著者

Keisuke Matsuo Takashi Ishiguro Takatomo Najama Yoshihiko Shimizu Yasuhito Kobayashi Makoto Mutou

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.58, no.16, pp.2367-2372, 2019-08-15 (Released:2019-08-15)

参考文献数

19

被引用文献数

15

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A 62-year-old man presented to our hospital for the further evaluation and treatment of his back pain, general fatigue, and dyspnea, which had developed 4 days after the 29th administration of nivolumab to treat his lung cancer. Based on his clinical history, elevated serum cardiac enzyme values, and cardiac magnetic resonance (CMR) imaging and myocardial biopsy findings, he was diagnosed with myocarditis induced by nivolumab. Corticosteroid therapy improved his condition, and CMR performed on hospital day 11 also showed remarkable improvement. Although nivolumab-induced myocarditis is rare, cardiologists should consider it when encountering patients treated with such a drug for malignant disease.

著者

Motoaki Sano

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.2870-19, (Released:2019-06-07)

参考文献数

17

被引用文献数

9

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It has become clear that sodium glucose cotransporter (SGLT)-2 inhibitors not only do not increase the incidence of cardiovascular events but they also reduce the duration of hospitalization for heart failure in type 2 diabetic (T2DM) patients. The administration of SGLT2 inhibitor in T2DM patients with hypertension and a fluid retention tendency lowers the blood pressure and mitigates fluid retention. It also reduces the heart rate in T2DM patients with a fast heart rate. As an explanation for the multifaceted effects of SGLT2 inhibitors on hemodynamics, we hypothesize that these agents act on the inter-organ communication pathway, which modulates the sympathetic nerve activity to the cardiovascular system.

著者

Atsushi Goto Mitsuhiko Noda Manami Inoue Maki Goto Charvat Hadrien

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.55, no.14, pp.1827-1830, 2016-07-15 (Released:2016-07-15)

参考文献数

17

被引用文献数

1 39

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Diabetes mellitus, especially type 2 diabetes, has been a major concern among health issues for Japanese policy requiring serious address. In this regard, the increasing number of people with diabetes in Japan over the past few decades has been regarded as a fundamental and evident problem. We herein clarify that the crude diabetes prevalence is likely to have increased mainly as a result of changes in the population distribution, namely, aging of the general population in Japan. We also predict the future trend for the number of people with diabetes according to available concrete evidence in this review.

著者

Fumihiro Asano Naofumi Shinagawa Takashi Ishida Akifumi Tsuzuku Motoko Tachihara Kenya Kanazawa Noriyuki Yamada Satoshi Oizumi Hiroshi Moriya

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.54, no.9, pp.1021-1025, 2015 (Released:2015-05-01)

参考文献数

19

被引用文献数

6 28 4

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Objective Bronchoscopy using radial-endobronchial ultrasound (R-EBUS) and virtual bronchoscopic navigation (VBN) is a promising method for diagnosing peripheral pulmonary lesions. We previously performed a randomized comparative trial (RCT) (i.e., VBN combined with EBUS RCT) involving patients with 30-mm or smaller peripheral pulmonary lesions and found that the addition of VBN to R-EBUS improved the diagnostic yield. In the present study, we performed a retrospective subanalysis in order to identify patients for whom VBN is useful. Methods The per-protocol population (194 cases) of the VBN combined with EBUS RCT was divided into subgroups based on the lesion size, lung lobe containing the lesion, lesion location, presence or absence of involved bronchi (bronchus sign) on thin-section CT and whether the lesion was detected on posterior-anterior (P-A) radiographs. The difference in the diagnostic yield between the VBN-assisted (VBNA) and non-VBN-assisted (NVBNA) groups was investigated. Results Within the bronchus sign-positive subgroup, the diagnostic yield in the VBNA and NVBNA groups was 94.4% (68/72) and 77.8% (56/72), respectively, showing a significantly higher yield in the VBNA group (p=0.004; odds ratio: 4.9). The yield was particularly high for lesions smaller than 20 mm (94.6% vs. 70.7%; p=0.006), lesions located in the peripheral third of the lung field (95.1% vs. 71.4%; p=0.005) and lesions invisible on P-A radiographs (90.0% vs. 41.7%; p=0.026). Conclusion VBN improves the diagnostic yield when combined with R-EBUS to assess lesions exhibiting involved bronchi on CT images.

