著者

Hideharu Hagiya Maya Kimura Toru Miyamoto Yuto Haruki 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.53, no.5, pp.511-514, 2014 (Released:2014-03-01)

参考文献数

11

被引用文献数

2 7

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Acute generalized exanthematous pustulosis (AGEP) is a self-limiting type of drug eruption that frequently occurs as a reaction to antibiotics, particularly penicillins or macrolides. Daptomycin (DAP) is a newly developed antibiotic that specifically targets methicillin-resistant Staphylococcus aureus infection. We herein present the case of a 77-year-old severe burn victim who was diagnosed with DAP-induced AGEP while receiving treatment in an intensive care unit. Although rare, physicians should be aware that the administration of DAP can cause AGEP, which may complicate the clinical course of patients with a high fever and inflammation.

著者

長谷川 大 南須原 康行 真木 健裕 三浦 巧 別役 智子 檜澤 伸之 西村 正治 小野塚 久夫 筒井 裕之

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.7, pp.1362-1364, 2006-07-10 (Released:2009-03-27)

参考文献数

7

被引用文献数

2

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症例は70歳男性. 発作性心房細動に対し, コハク酸シベンゾリン (シベノール®) の服用を開始したところ, 15日目ごろより労作時呼吸困難を自覚し, 25日目に胸部異常陰影を指摘された. 抗生剤投与にて改善がみられないため, 我々はコハク酸シベンゾリンによる薬剤性肺炎も疑い, 同剤を中止した上でステロイド治療を施行した. 肺炎の改善を認めたが発作性心房細動が再発したため, 慎重な観察の下同剤を再開したところ肺炎の再増悪を認めた. 以上よりコハク酸シベンゾリンによる薬剤性肺炎と診断した.

著者

八尾 恒良

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.91, no.Supplement-Mar, pp.38-42, 2002-03-20 (Released:2008-08-14)

参考文献数

5

著者

Asami Nimura Nobuyuki Sato Hitoshi Sakuragi Satoshi Koyama Junichi Maruyama Ahmed Karim Talib Naoki Nakagawa Naka Sakamoto Hisanobu Ota Yasuko Tanabe Toshiharu Takeuchi Yuichiro Kawamura Naoyuki Hasebe

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.50, no.18, pp.1957-1961, 2011 (Released:2011-09-15)

参考文献数

14

被引用文献数

5

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We describe a case of advanced atrioventricular (AV) block, in which treatment with cilostazol was effective in recovering the AV conduction. The patient was referred to our hospital for close examination of the advanced AV block and permanent pacemaker implantation. Although the patient had experienced third-degree AV block with occasional AV synchrony for more than two days, the AV conduction completely recovered after treatment with oral cilostazol at 200 mg/day. Here we discuss the possible mechanism of the improvement in the AV conduction by cilostazol.

著者

高須 信行

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.6, pp.1075-1079, 1998-06-10 (Released:2008-06-12)

参考文献数

2

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甲状腺クリーゼは甲状腺機能亢進症が極端に増悪し,生命の危機に直面した状態である.甲状腺機能亢進症の患者に,急激に,高熱,頻脈,流れるような汗,下痢,精神不安がでてきたものを甲状腺クリーゼという.やがて意識がなくなる.手術,感染,糖尿病性昏睡などが誘因となる.早期に診断し,治療することが大切である.適切な治療が行なわれないと死に至る.治療は循環系を中心にした全身管理と急速に甲状腺ホルモン産生・分泌を抑制することである.甲状腺ホルモンを下げるためにヨードを投与する.

著者

Kensaku Aihara Tomohiro Handa Sonoko Nagai Kiminobu Tanizawa Kizuku Watanabe Yuka Harada Yuichi Chihara Takefumi Hitomi Toru Oga Tomomasa Tsuboi Kazuo Chin Michiaki Mishima

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.50, no.11, pp.1157-1162, 2011 (Released:2011-06-01)

