著者
Tomomi Kinoshita Ryu-ta Abe Akiyo Hineno Kazuhiro Tsunekawa Shunya Nakane Shu-ichi Ikeda
出版者
The Japanese Society of Internal Medicine
雑誌
Internal Medicine (ISSN:09182918)
巻号頁・発行日
vol.53, no.19, pp.2185-2200, 2014 (Released:2014-10-01)
参考文献数
49
被引用文献数
57 72

Objective To investigate the causes of neurological manifestations in girls immunized with the human papillomavirus (HPV) vaccine. Methods During the past nine months, 44 girls visited us complaining of several symptoms after HPV vaccination. Four patients with other proven disorders were excluded, and the remaining forty subjects were enrolled in this study. Results The age at initial vaccination ranged from 11 to 17 years, and the average incubation period after the first dose of the vaccine was 5.47±5.00 months. Frequent manifestations included headaches, general fatigue, coldness of the legs, limb pain and weakness. The skin temperature examined in 28 girls with limb symptoms exhibited a slight decrease in the fingers (30.4±2.6°C) and a moderate decrease in the toes (27.1±3.7°C). Digital plethysmograms revealed a reduced height of the waves, especially in the toes. The limb symptoms of four girls were compatible with the Japanese clinical diagnostic criteria for complex regional pain syndrome (CRPS), while those in the other 14 girls were consistent with foreign diagnostic criteria for CRPS. The Schellong test identified eight patients with orthostatic hypotension and four patients with postural orthostatic tachycardia syndrome. The girls with orthostatic intolerance and CRPS commonly experienced transient violent tremors and persistent asthenia. Electron-microscopic examinations of the intradermal nerves showed an abnormal pathology in the unmyelinated fibers in two of the three girls examined. Conclusion The symptoms observed in this study can be explained by abnormal peripheral sympathetic responses. The most common previous diagnosis in the studied girls was psychosomatic disease. The social problems of the study participants remained unresolved in that the severely disabled girls stopped going to school.
著者
Ryota Hikiami Hodaka Yamakado Shinsui Tatsumi Takashi Ayaki Yuichiro Hashi Hirofumi Yamashita Nobukatsu Sawamoto Teruyuki Tsuji Makoto Urushitani Ryosuke Takahashi
出版者
The Japanese Society of Internal Medicine
雑誌
Internal Medicine (ISSN:09182918)
巻号頁・発行日
vol.57, no.13, pp.1917-1919, 2018-07-01 (Released:2018-07-01)
参考文献数
10
被引用文献数
1

We herein report a 15-year-old girl who developed rapid progressive muscle weakness soon after the third injection of a bivalent human papilloma virus (HPV) vaccine. Although immunotherapies were performed for possible vaccine-related disorders, she died of respiratory failure 14 months after the onset of the disease. A genetic analysis identified a heterozygous p.P525L mutation of the fused in sarcoma (FUS) gene, and a histopathological analysis was also consistent with FUS-associated amyotrophic lateral sclerosis (ALS) without any evidence of neuroinflammation. We concluded the diagnosis to be FUS-ALS, although we cannot completely rule out the possibility that the vaccination worked as a trigger.
著者
Kenji Sekiguchi Naoko Yasui Hisatomo Kowa Fumio Kanda Tatsushi Toda
出版者
The Japanese Society of Internal Medicine
雑誌
Internal Medicine (ISSN:09182918)
巻号頁・発行日
vol.55, no.21, pp.3181-3184, 2016-11-01 (Released:2016-11-01)
参考文献数
20
被引用文献数
3 6

We herein present two cases of acute disseminated encephalomyelitis (ADEM) following vaccination against human papilloma virus (HPV). Case 1 experienced diplopia and developed an unstable gait 14 days after a second vaccination of Cervarix. Brain magnetic resonance imaging (MRI) showed an isolated small, demyelinating lesion in the pontine tegmentum. Case 2 experienced a fever and limb dysesthesia 16 days after a second vaccination of Gardasil. Brain MRI revealed hyperintense lesion in the pons with slight edema on a T2-weighted image. Both cases resolved completely. It is important to accumulate further data on confirmed cases of ADEM temporally associated with HPV vaccination.
著者
Yoshifumi Yamada Junichi Uchida Hisa Izumi Yoko Tsukamoto Gaku Inoue Yuichi Watanabe Junichiro Irie Satoru Yamada
出版者
The Japanese Society of Internal Medicine
雑誌
Internal Medicine (ISSN:09182918)
巻号頁・発行日
vol.53, no.1, pp.13-19, 2014 (Released:2014-01-01)
参考文献数
26
被引用文献数
7 36