著者

Emi Mashima Yu Sawada Manabu Yoshioka Motonobu Nakamura

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.9714-17, (Released:2018-03-30)

被引用文献数

1

著者

Kengo Maeda Tomoyuki Shiraishi

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.57, no.5, pp.745-750, 2018-03-01 (Released:2018-03-01)

参考文献数

13

被引用文献数

2

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Japanese people born before World War II learned Japanese kana (Japanese syllabograms) writing in a style that is not currently used. These individuals had to learn the current style of kana orthography after the war. An 85-year-old man was taken to our hospital by his family who were surprised by his diary. It was written with kanji (Japanese ideograms) and katakana using the prewar style. A neuropsychological examination revealed impaired recall of hiragana. Neuroimaging studies revealed atrophy of the left fronto-parietal lobe and hypoperfusion of the left frontal lobe. His allographic agraphia might have resulted from the disturbance of the current style of kana orthography.

著者

Yoshitsugu Higashi Shigeki Nakamura Yasuhiro Tsuji Chika Ogami Kaoru Matsumoto Koyomi Kawago Kotaro Tokui Ryuji Hayashi Ippei Sakamaki Yoshihiro Yamamoto

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.57, no.2, pp.253-258, 2018-01-15 (Released:2018-01-15)

参考文献数

31

被引用文献数

18

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A 53-year-old man was admitted to the hospital with a diagnosis of cellulitis and osteomyelitis. Twenty-four days after the initiation of daptomycin and sulbactam/ampicillin, he developed a fever and pulmonary infiltration. Bronchoalveolar lavage revealed a high number of eosinophils, while an intracutaneous test revealed positivity for daptomycin. The patient improved after discontinuing antimicrobial therapy. The plasma daptomycin minimum concentration (Cmin) was elevated (27.4 μg/mL), but plasma protein binding of daptomycin was low (87.8%). Although the pathophysiology of eosinophilic pneumonia remains unclear, antigenic stimulation due to daptomycin accumulation in the alveoli may have caused continuous immune activation.

著者

Sachiko Furukawa Kazunari Oobu Masafumi Moriyama Shintaro Kawano Saori Sako Jun-Nosuke Hayashida Ryota Matsubara Ken-Ichi Ogata Tamotsu Kiyoshima Seiji Nakamura

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.8946-17, (Released:2017-12-08)

参考文献数

33

被引用文献数

22

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Long-term methotrexate (MTX) treatment can cause MTX-related lymphoproliferative disorder (MTX-LPD). We experienced a case of MTX-LPD that was associated with severe osteonecrosis of the jaw mimicking medication-related osteonecrosis of the jaw. The patient was an 81-year-old woman with rheumatoid arthritis (RA) who was treated with MTX and bisphosphonate. After 7 years, she was referred to our department for the assessment of giant ulcer and exposure of the alveolar bone of the left maxilla. Histopathological and immunological analyses confirmed a diagnosis of MTX-LPD. At seven months after the cessation of MTX treatment, the ulcerative and necrotic lesions had markedly decreased in size. A 1-year follow-up examination showed no evidence of recurrence and good RA control.

著者

近藤 智善 広西 昌也

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.89, no.4, pp.629-633, 2000-04-10

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振戦は安静時振戦,姿勢時振戦,企図振戦,動作時振戦に区別される.小脳性協調運動障害の現れと解される動作時振戦や代謝異常による振戦を除いて,小脳歯状核・赤核・視床を結ぶ経路のどこかの障害で振戦のリズムが発生し,振戦の性状の違いは筋トーヌスの差によるとの説がある.パーキンソン病の振戦と本態性振戦に対する薬物治療以外は特異的な内服療法はなく,視床Vim核の定位的破壊術の適用が考慮される症例がある.

