoshiaki Ishigatsubo Takeshi 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.54, no.18, pp.2315-2320, 2015 (Released:2015-09-15)

参考文献数

20

被引用文献数

5

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Objective In the 1950s, a high-dose (40-70 mg/kg/day) of pyrazinamide (PZA), was reported to cause drug-induced liver injury (DILI) at an unacceptable frequency. It remains unclear whether adding PZA (Z) at the currently accepted low-dose (20-25 mg/kg/day) for two months to a regimen of isoniazid (H) + rifampicin (R) + ethambutol (E) actually increases the risk of DILI. Method Smear-positive tuberculosis patients were treated with daily HRE or HRZE regimen under direct observation. We used three independent models. Model 1 was analyzed with a multivariate Cox-analysis using a pre-matched cohort. Next, propensity score matching was conducted using the nearest neighbor method with caliper of 0.03. Models 2 and 3 were analyzed by univariate and multivariate Cox-analyses, respectively, with the matched cohort. DILI was assessed based on the guidelines of the American Thoracic Society. Results We reviewed the records of 383 patents (male, n=260; female n=123; mean age, 64±20 years). Among these patients, 75 patients were treated with HRE and 308 were treated with HRZE. DILI occurred in the first two months in 24% (18/75) and 8% (24/308) of the HRE-treated and HRZE-treated cases, respectively. In all three of the models, DILI was less frequent in patients treated with the HRZE regimen: Model 1, HR of 0.30 (95% confidence interval (CI) 0.14-0.68, p=0.004); Model 2, HR of 0.37 (95%CI 0.14-0.96, p=0.041); and Model 3, HR of 0.34 (95%CI 0.12-0.94, p=0.038). Conclusion The addition of the currently accepted low dose (20-25 mg/kg/day) of PZA to the HRE regimen did not increase the incidence of DILI during the first two months of treatment.

著者

Shintaro Sagami Yoshitaka Ueno Shinji Tanaka Kenta Nagai Ryohei Hayashi Kazuaki Chayama

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.17, pp.2167-2172, 2015 (Released:2015-09-01)

参考文献数

21

被引用文献数

11

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A 52-year-old woman with ulcerative colitis was admitted to our hospital for an ulcerative colitis flare-up under salazosulfapyridine therapy. The symptoms improved with high-dose corticosteroids. After prednisolone was tapered to 10 mg, the frequency of diarrhea increased. The diarrhea was accompanied by joint pain and a skin ulcer with abscess formation, which was diagnosed to be pyoderma gangrenosum. The patient was started on adalimumab. A positive response to the adalimumab therapy was observed after 2 weeks, during which time the ulcerative skin lesion healed completely, however, colonic mucosal healing was achieved at 2 months. Therefore, adalimumab appears to be an effective therapeutic option for patients with ulcerative colitis-associated pyoderma gangrenosum.

著者

Takaaki Ishiyama Toshinori 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.54, no.16, pp.1959-1960, 2015 (Released:2015-08-15)

参考文献数

7

著者

Toshio Naito Keito Torikai Masafumi Mizooka Fujiko Mitsumoto Kenji Kanazawa Shiro Ohno Hiroyuki Morita Akira Ukimura Nobuhiko Mishima Fumio Otsuka Yoshio Ohyama Noriko Nara Kazunari Murakami Kouichi Mashiba Kenichiro Akazawa Koji Yamamoto Mika Tanei Masashi Yamanouchi Shoichi Senda Susumu Tazuma Jun Hayashi

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.16, pp.1989-1994, 2015 (Released:2015-08-15)

参考文献数

26

被引用文献数

7 8

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Objective Although inflammatory markers, such as the white blood cell (WBC) count, erythrocyte sedimentation rate (ESR) and levels of C-reactive protein (CRP) and procalcitonin, are widely used to differentiate causes of fever of unknown origin (FUO), little is known about the usefulness of this approach. We evaluated relationships between the causes of classical FUO and the levels of inflammatory markers. Methods A nationwide retrospective study including 17 hospitals affiliated with the Japanese Society of Hospital General Medicine was conducted. Patients This study included 121 patients ≥18 years old diagnosed with "classical FUO" (axillary temperature ≥38.0°C at least twice over a ≥3-week period without elucidation of the cause on three outpatient visits or during three days of hospitalization) between January and December 2011. Results The causative disease was infectious diseases in 28 patients (23.1%), non-infectious inflammatory disease (NIID) in 37 patients (30.6%), malignancy in 13 patients (10.7%), other in 15 patients (12.4%) and unknown in 28 patients (23.1%). The rate of malignancy was significantly higher for a WBC count of <4,000 /μL than for a WBC count of 4,000-8,000 /μL (p=0.015). Among the patients with a higher WBC count, the rate of FUO due to NIID tended to be higher and the number of unknown cases tended to be lower. All FUO patients with malignancy showed an ESR of >40 mm/h. A normal ESR appeared to constitute powerful evidence for excluding a diagnosis of malignancy. In contrast, the concentrations of both serum CRP and procalcitonin appeared to be unrelated to the causative disease. Conclusion The present study identified inflammatory markers that should be considered in the differential diagnosis of classical FUO, providing useful information for future diagnosis.

著者

三宅 一徳

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.94, no.12, pp.2467-2472, 2005-12-10 (Released:2008-06-12)

参考文献数

6

被引用文献数

1 1

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臨床検査値の判別指標としては,基準値(基準範囲)とカットオフ値(病態識別値)という2種の数値が提供されている.基準値は健康な集団における検査値変動(生理的変動)に設定根拠を置く.近年,生理的変動を解析する手法の理論的整備が進み,各検査項目の基準範囲が病態判定上どのような意義を有するかを明確化できるようになった.また,近年では診療ガイドラインなどで基準値とは別に病態識別値が設定される項目も多くなってきている.