Objective Although caloric restriction is a widely used intervention to reduce body weight and insulin resistance, many patients are unable to comply with such dietary therapy for long periods. The clinical effectiveness of low-carbohydrate diets was recently described in a position statement of Diabetes UK and a scientific review conducted by the American Diabetes Association. However, randomised trials of dietary interventions in Japanese patients with type 2 diabetes are scarce. Therefore, the aim of this study was to examine the effects of a non-calorie-restricted, low-carbohydrate diet in Japanese patients unable to adhere to a calorie-restricted diet. Methods The enrolled patients were randomly allocated to receive a conventional calorie-restricted diet or low-carbohydrate diet. The patients received consultations every two months from a registered dietician for six months. We compared the effects of the two dietary interventions on glycaemic control and metabolic profiles. Results The HbA1c levels decreased significantly from baseline to six months in the low-carbohydrate diet group (baseline 7.6±0.4%, six months 7.0±0.7%, p=0.03) but not in the calorie-restricted group (baseline 7.7±0.6%, six months 7.5±1.0%, n.s.), (between-group comparison, p=0.03). The patients in the former group also experienced improvements in their triglyceride levels, without experiencing any major adverse effects or a decline in the quality of life. Conclusion Our findings suggest that a low-carbohydrate diet is effective in lowering the HbA1c and triglyceride levels in patients with type 2 diabetes who are unable to adhere to a calorie-restricted diet.
著者
Shogo Hanai Mitsunaga Iwata Teruhiko Terasawa
出版者
The Japanese Society of Internal Medicine
雑誌
Internal Medicine (ISSN:09182918)
巻号頁・発行日
pp.2339-18, (Released:2019-06-27)
参考文献数
9

Pivoxil-containing cephalosporins can result in symptomatic hypocarnitinemia in children. We herein report a case of an 85-year-old man at risk of carnitine deficiency who developed relapsing symptomatic hypoglycemia after treatment with cefcapene pivoxil for urinary tract infection. On admission, laboratory tests showed low blood carnitine concentrations with low normal blood ketone levels. The patient was successfully treated by the oral administration of levocarnitine and dietary modification, including aggressive consumption of meat and dairy products, and remained symptom-free for nine months after the correction of carnitine concentrations. Healthcare providers should be cautious when prescribing pivoxil-containing antimicrobials to patients at high risk of hypocarnitinemia.
著者
大林 正人 田中 誠一 小町 裕志
出版者
The Japanese Society of Internal Medicine
雑誌
日本内科学会雑誌 (ISSN:00215384)
巻号頁・発行日
vol.97, no.1, pp.153-154, 2008-01-10
参考文献数
9

麻痺肢の擬人化とは,麻痺肢に対してあたかもそこに人格が宿ったかのようにふるまう症候である.今回68歳の右視床出血の女性患者において,入院数日後から麻痺を認めた左上肢に対して「てっちゃん」と名づけて話しかけるという特異な行動を認めた.意識障害や認知機能異常は認められず,身体失認が軽度認められる程度であった.擬人化は長期にわたり持続した.<br>
著者
Makoto Eriguchi Kotaro Iida Shuhei Ikeda Manabu Osoegawa Kenya Nishioka Nobutaka Hattori Hiroshi Nagayama Hideo Hara
出版者
The Japanese Society of Internal Medicine
雑誌
Internal Medicine (ISSN:09182918)
巻号頁・発行日
pp.2028-18, (Released:2019-02-25)
参考文献数
17