著者

Masashi Goto Takashi Kawamura Takuro Shimbo Osamu Takahashi Masahiko Ando Koichi Miyaki Takahiko Nohara Hidetsuna Watanabe Isamu Suzuki Mitsuru Aono for the Great Cold Investigators-II

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.46, no.15, pp.1179-1186, 2007 (Released:2007-08-02)

参考文献数

17

被引用文献数

5 10

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Objective: To investigate whether loxoprofen, one of the nonsteroidal anti-inflammatory drugs, prolongs the recovery process of naturally acquired upper respiratory tract infections (URTIs) in the clinical setting. Methods: A double-blind, randomized, placebo-controlled trial was conducted in 23 outpatient facilities in Japan. Patients aged 18 through 65 years suffering from URTIs were randomly assigned to receive loxoprofen or its placebo. The primary outcome was duration of illness in days. Results: A total of 174 patients were available for the analyses. Duration of illness was 8.94 ± 3.20 days in the loxoprofen group compared to 8.39 ± 3.39 days in the placebo group (P=.19). The number of days with limited daily activities was fewer in the loxoprofen group than in the placebo group (2.12 ± 2.05 days vs. 2.68 ± 2.54 days, P=.17). Although severe symptoms were less frequent on days 1, 2, and 3 in the loxoprofen group (27%, 33%, and 29%, respectively) than in the placebo group (32%, 39%, and 37%, respectively), symptoms were more frequent on days 6 through 12 in the loxoprofen group (difference, 5-13%). Adverse events were more common in the loxoprofen group (9.5% vs. 1.1%, P=.051). Conclusion: Loxoprofen did not significantly modify the recovery process of URTIs except for a slight tendency to delay.

著者

Celik Ozlem Buyuktas Deram Sevinc Mustafa Tascilar Koray Demirkesen Cuyan Tasan Ertugrul

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.50, no.18, pp.1973-1976, 2011 (Released:2011-09-15)

参考文献数

15

被引用文献数

6 8

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Propylthiouracil (PTU) is an antithyroid drug which is known to cause drug-induced vasculitis. PTU is implicated in 80-90% of cases of anti-neutrophil cytoplasm circulating antibody (ANCA)-associated vasculitis caused by anti-thyroid drugs which induce ANCA production. Sweet's syndrome is characterized by fever, leucocytosis, neutrophilia and the sudden onset of painful skin lesions. The pathology of the disease is still unclear. Cytokine dysregulation including interleukin-6 and endogenous granulocyte colony-stimulating factor (G-CSF) are thought to play a role in the pathogenesis of Sweet's syndrome. PTU and G-CSF are known to cause Sweet's syndrome and other neutrophilic dermatosis. The presence of ANCA can have a diagnostic value in Sweet's syndrome. Systemic corticosteroids are the first-line therapy for both diseases. Here we report a female patient with Graves' disease who developed ANCA and Sweet's syndrome after using PTU and G-CSF.

著者

森 俊平 太田 耕造 嶋内 亜希子 中條 和志 木村 時久

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.92, no.11, pp.2250-2252, 2003-11-10

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症例は57歳,男性.意識消失発作,脱力を主訴に受診.平成5年の食道癌根治術以降,食事摂取量が減少すると共に日本酒を多く摂るようになり,来院時著明な低Na, K血症を認めた.ビールを多飲し,食事を摂取しない場合,高度の低Na血症を示す症例はBeer Potomaniaとして知られている⁷⁾.日本酒はビールと同様に電解質に乏しく,長期の飲酒と食事摂取量低下により同様の病態が生じ得ることを考察した.

著者

Bonpei Takase Katsumi Hayashi Satoko Takei Tetsuya Hisada Nobuyuki Masaki Masayoshi Nagata

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.9318-21, (Released:2022-05-14)

参考文献数

15

被引用文献数

7

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Coronavirus disease 2019 (COVID-19) has become a pandemic, and vaccines remain the only effective tools available for ending it. However, their side effects, such as syncope, which mimics sudden cardiac death, are serious concerns. We herein report 6 cases of delayed vasovagal syncope and presyncope (VVR) caused by COVID-19 vaccination among 25,530 COVID-19 patients. The prevalence of delayed VVR due to COVID-19 vaccination was 0.026%. In addition, no delayed VVR was found among 17,386 patients who received the influenza vaccine. Delayed VVR is likely to be overlooked if medical staff are not aware of this symptom. This report provides significant information regarding effects of COVID-19 vaccination.

著者

Yasuhiro Oda Yoichiro Ikeda Hiroyuki Abe Akinori Hashiguchi Kazuhito Hatanaka Toshihiro Sawai Tetsuo Ushiku Masaomi Nangaku

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1117-22, (Released:2023-04-28)

参考文献数

3

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An 84-year-old man developed a membranoproliferative glomerulonephritis pattern of injury, and the most likely cause detected during a workup was monoclonal IgG-λ in the urine and serum. Predominant IgG and λ light chain deposition was confirmed only by immunofluorescence using formalin-fixed, paraffin-embedded tissue and not by immunohistochemistry. A smaller and non-linear dynamic range of immunohistochemistry makes it less quantitative than immunofluorescence staining and may explain why immunohistochemistry failed to detect the light chain restriction. This case suggests that immunohistochemistry may not serve as a substitute for immunofluorescence on formalin-fixed, paraffin-embedded tissue in detecting masked monoclonal immunoglobulin deposits, although further research is warranted.

