著者

猿田 享男

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.85, no.2, pp.285-291, 1996-02-10 (Released:2008-06-12)

参考文献数

20

---

ある一定濃度のインスリンの存在下で,正常に発揮されるインスリン効果がみられない状態がインスリン抵抗性である.当初は,肥満者やインスリン非依存性糖尿病患者等,ある特殊な病態にみられる変化と考えられていたが,最近になって,想像された以上に多くの疾患がこの病態に関与していることが明らかとなった.さらにインスリン抵抗性を基礎病変として,糖代謝異常のほか,高脂血症,高血圧,血液凝固系の異常等の諸変化をきたし,動脈硬化の進展から,脳・心血管系疾患の発症に密接に関与する病態として注目されるようになった.このような諸病態を総括する名称としてsyndrome X, deadly quartet,あるいは本稿のテーマとなっているインスリン抵抗性症侯群等が提唱されている.さらにこのような病態を呈するものでは,内臓に過剰な脂肪蓄積を呈することが多いことから,内臓脂肪症侯群なる概念も提唱されてきている.

著者

Po-Yu Tseng Der-Cherng Tarng Wu-Chang Yang Chih-Yu Yang

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.1589-1590, 2014 (Released:2014-07-15)

参考文献数

2

被引用文献数

4

著者

Kenichiro Yaita Kazuhiko Nakaharai Yukihiro Yoshimura Motoharu Hirano

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.1591-1592, 2014 (Released:2014-07-15)

参考文献数

2

被引用文献数

4

著者

天野 宏一

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.10, pp.2880-2885, 2012 (Released:2013-10-10)

参考文献数

11

---

RAの病態に関わる炎症性サイトカインや免疫担当細胞の細胞表面分子を標的としたモノクローナル抗体や,これら標的分子の受容体とIgGとの融合蛋白製剤が開発されてきた.これらの生物学的製剤は,RAの関節炎を著明に改善するだけでなく,骨破壊の進行も抑制する画期的薬剤である.しかし,結核やニューモシスチス肺炎などの日和見感染症,アレルギー反応などの有害事象があり,適応を考えた慎重な投与が望まれる.

著者

Ryutaro Tanizaki Jin Takasaki

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.13, pp.1457-1458, 2014 (Released:2014-07-01)

参考文献数

2

著者

Jun Matsuyama Kunihiro Tsuji Hisashi Doyama Fae Kim Yasuhito Takeda Yosuke Kito Renma Ito Hiroyoshi Nakanishi Tomoyuki Hayashi Yohei Waseda Shigetsugu Tsuji Kenichi Takemura Shinya Yamada Toshihide Okada Honin Kanaya

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.16, pp.2231-2234, 2012 (Released:2012-08-15)

参考文献数

18

被引用文献数

8 17

---

Severe hypomagnesemia is a serious clinical condition. Proton pump inhibitor (PPI) induced hypomagnesemia has been recognized since 2006. In March 2011 the U.S. Food and Drug Administration advised that long-term use of PPI can induce hypomagnesemia. We report the first Japanese case of hypomagnesemia associated with chronic use of PPIs in a 64-year-old man hospitalized for nausea, bilateral ankle arthritis, and tremor of the extremities who had convulsions 3 days after admission. Blood analysis showed severe hypomagnesemia. He had been taking rabeprazole (10 mg/day) for 5 years. After stopping rabeprazole and correcting the electrolytes imbalances, his symptoms improved without recurrence.