We herein report the case of a 38-year-old man who developed parkinsonism 4 years after ingesting glyphosate. The patient presented with right-sided bradykinesia and cogwheel rigidity without autonomic symptoms. Magnetic resonance imaging of the brain and [123I]-metaiodobenzylguanidine myocardial scintigraphy were normal. A drastic response to levodopa and the presence of levodopa-induced dyskinesia without strong non-motor symptoms were seen in this patient. We considered that young-onset atypical parkinsonism was associated with a history of sublethal glyphosate ingestion. Epidemiologic investigations have shown that exposure to pesticides is a risk factor for Parkinson' s disease (PD). Our findings support the notion that glyphosate exposure might be related to the onset of PD.
著者
Yoshito Kamijo Michiko Takai Yuji Fujita Kiyotaka Usui
出版者
The Japanese Society of Internal Medicine
雑誌
Internal Medicine (ISSN:09182918)
巻号頁・発行日
vol.57, no.15, pp.2141-2146, 2018-08-01 (Released:2018-08-01)
参考文献数
30
被引用文献数
3

Objective We conducted a retrospective study on the epidemiological and clinical features of patients with acute caffeine poisoning in Japan. Methods Letters requesting participation were sent to 264 emergency departments of hospitals, and questionnaires were mailed to those that agreed to participate. Patients Participants were patients transported to emergency departments of hospitals between April 2011 and March 2016 after consuming large or massive amounts of caffeinated supplements and/or energy drinks (caffeine dose ≥1.0 g). Results We surveyed 101 patients from 38 emergency departments. Since April 2013, the number of patients has markedly increased. Of these young patients (median age, 25 years), 53 were men, and 97 had consumed caffeine in tablet form. Estimated caffeine doses (n=93) ranged from 1.2 to 82.6 g (median, 7.2 g). Serum caffeine levels on admission (n=17) ranged from 2.0 to 530.0 μg/mL (median level, 106.0 μg/mL). Common abnormal vital signs and laboratory data on admission included tachypnea, tachycardia, depressed consciousness, hypercreatinekinasemia, hyperglycemia, hypokalemia, hypophosphatemia, and hyperlactatemia. Common signs and symptoms in the clinical course included nausea, vomiting, excitement/agitation, and sinus tachycardia. Seven patients (6.9%) who had consumed ≥6.0 g of caffeine, or whose serum caffeine levels on admission were ≥200 μg/mL, developed cardiac arrest. Ninety-seven patients (96.0%) recovered completely, but 3 patients (3.0%) died. Conclusion The present analysis of data from more than 100 emergency patients revealed clinical features of moderate to fatal caffeine poisoning. We recommend highlighting the toxicity risks associated with ingesting highly caffeinated tablets.
著者
Ryota Hikiami Hodaka Yamakado Shinsui Tatsumi Takashi Ayaki Yuichiro Hashi Hirofumi Yamashita Nobukatsu Sawamoto Teruyuki Tsuji Makoto Urushitani Ryosuke Takahashi
出版者
The Japanese Society of Internal Medicine
雑誌
Internal Medicine (ISSN:09182918)
巻号頁・発行日
pp.0285-17, (Released:2018-02-09)
参考文献数
10
被引用文献数
1

We herein report a 15-year-old girl who developed rapid progressive muscle weakness soon after the third injection of a bivalent human papilloma virus (HPV) vaccine. Although immunotherapies were performed for possible vaccine-related disorders, she died of respiratory failure 14 months after the onset of the disease. A genetic analysis identified a heterozygous p.P525L mutation of the fused in sarcoma (FUS) gene, and a histopathological analysis was also consistent with FUS-associated amyotrophic lateral sclerosis (ALS) without any evidence of neuroinflammation. We concluded the diagnosis to be FUS-ALS, although we cannot completely rule out the possibility that the vaccination worked as a trigger.
著者
Yuki Kataoka Shunkichi Ikegaki Daisuke Kato Toshihiko Takada Yasushi Tsujimoto Sho Sasaki Sei Takahashi
出版者
The Japanese Society of Internal Medicine
雑誌
Internal Medicine (ISSN:09182918)
巻号頁・発行日
pp.2312-18, (Released:2019-03-28)
参考文献数
21