参考文献数

32

被引用文献数

8 37

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Objective We identified the prognostic relevance of pneumothorax in interstitial lung disease (ILD) patients and evaluated the efficacy and safety of autologous blood-patch pleurodesis. Methods We retrospectively reviewed 59 occurrences of pneumothorax in 34 ILD patients identified over a 12-year period. Results Air leakage ceased in 16 of 22 (72.7%) episodes after blood pleurodesis and in 11 of 14 (78.6%) episodes after chemical pleurodesis. Both the cure ratio and recurrence ratio in the cure episodes were comparable with those in the chemical pleurodesis group (p=0.99 and 0.99, respectively). In addition, there were no harmful events associated with blood pleurodesis. The median survival time after the first episode of pneumothorax was less than 9 months in patients with idiopathic interstitial pneumonia (IIP) and only around 3 years in the patients with other types of ILD, which have essentially favorable outcomes. Kaplan-Meier survival estimates were significantly worse in the patients with concomitant pneumomediastinum than in those without (p<0.05). A multivariate Cox regression analysis identified that the number of episodes of pneumothorax, IIP diagnosis and concomitant pneumomediastinum were independent predictors of death. Conclusion Autologous blood-patch pleurodesis is safe and worth considering as a first-line treatment for pneumothorax secondary to ILD. However, despite treatments, the prognosis after the onset of pneumothorax in ILD patients was found to be poor. In addition, concomitant pneumomediastinum may further worsen the prognosis.

著者

Norihiro Nagamura Sayaka Ueno Hirofumi Fujishiro Hideyuki Oonuma

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.145-149, 2014 (Released:2014-01-15)

参考文献数

28

被引用文献数

3 12

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A 52-year-old woman presented to our hospital due to elevated liver enzyme levels and hypereosinophilia. Liver biopsy specimens revealed chronic hepatitis with abundant eosinophils and immunoglobulin G4(IgG4)-positive plasma cell infiltration. Systemic lymphadenopathy, including that involving the hepatic hilar lymph nodes, was observed on computed tomography, and the cervical lymph node biopsy specimens exhibited lymphoid follicular hyperplasia and IgG4-positive plasma cell infiltration. It is sometimes difficult to distinguish hypereosinophilic syndrome (HES) from IgG4-related disease, as some of the clinical findings overlap. The numerous areas of eosinophilic infiltration observed in the liver indicated a diagnosis of HES in our case.

著者

Toru Hashimoto Kimika Arakawa Yuko Ohta Takaichi Suehiro Noriko Uesugi Masaru Nakayama Takuya Tsuchihashi

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.46, no.5, pp.241-245, 2007 (Released:2007-03-01)

参考文献数

22

被引用文献数

5 10

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A 60-year-old woman was admitted because of multiple bone pain. Examination revealed hypophosphatemic osteomalacia and acquired Fanconi syndrome. Further exploration revealed monoclonal gammopathy of undetermined significance (MGUS) excreting urinary Bence Jones protein (kappa light chain). Renal biopsy showed non-specific tubulointerstitial nephritis, yet neither crystalline inclusions in the cytoplasm of the tubular epithelium nor myeloma casts nor amyloid deposits were found. She was treated with supplementation by phosphate, alkali agents, and vitamin D, and responded well to the treatment symptomatically and biochemically. MGUS was observed without chemotherapy. Myeloma had not developed after 10 months follow-up.

著者

Takumu Hasebe Koji Sawada Shunsuke Nakajima Shigeaki Maeda Masami Abe Yasuaki Suzuki Takaaki Ohtake Chitomi Hasebe Mikihiro Fujiya Yutaka Kohgo

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.1, pp.29-33, 2014 (Released:2014-01-01)

参考文献数

17

被引用文献数

1

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A 70-year-old Japanese man was hospitalized for expanding purpura and chronic disseminated intravascular coagulation (DIC) caused by decompensated liver cirrhosis. As there are no effective treatments for chronic DIC caused by liver cirrhosis, we decided to administer recombinant human soluble thrombomodulin (rhsTM) after he provided informed consent. The DIC was rapidly improved; however, the purpura and coagulopathy recurred after two months, and repeated rhsTM treatments were required. The rhsTM treatment sufficiently controlled the coagulopathy for two years, without any complications, including bleeding. This is the first report demonstrating that rhsTM can be administered safely and repeatedly to a patient with decompensated liver cirrhosis, and that it appears to be associated with a favorable outcome.