著者

Shojiro Minomo Kazunobu Tachibana Kazunari Tsuyuguchi Masanori Akira Masanori Kitaichi Katsuhiro Suzuki

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.5, pp.491-495, 2015 (Released:2015-03-01)

参考文献数

10

被引用文献数

2

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Summer-type hypersensitivity pneumonitis includes a spectrum of granulomatous lung diseases that result from the inhalation of Trichosporon species in the summer. Hot tub lung is a granulomatous lung disease caused by the inhalation of water aerosols containing non-tuberculous mycobacteria. We herein describe a case of hot tub lung that deteriorated during the winter season. Every winter, the patient's symptoms, laboratory findings and chest images worsened. Genetically identical Mycobacterium avium strains were detected in his sputum and bathtub. The circulation of bathtub water during the winter months only exacerbated his symptoms in the winter.

著者

古賀 道明 神田 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.102, no.8, pp.1958-1964, 2013-08-10 (Released:2014-08-10)

参考文献数

12

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脳炎の代表格であるヘルペス脳炎は,脳炎の一般的な特徴(発熱や髄膜刺激徴候,脳脊髄液異常)に加え,辺縁系脳炎としての臨床像(記憶障害や精神症状,大脳辺縁系にみられるCT・MRI病変分布)が特徴的である.本症を疑った時点でアシクロビル投与を開始するが,同時に他の辺縁系脳炎(HHV-6脳炎や自己抗体介在性脳炎)の可能性を想定しておくべきである.プリオン病はいまだに有効な治療法はなく感染予防が重要で,厚生労働省研究班の感染予防ガイドラインに基づき診療することが推奨される.

著者

加地 正英 庄司 紘史

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.85, no.5, pp.693-698, 1996-05-10 (Released:2008-06-12)

参考文献数

7

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最も代表的な日本脳炎は近年本邦での患者は数人の発生を認めるのみとなったが,単純ヘルペス脳炎ではMRIやPCR法などにより,早期に診断が可能となり年間300~400例前後の発症を認め,また多彩な臨床病型が認められる様になってきた.その他国際交流の活発化に伴いHIV感染症の増加が懸念され, HIV脳症,非定型的無菌性髓膜炎等の神経障害が問題となってきている.本稿ではこれらの代表的神経系感染症の疫学についてのべた.

著者

Akemi Okui Yoshihiko Soga Susumu Kokeguchi Motoko Nose Reiko Yamanaka Nobuchika Kusano Manabu Morita

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.14, pp.1809-1814, 2015 (Released:2015-07-15)

参考文献数

21

被引用文献数

1 5

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The detection of infective endocarditis (IE) of oral origin has been previously discussed. However, there are few reports confirming this infection using molecular biological techniques. We herein describe the case of a 67-year-old man who developed IE. Blood culture samples and strains obtained from the gingival and buccal mucosa showed 100% identity to Enterococcus faecalis JCM 5803 on sequencing of 16S rRNA gene fragments. A random amplification of polymorphic DNA (RAPD) analysis showed the same pattern for these samples, thus confirming the identity of E. faecalis isolates in the blood and oral mucosa. Our observations provide novel information regarding the level of identity between IE pathogens and oral bacteria.

著者

Morihiko Oya Takao Tanimoto Takayuki Yamamoto Yukiya Hakozaki

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.14, pp.1803-1808, 2015 (Released:2015-07-15)

参考文献数

30

被引用文献数

8

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A 33-year-old previously healthy man injured his gums and subsequently developed dyspnea and fever. A chest X-ray showed nodules and infiltrates in both lungs, and the patient was initially diagnosed with pneumonia and administered meropenem hydrate, although his symptoms did not improve. A blood culture identified Fusobacterium necrophorum, and thrombophlebitis in the internal jugular vein of the neck was observed on computed tomography and ultrasound scans. We replaced the meropenem with clindamycin, sulbactam/ampicillin and metronidazole, and the patient's symptoms improved.

著者

Norihiko Ohashi Takenori Okada Mio Uchida Michitaka Amioka Mai Fujiwara Shunichi Kaseda

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.14, pp.1761-1763, 2015 (Released:2015-07-15)

参考文献数

10

被引用文献数

17

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Left ventricular thrombus (LVT) after acute myocardial infarction (AMI) is a risk factor for embolic complications. Although warfarin has traditionally been used to treat LVT, it has relevant disadvantages that limit its use. We herein describe the case of a 78-year-old man with AMI who had a history of paroxysmal atrial fibrillation. Following 10 days of urgent coronary reperfusion therapy, transthoracic echocardiography revealed a moderately sized LVT in the apex, which subsequently disappeared after 18 days of treatment with dabigatran. This case demonstrates that dabigatran may represent an alternative to warfarin as a therapeutic option in patients with LVT after AMI.

著者

楠本 茂 田中 靖人

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.7, pp.1645-1653, 2014-07-10 (Released:2015-07-10)

参考文献数

10

被引用文献数

1 2

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免疫抑制療法後のB型肝炎ウイルス(HBV)再活性化は,ときに致死的となる合併症であり,その対策のポイントはあらかじめリスク評価(スクリーニング検査)を行うことである.再活性化リスクに応じて,抗ウイルス薬の予防投与あるいはHBV-DNAモニタリングによるpreemptive therapyを行うことで,劇症肝炎予防が期待できる.C型肝炎ウイルス再活性化による劇症肝炎はまれであるが,肝硬変,肝がんについて長期フォローアップが重要である.

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.3, pp.745-764, 2013 (Released:2014-03-10)