Objective To describe the clinical research support systems in Japanese board certification programs of internal medicine and to assess the relationship between these support systems and the scholarly activities of residents. Methods In 2018, a 26-item web questionnaire was mailed to 542 points of contact of hospitals listed as certified residency programs of internal medicine in order to obtain information about the presence of a research support system and scholarly activity from 2016. We used hospital characteristic data from the Japanese Diagnostic Procedure Combination database, a national inpatient database, and the annual report of the Japanese Society of Internal Medicine. Results A total of 228 hospitals (42%) responded to the survey. There were regular research lectures in 129 hospitals (57%), protected time (time to perform research during working hours) in 53 hospitals (23%), research consultations in 175 hospitals (77%), regular journal clubs in 213 hospitals (77%), regular research conferences in 151 hospitals (66%), data warehouses in 139 hospitals (61%), and financial research support from the hospital budget in 140 hospitals (61%). A multivariate analysis showed that none of the research support systems were related to the number of conference presentations. In contrast, protected time (odds ratio [OR] 3.66, 95% confidence interval [CI] 1.43-9.39) and regular research conferences (OR 2.20, 95% CI 1.14-4.23) were related to the presence of clinical research presentations in scientific conferences hosted by residents. Conclusion Protected time and regular research conferences were related to the scholarly activity of residents in Japanese teaching hospitals.
著者
Tomoharu Ishikawa Muneto Tatsumoto Katuhiro Maki Minoru Mitsui Hiroshi Hasegawa Koichi Hirata
出版者
The Japanese Society of Internal Medicine
雑誌
Internal Medicine (ISSN:09182918)
巻号頁・発行日
pp.2206-18, (Released:2019-02-01)
参考文献数
33

Objectives Sound hypersensitivity is highly comorbid with migraine headaches. To elucidate the pathogenic mechanism of migraine attacks, we must first identify the types of everyday environmental sounds they perceive as unpleasant and clarify the acoustic properties of such sounds. This study aimed to clarify the true nature of "noise," i.e. everyday sounds perceived as unpleasant by migraineurs, by evaluating their subjective comfort/discomfort in response to several sounds commonly heard in everyday life. Methods Participants were presented with 20 environmental sounds they would likely hear daily. Subjects rated the pleasantness/unpleasantness of each stimulus using a nine-step scale. Patients We recruited 50 adults with migraine headaches (46 women, 4 men) and 50 healthy controls (35 women, 15 men). Results Migraineurs provided statistically significantly lower (more unpleasant) ratings to ambulance sirens, police car sirens, and railroad crossing bells than did controls. Our analysis also investigated the acoustic characteristics associated with higher rating gaps between the two groups. Greater divergence in ratings for the same stimulus was associated with less power (smaller amplitude envelope) and slower temporal variation in signals in the 400-Hz band. Conclusion We identified specific signal components associated with different subjective (un) pleasantness scores between migraineurs and healthy adults, which may lead to the elucidation of the pathogenic mechanism underlying migraine attacks triggered by sound.
著者
渡辺 彰 名村 正伸 金谷 法忍 大家 他喜雄 林 守源
出版者
The Japanese Society of Internal Medicine
雑誌
日本内科学会雑誌 (ISSN:00215384)
巻号頁・発行日
vol.76, no.9, pp.1409-1413, 1987

症例は26才男性で,急性左心不全で入院した.心電図は心室内伝導傷害と前側壁心筋梗塞の所見を示した. CPKは最高10470IUに上昇し, LDHは6620IUに上昇した.入院第51病日に心臓カテーテル検査を施行した.左室造影では心筋収縮能はび漫性に低下していた.選択的冠動脈造影では左冠動脈主幹部に長さ1.6cmの辺縁が平滑な50%の狭窄を認めた.また,前下行枝に長さ2.8cmにわたり冠動脈内陰影欠損を認めた.血中ウイルス学的検査でムンプスウイルス抗体価が有意に変動した.発症1年後の右室心内膜心筋生検から心筋炎と診断した.以上より,冠動脈病変を呈したムンプスウイルス心筋炎と診断し,冠動脈病変の病因として冠動脈炎が考えられた.
著者
Yurika Iwasawa Naoto Hosokawa Mariko Harada Satoshi Hayano Akihiko Shimizu Daisuke Suzuki Kei Nakashima Makito Yaegashi
出版者
The Japanese Society of Internal Medicine
雑誌
Internal Medicine (ISSN:09182918)
巻号頁・発行日
pp.0787-18, (Released:2018-09-12)
参考文献数
20