著者

Shingo Fujita Junji Kozawa Chisaki Ishibashi Takekazu Kimura Tetsuhiro Kitamura Kenji Fukui Tetsuyuki Yasuda Hiromi Iwahashi Akihisa Imagawa Iichiro Shimomura

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.56, no.11, pp.1383-1385, 2017-06-01 (Released:2017-06-01)

参考文献数

14

被引用文献数

1 1

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An impaired awareness of hypoglycemia is a serious problem in diabetic patients, which can lead to life-threatening severe hypoglycemia. Recurrent hypoglycemia attenuates the function of the central, mainly hypothalamic, nervous system and it causes an impaired awareness of hypoglycemia. Vitamin B12 deficiency is also associated with the dysfunction of central nervous system. We report a 72-year-old type 1 diabetic patient with vitamin B12 deficiency whose impaired awareness of hypoglycemia improved after 4 weeks of vitamin B12 administration with an increased counter-hormone secretion in response to hypoglycemia. We should recognize vitamin B12 deficiency as one of the causes of an impaired awareness of hypoglycemia in diabetic patients.

著者

Kanako Nagaoka Daisuke Katagiri Masatoshi Matsunami Miria Chinen Kurumi Seki Junko Fukuda Mamiko Ohara Tomo Suzuki

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.2143-23, (Released:2023-10-20)

参考文献数

25

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A 47-year-old man was admitted to our hospital with acute kidney injury, severe hypertension, heart failure, thrombocytopenia, and elevated lactate dehydrogenase. Renal biopsy revealed fibrin thrombi within the glomerular capillaries and moderate fibrotic intimal thickening in the interlobular arteries. The histological diagnosis was thrombotic microangiopathy (TMA). Regarding cardiac involvement, we found marked stenosis in the left anterior descending artery on coronary angiography and cardiomyopathy on myocardial biopsy. Blood concentrations of amphetamine and methamphetamine were high (14.1 ng/mL and 333 ng/mL, respectively). It is important to consider methamphetamine as a cause of renal TMA and multi-organ dysfunction.

著者

Ikuo Shimizu Takashi Watari Satoshi Watanuki Takuma Hata

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.2418-23, (Released:2023-10-06)

参考文献数

29

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Objective This study evaluated the implementation status of morbidity and mortality conferences in internal medicine specialty training programs in Japan. Methods This cross-sectional study surveyed hospitals in Japan with certified internal medicine specialty training programs. Program directors or equivalently responsible physicians managing certified internal medicine training programs were invited to participate in this study (n=619). Materials Data were collected using an online questionnaire that included questions about the number of morbidity and mortality conferences, types of cases covered, collaboration of the patient safety section and other health professions, and whether or not the conferences were conducted by a subspecialty department-led or program-based. Results Responses were received from 123 hospitals (19.8% response rate), of which 59 (48%) had some form of internal medicine morbidity and mortality conference in place. The average number per year was 9.63 (standard deviation: 18.12). Hospitals with morbidity and mortality conferences in subspecialty departments held significantly more conferences than X (please define X). Furthermore, the involvement of the patient safety department tended to be associated with holding more conferences. Autopsy rates were significantly higher in hospitals with program-based internal medicine morbidity and mortality conferences than subspecialty-led. Conclusion Internal medicine specialty training hospitals had more morbidity and mortality conferences than previously reported. Program-based morbidity and mortality conferences in internal medicine are associated with higher autopsy rates and may lead to an organizational reporting culture and lifelong learning attitudes that support patient safety. Collaboration with organizational management sections, such as patient safety, would be effective in implementing these conferences in internal medicine training programs.