著者

Hidetomo MARUYOSHI Kensuke TOYAMA Sunao KOJIMA Hiroaki KAWANO Norihisa OGATA Shinzo MIYAMOTO Tomohiro SAKAMOTO Michihiro YOSHIMURA Hisao OGAWA

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.44, no.2, pp.124-128, 2005 (Released:2005-03-05)

参考文献数

22

被引用文献数

8 20

---

A 49-year-old woman complained of hearing loss and diminution of left radial arterial pulsation. She had been diagnosed with sudden deafness and treated with corticosteroids. Her audibility deteriorated again after the cessation of the therapy. Angiograms showed stenosis in the bilateral carotid arteries, the left vertebral artery, the left subclavian artery, and the pulmonary arteries. She was diagnosed with Takayasu’s arteritis. After steroid therapy was restarted, there were improvements in her audibility, radial arterial pulsation, and levels of inflammatory markers (erythrocyte sedimentation rate, C-reactive protein, and gamma-globulin), fibrinogen, interleukin-6, and RANTES (regulated on activation, normal T cell expressed and secreted).

著者

Hiroaki Kikuchi Makoto Aoyagi Kiyotaka Nagahama Yu Yajima Chisato Yamamura Yohei Arai Suguru Hirasawa Shota Aki Naoto Inaba Hiroyuki Tanaka Teiichi Tamura

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.11, pp.1131-1135, 2014 (Released:2014-06-01)

参考文献数

14

被引用文献数

3 11

---

A 76-year-old woman with a history of lumbar fracture and marked proteinuria, bilateral pitting edema, malaise and pruritus was referred for an evaluation of an impaired renal function. A renal biopsy led to a tentative diagnosis of acute interstitial nephritis (AIN) with minimal change disease caused by nonsteroidal anti-inflammatory drugs (NSAIDs). Following the discontinuation of oral NSAIDs, the patient's symptoms disappeared spontaneously. However, nephrotic-range proteinuria relapsed one month after discharge, following loxoprofen patch use. The withdrawal of the topical loxoprofen patches once again resulted in the disappearance of all symptoms. This is the first case report of nephrotic-range proteinuria and AIN secondary to topical NSAID patch use.

著者

Tomonori Ozeki Naotaka Ogasawara Shinya Izawa Mari Mizuno Kenichiro Yanamoto Hisatsugu Noda Noriko Okaniwa Atsushi Tanabe Makoto Sasaki Kunio Kasugai

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.11, pp.1183-1187, 2013 (Released:2013-06-01)

参考文献数

15

被引用文献数

4 10

---

A 63-year-old woman was admitted with symptoms of watery diarrhea and generalized edema lasting for five months. She had been administered 15 mg/day of lansoprazole. Laboratory findings revealed severe hypoproteinemia with normal liver, renal, thyroid and adrenal functions and no proteinuria. Colonoscopy revealed edematous mucosa, minor diminished vascular transparency and apparent longitudinal linear lacerations. The histopathological findings were compatible with a diagnosis of collagenous colitis (CC). Protein leakage from the colon was identified on 99mTc-human serum albumin scintigraphy. The results indicated CC associated with protein-losing enteropathy. Discontinuing lansoprazole ameliorated the watery diarrhea and generalized edema, increased the serum albumin level and improved the hypoproteinemia.

著者

Kensuke Nakamura Ryota Inokuchi Kent Doi Tatsuma Fukuda Kurato Tokunaga Susumu Nakajima Eisei Noiri Naoki Yahagi

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.10, pp.1071-1073, 2014 (Released:2014-05-15)

参考文献数

20

被引用文献数

3 10

---

Various unmeasured anions other than lactate appear in the blood of septic patients, including ketones. However, the occurrence of sepsis-induced ketoacidosis without diabetes mellitus has not been reported to date. We herein describe severe ketoacidosis in a patient with septic shock despite the absence of diabetes, alcohol and starvation. A 76-year-old woman presented with septic shock due to acute obstructive cholangitis. She exhibited ketoacidosis and a remarkably strong ion gap, except for ketones. Sepsis alone may lead to ketoacidosis in patients without diabetes under specific conditions. The accumulation of ketones and other strong anions can occur in cases involving a decreased metabolic function. There may be a pathological condition called septic ketoacidosis.