A 62-year-old man with diabetes mellitus and a two-day history of fever and dyspnea presented at our hospital. He was diagnosed with community-acquired pneumonia (CAP), septic shock, and respiratory failure. Sputum Gram staining revealed Gram-negative coccobacilli. Based on the Gram staining findings and history, Acinetobacter baumannii was considered as one of the causative organisms of his CAP. Consequently, he was successfully treated with the initial administration of meropenem. We suggest that A. baumannii should be considered as one of the possible causative organisms of CAP based on a fulminant clinical course, and the presence of Gram-negative coccobacilli.
著者
高橋 和郎 北川 達也
出版者
The Japanese Society of Internal Medicine
雑誌
日本内科学会雑誌 (ISSN:00215384)
巻号頁・発行日
vol.65, no.3, pp.256-262, 1976
被引用文献数
1

最近多発した浮腫を伴う急性多発性神経炎25例につき,発生頻度ならびに成因について検討した.年次別にみると昭和48年以後年ごとに多発する傾向があり,春から初秋にかけて発症することが多く,とくに若年男性に多い.食事は全例白米食で,強化米はなく,インスタント食品の多食,高糖質,低VB<sub>1</sub>の清凉飲料水の多飲が目立つた.又発症時激しい運動をしているものが多かつた.詳細に検討した2症例において血中B<sub>1</sub>濃度はやや低値,乳酸,ピルビン酸濃度はやや高値,平日ならびにB<sub>1</sub>負荷時の尿中B<sub>1</sub>排泄量は明らかな低値を示した.さらにB<sub>1</sub>投与が特異的に症状改善をもたらす所などから,本症が脚気neuropathyであることを明らかにした.末梢神経は軸索変性を示し,とくに初期には特異な管状構造物が軸索内に多数出現した.有髄線維に比し,無髄線維の変化は軽度であつた.最近脚気が増加し始めたことは,本邦栄養食品に何らかの欠陥が生じ始めたことを示すものである.
著者
Eiji Kitamura Yuko Kondo Naomi Kanazawa Tsugio Akutsu Kazutoshi Nishiyama Takahiro Iizuka
出版者
The Japanese Society of Internal Medicine
雑誌
Internal Medicine (ISSN:09182918)
巻号頁・発行日
pp.1846-18, (Released:2018-11-19)
参考文献数
9

Autoimmune encephalitis (AE) is an immune-mediated encephalitis characterized by the subacute onset of memory deficits, altered mental status, or psychiatric symptoms. Limbic encephalitis associated with rheumatoid arthritis (RA) has not been reported yet. A 57-year-old man presented with the subacute onset of headache, depression, and anorexia 7 months before the onset of RA. Brain magnetic resonance imaging showed symmetric parenchymal lesions involving the medial temporal lobes. He was diagnosed with RA and AE, but no autoantibodies to neuronal intracellular or cell-surface antigens were identified in either the serum or cerebrospinal fluid. His symptoms improved with immunotherapy. AE can develop as an extra-articular manifestation of RA.
著者
Reina Kawamura Eiichiro Nagata Masako Mukai Yoichi Ohnuki Tomohiko Matsuzaki Kana Ohiwa Tomoki Nakagawa Mitsutomo Kohno Ryota Masuda Masayuki Iwazaki Shunya Takizawa
出版者
The Japanese Society of Internal Medicine
雑誌
Internal Medicine (ISSN:09182918)
巻号頁・発行日
vol.56, no.24, pp.3357-3359, 2017-12-15 (Released:2017-12-15)
参考文献数
9
被引用文献数
1