著者

Akira Sato Michio Sata Kenji Ikeda Takashi Kumada Namiki Izumi Yasuhiro Asahina Yukio Osaki Kazuaki Chayama Shuichi Kaneko Akito Sakai Morikazu Onji Yoichi Hiasa Takumi Omura Itaru Ozeki Osamu Yokosuka Shuichiro Shiina Mariko Itsubo Shuhei Nishiguchi Katsuharu Hirano Tatsuya Ide Shotaro Sakisaka Takahiro Yamasaki Isao Hidaka Masatoshi Tanaka Soo Ryang Kim Takafumi Ichida

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.24, pp.2701-2706, 2013 (Released:2013-12-15)

参考文献数

32

被引用文献数

4 14

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Objective We attempted to elucidate the clinical features of chronic hepatitis C patients who develop hepatocellular carcinoma (HCC) after achieving a sustained viral response (SVR) to interferon (IFN) therapy. Methods The clinical features of 130 patients at 19 hospitals who developed HCC after obtaining an SVR were retrospectively reviewed. Results Overall, 107 (82%) of the 130 patients were men, with 92 (71%) being ≥60 years of age and 76, 38 and 16 developing HCC within 5, 5-10 and 10-16.9 years after IFN therapy, respectively. Before receiving IFN therapy, 92 (71%) patients had cirrhosis and/or a low platelet count (<15×104 cells/μL). Lower albumin (<3.9 g/dL) and higher alpha fetoprotein (AFP) (≥10 ng/mL) levels were identified in a multivariate analysis to be independent variables of the development of HCC within five years after IFN therapy. Among 4,542 SVR patients, HCC occurred in 109 (2.4%) during a 5.5-year follow-up period, thus resulting in an occurrence rate of 4.6% for men and 0.6% for women. Conclusion SVR patients with lower albumin or higher AFP levels require careful assessments to prevent early HCC development after IFN therapy. HCC occurrence within >10 years of IFN therapy is not uncommon, and the risk factors remain uncertain, thus suggesting that all SVR patients should undergo long-term follow-up examinations for HCC development.

著者

新実 彰男

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.95, no.8, pp.1487-1492, 2006-08-10 (Released:2009-03-27)

参考文献数

10

被引用文献数

3 3

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咳喘息は咳のみを症状とする喘息の亜型で, 慢性咳嗽の主要な原因疾患である. 喘鳴を伴う典型的喘息と同様に気道の好酸球性炎症やリモデリングを伴う. 第一選択薬の吸入ステロイド療法により成人例の約30%にみられる典型的喘息への移行は減少する可能性がある. 近年提唱された類縁疾患であるアトピー咳嗽と非喘息性好酸球性気管支炎は, 同様に好酸球性気道炎症を特徴とするが, 気道過敏性がなく典型的喘息への移行が少ない点などが咳喘息と異なる.

著者

蓮沼 剛

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.4, pp.859-865, 2008 (Released:2012-08-02)

参考文献数

17

著者

清田 浩

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.11, pp.2238-2245, 2006-11-10 (Released:2009-03-27)

参考文献数

14

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尿路感染症は外尿道口からの起炎菌の上行性感染により起こる. 起炎菌の多くは大腸菌あるいはコアグラーゼ陰性ブドウ球菌であるが, これら以外が起炎菌であるときには尿路に基礎疾患をもつ複雑性尿路感染症を考慮する必要がある. 男性の尿道炎の主な起炎菌は淋菌とクラミジアであるが, 前者は薬剤耐性菌が多く, 注射用抗菌薬であるスペクチノマイシン, セフトリアキソンあるいはセフォジジムのみが有効である. クラミジアには薬剤耐性菌はないがアジスロマイシンのみが単回内服投与が可能である. 内科医診療の際の注意点を述べた.

著者

Serdal Ugurlu Erkan Caglar Tijen Erdem Yesim Eda Tanrikulu Gunay Can Pinar Kadioglu

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.47, no.4, pp.205-209, 2008 (Released:2008-02-15)