著者

Yuji Yamada Yoshitaka Miyakawa Mitsuaki Sawano Yutaka Okano

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.10, pp.1083-1085, 2014 (Released:2014-05-15)

参考文献数

15

被引用文献数

2 10

---

Acquired coagulation factor deficiency is a rare disorder that occurs in patients with drug reactions, malignancy and collagen diseases as well as during pregnancy. Most cases are caused by factor VIII inhibitors. We herein describe the case of a 61-year-old Japanese man with acquired factor V inhibitor who developed symptoms 11 days after lung surgery for empyema. The patient required mechanical ventilation to treat acute respiratory failure due to severe pulmonary hemorrhage. He responded poorly to steroid pulse therapy; however, treatment with rituximab was successful.

著者

Yusuke Nakade Masaki Fujimura Noriyuki Ohkura Masako Nakata Yuko Nanbu Hiroyasu Oe Hiroshi Horita Yoshio Sakai Takashi 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.52, no.18, pp.2017-2023, 2013 (Released:2013-09-15)

参考文献数

17

被引用文献数

1 4

---

Objective Partial expiratory flow-volume curves have the potential to detect mild bronchoconstriction because they are not affected by the modulatory effects of deep inspiration. The aim of this study was to investigate the relationship between the efficacy of bronchodilator therapy (BDT) in treating the cough and to assess the increase in the expiratory flow of the partial flow-volume curve at 40% above the residual volume level (PEF40) caused by treatment with a short-acting beta-2 agonist (SABA) in patients with chronic nonproductive cough. Methods We measured the reversibility of PEF40 caused by a SABA in 42 patients with chronic nonproductive cough at visit 1 (day 0). The patients received BDT for six days. The visual analogue scale (VAS) was used to assess the efficacy of BDT in treating coughing at visit 2 (day 7) (0 mm, 'no cough;' 100 mm, 'no change in coughing'). Results Reversibility of the PEF40 was correlated (r=0.690, p<0.001) with the VAS score determined at visit 2 and was higher in the patients with cough variant asthma (CVA) (44.9±18.3%) than in those with atopic cough (13.4±10.4%) (p<0.01). Conclusion Reversibility of the PEF40 predicted the efficacy of BDT in patients with chronic nonproductive cough and helped to identify patients with CVA.

著者

岡崎 亮

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.4, pp.742-747, 2007 (Released:2012-08-02)

参考文献数

11

被引用文献数

5 7

---

ビタミンD充足度の最良の指標は血中25(OH)D濃度である.現在,基準値は,概ね10~70ng/mlである.通常,25(OH)D濃度が基準値以下の場合を,ビタミンD欠乏症とし,くる病・骨軟化症の原因となる病態である.近年,血中25(OH)D濃度が基準値範囲内でも低値傾向を示す場合,高率に副甲状腺ホルモン分泌の亢進,骨代謝回転の増加,転倒頻度の増加などがもたらされることが明らかになった.このような状態を,ビタミンD不足と呼ぶ.我々は,少なくとも血中25(OH)D濃度が,25ng/ml以上なければ,ビタミンD充足状態とは言えないと考えている.ビタミンD不足を回避するためには,日光曝露が重要だが,それが困難な場合には,現行のビタミンD摂取基準量(200 単位/日)では不十分であり,少なくとも400 単位/日の摂取が望まれる.

著者

福井 次矢 森實 敏夫 佐藤 温 松村 真司 水野 篤

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.12, pp.3054-3069, 2010 (Released:2013-04-10)

著者

Masamitsu Yaguchi Hisa Yaguchi

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.16, pp.1833-1833, 2010 (Released:2010-08-13)

参考文献数

2

被引用文献数

2 4

著者

佐藤 俊 渡邉 香奈 石田 卓 吉川 素子 金沢 賢也 斎藤 純平 大塚 義紀 棟方 充 鈴木 均 丸山 幸夫

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.95, no.2, pp.356-358, 2006-02-10 (Released:2009-03-27)

参考文献数

7

被引用文献数

1 2

---

症例は47歳, 男性. 拡張型心筋症による発作性心房粗動に対しアミオダロンの投与を開始, 2年後に胸部X線写真にて異常陰影が出現. 肺胞洗浄, 肺生検所見などから総合的にアミオダロンによる薬剤性肺炎と診断した. 短期間のステロイド治療が奏功し, 現在まで再燃は認めない. 本症では肺胞洗浄液にて好酸球の著増を認め, 細胞毒性による肺障害と免疫学的機序を背景とした好酸球性肺炎の併発が考えられた.