A 54-year-old woman with adenocarcinoma of the lung and lymph node metastasis experienced nystagmus and cerebellar ataxia 2 weeks after initiating nivolumab therapy. An evaluation for several autoimmune-related antibodies and paraneoplastic syndrome yielded negative results. We eventually diagnosed the patient with nivolumab-induced acute cerebellar ataxia, after excluding other potential conditions. Her ataxic gait and nystagmus resolved shortly after intravenous steroid pulse therapy followed by the administration of decreasing doses of oral steroids. Nivolumab, an immune checkpoint inhibitor, is known to induce various neurological adverse events. However, this is the first report of acute cerebellar ataxia associated with nivolumab treatment.
著者
Kentaro Iwata Asako Doi Goh Ohji Hideaki Oka Yuichiro Oba Kohei Takimoto Wataru Igarashi David H. Gremillion Toshihiko Shimada
出版者
The Japanese Society of Internal Medicine
雑誌
Internal Medicine (ISSN:09182918)
巻号頁・発行日
vol.49, no.22, pp.2423-2432, 2010 (Released:2010-11-15)
参考文献数
27
被引用文献数
43 79

Introduction Sivelestat is neutrophil elastase inhibitor, which is widely used in Japan for the treatment of acute lung injury. However, the clinical efficacy of the medication has not been convincingly demonstrated. Methods We conducted a systematic review and meta-analysis of randomized controlled trials on sivelestat for the treatment of acute lung injury and acute respiratory distress syndrome. Studies were identified using MEDLINE, EMBASE, Cochrane library, conference proceedings, and references of included studies. Authors were contacted if necessary. ICHUSHI, the Japanese database for medical literature and conference proceedings was also used for the search, since many studies on sivelestat were published in Japanese language and not registered in major databases such as MEDLINE. The primary outcome was mortality within 28-30 days after randomization. Relative risks were pooled with the random effect model. Results 8 trials were included in the analysis. There was no difference in mortality within 28-30 days after randomization (relative risk 0.95, 95% confidence interval 0.72 to 1.26). Subgroup analysis conducted only on studies conducted in Japan showed the same result (0.59, 0.28 to 1.28). There was no difference in mechanical ventilation days (standardized mean difference -0.43, -1.12 to 0.27), but sivelestat was associated with a better short term PaO2/FiO2 ratio (0.30, 0.05 to 0.56). Heterogeneity was not significant for the main analysis and funnel plot did not suggest publication bias. Conclusion Sivelestat was not associated with decreased mortality, even when including studies published in Japanese language.
著者
高橋 和郎 田中 和子 西川 清方 米本 哲人
出版者
The Japanese Society of Internal Medicine
雑誌
日本内科学会雑誌 (ISSN:00215384)
巻号頁・発行日
vol.64, no.10, pp.1140-1152, 1975
被引用文献数
1

8例の特異な急性多発性神経炎について臨床的ならびに末梢神経の電顕的検討を行なつた.これらの症例は下肢の著しい浮腫,疼痛をもつて始まり,上行性の運動麻痺,駆幹あるいは四肢末端の知覚障害,深部反射の低下をみる.麻痺は顔面神経に及ぶことがあり,一般に四肢末端に強い。知覚障害は比較的軽い.発症は急性あるいは亜急性で時に寛解,増悪を示し,しばしば,発熱,白血球減少,血沈促進, CRP陽性, A/G比低下など感染,アレルギーを思わせる所見を有する.同時に著しい心拡大,心雑音,時に心電図異常を認める.心臓症状は多発性神経炎の回復に先立つて軽快する.神経症状はGuil1ain-Barré症候群に類似するが,脳脊髄液は細胞数増加を示すことが多いが蛋白量は正常である。末梢神経は軸索,髄鞘共に著しい障害を示し,軸索再生,髄鞘再生の像がみられ,障害は有髄線維に著しい.再生した細い無髄線維の著しい増加がみられる.筋は軽度の血管周囲性リンパ球浸潤を示すものがあるが,筋炎という程の所見ではなく,一般に神経原性萎縮を示す.いずれも男性で1973年から1974年にかけて発症し,近年多発する傾向がある.脚気にも類似するが,要因と思われるものが見出し難く,かつしばしば感染,アレルギーを思わせる所見を有する.