参考文献数

27

被引用文献数

3 8

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Objective To determine the characteristics of thyroid nodules by using fine needle aspiration (FNA) biopsy and ultrasonography. Patients and Methods FNAs of 1,004 patients with thyroid nodules between 2000 and 2007 were evaluated retrospectively. The surgical records of 101 of the patients were available and reviewed. The Odds ratios for nodule characteristics were calculated individually. Results The sensitivity of FNA was 66.7% and the specifity was 95.2%. Positive predictive value was 72.7% and negative predictive value was 93.7%. Our diagnostic accuracy was 90.5%. Solitary nodules, irregular margins and microcalcifications were associated with increased risk of malignancy with Odds ratios 3.61 (95% CI: 1.25-10.42; p= 0,017); 5.44 (95% CI: 1.76-16.78; p= 0,003) and 39.29 (95% CI 8.32-185.47; p< 0.001) respectively. Macrocalcification, age, gender and thyroid status were not associated with increased risk of malignancy. Conclusion Our data suggest that FNA is a reliable, reproducible and valid method to evaluate thyroid nodules and ultrasonographic features, especially microcalcification is a very important predictor of malignancy.

著者

園生 智弘 徳重 真一 田中 真生 前川 理沙 椎尾 康

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.1, pp.161-163, 2012 (Released:2013-04-11)

参考文献数

9

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Crowned dens syndrome(CDS)は軸椎歯突起周囲の靭帯にピロリン酸カルシウム結晶が沈着し,発熱,頸部痛,炎症所見を示す急性関節炎で,高齢女性に好発する偽痛風の一型である.2症例は72歳女性と31歳女性,いずれも頸部痛,炎症反応の上昇を伴った.頸椎単純CTとその再構成画像で歯突起周囲靭帯の石灰化を認めCDSと診断.非ステロイド性抗炎症薬投与により,自覚症状と炎症所見の消失をみた.炎症所見を伴う頸部痛では本疾患を念頭におき,CTで石灰化の有無を検討する必要がある.

著者

Yoshiaki Kaneko Tadashi Nakajima Tadanobu Irie Masahiko Kurabayashi

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.19, pp.2287-2288, 2013 (Released:2013-10-01)

参考文献数

2

被引用文献数

1

著者

永田 正喜 青木 洋介

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.3542-3550, 2011 (Released:2013-04-11)

参考文献数

14

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肺炎診療における耐性菌の増加,医療・介護関連肺炎(NHCAP:Nursing-healthcare associated pneumonia)といった新しいカテゴリー分類,LVFX(levofloxacin)注射薬,AZM(azithromycin)SRの新規承認などが注目されている.耐性菌が起炎菌となりうる状況を把握し,抗菌薬を正しく使用することが肺炎による死亡率の低下につながる.

著者

Shinji Teramoto Norihito Hida Hiroaki Ishikawa Nobuyuki Hizawa

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.19, pp.2289-2290, 2013 (Released:2013-10-01)

参考文献数

2

被引用文献数

1 1

著者

岩田 敦 朔 啓二郎

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.100, no.7, pp.2036-2038, 2011 (Released:2013-04-10)

参考文献数

5

著者

Kazuhide Higuchi Takashi Joh Koji Nakada Ken Haruma

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.13, pp.1447-1454, 2013 (Released:2013-07-01)

参考文献数

23

被引用文献数

5 14

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Objective Proton pump inhibitors (PPIs) are widely used as the mainstay of treatment for erosive reflux esophagitis, based on the excellent results obtained in clinical trials. However, the endoscopic remission rates in patients treated with PPIs in actual clinical settings have not been fully assessed. We conducted a nationwide survey to evaluate the effectiveness of PPIs based on endoscopic findings in real-world clinical settings. Methods This was a multicenter retrospective study conducted among 41 Japanese institutions. Endoscopic findings before and after PPI therapy were collected from the medical records of patients diagnosed with Los Angeles grade A-D reflux esophagitis who had been treated with a PPI for at least eight weeks before undergoing a second endoscopy. The remission rates of erosive esophagitis, defined as the percentage of patients with grade N or M findings following PPI therapy, were calculated. Results Data for 541 patients were analyzed. At first endoscopy, 45.5%, 30.3%, 15.9% and 8.3% of patients were diagnosed with grade A, B, C and D esophagitis, respectively. The mean duration of PPI therapy was 410 days, and the mean remission rate was 61.6%. The remission rate was significantly lower in the patients with more severe erosive esophagitis based on the LA grade before PPI therapy. Conclusion This study revealed that approximately 40% of the patients did not achieve remission of erosive esophagitis following PPI therapy for a mean of 1.1 years. This suggests the necessity of providing careful follow-up using periodic endoscopy and appropriately selecting PPI therapy.