著者

Rina Onishi Koshiro Kanaoka Junichi Sugiura Motoko Tokunaga Yasuhiro Takemoto Kenji Onoue Yuta Yamamoto Manabu Horii Yoshihiko Saito

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1177-18, (Released:2018-07-06)

参考文献数

11

被引用文献数

4 5

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Fabry disease is an X-linked lysosomal storage disorder caused by a deficiency of α-galactosidase A and is classified into two types: classical and variant. The classical type exhibits classic manifestations, but the variant type does not and is therefore difficult to identify sometimes. A 73-year-old woman with a first episode of heart failure was admitted to our hospital. Her left ventricular wall motion was mildly reduced without hypertrophy. Urine sediment revealed mulberry cells, leading to the diagnosis of Fabry disease. In cases without typical clinical findings, urinary mulberry cells may help diagnose Fabry disease.

著者

Taisuke Jo Daisuke Shigemi Takaaki Konishi Hayato Yamana Nobuaki Michihata Ryosuke Kumazawa Akira Yokoyama Hirokazu Urushiyama Hiroki Matsui Kiyohide Fushimi Takahide Nagase Hideo Yasunaga

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

pp.1946-23, (Released:2023-07-26)

参考文献数

24

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Objective The effect of Rikkunshito, a Japanese herbal Kampo medicine, on chemotherapy-induced nausea and vomiting (CINV) has been evaluated in several small prospective studies, with mixed results. We retrospectively evaluated the antiemetic effects of Rikkunshito in patients undergoing cisplatin-based chemotherapy using a large-scale database in Japan. Methods The Diagnosis Procedure Combination inpatient database from July 2010 to March 2019 was used to compare adult patients with malignant tumors who had received Rikkunshito on or before the day of cisplatin administration (Rikkunshito group) and those who had not (control group). Antiemetics on days 2 and 3 and days 4 and beyond following cisplatin administration were used as surrogate outcomes for CINV. Patient backgrounds were adjusted using the stabilized inverse probability of treatment weighting, and outcomes were compared using univariable regression models. Results We identified 669 and 123,378 patients in the Rikkunshito and control groups, respectively. There were significantly fewer patients using intravenous 5-HT3-receptor antagonists in the Rikkunshito group (odds ratio, 0.38; 95% confidence interval, 0.16-0.87; p=0.023) on days 2 and 3 of cisplatin-based chemotherapy. Conclusion The reduced use of antiemetics on day 2 and beyond of cisplatin administration suggested a beneficial effect of Rikkunshito in palliating the symptoms of CINV.

著者

Yasuaki Okuda Toshiyuki Yamada Mitsuharu Ueda Yukio Ando

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.57, no.23, pp.3351-3355, 2018-12-01 (Released:2018-12-01)

参考文献数

11

被引用文献数

33 32

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Objective To clarify the underlying diseases, clinical manifestations, and treatment strategies for Amyloid A (AA) amyloidosis (AAA) in Japanese patients. Methods We conducted a survey on Japanese patients with AAA treated between January 1, 2012, and December 31, 2014. Results A total of 199 patients with AAA were included in the present study. The underlying diseases of AAA were rheumatoid arthritis (60.3%), uncharacterized inflammatory disorders (11.1%), neoplasms (7.0%), other rheumatic diseases (6.5%), inflammatory bowel diseases (4.5%), chronic infection (4.5%), Castleman's disease (4.0%), and autoinflammatory diseases (2.0%). The clinical manifestations at the diagnosis of AAA were moderate to severe renal dysfunction (46.2%), moderate to severe proteinuria (30.7%), intractable diarrhea (32.2%), melena (4.5%), paralytic ileus (3.5%), heart failure (11.6%), cardiac conduction disturbances (10.1%), arrhythmia (5.5%), and hypothyroidism (11.6%). Diagnostic biopsies were performed most frequently in the gastrointestinal tract (66.3%), followed by the kidneys (22.1%), heart (5.5%), abdominal fat (4.0%), and others (3.0%). Biologics were used to treat 97 patients with AAA (48.7%). Tocilizumab (TCZ) was administered to 66 patients, with 95.5% showing good responses. Anti-TNF agents were administered to 27 patients, with 74.1% showing good responses. The treatment effects of TCZ were significantly superior to those of anti-TNF agents (p<0.007). Conclusion The most common underlying diseases of AAA were rheumatic diseases. Uncharacterized inflammatory disorders and neoplasms were also frequently observed in patients with AAA. Renal and gastrointestinal manifestations were common and important for the diagnosis of AAA, with cardiac manifestations also being of significance. Biologics, particularly TCZ, were effective therapeutic modalities.