著者

Seiji Kishi Satoshi Yamada Fumi Kishi Eriko Shibata Motokazu Matsuura Kojiro Nagai Akira Mima Hideharu Abe Toshio Doi

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.16, pp.2197-2201, 2012 (Released:2012-08-15)

参考文献数

37

被引用文献数

5 5

---

The prevalence of postinfectious glomerulonephritis has decreased in most developed countries. We report the case of a previously healthy, immunocompetent 65-year-old woman who developed acute glomerulonephritis associated with human parvovirus B19 infection. She was referred by her primary care physician for suspected congestive heart failure but she had an elevated creatinine level and an abnormal urinalysis. Renal biopsy showed diffuse endocapillary proliferative glomerulonephritis. After biopsy, we learned that she had been in frequent contact with her grandson who had been diagnosed with erythema infectiosum. Her human parvovirus B19 serum IgM titer was elevated at 3.50, indicating current infection.

著者

Shoichi Fukui Yasunobu Takizawa Naoko Kubota Tomomi Okamoto Tsunekazu Hishima

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.805-808, 2014 (Released:2014-04-01)

参考文献数

25

被引用文献数

1 5

---

A 48-year-old man visited our hospital complaining of a tender mass in the left side of the neck. He was diagnosed with tuberculous lymphadenitis based on the results of a biopsy. Shortly after the diagnosis, oral aphthae, erythema nodosum-like lesions on the lower legs and genital ulcers developed. A diagnosis of cutaneous tuberculosis was ruled out according to a negative mycobacterial culture of tissues obtained from stained smears and lesional biopsy specimens. The patient's symptoms remitted following the introduction of antituberculous therapy. We assume that tuberculous lymphadenitis was strongly associated with the appearance of Behçet's disease-like symptoms in this case.

著者

赤水 尚史

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.102, no.3, pp.618-623, 2013 (Released:2014-03-10)

参考文献数

4

著者

Po-Yu Liu Chin-Fu Lin Kwong-Chung Tung Ching-Lin Shyu Ming-Ju Wu Jai-Wen Liu Chi-Sen Chang Kun-Wei Chan Jin-An Huang Zhi-Yuan Shi

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.4, pp.431-438, 2013 (Released:2013-02-15)

参考文献数

50

被引用文献数

6 43

---

Objective Shewanella bacteremia is an uncommon but potentially fatal disease. Although hepatobiliary diseases have been proposed to be risk factors for various Shewanella infections, little is known about the features of Shewanella bacteremia in patients with hepatobiliary diseases. This study aims to characterize the presentation and risk factors of Shewanella bacteremia in patients with hepatobiliary diseases. Methods We retrospectively investigated the clinical features, microbiology and outcomes of patients with Shewanella bacteremia who were admitted to a tertiary medical center between January 2001 and December 2010. All isolates were confirmed to the species level using 16S rRNA sequencing analyses. The English language medical literature was searched for previously published reports. Results Fifty-nine cases of Shewanella bacteremia, including nine at the hospital, were identified, 28 (47.4%) of which involved underlying hepatobiliary diseases, representing an important risk factor. In 12 of the 28 cases, the infections involved the hepatobiliary system; with a tendency towards an Asian origin. In our case series of nine patients, Shewanella haliotis was isolated in five patients. The majority of our patients lived in coastal areas, consumed seafood regularly and developed bacteremia during the summer season. Conclusion It is recommended that the possibility for Shewanella infection be considered in patients with bacteremia and also underlying hepatobiliary diseases, particularly if patients present with hepatobiliary infections, a history of seafood, or development of the disease during the summer.